The Quality Initiative for Assisted Living

Why Take the Initiative? 

All around the country, skilled nursing centers and assisted living communities are providing extraordinary care to millions of seniors and individuals with disabilities. However, improving the quality of care provided is an ongoing journey that never ceases. 

Taking a cue from the 100,000 Lives campaign, AHCA/NCAL set forth ambitious goals with measurable targets to demonstrate the long term and post-acute care profession’s commitment to continuing its quality journey. As our nation’s leaders and the public demand a higher quality, lower cost health care system, the Quality Initiative plays an important role by:

  • preparing providers for possible reimbursement changes based on quality outcomes;
  • focusing on current national priorities and key indicators of quality care;
  • encouraging efficiency with health care dollars;
  • promoting consistent data measurement with continuing tracking;
  • highlighting the importance of goal setting with sustainable improvement;
  • and fostering person-centered care.


  • Safely Reducing Hospital Readmissions in Assisted Living

    Contains 4 Component(s)

    Safely reduce hospital readmissions within 30 days of hospital discharges to a rate of 20% or less.

    The Issue

    Hospitalization is disrupting to elderly individuals and puts them at greater risk for complications and infections. Hospitalization also increases the likelihood of reduced functioning on return to the assisted living community.

    Hospital readmissions not only have the potential for negative physical, emotional and psychological impacts on assisted living residents, but also cost the Medicare program billions of dollars.

    Preventing these events whenever possible is always beneficial to residents and has been identified by policymakers and providers as an opportunity to reduce overall health care system costs. The issue has become a top priority for CMS and managed care programs over the past several years.

    Ideas to Get Started

    • Start tracking your hospital readmission rates with LTC Trend Tracker
    • Access INTERACT for Assisted living
    • Monitor days and times residents are being sent to the hospital to look for trends
    • Implement consistent assignment to allow staff to detect changes in a resident’s status
    • Encourage all residents to have advanced directives, and make sure staff are aware of residents’ needs and wishes

    Assisted Living Nursing

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  • Safely Reducing the Off-Label Use of Antipsychotics in Assisted Living

    Contains 8 Component(s)

    Safely reduce the off-label use of antipsychotics to a rate of 15% or less.

    The Issue

    Nearly two out of five individuals in assisted living are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of communication. This can be challenging for families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

    The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia. They increase the risk of death, falls and fractures, hospitalizations, and other complications resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing Medicare hundreds of millions.

    The intent of this Quality Initiative goal is to encourage alternative strategies for responding to challenging behavioral expressions in persons living with dementia before considering medications and to ensure that antipsychotic medications, when used, are as appropriate and safe as possible.

    Ideas to Get Started

    • Start tracking your off-label use of antipsychotics with LTC Trend Tracker
    • Make sure staff understand dementia and the disease process
    • Implement consistent assignment, so that staff works with residents closely to understand preferences and communication methods
    • Look for non-pharmacologic interventions to enhance an individual’s quality of life
    • Help educate family members, health care partners, and other community members about the risks associated with off-label us of antipsychotics

    Get other ideas from Granite Ledges in New Hampshire, which used a team approach to decrease off-label use of antipsychotics.

    Dementia Beyond Drugs:Changing the Culture of Care

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  • Increasing Staff Stability in Assisted Living

    Contains 5 Component(s)

    Reduce turnover among direct care staff to a rate of 50% of less.

    The Issue

    Those who work most closely with residents are at the core of providing quality care. Research shows that satisfied staff contributes to greater quality of life of the residents in assisted living communities and provide better quality of care.

    With a more satisfied, well-trained, and committed staff, providers see increased retention rates and fewer work-related incidents and injuries to the workforce, all of which contribute to better overall performance of the community. The more consistent and dedicated the staff is, the more they understand and are able to effectively respond to each person’s needs – reinforcing the long term care profession’s commitment to delivering person-centered care.

    Ideas to Get Started

    • See how much staff turnover is costing your organization with the AHCA/NCAL’s Cost of Turnover Calculator
    • Start tracking turnover and retention on LTC Trend Tracker and benchmark to your peers
    • Conduct annual staff satisfaction surveys to identify areas for improvement
    • Empower employees to participate in quality improvement projects, including to recognize and resolve issues, so they are more invested with the organization

    How to Recruit Staff

    This one-pager provides ideas on how your assisted living community can recruit staff. Ideas include different ways to advertise, incentives to offer, supporting current employees, and building a presence in the broader community. 

    Introducing Peer Mentoring in Long-Term Care Settings

    Introducing Peer Mentoring in Long-Term Care Settings

    This resource provides guidance on implementing a peer mentoring program in your assisted living community.

    Licensure and Certification Programs

    Licensure and Certification Programs

    Organizations that support staffs' professional development in long term care may help build company loyalty. These licensure and certification programs for various staff levels will help individuals advance.

    The Staff Stability Toolkit with CD-ROM 

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    The Staff Stability Toolkit with CD-ROM
  • Increasing Customer Satisfaction in Assisted Living

    Contains 5 Component(s)

    90% or more residents and/ or family members are satisfied with their experience.

    The Issue

    Listening to the needs and wishes of our residents and their loved ones is how assisted living providers ensure person-centered care. Research also shows that communities with the highest rates of satisfaction perform better in other organizational outcomes.

    Ideas to Get Started

    • Work with your customer satisfaction vendor to add CoreQ into your surveys
    • Upload your CoreQ data to LTC Trend Tracker to benchmark with your peers
    • Utilize additional questions in your satisfaction surveys to identify and address areas for improvement
    • Share results with resident and family councils and staff, utilizing feedback
    • Develop a process for addressing and responding to complaints
    • Utilize feedback to assist in prioritizing quality improvement projects. 

    Assessing Satisfaction In Health and Long-Term Care

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