Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL)

The past 20 years have seen a dramatic shift in residential long term care, as medically frail older adults with complex health conditions who previously received care in nursing homes and hospitals are now residing in Assisted Living Communities (ALCs). In 2003, Wisconsin had 43,052 nursing home resident beds compared to 30,411 Assisted Living resident beds. By 2015, nursing home resident beds decreased by approximately 8,600 (total = 34,463 beds) versus an increase in Assisted Living resident beds of 23,972 (total=54,383 beds) (Johnson, 2016). As the number of individuals living in ALCs increases so does the need to provide, ensure, and improve quality in these communities.

Unlike nursing homes, ALCs have few federal or state requirements and limited oversight for quality improvement.

Similar to nursing home facilities, ALCs offer a range of services, from home-like settings with minimal care to multiple skilled services. The minimum age requirement for residing in an ALC is 18 years. The state of Wisconsin has 3 types of residential ALCs that are licensed by the Wisconsin Department of Health Services Department of Quality Assurance:

1. Adult Family Home (AFH): 3-4 bed residential home, where adults who are not related to the operator reside and receive care, they provide treatment or services above the level of room and board and may include up to seven hours per week of nursing care per resident.
2. Community Based Residential Facility (CBRF): 5-257 bed residential home, where five or more unrelated people live together in a community setting. CBRFs provide services to people of advanced age, persons with dementia, developmental disabilities, mental health problems, physical disabilities, traumatic brain injury, AIDS, Alcohol and Other Drug Abuse, correctional clients, pregnant women needing counseling and/or the terminally ill.
3. Residential Care Apartment Complex (RCAC): 5-109 individual apartments, where five or more adults reside in an independent apartment complex (sometimes referred to as independent living). Apartments must each have a lockable entrance and exit; a kitchen, including a stove (or microwave oven); and individual bathroom, sleeping and living areas.

For further information and consumer assistance about Assisted Living in Wisconsin please contact The State of Wisconsin Board on Aging and Long Term Care. The state of Wisconsin Department of Health Services has a great deal of information about ALCs and Finding and Choosing an Assisted Living Facility.

Background

• Wisconsin has a rich history of community based programs, including licensure of the first Community Based Residential Facility (CBRF) in 1979. As a public funding agency, the Department of Health Services (DHS) has honored consumer choice providing supports for people to live in the least restrictive, most integrated setting possible. Beginning with the enactment of the Community Option Program (COP) in 1981 and through the creation of Family Care in 1999, Wisconsin has been a national leader in relocation efforts from institutions to community settings.
• In 1980 Wisconsin ranked 2nd nationally in the number of nursing homes beds per capita with 87 nursing home beds per 1,000 residents 65 years of age and over. Thirty years later that ranking moved to 20th nationally with 46 nursing home beds per 1,000 residents 65 years of age and over, an increase of 47%. In 2008 Wisconsin Assisted Living beds surpassed nursing home beds with the gap widening each year since.
• Since 1979 Assisted Living licensed beds have increased 34 consecutive years while the regulatory agency resources has not kept up with the increasing workload.
• Wisconsin’s innovative regulatory approaches have improved overall quality in Assisted Living while also receiving national recognition.
• Wisconsin has four strong Assisted Living provider associations supporting their members to improve the care and services they provide to the residents/tenants in their communities.
• Wisconsin’s ombudsman program is a national leader with committed resources to the advocacy of residents in Assisted Living Communities (ALCs).

Project Goals

• Create a Public/Private collaboration with DHS Division of Quality Assurance and Division of Long Term Care, Wisconsin’s four provider associations that include LeadingAge Wisconsin, Wisconsin Assisted Living Association (WALA), Wisconsin Center for Assisted Living (WiCAL), and Residential Services Association of Wisconsin (RSA-WI), Wisconsin’s advocacy agency, the ombudsman program, and the University of Wisconsin-Madison’s Center for Health Systems Research & Analysis (CHSRA)
• Incentivize Assisted Living Communities to strive for excellence through internal quality improvement
• Collaborate with provider associations to develop a comprehensive QI & QA program and to help their members to be successful.
• Collaborate with the CHSRA to improve long-term care and health systems by creating performance measures and developing information and decision support systems.
• Provide regulatory relief for high performing Assisted Living Communities.
• Define the level of excellence that will be recognized by public funding agencies, insurance companies, Assisted Living Communities, advocates, legislators, general public and other key stakeholders.

Project Activities

• Implement the WCCEAL infrastructure using a grant secured by CHSRA;
• DHS approves provider association Quality Improvement and Quality Assurance programs;
• Develop a website and password-protected web-based information system for members of WCCEAL;
• Develop a standardized Resident Satisfaction Survey for WCCEAL members;
• Develop performance measures of quality improvement structures, processes, and outcomes for WCCEAL members;
• Create a firewall preventing the DHS from accessing Assisted Living Community specific WCCEAL data.; and
• Provide feedback to provider associations and Assisted Living Communities on their resident satisfaction and quality improvement performance with trend information and comparisons to peers and other cohorts.

Deliverables

• 11/30/2009 - WCCEAL established
• 09/17/2010 - DQA updated database to capture WCCEAL members
• 05/09/2011 - CHSRA awarded $200,000 to develop and pilot-test WCCEAL from the 2011 ICTR Community Collaboration Grant
• 04/06/2012 - All four provider Association’s QA/QI programs approved
• 06/12/2012 – Resident Satisfaction Survey finalized and approved
• 11/02/2012 - CHSRA launched WCCEAL Website https://wcceal.chsra.wisc.edu/
• 11/12/2012 - WCCEAL Satisfaction Survey process launched
• 02/25/2013 - WCCEAL Quality Improvement Data Submission process launched
• 06/18/2014 - CHSRA awarded $150,000 to investigate falls prevention programs among WCCEAL members, from the 2014 ICTR Dissemination and Implementation Award
• 01/01/2015 – WCCEAL introduced new Falls Prevention questions
• 09/15/2015 – WCCEAL Membership Rules implemented
• 10/21/2015 – DHS and CHSRA awarded a $1,000,000 grant to scale-up the statewide impact of WCCEAL from the 2015 Wisconsin Partnership Program Community Impact Grant
• 10/26/2015 – Music & Memory SM awarded $10,292 to pilot-test the Music and Memory program with iPads in ALCs, from the Park Family Foundation

Dissemination

• 30+ Presentations about WCCEAL to various stakeholder groups including CMS, the Center for Excellence in Assisted Living (CEAL), Assisted Living Federation of America (ALFA), national Ombudsman groupand at the different state Assisted Living conferences.
• WCCEAL benchmark data on resident satisfaction and quality improvement currently covers 24% of Wisconsin Assisted Living Communities licensed beds.

Research and Evaluation

• 7/1/2010 to Present: Wisconsin Department of Health Services (DHS)  - WCCEAL Infrastructure and Research
• 09/01/2011 – University of Wisconsin Institute for Clinical and Translational Research Community Collaboration Grant
• 09/01/2014 – University of Wisconsin Institute for Clinical and Translational Research Falls Prevention grant
• 11/01/2015 – Park Family Foundation Music and Memory grant
• 03/01/2016 – Wisconsin Partnership Program Community Impact grant

Honors

• 2015 – WCCEAL recognized as a Bright Ideas through the Harvard Innovations in Government Program, a program of the Ash Center for Democratic Governance and Innovation at the Kennedy School of Government at Harvard University.

This is a list of the members of the Coalition Advisory group. The WCCEAL Advisory group meets monthly to discuss, build and improve the WCCEAL program, project and infrastructure in order to increase quality of care for all those residing in Wisconsin ALCs.

• Barbara Bowers, U.W. Madison
• Heather Bruemmer, BOALTC
• Kevin Coughlin, DHS
• Christopher Crnich, U.W. Madison
• Kate Dickson, WiCAL
• Dan Drury, RSA
• Jay Ford, CHSRA
• Alfred Johnson, DHS
• Chris Kenyon, M3 Insurance
• Lindsey Kreitzman, Bureau of Adult Long Term Care
• Kim Marheine, BOALTC
• Janice Mashak, LeadingAge Wisconsin
• Jim Murphy, WALA
• Susan Nordman Oliveira, CHSRA
• Cindy O'Connell, DHS
• Brian Purtell, WiCAL
• Edmond Ramly, CHSRA
• John Sauer, LeadingAge Wisconsin
• Jackie Strader, WiCAL
• Jim Williams, LeadingAge Wisconsin
• Otis Woods, DHS
• Dennis Yadon, WALA
• David Zimmerman, CHSRA

Assisted Living Communities (ALCs) Interested in Joining WCCEAL

ALCs interested in joining WCCEAL must first be part of one of the 4 Wisconsin Assisted Living Association quality improvement programs. ALCs should contact their member Association for further information about joining WCCEAL.

LeadingAge Wisconsin 204 S. Hamilton St. Madison, WI 53703 Phone: (608)255-7060 Email: info@wahsa.org	WI Assisted Living Association PO Box 7730 Madison, WI 53707-7730 Phone: (608) 288-0246 Email: info@ewala.org	WHCA/WiCAL 121 E. Wilson St., L200 Madison, WI 53703 Phone: (608) 257-0125 Email: info@whca.com	Residential Services Association of WI 6737 W Washington St, Suite 1300 Milwaukee, WI 53214 Phone: (414) 276-9273 Email: info@rsawisconsin.org

To remain in good standing and be listed in the ALC membership section of this website all ALCs must abide by the WCCEAL membership rules.

Associations interested in joining WCCEAL

WCCEAL is a public/private collaboration between the a) Wisconsin Department of Health Services, b) Wisconsin’s four assisted living provider associations that include Leading Age Wisconsin, Wisconsin Assisted Living Association (WALA), Wisconsin Center for Assisted Living (WiCal), and Residential Services Association of Wisconsin (RSA), c) Wisconsin’s consumer advocacy agency and ombudsman program, and d) the University of Wisconsin-Madison’s Center for Health Systems Research and Analysis (CHSRA). All WCCEAL Associations must abide by the Association Guiding Values for Participation in WCCEAL. To receive more information about the Collaborative please contact the WCCEAL Helpdesk (wcceal_help@chsra.wisc.edu).

The following is a list of all member ALCs currently in good standing in the WCCEAL program. ALCs must abide by the WCCEAL membership rules in order to participate in WCCEAL and be listed below.

WCCEAL Membership (as of August 15, 2017)

This list can be sorted by using the arrows on each column heading or filtered by using the dropdown lists or text boxes. You can receive additional information about these and other health and residential care providers in Wisconsin using the Wisconsin Department of Health Services Provider Search.

* New WCCEAL Member (first 2 quarters after enrollment)

* New WCCEAL Member

Division of Medicaid Services (DMS): DMS provides leadership and funding support for the Coalition including funding for design and maintenance of the WCCEAL website and information system.

The Board on Aging and Long Term Care, operates the Long Term Care Ombudsman, Volunteer Ombudsman, and Medigap Helpline Programs. It is the premier resource for information and advocacy.

Division of Quality Assurance (DQA): DQA provides regulator and licensing information for ALCs in Wisconsin and the Coalition, as well as providing  survey relief to WCCEAL members.

CHSRA is the academic partner, providing website and database design and management. Also providing academic and evidence based research expertise and collaboration.

To become a member of WCCEAL, ALCs must first be part of one of the 4 Wisconsin Assisted Living Association quality improvement programs. Those interested in joining WCCEAL should first contact one of the following Associations to become an active member of their quality improvement program. All WCCEAL Association must abide by the Association Guiding Values for Participation in WCCEAL.

Echelon - A Quality Improvement Program for Those Who Strive for Excellence in Assisted Living

The LeadingAge Wisconsin Echelon is a systematic and all encompassing program to serve assisted living professionals who strive for excellence in the care and services they offer.

Echelon grew out of the LeadingAge Wisconsin Assisted Living Quality Improvement Network. Driven by the passion and commendable efforts of the many Network members, LeadingAge Wisconsin has developed and maintains an unparalleled forum for peer networking and sharing, a series of quality improvement initiatives, quality improvement modules, staff training modules, and certification courses for RCAC and CBRF managers.

The WALA Diamond Accreditation Program is a voluntary quality management program that is available to WALA members.

The purpose of this program is to improve and maintain high standards of quality care and services for residents of Wisconsin's assisted living facilities where individual needs are met in safe, healthy, respectful and dignified environments.

The Diamond Accreditation Program is a cost-effective quality management program. It is an invaluable guide to help improve the quality of your business and increase the quality of care you provide to your residents.

PEAL is a voluntary program open to all WiCAL members, regardless of their licensure or certification, or whether they are currently qualified for the abbreviated survey process. Participation is voluntary, but all members are strongly encouraged to participate. Participating facilities will be trained in recognized performance excellence criteria and quality improvement processes. Specifically, the PEAL program will rely heavily on the Baldrige 2011-2012 Healthcare Criteria for Performance Excellence as the foundational of the program.

The mission of RSA Wisconsin is to exist as a resource to foster a community for advocacy and education for excellence in community residential and related support services. It is the goal of RSA to positively impact residential and other support services throughout Wisconsin by supporting providers in the fields of Disabilities, Aging Services, Mental Health, and Community Corrections so that they can achieve the highest level of service to individuals with these challenges throughout Wisconsin. It is for this reason that the STAR Quality Accreditation Program was developed.

The following programs were reviewed by DHS and CHSRA staff and approval was granted as follows:

Associated Research Grants:

2014 ICTR Dissemination and Implementation Award. CHSRA awarded $150,000 grand to investigate falls prevention programs among WCCEAL members.

Park Family Foundation Grant. $10,000 Music & memory grand to pilot-test the Music and Memory program with iPads in ALCs.

The password protected section of the WCCEAL website is available only to members of WCCEAL. It consists of an annual resident satisfaction survey, an instrument to collect information about each member ALC’s quality improvement structure, processes, and outcomes, webpages for ALCs and associations to monitor their data benchmarked against other participating ALCs, and quality improvement tools and resources for ALCs and associations.

The resident satisfaction survey is administered at the ALC level once per year between January and April. ALCs and their associations can compare their performance with other providers in the state, in seven areas: staff, resident rights, environment, activities, meals and dining, health management/care, and overall ratings. The quality improvement data is collected from ALC members once per quarter providing information about the ALCs quality improvement structure, processes and outcomes.

The output of the system is a series of web-based reports on the results of the satisfaction measures, the quality improvement variables, and the ALCs’ rate of participation in the data collection. These reports permit the participating communities to review their performance and compare themselves to their counterparts in the program. More extensive information on individual ALC performance and participation is available to the Associations, since they are integral to the feedback and quality improvement functions of WCCEAL.

Below is a WCCEAL activity timeline: