Strengthening Quality Assurance in Senior Living: Do You Know Where Your QAPI is?
QAPI programs improve care, staff engagement, and satisfaction. Learn how to implement an effective approach to foster accountability and impact.
If you work in long-term care, you’ve probably heard the acronym QAPI, or Quality Assurance and Performance Improvement. Quality assurance in senior living is an integral part of long-term care, in part due to the Affordable Care Act (ACA), which requires that all skilled nursing centers develop QAPI programs. The QAPI requirements were included in the Centers for Medicare and Medicaid Services’ (CMS) revised Requirements of Participation (RoP) for nursing centers, published in October 2016.
QAPI programs can be a vulnerable area that may result in multiple deficiencies during the survey process. If the QAPI program is not effective, it can result in poor outcomes for residents, staff, and your entire community. The QAPI requirement requires that all nursing homes establish and implement effective, comprehensive, data-driven QAPI programs that focus on systems of care, including indicators of outcomes of care, quality of life, and resident/staff satisfaction. Simply put, QAPI is the foundation of quality assurance in senior living.
QAPI is the merger of two complementary approaches to quality management: Quality Assurance (QA) and Performance Improvement (PI). QA and PI combine to form QAPI, a comprehensive approach to ensuring high-quality care. Kara Emig, Director of Nutrition and Wellness for CCL Hospitality Group, sums it up as “The intent of QAPI is to develop, implement, and maintain a comprehensive, data-driven program that focuses on systems of care, outcomes of care, and improves the quality of life for our residents.” In other words, it is a proactive approach to performance management and improvement.
An effective QAPI program involves multiple disciplines within the community and focus on practical and creative problem solving. It is important to systematically evaluate and analyze all data collected to understand the root cause and put processes in place to improve care.
Quality Assurance (QA)—This is a retrospective look at the care provided to patients and the effectiveness of the organization’s operations in doing so. Data collected includes, but is not limited to:
Performance Improvement (PI)—The second part of an effective QAPI program is analyzing all the information collected to identify any trends that have led to noncompliance with regulations or have resulted in poor resident outcomes.
Using the PLAN, DO, STUDY, ACT (PDSA) method helps to determine if the processes in place are actually working or if there is need to re-adjust and evaluate to achieve the desired outcomes.
Driving quality and performance is a priority for at CCL and when an adverse trend, such as foods not being served at a palatable temperature or items are missing from a tray, it is observed and a departmental performance improvement plan is developed. An example of a working PIP includes:
Asking “why” is the key to developing sustainable action plans. Root cause analysis can significantly improve resident satisfaction and elevate the overall quality assurance in senior living communities.
Throughout the planning and development of QAPI for care providers, CMS identified it would be necessary to include tools and resources for nursing home surveyors and consumers, facilitating a true paradigm shift for communities. CMS offers multiple training sessions for communities, consumers, and surveyors to better identify when negative outcomes are symptoms of underlying system failures—helping to empower and engage staff, residents, families, and advocates.
The official QAPI webpage for nursing homes can be found here.
QAPI can be complex, but it is imperative to keep it simple by breaking it down and delegating so that all staff can understand and participate. At CCL Hospitality Group, we understand the significance and importance of the QAPI process and strive to incorporate a culture of accountability and compliance in every level of the organization. To support these goals, we use a robust and comprehensive electronic platform to capture data and evaluate trends. Leadership takes a “hands-on approach” to work closely with team members to create an action plan that will result in sustainable positive change.
When implemented effectively, QAPI can lead to benefits such as greater cohesion among residents, staff, and families; enhanced staff competencies; and a shift toward caregivers becoming active performance improvement partners. Ultimately, this proactive model supports better care and stronger quality assurance in senior living environments.
An effective QAPI program can transform long-term care communities by promoting continuous focus on both care quality and quality of life. It’s worth the investment to do it right, for your team, your community, and the residents you serve.
