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Featured Resource: Five-Star Quality Rating System - The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them.

As you know, CMS posted six new quality measures on Nursing Home Compare in April. Beginning July 27, five of those measures will be incorporated into the five-star rating system on Nursing Home Compare. The User’s guide explains the changes made to the QM domain and additional methodological changes that will be introduced in July, including:

  • Using four quarters of data rather than three for determining QM ratings.

  • Reducing the minimum denominator for all measures (short-stay, long-stay, and claims-based) to 20 summed across four quarters.

  • Revising the imputation methodology for QMs with low denominators meeting specific criteria. A facility’s own available data will be used and the state average will be used to reach the minimum denominator.

  • Using national cut points for assigning points for the ADL QM rather than state-specific thresholds.


Advancing Excellence

Advancing Excellence in America’s Nursing Homes: Supported by CMS, the Commonwealth Fund, and others, The Advancing Excellence Campaign provides tools and resources to improve nursing home care in clinical and organizational areas.

Alliant Quality Nursing Home Portal


American Health Care Association

American Health Care Association (AHCA) is rolling out the expansion of the Quality Initiative to further improve quality care in skilled nursing care centers.  For the next three years, the Initiative will challenge member organizations to apply a systematic approach, such as the nationally recognized Baldrige Performance Excellence Framework, to achieve more ambitious targets in eight critical areas with a special focus on three priorities—improvements in organizational success; short-term/post-acute care; and long-stay/dementia care.

These areas are aligned with the Centers for Medicare & Medicaid Services (CMS)’ Quality Assurance/Performance Improvement (QAPI) program and federal mandates, such as the Five-Star and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act

Antipsychotic Reduction

Antipsychotic Drugs & Dementia Care  - Nursing Home 411  


         TAP Catheter-Associated Urinary Tract Infection (CAUTI) Toolkit Implementation Guide: Links to Example Resources


Disclaimer: The links in the domains below are not mutually exclusive nor do they represent an exhaustive list of all the possible resources available. Furthermore, the links presented do not constitute an endorsement of these organizations or their programs by the Centers for Disease Control and Prevention (CDC) or the federal government, and none should be inferred.


On this Page


  • General Infrastructure, Capacity, and Processes
  • Appropriate Indications for Indwelling Urinary Catheter Insertion
  • Aseptic Insertion of Indwelling Urinary Catheter

  • Proper Indwelling Urinary Catheter Maintenance
  • Timely Removal of Indwelling Urinary Catheter
  • Preventing Candiduria and Detecting Asymptomatic Bacteriuria


C-Diff One-pager - Deadly Diarrhea

Civil Money Penalty Funds

Application for the State Request for Approval of Use of Civil Money Penalty Funds for Certified Nursing Homes: In accordance with Survey & Certification transmittal 12-13-NH dated December 16, 2011, States must obtain approval from the Centers for Medicare & Medicaid Services (CMS) for the use of federally imposed civil money penalty (CMP) funds. A copy of this transmittal is available on the CMS website, at Effective January 1, 2012, CMS has established a process for reviewing applications that seeing funding to improve resident outcomes in certified nursing homes.  Only CMP fund applications that meet the statutory intent of the regulations, Federal law and policy will be considered. Special thanks to the Region IV-CMP Coalition for their assistance in developing this CMP Grant request form to promote consistency, transparency and best practices.  Region IV states include Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.  Requests to use CMP funds may be made by various organizations and entities.  Applications may be submitted by certified nursing homes, academic or research institutions, state, local or tribal governments, profit or not-for-profit, or other types of organizations.

Culture Change

Implementing Change in Long-Term Care: A Practical Guide to Transformation: This resource was prepared by Barbara Bowers and others with a grant from the Commonwealth Fund to the Pioneer Network. Although it deals with implementing culture change (not QAPI), it is a good resource for the change process.


CMS Issues S&C Memo: Focused Dementia Care Survey Tools

According to the memo, the pilot project of these focused surveys took place in 2014 in order to examine the process for prescribing antipsychotic medications and assess compliance with other federal requirements related to dementia care practices in nursing homes. The pilot was initiated to gain new insights about surveyor knowledge, skills, and ways that the current survey process may be streamlined to more efficiently and accurately identify and cite deficient practice.

In 2015, the expansion project involved a more intensive and targeted review of dementia care, the utilization of antipsychotic medications to broaden the opportunities for quality improvement among providers.

CMS is sharing the revised survey materials that were developed for the pilot and expansion efforts. The intent is that facilities use these tools to assess their own practices in providing resident care. Attachments are provided below in the form of links:

SC16-04.03 Attach 2 – Resident Questions

SC16-04.02 Attach 1 – Facility Questions

SC16-04.01 NH – Focused Dementia Care Survey Tools


Hand in Hand

CMS Hand in Hand: A Training Series for Nursing Homes:  The Hand in Hand training materials consist of an orientation guide and six one-hour, video-based modules, each of which with a DVD and an accompanying instructor guide. Though Hand in Hand is targeted to nurse aides, it has real value for all nursing home caregivers, administrative staff and anyone who touches the lives of nursing home residents. While annual training for nurse aide's on dementia care and abuse prevention is required in current nursing home regulations, CMS does not require nursing homes to use the Hand in Hand training specifically. Other tools and resources are also available

Hospital Readmissions

CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents: This initiative is operating in seven states with over 145 nursing facilities to implement evidence-based interventions aimed at enhancing care, improving outcomes, and reducing costs. These interventions range from implementing indirect care models for best practices (e.g., “train the trainer”), to deploying highly skilled clinicians to deliver direct bedside care. The initiative also includes some unique components such as telemedicine, oral care, and the use of consultant social workers and pharmacists. These interventions address specific issues within nursing homes, seek to enhance the quality of care delivered facility-wide, and are consistent with the goals of QAPI.                                                                                                                                                                                                                                                                                            


Review of Patterns of Low-Risk Residents with Loss of Bladder or Bowel in Your Home

Infection Prevention

Centers for Disease Control and Prevention's (CDC) Website for Nursing Homes and Assisted Living (LTC Facilities)

AHRQ and Joint Commission Launch E-Learning Module to Reduce Long-term Care Infections: Assisted living and nursing home staff at all levels can help prevent healthcare-associated infections by using a 50-minute e-learning tool based on high reliability principles. The online module teaches long-term care facilities to apply these principles, which can help them achieve safety, quality and efficiency goals, to prevent infections and achieve high safety performance over extended periods. The Joint Commission developed the e-learning module with partial funding from AHRQ. It features quizzes and a searchable database of practical resources. The free CDs and online formats are available to all facilities, not only Joint Commission customers.

CDC - "Safer Healthier Home" Poster

Hand Hygiene Observer Training

Interact II by Pathway Health

Interact II:  An example of a more extensive set of tools, INTERACT II is a system of tools to improve how nursing home caregivers communicate around change in resident condition. This comprehensive set of tools could be considered a QAPI process toolkit as well.

National Partnership

National Partnership:  A CMS partnership with federal and state agencies, nursing homes, other providers, advocacy groups, and caregivers to improve comprehensive dementia care.


Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network:  The CDC’s National Healthcare Safety Network (NHSN) provides nursing homes and other long term care facilities with a customized system to track infections in a streamlined and standardized way. When facilities track infections, they can identify opportunities for prevention and monitor progress toward stopping infections. On the national level, data entered into NHSN by long term care facilities will help define the burden of infections in this setting and gauge progress toward national infection prevention goals.

Nursing Home Collaborative Information – NNHQCC     

National Nursing Home Quality Care Collaborative Change Package - March 2015:  The National Nursing Home Quality Care Collaborative (NNHQCC) Change Package is a menu of strategies, change concepts, and specific actionable items that nursing homes can choose from to begin testing for purposes of improving residents’ quality of life and care. The Change Package was originally intended for nursing homes participating in the National Nursing Home Quality Care Collaborative led by CMS and the Medicare Quality Improvement Organizations (QIOs), to improve care for the millions of nursing home residents across the country. The Change Package was developed from a series of ten site visits to nursing homes across the country, and the themes that emerged regarding how they approached quality and carried out their work. It focuses on the successful practices of high performing nursing homes.

2014 Nursing Home Quality Initiative Crosswalk:  The Centers for Medicare & Medicaid Services (CMS) and Advancing Excellence in America’s Nursing Homes national campaign coordination group developed a set of common questions and answers for nursing homes in order to clarify how some of the many initiatives relate to and are aligned with each other. The purpose is to help nursing homes better understand how to participate in and benefit from various initiatives.  



QAPI Written How-to Guide:  The QAPI plan will guide your organization's performance improvement efforts.

QAPI Process Tool Framework:  In a collaborative effort with the University of Minnesota and Stratis Health, subject matter experts, consumer groups and nursing home stakeholders, CMS created “process” tools that may be used to implement and apply some of the basic principles of QAPI. A Process Tool Framework has been created to crosswalk each CMS Process Tool to the QAPI Five Elements. This framework includes a description of the purpose or goal for each tool that is hyperlinked within the framework.

QAPI Website ~ Quality Assurance & Performance Improvement:  The following resources are available: QAPI at a Glance, QAPI tools, QAPI News Brief and Video.

QAPI Self Assessment Tool Fillable Document  2015   | Survey Monkey Link to QAPI Assessment Tool

Fillable PDSA Worksheet

Quality Improvement

Model for ImprovementThe Institute for Health Care Improvement uses the Model for Improvement as the framework to guide improvement work. This model, developed by Associates in Process Improvement, is a simple, yet powerful tool for accelerating improvement. Learn about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA).         

Root Cause Analysis                                                                                                                                                                                                                                                                                                                                                    


Agency for Healthcare Research and Quality - TeamSTEPPS Program:  The Department of Defense and the Agency for Healthcare Research and Quality developed the TeamSTEPPS program to optimize performance among teams of healthcare professionals and improve collaboration and communication. The Long-Term Care version addresses issues specific to nursing homes.


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