Over the past two decades, nursing homes in New York have began to care for more medically complex residents and patients. Hospital patients are discharged ‘sicker and quicker’ to skilled nursing facilities and as hospitals focus on shorter lengths of stay, decreasing costs, and reducing readmission rates.

Representatives of the New York Medical Directors Association (NYMDA) and the New York State Department of Health (DOH) convened a workgroup of stakeholders to improve health outcomes and quality of life for nursing home residents and patients by strengthening medical direction and medical care through the provision of written guidance for medical staff.

The resulting guidelines titled, “Role of the Medical Director in the Nursing Home,” and “Role of the Attending Physician in the Nursing Home,” are a set of principles and practices for providing high-quality, person-directed medical care in nursing homes in New York State.

The stakeholder workgroup, spearheaded by the three statewide nursing home associations, Healthcare Association of New York State, LeadingAgeNY, and the New York State Health Facilities Association, Inc. launched a three-year educational initiative titled,  Education, Training, and Technical Assistance (ETTA), Enhancing the Nursing Home Medical Director Guidelines and Quality Improvement Process.  ETTA was funded by state civil monetary penalties collected as nursing home survey enforcements.

The ETTA project solicited volunteer facilities from across the state and provided them with access to free, statewide education and technical assistance to successfully integrate the Guidelines in their organizations.  ETTA applied a quality improvement systems process of self-assessment, priority setting, and guidelines Action Plan development and execution.   Two dozen regional workshops provided hands-on team building for facility leadership teams – Administrator, Director of Nursing, and Medical Director – and time to attack leadership challenges associated with their Action Plans.  In addition, didactic content included topics on INTERACT, palliative care, and the regulations surrounding medical direction and services in nursing homes.

A second level of the project was the ETTA Facility Program, offering leadership teams in-house facilitators who provided a more structured and intense level of participation and assistance to move facilities’ Action Plans and guidelines implementation forward.

A third feature of ETTA was the “Virtual Mentoring” of nursing home medical directors by ETTA physician faculty. “Virtual Mentoring” offered facility medical directors opportunities for direct engagement with physician faculty through conference calls, where they could discuss directly with physician leaders,  their challenges of being a medical director and leader.

ETTA also provided educational webinars, opened to all nursing homes statewide, offering education on reimbursement of physician services, credentialing nursing home medical practitioners, preventing unnecessary re-hospitalizations of nursing home residents, sepsis, and best practices on nursing home quality improvement initiatives under ETTA.  All ETTA programs, materials, and webinars are archived and publicly accessible on the ETTA Project Website. 

In project surveys, administrators, directors of nursing, and medical directors consistently reported that the overwhelming impact of ETTA was improved team communication and collaboration.  Quality improvement, as measured by survey outcomes and measures tracked by each team, was also noted.  Each group reported that both the vision and path of the facility was better defined after participation in ETTA, as was the role of the medical director in the organization.  The biggest regret expressed by all parties in ETTA was the conclusion of the project anticipated in December 2016.

Because of the overwhelming benefits experienced and reported by ETTA participating nursing homes and the extraordinary team development and resilience observed by the ETTA project faculty in the participating ETTA nursing homes, the project faculty are exploring ways to continue and expand ETTA for the future.