As the population of older Americans continues to increase, the heightened need for high-quality long-term care facilities has become the centerpiece of the policy debate concerning elder citizens. Aging Americans have all too often been relegated to sub-par facilities where the resources are limited and the personnel lack the ability to deliver appropriate care to residents. Through heavy media coverage, the general public in Illinois witnessed several scandals concerning incidents of poor care in nursing home facilities. Public outcry and concern about the treatment of elderly people--especially those who could not afford private or special services--pushed the Illinois Department of Public Aid to act decisively to address the inconsistency in elder care.
Quality Incentive Program (QUIP) aims to improve care through a positive incentive and education plan. The state of Illinois has standardized factors that represent high-quality care and provides financial bonuses to facilities that meet those specifications. QUIP is predicated on three assumptions: that the state should be an active partner in improving quality care; that quality care should be evaluated based on client treatment and outcomes, not just the physical attributes of homes; and that the customary punitive approach to regulation should be supplemented by one that makes creative use of incentives. Based on the delineated standards, each facility is given a "star" rating (1-6) relating to the quality of care demonstrated. This rating is publicized, used to evaluate progress and taken into consideration in the awarding of financial bonuses. One hundred fifty registered nurses evaluate facilities and educate staff on how to improve the quality of care given to patients.
The nursing homes in Illinois serve 56,000 residents who receive public funds to pay for their care. QUIP focuses on assessing the care given to this population and awards bonuses that affect an entire facility and every resident based on the quality of care given to patients who receive public assistance. QUIP's combination of incentives and information is designed to improve the quality of patient care across the state and ensure that elder residents throughout Illinois receive equal services.
Although no formal evaluation has taken place in the first year of this program, nurses testify that they have seen an improvement in care and a shift in nursing home ethos since QUIP began. One evaluator asserts that QUIP has broadened the horizons of many facility staff including administrators. Instead of viewing the homes as spaces where elderly people wait to die, they have begun to see the benefits of meaningful engagement with residents, personalizing care, and respecting the dignity of clients. While the incentive system is one motivating factor, according to nurses, the clear benefits of more sensitive care for clients has made nursing home staff committed to better practices. A spirit of cooperation between the evaluators and facility staff is fostered through these ongoing teaching relationships. QUIP nurses act as collaborators in the project of improving care, not just assessment administrators.
Participation in the QUIP program is voluntary. It is therefore significant that 95 percent of homes in Illinois elected to be "QUIPed" in 1985. This was an increase from the first round of evaluations where 81 percent of homes participated. Many more homes received favorable ratings than in the first set of assessments, with the number of facilities receiving four, five, or six stars increased by 83 percent, from 128 to 234. The quality of elderly care in Illinois is clearly improving due to the QUIP evaluation and education process. Residents, their families, and the public have a meaningful and reliable source of information regarding quality of nursing home care and insurance that older Americans in Illinois are being treated with respect and integrity.