Healthcare Fundamentals Remain Critical to Quality Care
I have been working in the disability field for 35 years. Over that time, I have witnessed enormous change. In 1990, when I started my career, person-centered planning was in its infancy. The Home & Community Based Services (HCBS) Waiver had not grown into the default funding model for residential and day services it is today. In Maryland, where I began my career, few people received a diagnosis of pervasive developmental disorder. Programs like Self-Directed services and Micro Boards had yet to offer people higher levels of autonomy. Back then, people were relegated to large “big box” day programs. The rationale behind most services was still that which governed the large institutions people had just left. We referred to services as community-based because that is where they took place. Most people lived on islands and only occasionally interacted with their non-disabled neighbors.
As I sat down for the final session of the National Association of State Directors of Developmental Disabilities Services (NASDDDS) conference in November, covering the importance in improving health outcomes, I realized how three decades later little has changed. Ensuring people have reliable health supports and are free from harm are the bedrock supports any state system can provide. Simply put, people cannot realize their full potential if they are not in good health. Providers must ensure that their nurses are well trained and proactive. So too, the Direct Support Professionals who implement the health and wellness plans that are vital to a good quality of life.
As the person responsible for developing QT’s Annual Monitoring report, I am keenly aware that too many people are not receiving the healthcare supports they need. Year after year we cite the same causes and recommendations. The following is from this year’s report. “Inadequate documentation, combined with inconsistent staff training and high turnover, hinders the delivery of high-quality care, and makes it challenging to create individualized, evidence-based care plans. Comprehensive records—such as Physician’s Orders, Health Care Management Plans, and Health Passports—are crucial for ensuring that diagnoses, medications, and care recommendations are accurate, consistent, and effectively communicated. Reviews conducted by our nurses for the 2023–2024 period revealed that only 38% of the people we monitored or visited had thorough records, emphasizing the critical need for significant improvement in accurate documentation.”
Consider this example from this year’s report. “The Primary Care Physician (PCP) for a 78-year-old man with a history of aspiration pneumonia ordered that all his fluids be thickened due to a risk of aspiration on thin liquids. During a routine home monitoring visit, our nurse observed he was drinking Dunkin’ Donuts coffee and a non-thickened glass of water placed directly in front of him. Although staff claimed the fluids had been thickened by the previous shift, our nurse’s inspection revealed that the drinks were not thickened. The staff was immediately directed to remove the non-thickened fluids and properly thicken them under our supervision. The incident was promptly reported to DDS as a safety concern, and
staff training on the critical importance of adhering to fluid thickening protocols was recommended to prevent similar occurrences in the future.”
There is no substitute for getting the fundamentals right. Knowing people and ensuring they have trained, motivated staff who communicate, coordinate, and document was essential in 1990 when I started and remains so now. Our full monitoring report will be available soon. If you would like to donate to help QT continue critical advocacy on healthcare, please click here!