This website has moved.
WCCEAL and eQuality are now part of the QID (Quality Improvement with Data) website.

Go to the new QID website

Video: Full introduction of the Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) and the eQuality data system
This is a 25 minute video presentation which was originally given in 2021 summarizing the WCCEAL coalition and it’s online data reporting system.

The following paper was published in the Journal of the American Medical Directors Association (JAMDA):

Implementing Large-Scale Data-Driven Quality Improvement in Assisted Living
Ramly, E., Parks, R., Fishler, T., Ford II, J. H., Zimmerman, D., & Nordman-Oliveira, S. (2022). Implementing large-scale data-driven quality improvement in assisted living. Journal of the American Medical Directors Association, 23(2), 280-287.

This award-winning publication is the first implementation study of large-scale data-driven quality improvement in assisted living, reporting implementation outcomes, core components, and implementation strategies building on a decade-long public-private collaboration.

Edmond Ramly, PhD, MS, received the William E. Scheckler, MD, Outstanding Research Publication Award (faculty or staff) for this publication in 2022.

WCCEAL was developed to help improve the quality of care provided to residents living in assisted living communities (ALCs). The WCCEAL program accomplishes this through a process of continuous quality improvement for the ALC. Members of WCCEAL, with the support of their Assisted Living association sponsor, commit to administering a yearly resident satisfaction survey and reporting quarterly Quality Improvement variables to assist in both reviewing how they are doing and improving in places they could do better. When looking for an ALC that invests in quality improvement, consumers and family members can use the public WCCEAL Member List to see which ALCs are members of WCCEAL as well as which ones are Gold Members. All WCCEAL members listed on the public membership list are participating in WCCEAL's continuous quality improvement. Gold Members are taking additional steps beyond the requirements of WCCEAL to help improve and ensure quality of care for their residents.

Satisfaction Survey

Every year the residents currently living in WCCEAL ALCs are asked to fill out a satisfaction survey. This survey is used to provide the ALC with feedback and to help them see areas for improvement. This survey and its data once returned to WCCEAL are kept anonymous and only aggregate information is provided to the ALC and other members of the WCCEAL coalition. Surveys do not need to be returned to the ALC. If you want to return your survey directly and anonymously to WCCEAL, please either use the provided postage paid return envelope or return your survey directly to:

WCCEAL/eQuality Satisfaction Survey
WARF Building UW-Madison
610 Walnut Street
Madison, WI 53726-2397

Further Concerns/Assistance

An important member of the WCCEAL coalition is the State of Wisconsin Board on Aging and Long-Term Care (BOALTC). The Board on Aging and Long Term Care employs long-term care ombudsmen, located throughout the state. Long-term care ombudsmen serve persons age 60 and older who live in WI-licensed and certified long-term care settings, responding to complaints about care and treatment, respect for rights of residents and providing education to long-term care providers and consumers.

Your voice is important in your assisted living community. If you have concerns you want addressed, the best place to start is discussing your concerns with a staff member whom you trust or the ALC manager/administrator, if you feel comfortable doing so.

If you have further concerns or questions you can also contact:

State of Wisconsin - Board on Aging & Long Term Care
1402 Pankratz Street, Suite 111
Madison, Wisconsin 53704

Ombudsman Program: 1-800-815-0015
Medigap Helpline: 1-800-242-1060
Email: BOALTC@Wisconsin.Gov
Website: http://longtermcare.wi.gov

Or contact the WCCEAL Helpdesk for further assistance:

Email: wcceal@qid.wisc.edu
Phone: 608-263-8575
Toll-Free: 1-888-300-8098

Core benefits of WCCEAL for Assisted Living Communities (ALC)

• Membership in a statewide coalition that represents providers, regulators, payers, residents, and quality improvement experts.
• Access to a secure data-driven platform to assess their quality improvement structures, processes, and outcomes using measures co-designed by statewide stakeholders.
• Regular feedback through data-driven reports that they can customize to compare themselves to ALC peer groups of their choice.
• Targeted support to adapt their quality improvement efforts, including expert coaching, peer mentoring, and active engagement in a state-approved quality improvement program.
• Free access to the Clinical Resource Center including the AMDA clinical practice guidelines for assisted living.
• Access to promotional media resources.

Additional benefits of WCCEAL for ALCs in good standing

• Public recognition on the WCCEAL website.
• Regulatory flexibility: If an assisted living community that qualifies for the abbreviated survey is a member of WCCEAL in good standing, that assisted living community is surveyed later than assisted living communities in the same situation that are not members of WCCEAL in good standing.
• Eligibility for premium discounts for liability insurance.

Assisted Living Communities (ALCs) Interested in Joining WCCEAL

ALCs interested in joining WCCEAL must first be part of an approved quality improvement program. ALCs should contact their member Association for further information about joining WCCEAL.

LeadingAge Wisconsin 204 S. Hamilton St. Madison, WI 53703 Phone: (608)255-7060 Email: info@leadingagewi.org	WI Assisted Living Association PO Box 7730 Madison, WI 53707-7730 Phone: (608) 288-0246 Email: info@ewala.org	WHCA/WiCAL 3902 Milwaukee St., #7235 Madison, WI 53714 Phone: (608) 257-0125 Email: info@whcawical.org	Disability Service Provider Network 16 N Carroll St., Suite 300 Madison, WI 53703 Phone: (608) 244-5310 Email: support@dspn.org

To remain in good standing and be listed in the ALC membership section of this website all ALCs must abide by the WCCEAL membership rules.

Associations interested in joining WCCEAL

WCCEAL is a public/private collaboration between the a) Wisconsin Department of Health Services, b) Wisconsin’s assisted living provider associations that include LeadingAge Wisconsin, Wisconsin Assisted Living Association (WALA), Wisconsin Center for Assisted Living (WiCal), and Disability Service Provider Network (DSPN), c) Wisconsin’s consumer advocacy agency and ombudsman program, and d) the University of Wisconsin-Madison. All WCCEAL Associations must abide by the Association Guiding Values for Participation in WCCEAL. To receive more information about the Collaborative please contact the WCCEAL Helpdesk (wcceal@qid.wisc.edu).

When assisted living communities and health care facilities implement internal quality assurance and quality improvement throughout their systems, they will have better outcomes. The core of WCCEAL is the implementation of an association developed, department approved comprehensive quality assurance, quality improvement program.

Echelon – A Quality Improvement Program for Those Who Strive for Excellence in Assisted Living

The LeadingAge Wisconsin Echelon is a systematic and all-encompassing program to serve assisted living professionals who strive for excellence in the care and services they offer.

Developed by assisted living professionals for assisted living professionals, Echelon is an unparalleled forum offering peer networking and sharing, a series of quality improvement initiatives, quality improvement modules, staff training modules, educational programs, workforce development tools, leadership development, policy and procedure resources, regulatory guidance and support, and certification courses for assisted living professionals.

Echelon provides collaborative guidance and support for each participating assisted living community as the community pursues its individual journey of quality improvement. Through Echelon, assisted living professionals become better by working together.

This program was reviewed by DHS and UW Madison - CHSRA staff and approval was granted as follows:

The LeadingAge Wisconsin CBRF and RCAC Quality Improvement Network (Now Echelon)

Approved 11/16/2010

The WALA Diamond Accreditation Program is a voluntary, cost-effective, and self-directed quality management program that is available to WALA provider members.

The purpose of this program is to improve and maintain high standards of quality care and services for residents of Wisconsin's assisted living communities where individual needs are met in safe, healthy, respectful and dignified environments.

The Diamond Accreditation Program is an invaluable resource to help improve the quality of your assisted living operations and increase the quality of care you provide to your residents.

This program was reviewed by DHS and UW Madison - CHSRA staff and approval was granted as follows:

WALA’s Diamond Accreditation Program

Approved 01/19/2012

PEAL is a voluntary program open to all WiCAL members, regardless of their licensure or certification, or whether they are currently qualified for the abbreviated survey process. Participation is voluntary, but all members are strongly encouraged to participate. Participating facilities receive training in recognized performance excellence criteria and quality improvement processes. Specifically, the PEAL program will rely heavily on the Baldrige Excellence Framework (Health Care) as the foundation of the program.

This program was reviewed by DHS and UW Madison - CHSRA staff and approval was granted as follows:

WiCAL’s Performance Excellence in Assisted Living (PEAL) Program

Approved 04/06/2012

The mission of the Disability Service Provider Network (DSPN) is to exist as a resource to foster a community for advocacy and education for excellence in community residential and non-residential support services. It is the goal of DSPN to positively impact residential and non-residential support services throughout Wisconsin by supporting providers in the fields of Disabilities, Mental Health, and Community Corrections so that they can achieve the highest level of service to individuals with these challenges throughout Wisconsin. It is for this reason that the STAR Quality Accreditation Program was developed.

This program was reviewed by DHS and UW Madison - CHSRA staff and approval was granted as follows:

RSA Star Quality Accreditation	Approved 12/20/2011
DSPN Star Quality Accreditation	Approved 2019

Division of Medicaid Services (DMS): DMS provides leadership and funding support for the Coalition including funding for design and maintenance of the WCCEAL website and information system.

The Board on Aging and Long Term Care, operates the Long Term Care Ombudsman, Volunteer Ombudsman, and Medigap Helpline Programs. It is the premier resource for information and advocacy.

Division of Quality Assurance (DQA): DQA provides regulator and licensing information for ALCs in Wisconsin and the Coalition, as well as providing survey relief to WCCEAL members.

University of Wisconsin-Madison is the academic partner, providing website and database design and management. Also providing academic and evidence based research expertise and collaboration.

To become a member of WCCEAL, ALCs must first be part of an approved quality improvement program. Those interested in joining WCCEAL should first contact one of the following Associations to become an active member of their quality improvement program. All WCCEAL Associations must abide by the Association Guiding Values for Participation in WCCEAL.

LeadingAge Wisconsin, a statewide membership organization, is dedicated to the work of long-term care and assisted living organizations who principally serve seniors and persons with a disability. Through the core services of advocacy, education, and networking and guided by member-driven strategies, LeadingAge Wisconsin supports the efforts and mission of those who care for others. Together, LeadingAge Wisconsin and its members pursue better services for better aging.

The Wisconsin Assisted Living Association (WALA) promotes standards of quality care and provides valuable member services to organizations providing assisted living services. WALA’s mission is to support providers in enhancing the best quality of life for residents in assisted living in Wisconsin through advocacy, education, communication, and quality initiatives.

Wisconsin Health Care Association & Wisconsin Center for Assisted Living (WHCA/WICAL) is a non-profit organization dedicated to representing, protecting and advancing the interests of Wisconsin’s long-term care provider community and the residents they serve. In addition to its advocacy on behalf of its members, staff and residents, WHCA/WiCAL strives to provide its membership with the benefits of affiliation through the development and dissemination of information, training, and quality improvement assistance.

The mission of the Disability Service Provider Network (DSPN) is to exist as a resource to foster a community for advocacy and education for excellence in community residential and non-residential support services. It is the goal of DSPN to positively impact residential and non-residential support services throughout Wisconsin by supporting providers in the fields of Disabilities, Mental Health, and Community Corrections so that they can achieve the highest level of service to individuals with these challenges throughout Wisconsin. It is for this reason that the STAR Quality Accreditation Program was developed.

Collaborators

M3 is an independent, privately owned, full-service insurance brokerage firm. Their senior living & social services practice group is leading the way in strategic employee benefits and business insurance, helping to navigate changing regulations, unique vulnerabilities to litigation, and a challenging employment landscape.

The Center for Excellence in Assisted Living (CEAL) is a non-profit collaborative of 6 national organizations. These organizations represent a unique blend of key stakeholders in assisted living. CEAL is an objective national center to disseminate current resources covering a wide array of information including research reports, training materials, consumer information, case studies, consensus documents and more to foster and promote quality improvement. They also provide a forum to discuss issues affecting assisted living and promote research in gap areas affecting assisted living.

Argentum member companies operate senior living communities offering assisted living, independent living, and memory care services to older adults and their families. Argentum is the largest national association exclusively dedicated to supporting companies operating professionally managed, resident-centered senior living communities and the older adults and families they serve. Since 1990, Argentum has advocated for choice, accessibility, independence, dignity, and quality of life for all older adults. Argentum expands senior living through industry-leading events, publications, education, and research.

The National Center for Assisted Living (NCAL) is the assisted living voice of the American Health Care Association (AHCA). NCAL is dedicated to serving the needs of the assisted living community through national advocacy, education, networking, professional development, and quality initiatives. NCAL's proactive, national focus on assisted living legislation is backed by the strongest and most influential long term care advocacy team in the country. NCAL members know that their voices will be heard by the national policymakers and regulators who continually seek to influence the future of assisted living.

LeadingAge represents more than 5,000 non-profit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside their members and 38 state partners, they use applied research, advocacy, education, and community-building to make America a better place to grow old.

Advisory Group

This is a list of the members of the Coalition Advisory group. The WCCEAL Advisory group meets monthly to discuss, build and improve the WCCEAL program, project and infrastructure in order to increase quality of care for all those residing in Wisconsin ALCs.

• Rick Abrams, WiCAL
• Erin Boutan, WALA
• Pat Boyer, WiCAL
• Heather Bruemmer, BOALTC
• Kevin Coughlin, DHS
• Christopher Crnich, UW Madison
• Lisa Davidson, DSPN
• Kate Dickson, WiCAL
• Taylor Goodland, M3 Insurance
• Alfred Johnson, DHS
• Jeff Kaphengst, DSPN
• Chris Kenyon, M3 Insurance
• Kim Marheine, BOALTC
• Janice Mashak, LeadingAge Wisconsin
• Kathy Meisner, DSPN
• Susan Nordman Oliveira, UW Madison
• Daniel Perron, DQA
• Mike Pochowski, WALA
• Edmond Ramly, UW Madison
• Lori Salzwedel, DQA
• John Sauer, LeadingAge Wisconsin
• Todd Smet, DSPN
• Judith Stych, DHS
• Robin Wolzenburg, LeadingAge Wisconsin
• Otis Woods, DHS
• David Zimmerman, UW Madison Professor Emeritus

Associated Research Grants:

2014 ICTR Dissemination and Implementation Award. UW Madison - CHSRA awarded $150,000 grand to investigate falls prevention programs among WCCEAL members.

Park Family Foundation Grant. $10,000 Music & memory grant to pilot-test the Music and Memory program with iPads in ALCs.

The past 20 years have seen a dramatic shift in residential long term care, as medically frail older adults with complex health conditions who previously received care in nursing homes and hospitals are now residing in Assisted Living Communities (ALCs). In 2003, Wisconsin had 43,052 nursing home resident beds compared to 30,411 Assisted Living resident beds. By 2015, nursing home resident beds decreased by approximately 8,600 (total = 34,463 beds) versus an increase in Assisted Living resident beds of 23,972 (total=54,383 beds) (Johnson, 2016). As the number of individuals living in ALCs increases so does the need to provide, ensure, and improve quality in these communities.

Unlike nursing homes, ALCs do not have federal regulations and oversight. The Wisconsin Bureau of Assisted Living (BAL) encourages ALCs regulated by BAL to formalize an internal Quality Assurance (QA) and Quality Improvement (QI) program.

Similar to nursing home facilities, ALCs offer a range of services, from home-like settings with minimal care to multiple skilled services. The minimum age requirement for residing in an ALC is 18 years. The state of Wisconsin has 3 types of residential ALCs that are licensed by the Wisconsin Department of Health Services Department of Quality Assurance:

1. Adult Family Home (AFH): 3-4 bed residential home, where adults who are not related to the operator reside and receive care, they provide treatment or services above the level of room and board and may include up to seven hours per week of nursing care per resident.
2. Community Based Residential Facility (CBRF): 5-257 bed residential home, where five or more unrelated people live together in a community setting. CBRFs provide services to people of advanced age, persons with dementia, developmental disabilities, mental health problems, physical disabilities, traumatic brain injury, AIDS, Alcohol and Other Drug Abuse, correctional clients, pregnant women needing counseling and/or the terminally ill.
3. Residential Care Apartment Complex (RCAC): 5-109 individual apartments, where five or more adults reside in an independent apartment complex (sometimes referred to as independent living). Apartments must each have a lockable entrance and exit; a kitchen, including a stove (or microwave oven); and individual bathroom, sleeping and living areas.

For further information and consumer assistance about Assisted Living in Wisconsin please contact The State of Wisconsin Board on Aging and Long Term Care. The state of Wisconsin Department of Health Services has a great deal of information about ALCs and Finding and Choosing an Assisted Living Facility.

Background

• Wisconsin has a rich history of community based programs, including licensure of the first Community Based Residential Facility (CBRF) in 1979. As a public funding agency, the Department of Health Services (DHS) has honored consumer choice providing supports for people to live in the least restrictive, most integrated setting possible. Beginning with the enactment of the Community Option Program (COP) in 1981 and through the creation of Family Care in 1999, Wisconsin has been a national leader in relocation efforts from institutions to community settings.
• In 1980 Wisconsin ranked 2nd nationally in the number of nursing homes beds per capita with 87 nursing home beds per 1,000 residents 65 years of age and over. Thirty years later that ranking moved to 20th nationally with 46 nursing home beds per 1,000 residents 65 years of age and over, an increase of 47%. In 2008 Wisconsin Assisted Living beds surpassed nursing home beds with the gap widening each year since.
• Since 1979 Assisted Living licensed beds have increased 34 consecutive years while the regulatory agency resources has not kept up with the increasing workload.
• Wisconsin’s innovative regulatory approaches have improved overall quality in Assisted Living while also receiving national recognition.
• Wisconsin has four strong Assisted Living provider associations supporting their members to improve the care and services they provide to the residents/tenants in their communities.
• Wisconsin’s ombudsman program is a national leader with committed resources to the advocacy of residents in Assisted Living Communities (ALCs).

Interested in working in assisted living? Visit the WCCEAL Member List. You can zoom in on the map or click the table and filter by the county you live in. Call the number listed for assisted living communities near you and ask about employment opportunities.

In an effort to attract and retain assisted living caregivers, WCCEAL has launched an initiative to support WCCEAL members. The initiative includes an employment contact in the Member Listing as well as resources available to WCCEAL members.

There are a number of resources available on the DHS WisCaregiver Career overview page which includes:

• Caregiver Workforce Issues
• Workforce Solutions which include recorded webinars and handouts to help improve recruitment and retention

The password protected section of the WCCEAL website (now known as eQuality) is available only to members of WCCEAL. It consists of an annual resident satisfaction survey, an instrument to collect information about each member ALC’s quality improvement structure, processes, and outcomes, webpages for ALCs and associations to monitor their data benchmarked against other participating ALCs, and quality improvement tools and resources for ALCs and associations.

The resident satisfaction survey is administered at the ALC level once per year between January and April. ALCs and their associations can compare their performance with other providers in the state, in seven areas: staff, resident rights, environment, activities, meals and dining, health management/care, and overall ratings. The quality improvement data is collected from ALC members once per quarter providing information about the ALCs quality improvement structure, processes and outcomes.

The output of the system is a series of web-based reports on the results of the satisfaction measures, the quality improvement variables, and the ALCs’ rate of participation in the data collection. These reports permit the participating communities to review their performance and compare themselves to their counterparts in the program. More extensive information on individual ALC performance and participation is available to the Associations, since they are integral to the feedback and quality improvement functions of WCCEAL.

Below is a WCCEAL activity timeline:

Text For Susan :)-+

2017 Pioneer Institute Better Government Competition WCCEAL is a special recognition awardee in the Pioneer Institute's 26th annual Better Government Competition. This year's topic was "Aging in America."

2016 AHFSA Award WCCEAL is a 2016 winner of the Association of Health Facility Survey Agencies (AHFSA) Promising Practice Award in the Category of Quality Improvement in the Regulatory Process.

2015 Bright Ideas Award Bright Ideas is an initiative that recognizes creative and promising government programs and partnerships, through the Innovations in Government Program, a program of the Ash Center for Democratic Governance and Innovation at Harvard Kennedy School.

Project Goals

• Create a Public/Private collaboration with DHS Division of Quality Assurance and Division of Long Term Care, Wisconsin’s four provider associations that include LeadingAge Wisconsin, Wisconsin Assisted Living Association (WALA), Wisconsin Center for Assisted Living (WiCAL), and Residential Services Association of Wisconsin (RSA-WI), Wisconsin’s advocacy agency, the ombudsman program, and the University of Wisconsin-Madison’s Center for Health Systems Research & Analysis (CHSRA)
• Incentivize Assisted Living Communities to strive for excellence through internal quality improvement
• Collaborate with provider associations to develop a comprehensive QI & QA program and to help their members to be successful.
• Collaborate with the UW Madison - CHSRA to improve long-term care and health systems by creating performance measures and developing information and decision support systems.
• Provide regulatory relief for high performing Assisted Living Communities.
• Define the level of excellence that will be recognized by public funding agencies, insurance companies, Assisted Living Communities, advocates, legislators, general public and other key stakeholders.

Project Activities

• Implement the WCCEAL infrastructure using a grant secured by UW Madison - CHSRA;
• DHS approves provider association Quality Improvement and Quality Assurance programs;
• Develop a website and password-protected web-based information system for members of WCCEAL;
• Develop a standardized Resident Satisfaction Survey for WCCEAL members;
• Develop performance measures of quality improvement structures, processes, and outcomes for WCCEAL members;
• Create a firewall preventing the DHS from accessing Assisted Living Community specific WCCEAL data.; and
• Provide feedback to provider associations and Assisted Living Communities on their resident satisfaction and quality improvement performance with trend information and comparisons to peers and other cohorts.

Deliverables

• 11/30/2009 - WCCEAL established
• 09/17/2010 - DQA updated database to capture WCCEAL members
• 05/09/2011 - UW Madison - CHSRA awarded $200,000 to develop and pilot-test WCCEAL from the 2011 ICTR Community Collaboration Grant
• 04/06/2012 - All four provider Association’s QA/QI programs approved
• 06/12/2012 – Resident Satisfaction Survey finalized and approved
• 11/02/2012 - UW Madison - CHSRA launched WCCEAL Website https://wcceal.chsra.wisc.edu/
• 11/12/2012 - WCCEAL Satisfaction Survey process launched
• 02/25/2013 - WCCEAL Quality Improvement Data Submission process launched
• 06/18/2014 - UW Madison - CHSRA awarded $150,000 to investigate falls prevention programs among WCCEAL members, from the 2014 ICTR Dissemination and Implementation Award
• 01/01/2015 – WCCEAL introduced new Falls Prevention questions
• 09/15/2015 – WCCEAL Membership Rules implemented
• 10/21/2015 – DHS and UW Madison - CHSRA awarded a $1,000,000 grant to scale-up the statewide impact of WCCEAL from the 2015 Wisconsin Partnership Program Community Impact Grant
• 10/26/2015 – Music & Memory^SM awarded $10,292 to pilot-test the Music and Memory program with iPads in ALCs, from the Park Family Foundation

Dissemination

• 30+ Presentations about WCCEAL to various stakeholder groups including CMS, the Center for Excellence in Assisted Living (CEAL), Assisted Living Federation of America (ALFA), national Ombudsman group and at the different state Assisted Living conferences.
• WCCEAL benchmark data on resident satisfaction and quality improvement currently covers 24% of Wisconsin Assisted Living Communities licensed beds.

Research and Evaluation

• 7/1/2010 to Present: Wisconsin Department of Health Services (DHS) - WCCEAL Infrastructure and Research
• 09/01/2011 – University of Wisconsin Institute for Clinical and Translational Research Community Collaboration Grant
• 09/01/2014 – University of Wisconsin Institute for Clinical and Translational Research Falls Prevention grant
• 11/01/2015 – Park Family Foundation Music and Memory grant
• 03/01/2016 – Wisconsin Partnership Program Community Impact grant

Honors

• 2015 – WCCEAL recognized as a Bright Ideas through the Harvard Innovations in Government Program, a program of the Ash Center for Democratic Governance and Innovation at the Kennedy School of Government at Harvard University.