States Collaborating to Form Assisted Living Quality Standards

The assisted living industry’s role of caring for an often frail and vulnerable population—seniors—makes its commitment to quality all the more important. With some states’ regulatory resources falling behind, senior living providers in states including Wisconsin and Arizona are stepping up through collaborations that emphasize quality improvement and assurance.

Assisted living is regulated state-by-state, with most states’ regulations calling for annual inspections of licensed assisted living communities. Those inspections don’t always happen on time.

“As an industry, we support annual unannounced inspections, but we have seen a few states—including New Jersey, Texas, and New York—where they are less frequent now because of cutbacks due to the budget,” says Maribeth Bersani, senior vice president of policy at ALFA.


States, as a result, are forming partnerships and collaborations to pave their own way toward quality control.

Collaborating for Quality

Wisconsin’s Bureau of Assisted Living is gearing up to expand a comprehensive quality assurance and quality improvement program for the state’s almost 3,600 assisted living communities, called the Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL).


The public-private initiative brings four trade associations—including the Wisconsin Assisted Living Association—to the table along with consumer advocates, two divisions of the state Department of Health Services, and the University of Wisconsin’s Center for Health Systems Research & Analysis (CHSRA).

“It’s unprecedented to have the associations, advocates, regulatory agencies, and an academic institution all at the same table working toward a common goal,” says Alfred Johnson, director of BAL. “It’s truly trendsetting. I haven’t seen anything like this in assisted living.”

BAL recently redesigned its survey process as assisted living exploded in the state, introducing an abbreviated survey system for certified communities with a good compliance history.

Resourcing concerns factored into WCCEAL’s development, but there’s more to the “trailblazing” system, says Kevin Coughlin, policy initiatives advisor for DHS’s Division of Long Term Care. It could eventually be a central depository for multiple quality measures, he says.

The program seeks to incentivize quality improvement for assisted living and long-term care by measuring performance and developing support systems.

Through WCCEAL’s website, participating providers can self-report occupancy, resident and staffing data, and quality improvement structure, process, and outcomes relating to falls, infections, and hospital readmissions.

Providers can also track resident satisfaction on an individual and community level, and can compare outcomes to other communities in the state.

“We’re in the early stages, but eventually this program could be a huge benefit to regulatory agencies,” Coughlin says. “We want other states to use this program.”

Growing Participation

Before that happens, though, state program participation must grow from the pilot’s 218 communities. The growth will take a systemic approach, says Johnson, as many collaborators will need to expand internally as well.

WALA has developed its own version of WCCEAL, its “Diamond Accreditation Program.” Providers must be WALA members to join and will automatically enter the larger state initiative.

“As we grow, we know a lot of our target market will need additional support,” says Jim Murphy, executive director of WALA, which currently has 43 provider members but hopes to reach 100 by year’s end.

WALA has developed its own programs around Wisconsin-specific standards along with a peer partner program that pairs providers needing support with other local association members who can provide support.

Increasing the number of participants in quality efforts will take time, but Murphy expects results will benefit the entire assisted living industry.

“The Taj Mahal was built one brick at a time,” says Murphy. “Any voluntary agreement to raise the bar, any program that make the industry better off, is favorable to the industry as a whole.”

Efforts in Arizona

Providers in other states are pursuing similar voluntary-participation measures to improve quality.

Arizona’s state regulatory agency recognizes accreditation by CARF International (Commission on Accreditation of Rehabilitation Facilities) in place of annual surveys, unless there’s a complaint.

Most assisted living organizations pursuing accreditation are striving for quality, says Sue Matthiesen, managing director of aging services for CARF International, who adds that the system isn’t new, but is seeing growth and gaining attention as a way to target resources.

“The number one reason assisted living providers are choosing this is because it helps the field be accountable,” she says. “This is a quality improvement model that uses frameworks [for providers] to self-assess and see where they’re doing well in their care delivery, and identify where they can improve.”

While finding ways to best allocate resources is an important focus, regulatory agencies are noticing—and approving—the voluntary desire among the assisted living industry to improve.

“Looking nationally, talking to my peers, everyone’s struggling with resources,” Johnson says. “Right now, the 218 assisted living communities in the program have volunteered to work with provider associations and the CHSRA program to implement a program that’s not being directed by state law. That in itself is amazing.”

Written by Alyssa Gerace

This article is sponsored by the Assisted Living Federation of America (ALFA) as part of its efforts to advance excellence and explore topics impacting the future of senior living. For more information about ALFA, visit