While the Centers for Medicare and Medicaid Services’ (CMS) bid to make resident satisfaction a mandatory part of federal regulation was shelved, a pilot program across skilled nursing facilities is demonstrating the power of resident councils to improve both care quality and the nursing home industry’s tarnished reputation.

An 18-month resident council pilot program in Connecticut involving 31 nursing homes highlighted the need for effective training, consistent follow-up and collaboration between residents and administrators.

The program shows that when resident councils aren’t viewed solely as a resident rights mechanism, or a box for administrators to check off, these groups are linked to better outcomes and a healthier culture within the nursing home, as well as better resident quality of life and quality care.

Following its success, there are now plans to scale the initiative beyond the state’s ombudsman program and toward an executive board made up of resident council presidents, according to the Moving Forward Coalition, which hosted a webinar on strengthening resident councils on Tuesday.

Such councils can be powerful change agents for advocacy too, participants in the pilot program shared. When residents are safe to speak and their voices are heard by the right people, policy can be influenced at the state or national level, they noted.

The 31-home pilot focused on establishing strong foundations for resident councils, recognizing that each council has different sizes, demographics and needs. Leaders, ombudsman staff and residents received training and ongoing support to help councils hold regular meetings, address challenges and strengthen membership. Moving Forward partnered with the Connecticut Long-Term Care Ombudsman Program to test and refine a 50-page resident council guide. The guide is designed to fast-track resident input to the core of nursing home decision-making.

“We wanted to help [residents] tie what are regular issues that people run into to the guide,” said Connecticut Community Ombudsman Program Manager Daniel Beem. “[We wanted to show residents] how do we kind of leverage that information and implement it in a meaningful way.”

A similar program was implemented in New Jersey prior to this latest initiative, Connecticut State Long Term Care Ombudsman Mairead Painter said during the webinar. Moving Forward is in the process of evaluating the impact of the pilot through interviews, led by LeadingAge LTSS Center at UMass Boston. So far, anecdotal experiences of the councils highlight stronger communication between all parties and a stronger sense of community among residents.

Councils foster quality care

Resident councils are connected to quality care, Painter said, when considering patient autonomy – residents knowing they have a say in how their day goes, and that they can reach out to their ombudsman to support them and keep everyone accountable.

“Quality can mean different things to different people, but as a base, do the residents feel like they’re being listened to … how does their day feel to them? That’s how they can connect their rights to that quality,” said Painter. “It’s about the way a home feels and the individuals who are working there and serving the population of people who live there.”

While resident councils are a guaranteed right and protected under federal regulations, Moving Forward and the state ombudsman program decided to launch the pilot program because they weren’t seeing meaningful change or support from nursing home staff.

“I’m not sure that administrative teams or recreation directors, who are often the people supporting the resident council, have a lot of education behind the meaning of it and the importance of it, and so it becomes just a box to check, and the residents feel that,” said Painter.

Ombudsman staff went into nursing homes as educators and coaches as part of the pilot program, training building leaders and residents on structuring the meetings and creating goals.

“We thought it was going to be about us collaborating with resident councils, and we had coaches put in place,” said Painter. “It wasn’t just that, we were collaborating with administrative teams as well, because they wanted it to go well.”

Closely related to resident councils is a focus on measuring patient satisfaction, something that has been considered at the federal level. The Centers for Medicare and Medicaid Services (CMS) has toyed with adding resident satisfaction as a quality measure in the SNF Quality Reporting Program (SNF QRP), which is included in the annual prospective payment rule.

The agency ended up nixing the measure in its final rule for 2024, lacking support during the final rule’s comment period the year before. Stakeholders said the measure would create burdensome regulations and tack on extra funding and time for operators.

Councils as advocacy tool

Such councils have potential beyond patient satisfaction, resident rights and clinical outcomes, Painter said. Councils would be well suited to connect with legislators, policymakers and community organizations, becoming vehicles for broader systems change.

“A group makes a louder noise than a single person. When you’ve got multiple people that are experiencing the same thing, and you can document that, you’ve got a way to make sure you have a follow-through of a response, and change can come through that,” said Jeanette Sullivan-Martinez, resident council member.

Resident councils in the state have already been doing just that, and policymakers have attended resident council meetings, citing them as sources of inspiration for policy.

Moving Forward plans to use lessons learned from the Connecticut pilot program to strengthen resident councils nationally while keeping the work resident-led and grounded in lived experience.

“One of the things that I learned is that Connecticut is special because of our size,” said Painter. “We have a lot of relationships between resident councils, the coaches, the administrative teams … how do we capture that and help to spread it to other states, other regions?”

Tech implementation is a good start, Painter said, making virtual meetings easy to launch and participate in – it was a way to get everyone involved, thanks to tech-savvy ombudsmen.