Negotiated risk Sixteen states have adopted or proposed a negotiated risk process to involve residents in care planning and to respect resident preferences which may pose risk to the resident or other residents. The purpose of this process is to define the services that will be provided to the resident with consideration for preferences of the resident as to how services are to be delivered. The agreement lists needs and preferences for a range of services and specific areas of activity under each service. Several states have developed additional staffing, disclosure and training requirements for facilities serving residents with Alzheimer's disease. Case managers in Medicaid home and community based services waiver programs also monitor quality for Medicaid beneficiaries.
New approaches are likely to emerge to promote quality.
Our survey identified 17 states that were interested in developing outcome measures for assisted living. Although the interest is high, much work needs to be done. Developing outcome measures requires collection of data and devising measurable indicators for people with chronic conditions. Two states, Maine and Vermont, will collect data from which such measures might be developed. Officials in Washington developed a review guide for inspectors that is intended to monitor quality of care and how the philosophy of assisted living is being implemented.