Built to Last

WiLQAL Brings Tailored Quality Improvement Support to Wisconsin Assisted Living Facilities

Wisconsin is home to more than 4,000 assisted living communities (ALCs). These organizations provide care to adults with increased daily needs who do not require nursing home-level skilled nursing care. Despite serving a growing population with increasingly complex needs, many ALCs lack access to quality improvement support and resources.  

That gap inspired the Wisconsin Initiative for Long-term Care Quality Advancement and Leadership (WiLQAL), a pilot program led by MetaStar in partnership with the University of Wisconsin-Madison and trade organizations across the state. Through evidence-based practices, hands-on support, and sustainable improvement strategies tailored to each facility’s needs, WiLQAL helps ALCs strengthen quality of care at no cost to participating communities. 

The Why of WiLQAL 

“The clinical level of care needed by the individuals living in these communities continues to grow,” said Emily Nelson, Vice President of Healthcare Transformation at MetaStar. When designing this pilot program, MetaStar, along with partner organizations, researched meaningful and helpful clinical programs and outcomes that could meet ALCs where they are, rather than expecting them to adapt to systems built for different organizations. 

While MetaStar is leading and funding the program, they brought the expertise and experience of partner organizations into the conversation, including Leading Age Wisconsin, the Wisconsin Center for Assisted Living (WiCAL), the Wisconsin Assisted Living Association (WALA), the Disability Service Provider Network (DSPN), the Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) at the University of Wisconsin, and the Wisconsin Department of Health Services (WI DHS). Using a human-centered design process, WiLQAL was intentional not to duplicate existing services. “There’s great work already happening across the state,” Nelson said, citing the Clinical Resource Center as one example. “The goal was not to replace existing resources but to build a coordinated support system that reflects the realities of assisted living across Wisconsin.”

Working with their cohorts, WiLQAL created a list of facilities to reach out to regarding the pilot program. “We opened it up to anybody who wanted a little more hands-on assistance,” said Penny Clary, Long-Term Care Project Specialist on MetaStar’s Healthcare Transformation team. Forty organizations throughout Wisconsin are participating in the pilot program, including small organizations that are just starting out and assisted living communities that are attached to skilled nursing facilities (SNFs) in a continuum of care setting. That range allows WiLQAL to test how tailored quality improvement strategies can work across different organizational sizes, structures, and resident populations. 

LOCK-ing In Meaningful Changes 

An ALC’s work with WiLQAL begins with an on-site assessment. “This allows us to see where people are in their journey,” explained Clary. “The assistance from WiLQAL is an enhancement that builds on each ALC’s existing strengths, workflows, and goals.” 

After the assessment, the ALC’s leadership will select two clinical measurement outcomes to help assess the ALC’s work with WiLQAL. These outcomes will also help WiLQAL evaluate the pilot program. “We’ll help them wherever they’re struggling or wherever they feel they need a little support,” said Clary. Allowing communities to prioritize the outcomes most meaningful to them helps ensure that improvement work remains relevant, practical, and sustainable.  

After an ALC has chosen their two clinical outcome measures, they are presented with Change Packages. Change Packages are “structured, topic-specific guides that help teams implement improvement,” according to program documentation. Topics include behavioral health, infection control and prevention, activities of daily living (ADLs) and personal care, adverse event management, culture of excellence, chronic condition management, quality and infrastructure, and care coordination. “We included important topics that we felt other data reporting didn’t capture,” said Clary. 

Within each Change Package, teams use the LOCK model to “help implement improvements in resident care and quality of life.” Nelson notes that they want consistency in how WiLQAL and the ALCs do the work. “Since this is a pilot program, we need to study its effectiveness,” she explained.  

L: Look for the Bright Spots

Rather than beginning with deficits or failures, WiLQAL is “changing that and starting with what is going well,” Nelson said. Recognizing existing strengths helps teams build practical solutions and celebrates the difficult work staff do every day. 

O: Observing

Observation is a key part of the WiLQAL process. WiLQAL spends time on site speaking with staff and residents to better understand each community’s unique challenges, workflows, and strengths. “That’s the secret sauce to WiLQAL,” Nelson said. “We’re talking with staff and residents, not just leadership.” Those observations help WiLQAL tailor improvement strategies to the day-to-day realities of each ALC. 

C: Collaborating In Huddles

“It’s important in this work that we include the perspectives of all levels of staff,” said Nelson. In a previous job as a certified nursing assistant (CNA), Nelson acknowledges the level of insight caregiving staff can provide. “Over time, my relationships with the people I took care of became more like partnerships,” she said. “I learned so much, both about them and from them. That knowledge is critical from quality, operational, and infrastructural perspectives.” Including frontline perspectives also helps create changes that staff are more likely to support and sustain over time. 

K: Keeping It Simple

There is often little time for most ALCs to introduce and sustain large improvement efforts. “We’re keeping learning and interventions bite-sized, rather than trying to overhaul entire systems,” explained Nelson. Small changes are usually easier to make and can lead to big wins. 

No matter the projects and improvements, WiLQAL will stay with the ALC until “the changes are embedded in the fabric of the organization and can sustain themselves,” said Nelson. This tailored, hands-on approach is what sets WiLQAL apart. Rather than delivering one-size-fits-all recommendations, the team works alongside communities to build changes that can realistically last. “Wherever an organization is, we’ll collectively do our best to improve the care that people receive,” said Clary.  

What WiLQAL Success Looks Like 

The WiLQAL pilot program concludes in March 2027. After it ends, WiLQAL will evaluate both clinical outcomes and participant experiences to determine what worked and where the program can potentially grow. The clinical measures will be used to help assess outcomes alongside surveys, questionnaires, and focus groups. Through a partnership with WCCEAL and its leader, Dr. Susan Nordman Oliviera, participants also receive access to the WCCEAL database, helping reduce duplicative data entry. 

For WiLQAL, success is not just about improving metrics. The long-term goal is to help ALCs build sustainable systems and strengthen staff engagement. Additionally, WiLQAL aims to create meaningful improvements that continue long after the program ends. 

“These organizations will be shaping the potential future of what WiLQAL will look like,” Clary said. “We’re here to work together to help define what quality looks like for you.” 

Starring… 

Emily Nelson is the Vice President of Healthcare Transformation at MetaStar. She just celebrated her eleventh anniversary with the organization. Starting at age 14, Emily has worked in long-term care (LTC). She started in the dietary department, became a CNA, then transitioned to a state surveyor. Now at MetaStar, she’s proud to be an active part of enhancing long-term care in Wisconsin. Long-term care has taught her what truly caring healthcare looks like, and she intends to continue supporting meaningful change in LTC.   

Penny Clary has been with MetaStar for just over three years. She works as a Long-Term Care Project Specialist within the Healthcare Transformation department. 

Kate Schultz has been a freelance writer for MetaStar for just over two years, though writing has featured prominently in her previous careers, both as a high school English teacher and a medical software tester. As a person with a degenerative medical condition, it’s essential to her future well-being that ALFs are supported by innovative and collaborative quality improvement groups like WiLQAL.