A qualitative case study design employing focus groups was used to evaluate certified nursing assistant (CNA) (n = 26) and resident (n = 30) perceptions of the Virginia Gold Quality Improvement Program, a Medicaid funded 2-year quality improvement intervention piloted in five nursing facilities. As part of the program, the nursing facilities implemented quality improvement projects to develop supportive work environments in an effort to reduce CNA turnover and improve quality of care. Overall, the focus group participants viewed Virginia Gold positively and reported that CNA turnover decreased, while care quality improved during the program. These findings are supported by a previous Virginia Gold evaluation as well as by the results from a quantitative analysis of nursing facility CNA turnover and quality of care data and interviews with selected nursing facility management staff (n = 7) 1-year following the program’s culmination. A key finding from the management interviews is that the quality improvement projects became self-sustaining over time allowing all five nursing facilities to continue the projects without state funding.


Medicaid, Nursing Facility, Work Environment, Quality Improvement, Certified Nursing Assistants, Program Evaluation, Qualitative Case Study Design, Focus Groups


The findings and conclusions in this study represent only the authors’ opinions and do not necessarily represent the views of the Virginia Department of Medical Assistance Services (DMAS). While staff members at DMAS reviewed the report, their review in no way represents an endorsement of the content, analysis, or findings of the study.

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