September 8, 2026
20 Years of Advancing Excellence
By Joanne Kaldy
The idea that “if you build it, they will come” sounds good, but change is not that easy. The Advancing Excellence in Long-Term Care Collaborative celebrates its 20th anniversary this year, but it didn’t reach this milestone without the commitment of many people and the ability to overcome barriers, set and reach common goals, and have the capacity to evolve.
Advancing Excellence began in 2006 as the National Nursing Home Quality Improvement Campaign, a collaboration of 30-plus organizations representing providers, professional organizations, government agencies, professional groups and associations, consumers, and others. The group’s mission was—and still is—making nursing homes better places to live, work, and visit. Its vision: Every nursing home resident in America experiences person-centered quality of life as a result of a stable and empowered workforce, dedicated to improving clinical and organizational outcomes, and engaging in open communication and transparency.
By bringing together leaders in the field and organizations including PALTmed and other professional societies, government agencies, academic institutions, providers, and more, Advancing Excellence created a strong, cohesive voice and used it to promote positive change and innovations. Victoria Walker, MD, FAAFP, CMD, current chair of the collaborative, says, “We were at the root of quality improvement work within nursing homes, and that was significant.” The collaborative helped identify appropriate, realistic quality improvement goals and the tools to track them, which was the basis for what eventually became the Quality Assurance and Performance Improvement (QAPI) regulations.
Once the QAPI regulations were released, there was much uncertainty and confusion about how to implement them, and Advancing Excellence provided some much-needed guidance on how to integrate QAPI into workflows and hold team meetings with a focus on quality improvement. “We started thinking through all the elements, clarifying them and bringing key elements to the surface,” says Christopher Laxton, CAE, retired former executive director of PALTmed, now an independent consultant in aging.
Ironing Out Pressing Issues
Over the past two decades, Advancing Excellence has brought both attention and action to the most pressing issues facing nursing homes, everything from antipsychotic use, falls, and restraint elimination to vaccinations and polypharmacy. The collective has not only worked on these issues but kept its finger on the pulse of change. “I think we can say that there’s been substantial improvements in nursing home quality, even though there continue to be challenges,” Mr. Laxton says. He noted that Advancing Excellence demonstrated the effectiveness of quality improvement processes—setting clear goals, understanding root causes, creating and following a plan, measuring outcomes, and repeating until the desired outcomes are achieved—in thousands of real-world nursing homes across the United States.
The Advancing Excellence Collaborative’s broad stakeholder group was a valuable resource during the COVID pandemic. Mr. Laxton recalls, “There was such an information vacuum at the start. Nobody knew anything about this virus. We didn’t know how to treat it. There were no therapeutics, and the vaccine hadn’t yet been created. The opportunity to meet frequently, share ideas, and learn from each other was crucial. Because we had broad representation, other groups, including Operation Warp Speed, found it valuable to ask questions and share information.” He adds, “The information we were sharing with each other during COVID was critically important because not everybody had the same access to information that was coming out.” Practitioners and care teams were able to use this at the bedside to care for patients, and policymakers and agencies were able to incorporate stakeholder feedback into their planning.
The Keys to Momentum
The Advancing Excellence structure, membership, and leadership have evolved, but the strong and consistent mission is embraced by everyone, which has enabled the collaborative to build and maintain momentum over the years. Mr. Laxton says, “Having a clearly articulated set of core values is key. This is not to say that we haven’t changed; we have evolved and yet continue to stay together. Any long-term care coalition such as ours needs to be willing and able to flex and adapt as issues and situations change.”
Chad Worz, PharmD, BCGP, FASCP, chief executive of the American Society of Consultant Pharmacists, says, “I think one key to Advancing Excellence’s sustained success is they have developed quite a megaphone.” For instance, he explains, the collaborative’s quarterly Spotlight Series calls attract 750 to 1,000 participants. By being responsive to members and participants, the collaborative highlights issues of interest that are not being addressed by others. He says, “We are able to reach quite a few people from all different walks of life and professional backgrounds. Those people, in turn, can implement what they learn and have an impact in their settings and implement changes on a widespread basis.”
Credibility Counts
When Advancing Excellence speaks, it is highly respected because it is not driven by special interests and profit; people listen, and that has an impact. For instance, the collaborative expressed support for PALTmed’s recommendation that the Centers for Medicare & Medicaid Services (CMS) begin keeping a medical directory registry, featuring the names of the nation’s 15,000 designated nursing home medical directors and associate medical directors. Mr. Laxton says, “It was very helpful to have the support of a broad coalition such as Advancing Excellence.” When PALTmed’s House of Delegates discussed the registry proposal, he recalls, recognition of the coalition’s support made it clear that this was an issue that went beyond the interest of PALTmed and its membership.
Personally, Professionally Powerful
The list of Advancing Excellence’s initiatives and activities is long. In addition to sharing information and resources and creating relationships to support high-quality care, the collaborative supports and disseminates member research and education, comments on new rules and requirements, educates providers regarding best practices and latest regulatory updates, and engages lawmakers and other decision-makers on policies of interest to this care setting. Advancing Excellence has created statements and white papers on topics such as value-based care and the American Health Care Act.
These efforts require time and energy on the part of the board and members, who agree that their efforts are well worthwhile. “We are here to make a positive difference in the lives of a very vulnerable population. Being involved with Advancing Excellence and its members reminds me why I chose to do the work I do, even in retirement,” says Mr. Laxton. “It has helped me grow as a person and a professional. It's always gratifying to be around smart, compassionate people who share a commitment to helping older adults in post-acute and long-term care.”
The ‘collaborative’ in the Advancing Excellence name is a key differentiator. Dr. Walker explains, “It is easy to become surrounded by like-minded people who can become an echo chamber. In Advancing Excellence, we try to break that cycle by actively seeking out stakeholders to share their different experiences, priorities, and ideas and use that broader understanding to work together to achieve our common goals.”
What’s Next?
“We are moving forward with a renewed focus on quality as defined by those of us who are passionate about improving care in this setting and not just by compliance,” says Dr. Walker. She adds, “We feel the heart of QAPI has been lost a bit in a focus on compliance. We want to get back to focusing on making nursing homes better places to live, work, and visit in ways that are practical, measurable, and inspiring.”
Learn more about the collaborative here.
Joanne Kaldy is a freelance writer living in New Orleans, LA.