For nursing home residents, quality of life is largely determined by the quality of the care they receive. Unfortunately, that quality is all too often inadequate. Current regulatory systems have failed in their efforts to assure high-quality care. Policy could vitally improve institutional quality of care in three ways: (1) increase efforts to derive a valid and reliable quality of care index that incorporates resident outcomes; (2) change the emphasis of resident care inspections; and (3) expand outside involvement. These elements are all essential and interdependent. They offer a myriad of creative opportunities for researchers, practitioners, and volunteers to make major contributions toward improving the quality of care, and, ultimately of life, for nursing home patients.
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References
1.
AbrahamsJ. P.WallachH. F.DivensS. (1979). Behavioral improvement in long-term geriatric patients during an age-integrated psychosocial rehabilitation program. Journal of the American Geriatrics Society, 27, 218–221.
2.
BarneyJ. L. (1974). Community presence as a key to quality of life in nursing homes. American Journal of Public Health, 64, 265–268.
3.
BarneyJ. L. (1977). The prerogative of choice in long-term care. Gerontologist, 37, 309–314.
4.
BarneyJ. L. (1987). Community presence in nursing homes. Gerontologist, 27, 367–369.
5.
BarryJ. T.MillerD. B. (1980). The nursing home visitor: Who, when, where, and for how long?Long Term Care and Health Services Administration Quarterly, 4, 261–274.
6.
ButlerP. (1979). Assuring the quality of care and life in nursing homes: The dilemma of enforcement. North Carolina Law Review, 57, 1317–1382.
7.
ChekrynJ.RoosL. L. (1979). Auditing the process of care in a new geriatric unit. Journal of the American Geriatrics Society, 27, 107–111.
8.
ClarkeT. R. (1980). Communicating with residents and their families. In Proceedings of the Fifth North American Symposium on Long-Term Care Administration. Washington, DC: American College of Nursing Home Administrators.
9.
ConnellyK.CohenP. K.WalshD. C. (1977). Periodic medical review: Assessing the quality and appropriateness of care in skilled nursing facilities. New England Journal of Medicine, 296, 878–880.
10.
CroseR.DuffyM.WarrenJ.FranklinB. (1987). Project OASIS: Volunteer mental health paraprofessionals serving nursing home residents. Gerontologist, 27, 359–362.
11.
DayP.KleinR. (1987). The regulation of nursing homes: A comparative perspective. Milbank Memorial Fund Quarterly, 65, 303–347.
12.
DiamondT. (1986). Social policy and everyday life in nursing homes: A critical ethnography. Social Science and Medicine, 23, 1287–1295.
13.
DonabedianA. (1980). The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
14.
DotyP.LiuK.WienerJ. (1985). An overview of long-term care. Health Care Financing Review, 6, 69–78.
15.
DreyerP. (1985). Nursing homes. In ArnheimL.WebbL., (Eds.), A health care agenda for the states. Washington, DC: Conference on Alternative State and Local Policies.
16.
DurmanE. C.DunlopB. D.RogersC.BurtG. (1979). Volunteers in social services: Consumer assessment of nursing homes. Washington, D.C.: Urban Institute.
17.
EustisN. N.PattenS. K. (1984). The effectiveness of long-term care. In MangenD. J.PetersonW. A., (Eds.), Research instruments in social gerontology: Health, program evaluation and demography. Minneapolis: University of Minnesota Press.
18.
GottesmanL. E. (1974). Nursing home performance as related to resident traits, ownership, size, and source of payment. American Journal of Public Health, 64, 269–276.
19.
GottesmanL. E.BourestomN. C. (1974). Why nursing homes do what they do. Gerontologist, 14, 501–506.
20.
GreenwaldS. R.LinnM. W. (1971). The intercorrelation of data on nursing homes. Gerontologist, 11, 337–340.
21.
GubriumJ. F. (1975). Living and dying at Murray Manor. New York: St. Martin's.
22.
HarelZ. (1981). Quality of care, congruence and well-being among institutionalized aged. Gerontologist, 21, 523–531.
23.
Health Care Financing Administration, Division of National Cost Estimates. (1987). National health expenditures 1986–2000Health Care Financing Review, 8, 1–36.
24.
HudsonR. B. (1987). Tomorrow's able elders: Implications for the state. Gerontologist, 27, 405–409.
25.
Institute of Medicine, Committee on Nursing Home Regulation. (1986). Improving the quality of care in nursing homes. Washington, DC: National Academy Press.
26.
JarboeG. R.McDanielC. D. (1985). Influence patterns and determinant attributes in nursing home choice situations. Journal of Health Care Marketing, 5, 19–30.
27.
KaneR. L. (1986). Outcome-based payment: A new beginning?Health Progress, pp. 36–70.
28.
KaneR. L.BellR.RieglerS.WilsonA.KeelerD. (1983). Predicting the outcomes of nursing home patients. Gerontologist, 23, 200–206.
29.
KosbergJ. I. (1974). Making institutions accountable: Research and policy issues. Gerontologist, 14, 510–516.
30.
KosbergJ. I.TobinS. S. (1972). Variability among nursing homes. Gerontologist, 12, 214–219.
31.
KurowskiB. D.ShaughnessyP. W. (1985). The measurement and assurance of quality. In VogelR. J.PalmerH. C., (Eds.), Long-term care. Washington, DC: Health Care Financing Administration.
32.
LeveyS.RuchlinH. S.StotskyB. A.KinlochD. R.OppenheimW. (1973). An appraisal of nursing home care. Journal of Gerontology, 28, 222–228.
33.
LinnM. W.GurelL.LinnB. S. (1977). Patient outcome as a measure of quality of nursing home care. American Journal of Public Health, 67, 337–344.
34.
ManardB. B.WoehleR. E.HeilmanJ. M. (1977). Better homes for the old. Lexington, MA: Heath.
35.
NettingF. E.HindsH. N. (1984). Volunteer advocates in long-term care: Local implementation of a federal mandate. Gerontologist, 24, 13–15.
36.
NettingF. E.ThibaultJ. M. (1986). Using volunteers with the elderly in health care settings. Journal of Applied Gerontology, 5, 139–152.
37.
RubinA.ShuttlesworthG. E. (1983). Engaging families as support resources in nursing home care: Ambiguity in the subdivision of tasks. Gerontologist, 23, 632–636.
38.
SchlenkerH. E.ShaughnessyP. W. (1984). Case mix, quality, and cost relationships in Colorado nursing homes. Health Care Financing Review, 6, 61–71.
39.
SteinS.LinnM. W.SteinE. M. (1986). Patients' perceptions of nursing home stress related to quality of care. Gerontologist, 26, 424–430.
40.
StevensJ. E. (1983). Quality assurance in long term care. Quality Review Bulletin, 9, 229–230.
41.
ThorburnP.MeinersM. R. (1986). Nursing home patient outcomes: The results of an incentive reimbursement experiment. (DHHS Publication No. PHS 86–3400). Rockville, MD: U.S. Department of Health and Human Services.
42.
UllmanS. G. (1984). Cost analysis and facility reimbursement in the long-term care industry. Health Services Research, 19, 83–102.
43.
UllmanS. G. (1986). Chain ownership and long-term health care facility performance. Journal of Applied Gerontology, 5, 51–63.
44.
UllmanS. G. (1987). Ownership, regulation, quality assessment, and performance in the long-term health care industry. Gerontologist, 27, 233–239.
45.
U.S. General Accounting Office. (1987). Medicare and Medicaid: Stronger enforcement of nursing home requirements needed. Washington, DC: Author.
46.
VladeckB. C. (1980). Unloving care. New York: Basic Books.
47.
WeissertW. G.ScanlonW. J.WanT.T.H.SkinnerD. E. (1983). Care for the chronically ill: Nursing home incentive payment experiment. Health Care Financing Review, 5, 41–49.
48.
WellsL.MacdonaldG. (1981). Interpersonal networks and post-relocation adjustment of the institutionalized elderly. Gerontologist, 21, 177–183.
49.
WillemainT. R. (1983). Survey-based indices for nursing home quality incentive reimbursement. Health Care Financing Review, 4, 83–90.
50.
WilliamsC. (1986). Improving care in nursing homes using community advocacy. Social Science and Medicine, 23, 1297–1303.
51.
ZischkaP. C.JonesI. (1984). Volunteer community representatives as ombudsmen for the elderly in long-term care facilities. Gerontologist, 24, 9–12.
