Quality of care in nursing homes for older people: Providers' perspectives and priorities

Abstract

The long-term care of older people is increasingly characterised by a mixed economy model and independent nursing homes have become an important contributor to this form of provision. Concerns about the quality of care in this sector have, however, focused attention on a number of policy issues. There are proposals to revise existing legislation, modify inspection processes, introduce national standards and consider alternative models of funding. Within this changing policy context, little is known about the challenges facing homes in providing quality care. This paper draws on the findings of a Delphi survey of 196 clinical nurse managers in the Anglia and Oxford region of the NHS Executive. The aim of the study was to identify and prioritise the challenges facing nurse managers in the delivery of quality care. A wide range of clinical nursing issues and 'indirect' nursing issues was identified. The findings highlight the demands of increasingly dependent residents of advanced age, including their needs for physical and psychosocial care. Funding constraints, recruitment and retention of staff, and education and training were priority issues believed by nurse managers to influence the quality of care they could deliver. The implications of these findings for policy and practice are considered.