The often-poor quality of nursing homes has been a consistent issue of concern for consumers, government, and researchers. Enduring issues surrounding nursing homes have been quality related. In the United States, approximately 1.6 million elderly and disabled persons receive care in 1 of the 17,000 nursing homes ( National Nursing Home Survey, 2004). However, nursing homes are still an essential component of the current long-term care system. This includes care by home health providers, adult day care, residential care, and assisted living (to name just four).
In recent years, the long-term care sector has changed considerably and is arguably evolving into a “system” in which care can be provided in settings that are more appropriate for consumers’ needs. If elders needed long-term care, it would invariably be provided in a nursing home. In the past, nursing home care and long-term care were synonymous. Implications: We conclude that improvements in nursing home quality have likely occurred, but improvements are still needed. Areas for future research are identified throughout the review. We speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes, including report cards, pay for performance, market-based incentives, and policy developments in the certification process. Results: Current quality indicators are presented as a mix of structural, process, and outcome measures, each of which has noted advantages and disadvantages. Current quality indicators and quality initiatives are discussed, including those included in the Facility Quality Indicator Profile Report, Nursing Home Compare, deficiency citations included as part of Medicare/Medicaid certification, and the Advancing Excellence Campaign. Donabedian's structure, process, and outcome (SPO) model is used to frame the discussion. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality.
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