The Quest for Nursing Home Quality

Abstract

Nursing homes are arguably the most criticized sector of the US health care system. In fact, the nursing home industry's entire history has been marked by cycles of public clamor for improvement and ineffective governmental responses. Over the past century, multiple attempts to improve the quality of nursing home care have had limited success. This article reviews these initiatives from the era of the poorhouse to the most recent reform law, implemented during the last decade. An analysis suggests that the historical reliance on government regulation has not ensured nursing home quality. Future efforts should address the most glaring weaknesses of nursing home regulation, including the lack of standardization of the survey and enforcement processes. In addition, new strategies are needed beyond a reformed inspection system. This article demonstrates that while the exact path to nursing home quality is somewhat uncertain, retracing history's steps will not lead nursing homes in the desired direction.

Dying in a rural residential aged care facility: An action research and reflection project to improve end‐of‐life care to residents with a non‐malignant disease

“…Rather, for Nolan et al (2008), keys to succeeding in raising the standards of care were in improving the image of aged care as a discipline, adopting a "relationship-centred approach to care" and incorporating a holistic approach to care (p. 412). Overall, the changing profile of the Australian and international aged care workforce to a predominately, less qualified staffing profile, highlights potential areas of concern regarding the quality of care being delivered to older residents in residential aged care facilities (Badger et al, 2009;Holloway & McConigley, 2009;Maas et al, 2008b;Tuckett, 2007;Winzelberg, 2003).…”

“…Achieving quality of care is dependent on numerous factors, including the commitment of the service providers; constraints to practice; the workers ability to perform within complex environments; workers functioning within their scope of practice and feedback through the use of evaluating service provision (Allen et al, 2008a;Brazil et al, 2006;Courtney, O'Reilly, Edwards & Hassall, 2007;Holloway & McConigley, 2009;Miller, Teno & Mor, 2004;Winzelberg, 2003). Shield, Wetle, Teno, Miller and Welch (2005) argued that the absence of doctors and insufficient staff numbers in American nursing homes impact on the quality of care provision for dying, nursing home residents.…”

“…The quality of care delivered in residential aged facilities is measurable and important (Achterberg 2004;Courtney, O'Reilly, Edwards & Hassall, 2007;Winzelberg, 2003). In Australia, Courtney, et al (2007) suggested that until their quality indicator tool was developed, there had been no formal systems to measure quality of clinical care in residential aged care systems.…”

“…Workplace culture is linked to numerous factors, as identified by Winzelberg (2003), who suggested that quality in United States nursing homes was difficult to achieve, due to regimented institutionalised care structures; a hierarchical nature of staffing with the resident having the lowest status; poorly paid staff; a hazardous, high injury risk work environment; high staff turnover rates; unstable organisation financial status; and for those facilities who are required to make a profit, financial pressures eroded their ability to administer a quality to the care.…”

“…Therefore, Winzelberg (2003) asserted that the negative workplace cultures prevent optimal end of life care delivery.…”