As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.

Contents

• Committee on Nursing Home Regulation
• Preface
• Acknowledgments
• 1. Introduction and Summary
  • Purpose of the Study
  • The Public Policy Context of the Study
  • Perspective On the Issues
  • Conclusions
  • Summary of Recommendations
• 2. Concepts of Quality, Quality Assessment, and Quality Assurance
  • Quality of Care in Nursing Homes
  • Quality of Life
  • Quality Assessment Criteria
  • Assessing Quality of Care
  • Perspective on Quality Assurance
  • Interpreting and Using Information for Quality Assurance
  • Quality Assurance and the Regulatory System
• 3. Regulatory Criteria
  • The Issues
  • Consolidating the Two Sets of Criteria
  • Resident Assessment
  • Revising and Strengthening the Conditions and Standards
  • Note On Staffing Standards
• 4. Monitoring Nursing Home Performance
  • The Issues
  • Problems with the Survey Process
  • Redesigning the Survey Process
  • PaCS: an New HCFA Survey Protocol
  • Increasing State Regulatory Capacity
  • Organizational Changes
• 5. Enforcing Compliance with Federal Standards
  • The Issues
  • Enforcement Attitudes
  • Federal Rules and Procedures
  • State Rules and Procedures
  • Enforcement Resources
• 6. Other Factors Affecting Quality of Care and Quality of Life in Nursing Homes
  • Involvement of Consumers and Consumer Advocates
  • Community Involvement
  • Management and Staff Motivation
• 7. Issues Requiring Further Study
  • Information Systems
  • Medicaid Payment Policies
  • Demand for and Supply of Nursing Home Beds
  • Staffing of Nursing Homes
  • Single- Versus Multiple-Occupancy Rooms
• 8. Actions Required and Cost Implications of the Recommendations
  • Legislative Actions Required
  • Revision and Addition of Survey and Certification Regulations
  • Design and Testing Activities
  • Cost Implications of the Recommendations
• Notes
• Appendix A History of Federal Nursing Home Regulation
• Appendix B Existing Snf Conditions of Participation and Icf Standards
• Appendix C Report of Survey of State Health Facility Licensure and Certification Agencies
• Appendix D Selected Data on Nursing Homes and Residents
• Appendix E Key Indicators of Quality of Care
• Glossary
• Acronyms and Initialisms

This volume is the final report of a study conducted under Contract No. 500-83-0054 with the Health Care Financing Administration.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government, and its own initiative in identifying issues of medical care, research, and education.