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Improving Quality in Long-Term Care

The Issue

The quality of long-term care is an area of interest and concern for many stakeholders, including providers, policymakers, and consumers. Long-term care not only serves a vulnerable population, it also represents a tremendous public investment of more than $100 billion dollars. Ensuring quality is challenging—oversight can be difficult, much data goes unreported or tracked, care is often provided by minimally trained paraprofessionals, and clients may be fearful of retaliation if they complain. This study, published in a special supplement to Medical Care Research and Review, examines two approaches to achieving higher quality in long-term care: the regulatory process and culture change.

What the Study Found

The nursing home regulatory process was designed to hold providers accountable for meeting certain performance standards, backed up by an enforcement mechanism and sanctions. There is, however, much dissatisfaction with the system. The author Mary Jane Koren, of The Commonwealth Fund, recommends strengthening and improving the process by broadening the diversity of survey teams to include social workers, pharmacists, and clinical psychologists, among others and by offering surveyors training opportunities in the latest developments in the field. In addition, the author recommends that surveyors work with staff at Quality Improvement Organizations, who can act as “change agents” and help facilities address systemic quality problems. Another means to improving quality of care is the Advancing Excellence (AE) in America’s Nursing Homes, a national coalition of stakeholders working with the Center for Medicare and Medicaid Services. The AE campaign has helped nursing home member organizations to improve care and track successes. Finally, Dr. Koren suggests that the culture change movement, which seeks complete transformation of LTC facilities into person-centered homes, can be the final piece in the drive to improve nursing home quality.


Improving the quality of our nation’s long-term care facilities must involve the government’s survey, regulation, and enforcement system, as well as voluntary efforts—such as quality campaigns and the culture change movement.

Publication Details



M. J. Koren, "Improving Quality in Long-Term Care," Medical Care Research and Review, Aug. 2010 67(4 Suppl.): 141S–150S.