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Journal Article


What Is Nursing Home Quality and How Is It Measured?

The Issue

Numerous indicators are used to assess the quality of nursing home care, and there are many initiatives focused on quality improvement in nursing facilities. Questions remain, however, about the accuracy and effectiveness of these indicators and initiatives. Meanwhile, quality problems remain common.

What the Study Found

The authors reviewed a range of quality indicators and improvement initiatives, including those used in the Facility Quality Indicators Profile Report, the federal Nursing Home Compare Web site, the Advancing Excellence in America’s Nursing Homes campaign, and deficiency citations issued as part of the Medicare and Medicaid certification process. Their analysis shows that all employ a mixture of structural, process, and outcome measures, "each of which has noted advantages and disadvantages."

Looking ahead, the health care reform law will require nursing homes to disclose ownership and financial information, as well as quality data on a Web site. Additional steps recommended by the authors include integrating nursing homes with the larger system of long-term care, enhancing current quality improvement initiatives, and upgrading the nursing home certification process.


Improvements in nursing home quality have "likely occurred," the authors conclude, but more improvements are still needed.

Publication Details



N. G. Castle and J. C. Ferguson, "What Is Nursing Home Quality and How Is It Measured?" The Gerontologist, Aug. 2010 5(4):426–42.