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The Gerontologist 43:19-27 (2003)
© 2003 The Gerontological Society of America

An Assessment of Strategies for Improving Quality of Care in Nursing Homes

Joshua M. Wiener, PhD2,

Correspondence: Address correspondence to Joshua M. Wiener, PhD, The Urban Institute, 2100 M Street, NW, Washington, DC 20037. E-mail: jwiener{at}

Purpose: Despite substantial regulatory oversight, quality of care in nursing homes remains problematic. This article assesses strategies for improving quality of care in these facilities. Design and Methods: This article reviews the research literature on eight strategies: strengthening the regulatory process, improving information systems for quality monitoring, strengthening the caregiving workforce, providing consumers with more information, strengthening consumer advocacy, increasing Medicare and Medicaid reimbursement, developing and implementing practice guidelines, and changing the culture of nursing facilities. Results: Although individual approaches vary, several themes emerge. First, several strategies require substantially more resources and will increase costs. Second, the research literature does not provide much guidance as to the effectiveness of these options. Third, several strategies assume a degree of data sophistication on the part of nursing homes that may not exist. Fourth, regulation is likely to continue to be the main strategy of quality assurance. Finally, the political saliency of nursing home quality issues is uneven. Implications: Quality of care in nursing homes is a major issue for which there is no simple solution.

Key Words: Long-term care • Nursing facilities • Regulation • Quality indicators

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Copyright © 2003 by The Gerontological Society of America.