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Understanding Quality of Care in Nursing Homes and Other Residential Settings

Since the evolution of nursing homes from 19th century almshouses to more medicalized environments in the 20th century, enhancing quality of care in nursing homes has remained paramount for gerontologists. The acknowledgment of quality of care deficiencies and the need for sweeping reform culminated in the 1987 Omnibus Budget Reconciliation Act which implemented a number of regulatory constraints on the nursing home industry, but concerns about the quality of care in nursing homes and other residential settings continue to persist. Advocates, researchers, policymakers, families, and residents themselves have collaborated to develop a number of striking innovations in how residential long-term care is delivered, marketed, and even “rebalanced” toward community-based service options. However, sufficient quality of care (or, processes of care as well as outcomes that may indicate fulfillment of or gaps in care) is less than universal in nursing homes and other residential settings. This particular issue of the Journal of Applied Gerontology describes, in compelling fashion, this ongoing quality care “chasm” in various residential settings. In the first article, Castle and colleagues surveyed more than 4,000 nurse aides in a representative sample of 767 nursing homes. Somewhat alarmingly, one in five nurse aides reported complying with hand washing regulations “all of the time” when caring for residents, and only four in 10 facilities appeared to ensure that such hand washing was performed. Castle, Handler, and Wagner (2016) identify a critical gap in quality of care in nursing homes, as it appears that the facilitation of necessary hand washing is an area ripe for future intervention development. Felix, Bradway, Ali, and Li (2016) offer an innovative article on barriers to admission for morbidly obese older adults following discharge from the hospital. More than 900 nursing directors in nursing homes in Arkansas and Pennsylvania were surveyed to ascertain predictors of admission for morbidly obese patients. Two thirds of the respondents indicated that obesity was a barrier to admission in their particular facilities; if nursing homes were staffed appropriately, obesity was perceived as less of an admission barrier. Alternatively, concerns about unavailable bariatric equipment were positively associated with perceived barriers to admission. Given the trends of increasing obesity across the life 623430 JAGXXX10.1177/0733464815623430Journal of Applied GerontologyEditorial research-article2015