Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

Long-term Care

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Quality of care is most important nursing home measure

In spite of their different and sometimes adversarial roles, nursing home advocates, administrators, regulators, ombudsmen, and nursing service directors agree on the three most important yardsticks for measuring how well the Nation's nursing homes are doing their job, according to a new study sponsored by the Agency for Health Care Policy and Research (HS07574). The five nursing home "stakeholder" groups said that the quality of the care they provide is the most important yardstick, followed closely by the quality of life of their residents and then by their residents' rights.

These three areas are among 17 "categories of quality" that the Health Care Financing Administration (HCFA) regulations require State governments to evaluate to determine if nursing homes should be certified for participation in Medicare and Medicaid. State agencies survey the nearly 17,000 nursing homes every 12 to 15 months on behalf of HCFA.

The study, which was led by Charlene Harrington, Ph.D., R.N., a professor of social and behavioral sciences at the University of California, San Francisco's School of Nursing, found that 89 percent of the stakeholders ranked quality of care among the three top categories, nearly 88 percent placed quality of life there, and about 75 percent put residents' rights among the top three. Although the stakeholders agreed on the three most important categories for measuring quality, they differed in how they thought each should be ranked. Nursing home advocates and nursing directors tended to give quality of care the highest ranking, whereas administrators and State licensing and survey agency training coordinators were more likely to pick quality of life as the most important category. State nursing home ombudsmen generally chose residents' rights as the most important.

Overall quality of care provided to residents, followed by their ability to carry out usual everyday activities, such as bathing, dressing, and eating (commonly referred to as activities of daily living), and care specifically aimed at helping residents maintain their ability to conduct these activities, were selected as the three most important subcategories of quality of care. The three most important subcategories of quality of life were dignity, self-determination, and participation, along with the accommodation of residents' needs, while exercise of rights, informing residents of their condition, and freedom from reprisal ranked first, second, and third in the residents' rights category.

The survey, which was conducted in 1996, involved administrators and nursing directors drawn from a random sample of nursing homes, ombudsmen, and survey training and certification coordinators from all 50 States and the District of Columbia and nursing home advocates from 34 States.

Details are in "Stakeholders' opinions regarding important measures of nursing home quality for consumers," by Dr. Harrington, Joseph Mullan, Ph.D., Lisa C. Woodruff, M.G.S., and others, in the May-June 1999 American Journal of Medical Quality, pp. 124-131.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care