(GAO, 1996b). GAO concluded that, although all states use assessments to develop a care plan, the comprehensiveness of the assessment varies, and most states do not have standardized terms. Also, most states do not require training in the administration of the instrument despite its importance.

There is strong interest in the possibility of identifying an instrument or set of core assessment elements that is applicable to all users of long-term care regardless of setting. This interest stems in part from a growing recognition of the overlap among the characteristics of long-term care populations served in different settings, and from a desire to compare the quality and costs of care across settings. The availability of such assessment tools for long-term care settings might also help in monitoring individuals as they move from one care level or setting to another. The development of uniform definitions of various community-based services, common measures, and common sets of codes for categorizing care users' physical, cognitive, and emotional functioning would facilitate the adoption of a common language for assessing long-term care needs and the outcomes of care. Clearly, much work is needed first to examine the diversity across states of the services, service settings and service arrangements, and the infrastructure for monitoring quality; and then to develop agreements on common core data elements and uniform definitions of various community-based arrangements.

Recommendation 4.1: The committee recommends that the Department of Health and Human Services and other appropriate organizations fund scientifically sound research toward further development of quality assessment instruments that can be used appropriately across the different long-term care settings and with different population groups.

The committee notes that the Agency for Healthcare Research and Quality has initiated some efforts in this area. For example, they have awarded a research grant to develop quality measures for residential facilities that can be used for multiple purposes.

INCORPORATING CONSUMER PERSPECTIVES IN MEASUREMENT OF QUALITY

Provision of long-term care should reflect the preferences of consumers. This suggests that data are needed about consumers' perspectives on the quality of their care, and that consumers should be included as a source of data on the quality of care. Although staff assessments are a



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