of expertise related to the scope of this study. The members of the committee consisted of academic health professionals, researchers, health providers, and long-term care advocates. This report presents the results of the examination by the committee, which began its work in early 1997.

Study Method

The committee examined the statutory requirements for long-term care services; conducted extensive reviews of research literature and empirical evidence; and gathered information during site visits, a public hearing, and two workshops. It relied mainly on existing information from a variety of sources, reviewing and analyzing research literature on the varied topics covered in this report.

From early 1997 to April 2000, the committee met on eight separate occasions to discuss long-term care dynamics with a focus on quality. Some of these meetings consisted of workshops that were open to the public. They provided an opportunity for the committee to expand its perspective and views by obtaining a wide range of opinions from interested and concerned groups—such as health care associations and advocacy groups from skilled nursing facilities, home health agencies, and assisted living agencies—on matters under consideration, especially ideas and concepts of how the presenters perceive, measure, and evaluate quality within the different long-term care settings. A listing of the meetings and the presenters can be found in Appendix A.

The committee commissioned five background papers in order to obtain expert and detailed analysis of some of the key issues.

  1. “Issues in the Quality of Long-Term Care for Children,” by Ruth E.K. Stein, M.D.

  2. “The Characteristics of Long-Term Care Users,” by William D. Spector, Ph.D., John A. Fleishman, Ph.D., Liliana E. Pezzin, Ph.D., and Brenda Spillman, Ph.D.

  3. “Quality of Care Problems Persist in Nursing Homes Despite Improvements Since the Nursing Home Reform Act,” by Marie F. Johnson, M.D., and Andrew M. Kramer, M.D.

  4. “Work Force Issues and Quality of Long-Term Care,” by Penny Hollander Feldman, Ph.D.

  5. “Long-Term Care Financing and Quality of Care,” by Joshua M. Wiener, Ph.D., and David G. Stevenson.

The committee appreciates and values their contributions.

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