Index

A

Accountability, general, 14, 33, 134, 138

see also External oversight;

Regulatory issues;

Standards

Accreditation, 4, 135, 137, 178

adult foster care and small group homes, 49, 94, 164

assisted living, 47

board and care homes, 45, 91-92

home health care agencies, 171-172

Medicaid, 178

Medicare, 178

nongovernmental, 122, 137, 171-172, 178, 223

residential care facilities, 45, 47

Acute care services, 28, 124, 129, 182

see also Special care units;

Subacute care units

Adult foster care homes, 45, 49-50, 94-95, 164, 250

see also Group homes

Adults, see Elderly persons;

Nonelderly adults

Advocacy, 11, 19, 135, 140, 174-177, 250

American Association of Retired Persons (AARP), 68, 164-165, 293

care management, 58

children, 174-175

funding, 19, 175-176

home and community-based services organizations, 55, 58, 67

information systems, promotion of, 177

Long-Term Care Ombudsman Program, 11, 79, 175-176

Medicaid, 67

nursing homes, 148, 161, 162, 176-177, 191

personal care services, 67, 177

residential care, 168, 202-203, 293

African Americans, 39

Age factors, 23-24

employment issues, 212

number in long-term care, 1, 39

population, aging of, 2, 22-23

see also Children and young adults;

Elderly persons;

Nonelderly adults

Agency for Health Care Policy and Research, 114, 127

AIDS, see HIV/AIDS

Alabama, 101

Alcohol and drug abuse, 126, 164

Alzheimer's Association, 293

Alzheimer's disease, see Dementia

American Academy of Nursing, 196

American Association of Retired Persons (AARP), 68, 164-165, 293

American Board of Family Practice, 62



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Improving the Quality of Long-Term Care Index A Accountability, general, 14, 33, 134, 138 see also External oversight; Regulatory issues; Standards Accreditation, 4, 135, 137, 178 adult foster care and small group homes, 49, 94, 164 assisted living, 47 board and care homes, 45, 91-92 home health care agencies, 171-172 Medicaid, 178 Medicare, 178 nongovernmental, 122, 137, 171-172, 178, 223 residential care facilities, 45, 47 Acute care services, 28, 124, 129, 182 see also Special care units; Subacute care units Adult foster care homes, 45, 49-50, 94-95, 164, 250 see also Group homes Adults, see Elderly persons; Nonelderly adults Advocacy, 11, 19, 135, 140, 174-177, 250 American Association of Retired Persons (AARP), 68, 164-165, 293 care management, 58 children, 174-175 funding, 19, 175-176 home and community-based services organizations, 55, 58, 67 information systems, promotion of, 177 Long-Term Care Ombudsman Program, 11, 79, 175-176 Medicaid, 67 nursing homes, 148, 161, 162, 176-177, 191 personal care services, 67, 177 residential care, 168, 202-203, 293 African Americans, 39 Age factors, 23-24 employment issues, 212 number in long-term care, 1, 39 population, aging of, 2, 22-23 see also Children and young adults; Elderly persons; Nonelderly adults Agency for Health Care Policy and Research, 114, 127 AIDS, see HIV/AIDS Alabama, 101 Alcohol and drug abuse, 126, 164 Alzheimer's Association, 293 Alzheimer's disease, see Dementia American Academy of Nursing, 196 American Association of Retired Persons (AARP), 68, 164-165, 293 American Board of Family Practice, 62

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Improving the Quality of Long-Term Care American Board of Medical Specialities, 62(n.9) American Geriatrics Society, 222 American Health Care Association, 194, 216, 223 American Medical Directors Association, 199, 222 American Nursing Association, 196 American Society of Internal Medicine, 62 Americans with Disabilities Act, 29, 103 Archstone Foundation, 3, 25 Arizona, 101 Assessment instruments, 8-10, 18, 37, 40, 47, 109, 117-120, 121-122, 127-134, 150-152 Assets and Health Dynamics of the Elderly Survey, 37(n.1) Assisted living, 6, 8, 10, 42, 45, 47-49, 92-94, 109 administrators, 47-48 defined, 47, 50, 168-169 elderly persons, 48(n.6), 92-94 financing, general, 64 functional status, 47, 49 General Accounting Office studies, 93, 94, 202, 249 licensure, 47 Medicare/Medicaid, 293 medication, 93, 166 number of facilities, beds, and residents, 47, 48 personal care services, 47, 48(n.6) personnel and personnel standards, 202, 203-204 privacy and dignity, 47, 49, 92-93 regulatory issues, 38, 93, 94, 166 state standards, 10, 47, 93, 164, 166, 168-169. 292-293 Assisted Living Quality Coalition, 169, 203, 216 Auditory impairments, 116 Australia, 107 B Balanced Budget Act, 16, 51, 193, 235, 236, 241-244 Bathroom facilities assisted living, 49 home health care, 207 nursing homes, 88, 229-230 Bed sores, see Pressure sores Board and care homes, 10, 45-47, 64, 68, 91-92, 124, 163-169, 202-203, 250 developmental disabilities, 46, 71 medication, 46, 91-92, 202, 203 regulatory issues, 45, 46, 91, 92, 163-169 safety, 92, 163 Supplemental Security Income, 47, 64, 68, 163 Bureau of Census, 250 Bureau of Labor Statistics, 13, 212 C California assisted living, 93 consumer-centered programs, 106-107 developmentally disabled persons, residential care, 96 home health care, 209 nursing homes, 78, 145, 153, 158, 197 personal care services, 55, 68, 209-210 Cardiovascular disease, 40 Care management, 3, 9, 15, 22, 69-70, 127, 135 children, 58, 71-72 consumer-centered services, 29, 71-72 developmentally disabled persons, 96 home and community-based services organizations, 54, 55, 58-59 individualization of care, 6, 28, 29, 127-128, 189, 229 restorative care, 8, 116 state government, 58, 68 see also Managed care Casemix, 242 nursing homes, 19, 74, 88, 90, 114, 117, 118, 123-124, 182, 188-195 (passim) residential care settings, 202 see also Resource Utilization Groups Casemix reimbursement, 19, 240-241 Centers for Advancement of Quality in Long-Term Care, 20, 234 Certification, 4, 8, 9, 10, 18, 135, 136-137, 172 home health care agencies, 7, 8, 43, 51, 52, 97, 171-172, 173-174, 206, 207, 208 Medicaid, 7, 8, 10, 17, 44, 47, 49, 51, 52, 174, 178, 207 Medicare, 7, 8, 10, 44, 47, 49, 51, 52, 174, 178, 207

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Improving the Quality of Long-Term Care nongovernmental, 122, 137 nursing homes, 7, 8, 18, 42, 43, 44, 76, 77, 137, 140-141, 143-163, 182 state survey activities, 18, 137, 142-163 voluntary, 122, 137, 171-172, 178, 223 Chains, see Multi-facility organizations Chemical restraints, see Physical and chemical restraints Children and young adults, 30, 40, 201 advocacy, 174-175 assessment design, 132-134 care management, 58, 71-72 cognitive factors, 40, 133, 217 consumer-centered care, 71-72 coordination of services, 70-71 diseases/conditions of children in care, 40 family issues, 104, 105 functional status, 133 home and community-based services organizations, 58, 104-105, 210 home care, 210 home health care agencies, 104-105, 207-208 informal care for, 217 informal caregivers for elderly, 59-60, 217 long-term care defined, 28 number in care, 2, 23-24 nursing home visits by, 88 physician skills, 61 professional education for, 61, 104-105 Supplemental Security Income program, 68 Children with Special Health Care Needs, 58 Clinical practice guidelines, 14, 15, 221-222, 224, 226-228, 232, 234 cost factors, 15, 221, 232 Clinton, William, 113 Cognitive factors, 24, 288, 289, 290 assessment instruments, 7, 8, 116, 127, 132 assisted living facilities, 49 board and care homes, 46-47 care management, 70 children, 40, 133, 217 elderly persons, 2, 38, 290 nursing home patients, 7, 43, 84, 85, 86, 116 residential care, 46-47, 166, 203-204 see also Dementia; Developmental disabilities; Mental retardation Community-based services, 3, 6-7, 8, 16, 27, 100-108 adult foster care homes, 45, 49-50, 94-95, 164, 250 advocacy, 174 assisted living facilities board and care homes, 10, 45-47, 64, 68, 91-92, 124, 163-169, 202-203 consumer-centered services, 29, 105-108, 131, 209 defined, 9, 41-42, 45, 91 demographics of users, 39 developmentally disabled persons, 24, 54, 95-96 elderly persons, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131 functional status, 91 group homes, 41, 45, 49-50, 71, 94, 250 licensure, 45 Medicaid, 16, 22, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236 personal attendant services, 29 residential care, 22, 41, 45-50, 91-96 state government role, 8, 45, 91, 289-290 see also Assisted living; Home and community-based services organizations Community Health Accreditation Program, 171 Complaints and complaint resolution, 19, 136, 138 advocacy, promotion of, 177 home health care, 170 Long-Term Care Ombudsman Program, 11, 79, 175-176 nursing homes, 79, 115, 144, 153, 162 Confidence Satisfaction Survey, 85 Connecticut, 244 Consumer Assessment of Health Plans, 134 Consumer attitudes, 5, 6, 22, 29-30, 31, 89, 94, 107, 108, 109, 127-131, 136, 174, 249 Consumer-centered care, 7, 28, 29, 31-34, 71-72, 75-76, 106-107, 138, 214, 249-250, 288-293 assessment instrument design, 127-132 care management, 29, 71-72 children, 71-72 decision making, general, 7, 28, 88 89(n.3), 166 defined, 29, 288, 289

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Improving the Quality of Long-Term Care Department of Health and Human Services role, 18, 108, 289 elderly persons, 29 financial issues, general, 29, 33 home and community-based health care, 29, 105-108, 109, 131 home care, 29, 71, 128, 131 home health care agencies, 128, 209 informal care, 29, 71, 128, 131 information systems, 8, 32, 110 nursing homes, 31, 32, 71, 88-89(n.3), 131, 148, 222, 289 personal care services, 29, 250 professional education, 29, 71 providers, general, 29, 33-34, 214 quality of life, 29, 32-33 regulatory issues, 33, 136, 138, 148, 165-166, 170 research funding, 18, 108, 289-290 state government role, 18, 108, 289 see also Advocacy; Complaints and complaint resolution Consumer Consortium on Assisted Living, 202, 204-205 Continence care, see Incontinence Continuing Care Retirement Communities, 42 Contracting practices, 9, 25, 33, 136, 165-166, 170, 249 home health care fraud, 96-97 Contractures, 78 Cost and cost-effectiveness, 15, 16-17, 22, 63-64, 223, 227, 236-239, 242 assessment instrument categories for, 115, 127 assisted living, 93, 94 board and care homes, 46 clinical practice guidelines, 15, 221, 232 home health care, 63-64, 97-98, 205, 242 nursing homes, 1, 63-64, 89, 90, 115, 162, 194-195, 221-224 (passim), 227, 229-230, 232, 236-238, 242-243 personnel standards and oversight, 13, 194-195, 205, 219 private health insurance, 69 process monitoring technology, 232 regulation, general, 139, 140 standards, 13, 15, 194-195, 219, 205, 221, 232 residential care, 166 see also Funding Criminal behavior abuse and neglect, 1, 13, 24, 78, 79, 138, 189, 192, 215-217 legislation, 13, 19, 216-217 D Day care, 43, 59 Decision making, consumer, general, 7, 28, 291 nursing home residents, 88-89(n.3) residential care, 166 see also Consumer-centered care Decubitus ulcers, see Pressure sores Dehydration, 82, 150, 192 Dementia, 40, 43, 49, 83, 86, 113, 204-205, 209, 211, 289 Demographic factors, 39 Baby Boom, 2, 23 educational attainment of care users, 39, 187 marital status, 39 number in long-term care, 1, 2, 22-23, 38 nursing home residents, 39, 43-44 race/ethnicity see also Age factors; Gender factors Dental health and care, 113, 116, 143, 182, 184, 189, 191 Department of Health and Human Services access to care, 18, 20 Agency for Health Care Policy and Research, 114, 127 assessment instrument development, 127 assisted living, 48(n.6) board and care homes, 46 Centers for Advancement of Quality in Long-Term Care, 20, 234 consumer-centered care research, 18, 108, 289 home and community-based services, 103 Medicaid/Medicare reimbursement research, 20, 238 National Center for Health Statistics, 37 nursing home staff study, 192 organizational capacity research, 20, 233-234 see also Health Care Financing Administration Department of Justice, 103

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Improving the Quality of Long-Term Care Department of Veterans Affairs, 3, 25, 81 see also Veterans Administration Depression, 116, 133 Developmental disabilities, 24, 40, 41, 71, 95-96, 201, 211, 290 board and care homes, 46, 71 community-based services, 24, 54, 95-96 defined, 24(n.2) home and community-based services organizations, 54 state government role, 24, 96 see also Mental retardation Diet, see Nutrition Dignity, see Privacy and dignity Dispute resolution, see Complaints and dispute resolution District of Columbia, 101 Drug abuse, see Alcohol and drug abuse Drugs, see Medication E Economic factors, see Cost and cost-effectiveness; Employment issues; Financial issues; Funding; Health insurance; Ownership of facilities; Poverty; Wages and salaries Eden Alternative, 88 Education, see Patient education; Professional education and training; Public education Educational attainment of care users, 39, 187 Education for All Handicapped Children Act, 71 Elderly persons, 2, 23, 40, 164 abuse and neglect of, 215 assisted living, 48(n.6), 92-94 board and care homes, 46, 91, 202-203 care management, 70 cognitive impairments, 2, 38, 290 community-based services, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131 Continuing Care Retirement Communities, 42 consumer-centered services, 29 functional status, 2, 38, 59-60 gender of care users, 2, 38, 43, 46, 51 geriatric specialists, 12, 62 home and community-based services organizations, 52, 54, 55, 126-127, 131 home care, 210 home health care, 51, 97-98, 205 informal care, 59-60, 217 number in long-term care, 1, 2, 22-23, 37, 38, 39, 59 physician training, 62 private insurance, 69 see also Medicare Emergency care, see Acute care services Emotional well-being, see Mental health and illness Employment issues, 13-14, 19, 60, 180-181, 211-218 assisted living, 94 children in care, training of, 71-72 criminal background checks, 1, 13, 24, 78, 79, 138, 189, 192, 215-217 home health care agencies, 207 nonelderly adults with disabilities, 55 number of long-term care workers, 60-61, 181 nursing homes, 12-13, 89, 113, 187, 189, 194-195, 199, 212, 213 occupational therapy, 11, 71, 180, 182, 190, 206, 207 personal attendants, 55, 209-210 see also Professional education and training; Providers and provider quality; Wages and salaries Ethnicity, see Race/ethnicity of care users External oversight, 9-11, 135-179 committee recommendations, 18-19 family members, 9, 11, 128, 135, 166, 174 mass media, 1, 9, 21, 24, 61, 135, 213 see also Accreditation; Advocacy; Certification; Licensure; Regulatory issues; Standards F Family members, 3, 7, 27, 36, 59, 60, 69, 95, 128, 174, 217-218, 249, 250, 288 child health care, 104, 105 coordination of services, 70-72 counseling of, 62 dementia patients, 86 external oversight and, 9, 11, 128, 135, 166, 174 of nursing home residents, 86. 87 personal attendant programs, 55 residential care, 166

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Improving the Quality of Long-Term Care social services defined, 27 see also Children and young adults; Informal care Financial issues, 15-17, 20, 36, 62-69, 235-252 adult foster care and small group homes, 49-50, 94 assisted living, 94 board and care homes, 46, 47 casemix reimbursement, 19, 240-241 consumer-centered care, 29, 33 contracting practices, 9, 25, 33, 136, 165-166, 170, 249 home care, 16, 62, 63-64, 247 home health care, 63, 99, 100, 242, 243-244 informal caregivers, 60, 63, 69 information systems, 110 nursing homes, 62, 63-64, 236-238, 242-243 social services defined, 27 see also Cost and cost-effectiveness; Funding; Health Care Financing Administration; Health insurance; Medicaid; Medicare; Regulatory issues; Wages and salaries Fines and penalties, 10, 18, 137 federal government, general, 10, 18, 137, 141-142, 148, 153-156, 158, 159-161 home health care agencies, 172-173 nursing homes, 10, 18, 137, 141-142, 148, 153-156, 158-162 residential care facilities, 165 Florida, assisted living, 93 Food, see Nutrition Foreign countries, see International perspectives; specific countries Foundation for Accountability, 134 France, 107 Friends, 3, 27, 59, 60 see also Informal care Functional mobility board and care homes, 47 defined, 27 nursing home residents, 5, 7-8, 12, 76, 229-230 physical therapy, 11, 12, 51, 53, 54, 61, 71, 182, 190 residential care, 76, 125 Functional status, 36, 37, 39, 75, 127 adult foster care homes, 94-95 assisted living, 47, 49 board and care homes, 46 children, 133 community-based residential care, 91 defined, 27 elderly persons, 2, 38, 59-60 home health care, 97, 98 informal care, 59-60 information systems on, 113 nursing home residents, 45, 79, 84, 94-95, 113, 116, 176, 189, 224 Resident Assessment Instrument (RAI), 7-8, 116, 125 staffing and, 12, 189 see also Developmental disabilities; Incontinence; Personal care services Funding, 64-69, 75, 233-234 access to care, research, 18 advocacy, 19, 175-176 assessment instrument development/use, 119-120, 127, 152, 153 consumer-centered care research, 18, 108, 289-290 home and community-based services organizations, 55, 120, 138 Medicaid/Medicare reimbursement research, 20, 238 nursing home assessment, 119-120, 152, 153, 195-196 organizational capacity, 20 public education, 19 regulatory accountability and, 18, 138 residential facilities assessment, 127 standards and, general, 136 state survey regulations and certification, 18 see also Financial issues; Medicaid; Medicare G Gender factors, 38, 39, 46 consumer satisfaction, 129 home care, 51 informal caregivers, 59 General Accounting Office, 68 assisted living, 93, 94, 202, 249 home and community-based services, 126-127 home health care, 96-97, 99-100, 169, 170-171, 172-173, 243

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Improving the Quality of Long-Term Care nursing homes, 68, 76, 77-78, 145, 148, 150-151, 152-153, 158, 160, 161 residential care, 93, 94, 163, 165-166, 202 Germany, 107 Government Accounting Office, 229 Government role, see Advocacy; Regulatory issues Group homes, 41, 45, 49-50, 71, 250 licensure, 49, 94 H HCBS, see Home and community-based services organizations Health Care Financing Administration (HFCA), 3-4, 25, 137, 178, 182, 242, 244 certification requirements, 10, 18 developmentally disabled persons, 96 home and community-based care, 66 home health care, 7, 96-99, 169-173 nursing home care, 3-4, 7, 12, 18, 25, 42, 79, 86, 119, 142, 195 nursing home personnel, 12, 19, 184-187, 192, 193, 195-196, 201 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 personal care services, 101-103 Resident Assessment Instrument, 7-8, 111, 115-120, 124-125, 128 see also Minimum data set see also Medicaid; Medicare Health insurance, 4, 69 elderly persons, 69 external oversight, 9 home health care, 63 information systems, 110 nursing home care, 63, 64 see also Managed care Health Insurance Portability and Accountability Act, 216 Health Plan Employer Data and Information Set, 133 Hearing impairments, see Auditory impairments Historical perspectives, 21-22, 220-221, 250-251, 252 attitudes of caregivers, 228-229 care management, 58 consumer-centered care, 28 developmentally disabled persons, 95 home health care, 169 number in care, various settings, 2, 37, 38, 43, 169 nursing homes, 25, 42-43, 44, 110-111, 141-144, 150, 153-154, 235 professional licensure, 136 HIV/AIDS, 4, 34, 54, 102, 209, 211 Home and community-based services organizations, 3, 52, 54-59, 100-108, 109, 125-127, 179 advocacy, 55, 58, 67 children, 58, 104-105, 210 consumer-centered services, 29, 105-108, 109, 131 defined, 41-42 developmentally disabled persons, 24, 54, 95-96 elderly persons, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131 employment issues, 60, 61 General Accounting Office studies, 126-127 Medicaid, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236 Medicare, 55, 103 nonelderly adults, 55, 59 nursing home care, avoidance of, 100-101 regulatory issues, 102-103, 138 state government role, 54-58, 66-67, 68, 69, 101-103, 111, 125-127, 238, 246 see also Personal care services Home care, 1, 3, 6, 16, 22, 25, 50-52, 53, 96-100, 109, 135-136, 138 attitudes toward, 31 casemix, 122 children, 210 consumer-centered services, 29, 71, 128, 131 elderly persons, 210 financing of, general, 16, 62, 63-64, 247 gender factors, 51 Medicaid, 7, 22, 51, 52, 55, 63, 64, 70 Medicare, 7, 16, 22, 50, 51, 52, 63, 64, 97-98, 99-100, 109 Resident Assessment Instrument, 111 number and number of residents, 43, 50-51, 169 On-line Survey Certification and Reporting (OSCAR) System, 7

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Improving the Quality of Long-Term Care Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171 personnel, general, 13, 51, 53, 61, 180, 209-210, 214 personnel standards, 11, 96-97, 167 state government role, 96, 97, 173, 238 surveys, 37, 173 see also“On-line...” and “Outcome...” supra see also Assisted living; Informal care Home health care agencies, 3, 50-52, 55, 70, 290-291 administrators, 96, 208 adolescents, 104-105 board and care homes, 10, 45-47, 64, 68, 71, 91-92, 124, 163-169, 202-203 children, 104-105, 207-208 certification, 7, 8, 43, 51, 52, 97, 171-172, 173-174, 206, 207, 208 consumer-centered care, 128, 209 cost factors, 63-64, 97-98, 205, 242 defined, 206 elderly persons, 51, 97-98, 205 employment issues, 207 financial issues, general, 63, 99, 100, 242, 243-244 functional status, 97, 98 General Accounting Office studies, 96-97, 99-100, 169, 170-171, 172-173, 243 Health Care Financing Administration, 7, 96-99, 169-173 hospitalization, 50 inspection of facilities, 170 licensed practical nurses, 51, 54, 61, 208 licensure, 7, 172, 173-174, 207 Medicaid, 43, 50, 170-171, 174, 207, 216 Medicare, 6, 8, 43, 50, 169-171, 172, 174, 206, 207, 208, 216, 236, 243 multi-facility organizations, 51 nurses, general, 51, 53, 54, 98-99, 100, 104, 206, 207, 208 nursing aides, 54 nutrition, 53, 54, 59, 68 outcomes, general, 8, 97-98 ownership of facilities, 51, 52, 53, 99 paraprofessional personnel, 51, 54, 181, 208-209, 291 patient education, 99 personnel and personnel standards, 181, 205-209, 212-213, 216 physical and chemical restraints, 206 physicians, 53, 54, 206 privacy and dignity, 207, 209 private insurance, 63 professional education, 206, 207-209 registered nurses, 51, 54, 61, 169-173, 206, 207, 208, 213, 291 regulation and standards, facilities, 167-168, 169-173, 206-209 state government role, 168, 170, 171, 173-174, 207, 208-209, 238 time factors, 50, 106, 121, 123, 208, 209 voluntary, 51, 52, 53, 54 see also Personal care services Homeless persons, 46(n.4) Hospice care, 37, 42, 50, 51, 52, 53, 54, 216 Hospitals and hospitalization acute care services, 28, 124, 129, 182 financial issues, general, 63 home health care and, 50 labor force, 61 managed care, 45 Medicaid, 65 Medicare, 64 nursing home residents hospitalized, 84, 89, 188, 190, 195 nursing homes, hospital based, 44, 63, 82, 183, 185 nursing staff, 187, 192 Housebound and Aid and Attendance Allowance Programs, 29, 106 Housekeeping personnel, 11, 51, 60, 63, 77, 88, 95, 180, 183, 184 I Illinois, 209, 244 Improving the Quality of Care in Nursing Homes, 3, 21 Incontinence board and care homes, 47 nursing homes, 82-83, 108, 113, 188, 223, 228, 229-230 Individualization of care, 6, 28, 29, 127-128, 189, 229 Individuals with Disabilities Act, 71 Informal care, 3, 7, 11, 37, 41, 59-60, 217-218, 249 children, 217 consumer-centered care, 29, 71, 128, 131 defined, 27

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Improving the Quality of Long-Term Care demographics of caregivers, 59-60 elderly persons, 59-60, 217 financial issues, 60, 63, 69 functional status, 59-60 gender factors, 59 nonelderly adults, 60 number using, 1-2, 38 religious organizations, 3, 59 social services defined, 27 training, 218 see also Paraprofessionals; Volunteers and voluntary organizations Information systems, 7-9, 14, 31, 33, 110-134, 224-227 advocacy, promotion of, 177 assessment instrument design/use issues, 8-10, 18, 37, 40, 47, 109, 117-123 (passim), 127-134, 143-144, 150-152 assisted living, 94, 109 community-based residential care, 45 consumer-centered, 8, 32, 110 education of caregivers, 218 financial issues, general, 110 managed care, 110, 111 mass media, 1, 9, 21, 24, 61, 135, 213 nursing home surveys of, 18, 37, 42, 142-153 Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171 quality of care, general, 3, 31, 33 Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128 see also Minimum data set see also Internet; Public education In-Home Supportive Services Program, 55, 68 Injuries, see Safety issues Inspection of facilities home health care, 170 nursing homes, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158 residential care, 165, 166 Institutional care, 32 attitudes of professionals in, 28 children in, 40 defined, 3, 41 number in care, 2, 37, 38, 40 special care units, 22, 43, 65, 113, 241-244 see also Nursing homes Institutional factors, see Organizational and institutional factors Insurance, see Health insurance; Managed care; Medicaid; Medicare Intermediate care, 4, 34, 37, 41, 42(n.2), 43, 216 International perspectives home and community-based care, 107 see also specific countries Internet nursing homes, On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 nursing homes, other, 161 Irvine Health Foundation, 3, 25 J Joint Commission on Accreditation of Healthcare Organizations, 171, 178, 223 K Kansas, 209 L Language therapy, see Speech and language therapy Legislation Americans with Disabilities Act, 29, 103 Balanced Budget Act, 16, 51, 193, 235, 236, 241-244 criminal background, provider checks, 13, 19, 216-217 Education for All Handicapped Children Act, 71 Health Insurance Portability and Accountability Act, 216 home and community-based services, 102-103, 216 Individuals with Disabilities Act, 71 Medicare Catastrophic Coverage Act, 45 Nursing Home Reform Act, 25, 142-143, 174, 176, 250-251

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Improving the Quality of Long-Term Care Older Americans Act, 11, 54, 59, 68 Long-Term Care Ombudsman Program, 11, 79, 175-176 Omnibus Budget Reconciliation Acts (OBRA), 3, 5-6, 7-8, 12, 14, 15, 16, 21, 25, 45, 79, 80, 81, 83, 90, 95, 108, 139-144 (passim), 150, 151, 153-154, 161, 162, 170, 171, 179, 182, 187, 190, 192-193, 206, 221, 224, 233, 234, 247 Patient Abuse Prevention Act (proposed), 216 Patient Self-Determination Act, 29 Rehabilitation Act, 55 Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128 see also Minimum data set Social Security Act, 66, 68, 163, 206, 207 see also Supplemental Security Income program see also Regulatory issues Licensed practical nurses (LPNs), 11, 60, 180, 216 board and care homes, 202 care management, 70 education, 196-197 home health care, 51, 54, 61, 208 number of, 61 nursing homes, 89, 61, 113, 182, 183, 187, 188-189, 196, 200, 201, 212, 213 wages, 194, 213 Licensure, 4, 9, 10, 135, 137, 172, board and care homes, 202, 203 home health care agencies, 7, 172, 173-174, 207 Medicaid, 7, 174, 207 Medicare, 7, 174, 207 nursing homes, 7, 89, 182 personal care attendants, 210 residential care facilities, 45, 47, 49, 92, 94, 137, 163, 164, 165, 202 state survey activities, 42, 137, 142-163, 164 see also Licensed practical nurses; Registered nurses Local services, see Community-based services Long-term care, defined, 1, 3, 27-28, 36 Long-Term Care Ombudsman Program, 11, 79, 175-176 M Maine, 101, 124 Managed care, 22, 69 Medicaid, 22, 69, 70, 111 Medicare, 22, 45, 50, 69 nursing homes, 45, 200-201 information systems, 110, 111 Marital status, 39 Massachusetts, 101, 226 Mass media, 1, 9, 21, 24, 61, 135, 213 Maternal and Child Health programs, 58 MDS, see Minimum data set Medicaid, 4, 8, 15-17, 20, 136-137, 214, 235-247 adult foster care and small group homes, 49-50, 94 advocacy, 67 assisted living, 293 board and care homes, 163 certification, 7, 8, 10, 17, 44, 47, 49, 51, 174, 178, 207 community-based services, 16, 22 home and community-based care, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236 home care, 7, 22, 51, 52, 55, 63, 64, 70 home health care agencies, 43, 50, 170-171, 174, 207, 216 hospitalization, 65 incentives, 4, 244 licensure, 7, 174, 207 managed care, 22, 69, 70, 111 nursing homes, 10, 15-17, 19, 20, 42(n.3), 43, 44, 63, 64, 67, 70, 80, 142, 161, 235, 239-240, 244-246 external oversight, 9, 10, 18, 42, 137, 142-153 personnel, general, 183, 185-187, 193-195, 237 personnel standards, 182, 193, 198, 201, 215, 216 Resident Assessment Instrument (RAI), 7-8, 111, 115-120 state survey and certification, 18, 42, 137, 143-153 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 personal care services, 55, 56-57, 66, 67, 101-103, 106

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Improving the Quality of Long-Term Care research funding, 20, 238 residential care, 70, 96, 202, 204, 293 state government, 10, 16, 17, 18, 19, 20, 42, 55, 56-57, 65, 66-67, 68, 69, 80, 101-103, 111, 125-127, 136, 137, 142-153, 170, 174, 207, 236, 238-241, 246, 251 see also Home and community-based service organizations Medical records, 153 Medicare, 4, 64-65, 69, 136-137, 214, 236, 239-240, 251 assisted living, 293 certification, 7, 8, 10, 44, 47, 49, 51, 52, 174, 178, 207 Department of Health and Human Services research, 20, 238 historical perspectives, 22 home and community-based services, 55, 103 home care, 7, 16, 22, 50, 51, 52, 63, 64, 97-98, 99-100, 109 home health care agencies, 6, 8, 43, 50, 169-171, 172, 174, 206, 207, 208, 216, 236, 243 hospitalization, 64 licensure, 7, 174, 207 managed care, 22, 45, 50, 69 nursing homes, 10, 16, 42(n.3), 43, 44-45, 63, 64-65, 142, 161, 236, 240, 242-243 certification, 42(n.3), 43-44 external oversight, 9, 10, 18, 42, 137, 142-153 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 personnel, general, 183-187, 195 personnel standards, 182, 193, 197-198, 201, 216 prospective payment system, 16, 20, 22, 50, 63, 65, 96-99 (passim), 117, 118, 122, 185, 186. 236, 238-244 (passim) research funding, 20, 238 residential care, 202, 204, 293 state government, 10, 16, 18, 42, 97, 136, 142-153, 170, 174, 207, 240-241, 251 survey and certification, 18, 42, 137, 143-153 Medicare Catastrophic Coverage Act, 45 Medicare Payment Advisory Commission (MedPAC), 241-242, 243 Medication, 10, 121, 291 assisted living, 93, 166 board and care homes, 46, 91-92, 202, 203 nursing homes, 143, 182, 184, 191, 199, 241 see also Physical and chemical restraints Men, see Gender factors Mental health and illness, 24, 40 adult foster care homes, 94 assessment instruments, 7-8, 9, 127, 133 assisted living facilities, 49 board and care homes, 46 children, 133 depression, 116, 133 family members, counseling, 62 home and community-based services organizations, 53-54 home health care, 53 nursing home care, 7-8, 43, 45, 113, 116, 184, 199 residential care, 46, 164 see also Dementia; Physical and chemical restraints Mental retardation, 4, 34, 37, 40, 41, 164, 201, 216 advocacy, 177 developmental disability defined, 24(n.3) group homes, 45 special education for children, 71 Methodology, see Research methodology Michigan, 101, 244 Minimum data set (MDS) integrated assessment instruments, 126 nursing homes, 8, 14, 15, 76, 90, 116-120, 149, 150, 221, 225-227 residential care, 124-125 Minnesota, nursing homes, 80, 189, 245, 246 Minorities, see Race/ethnicity of care users Missouri, 101 Mobility, see Functional mobility Multi-facility organizations home health care, 51 nursing homes, 10, 43, 44, 149-150, 243

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Improving the Quality of Long-Term Care N National Center for Health Statistics, 37, 42, 123 National Citizens' Coalition for Nursing Home Reform, 191 National Council on Quality Assurance, 134 National Health Interview Survey, 37(n.1) National Health Provider Inventory, 45 National Home Health Agency Prospective Payment Demonstration, 96 National Institutes of Health, 85 National League for Nursing, 171 National Long-Term Care Survey, 37(n.1), 59, 246 National Nursing Home Survey, 42 National Study of Assisted Living for the Frail Elderly, 48(n.6) Netherlands, 107 New Hampshire, 209 New Jersey, 209, 293 New York State, 200, 241 Nonelderly adults, 2, 24, 38-40 adult foster care homes, 45, 49-50, 94-95, 164, 250 advocacy, 174-175 care management, 59 diseases requiring care, 40 home and community-based services organizations, 55, 59 informal care, 60 number in long-term care, 1, 23, 39 North Carolina, 124, 125 North Dakota, 101, 245 Nurses and nursing, general, 12-13, 17, 18, 65, 70, 89, 212 adult foster care homes, 95 assisted living facilities, 49, 93 board and care homes, 46, 202-203 care management, 58 education and training, 156, 196-198, 202-203 home health care, 51, 53, 54, 98-99, 100, 104, 206, 207, 208 hospitals, 187, 192 nursing homes, 113, 142, 143, 183-195, 230, 237 pressure sores, 80-81 residents-to-nurses ratios, 12, 187, 190, 191, 192 see also Licensed practical nurses; Nursing assistants; Registered nurses Nursing assistants (NAs), 11, 12, 17, 60-61, 180, 212, 215-216 board and care homes, 202-203 education, 156, 197-198, 202-203 home health care, 54 nursing homes, 61, 88, 113, 143, 188, 189, 190, 191, 192, 212, 229, 232 wages, 194, 213, 214 Nursing Home Casemix and Quality Demonstration project, 117, 118 Nursing Home Casemix and Quality Demonstration Resident Status Measurement , 118 Nursing Home Reform Act, 25, 142-143, 176, 250-251 Nursing homes, 1, 2, 5-6, 12-16 (passim), 20, 24, 41, 42-45, 76-90, 108, 244-246, 250-251 accreditation, 7, 42, 43, 44, 76, 89, 140-141, 161-162, 182 administrators and administration, 143, 161-162, 182, 184, 191, 196-197, 198-202, 212, 242-243 advocacy, 148, 161, 162, 176-177, 191 bathroom facilities, 88, 229-230 care management, 70, 71 casemix, 19, 74, 88, 90, 114, 117, 118, 123-124, 182, 188-195 (passim) casemix reimbursement, 19, 240-241 certification, 7, 42, 43, 44, 76, 89, 140-141, 161-162, 182 children, visits to homes, 88 clinical practice guidelines, 14, 15, 221-222, 224, 226-228 cognitive factors, 7, 43, 84, 85, 86, 116 complaints and complaint resolution, 79, 115, 144, 153, 162 consumer-centered care, 31, 32, 71, 88-89(n.3), 131, 148, 222, 289 cost factors, 1, 63-64, 89, 90, 115, 162, 194-195, 221-224 (passim), 227, 229-230, 232, 236-238, 242-243 definitional issues, 42(n.3), 221, 250 dementia patients, 40, 43, 83, 86, 113, 204-205, 209, 211, 289 demographics of users, 39, 43-44

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Improving the Quality of Long-Term Care Department of Health and Human Services study, 192 employment issues, 12-13, 89, 113, 187, 189, 194-195, 199, 212, 213 family members, 86.87 financing of care, general, 62, 63-64, 236-238, 242-243 functional mobility, 5, 7-8, 12, 76, 229-230 functional status, general, 45, 79, 84, 94-95, 113, 116, 176, 189, 224 General Accounting Office studies, 68, 76, 77-78, 145, 148, 150-151, 152-153, 158, 160, 161 Health Care Financing Administration, 3-4, 7, 12, 18, 25, 42, 79, 86, 119, 142, 195 personnel, 12, 19, 184-187, 192, 193, 195-196, 201 state survey and certification, 18, 42, 137, 143-163 historical perspectives, 25, 42-43, 44, 110-111, 141-144, 150, 153-154, 235 home and community-based services and avoidance of, 100-101 hospital-based, 44, 63, 82, 183, 185 hospitalization of residents, 84, 89, 188, 190, 195 incontinence, 82-83, 108, 113, 188, 223, 228, 229-230 information systems, 110, 122-123, 223-227 inspection of facilities, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158 Internet, 161 licensure, 7, 89, 182 managed care, 45, 200-201 Medicaid, see Medicaid, nursing homes Medicare, see Medicare, nursing homes medication, 143, 182, 184, 191, 199, 241 mental health and illness, 7-8, 43, 45, 113, 116, 184, 199; see also“dementia patients” supra multi-facility organizations, 10, 43, 44, 149-150, 243 number in care, 1, 2, 22-23, 37, 39, 42, 43 nutrition, 77, 78, 82, 85, 113, 116, 142, 143, 150, 153, 182, 184, 188, 191-192, 198, 229, 230 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 organizational factors, 14, 200, 221-234 outcomes of care, general, 4, 7-8, 14, 15, 17, 80-81, 223 ownership of facilities, 44, 47, 88, 113, 114, 149-150 pain and pain management, 77, 78, 80, 83-84, 150 personnel, 12, 15, 17, 19, 79, 89, 90, 114-115, 149, 180, 183-201, 212, 213, 223-224, 228-232, 237 education and training, 156, 187, 196-201, 223 licensed practical nurses, 61, 89, 113, 182, 183, 187, 188-189, 196, 200, 201, 212, 213 nurses, general, 113, 142, 143, 183-195, 230, 237 nursing aides, 61, 88, 113, 143, 188, 189, 190, 191, 192, 212, 229, 232 paraprofessionals, general, 181 physicians, 113, 143, 199-201 registered nurses, 61, 113, 182, 183, 187, 188-190, 191, 192-194, 212, 237 standards, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216 physical and chemical restraints, 77, 78, 79-80, 89, 108, 153, 182, 184, 195, 199-202, 251 pressure sores, 77, 78, 79, 80-82, 84, 150, 188, 192, 199 privacy and dignity, 5, 77, 85, 88, 108, 110, 198, 229 private insurance, 63, 64 private sector, 43, 44, 243 quality management systems, 14, 15, 221, 222-223 quality of life, general, 5, 6, 12, 32, 84-90, 108, 142, 143, 155, 156, 192, 231 pain and pain management, 77, 78, 80, 83-84, 150 race/ethnicity of residents, 39, 43 record keeping, 153, 195-196

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Improving the Quality of Long-Term Care regulatory issues, see Regulatory issues, nursing homes research funding, 119-120, 152, 153, 195-196 research methodology, 84-87, 90, 143-144, 150-152, 153 resident councils, 176 Resident Assessment Instrument (RAI), 7-8, 111, 115-120 minimum data set (MDS), 8, 14, 15, 76, 90, 110, 116-120 resident assessment protocols (RAPs), 8, 115, 225, 226, 227-228 Resource Utilization Groups (RUGs), 117, 118, 184-186, 193 safety issues, 5, 7, 10, 76, 77, 78-79, 85, 86, 142, 153, 155, 156-158, 198 social factors and services, 88, 94, 116, 182, 184, 191 special care units, 22, 43, 113, 241-244 standards, 114, 140-163, 176-177, 182, 191-195, 235 state government, 10, 16, 17, 18, 19, 42, 79, 80, 81, 118, 126, 137, 142-163, 197, 198, 236, 238, 241, 246 subacute care units, 22, 43, 65, 113, 241-244 surveys of, 18, 37, 42, 137, 142-158 time factors, 15, 89, 118, 123, 151, 153, 156, 159, 160, 182, 183-187, 188, 189, 194, 199-200, 226-227, 229-231, 237 volunteers, 44 Nutrition assisted living, 48(n.6) food handling, 10, 163 home health care, 53, 54, 59, 68 nursing homes, 77, 78, 82, 85, 113, 116, 142, 143, 150, 153, 182, 184, 188, 191-192, 198, 229, 230 regulatory issues, 3, 10, 142, 143, 150, 153 weight problems, 74, 78, 118, 150 O OASIS, see Outcome and Assessment Information Set Occupational therapy, 11, 71, 180, 182, 184, 190, 206, 207 Office of the Inspector General, 215-216 Ohio, assisted living, 93 Old age, see Elderly persons Older Americans Act, 11, 54, 59, 68 Long-Term Care Ombudsman Program, 11, 79, 175-176 Omnibus Budget Reconciliation Acts (OBRA), 3, 5-6, 7-8, 12, 14, 15, 16, 21, 25, 45, 79, 80, 81, 83, 90, 95, 108, 139-144 (passim), 150, 151, 153-154, 161, 162, 170, 171, 179, 182, 187, 190, 192-193, 206, 221, 224, 233, 234, 247 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 Oregon adult foster care homes, 94, 95 assisted living, 93, 293 board and care homes, 202-203 nursing homes, 246 personal attendant programs, 5 Organizational and institutional factors, 2-3, 14-15, 69-72, 180, 220-234 child care, 70-72, 105 clinical practice guidelines, 14, 15, 221-222 coordination of services, 69-72, 105 family issues, 70-72 nursing homes, 14, 200, 221-234 quality management systems, 14, 15, 221, 222-223 see also Accreditation; Care management; Certification; Community-based services; External oversight; Information systems; Licensure; Managed care; Ownership of facilities; Regulatory issues; Residential care settings; Standards OSCAR, see On-line Survey Certification and Reporting (OSCAR) System Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171 Outcomes of care, 4, 5, 7-9, 33, 74-75, 110-134, 233-234 chronically poor providers, 18, 111, 141, 148-150, 158-161, 251 see also Fines and penalties consumer-centered care, 74-75 definitional issues, 8-9, 29-30, 31, 74

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Improving the Quality of Long-Term Care home health care, 8, 97-98 nursing homes, 4, 7-8, 14, 15, 17, 80-81, 223 see also External oversight; Information systems Ownership of facilities, 213 adult foster homes, 50 home health care agencies, 51, 52, 53, 99 hospices, 51, 53 nursing homes, 44, 47, 88, 113, 114, 149-150 see also Multi-facility organizations P Pain and pain management, nursing homes, 77, 78, 80, 83-84, 150 Paraprofessionals, 3, 11, 59, 60-61, 180, 181, 214, 215 home health care, 51, 54, 181, 208-209, 291 nursing homes, 181 regulatory requirements, 9, 138-139 residential care, 205 see also Housekeeping personnel; Nursing assistants; Personal care services Patient Abuse Prevention Act (proposed), 216 Patient education, 55, 71, 138 home health care, 99 Penalties, see Fines and penalties Personal care homes, 41, 164, 202 Personal care services, 1, 3, 4, 6, 13, 22, 68, 101-103, 109 adult foster care homes, 94, 95 advocacy, 67, 177 assisted living, 47, 48(n.6) community-based, 29, 54-55, 56-57, 66-67, 101 consumer-centered, 29, 250 defined, 27 education of staff, 174 employment issues, 55, 209-210 family members, 55 Health Care Financing Administration, 101-103 licensure, 210 Medicaid, 55, 56-57, 66, 67, 101-103, 106 personnel, 61, 174, 209-210, 212 regulation and standards, 18, 102-103, 173, 174 state government role, 54-55, 56-57, 66-67, 68, 101-103, 174, 209-210 Pharmaceuticals, see Medication Physical and chemical restraints, 3 board and care homes, 91-92 community-based residential care, 91 home health care agencies, 206 nursing homes, 77, 78, 79-80, 89, 108, 153, 182, 184, 195, 199-202, 251 regulations, 3, 6, 139 Physical therapy, 11, 12, 51, 53, 54, 61, 71, 182, 190 Physicians, 11, 51, 62, 125 board and care homes, 203 education and training, 61, 62, 199-201 home health care, 53, 54, 206 nursing homes, 113, 143, 199-201 Poverty, see Medicaid; Supplemental Security Income program Practice guidelines, see Clinical practice guidelines Pressure sores, 123 nursing homes, 77, 78, 79, 80-82, 84, 150, 188, 192, 199 Primary care, 28 Privacy and dignity, 5, 6, 10, 71, 76, 288 assisted living, 47, 49, 92-93 contracting practices, 9, 25, 33, 136, 165-166, 170, 249 home health care agencies, 207, 209 nursing homes, 5, 77, 85, 88, 108, 110, 198, 229 residential care, 164, 169 see also Bathroom facilities; Physical and chemical restraints Private sector, general, 22, 70 adult foster care and small group homes, 50 home health care, 51, 52, 53 hospice care, 51, 53 nursing homes, 43, 44, 243 residential care, 108, 166-167 state collaboration in information dissemination, 18 see also Assisted living; Board and care homes; Health insurance; Managed care; Multi-facility organizations; Ownership of facilities

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Improving the Quality of Long-Term Care Professional education and training, 13, 19, 60, 74, 139, 180, 181, 210-211, 215, 234 administrators, 196-197, 198-202, 208 assessment instruments, surveyors, 8, 115, 117, 152-153 assisted living, 93 child care, 61, 104-105 consumer-centered services, 29, 71 home health care, 206, 207-209 informal caregivers, 218 nursing aides, 156, 197-198, 202-203 nursing home personnel, 156, 187, 196-201, 223 personal care, 174 physicians, 62, 199-201 registered and licensed practical nurses, 196-197 residential care staff, 93, 166, 168, 202-203, 204-205 standards, 19, 71, 181 Program of All-Inclusive Care for the Elderly, 70 Proprietary care facilities, see Private sector Prospective payment system, 16, 20, 22, 50, 63, 65, 96-99 (passim), 117, 118, 122, 185-187, 236, 238-244 (passim) Providers and provider quality, 1, 3, 4, 10, 11-14, 41-62, 180-219 accountability, general, 33 attitudes, 28, 187, 195, 228-229, 232 chronically poor providers, 10, 18, 111, 137, 141-142, 148-150, 153-156, 158-162, 251 criminal behavior by providers, 1, 13, 24, 78, 79, 138, 189, 192, 215-217 day care, 43, 59 personnel standards, 11, 12, 13, 19, 71, 74, 96-97, 142, 167, 180-219 (passim) assisted living, 202, 203-204 cost factors, 13, 205, 194-195, 219 federal government, general, 11, 181, 182-183, 191-194 home health care agencies, 181, 205-209, 212-213, 216 Medicaid, 182, 193, 198, 201, 215, 216 Medicare, 182, 193, 197-198, 201, 216 nursing homes, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216 personal care services, 18, 102-103, 173, 174 residential care, general, 202-203 state, 11, 19, 181, 182-183, 202, 215-216 personnel-to-residents ratios, 12, 187, 190, 191, 192, 202 staffing issues, general, 11-14, 19, 32, 61, 109, 112, 113, 114-115, 134, 163 standards, facilities, 11, 33-34, 135-179 Psychological factors, see Mental health and illness Psychotropic medications, see Physical and chemical restraints Public education, 3, 19, 249, 292 advocacy and, 175, 177 children, 133 children, special education, 71 mass media, 1, 9, 21, 24, 61, 135, 213 social services defined, 27 Q Quality management systems, 14, 15, 221, 222-223 Quality of life, general, 10, 12-13, 20, 23, 42, 74, 179, 234, 287-288 adult foster care homes, 95 advocacy, 176 attitudes and, 29-30 board and care homes, 46, 92 consumer-centered care, 29, 32-33 cultural attitudes, 22 defined, 29-30, 84 nursing homes, 5, 6, 12, 32, 84-90, 108, 142, 143, 155, 156, 192, 231 pain and pain management, 77, 78, 80, 83-84, 150 REAL (real experiences and assessment of life), 85, 86 regulatory issues, 10, 77, 78, 80, 83-84, 139, 141, 142, 143, 150 research methodology, 84-87, 90 residential care, general, 10, 108, 292-293 see also Functional status; Incontinence; Nutrition; Pressure sores; Privacy and dignity; Safety issues

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Improving the Quality of Long-Term Care R Race/ethnicity of care users, 39 board and care homes, 46 consumer satisfaction, 129 home health care, 51 nursing homes, 39, 43 RAI, see Resident Assessment Instrument REAL (real experiences and assessment of life), 85, 86 Recreational services, 46, 92, 95 Registered nurses (RNs), 11, 60, 180, 216 board and care homes, 202 education, 196-197 home health care, 51, 54, 61, 169-173, 206, 207, 208, 213, 291 number of, 61 nursing homes, 61, 113, 182, 183, 187, 188-190, 191, 192-194, 212, 237 wages, 194, 213 Regulatory issues, 3, 4, 5, 7, 9-10, 135, 136-140, 291-293 advocacy and, 177 arguments for and against regulation, 138-140 assisted living, 93, 94, 166 attitudes of enforcement personnel, 141 board and care homes, 45, 46, 91, 92, 163-169 consumer-centered care, 33, 136, 138, 148, 165-166, 170 cost factors, general, 139, 140 dispute resolution, 144, 162 funding and, 18, 138 home and community-based services, 102-103, 138 home health care agencies, 167-168, 169-173, 206-209 information systems, 7, 110 nursing homes, 138, 140-153 advocacy and, 176-177 dispute resolution, 144, 162 federal, 3, 5-6, 7-8, 9, 10-11, 12, 14, 15, 16, 18, 21, 79, 80, 81, 83, 89, 90, 136-137, 139-163 inspection of facilities, 18, 37, 42, 76, 81, 82, 112, 113, 114-115, 137, 142-158 sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 158-162 state, 9, 10-11, 18, 20, 89, 140-163 nutrition, 3, 10, 142, 143, 150, 153 On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237 paraprofessionals, general, 9, 138-139 personal care services, 18, 102-103, 173, 174 physical and chemical restraints, 3, 6, 139 quality of life, 10, 77, 78, 80, 83-84, 139, 141, 142, 143, 150 Resident Assessment Instrument (RAI), 7-8, 111, 115-120 minimum data set (MDS), 8, 14, 15, 76, 90, 116-120, 149, 150, 221, 225-227 residential care, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293 sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 159-160 state survey regulations, 18, 42, 137, 142-163, 164, 251 see also Accreditation; Certification; Legislation; Licensure; Standards Rehabilitation Act, 55 Rehabilitation services and facilities, 8, 12, 22, 30, 41, 55, 64, 65, 77, 79, 89, 98, 113, 116, 143, 182, 190 see also Occupational therapy; Physical therapy; Speech and language therapy Relatives, see Family members Religious institutions, informal caregivers, 3, 59 Research methodology, 37 assessment instruments, 8-10, 18, 37, 40, 47, 109, 117-123 (passim), 127-134, 143-144, 150-152 nursing home research/inspection surveys, 84-87, 90, 143-144, 150-152, 153 quality of life studies, 84-87, 90 see also Information systems Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128 see also Minimum data set Resident assessment protocols (RAPs), 8, 115, 225, 226, 227-228

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Improving the Quality of Long-Term Care Residential care settings, 1, 3, 6, 22, 25, 108-109, 124-125, 127 advocacy, 168, 202-203, 293 casemix, 202 cognitive factors, 46-47, 166, 203-204 community-based services, 22, 41, 45-50, 91-96 cost factors, 166 developmentally disabled persons, 24, 95-96 employment, general, 13, 61, 181 family members, 166 functional mobility, 76, 125 functional status, general, 91 General Accounting Office studies, 93, 94, 163, 165-166, 202 group homes, 41, 45, 49-50, 71, 94, 250 inspection of facilities, 165, 166 licensure, 45, 47, 49, 91-92, 94, 137, 163, 164, 165, 202 Medicaid, 70, 96, 202, 204, 293 Medicare, 202, 204, 293 mental health and illness, 46, 164 minimum data set, 124-125 number of, 43 number of residents in, 1-2, 22-23, 43 paraprofessional personnel, 181 personnel, 108-109, 181, 202-205 personnel, education of, 93, 166, 168, 202-203, 204-205 personnel standards, 202-203 privacy and dignity, 164, 169 quality of life, 10, 108, 292-293 regulatory issues, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293 research funding, 127 safety, 5, 76, 205 time factors, 204-205 see also Adult foster care homes; Assisted living; Board and care homes; Hospice care; Institutional care Resource Utilization Groups (RUGs), 117, 118, 184-186, 193 Respiratory disease, 40 Restraints, see Physical and chemical restraints Rhode Island, 101 Robert Woods Johnson Foundation, 3, 25, 103, 120 S Safety issues, 7, 10, 13, 31, 138, 139, 288 abuse and neglect, 13, 78, 79, 138, 189, 192, 215-217 board and care homes, 92, 163 community-based residential care, 91 home health care agencies, 205 nursing homes, 5, 7, 10, 76, 77, 78-79, 85, 86, 142, 153, 155, 156-158, 198 residential care, 5, 76, 205 see also Physical and chemical restraints Salaries, see Wages and salaries Sanctions, regulatory, see Complaints and complaint resolution; Fines and penalties Securities and Exchange Commission, 213 Social factors and services, 11, 75 adult foster care homes, 94, 95 assessment instrument design, 116, 131 assisted living, 93 attitudes about long-term care needs, 22 board and care homes, 92 care management, 58 definition of social services, 27 friends, 3, 27, 59, 60 funding from 75 home health care, 53, 54 number of social workers, 61 nursing homes, 88, 94, 116, 182, 184, 191 recreational services, 46, 92, 95 residential care, 203 standards of care, 5, 10, 182, 184, 191, 203 see also Family members; Informal care Social Security Act, 66, 68, 163, 206, 207 Social Services Block Grant, 68 see also Supplemental Security Income program Special care units, 22, 43, 113, 241-244 Alzheimer's disease, 113 Specialists and specialization, 12, 62, 70, 104, 124, 187, 189, 190-191, 196 see also Occupational therapy; Physical therapy Speech and language therapy, 11, 71, 121, 180, 182, 184, 189, 206, 207 SSI, see Supplemental Security Income program

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Improving the Quality of Long-Term Care Standards, 3, 5, 9-10, 11, 18, 75, 76, 33-34, 135-179 advocacy and, 177 assessment instruments and methodologies, 8-9, 14, 114, 115-116, 123 assisted living, 10, 47, 93, 164, 166, 168-169, 202, 203-204, 292-293 child care, 104-105 clinical practice guidelines, 14, 15, 221-222, 224, 226-228, 232, 234 cost factors, 13, 15, 194-195, 219, 205, 221, 232 definitional issues, substandard quality of care, 156, 158-159 funding for, 136 home care, 11, 96-97, 167 home health care agencies, 169-173, 181, 205-209, 212-213, 216 inspection of facilities, home health care, 170 nursing homes, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158 residential care, 165, 166 nursing home audit procedures, 114 nursing homes, 140-163, 176-177, 182, 191-195, 235 personnel, 11, 12, 13, 19, 71, 74, 96-97, 142, 167, 180-219 (passim) assisted living, 202, 203-204 cost factors, 13, 194-195, 205, 219 federal government, general, 11, 181, 182-183, 191-194 home health care agencies, 181, 205-209, 212-213, 216 Medicaid, 182, 193, 198, 201, 215, 216 Medicare, 182, 193, 197-198, 201, 216 nursing homes, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216 personal care services, 18, 102-103, 173, 174 residential care, general, 202-203 state, 11, 19, 181, 182-183, 202, 215-216 professional education, 19, 71, 181 purchaser of care, set by, 135 residential care, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293 sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 159-160 social factors and services, 5, 10, 182, 184, 191, 203 state, 10, 11, 19, 181, 182-183, 202, 215-216, 292-293 substandard facilities and programs, 10, 18, 137, 141-142, 148-150, 153-156, 158-162, 251 voluntary, 137, 171-172, 178, 202-203, 204-205 see also Accreditation; Certification; Licensure; Outcomes of care; Regulatory issues State Supplemental Payments, 47, 64, 68 Stroke, 40 Subacute care units, 22, 43, 65, 113, 241-244 Supplemental Security Income program, 68 adult foster care and small group homes, 49 board and care homes, 47, 64, 68, 163 children, 68 State Supplemental Payments, 47, 64, 68 T Tennessee, nursing homes, 80 Texas, 209, 293 Toilet facilities, see Bathroom facilities; Incontinence Training, see Patient education; Professional education and training; Public education Transportation services, 46, 53, 59 U United Hospital Fund, 213 V Veterans Administration, 29, 106 see also Department of Veterans Affairs Visual impairments, 40, 116

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Improving the Quality of Long-Term Care Volunteers and voluntary organizations, 3, 59 accreditation agencies, 122, 137, 171-172, 178, 223 children, consumer-centered care, 72 external oversight, 9 home health care and hospice facilities, 51, 52, 53, 54 nursing homes, 44 religious organizations, 3, 59 residential care, 168-169 standards, voluntary, 137, 171-122 178, 202-203, 204-205 see also Advocacy; Informal care W Wages and salaries, 13-14, 19, 61, 180, 187, 194-195, 210, 211, 213-215, 242 assisted living, 94 Washington, D.C., see District of Columbia Washington State, 293 Weight problems, 74, 78, 118, 150 Welfare, see Medicaid; Supplemental Security Income program Wisconsin, 245, 246 Women, see Gender factors World Wide Web, see internet