Nursing home quality: a framework for analysis

Previous efforts to evaluate nursing home quality have been hampered by the lack of a conceptual model that specifies the major components and specifically associates measurable indicators with quality. An extensive literature review reveals many fragmented pieces of information, but no framework in which to fit the pieces together. The model presented here identifies four major dimensions of nursing home quality: (a) staff intervention, (b) physical environment, (c) nutrition/food service, and (d) community relations. These dimensions go beyond traditional "quality of care" by including quality-of-life considerations as well. The dimensions are each further divided into two subdimensions. I propose that measurable indicators for each of these eight subdimensions can be combined to make an effective and comprehensive quality measure.