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Regulating U.S. nursing homes: are we learning from experience?

K Walshe1

  • 1Health Services Management Centre, University of Birmingham, United Kingdom.

Health Affairs (Project Hope)
|January 31, 2002
PubMed
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Despite decades of regulation, U.S. nursing home quality remains poor. This paper examines the regulatory system

Area of Science:

  • Healthcare policy
  • Gerontology
  • Public health

Background:

  • Nursing home quality of care is a long-standing public concern in the U.S.
  • Existing state licensure and federal certification systems have not resolved issues of poor quality, neglect, and abuse.

Purpose of the Study:

  • To describe the development of the current nursing home regulatory system.
  • To examine the impact of this regulatory system.
  • To identify characteristics that may hinder regulatory effectiveness based on broader regulatory literature.

Main Methods:

  • Historical review of the nursing home regulatory system.
  • Analysis of the impact of current regulations.
  • Literature review on regulatory effectiveness.

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Main Results:

  • The current complex regulatory system has been in place for over thirty years.
  • Despite regulatory efforts, endemic problems of poor quality, neglect, and abuse persist.
  • Certain characteristics of the regulatory system may have limited its effectiveness.

Conclusions:

  • Future regulatory reform requires greater attention to lessons learned from regulation in other fields.
  • Increased utilization of research and formative evaluation is recommended for improving nursing home oversight.