The taste for regulation in long-term care

Concerns about the quality of long-term care have resulted in an extensive array of regulations governing provider behavior. This article reports the results of a survey of 1,147 long-term care specialists on issues related to the government's performance in assuring quality and improving care. With the exception of providers, more than half of specialists ranked the quality of the average nursing home as fair or poor; home health agencies and even assisted-living facilities fared only somewhat better. Yet despite the perceived ineffectiveness of the current regime, the majority of specialists expressed a general willingness to continue pursuing more stringent and enhanced enforcement and to proceed down the same path with assisted-living facilities. Furthermore, while most were not sanguine about public reporting, the majority favored pay-for-performance, even though both rely on the same information. In addition to constituency group affiliation, differences in views derived largely from respondents' ideological predispositions.