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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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THE NATIONAL IMPERATIVE TO IMPROVE

NURSING HOME QUALITY

Honoring Our Commitment to Residents, Families, and Staff

Committee on the Quality of Care in Nursing Homes

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by The John A. Hartford Foundation, The Commonwealth Fund, The Sephardic Foundation on Aging, Jewish Healthcare Foundation, and The Fan Fox & Leslie R. Samuels Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-68628-0
International Standard Book Number-10: 0-309-68628-8
Digital Object Identifier: https://doi.org/10.17226/26526
Library of Congress Catalog Number: 2022935879

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Copyright 2022 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation:
National Academies of Sciences, Engineering, and Medicine. 2022. The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff. Washington, DC: The National Academies Press. https://doi.org/10.17226/26526.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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COMMITTEE ON THE QUALITY OF CARE IN NURSING HOMES

BETTY R. FERRELL (Chair), Director and Professor, City of Hope National Medical Center, Division of Nursing Research and Education

GREGORY L. ALEXANDER, Professor of Nursing, Columbia University School of Nursing

MARY ERSEK, Senior Scientist, Department of Veteran Affairs; Professor of Palliative Care, University of Pennsylvania Schools of Nursing and Medicine

COLLEEN GALAMBOS, Helen Bader Endowed Chair in Applied Gerontology and Professor, University of Wisconsin–Milwaukee; Adjunct Professor, Medical College of Wisconsin

DAVID C. GRABOWSKI, Professor of Health Care Policy, Harvard Medical School

KATHY GREENLEE, Chief Executive Officer, Greenlee Global LLC

LISA G. KAPLOWITZ, Physician Consultant, COVID Vaccine Unit, Virginia Department of Health

R. TAMARA KONETZKA, Louis Block Professor of Public Health Sciences, University of Chicago

CHRISTINE A. MUELLER, Professor and Senior Executive Associate Dean for Academic Programs, University of Minnesota School of Nursing

MARILYN J. RANTZ, Curators’ Professor Emerita, University of Missouri Sinclair School of Nursing

DEBRA SALIBA, Director, Borun Center and Professor of Medicine, University of California, Los Angeles; Physician Scientist, Geriatric Research Education and Clinical Center, Los Angeles Veterans Health Administration; Senior Natural Scientist, RAND

WILLIAM SCANLON, Consultant, West Health

PHILIP D. SLOANE, Goodwin Distinguished Professor of Family Medicine and Geriatrics, School of Medicine and Co-Director, Program on Aging, Disability and Long Term Care, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill

DAVID G. STEVENSON, Professor, Department of Health Policy, Vanderbilt University School of Medicine; VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC)

JASMINE L. TRAVERS, Assistant Professor, Rory Meyers College of Nursing, New York University

REGINALD TUCKER-SEELEY, Vice President, Health Equity, ZERO-The End of Prostate Cancer; Edward L. Schneider Assistant Professor of Gerontology, Leonard Davis School of Gerontology, University of Southern California

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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RACHEL M. WERNER, Executive Director, Leonard Davis Institute of Health Economics; Professor of Medicine, University of Pennsylvania; Core Investigator, Crescenz Veterans Affairs Medical Center

Study Staff

LAURENE GRAIG, Study Director

TRACY A. LUSTIG, Study Director

KAITLYN FRIEDMAN, Associate Program Officer (through December 2021)

NIKITA VARMAN, Research Associate

RUKSHANA GUPTA, Research Assistant

MICAH WINOGRAD, Financial Officer

ANNE MARIE HOUPPERT, Senior Librarian

SHARYL J. NASS, Director, Board on Health Care Services

Consultants

JOE ALPER, Science Writer

MARISA G. PINEAU, FrameWorks Institute

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by CHRISTINE K. CASSEL, University of California, San Francisco, and DAVID B. REUBEN, University of California, Los Angeles. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Acknowledgments

The study committee and the Health and Medicine Division (HMD) project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and to inform deliberations.

This committee appreciates the sponsors of this study for their generous financial support: The John A. Hartford Foundation, The Commonwealth Fund, Jewish Healthcare Foundation, The Sephardic Foundation on Aging, and The Fan Fox & Leslie R. Samuels Foundation. The contents provided do not necessarily represent the official views of the sponsors.

The committee benefited greatly from discussions with individuals who made presentations during the committee’s open sessions and participated in the discussions:

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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The committee is very grateful to these presenters for volunteering to share their knowledge, data, and expert opinions with the committee and the members of the public who attended the committee’s open sessions. The committee also appreciates the many nursing home residents, families, and staff who submitted their perspectives and experiences.

Deep appreciation goes to staff at the National Academies of Sciences, Engineering, and Medicine for their efforts and support in the report process, especially to Dana Korsen, Stephanie Miceli, Devona Overton, Marguerite Romatelli, Tina Seliber, Lauren Shern, Leslie Sim, Dorothy Zolandz, and the staff of the National Academies Research Center, including Rebecca Morgan. The committee also gives special thanks to Joe Alper for

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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his writing and editing contributions, Marissa Pineau for her messaging and framing expertise, and Annalee Gonzales for her graphic design support.

Finally, the committee also recognizes and extends gratitude for all the nursing home residents, families, staff, and organizations that have fought tirelessly to improve nursing home care.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Preface

The Committee on the Quality of Care in Nursing Homes began their work in the fall of 2020 at a pivotal time when a bright light had been cast on care delivered in nursing homes because of the COVID-19 pandemic. While much of society previously had little awareness of the care delivered in nursing homes, the evening news channels and social media projected daily images of the pandemic’s impact and of the inadequate care that put the safety of both residents and staff at risk while distraught family members watched from afar as their frail older loved ones were kept in isolation. The committee worked to describe the care being delivered in nursing homes before the pandemic, now made manifest by the crisis.

The committee was given a substantial task of examining how the United States “delivers, finances, measures, and regulates the quality of nursing home care.” The challenge was enormous, but as reflected in the final recommendations, real change in nursing home care will require bold action in each of these domains. In the report chapters that follow, the committee presents the evidence of the need for change followed by specific recommendations. The final chapter concludes that “the way the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.”

The discussions of the committee often centered around core values of a society that truly cares for the most vulnerable. We began our work with creating a word map of key words and phrases that described what we all hoped for in nursing home care. Words such as safety, equity, peaceful, joyous, integrity, and comfort were often shared as we all imagined what care in a nursing home should be. The committee members were constantly

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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aware of the data, literature, and daily news stories of the travesties in nursing home care as they wrote this report. The committee also recognized the many examples of outstanding care being provided in nursing homes and realized that across the United States nursing home staff representing all disciplines are each day providing wonderful care to residents who they consider as beloved family members. Sadly, these staff have put their own lives at risk and are often not well trained, supported, or compensated. This report and the committee’s recommendations assert strongly that residents of nursing homes need better care—and the people caring for them also need better care. The committee report is clear that we will not realize good-quality care of residents until we invest in the bedside staff who care for them.

The committee often reflected on the 1986 Institute of Medicine report Improving the Quality of Care in Nursing Homes, which was a critical milestone yet whose recommendations were not fully realized. As a nation we have made promises for better care in nursing homes, and those promises have not been kept. Our hope is that commitment and promises for quality nursing home care that were voiced throughout the pandemic will become promises kept. The recommendations from the committee are thoughtful and strategic. Perhaps the committee’s biggest challenges came when we tried to balance the need for very aggressive, overdue change with the reality of limited resources, competing priorities, and the complexity of systems change. We believe the recommendations in this report achieve that balance of what is possible and what is desperately needed.

Is it too much to ask that each and every resident in every nursing home receives care that includes high-quality physical care, behavioral health, safety, and psychological support? Is it too much to ask for a plan of care to establish what is most needed for each resident to receive high-quality care that is truly person centered? Are we too bold to recommend on-site registered nurse coverage in nursing homes, a social worker, and an infection control specialist? After all that we have witnessed during the COVID-19 pandemic, is it too much to ask that nursing assistants are better trained to deliver care to often frail people with limited social support or resources in the last years of their lives? It is not too much to ask that all residents receive good-quality care regardless of race, ethnicity, or geographic location? In fact, the recommendations in this report are no more than what any one of us would want for ourselves or for those we love if we or they were in a nursing home. How can we not accept the committee’s recommendations and profoundly change the delivery of care in U.S. nursing homes?

As with the evaluation of most areas of significant importance to our society, adopting and implementing the recommendations of this report will require more than funding, organizational commitment, education, and changing health policy—it will require moral courage. Improving the

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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quality of care in nursing homes for the decades ahead will be a continuing process requiring research to strengthen our knowledge of best care, test models to deliver that care, and investment in the education and training of all of those who work in nursing homes. The recommended approach is bold, but it is possible. But most importantly, it is right. Indeed, improving nursing home care is a moral imperative because it is clearly the right thing to do. It is also a national imperative because it represents society’s commitment to caring for those who cannot care for themselves.

It has been a great privilege to have served as chair of this committee. This report will be published as I celebrate my 45th year as a nurse, and I consider it one of the highlights of my career to have devoted over a year to working with this committee of some of the most dedicated colleagues I have known. Most have devoted their careers to advocating for improved care in nursing homes—a pursuit that has not been well funded, often recognized, or rewarded. These members each brought their knowledge and their passion for improved care to the table.

We are in great debt to the staff of the National Academies for their commitment to this work. Laurie Graig and Tracy Lustig as senior program staff led the project with the greatest integrity and vision. The entire staff of the National Academies, including Kaitlyn Friedman, Nikita Varman, and Rukshana Gupta, offered their dedication, organization, and energy to a task that at times seemed overwhelming.

As a nation, we will hopefully see the COVID-19 pandemic resolve in the months that will follow the release of this report. It will be too easy to turn our eyes away from the reform needed in nursing home care. This is the moment; this is the time to keep the promise of better care for those who are the most vulnerable in our society. The committee has delivered the blueprint to build a system of care that honors those who call the nursing home their home and the dedicated staff who care for them. Improving care in nursing homes is possible. It can be done. It must be done.

Betty Ferrell, Ph.D., FAAN, FPCN, CHPN, Chair
Committee on the Quality of Care in Nursing Homes

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Acronyms and Abbreviations

AADNS American Association of Directors of Nursing Services
ABPLM American Board of Post-Acute and Long-Term Care Medicine
ACA Patient Protection and Affordable Care Act
ACL Administration for Community Living
ACO accountable care organization
ACP advance care planning
ADE adverse drug event
ADL activity of daily living
ADRD Alzheimer’s disease and related dementias
AHCA American Health Care Association
AHRQ Agency for Healthcare Research and Quality
AMDA Society for Post-Acute and Long-Term Care Medicine
AONL American Organization for Nursing Leadership
APM alternative payment model
APRN advanced practice registered nurse
APS adult protective services
ATOP Nevada Admissions and Transitions Optimization Program
BIPOC Black, Indigenous, and other people of color
BPCI Bundled Payments for Care Improvement Initiative
BSW bachelor’s degree in social work
CAH critical access hospital
CAHPS Consumer Assessment of Healthcare Providers and Systems
CASPER Certification and Survey Provider Enhanced Reporting
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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CDC Centers for Disease Control and Prevention
CE continuing education
CHIP Children’s Health Insurance Program
CJR Comprehensive Care for Joint Replacement Model
CLASS Act Community Living Assistance Services and Supports Act
CMMI Center for Medicare and Medicaid Innovation
CMS Centers for Medicare & Medicaid Services
CNA certified nursing assistant
COVID-19 severe acute respiratory syndrome coronavirus-19 (SARS-CoV-2)
CRB care-resistant behavior
C-SNP chronic condition special needs plan
CSWE Council on Social Work Education
DHS U.S. Department of Homeland Security
DNR do not resuscitate
DOJ U.S. Department of Justice
D-SNP dual special needs plan
ECHO Extension for Community Healthcare Outcomes
ED emergency department
EHR electronic health record
eMAR electronic medication management system
EMR electronic medical record
ESF emergency support function
FEMA Federal Emergency Management Agency
FFS fee-for-service
FIDE fully integrated dual eligible
FY fiscal year
GAO U.S. Government Accountability Office
HAI health care–associated infection
HHS U.S. Department of Health and Human Services
HIE health information exchange
HIT health information technology
HITECH Health Information Technology for Economic and Clinical Health Act of 2009
HRSA Health Resources and Services Administration
HUD U.S. Department of Housing and Urban Development
IHI Institute for Healthcare Improvement
INTERACT Interventions to Reduce Acute Care Transfers
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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IOM Institute of Medicine
I-SNP institutional special needs plan
LGBTQ+ lesbian, gay, bisexual, transgender, queer (or questioning), and others
LPN licensed practical nurse
LTC long-term care
LTSS long-term services and supports
LVN licensed vocational nurse
MA Medicare Advantage
MCWB Mouth Care Without a Battle
MDS Minimum Data Set
MedPAC Medicare Payment Advisory Commission
MIPS Merit-Based Incentive Payment System
MOQI Missouri Quality Initiative
MSW master’s degree in social work
NAICS North American Industry Classification System
NASW National Association of Social Workers
NCAL National Center for Assisted Living
NIH National Institutes of Health
NNHI National Nursing Home Initiative
NP nurse practitioner
NQF National Quality Forum
NRF National Response Framework
NY–RAH New York–Reducing Avoidable Hospitalizations
OBRA 87 Omnibus Budget Reconciliation Act of 1987
OIG U.S. Office of the Inspector General
ONC Office of the National Coordinator for Health Information Technology
OPTIMISTIC Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care
OTC over the counter
P4P pay-for-performance
PA physician assistant
PASRR preadmission screening and annual resident review
PDPM patient-driven payment model
PIPP Minnesota Performance-Based Incentive Payment Program
POLST physician’s order for life-sustaining treatment
PPE personal protective equipment
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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QAPI quality assurance and performance improvement
QIO Quality Improvement Organization
QIPMO Quality Improvement Program for Missouri
QOL quality of life
RAI Resident Assessment Instrument
RAVEN Reduce Avoidable Hospitalizations using Evidence-Based Interventions for Nursing Facilities
REIT real estate investment trust
RN registered nurse
SAPO state-authorized portable order
SCTT Systems Change Tracking Tool
SFF Special Focus Facility
SMI serious mental illness
SNF skilled nursing facility
SNFist skilled nursing facility specialist
SNP special needs plan
VA U.S. Department of Veterans Affairs
VBP value-based payment
VHA Veterans Health Administration
WISH Act Well-Being Insurance for Seniors to be at Home Act
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Abstract

Nursing homes play a unique dual role in the nation’s long-term care continuum, serving both as a place where people receive needed health care and a place they call home. Although long-term care is increasingly being provided in home- and community-based settings, nursing homes will likely always be needed for individuals who cannot get the level of care they require in those settings. The 1986 Institute of Medicine1 report Improving the Quality of Care in Nursing Homes described numerous concerns, including neglect and abuse of nursing home residents, poor quality of life, excessive cost, inconsistent (or lack of) oversight, and the need for high-quality data. While many improvements have been made since then, the enormous toll that the COVID-19 pandemic had on nursing home residents, their families, and staff has brought new attention to the longstanding shortfalls that continue to plague nursing homes.

This report identifies critical opportunities to improve the quality of care in nursing homes through both short- and long-term actions across a wide variety of domains. Many recommendations will require dedicated coordination among federal and state governments, nursing homes, health care and social care providers, payers, regulators, researchers, and others as well as the active engagement of residents and their families. The nursing home sector urgently needs to be strengthened so that it can

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1 As of March 2016 the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine (National Academies) continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM). The IOM name is used to refer to reports issued prior to July 2015.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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respond effectively to the next public health emergency as well as drive critically important and urgently needed innovations to improve the quality of nursing home care. Implementation of the committee’s integrated set of recommendations will move the nation closer to making high-quality, person-centered, and equitable care a reality for all nursing home residents, their chosen families, and the nursing home staff who provide care and support them in achieving their goals.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. Washington, DC: The National Academies Press. doi: 10.17226/26526.
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Next: Summary »
The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff Get This Book
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Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of nursing home care have resulted in a system that often fails to ensure the well-being and safety of nursing home residents. The devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.

With support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff identifies seven broad goals and supporting recommendations which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes.

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