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Quality of Long-Term Care - Future Approaches

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Total quality management (TQM) represents a major new approach to managing long-term care. TQM is the integration of a customer-focused, continuous-improvement philosophy, analytical skills, people skills, and a structure and organization within an internal and external culture (organizational or corporate culture which represents the values and beliefs of the organization) driven by leadership. The uniqueness and power of TQM is the integration and balance of the different components, not in the use of its individual parts. Moreover, TQM is grounded in a philosophy of meeting and exceeding customer-defined requirements and working for continuous improvement.

Recent work on quality has identified five principles that are applicable to quality efforts in long-term care:

  1. Providers must know their customers. Quality improvement suggests that organizations have a range of customers. It is essential for agencies to recognize the many different customer groups that they serve. In long-term care, important customer groups such as home-health or nursing-home aides are often ignored.
  2. Providers must listen to consumers. Quality improvement indicates knowing what consumers want and how they feel about the long-term care service delivered is an essential ingredient in achieving quality.
  3. Information is essential for good decision making. For many agencies, basic information about the service recipients, costs, and outcomes of care are simply not available. Quality improvement suggests that agencies must be able to use systematic information to make decisions.
  4. The group is smarter than the individual. This principle states that, in the problem solving and improvement process, a group, in this case, a group of individuals involved in the delivery of service, will make better decisions than an individual, and therefore must be involved in changing the way care is delivered.
  5. Suboptimization is a key challenge facing organizations. Suboptimization occurs when one unit maximizes its efficiency at the expense of other units within the organization. Rather than having individual department or unit goals, agencies need to have a common goal—quality long-term care service.

Implementing total quality principles requires a clear commitment to continuously improving the quality of services delivered. Such programs are not easy to develop, but without a solid approach to involving consumers in the quality process, it is difficult to achieve the quality goals desired by providers and consumers.

SHAWN DAVIS ROBERT A. APPLEBAUM

See also AGING IN PLACE; ASSISTED LIVING; HOME CARE AND HOME SERVICES; LONG-TERM CARE; NURSING HOMES.

BIBLIOGRAPHY

APPLEBAUM, R., and DAVIS, S. "Long-Term Care Off to the Races: But Does Anyone Know Where the Finish Line Is?" The Gerontologist 40 (2000): 377–379.

APPLEBAUM, R.; STRAKER, J.; and GERON, S. Assessing Satisfaction in Health and Long-Term Care; Practical Approaches to Hearing the Voices of Consumers. New York: Springer, 2000.

Assisted Living Quality Coalition. Assisted Living Quality Initiative: Building a Structure that Promotes Quality. Washington, D.C.: ALQC, 1998.

CRAMER, B.; HARMUTH, S.; and GAMBLE, E. Comparing State Efforts to Address the Recruitment and Retention of Nurse Aide and Other Paraprofessional Aide Workers. Raleigh, N.C.: North Carolina Division of Facility Services, 1999.

EUSTIS, N.; KANE, R.; and FISCHER, L. "Home Care Quality and Home Care Workers: Beyond Quality Assurance as Usual." The Gerontologist 33 (1993): 47–54.

HARRINGTON, C.; CARRILLO, S.; THOLLAUG, P.; and SUMMERS, R. "Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1991 through 1997." Washington, D.C.: Health Care Financing Administration. www.hcfa.gov/medicaid

HAWES, C.; ROSE, M.; and PHILLIPS, C. A National Study on Assisted Living for the Frail Elderly: Results of a National Survey of Facilities. Beachwood, Ohio: Myers Research Institute, Menorah Park Center on Aging, 1999.]

Institute on Medicine. Best at Home: Assuring Quality Long-Term Care in Home and Community-Based Settings. Washington, D.C.: National Academy Press, 1996.

Institute on Medicine, Committee on Improving Quality in Long-Term Care. Improving the Quality of Long-Term Care. Washington, D.C.: National Academy Press, 2001.

Institute on Medicine, Committee on Nursing Home Regulation. Improving the Quality of Care in Nursing Homes. Washington, D.C.: National Academy Press, 1986.

KANE, R.; KANE, R.; and LADD, R. The Heart of Long-Term Care. New York: Oxford University Press, 1998.

MOLLICA, R., and SNOW, K. State Assisted Living Policy: 1996. Portland, Maine: National Academy for State Health Policy, 1996.

PHILLIPS, C. "Measuring and Assuring Quality Care in Nursing Homes." In Linking Quality of Long-Term Care and Quality of Life. Edited by L. Noekler and Z. Harel. New York: Springer, 2001.

PHILLIPS, C.; MORRIS, J.; HAWES, C.; FRIES, B.; MOR, V.; NENNSTIEL, M.; and IANNACCHIONE, V. "Association of the Resident Assessment Instrument (RAI) with Changes in Function, Cognition, and Psychosocial Status." Journal of the American Geriatrics Society 45, no. 8 (1997): 986–993.

SCANLON, WILLIAM. Nursing Workforce: Recruitment and Retention of Nurses and Nurse Aides Is a Growing Concern. GAO-01-750T. Washington, D.C.: United States Governmental Printing Office, 2001.

U.S. General Accounting Office. Assisted Living: Quality of Care and Consumer Protection Issues in Four States. Washington, D.C.: U.S. Governmental Printing Office, 1999.

U.S. General Accounting Office. Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies. Washington, D.C.: U.S. Governmental Printing Office, 1997.

U.S. General Accounting Office. Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Standards. Washington, D.C.: U.S. Governmental Printing Office, 1999.

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