Unloving Care Revisited: The Persistence of Culture

SUMMARY In the almost 25 years since Unloving Care was written, there have been substantial changes in the characteristics of nursing homes, their residents, their staffs, and the regulatory structures in which they operate. But some of the chronic malaise that characterizes the dominant culture in many nursing homes appears to be remarkably persistent. As I argued in Unloving Care, significant improvements in the quality of life and quality of care in nursing homes-and as both cause and effect, in the culture of nursing homes-will only be achieved once we have a clearer consensus on the roles we want nursing homes to play in the health care and long-term care systems. The generalized confusion in this area continues to be exacerbated by the twists and turns of public policy.