Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies' Report on the Quality of Care in Nursing Homes

The National Academies of Sciences, Engineering, and Medicine (NASEM) Committee on the Quality of Care in Nursing Homes had a broad mandate: to examine how the United States “delivers, finances, measures, and regulates the quality of nursing home care” (National Academies of Sciences, Engineering, and Medicine, 2022, p. xvii). The resultant goals and associated recommendations encompass a broad array of strategies and actors needed to improve the quality of care. At their core are a vision and guiding principles that, if enacted, the Committee asserts will transform the day-to-day delivery of care: “nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses benefits and risks of care and treatments” (National Academies of Sciences, Engineering, and Medicine, 2022, p. 498i). Care delivery must be person centered: that is, care that meets the unique needs, goals, values, and preferences of residents. Despite the long-standing expectation that the care provided to nursing home residents is holistic and focused on individual needs and preferences, the Committee found that, even prior to the coronavirus disease 2019 (COVID19) pandemic, the quality of care in nursing homes was neither consistently comprehensive nor of high quality. Furthermore, the regulations that have been in place for 35 years have not been fully enforced. Failures in care delivery involve many aspects of care and have myriad causes. Some of these causes include inadequately prepared and compensated staff, high administrative and staff turnovers, a lack of health information technology to support care coordination, the complex psychosocial and medical needs of residents, and regulations that incentivize care that is not aligned with patients' or residents' goals and preferences. Based on these findings, the Committee articulated seven overarching goals to improve the quality of nursing home care. This paper focuses on selected issues in care delivery, quality measurement, and quality improvement. We provide an overview of the goals and recommendations associated with these three areas. Then, we then suggest action steps for those working to improve and provide care and services to nursing home residents or other services to the nursing home industry. We conclude with implications for gerontological leaders, clinicians, and policy-makers. Received: 26 January 2023 Accepted: 26 January 2023