Nursing Home Care in the USA

Nursing homes (NHs) remain a critical element of the healthcare continuum, accommodating an increasingly frail and dependent population of primarily older adults. The NH Reform Act of 1987 dramatically changed the provision of care in NHs by setting quality standards and defining key processes of care. The majority of NHs are for-profit, have an average of 106 beds, and operate within a strict regulatory framework defined by both federal and state government. Medical care in the NH is provided by physicians, nurse practitioners, and physician assistants under the stewardship of the medical director. Specific medical staff organizational models exist, some of which have been associated with improved care outcomes. The delivery of medical care in the NH is complex given the high prevalence of physical and psychological illness. Timely and accurate diagnosis and treatment is challenging as medical providers are often not on site and resources in the NH are constrained. Mandated quality improvement processes assure timely problem identification and continuous performance improvement.