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Notes CHAPTER 1 The original contract specified a 22-month study. The contract completion date was subsequently extended 7 months. 2. U.S. Senate Special Committee on Aging. 1974. Nursing Home Care in the United States: Failure in Public Policy. Washington, D.C.: U.S. Government Printing Office. 3. Mendelson, Mary Adelaide. 1974. Tender Loving Creed. 4. Moss, Frank, and Vat Halamanderis. 1977. Too Old, Too Sick, Too Bad--Nursing Homes in America. Germantown, Maryland: Aspen Systems Corporation. 5. Arkansas Legislative Joint Performance Review Committee. 1978. Nursing Home Study--1978: Evaluation of State Regulation of the Nursing Home Industry. 6. Commission on California State Government Organization and Economy. 1983. The Bureaucracy of Care: Continued Policy Issues for Nursing Home Services and Regulation. 7. Auditor General of California. 1982. The Department of Health Services. Long-Term Care Facilities. 213

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214/ NOTES S. Colorado Attorney General's Office. 1977. Report of the Attorney General Concerning the Regulation of the Nursing Home Industry in the State of Colorado. 9. Governor's Blue Ribbon Nursing Home Commission. 1976, 1980. Report of the Blue Ribbon Committee to Investigate the Nursing Home Industry in Connecticut. 10. Office of the Inspector General, Florida Department of Health and Rehabilitative Services. 1981. Nursing Home Evaluative Report. 1. Office of the Inspector General, Florida Department of Health and Rehabilitative Services. 1983. An Evaluation of the District XI Long-Term Care Unit. 12. Illinois Legislative Investigating Commission. 1984. Regulation and Funding of Illinois Nursing Homes. 13. Maryland Commission on Nursing Homes. 1973. Report of the Governor's Commission on Nursing Homes. 14. Plante and Moran Consultants Inc. 1981. Michigan Department of Public Health, Bureau of Health Care Administration, Division of Health Facilities Certification and Licensure Management and Operations Review. 15. Minnesota House and Senate Select Committees on Aging. 1976. Final Report, Nursing Home Study. 16. New Jersey State Nursing Home Study Committee. 1978. New Jersey Report on Long-Term Care. 17. New York State Moreland Act Commission. 1975. Regulating Nursing Home Care: The Paper Tigers. 18. New York State Moreland Act Commission. 1976. Long-Term Care Regulation: Past Lapses, Future Prospects. 19. Ohio General Assembly Nursing Home Commission. 1978. A Program in Crisis: An Interim Report. 20. Ohio General Assembly Nursing Home Commission. 1979. A Program in Crisis: Blueprint for Action. 21. Oregon Joint Interim Nursing Home Task Force. 1978. Report of the Joint Interim Task Force on Nursing Homes. 22. State of Texas Nursing Home Task Force. 1979. Report on Nursing Homes to the Attorney General of the State of Texas. 23. Joint Legislative Audit and Review Commission. 1978. Long-Term Care in Virginia.

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NOTES/215 24. Spalding, Joy. 1985. A Consumer Perspective on Quality Care: The Residents' Point of View. Analysis of Residents' Discussions. National Citizens' Coalition for Nursing Home Reform. Washington, D.C. 25. Weisbrod, B. A., and M. Schlesinger. December 1983. Public, Private, Non-Profit Ownership and the Response to Asymmetric Information: The Case of Nursing Homes. Unpublished paper. 26. U.S. House of Representatives. Select Committee on Aging. July 1985. America's Elderly at Risk. Washington, D.C.: U.S. Government Printing Office. 27. Scanlon, William J. 1980. Nursing Home Utilization Patterns: Implications for Policy. Journal of Health Politics, Policy and Law 4~4~:619-641. 28. The terms "patients" and "residents" often are used interchangeably when referring to the recipients of care in nursing homes. The current federal regulations pertaining to Skilled Nursing Facilities use the term "patients." The Intermediate Care regulations refer to "residents." The committee prefers the term "residents" for those being cared for in nursing homes because it more clearly conveys the idea that most people admitted to nursing homes live in them for many months or years. 29. The committee received testimony to this effect from dozens of witnesses at the public meetings it conducted in Philadelphia, Atlanta, Dallas, Minneapolis, and Los Angeles in September 1984. Similar testimony was recorded in public hearings conducted by the HCFA in 1978. 30. Katz, S., and C. A. Akpom. 1976. A Measure of Primary Sociobiological Function. International Journal of Health Sciences 6~3~:493-507. The "activities of daily living" are bathing, dressing, toileting, transfer, continence, and feeding. 31. Scanlon, W. J., and J. Feder. January 1984. The Long-Term Care Marketplace: An Overview. Health Care Financial Management. Pp. 1-13. 32. These pressures are attributable primarily to demographic trends--the rapid growth in the numbers of very old and very frail elderly persons in the population, and the constraints on nursing home bed

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216/ NOTES supply which have resulted in a nursing home bed shortage in most parts of the country. Unfortunately, good recent data to demonstrate the increasing proportion of heavy-care residents are not available. The last national nursing home survey was conducted in 1977. The National Center for Health Statistics now plans to conduct its next national survey of nursing homes in 1986. The most recent analysis of the available data is contained in: U.S. General Accounting Office. 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services Are Creating Problems for the States and the Elderly. Report to the Chairman of the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives. GAO/IPE-84- 1, October 21, 1983. 33. Health Care Financing Administration . 1985. Unpublished data based on "cleaned" 1984 Medicare/Medicaid data. 34. U.S. Department of Health and Human Services, Office of Inspector General. April 1982. Board and Care Homes: A Study of Federal and State Actions to Safeguard the Health and Safety of Board and Care Home Residents. Washington, D.C. 35. Sirrocco, A. 1983. An Overview of the 1980 National Master Facility Inventory Survey of Nursing and Related Care Homes. National Center for Health Statistics. 36. National Center for Health Statistics. 1981. Utilization Patterns and Financial Characteristics of Nursing Homes in the United States: 1977 National Nursing Home Survey. Data from the National Health Survey Series B. No. 53, HHS Pub. No. (PH5) 81-1714. 37. U.S. Senate, Special Committee on Aging. 1984. Developments in Aging: 1983. Vol. 1. Washington, D.C. 38. Arnett, R. H. III, C. S. Cowells, L. M. Davidoff, and M. S. Freeland. Spring 1985. Health Spending Trends in the 1980s. Health Care Financing Review. U.S. Department of Labor, Bureau of Labor Statistics. 1984. Employment Projections for 1995, Bulletin 2197. Washington, D.C. 40. U.S. Department of Health, Education, and Welfare. 1974. Enforcement of Life Safety Code Requirements in

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NOTES/217 Skilled Nursing Facilities. Office of Nursing Home Affairs, Public Health Service. January. 41. Smith v. Heckler, 747 F.2d 583 (lOth Cir. 1984~. Smith v. O'Halloran, 557 F. Supp. 289 (D. Colo. 1983), rev'd sub nom. 42. Kemanis, V. 1980. A Critical Evaluation of the Federal Role in Nursing Home Quality Enforcement, 51 University of Colorado Law Review 607. 43. Estimated. The actual fraction may be larger. In states with "medically needy" programs, many of the residents with private incomes below the "medically needy" eligibility ceiling share the costs of nursing home care with Medicaid. 44. National Center for Health Statistics. 1979. The National Nursing Home Survey: 1977 Summary for the United States, Vital and Health Statistics. Data from the National Health Survey Series 13, No. 43. HHS Pub. No. (PHS) 79-1794. 45. U.S. General Accounting Office. October 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services Are Creating Problems for the States and the Elderly. Report to the Chairman of the Subcommittee on Health and the Environment, Committee on Energy and Commerce, House of Representatives. 46. Systemetrics, Inc. December 1983. The MMACS Long-Term Care Data Base: Construction of a New Research File and an Assessment of Its Quality and Usefulness. Report prepared for the Health Care Financing Administration. CHAPTER 2 1. National Center for Health Statistics. April 1981. Characteristics of Nursing Home Residents, Health Status, and Care Received: National Nursing Home Survey, United States, May-December 1977. U.S. Department of Health and Human Services Pub. No. (PHS) 81-1712. 2. Linn, M., and J. Mossey. Summer 1980. The Role of Payment Sources in Differentiating Nursing Home Residents, Services and Payments. Health Care Financing Review.

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218/NOTES Sangl, J. 1982. The Family Support System of Elderly. In Long-Term Care: Perspectives from Research and Demonstrations. R. Vogel and H. Palmer (eds.~. Health Care Financing Administration. 4. Shanas, E. April 1979. The Family as a Social Support System in Old Age. The Gerontologist 19(2): 169- 174. 5. Nahemow, L., and R. Bennett. 1967. Attitude Change with Institutionalization of the Aged. Unpublished Final Report, Biometrics Research, New York State Department of Mental Hygiene. 6. Brown, B. F. November 1980. The Impact of Confidants on Adjusting to Stressful Events in Adulthood. Paper presented at the Annual Meetings of the Gerontological Society of America. San Diego. 7. National Center for Health Statistics. 1979. The National Nursing Home Survey: 1977. Summary for the United States. Washington, D.C.: U.S. Government Printing Office. S. Morris, J. N., S. Sherwood, and E. Bernstein. 1984. Quality of Life Standards in Long-Term Care Institutions. Unpublished paper commissioned by the Institute of Medicine Committee on Nursing Home Regulation and presented at a workshop in December 1984. 9. National Academy of Sciences, Institute of Medicine. 1976. Assessing Quality in Health Care: An Evaluation. 10. Goffman, E. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Innovates. New York: Anchor Books. Katz, S., and C. A. Akpom. 1976. A Measure of Primary Sociobiological Function. International Journal of Health Sciences 6~3~:493-507. 12. Kurowski, B., and P. Shaughnessy. 1982. The Measurement and Assurance of Quality. In Long-Term Care. Pers pectives f rom Research and Demonstrations. R. Vogel and H. Palmer (eds). Health Care Financing Administration. 13. Staff of the Benjamin Rose Hospital. 1958. Multidisciplinary Study of Illness Among Aged

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NOTES /219 Persons: I. Methods and Preliminary Results. Journal of Chronic Disorders 7:332-344. 14. Katz, S., A. Ford, A. Chinn, and V. Newill. 1966. Prognosis After Stroke. Part II. Long-Term Course of 159 Patients. Medicine 45:236-246. Katz, S., P. Vignos, R. Moskowitz, H. Thompson, and K. Svec. 1968. Comprehensive Outpatient Care in Rheumatoid Arthritis, a Controlled Study. Journal of the American Medical Association 206:1249-1254. 16. Steinberg, F., and M. Frost. 1963. Rehabilitation of Geriatric Patients in a General Hospital: A Follow-Up Study of 43 Cases. Geriatrics 1 S: 158- 164. 17. Kark, S. 1974. Disease and Disability. In Epidemiology and Community Medicine. New York: Appleton-Centry-Crof Is. 18. Katz, S., A. Ford, R. Moskowitz, B. Jackson, and M. Jaffe. 1963. Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psycho-Social Function. Journal of the American Med ical Association 185:914-919. 19. Grotz, R. T., N. D. Henderson, and S. Katz. 1972. A Comparison of the Functional and Intellectual Performance of Phenylketonuric, Anoxic and Down's Syndrome Individuals. American Journal of Mental Deficiencies 76~6~:710-717. 20. Mitchell, J. 1978. Patient Outcomes in Alternative Long-Term Settings. Med ical Care 16:439-452. 21. Kurowski, B., R. Schlenker, and G. Tricarico. 1979. Applied Research in Home Health Services, Vol. II: Cost per Episode. Denver, Colorado: Center for Health Services Research, University of Colorado, Health Sciences Center. 22. Chekryn, J., and L. L. Roos. 1979. Auditing the Process of Care in a New Geriatric Unit. Journal of the American Geriatrics Society 27:107-111. 23. Gurland, B., P. Cross, A. Mann, and A. MacDonald. 1984. Comparisons of the Care of the Demented Elderly in New York and London. Pp. 327-337 in Senile Dementia: Outlook for the Future. J. Wertheimer and M. Marois (eds.~. New York: Alan R. Liss, Inc. 24. Mann, A. H., K. Wood, P. Cross, B. Gurland, P. Schieber, and H. Haefnere. 1984. Institutional Care 15.

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220 / NOTES of the Elderly: A Comparison of the Cities of New York, London and Mannheim. Social Psychiatry 19~3~:97- 102. Springer-Verlag. 25. National Academy of Sciences, Institute of Medicine. 1984. Summary of Committee on Nursing Home Regulation Public Meetings on Nursing Home Regulation. Unpublished staff working paper. 26. Cross, P., B. Gurland, and A. Mann. 1983. Long-Term Institutional Care of Demented Elderly People in New York City and London. Bulletin of the New York Academy of Medicine 59~3~:267-275. 27. Kramer, Morton. 1984. Trends of Institutionalization and Prevalence of Mental Disorders in Nursing Homes. In Mental Illness in Nursing Homes: Agenda for Research. Mary Harper and Barry Lebowitz (eds.~. National Institute of Mental Health. Rockville, Maryland. August 1983. 28. U.S. Department of Health, Education, and Welfare. Public Health Service; National Center for Health Statistics. 1980. Health in the United States. Washington, D.C.: HEW Pub. No. (PHS) 78-1232. December 1978. 29. Cohen, G. D. July 1977. Approach to the Geriatric Patient. Medical Clinics of North America 61 (4~:855-866. 30. Campbell, A., P. E. Converse, and W. L. Rodgers. 1976. The Quality of American Life. New York: Russell Sage Foundation. 31. Andrews, F., and S. Withey. 1976. Social Indicators of Well-Being. New York: Plenum Press. 32. Lawton, M. P. 1982. Competence, Environmental Pressure, and the Adaptation of Older People. In Aging and the Environment: Theoretical Approaches. M. Lawton, P. Windley, and T. Byerts (eds.~. New York: Springer-Verlag. 33. Bennett, Clifford. 1980. Nursing Home Life: What It Is anc/t What It Could Be. New York: Tiresias Press. 34. Spalding, Joy. 1985. A Consumer Perspective on Quality Care: The Residents' Point of View. Analysis of Residents' Discussions. National Citizens' Coalition for Nursing Home Reform. Washington, D.C.

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NOTES/221 Gastil, R. 1978. Social Indicators and Quality of Life. Public Administration Review 30:596-601. Morgan, J. N., and J. D. Smith. 1969. Measures of Economic Well-Offness and Their Correlates. American Economic Review 59:912-926. George, L., and L. Bearon. 1980. Qua1tity of Life in Older Persons. Meaning and Measurement. New York: Human Sciences Press. Ward, Daniel H. 1984. A Nursing Home Management System for Doing More for Less: The Responsive Caregiving Model. Unpublished paper commissioned by the Institute of Medicine Committee on Nursing Home Regulation and presented at a workshop in December 1985. Miller, M. B. 1975. Iatrogenic and Nursigenic Effects of Prolonged Immobilization of the Ill Aged. Journal of the American Geriatrics Society 23:360-369. 40. Miller, M. B., H. Clara, and Evelyn M. Hamil. Rehabilitating Patients with Chronic Disease. Nursing Outlook 6:324-325. 41. Margolin, Reuben J., and Francis Hurwitz. 1963. The Number One Need in the Nursing Home? Rehabilitation. Nursing Homes. January 1963 (pt. 1) and February 1963 (pt. 2~. 42. Bier, Ruth Irwin. 1961. Rehabilitation on a Shoestring. The American Journal of Nursing 61:98-100. 43. Donabedian, Avedis. 1980, 1982. Explorations in Quality Assessment and Monitoring: The Definitions of Quality and Approaches to Its Assessment (Vol. 1~; The Criteria and Standards of Quality (Vol. 2~. Ann Arbor, Michigan: Health Administration Press. 44. Katz, S. December 1978. A New Approach to Quality Assurance. Paper presented at the First National Long-Term Care Conference of the Academy for Gerontologic Education and Development. 45. Connelly, K., P. K. Cohen, and D. Walsh. April 1977. Periodic Medical Review: Assessing the Quality and Appropriateness of Care in Skilled Nursing Facilities. The New England Journal of Medicine 296(15~:578-880.

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222 / NOTES 46. Shaughnessy, P., R. Schlenker, B. Harley, N. Shanks, G. Tricarico, V. Perry, B. Kurowski, and A. Woodson. 1980. Long-Term Care Reimbursement and Regulation: A Study of Cost, Case Mix, and Quality. Working Paper 4, First-Year Analysis Report. Denver, Colorado: Center for Health Services Research, University of Colorado Health Sciences Center. 47. Greenberg, J. 1980. Cost, Case Mix, Quality and Facility Characteristics in Minnesota's Nursing Homes: An Exploratory Analysis. First-Year Progress Report. Minneapolis, Minnesota: Center for Health Services Research, University of Minnesota. 48. Linn, M. W., L. Gurel, and B. S. Linn. 1977. Patient Outcome as a Measure of Quality of Nursing Home Care. American Journal of Public Health 67(April):337-344. 49. Lawton, M. 1980. Residential Quality and Residential Satisfaction Among the Elderly. Research on Aging 2:309-328. 50. Larson, R. 1978. Thirty Years of Research on the Subjective Well-Being of Older Americans. Journal of Gerontology 33:109- 125. 51. Bennett, R. 1963. The Meaning of Institutional Life. The Gerontologist 3:117- 125. 52. Coe, R. W. 1965. Self-Conception and Institutionalization. In Older People and Their Social World. A. Rose and W. Peterson (eds.~. Philadelphia: F. A. Davis. 53. Kahana, E., S. Liang, and B. Felton. 1980. Alternative Models of Person-Environment Fit: Prediction of Morale in Three Homes for the Aged. Journal of Gerontology 35:584-595. 54. Lieberman, M. 1974. Relocation Research and Social Policy. The Gerontologist 14:494-501. 55. Noelker, L., and Z. Harel. 1978. Predictors of Well-Being and Survival Among Institutionalized Aged. The Gerontologist 19:562-567. 56. Ray, W., C. Federspiel, and W. Schaffner. 1980. A Study of Antipsychotic Drug Use in Nursing Homes: Epidemiological Evidence Suggesting Misuse. American Journal of Public Health 70(May):485-491.

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NOTES/223 57. Keeler, E., R. L. Kane, and D. Solomon. March 1981. Short- and Long-Term Residents of Nursing Homes. Meclical Care 19~3~:363-369. 58. Langer, E. J., and J. Rodin. 1976. The Effects of Choice and Enhanced Personal Responsibility for the Aged: A Field Experiment in an Institutional Setting. Journal of Personality and Social Psychology 34:191-198. 59. Papsidero, J., S. Katz, S. Kroger, and C. Apkom. 1979. Chance for Change. Implications of the Chronic Disease octet. East Lansing, Michigan: Michigan State University Press. 60. Harley, B., D. Landes, and B. Kurowski. 1981. Working Paper 10. Case Mix and Quality: Design and Development of a Methodology for Data Collection. Denver, Colorado: Center for Health Services Research, University of Colorado, Health Science Center. 61. Kane, Rosalie A. 1984. Working paper for the National Academy of Sciences, Institute of Medicine, Committee on Nursing Home Regulation. 62. Kane, R. L., R. Bell, S. Riegler, A. Wilson, and E. Keeler. 1983. Predicting the Outcomes of Nursing Home Patients. The Gerontologist 23~2~:200-206. 63. Kane, Rosalie A. 1981. Assuring Quality of Care and Quality of Life in Long-Term Care. Quality Review Bulletin 7~0ctober):3- 10. 64. Anderson, N., and L. Stone. 1969. Nursing Homes Research and Public Policy. The Gerontologist 9:214-218. 65. Gonnella, J., D. Louis, and J. McCord. January 1976. The Staging Concept--An Approach to the Assessment of Outcome in Ambulatory Cases. Medical Care 14~1~:13-21. 66. Greenfield, S., N. Solomon, R. Brook, and A. Davies-Avery. 1978. Development of Outcome Criteria and Standards to Assess the Quality of Care for Patients with Osteoarthritis. Journal of Chronic Diseases 31:375-388. 67. Bowker, L. H. 1982. Humanizing Nursing Home Care. Lexirigton, Massachusetts: Lexington Books, D.C. Health and Company.

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NOTES/227 CHAPTER 3 U.S. Department of Health and Human Services. 1985. Health Care Financing Administration, Office of Research and Demonstrations, Washington, D.C. Unpublished data. Michoki, R. J., and P. P. Lamy. 1976. The Care of Decubitus Ulcers Pressure Sores. Journal of the American Geriatrics Society 24:217-24. Zimmer, J. G. 1979. Medical Care Evaluation Studies in Long-Term Care Facilities. Journal of the American Geriatrics Society 27:62-72. 4. Powell, J. 1984. The Systematic Use of Patient Assessment Data for Managing Nursing Homes. Background paper prepared for the Committee on Nursing Home Regulation, National Academy of Sciences, Washington, D.C. Holder, E. L., and B. W. Frank. 1984. Resident Participation in Nursing Homes. Paper prepared for consumer issues workshop conducted by the Institute of Medicine Committee on Nursing Home Regulation and presented at a workshop in December 1984. 6. Weisfeld, N. 1984. Accreditation, Certification, and Licensure of Nursing Home Personnel: A Discussion of Issues and Trends. Background paper prepared for Committee on Nursing Home Regulation, Institute of Medicine, National Academy of Sciences, Washington, D.C. 7. Stryker, R. Summer 1982. The Effect of Managerial Intervention on High Personnel Turnover in Nursing Homes. Journal of Long-Term Care Administration. 1 0~2~:2 1 -33 S. Schwartz, A. N. February 1974. Staff Development and Morale Building in Nursing Homes. The Gerontologist 14~1~:50-53. 9. Sand, P., and R. Berni. March 1974. Incentive Contract for Nursing Home Aides. American Journal of Nursing. 10. Crawford, S., H. Waxman, and E. Carner. 1983. Using Research to Plan Nurse Aide Training. American Health Care Association Journal 9:59-61.

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228/NOTES 11. Feldman, J., R. E. Burke, and J. Schwarzmann. 1978. The Training of Unlicensed Long-Term Care Personnel. Final Report for Contract #HRA 230-76-0272. Chicago, Illinois: Johnston R. Bowman Health Center for the Elderly, Rush-Presbyterian. St. Luke's Medical Center, and Medicus Systems Corp. 12. U.S. Senate, Special Committee on Aging. October 1. 1984. Senate Hearing 98-1091 on Discrimination Against the Poor and Disabled in Nursing Homes. 98th Congress, 2d Session. Washington, D.C.: U.S. Government Printing Office. 13. Greenless, J. S., J. M. Marshall, and D. E. Yett. May 1984. Nursing Home Admissions Policies Under Reimbursement. The Bell Journal of Economics. 14. Schlenker, R. E. October 1984. Nursing Home Reimbursement, Quality, and Access--A Synthesis of Research. Paper commissioned by the IOM Committee on Nursing Home Regulation. 15. Scanlon, W. J. 1980. Nursing Home Utilization Patterns: Implications for Policy. Journal of Health Politics, Policy and Law 4~4~:619-641. 16. Scanlon, W. J. 1980. A Theory of the Nursing Home Market. Inquiry 17:25-41. 17. Feder, J., and W. Scanlon. 1980. Regulating the Bed Supply in Nursing Homes. Milbank Memorial Fund Quarterly 58~1~:54-~. 18. Feder, J., and W. Scanlon. 1982. The Underused Benefit: Medicare's Coverage of Nursing Home Care. The Urban Institute. Washington, D.C. 19. Cotterill, Philip G. 1983. Provider Incentives Under Alternative Reimbursement Systems. Chapter XVIII in Ronald J. Vogel and Hans C. Palmer (eds.~. Long Term Care: Perspectives from Research and Demonstrations. Health Care Financing Administration. Washington, D.C. 20. U.S. General Accounting Office. October 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services Are Creating Problems for the States and the Elderly. 21. Barney, Jane L. March 1974. Community Presence as a Key to Quality of Life in Nursing Homes. American Journal of Public Health 64~3~:265-268.

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NOTES / 229 22. Dobrof, Rose. December 1984. Community Involvement: An Approach to Enhancement of Quality of Life in Nursing Homes. Unpublished paper prepared for National Academy of Sciences/Institute of Medicine Committee on Nursing Home Regulation. 23. Buford, A. O. III. October 1984. Advocacy for the Nursing Home Resident: An Examination of the Ombudsman Function and Its Relationship to Licensing and Certification Activities in Insuring Quality of Care. Paper presented to consumer issues workshop conducted by the Institute of Medicine Committee on Nursing Home Regulation. Dobroff, R. 1977. Social Work Consultation in Nursing Homes. National Association of Social Workers, Contract No. HRA 230-75-0203. Washington, D.C. 25. Gehrke, J., and S. Wattenberg. 1981. Assessing Social Services in Nursing Homes. Health and Social Work 6:274-282. 26. Mercer, S., and D. Garner. 1981. Social Work Consultation in Long-Term Care Facilities. Health and Social Work 6:5-13. 27. Brody, E. 1974. A Social Work Guide for Long-Term Care Facilities, National Institute of Mental Health, Contract No. HSM-42-71-76, Rockville, Maryland. 28. Jorgenson, L. A., and R. Kane. 1976. Social Work in the Nursing Home: A Need and an Opportunity. Social Work in Health Care 1:471-482. 29. Mercer, Susan, and Rosalie A. Kane. 1979. Helplessness and Hopelessness Among the Institutionalized Aged. Health and Social Work 4:9-116. 30. Pearman, L., and J. Scares. 1976. Unmet Social Service Needs in Skilled Nursing Facilities. Social Work in Health Care 1:457-470. 31. U.S. Senate, Special Committee on Aging. December 1974. Nursing Home Care in the United States: Failure in Public Policy. An Introductory Report. Senate Report No. 93-1420. 93rd Congress, 2d Session. Vladeck, B. 1980. Unloving Care: The Nursing Home Tragedy. New York: Basic Books.

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230 / NOTES Waxman, H., E. Carner, and G. Berkenstock. 1984. Turnover and Job Satisfaction Among Nursing Home Aides. The Gerontologist 24~5~:503-509. Iowa State Department of Health, Division of Health Facilities. December 1982. Quantity of Health Care in Iowa Nursing Homes: Results from the ICE Outcome-Oriented Survey. Thomas, W. H., and L. Schlesinger. December 1984. Steps to Real Nursing Home Reform. Paper presented to workshop on management incentives conducted by Institute of Medicine Committee on Nursing Home Regulation. CHAPTER 4 1. U.S. General Accounting Office. October 14, 1982. Audit of Medicaid Costs Reported by Autumn Hills Convalescent Centers, Houston, Texas. Washington, D.C.: GAO/HRD-83-9. 2. Smith v. O'Halloran, 557 F. Supp. 289 (13. Colo. 1983), rev'd sub nom. Smith v. Heckler, 747 F.2d 583 (1Oth Cir. 1984). 3. Health Care Financing Administration, Health Standards Quality Bureau. 1981. Unpublished analysis of 1981 MMACS data. 4. Systemetrics, Inc. December 1983. The MMACS Long-Term Care Data Base: Construction of a New Research File and an Assessment of Its Quality and Usefulness. 5. Shaughnessy, P. W., R. Schlenker, and I. Yslas. 1983. Case Mix, Quality, and Cost: Major Findings and Implications of the Colorado Nursing Home Study. Center for Health Services Research, University of Colorado Health Sciences Center. Denver, Colorado. 6. Kurowski, B., and P. W. Shaughnessy. 1983. The Measurement and Assurance of Quality. Chapter IV in Long-Term Care: Perspectives front Research and Demonstrations. R. J. Vogel and H. C. Palmer (eds.~. Washington, D.C.: Health Care Financing Administration, U.S. Department of Health and Human Services.

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NOTES/231 Schneider, D., and A. O'Sullivan. 1980. Quality Assurance for Long-Term Care: Revising the Periodic Review. Schneider and Associates. Troy, New York. Mimeograph. 8. Massachusetts Department of Public Health. 1984. Quality Assurance by Sampling: First Annual Report. August 29, 1983-February 14, 1984. Unpublished. Wisconsin Department of Health and Social Services, Division of Health. 1979. Annual Report: Nursing Home Quality Assurance Project, FY 1978-1979. Madison, Wisconsin. 10. Colorado Department of Health, Medical Care Licensing and Certification Division. 1980. "QC" Factors, a Relationship Between Computerization, Patient Care, and the Regulatory Process. Denver, Colorado. 11. Illinois Department of Public Health and Medicus Systems Corporation. November 1976. Regulatory Use of a Quality Evaluation System for Long-Term Care. Final report to Department of Health, Education, and Welfare, Contract #HSM 110-73-499. 12. Ohio Nursing Home Commission. 1979. A Program in Crisis: Blueprint for Action. Final Report of the Ohio Nursing Home Commission. Ohio General Assembly. Columbus. 13. Shanks, N., et al. 1983. Evaluation of the Reimbursement Provisions of Amended Substitute House Bill 176. A Report to the Ohio Department of Public Welfare. Center for Health Services Research, University of Colorado Health Sciences Center. Denver. 14. Lee, Y. S., and S. Braun. 1981. Health Care for the Elderly: Designing a Data System for Quality Assurance. Computers, Environment, and Urban Systems 6(Spring):49-82. 15. Lee, Y. S. 1984. Performance of Intermediate Care Facilities in Iowa: A Preliminary Analysis. Performed for the Iowa Department of Health, Division of Health Facilities [or Nursing Homes and Quality of Health Care: The First Year of Results of an Outcome-Oriented Survey. Journal of Health and Human Resource Administration 7(Summer): 32-601.

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232 / NOTES 16. Bisenius, M. F. 1984. Quality of Health Care in Iowa Nursing Homes: Results from the ICE Outcome-Oriented Survey, December 1, 1982-November 20, 1983. Iowa State Department of Health, Division of Health Services, Des Moines. 17. New York Department of Health. May 1984. Report to the Governor and the Legislature on the New Surveillance Process for New York State Residential Health Care Facilities. Office of Health Systems Management. Albany, New York. 18. Mathematica Policy Research, Inc. January 1985. Evaluation of the State Demonstrations in Nursing Home Quality Assurance Processes. Final report. 19. DiBernardis, J., and D. Gitlin. November 1979. Identifying and Assessing Quality Care in Long-Term Care Facilities in Montana. Report to the Department of Social Rehabilitation Services, State of Montana, under Contract No. 80-070-0016. Center of Gerontology, Montana State University. Bozeman. 20. Donabedian, A. 1980. Explorations in Quality Assessment and Monitoring. Vol. 1: The De f inition of Quality and Approaches to Its Assessment. Ann Arbor, Michigan: Health Administration Press. 21. Glascock, J. 1985. The Modified Survey Process--Traditional Survey Process Evaluation Project. Seattle, Washington: The Hesperides Group. 22. Rehabilitation Care Consultants. Evaluation of the Iowa Outcome-Oriented Survey Process. 23. U.S. Department of Health and Human Services. 1983. Inventory of Surveyors of Medicare and Medicaid Programs, United States, 1983. Health Care Financing Administration, Health Standards and Quality Bureau. Unpublished, Baltimore, Maryland. 24. Association of Health Facility Licensure and Certification Agency Directors. October 1983. Summary Report: Licensure and Certification Operations. U.S. Department of Health and Human Services. 1980. Proceedings of Symposium on Integration of Health and Safety Survey and Inspection of Care Review. Health Standards and Quality Bureau, Baltimore, Maryland. 26. U.S. Department of Health and Human Services. May 1984. Inspection of Care Report. Health Care

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NOTES / 233 Financing Administration, Health Standards anti Quality Bureau. Baltimore, Maryland. 27. U.S. Department of Health and Human Services. 1981. Unpublished data from research in progress. Health Care Financing Administration, Office of Research and Demonstrations. Washington, D.C. 28. Health Care Financing Administration, Medicare Medicaid Automated Certification System. 1981. Unpublished analysis. CHAPTER 5 1. Institute of Medicine, Committee on Nursing Home Regulation. December 1984. Case Studies of Nursing Home Regulation in Six States. Unpublished Reports. 2. National Association of Attorneys General. February 1978. Enforcing Quality of Care in Nursing Homes. Committee on the Office of Attorney General. U.S. Senate. February 9, 1970. Medicare and Medicaid.: Problems, Issues, and Alternatives. Report of the staff to the Senate Committee on Finance, 91st Congress, 2d Session. Committee print. 4. Health Care Financing Administration. 1981. Provider Certification State Operations Manual. Unpublished manual. 5. U.S. Department of Health and Human Services. 1984. Survey and Certification National Review. Unpublished Briefing Materials. Health Standards and Quality Bureau, Health Care Financing Administration. 6. Casper, S. K., and R. E. Burke. February 1985. Policy Recommendations for the Survey Process. Prepared for the Institute of Medicine Committee on Nursing Home Regulation. 7. Jost, Timothy S. December 1984. Enforcement of Quality Nursing Home Care in the Legal System. Prepared for the Institute of Medicine Committee on Nursing Home Regulation. 8. Mathematica Policy Research, Inc. January 1985. Evaluation of the State Demonstrations in Nursing Home Quality Assurance Processes. Final report. 3.

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234 / NOTES 9. Institute of Medicine. 1984. Survey of State Health Facility Licensure and Certification Agency. (See Appendix C for a report on the survey.) 10. Data from Medicare Medicaid Automated Certification System on terminations during fiscal years 1983 and 1984. 1983-1984. Health Care Financing Administration, Health Standards and Quality Bureau. 11. U.S. Fecleral Register. February 21, 1985. Medicare and Medicaid Programs: Intermediate Sanction of Long-Term Care Facilities. 50(35):7 1 9 1 -7 1 98. 12. Association of Health Facility Licensure and Certification Agency Directors. 1983. Licensure and Certification Directors. Unpublished summary report. 13. Minnesota General Statutes. 1982. Nursing Homes, section 1 44A.0 1 14. Johnson, Sandra H. January 7, 1985. Evaluation of the Use of Intermediate Sanctions by the States and Recommendations for State and Federal Enforcement Policies. Prepared for the Institute of Medicine Committee on Nursing Home Regulation. CHAPTER 6 1. Holder, E. L., and B. W. Frank. December 1984. Resident Participation in Nursing Homes: A Key to the Improvement of Life in Nursing Homes and Improvement in the Nursing Home Regulatory System. Prepared for Institute of Medicine conference. 2. Institute of Medicine, Committee on Nursing Home Regulation, Public Meetings. October-December 1984. 3. Institute of Medicine, Committee on Nursing Home Regulation. 1985. Survey of State Licensure and Certification Directors. (Appendix C contains a summary of the findings of this survey.) 4. U.S. Department of Health, Education, and Welfares Administration on Aging. May 1975. Program Instruction 75-30. U.S. Congress. 1985. Older American's Act of 1965, as amended in 1984. Washington, D.C.: U.S. Government Printing Office.

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NOTES/235 6. Testimony before House Select Committee on Aging, Committee on Human Services. September 10, 1985. 7. Buford, A. D. 1984. Advocacy for the Nursing Home Resident: An Examination of the Ombudsman Function and Its Relationship to Licensing and Certification Activities in Ensuring Quality of Care. Prepared for the Institute of Medicine Conference on Nursing Home Regulation. S. Institute of Medicine, Committee on Nursing Home Regulation. 1984. Consumer Workshop. 9. Meeting of State Long-Term Care Ombudsmen, Philadelphia, Pennsylvania, November 1984. 10. Kosberg, J. I. October 1984. Advocacy Organizations for Nursing Home Residents: A National Study. 11. U.S. Department of Health, Education, and Welfare, National Center for Health Statistics, July 1979. National Nursing Home Survey: 1977 Summary for the United States. HEW Pub. No. 79-1794. 12. U.S. Office of Management and Budget. April 27, 1984. Circular 1-12: Cost Principles for Non-Profit Organizations; Lobbying Revision, Federal Register 49(83): 18260- 18277. 13. Zischka, P. C., and I. Jones. February 1984. Volunteer Community Representatives as Ombudsmen for the Elderly in Long-Term Care Facilities. The Gerontologist 24(1):9- 15. 14. Barney, Jane L. March 1974. Community Presence as a Key to Quality of Life in Nursing Homes. American Journal of Public Health 64~3~:265-268. Dobrof, Rose. December, 1984. Community Involvement: An Approach to Enhancement of Quality of Life in Nursing Homes. Unpublished paper prepared for Institute of Medicine Committee on Nursing Home Regulation. 16. Zwick, Daniel. November 1984. The HCFA Proposal to Accord "Deemed States" to Nursing Homes Accredited by JCAH. Unpublished paper prepared for the Institute of Medicine Committee on Nursing Home Regulation. 17. Weisfeld, N. 1984. Accreditation, Certification, and Licensure of Nursing Home Personnel: A Discussion of Issues and Trends. Unpublished paper.

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236 / NOTES 18. Aiken, L. H., M. Mezey, J. Lynaugh, and C. Buck. March 1985. Teaching Nursing Homes: Prospects for Improving Long-Term Care. Journal of the American Geriatrics Society 33~3~:196-201. 19. Pattee, J. December 1984. Physicians Serving Nursing Homes. Unpublished paper prepared for Institute of Medicine Committee on Nursing Home Regulation. 20. Adams, Carl, and Julia Powell. 1980. Patient Assessment Computerized. National Health Corporation. Murfreesboro, Tennessee. 21. Gustafson, D. H., and D. Zimmerman. December 1984. The Potential for Incentives to Improve Quality of Care in Nursing Homes. Prepared for Institute of Medicine Committee on Nursing Home Regulation. 22. Institute of Medicine, Committee on Nursing Home Regulation. 1984. Report on Management Workshop. 23. Association of Health Facility Licensure and Certification Directors. 1983 Survey. CHAPTER 7 1. In Rhode Island, the state licensure and certification agency obtained voluntary agreement from all nursing home operators to maintain up-to-date standard resident assessment data on all residents. These data were to be used by state surveyors for sampling purposes in testing the new Health Care Financing Administration PaCS survey instrument. Although it was not suggested by the state agency, about half of the nursing homes immediately began entering the data into their own computers and offered to transmit it by telephone to the regulatory agency to facilitate sampling by the surveyors. 2. Urban Systems Research and Engineering, Inc. 1984. Short-Term Evaluation of Medicaid: Selected Issues. Unpublished Report. Cambridge, Massachusetts. U.S. General Accounting Office. October 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services Are Creating Problems for the States and the Elderly. 3.

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NOTES / 237 4. Levit, K.R., H. Lazenby, D. R. Waldo, and L. M. Davidolf. Fall 1985. National Health Expenditures, 1 984. Health Care Financing Review 7~1~:20. 5. Schlenker, R. 1984. Nursing Home Reimbursement, 6. Quality, and Access--A Synthesis of Research. Paper commissioned by Institute of Medicine. Texas is a major exception. It has statewide occupancy rates below 85 percent, although this is not true in a couple of the larger cities. Texas also pays among the lowest Medicaid nursing home rates in the country. 7. Bayo F., and J. Fabler. 1980. United States Population Projections for OASDI Cost Estimates, 1980. Social Security Administration, Office of the Actuary: Actuarial Study No. 82, SSA Pub. No. 11-11529. S. Morris, J. M., S. Morris, and S. Sherwood. 1984. Assessment of Informal and Formal Support Systems in High Risk Elderly Populations. Pp. 223-253 in Functional Assessment in Rehabilitation Medicine. C. V. Granger and G. E. Gresham (eds.~. Baltimore, Maryland: Williams and Wilkins. 9. Curtis, R. E., and L. R. Bartlett. 1984. The High Cost of Long-Term Care Squeezes State Budgets. Generations 9~1~:22-25. 10. Powell, Julia. 1984. The Systematic Use of Patient Assessment Data for Managing Nursing Homes. Paper commissioned by National Academy of Sciences/Institute of Medicine Committee on Nursing Home Regulation.