This report identifies problem areas regarding the quality of care for individuals receiving home care services or living in residential care settings, briefly reviews the current strategies under way or planned to assess and improve that care, and assesses the likelihood that these strategies can significantly address the major areas of concern. It also provides recommendations on what further work should be undertaken by the Institute of Medicine (IOM) in this area.


The 1992 reauthorization of the Older Americans Act1 directs the Secretary of the U.S. Department of Health and Human Services (DHHS) to arrange for the IOM to conduct two studies on the quality of care for older and disabled individuals (Appendix A contains the legislative mandate). Specifically, the two studies are to examine (1) the quality of board and care facilities and (2) the quality of home care services. The legislation sets forth several specific areas of investigation. Among the more important are

  • the appropriate roles of federal, state, and local governments in ensuring the health and safety of patients and clients receiving home care services or living in board and care facilities; and

  • whether or not existing quality, health, and safety requirements, as well as licensing and certification requirements and their enforcement, are appropriate, effective, and adequate.

Despite the legislative mandate to conduct the studies, no specific funding has ever been appropriated for them. In the spring of 1995, the Administration on Aging (AoA) decided to provide funding for the IOM to develop recommendations regarding the conceptual framework and provisional design for these two studies or for a single, comprehensive study. A planning committee was convened in July to explore the topic.

Although AoA is sponsoring the current planning activity, the larger work will be of interest to many other parties. Within the federal government, several other departments have missions that include responsibilities pertinent to these two topics. Within DHHS, these include the Health Care Financing Administration, the National Institute on Aging, the Bureau of Maternal and Child Health, the Administration for Developmental Disabilities, and the Office of the Assistant Secretary for Planning and Evaluation. Other departments include the Social Security Administration and the Department of Education (in particular, its Office of Special Education and Rehabilitative Services and the National Institute


P.L. 102-375, §212, 106 Stat. 1195.

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