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Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
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Index

A

Accountability, general, 14, 33, 134, 138

see also External oversight;

Regulatory issues;

Standards

Accreditation, 4, 135, 137, 178

adult foster care and small group homes, 49, 94, 164

assisted living, 47

board and care homes, 45, 91-92

home health care agencies, 171-172

Medicaid, 178

Medicare, 178

nongovernmental, 122, 137, 171-172, 178, 223

residential care facilities, 45, 47

Acute care services, 28, 124, 129, 182

see also Special care units;

Subacute care units

Adult foster care homes, 45, 49-50, 94-95, 164, 250

see also Group homes

Adults, see Elderly persons;

Nonelderly adults

Advocacy, 11, 19, 135, 140, 174-177, 250

American Association of Retired Persons (AARP), 68, 164-165, 293

care management, 58

children, 174-175

funding, 19, 175-176

home and community-based services organizations, 55, 58, 67

information systems, promotion of, 177

Long-Term Care Ombudsman Program, 11, 79, 175-176

Medicaid, 67

nursing homes, 148, 161, 162, 176-177, 191

personal care services, 67, 177

residential care, 168, 202-203, 293

African Americans, 39

Age factors, 23-24

employment issues, 212

number in long-term care, 1, 39

population, aging of, 2, 22-23

see also Children and young adults;

Elderly persons;

Nonelderly adults

Agency for Health Care Policy and Research, 114, 127

AIDS, see HIV/AIDS

Alabama, 101

Alcohol and drug abuse, 126, 164

Alzheimer's Association, 293

Alzheimer's disease, see Dementia

American Academy of Nursing, 196

American Association of Retired Persons (AARP), 68, 164-165, 293

American Board of Family Practice, 62

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

American Board of Medical Specialities, 62(n.9)

American Geriatrics Society, 222

American Health Care Association, 194, 216, 223

American Medical Directors Association, 199, 222

American Nursing Association, 196

American Society of Internal Medicine, 62

Americans with Disabilities Act, 29, 103

Archstone Foundation, 3, 25

Arizona, 101

Assessment instruments, 8-10, 18, 37, 40, 47, 109, 117-120, 121-122, 127-134, 150-152

Assets and Health Dynamics of the Elderly Survey, 37(n.1)

Assisted living, 6, 8, 10, 42, 45, 47-49, 92-94, 109

administrators, 47-48

defined, 47, 50, 168-169

elderly persons, 48(n.6), 92-94

financing, general, 64

functional status, 47, 49

General Accounting Office studies, 93, 94, 202, 249

licensure, 47

Medicare/Medicaid, 293

medication, 93, 166

number of facilities, beds, and residents, 47, 48

personal care services, 47, 48(n.6)

personnel and personnel standards, 202, 203-204

privacy and dignity, 47, 49, 92-93

regulatory issues, 38, 93, 94, 166

state standards, 10, 47, 93, 164, 166, 168-169. 292-293

Assisted Living Quality Coalition, 169, 203, 216

Auditory impairments, 116

Australia, 107

B

Balanced Budget Act, 16, 51, 193, 235, 236, 241-244

Bathroom facilities

assisted living, 49

home health care, 207

nursing homes, 88, 229-230

Bed sores, see Pressure sores

Board and care homes, 10, 45-47, 64, 68, 91-92, 124, 163-169, 202-203, 250

developmental disabilities, 46, 71

medication, 46, 91-92, 202, 203

regulatory issues, 45, 46, 91, 92, 163-169

safety, 92, 163

Supplemental Security Income, 47, 64, 68, 163

Bureau of Census, 250

Bureau of Labor Statistics, 13, 212

C

California

assisted living, 93

consumer-centered programs, 106-107

developmentally disabled persons, residential care, 96

home health care, 209

nursing homes, 78, 145, 153, 158, 197

personal care services, 55, 68, 209-210

Cardiovascular disease, 40

Care management, 3, 9, 15, 22, 69-70, 127, 135

children, 58, 71-72

consumer-centered services, 29, 71-72

developmentally disabled persons, 96

home and community-based services organizations, 54, 55, 58-59

individualization of care, 6, 28, 29, 127-128, 189, 229

restorative care, 8, 116

state government, 58, 68

see also Managed care

Casemix, 242

nursing homes, 19, 74, 88, 90, 114, 117, 118, 123-124, 182, 188-195 (passim)

residential care settings, 202

see also Resource Utilization Groups

Casemix reimbursement, 19, 240-241

Centers for Advancement of Quality in Long-Term Care, 20, 234

Certification, 4, 8, 9, 10, 18, 135, 136-137, 172

home health care agencies, 7, 8, 43, 51, 52, 97, 171-172, 173-174, 206, 207, 208

Medicaid, 7, 8, 10, 17, 44, 47, 49, 51, 52, 174, 178, 207

Medicare, 7, 8, 10, 44, 47, 49, 51, 52, 174, 178, 207

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

nongovernmental, 122, 137

nursing homes, 7, 8, 18, 42, 43, 44, 76, 77, 137, 140-141, 143-163, 182

state survey activities, 18, 137, 142-163

voluntary, 122, 137, 171-172, 178, 223

Chains, see Multi-facility organizations

Chemical restraints, see Physical and chemical restraints

Children and young adults, 30, 40, 201

advocacy, 174-175

assessment design, 132-134

care management, 58, 71-72

cognitive factors, 40, 133, 217

consumer-centered care, 71-72

coordination of services, 70-71

diseases/conditions of children in care, 40

family issues, 104, 105

functional status, 133

home and community-based services organizations, 58, 104-105, 210

home care, 210

home health care agencies, 104-105, 207-208

informal care for, 217

informal caregivers for elderly, 59-60, 217

long-term care defined, 28

number in care, 2, 23-24

nursing home visits by, 88

physician skills, 61

professional education for, 61, 104-105

Supplemental Security Income program, 68

Children with Special Health Care Needs, 58

Clinical practice guidelines, 14, 15, 221-222, 224, 226-228, 232, 234

cost factors, 15, 221, 232

Clinton, William, 113

Cognitive factors, 24, 288, 289, 290

assessment instruments, 7, 8, 116, 127, 132

assisted living facilities, 49

board and care homes, 46-47

care management, 70

children, 40, 133, 217

elderly persons, 2, 38, 290

nursing home patients, 7, 43, 84, 85, 86, 116

residential care, 46-47, 166, 203-204

see also Dementia;

Developmental disabilities;

Mental retardation

Community-based services, 3, 6-7, 8, 16, 27, 100-108

adult foster care homes, 45, 49-50, 94-95, 164, 250

advocacy, 174

assisted living facilities board and care homes, 10, 45-47, 64, 68, 91-92, 124, 163-169, 202-203

consumer-centered services, 29, 105-108, 131, 209

defined, 9, 41-42, 45, 91

demographics of users, 39

developmentally disabled persons, 24, 54, 95-96

elderly persons, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131

functional status, 91

group homes, 41, 45, 49-50, 71, 94, 250

licensure, 45

Medicaid, 16, 22, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236

personal attendant services, 29

residential care, 22, 41, 45-50, 91-96

state government role, 8, 45, 91, 289-290

see also Assisted living;

Home and community-based services organizations

Community Health Accreditation Program, 171

Complaints and complaint resolution, 19, 136, 138

advocacy, promotion of, 177

home health care, 170

Long-Term Care Ombudsman Program, 11, 79, 175-176

nursing homes, 79, 115, 144, 153, 162

Confidence Satisfaction Survey, 85

Connecticut, 244

Consumer Assessment of Health Plans, 134

Consumer attitudes, 5, 6, 22, 29-30, 31, 89, 94, 107, 108, 109, 127-131, 136, 174, 249

Consumer-centered care, 7, 28, 29, 31-34, 71-72, 75-76, 106-107, 138, 214, 249-250, 288-293

assessment instrument design, 127-132

care management, 29, 71-72

children, 71-72

decision making, general, 7, 28, 88 89(n.3), 166

defined, 29, 288, 289

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Department of Health and Human Services role, 18, 108, 289

elderly persons, 29

financial issues, general, 29, 33

home and community-based health care, 29, 105-108, 109, 131

home care, 29, 71, 128, 131

home health care agencies, 128, 209

informal care, 29, 71, 128, 131

information systems, 8, 32, 110

nursing homes, 31, 32, 71, 88-89(n.3), 131, 148, 222, 289

personal care services, 29, 250

professional education, 29, 71

providers, general, 29, 33-34, 214

quality of life, 29, 32-33

regulatory issues, 33, 136, 138, 148, 165-166, 170

research funding, 18, 108, 289-290

state government role, 18, 108, 289

see also Advocacy;

Complaints and complaint resolution

Consumer Consortium on Assisted Living, 202, 204-205

Continence care, see Incontinence

Continuing Care Retirement Communities, 42

Contracting practices, 9, 25, 33, 136, 165-166, 170, 249

home health care fraud, 96-97

Contractures, 78

Cost and cost-effectiveness, 15, 16-17, 22, 63-64, 223, 227, 236-239, 242

assessment instrument categories for, 115, 127

assisted living, 93, 94

board and care homes, 46

clinical practice guidelines, 15, 221, 232

home health care, 63-64, 97-98, 205, 242

nursing homes, 1, 63-64, 89, 90, 115, 162, 194-195, 221-224 (passim), 227, 229-230, 232, 236-238, 242-243

personnel standards and oversight, 13, 194-195, 205, 219

private health insurance, 69

process monitoring technology, 232

regulation, general, 139, 140

standards, 13, 15, 194-195, 219, 205, 221, 232

residential care, 166

see also Funding

Criminal behavior

abuse and neglect, 1, 13, 24, 78, 79, 138, 189, 192, 215-217

legislation, 13, 19, 216-217

D

Day care, 43, 59

Decision making, consumer, general, 7, 28, 291

nursing home residents, 88-89(n.3)

residential care, 166

see also Consumer-centered care

Decubitus ulcers, see Pressure sores

Dehydration, 82, 150, 192

Dementia, 40, 43, 49, 83, 86, 113, 204-205, 209, 211, 289

Demographic factors, 39

Baby Boom, 2, 23

educational attainment of care users, 39, 187

marital status, 39

number in long-term care, 1, 2, 22-23, 38

nursing home residents, 39, 43-44

race/ethnicity

see also Age factors;

Gender factors

Dental health and care, 113, 116, 143, 182, 184, 189, 191

Department of Health and Human Services access to care, 18, 20

Agency for Health Care Policy and Research, 114, 127

assessment instrument development, 127

assisted living, 48(n.6)

board and care homes, 46

Centers for Advancement of Quality in Long-Term Care, 20, 234

consumer-centered care research, 18, 108, 289

home and community-based services, 103

Medicaid/Medicare reimbursement research, 20, 238

National Center for Health Statistics, 37

nursing home staff study, 192

organizational capacity research, 20, 233-234

see also Health Care Financing Administration

Department of Justice, 103

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Department of Veterans Affairs, 3, 25, 81

see also Veterans Administration

Depression, 116, 133

Developmental disabilities, 24, 40, 41, 71, 95-96, 201, 211, 290

board and care homes, 46, 71

community-based services, 24, 54, 95-96

defined, 24(n.2)

home and community-based services organizations, 54

state government role, 24, 96

see also Mental retardation

Diet, see Nutrition

Dignity, see Privacy and dignity

Dispute resolution, see Complaints and dispute resolution

District of Columbia, 101

Drug abuse, see Alcohol and drug abuse

Drugs, see Medication

E

Economic factors, see Cost and cost-effectiveness;

Employment issues;

Financial issues;

Funding;

Health insurance;

Ownership of facilities;

Poverty;

Wages and salaries

Eden Alternative, 88

Education, see Patient education;

Professional education and training;

Public education

Educational attainment of care users, 39, 187

Education for All Handicapped Children Act, 71

Elderly persons, 2, 23, 40, 164

abuse and neglect of, 215

assisted living, 48(n.6), 92-94

board and care homes, 46, 91, 202-203

care management, 70

cognitive impairments, 2, 38, 290

community-based services, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131

Continuing Care Retirement Communities, 42

consumer-centered services, 29

functional status, 2, 38, 59-60

gender of care users, 2, 38, 43, 46, 51

geriatric specialists, 12, 62

home and community-based services organizations, 52, 54, 55, 126-127, 131

home care, 210

home health care, 51, 97-98, 205

informal care, 59-60, 217

number in long-term care, 1, 2, 22-23, 37, 38, 39, 59

physician training, 62

private insurance, 69

see also Medicare

Emergency care, see Acute care services

Emotional well-being, see Mental health and illness

Employment issues, 13-14, 19, 60, 180-181, 211-218

assisted living, 94

children in care, training of, 71-72

criminal background checks, 1, 13, 24, 78, 79, 138, 189, 192, 215-217

home health care agencies, 207

nonelderly adults with disabilities, 55

number of long-term care workers, 60-61, 181

nursing homes, 12-13, 89, 113, 187, 189, 194-195, 199, 212, 213

occupational therapy, 11, 71, 180, 182, 190, 206, 207

personal attendants, 55, 209-210

see also Professional education and training;

Providers and provider quality;

Wages and salaries

Ethnicity, see Race/ethnicity of care users

External oversight, 9-11, 135-179

committee recommendations, 18-19

family members, 9, 11, 128, 135, 166, 174

mass media, 1, 9, 21, 24, 61, 135, 213

see also Accreditation;

Advocacy;

Certification;

Licensure;

Regulatory issues;

Standards

F

Family members, 3, 7, 27, 36, 59, 60, 69, 95, 128, 174, 217-218, 249, 250, 288

child health care, 104, 105

coordination of services, 70-72

counseling of, 62

dementia patients, 86

external oversight and, 9, 11, 128, 135, 166, 174

of nursing home residents, 86. 87

personal attendant programs, 55

residential care, 166

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

social services defined, 27

see also Children and young adults;

Informal care

Financial issues, 15-17, 20, 36, 62-69, 235-252

adult foster care and small group homes, 49-50, 94

assisted living, 94

board and care homes, 46, 47

casemix reimbursement, 19, 240-241

consumer-centered care, 29, 33

contracting practices, 9, 25, 33, 136, 165-166, 170, 249

home care, 16, 62, 63-64, 247

home health care, 63, 99, 100, 242, 243-244

informal caregivers, 60, 63, 69

information systems, 110

nursing homes, 62, 63-64, 236-238, 242-243

social services defined, 27

see also Cost and cost-effectiveness;

Funding;

Health Care Financing Administration;

Health insurance;

Medicaid;

Medicare;

Regulatory issues;

Wages and salaries

Fines and penalties, 10, 18, 137

federal government, general, 10, 18, 137, 141-142, 148, 153-156, 158, 159-161

home health care agencies, 172-173

nursing homes, 10, 18, 137, 141-142, 148, 153-156, 158-162

residential care facilities, 165

Florida, assisted living, 93

Food, see Nutrition

Foreign countries, see International perspectives;

specific countries

Foundation for Accountability, 134

France, 107

Friends, 3, 27, 59, 60

see also Informal care

Functional mobility

board and care homes, 47

defined, 27

nursing home residents, 5, 7-8, 12, 76, 229-230

physical therapy, 11, 12, 51, 53, 54, 61, 71, 182, 190

residential care, 76, 125

Functional status, 36, 37, 39, 75, 127

adult foster care homes, 94-95

assisted living, 47, 49

board and care homes, 46

children, 133

community-based residential care, 91

defined, 27

elderly persons, 2, 38, 59-60

home health care, 97, 98

informal care, 59-60

information systems on, 113

nursing home residents, 45, 79, 84, 94-95, 113, 116, 176, 189, 224

Resident Assessment Instrument (RAI), 7-8, 116, 125

staffing and, 12, 189

see also Developmental disabilities;

Incontinence;

Personal care services

Funding, 64-69, 75, 233-234

access to care, research, 18

advocacy, 19, 175-176

assessment instrument development/use, 119-120, 127, 152, 153

consumer-centered care research, 18, 108, 289-290

home and community-based services organizations, 55, 120, 138

Medicaid/Medicare reimbursement research, 20, 238

nursing home assessment, 119-120, 152, 153, 195-196

organizational capacity, 20

public education, 19

regulatory accountability and, 18, 138

residential facilities assessment, 127

standards and, general, 136

state survey regulations and certification, 18

see also Financial issues;

Medicaid;

Medicare

G

Gender factors, 38, 39, 46

consumer satisfaction, 129

home care, 51

informal caregivers, 59

General Accounting Office, 68

assisted living, 93, 94, 202, 249

home and community-based services, 126-127

home health care, 96-97, 99-100, 169, 170-171, 172-173, 243

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

nursing homes, 68, 76, 77-78, 145, 148, 150-151, 152-153, 158, 160, 161

residential care, 93, 94, 163, 165-166, 202

Germany, 107

Government Accounting Office, 229

Government role, see Advocacy;

Regulatory issues

Group homes, 41, 45, 49-50, 71, 250

licensure, 49, 94

H

HCBS, see Home and community-based services organizations

Health Care Financing Administration (HFCA), 3-4, 25, 137, 178, 182, 242, 244

certification requirements, 10, 18

developmentally disabled persons, 96

home and community-based care, 66

home health care, 7, 96-99, 169-173

nursing home care, 3-4, 7, 12, 18, 25, 42, 79, 86, 119, 142, 195

nursing home personnel, 12, 19, 184-187, 192, 193, 195-196, 201

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

personal care services, 101-103

Resident Assessment Instrument, 7-8, 111, 115-120, 124-125, 128

see also Minimum data set

see also Medicaid;

Medicare

Health insurance, 4, 69

elderly persons, 69

external oversight, 9

home health care, 63

information systems, 110

nursing home care, 63, 64

see also Managed care

Health Insurance Portability and Accountability Act, 216

Health Plan Employer Data and Information Set, 133

Hearing impairments, see Auditory impairments

Historical perspectives, 21-22, 220-221, 250-251, 252

attitudes of caregivers, 228-229

care management, 58

consumer-centered care, 28

developmentally disabled persons, 95

home health care, 169

number in care, various settings, 2, 37, 38, 43, 169

nursing homes, 25, 42-43, 44, 110-111, 141-144, 150, 153-154, 235

professional licensure, 136

HIV/AIDS, 4, 34, 54, 102, 209, 211

Home and community-based services organizations, 3, 52, 54-59, 100-108, 109, 125-127, 179

advocacy, 55, 58, 67

children, 58, 104-105, 210

consumer-centered services, 29, 105-108, 109, 131

defined, 41-42

developmentally disabled persons, 24, 54, 95-96

elderly persons, 37, 48(n.6), 52, 54, 55, 92-94, 126-127, 131

employment issues, 60, 61

General Accounting Office studies, 126-127

Medicaid, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236

Medicare, 55, 103

nonelderly adults, 55, 59

nursing home care, avoidance of, 100-101

regulatory issues, 102-103, 138

state government role, 54-58, 66-67, 68, 69, 101-103, 111, 125-127, 238, 246

see also Personal care services

Home care, 1, 3, 6, 16, 22, 25, 50-52, 53, 96-100, 109, 135-136, 138

attitudes toward, 31

casemix, 122

children, 210

consumer-centered services, 29, 71, 128, 131

elderly persons, 210

financing of, general, 16, 62, 63-64, 247

gender factors, 51

Medicaid, 7, 22, 51, 52, 55, 63, 64, 70

Medicare, 7, 16, 22, 50, 51, 52, 63, 64, 97-98, 99-100, 109

Resident Assessment Instrument, 111

number and number of residents, 43, 50-51, 169

On-line Survey Certification and Reporting (OSCAR) System, 7

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171

personnel, general, 13, 51, 53, 61, 180, 209-210, 214

personnel standards, 11, 96-97, 167

state government role, 96, 97, 173, 238

surveys, 37, 173

see also“On-line...” and “Outcome...” supra

see also Assisted living;

Informal care

Home health care agencies, 3, 50-52, 55, 70, 290-291

administrators, 96, 208

adolescents, 104-105

board and care homes, 10, 45-47, 64, 68, 71, 91-92, 124, 163-169, 202-203

children, 104-105, 207-208

certification, 7, 8, 43, 51, 52, 97, 171-172, 173-174, 206, 207, 208

consumer-centered care, 128, 209

cost factors, 63-64, 97-98, 205, 242

defined, 206

elderly persons, 51, 97-98, 205

employment issues, 207

financial issues, general, 63, 99, 100, 242, 243-244

functional status, 97, 98

General Accounting Office studies, 96-97, 99-100, 169, 170-171, 172-173, 243

Health Care Financing Administration, 7, 96-99, 169-173

hospitalization, 50

inspection of facilities, 170

licensed practical nurses, 51, 54, 61, 208

licensure, 7, 172, 173-174, 207

Medicaid, 43, 50, 170-171, 174, 207, 216

Medicare, 6, 8, 43, 50, 169-171, 172, 174, 206, 207, 208, 216, 236, 243

multi-facility organizations, 51

nurses, general, 51, 53, 54, 98-99, 100, 104, 206, 207, 208

nursing aides, 54

nutrition, 53, 54, 59, 68

outcomes, general, 8, 97-98

ownership of facilities, 51, 52, 53, 99

paraprofessional personnel, 51, 54, 181, 208-209, 291

patient education, 99

personnel and personnel standards, 181, 205-209, 212-213, 216

physical and chemical restraints, 206

physicians, 53, 54, 206

privacy and dignity, 207, 209

private insurance, 63

professional education, 206, 207-209

registered nurses, 51, 54, 61, 169-173, 206, 207, 208, 213, 291

regulation and standards, facilities, 167-168, 169-173, 206-209

state government role, 168, 170, 171, 173-174, 207, 208-209, 238

time factors, 50, 106, 121, 123, 208, 209

voluntary, 51, 52, 53, 54

see also Personal care services

Homeless persons, 46(n.4)

Hospice care, 37, 42, 50, 51, 52, 53, 54, 216

Hospitals and hospitalization

acute care services, 28, 124, 129, 182

financial issues, general, 63

home health care and, 50

labor force, 61

managed care, 45

Medicaid, 65

Medicare, 64

nursing home residents hospitalized, 84, 89, 188, 190, 195

nursing homes, hospital based, 44, 63, 82, 183, 185

nursing staff, 187, 192

Housebound and Aid and Attendance Allowance Programs, 29, 106

Housekeeping personnel, 11, 51, 60, 63, 77, 88, 95, 180, 183, 184

I

Illinois, 209, 244

Improving the Quality of Care in Nursing Homes, 3, 21

Incontinence

board and care homes, 47

nursing homes, 82-83, 108, 113, 188, 223, 228, 229-230

Individualization of care, 6, 28, 29, 127-128, 189, 229

Individuals with Disabilities Act, 71

Informal care, 3, 7, 11, 37, 41, 59-60, 217-218, 249

children, 217

consumer-centered care, 29, 71, 128, 131

defined, 27

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

demographics of caregivers, 59-60

elderly persons, 59-60, 217

financial issues, 60, 63, 69

functional status, 59-60

gender factors, 59

nonelderly adults, 60

number using, 1-2, 38

religious organizations, 3, 59

social services defined, 27

training, 218

see also Paraprofessionals;

Volunteers and voluntary organizations

Information systems, 7-9, 14, 31, 33, 110-134, 224-227

advocacy, promotion of, 177

assessment instrument design/use issues, 8-10, 18, 37, 40, 47, 109, 117-123 (passim), 127-134, 143-144, 150-152

assisted living, 94, 109

community-based residential care, 45

consumer-centered, 8, 32, 110

education of caregivers, 218

financial issues, general, 110

managed care, 110, 111

mass media, 1, 9, 21, 24, 61, 135, 213

nursing home surveys of, 18, 37, 42, 142-153

Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171

quality of care, general, 3, 31, 33

Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128

see also Minimum data set

see also Internet;

Public education

In-Home Supportive Services Program, 55, 68

Injuries, see Safety issues

Inspection of facilities

home health care, 170

nursing homes, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158

residential care, 165, 166

Institutional care, 32

attitudes of professionals in, 28

children in, 40

defined, 3, 41

number in care, 2, 37, 38, 40

special care units, 22, 43, 65, 113, 241-244

see also Nursing homes

Institutional factors, see Organizational and institutional factors

Insurance, see Health insurance;

Managed care;

Medicaid;

Medicare

Intermediate care, 4, 34, 37, 41, 42(n.2), 43, 216

International perspectives

home and community-based care, 107

see also specific countries

Internet

nursing homes, On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

nursing homes, other, 161

Irvine Health Foundation, 3, 25

J

Joint Commission on Accreditation of Healthcare Organizations, 171, 178, 223

K

Kansas, 209

L

Language therapy, see Speech and language therapy

Legislation

Americans with Disabilities Act, 29, 103

Balanced Budget Act, 16, 51, 193, 235, 236, 241-244

criminal background, provider checks, 13, 19, 216-217

Education for All Handicapped Children Act, 71

Health Insurance Portability and Accountability Act, 216

home and community-based services, 102-103, 216

Individuals with Disabilities Act, 71

Medicare Catastrophic Coverage Act, 45

Nursing Home Reform Act, 25, 142-143, 174, 176, 250-251

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Older Americans Act, 11, 54, 59, 68

Long-Term Care Ombudsman Program, 11, 79, 175-176

Omnibus Budget Reconciliation Acts (OBRA), 3, 5-6, 7-8, 12, 14, 15, 16, 21, 25, 45, 79, 80, 81, 83, 90, 95, 108, 139-144 (passim), 150, 151, 153-154, 161, 162, 170, 171, 179, 182, 187, 190, 192-193, 206, 221, 224, 233, 234, 247

Patient Abuse Prevention Act (proposed), 216

Patient Self-Determination Act, 29

Rehabilitation Act, 55

Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128

see also Minimum data set

Social Security Act, 66, 68, 163, 206, 207

see also Supplemental Security Income program

see also Regulatory issues

Licensed practical nurses (LPNs), 11, 60, 180, 216

board and care homes, 202

care management, 70

education, 196-197

home health care, 51, 54, 61, 208

number of, 61

nursing homes, 89, 61, 113, 182, 183, 187, 188-189, 196, 200, 201, 212, 213

wages, 194, 213

Licensure, 4, 9, 10, 135, 137, 172, board and care homes, 202, 203

home health care agencies, 7, 172, 173-174, 207

Medicaid, 7, 174, 207

Medicare, 7, 174, 207

nursing homes, 7, 89, 182

personal care attendants, 210

residential care facilities, 45, 47, 49, 92, 94, 137, 163, 164, 165, 202

state survey activities, 42, 137, 142-163, 164

see also Licensed practical nurses;

Registered nurses

Local services, see Community-based services

Long-term care, defined, 1, 3, 27-28, 36

Long-Term Care Ombudsman Program, 11, 79, 175-176

M

Maine, 101, 124

Managed care, 22, 69

Medicaid, 22, 69, 70, 111

Medicare, 22, 45, 50, 69

nursing homes, 45, 200-201

information systems, 110, 111

Marital status, 39

Massachusetts, 101, 226

Mass media, 1, 9, 21, 24, 61, 135, 213

Maternal and Child Health programs, 58

MDS, see Minimum data set

Medicaid, 4, 8, 15-17, 20, 136-137, 214, 235-247

adult foster care and small group homes, 49-50, 94

advocacy, 67

assisted living, 293

board and care homes, 163

certification, 7, 8, 10, 17, 44, 47, 49, 51, 174, 178, 207

community-based services, 16, 22

home and community-based care, 55, 66-67, 70, 101-103, 106, 125-127, 164, 235-236

home care, 7, 22, 51, 52, 55, 63, 64, 70

home health care agencies, 43, 50, 170-171, 174, 207, 216

hospitalization, 65

incentives, 4, 244

licensure, 7, 174, 207

managed care, 22, 69, 70, 111

nursing homes, 10, 15-17, 19, 20, 42(n.3), 43, 44, 63, 64, 67, 70, 80, 142, 161, 235, 239-240, 244-246

external oversight, 9, 10, 18, 42, 137, 142-153

personnel, general, 183, 185-187, 193-195, 237

personnel standards, 182, 193, 198, 201, 215, 216

Resident Assessment Instrument (RAI), 7-8, 111, 115-120

state survey and certification, 18, 42, 137, 143-153

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

personal care services, 55, 56-57, 66, 67, 101-103, 106

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

research funding, 20, 238

residential care, 70, 96, 202, 204, 293

state government, 10, 16, 17, 18, 19, 20, 42, 55, 56-57, 65, 66-67, 68, 69, 80, 101-103, 111, 125-127, 136, 137, 142-153, 170, 174, 207, 236, 238-241, 246, 251

see also Home and community-based service organizations

Medical records, 153

Medicare, 4, 64-65, 69, 136-137, 214, 236, 239-240, 251

assisted living, 293

certification, 7, 8, 10, 44, 47, 49, 51, 52, 174, 178, 207

Department of Health and Human Services research, 20, 238

historical perspectives, 22

home and community-based services, 55, 103

home care, 7, 16, 22, 50, 51, 52, 63, 64, 97-98, 99-100, 109

home health care agencies, 6, 8, 43, 50, 169-171, 172, 174, 206, 207, 208, 216, 236, 243

hospitalization, 64

licensure, 7, 174, 207

managed care, 22, 45, 50, 69

nursing homes, 10, 16, 42(n.3), 43, 44-45, 63, 64-65, 142, 161, 236, 240, 242-243

certification, 42(n.3), 43-44

external oversight, 9, 10, 18, 42, 137, 142-153

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

personnel, general, 183-187, 195

personnel standards, 182, 193, 197-198, 201, 216

prospective payment system, 16, 20, 22, 50, 63, 65, 96-99 (passim), 117, 118, 122, 185, 186. 236, 238-244 (passim)

research funding, 20, 238

residential care, 202, 204, 293

state government, 10, 16, 18, 42, 97, 136, 142-153, 170, 174, 207, 240-241, 251

survey and certification, 18, 42, 137, 143-153

Medicare Catastrophic Coverage Act, 45

Medicare Payment Advisory Commission (MedPAC), 241-242, 243

Medication, 10, 121, 291

assisted living, 93, 166

board and care homes, 46, 91-92, 202, 203

nursing homes, 143, 182, 184, 191, 199, 241

see also Physical and chemical restraints

Men, see Gender factors

Mental health and illness, 24, 40

adult foster care homes, 94

assessment instruments, 7-8, 9, 127, 133

assisted living facilities, 49

board and care homes, 46

children, 133

depression, 116, 133

family members, counseling, 62

home and community-based services organizations, 53-54

home health care, 53

nursing home care, 7-8, 43, 45, 113, 116, 184, 199

residential care, 46, 164

see also Dementia;

Physical and chemical restraints

Mental retardation, 4, 34, 37, 40, 41, 164, 201, 216

advocacy, 177

developmental disability defined, 24(n.3)

group homes, 45

special education for children, 71

Methodology, see Research methodology

Michigan, 101, 244

Minimum data set (MDS)

integrated assessment instruments, 126

nursing homes, 8, 14, 15, 76, 90, 116-120, 149, 150, 221, 225-227

residential care, 124-125

Minnesota, nursing homes, 80, 189, 245, 246

Minorities, see Race/ethnicity of care users

Missouri, 101

Mobility, see Functional mobility

Multi-facility organizations

home health care, 51

nursing homes, 10, 43, 44, 149-150, 243

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

N

National Center for Health Statistics, 37, 42, 123

National Citizens' Coalition for Nursing Home Reform, 191

National Council on Quality Assurance, 134

National Health Interview Survey, 37(n.1)

National Health Provider Inventory, 45

National Home Health Agency Prospective Payment Demonstration, 96

National Institutes of Health, 85

National League for Nursing, 171

National Long-Term Care Survey, 37(n.1), 59, 246

National Nursing Home Survey, 42

National Study of Assisted Living for the Frail Elderly, 48(n.6)

Netherlands, 107

New Hampshire, 209

New Jersey, 209, 293

New York State, 200, 241

Nonelderly adults, 2, 24, 38-40

adult foster care homes, 45, 49-50, 94-95, 164, 250

advocacy, 174-175

care management, 59

diseases requiring care, 40

home and community-based services organizations, 55, 59

informal care, 60

number in long-term care, 1, 23, 39

North Carolina, 124, 125

North Dakota, 101, 245

Nurses and nursing, general, 12-13, 17, 18, 65, 70, 89, 212

adult foster care homes, 95

assisted living facilities, 49, 93

board and care homes, 46, 202-203

care management, 58

education and training, 156, 196-198, 202-203

home health care, 51, 53, 54, 98-99, 100, 104, 206, 207, 208

hospitals, 187, 192

nursing homes, 113, 142, 143, 183-195, 230, 237

pressure sores, 80-81

residents-to-nurses ratios, 12, 187, 190, 191, 192

see also Licensed practical nurses;

Nursing assistants;

Registered nurses

Nursing assistants (NAs), 11, 12, 17, 60-61, 180, 212, 215-216

board and care homes, 202-203

education, 156, 197-198, 202-203

home health care, 54

nursing homes, 61, 88, 113, 143, 188, 189, 190, 191, 192, 212, 229, 232

wages, 194, 213, 214

Nursing Home Casemix and Quality Demonstration project, 117, 118

Nursing Home Casemix and Quality Demonstration Resident Status Measurement , 118

Nursing Home Reform Act, 25, 142-143, 176, 250-251

Nursing homes, 1, 2, 5-6, 12-16 (passim), 20, 24, 41, 42-45, 76-90, 108, 244-246, 250-251

accreditation, 7, 42, 43, 44, 76, 89, 140-141, 161-162, 182

administrators and administration, 143, 161-162, 182, 184, 191, 196-197, 198-202, 212, 242-243

advocacy, 148, 161, 162, 176-177, 191

bathroom facilities, 88, 229-230

care management, 70, 71

casemix, 19, 74, 88, 90, 114, 117, 118, 123-124, 182, 188-195 (passim)

casemix reimbursement, 19, 240-241

certification, 7, 42, 43, 44, 76, 89, 140-141, 161-162, 182

children, visits to homes, 88

clinical practice guidelines, 14, 15, 221-222, 224, 226-228

cognitive factors, 7, 43, 84, 85, 86, 116

complaints and complaint resolution, 79, 115, 144, 153, 162

consumer-centered care, 31, 32, 71, 88-89(n.3), 131, 148, 222, 289

cost factors, 1, 63-64, 89, 90, 115, 162, 194-195, 221-224 (passim), 227, 229-230, 232, 236-238, 242-243

definitional issues, 42(n.3), 221, 250

dementia patients, 40, 43, 83, 86, 113, 204-205, 209, 211, 289

demographics of users, 39, 43-44

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Department of Health and Human Services study, 192

employment issues, 12-13, 89, 113, 187, 189, 194-195, 199, 212, 213

family members, 86.

87

financing of care, general, 62, 63-64, 236-238, 242-243

functional mobility, 5, 7-8, 12, 76, 229-230

functional status, general, 45, 79, 84, 94-95, 113, 116, 176, 189, 224

General Accounting Office studies, 68, 76, 77-78, 145, 148, 150-151, 152-153, 158, 160, 161

Health Care Financing Administration, 3-4, 7, 12, 18, 25, 42, 79, 86, 119, 142, 195

personnel, 12, 19, 184-187, 192, 193, 195-196, 201

state survey and certification, 18, 42, 137, 143-163

historical perspectives, 25, 42-43, 44, 110-111, 141-144, 150, 153-154, 235

home and community-based services and avoidance of, 100-101

hospital-based, 44, 63, 82, 183, 185

hospitalization of residents, 84, 89, 188, 190, 195

incontinence, 82-83, 108, 113, 188, 223, 228, 229-230

information systems, 110, 122-123, 223-227

inspection of facilities, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158

Internet, 161

licensure, 7, 89, 182

managed care, 45, 200-201

Medicaid, see Medicaid, nursing homes

Medicare, see Medicare, nursing homes

medication, 143, 182, 184, 191, 199, 241

mental health and illness, 7-8, 43, 45, 113, 116, 184, 199;

see also“dementia patients” supra

multi-facility organizations, 10, 43, 44, 149-150, 243

number in care, 1, 2, 22-23, 37, 39, 42, 43

nutrition, 77, 78, 82, 85, 113, 116, 142, 143, 150, 153, 182, 184, 188, 191-192, 198, 229, 230

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

organizational factors, 14, 200, 221-234

outcomes of care, general, 4, 7-8, 14, 15, 17, 80-81, 223

ownership of facilities, 44, 47, 88, 113, 114, 149-150

pain and pain management, 77, 78, 80, 83-84, 150

personnel, 12, 15, 17, 19, 79, 89, 90, 114-115, 149, 180, 183-201, 212, 213, 223-224, 228-232, 237

education and training, 156, 187, 196-201, 223

licensed practical nurses, 61, 89, 113, 182, 183, 187, 188-189, 196, 200, 201, 212, 213

nurses, general, 113, 142, 143, 183-195, 230, 237

nursing aides, 61, 88, 113, 143, 188, 189, 190, 191, 192, 212, 229, 232

paraprofessionals, general, 181

physicians, 113, 143, 199-201

registered nurses, 61, 113, 182, 183, 187, 188-190, 191, 192-194, 212, 237

standards, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216

physical and chemical restraints, 77, 78, 79-80, 89, 108, 153, 182, 184, 195, 199-202, 251

pressure sores, 77, 78, 79, 80-82, 84, 150, 188, 192, 199

privacy and dignity, 5, 77, 85, 88, 108, 110, 198, 229

private insurance, 63, 64

private sector, 43, 44, 243

quality management systems, 14, 15, 221, 222-223

quality of life, general, 5, 6, 12, 32, 84-90, 108, 142, 143, 155, 156, 192, 231

pain and pain management, 77, 78, 80, 83-84, 150

race/ethnicity of residents, 39, 43

record keeping, 153, 195-196

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

regulatory issues, see Regulatory issues, nursing homes

research funding, 119-120, 152, 153, 195-196

research methodology, 84-87, 90, 143-144, 150-152, 153

resident councils, 176

Resident Assessment Instrument (RAI), 7-8, 111, 115-120

minimum data set (MDS), 8, 14, 15, 76, 90, 110, 116-120

resident assessment protocols (RAPs), 8, 115, 225, 226, 227-228

Resource Utilization Groups (RUGs), 117, 118, 184-186, 193

safety issues, 5, 7, 10, 76, 77, 78-79, 85, 86, 142, 153, 155, 156-158, 198

social factors and services, 88, 94, 116, 182, 184, 191

special care units, 22, 43, 113, 241-244

standards, 114, 140-163, 176-177, 182, 191-195, 235

state government, 10, 16, 17, 18, 19, 42, 79, 80, 81, 118, 126, 137, 142-163, 197, 198, 236, 238, 241, 246

subacute care units, 22, 43, 65, 113, 241-244

surveys of, 18, 37, 42, 137, 142-158

time factors, 15, 89, 118, 123, 151, 153, 156, 159, 160, 182, 183-187, 188, 189, 194, 199-200, 226-227, 229-231, 237

volunteers, 44

Nutrition

assisted living, 48(n.6)

food handling, 10, 163

home health care, 53, 54, 59, 68

nursing homes, 77, 78, 82, 85, 113, 116, 142, 143, 150, 153, 182, 184, 188, 191-192, 198, 229, 230

regulatory issues, 3, 10, 142, 143, 150, 153

weight problems, 74, 78, 118, 150

O

OASIS, see Outcome and Assessment Information Set

Occupational therapy, 11, 71, 180, 182, 184, 190, 206, 207

Office of the Inspector General, 215-216

Ohio, assisted living, 93

Old age,

see Elderly persons

Older Americans Act, 11, 54, 59, 68

Long-Term Care Ombudsman Program, 11, 79, 175-176

Omnibus Budget Reconciliation Acts (OBRA), 3, 5-6, 7-8, 12, 14, 15, 16, 21, 25, 45, 79, 80, 81, 83, 90, 95, 108, 139-144 (passim), 150, 151, 153-154, 161, 162, 170, 171, 179, 182, 187, 190, 192-193, 206, 221, 224, 233, 234, 247

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

Oregon

adult foster care homes, 94, 95

assisted living, 93, 293

board and care homes, 202-203

nursing homes, 246

personal attendant programs, 5

Organizational and institutional factors, 2-3, 14-15, 69-72, 180, 220-234

child care, 70-72, 105

clinical practice guidelines, 14, 15, 221-222

coordination of services, 69-72, 105

family issues, 70-72

nursing homes, 14, 200, 221-234

quality management systems, 14, 15, 221, 222-223

see also Accreditation;

Care management;

Certification;

Community-based services;

External oversight;

Information systems;

Licensure;

Managed care;

Ownership of facilities;

Regulatory issues;

Residential care settings;

Standards

OSCAR, see On-line Survey Certification and Reporting (OSCAR) System

Outcome and Assessment Information Set (OASIS), 8, 96, 97, 120-122, 128, 171

Outcomes of care, 4, 5, 7-9, 33, 74-75, 110-134, 233-234

chronically poor providers, 18, 111, 141, 148-150, 158-161, 251

see also Fines and penalties

consumer-centered care, 74-75

definitional issues, 8-9, 29-30, 31, 74

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

home health care, 8, 97-98

nursing homes, 4, 7-8, 14, 15, 17, 80-81, 223

see also External oversight;

Information systems

Ownership of facilities, 213

adult foster homes, 50

home health care agencies, 51, 52, 53, 99

hospices, 51, 53

nursing homes, 44, 47, 88, 113, 114, 149-150

see also Multi-facility organizations

P

Pain and pain management, nursing homes, 77, 78, 80, 83-84, 150

Paraprofessionals, 3, 11, 59, 60-61, 180, 181, 214, 215

home health care, 51, 54, 181, 208-209, 291

nursing homes, 181

regulatory requirements, 9, 138-139

residential care, 205

see also Housekeeping personnel;

Nursing assistants;

Personal care services

Patient Abuse Prevention Act (proposed), 216

Patient education, 55, 71, 138

home health care, 99

Penalties, see Fines and penalties

Personal care homes, 41, 164, 202

Personal care services, 1, 3, 4, 6, 13, 22, 68, 101-103, 109

adult foster care homes, 94, 95

advocacy, 67, 177

assisted living, 47, 48(n.6)

community-based, 29, 54-55, 56-57, 66-67, 101

consumer-centered, 29, 250

defined, 27

education of staff, 174

employment issues, 55, 209-210

family members, 55

Health Care Financing Administration, 101-103

licensure, 210

Medicaid, 55, 56-57, 66, 67, 101-103, 106

personnel, 61, 174, 209-210, 212

regulation and standards, 18, 102-103, 173, 174

state government role, 54-55, 56-57, 66-67, 68, 101-103, 174, 209-210

Pharmaceuticals, see Medication

Physical and chemical restraints, 3

board and care homes, 91-92

community-based residential care, 91

home health care agencies, 206

nursing homes, 77, 78, 79-80, 89, 108, 153, 182, 184, 195, 199-202, 251

regulations, 3, 6, 139

Physical therapy, 11, 12, 51, 53, 54, 61, 71, 182, 190

Physicians, 11, 51, 62, 125

board and care homes, 203

education and training, 61, 62, 199-201

home health care, 53, 54, 206

nursing homes, 113, 143, 199-201

Poverty, see Medicaid;

Supplemental Security Income program

Practice guidelines, see Clinical practice guidelines

Pressure sores, 123

nursing homes, 77, 78, 79, 80-82, 84, 150, 188, 192, 199

Primary care, 28

Privacy and dignity, 5, 6, 10, 71, 76, 288

assisted living, 47, 49, 92-93

contracting practices, 9, 25, 33, 136, 165-166, 170, 249

home health care agencies, 207, 209

nursing homes, 5, 77, 85, 88, 108, 110, 198, 229

residential care, 164, 169

see also Bathroom facilities;

Physical and chemical restraints

Private sector, general, 22, 70

adult foster care and small group homes, 50

home health care, 51, 52, 53

hospice care, 51, 53

nursing homes, 43, 44, 243

residential care, 108, 166-167

state collaboration in information dissemination, 18

see also Assisted living;

Board and care homes;

Health insurance;

Managed care;

Multi-facility organizations;

Ownership of facilities

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Professional education and training, 13, 19, 60, 74, 139, 180, 181, 210-211, 215, 234

administrators, 196-197, 198-202, 208

assessment instruments, surveyors, 8, 115, 117, 152-153

assisted living, 93

child care, 61, 104-105

consumer-centered services, 29, 71

home health care, 206, 207-209

informal caregivers, 218

nursing aides, 156, 197-198, 202-203

nursing home personnel, 156, 187, 196-201, 223

personal care, 174

physicians, 62, 199-201

registered and licensed practical nurses, 196-197

residential care staff, 93, 166, 168, 202-203, 204-205

standards, 19, 71, 181

Program of All-Inclusive Care for the Elderly, 70

Proprietary care facilities, see Private sector

Prospective payment system, 16, 20, 22, 50, 63, 65, 96-99 (passim), 117, 118, 122, 185-187, 236, 238-244 (passim)

Providers and provider quality, 1, 3, 4, 10, 11-14, 41-62, 180-219

accountability, general, 33

attitudes, 28, 187, 195, 228-229, 232

chronically poor providers, 10, 18, 111, 137, 141-142, 148-150, 153-156, 158-162, 251

criminal behavior by providers, 1, 13, 24, 78, 79, 138, 189, 192, 215-217

day care, 43, 59

personnel standards, 11, 12, 13, 19, 71, 74, 96-97, 142, 167, 180-219 (passim)

assisted living, 202, 203-204

cost factors, 13, 205, 194-195, 219

federal government, general, 11, 181, 182-183, 191-194

home health care agencies, 181, 205-209, 212-213, 216

Medicaid, 182, 193, 198, 201, 215, 216

Medicare, 182, 193, 197-198, 201, 216

nursing homes, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216

personal care services, 18, 102-103, 173, 174

residential care, general, 202-203

state, 11, 19, 181, 182-183, 202, 215-216

personnel-to-residents ratios, 12, 187, 190, 191, 192, 202

staffing issues, general, 11-14, 19, 32, 61, 109, 112, 113, 114-115, 134, 163

standards, facilities, 11, 33-34, 135-179

Psychological factors, see Mental health and illness

Psychotropic medications, see Physical and chemical restraints

Public education, 3, 19, 249, 292

advocacy and, 175, 177

children, 133

children, special education, 71

mass media, 1, 9, 21, 24, 61, 135, 213

social services defined, 27

Q

Quality management systems, 14, 15, 221, 222-223

Quality of life, general, 10, 12-13, 20, 23, 42, 74, 179, 234, 287-288

adult foster care homes, 95

advocacy, 176

attitudes and, 29-30

board and care homes, 46, 92

consumer-centered care, 29, 32-33

cultural attitudes, 22

defined, 29-30, 84

nursing homes, 5, 6, 12, 32, 84-90, 108, 142, 143, 155, 156, 192, 231

pain and pain management, 77, 78, 80, 83-84, 150

REAL (real experiences and assessment of life), 85, 86

regulatory issues, 10, 77, 78, 80, 83-84, 139, 141, 142, 143, 150

research methodology, 84-87, 90

residential care, general, 10, 108, 292-293

see also Functional status;

Incontinence;

Nutrition;

Pressure sores;

Privacy and dignity;

Safety issues

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

R

Race/ethnicity of care users, 39

board and care homes, 46

consumer satisfaction, 129

home health care, 51

nursing homes, 39, 43

RAI, see Resident Assessment Instrument

REAL (real experiences and assessment of life), 85, 86

Recreational services, 46, 92, 95

Registered nurses (RNs), 11, 60, 180, 216

board and care homes, 202

education, 196-197

home health care, 51, 54, 61, 169-173, 206, 207, 208, 213, 291

number of, 61

nursing homes, 61, 113, 182, 183, 187, 188-190, 191, 192-194, 212, 237

wages, 194, 213

Regulatory issues, 3, 4, 5, 7, 9-10, 135, 136-140, 291-293

advocacy and, 177

arguments for and against regulation, 138-140

assisted living, 93, 94, 166

attitudes of enforcement personnel, 141

board and care homes, 45, 46, 91, 92, 163-169

consumer-centered care, 33, 136, 138, 148, 165-166, 170

cost factors, general, 139, 140

dispute resolution, 144, 162

funding and, 18, 138

home and community-based services, 102-103, 138

home health care agencies, 167-168, 169-173, 206-209

information systems, 7, 110

nursing homes, 138, 140-153

advocacy and, 176-177

dispute resolution, 144, 162

federal, 3, 5-6, 7-8, 9, 10-11, 12, 14, 15, 16, 18, 21, 79, 80, 81, 83, 89, 90, 136-137, 139-163

inspection of facilities, 18, 37, 42, 76, 81, 82, 112, 113, 114-115, 137, 142-158

sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 158-162

state, 9, 10-11, 18, 20, 89, 140-163

nutrition, 3, 10, 142, 143, 150, 153

On-line Survey Certification and Reporting (OSCAR) System, 7, 12, 76, 77, 81-82, 90, 112-115, 153, 183, 187, 236-237

paraprofessionals, general, 9, 138-139

personal care services, 18, 102-103, 173, 174

physical and chemical restraints, 3, 6, 139

quality of life, 10, 77, 78, 80, 83-84, 139, 141, 142, 143, 150

Resident Assessment Instrument (RAI), 7-8, 111, 115-120

minimum data set (MDS), 8, 14, 15, 76, 90, 116-120, 149, 150, 221, 225-227

residential care, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293

sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 159-160

state survey regulations, 18, 42, 137, 142-163, 164, 251

see also Accreditation;

Certification;

Legislation;

Licensure;

Standards

Rehabilitation Act, 55

Rehabilitation services and facilities, 8, 12, 22, 30, 41, 55, 64, 65, 77, 79, 89, 98, 113, 116, 143, 182, 190

see also Occupational therapy;

Physical therapy;

Speech and language therapy

Relatives, see Family members

Religious institutions, informal caregivers, 3, 59

Research methodology, 37

assessment instruments, 8-10, 18, 37, 40, 47, 109, 117-123 (passim), 127-134, 143-144, 150-152

nursing home research/inspection surveys, 84-87, 90, 143-144, 150-152, 153

quality of life studies, 84-87, 90

see also Information systems

Resident Assessment Instrument (RAI), 7-8, 111, 115-120, 124-125, 128

see also Minimum data set

Resident assessment protocols (RAPs), 8, 115, 225, 226, 227-228

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Residential care settings, 1, 3, 6, 22, 25, 108-109, 124-125, 127

advocacy, 168, 202-203, 293

casemix, 202

cognitive factors, 46-47, 166, 203-204

community-based services, 22, 41, 45-50, 91-96

cost factors, 166

developmentally disabled persons, 24, 95-96

employment, general, 13, 61, 181

family members, 166

functional mobility, 76, 125

functional status, general, 91

General Accounting Office studies, 93, 94, 163, 165-166, 202

group homes, 41, 45, 49-50, 71, 94, 250

inspection of facilities, 165, 166

licensure, 45, 47, 49, 91-92, 94, 137, 163, 164, 165, 202

Medicaid, 70, 96, 202, 204, 293

Medicare, 202, 204, 293

mental health and illness, 46, 164

minimum data set, 124-125

number of, 43

number of residents in, 1-2, 22-23, 43

paraprofessional personnel, 181

personnel, 108-109, 181, 202-205

personnel, education of, 93, 166, 168, 202-203, 204-205

personnel standards, 202-203

privacy and dignity, 164, 169

quality of life, 10, 108, 292-293

regulatory issues, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293

research funding, 127

safety, 5, 76, 205

time factors, 204-205

see also Adult foster care homes;

Assisted living;

Board and care homes;

Hospice care;

Institutional care

Resource Utilization Groups (RUGs), 117, 118, 184-186, 193

Respiratory disease, 40

Restraints, see Physical and chemical restraints

Rhode Island, 101

Robert Woods Johnson Foundation, 3, 25, 103, 120

S

Safety issues, 7, 10, 13, 31, 138, 139, 288

abuse and neglect, 13, 78, 79, 138, 189, 192, 215-217

board and care homes, 92, 163

community-based residential care, 91

home health care agencies, 205

nursing homes, 5, 7, 10, 76, 77, 78-79, 85, 86, 142, 153, 155, 156-158, 198

residential care, 5, 76, 205

see also Physical and chemical restraints

Salaries, see Wages and salaries

Sanctions, regulatory, see Complaints and complaint resolution;

Fines and penalties

Securities and Exchange Commission, 213

Social factors and services, 11, 75

adult foster care homes, 94, 95

assessment instrument design, 116, 131

assisted living, 93

attitudes about long-term care needs, 22

board and care homes, 92

care management, 58

definition of social services, 27

friends, 3, 27, 59, 60

funding from 75

home health care, 53, 54

number of social workers, 61

nursing homes, 88, 94, 116, 182, 184, 191

recreational services, 46, 92, 95

residential care, 203

standards of care, 5, 10, 182, 184, 191, 203

see also Family members;

Informal care

Social Security Act, 66, 68, 163, 206, 207

Social Services Block Grant, 68

see also Supplemental Security Income program

Special care units, 22, 43, 113, 241-244

Alzheimer's disease, 113

Specialists and specialization, 12, 62, 70, 104, 124, 187, 189, 190-191, 196

see also Occupational therapy;

Physical therapy

Speech and language therapy, 11, 71, 121, 180, 182, 184, 189, 206, 207

SSI, see Supplemental Security Income program

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Standards, 3, 5, 9-10, 11, 18, 75, 76, 33-34, 135-179

advocacy and, 177

assessment instruments and methodologies, 8-9, 14, 114, 115-116, 123

assisted living, 10, 47, 93, 164, 166, 168-169, 202, 203-204, 292-293

child care, 104-105

clinical practice guidelines, 14, 15, 221-222, 224, 226-228, 232, 234

cost factors, 13, 15, 194-195, 219, 205, 221, 232

definitional issues, substandard quality of care, 156, 158-159

funding for, 136

home care, 11, 96-97, 167

home health care agencies, 169-173, 181, 205-209, 212-213, 216

inspection of facilities, home health care, 170

nursing homes, 18, 37, 42, 76, 81, 82, 84-87, 90, 112, 113, 114-115, 137, 142-158

residential care, 165, 166

nursing home audit procedures, 114

nursing homes, 140-163, 176-177, 182, 191-195, 235

personnel, 11, 12, 13, 19, 71, 74, 96-97, 142, 167, 180-219 (passim)

assisted living, 202, 203-204

cost factors, 13, 194-195, 205, 219

federal government, general, 11, 181, 182-183, 191-194

home health care agencies, 181, 205-209, 212-213, 216

Medicaid, 182, 193, 198, 201, 215, 216

Medicare, 182, 193, 197-198, 201, 216

nursing homes, 11, 12, 71, 74, 142, 181, 182-183, 191-198, 201, 215, 216

personal care services, 18, 102-103, 173, 174

residential care, general, 202-203

state, 11, 19, 181, 182-183, 202, 215-216

professional education, 19, 71, 181

purchaser of care, set by, 135

residential care, 8, 10, 45, 46, 91, 92, 163-169, 202-204, 292-293

sanctions for noncompliance, 10, 18, 137, 141-142, 148, 153-156, 158, 159-160

social factors and services, 5, 10, 182, 184, 191, 203

state, 10, 11, 19, 181, 182-183, 202, 215-216, 292-293

substandard facilities and programs, 10, 18, 137, 141-142, 148-150, 153-156, 158-162, 251

voluntary, 137, 171-172, 178, 202-203, 204-205

see also Accreditation;

Certification;

Licensure;

Outcomes of care;

Regulatory issues

State Supplemental Payments, 47, 64, 68

Stroke, 40

Subacute care units, 22, 43, 65, 113, 241-244

Supplemental Security Income program, 68

adult foster care and small group homes, 49

board and care homes, 47, 64, 68, 163

children, 68

State Supplemental Payments, 47, 64, 68

T

Tennessee, nursing homes, 80

Texas, 209, 293

Toilet facilities, see Bathroom facilities;

Incontinence

Training, see Patient education;

Professional education and training;

Public education

Transportation services, 46, 53, 59

U

United Hospital Fund, 213

V

Veterans Administration, 29, 106

see also Department of Veterans Affairs

Visual impairments, 40, 116

Suggested Citation:"Index." Institute of Medicine. 2001. Improving the Quality of Long-Term Care. Washington, DC: The National Academies Press. doi: 10.17226/9611.
×

Volunteers and voluntary organizations, 3, 59

accreditation agencies, 122, 137, 171-172, 178, 223

children, consumer-centered care, 72

external oversight, 9

home health care and hospice facilities, 51, 52, 53, 54

nursing homes, 44

religious organizations, 3, 59

residential care, 168-169

standards, voluntary, 137, 171-122 178, 202-203, 204-205

see also Advocacy;

Informal care

W

Wages and salaries, 13-14, 19, 61, 180, 187, 194-195, 210, 211, 213-215, 242

assisted living, 94

Washington, D.C., see District of Columbia

Washington State, 293

Weight problems, 74, 78, 118, 150

Welfare, see Medicaid;

Supplemental Security Income program

Wisconsin, 245, 246

Women, see Gender factors

World Wide Web, see internet

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Improving the Quality of Long-Term Care Get This Book
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Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves.

Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers.

Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions.

This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

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