The various services and settings for the provision of long-term care represent related but separate sectors of care often facing different issues with regard to topics studied by the committee. As stated earlier, the nature and extent of systematic empirical information also vary by providers and settings. In fact, a major problem in developing a balanced examination of the issues across settings is the paucity of reliable and systematic data and research for most of the care settings with the exception of nursing homes. Therefore, for the most part they are discussed separately within each chapter.

Chapter 2 summarizes the profile of long-term care in terms of who uses it, who provides it, and how it is currently financed.

Chapter 3 provides a framework for assessing the quality of long-term care and summarizes what is known about the current state of quality in different settings of long-term care. Chapter 4 discusses the current information systems for monitoring performance that could be used to assess, monitor, and improve quality of care.

Chapter 5, Chapter 6, Chapter 7, Chapter 8through Chapter 9 examine a range of issues and needed changes leading toward building a better policy environment in long-term care. These efforts include improvements in defining and enforcing basic standards of care, maintaining an adequate and qualified work force, building organizational capacity to improve care, and finally, designing reimbursement methods that encourage both quality and efficiency in care.

Although the committee has made every effort to obtain data and objective evidence based on research, some of its conclusions are necessarily derived from professional judgment based on the expertise and experience of committee members and on testimony and information provided by constituencies. In such cases, the committee has so indicated.

The report considers similarities and differences in the circumstances and concerns of various users of long-term care, including children, but it devotes more attention to older adults, both because they are the major users of long-term care, with prospects for further growth in their numbers, and because the long-term care literature and policy agendas also focus on aged adults and adults with disabilities. The report reviews nursing homes in more depth than other service settings because of long-standing problems of quality of care in these settings and because the literature on the quality of care in other settings is very limited.