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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
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
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
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
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
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
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
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
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
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
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.2)
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
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
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
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
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
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
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
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
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
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, 171-172, 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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