This is the second in a series of three articles

Poor quality care has been an enduring feature of many of the 16 500 residential nursing facilities that provide care to 1.6 million people in the United States.1 Despite three decades of public concern, government surveys and data collected by the federal government continue to show that residents of nursing homes experience problems in their care (figure). In 1998 and 1999, 25-33% of nursing homes had serious or potentially life threatening problems in delivering care and were harming residents. 3 4 In 1999, state inspectors found that 26% of the nation's nursing facilities had poor food hygiene; 21% provided care that was inadequate; 19% had environments that contributed to injuries in residents; and in 18% pressure sores were treated improperly. The eight most common deficiencies identified in 1999 are shown in the box.2 About 77% of facilities that were performing poorly had problems in subsequent surveys conducted by state licensing and certification agencies.2