Intended for healthcare professionals

Education And Debate

Impact of legislation on nursing home care in the United States: lessons for the United KingdomCommentary: A new script for nursing home care in the United Kingdom?

BMJ 1999; 319 doi: (Published 16 October 1999) Cite this as: BMJ 1999;319:1060
  1. Carmel M Hughes, Harkness fellow in healthcare policy (,
  2. Kate L Lapane, assistant professor in epidemiology,
  3. Vincent Mor, director
  1. Center for Gerontology and Health Care Research, Brown University, Box G-B213, Providence, RI 02912, USA
  2. a Trent Institute for Health Services Research, University of Sheffield, Sheffield S1 4DA
  3. b Directorate of Medicine, Leicester General Hospital NHS Trust, Leicester LE5 4PW
  1. Correspondence to: C M Hughes, School of Pharmacy, Queen's University of Belfast, Belfast BT9 7BL
  • Accepted 12 May 1999

Despite the growing recognition that our ageing population represents a major challenge to the provision of health services,1 2 no major government policy initiative had focused on this topic until the recent establishment of a royal commission. The royal commission was asked to concentrate on funding, but it was also required to define and establish mechanisms to assure the quality of long term care for elderly people, and was instructed to consider “the expectations of elderly people for dignity and security in the way in which their long term needs are met.”3

In the United States, where long term care has undergone dramatic changes in the past 10 years, the quality of care continues to be hotly debated. The impetus for changes in the long term care system includes legislation and regulation in the form of the Nursing Home Reform Act of 1987. One aspect of this legislation pertained to the appropriateness of prescribing. We summarise briefly the legislation in respect of prescribing, its implementation, and influence on nursing home care delivery and consider alternative approaches for the United Kingdom.

Summary points

Excessive use of psychotropic medication was commonplace in nursing homes in the United States before the Nursing Home Reform Act 1987 was passed

After legislation, psychotropic drugs were used less and a more structured approach to care planning was observed

In the United Kingdom, policy relating to nursing home care is unclear and explicit criteria for quality prescribing have not been formulated

A combination of structured assessment and review of patients, concerted educational interventions, and greater multidisciplinary working may improve long term care in the United Kingdom

Prescribing practices in nursing homes

Before the Nursing Home Reform Act, psychotropic drugs were used widely in US nursing homes.46 These drugs were prescribed for 43%-55% of patients in homes, despite the lack …

Correspondence to: A R Turrell

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