Intended for healthcare professionals

Education And Debate Regulating nursing homes

Residential nursing facilities in the United States

BMJ 2001; 323 doi: (Published 01 September 2001) Cite this as: BMJ 2001;323:507
  1. Charlene Harrington, professor (
  1. Department of Social and Behavioral Sciences, University of California at San Francisco, 3333 California Street, San Francisco, CA 94118, USA

    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

    Violations of care standards in nursing homes in the United States, 1991-92

    Summary points

    Poor quality care for the 1.6 million people in nursing homes in the United States has existed for 25 years

    Care in as many as one third of nursing homes jeopardises the health and safety of residents

    The largely profit making nursing home industry provides fewer nurses and poorer quality of care than non-profit homes and government run nursing homes

    A fundamental cause of poor care is the low number of nurses and other staff required by law

    Monitoring and enforcement of quality standards, which has been devolved to the states, has been weak because standards are lax

    The US government has failed to hold the nursing home industry accountable for how government funds are spent and to protect residents from …

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