Poor quality care has been an enduring feature of many of the 16500 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
- 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 poor care
Between 1993 and 1999, there was an increase in the number of residents developing contractures, pressure sores, and incontinence; being bedbound; and receiving psychotropic drugs.2 In a study of nursing home residents who had died, more than half had received unacceptable care that endangered their health or safety; this care included failure to properly treat pressure sores, failure to manage pain, and some had had a dramatic, unplanned loss of weight.4 Given the scale and chronic nature of quality of care issues and the failures in resolving them, what can the United Kingdom learn from the experiences of the United States?