Caring for a frail person is an intimate service conducted in a private setting. Often the frail person is not in a situation to be able to insist on quality services or to do anything if a caregiver is not acting properly or effectively. The setting and character of long-term care present challenges for quality assurance and require careful attention to assure quality.

This Topic Summary synthesizes Program Results on work funded by the Robert Wood Johnson Foundation (RWJF) to improve the quality of long-term care.

• Quality Improvement Research—In 1998, RWJF supported research on the effect of federal reform legislation on the quality of long-term care in long-term-care settings including nursing homes, assisted-living facilities, home health care and board-and-care facilities. In 2002, with support from RWJF, AcademyHealth convened an invitational conference on the role of research in strengthening the delivery of long-term care.
• Measuring Quality—In the late 1980s, little was known about the quality of long-term care, or how to measure the effectiveness of long-term-care services. RWJF supported several projects that aimed to improve the tools used to measure the quality of home health care and nursing home care.
• Workforce—One strategy for improving the quality of care is to improve the training, recruitment and work environment of those who provide care. This includes:
  • Nursing Home Staffing Models—Three projects experimented with new models for staffing nursing homes.
  • Frontline Workforce—Two projects convened experts to discuss the demographics of aging and its effect on the front line long-term-care workforce. One project recruited low-income Hispanic women to provide high quality, culturally sensitive home health care.
• Care Innovations—These projects experimented with new services or new twists on existing services.