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Quality of Life

United States. Department of the Army. Office of the Deputy Chief of Staff for Personnel

Published: 1979

Total Pages: 170


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Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
Far more people are surviving to old age than at any time in our history. Medical interventions can now prevent or postpone many of the health problems traditionally associated with old age. Furthermore, the goal of medical care for the elderly has progressed beyond survival to maximizing quality of life, yet little attention has been paid to the overall quality of medical care that older people receive. In fact, existing measures of quality or health status are often inappropriate for the elderly. RAND Health has collaborated with Pfizer, Inc. to create the first quality-of-care assessment system for older persons. The goals of the Assessing Care of Vulnerable Elders (ACOVE) project were to define the population of vulnerable elderly, identify important medical conditions that affect this group, develop a set of evidence-based indicators of quality of care for this population, and design a tool to assess quality of care at the health system level. To develop the system, a national panel of geriatrics experts identified the medical conditions prevalent among older adults that contribute most to morbidity, mortality, and functional decline; that could be measured; and for which effective methods of treatment or prevention are available. Using these criteria, the advisory committee chose 22 topics, including diseases, syndromes, physiological impairments, and clinical situations, for which quality-of-care indicators could be developed. For each topic, the RAND team developed quality-of-care indicators that could be measured using processes of care. The expert panel assessed the evidence supporting links between each care process and improved outcomes in older adults, which resulted in 236 ACOVE quality indicators. These indicators can be used to assess whether health plans are delivering care that meets minimum standards for quality.