Regulation of the quality of nursing home care in the United States.

There is considerable evidence that conditions in nursing homes in the United States are far from optimal. Problems in nursing homes are understandable, given the fact that nursing home care is generally provided through private facilities, and that payment rates are often inadequate to support quality care. The 1987 Nursing Home Reform Act attempts to address problems in nursing homes by setting standards that address common problems, establishing survey methods that look at process and outcome as well as structure, and providing flexible sanctions to address the range of problems found in inadequate facilities. This article describes conditions in American nursing homes, and what is being done about them.