Institutional care: caregivers and quality.

Quality of care in nursing homes is very much in the eye of the beholder. How we as a nation define and measure quality in many ways reflects our beliefs about life, death and aging, and the value we ascribe to those who care for those who are infirm. Many people typify quality as an intangible that can be detected from the minute you enter a nursing home. Others know better. They recognize that the problems nursing home patients face are highly complex and require both a caring and sophisticated response. There is general agreement that a central factor determining quality of care in nursing homes is the level and skill mix of staffing. Yet how to attract, reward, and retain professional nurses remains elusive, as does how to measure their success.