Improving quality of long-term care

Long-term care is an important, albeit often neglected component of the health care system. In 1996, there were 1.6 million persons residing in nursing homes.(1) Nursing home residents are characterized by high levels of functional disability, frailty, major illness, and medication use. Ninety-two percent have dependencies in activities of daily living,(2) 30% to 50% are not independently ambulatory,(3) nearly all have disabling somatic(4) or mental(5) illnesses, and residents receive an average of 5 to 7 active medications.(6) There are perhaps twice as many persons of equal functional impairment who receive care in other settings.(4) Persons turning 65 years of age are predicted to have a 43% lifetime probability of entering a nursing home, and 55% of these will reside in a nursing home for at least 1 year(8).