6 March 2023
An effort to improve nursing home quality in the United States that could serve as a model for other countries is underway. The 2022 National Academies of Science, Engineering, and Medicine (NASEM) report, The National Imperative to Improve Nursing Home Quality , was the catalyst for a multi-faceted and multi-stakeholder effort to change the course of nursing home quality, which has been recognized as a serious problem for decades.
An effort to improve nursing home quality in the United States that could serve as a model for other countries is underway. The 2022 National Academies of Science, Engineering, and Medicine (NASEM) report, The National Imperative to Improve Nursing Home Quality , was the catalyst for a multi-faceted and multi-stakeholder effort to change the course of nursing home quality, which has been recognized as a serious problem for decades. Nursing home financing, delivery and regulation are “ineffective, inefficient, inequitable, fragmented, and unsustainable”, resulting in “poor resident outcomes, substantial government spending, pervasive inequities, and an underpaid and demoralized workforce” . These outcomes affect 1.4 million people, including 57 percent long stay residents (average duration 2.3 years) and the remainder short-stay residents (average duration 28 days) .
Background of Nursing Home Quality Reform
The most recent major policy initiative to improve nursing home care quality in the U.S. occurred more than three decades ago: the 1987 Omnibus Budget Reconciliation Act (OBRA 1987, also known as the Nursing Home Reform Act of 1987). The legislation became law after the Institute of Medicine (the National Academy of Medicine’s precursor organization) published the 1986 report, Improving the Quality of Care in Nursing Homes. The law established some standards for nursing home care delivery, but the findings in the recent Nursing Home Quality report are evidence that current nursing home care quality in the U.S. continues to fall far short of needs and expectations.
The Moving Forward Nursing Home Quality Coalition
Nursing home quality reform in the U.S. now has a strategic, inclusive, and broad-based coalition of stakeholders focusing on improved care quality. The Moving Forward Nursing Home Quality Coalition was launched in June 2022 . The coalition’s four primary focus areas are resident-directed care, workforce, finance, and accountability, and its four core values are feasibility, sustainable impact, equity, and collaboration. The coalition envisions a future where “Every nursing home will be a community in which lives are nurtured, residents are empowered, and people want to work.” To achieve its vision, the coalition has created a growing network of diverse stakeholders, including residents, family members, advocates, and subject matter experts. Coalition work is structured within a steering committee and seven committees aligned with the NASEM report goals.
Of note is the coalition’s ambitious and structured timeline, shown below. Each committee has short- and long-term priorities. Currently, committees are developing their action plans. During the phase scheduled to begin in June 2023, committees will test and promote policy and practice change, with ongoing evaluation and course correction when needed.
Moving Forward Nursing Home Quality Coalition, 2023. https://movingforwardcoalition.org/
Beyond the coalition, communications efforts are underway to raise awareness of the NASEM report and its recommendations. In February, 2023, the Gerontological Society of America’s Public Policy and Aging Report published a special issue containing articles that provided detailed policy assessments of key aspects of nursing home quality that go beyond the NASEM report. Articles address a well-prepared workforce; care delivery, quality measurement and quality improvement; policies and recommendations about certified nursing assistants; payment reform; and health information technology adoption.
An article in Next Avenue, a nonprofit digital journalism publication on focused on aging produced by Twin Cities Public Broadcasting Service, published a story in December titled “Why Nursing Home Reform Is Finally Coming” . Beyond highlighting the Moving Forward Coalition’s efforts, the story describes President Biden’s emphasis on improving nursing home care quality.
Attention to thoughtful and consistent messaging about the NASEM report and improving quality care is critical to catalyzing change. The FrameWorks Institute, with funding from the John A. Hartford Foundation, released a report titled Communicating About Nursing Home Care: Findings and Emerging Recommendations . The report offers guidance about how to talk about improving nursing home quality, highlighting the need to start with a solution, focus on relationships and interconnectedness, emphasize collective responsibility, and paint a picture of quality of care.
One aspect of these efforts that is unusual globally is that they are funded by private philanthropy, not government. While people who work in government have been involved, this is primarily driven by the non-profit private sector.
Other countries with nursing home quality concerns may monitor these efforts and consider adopting aspects that are relevant within their contexts. Although the effort is not complete, there is optimism among U.S. experts in nursing home quality that this multi-pronged approach will actualize nursing home reform and the Moving Forward Coalition’s vision for a world where nursing homes are “communit[ies] in which lives are nurtured, residents are empowered, and people want to work.”
 National Academies of Sciences, Engineering, and Medicine. The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff. Washington, DC: The National Academies Press, 2022. https://doi.org/10.17226/26526.
 Travers, Jasmine L., Gregory Alexander, Marissa Bergh, Alice Bonner, Howard B. Degenholtz, Mary Ersek, Betty Ferrell et al. 2022 NASEM Quality of Nursing Home Report: Moving Recommendations to Action. Public Policy & Aging Report 33, no. Supplement_1 (2023): S1-S4.
 Moving Forward Coalition, https://movingforwardcoalition.org, accessed 6 March, 2023.
 Eisenberg, Richard. Why Nursing Home Reform is Finally Coming. Next Avenue, 28 December, 2022.
 Assar, Mia, Volmert, Andrew. Communicating About Nursing Home Care: Findings and Emerging Recommendations. The FrameWorks Institute, 11 April, 2022.
Maureen Henry, JD, PhD
International Longevity Center – USA