© 2003 BMJ Publishing Group & Institute for Healthcare Improvement
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The decision to move an elderly person into a nursing home is often made on the grounds that they will be safer there. But this assumption may be misplaced, according to the author of this paper. He reports that there are many unsafe situations in the 17 000 nursing homes in the US—including falls, adverse drug events, pressure ulcers, problems with tube feeding, and equipment breakdowns. Better reporting of errors would help, but this will be difficult to achieve in view of the "pervasively adversarial—bordering on poisonous—legal, economic, political and medical environment surrounding the US nursing home industry". The author advocates a range of changes, such as modified Medicaid and Medicare payments, better information, quality initiatives, more financial support, and better communication between residents, family, and staff. "To meet . . . expanded expectations and preferences will be a formidable task, calling for expansive thinking and ingenuity beyond simple compliance
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