Measuring the quality of long-term care in institutional and community settings

Our objective lies in clarifying the basic issues in long-term care LTC policy, describing instruments for the comprehensfve assessment of those receiving LTC In institutional and community settings. and demonstrating how the assessment database could be used to measure quality.

A clearly defined LTC policy is needed to avoid distortions and fiscal strains in programmes designed for health, social welfare and housing. Since the need for LTC services can be broadly interpreted, policy-makers should first focus on developing entitlement standards to ensure equitable access. Next, the locus should be on measuring quality by collecting data on the process of care and

how it impacts on the functional, cognitive and emotional status or the recipients.

The development of the MOS (Minimum Data Set in the United States was a break through towards obtaining accurate data for this purpose. The MDS has been mandated In virtually every nursing home In the United States since 1991, and also In Iceland and two provinces In Canada. It has

been translated and validated in over 20 countries. A home cere version of the MDS, the MDS-HC. has been developed by InterRAI, an International non-profit organisation of researchers and clinicians. This development shares core assessment items so that seamless care can be provided regardless of site.

while also having specific items tailored to meet the unique needs in home care.

Using the databases of the MDS and MDS-HC, quality indicators have been developed to compare quality among providers within and across countries. In Canada, data for hospitals providing complex continuing care in the province of Ontario showed that a third of patients were restrained on a daily basis, which might lead to pressure ulcers. This finding contributed to the recent adoption of more

restrictive policies on restraint use in Ontario. Otherwise, the pilot Implementation of quality indicators

in single point entry agencies to community and institutional services still in Ontario showed that a high

proportion of clients who would potentially have benefited from rehabilitation did not receive such services.