Purpose: Special Focus Facilities (SFFs) are nursing facilities designated by the Centers for Medicare & Medicaid Services to be of chronic poor quality. Relatively few nursing facilities are included in this initiative. The purpose of this research was to examine whether nursing facilities included in the 2007 SFF initiative subsequently…

Purpose: In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. Design and Methods: A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO)…

Purpose: Weak empirical evidence exists showing that nursing home staffing levels influence quality of care. We propose that weak findings have resulted in many prior analyses because research models have underspecified the labor composition needed to influence care processes that, in turn, influence quality of care. In this analysis, we specified…

Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

Purpose: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Design and Methods: Data on state initiatives and programs…