Policy without technology: a barrier to improving nursing home care.

Standards of care are written for nursing homes without a realistic assessment of whether there is an intervention protocol or resources to meet these standards. This situation produces unfair pressures on nursing home providers, who react with paper compliance strategies, and creates a barrier to implementing new interventions that do meet care standards once they are developed. This article explores this barrier and illustrates examples of interventions that have been attempted in nursing homes using a continuous quality improvement model. The development of quality indicators based on assessment data available in all nursing homes is a step toward making the survey process more focused on outcomes rather than on paper compliance. Much more research is needed to design effective clinical interventions and to provide nursing homes with the technologies necessary to target them. Internal nursing home quality assurance programs based on principles of continuous quality improvement, with reinforcement from the external survey process, are suggested as a strategy to maintain clinically effective interventions. Applied research centers based in long-term care facilities should be supported in order to accomplish such research designed to improve the care and quality of life our increasing frail nursing home population.