The quest for nursing home quality: learning history's lessons

Nursing homes are arguably the most criticized sector of the US health care system. In fact, the nursing home industry's entire history has been marked by cycles of public clamor for improvement and ineffective governmental responses. Over the past century, multiple attempts to improve the quality of nursing home care have had limited success. This article reviews these initiatives from the era of the poorhouse to the most recent reform law, implemented during the last decade. An analysis suggests that the historical reliance on government regulation has not ensured nursing home quality. Future efforts should address the most glaring weaknesses of nursing home regulation, including the lack of standardization of the survey and enforcement processes. In addition, new strategies are needed beyond a reformed inspection system. This article demonstrates that while the exact path to nursing home quality is somewhat uncertain, retracing history's steps will not lead nursing homes in the desired direction.     

Parathyroid adenomas evaluated by Tl-201/Tc-99m pertechnetate subtraction scintigraphy and high-resolution ultrasonography

Thallium-201/technetium-99m pertechnetate subtraction scintigraphy of the parathyroid glands was performed in a prospective study of 33 patients who had undergone bilateral neck exploration for elevated serum calcium and serum parathyroid hormone levels. In 31 cases, the Tl-201/Tc-99m subtraction technique yielded an overall sensitivity of 81%, specificity of 99%, and accuracy of 94% for identifying solitary parathyroid adenomas. Tl-201/Tc-99m subtraction scintigraphy correctly identified 73% of parathyroid adenomas weighing less than 499 mg, 79% of those weighing 500-1,499 mg, and 100% of adenomas weighing more than 1,500 mg. In a subgroup of 24 patients with solitary parathyroid adenomas who underwent both scintigraphy and high-resolution sonography, the sensitivity, specificity, and accuracy of both procedures were similar.     

Factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care facilities

PURPOSE: We identify resident, nursing assistant, and facility factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care. DESIGN AND METHODS: We used a cross-sectional survey of 143 nursing assistants providing care to 335 residents in 38 residential care/assisted living (RC/AL) facilities and nursing homes in four states. We assessed resident quality of life by using the Quality of Life-Alzheimer's Disease Scale (QOL-AD). RESULTS: Scores on the quality-of-life scale were most strongly associated with resident clinical conditions, including severity of cognitive and functional impairments, depression, and behavioral symptoms of dementia. There was also an independent positive association between nursing assistants' ratings of resident quality of life and their own attitudes regarding dementia-person-centered care as well as training. However, the results of hierarchical linear modeling suggest that some sources of nursing assistant variability in quality-of-life ratings remain unidentified. IMPLICATIONS: Quality-of-life ratings by nursing assistants may be influenced by their attitudes about dementia and their confidence in addressing residents' fundamental care needs.