Completeness of admission of residents assessments in teaching nursing homes

In order to assess one aspect of the quality of care within teaching nursing homes, we examined how well these homes conform to geriatric experts' expectations for the admission assessment of elderly nursing home residents. Four hundred-sixty records representing new admissions to five teaching nursing homes over a 1-year period were assessed for completion of items considered important parts of the admission assessment by geriatric experts. Univariate and multivariate analyses both suggest the following four findings. First, the admission assessments performed at teaching nursing homes reflect geriatric experts' priority areas with two exceptions: (1) the assessment of affective disorders and (2) the identification of advance directives. Second, physician-nurse practitioner teams perform the high priority parts of the admission assessment to a degree similar to that of physicians alone. Third, resident's age and expected length of stay partially determine the extent of the admission assessment, as patients with shorter lengths of stay generally received a more complete assessment. Fourth, even among teaching nursing homes, there are significant differences between nursing homes in the performance of comprehensive admission assessment by nursing home clinicians.