Quality of Life: The Institutional Culture Defined by Administrative and Resident Values

As the graying population, increasing costs, and public regulation place new demands on the institutional long-term care setting, administrators face a major challenge in ensuring quality of care and of life. Quality of life in long-term care has been defined by the subjective importance and perceived availability of autonomy, interpersonal relations, and security. Quality of care is the effective provision of health care resources in appropriate quantity and duration to respond to actual need. As such, it is but one, albeit essential, component of quality of life in the nursing home. These two concepts are based on somewhat different underlying values that create different criteria for decision making. We use the experience of one urban 1, 100-bed multilevel nursing home to illustrate how a multifaceted quality-assurance program including resident input can be developed and implemented using quality of life standards to define and evaluate institutional culture and practices. Mechanisms for monitoring quality of life include a quality-assurance department, grievance/complaint procedures, resident government, staff committees, structured rounds, and educational programs. Examples illustrate how an emphasis on quality of life and of care can result in institutional conflict and how such conflicts can be reconciled.