True care nurtures spiritual, mental, and social health, not just physical.

Quality of Care demands that people receiving long-term care should be treated with dignity. True quality of care speaks to the way a long-term care recipient is treated every day by everyone with whom they come in contact, and by the provider organization itself. Specific examples are the way the nurse approaches the consumer about taking medications and the manner in which an aide provides help with personal and private care.

Quality of Care means something different to each person and considers their unique needs and experiences. Quality of Care establishes approaches which make sense for each individual and their unique circumstances. 

Quality of Care is, of course, measured in the prevention, early detection, and competent treatment of physical illnesses, injuries, accidents, and other medical needs. That measure, however, is not all that Quality of Care is about. That measure is the foundation upon which every aspect of the care of each consumer is built. Quality of Care is “all of the above” (and all of the below!) and not a singular concept.

The care plan forms the basis for how the daily life of each person receiving care will unfold: what needs will be met, and how; how the consumer’s choices, priorities, goals, and preferences will be built into each consumer’s routine; and how this plan will be implemented and accomplished. The family representative of a long-term care recipient is considered a member of the care plan team, not a visitor. If the consumer cannot speak for oneself, the representative’s role is critical. 

The care plan should address medical, physical, mental, and social aspects of the consumer’s life. It should be goal directed to maintain or enhance the consumer’s experiences at the highest practicable level of the person receiving care, not the provider.  This concept includes, for example:

• A person entering long-term care who is ambulatory should remain ambulatory, with support services and therapies to improve, maintain, or slow the loss of functioning. The antithesis of this principle is too often the approach taken in long-term care settings: confining the person to a wheelchair “to prevent falls” – when staff assistance as needed, and physical therapy to increase or maintain strength and balance, should be the standard of practice. 
• A person entering long-term care who is continent of bowel and bladder should remain continent and, if their medical condition requires the use of a catheter, the goal should be to remove the catheter as soon as possible unless medically contraindicated. Catheters and protective undergarments must NOT take the place of staff attentiveness to the toileting needs of the care recipient.
• A person entering long-term care who receives and tolerates a diet of whole foods presented with typical dining preparation should remain able to receive such a diet, with support and therapies if needed to enable the care recipient to chew and swallow. When an altered diet is medically necessary, such as pureed foods or thickened liquids, the meals should be presented in a manner to encourage their intake. Regardless of the dietary needs, the individual preferences and choices of the care recipient should be honored to the greatest extent possible.

Decline may be inevitable in progressive or degenerative disease processes; but it should never be hastened by poor care or for staff convenience.

The Consumer’s Care Plan

Each consumer is assigned a number of professional and paraprofessional staff to develop a plan by which the long-term care provider will identify and work to meet the consumer’s needs.  The family members of the person receiving care are considered members of the care plan team (unless the consumer does not consent to this practice). In cases where the consumer is incapacitated, often there is a family member with power of attorney or designated as a legal representative who fills this role.  

Families must often take the initiative to assume this role. It is this representative’s responsibility to ensure that all their loved one’s needs — medical, nutritional, communication, social, mental, psychological, recreational, religious, and personal preferences — are addressed in the care plan, which serves as the guide for all staff working with the consumer.  

Properly organized providers have a social worker, case manager, or care coordinator on staff to assist in the process of developing and participating in the care plan. The care plan should have stated goals for maintaining the consumer’s well-being in all the areas of the their life. The family should gain a clear understanding of these goals and how staff will work toward them. Regularly scheduled updates should keep the family updated on progress; issues should be discussed as they arise.  Natural aging-related decreases in the consumer’s functioning will occur and the care plan should be modified as needed.

What -- and Who -- Is Involved In Developing a Comprehensive Care Plan?  See the drop-down box below.

NOTE:  A comprehensive care plan is needed whether or not the provider will be responsible for all aspects of the consumer's life.  For example, it is important for a home care provider to know that attending religious services is important to the person receiving care.  Without this knowledge, the provider will not make an effort to schedule home care services to assist the consumer in the tasks to get ready or to attend religious services.  Weekends are not always a routine service day for some providers.

Practicalities in Quality of Care

Quality of Care requires that consumers receive medication only as necessary, and only when a proper diagnosis indicates that the medication is appropriate for that condition.  Our Mother’s Voice empowers families and advocates to speak out for consumers when they can only communicate feeling sick by acting agitated, and so receive medication to calm their behavior instead of treat the illness.  Thus empowered, the advocate can say on behalf of the consumer, “I do not need medicine to calm me down!  I am sick!  I need to have the doctor check me out!” The family must speak out when their loved one cannot.  Certainly, there are cases when medications are appropriate and necessary.  Quality of Care distinguishes these cases and responds correctly.

Accidents will happen. Quality of Care is evident in how the care environment is organized to prevent accidents and respond to accidents that do occur. Consumers should be supervised adequately. Investigation, follow-up, and systems changes to prevent recurrence of accidents are all components of Quality of Care. Quality of Care minimizes staff distractions, establishes safe environments and practices, and ensures that staff members are actively engaged with consumers, not involved in nonwork-related pursuits.

Quality of Care ensures consumers are free from physical or chemical restraints used for purposes of discipline or convenience, and which are not required to treat the consumer’s medical symptoms. Recipients of care must not be exposed or vulnerable to verbal, sexual, physical, or other forms of abuse, neglect, or exploitation. How any allegations or acts of such treatment are handled can determine the presence or absence of Quality of Care. All alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown sources and misappropriation of the consumer’s property are to be reported immediately to the administration of the service provider and to other officials as established by state law.  

The provider must complete an internal investigation of all violation reports and complaints, and submit the findings to those officials within a specific timeframe. In cases where violations of law or crimes may have occurred, law enforcement may be required to conduct an independent investigation. Certain actions, as each situation requires, must be taken when any violation is verified. The laws governing abuse and reporting must be posted in every facility.  

The terms abuse, neglect, exploitation, and misappropriation of property are defined on our “What You Can Do” page

Source: Code of Federal Regulations, 42CFR483.25, 42CFR483.12, 42CFR483.20, 42CFR483.24, 42CFR483.40, 42CFR483.45, 42CFR483.70, 42CFR483.75, and 42CFR483.85, and the Center for Medicare & Medicaid Services.