Drug Use in Nursing Homes: Legislating for Quality

Carmel M. Hughes, PhD
Senior Lecturer in Primary Care,
Pharmacy and National Primary Care Career Scientist,
School of Pharmacy,
The Queen's University of Belfast,
Northern Ireland.

Populations in the developed world are aging and the greatest demographic change is seen in those over the age of 80 years. Although it is a remarkable achievement in human survival, this demographic shift does present major challenges to health policy makers and providers. Health care for older people will need to be delivered at many levels--i.e., acute, intermediate, residential and home settings. The long-term care sector (nursing and residential homes) represents one area that can expect to face greater demands for delivery of quality services.

Quality of care and its assessment have become major concerns in most health markets in the developed world and long-term care is no exception. Perhaps the best system for assessing quality exists in the United States (US). This paper will provide an overview of the approach taken in US nursing homes with respect to drug use and contrast this with strategies in other countries.

Legislating for better care: the US situation
In 1983, the US Congress asked the Institute of Medicine to make recommendations for improving the quality of care in nursing homes.1 The report, published in 1986,2 revealed substantial evidence of appallingly bad care in many nursing homes in the USA.