The quality care pyramid.

"We provide quality care," proudly states the health-care profes sional-yet the negative image of long-term care persists. If quality care is being provided, why does the uproar continue regarding the poor quality of care received by the institutionalized population? Why are more rules and regulations being legislated? Why are numerous studies being undertaken on the improvement of long-term care? Could the problem originate in the eyes of the providers?

This article serves to address the nonperception of the simple but comprehensive questions: "What is quality care?" "What are the components of quality care?" "How can you ensure that a consistent level of quality is occurring?

What is quality care?

Quality care in the long-term setting differs greatly from quality care in the acute-care hospital. For many residents, the nursing home is home, and not merely a site where they are treated for the elimination of a medical problem. Quality care walks hand-in-hand "gth quality of life. That relationship is noted in a 1986 study by the Institute of Medicine,' which states,

"Thus quality of life is very important for its own sake (that is, as an outcome goal) and because it is intimately related to quality of care in nursing homes." Therefore, quality care is the holistic care provided in a therapeutic milieu for and with the institutionalized client. Holistic care addresses each person as a total person-the physical, psychosocial, emotional, and spiritual being. It is care provided by and with an interdisciplinary team including the resident, the physician, nurse, social worker, actvity/recreationalist, dietitian, and family or significant other. The psychiatrist, psychologist, and other pertinent disciplines join the team based on an individual client's needs. It is a balanced approach, with no one discipline's skills more important than another's. There has to be a cooperative wheel of interaction among the professional health-care providers to ensure that a quality life is derived from receiving quality care.

The components of quality care

Quality care can best be illustrated through the use of a pyramid (Figure 1). The summit is denoted as the quality of care/life. The base line is the mission statement and the philosophy of the facility. Does the mission statement address the independence, the self-worth, the rights and responsibilities, and the overall quality of life that you deem important to restore, maintain, or enhance each resident's life? For example, have you precisely stated the philosophy of care when deterioration and/or imminent death occurs? The mission statement and the philosophy must project your perceptions of care so carefully that a visual image emerges from the words. They must be believed and practiced by all care-givers, regardless of the degree of hands-on care experienced in their daily job duties. They must be so evident that the resident and his family sense the philosophy when they enter your establishment.