The regulation and enforcement of federal nursing home standards, 1991-1997

This article reports historical trend data on resident characteristics and conditions, problems, and deficiency patterns for nursing facilities from 1 991 through 1997 from Health Cave Financing Administration (HCFA) administr ative records from the On-line Survey, Certification, and Reporting System (OSCAR). Over this period, residents show some increases in dependency and conditions, although there was a decline in the use of restraints. The defi ciencies reveal continued quality problems in some nursing homes, although the average number of deficiencies given to facilities declined by 44 perce nt between 1991 and 1997. The discussion considers possible explanations fo r the decline in deficiencies, including whether the quality of care in nur sing homes has improved or whether the enforcement process has gradually be en weakened.