Long-term care and a good quality of life: Bringing them closer together

Long-term care policies and programs in the United States suffer from a maj or flaw: They are balanced toward a model of nursing home care that, regard less of its technical quality, tends to be associated with a poor quality o f life for consumers. This article proposes quality-of-life domains-namely, security, comfort, meaningful activity, relationships, enjoyment, dignity, autonomy, privacy, individuality, spiritual well-being, and functional com petence. It argues that these kinds of quality-of-life outcomes are minimiz ed in current quality assessment and given credence only after health and s afety outcomes are considered. Five trends are reviewed that might lead to a more consumer-centered emphasis on quality of life: the disability rights movement, the emphasis on consumer direction, the growth of assisted livin g, increasing attention to physical environments, and efforts to bring abou t culture change in nursing homes. Building on these trends, the article co ncludes with strategies to move beyond current stalemates and polarized arg uments toward forms of long-term care that are more compatible with a good quality of life.