Regulating US nursing homes: Are we learning from experience?

The quality of care in U.S. nursing homes has been a recurrent matter of pu blic concern and policy attention for more than thirty years. A complex reg ulatory system of state licensure and federal certification is in place, bu t problems of poor quality and neglect and abuse of patients still appear t o be endemic. This paper describes how the current system of regulation dev eloped, examines its impact, and draws on the wider literature on regulatio n to outline some characteristics that may have detracted from Its effectiv eness and contributed to its disappointing results. Future regulatory 1.28 reform should pay more attention to the lessons of regulation in other sett ings and make more use of research and formative evaluation.