Nursing Home Safety: Current Issues and Barriers to Improvement^*

The past few decades have seen increasing concern about the quality of nursing home (NH) care. As with other health care sectors, NHs have attempted to embrace a culture of safety, but the additional barriers that they face place the NH industry at a distinct disadvantage. In this review, we provide a summary of current models of NH quality and an overview of two important clinical areas for quality improvement: pressure ulcers and falls. Despite heavy regulation of the NH industry, hoped-for improvements in quality have been limited. We argue that systemic barriers, such as staffing shortages, NH organization, and an adversarial regulatory environment, preclude advances in NH quality.