Are standards important in long-term care?

While conversion of private NHs to public non-profit status has been advocated, this may be a difficult goal to reach. However, given the potential conflict between profits and adequate type and levels of care in the largest sector of the NH system, government regulation based on enhanced evidence-based standards appears to be essential. The complexity of care for seniors in NHs suggests that developing standards would be most effective if based on a client-centred, problem solving approach ie first defining the clinical profiles and key issues that must be managed and then identifying the best interventions, integrating the ideal with the practical, determining standards for required type and intensity of interventions, modernizing training standards of staff providing care, considering specialty consultation requirements, and re-defining minimal physical plant design to address the needs of the current resident population. Families remain an integral part of the NH process for many, perhaps most residents. This is often a highly fraught experience for families, with no systematic approach to integration of family carers into the care process as appropriate. The welfare of NH residents would be enhanced by setting standards that include integration of families the care process. The status of front-line staff needs to be upgraded in recognition of the complex and demanding nature of the work. NH care can no longer be the job of last resort for untrained caregivers.