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Project Information

Project Information

The Quality of Care in Nursing Homes

Project Scope:

An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will examine how our nation delivers, finances, regulates, and measures the quality of nursing home care with particular emphasis on challenges that have arisen in light of the COVID-19 pandemic.  The committee will consider a broad range of issues such as:

  • ways to generate and assess the evidence base for interventions, structures, policies, and care models to promote care innovation while assuring quality of care;
  • the impact of current oversight and regulatory structures (including enforcement and penalties) on care quality and outcomes, which may include examination of: the meaningfulness of the current five star rating system and how it is interpreted by consumers and clinicians; and /or the validity, efficiency, and effectiveness of the current survey and certification structures and methods, including inspection standards, training of surveyors, and their adherence to standards.
  • the appropriateness of current emergency preparedness regulations and strategies for nursing homes in light of different environmental and pandemic threats to residents.
  • the influence of current nursing home real estate ownership and payment models on the delivery of high-quality care and regulatory compliance;
  • the role of the facility medical director as the clinical leader in nursing homes;
  • strategies to attract, train, and retain a more skilled workforce to nursing homes and survey agencies; and
  • the role of nursing homes in the continuum of post-acute and long-term care.
The committee will develop a set of findings and recommendations to delineate a framework and general principles for improving the quality of care in today’s nursing homes, delivering high quality care in a consistent manner, and ensuring the safety and well-being of residents and staff in nursing homes. The committee may also consider the relevance of their findings and recommendations to other long-term care settings, if applicable.

Status: Current

PIN: HMD-HCS-20-16

Project Duration (months): 18 month(s)

RSO: Graig, Laurene


Board on Health Care Services


Behavioral and Social Sciences
Health and Medicine

Geographic Focus:

Committee Membership

Committee Post Date: 10/14/2020

Betty R. Ferrell - (Chair)
Betty R. Ferrell, Ph.D., FAAN is the Director of Nursing Research & Education and a Professor at the City of Hope Medical Center in Duarte, California. She has been in nursing for more than 43 years and has focused her clinical expertise and research in pain management, quality of life (QOL), and palliative care. Dr. Ferrell is a Fellow of the American Academy of Nursing and she has over 450 publications in peer-reviewed journals and texts. She is the Principal Investigator of the “End-of-Life Nursing Education Consortium (ELNEC)” project. She directs several other funded projects related to palliative care in cancer centers and QOL issues, including ELNEC-Geriatrics for Long-Term settings. Dr. Ferrell was Co-Chairperson of the National Consensus Project for Quality Palliative Care. Dr. Ferrell completed a master’s degree in theology, ethics and culture from Claremont Graduate University in 2007. Dr. Ferrell is recognized for her career as an oncology researcher addressing issues such as quality of life, family caregiving and palliative care, to name a few. She has authored twelve books including the Oxford Textbook of Palliative Nursing. She is co-author of the text, The Nature of Suffering and the Goals of Nursing (2008) and Making Health Care Whole: Integrating Spirituality into Patient Care (2010). In 2013, she was named one of the 30 Visionaries in the field by the American Academy of Hospice and Palliative Medicine. Dr. Ferrell was elected to the National Academy of Medicine in 2019.
Gregory L. Alexander
Gregory L. Alexander, Ph.D., RN, FAAN, FACMI, professor at the Columbia University School of Nursing, is an internationally recognized nursing informaticist and clinical expert with more than 25 years of research and clinical leadership. His program of research is focused on technologies used to support patient care delivery, with an emphasis on aging populations. He leads an AHRQ-funded R01 to benchmark national trends in information technology adoption and the impact on quality measures in nursing homes. As a Fulbright U.S. Scholar in 2017, he worked with an Australian research team to investigate IT use as it related to resident care, clinical support, and quality measures in a sample of nursing homes in New South Wales. Dr. Alexander’s book, An Introduction to Clinical Health Information Technology for Long Term/Post-Acute Care (LTPAC) Settings, shows how research identifies and promotes evidence informing new models of care, including technology implementation trends and safety and quality impacts for long-term and post-acute settings.
Mary Ersek
Mary Ersek, Ph.D., RN, FPCN is a Professor of Palliative Care at the University of Pennsylvania School of Nursing, with a secondary appointment at the Perelman School of Medicine, University of Pennsylvania. She is also a Senior Scientist with the Department of Veterans Affairs (VA). For more than twenty years, Dr. Ersek has led and collaborated with other investigators on many research projects aimed at improving care in nursing homes and for persons with dementia. These studies involved recruiting and working with facilities, staff and providers, and residents and their families from over 70 nursing homes across the United States from Seattle, Washington to Philadelphia, Pennsylvania to Tuscaloosa, Alabama. In addition to these studies, Dr. Ersek developed the End-of-Life Nursing Education Consortium (ELNEC) Geriatric curriculum which has been disseminated to nursing home staff across the United States. From 2005-2008, Dr. Ersek served on the Washington State Board of Nursing Home Administrators.
Colleen Galambos
Colleen Galambos, Ph.D., LCSW, LCSW-C, ACSW, FGSA, is professor and Helen Bader Endowed Chair in Applied Gerontology at UW-Milwaukee. Dr. Galambos is also a fellow of the Gerontological Society of America and a National Association of Social Workers Pioneer. She is an adjunct professor with the Medical College of Wisconsin. Her practice experience includes clinical, administrative, policy, and research positions in a variety of health and long-term care organizations. Dr. Galambos’ active research areas include care transitions, advance care planning/end of life decision making, aging in place, health and long–term care systems quality improvement, gerontechnology, older adults and behavioral health, practice approaches in work with older adults, and competency based gerontological education. Most recently, she worked as an investigator on several research projects aimed at improving long-term care, funded by the Centers for Medicare and Medicaid, National Institutes of Health, and the Agency for Healthcare Research and Quality, totaling over $37 million in grant support.
Lisa Glauser Kaplowitz
Lisa Glauser Kaplowitz, M.D., M.S.H.A., is Public Health Physician and Deputy Health Officer for Arlington County, Virginia, a position she has held since April 2019. From 2010-2019, she worked within the U.S. Department of Health and Human Services. She was Senior Medical Advisor within the Office of the Assistant Secretary for Preparedness and Response (ASPR) (October 2015-March 2019) and in the Substance Abuse and Mental Health Services Administration (SAMHSA) (October 2015-February 2018). From March 2010-October 2015 she was Deputy Assistant Secretary for Policy in the Office of the ASPR, responsible for directing and coordinating policy and strategic planning for the Office of the ASPR. Prior to joining DHHS, Dr. Kaplowitz was Director of the Health Department for the City of Alexandria. From 2002 – 2008, she was Deputy Commissioner for Emergency Preparedness and Response (EP&R) in the Virginia Department of Health (VDH), responsible for the development and implementation of Virginia’s public health and medical response to all natural and man-made emergencies. She was a health policy fellow with the Institute of Medicine (now National Academy of Medicine) in Washington D.C. in 1996-1997, working in Senator Jay Rockefeller’s Office on health financing and end of life care.
David C. Grabowski
David C. Grabowski, Ph.D., is a professor of health care policy in the Department of Health Care Policy at Harvard Medical School. His research examines the economics of aging with a particular interest in the areas of long-term care and post-acute care. He has published over 170 peer-reviewed research articles and his work has been funded by the National Institute on Aging, Agency for Healthcare Research and Quality, and a number of private foundations. He has testified in front of Congress four times on issues related to the care of older adults. Dr. Grabowski is a member of the Medicare Payment Advisory Commission (MedPAC). He has also served on several CMS technical expert panels, including the recent CMS Coronavirus Commission on Safety and Quality in Nursing Homes. He is an associate editor of the journal Forum for Health Economics and Policy and he is a member of the editorial boards of American Journal of Health Economics and B.E. Journals in Economic Analysis & Policy.
Kathy Greenlee
Kathy Greenlee, J.D., is President and CEO of Greenlee Global LLC. She currently works with the State of Kansas as the Kansas COVID-19 LTSS Liaison, and interacts with state and local agencies responding to the pandemic. She also works with states on improving government programs that address aging, disability, and abuse. From 2009-2016, Kathy Greenlee served as the Assistant Secretary for Aging at the U.S. Department of Health and Human Services in Washington, D.C. She was appointed to the position by President Obama and confirmed by the U.S. Senate. In 2012, Assistant Secretary Greenlee became Administrator of the Administration for Community Living (ACL), an agency she created by combining the Administration on Aging, the Office on Disability, and the Administration for Developmental Disabilities. When the Workforce Investment and Opportunities Act was signed into law, the National Institute for Disabilities, Independent Living, and Rehabilitation Research was moved to ACL, as were the programs that support Centers for Independent Living. She previously served 18 years in the Kansas state government as an Assistant Attorney General, General Counsel for the Kansas Insurance Department, Chief of Staff for the Governor, State Long-Term Care Ombudsman, and Kansas Secretary of Aging. During her 25 years of public service, Assistant Secretary Greenlee developed expertise in the areas of aging, long-term care, disability, elder abuse, Medicaid long-term care, health care and community services innovation, and LGBT health. Greenlee recently joined the HSS Advisory board to WellSky; board members provide general advice on key issues in aging, disability, and homelessness.
R. Tamara Konetzka
R. Tamara Konetzka, Ph.D., is a professor of health services research in the Department of Public Health Sciences at the University of Chicago, with a secondary appointment in the Department of Medicine, Section of Geriatrics and Palliative Medicine. Professor Konetzka conducts research in health economics; aging, post-acute and long-term care; and Medicare and Medicaid policy, focusing on the relationship between economic incentives and quality of care. Her research combines rigorous methodological training with extensive institutional knowledge of long-term care providers and policies acquired through previous experience in the industry. Much of her research involves econometric analysis of large data sets including Medicare claims, Medicaid claims, nursing home MDS, and the Health and Retirement Study. Many of her published studies explore the quality of nursing home care and how public policy might improve it. Professor Konetzka serves on the editorial boards of Health Services Research and JAMDA and is Editor in Chief of Medical Care Research and Review. She also serves on the technical expert panel that advises CMS on the Nursing Home Compare 5-star rating system that publicly reports nursing home quality.
Christine A. Mueller
Christine A. Mueller, Ph.D., RN, FGSA, FAAN, is professor, Senior Executive Associate Dean for Academic Programs, and long term care professor in nursing at the School of Nursing at the University of Minnesota. Dr. Mueller's 46 year career has focused on improving the care of elders living in nursing homes, specifically on factors that can influence quality of nursing home care such as nurse staffing, care delivery systems, and the role of the nurse and nursing home culture change. In the 1990's, she worked on the project team for the HCFA Multistate Nursing Home Case-Mix and Quality demonstration project that developed the Minimum Data Set (MDS) Plus (now the MDS 3.0), quality indicators, and the Resource Utilization Group case-mix classification system for nursing homes. She was a team lead for the state of Minnesota to design a case-mix classification system for Minnesota nursing homes and a set of quality indicators that have been used for quality payment incentives and a public report card. Dr. Mueller previously served on the board of directors for the Pioneer Network, the national organization promoting person-directed care in nursing homes.
Marilyn J. Rantz
Marilyn Rantz, RN, Ph.D., FAAN, Curators’ Professor Emerita of Nursing, has been affiliated with the MU Sinclair School of Nursing (MUSSON) since 1992. She held the named position of University Hospital Professor of Nursing, has a joint appointment in the Department of Family and Community Medicine, was designated Helen E. Nahm Chair 2008-2015, and was awarded the MU Curators’ Professor title in 2010. In 2012, she was elected into the National Academy of Medicine (formerly Institute of Medicine), and is the only individual to be twice named as an Edge Runner by the American Academy of Nursing for two different innovations:; 2008 for Aging in Place and TigerPlace and 2012 for the Quality Improvement Program for Missouri (QIPMO).
Dr. Rantz has sustained a research program to improve the quality of care for the elderly. Her innovative work in nursing home quality spans 40 years, both in practice and as a leading researcher. She is an international expert in quality measurement in nursing homes. In 2012 and 2016, she secured $14.8 million and $19.8 million grants from the Centers for Medicare and Medicaid Services (CMS) for their Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents - Phase 1 and Phase 2; two of the largest received across all MU campuses. In total, Dr. Rantz and her multidisciplinary research teams have garnered over $89 million in funds to support work measuring effectiveness of nurse care coordination, cutting edge research in long-term care, new delivery models of care for older adults, and technology development to enhance aging in place of community-dwelling elders. In fall 2020, she will be inducted as a Living Legend by the American Academy of Nursing.
Debra Saliba
Debra Saliba, M.D., M.P.H. is a professor of medicine UCLA where she holds the Anna & Harry Borun Endowed Chair in Geriatrics. At the Los Angeles VA, she is in the GRECC and is associate director for education in the HSR&D Center of Innovation. She also is a senior natural scientist at the RAND Corporation. As a practicing geriatrician and health services researcher, Dr. Saliba's research focuses on creating tools and knowledge that can be applied to improving quality of care and quality of life of vulnerable older adults across care settings, including clinics, hospitals, homes, post-acute care and nursing homes. She was the principal investigator for CMS's MDS 3.0 Revision and Evaluation project and collaborative VA MDS Validation project. Her current research includes developing measures of physician performance in post-acute and long-term care; inclusion of patient and family priorities in weighting quality measures; an evaluation of the implementation of the balancing incentives program; and the relationship between nursing home quality and staffing structures. Dr. Saliba is deputy editor for the Journal of the American Geriatrics Society and past president and board chair of the American Geriatrics Society. She serves on several national expert panels, including the CMS 5-star technical expert panel.
William J. Scanlon
William J. Scanlon, Ph.D. is an independent consultant to West Health. He is also a member of the Medicaid and CHIP Payment and Access Commission and the Academy Health Oral Health Interest Group Advisory Committee. He began conducting health services research on the Medicaid and Medicare programs in 1975, with a focus on such issues as the provision and financing of long-term care services and supports and provider payment policies. He previously held positions at Georgetown University and the Urban Institute, was managing director of health care issues at the U.S. Government Accountability Office, and served on the Medicare Payment Advisory Commission. Dr. Scanlon received his doctorate in economics from the University of Wisconsin, Madison.
Philip D. Sloane
Philip David Sloane, M.D., M.P.H., is a distinguished professor and Director of Academic Advancement at the University of North Carolina at Chapel Hill School of Medicine. He co-directs the Program on Aging, Disability, and Long-Term Care of the Cecil G. Sheps Center for Health Services Research at UNC-CH. He is particularly noted for his work around the management of behavioral symptoms in Alzheimer’s disease, for which he received the prestigious Pioneer Award from the US Alzheimer’s Association. Dr. Sloane is also committed to the education of professionals, paraprofessionals, and consumers. He co-edits Essentials of Family Medicine and Primary Care Geriatrics, and he co-founded the Carolina Alzheimer’s Network, a program dedicated to training primary care providers in evidence-based dementia care. Four of his current projects involve translational research; topics include antibiotic stewardship in long-term care; assisting caregivers of persons with dementia in assessing and managing medical symptoms; and training nursing assistants to provide better oral hygiene care. Dr. Sloane is also the co-Editor-in-Chief of the Journal of Post-Acute and Long-Term Care Medicine (JAMDA).
David G. Stevenson
David G. Stevenson, Ph.D., is currently a Professor of Health Policy in the Department of Health Policy at Vanderbilt University School of Medicine. Dr. Stevenson’s primary research interests are long-term care and end-of-life care. His previous work has focused on a broad range of topics in these areas, including the evolution of Medicare’s hospice benefit, the role of ownership in the provision of resident and patient care, and quality assurance in the nursing home and hospice sectors. Dr. Stevenson received a BA from Oberlin College, a SM in health policy and management from the Harvard T.H. Chan School of Public Health, and a PhD in health policy from Harvard University. His previous faculty appointment was in the Department of Health Care Policy at Harvard Medical School.
Jasmine L. Travers
Jasmine L. Travers, Ph.D., M.H.S, RN, AGPCNP-BC, is an assistant professor of nursing at NYU Rory Meyers College of Nursing, RWJF Harold Amos Scholar, and an Adult-Gerontological Nurse Practitioner. Her career is dedicated to designing and conducting research to improve health outcomes and reduce health disparities in vulnerable older adult groups using both quantitative and qualitative approaches. Her current work focuses on mitigating disparities in appropriate access and use of quality in-home and nursing home care for older adults. As a health services researcher, she has leveraged many datasets to investigate these issues, including the Health and Retirement Study, Minimum Data Set, and Nursing Home Compare. Dr. Travers has published widely on the topics of aging, long-term care, health disparities, workforce diversity, and infections. Prior to joining the faculty at NYU, Dr. Travers completed a postdoctoral fellowship with the National Clinician Scholars Program at Yale University and a T32 funded postdoctoral fellowship at the New Courtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She completed her doctoral training in health services research with a specialization in gerontology at Columbia University School of Nursing.
Reginald Tucker-Seeley
Reginald Tucker-Seeley, M.A., Sc.M., Sc.D., is the inaugural holder of the Edward L. Schneider chair in gerontology and Assistant Professor in the Leonard Davis School of Gerontology at the University of Southern California. His research has focused primarily on social determinants of health across the life course, such as the association between the neighborhood environment and health behavior; and on individual-level socioeconomic determinants of multi-morbidity, mortality, self-rated physical, mental, and oral health, and adult height. Tucker-Seeley has a longstanding interest in the impact of health and social policy on racial/ethnic minorities and across socioeconomic groups. He has experience working on local and state-level health disparities policy, and in the measuring and reporting of health disparities at the state level.
Rachel M. Werner
Rachel M. Werner, M.D., Ph.D., is the Executive Director of the Leonard Davis Institute of Health Economics. She is Professor of Medicine at the University Of Pennsylvania Perelman School Of Medicine as well as the Robert D. Eilers Professor of Health Care Management at the Wharton School and a practicing physician at the Philadelphia VA. Over the last 15 years, Dr. Werner has built a foundational research program examining the effects of health care policies on health care delivery, with a focus on provider payment and quality improvement incentives. This research has revealed the many intended and unintended effects of quality measurement and incentives, and was among the first to recognize that public reporting of quality information may worsen racial disparities. She is a Core Investigator with the VA HSR&D Center for Health Equity Research and Promotion (CHERP). She has received numerous awards for her work, including the Alice Hersh New Investigator Award from AcademyHealth, the Presidential Early Career Award for Scientists and Engineers, and the American Federation of Medical Research (AFMR) Outstanding Investigator Award. Dr. Werner was elected to the National Academy of Medicine in 2018.

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