[caption id="attachment_73610" align="aligncenter" width="500"] Pexels[/caption]

A look at the landmark reports, federal reforms, and persistent measurement gaps that have shaped how the United States counts abuse in long-term care.

In 1986, the Institute of Medicine (now the National Academy of Medicine) published a study that would reshape American long-term care policy for a generation. Commissioned by Congress, "Improving the Quality of Care in Nursing Homes" concluded that quality of care and quality of life in many U.S. nursing homes were not satisfactory and that abuse and neglect were common in facilities receiving Medicare and Medicaid funds. That report led directly to the 1987 Omnibus Budget Reconciliation Act, which contained the Federal Nursing Home Reform Act, the most significant overhaul of nursing home regulation since the creation of Medicare itself in 1965. Forty years on, the historical data tells a more complicated story than a clean before-and-after. The reforms changed what facilities are required to do. They also changed what gets measured, how it gets measured, and what we now know is being missed.