THE LEVEL OF QUALITY OF CARE IN ELDERLY NURSING HOMES: THE CASE OF NORTH MACEDONIA

Abstract

Elderly nursing homes really began to develop following passage of the Social Security Act of 1935, which provided payment to individual beneficiaries and thus turned indoor relief into "outdoor relief." That is, community-based services began to emerge that prevented the need for almshouse placement. With passage of the Kerr-Mills Medical Assistance to the Aged Act in 1950, which allowed for direct payment to care providers, and with increases in the number of older adults in the population, the nursing home industry boomed. Elderly nursing home policy was developed from social welfare issues regarding care of the poor. A strategy known as ''indoor relief" was developed in Elizabethan England when social planners used almshouses to care for the poor, who were divided into the "deserving poor" (those who were unable to work) and the "undeserving poor" (those who were perceived as morally corrupt because they were able to work). The poor elderly were housed in almshouses and exempt from moral judgments because of their age and inability to work. Long-term institutional care of elderly residents falls into two major categories: traditional nursing homes, which primarily are facilities that provide either intermediate-level nursing care or skilled nursing care, but might also include "board-and-care" residential homes, and recent alternatives to the traditional nursing homes, such as foster care homes, family homes, or assisted-living homes. Numbers of homes are presented to illustrate trends in the availability of institutional long-term-care options. A number of residential care models have recently arisen in response to the need to develop alternatives to the medical model emphasis in most traditional long-term-care facilities. These alternatives include a range of state-licensed residential living environments such as foster care, family homes, residential care facilities, and assisted-living arrangements.
The purpose of this paper is to illustrate the process of the development stages of nursing homes and the care of the elderly by medical personnel. The paper begins with an analysis of the historical development of nursing homes, the setting for long-term care and care conditions as well as appropriate alternatives in this domain. In addition to highlighting the nature of the functioning of old people's homes, the need for an assessment of the strategies for improving quality care in elderly homes. Regarding the methodological framework, the paper uses qualitative methods, more specifically the method of content analysis and the method of synthesis and generalization. For the purpose of more consistent analysis, the paper also applies quantitative analysis, ie a survey, whose data are presented graphically, based on claims placed on a Likert scale, regarding the current situation about the issue, in North Macedonia. In conclusion, valid, reliable, and timely data about nursing facility residents and the care they receive are fundamental to all strategies for monitoring and improving quality of care. It is essential both to outside regulators and to individual providers. Key data about all nursing home residents are collected as part of the state-mandated minimum data set. Originally designed for needs assessment and care planning, this system periodically collects information on resident functional and medical status