Mohammed T. Abou-Saleh

QUALITY OF LIFE AND CARE IN INSTITUTIONS 729of the several types of input into measuring quality are tasks forthe future.The Economic PerspectiveThis chapter cannot do justice to the economic ramifications ofquality of care and quality of life. In general, increased qualitycomes at a cost. In the case of both the profit-seeking institutionand the governmental or non-profit institution, there are obviousconstraints on the extent to which higher quality can be financed.This observation helps identify another distinction betweenquality of care and quality of life. Quality of care, being a lifeand-healthissue, is capable of being defined in terms of minimallyacceptable threshold levels. These levels can in turn be definedreasonably clearly and used as the basis for licensing or potentialdecertification.CONCLUSIONIt is a different issue whether what has been defined as quality oflife can be audited and used legally to improve the quality ofnursing homes. Surveyors could conceivably become equipped todiagnose quality-of-life deficiencies and cite them to the point ofremoval of licensure. This appears problematic because qualityof life has so many subjective aspects. Surveyors would no doubtbe reluctant to make such citations and political pressure fromowners would minimize the legal clout of such citations. Onepossible outcome is that the present survey process will continueto be used to correct the most egregious lapses in minimumquality of care. Beyond the merely adequate quality of careattained by correcting basic deficiencies, improvement in qualityof life up through the positive to excellent ranges may be amatter better controlled by the marketplace than by legalenforcement. Quality-of-life audits could lead toward intrafacilityself-assessment, staff training and growth, articulating possibleavenues for improvement on which administration and staffcould work proactively. The greatest weakness of the marketplacehypothesis, however, is that the present market isresponsible primarily to the upper income range of clientfamilies. If market-driven improvement in quality of life is tooccur, we should have to see greater equalization of opportunityand increasing competition for the patronage of governmentsubsidizedresidents as well as those who pay in full for theircare. Despite such difficulties, we should leave room for thepossibility that improved quality of life in nursing homes mayemerge better with indigenous rather than legal motivation. Inthe UK, there is some hope that the cultural and ethical normsmay support the general public and governmental view thatquality of care and quality of life are both basic rights of allcitizens. This motivation might over time become more effectivethan either legal regulation or market competition 19 .REFERENCES1. US Department of Health and Human Services (HHS), Health CareFinancing Administration. 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