To the Editor: In one of a series of articles appearing in the Journal concerning the nursing-home industry, Vladeck (Sept. 30 issue)1 indicates that there is an implicit assumption that a positive relation exists between the quality of resident care and facility costs. As Vladeck points out, however, there is no empirical evidence supporting this assumption. Nursing-home quality may be more a function of staff and administrative attitudes — characteristics that may be independent of facility costs. I recently conducted an extensive study of New York nursing homes and obtained interesting results concerning the relation between the quality of facilities.
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