Quality and Costs in the Nursing-Home Market

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.