How Long-Term Care Quality Assurance Measures Address Dementia in Australia, England, Japan, and the United States

The prevalence of people with dementia living in long-term care (LTC) is high and rising internationally, and the need to improve LTC for people with dementia is widely recognized. In some countries, LTC quality assurance programs use quantitative measures of LTC quality, and international bodies emphasize the importance of person-centered care and healthy ageing outcomes. To better understand how LTC quality assurance programs address dementia, programs were reviewed in four countries—Australia, England, Japan, and the United States. Quality measures from each program were identified (n = 38) and examined to determine how they address dementia. Most measures did not address dementia, but four risk-adjusted for dementia (antipsychotic use, fractures, falls, mobility), one was dementia-specific (dementia/delirium hospitalizations), and one excluded people with dementia (losing bowel/bladder control). The other 32 measures were calculated equally regardless of the prevalence of dementia among LTC residents. Overall, LTC quality measurement differs internationally, but few measures address dementia. When dementia is addressed in quality measure calculations, it is most often as a risk-adjustor. Risk adjustment can help with attributing performance on these measures to the LTC setting rather than to the types of residents that the setting serves, but risk adjustment factors also are highly amenable to fraud, and thus require ongoing monitoring. Although LTC quality assessment programs and measures can help ensure people with dementia have access to quality LTC, adoption of measures that are meaningful to people with dementia—including measures of person-centered care and healthy ageing outcomes—remains needed.