Nursing home safety matters, but it's not an easy matter.

The study by Lapane and Quilliam published in this issue of Journal of the American Medical Directors Association explores an important issue in social science methodology, namely, how to distribute resident safety perception questionnaires among nursing home employees in a manner that will yield the highest response rate (and presumably the most reliable data). From a social policy and clinical practice perspective, however, we might vigorously inquire about this research, “So what?” Does it matter what workers perceive about nursing home safety and, even more fundamentally, does the nursing home safety situation itself really matter? As to the latter question at least, we would all respond resoundingly in the affirmative: nursing home safety is an incontrovertibly significant concern indeed. However, getting a firm analytic handle on that concern and, more significantly, actually doing something positive about it is an exceedingly difficult task. Making the care of nursing home residents safer is, first and foremost, an ethical imperative. It is driven by the fundamental moral precepts of beneficence (helping or doing good for others) and nonmaleficence (preventing harm) and the nursing home’s fiduciary responsibility to protect the welfare of vulnerable, dependent individuals who have placed their trust in the facility’s promise to care for them safely. Moreover, achieving a safe environment for residents, staff, and visitors is an important and necessary component of a nursing home’s overall legal and financial risk management strategy in a contemporary climate of escalating professional negligence and workers’ compensation litigation being brought against the nursing home industry; in the absence of personal injury, there is no basis for litigation or liability. In addition, an effective safety program can help facilities avoid administrative sanctions for being out of compliance with applicable regulatory requirements. Finally, there is a viable business case for improving safety in nursing homes (just as there is for error prevention in the hospital and medical office settings). In the modern longterm care marketplace, nursing homes now have to compete