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There have traditionally been a variety of approaches to the conceptualization and measurement of long-term care "quality". One such approach is the judgment of an expert; although such evaluations are useful and often informed by years of experience, experts often find it difficult to articulate the specific criteria that shaped their judgment. Other approaches tend to focus on issues of safety and security which--though clearly critical--may reflect but a small part of the mission and program of an institution.
These concerns are timely, because interest in the assessment of environmental "quality" has been rekindled by the rapid growth in the number of Special Care Units (SCUs) for people with Alzheimer's disease and related dementias. People are eager...