Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement

J Am Med Dir Assoc. 2020 Nov;21(11):1587-1591.e2. doi: 10.1016/j.jamda.2020.08.016. Epub 2020 Sep 28.


Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is "Omissions of care in nursing homes encompass situations when care-either clinical or nonclinical-is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident." This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research.

Keywords: Medical errors; care left undone; health care rationing; missed care; unmet need.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Humans
  • Long-Term Care
  • Motivation
  • Nursing Homes
  • Quality Improvement*
  • Quality of Life*