Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.

A key element of the President's Management Agenda is the expansion of electronic government (e-government) to enhance access to information and services, particularly through the Internet. In response, the Office of Management and Budget (OMB) established a task force that selected a strategic set of initiatives to lead this expansion. GAO previously reviewed the completeness of the information used for choosing and overseeing these initiatives, including business cases and funding plans. E-government offers many opportunities to better serve the public, make government more efficient and effective, and reduce costs. To achieve these goals, the 25 e-government initiatives selected by OMB's Quicksilver task force focus on a wide variety of services, aiming to simplify and unify agency work processes and information flows, provide one-stop services to citizens, and enable information to be collected on line once and reused, rather than being collected many times. For example, Recreation One-Stop is a Web portal for a single point of access to information about parks and other federal, state, and local recreation areas. Other initiatives are being pursued that do not necessarily rely on the Internet, such as the e-Payroll initiative to consolidate federal payroll systems. GAO's review of the initial planning documents for the initiatives highlights the critical importance of management and oversight to their success. Important aspects--such as collaboration and customer focus--had not been addressed in early program plans for many of the projects, and major GAO's review of the initial planning documents for the initiatives highlights the critical importance of management and oversight to their success. Important aspects--such as collaboration and customer focus--had not been addressed in early program plans for many of the projects, and major uncertainties in funding and milestones were not uncommon. As shown by GAO's comparison of the content of the initiatives' business cases with best practices, all the business cases included key information, but many elements were missing. In particular, fewer than half addressed collaboration and customer focus, despite the importance of these topics to e-government strategy and goals. Similarly, the accuracy of estimated costs in the funding plans was questionable: between May and September 2002, these estimates for 12 of the initiatives changed significantly--by more than 30 percent. Accurate cost, schedule, and performance information is essential to ensure that projects are on schedule and achieve their goals.