Health Care Education Associates proposes to develop a quality assurance self-assessment package that includes instrumentation and supporting training materials, for use by staff personnel in skilled nursing facilities. The long-term objectives of the proposal are to help increase nursing home compliance to regulatory standards, reduce costs to nursing homes and government agencies that result from noncompliance, and generally to improve the quality of care provided to residents. The specific aims of this proposal are to increase provider ability to monitor and assess the quality of nursing care delivered, through the use of a standardized assessment tool, to increase provider ability to identify, assess, and document improvements made in the quality of care, to develop skills of nursing home personnel to monitor the quality of care, solve problems, and identify possible actions that can be taken to improve quality, and to increase resident participation in the assessment of care and identification of solutions to problems. In order to meet the specific aims identified, HealthCare Education Associates proposes to develop the following: 1) a self-assessment tool based on the most current established standards of care that are outcome-oriented and resident centered; 2) a training component aimed at nursing administrators regarding the implementation of the quality assurance program; 3) a training component aimed at nursing home personnel to increase knowledge of quality standards and skills in assessment and problem solving. At the end of Phase I, the quality assessment tool and supporting training materials will be commercially available to the more than 8000 skilled nursing facilities in the United States.