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It is with great pleasure that I read Dr. Donna McCabe’s excellent column “The Teaching Nursing Home” in the most recent edition of HIGN’s Newsletter (April, 2025). As Dr. McCabe emphasizes, the current Teaching Nursing Home model initiatives build on work started in the 1980s. I was Director of the Robert Wood Johnson Foundation Teaching Nursing Home (RWJ TNH) from 1981-1987. I write this column to provide further context for the current TNH initiatives.
The RWJ TNH was a 5 year, $5 million national initiative administered at the University of Pennsylvania School of Nursing. The program came on the heels of an influential book written by Bruce Vladeck, Unloving Care: The Nursing Home Tragedy (1980) that exposed extremely poor care in many of the nations’ nursing homes. The RWJ TNH built on the model linking Schools of Medicine with Veteran Administration Hospitals in order to expand clinical experiences for medical students and residents and improve care in VA Hospitals. The TNH was the first major clinical/research initiative funded by RWJ that was exclusively directed by nursing.
The RWJ TNH involved 11 Schools of Nursing and nursing homes selected through a national competitive process. The goals of the program, similar to those laid out by
Dr. McCabe, were, on the nursing school side, to provide students with expanded and rich clinical experiences and to infuse the BSN curriculum with additional geriatric content. On the nursing home side, the goal was to improve staff preparation and raise the level of care in nursing homes. The model relied heavily on geriatric nurse practitioners who held joint faculty appointments in the school and clinical appointments in the nursing home. Some TNHs also used mental health nurse practitioners in dual school/home appointments.
The RWJ TNH was rigorously evaluated. The evaluation showed both expanded geriatric content and courses in the participating Schools of Nursing and improved care in the nursing homes as compared to a matched control group (Shaughnessy & Kramer, Health Care Finance Review, 1995). The TNH also had the unmeasured but clearly evident outcome of creating a cadre of geriatric nurse faculty and researchers who subsequently committed their academic careers to care and research aimed at improving care in nursing homes.
In the 1990’s, the extraordinary support of geriatric nursing by the John A. Hartford Foundation, including funding to develop the Hartford Institute for Geriatric Nursing (HIGN) at NYU Meyers, served to expand on TNH outcomes to encourage required geriatric nursing courses and improved geriatric clinical experiences in BSN nursing programs.
But as Dr. McCabe points out, the outcomes achieved in the nursing homes were generally not sustained once TNH funding ended.
Given the continued concern as to the quality of care in nursing homes, revitalizing the TNH concept detailed in Dr. McCabe's column has the potential to revitalize nursing education’s commitment to care of nursing home residents while providing nursing homes with the critical resources that they need to improve quality care. I look forward to an update on the outcomes of this initiative in future HIGN Newsletters.
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