Abstract
This study examines the link between human resource management, (HRM), work organization and patient care quality in US long-term care settings, proposing a key role for both management philosophy and improved front-line staffing arrangements in delivering consistently higher quality care, defined to include both physical and psychological outcomes. Using the ‘high performance’ model from industrial relations as a lens, the paper identifies three distinct systems of HR and nursing-home management: traditional low-service quality, high service quality medical rehabilitative and ‘new paradigm regenerative’. The original research includes case studies conducted in twenty facilities in California and Pennsylvania, USA.