Executive from 14 large nursing home companies and their leading lobbying trade associations signed on to a plan designed to bring fundamental change in the industry by 2006. Officials said they wanted the pledge to start the beleaguered long-term care industry on a path to improved quality and financial stability.

"This is a quest for integrity," said William L. Minnix, president of the American Association of Homes and Services for the Aging.

Organizations and individual companies signed a pledge committing them to quality improvement programs, workforce improvements and heightened attention to patient rights. The self-authored pledge also commits companies to undefined "ethical practices" and "financial stewardship. "

Nursing homes and other long-term care facilities are the target of an increasing number of lawsuits and regulatory actions. Companies are facing numerous court cases alleging negligence and wrongful death at homes as well as increased scrutiny from the federal Centers for Medicare and Medicaid Services (CMS), the agency that controls most of their income via government health programs.

Nursing homes have been the subject of a round of congressional hearings where industry critics have had the chance to expose industry shortcomings in front of the media.

The industry is also plagued by chronic shortages in nurses and other workers, a factor many consumers' groups blame for a low overall quality of care and a growing number of lawsuits.

John Rother, the chief lobbyist for the AARP, the country's largest senior citizen's group, said the current environment left the industry "no way out other than this. "

Charles Roadman, who directs the American Health Care Association, a nursing home group, said that companies would establish a private independent commission to monitor homes' performance and report on it to government agencies and to Congress. He pledged that the industry would also continuously monitor consumer satisfaction with services.

"We want consumers to feel confident," Roadman said.

Federal regulators are preparing in October to begin publishing performance data on nursing homes in all 50 states. The program is currently publishing 9 performance standards in 6 states on the CMS web site.

"We have a significant problem, perception and reality in the nursing homes," said CMS Administrator Thomas Scully. Turning the industry around "may take a couple of years," he added.

Industry officials said that their initiative would guarantee better compliance with existing federal regulations and would encourage nursing homes to work at minimizing fraud within the Medicare and Medicaid systems. Government health programs fund over 80% of all nursing home care in the US.

"We wish to be part of the solution, and not the problem," the industry pledge states.

Rother, the AARP lobbyist, said that his group was encouraged by the industry's action.

"Promises are one thing and performance is another. We are here to hold this industry accountable," he said.