Perceived and observed quality of long-term care for residents - Does functional ability account?

Abstract

Measuring quality in long-term residential care involves challenges concerning both the measurement method and the impaired functional ability of many older people. Ensuring quality in care is even more important for people with functional impairments, as this is a vulnerable group who may be unable to report poor quality of care for themselves. The aim of this study was to analyse how perceived and observed assessments of the quality of care varied according to the residents' functional ability. The data (n=278) used in the analyses included residents', family members' and staff assessments of perceived and observed quality of care combined with the Resident Assessment Instrument (RAI) scales measuring the same residents' functional abilities (physical, psychological, cognitive and social). Observations were included in the data if all four assessment types (by residents, family members, staff and the RAI) were available. The dimensions of quality of care emerging from the factor analysis were used. Linear regression was used to explore the association between resident's functional abilities and assessed quality of care. Higher level of depression symptoms and higher level of dependency in activities of daily living (ADL) were significantly associated with lower level of perceived and observed quality of care. By contrast, the level of residents' cognitive functioning was not significantly associated with any quality dimensions. The social aspect was the only dimension of functional ability on which better functional ability indicated better quality of care, although differences between respondent groups were also observed. These analyses emphasize the importance of taking residents' functional ability into account when collecting information on and interpreting the results of perceived and observed quality of care reported separately by residents, family members and staff. The information obtained can inform care professionals of how dimensions of residents' functional impairments are associated with perceived and observed quality of care and the quality of older people's care can thereby be improved.