Quality Of Care In Homes Research Articles

Validity and Reliability of the Korean Version of the Observable Indicators of Nursing Home Care Quality Evaluation Instrument

The purposes of this study were; 1) to test the validity and reliability of the Korean version of Rantz's Observable Indicators of Nursing Home Care Quality Instrument (ONHQ) and 2) to evaluate the quality of Korean nursing homes. The study employed a three-phase methodological research design. 1) The original instrument of Rantz's ONHQ was translated into Korean and modified by Korean nursing home experts. 2) A pilot study using the modified instrument was done in 20 nursing homes to examine inter-rater reliability. 3) The validity and reliability were tested in 98 nursing homes. Seven factors were extracted through factor analysis: 'communication', 'care delivery', 'grooming', 'odor', 'environment-basics', 'environment-access', and 'environment-homelike'. These factors explained 86.07% of the total variance. Cronbach's alpha coefficient of the 30 items was .97 indicating a high internal consistency of the instrument. Inter-rater reliability according to Kappa was .82. The average score of nursing home quality was 112.07 indicating an average range of quality level. The Korean version of the ONHQ was identified as a tool with a high degree of validity and reliability. This tool can be effectively used to assess the quality of nursing homes by professions as well as family members.

A Hindrance or a Help? The Contribution of Inspection to the Quality of Care in Homes for Older People

There has been no real attempt to explore the contribution and effectiveness of inspection as a catalyst for change and improving service provision. In England the Government is currently reviewing the way that one regulatory body, the Commission for Social Care Inspection (CSCI), operates and carries out its inspection functions in relation to care homes for older people. This article reports on a study carried out in 2004 that asked managers of care homes for older people about their views and experiences of inspection and ways to improve the process. The findings endorse inspection as a necessary intervention. Managers identified that the main purposes of inspection were: to ensure the well-being of residents; to achieve or comply with standards; to check that the home was running properly and to act as a double check against the homes own audits. The two most useful aspects of inspection were as a means of providing feedback and as support and guidance to managers. The expertise of the inspector needs to be better deployed to drive up standards of care and maximise their influence to promote an improvement in services and innovation in practice.

Using an observational tool to inspect standards in care homes.

Inspections of service quality in care homes should focus on service users' experience of the care provided. However, this is a particular challenge in services for people with cognitive disabilities. Direct feedback from people in care may be hampered by fear of repercussion, low expectations or sensory and physical difficulties that make taking part in an interview difficult. Directly observing care has always formed an unstructured part of the inspection process. Dementia Care Mapping is too resource intensive to be a suitable tool for regular inspections. Therefore, the Commission for Social Care Inspection (CSCI) felt that a new observational tool was needed.

Variations in quality of Home Care between sites across Europe, as measured by Home Care Quality Indicators

The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for monitoring quality of care. Research questions were, "Do HCQI scores vary between home care organizations in different countries?" and "Are one or more country-specific sites consistently scoring better on most or all HCQIs"? a cross-sectional observational study of 65+ randomly selected clients of home care organizations in urban areas in 11 European countries who had been receiving home care for at least two weeks. Data were collected with the MDS-HC. The scoring of 16 prevalent quality indicators for home care, adjusted for population differences, was calculated with baseline data. Population size at baseline was 4,007 clients. Among home care clients in Europe, "rehabilitation potential in Activities of Daily Living and no therapies" (average 75.9%) and "inadequate pain control" were the most common quality problems. The prevalence between populations studied in various countries varied substantially. No country-specific site consistently scored worst or best. HCQIs derived from the MDS-HC detect variance in quality scores between home care in the 11 partner countries. The highest prevalence of unwanted outcomes were most often found in the Czech Republic, Italy and Germany. Although further research is necessary, we believe that HCQIs may be of great value for quality improvement in home care.

Contested Professionalism Payments for Care and the Quality of Home Care

In the recent past, policy makers have emphasized the benefits and positive aspects of direct payments for care of frail elderly people. In this article, the authors present the theoretical framework of “struggling logics of home care,” by means of which they explore the underlying logics of the introduction of payments for care: market, family, and state. More specifically, the authors show the strengths and weaknesses of a fourth logic—professionalism—and expound how this logic is submitted to marketized and familialized payments for care. The authors conclude that there are indeed some positive aspects of the trend toward payments for care. However, (female) professional home care workers benefit hardly at all. On the long term, this could also erode the quality of care provided to recipients.

Using older home care user experiences in performance monitoring

Home care services play a fundamental role in England in supporting older and disabled people in their own homes. In order to identify and monitor the degree to which these services are providing good quality services, in 2003 the government required all councils with social services responsibilities (CSSR) to undertake user experience surveys among older service users. The questionnaire was required to include four questions, two of which were designed to be used as Best Value Performance Indicators (BVPI) reflecting the quality of home care of older people. Thirty-four local authorities participated in an extension study providing data from 21 350 home care users. The aim of the study was to answer three questions: (1) Do the performance indicators reflect home care quality? (2) Are the performance indicators using the most appropriate cut-off points? (3) What are the underlying constructs of home care quality? Evidence was found to support the use of two of the performance indicators and the current cut-off point being used for the satisfaction indicator. Factor analysis identified indicators of important dimensions of quality that were associated with overall satisfaction.

Quality of life, quality of care and resident satisfaction in care homes

Abstract Recent years have seen a growing interest in the study and measurement of both quality of life (QOL) and quality of care (QOC), influenced at least in part by the increased importance being given to 'accountability' relating to health and social care. In the widest sense, QOL is all-encompassing, including material, physical, social, emotional and spiritual dimensions, while QOC can be considered to be a somewhat more limited concept. 'Satisfaction' is often used as a primary indicator of QOL and/or QOC, although the way in which it is conceptualised and measured varies somewhat according to factors such as context and study population. In this paper a number of issues relating to the assessment of QOL and QOC in care homes for older people are discussed, with a particular focus on resident satisfaction as a key indicator. Results of an Australian study of resident satisfaction in care homes and its relevance to the UK context are then discussed.

Family caregiver burden and quality of home care in the context of the Long‐Term Care insurance scheme: an overview

AbstractThis review outlines the findings of 22 studies conducted between 1997 and 2005 by Arai and 19 collaborators regarding caregiver burden and assessment of quality of home care for the elderly. The published research covers the following: cross‐sectional studies on caregiver burden; changes in caregiver burden; appropriateness of the Long‐Term Care insurance assessment scheme; attitudes towards caregiving among caregivers; the development of the short Japanese version of the Zarit Caregiver Burden Interview (J‐ZBI_8); and the effectiveness of service use in reducing caregiver burden and development of a Home Care Quality Assessment Index (HCQAI).

The CARE (Combined Assessment Of Residential Environments) profiles: a new approach to improving quality in care homes

This paper briefly describes the rationale for and the development of the CARE (Combined Assessment of Residential Environments) profiles. The CARE profiles represent a new approach to quality improvement in care homes for older people that seeks to gain the views of residents, relatives and staff, and to use these as a basis for celebrating what works well in a home and identifying areas that need attention. The paper begins with a consideration of the limitations of existing quality initiatives and argues for a model that is more inclusive. Subsequently, the theoretical underpinnings of the CARE profiles, positive events, the Senses Framework, and a relationship‐centred approach to care are outlined. The process by which the CARE profiles were developed is then described and a case study highlighting how they might be used is presented.

Field Testing, Refinement, and Psychometric Evaluation of a New Measure of Nursing Home Care Quality

The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The development of the OIQ was based on extensive qualitative and iterative quantitative work that described nursing home care quality and did initial validity and reliability field testing of the instrument in 123 nursing homes in 1 state. The scale is meant for researchers, consumers, and regulators interested in directly observing and quickly evaluating (within 30 minutes of observation) the multiple dimensions of care quality in nursing homes. After extensive testing in this study, the Observable Indicators instrument has been reduced to 30 reliable and discriminating items that have a conceptually coherent hierarchical factor structure that describes nursing home care quality. Seven first-order factors group together into two second-order factors of Structure (includes Environment: Basics and Odors) and Process (includes Care Delivery, Grooming, Interpersonal Communication, Environment: Access, and Environment: Homelike) that are classic constructs of Quality, which was the third-order factor. Internal consistency reliability for the 7 first-order factors ranged from .77 to .93. Construct validity analyses revealed an association between survey citations and every subscale as well as the total score of the OIQ instrument. Known groups analysis revealed expected trends in the OIQ scores. The Observable Indicators instrument as a whole shows acceptable interrater and test-retest reliabilities, and strong internal consistency. Scale subscales show acceptable reliability as well. Generalizability Theory analyses revealed that dependability of scores can be improved by including a second site observer, or by revisiting a site. There is a small additional benefit from increasing observers or visits beyond two.

Assessing care home quality using routine regulatory information

Quality is an essential criterion by which care homes for older people are judged. However the measurement of quality is both challenging and potentially costly. This paper examines the potential of using routinely generated data from inspection processes as quality indicators. It indicates that generation of such information is possible, providing material that may be used in research and also for more general guidance.

Nursing Home Consumer Complaints and Quality of Care: A National View

This study uses 5 years of national data on investigated nursing home complaints (1998-2002) to evaluate whether complaints might be used to assess nursing home quality of care. On-Line Survey Certification and Reporting (OSCAR) data are used to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. The analyses are undertaken in the context of considerable cross-state variation in nursing home complaint processes and rates. Complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were significantly positively associated with survey deficiencies and the presence of serious survey deficiencies, and significantly negatively associated with nurse and nurse aide staffing. Complaints performance was significantly predictive of survey deficiencies at subsequent inspections. This study presents the first national evidence for using consumer complaints to assess nursing home quality of care. Despite limitations, nursing home complaints appear to offer a real-time signal of quality concerns.

Direct Observations of Nursing Home Care Quality: Does Care Change When Observed?

Recent research demonstrates that care recorded by nursing home (NH) staff is often inaccurate. Direct observations of care may therefore be of critical importance in assessing and improving care in this setting. Unfortunately, despite their apparent use in several types of quality assurance activities, there is little written information about the reliability or accuracy of observational procedures in NHs. This paper provides information about one important measurement issue (reactivity) that is often cited as a limitation of observational procedures in measuring usual care practices accurately. Descriptive. Seven nursing homes. Staff and residents. Direct observational time in bed; repositioning and feeding assistance. Observational measures of care quality were stable over multiple observation periods and consistently detected quality problems even on the first and last days of observation. Direct observations of care provided to residents do not appear to change provider behavior.

Consulting Youth about Residential Care Environments in Scotland

The National Care Standards (NCS) are the baselines for measuring the quality of care in children's homes in Scotland. The Scottish Commission for the Regulation of Care inspects the standard of residential care environments. The SCRC commissioned the development of a methodology to encourage children's participation in inspecting their care environments, while yielding information about how well the NCS were being met. Using the NCS as the framework, a participation methodology consisting of focus groups, questionnaires and interviews was constructed. The methodology was designed to incorporate ideas about re-envisioning children's services as children's spaces. It was piloted with 24 young people in residential care, aged between 15 and 19 years, during February and March 2004. Findings indicated that young people appreciated the opportunity to give their views about their care environment. They made suggestions about improving the mix of residents, staff attitudes and feeling safe.

在宅ケアの質評価法Ｈｏｍｅ Ｃａｒｅ Ｑｕａｌｉｔｙ Ａｓｓｅｓｓｍｅｎｔ Ｉｎｄｅｘ：ＨＣＱＡＩの妥当性の検証

To confirm the convergent validity of the Home Care Quality Assessment Index (HCQAI), developed by Dr. Arai et al., which is used for overall assessment of home care in three areas: 1) conditions of the disabled elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input), based on professional staff observation. We surveyed 102 pairs of disabled elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. The validity of HCQAI was investigated by computing the Spearman rank correlation coefficient between the subscales of the HCQAI and the variables measuring "outcome", "process" and "input", respectively. "Yokaigodo" (Government-Certified Disability Index), the Activities of Daily Living (ADL) of the disabled elderly, severity of dementia, the Short-Memory Questionnaire (SMQ) and Troublesome Behavior Scale (TBS) were used for the "outcome" variables."The impression of home care", a new scale developed for this study, was used as a variable to evaluate "process and input". The HCQAI subscales for "outcome" indicators were significantly correlated with the other above-described variables measuring "outcome", but not with "the impression of home care", the variable evaluating "process and input". All 5 HCQAI subscales for "process" and "input" were significantly correlated with "the impression of home care", but 4 out of 5 HCQAI subscales were not significantly correlated with the variables measuring "outcome". These findings indicate that each subscale of the HCQAI has the expected properties. Therefore, the convergent validity of the HCQAI is confirmed.

Improving the Quality of Nursing Home Care and Medical-Record Accuracy With Direct Observational Technologies

Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and ability of providers to identify areas for improvement. Observational protocols designed for use by survey and quality-assurance staff can provide the independent information necessary for improving both medical record accuracy and residents' quality of life. Unfortunately, observational protocols currently used in survey and quality-assurance activities are not designed in a manner that is consistent with the scientific principles that guide observational measurement. The purpose of this article is to describe the steps to develop a standardized and scientifically defensible observational system to assess nursing home care quality.

Older Widows' Expectations of Home Care Nurses

ABSTRACT The concept of expectations has been integral to research on home care satisfaction, but little is known about expectations of home care. The aim of this longitudinal phenomenological study was to describe part of the personal-social context of older widows' experience of home care-that of holding expectations of home care nurses. Data were drawn from interviews over three years with the 11 women who had home care nurses. The context of the home care experience was featured by leaning on helpers more at this stage and by expecting the nurse to do what the nurse is supposed to do, with its five parts including expecting the nurse to know how to do what needs to be done. Findings exemplified conceptual overlap among standard realms of expectations, such as behaviors and outcomes, and revealed the relevance of such data in appraisals of home care quality.

VNAA CHAMP Program to Measure and Raise Quality of Geriatric Home Care for All Agencies

Colleen Collins Shaddox is President, Quicksilver Communication, Hamden, Connecticut. Address for correspondence: 204 Davis Street, Hamden, CT 06517-3503 ([email protected]). Colleen was hired as a consultant by the VNAA to write this article for HHN.

Nutrition and the Dining Experience in Long-Term Care: Critical Indicators of Nursing Home Quality of Care

nursing care in particular, are at a crossroads. With the predicted growth of the older adult population, and the population of older adults who will require dementia-specific care, long-term care facilities face a probable and rapid increase in the need and demand for skilled nursing services. In fact, the number of adults over the age of 65 in nursing facilities* is predicted to double by 2020. Currently, there are 16,032 nursing facilities in the United States with more than 1.4 million residents. In North Carolina, there are 424 nursing facilities with capacity for 42,897 residents. In the face of the changing demographics in our society, nursing facilities are re-engineering to embrace the future and successfully meet these challenges. Part of the re-engineering will involve modifications of the physical plant, new construction and innovations in technology and services to match the evolving needs of residents. This issue of the North Carolina Medical Journal focuses on one of the most salient aspects of long-term care quality—food and the dining experience (as well as hydration and fluid intake). Nutrition is one of the major determinants of successful aging and, for most, eating is one of life’s most pleasant daily experiences. In the long-term care setting, the medical-nutritional needs of nursing facility residents are often competing with the provision of “consumer-defined” quality of care. To begin with, nursing facility residents often have complex healthcare conditions that limit their function, depress their senses of taste and smell, require multiple medications, and necessitate therapeutic or mechanically altered diets. These treatments can limit independence, choice, and pleasure and, thus, have a negative effect on quality of life. In the interest of preserving both the health and happiness of their residents, long-term care facilities are trying to find a balance between the residents’ required medical treatments and personal preferences. North Carolina’s nursing facilities are finding ways to achieve this balance as they also juggle the logistic challenges of feeding large numbers people in a highly regulated industry. Many of these specific efforts are described in the commentary by Nadine Pfeiffer, BSN, RN, and her colleagues in this issue of the Journal.

Establishing customer relationship management framework in nursing homes

The population of Taiwan has aged rapidly during the mid-1980s, and Taiwan formally became an ageing society in 1993. The elderly population of Taiwan reached 9.09% of the total population in April 2003. A significant need exists for medical and long-term care services for this aged population, especially nursing homes with professional care services. Consequently, nursing home care quality has become a major issue in Taiwan. This study establishes a customer relationship management (CRM) framework for nursing homes. CRM in nursing homes involves three aspects, namely case management customer relationships, information management customer relationships, and care management customer relationships. CRM in a nursing homes is further divided into nine sub-phases: interactive mechanism, assessment of demand model, customer data collection, data analysis, knowledge management, care design, care delivery, support from the related units, monitoring and feedback. This study also ranked the sequence of 84 indicators of CRM based on their importance. Focusing on these indicators can enable a nursing home to effectively improve its care quality.