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A national-level analysis of the relationship between nursing home satisfaction and quality in the US

2018 Conference Presentation

Outcomes and quality United States

11 September 2018

A national-level analysis of the relationship between nursing home satisfaction and quality in the US

Pamela Nadash, University of Massachusetts Boston, United States

Edward Miller, University of Massachusetts Boston, United States
Jennifer Hefele, University of Massachusetts Boston, United States
Adrita Barooah, University of Massachusetts Boston, United States
Xiao (Joyce) Wang, University of Massachusetts Boston, United States


Background: To choose the nursing home (NH) that will best serve them, consumers and their families require information that is both credible and responsive to their needs. Government, too, requires good information about NH performance to perform its oversight and program management functions, incentivize quality improvement, and respond to consumers’ desire for information. Such information is particularly important given serious and ongoing concerns about poor NH quality.

Evidence shows that prospective NH residents and their families desire data on consumer satisfaction. Moreover, the consumer perspective on quality is particularly salient in NHs, given that the nature of a NH stay extends well beyond receipt of healthcare services to touch all aspects of a resident’s life. Outside the NH sector, consumer experience and satisfaction data are becoming routine and considered integral to performance evaluation. The federal government in the U.S., however, does not require NHs to collect satisfaction data, nor is consumer satisfaction among the quality indicators reported on the federal public reporting website, NH Compare.

Methods: Collecting satisfaction data has costs; it can be justified only if it provides information that supplements, rather than duplicates, currently available information on quality. However, evidence is scant on the relationship between consumer satisfaction and quality in the NH sector beyond the limited number of states mandating collection of satisfaction data. This study thus examines the association between satisfaction and quality among NHs nationally. The sample comprises 1,765 NHs in the 50 states and District of Columbia that used the My InnerView resident or family satisfaction instrument in 2013 and 2014, merged with Certification and Survey Provider Enhanced Reporting, LTCfocus, and NH Compare data. Family and resident satisfaction correlated modestly; both correlated weakly and negatively with any quality of care (QoC) and any quality of life (QoL) deficiencies and positively with the NH Compare 5-star rating. The positive relationship between satisfaction and the 5-Star rating persisted after adjusting for covariates; only the negative relationship between QoC deficiencies and family satisfaction remained. The overall models explained relatively small proportions of the variance in satisfaction; the correlates of satisfaction varied between residents and families.

Results: Findings indicate that consumer satisfaction provides a different perspective on resident and family experiences with NH care than prevailing measures of quality do. Yet satisfaction information is not used to incentivize quality improvement nor has it been added to the NH Compare website, despite residents’ and their families’ desire for such information and the disappointing consumer utilization of the site. Adding satisfaction information to the objective measures already available on NH Compare may well increase its attractiveness, increasing traffic to the site and improving its ability to inform NH choice.