Scuola Superiore Sant'Anna di Pisa
What affects residents and family experience with Nursing Homes in Italy
Objective: This study compared family and residents’ ratings of overall facility-level assessments of quality of life across nursing homes (NHs) in Tuscany Region (Italy) and whether the dimensions of care most important to families’ and residents’ overall assessments of quality in LTC are similar. Though prior research has mainly focused on whether family members are good proxies for resident quality of life, while family is important independent evaluator of NHS quality considering also that relatives and other caregivers are often the prime decision-maker for admission decisions and quality monitoring. Method: This study, using data drawn from a regional project, aims at analyzing residents and family experience assessments in 2012 in almost 60 NHs in Tuscany Region. NHs were randomly selected, stratified by geography. Face-to-face interviews were conducted with 1,116 residents, using a structured questionnaire. The number of residents approached in each home was a function of its size. Telephone assisted interviews were conducted with 1013 relatives. The questionnaire, which was pre-tested in a NH not participating in this study, was structured in about 60 closed-ended questions covering nine dimensions (number of questions pertaining to each dimension is shown in parentheses): 1.Welcome and orientation(3); 2.Comfort(7); 3.Services (8); 4. Activities (9); 5.External relationships (4); 6.Assistance and care 12); 7.Staff 9); 8.Privacy (3); 9.Overall quality 2). Correlations between overall quality rating and other items of experience and satisfaction were compared across residents and family respondents using two different logistic regression model. Results: Overall quality for the NHs was rated positively for about 83% for families and about 70% for residents. Overall NHS-level ratings by family and resident respondents were correlated for a set of common items, as comfort and welcome and orientation and staff’s skill. Meaningful activity, services and autonomy were most strongly correlated to overall home ratings for residents while medical care and sharing decisions and information were most strongly related to overall NHs ratings for family. Conclusions: Knowledge about how the resident and family experience care quality in nursing homes is fundamental for determining what is quality of life and care. Taking residents’ and family members’ preferences and values into account when developing quality measures, contributes to creating person-centered nursing home services. However the items that influence the perception of a good quality in a NHs may vary among residents and family and the two groups provide distinct and valuable information regarding NHS quality.
1 September 2014