How do those who have lived in or visited nursing homes perceive the services, staffing, environment, and caregiving?
In 2001, more than one-third of people with substantial nursing home experience expressed dissatisfaction with the care that they, a family member, or a friend received in the past three years. Between 16 percent and 41 percent reported inadequacies with nursing home staffing, environment, or caregiving.
Why is this important?
About 1.5 million Americans reside in nursing homes at any given timea population that is vulnerable and has many medical and psychosocial needs. Yet little is known about their experiences with care since there is no national standardized survey of nursing home patient experience.
To fill this gap, a 2001 national opinion poll assessed the perceptions of a subgroup of the general population who had substantial nursing home experience, either as a nursing home resident or from regularly visiting family or friends in nursing homes.
Findings
In a 2001 survey of those with substantial nursing home experience, more than one-third of respondents (37%) expressed dissatisfaction with the care that they or friend or family member received in the past three years. Likewise, more than one-third (36%) said that they would not recommend the nursing home to someone else.
A sizable minority (16% to 41%) reported inadequacies with certain aspects of nursing home staffing, living environment, and caregiving. For example, about one-quarter (25%) reported serious problems such as mistreatment or abuse of residents by nursing home staff (NewsHour/KFF/HSPH 2001).
Implications
Perceptions of nursing home care are mixed, with a fundamental gap in expectations for a large minority of people with substantial nursing home experience. Nursing home administrators, consumers, and regulators would benefit from ongoing data on nursing home experience to assess and improve nursing home care.
Improvement Ideas and Resources
A coalition of long-term care providers, caregivers, medical and quality experts, government agencies, and consumers has initiated the Advancing Excellence in America's Nursing Homes Campaign to improve quality of care and quality of life for nursing home residents. One goal is for more than 80 percent of nursing homes to assess resident and family experience of care and incorporate this information into quality improvement plans.
- A field trial of an instrument to measure nursing home resident quality of life (Kane et al. 2004) suggests that "in addition to facility-wide programs or policies, an assessment and care planning model could be developed to promote individualized attention" to quality of life (Degenholtz et al. 2006).
- The federal Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services are developing a Nursing Home Survey as part of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiative for monitoring and improving quality and patient satisfaction.
Measure:
The denominator includes survey respondents with "substantial nursing home experience," defined as those who report that, in the past three years, they have been a resident in a nursing home or have known someone in a nursing home and visited them at least once a month over that time. Only a subset of the results is shown in the charts. The sampling error was 6 percentage points (NewsHour/KFF/HSPH 2001).
Limitations:
Self-reported data are subject to potential recall bias. Results may not fully capture the experiences of nursing home residents with cognitive impairments who could not express their own opinions and whose experiences are likely to differ substantially from other residents because of greater challenges.
Source:
The National Survey on Nursing Homes was a telephone survey conducted from April 23, 2001, to June 3, 2001 among a randomly selected, nationally representative sample of 1,309 adults (age 18 and older). Data shown in the charts represent a subsample of 323 respondents with substantial nursing home experience (NewsHour/KFF/HSPH 2001).
References:
* Indicates source of data used in the chart(s).
Degenholtz, H. B., R. A. Kane, R. L. Kane et al. 2006. Predicting Nursing Facility Residents' Quality of Life Using External Indicators. Health Services Research 41 (2): 33556.
Kane, R. L., B. Bershadsky, R. A. Kane et al. 2004. Using Resident Reports of Quality of Life to Distinguish Among Nursing Homes. Gerontologist 44 (5): 62432.
* NewsHour/KFF/HSPH (NewsHour with Jim Lehrer/Kaiser Family Foundation/Harvard School of Public Health). 2001. National Survey on Nursing Homes. Menlo Park, Calif.: The Henry J. Kaiser Family Foundation.