Objective: The objective of this study was to describe the relationship among nursing facility performance on governmental regulatory surveys and residents’ perceptions of nursing facility quality; to evaluate nursing facility quality within Juran’s Quality Improvement Framework; and to ascertain whether facility survey performance can predict resident quality perception.
Design: A descriptive correlational design was utilized for this study.
Population, Sample, Setting, Years: The target population for this study was older adults residing in nursing facilities. The accessible population was older adult residents of nursing facilities in south Louisiana. Random sampling with replacement of eligible residents was conducted in facilities representing different levels of regulatory compliance. Invitations to participate were mailed to administrators of south Louisiana nursing facilities representing all levels of survey deficiency categories. Subjects were recruited from those facilities where permission to interview residents and review medical records was granted. An equal number of subjects (5) was included from each facility. Surveys were conducted between September 2000 and March 2001.
Variables Studied: Nursing facility quality Nursing facility compliance Perceived quality of life Perceived quality of care
Methods: Three tools were used in the course of the study to assess perceived quality of care and perceived quality of life in nursing facility residents, and the degree to which their respective facilities complied with regulatory guidelines: Ferrans and Powers’ Quality of Life Index Nursing Home Resident Satisfaction Scale (Zinn) Facility Performance Index Demographic data were collected from resident medical records. Demographic variables included: gender, age, length of stay, race, level of education, marital status, and method of payment. The facility performance score was correlated with the overall QLI scores and the NHRSS general satisfaction score. Multiple correlation was used to indicate the relationship between the predictor variables (perceived quality of care and facility performance) and perceived quality of life.
Findings: No significant relationship was detected among the study variables. Further, facility performance could not be used to predict resident perceived quality. Resident surveys revealed emphasis on different measures of quality than those utilized in facility surveys.
Conclusions: Despite assumptions to the contrary, the survey and certification process utilized by state and federal agencies does not meet Juran’s criteria for Quality Improvement within long term care organizations. Without identification and emphasis on customer (resident and family) desires and definitions of quality, true quality of care and quality of life cannot exist.
Implications: Administrators, regulators, and direct care givers in long term facilities must recognize the gap between regulatory and customer definitions of quality. While survey criteria cannot be completely discounted, resident-centered desires must be incorporated into evaluative standards to truly validate and quantify the quality of care delivered in nursing facilities.
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