Aged Care Residents’ Perspectives on Quality of Care in Care Homes: A Systematic Review of Qualitative Evidence

Abstract

There is increasing interest in harnessing aged care residents’ perspectives to drive quality improvement in aged care homes. We conducted a systematic review of qualitative evidence including literature examining residents’ descriptions of “quality of care” in aged care homes, using database searches and screening records according to eligibility criteria. Three independent reviewers conducted quality assessment of forty-six eligible articles and performed thematic synthesis of articles’ findings. We distinguish nine key themes describing factors influencing quality care: staffing levels, staff attitude, continuity, routine, environment, decision-making and choice, dignity of risk, activities, and culture and spirituality. While many themes were consistent across studies, residents’ prioritization of them varied. Aged care home residents have differing conceptions of quality care as well as heterogeneous and dynamic needs and preferences. Care providers are best able to facilitate quality care when intentional efforts are made to recognize this and tailor delivery of services the individual residents.

What is and what ought to be: A meta‐synthesis of residential aged care staffs’ perspectives on quality care

“…The aim of this meta-synthesis is to locate and synthesise current qualitative evidence of aged care staff's perspectives on quality of care within residential aged care settings. This meta-synthesis not only fills a knowledge gap in relation to current work around quality care, but also compliments the previous review of residents' perspectives on quality of care, conducted by our team (Gilbert et al, 2021).…”

“…Inclusion was conditional on providing direct quotations, as it was believed that this best ensures the perspectives of aged care staff are being represented. Grey literature was not included in the search strategy, in line with strategy of our companion study on resident's perspectives (Gilbert et al, 2021). Where appropriate, grey literature is incorporated into the introduction and discussion of this meta-synthesis.…”

“…MeSH terms and/or keywords PubMed ("Homes for the Aged"[Mesh] OR "Nursing Homes"[Mesh]) AND ("Qualitative Research"[Mesh] OR "Anthropology, Cultural"[Mesh] OR "Focus Groups"[Mesh] OR "Interviews as Topic"[Mesh]) ProQuest (MAINSUBJECT.EXACT("Managed care") OR MAINSUBJECT.EXACT("Nursing homes") OR noft("aged care") OR noft("nursing home")) AND (MAINSUBJECT.EXACT("Qualitative research") OR noft("qualitative research") OR noft("focus groups") OR noft("semi-structured interviews") OR MAINSUBJECT.EXACT("Ethnography") OR MAINSUBJECT.EXACT("Medical anthropology") OR MAINSUBJECT.EXACT("Cultural anthropology")) AND (MAINSUBJECT.EXACT("Patient satisfaction") OR MAINSUBJECT.EXACT("Customer satisfaction") OR MAINSUBJECT.EXACT("User satisfaction") OR MAINSUBJECT.EXACT("Consumer satisfaction") OR MAINSUBJECT. EXACT("Quality of care") OR MAINSUBJECT.EXACT("Quality of life") OR noft("satisfaction") OR noft(good N/3 care) OR noft(quality N/3 care) OR noft(quality N/3 life)) Those with a significant observational or ethnographic component were also excluded, in line with a previous review on aged care resident perspectives (Gilbert et al, 2021). Search results were imported into Covidence for initial screening (www.covid ence.org) and then imported into JBI SUMARI for full-text screening and appraisal (www.jbisu mari.org).…”

“…reviews, quantitative studies, theoretical or discussion pieces), (ii) focussed on a specific clinical outcome or condition (incl. palliative care) (iii) duplicates (iv) focussed on quality of life or evaluation of indicators (v) studies with a significant observational/ethnographic component (vi) studies prior to 2009 (as per complementary paper, Gilbert et al, 2021)…”

Family Members’ Experiences with the Healthcare Professionals in Nursing Homes – A Survey Study

“…This is a well-known situation in many nursing homes, which has generated a substantial amount of criticism, as it does not promote continuity of care. 27 Discussions concerning care have led to many studies aiming to examine what quality of care means for residents in nursing homes, 28 and also what it means for family members. 29 There are probably many factors involved that contribute to this problem, for example, organizational and economic factors.…”