Nursing Home Quality: A Framework for Analysis

Abstract

Previous efforts to evaluate nursing home quality have been hampered by the lack of a conceptual model that specifies the major components and specifically associates measurable indicators with quality. An extensive literature review reveals many fragmented pieces of information, but no framework in which to fit the pieces together. The model presented here identifies four major dimensions of nursing home quality: (a) staff intervention, (b) physical environment, (c) nutrition/food service, and (d) community relations. These dimensions go beyond traditional "quality of care" by including quality-of-life considerations as well. The dimensions are each further divided into two subdimensions. I propose that measurable indicators for each of these eight subdimensions can be combined to make an effective and comprehensive quality measure.

An Integrated Conceptual Model of Quality of Life for Older Adults Based on a Synthesis of the Literature

“…Taking into consideration such things as the political and social environment, material resources, and most importantly, the meanings that individuals attach to situations and events in their lives, are key factors in this quality of life social model (Baxter and Shetterly 1998;Bond 1999;Bury and Holme 1990;McDowell and Newell 1987). McDowell & Newell 1987 Moberg 1990Schipper et al 1990Rabiner et al 1997 Indicators of social well-being generally include a sense of belonging and social environmental factors such as recreation and leisure/social activities, contact with statutory and voluntary organizations, community interactions, and family and social networks/relationships and support, including affection, positive interaction, socialization, psychosocial support, informational support, and emotional support/reassurance (Atchley 1991;Baxter and Shetterly 1998;Becker et al 1993;Bond 1999;Brink 1997;Capitman et al 1997;Frisch et al 1992;Glass 1991;Kane 1998Kane , 2001Keigher et al 2000;Lassey and Lassey 2001;Marinelli and Plummer 1999;Raphael et al 1997). The size and composition of social networks, the quantity of social contact, and the quality of support provided are variables influencing social well-being (Albert et al 1997;Baxter and Shetterly 1998;Becker et al 1993;Bury and Holme 1990;Kane 2001;Lassey and Lassey 2001;Marinelli and Plummer 1999).…”

“…In regard to social relationships, Kane (2001) argued that relationships make life worth living, whether they are relationships of love, friendship, or even of enmity and rivalry. Glass (1991) distinguished between "inside-out activities" and "outside-in activities" when referring to community interactions. Inside-out activities maintain the older person's interactions with his or her community by occasionally helping him/her get out of the house (e.g., shopping, banking, church).…”

A nursing intervention for older adults in living nursing home: Reminiscence therapy

“…[3] Huzurevi bakımı yaşlıların ziksel, ruhsal ve sosyal kapasitesini mümkün olabilecek en uzun sürede devamlılığının sağlanmasını [4] ve sadece klinik bakımını değil, yaşlıların sosyal ve psikolojik ihtiyaçlarının karşılanmasını kapsamaktadır. [5] Yapılan çalışmalarda huzurevinde yaşayan yaşlıların evde yaşayan yaşlılara göre yaşam kalitesinin daha düşük olduğu ortaya konmuştur. [6][7][8] Evinde yaşayan yaşlılar ile huzurevinde yaşayan yaşlıların sağlığı geliştirme davranışlarının karşılaştırıldığı bir çalışmada, evinde yaşayan yaşlıların sağlığı geliştirme davranışlarının huzurevinde yaşayan yaşlılara göre daha fazla olduğu belirtilmiştir.…”

Nursing Home Safety: Current Issues and Barriers to Improvement

“…Unlike most other medical care sites, NHs are responsible for each resident's physical surroundings and opportunities for meaningful social interaction. Glass (26) identified four main goals of NH care (a safe and clean environment, maximized functional independence, control and maintenance of health conditions, and promotion of positive feelings and resident dignity) and then used them to guide the development of an early multidimensional model of quality.…”

“…This model consisted of only four dimensions, each of which were divided into two subdimensions: staff intervention (quality of care, quality of caring), physical environment (general, individual), nutrition and food services (nutritional adequacy, appeal), and community relations (inside out, outside in) (26).…”