Structure and process quality as predictors of satisfaction with elderly care

Abstract

What is known about this topic• Quality of care can be decomposed into three distinct but related components of structure, process and outcome.• Quality of caring relationships predicts satisfaction with care. What this paper adds• In a Swedish national survey, structural variables such as budget per elderly person and care personnel certification/training showed no relationships with the elderly person's evaluation of care in terms of satisfaction, while staffing and budget per capita AbstractThe structure versus process approach to quality of care presented by Donabedian is one of the most cited ever. However, there has been a paucity of research into the empirical validity of this framework, specifically concerning the relative effects of structure and process on satisfaction with elderly care as perceived by the older persons themselves. The current research presents findings from a national survey, including a wide range of quality indicators for elderly care services, conducted in 2012 at the request of the Swedish National Board of Health and Welfare in which responses from 95,000 elderly people living in 324 municipalities and districts were obtained. The results revealed that the only structural variable which significantly predicted quality of care was staffing, measured in terms of the number of caregivers per older resident. More interestingly, process variables (e.g. respect and access to information) explained 40% and 48% of the variance in satisfaction with care, over and above the structural variables, in home care and nursing homes respectively. The findings from this large nationwide sample examining Donabedian's model suggest that quality in elderly care is primarily determined by factors pertaining to process, that is, how caregivers behave towards the older persons. This encourages a continued quality improvement in elderly care with a particular focus on process variables.Keywords: elderly care, process, quality of care, satisfaction, structure were weakly associated with satisfaction in nursing homes.• Process factors such as respect and access to information were strongly associated with satisfaction.• The integrated model on quality of care presented by Donabedian is a useful framework for predicting client satisfaction in elderly care.

Understanding eldercare users' views on quality of care and strategies for dealing with problems in Swedish home help services

“…A study including data from the 2012 national eldercare survey showed no statistically significant association between users' experience of influence and care satisfaction in home help services. The authors suggest that the lack of significant association might be explained by the fact that the users receive care in their own home and, therefore, experience autonomy and influence (Kajonius & Kazemi ). The present study showed that many users did not believe it was really possible to influence care provision, and this belief might lead to strategies such as adaptation and trivialisation.…”

Knowledge and views about coordinated individual planning from the perspective of active older adults

“…The results suggest that it is not enough to provide information; the professionals also have to make a conscious effort to include the individual and his/ her informal caregiver or members of the team so that they are actively involved in the planning and decision-making process. To establish a true partnership, it is necessary to move away from didactic or paternalistic care provision [21]. Various professionals have to let go of their power and regard the individual as a competent partner involved in planning his or her own care.…”

Variations in user-oriented elderly care: a multilevel approach

“…More importantly, this previous research has convincingly demonstrated that satisfaction with care is mainly predicted by the experience of the care process at the interpersonal level (Kajonius and Kazemi, 2016c). Care process was tapped by ratings of how the older person perceived information sharing, respect from the care workers…”