Quality of care for nursing home residents: Development evaluation and review of clinical indicators of care

Abstract

This study aimed to develop indicators of clinical care designed specifically for residents with high level needs in Australian nursing homes. It was hypothesised that standards of care would be higher in those nursing homes in which such measures of quality were applied. Following nine case studies, which included 121 in-depth interviews with industry participants, and a national survey of 208 nursing homes, a series of 18 indicators were identified. They were trialed, evaluated, and revised during a period of residency in a major metropolitan facility. The indicators were assigned to one of four care domains: resident health, personal care, resident lifestyle, and the care environment, and compiled into an Australian Quality Matrix of clinical care (AQM). Three indicators were attached to the first care domain: the prevalence of stage 1-4 pressure ulcers, the incidence of infections from all sources, and the prevalence of poly pharmaceutical regimens of medications. Six indicators applied to the second care domain: the prevalence of incontinence, the incidence of dehydration, the prevalence of skin tears, the incidence of residents with compromised mobility, the incidence of symptoms of oral/dental deterioration, and the incidence of visual or auditory deterioration. Four indicators were related to care domain three: the prevalence of weight loss, the prevalence of inactive residents, the incidence of pastoral visits for spiritual care, and the prevalence of residents with behavioural symptoms affecting others. The fourth care domain also incorporated four indicators: the incidence of residents who are restrained on a daily basis, the prevalence of residents who fall, the incidence of residents with symptoms of depression and the incidence of family support. The study recommended that the AQM be the subject of a multi centre multi state trial to confirm its validity and reliability. It further recommended that future research address the relationship between quality of care and quality of life in the Australian context. In addition, the differences between rural and urban service provision, detected during the project, should be further investigated.