Forms

Quality-of-life Assessment

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Modules - Quality-of-life Assessment

INTERVIEW FORMS TO ASSESS CARE PREFERENCES FOR:

Toileting assistance (PDF)
Walking assistance (PDF)
Dressing and personal hygiene assistance (PDF)
Getting in and out of bed (PDF)
Social activity participation (PDF)
All of the above care areas (PDF)

INTERVIEW FORMS TO ASSESS:

FORMS FOR TARGETING INTERVIEWS

FORMS FOR ASSESSING QUALITY INDICATORS

For Incontinence Care (use both forms together):

Medical Record Review (PDF)
Quality Indicator Data Sources and Scoring Rules (PDF)

For Pain Management:

Pain Quality Indicators: Medical Record Data and Scoring Form (PDF)

For Feeding Assistance:

For Pressure Ulcer Care:

Pressure Ulcer Quality Indicators, Data Sources, Eligibility, and Scoring Rules (PDF)

We worked with researchers at RAND, a southern California think tank, to develop a series of quality indicators (QI) that nursing home staff and outside surveyors can use to evaluate a facility's quality of care in such domains as incontinence management, pain management, weight loss prevention, and pressure ulcer prevention. Presented as a series of if/then statements, each set of QIs outline minimally acceptable care for that particular domain. QIs, writes RAND, "set a minimal standard for acceptable care-standards that, if not met, almost ensure that the care is of poor quality." Thus there should be no excuse for not meeting these indicators.

Based on expert opinion and existing best-practice guidelines, all of our QI-associated assessment and treatment tasks are both related to positive outcomes for residents and feasible for nursing home staff to implement. Use the QI forms listed above to evaluate the quality of care in your facility.

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