Quality-of-life Assessment
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Quality of Life Assessment
ASSESSING SATISFACTION AND QUALITY OF LIFE IN NURSING HOMES
Quality of life (QOL) is a multi-dimensional, inherently subjective construct that defies easy definition. Not surprisingly then no single website sufficiently embraces the complex task of assessing and improving QOL for nursing home residents. As a result, Quality Improvement Organizations and nursing home providers intent on improving QOL for residents may want to consult a variety of online resources as they develop plans for action. This page is a compilation of websites and web pages worth consulting. Please contact us to recommend additional online resources.
Assessing Quality of Life in Nursing Homes
In 1998 the Centers for Medicare and Medicaid Services contracted with renowned gerontologist Rosalie Kane and her colleagues at the University of Minnesota to develop and test measures and indicators of quality of life (QOL) for nursing home residents. Kane’s study, reported in 2003, is notable for how unflinchingly it shatters stereotypes about residents with dementia ("It is feasible to collect information directly from nursing home residents about their own QOL. Even residents with substantial cognitive confusion completed QOL interviews.") and for its clear-headed practice recommendations ("The poor performance of proxies suggests that whenever a resident can be interviewed directly, proxies should not be used in lieu of resident self-report."). The research team identified 11 QOL domains that could be tapped in 54 questions. This question set has been further distilled into 14 items for inclusion as a brand new—-and controversial—-section in the Minimum Data Set, version 3.0, which is under development. Follow these links to learn more:
Assessing Quality of Life for Non-Communicative Residents
In some nursing units, particularly dementia care units, few if any residents are able to respond to interviews. In their final report on quality of life (QOL) in nursing homes, Kane, et al., lamentably conclude:
Determining QOL for those who cannot express themselves verbally, even in short and simple interviews remains a problem. Many residents with substantial dementia according to the MDS (Minimum Data Set) could complete usable QOL responses; we, therefore, recommend against any MDS-based screening prior to conducting QOL interviews. That being said, many people who are unable to respond lack a voice, and in some instances we cannot really infer their QOL from any non-verbal clues. One could rely on those who can respond to serve as the sentinels for those who cannot, but such a policy is uncomfortable. More work is needed to identify ways to give the resident who cannot communicate a better voice (Conclusions, page 13.5).
Any suggestions? We welcome your recommendations. Contact us.
Mandate for Quality Improvement Organizations to Assess Satisfaction
As part of their 8th Statement of Work (SoW), state Quality Improvement Organizations (QIOs) are working with nursing homes to measure and improve resident satisfaction. This task is one step toward a larger goal of promoting culture change within nursing homes as a means of enhancing quality of life for residents. Quality Partners of Rhode Island, which serves as the Nursing Home Quality Improvement Organization Support Center, has developed and disseminated to the QIOs a list of validated proprietary and non-proprietary as well as cost-based and free satisfaction tools for QIOs to use in this task. These have been reviewed and approved by the Centers for Medicare and Medicaid Services as acceptable tools for the measurement of satisfaction in the 8th SoW. For more information, visit these sites:
Culture Change
Culture change. It's a phrase approaching trendiness in the long-term-care community, but that should not detract from the merits of a resident-centered movement that dates back to 1997 with the first meeting of the Nursing Home Pioneers, which evolved into today's Pioneer Network. Though their strategies may differ, all of the culture change organizations listed below are working to change nursing home care in ways that enhance quality of life (QOL) for residents. All of them are eager to work collaboratively with state Quality Improvement Organizations and nursing homes intent on improving QOL.
Continuous Quality Improvement
In a "Brief History of Geriatrics," geriatrician John E. Morley notes that John F. Schnelle, Ph.D., director of the UCLA/JHA Borun Center, made history when, "In the early 1990s, (he) began to publish articles on the use of quality control techniques for reducing restraints and managing incontinence." Other gerontological researchers followed Schnelle’s lead, "espousing total quality assurance as an important step in improving quality for older individuals (Morley, 2004)." All of the daily care interventions presented as modules on our Borun Center website are built around principles of continuous quality improvement, especially the dictum that timely data gathering, analysis, and feedback can rapidly improve quality of care. These websites and pages present additional approaches to continuous quality improvement:
Other Resources
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