Consumer satisfaction an indicator of quality of care in nursing homes

"Satisfaction scores are clearly an important indicator of the quality of care in nursing homes," said Yue Li, Ph.D., an associate professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences and lead author of the study. "When used with other quality of care indicators, these assessments have great potential to empower consumers to make choices, incent improvements by nursing homes, and inform pay-for-performance."

In 2002, the Centers for Medicare and Medicaid Services (CMS) began to make publically available quality report cards for all certified nursing homes. These reports included clinically-oriented performance measures such as staffing levels, citations, and patient outcomes.

In 2005, six states, including Massachusetts, launched projects to evaluate consumer satisfaction with nursing homes. Nursing home residents and their families were asked to fill out a survey that asked them to grade overall satisfaction and whether or not they would recommend the home to a friend. The questionnaire also asked respondents to provide satisfaction scores in several specific areas, such as staffing and administration, the home's physical environment, activities offered, their personal care, meals, and personal rights.

CMS is considering expanding the state satisfaction surveys to the national level, a step that the authors believe could have significant policy implications in terms of how nursing homes are compensated for care. This financial incentive coupled with informed consumers should compel nursing homes to improve or maintain a high level of care.

Using data from 2005, 2007, and 2009, Li and his colleagues reviewed the survey results for Massachusetts nursing homes. They found that while overall satisfaction was consistently high, certain areas such as physical and social activities and meals met less satisfaction.

There was also significant variation in scores with 25 percent of homes received scores of "less than satisfactory." Nursing homes with higher scores also tended to have higher staffing levels and fewer citations for deficiencies, an indication that the satisfaction scores correlated with quality of care. Additionally, non-profit and government owned nursing homes scored higher compared to their for-profit counterparts.