This study investigated the extent to which factors not directly related to the caregiving situation predicted family members' perceptions of the quality of nursing home care their elderly relative received. A conceptual model based on consumer satisfaction theory was used to test the extent to which factors associated with family members' expectations for care and their emotional response to the nursing home placement predicted perceptions of quality among 452 relatives representing the residents of two skilled care facilities. The entire model accounted for 27% of the variation in quality assessments. Attitudes towards nursing homes in general, length of resident stay and emotional responses to the placement (concern about the racelethnicity of caregivers, caregiver burden and caregiver emotional distress) were found to be significant predictors of perceptions of quality.
KEY worms-nursing homes; quality of care; regulation Long-standing concern about the quality of care provided by nursing homes has led to efforts to better define, measure and assure quality. The Institute of Medicine's Report Improving the Quality of Care in Nursing Homes (IOM, 1986) proposed guidelines that emphasize residents' rights as well as outcomes of care. These recommendations served as the basis for changes in the criteria for Medicaid and Medicare certification and the means by which compliance with these criteria are determined by state regulatory agencies. As a result, the survey process relies more heavily than in the past on information from residents and their advocates, as well as on actual observations of care.
Measuring resident satisfaction is, however, as