Quality of living in long-term care environments: A psychometric analysis of the H.O.M.E Scale

Research related to quality of life in long-teen care settings has been hampered by murky conceptual definitions and a paucity of measurement tools designed to capture outcomes sensitive to environmental variables. The primary aim of this study was to test the psychometric properties of the H.O.M.E. Scale, an instrument to measure quality of living in an environmental context as conceptualized by feeling “at-home” in a place. Home was defined as an existential place of meaning and optimum person-environment relationship characterized by dynamic energy transactions between the self and the physical, social, cultural, temporal, spiritual lifeworld. The H.O.M.E. Scale is a 25-item Likert scale with a balance of positive and negative statements. Expert panel review during instrument development demonstrated a content validity index of 0.88 and a rating of 0.71 for inter-rater agreement for the 54-item development instrument. In this study, a refined 25-item scale (refined and optimized during pilot testing) was administered to 200 older adults living in a variety of community and residential living situations across the state of Connecticut. Principal components analysis provided support for criterion-related validity by eliciting a 3-factor solution consistent with theoretical predictions. Dimensions of person-environment relationship elicited were “attachment,” “ disconnection” and “ownership.” Mean scores for at-home-ness were lower for institution dwellers than for community dwellers even after controlling for health, choice in dwelling, and housing satisfaction (Wilk\u27s Lambda F(4,266) = 2.71, p \u3c .05). Reliability of the home scale was supported with internal consistency reliability of 0.95 for the entire scale and 0.84–0.95 for subscales. Test-retest reliability was robust in a small subsample of participants who completed a second H.O.M.E. Scale 3 to 4 weeks after the first (r = 0.86, p \u3c .01). The H.O.M.E. Scale demonstrates sound psychometric properties and provides a tool for research to narrow the knowledge gap related to person-environment relationship. The instrument is unique in its conception of at-home-ness as a vital outcome to be studied in eldercare and will help the research community evaluate whether we have answered Kane\u27s (1995) call for the transformation of long-term care environments into livable habitats.