The Efficacy of Quality Care Initiative Implementation in Nursing Homes Measured by Client Satisfaction

Converting the nursing home institutional model to a model of person-centered care for the purpose of improving nursing home quality has gained interest since the Omnibus Reconciliation Act was passed by the Federal Government in 1987. In the past, emphasis on providing a safe and healthy environment made it challenging to create a home-like environment for residents. Recently, however, several design initiatives have emerged radically changing the culture of the traditional nursing home to one focused on person-centered care designed creating a home-like environment and increasing the quality of life of residents. Three such initiatives were examined in the present study: the Eden Alternative, the Quality of Life Project, or the Nursing Home Quality Initiative. Specifically, it was hypothesized that nursing homes in Nebraska implementing a quality of life initiative, defined as the Eden Alternative, the Quality of Life Project, or the Nursing Home Quality Initiative, would result in greater satisfaction among nursing home residents, staff members, and family members, relative to nursing homes that did not employ these initiatives. Using a non-experimental (posttest only) design, 49 nursing homes responded to a mail-out survey designed to assess satisfaction in each group: 24 in the intervention group and 25 in the comparison group. Satisfaction was assessed using Vivian Tellis Nayak’s Customer Satisfaction in Long-Term Care: A Guide to Assessing Quality (2003). These instruments assess satisfaction among three important constituencies: nursing home residents, staff members, and family members with multiple dimensions of satisfaction assessed, along with a global measure of satisfaction for each group. Although satisfaction was uniformly high across all domains, there were no statistically significant differences observed between the nursing homes employing the quality of life initiatives and those not employing them on any of the satisfaction measures. The null findings are consistent with those reported in previous studies in other regions and have implications for consumers of long-term care services