title: Perceived and observed quality of long-term care for residents - Does functional ability account?
abstract: BACKGROUND
  Measuring quality in long-term residential care involves challenges concerning both the measurement method and the impaired functional ability of many older people. Ensuring quality in care is even more important for people with functional impairments, as this is a vulnerable group who may be unable to report poor quality of care for themselves.
  
  
  OBJECTIVE
  The aim of this study was to analyse how perceived and observed assessments of the quality of care varied according to the residents' functional ability.
  
  
  METHODS
  The data (n = 278) used in the analyses included residents', family members' and staff assessments of perceived and observed quality of care combined with the Resident Assessment Instrument (RAI) scales measuring the same residents' functional abilities (physical, psychological, cognitive and social). Observations were included in the data if all four assessment types (by residents, family members, staff and the RAI) were available. The dimensions of quality of care emerging from the factor analysis were used.
  
  
  METHODS
  Linear regression was used to explore the association between resident's functional abilities and assessed quality of care.
  
  
  RESULTS
  Higher level of depression symptoms and higher level of dependency in activities of daily living (ADL) were significantly associated with lower level of perceived and observed quality of care. By contrast, the level of residents' cognitive functioning was not significantly associated with any quality dimensions. The social aspect was the only dimension of functional ability on which better functional ability indicated better quality of care, although differences between respondent groups were also observed.
  
  
  CONCLUSIONS
  These analyses emphasize the importance of taking residents' functional ability into account when collecting information on and interpreting the results of perceived and observed quality of care reported separately by residents, family members and staff.
  
  
  CONCLUSIONS
  The information obtained can inform care professionals of how dimensions of residents' functional impairments are associated with perceived and observed quality of care and the quality of older people's care can thereby be improved.
authors.affiliation: Department of Ageing, Disability and Functioning, National Institute for Health and Welfare, Helsinki, Finland.|School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Anja
authors.initials: A
authors.lastname: Kahanpää
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Anja
authors.initials: A
authors.lastname: Noro
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Lehto
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Perälä
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications; D004185:Disability Evaluation; D005260:Female; D005387:Finland; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D026684:Personal Autonomy; D011787:Quality of Health Care; D055815:Young Adult
keywords: functional ability; long-term care; older people; quality of care; resident assessment instrument