Family member perceptions of nursing home residential quality of lifeedit
Family member perceptions of resident QOL (FMPRQOL) were measured using 25 items from a biennial, state-mandated survey of family satisfaction in nursing homes. Analyses used data from family members surveyed in 2012 through a census-proportionate, random sample of residents in ~1,000 facilities. Ensuring minimum individual and facility return/completion rates yielded a final N of 19,908 family members from 867 facilities. Hierarchical multi-level models examined resident, family member, and facility predictors of FMPRQOL (α=0.935). Higher FMPRQOL ratings were associated with the characteristics of residents (e.g., younger age and better ADL functioning) and family members (e.g., older age, male, and frequent communication with staff) and explained 22% of the individual-level variability in FMPRQOL. Ten percent of the variance in FMPRQOL was between facilities. Facility characteristics (e.g., not-for-profit status and high staff retention) were associated with higher perceived resident QOL. Variance accounted for by facility-level predictors ranged from 5% (effect of family member involvement) to 55% (overall mean ratings of FMPRQOL). The positive relationship between resident ADL functioning and perceived QOL was enhanced in chain-based versus stand-alone facilities, whereas this relationship was attenuated in facilities with a high percentage of residents with dementia and/or depression. More frequent visits and greater family involvement in resident care were associated with lower FMPRQOL. Increased monitoring could result from resident decline, sub-optimal care, or reluctance to relinquish caregiving duties. Facilities can enhance family member perceptions of resident QOL by improving communication between staff and family, reducing staff turnover, and encouraging meaningful family involvement in resident care.