To grade nursing homes, ask the residents

U. ROCHESTER (US) — Consumer satisfaction surveys of nursing home residents and their families could be a valuable tool to both inform consumer choice and reward homes for quality of care.

“Satisfaction scores are clearly an important indicator of the quality of care in nursing homes,” says Yue Li, associate professor of public health sciences at the University of Rochester Medical Center. “When used with other quality of care indicators, these assessments have great potential to empower consumers to make choices, incent improvements by nursing homes, and inform pay-for-performance.”

In 2002, the Centers for Medicare and Medicaid Services (CMS) began to make publicly available quality report cards for all certified nursing homes.   These reports included clinically-oriented performance measures such as staffing levels, citations, and patient outcomes.


In 2005, six states, including Massachusetts, launched projects to evaluate consumer satisfaction with nursing homes. Nursing home residents and their families were asked to fill out a survey that asked them to grade overall satisfaction and whether or not they would recommend the home to a friend.

The questionnaire also asked respondents to provide satisfaction scores in several specific areas, such as staffing and administration, the home’s physical environment, activities offered, their personal care, meals, and personal rights.

CMS is considering expanding the state satisfaction surveys to the national level, a step that could have significant policy implications in terms of how nursing homes are compensated for care.

This financial incentive coupled with informed consumers should compel nursing homes to improve or maintain a high level of care.

For the new study, published in the journal Health Affairs, Li and colleagues used data from 2005, 2007, and 2009 to review the survey results for Massachusetts nursing homes. They found that while overall satisfaction was consistently high, certain areas such as physical and social activities and meals met less satisfaction.

There was also significant variation in scores with 25 percent of homes receiving scores of  “less than satisfactory.” Nursing homes with higher scores also tended to have higher staffing levels and fewer citations for deficiencies, an indication that the satisfaction scores correlated with quality of care.

Non-profit and government owned nursing homes scored higher compared to their for-profit counterparts.

Researchers from the University of California, San Francisco, and the University of California, Irvine contributed to the study, which was funded by the National Institute of Aging.

Source: University of Rochester