Care recipients' and family members' perceptions of quality of older people care: a comparison of home-based care and nursing homes

Aims. To compare care recipients' and their relatives' perceptions of quality of care in nursing homes and home-based care. Background. Older people care is increasingly being provided in community care facilities and private homes instead of hospitals. A few studies have compared care recipients' and relatives' perceptions of care quality in nursing homes as opposed to home-based care. Design. Cross-sectional surveys. Methods. Care recipients' and relatives' perceptions of quality of care were measured by questionnaire in 2003 in two older people care organisations. Quality measures were compared between care settings. Multiple regression was used to determine the predictors of overall quality ratings for each group, and possible interactions between quality measures and care settings were tested. Results. Care recipients rated their opportunities for activities significantly lower in home care than in nursing homes. Relatives of care recipients in home-based care rated several aspects of care quality significantly lower than relatives of nursing home residents. No significant interaction effects regarding predictors of overall quality ratings between the care settings were found. Staff behaviour was the strongest predictor of care recipients' overall quality rating, and staff professional skills were the strongest predictor of relatives' overall quality rating. Conclusions. Compared with nursing homes, home-based older people care seems to be in greater need of development regarding staff competence, staff interaction with relatives and activities offered to older people. In both settings, nursing staff behaviour influences these stakeholders' satisfaction with care. Relevance to clinical practice. These results point to a need to improve services in both care settings, but especially in home-based care. It is suggested that care recipients' preferences for social and physical activities be investigated on a regular basis in both care settings. Efforts should also be made to improve communication and interaction between family members and older people care staff, especially in home-based care.