JAMDA
Volume 7, Issue 9 , Pages 541-544, November 2006

Direct Observations of Nursing Home Care Quality: Does Care Change When Observed?

  • John F. Schnelle, PhD

      Affiliations

    • Geriatric Research Education and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, CA
    • Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, Los Angeles, CA
    • UCLA Department of Medicine, Division of Geriatrics, Los Angeles, CA
    • Corresponding Author InformationAddress correspondence to John F. Schnelle, PhD, Borun Center for Gerontological Research, 7150 Tampa Avenue, Reseda, CA 91335.
    • ,
  • Joseph G. Ouslander, MD

      Affiliations

    • Division of Geriatric Medicine and Gerontology, Department of Medicine, and the Center for Health in Aging, Emory University School of Medicine, Atlanta, GA
    • Atlanta VA Rehabilitation Research and Development Center, Atlanta, GA
    • The Birmingham/Atlanta VA GRECC, Atlanta, GA.
    • ,
  • Sandra F. Simmons, PhD

      Affiliations

    • Borun Center for Gerontological Research, Los Angeles Jewish Home for the Aging, Los Angeles, CA
    • UCLA Department of Medicine, Division of Geriatrics, Los Angeles, CA

published online 28 May 2006.

Objectives

Recent research demonstrates that care recorded by nursing home (NH) staff is often inaccurate. Direct observations of care may therefore be of critical importance in assessing and improving care in this setting. Unfortunately, despite their apparent use in several types of quality assurance activities, there is little written information about the reliability or accuracy of observational procedures in NHs. This paper provides information about one important measurement issue (reactivity) that is often cited as a limitation of observational procedures in measuring usual care practices accurately.

Design

Descriptive.

Setting

Seven nursing homes.

Participants

Staff and residents.

Measurements

Direct observational time in bed; repositioning and feeding assistance.

Results

Observational measures of care quality were stable over multiple observation periods and consistently detected quality problems even on the first and last days of observation.

Conclusion

Direct observations of care provided to residents do not appear to change provider behavior.

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 This research was supported by Grant AG10415 from the National Institute on Aging, University of California at Los Angeles Claude D. Pepper Older Americans Independence Center.

PII: S1525-8610(06)00179-4

doi:10.1016/j.jamda.2006.03.009

JAMDA
Volume 7, Issue 9 , Pages 541-544, November 2006

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