Conflicting definitions of nursing home quality: Using employee perceptions to assess the validity and reliability of government mandated quality measures

This study examined the perceptions of nursing home employees regarding the relationship between quality indicators and the care provided by a nursing home. The research was designed to investigate the disagreement between government regulators and nursing home providers regarding the current method of measuring and reporting nursing home quality. Two-hundred-ninety-three employees from three different nursing homes completed the Survey on Nursing Home Quality Measures. The respondents used a 5-point Likert scale to express the extent they believed 9 quality indicators can be controlled by a nursing home. Four of the quality indicators were validated as being related to the quality of care provided by a nursing home, based on the perceptions of the employees; 5 quality indicators were not. The research concluded that the Center for Medicare and Medicaid Services (CMS) Quality Measures (QMs) are not appropriate for public reporting purposes at this time. However, the QMs could be the basis for a composite nursing home performance measure that can be used to monitor the consistency of the regulatory survey process. The research also provides empirical evidence regarding the relationship between staff characteristics and the perception of quality. Nursing home structural characteristics and the resident care status of an employee do not have an impact on an employee's perception of quality. However, the employee's perception of quality is affected by their management status, licensure status, and length of employment.