Family members as proxies for satisfaction with nursing home care

Many benefits to collecting and reporting satisfaction information from nursing home residents, including promoting quality initiatives, consumer choice, and improved care, have been described. Yet barriers to collecting resident satisfaction information exist, the most significant of which is the often low cognitive status of residents. An alternative source of information can come from family members serving as proxies for the residents. A study was conducted to explore the agreement and association of nursing home residents' responses with family member proxy responses.

Satisfaction data from 286 paired residents and family members in 42 facilities were collected in 1999. The satisfaction questionnaire consisted of 16 items evaluating the art of care, technical quality, efficacy, amenities of the care environment, and global satisfaction. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients were used to compare resident and proxy responses.

In general, proxy satisfaction ratings were higher than the same ratings given by residents. Proxy ratings varied less from residents' ratings for the amenities items, which were considered the most concrete items. Proxy ratings were much higher for the art of care and efficacy domain items--the least concrete questions.

Proxy ratings do not necessarily substitute for resident ratings and are dependent on the nature of the question asked. Examining resident-proxy responses at different points in time may be useful.