Defining quality in assisted living: comparing apples, oranges, and broccoli

Area of Science:

• Gerontology
• Health Services Research
• Quality Improvement

Background:

• Assisted living is a growing sector of long-term care.
• There is a lack of consensus on the definition and purpose of assisted living.
• This ambiguity complicates quality assessment.

Purpose of the Study:

• To discuss quality measures and indicators for assisted living.
• To examine the uses of quality information in assisted living.
• To clarify the role and purpose of assisted living.

Main Methods:

• Review of major assisted living quality studies.
• Development of models based on provider and policymaker claims.
• Search for quality measures aligned with assisted living goals.

Main Results:

• Quality is multidimensional, encompassing care, life, environment, and rights.
• Disagreement among stakeholders (consumers, providers, regulators) hinders quality comparison.
• Lack of consensus confounds comparisons between assisted living settings and other long-term care.

Conclusions:

• Propose methods for comparing quality dimensions in assisted living.
• Inform consumer information systems, quality monitoring, and policy research.
• Quality indicators should include structural, process, and outcome measures, plus resident feedback beyond satisfaction.