Development of the Care Environment Scale-Long-Term Care

Area of Science:

• Gerontology and Health Services Research
• Quality Improvement in Healthcare Settings

Background:

• Analyzing the care environment is crucial for Quality Assurance and Performance Improvement (QAPI) in long-term care.
• Existing tools may not adequately capture staff perceptions of the care environment for targeted improvement.

Purpose of the Study:

• To develop and psychometrically evaluate a tool for long-term care staff to assess the care environment.
• To create a measure that can guide performance improvement initiatives within long-term care facilities.

Main Methods:

• Initial item development through focus groups with 57 interdisciplinary participants across five nursing homes.
• Content validity assessed by an expert panel (item content validity index = 1.0).
• Pilot testing for internal consistency and reliability involved 425 staff members across 30 nursing homes and four assisted living facilities, with intrarater reliability tested on 66 registered nurses.

Main Results:

• The Care Environment Scale-Long-Term Care (CES-LTC) demonstrated strong internal consistency (Cronbach's alpha = .90).
• Exploratory factor analysis identified three key factors: Institutional Values, Access to Resources, and Person-Centered Approaches.
• Good test-retest reliability was found (overall ICC = 0.78).

Conclusions:

• The CES-LTC is a valid and reliable measure of staff perceptions of the long-term care environment.
• This scale can effectively engage staff in QAPI activities, including root cause analysis and improvement efforts.