Patients and staff assess social climate of different quality nursing homes

Three hundred and one patients and 231 nursing staff from 10 community nursing homes (categories from good to poor by independent judges) rated a 63-item scale assessing social climate along seven dimensions: cohesion, conflict, independence, self-exploration, organization, resident influence, and physical comfort. Regardless of quality of homes, mean ratings by staff were more favorable (p less than 0.001 using multivariate analysis of variance) than patient ratings on four of the seven factors. When staff attitudes were compared by quality of homes, less favorable staff ratings were found for cohesion, independence, and self-exploration in poorer quality homes. Patient responses were significantly less favorable on five of seven dimensions in poorer quality homes. In summary, nursing home patients react more negatively to their institutional environments than do staff, and though poorer institutional quality does correspond to less favorable ratings by staff and patients, it is still the patient group that reacts in a more negative manner.