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Consumer-reported quality indicators for publicly funded home- and community-based services: development and
Tetyana P Shippee1, Jack M Wolf2, Romil R Parikh1
1Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States.
The Gerontologist
|July 6, 2026
Summary
New quality indicators were developed for home and community-based services (HCBS) using consumer feedback. These seven indicators help assess and improve HCBS quality for older adults.
Area of Science:
- Gerontology
- Health Services Research
- Psychometrics
Background:
- Consumer-reported measures are crucial for assessing person-centeredness in home and community-based services (HCBS).
- Existing administrative data for HCBS quality assessment often lacks consumer perspectives.
- The National Core Indicators-Aging and Disability (NCI-AD) Adult Consumer Survey (ACS) provides an opportunity to integrate consumer-reported data.
Purpose of the Study:
- To develop and validate novel consumer-reported quality indicators (QIs) for older adults receiving publicly funded HCBS.
- To address the gap in administrative data by incorporating the consumer voice in quality assessment.
- To create reliable measures for evaluating the quality of HCBS from the user's perspective.
Main Methods:
- Exploratory factor analyses were conducted on NCI-AD ACS data (2018-2019 wave, n=5,572 older adults).
- Seven QIs were identified and validated through a technical expert panel (qualitative) and confirmatory factor analyses (quantitative) using 2017-2018 data (n=9,145).
Main Results:
- Seven consumer-reported QIs were developed and validated: service satisfaction, staff quality, environmental safety, service decision-making, daily life decision-making, community inclusion, and overall health/quality of life.
- Reliability analyses (Cronbach's alpha and McDonald's omega) indicated good to excellent internal consistency for most QIs.
- Exploratory analyses suggested potential differences in QI scores based on dementia status and age.
Conclusions:
- The seven newly developed QIs offer a robust, consumer-centered approach to evaluating HCBS quality.
- These indicators can be utilized by researchers, providers, and policymakers to monitor and enhance service quality.
- The QIs provide actionable targets for quality improvement initiatives in publicly funded HCBS programs.
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