Quality of care from the elderly person's perspective: subjective importance and perceived reality

The aim of this study was to carry out a theoretically-based survey of elderly persons' perceptions of quality of care, in terms of their evaluations of actual care conditions, as well as the subjective importance they ascribe to these. The sample consisted of 428 elderly (> or = 60 years) persons, in four different care environments: a geriatric department (N = 51); persons receiving home nursing (N = 111); nursing homes (N = 111); and service homes (N = 154) in two Swedish cities. Data were collected by way of personal interviews, structured from the questionnaire, Quality from the Patients' Perspective (QPP). The QPP is theory-based and consists of 40 items covering 17 factors. Each item was evaluated in two ways by the respondent: assessment of perceived reality, and evaluation of subjective importance (Likert scales). The results show that personal characteristics, such as age, sex, and self-rated health, had a limited effect on reports of what were regarded as highly important care characteristics, as well as on ratings of actual care conditions. Psychological well-being was strongly related to perceived reality ratings: a favorable well-being covaried with favorable ratings and vice versa. Considerable differences were noted in both types of ratings when the four types of care environments were compared. On the subjective importance scales, persons living in service homes reported lower scores, particularly on the scales designed to measure the medical-technical competence of the caregivers. On the perceived reality scales, the participants in service homes and the geriatric department scored lower.(ABSTRACT TRUNCATED AT 250 WORDS)