Quality Indicators for Home and Community-Based Services

1. Quality Indicators for Home and Community-Based Services Scott Miyake Geron, Ph.D. Boston University School of Social Work State Long-Term Care Program Conference, Indianapolis, 2002 Geron

2. Quality for Whom? Regulators/ Administrators Professionals/ Researchers Consumers Geron

3. Quality ‘Riddle’ in Long-Term Care • Consumers, using professional or ‘objective’ standards of quality, sometimes seem to choose a lesser standard of care but still seem quite pleased with their choices -- indeed, often more pleased than consumers who are assured of receiving care from a provider with more professional credentials. Geron

4. Problems with Existing Satisfaction Measures • Rely on acute care measures • Use single-item global satisfaction measures • Developed for a particular program • Fail to test for validity and reliability • Fail to define satisfaction • Fail to incorporate consumer perspectives on satisfaction Geron

5. Dimensions of Home Care Satisfaction Identified in Focus Groups Competency Choice Humaneness Adequacy Dependability Continuity of Care Accessibility Advocacy Geron

6. Home Care Satisfaction Measure (HCSM): • Homemaker Services (HCSM-HM13) • Home Health Aide Service (HCSM-HHA13) • Home Delivered Meals (HCSM-MS11) • Grocery Service (HCSM-GS10) • Case Management Service (HCSM-CM13) Geron

7. Current Applications • Massachusetts Executive Office of Elder Affairs • Florida Department of Elder Affairs • Rhode Island Department of Elder Affairs • Hawaii Department of Elder Affairs • Demonstration states in Administration on Aging Performance Outcomes Measures Project (POMP) - 12 States Geron

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9. Consumers vs. Professional Definitions of Quality • My Homemaker has become a friend.(HCSM-HM13, Item 3) • My Case manager does extra things for me. (HCSM-CM13, Item 11) • I need more hours of homemaker service each week (HCSM-HM13, Item 6) Geron

10. Often the Food is So Bad I Do Not Eat It Geron

11. Satisfaction Benchmark • The benchmark score for a service is the average satisfaction score for all agencies providing that service • Benchmark boundary scores are based on statistical conventions to interpret differences in scores • Sample sizes were selected that provide confidence that difference scores are not due to random error Geron

12. Revised 1999 HCSM Benchmarks Geron

13. Reports and Findings • Agency Profile • statistical summary • graphical profile • Item Analyses • individual item scores • comparison of item scores to benchmark item scores • User’s Manual • Question by Question Manual Geron

14. Graphical Profile of HCSM Results Geron

15. Displaying Comparative Case Management Outcomes Geron

16. Interpretation of Results • Satisfaction assessments should be used as a relative measure; used alone, the results can be easily misinterpreted and misused • The appropriate use and interpretation of satisfaction results is to compare individual provider results to a standard or benchmark for particular services • Satisfaction assessments, while obviously important, should not serve as the sole criterion of quality care Geron

17. Summary Program and Policy Uses • Consumer-based quality measure • Valid and reliable information • General and service specific satisfaction • Domain and dimension specific satisfaction • Evaluation of change over time Geron