DIRECT ASSESSMENT OF QUALITY OF CARE IN A GERIATRIC NURSING-HOME

Direct observation was used to examine multiple aspects of care provid ed in a proprietary nursing home. Time samples were taken at random in tervals, 7 days per week for 5 weeks, across several categories of env ironmental and resident conditions as well as staff and resident activ ity Results showed a high degee of compliance with predefined standard s (based on current federal regulations) for environmental and residen t conditions. Overall distributions of resident and staff activity sho wed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff s pending the majority of their time engaged in nonresident work. When d ata were analyzed across areas of the facility, times of day, and week days versus weekends, some differences were noted. Weekend versus week day comparisons showed higher resident:staff ratios on weekends and mo re resident inactivity bur no significant differences in environmental or resident conditions. In addition, more frequent resident care, res ident interaction, and resident activity were observed in Medicare uni ts than in non-Medicare units. Results are discussed in terms of feder al requirements for monitoring the quality of care in nursing homes an d the potential use of time sampling expressly for this purpose.