A POSTAL SURVEY OF THE QUALITY OF LONG-TERM INSTITUTIONAL CARE

There is increasing interest in measuring and regulating the quality o f long-term institutional care for elderly people during an era of cha nge in the funding and provision of such care. We report the developme nt and use of a postal questionnaire intended as a cheap, reliable and valid method for quality evaluation. The 18-item questionnaire was de rived from a set of standards for quality of long-term care originally selected by patients and staff as appropriate for this purpose. The q uestionnaire was sent to a random sample of private residential homes and to all other voluntary, local authority and health service establi shments providing long-term care in one health district. There was a 9 4% response rate. Follow-up in-depth studies in a stratified random sa mple of establishments were undertaken. Reliability of the questionnai re was acceptable (intrarater, r = 0.88; interrater, r = 0.73). There were significant differences in quality scores between sectors (p < 0. 001) and a positive correlation between quality score and physical ind ependence of residents, as measured by the Barthel Index (r = 0.48). T he postal questionnaire, able to detect differences within and between the different sectors of care provision, has potential for setting na tional and local sectoral norms for quality of care. It could be used as a screening tool for individual establishments and inspectorate bod ies prior to more detailed internal or external audit.