Abstract

Background: Internationally, the quality of life of people receiving health and long-term care services is considered an important indicator of service quality. Previous research, conducted in England, indicated a significant positive relationship between provider quality ratings and the impact homes are having on residents’ quality of life in residential but not nursing homes (Netten et al, 2012). Since this research, the English care regulator has changed and a new star rating system, ranging from one (inadequate) to four (outstanding) stars, has been introduced. Given that consultations with members of the public suggest that prospective care home residents and their families would value an indicator of residents’ quality of life when choosing a care home (Trigg et al, 2013), how well these star ratings reflect residents’ quality of life is likely to be of public interest.

Methods: We collected care-related quality of life data about 293 care homes residents living in 34 care homes for older people in the South East of England (20 nursing and 14 residential). Owing to small numbers of homes rated as inadequate (1*) or outstanding (4*), we collapsed star ratings into two categories for the purposes of our analysis. 29% of homes were rated as inadequate/requiring improvement, which is slightly more than the national picture (22%) and 71% were rated as good/outstanding, which is slightly less than the national picture (78%).

Results: Resident care-related quality of life data was collected using the mixed-methods version of the Adult Social Care Outcomes Toolkit (ASCOT), which enables the inclusion of residents with dementia. Residents ranged from 50-105 years old (mean = 85 years), the majority were female (67%) and around half (52%) had a diagnosis of dementia. At the individual level, care-related quality of life was negatively associated with needing help with more activities of daily living, having a diagnosis of dementia and the presence of challenging behaviour. Home-level factors, such as type of home (nursing/residential) and size of home were not significantly associated with quality of life but CQC quality ratings were. Multilevel modelling, controlling for variation in individual and home level characteristics, found that residents living in homes rated as good/outstanding had significantly better care-related quality of life than residents living in homes requiring improvement/inadequate.

Conclusion: Whilst some caution must be exercised concerning the relatively modest sample size, our findings suggest that the new quality rating system might serve as a good indicator of residents’ quality of life when prospective residents and their families are considering a move into a care home.