Abstract

Introduction: Quality measurement in Nursing Homes (NHs) has become an important issue in the international debate, both for policymakers and researchers. However, there is a paucity of international comparisons of residents’ experience in NHs. Given these premises, the aim of this paper is to compare the quality of Long-Term Care (LTC) between Ontario (Canada) and Tuscany (Italy) using survey data on residents’ satisfaction and experiences in NHs in the two countries.

Method: Tuscany and Ontario have developed two surveys on NHs residents’ experience and satisfaction using a similar methodology and approach. NHs were selected randomly to participate in the project taking into account also geographical distribution in the Regions. Since NHs involved in the project were different both in size, the sample sizes were defined by assigning a minimum number of interviews to each structure. Tuscany sample: residents who validly completed the questionnaire were 1116, about 66% of the residents to whom the questionnaire was proposed, from 60 different Nursing Homes. Ontario sample: structured interviews, to 681 residents from 30 LTC homes in Ontario, were conducted using the Smaller World Survey of Resident Satisfaction. Multivariable linear regression has been performed to predict possible factors associated with higher quality of the NHs; in particular overall quality is considered as the willingness to recommend (WTR) the NHs to family and friends (dependent variable). Similar questions regarding aspects of care in both countries have been selected as predictors of WTR. The items (independent variables) are related to room quality, staff and relationship with the staff, comfort and services, autonomy, dignity and security.

Results: No statistically significant differences between regions were found with respect to sex, age, perceived health status and length of stay of the residents. Descriptive results indicate that the samples in the two countries score similar in terms of satisfaction for the care received: in Italy almost the 62% would completely recommend the NHs to family and friends while in Ontario the percentage is about 80%. Regression analysis shows that a strong predictor of WTR is related to staff, both on skill and relationship. For Ontario, a strong predictor of willingness to recommend is also the perceived security in living condition and care and the autonomy (i.e. not being able to choose when having a bath or shower or having the freedom to decide which activity to do every day); while in Tuscany comfort (i.e. quality of the room, the smell around the NH, if the NH needs repairs) is considered a factor the influence the WTR.

Conclusion: Internationally, the understanding of quality of care from a resident perspective has been explored in previous works, with the main focus on identifying domains significant to quality of life in NHs and link them to quality of care (see Kane 2001); this research performed an international comparison about QoL and satisfaction for NHs residents. Different predictors assessed in the regression models underline that quality in NHs is a concept not universally determined and perceived.

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