Skip to main content
SpringerLink
Log in

Qualitative analyses of nursing home residents’ quality of life from multiple stakeholders’ perspectives

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for “good” quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses.

Methods

Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life.

Results

Overall, the majority of residents perceived their quality of life as “good,” though differences were noted in their main contributing factors when compared to staff members’ and management’s perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives.

Conclusions

Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vanleerberghe, P., De Witte, N., Claes, C., Schalock, R. L., & Verte, D. (2017). The quality of life of older people aging in place: A literature review. Quality of Life Research,26(11), 2899–2907. https://doi.org/10.1007/s11136-017-1651-0.

    Article  PubMed  Google Scholar 

  2. Schenk, L., Meyer, R., Behr, A., Kuhlmey, A., & Holzhausen, M. (2013). Quality of life in nursing homes: Results of a qualitative resident survey. Quality of Life Research,22(10), 2929–2938. https://doi.org/10.1007/s11136-013-0400-2.

    Article  PubMed  Google Scholar 

  3. Shippee, T. P., Henning-Smith, C., Kane, R. L., & Lewis, T. (2015). Resident- and facility-level predictors of quality of life in long-term care. The Gerontologist,55(4), 643–655. https://doi.org/10.1093/geront/gnt148.

    Article  PubMed  Google Scholar 

  4. Degenholtz, H. B., Rosen, J., Castle, N., Mittal, V., & Liu, D. (2008). The association between changes in health status and nursing home resident quality of life. The Gerontologist,48(5), 584–592. https://doi.org/10.1093/geront/48.5.584.

    Article  PubMed  Google Scholar 

  5. Kane, R. A., Kling, K. C., Bershadsky, B., Kane, R. L., Giles, K., Degenholtz, H. B., et al. (2003). Quality of life measures for nursing home residents. Journal of Gerontology. Series A, Biological Sciences and Medical Sciences,58(3), 240–248. https://doi.org/10.1093/gerona/58.3.m240.

    Article  Google Scholar 

  6. Kane, R. A. (2001). Long-term care and a good quality of life: Bringing them closer together. The Gerontologist,41(3), 293–304. https://doi.org/10.1093/geront/41.3.293.

    Article  CAS  PubMed  Google Scholar 

  7. Burack, O. R., Weiner, A. S., Reinhardt, J. P., & Annunziato, R. A. (2012). What matters most to nursing home elders: Quality of life in the nursing home. Journal of the American Medical Directors Association,13(1), 48–53. https://doi.org/10.1016/j.jamda.2010.08.002.

    Article  PubMed  Google Scholar 

  8. Haugan, G. (2014). Meaning-in-life in nursing-home patients: A correlate with physical and emotional symptoms. Journal of Clinical Nursing,23(7–8), 1030–1043. https://doi.org/10.1111/jocn.12282.

    Article  PubMed  Google Scholar 

  9. Sarvimaki, A., & Stenbock-Hult, B. (2000). Quality of life in old age described as a sense of well-being, meaning and value. Journal of Advanced Nursing,32(4), 1025–1033.

    Article  CAS  PubMed  Google Scholar 

  10. Irving, J., Davis, S., & Collier, A. (2017). Aging with purpose: Systematic search and review of literature pertaining to older adults and purpose. International Journal of Aging and Human Development,85(4), 403–437. https://doi.org/10.1177/0091415017702908.

    Article  PubMed  Google Scholar 

  11. Godin, J., Keefe, J., Kelloway, E. K., & Hirdes, J. P. (2015). Nursing home resident quality of life: Testing for measurement equivalence across resident, family, and staff perspectives. Quality of Life Research,24(10), 2365–2374. https://doi.org/10.1007/s11136-015-0989-4.

    Article  PubMed  Google Scholar 

  12. Gerritsen, D. L., Steverink, N., Ooms, M. E., de Vet, H. C. W., & Ribbe, M. W. (2007). Measurement of overall quality of life in nursing homes through self report: The role of cognitive impairment. Quality of Life Research,16(6), 1029–1037. https://doi.org/10.1007/s11136-007-9203-7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kane, R. L., Kane, R. A., Bershadsky, B., Degenholtz, H., Kling, K., Totten, A., et al. (2005). Proxy sources for information on nursing home residents’ quality of life. Journal of Gerontology. Series B, Psychological Sciences and Social Sciences,60(6), S318–S325. https://doi.org/10.1093/geronb/60.6.s318.

    Article  Google Scholar 

  14. Kehyayan, V., Hirdes, J. P., Tyas, S. L., & Stolee, P. (2015). Residents’ self-reported quality of life in long-term care facilities in Canada. Canadian Journal on Aging,34(2), 149–164. https://doi.org/10.1017/s0714980814000579.

    Article  PubMed  Google Scholar 

  15. Kane, R. L., Rockwood, T., Hyer, K., Desjardins, K., Brassard, A., Gessert, C., et al. (2005). Rating the importance of nursing home residents’ quality of life. Journal of the American Geriatrics Society,53(12), 2076–2082. https://doi.org/10.1111/j.1532-5415.2005.00493.x.

    Article  PubMed  Google Scholar 

  16. Kane, R. A., Caplan, A. L., Urv-Wong, E. K., Freeman, I. C., Aroskar, M. A., & Finch, M. (1997). Everyday matters in the lives of nursing home residents: Wish for and perception of choice and control. Journal of the American Geriatrics Society,45(9), 1086–1093.

    Article  CAS  PubMed  Google Scholar 

  17. Andresen, E. M., Vahle, V. J., & Lollar, D. (2001). Proxy reliability: Health-related quality of life (HRQoL) measures for people with disability. Quality of Life Research,10(7), 609–619.

    Article  CAS  PubMed  Google Scholar 

  18. Drageset, J., Haugan, G., & Tranvag, O. (2017). Crucial aspects promoting meaning and purpose in life: Perceptions of nursing home residents. BMC Geriatrics. https://doi.org/10.1186/s12877-017-0650-x.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Johs-Artisensi, J. L. (2017). Operationalizing person-centered care practices in long-term care: Recommendations from a “Resident for a Day” experience. Patient Experience Journal,4(3), 76–85.

    Article  Google Scholar 

  20. Kane, R. A., Kane, R. L., Giles, K., Lawton, M. P., Bershadsky, B., & Kling, K. (2000). First findings from wave 1 data collection: Measures, indicators, and improvement of quality of life in nursing homes. Minneapolis, MN: University of Minnesota, Division of Health Services Research, Policy, and Administration.

    Google Scholar 

  21. United States Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2019). Long Term Care Survey Process Procedure Guide. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/LTCSP-Procedure-Guide.pdf. Accessed 21 June 2019.

  22. United States Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2019). The Skilled Nursing Facility Value-Based Purchasing (SNFVBP) Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html. Accessed 21 June 2019.

  23. Janda, M., Eakin, E. G., Bailey, L., Walker, D., & Troy, K. (2006). Supportive care needs of people with brain tumours and their carers. Supportive Care in Cancer,14(11), 1094–1103. https://doi.org/10.1007/s00520-006-0074-1.

    Article  PubMed  Google Scholar 

  24. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology,3(2), 77–101.

    Article  Google Scholar 

  25. Barker, C., & Pistrang, N. (2005). Quality criteria under methodological pluralism: Implications for conducting and evaluating research. American Journal of Community Psychology,35(3–4), 201–212. https://doi.org/10.1007/s10464-005-3398-y.

    Article  PubMed  Google Scholar 

  26. Haugan, G. (2014). Nurse–patient interaction is a resource for hope, meaning in life and self-transcendence in nursing home patients. Scandinavian Journal of Caring Sciences,28(1), 74–88. https://doi.org/10.1111/scs.12028.

    Article  PubMed  Google Scholar 

  27. Haugan, G. (2013). The relationship between nurse–patient interaction and meaning-in-life in cognitively intact nursing home patients. Journal of Advanced Nursing,70(1), 107–120.

    Article  PubMed  Google Scholar 

  28. Tseng, S. Z., & Wang, R. H. (2001). Quality of life and related factors among elderly nursing home residents in southern Taiwan. Public Health Nursing,18(1), 304–311.

    Article  CAS  PubMed  Google Scholar 

  29. Zimmerman, S., Sloane, P. D., Williams, C. S., Reed, P. S., Preisser, J. S., Eckert, J. K., et al. (2005). Dementia care and quality of life in assisted living and nursing homes. The Gerontologist,45(Suppl. 1), 133–146. https://doi.org/10.1093/geront/45.suppl_1.133.

    Article  PubMed  Google Scholar 

  30. Bishop, C. E., Squillace, M. R., Meagher, J., Anderson, W. L., & Wiener, J. M. (2009). Nursing home work practices and nursing assistants’ job satisfaction. The Gerontologist,49(5), 611–622. https://doi.org/10.1093/geront/gnp040.

    Article  PubMed  Google Scholar 

  31. Pfefferle, S. G., & Weinberg, D. B. (2008). Certified nurse assistants making meaning of direct care. Qualitative Health Research,18(7), 952–961. https://doi.org/10.1177/1049732308318031.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Koren, M. J. (2010). Person-centered care for nursing home residents: The culture-change movement. Health Affairs. https://doi.org/10.1377/hlthaff.2009.0966.

    Article  PubMed  Google Scholar 

  33. Castle, N. G. (2011). The influence of consistent assignment on nursing home deficiency citations. The Gerontologist,51(6), 750–760. https://doi.org/10.1093/geront/gnr068.

    Article  PubMed  Google Scholar 

  34. Terada, S., Oshima, E., Yokota, O., Ikeda, C., Nagao, S., Takeda, N., et al. (2013). Person-centered care and quality of life of patients with dementia in long-term care facilities. Psychiatry Research,205(1–2), 103–108. https://doi.org/10.1016/j.psychres.2012.08.028.

    Article  PubMed  Google Scholar 

  35. Robertson, S., Cooper, C., Hoe, J., Hamilton, O., Stringer, A., & Livingston, G. (2017). Proxy rated quality of life of care home residents with dementia: A systematic review. International Psychogeriatrics,29(4), 569–581. https://doi.org/10.1017/s1041610216002167.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Carrier, N., West, G. E., & Ouellet, D. (2009). Dining experience, foodservices and staffing are associated with quality of life in elderly nursing home residents. Journal of Nutrition, Health, and Aging,13(6), 565–570.

    Article  CAS  PubMed  Google Scholar 

  37. Johs-Artisensi, J. L., Olson, D. M., & Nahm, A. Y. (2016). Development of a self-assessment tool to facilitate decision-making in choosing a long term care administration major. Educational Gerontology,42(1), 1–18. https://doi.org/10.1080/03601277.2015.1051414.

    Article  Google Scholar 

  38. Hubbard, G., Tester, S., & Downs, M. G. (2003). Meaningful social interaction between older people in institutional care settings. Ageing and Society,23, 99–114.

    Article  Google Scholar 

  39. Bergland, A., & Kirkevold, M. (2008). The significance of peer relationships to thriving in nursing homes. Journal of Clinical Nursing,17(10), 1295–1302. https://doi.org/10.1111/j.1365-2702.2007.02069.x.

    Article  PubMed  Google Scholar 

  40. Powers, B. A. (1991). The meaning of nursing home friendships. Advances in Nursing Science,14(2), 42–58.

    Article  CAS  PubMed  Google Scholar 

  41. Palacios-Cena, D., Gomez-Calero, C., Cachon-Perez, J. M., Velarde-Garcia, J. F., Martinez-Piedrola, R., & Perez-De-Heredia, M. (2016). Is the experience of meaningful activities understood in nursing homes? A qualitative study. Geriatric Nursing,37(2), 110–115. https://doi.org/10.1016/j.gerinurse.2015.10.015.

    Article  PubMed  Google Scholar 

  42. Boccuti, C., Casillas, G., & Neuman, T. (2015). Reading the stars: Nursing home quality star ratings, nationally and by state. Washington, DC: Kaiser Family Foundation.

    Google Scholar 

  43. Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging,8, 1–10. https://doi.org/10.2147/cia.s38589.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hall, S., Dodd, R. H., & Higginson, I. J. (2014). Maintaining dignity for residents of care homes: A qualitative study of the views of care home staff, community nurses, residents and their families. Geriatric Nursing,35(1), 55–60. https://doi.org/10.1016/j.gerinurse.2013.10.012.

    Article  PubMed  Google Scholar 

  45. Pinquart, M. (2002). Creating and maintaining purpose in life in old age: A meta-analysis. Aging International,27, 90–104.

    Article  Google Scholar 

  46. Tellis-Nayak, V., & Tellis-Nayak, M. (2016). Return of compassion to healthcare. New York: Page Publishing, Inc.

    Google Scholar 

  47. Haugan, G. (2014). Meaning-in-life in nursing-home patients: A valuable approach for enhancing psychological and physical well-being? Journal of Clinical Nursing,23(13–14), 1830–1844. https://doi.org/10.1111/jocn.12402.

    Article  PubMed  Google Scholar 

  48. Williams, C., Hadden, L., Mortimore, E., Nagy, F., Plotzke, M., & White, A. (2010). Measuring nursing home quality—The five-star rating system. In SAS Global Forum 2010 conference (2010, April).

  49. Roberts, T., Nolet, K., & Bowers, B. (2015). Consistent assignment of nursing staff to residents in nursing homes: A critical review of conceptual and methodological issues. The Gerontologist,55(3), 434–447. https://doi.org/10.1093/geront/gnt101.

    Article  PubMed  Google Scholar 

  50. Castle, N. G. (2012). Consistent assignment of nurse aides: Association with turnover and absenteeism. Journal of Aging and Social Policy,25(1), 48–64. https://doi.org/10.1080/08959420.2012.705647.

    Article  Google Scholar 

Download references

Acknowledgements

The analyses and findings reported in this study are the product of an independent study conducted at the University of Wisconsin – Eau Claire. The authors received no specific Grant or financial support for the research, authorship, and/or publication of this article from any funding agency in the public, commercial, or nonprofit sectors.

Author information

Authors and Affiliations

  1. Department of Management and Marketing, University of Wisconsin – Eau Claire, 105 Garfield Avenue, Eau Claire, WI, 54702, USA

    Jennifer L. Johs-Artisensi & Douglas M. Olson

  2. Department of Health Services and Senior Living Leadership, College of Health Professions, Bellarmine University, Louisville, KY, USA

    Kevin E. Hansen

Authors
  1. Jennifer L. Johs-Artisensi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin E. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Douglas M. Olson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer L. Johs-Artisensi.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the Ethical Standards of the University of Wisconsin – Eau Claire Institutional Review Board, who approved this study, and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix: Qualitative interview questions by stakeholder group

Appendix: Qualitative interview questions by stakeholder group

Resident questions

  1. (1)

    In general, how would you define good quality of life for residents in long-term care settings?

  2. (2)

    Do you feel that you have a good quality of life in this care community?

    1. (a)

      (If yes) What contributes to you having a good quality of life here?

    2. (b)

      (If not sure/no) What could we do in this care community to improve your quality of life?

Certified nursing assistant (CNA) questions

  1. (1)

    In general, how would you define good quality of life for residents in long-term care settings?

  2. (2)

    Do you feel that resident have a good quality of life in this care community?

    1. (a)

      (If yes) What contributes to residents having a good quality of life here?

    2. (b)

      (If not sure/no) What could we do in this care community to improve residents’ quality of life?

Activities director questions

  1. (1)

    In general, how would you define good quality of life for residents in long-term care settings?

  2. (2)

    How do you individualize care, services, or activities to maximize quality of life for residents?

  3. (3)

    Do you feel that residents have a good quality of life in this care community?

    1. (a)

      (If yes) What contributes to residents having a good quality of life here?

    2. (b)

      (If not sure/no) What would we do in this care community to improve residents’ quality of life?

Social worker questions

  1. (1)

    In general, how would you define good quality of life for residents in long-term care settings?

  2. (2)

    How do you individualize care, services, or activities to maximize quality of life for residents?

  3. (3)

    Do you feel that residents have a good quality of life in this care community?

    1. (a)

      (If yes) What contributes to residents having a good quality of life here?

    2. (b)

      (If not sure/no) What could we do in this care community to improve residents’ quality of life?

Administrator questions

  1. (1)

    In general, how would you define good quality of life for residents in long-term care settings?

  2. (2)

    How do you individualize care, services, or activities to maximize quality of life for residents?

  3. (3)

    Do you feel that residents have a good quality of life in this care community?

    1. (a)

      (If yes) What contributes to residents having a good quality of life here?

    2. (b)

      (If not sure/no) What could we do in this care community to improve residents’ quality of life?

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johs-Artisensi, J.L., Hansen, K.E. & Olson, D.M. Qualitative analyses of nursing home residents’ quality of life from multiple stakeholders’ perspectives. Qual Life Res 29, 1229–1238 (2020). https://doi.org/10.1007/s11136-019-02395-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-019-02395-3

Keywords

Search

Navigation