Chapter 13

Conclusions, Implications, and Recommendations The multi-faceted work described in this report reflects a 5-year concentration on quality of life (QOL) in nursing homes. The study was larger and more detailed than previous work on nursing-home QOL. It has yielded a number of tools and approaches, as well as suggested hypotheses and areas that might be fruitful for further research. At this writing, ideals about the “good nursing home” are undergoing considerable upheaval as the culture change movement proposes dramatically different ways to design and organize care in nursing homes and assisted living settings are serving some people who would formerly have been in nursing homes (Lustbader, 2000; Weiner & Ronch, 2003). Also, some people with nursing home levels of need are receiving care in Assisted Living settings where by design they are likely to have more autonomy and privacy than do nursing-home residents, and such innovations are expected to improve QOL. They may also increase the expectations of frail older people in group residential settings. It will be important to be able to measure QOL to track the effects of such changes. Summary of Findings Major findings from this project are listed below: 1. It is feasible to collect information directly from nursing home residents about their own QOL. Even residents with substantial cognitive confusion can complete QOL interviews. On average, we were able to collect first-hand data from 60% of residents in a nursing home. 2. The 11 QOL domains that we identified (comfort, security, functional competence, relationships, enjoyment, meaningful activity, dignity, individuality, privacy, autonomy, and spiritual well-being) could be tapped in 54 questions. These QOL domains are