An Exploratory Study of Stakeholder Perspectives on Quality Priorities for Long-Term Services and Supports for Older Adults

Abstract

Major state and federal initiatives are underway to assess and improve the quality of long-term services and supports (LTSS) received by older adults in nursing homes, assisted living facilities, and other community-based settings. Although people who use LTSS (consumers) and their families are key stakeholders in LTSS quality, they are rarely included in the policy and organizational discussions in which priorities for LTSS quality are set. Prior studies have typically used qualitative methods and examined consumer and family views on LTSS quality in relation to only one setting. Within the U.S., most of these studies were completed 15-20 years ago and results may not reflect the values of consumers and families today. Further, prior studies have rarely included multiple stakeholder perspectives, limiting the ability to compare priorities across different groups. The present study explored which aspects of LTSS quality consumers, families, and LTSS professionals value most highly and whether stakeholder views on quality priorities differ. The study addressed nine domains of quality from a person-centered perspective. Several methods were used, including: 1) development of an integrated valuing framework for LTSS quality; 2) use of Q methodology, which uses a forced ranking distribution, factor analysis, and qualitative interpretation of patterns observed; and 3) a survey containing rating, ranking, and open-ended questions. A convenience sample of 70 individuals in Minnesota representing the targeted stakeholder groups participated the Q methodology component of the study and 417 participated in the survey. Across two data collection methods, participants overall identified safety/security, dignity/respect, and staffing/staff competence as the highest priorities for LTSS quality. Although there was considerable agreement among stakeholders on top priorities, consumers rated most aspects of LTSS quality as less important than professionals, which may indicate diminished or adjusted expectations. However, consumers placed more emphasis on aspects of the physical environment than professionals. Study participants, particularly consumers and families, rated autonomy/choice as less important than most other aspects of LTSS quality, a finding that necessitates further exploration. By-person factor analysis and participant comments provide insights into survey findings. Study results highlight the need for more dialogue to clarify stakeholders’ values related to LTSS and ensure policies and practices align with these goals.