Giving Voice to the Vulnerable: The Development of a CAHPS Nursing Home Survey Measuring Family Member Experiences

Elizabeth Frentzel, Christian Evensen, San Keller, and Steven Garfinkel; Judith Sangl, Agency for Healthcare Quality and Research; Carol Cosenza, Center

This survey was developed under the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program at the Agency for Healthcare Research and Quality.  The work was supported by the Agency’s CAHPS II cooperative agreements with AIR, the RAND Corporation, and Yale University. AIR senior researcher Elizabeth Frentzel led a team of researchers from AIR, the University of Massachusetts at Boston and RAND in developing the survey, which measures family members’ experiences of the nursing home care received by their loved ones. The work included formative research, cognitive testing of survey items, a field test of the draft questionnaire, psychometric analysis to develop composites and scoring algorithms, and research on reporting results to the public. The survey measures cleanliness, staff training, staffing levels, quality of interactions between staff and residents, quality of food, social engagement and privacy.

Unlike other CAHPS surveys, the CAHPS nursing home family member survey was developed to solicit information from respondents who do not directly receive care. This survey complements the previously-developed nursing home resident survey and, when administered in nursing homes, the results of the survey will provide a way to address the care experience of the most vulnerable residents in nursing homes: those who are too cognitively impaired to respond for themselves.

The CAHPS program is a multi-year initiative of AHRQ to support and promote the assessment of consumers' experiences with health care. The goals of the program are to develop standardized patient surveys that can be used to compare results among health care providers and delivery systems over time; and to generate tools and resources that sponsors can use to produce understandable and usable comparative information for consumers and health care providers to improve consumer choice and quality of care.