Can resident-centred inspection of nursing homes work with very sick residents?

This paper seeks to address the issue of whether a resident-centred inspection process can be effective in a nursing home environment dominated by residents who require high levels of care. Two fundamental criticisms of the current Australian monitoring process are its reliance on standards that are subjective resident-centred standards and its reliance on the views of residents concerning the quality of care provided in the home. These criticisms are becoming all the more important as survival rates for the aged increase and the average level of disability of nursing home residents continues to worsen. Our data suggest that the resident-centred process, despite some difficulties, is both reliable and practical, regardless of the care needs of residents in the home. Data collected from inspection teams show that inspectors use a variety of sources to validate information, with residents being one component. These sources vary little in importance between homes with different levels of care needs or behavioural problems. Perhaps of more importance is the finding that a home's overall performance across 31 resident-centred standards is not affected by either the home's average level of total care needs or the number of residents with severe behavioural problems. There are some significant effects (in both directions) of resident disability on compliance with particular standards. Most notable is the finding that the standard requiring appropriate use of restraint is less likely to be met when there are large numbers of residents with high levels of disability or behavioural problems.