The Concept of Quality of Long-Term Care.

To study quality of care (as well as quality of life) in a cross-national research design requires the use of some pre-defined criteria on what is or what is not good quality. This is not easy as on the one hand, quality of care has been defined in many ways, and on the other, the quality of long-term care of older people is weakly defined. Further, the definitions of quality of care from the perspectives of the clients are rare (e.g. Baldock & Hadlow, 2002; Bowling, 1997), and same regards definitions of quality from a multi-professional perspective (Nies & Berman, 2004). Regarding the quality of long-term care of older people, homecare seems to lack quality definitions (e.g. Paljärvi, Rissanen, & Sinkkonen, 2003; Thomé, Dykes, & Rahm Hallberg, 2003), more often than nursing care and institutional care (e.g. Ranz, Zwygart-Stauffacher, & Popejoy, 1999). In health care, the definition given by Donabedian (1969, 1980) is a widely accepted framework to evaluate quality of care. According to this model, the quality of (health) care needs to be ensured in the three following aspects:Structure: the stable elements of the care system in a community that facilitate or inhibit the access to and provision of services. In health and welfare economics these factors are called inputs, meaning issues such as material resources and financial investments as well as societal goals given to the care.Process: the interaction between the client and a provider. Two dimensions are important here—the technical excellence of given care (appropriateness and skilfulness of the intervention) and interpersonal excellence (humanity and responsiveness to client preferences).Outcomes: results of care including clinical status, functional status, client satisfaction, and improved QoL of the client. These elements are reflected in the current definitions of the quality of care and in the methods of evaluating the quality, especially regarding health care. [ABSTRACT FROM AUTHOR]