Care-as-service, care-as-relating, care-as-comfort: understanding nursing home residents' definitions of quality.

PURPOSE This study explored how nursing home residents define quality of care. DESIGN AND METHODS Data were collected through in-depth interviews and were analyzed using grounded dimensional analysis. RESULTS Residents defined quality in three ways: (a) Care-as-service residents focused on instrumental aspects of care. They assessed quality using the parameters of efficiency, competence, and value. (b) Care-as-relating residents emphasized the affective aspects of care, defining quality as care that demonstrated friendship and allowed them to show reciprocity with their caregivers. (c) Care-as-comfort residents defined quality as care that allowed them to maintain their physical comfort, a state that required minute and often repetitive adjustments in response to their bodily cues. IMPLICATIONS Residents' perceptions of care quality have implications for long-term care practice. The integration of these perceptions into quality assurance instruments could improve the usefulness of tools designed to obtain resident input.