The Big Q: What Does "Quality" Really Mean for Long-Term Care?

Quality is a hot topic in long-term care. It’s a goal many providers strive for, and quality care is something most if not all care seekers would say they want.

But what do they mean by “quality?” In long-term care, quality metrics historically have focused on safety, and more complete measures that both providers and consumers can embrace have been lacking. So when care seekers say they want quality and providers say they deliver quality, it’s not always clear what either group means—or even whether they’re talking about the same thing.

At CareScout, we believe care seekers and providers deserve better. Together with an advisory board, we’ve developed real-world standards for quality care that include person-centered care as well as safety.

We see person-centered care, which reflects a care recipient’s goals, values, and preferences, as the North Star of quality in long-term care. It encompasses not just physical but mental, social, and spiritual health to support an aging journey that is dignified, connected, and fulfilling.

Although person-centered care is gaining attention and the Centers for Medicare & Medicaid Services (CMS) has begun to embrace it, the CareScout Quality Network is the first network engaging with long-term care providers to foster and measure person-centered care.

Here is what we look for in providers who wish to join our network—and what we mean by quality care.

Providers are asked to meet certain standards to join the CareScout Quality Network. Some of the quality measures we review include:

• Up-to-date credentials, including licensure and insurance   

• On-site or virtual survey of business practices, staffing and retention, training, and policies and procedures — which should demonstrate attention to both safety and person-centered care 

• CMS star ratings (not applicable to home care or assisted living, another reason a new system for measuring quality is needed)

We also look for a demonstration of financial health to assure a provider can continue their current person-centered care practices. Our advisory board reviews each provider application, because we believe the standard for quality in long-term care should be taken seriously and receive proper external review.  

Following qualification, CareScout surveys a provider’s clients and staff to obtain baseline person-centered care scores. We measure the extent to which clients feel:

1. The care and support they receive from the provider’s staff follow a plan that is based on their choices, beliefs, and what’s important to them.  

2. The staff is knowledgeable about their preferences, and will change how they care for the client based on their preferences. 

3. The staff engages the client’s family / support network in their care, and they respect their preferences for which members of their family / support network they want involved. 

4. They feel valued and respected by the provider’s staff. 

5. They are listened to and have a voice in their own care and the services they receive. 

6. The staff uses language they can understand when communicating about the client’s options and needs. 

7. The staff spends time with the client and do not seem rushed when they interact with them.  

8. The provider’s staff knows the client and their values, and the client has been able to get to know the individuals who work with them.  

9. Staff are empathetic, and they understand and address the client’s feelings and concerns when working with them. 

10. The staff helps the client to understand their options, especially when the client needs to receive care in different locations, and they help prepare the client for transitions.

Our standards include how a provider’s staff feels about their work experience, because if job satisfaction is low or staff feel constrained in any way, they may not deliver on the promises of person-centered care. We measure the extent to which staff feel their peers and co-workers: 

1. Respect the choices and preferences of their clients in how, when, and where they want to be cared for. 

2. Ensure that care plans they create for their clients reflect clients’ choices, preferences, and what’s important to them. 

3. Respect the different cultures of their clients and serve them in ways that are appropriate to their background. 

4. Communicate with their clients using language they can understand. 

5. Are effective at communicating with each other and holding each other accountable regarding the needs of their clients. 

In addition, we ask staff to what extent they feel their employer equips them to facilitate clients’ interactions with their loved ones; values the training, experience, and the unique capabilities staff bring to the job; helps them understand the importance of their work; gives them what they need to deliver care based on their clients’ choices and values; and gives staff the time to engage with their clients and get to know them as individuals. (See “Can Person-Centered Care Address Staff Turnover?”)

Together, these surveys help assess the quality of a provider’s care and the health of their person-centered care climate.

CareScout also collects data from clients and staff to determine a provider’s net promoter score (NPS).

The NPS measures customer and employee loyalty by asking care recipients whether they would recommend a provider to others, and staff whether they would recommend working for their employer to a friend. 

The highest ratings (promoters) minus the lowest ratings (detractors) yields a “net” promoter score. We also ask about the quality of backend service and support, such as helpfulness of the office staff, to better understand a provider’s net promoter score.

A solid business profile, a healthy person-centered care climate, and a strong reputation for service and support—this is the standard for the CareScout Quality Network.  It’s a standard that includes clear and meaningful quality measures for long-term care based on person-centered principles. 

Quality is never a one-and-done. Once a provider is in our network, our person-centered care education and survey program provides training, collaboration, and evaluation around person-centered care practices. 

We then elevate providers for meeting carefully defined person-centered care standards by highlighting their CareScout.com profiles to care seekers. For all providers in our network, the program establishes a real-world baseline from which to make real-world improvement. 

At CareScout, we look forward to the CareScout Quality Network growing as more providers seek to join our movement toward person-centered care and our mission to reframe the aging journey.  

In person-centered care we’ve created a quality standard that sets clear expectations for how providers can support their clients’ goals for a meaningful life and their staff’s desire for meaningful work. It’s a standard all of us in the long-term care system can embrace and aspire to.