The development of instruments to describe residents, homes, operators, and staff and to capture key elements of quality was another major task.
We developed three basic types of measures: (1) those used to describe homes and residents, (2) those used as covariates in the analysis of the effect of regulation and licensure on quality, and (3) those used to evaluate the quality of care and life in the homes.
We used fairly straightforward measures to describe residents and homes. Most come directly from individual items on the various survey instruments. In addition to these variables, we constructed several composite measures (e.g., facility occupancy rate, average payment per month per resident, counts of the number of different services offered by the facility, and an aggregate case mix classification describing the bulk of facility residents). Additionally, we used several scales to characterize residents’ physical and emotional functioning: a count of the number of ADL dependencies, the five-item Mental Health Inventory (McHorney et al., 1994) and a three-level mental health status measure that was constructed from the Blessed Scale, and, for residents with proxy respondents, ratings of the resident’s cognitive function using the Cognitive Performance Scale (Morris et al., 1994).