A comparison of methods to assess nursing home residents' unmet needs.

PURPOSE This paper compares three interview methodologies to assess nursing home (NH) residents' unmet needs with regard to activity of daily living (ADL) care. DESIGN AND METHODS The study was a survey of 70 residents across seven ADL care domains. The three types of interview methods included: (a) direct satisfaction questions about ADL care, (b) questions that compared residents' preferences about ADL care frequency or occurrence to perceptions of the ADL care delivered (discrepancy measure), and (c) open-ended questions that asked what residents wanted changed about ADL care. RESULTS Estimates of the proportion of residents with unmet needs were significantly higher with the discrepancy and open-ended measures as compared to the direct satisfaction measures across most ADL care domains (McNemar's Test; p <.05-p <.01). IMPLICATIONS The analysis of residents' responses to open-ended questions produced the most useful information for individualizing aspects of technical care and assessing the interpersonal quality of care, whereas the discrepancy questions elicited specific information useful for changing the frequency or occurrence of ADL care. Interview methodologies that directly ask residents questions about satisfaction with ADL care are the least useful for designing improvement interventions.