Assisted living resident quality of life questionnaire: development and validation

As an increasing number of older adults in the U.S. seek out assisted living services, there is a continued need to comprehensively assess quality within assisted living facilities to ensure consumers are well-informed when deciding where to seek care, and to assist quality improvement efforts within facilities. The current study aimed to develop, test, and validate a questionnaire to holistically measure quality of life among assisted living residents, which is one metric for quality in assisted living. The questionnaire development, testing, and validation process included three phases. First, informed by existing literature, an item bank was created and then refined based on stakeholder feedback and cognitive interviews with assisted living residents. Second, targeted pilot testing was completed via mailed questionnaires and in-person cognitive interviews with assisted living residents in memory care units. Third, pilot testing across Minnesota, via in-person, phone, and mail administration, was conducted to test the reliability and validity of the measure. Factor analysis results revealed five subscales: The People Who Work Here; Food; Security, Safety & Privacy; Choice/Autonomy; Religion/Spirituality. Two additional sub-domains were identified: Activities and Finances. All sub-scales indicated adequate to high internal consistency and were positively correlated with other indicators of resident satisfaction in expected ways. Measurement equivalence across administration modes (mail, phone, in-person) suggests inter-changeability. The questionnaire developed and tested in this study to measure resident quality of life in assisted living facilities is a valid and reliable tool that can be used in large-scale measurement efforts to capture one aspect of quality at the facility level.