Clustered domestic model of residential care is associated with better consumer rated quality of care

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Gnanamanickam, Emmanuel
Dyer, Suzanne M
Milte, Rachel
Liu, Enwu
Ratcliffe, Julie
Crotty, Maria
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Oxford University Press
© The Author(s) 2018.
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The Author(s)
Objective To compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia. Design Cross-sectional study. Setting Seventeen residential aged care facilities in four Australian states providing alternative models of care. Study participants A sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study. Main outcome measure Consumer rated quality of care was measured using the Consumer Choice Index–6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated. Results Overall consumer rated quality of care (Mean ∆: 0.138, 95% CI 0.073–0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care. Conclusions Homelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.
© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
dementia, nursing home, quality of healthcare, Australia, self-report, quality of care
S. Gnanamanickam, E., M. Dyer, S., Milte, R., Liu, E., Ratcliffe, J., & Crotty, M. (2018). Clustered domestic model of residential care is associated with better consumer rated quality of care. International Journal for Quality in Health Care.