ArticleThe Gerontologist2026
Consumer-reported quality indicators for publicly funded home- and community-based services: development and validation.
Article in The Gerontologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesConsumer-reported measures are important quality indicators for ensuring person-centeredness in home and community-based services (HCBS). However, administrative data commonly used to assess HCBS quality often lacks consumer-reported measures. To address this gap, we developed and validated novel consumer-reported quality indicators using data from the National Core Indicators-Aging and Disability (NCI-AD) Adult Consumer Survey. RESEARCH DESIGN AND
methodsWe conducted exploratory factor analyses using the 2018-2019 survey wave of NCI-AD (n = 5,572 community-dwellingolder consumers, age ≥65 years) and identified seven QIs. We then confirmed the validity of these seven new QIs in 2 ways: (a) qualitatively through a technical expert panel (for face validity and contextualization) and (b) quantitatively, using confirmatory factor analyses in the 2017-2018 survey wave (n = 9,145 community-dwelling consumers, age ≥65 years).
resultsThe seven validated QIs were service satisfaction, staff quality, environmental safety, service decision-making, daily life decision-making, community inclusion, and overall health and quality of life. Internal consistency was strong across domains (Cronbach's alpha = 0.63-0.89; McDonald's omega = 0.70-0.90). Exploratory analyses also identified differences in selected QI scores by dementia status and age. DISCUSSION AND IMPLICATIONS: These seven consumer-reported QIs provide a practical, validated framework for evaluating person-centered HCBS quality. They can support researchers, providers, and policymakers in monitoring service quality, identifying modifiable targets for improvement, and advancing quality measurement in publicly funded HCBS.
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