Development of the combined assessment of residential environments (CARE) profiles

Aim: This paper reports the development and initial testing of the combined assessment of residential environments (CARE) profiles, which identify the frequency of positive events over a specified time based on the perceptions of residents, relatives and staff in care home settings. Background: Despite the well-known benefits of positive events for subjective well-being, little is known about the nature of positive events experienced by residents, relatives and staff in care homes. There is also a dearth of tools capable of systematically evaluating how frequently these events occur in this context. Methods: The CARE profiles were developed and tested between February 2004 and June 2005 with a combined sample of 372 residents, relatives and staff drawn from 11 care homes. An Event Frequency Approach was adopted to create three questionnaires (residents, relatives and staff), each containing 30 consensually valid positive events. The thematic content of these events was balanced for each questionnaire using the Senses Framework as a theoretical model. Once completed, the CARE profiles were tested in four care homes. Results: Test data from the CARE profiles were used to produce a bar chart showing median frequencies of positive events experienced by residents, relatives and staff during the timeframe in question (e.g. 1 month). These profiles were shown to be internally consistent, with alpha scores ranging from 0·70 to 0·89 for residents, 0·91 to 0·94 for relatives and 0·78 to 0·92 for staff. Conclusion: We envisage that feedback from the CARE profiles will both reinforce good care home practice and identify areas for change based on the experiences of all major stakeholders. However, further development of the profiles is needed if the experiences of cognitively impaired residents are to be included in the assessment process.