University of Texas at Austin social work researcher examines what makes a good nursing home

AUSTIN, Texas—It’s the little things—sometimes as simple as giving the resident a choice of when to take a shower—that count when considering what is good quality of care in a nursing home, says a University of Texas at Austin researcher in a new study.

In her research on the nursing home industry in Texas, Dr. Roberta Greene, professor in the School of Social Work, examined what people want in terms of a nursing home. “We wanted to shed light on what makes a good nursing home,” said Greene. “We know a great deal about what makes a bad one.”

Findings from Greene’s study, “The Nursing Home Crisis: A Consumer Study of Texas Nursing Home Care,” will appear in the Journal of Gerontological Social Work this spring. Funding for the study was provided by the Wolens Foundation.

There have been many reports that examine escalating costs, inadequate numbers of qualified personnel and challenges to Medicaid and Medicare, “but we also need to ask people what do they like,” Green said.

“We found people want the basics in a nursing home. Most of the time, it is simply creating a more home-like atmosphere. Good homes give people more choices and make livings spaces more individualized—like putting wallpaper up and hanging pictures and awards. There could be a choice of two or three things for dinner or having a bubble bath.”

Residents also value a caring, cheerful and loving staff. “They talk to you and really try and help you. Mary even gives me a hug,” said one resident.

Good nursing homes today even have pets and gardens.

“Clearly, quality of care involves more than readily identifiable medical aspects of care,” Greene said. “The best care, in fact, involves a radical culture change: creating a partnership of families, friends and staff—nurses, social workers, dieticians and janitors—to review the specific needs and likes and dislikes of a nursing home resident.

“The more family and friends are attentive, the more the staff is attentive,” she said. “Family and friends should never sell themselves short. They too can influence the quality of care.”

Because of their reputation and frequent headlines about poor care, nursing homes often are the least preferred alternative of older Americans and their loved ones. “Nonetheless, there are 17,000 nursing homes across the country with as many as three million people cared for in nursing facilities in any given year,” said Greene. “It is imperative to continue to find the means of improving resident care.”

Compounding the crisis, she said, are projections indicating that Texas is one of the fastest growing areas in the country in population of adults over age 65 and also in numbers of those over age 85. The state is fourth in the nation in number of older adults.

Greene’s research involved interviewing nursing home residents, family members and administrators to get their perspectives of what makes a good quality nursing home. Also involved in the study from the university were Sandra Graham of the School of Nursing and Shirley Haulotte of the School of Social Work.

Family members said they were impressed with nursing homes that had no odor, a family-home-like atmosphere and a “comfortable” feeling. They also wanted to be kept informed of changes in a resident’s well-being and noticed when staff went door-to-door to encourage residents to attend activities.

“There has been a gradual shift from seeing nursing home residents and their families as passive recipients of care to consumers,” said Greene. “We should pay attention.”

Greene can be reached at 512-232-4168 or by e-mail at

For more information contact: Nancy Neff, 512-471-6504.