The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS)

J Aging Soc Policy. 2007;19(2):63-82. doi: 10.1300/J031v19n02_04.


We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.

MeSH terms

  • Consumer Behavior*
  • Humans
  • Nursing Homes*
  • Quality of Health Care*
  • Quality of Life*
  • Research Design*
  • Surveys and Questionnaires
  • United States