According to the 2022 Korean Statistical Office report, adults aged 65 and over in the Republic of Korea (South Korea) comprised 17.5% of the total population, a figure expected to rise to 46.4% (approximately half the total population) by 2070 [1]. With the rapid aging of the population, there has been an increase in chronic diseases such as stroke, cardiovascular disease, and dementia. Simultaneously, the number of families available to support the growing older adult population is declining [2]. In response, South Korea introduced a long-term care insurance system for older adults in July 2008. Fifteen years post-implementation, this social care system has seen some success. However, its core objectives, including “promoting the health and quality of life of older adults” and reducing the burden on their families, have not been fully met, indicating that there is still room for improvement [3]. In particular, families utilizing long-term care facility services frequently express concerns about the loss of autonomy and privacy for their older family members, as well as disruptions to their social relationships due to the impersonal and standardized approaches of these facilities [4, 5].

To address these issues in long-term care facilities, Western countries, which introduced long-term care systems much earlier than South Korea, have developed the concepts of person-centered care and patient experience to enhance the quality of life for residents. These countries require that patient experience surveys be conducted regularly [6, 7]. In this paper, the term “long-term care” specifically refers to nursing homes. This distinction is made because, although patient experience surveys are common in hospitals focused on treatment, similar research in long-term care settings, which focus on nursing, is lacking. Therefore, we propose that a patient experience survey encompassing both care and quality of life within long-term care systems is needed.

Person-centered care emerged as an alternative to the traditional disease-centered model in the 1980s, in response to recognized quality issues in long-term care facilities in the United States. It involves the perception and practice of delivering care that aligns with the individual’s preferences and needs, while respecting their self-esteem, independence, and autonomy [6, 8]. Patient experience encompasses both the objective reporting of events during the care process and the subjective evaluations provided by the patient [9]. Wolf et al. [10] highlighted the importance of patient-centeredness by defining patient experience as an activity that identifies the patient’s needs, delivers the desired services, actively fosters trusting relationships, and inspires.

In self-reported surveys on the service experiences of older adult residents in long-term care facilities, the residents' perspectives are considered the most accurate measure [11]. However, many of these residents have varying degrees of cognitive impairment, and in cases of severe cognitive decline, it becomes challenging or impossible for them to accurately convey their views on the quality of care they receive. Therefore, it is crucial to include the perceptions of their families or care providers to fully assess their service experiences [12]. A previous survey that explored the experiences of families of older adults in long-term care facilities—including their views on staff performance and the autonomy of residents—revealed a statistically significant negative correlation with key quantitative indicators of long-term care quality, such as the incidence of pressure ulcers, hospitalization rates, and mortality rates. This suggests that evaluations of experience by family members play a vital role in assessing the quality of long-term care facilities [8]. Additionally, a study conducted outside of Korea examined patient experience surveys focusing on non-quantitative aspects of long-term care facilities, such as attention to recipients, personal hygiene, regular medical services, the physical environment, cleanliness, social relationships, food quality, communication with family, and physical therapy. The findings showed a moderate correlation with the 5-star quality index, a prominent quantitative quality index in the United States that includes data on falls, pressure ulcers, urinary tract infections, improvements in daily living abilities, and emergency room visits. When older adults themselves were surveyed on the same items, the results demonstrated a significant negative correlation, confirming that patient experience surveys of older residents and their families are valuable tools for complementing quantitative quality indicators and assessing the quality of long-term care facilities [13].

Recent studies on the service experiences of long-term care facility residents have primarily been qualitative in nature. Examples include a study examining the relationship between caregiver image and trust and the burden of care, another exploring key factors that enhance residents' quality of life, and research focusing on the families of older adult residents. However, empirical studies addressing the service experiences of these families are limited [14, 15, 16]. Given South Korea's rapidly aging population, there is an urgent need to develop a measurement tool for service experiences. This tool should accurately reflect the perspectives of family members of older adults in long-term care facilities and serve as a benchmark for improving service performance and quality within the Korean context.

In this study, we utilized a scoping review method to analyze and summarize published English-language studies concerning tools developed for measuring the service experience of family members of older adults in long-term care facilities outside of South Korea. This approach was chosen because no such tool has been specifically developed for use in South Korea. A scoping review is typically conducted prior to a systematic literature review as it encompasses a broad spectrum of related literature and provides an overview without conducting an extensive quantitative synthesis or evaluating the quality of the research. Using the findings from this review, we identified the components necessary for a service experience measurement tool tailored for families of older adults in long-term care facilities within the Korean context. Additionally, we conducted a systematic review of research papers on the development and psychological assessment of tools to measure service experiences for this demographic, focusing on studies published in non-Korean journals from the 1990s to the present. As a result, we identified various sub-factors (domains) essential for developing a tool to measure service experiences for families of older adults in long-term care facilities in South Korea.

This scoping review analyzed seven studies that focused on the development and psychological assessment of tools to measure service experiences for family members of older adults in long-term care facilities, designed for non-Korean contexts. The scope and domains of these tools varied according to the objectives of the research. Upon analyzing the themes addressed by the tools, five key themes emerged: environment, information and family member involvement, tailored care, respect, and a responsive workforce.

Tools to measure service experiences were employed to assess whether patient-centered care was being delivered from the perspective of the subject. It was determined that patient experience was evaluated from various viewpoints, including solely family; family and older adults; family and staff; as well as family, older adults, and staff. This finding contrasts with a previous study that analyzed the concept of patient-centered care in Korean nursing publications. That study reported that the majority of the 31 studies reviewed either mentioned or assessed patient-centered care primarily from the perspective of medical or facility staff, with only one study evaluating it from the perspective of the subject [23]. In the Korean context, it is essential to measure the service experience in long-term care facilities from the perspectives of not only facility staff, but also older adults and their families.

Turning to the results of the thematic analysis, the first theme identified was “environment," which included seven domains. This theme was derived from five of the seven selected articles. As the number of long-term care facilities increases and the role of social care becomes more prevalent, both family members of older adults in these facilities and other stakeholders are increasingly concerned about the quality of care and the quality of life of the residents [24]. Since older adults reside in these facilities, it is crucial to consider their quality of care and quality of life concurrently [4, 25]. The transition from their homes to long-term care facilities necessitates ongoing efforts to enhance their quality of life and quality of care through approaches like “resident-centered care” and “creating a home-like environment.” Previous research, including a study conducted in South Korea, has demonstrated improvements in the quality of life and the creation of a more human-centered environment in long-term care facilities due to this cultural shift [4, 26]. In this study, the environment theme included not only the physical aspects but also the psychological aspects, such as culture. Notably, domains like well-being, food and meals, physical environment, and safety were mentioned in more than three articles and should be considered when developing tools for use in the Korean context.

The second theme, “information and family member involvement,” encompassed seven domains and was derived from five of the seven selected articles. This theme aligns with the findings of a qualitative study examining the experiences of family members whose elderly parents transitioned from their homes to long-term care facilities. The study revealed that although the respondents believed the care in the facilities was superior to that at home, they still felt a profound sense of sadness and regret [16]. Similarly, another study that conducted in-depth interviews with 13 family members of older adults in long-term care facilities found that residents desired their family members to have a voice in the services provided and to participate in decision-making processes [5]. Therefore, it is crucial to provide timely information and actively involve family members of older residents in the decision-making processes at long-term care facilities to improve the quality of service experiences.

The third theme, “tailored care,” included five domains and was derived from five of the selected articles. Older adult residents in long-term care facilities should not be perceived merely as patients with diseases, but rather as individuals leading ordinary lives within these settings. Therefore, “tailored care” plays a crucial role, significantly influencing the quality of life for these older adults [23, 27]. Furthermore, research on the factors affecting service quality in long-term care facilities, conducted with nursing facility staff, revealed that aspects of “tailored care"—such as individualized care and organizational support—were strongly positively associated with the quality of care services. This underscores the high value placed on “tailored care” by not only the older adults and their families but also by facility employees, highlighting its importance in enhancing service experiences in long-term care settings [28].

The fourth theme, “respect,” encompassed four domains and was derived from three of the seven articles reviewed. These domains are autonomy, dignity, privacy protection, and the staff’s kindness and respect toward family members. These elements are crucial to the concept of patient-centeredness, which is a significant aspect of patients' experiences [9, 10]. Additionally, the concept of a positive service experience for older adult residents in long-term care facilities within the Korean context aligns with the “respect” domains identified as key factors in this study. This alignment indicates that both older adult residents and their family members place a high value on respect [29].

The fifth theme, “a responsive workforce,” included only two domains but was derived from five of the seven selected articles. The World Health Organization proposes that “responsiveness” could be another term for measuring patient experience. This suggestion stems from the definition of “responsiveness” as “satisfaction with the health system from the perspective of the patient experience,” which is considered a crucial aspect of patient experience, surpassing mere patient satisfaction [30]. The theme of “immediate response of staff” is similarly reflected in this study [29]. Addressing the needs of older residents and their families promptly, however, necessitates policy measures such as recruiting adequate care staff, enhancing standards for care staff deployment, and enforcing strict supervision by facility directors to ensure staff compliance [5].

This study is significant because it provides foundational data and policy implications for creating a service experience measurement tool tailored for family members of older adults in long-term care facilities in South Korea. With the population aging rapidly and the consequent rise in the utilization of long-term care services, ensuring the quality of care and the quality of life for older adult residents in these facilities has become a critical societal concern.

This study had certain limitations. We did not include gray literature or articles in languages other than English in our search due to time constraints. Additionally, the scope of the topic and the literature review protocol were not registered before the commencement of the study.

This scoping review analyzed the literature on tools to measure the service experiences of family members of older adults in long-term care facilities, focusing on studies published in non-Korean academic journals. It identified and confirmed the domains and items of the tools employed. The analysis yielded five major themes: environment, information and family member involvement, tailored care, respect, and a responsive workforce.

Based on the findings, we propose the following suggestions for future research. First, our study identified the main domains of the service experience of family members of older adults in long-term care facilities through non-Korean literature; future qualitative studies should explore these components within the Korean context. Second, we recommend the development and implementation of intervention programs aimed at enhancing the quality of care and life for older adult residents in long-term care facilities, drawing on the main domains of the service experience identified in this study. Third, future research should focus on creating a reliable measurement tool for assessing the service experience of older adults in long-term care facilities in South Korea, which can be directly evaluated by family members to ensure their experiences are accurately reflected in efforts to improve facility quality. Lastly, since our study was limited to literature in English and did not include gray literature, future research should consider a broader range of literature sources.