Population aging is a defining characteristic of our time. By 2050, the number of people aged 65 years or older is expected to reach 1.6 billion, representing more than 16 % of the world's population.1 This phenomenon not only leads to an increase in the older population but also an increase in the number of people with chronic diseases.2 According to recent research, 31.7 % to 51.8 % of the population were reported to be suffering from one or more chronic diseases.2,3 This constitutes a critical problem resulting in high social, economic, and health-related costs for both present and future societies.1,2 In particular, vulnerable older adults suffering from serious chronic diseases and physical and cognitive disabilities can no longer receive care through the efforts of their families alone; therefore, a social and public system that provides long-term care has become necessary.4 Accordingly, the number of older adults living in long-term care facilities (LTCF) has increased, and various safety issues are emerging.5,6

Recently, the concepts of safety and quality of care have been used interchangeably, and an emphasis is being placed on improving the quality of care provided in LTCF.7,8 The outbreak of coronavirus disease (COVID-19) has highlighted the need to develop effective measures in LTCF to ensure the safety of residents.9 Although there is no national consensus on LTCF safety and quality indicators, prior research in nursing homes in the United States has focused on four areas: injurious falls, pressure ulcers, medication errors, and infections.7 In a study targeting Australian nursing homes, 12 quality and safety indicators were identified: antibiotic use, high sedative load, chronic opioid use, antipsychotic use, premature mortality, emergency department presentations, falls, fractures, pressure injuries, delirium and/or dementia, weight loss/malnutrition, medication-related events.10 A New Zealand study presented four indicators: pressure injuries, incontinence, malnutrition, and falls.11

Additionally, efforts have been made to improve the quality of nursing homes in the United States since 2002 with the introduction of Nursing Home Compare (NHC), which publicly reports the quality of these establishments.8 However, despite these efforts, it has been found that the measurement results provided by NHC have weak and inconsistent correlations with the outcomes related to resident safety in LTCF, such as pressure ulcers, infections, falls, and medication errors.8,12 To find the reason for this, previous research has highlighted that patient safety culture is an important factor in LTCF to improve their quality and safety of care13,14,15 and has been measuring patient safety culture as an indicator of patient safety.16

Meanwhile, other studies reported no effect of patient safety culture on the association between safety and quality of care for LTCF residents.12,17 It has been argued that reflection is necessary because this tool does not include items related to residents’ health outcomes, and a high patient safety culture does not directly guarantee high safety behavior that staff provide to residents.17,18 To achieve this, a comprehensive assessment tool that includes not only patient safety culture but also the quality of care that influences resident outcomes is needed. Therefore, this study developed a questionnaire to evaluate the safety activities of LTCF staff supporting older adult residents’ quality of care and tested the validity of the developed scale.