Resident Satisfaction with Independent Living Facilities in Continuing Care Retirement Communities Read more
The Impact of Stress and Support on Nursing Assistant Satisfaction With Supervision This research applies a stress-and-social-support conceptual model to investigate the effects of personal and facility characteristics, job-related and personal stressors, and social support in the workplace on nursing assistant (NA) satisfaction with supervision. Survey data are from in-person interviews with 338 NAs employed at 22 skilled nursing facilities. Structural equation modeling was used to determine the model’s goodness of fit. Results show that personal stressors (family, financial, and health concerns) have the greatest impact on satisfaction with supervision. Positive support in the workplace attenuated the effects of job-related stressors on the outcome. Findings suggest NAs’ personal stressors require careful attention from supervisory and human resources staff because they directly affect worker satisfaction with supervision. Employee Assistance Programs and training for supervisors in team building, communication, and motivational skills are needed to promote more positive relationships with and among NAs. Read more
Understanding Consumer Satisfaction in Continuing Care Retirement Communities This study focused on examining consumer satisfaction with the care and services provided to elders residing in continuing care retirement communities (CCRCs). Telephone interviews were conducted with a total of 137 respondents residing in both Independent Living (IL) facilities and Assisted Living (AL) in eight different CCRCs. Of these, 116 were IL residents and 21 were AL residents. Nursing home residents were excluded because Ohio was implementing mandatory nursing home family and resident satisfaction surveys. Residents on average were, 83 years old, primarily Caucasian and the majority were widowed. Three-fourths of them were female and over half had some college or a college degree. In addition, 41 family members of the 137 residents were also interviewed. The family members were on average, 56 years old, Caucasian, and the majority were female children. Both residents and their family members said that the primary reason for choosing a particular CCRC was that it was close to family members. As to why residents had to move to a CCRC, both families and residents said that it was because of physical health problems of either the resident or his/her spouse. In fact, residents and families cited more similar than dissimilar answers regarding why they chose a particular CCRC, reasons for moving from the resident’s previous residence, and the importance of certain types of services, although the order of preferences differed slightly. Information from Administrators of all eight CCRCs was collected to examine the range of services that facilities offered and their price structure and these varied greatly between and within facilities. Monthly rent in the IL facilities ranged from $579.00 to $3,332. In the AL facilities, single occupancy monthly rent ranged from $2,040 to $5,710. Examining Satisfaction with Care and Services An instrument examining resident satisfaction care was tested for its reliability and validity. It proved to be a highly reliable and valid instrument that had six major domains/factors: Admission; Appearance of the Facility; Food and Dining Services; Maintenance of Facility; Management, and, Safety and Security. An underlying measure of Resident Overall Satisfaction was also identified comprising of 48 items that contained items from the above-mentioned six domains. A similar instrument was used to test family satisfaction with care and services. With respect to examining what predicted Resident Overall Satisfaction, a multiple regression was run and two areas proved to be significant predictors of Resident Overall Satisfaction: the positive nature of resident and staff interactions and the residents’ perception of what services are important to them. Similar analyses on Family Overall Satisfaction could not be conducted because of the small sample size of the family dataset (family n =41). An examination of the open-ended comments by the residents and families revealed that both had positive and negative comments to make. They complained of things like the physical design, the environment and its surroundings, management issues and meals and dining services. The topmost things that residents praised the CCRCs for were the freedom to live their own lifestyle, the pleasant and friendly atmosphere and feeling that they had a safety net. The topmost things that families praised were the surroundings and the environment (even though some criticized this), the positive interactions with staff and the services/conveniences. Implications for Practice The findings from the quantitative analyses and the comments suggest that understanding the consumer perspective is critical to providing appropriate services. We suggest that Administrators encourage positive interaction and communication between consumers and staff to provide care that is appropriate, considered important and enhances consumer satisfaction. Limitations of the Study The limitations of the study include the fact that it was conducted only in one State with a small sample of eight CCRCs. Further, more IL than AL residents were interviewed. The study needs to be replicated with a larger sample size, and in more states, with equal numbers of residents in IL, AL and nursing facilities to enhance the generalizability of the findings. Read more
Developing a Satisfaction Survey for Families of Ohio’s Nursing Home Residents Purpose: The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio’s nursing homes. Design and Methods: Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were ‘‘most involved’’ in their relative’s care completed an instrument with 97 satisfaction items. Results: Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability (a = .76 and above, except for one), test–retest reliability ranged from .49 to .88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. Implications: Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government. Read more
Circumstances Leading to Placement A Difficult Caregiving Decision Due to advances made in medicine and healthcare, older adults are living longer but enduring problems with physical functioning and health over longer periods of time. In addition, the percentage of older adults with cognitive impairments is increasing. Caregiving duties, which decades ago lasted for months, now last for years. This long-term strain of caring for an older adult who is physically and/or cognitively impaired may lead many caregivers to feel frustrated, angry, overwhelmed, and isolated. As a result of this stress many caregivers resort to nursing home placement. The Caregiver Options Program and Evaluation research project was undertaken to provide service options to participating caregivers to alleviate some of the debilitating stress associated with caregiving and postpone institutionalization. Results of logistic regression indicate the predictors of nursing home placement were whether the caregiver felt she/he had provided good care, and whether the elder had a problem with household tasks and/or woke the caregiver or other family members up during the night. Findings suggest that elderly care receivers who are predominately low-to-middle income have a physical and/or cognitive impairment, along with their caregivers, need to be especially targeted for help by case managers early in the caregiving process before placement becomes the only alternative. Read more
Family Satisfation with Nursing Home Care for Relatives with Dementia Families of residents with dementia from five nursing homes were interviewed to assess if they believed improvements were needed in the care provided to their relatives. Quality of care was assessed in a variety of service and staff areas that factored into two domains of care: (a) environmental and administrative services and (b) direct care. Families who perceived significant improvements were needed in environmental and administrative services had more negative interactions with staff, perceived nurse assistants as being insensitive, and helped relatives with more activities of daily living (ADL). With respect to direct care, families perceived significant improvements were needed when they had more negative interactions with staff and helped their relatives with more ADL. These findings highlight the importance of promoting positive family-staff interactions, providing direct care in a sensitive manner, and exploring the reasons why families get involved in ADL to improve family satisfaction with care. Read more
The Stress Process of Family Caregiving in Institutional Settings Purpose: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities. Design and Methods: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression. Results: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident–caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors. Implications: These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes. Read more
The Influence of Religious and Personal Values on Nursing Home Residents’ Attitudes Toward Life-Sustaining Treatments A cross-sectional survey design was used to interview 133 Jewish, Catholic and Protestant residents from 13 nursing homes to examine the influence of religious and personal values on attitudes toward life-sustaining treatments. Subjects on average were 83 years old, Caucasian and female, with more than half having Advance Directives (ADs). Jewish subjects, as well as those who relied on God, were better educated and more anxious about death, had significantly more positive attitudes toward life-sustaining treatments at the end-of-life. On the other hand, those who had implemented ADs desired fewer life-sustaining treatments. Finding demonstrate that understanding individual desires for life-sustaining treatments is complex. Practitioners who provide education on end-of-life decisions need to discuss a myriad of issues including individual religious and personal values and other characteristics in an effort to understand and respect treatment choices. Read more
An Overview of the Process of Conducting Consumer Satisfaction Surveys in Nursing Facilities This chapter deals with the process of conducting consumer satisfaction surveys in nursing facilities. It is primarily focused on providing a “do-it-yourself” approach, and deals with issues such as how important staff commitment is before undertaking such an enormous task; whom the consumer is in the nursing home; methods for surveying consumers; tips for developing an instrument in-house; pretesting and piloting instruments; establishing reliability and validity; what tasks are involved in the actual implementation of the survey; how to analyze the data; and how to present the findings. It concludes with a case example of a nursing facility that designed and conducted its own survey. Since the tasks involved in developing an in-house survey are numerous, and require expertise and skill in survey methodology, this chapter is only meant as an overview of the process of conducting consumer satisfaction surveys in long-term care (LTC). Toward that end, the references may be used to obtain more detailed information on the tasks involved. Read more
