Ethical Issues in Conducting Customer Satisfaction Surveys in Long-Term Care Institutions Ethics is a field of study that deals with concepts and principles about what is right and wrong. Several researchers have discussed the main ethical issues in long-term care facilities (Elander, Drechsler, & Persson, 1993; Moody, 1983), such as 1) conflict of interests and divided professional loyalties, 2) paternalism versus autonomy, 3) confidentiality versus beneficence, and 4) the allocation of limited resources versus getting maximum benefits. The planning and implementation of customer satisfaction surveys in nursing homes is accompanied by similar as well as unique ethical issues. This chapter takes these four principles and examines them in light of the planning and implementation of customer satisfaction surveys in nursing homes. First, issues surrounding each ethical dilemma, including making decisions as to what the ethical controversy or problem actually is, are presented. Second, several suggestions and alternatives to solve the dilemmas are suggested. Read more
Humanizing Long-Term Care Forging a Link Between Quality of Care and Quality of Life This chapter begins with a review and discussion of long-term and chronic care to place quality of life issues in a historical context. It then discusses the concepts of quality of care and quality of life and how they are linked through the process of providing care to the maintenance and enhancement of the self. Third, environmental, structural, organizational, and interpersonal factors that support the process of caring and the enhancement of qualities of care and life are covered. The chapter concludes with the implications of this linkage for efforts to improve the quality of life for older persons with chronic illnesses and impairments requiring long-term care services. Read more
Predictors of Advance Directives in Institutionalized Elderly This study used a cross-sectional design to interview 133 cognitively alert residents from 13 nursing facilities to examine the predictors of Advance Directives (ADs). A logistic regression examined the effect of Locus of Control (LOC) in predicting the presence of ADs, after controlling for residents' background characteristics and organizational factors. The findings suggested that LOC was not significant. Rather, two background characteristics, religious affiliation and knowledge of ADs, predicted having ADs. More specifically, Jews and Catholics compared to Protestants, and those with more knowledge of ADs had implemented ADs. From a practice perspective, educational programs geared at examining differences in religious affiliation and knowledge of the subject are likely to impact residents' implementation of ADs. As a note of caution, the findings from the study need to be tested with larger, more generalizable samples. Read more
Prevalence and Problems in the Use of Satisfaction Surveys Results from Research on Ohio Nursing Homes The purpose of this chapter is to investigate the extent to which consumer satisfaction surveys are being conducted in skilled nursing facilities in the state of Ohio, the nature of the survey process and outcomes, and reported problems with satisfaction surveys. To date, research has not examined these issues, hence there is a lack of empirical information to gauge the prevalence and effectiveness of the consumer satisfaction survey process and outcomes from the perspective of facility staff. This study helps to fill the gap in the research literature by providing information on satisfaction surveys, based on interviews with management staff from a random sample of nursing homes throughout the state that are certified by the Ohio Department of Health as licensed providers. Read more
Predictors of Institutionalization for Persons with Alzheimer’s Disease and the Impact on Family Caregivers This study examines the factors which differentiate family caregivers who placed (n = 284) versus continued to provide in-home care (n = 642) to relatives with dementia over a 2-year period. Caregiver variables (i.e., income, kin relations, depression, burden, physical health, and social support) and care receiver variables (i.e., level of functional impairment and age) were entered into a logistic regression analysis predicting subsequent placement versus continuing care at home. Results indicate that compared to continuing care subjects, caregivers most likely to place their family member were more depressed, caring for impaired relatives with more problem behaviors (e.g., wandering, inappropriate behavior) and receiving respite assistance. After placement, caregivers were found to be more burdened and to have declined slightly in their levels of subjective physical health. Findings suggest that interventions for family caregivers before and after placement may be beneficial in alleviating the negative effects of this stressful transition. Read more
Restraint Removal and Changes in Social Response Among Nursing Home Residents This study investigated whether removing physical restraints from previously restrained nursing home residents would change their social response. A quasi-experimental design was used to obtain data from 93 previously restrained subjects who became restraint-free (experimental group) and from 93 randomly selected never-restrained subjects (nonequivalent control group) in seven nursing homes. A repeated measures analysis of covariance (ANCOVA) controlling for group differences in cognitive status and physical activities of daily living (PADL) was used to examine changes in social response at pretest, posttest, and follow-up. Findings suggested that restraint removal had no effect on changing social response over time. Even after attempting to control for differences between groups, social response was significantly related to subjects’ cognitive abilities and PADL status. The control group was better functioning in both areas, and this affected their ability to respond socially at a much higher level throughout the study than the experimental group. Read more
The Effect of Activity Involvement and Social Relationships on Boredom Among Nursing Home Residents This study investigated the types of activities that nursing home residents participate in, and whether participation in group activities and quality of residents' social networks could explain reports of boredom. Results indicated that residents enjoyed both solitary activities (watching TV, reading) as well as group activities like parties, social programs, playing cards and other games. Further, boredom was not related to participation in group activities but rather to depression, negative interactions with social network members and, perhaps, with a lack of friendships with other residents. Findings indicate that the personal and mental health needs of residents should be given major consideration while designing group activities for residents. Read more
Nursing Assistants Caring for Dementia Residents in Nursing Homes Most research on nursing home care has focused on its problems and shortcomings, with few positive reports concerning resident care. The current study investigates a neglected aspect of nursing home research. family members' positive perceptions of the care nursing assistants provide to residents with dementia. Content analysis of cross-sectional data from 133 family member interviews from five nursing homes revealed four positive themes: • Family members' appreciation for how difficult it is to care for persons with dementia and understanding constraints imposed by understaffing, heavy workloads, and low wages; • Care provided by nursing assistants that exceeds expectations; • Positive expressions between nursing assistants and residents and residents' family members; and • Identification of a kin-like relationship between residents and nursing assistants. Read more
