Racism Reported By Direct Care Workers in Long-Term Care Settings This article focuses on reports of racism experienced by direct care workers (DCWs). These DCWs provide the majority of hands-on care to older residents/ clients that need help with activities of daily living such as bathing and dressing in long-term care (LTC) settings. Interviews were conducted with 644 DCWs working in three types of LTC settings. Proportionate random sampling techniques were used to select 49 LTC agencies from a five-county area in northeast Ohio. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. Analyses reported include frequencies, chi-square tests, and analysis of variance. Hearing racial and ethnic remarks, particularly from residents/clients, was widely reported by DCWs. Despite this, DCWs were likely to believe that remarks from residents/clients were not intended to hurt their feelings. Although DCWs heard fewer racial/ethnic remarks from family members or other staff, they were likely to believe that such remarks were intended to hurt their feelings. At the organizational level, DCW reports of hearing racial/ethnic remarks in nursing homes were more frequent than those in other LTC settings. Further, DCWs in organizations in which racial differences between them and the residents/clients that they served was very large reported hearing significantly more racial/ethnic remarks. These findings have important implications for addressing racism in LTC agencies with anti-discrimination policies and programs. Read more
Strengthening the Direct Care Workforce Preliminary Recommendations from a National Panel of Experts in Long-Term Care Read more
Factors Affecting Frontline Workers’ Satisfaction with Supervision Objective: This research was guided by a stress and support model to examine the effects of frontline workers’ background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Methods: Survey data were collected from 644 workers in 49 long-term–care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results: Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion: Findings suggest organizational interventions to address workers’ financial and health issues and management practices such as better training programs and peer mentoring could enhance workers’ satisfaction with supervision. Read more
The Impact of Stress and Support on Direct Care Workers’ Job Satisfaction Purpose: This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers’ (DCW) job satisfaction. Design and Methods: Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. We examined the influence of components of the LTC stress and support model on DCW job satisfaction. Initially, we ran a multiple regression analysis by entering individual-level DCW predictors with job satisfaction as the outcome. Subsequently, we used hierarchical linear modeling to examine the influence of organizational factors on DCW job satisfaction after controlling for significant individual-level DCW variables. Results: Components of the model explained 51% of the variance in DCW job satisfaction. Background characteristics of DCWs were less important than personal stressors (e.g., depression), job-related stressors (e.g., continuing education), and social support (e.g., interactions with others) in predicting job satisfaction. Results from hierarchical linear modeling analysis showed that nursing homes compared to the two other types of LTC organizations had lower average DCW job satisfaction rates, as did organizations offering lower minimum hourly rates and those reporting turnover problems. Implications: Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction. Read more
Developing and Testing a Satisfaction Survey for Nursing Home Residents The Ohio Experience Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data–a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications. Read more
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
