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
Evaluating the Ohio Elder Abuse and Domestic Violence in Late Life Screening Tool and Referral Protocol This article describes the evaluation processes employed in the Ohio project to develop and test screening tools and referral protocols on elder abuse and domestic violence. Three focus groups and a Roundtable of experts were utilized to develop the materials in the first year. In the second year, a formal quantitative evaluation that involved 160 practitioners in Ohio was implemented to review the materials and to use them with clients. Findings from the quantitative evaluation were incorporated to make changes that led to a final document that was much simpler, less lengthy, and more relevant to beginning practitioners. 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
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
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
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
Falls Among Nursing Home Residents An Examination of Incident Resports Before and After Restraint Reduction Programs Objective: To examine changes in the rate of falling of an experimental group of restrained subjects who underwent restraint reduction, and to compare their rate of falling with a group of subjects who did not have restraint orders during the study period. Design: A quasi‐experimental, multiple time‐series study utilizing the principles of single‐subject design. Each subject was followed for 25 weeks before and 25 weeks after initiation of the intervention. Setting: Seven nursing homes. Intervention: Formal programs aimed at reducing all bed and chair restraints were initiated in all sites after staff received education and training. Multidisciplinary teams implemented the restraint reduction process on a case‐by‐case basis, beginning with 1 unit/floor at a time in each site. Most experimental subjects reached their optimum restraint‐elimination/reduced status within 2 weeks of intervention initiation. The implementation periods ranged from 4 months to more than a year. Participants: Subjects with chart orders for restraints at the start of the study comprised the experimental group and participated in the restraint reduction program (184 subjects). Subjects with no orders for restraints during the study period comprised the nonequivalent control group (111 subjects) and, therefore, did not undergo the intervention. Measurements: Incident reports documenting all falls during the study period were examined. Falls, the dependent variable, were classified as serious or nonserious. The independent variable (intervention) was the restraint reduction program offered to experimental subjects. Based on the principles of single subject design, the impact of the intervention on falls was calculated before and after the date the restraint reduction process was initiated for an individual (experimental group) subject. For the control group, the pre‐ and posttest period was calculated from the start date of the restraint reduction program on the unit on which each subject resided. Results: Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for this group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time. Read more
Predictors of the Use of Respite Services by Caregivers of Alzheimer’s Patients Racial and Generational Differences This research applies one prominent model of service utilization (the Andersen Newman Model) to better understand the way in which family care givers utilize respite services when caring for older relatives. Specifically, this research examines racial (black and white) and generational (spouse and adult-child) differences between caregivers of Alzheimer's patients and the volume and type of respite services used. The sample (N= 359) is drawn from six Northeast Ohio programs in a consortium that uses a personal computer-based information system to collect intake, assessment, service use, and program satisfaction data from respite clients. Racial differences are found in client attrition and turnover. Results also show adult-child caregivers are the greatest users of day care. These generational differences persist despite the similarities in patient and caregiver need. Fee subsidy and relationship strain between the caregiver and elder predict the amount of service used. Findings suggest that practitioners need to take into account racial and generational factors in addition to traditional patient and caregiver needs when formulating care plans. Read more
