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
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
