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
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
