What is the Ohio Long-term Care Facility
Resident Satisfaction Survey?
Ohio Revised Code section 173.47 requires the Ohio Department of Aging to conduct a customer satisfaction survey of each long-term care facility.In 2006, the Department conducted its Family Satisfaction Survey.This year, the Department will survey residents of all nursing homes and residential care facilities.A standardized survey and interview process will be administered in order to measure satisfaction with your facility. Current residents will participate in face-to-face interviews conducted by trained and supervised interviewers.
Who is funding this project?
In accordance with state law, the Department of Aging collects an annual fee from
nursing homes and residential care facilities to help support the cost of the Ohio Long-Term Care Consumer Guide, including the family and consumer satisfaction surveys. Each nursing facility is charged $400 and each residential care facility is charged $300 annually.
What is the
purpose of the Ohio Long-term Care Facility Resident Satisfaction Survey?
The purpose of the 2007 survey is:
1)
To
increase long-term care facility awareness of resident perspectives of their
services;
2)
To
provide long-term care facilities with information on which to base quality
improvement activities;
3)
To
provide resident satisfaction information on the Long-term Care Consumer Guide
(www.ltcohio.org), an online public
report that helps people who are looking for a long-term care facility make
informed choices about long-term care for themselves or their loved one(s);
4)
The
nursing home resident satisfaction survey results will also be used as part of the
quality add-on formula for Medicaid reimbursement.A higher than average resident satisfaction score earns a point
toward the quality incentive that may increase a nursing homeís Medicaid
reimbursement rate.
What is the sampling plan for Ohio?
We are conducting proportional stratified random sampling.The number of interviews to complete will vary based on the number of residents in your facility.You will submit a resident census list to Vital Research two weeks before your scheduled interview dates. Only those residents who are in your facility the day you submit your census list can be approached for interview.That is, the list is frozen at that point in time.A random sample of residents will be selected at Vital Research and provided to the interviewers. Interviewers will know how many interviews to conduct from among the list they are given by Vital Research. On the first day of interviews, you will also be asked to provide a list of all residents in isolation or whose legal guardian does not want them to be interviewed.Interviewers will cross those residents off their lists.
Who
was responsible for developing and testing the nursing home resident
satisfaction survey?
The Scripps Gerontology Center at Miami University of Ohio, and the Margaret Blenkner Research Institute of Benjamin Rose in Cleveland, Ohio were responsible for developing and testing the Ohio Nursing Home Resident Satisfaction Survey in 2001, with input from the Consumer Guide Advisory Council established by the Ohio Department of Aging.The interview questions have been implemented in two statewide satisfaction surveys in both Ohio (2002 and 2003) and Rhode Island (2005 and 2006) and have been extensively tested for reliability and validity. The 2003 nursing home resident satisfaction survey instrument has been refined based on lessons learned in 2003 and subsequent statewide surveys in RI.
Who was responsible for developing and
testing the residential care facility resident satisfaction survey?
In 2006, researchers at the Scripps Gerontology Center at Miami University of Ohio and the Margaret Blenkner Research Institute developed and tested the residential care facility resident interview.This is the first statewide satisfaction survey of residential care facility residents in the nation. The survey has been pre-tested and will be piloted this year.
How are interviewers trained?
Interviewers have an intensive 3-day training that includes classroom instruction and a great deal of practice conducting supervised interviews of residents with expert feedback.They learn how to administer a structured interview the same way to each resident and the same way as all the other interviewers are administering it.They are taught to approach each resident on the list with a positive attitude, regardless of appearance, believing that he or she will be able to provide opinions about their long-term care facility experiences.If a resident gives no answer, or gives answers that are not responsive to the stated question, to four questions in a row, the interview is discontinued and the resident is thanked for the time and helpfulness offered.If the resident gets tired in the middle of the interview, the interviewer may come back at a later time to complete it.Interviewers also learn that they are not conducting an observation study, and that their own personal views about a long-term care facility are of no importance.They implement a unique role, serving as a vehicle for the opinions of residents, those who actually reside in the facilities, to be heard and accurately recorded. Two trained field supervisors will visit different interviewers each day in facilities across the state, conducting quality assurance activities and providing reinforcement and corrective feedback.
Why should a facility participate in the
statewide survey?
The statewide survey is an opportunity for nursing homes
and residential care facilities to learn about their residentsí opinions.
Facilities can compare their residentsí opinions with statewide opinions
because all facilities will use the same reliable and valid survey instruments.
Satisfaction scores will be reported separately for nursing care facilities and
residential care facilities.Facilities
will be provided with the overall resident satisfaction and domain scores and
may use that information for quality improvement purposes, newsletters, or
other materials.For residents and
families, choosing a long-term care facility is a difficult decision.The more information people have about every
long-term care facility, the better decisions they can make.By participating in standard satisfaction
surveys, a facility broadens its opportunity to convey information to new
consumers.
How many long-term care facilities are
likely to participate in the survey?
Will
the resident satisfaction interviews hurt the long-term care facility?
The philosophy and purpose of the
resident satisfaction survey is not to identify "bad apples," but rather to
learn how residents view their experiences and to provide an opportunity to
make things better, from the residentís point of view.The best way to help the long-term care
facility is for residents to provide honest opinions.
Can we get a copy of the results?
Upon completion of the survey project, the Ohio Department
of Aging will provide you with your results compared with statewide data.The results will also be available to the
public on the Internet in the Ohio Long-term Care Consumer Guide: www.ltcohio.org.We expect results to be available by early 2008.
Is this an anonymous survey?
Yes.All
residentsí answers are sent to the independent research organization, Vital
Research.The survey uses a resident
identification number assigned by Vital Research to keep residentsí answers
confidential.A summary of the results
of each long-term care facilityís residents will be reported.Individual resident surveys will be
destroyed at the end of the survey project.
How long does the interview take?
The interview is brief and takes approximately 15-20 minutes to complete.
Why are residents with dementia being
interviewed?
Inclusion of residents with dementia not only strengthens the reliability of the results, but also it is ethical to try to include all residentsí perspectives.In long-term care facility satisfaction research, families and facility staff once served as surrogates for residents.The frailty of the long-term care facility residents makes them expensive to interview, and their varying levels of dementia led some to believe that they cannot speak for themselves.Numerous research groups worked in the 1990s to develop reliable and valid resident satisfaction tools to capture perceptions of long-term care facility residents, including those with dementia.The nursing home and residential care facility resident satisfaction surveys being used for this statewide project have been designed and field-tested for use with this population.The interviewer-training program, which includes methods proven to achieve a high response rate, is based on Vital Researchís decade of experience conducting over 95,000 resident interviews. The interviewers are trained in how to interview residents who are cognitively impaired or who are hearing impaired.They are trained in strategies for handling challenging situation and when to discontinue an interview if a resident is non-responsive.
Why not just ask the people with the highest
cognitive functioning about their satisfaction?
Residents with dementia comprise the largest and most vulnerable group of long-term care facility residents.Not only does their inclusion strengthen the reliability of the results, but also it is ethical to try to include all residentsí perspectives.It provides a more realistic view of residentsí experiences in long-term care facilities.If the majority of residents are systematically omitted from satisfaction surveys, the information cannot be considered accurate.
Why not let staff or families guide the
interviewer to residents who can be interviewed?
Interviewers use questions and techniques that are specially designed to
elicit answers from residents with impairments.People who appear unresponsive or uncooperative to family members
or staff may very well be able to participate in an interview.
Why not let the staff and families answer
for residents?
Many studies have shown that staff and families provide different answers from one another and different answers from residents.Each groupís opinions are important, but cannot substitute for one another.
To what
extent are residents with dementia being included in long-term care facility
consumer satisfaction surveys today?
A number of resident satisfaction tools are being implemented statewide in order to inform consumers of all residentsí perspectives, including those with dementia:In 2004, British Columbia interviewers invited every resident in every nursing facility to participate; while in 2002 and 2003 Ohio conducted interviews with a sample of residents in every nursing facility.In Rhode Island (2005 and 2006) and Minnesota (2005, 2006 and 2007) interviews were conducted with residents using a sampling plan similar to Ohio.
Here is an example of response rates for residents of different cognitive levels, when using a satisfaction tool designed especially for use across all cognitive levels.
What are the characteristics of a resident
satisfaction tool that is appropriate for residents across cognitive levels?
Resident satisfaction tools should be multi-dimensional, covering various aspects of daily experience in the long-term care facility. The questions should be concrete, rather than abstract.Questions should be short and free of conditional phrases and clauses.Thus they are one-step questions that a resident can remember the beginning of by the time the interviewer gets to the end. For large-scale satisfaction surveying, it is important that the questions be closed ended and have few response categories (yes, no; always, sometimes, hardly ever, never). Residents at Cognitive Performance Scale (CPS) levels 0-2 will usually elaborate on the answer category they select, adding a conditional statement, an example, or synonyms.At approximately CPS level 3, some people begin to have difficulty composing narrative answers, and especially at level 4 and 5, residents will be able to state the answer category of their choice with little additional explanation.The words and phrases used should be typical for the generation being surveyed, and they should be easy to hear and to see on the lips, because hearing loss interacts negatively with cognitive loss to make cognitive performance appear much worse than it actually is.
What about
the accuracy of the opinions of residents with dementia?
Any consumer satisfaction survey reflects consumer opinions.These surveys elicit how we, as consumers, feel about the services we receive in any given situation.We are not providing objective facts, but rather our perspective about the world as seen through our own eyes.In addition, rarely is our perspective in question.We donít ponder whether consumers provide a truthful or accurate response, because we know that it only reflects an opinion."Did you wait in line more than 10 minutes?"Because Iím impatient, I say I did. The person next to me in line, who has nothing but time, says he didnít.In resident satisfaction surveys, we are interested in every residentís perspective, because only then will we have a complete understanding of satisfaction in long-term care facilities.