Nursing home administrators' views of their own and volunteer resident advocates' enhancement of long-term care

Volunteers perform much of the work of federally mandated state ombudsman programs which may include review of resident care in nursing facilities to protect against abuse and neglect. Although volunteers' activities may take place in the nursing facility, Nursing Home Administrators' (NHAs) views of their work are seldom studied. Data from questionnaires completed by 199 NHAs predicted enhancement (improvement) of long-term care by volunteer resident advocates. Administrators also described their advice for improvement of care. NHAs' perceptions of residents' pleasure and families' satisfaction with volunteers' visits were associated with enhancement of long-term care. Effectiveness attributed to volunteers' protection of rights and resolution of complaints was not related to perceived enhancement of long-term care. Answers to a number of remaining questions could enhance the efforts of volunteers in ombudsman programs, improve long-term care, and diminish opportunities for abuse.     

Implementation and results of the statewide ONHRSS

In response to increased consumer demand, state governments are publishing more detailed information about the quality of nursing homes. In 2002, Ohio legislation mandated the publication of a Long-Term Care Consumer Guide that included information on nursing home resident and family satisfaction surveys. Using the 2002 Ohio Nursing Home Resident Satisfaction Survey as an example, this article addresses two research questions: (1) how can statewide resident face-to-face satisfaction interviews be implemented to maximize participation of residents and facilities and produce reliable and valid results, and (2) how satisfied are residents with their nursing home experiences, overall and by level of cognitive function.     

Nursing home performance on select publicly reported quality indicators and resident risk of hospitalization: grappling with policy implications

This study examines how resident risk of hospitalization varies in relation to facility performance on select quality indicators (QIs). Using a 15% sample, three years of Medicaid reimbursement data from over 525 nursing homes (NHs) were linked with four years of hospital claims data and facility-level data to investigate whether residents of NHs with worse (better) than expected performance on QIs experienced increased (decreased) risk of hospitalization. Logistic regression results indicate that variations in hospitalization risk among NH residents are explained in part by facility performance on QIs. Residents from NHs with more decubitus ulcers, with greater use of physical restraints, and with a higher than expected incidence of unexplained weight loss/gain experienced increased risk of hospitalization.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Racial and Ethnic Differences in the Prevalence of Depressive Symptoms Among U.S. Nursing Home Residents

This study aimed to examine racial and ethnic differences in significant depressive symptoms among long-term nursing home residents. We analyzed the 2014 national Minimum Data Set linked to a nursing home file and estimated multivariable logistic regressions to determine the associations of race and ethnicities with significant depressive symptoms (score ≥ 10 on the 9-item Patient Health Questionnaire [PHQ-9] scale) and whether associations were explained by resident and nursing home covariates. Stratified analyses further determined independent associations in subgroups of residents. We found that the prevalence rate of PHQ-9 scores ≥ 10 was 8.8% among non-Hispanic White residents (n = 653,031) and 7.4%, 6.9%, and 6.6% among Black (n = 97,629), Hispanic (n = 39,752), and Asian (n = 16,636) residents, respectively. The reduced likelihoods of significant depressive symptoms for minority residents compared to non-Hispanic Whites persisted after sequential adjustments for resident and nursing home covariates, as well as in stratified analyses. The persistently lower rate of significant depressive symptoms among racial and ethnic minority residents suggests that training of nursing home caregivers for culturally sensitive depression screening is needed for improved symptom recognition among minority residents.     

Birthday celebrations as a family homelessness intervention: a mixed-methods analysis

Families report that the experience of homelessness presents a significant barrier to family functioning and interrupts regular family routines. This study uses data from 22 homeless shelters in Massachusetts to examine the relationship between birthday parties for homeless children, family functioning, and parent well-being in homeless families. The study includes a sample of 255 residents across 20 homeless shelters in both urban and rural communities that received regular monthly birthday parties from a nonprofit agency. A small comparison sample of 25 residents came from two shelters that were not receiving birthday parties from the nonprofit agency. Data from 78 staff members working at all 22 shelters was collected on shelter environment and resident cohesion. Results indicated that residents in those shelters that received monthly birthday party celebrations for children had higher levels of happiness. Residents’ satisfaction with the birthday parties showed correlations between levels of hope, happiness, and parental empowerment. Shelter staff who reported higher levels of satisfaction with birthday parties also reported higher levels of resident cohesion. Results point toward the value of continuing regular family routines, such as annual birthday celebrations, to help mitigate the stressors and disruptions of homelessness on families.     

Nursing home satisfaction,biography, and the life worlds of psychiatrically disabled residents

The stereotype of nursing home life as a uniformly dismal experience is pervasive in American culture, but this examination of the attitudes of psychiatrically disabled residents calls this generality into question. Residents in this study exemplified a range of opinions about the nursing home — some were clearly satisfied or dissatisfied, but most were ambivalent. In this paper, I explore the relationship between nursing home satisfaction and individual interpretive activity through the biographies of three residents. I find that how residents made sense of their lives was powerfully linked to their perspectives on nursing home residence. In particular, satisfaction was linked to how each resident viewed his or her illness, institutionalization, and life purpose. Understanding the phenomenological contributors to the meaning of nursing home life is essential to appreciating how it is that residents in the same environment can have vastly different outlooks on their surroundings.     

Influence of Satisfaction with Services on Assisted Living Resident Satisfaction

The purpose of our investigation was to provide insight into the service domains that most heavily influenced self-reported resident satisfaction among residents in assisted living facilities. Data was gathered from the 2008 Press Ganey Assisted Living Survey. Satisfaction with service domains was measured using 7 subscales addressing the areas of activities, staff attentiveness, meals, apartment space, facility attractiveness, personal issues, and management. Generalized linear mixed models were specified to assess the influence of demographics, functional status, self-rated health, and satisfaction with service domains on resident satisfaction. In the final multivariate model self-rated health, independence with laundry and finances, and satisfaction with aides, meals and management demonstrated a significant positive effect on resident satisfaction. As the number of assisted living facilities continues to increase, senior management would be wise to consider which domains of service are particularly salient in assisted living environments.     

HCBS Spending and Nursing Home Admissions for 1915(c) Waiver Enrollees

Medicaid waiver programs for home- and community-based services (HCBS) have grown rapidly and serve a population at high risk for nursing home (NH) admission. This study utilized the Medicaid Analytic Extract Personal Summary File and the NH Minimum Data Set and tested whether higher levels of per-beneficiary HCBS spending were associated with (1) lower risk of long-term (90+ days) NH admission and (2) higher functional/cognitive impairment at admission for new enrollees in 1915(c) aged or aged and disabled waiver programs. Waiver enrollees in states and counties with higher HCBS spending were found to have lower risk of long-term NH admission and greater functional impairment at NH admission compared to waiver enrollees in states and counties with lower spending. This indicates that higher per-enrollee HCBS spending may enable waiver enrollees to remain in the community until their functional impairment becomes more severe.     

Family Support in Nursing Homes Serving Residents with a Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes.     

The Influence of the Experienced Residential Environment on Old People's Life Satisfaction

This paper investigates the extent to which the subjectively interpreted qualities of the housing environment influence the life satisfaction (LSI-A) of elderly residents. It assesses the relative importance of social and physical environmental attributes while controlling for the effects of an elderly population's personal characteristics and activity patterns. Data were obtained from structured interviews given to a random sample of 400 persons aged 60 and older living in a middle class urban community. Results from several multiple regression analyses revealed the statistically significant (p < .05) direct effects of 9 social and physical environment experiences on old people's life satisfaction. Together they increased from 35% to 49% the amount of statistical variation that was explained by old people's personal characteristics alone. The psychological basis for the impact of this experienced environment on life satisfaction is discussed.     

Testing the Longitudinal Impact of Work Variables and Performance Appraisal Satisfaction on Subsequent Overall Job Satisfaction

Using a longitudinal sample of medicaltechnologists (MTs) this study found, after controllingfor prior overall job satisfaction, individualdifference, and organization-level variables, that taskresponsibilities and employee performance appraisal satisfactionsignificantly affected subsequent overall MT jobsatisfaction. Overall job satisfaction significantlydeclined for repeat-respondents over the 4-year period. Data also suggested that the impact of taskresponsibilities on overall job satisfaction candissipate over time, and that the supervisor's role inaffecting employee job satisfaction is important.Results and limitations are discussed.     

Relationships Between (Step)Parents and Adult (Step)Children: Explaining Influences on Life Satisfaction and Marital Quality

The purpose of this study was to examine important influences of adult (step)children’s relationships with their biological fathers, biological mothers, and resident stepparents on their life satisfaction and marital quality and the moderating role of stepparent gender. The sample (N = 215) was from Wave 3 of the National Survey of Families and Households (NSFH). Results illustrate that (a) biological mothers and stepparents positively influenced life satisfaction among adult (step)children regardless of stepfamily type; and (b) that the influence of parent–child relationship quality on the adult child’s marital quality did vary as a function of stepfamily type. Specifically, there was a positive link between current stepmother–child relationship quality and the focal child’s current marital quality. The opposite link was found for those reared in stepfather households.     

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1–10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.     

Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts

In recent years, nursing home (NH) researchers have paid increasing attention to socio-economic and racial/ethnic disparities in quality of care. Although there is growing evidence of disparities in resident health outcomes, less is known about the ways in which these differences manifest in care processes from a qualitative perspective. This paper addresses this gap by comparing staff-resident interactions in two urban, non-profit NHs, including roughly 50 staff participants in each facility. The researcher conducted ethnographic observation in one facility serving a white, middle class community and another serving low-income Black and Hispanic clients from an underserved neighborhood. Grounded theory methods generated three categories of interaction—activating, relating, and attending—which were performed differently in the two NHs. In the more affluent facility, staff interacted with residents in a dynamic fashion, adapting to residents’ responses, and they were relatively well equipped with resident-specific information when responding to individual concerns. In the safety-net facility, staff interacted with residents in a one-directional, “didactic” fashion, providing instruction without a mechanism for adapting to residents’ responses, and they were not as well equipped with resident-specific information. These differences reflected disparities between the two facilities in staff communication skills, underscoring the importance of workforce development to enhance the quality of staff-resident interaction and promote resident-centered care. This study raises further questions about the role of neighborhood contexts in shaping organizational processes that influence quality of life for NH residents. Moreover, the study offers a unique contribution to the NH literature by generating a typology of styles of interaction that can be used to develop a conceptual framework for understanding staff-resident interaction in the nursing home. Such a framework can inform efforts to improve residents’ quality of life.     

MEANING,DISCREPANCY, AND SATISFACTION IN THE NURSE ROLE

What it means to be a nurse has changed over time. This article explores the changing meanings for the nurse role in a sample of Bachelor of Science nursing students by analyzing 30 nurse role attributes documented in the nursing literature. Students' perceptions of obligatory and self-in-role meanings are assessed, and multiple role meaning dimensions are identified. Identity-discrepancy theory is used to determine whether discrepancies between obligatory and self-in-role meanings are related to role satisfaction. Findings suggest that discrepancies in some nurse role meaning dimensions are predictive of role satisfaction. The implications for role exit and the nursing shortage are discussed.     

Perceptions of physical restraint use and barriers to restraint reduction in a long-term care facility

The use of restraints in nursing homes has been curtailed in the United States since the passage of the 1987 federal legislation regulating restraint practices. This study used focus groups with administrators and nursing staff in a skilled nursing facility to examine their views of restraints and perceptions of conditions in the nursing home environment that affect restraint use. Although respondents lacked a shared definition of a "restraint," they did identify contextual factors that in combination with resident characteristics produced situations in which restraint use was justified. Implications of these findings for staff education on restraint reduction are discussed.     

Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

Job satisfaction among nurse assistants employed in nursing homes: An analysis of selected job characteristics

The quality of life of residents of nursing homes depends heavily upon the work of nurse assistants (also known as nurse aides). However, beyond basic demographic data, little is currently known about this highly important category of care providers. This study explores the relationships between selected job characteristics and job satisfaction of 138 nurse assistants employed in nursing homes in Ohio. Factor analyses reveal four dimensions among these job characteristics. These dimension are labeled supervision, personal recognition, family/ work conflict, and qualifications. Only qualifications fail to show a significant correlation with the nurse assistants' levels of job satisfaction. The strongest relationship is with supervision. The implications of the findings for job satisfaction and job performance among nurse assistants are discussed.     

Neglect of older adults in Michigan nursing homes

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.