Making the decision to move a loved one into a nursing home is a big decision, which often leaves family members with questions and concerns regarding their satisfaction with their loved one’s care and quality of life (QOL) while in the facility.
To measure family satisfaction in nursing homes, most states rely upon measures developed by the nursing home industry that have not undergone rigorous testing. There is now, however, a new tool developed by researchers at the University of Minnesota’s School of Public Health, in collaboration with Minnesota Department of Human Services, that provides validated measures of family satisfaction. These measures have been used in all nursing homes in Minnesota and show strong performance among consumers.
The tool consists of 32 questions. Family members are asked to reflect on their experiences with the nursing facility and the care given there. They grade each item on a scale from A-F, where A=excellent; B=very good; C=average; D=below average; and F = failing.
In a new study published in Research on Aging, researchers explored the attributes of this tool including what domains it measures as well as whether family satisfaction is associated with measures of resident QOL.
“We have been asked why family satisfaction is an important measure. The literature has many criticisms of ‘satisfaction’ as a quality indicator—generally speaking, that it’s too general and suffers from social acceptability bias,” said Tetyana Shippee, Ph.D., lead author of the study and assistant professor in the School of Public Health. “In the case of nursing homes, however, family members are key stakeholders and their voice matters both for consumer choices and for policy efforts in improving the quality of nursing home care.”
The study asks the question about how closely family satisfaction is aligned with resident QOL scores on the facility level. Shippee found a weak association between family satisfaction reports and resident QOL reports, confirming that residents and families are distinct audiences and their voices need to be captured separately (in other words, family satisfaction surveys should be used in addition to, not in place of, resident surveys).
Furthermore, Shippee and her colleagues studied facility characteristics associated with family satisfaction. They found:
- Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with worse family satisfaction across different areas of satisfaction. Of these, higher resident acuity (residents with more health limitations in the facility) deserves particular attention because of its larger effect size.
- Findings about resident acuity in the facility are also most consistent in predicting lower family satisfaction. These findings may represent stigma attached to higher health needs, which may create an environment less favored by families and family members refusing to accept the fact that their loved ones also need higher care.
- Facilities with higher quality of care scores and non-profit ownership were associated with better family member satisfaction in all four domains.
“As long-term care becomes more consumer-focused, understanding patterns of consumer satisfaction and the factors that are correlated with it will take on increasing importance. Family members are important consumers and stakeholders,” said Shippee. “For persons with significant cognitive deficiencies, they are the spokespersons. For other residents, they are an important group, whose opinions count in daily decisions and facility reputation overall. In a growing climate of quality improvement, consumer feedback will be a critical source of information.”
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