Jane Straker

Developing and testing a satisfaction survey for nursing home residents: the Ohio Experience.

Abstract Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data—a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.

The Nursing Home Five Star Rating: How Does It Compare to Resident and Family Views of Care?

PURPOSE OF THE STUDY In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a five-star rating system of nursing homes in the United States. These star ratings have been widely publicized both by CMS and the national and state media. Although the components of the star rating system take into account various dimensions of quality, satisfaction of nursing home residents and their families is not taken into consideration. DESIGN AND METHODS The current study compares the CMS star rating system to nursing home satisfaction data reported by residents and their families in Ohio. RESULTS Findings indicate that the star rating system does not adequately reflect consumer satisfaction. IMPLICATIONS We recommend that the star system be refined to include a consumer component.

Using high-intensity care management to integrate acute and long-term care services: substitute for large scale system reform?

This study evaluates a demonstration that used high intensity care management to improve integration between the acute and long-term care service systems. The demonstration intervention included the use of clinical nurse care manager, supervised by a geriatrician, to supplement an existing in-home care management system. Chronically disabled home care clients age 60 and over were randomly assigned (N = 308) to receive enhanced clinical services plus traditional care management, or to the control group, to receive the normal care management services provided. Treatment group members were expected to experience lower use of hospitals and nursing homes and lower overall health and long-term care costs. Research subjects were followed for up to 18 months using Medicare records and mortality data. A sub-sample (N = 150) also received in-person interviews to cover a range of health and social outcomes anticipated as a result of the intervention. Although there was some variation in health use and cost across treatment and control groups over the 18 month time period, the overall conclusion is that there were no differences between groups on any of the outcome variables examined. Efforts to integrate the acute and long-term care systems have proven to be difficult. This intervention, which attempted to create integration through high intensity care managers, but without financial or regulatory incentives, was simply unable to create enough change in the care system to produce significant change for the clients served.

The changing world of long-term care: a state perspective.

Abstract Based on data from an eight year longitudinal study of Ohios long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future.

Worker Injuries and Safety Equipment in Ohio Nursing Homes

A survey of Ohio nursing homes was conducted in 2007 to examine whether injury rates were related to facility characteristics and availability of safety equipment. The median rate of injury in the 898 facilities was 5.7 injuries per 100 workers per year. Although 95% of the facilities had written resident lift-ing policies, only 22% of these were zero-lift policies. Gait transfer belts(99%) and portable total-lift hoists(96%) were common, whereas ceiling-mounted total-lift hoists were rarely reported (7%). In a multivariable analysis, injury rate ratios increased with the proportion of residents using wheel-chairs and were lower in smaller facilities. Facilities without a lifting policy had a higher estimated injury rate than facilities without such a policy; however, none of the safety equipment was associated with significant changes in injury rates. More information, such as frequency of use and access to ver-sus availability of equipment, may be needed to better understand the im-pact of safety equipment on nursing home worker injury rates.

Sample size requirements for studying small populations in gerontology research

Calculating sample sizes required to achieve a specified level of precision when estimating population parameters is a common statistical task. As consumer surveys become increasingly common for nursing homes, home care agencies, other service providers, and state and local administrative agencies, standard methods to calculate sample size may not be adequate. Standard methods typically assume a normal approximation and require the specification of a plausible value of the unknown population trait. This paper presents a strategy to estimate sample sizes for small finite populations and when a range of possible population values is specified. This sampling strategy is hierarchical, employing first a hypergeometric sampling model, which directly addresses the finite population concern. This level is then coupled with a beta-binomial distribution for the number of population elements possessing the characteristic of interest. This second level addresses the concern that the population trait may range over an interval of values. The utility of this strategy is illustrated using a study of resident satisfaction in nursing homes.

Care managers as research interviewers: A test of a strategy for gathering consumer Satisfaction information

Care managers from local Area Agencies on Aging, operating Ohio’s home- and community based waiver program (PASSPORT), were trained as research interviewers to collect consumer satisfaction data from clients receiving in-home services using the Home Care Satisfaction Measure (Geron, Smith, Tennstedt, Jette, Chassler, & Kasten, 2000). The data for homemaker and home health aide scales were comparable to those collected by independent research interviewers for interrater reliability and showed no significant difference between the two groups. The scores on the home-delivered meals index obtained by care managers were slightly but significantly higher than those obtained by the research interviewers. A slight, but significant, difference was found on the home-delivered meals index, although differences between most individual items were not significant. Overall, findings indicate that care managers, when appropriately trained, can collect reliable, scientifically sound data, providing a cost-effective method for collecting satisfaction information from consumers receiving in-home care.

The Residential Long-Term Care Role in Health Care Transitions

The objective of the current study is to describe the activities long-term care facilities are undertaking to reduce hospital admissions and readmissions by working to improve health care transitions. The data were collected via an online survey from 888 nursing facilities (NFs) and 527 residential care facilities (RCFs) that completed the care integration module of the Ohio Biennial Survey of Long-Term Care. Questions focused on partnerships, current work, type of care model, and perceived barriers to reducing hospital readmissions. More than nine in 10 (93.1%) of NFs and 63.6% of RCFs reported being engaged in a program to reduce hospital admissions/readmissions. Evidence-based care models were utilized by two thirds of NFs and one third of RCFs. Financial barriers were the most frequently cited challenges faced by facilities. Long-term care settings are increasingly becoming transitional care stops for short-term stay residents. Ensuring that facilities are well versed in current transition research and practice is critical to improve system outcomes.

An International Comparison of the Ohio Department of Aging-Resident Satisfaction Survey: Applicability in a U.S. and Canadian Sample

PURPOSE OF THE STUDY The majority of resident satisfaction surveys available for use in assisted living settings have been developed in the United States; however, empirical assessment of their measurement properties remains limited and sporadic, as does knowledge regarding their applicability for use in settings outside of the United States. This study further examines the psychometric properties of the Ohio Department of Aging-Resident Satisfaction Survey (ODA-RSS) and explores its applicability within a sample of Canadian assisted living facilities. DESIGN AND METHODS Data were collected from 9,739 residential care facility (RCF) residents in Ohio, United States and 938 assisted-living residents in British Columbia, Canada. Confirmatory factor analysis was used to assess the instruments psychometric properties within the 2 samples. RESULTS Although the ODA-RSS appears well suited for assessing resident satisfaction in Ohio RCFs, it is less so in British Columbia assisted living settings. Adequate reliability and validity were observed for all 8 measurable instrument domains in the Ohio sample, but only 4 (Care and Services, Employee Relations, Employee Responsiveness, and Communications) in the British Columbia sample. IMPLICATIONS The ODA-RSS performs best in an environment that encompasses a wide range of RCF types. In settings where greater uniformity and standardization exist, more nuanced questions may be required to detect variation between facilities. It is not sufficient to assume that rigorous development and empirical testing of a tool ensures its applicability in states or countries other than that in which it was initially developed.

Cross-Sectoral Partnerships By Area Agencies On Aging: Associations With Health Care Use And Spending

Area Agencies on Aging (AAAs)-which coordinate social services for older adults in communities across the US-regularly address social determinants of health, sometimes in partnership with other social services and health care organizations. Using data from a 2013 national survey of these agencies, we examined whether their partnership activities were associated with 2014 levels of avoidable health care use and spending for older adults in counties served by each AAA. Multivariate regression models adjusted for agency characteristics, county demographic characteristics, and health care supply factors. We found that counties whose AAAs maintained informal partnerships with a broad range of organizations in health care and other sectors had significantly lower hospital readmission rates, compared to counties whose AAAs had informal partnerships with fewer types of organizations. Counties whose AAAs had programs to divert older adults from nursing home placement had significantly lower avoidable nursing home use, compared to counties whose AAAs lacked such programs. Our findings suggest that AAAs may be a promising source of leadership for cross-sectoral partnerships that effectively address both social and medical determinants of health for older adults, who account for a substantial share of overall health care spending.