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					                                                            Long term care resident satisfaction survey

LONG TERM CARE RESIDENT                                     included 36 questions. One of these
                                                            examined the overall satisfaction/
SATISFACTION SURVEY                                         dissatisfaction of residents with long-term
                                                            care facilities.
The goal of this study was to examine                       A face to face interview format was used to
resident satisfaction and dissatisfaction with              do the survey. Five students were hired to
the care, services and environment in                       perform interviews. The interviewers were
Calgary Long Term Care (LTC) facilities as                  selected because of their experience
part of a two-year examination of Client                    working with residents of long-term care
Satisfaction in all major service areas within              facilities and their suitability for this work.
the CRHA. In collaboration with the care                    They were given an extensive orientation
centres, the general scope was expanded to                  and extensive training. The survey was a
provide more specific information to the                    collaborative effort: A long-term care
individual care centres and to allow for                    specialist from Supported Living Services
better comparison between the care                          managed the interviewers; The Health
centres. The resulting survey was much                      Assessment and Surveillance department
larger in terms of the numbers of patients                  managed the logistics; and a staff member
examined and this increased confidence in                   from each care centre helped set up
the accuracy of the results.                                interviews and deal with any problems that
                                                            arose on site.
Many challenges exist when attempting to
measure dissatisfaction of this population.                 Care centre residents were eligible to
Care centre residents can be heavily                        participate in the survey if they were able to
dependent, fearful of retribution, unable to                complete it reliably. Care centre staff rated
communicate or comprehend and develop                       residents cognitive ability using a rating
limited expectations. Despite these                         scale. Residents were later excluded
challenges, dissatisfaction research in                     according to this scale or by interview staff if
Continuing Care is a worthwhile endeavour                   significant cognitive problems were evident.
because satisfaction with care, services and                Residents were also excluded if they were
environment has a direct bearing on quality                 unable to understand or communicate in
of life for these individuals. The goal of this             English; if they had been a resident for less
study is to provide constructive feedback to                than four months; or if they were in the
care centre managers, which may help                        acute process of dying. Up to three attempts
them find ways to decrease dissatisfaction                  were made to survey all eligible residents.
in continuing care environments.
Method                                                      A total of 1,470 completed surveys were
A literature review and the Alberta Health                  obtained from residents in 23 care centres.
Outcomes Project Resident Survey were                       The proportion of satisfied responses to
used as a starting point for developing the                 each question was determined. A satisfied
survey tool. After this, cognitively intact                 response was defined as those that
residents in two care centres were                          confirmed agreement with positively worded
interviewed to determine appropriate                        questions. A dissatisfied response was
questions and the format of the response                    defined as one that was not in agreement
scale. A sample of 30 residents was given                   with these questions. These responses
test-retest analysis to further refine the                  included “no” or “neither yes or no.”
questionnaire. The final questionnaire                      Interviewers were trained to select the

Health Service Delivery Highlights, Volume 6, Summer 2000                                            5
                                                            Long term care resident satisfaction survey

“neither yes or no” response when residents
indicated either inconsistent or mixed                      Logistic regression analysis was used to
satisfaction. This response is quite different              determine the relative importance of each
from “don’t know” or “not relevant” because                 dimension to overall satisfaction/
it indicates the resident is partially                      dissatisfaction. The regression analysis
dissatisfied. Because the data from this                    indicated that the most relevant factors are
survey (and satisfaction surveys in general)                as follows, ordered from most relevant to
are positively skewed, the "partially                       least relevant.
dissatisfied" choice option is important from
a statistical point of view.                                1.   The staff is caring.
                                                            2.   The care centre feels like home.
The proportion of residents providing                       3.   The staff addresses my needs.
satisfied responses to the single overall                   4.   The staff take care of my property.
satisfaction question was 88.09%. The                       5.   I receive the medical care I need.
average positive response to all questions                  6.   The staff helps me to go to the bathroom.
was 77%, with the lowest score on a single                  7.   I have a close relationship with the staff.
question being 50.35% and the highest                       8.   The care centre gives me privacy.
being 96.63 %.
                                                            Table 2 identifies the care centres with
Factor Analysis was used to determine the                   significant differences when compared to all
common dimensions among the questions.                      other care centres by dimensions important to
This process identified clusters of questions               overall satisfaction, as measured by the
where resident responses are strongly                       overall satisfaction question. This analysis
related. A total of 16 factors were                         gives care centres a point of reference for
established (Table 1). An average score for                 each dimension. It was suggested that care
each of these factors was determined for                    centres with negative results and those with
each care centre. The average score for                     positive results work together to evaluate
each care centre was then compared with                     these polar differences. This information
the average score for all remaining care                    could help care centres to determine “best
centres as a group using a T-test. Care                     practices” with regard to satisfaction/
centres, which had significant positive or                  dissatisfaction.
negative differences from the average
score, were identified.

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                                                                     Long term care resident satisfaction survey

Table 1.       Statements classified by respective dimensions according to
               Factor Analysis, CRHA, 1999
DIMENSION                              STATEMENTS
The staff is caring.                   The care I get here is right for me.
                                       The staff work with me to meet my needs.
                                       I am treated with respect by the staff.
                                       I feel safe when I receive care from staff.
                                       Staff are cheerful and kind.
                                       I feel staff understand me when I speak.
Privacy                                I have enough privacy.
                                       There is enough privacy for visiting.
                                       I get enough quiet.
Close relationship with staff          There is a staff person here that I can confide in.
                                       Staff tell me what I need to know about by health and medical condition.
                                       I feel free to speak up to staff when I am unhappy with something.
                                       I have made new friends with residents or staff since I moved here.
Staff address my needs.                The staff come quickly when I need help.
                                       I have to do things against my wishes.
                                       My nursing assistants and aids are changed too often.
Bathing                                I am happy with the numbers of baths I get each week.
                                       My bath time is long enough for me.
Cleanliness and food                   The care centre is kept clean.
                                       The meals here are of a good quality.
                                       I get enough to eat each day.
Medical care                           I have easy access to a doctor.
                                       I receive good medical care.
Care of property                       My personal property is treated with care and respect.
                                       I am happy with the laundry services for my personal items.
Homelike                               The care centre has a home-like and pleasant atmosphere.
                                       I go out as much as I would like.
Enough time to eat meals               I have enough time to eat my meals.
Help to go to the bathroom             I have the help I need to go to the bathroom.
Recreational activities                I like the activities here.
Self-care                              Staff allow me to take care of myself.
Freedom to choose what to do           I choose what I will do with my time during the day.
Freedom to bring things                I am free to bring personal things into my room.
Nothing to do                          I often sit around with nothing to do.
Source: Quality Improvement and Health Information Directorate

Health Service Delivery Highlights, Volume 6, Summer 2000                                                     7
                                                                 Long term care resident satisfaction survey

                       Table 2. Clusters of care centres with significant (p<0.10)
                                   positive or negative satisfaction
                      by dimensions important to overall satisfaction. CRHA, 1999.
               Domain                             Care Centre        Negative Positive Pvalue
               Staff                              BBB                            X               0.01
               (R= .24)                           GGG                X                           0.09
                                                  LLL                            X               0.07
               Home like                          KKK                            X               0.08
               (R=.14)                            VVV                X                           0.05
                                                  DDD                            X               0.02
                                                  WWW                X                           0.07
                                                  AAA                X                           0.03
               Address need                       KKK                X                           0.01
               (R=.12)                            MMM                            X               0.07
                                                  XXX                X                           0.06
               Property                           KKK                            X               0.00
               (R=.11)                            VVV                            X               0.00
                                                  ZZZ                X                           0.01
                                                  CCC                            X               0.02
                                                  OOO                X                           0.02
                                                  HHH                            X               0.03
               Medical Care                       KKK                X                           0.00
               (R=.09)                            VVV                            X               0.00
                                                  BBB                            X               0.00
                                                  CCC                            X               0.03
                                                  TTT                            X               0.03
                                                  LLL                            X               0.03
                                                  HHH                            X               0.01
               Help to bathroom                   YYY                X                           0.07
               R=.09                              CCC                X                           0.04
               Privacy                            KKK                            X               0.01
               (R=.07)                            SSS                            X               0.08
                                                  ZZZ                X                           0.08
                                                  EEE                X           X               0.04
               Close Relationship Staff           ZZZ                X                           0.05
               (R=.07)                            CCC                X                           0.00
                                                  DDD                            X               0.09
                                                  FFF                            X               0.01
                                                  HHH                            X               0.01
Source: Quality Improvement and Health Information Directorate

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                                                            Long term care resident satisfaction survey

For example: For the dimension “Staff                       resident satisfaction). However, one
caring,” it would be useful for GGG to                      exception to this trend indicates that other
examine why BBB and LLL are doing well.                     factors such as management also play a
(By agreement, all care centre specific data                significant role.
was considered confidential; and sharing of
information is therefore contingent on
voluntary co-operation in an often                          Conclusions
competitive environment).                                   Overall, the results of the “Long-term Care
                                                            Resident Satisfaction Survey” indicate that
Gender, time in the care centre and the size                residents are highly satisfied with the care,
of the facility were not shown to be                        the services, and the environment provided
associated with overall dissatisfaction.                    by all of the care centres that were studied.
There was an association with overall                       However, opportunities for improvement are
satisfaction and age of the patient, but this               evident. These have been identified on the
relationship dropped from the regression                    basis of their relevance to overall
model.                                                      satisfaction and on the basis of significant
                                                            differences in satisfaction of individual care
The amount of care required for each                        centres relative to all other care centres. In
patient is tracked in a measure called the                  general, a factor satisfaction score lower
"Adjusted Nursing Workload": This measure                   than 80% may indicate an opportunity to
was also evaluated against a rank score of                  review current practices and make
satisfaction (using one of many possible                    adjustments.
ranking methods). Care Centres with higher
requirements of care tended to show lower                   Three opportunities have been identified as
satisfaction scores while care centres with                 regional priorities. In order of importance,
lower requirements of care had an equal                     they are
distribution of results. This data suggests                 1. The care centre feels like home.
that care centres with high workload may                    2. The staff addresses my needs.
not receive enough resources to address                     3. I have a close relationship with the staff.
their additional needs (as reflected by

For further information contact Tim Cooke, (209-8479), Quality Improvement and Health Information

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