Nursing Home Satisfaction Surveys: Differences by Race, Age, and Gender

Nursing home satisfaction information has gained substantial traction as a quality indicator representing the consumers perspective. However, very little research has examined differences in satisfaction related to race, age and gender. As a quality metric, satisfaction measures are variously used for quality improvement, benchmarking, public reporting, and for adjustment to payments. As such, valid comparisons among facilities are important. To our knowledge, no adjustment to satisfaction scores are currently used for nursing homes. However, in many other settings this is a common practice. In this research, nursing home resident, family, and discharge satisfaction scores were examined from >4,000 participants. The data were collected in 2020 and come from 420 facilities. Satisfaction information came from the CoreQ surveys, which include 23 individual questions four of which can be combined to produce an overall satisfaction score. These CoreQ nursing home surveys are endorsed by NQF. Generally lower overall satisfaction scores were found for family members compared to current residents or discharged residents. Minorities (Black, Asian, Hispanic) had lower overall satisfaction scores compared to whites; however, the differences were not significant at conventional levels. Participants of the lowest age (<65 years) were significantly (p=<.05) less satisfied than older participants (>75 years) and males were significantly (p=<.05) less satisfied than females. The findings indicate that some case-mix adjustment may be applicable for nursing home satisfaction scores.

The Effect of Nurse Aide Retention on Ohio's Nursing Home Resident Care Experience Scores: A Facility-Level Analysis

The objective of the study was to analyze whether higher nurse aide retention was related to better resident care experiences using an overall score and seven domain scores among a sample of Ohio nursing homes. The 2017 Ohio Biennial Survey of Long-Term Care Facilities was used in combination with the 2017 Ohio Nursing Home Resident Satisfaction Survey. These data were merged with the Ohio Medicaid Cost Report, Certification and Survey Provider Enhanced Reports, LTC Focus, Area Health Resource File, Rural Urban Commuting Area data, and Payroll-based Journal Public Use Files. The analytic sample (N=690) represents freestanding facilities with a full-year cost report. The analysis included means and frequencies, ANOVAs with Tukey adjustments, and linear regressions that controlled for heteroskedasticity. Quartiles of the CNA retention rate were used to define four groups: low, medium, high, and extremely high. After controlling for facility and county characteristics, facilities with high CNA retention (61-72%) had significantly higher overall resident care experience scores by 1.27 percentage points and better environment scores by 1.35 percentage points compared to those with low CNA retention (0-48%). Medium retention (49-60%) also had significantly better environment scores than low retention. Compared to the high retention group, facilities with extremely high retention (73%+) had significantly lower scores for the overall resident care experience, facility culture, caregivers, and spending time. Maintaining a high retention rate of CNAs is important, but there were surprising negative effects from having extremely high retention potentially due to high burnout or poor person-job fit.