Abstract

Satisfaction with care is a topic of growing importance to health care policy makers. This study conducted in Washington State, measures the satisfaction of residents entering three different types of community residential care (CRC) facilities and relates this satisfaction to the type of facility, facility characteristics, and individual characteristics of the resident. Adult Family Homes, in particular, were associated with greater satisfaction than Adult Residential Care, and equal satisfaction to Assisted Living while treating residents with lower health status. The evidence from Washington indicates that a broader application of such programs across Canada merits consideration. Background: Despite its growing importance, the measurement of satisfaction with care is still a relatively undeveloped field, particularly for the rapidly growing sector of community residential care (CRC). CRC facilities have emerged in recent years as an alternative to nursing homes for providing care in settings that allow residents more independence. This study, conducted in Washington State, measures the satisfaction of residents entering three different types of CRC facilities and relates this satisfaction to the type of facility, facility characteristics, and individual characteristics of the resident.

Methods: Subjects were chosen from all individuals placed by the state Aging and Adult Services agency to any of three types of CRC facilities: Adult Family Homes (AFH), small programs caring for 2 to 6 residents; Adult Residential Care facilities (ARC), caring for between 12 and 106 people with histories of homelessness and substance abuse; and Assisted Living facilities (AL), generally large programs (i.e., capacity between 12 and 206) with an emphasis on resident independence. Interviews were conducted with a sample of 176 residents three months after admission to the facility. Three measures of satisfaction were evaluated: global satisfaction, based on three questions on satisfaction with food, room, and staff; environmental satisfaction, based on four questions measuring comfort living in the facility; and interpersonal satisfaction, based on four questions relating to residents' perception of their personal treatment at the facility. Independent variables considered for inclusion were grouped in four categories: physical characteristics (i.e., percentage of residents in private rooms, and type of facility); policies and services measuring level of independence; aggregate resident characteristics (i.e., percentage of paying residents, and percent over 65 years old); and individual resident demographic and health status characteristics. The relationships between each of the three measures of satisfaction and the independent variables were assessed through a series of statistical analyses.

Findings: Residents were generally satisfied with their care, with median scores for all three measures of satisfaction equal to 80% or more of the maximum possible. Surprisingly, few variables proved to have significant effects on the satisfaction measures. Among the most significant factors associated with satisfaction was the type of facility. Residents in ARC facilities were much less likely to be satisfied with their care than residents in AL or AFH, while AFH residents were more likely to be satisfied with their care environment. Better self-assessed health status was associated with all measures of satisfaction, while cognitive impairment was associated with higher global satisfaction. The ability for the resident to bring their own furnishings positively influenced interpersonal satisfaction. Residents who were not married had higher levels of interpersonal satisfaction, and female residents were more satisfied with their environment than males. Finally, lower levels of education were significantly associated with higher environmental satisfaction.

Conclusions: The majority of the independent variables included in the study were not associated with resident satisfaction. This fact calls into question whether these variables accurately captured the concepts they were intended to represent. Nevertheless, there is one important positive finding: the significant differences in resident satisfaction among the three different types of facilities. In particular, AFH were associated with significantly higher resident satisfaction than ARC facilities, and equal satisfaction to AL while treating residents with lower health status. AFH facilities are significantly less expensive than AL and ARC. Some provinces in Canada have accreditation programs and funding availability for facilities similar to Washington's AFHs (e.g., Quebec). The evidence from Washington indicates that broader applications of such programs across Canada merits consideration.

Reference: Curtis, MP, Sales, AEB, Sulliven, JH, Gray, SL, Hedrick, SC. "Satisfaction with Care Among Community Residential Care Residents." Journal of Aging and Health, February, 2005, 17(1): 3-27.