Table 2. Voices of Seniors Regarding Home Care Services page 1 of 5

Purpose	Location, Sample & Measurements	Findings	Authors
Examine experiences & outcomes of seniors using home care services	California, low income Medicaid home care consumers 511 consumer directed model family/clients 584 professional agency model family/clients Telephone interviews	Consumer directed models more positive in all outcomes and -unmet IADL needs -service satisfaction Family of consumer models more positive with safety & service satisfaction	Benjamin, et al., 2000
Determine relationship of client choice and satisfaction	Michigan, Maryland, & Texas 879 seniors receiving personal assistant home care through Medicaid Telephone survey	Greater choice in hiring, firing, scheduling, supervising, and paying attendants associated with higher satisfaction areas More than 90% given choice in selecting assistant reported high levels of satisfaction compared to 59% of those without choice of assistant.	Commonwealth Fund, 1991
Identify dimensions of care associated with excellence versus satisfaction Identify dimensions of care separating satisfaction from dissatisfaction	Midwestern rural/urban areas 696 clients recently discharged from 13 home care agencies Mail survey with 46 items, Likert responses	Excellence/Satisfaction Discriminators 1 Staff unhurried 2 Staff helped manage illness better 3 How to reach on call explained 4 Staff were clean 5 Staff on time Satisfaction/ Dissatisfaction Discriminators 1 Staff help me feel better 2 Early discharge instructions 3 Explained medicine instructions 4 Nurse communicated with family 5 Staff were unhurried	Dansky & Brannon, 1996

Table 2. Voices of Seniors Regarding Home Care Services Page 2 of 5

Purpose

Location,
Sample &
Measurements

Findings

Authors

Rank importance clients ascribe to their values
Determines differences in values between new and ongoing clients

One urban/rural Midwestern site and one urban Western site
790 clients, 2 1/2 hour semi -structured interviews
Two questionnaires with open and closed ended questions

Values ranked by importance:
1 Freedom/safety
2 Home surroundings & atmosphere
3 Helper traits & competence
4 Involvement of family
5 Activities
6 Privacy - general, body, social, $

Very important values
	Clients
	New	On- going
Freedom/ safety	71%	79%	* (p≤.05)
Home	85%	76%
Helper	77%	75%
Involve Family	73%	64%	* (p≤.05)
Activities	52%	56%	** (p≤.001)

Degenhotz, Kane, & Kivnick, 1997

Explore worker-
client relationships

Minnesota
54 home care clients with at least 2 visits per week
In-depth interviews with open and closed questions

The majority of clients expresses satisfaction with their worker
66% describe worker as friend or "like family"
66% report worker does "extras"
75% discuss personal problems with workers
25% claim workers work beyond paid hours

Eustis & Fischer, 1991

Identify dimensions of general satisfaction with home care

Alberta, Canada
10 senior clients
-from home care scenarios, seniors identified importance of various dimensions

Dimensions of client satisfaction are:
availability of care,
continuity of care,
provider competence &
personal qualities of the provider

Most important qualities for provider satisfaction:
sensitivity to clients'needs
and interpersonal skills of the home care workers

Forbes, 1996

Table 2. Voices of Seniors Regarding Home Care Services Page 3 of 5

Purpose	Location, Sample & Measurements	Findings	Authors
Determine client interest in greater autonomy Determine satisfaction with worker and case manager	Massachusetts 883 home care clients Telephone interviews with 55 closed-ended questions	78% preferred some overall control 18% wanted more control Most clients would accept less case manager attention, only small percentage wanted less contact Willing to accept responsibility: 39% for scheduling 37% for supervising 29% for hiring 26% for paying worker 24% for firing	Glickman, et al., 1997
Explore domains of satisfaction with home health care nursing	Vermont 73 clients, both active and discharged Client Satisfaction Survey by Reeder and Chen	Overall high satisfaction with nurses Most satisfaction with nurses in: -not too busy to spend time talking -efficient in doing work -patience with client Less satisfaction with nurse in: -teach how to stay healthy -discuss changes since last visit -tells about tests & procedures -want involvement with decision making	Laferrier, 1993
Identify problems following discharge from hospital	Amsterdam, Netherlands 145 seniors 1 week after hospital discharge 1/2 mail survey & 1/2 interviewed at home; closed & open ended questions	Most frequent problems: -feeling ill informed -questions regarding illness & recovery Other needs & problems: -questions rearding prescriptions/life rules -difficulty with housekeeping Most seniors relied on relatives for support: 37% had unmet needs	Mistiaen, et al., 1997

Table 2. Voices of Seniors Regarding Home Care Services Page 4 of 5

Purpose	Location, Sample & Measurements	Findings	Authors
Determine key drivers of home care client satisfaction	All regions of US 160,000 clients from 183 agencies Mail survey, closed ended questions	Key Drivers of Client Satisfaction: Care Process-strongest driver Staff show concern for patient as a person, enough time spent with patient staff are dependable & timely Client Involvement/Education Involved in care decisions; family involved staff encourage questions; clear explanations of care & procedures Orientation to Home Care: Know whom to call for questions & how to voice a complaint; good staff explanations Perceived medical outcome - weakest driver Condition improved as much as expected & patient gained better understanding of condition	Seibert, 1996
Determine client preferences of nurse caring behaviors	Michigan 28 recently discharged home care clients Interviews with Caring Assessment Instrument (CARE-Q); respondents sorted 50 nurse behavior cards into order of importance	Top caring behaviors: 1 Know when to call the doctor 2 Listens to the patient 3 Talks to the patient 4 Gives tx and meds on time 5 Puts patient first 6 Knows how to do techniques 7 Quick response to calls 8 Good physical care 9 Honest about medical condition 10 Uses understandable language	Smit and Spoelstra, 1991

Table 2. Voices of Seniors Regarding Home Care Services Page 5 of 5

Purpose	Location, Sample & Measurements	Findings	Authors
Identify consumer concerns and preferences	Cleveland, Ohio 200 recently discharged home care clients or caregivers in 20 focus groups	Core concerns: 1 Pre-discharge preparation & instruction 2 Orientation of patient to services 3 "Style of Care" 4 Scheduling of visits 5 Continuity of direct care staff 6 Staff Attire 7 Concern, listening, attention 8 Teaching appropriate to learning readiness 9 Preserving patient dignity & privacy 10 Perceptions of Outcome	Stricklin, 1993
Identify recommendations for improving home care services post hospitalization	Chicago suburb 44 discharged patients 21 caregivers of patients In home interviews, open ended questions & satisfaction scales with Likert scales	General satisfaction= 4.75 from 5 point scale. Client who received medication info more satisfied than those who did not.	Weaver, et al., 1998
Identify dimensions of quality home care workers	78 home care clients Two telephone surveys: 1st survey asked clients to evaluate characteristics of workers 2nd survey asked open ended questions	The top three job related skills were: punctuality, safety awareness, organizational skills (None focused on technical competence)	Woerner & Philips, 1989