Table 4. Voices of Seniors Using Nursing Homes page 1 of 7

Purpose	Location, Sample & Measurements	Findings	Authors
Describe what makes nursing homes dehumanizing	Washington D.C., Massachusetts, and Arizona Examined diaries of 3 Nursing Home Residents	Dehumanizing characteristics: Lack of control, privacy relationships control: admission to home, food, ADLs, and care preferences privacy: family visits, possessions, bodily functions, birthdays and death relationships: roommates, staff, religious and social activities and other residents	Berdes, 1988
Explore residents' definition of quality care & dimensions of daily life	Madison, Wisconsin 3 nursing facilities 26 residents 2 In-depth interviews with each resident, ground dimensional analysis of data	Definitions of quality varied by type of resident 1. For higher income residents, quality = care as a purchased service; poor quality meant having to wait, poor outcomes, etc. 2. For frail residents, quality = care which provided physical comfort (a pillow, drink, etc.) 3. Largest % residents, quality = relationship with staff, degrees of closeness experienced	Bowers, Fibich, & Jacobson, 2001
Examine factors which differentiate men and women's adjustment to nursing homes	Rural middle West 4 nursing homes, 114 residents Resident interviews regarding personal histories and experiences Social workers completed Staff Rating Index for adjustment scores on each resident	Women were perceived as significantly less well adjusted to nursing home life than were men. For women, significant factors related to adjustment were voluntary placement in home and previous living arrangements For men, no one variable predicted adjustment	Joiner & Freudiger, 1993

Table 4. Voices of Seniors Using Nursing Homes Page 2 of 7

Purpose

Location,
Sample &
Measurements

Findings

Authors

Compare three interview methods to assess nursing home residents' needs in the ADL area

3 floors of 1 SNF

70 residents interviewed for 7 ADL needs in 3 ways:
a) Direct satisfaction ratings
b) Discrepancy questions (e.g., do you want more or less mobility care?
c) open ended questions (what type of change would you want?)

Open ended questions produced most useful answers.
Unmet needs were significantly highest for discrepancy and open ended measures compared to direct satisfaction questions.

% dissat.	A	B	C
Dressing	4	36	32
In/out of bed	12	41	33
Mealtime	4	40	18
Pad changes	3	37	32
Showering	7	36	31
Toileting	6	43	14
Walking	24	76	35

Levy- Storms, et al., 2002

Determine most important values of residents

Texas
1 nursing home
134 residents
Forced ranking of 10 values
Values were paired and respondents chose most important value.

All values seemed very important to resident as they ranked values very close (standard deviation = 2.86)

Order of rankings for residents
1 Family & Visitors
2 Clean & comfortable surroundings
3 Good food
4 Caring Staff
5 Feeling useful
6 Affection
7 Religious Activities
8 Social Activities
9 Flexibility in daily schedule
10 Privacy

Knox & Upchurch, 1992

Table 4. Voices of Seniors Using Nursing Homes Page 3 of 7

Purpose	Location, Sample & Measurements	Findings	Authors
Determine most important qualities of nursing homes	15 cities in USA Groups of nursing home residents participated in a series of three focus groups each (450 residents, 135 discussion groups) Discussions with open ended questions	Most important components of quality care in: 1-Staff with good attitudes & feelings 2-Homelike environment 3-Food variety, choices, preparation & service 4-Activities 5-Medical care 6-Cleanliness 7-Administration 8-Religious participation 9-Resident council and rights 10-Community activities	National Citizens' Coalition for Nursing Home Reform, 1985
Understand how the decision to enter a nursing home was made and feelings about it	New South Wales 5 nursing homes 19 seniors In-depth interviews	Themes emerged: 1 there was no choice 2 lost everything to go to the home 3 felt self was devalued 4 believe it was their end of life	Nay, 1995
Investigate the experiences of older people as they move from a hospital into a nursing home	Northern & Yorkshire Region, England 20 seniors, 17 family members - after discharge from hospital to a nursing home open ended interviews with one month in home	Move had profound change in their lives -move was distressing, lifestyle uncomfortable -move was relief from the anxiety and uncertainty -life unexpectedly pleasant Seniors did not view themselves as in control or with choices, just accepted move into home; asked family to select one	Reed & Morgan, 1999

Table 4. Voices of Seniors Using Nursing Homes Page 4 of 7

Purpose

Location,
Sample &
Measurements

Findings

Authors

Compare objective data regarding incontinence and mobility care quality with resident surveys

3 nursing homes,
99 incontinent residents interviewed;

Satisfaction measurements:
1) Direct scaled satisfaction questions
2) Indirect satisfaction = preference questions, e.g., do you want (more or less) mobility care?
3) Objective
Discrepancy = observed - preferred number of times want care
4) perceived discrepancy = preferred - perceived times care wanted

Average pad change / day = 0.57
Assists to the toilet / day = 0.37
Assists to walk / day = 0.23
52%, 64% & 78%
residents had accurate memory of pad changes, assists & walks (respectively)
Residents' reported preferences were an average of 2 more pad changes, 1.5 more toilet assists, and 2 more walk assists than normally received.
Direct satisfaction questions, are consistently higher than other questions. The objective and perceived discrepancy questions gave the most dissatisfaction.

Simmons & Schnelle, 1999;
Simmon, Schnelle, and Rahman, 1998

Assess whether nursing homes could utilize SERVQUAL questionnaire to determine service quality

Wisconsin
41 nursing homes
416 family members of
Questionnaire had 21 questions.
Each question used 7 point response scale.

Family members scores aggregated by nursing home to determine means/ nursing home
The number of deficiencies and complaints correlated to mean satisfaction scores (scale = 1-7)

Mean satisfaction
Responsiveness	4.99
Reliability	6.13
Assurance	6.11
Empathy	5.89
Tangibles	6.12

All correlations statistically significant, except -0.16.

Steffen & Nystrom, 1997

Table 4. Voices of Seniors Using Nursing Homes Page 5 of 7

Purpose	Location, Sample & Measurements	Findings	Authors
Determine residents' perceptions of nursing staff and their relationship to independent judgments of nursing home quality	Miami, Florida 10 nursing homes 239 residents Residents completed two questionnaires evaluating nursing staff. First scale had 6 items with a 5 point response set. Second instrument had brief situation and residents stated what they thought their nursing staff would do. Three external health professionals rated nursing home quality on 4 point scale.	In poorer quality homes, residents perceived nurses had less respect, communication, and concern. The response to call lights was slower and residents believed staff members did not like their work. For the second questionnaire, residents in poorer quality homes less often selected favorable behaviors.	Stein, et al., 1986

Table 4. Voices of Seniors Using Nursing Homes Page 6 of 7

Purpose

Location,
Sample &
Measurements

Findings

Authors

Determine if residents' ratings of the social climate is significantly associated with independent judgments of nursing home quality

Miami, Florida
10 nursing homes, and 301 residents completed the Sheltered Care Environment Scale.
Social workers independently rated the quality of care in these homes as good, fair poor.

Resident ratings of social climate (highest possible score = 100):

	Good Homes	Poor Homes
Cohesion	66.2	41.1**
Conflict	33.5	40.7
Independence	38.7	30.6*
Self-explorations	27.9	32.4*
Organization	72.4	53.9***
Resident influence	62.5	40.3***
Physical comfort	77.0	65.2*

* = statistically significant differences

Stein, et al., 1987

Explore how family members perceive their roles and their perceptions of the quality of care provided their relative.

Minneapolis
3 nursing homes
25 family members
1-2 hour semi structured interviews were conducted
Family members Interviews were audiotaped & two independent researchers identifying emerging themes

Roles and involvement included:
maintaining family connectedness
maintaining resident's dignity
maintaining control over room
serving as an advocate for relative & other residents
maintaining & improving health of relative
Majority of family members were satisfied with overall quality of life and care.
Identified Quality Concerns:
1-Lack of communication among staff, residents, & family members
2-Don't trust consistent good care given
3-Fail to maintain residents' dignity
4-Discourage families' involvement

Stum and Schmitz, 1990

Table 4. Voices of Seniors Using Nursing Homes Page 7 of 7

Purpose	Location, Sample & Measurements	Findings	Authors
Classify personal care complaints against nursing homes	Texas All complaint records for 49 nursing homes in Texas reviewed for 2 years (340 complaints)	40% of all complaints were personal care complaints (340) complaints categorized: 27% bathing & personal hygiene 19% respect and consideration 12% supervision & safety 9% feeding care 8% incontinence care 7% comfort and assistance 6% response to call lights 5% decubitus care 3.5% water and fluid intake 3.5 rehab and preventive care	Wagnild, 1986