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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Small is beautiful? Explaining resident satisfaction in Swedish nursing home care

Authors: Douglas Spangler, Paula Blomqvist, Ylva Lindberg, Ulrika Winblad

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Resident satisfaction is an important aspect of nursing home quality. Despite this, few studies have systematically investigated what aspects of nursing home care are most strongly associated with satisfaction. In Sweden, a large number of processual and structural measures are collected to describe the quality of nursing home care, though the impact of these measures on outcomes including resident satisfaction is poorly understood.

Methods

A cross-sectional analysis of data collected in two nationally representative surveys of Swedish eldercare quality using multi-level models to account for geographic differences.

Results

Of the factors examined, nursing home size was found to be the most important predictor of resident satisfaction, followed by the amount of exercise and activities offered by the nursing home. Measures of individualized care processes, ownership status, staffing ratios, and staff education levels were also weakly associated with resident satisfaction. Contrary to previous research, we found no clear differences between processual and structural variables in terms of their association with resident satisfaction.

Conclusions

The results suggest that of the investigated aspects of nursing home care, the size of the nursing home and the amount activities offered to residents were the strongest predictors of satisfaction. Investigation of the mechanisms behind the higher levels of satisfaction found at smaller nursing homes may be a fruitful avenue for further research.
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Literature
1.
Sanford A, Orrell M, Tolson D, Abbatecola AM, Arai H, Bauer JM, et al. An International Definition for “Nursing Home.” J Am Med Dir Assoc 2015;16(3):181–184.PubMed
2.
Isaksson D, Blomqvist P, Winblad U. Privatization of social care delivery – how can contracts be specified? Public Manag rev. 2017;27:1–20.
3.
Colombo F, Murakami Y. Measuring quality in long-term care. In: OECD/European Commission, editor. A Good Life in Old Age?: Monitoring and Improving Quality in Long-term Care. OECD health policy studies, OECD publishing; 2013. p. 53–92.
4.
Gerritsen DL, Steverink N, Ooms ME, de Vet HCW, Ribbe MW. Measurement of overall quality of life in nursing homes through self-report: the role of cognitive impairment. Qual Life Res. 2007;16(6):1029–37.PubMedPubMedCentral
5.
Spector A, Orrell M. Quality of life (QoL) in dementia: a comparison of the perceptions of people with dementia and care staff in residential homes. Alzheimer Dis Assoc Disord. 2006;20(3):160–5.PubMed
6.
Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1):41–8.PubMed
7.
Tsai TC, Orav EJ, Jha AK. Patient satisfaction and quality of surgical care in US hospitals. Ann Surg. 2015;261(1):2–8.PubMedPubMedCentral
8.
Hoe J, Hancock G, Livingston G, Orrell M. Quality of life of people with dementia in residential care homes. Br J Psychiatry. 2006;188(5):460–4.PubMed
9.
Hoe J, Katona C, Roch B, Livingston G. Use of the QOL-AD for measuring quality of life in people with severe dementia—the LASER-AD study. Age Ageing. 2005;34(2):130–5.PubMed
10.
Kane RA, Kling KC, Bershadsky B, Kane RL, Giles K, Degenholtz HB, et al. Quality of life measures for nursing home residents. J Gerontol Ser A. 2003;58(3):M240–8.
11.
Thorgrimsen L, Selwood A, Spector A, Royan L, de Madariaga LM, Woods RT, et al. Whose quality of life is it anyway?: the validity and reliability of the quality of life-Alzheimer’s disease (QoL-AD) scale. Alzheimer Dis Assoc Disord. 2003;17(4):201–8.PubMed
12.
Donabedian A. Explorations in quality assessment and monitoring. Volume I, the definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press; 1980.
13.
Donabedian A. Quality assessment and assurance: Unity of purpose. Diversity of Means Inquiry. 1988;25(1):173–92.PubMed
14.
Backhaus R, Verbeek H, van Rossum E, Capezuti E, Hamers JPH. Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies. J Am Med Dir Assoc. 2014;15(6):383–93.PubMed
15.
Baldwin R, Chenoweth L. dela Rama M, Wang AY. Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality. Health Care Manag Rev. 2017;42(4):315–27.
16.
Hillmer MP, Wodchis WP, Gill SS, Anderson GM, Rochon P. a. Nursing home profit status and quality of care: is there any evidence of an association? Med Care Res Rev. 2005;62(2):139–66.PubMed
17.
Williams J, Hadjistavropoulos T, Ghandehari OO, Yao X, Lix L. An evaluation of a person-centred care programme for long-term care facilities. Ageing Soc. 2015 Mar 7;35(03):457–88.
18.
Chou S-C, Boldy DP, Lee AH. Factors influencing residents’ satisfaction in residential aged care. The Gerontologist. 2003;43(4):459–72.PubMed
19.
Bishop CE, Weinberg DB, Leutz W, Dossa A, Pfefferle SG, Zincavage RM. Nursing assistants’ job commitment: effect of nursing home organizational factors and impact on resident well-being. The Gerontologist. 2008;48(suppl 1):36–45.PubMed
20.
Lucas JA, Levin CA, Lowe TJ, Robertson B, Akincigil A, Sambamoorthi U, et al. The relationship between organizational factors and resident satisfaction with nursing home care and life. J Aging Soc Policy. 2007;19(2):125–51.PubMed
21.
Kenkmann A, Price GM, Bolton J, Hooper L. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision. BMC Geriatr. 2010;10.
22.
Poey JL, Hermer L, Cornelison L, Kaup ML, Drake P, Stone RI, et al. Does person-centered care improve residents’ satisfaction with nursing home quality? J am med Dir Assoc. 2017 Jul 25;
23.
Tse MMY. Therapeutic effects of an indoor gardening programme for older people living in nursing homes. J Clin Nurs. 2010 Apr;19(7–8):949–58.PubMed
24.
Erlandsson S, Storm P, Stranz A, Szebehely M, Trydegård G-B. Marketising trends in Swedish eldercare: competition, choice and calls for stricter regulation. In: Meagher G, Szebehely M, editors. Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm: Department of Social Work, Stockholm University; 2013. p. 23–83.
25.
OECD. A Good Life in Old Age?: Monitoring and Improving Quality in Long-term Care. OECD Publishing; 2013. (OECD Health Policy Studies).
26.
Winblad U, Blomqvist P, Karlsson A. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden. BMC Health Serv Res. 2017;17(1):487.PubMedPubMedCentral
27.
Hjelmar U, Bhatti Y, Petersen OH, Rostgaard T, Vrangbæk K. Public/private ownership and quality of care: evidence from Danish nursing homes. Soc Sci Med. 2018;216:41–9.PubMed
28.
Kajonius PJ, Kazemi A. Structure and process quality as predictors of satisfaction with elderly care. Health Soc Care Community. 2016;24(6):699–707.PubMed
29.
SFS 2001:453. Socialtjänstlag. Stockholm: Socialdepartementet;
30.
31.
32.
Moberg L. Marketisation of Nordic eldercare – is the model still universal? J Soc Policy. 2017 Jul 21;46(03):603–21.
33.
Moberg L, Blomqvist P, Winblad U. Professionalized through audit? Soc Policy Adm: Care workers and the new audit regime in Sweden; 2017.
34.
35.
36.
NBHW. Vad tycker de äldre om äldreomsorgen? - en rikstäckande undersökning av äldres uppfattning om kvaliteten i hemtjänst och äldreboenden 2012. Stockholm; 2012.
37.
38.
Gustafsson I-B, Öström Å, Johansson J, Mossberg L. The five aspects meal model: a tool for developing meal services in restaurants. J Foodserv. 2006;17(2):84–93.
39.
40.
Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.PubMed
41.
DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. J Gen Intern Med. 2006;21(3):267.PubMedPubMedCentral
42.
Bostick JE, Rantz MJ, Flesner MK, Riggs CJ. Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006;7(6):366–76.PubMed
43.
Bergman MA, Johansson P, Lundberg S, Spagnolo G. Privatization and quality: evidence from elderly care in Sweden. J Health Econ. 2016;49:109–19.PubMed
44.
Pearl J. Causal diagrams for empirical research. Biometrika. 1995 Dec 1;82(4):669–88.
45.
Harrell FEJ. rms: Regression Modeling Strategies. 2018.
46.
Gelman A, Hill J. Data analysis using regression and hierarchical/multilevel models. Cambridge: New York, NY; 2007.
47.
Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015 Oct;67(1):1–48.
48.
49.
Nakagawa S, Schielzeth H. A general and simple method for obtaining R2 from generalized linear mixed-effects models. Methods Ecol Evol. 2013;4(2):133–42.
50.
Carter MW, Porell FW. Variations in hospitalization rates among nursing home residents: the role of facility and market attributes. The Gerontologist. 2003;43(2):175–91.PubMed
51.
Cioltan H, Alshehri S, Howe C, Lee J, Fain M, Eng H, et al. Variation in use of antipsychotic medications in nursing homes in the United States: a systematic review. BMC Geriatr. 2017;17(1):32.PubMedPubMedCentral
52.
Castle NG, Engberg J. Organizational characteristics associated with staff turnover in nursing homes. The Gerontologist. 2006 Feb 1;46(1):62–73.PubMed
53.
Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, et al. Nursing home quality, cost, staffing, and staff mix. The Gerontologist. 2004;44(1):24–38.PubMed
54.
Cichocki M, Quehenberger V, Zeiler M, Adamcik T, Manousek M, Stamm T, et al. Effectiveness of a low-threshold physical activity intervention in residential aged care--results of a randomized controlled trial. Clin Interv Aging. 2015;10:885–95.PubMedPubMedCentral
55.
Underwood M, Lamb SE, Eldridge S, Sheehan B, Slowther A-M, Spencer A, et al. Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial. Lancet. 2013;382(9886):41–9.PubMedPubMedCentral
56.
Mathey M-FAM, Vanneste VGG, De Graaf C, De Groot LC, Van Staveren WA. Health effect of improved meal ambiance in a Dutch nursing home: a 1-year intervention study. Prev Med. 2001;32:416–23.PubMed
57.
Liu W, Galik E, Boltz M, Nahm E-S, Resnick B. Optimizing eating performance for older adults with dementia living in long-term care: a systematic review. Worldviews Evid-Based Nurs. 2015;12(4):228–35.PubMed
58.
Castle NG. Nursing home caregiver staffing levels and quality of care: a literature review. J Appl Gerontol. 2008;27(4):375–405.
59.
Castle NG, Anderson RA. Caregiver staffing in nursing homes and their influence on quality of care. Med Care. 2011;49(6):545–52.PubMed
60.
Hyer K, Thomas KS, Branch LG, Harman JS, Johnson CE, Weech-Maldonado R. The influence of nurse staffing levels on quality of Care in Nursing Homes. The Gerontologist. 2011;51(5):610–6.PubMedPubMedCentral
61.
Shin JH, Hyun TK. Nurse staffing and quality of Care of Nursing Home Residents in Korea. J Nurs Scholarsh. 2015;47(6):555–64.PubMed
62.
NBHW. Bilaga 4: Fördjupad bortfallsanalys. In: Vad tycker de äldre om äldreomsorgen? - en rikstäckande undersökning av äldres uppfattning om kvaliteten i hemtjänst och äldreboenden 2012. Stockholm: NBHW; 2012. p. 67–69.
63.
Wicherts JM, Veldkamp CLS, Augusteijn HEM, Bakker M, van Aert RCM, van Assen MALM. Degrees of freedom in planning, running, analyzing, and reporting psychological studies: a checklist to avoid p-hacking. Front Psychol. 2016;7:1832.PubMedPubMedCentral
64.
Mazor KM, Clauser BE, Field T, Yood RA, Gurwitz JH. A demonstration of the impact of response bias on the results of patient satisfaction surveys. Health Serv Res. 2002;37(5):1403–17.PubMedPubMedCentral
65.
Sitzia J, Wood N. Response rate in patient satisfaction research: an analysis of 210 published studies. Int J Qual Health Care. 1998;10(4):311–7.PubMed
Metadata
Title
Small is beautiful? Explaining resident satisfaction in Swedish nursing home care
Authors
Douglas Spangler
Paula Blomqvist
Ylva Lindberg
Ulrika Winblad
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4694-9

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