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Programs for the secondary consumer of long-term care services

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Programs for the secondary consumer of long-term care services

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Content PROGRAMS FOR THE SECONDARY CONSUMER OF LONG-TERM CARE
SERVICES
by
Marcia Ellen Lambert
A Thesis Presented to the
FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE IN GERONTOLOGY
May 1987
Copyright 1987 Marcia Ellen Lambert
UMI Number EP58937
Ail rights reserved
INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
Disssrtalioin F^icMismng
UMI EP58937
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
Microform Edition © ProQuest LLC.
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unauthorized copying under Title 17, United States Code
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789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 48106- 1346
UHIVBRSITV Of SOUTHERN CALIFORNIA
LEONARD PAl/IS SCHOOL OF GERONTOLOGY .
UNIVERSITY PARK ^
LOS ANGELES, CALIFORNIA 90007
TfuU mUXtzn by
______________Marcia Ellen Lambert _______ _
undeA th z difizctoK her Tke^ÂJ> Commùttzz,
and app^ovtd by aZZ iXA mejnbe/u, ha6 been pA,e-
àented to and accepted by the Vean The LeonoAd
Vavt6 Schoot O j J GeAontotogy, tn poAttaZ {^utitiZment
0 ^ th e xequtAementi ion. the degn.ee oi
MASTER OF SCIENCE IN GERONTOLOGY
Vote
THESIS COmiTTEE
é?. l/ÀcJ_____________
CkatAman
11
DEDICATION
In Memory of a Superior Electrical Engineer, Louis B.
Lambert, Ph.D., 1928-1970. "My Father" .
Ill
ACKNOWLEDGMENTS
The successful completion of this thesis would not
have been accomplished without the encouragement,
support and financing I have received from multiple
sources. I would like to express my appreciation to
my thesis committee for their time, guidance and
support: Eileen Crimmins, Ph.D. (Chairman of the
thesis committee) and Carolyne E. Paul, Ph.D. (second
reader of the thesis committee) . The computer
analysis could not have occurred without the patient
teaching and support of Mary Jackson.
Special thanks to Mr. William L. Pierpoint, Mr. Tom
Konig and Mr. William C. Scott for their health care
expertise and financial backing.
I would also like to thank the long-term care
administrators and family members who actively
participated in the questionnaire process.
I wish to express my personal appreciation to my
mother, Phyllis Lacon, for setting an excellent
example of a successful woman who serves a portion of
the health care needs in her community. I would also
like to thank her for suggesting that I not get
married until I finished my Master's degree and to my
dear Patrick Flood for waiting for me.
IV
I wish to express my personal appreciation to all
of my colleagues at the Leonard Davis School for their
words of encouragement that always helped to keep me
going as I strived to complete this study.
V
TABLE OF CONTENTS
Page
DEDICATION.............................................. ii
ACKNOWLEDGMENTS.................................... iii
LIST OF TABLES......................................... vii
CHAPTER
I. INTRODUCTION.................................. 1
II. LITERATURE REVIEW........................... 4
Intro duc t ion
Decision Making Process
Quality of the Relationship Between Parent
and Child
Family Involvement in Nursing Home Care
Quality and Enjoyment of Visits
Programs for the Family Members of Nursing
Home Residents
Conclusion
Hypothesis Statement
III. METHODOLOGY........ ■......................... 26
Introduction
Research Method
Setting and Sample
Questionnaire Development
IV. RESULTS........................................ 34
Introduction
Educational Classes
Support Groups
Focus Groups
Family Council Meetings
Joining an Educational Committee
Family Counseling
Willingness to Pay $20.00 for a Doctor to
Speak on Special Topics
Best Time to Conduct Classes
Open-Ended Questions
Summary of
VL
V. ANALYSIS OF OFFERING SPECIFIC PROGRAMS AT
EACH CENTER................................... 45
Interest in Programs by Nursing Center
Educational Programs
Support Groups
Focus Groups
Doctors to Speak on Special Topics
Family Counseling
Family Councils
Level of Care
Bed Size of a Facility
Cone lus ions
VI. SUMMARY AND CONCLUSIONS................... 55
Overview of the Findings
Implications and Recommendations
Suggestions for Future Research
BIBLIOGRAPHY............................................ 68
APPENDICES.............................................. 96
LIST OF TABLES
Page
VI 1
Table 1
Table 2
Table 3
T able 4
T able 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 11
Table 12
Table 13
Number of Questionnaires
Mailed and Frequency of
Response s............................ 70
Frequency and Percent of
Responses by Age
of Respondents...................... 71
Demographic Characteristics
of Respondents...................... 72
Percent of Respondents
Interested in Programs........... 74
Interest in Attending
Educational Classes by Gender... 75
Interest in Attending
Educational Classes by
Age of Respondent........... 76
Interest in Attending
Educational Classes by
Relationship to the Patient.... 77
Interest in Attending
Educational Classes by Length
of Time Patient is in
the Facility....................... 78
Interest in Attending
Support Groups by Gender........ 79
Interest in Attending a
Focus Group by Gender........... 80
Interest in Attending a
Focus Group by Length of
Time the Resident is in the
Long-Term Care Center........... 81
Interest in Attending Family
Counseling Sessions by Gender.. 82
Interest in Attending Family
Counseling Sessions by Age
of Respondent...................... 83
VI 1 1
Table 14 Interest in Attending
Counseling Sessions by
Length of Time Resident is
in Long-Term Care Center......... 84
Table 15 Best Time Available to Attend
Classe s/Counseling
Sessions by Gender............... 85
Table 16 Best Time Available to
Attend Classes by Employment
S tatus............................... 8 6
Table 17 Summary of the Relationship
Between Characteristics of
Resident and Whether Program
is Desired.......................... 87
Table 18 Percent Interested in
Attending Programs by Center 88
Table 19 Number of Respondents
Interested in Attending
Programs by Center..... 89
Table 20 Number and Percent of
Respondents Interested in
Attending Family Councils by
Center........................... 90
Table 21 Percent of Respondents
Interested in Attending
Focus Groups by Level of Care 91
Table 22 Percent of Respondents
Willing to Pay $10.00 for
Family Counseling by
Leve1 of Care.............. 92
Table 23 Percent Interested in
Attending Family Councils by
Leve1 of Care.................. 93
IX
Table 24 Interest in Joining an Educational
Committee by Level of
Care................................ 94
Table 25 Interest in Attending Family
Councils by Bed Size of a
Fac ility.......................... 9 5
CHAPTER I
INTRODUCTION
The purpose of this study is to examine the needs
of the secondary consumer or the purchasers of long
term care services. Past research indicates there is
a need to offer programs to the family members of
nursing home residents. For instance, York & Calsyn
(1977) indicated there was a need to help families
make their visits with their older relative more
productive. The results of their study also indicated
that family members were interested in attending
programs including, classes on aging, advice on how to
make their visiting more productive and enjoyable and
meeting with other families to share concerns and
problems. This study, however, was limited in scope
and only studied three Lansing Michigan area nursing
home s.
The purpose of the current study is to examine
further the interest of the secondary consumer or
purchaser of nursing home services in 45 long-term
care centers located in five western states. The
intent is to determine if the purchasers have any
interest in attending programs that could be offered
to them after admission of their relative or friend
into a nursing home. The goal of this study is to
2
identify programs and services of interest for the
family members, caretakers and friends of residents in
long-term care centers and make recommendations as to
which new programs and services should be offered in
the future.
The primary goal of this study is to identify
programs and target the best time to offer these
programs to the family members, care takers and
friends of long-term care residents. A secondary goal
is to assess: 1) the types of novel programs and
services these consumers would be interested in seeing
at the nursing center and 2) what could be done help
them enjoy their visits. This information will be
extremely helpful to the management of skilled nursing
facilities. It will allow them to target specific
programs as well as to assess the types of services
the consumer believes are most important.
These programs are intended not only to meet the
interest level of the consumer, it is possible that
they could also: 1) improve the relationship between
the facility and the family members, 2) decrease
family - centered complaints to the health department,
3) reduce unreasonable expectations that family
members may have about skilled nursing and long-term
care, 4) provide a service to the community, 5)
3"
improve resident-family interaction and 6) decrease
guilt of family members after choosing
The results of this study will be used to develop a
training program for selected employees of long-term
care facilities. The training program will include
suggested programs topics, courses and additional
resources to develop programs for the family members
of skilled nursing and long-term care facilities.
A literature review will follow and cover the
topics of; the decision making process of finding a
nursing home, the quality of the relationship between
parent and the child, family involvement in the
nursing home care and the quality and enjoyment of
visits and programs for the family members of nursing
home residents. A hypothesis will be developed and a
study conducted to prove or disprove this hypothesis.
The results of the study will be reported and
conclusions, recommendations and implications for
future research discussed in detail.
CHAPTER II
LITERATURE REVIEW
Introduction
A review of the literature was conducted to reveal
past research studies on the topics of: the decision
making process of the family members (and the factors
that enter into that process) , the quality of the
relationship between the parent and the child (and how
this is affected by nursing home placement), the
family involvement in nursing home care, the quality
and enjoyment of visits and programs for the family
members and adult children of nursing home residents.
An analysis of these topics will facilitate the
development of a hypothesis.
The residents of a nursing center are the consumer
group that are the actual users of the product of the
nursing services. This product is in the form of
services that may include components of skilled
nursing care, medical care, personal care,
rehabilitative care and domiciliary care (room and
board). There are also intangible services such as
respect, understanding and warmth that come from the
staff to the residents. However, at the time that an
individual is placed in the situation of requiring a
nursing care center, he or she may need assistance in
5“
the selection process. The person who gives
assistance to the infirm elderly is considered the
secondary consumer.
Richard Buchanon, a proponent of this viewpoint,
identifies secondary consumers as physicians,
social workers, hospitals discharge
coordinators, lawyers, clergy and relatives.
Data from HEW s National Nursing Home Survey,
1977, substantiates, Buchanon's premise. For
residents of nursing homes in 1977, the persons
who most often made arrangements for admission
were the resident's children, other people
(i.e., friend, guardian, attorney, physician or
clergy) and other relatives. Quite often the
person who arranged the admission, other than
the actual resident, will continue to p 1 ay an
active role in monitoring the continued
residence. This will necessitate the
recognition of two distinct consumer groups-the
resident and their sponsors. (Johnson, 1982)
There are many social myths regarding the family
relations of old people. The primary myth is that
older people are alienated from their families,
particularly from their children. This myth was
disproved by Ethel Shanas (1979). She found evidence
that led her to conclude that older people are not
rejected by their families. In the United States most
old people with children live close to at least one of
their children and see at least one child often. Most
old people see their siblings and relatives often, and
old people, when either bedfast or housebound because
of ill health, are twice as likely to be living at
home as to be resident in an institution.
6
Decision Making Process
The decision making process that is used when
selecting a nursing home for a friend or family member
is a brief and unsophisticated process. Although
there are many pamphlets that have been written on
"How to Choose a Nursing Home," family members often
do not have a great deal of time to decide to place
someone in a nursing home. They are usually compelled
to place a family member in a nursing home after an
acute hospitalization or after all other types of care
are exhausted. The decision making process was
studied by York & Calsyn (1977), Smallegan (1979),
Smallegan (1981), Johnson & Werner (1982), Smith
(1984) and Hatch & Franken (1984).
In a recent study of consumer behavior in nursing
center services, Scott M. Smith (1984) attempted to
increase administrator and director understanding of
the market's selection of long-term care services and
the family decision-making unit responsible for the
center selection. Decision maker perceptions of the
importance of daily operations and programs were also
dis eus s e d.
The research was part of a larger study
investigating the determinants of satisfaction
in the selection of a long-term care facility.
All persons surveyed were family, or in some
cases friends responsible for the care of those
persons currently enrolled in long term care
s. A questionnaire was developed that
identified the relative importance of decision
variables used by the decision makers in the
selection of long-term care services, (Smith,
1984)
The conclusions of this study focused on the
primary importance of the need for management to
understand the decision process through which decision
makers progress. "The first major finding is that the
decision process for selection of a long-term care
facility is limited in scope and is best described as
brief" (Smith, 1984). The average number of
facilities visited, called or inquired about through
the mail was 3.4. This number was reduced to a
smaller number for final consideration, the mean
number of which was 1.7. The decision maker has a
very short decision time due to the urgency of the
need for services. This fact coupled with the limited
number of facilities evaluated at the time the
decision was made places the decision maker very close
to making a decision when initial contact with
representatives from a facility are made.
The second finding was that the decision maker
knows very little about long-term care facilities.
The findings indicate that observable variables,
such as cleanliness of the facility, competency
of the nursing and medical staff (qualifications
of medical and nursing staff), safety,
pleasantness of the atmosphere and courtesy of
the staff were the most important attributes in
the selection decision. Cost of the
was not a major point of evaluation. Managerial
implications dictate that facility cleanliness
and general pleasantness of the staff and
administration be kept at a high level, as they
are of primary importance in facility selection.
(Smith, 1984)
It was interesting to note that advertising
communication directed at decision makers was shown to
be of minimal effect.
Physicians were reported to have the single
largest influence on the choice of a facility.
Marketing to physicians as a service to their
patients is a promising direction for facility
management. Communication is also suggested for
the decision maker after the selection decision
is made. This communication would assume the
role of communicating assurances that adequate
care is being administered. (Smith, 1984)
York & Calsyn (1977) determined that although
families do not ignore the elderly, they are not very
thorough or sophisticated in their search for a
nursing home for their older relative.
Fifty-one percent of the families did not even
visit the home their relative was placed in
prior to placement. Only 31% of the families
visited three or more homes before making their
decision. Availability of a bed (75%) and
location (62%) were the principal reasons given
by families for choosing a particular home.
Quality of staff (35%), quality of physical care
(10%), quality of the activity program (12%),
cleanliness (24%), and cost (15%) were much less
influential in the choice of a nursing home.
(York & Calsyn, 1977)
Physicians (83%) and hospital social workers (43%)
were listed by the family as being important factors
in the decision to place the patient in the nursing
9
home. However, the nursing home staff and the patient
themselves have less effect in the decision to place
the patient.
Smallegan (1979) conducted a pilot study of
decision makers for 19 persons in long term care
ins t i tut ions.
The decision makers were asked about their
concerns at the time of the admission, how long
the problems had been of concern, with whom they
talked about the decision, who else helped to
make the decision, and the reasons for their
decisions. (Smallegan, 1981)
The myth that elderly are "dumped" in nursing homes
was partially dispelled by this study. Smallegan
found that of the 19 admittees, nine were decision
makers.
Thus nearly half of the patients were involved
in the decision, and approximately two-thirds
appeared to concur. This sample was selected
from less debilitated patients. It is possible
that this factor accounts for the relatively
high percentage of patients who were decision
makers. (Smallegan, 1981)
Smallegan (1981) found that the other large groups
of decision makers were offspring and social workers.
Of the 34 total decision makers interviewed by
Smallegan, 9 were admittees, 7 adult children, 4
sisters, 7 social workers, 3 physicians, 1 mother, 1
granddaughter, 1 niece, 1 clergyman. The social
workers however, considered themselves only as helping
in making the decision, not as the actual decision
10
makers. Yet in each case someone had suggested that
they be part of the decision making process.
The research of this study found that even though
physicians recommended that an elderly person be
placed in a nursing center, the family did not act on
that advice until they believed they could no longer
manage to care for their own. The family only placed
its relative in a nursing center when the situation
deteriorated.
The precipitation of admission into a long-term
care institution was in the majority of cases due to
hospitalization. "Additionally, most of those
admitted to nursing homes had mobility problems at the
time of release from the hospital" (Smallegan, 1981).
The author of this study found no evidence of masking
or denial before admission. The people said they had
known things could not go on forever and seemed to
have kept the patient out of the nursing home for as
long as they could find a way to manage.
The decision makers rarely looked for options
between full-time care at home and the nursing
home. Rather, by the time the decision was
made , most patients had been cared for at home
for a period of time and the people involved
were so stressed by the situation that they were
ready to decide on nursing home placement even
though the decision was painful. (Smallegan,
1981)
11
The decision to admit these patients came when the
combination of the disruption to the home and level of
care needed proved to be to overwhelming.
All of the admittees had lived outside nursing
homes for a period of time after the onset of
debilitation. The decision for nursing home
admission care when that arrangement became too
difficult and no one was able to offer another
reasonable option. (Smallegan, 1981)
Hatch & Franken (1984) examined the decision making
process of adult children of nursing home residents.
The results indicated over half of the decisions
were related to paternal health and availability
of family care. Relationships between family
members usually remained the same or improved
after placement. In 89% of the cases, adult
children consulted other family members or
professional persons. Families made the
decision jointly in only 30% of the cases, and
doctors or parents themselves made the decisions
in the remaining instances. Chronic and recent
health problems of the parent appeared as the
most critical factors with the lack of family
members with both the time and ability to care
for the elderly person following closely....Data
from this study support the work of Brody
(19 7 7), Shanas (1979), and Teresi (1979) which
indicated decisions for nursing home placement
were made in the context of love, often after
alternatives such as family care had been
considered. Decisions were made on the basis of
values, available alternatives and both parental
and family needs. Major considerations were the
parents' health and the ability of the family to
provide necessary care. (Hatch & Franken, 1984)
The decision to place a family member in a nursing
home might cause guilt reactions. A study by Johnson
& Werner (1982) was conducted to examine the
relationships among a number of factors in the
12
decision making process and the amount of guilt
experienced within one year of the decision. The less
perceived choice a family member has when making a
decision to transfer or place a loved one in a nursing
center the less guilt should be experienced. For
example, if a physician recommends placement, or there
are several physical or psychological ailments, or
severe disabilities that could be sufficiently
compelling that the family members would feel little
choice. They would place responsibility of the
decision on the situation and not themselves, thereby
transferring the guilt.
They also examined the perceptions of pre-transfer
events for the relatives and other aspects of the
decision to move the patient that might affect
subsequent guilt reactions. In general respondents
were comfortable with their decisions. Most (80%) of
the patients had been moved from a hospital) and for
whatever reason the families had little opportunity to
seek out other alternatives. The diffusion of
responsibility hypothesis was not supported by the
correlation between respondent's guilt and his/her
degree of involvement. A recommendation by an expert
was not sufficient to reduce guilt but the decision by
13
(or possibly agreement with) a significant other is
(Johnson & Werner, 1982).
In conclusion, the decision making process of
placing a family member in a long-term care facility
is a brief and unsophisticated process. The decision
maker knows very little about long-term care
facilities and therefore, the decision is made on the
basis of location, availability, perceptions and
parental and family needs.
An adult child is compelled to place their parent
in a nursing home after an acute hospitalization or
after the patient is cared for at home and the
arrangement becomes too difficult to manage. A
physician will make the initial recommendation to
place the patient in a nursing home however, the
family does not act until they believe they can no
longer make it on their own.
The decision to place or transfer a family member
in a nursing home is made in the context of love. The
elderly are not dumped in nursing homes and are often
involved in the decision making process. Many
decision makers are often comfortable with their
decision to place a loved one in a nursing home. The
less choice a family member has in the decision, the
less guilt they perceive. There is also support for
14
the idea that parents should participate in the
decision making process.
There is a need for the management of skilled
nursing facilities to understand the decision making
process. The decision maker is usually compelled to
place their family member in a facility and has very
little time to 1earn about them. Advertising directed
to the consumer was found to have very little effect.
It has been suggested to market the facility to the
physicians. The physicians will make the initial
recommendation to the family and once they are ready
to place their loved one in a facility will act on
his recommendation.
Quality of the Relationship Between Parent and Child
After the decision making process has occurred and
the family or adult child has made a decision to
institutionalize their parent, changes occur in their
relationship. Four studies have been reviewed that
reveal how institutionalization affected the
relationship between the adult child and parent.
The first study examined how institutionalization
of an elderly parent affected the relationship between
the parent and the child who was instrumental in
placing the parent in the institution, as seen by both
15
generations. The important issues involved changes,
whether positive or negative in family interaction
following institutionalization (Smith & Bengtson,
1979) .
Six ideal types of consequences for family
relations were revealed, "The six types reflect
improvement, continuation, or deterioration of family
relationships following institutionalization, and were
distributed among families in the study as follows:
Renewed closeness and strengthening of family ties
(30%); Discovery of new love and affection (15%);
Continuation of closeness (25%) ; Continuation of
separateness (20%); Quantity without quality
interaction (10%); and Abdication: Institutions as
dumping ground" (Smith & Bengtson, 1979).
Renewed closeness was the most common type due to
the fact that in most cases institutionalization was
sought out by the child for the parent. After
placement, the child became freer to provide the
psychosocial and emotional aspects of care.
These patterns were expressed by both generations
in over one-half the families. Such patterns fail to
perpetuate the notion that families have abandoned the
institutionalized elderly. In fact, they even suggest
the opposite, that institutionalization actually
16
strengthens family relations. This might be due to
the fact that strains of caring for the elderly parent
are alleviated and this allows the child to
participate in a parents' care with less stress.
Before accepting this study as the final word, it
should be noted that this study had an extremely small
sample size and therefore it may not be representative
of the adult children of the institutionalized elderly
as a who le.
The second study in which the quality of the
relationship between adult child and parent was
examined was conducted by Hatch and Franken (1984) .
These researchers found that relationships between
family members usually remained the same or improved
after placement. The quality of the relationships
between the parent and child did not change due to the
placement decision.
In addition, the study revealed that none of the
parents who decided about their own placement seemed
to change their attitudes toward their children.
The third study by York & Calsyn (1977) found that
families do not separate themselves from their older
relative after placement. Nearly all of the families
studied maintained frequent phone contact with their
institutionalized family member.
17
The fourth study by Smith & Bengtson (1979) found a
reason mentioned by respondents for the strengthening
of family relationships was the parent's involvement
with other residents in the facility. Some parents
found themselves being able to help others and to grow
close to others. The parents then had something to
look forward to besides family visits. Growth of new
relationships also led to growth of family
relationships.
In conclusion, the quality of the relationship
between parent and child may change or remain the same
after the parent is institutionalized. The positive
consequences found after placement were renewed
closeness and discovery of new love and affection.
Children were found to continue to maintain frequent
phone contact with their parents. The children have
also been found to strengthen their family
relationships by becoming involved with other
residents in the facility.
Once the child is relieved of the burden of caring
for their parent by allowing the institution to care
for them, the child then becomes freer to provide the
psychosocial and emotional aspects of care. It has
been found that after institutionalizing a family
18
member, family relations can actually be strengthened.
Family Involvement in Nursing Home Care
The previous findings indicated that the
relationship between family members after placing a
loved one in a nursing center usually improved or
remained the same. The involvement of family members
in nursing home care has an impact on the continued
quality of the personal relationship between the
parent and child. Research has been conducted to
determine the quantity and quality of family visits to
patients in skilled nursing centers.
York & Calsyn (1977) investigated the quantity and
quality of family visits to the patient after
placement in a nursing home. The investigation was
undertaken in order to study some of the factors that
affect family involvement in nursing home care,
York & Calsyn (1977) found the families in the
study stayed involved with their older relatives after
placement. The mean number of visits per month was
12. Only two families visited the nursing home less
than twice monthly. They also found that families
tended to maintain patterns of involvement established
before placement. "The amount of family involvement
with the patient prior to placement was related to the
19
number of visits after placement" (York & Calsyn,
1977) .
Families tend to stay involved with their loved
ones after placement in a nursing home. However, the
quality and enjoyment of the visit is an important
factor in maintaining a healthy relationship. The
topic of quality and enjoyment of nursing home visits
is covered in the next section.
Quality and Enjoyment of Visits
The research of York & Calsyn, 1977 support the
findings that families do not abandon their relatives
in a nursing home. They determined a much more
significant and problematic issue is the quality and
enjoyment of visits.
Forty-two percent of the families reported
enjoying less than half of their visits.
Enjoyment of visits was not related to what was
done on visits (i.e., activities versus just
talking). However, enjoyment of visits was
related to the amount of mental deterioration of
the patient. Families of those older people who
were disheveled and/or confused seemed to have
less enjoyable visits. However, enjoyment of
visits was not significantly related to physical
or sensory disabilities. Family members
confirmed that they did have greater difficulty
coping with mental deterioration (37%) than
physical disabilities (15%). (York & Calsyn,
1977 )
The quantity of research on the topic of quality of
enjoyment of visits is limited. However, it is
20
important to note that families level of enjoyment was
not related to participation in any activities during
the visit and they do not enjoy visiting a nursing
home when their family member has deteriorated
mentally.
Programs for the Family Members of Nursing Home
Re s idents
The results of numerous studies have indicated the
need to develop programs for the family members of
nursing home residents (York & Calsyn 1977; Hatch &
Franken 1984; Dobrof & Litwak, 1977). The results of
the study by York & Calsyn (1977 ) indicated the need
to help families make their visits with their older
relatives more productive. In this respect, 83% of
the families indicated they would want to take part in
some sort of program that might be offered by the
nursing home for their benefit. "Over 2/3 wished to
meet with the staff, 51% indicated that they would
attend classes on aging; and 47% expressed interest in
getting advice on how to make their visiting more
productive and enjoyable. A lesser but still
considerable amount ; 30%, were interested in meeting
with other families to share concerns and problems"
(York & Calsyn, 1977).
21
Suggestions for programs were classes concerning
the aging process, a program in nursing home visiting
and group meetings for families. Training families to
visit more productively would be geared toward
improving the quality and enjoyment of these visits
for both parties and toward developing a therapeutic
and constructive role for the family. This study also
indicated that the nursing staff was somewhat filling
this gap in support ive help for the family. "Over 80%
of the families felt that they received some support
from the nurses in dealing with their relatives'
physical problems and 38% in dealing with emotional
problems from the nurses aides, a group traditionally
looked upon as the least knowledge ab1e and
professional in a nursing home" (York & Calsyn, 1977).
The respondents of the York & Calsyn (1977) study
wanted support and educational groups, skill training,
and referrals to agencies which could provide help
before, during and after the decision process.
Hatch & Franken (1984) made recommendations from
their study to develop programs that would help
families who are caring for elderly parents at home,
who are evaluating alternatives for care, and who are
trying to help parents adjust to placement. Respite
care, day care centers, or day care services at
2 2
nursing homes might permit some parents to remain with
their children. Short-term care of the elderly during
family trips and day care in nursing homes might add
to nursing home revenues thus easing overhead costs
for everyone and might also provide an adjustment or
get-acquainted time for potential full-time residents
(Hatch & Franken, 1984).
Many parents and children interviewed expressed a
need for more extensive community services.
Counseling of families following
institutionalization may be more effective.
Perhaps much of the guilt that so many children
feel because they cannot take care of their
parents could be lifted if consequences are
realistically explored. The findings of this
study indicate that family members are involved
with their institutionalized parent. The
program of the institution then must involve not
only the r e s i dent - p at i ent s , but all their
children and grandchildren. Families must be
encouraged to be involved and not treated as
intruders within the institutional setting.
(York & Calsyn, 1977)
Hatch & Franken (1984) found that children felt the
need for personal support, medical advice, and
information about alternatives and agencies. The
majority of these needs were not met. Feelings of
love, sadness, guilt, helplessness, and resignation
were common. Family counseling and supportive
educational groups were recommended to aid decision
making adjustment.
23
Dobrof and Litwak (1977) give several suggestions
for incorporating family members into the services
offered to resident-patients. Some of their ideas
include special Sunday entertainment for families,
arts and crafts exhibits, family programs on special
holidays and days set up just to honor families such
as Grandparent's Day.
Cone lus ion
In conclusion, a review of the literature indicates
that family members do not dump the elderly in nursing
homes. The nursing home residents' children, other
relatives and friends make their arrangements for them
and continue to play an active role in monitoring
their continued stay at the facility. Although the
decision making process is difficult for family
members, they are usually comfortable with their
decision once it has been made. The families however
are not very thorough or sophisticated in their search
for a nursing home. This is due to the fact that the
majority of nursing home placements take place after
an acute hospitalization and there is little time to
visit many nursing homes.
After the decision has been made to place a family
member in a skilled nursing facility, the quality of
24
the relationship between the adult child and their
parent generally remained the same or improved.
Research has indicated that adult children have often
have a renewed closeness with their parent after
institutionalizing them. The child was able to
provide their parent with the psychosocial and
emotional aspects of care that they could not provide
under the strains of caring for the parent at home.
The results of the studies indicated a need to
develop programs for the family members of nursing
home residents. Families were interested in attending
programs that would take place in a nursing center.
There was interest in meeting with the staff,
attending classes on aging, getting advice on how to
make their visits more enjoyable, meeting with other
families to share concerns and problems, counseling
programs and more community services.
The hypothesis to be tested in this study follows
from these findings. This study will attempt to
significantly expand the sample size of any previous
attempts to assess the need for family programs in
nursing centers.
25
Hypothesis Statement
There is a need to offer programs or services to
the adult children, friends of the o r
patients who are in nursing homes.
26
CHAPTER III
METHODOLOGY
Introduction
The purpose of conducting this study was to improve
and increase the programs offered to the relatives and
friends of the residents in skilled nursing
facilities. The results of the questionnaires were to
be used to help develop new programs for the friends
and family of nursing home residents. It was
important to target programs and services that the
family members were interested in attending. The
future success of these programs would depend on the
interest level and response rate of the answers to
this questionnaire.
Permission was granted to conduct the study by the
corporate executive officer and the president of the
long-term care group of a major health care
corporation based in Los Angeles. Questionnaires were
distributed to 45 long-term care facilities in five
western states (California, Arizona, Texas, Oregon and
Washington).
All the questionnaires were printed with a cover
27
letter that described the purpose of the project
(Appendix A).
Research Method
The investigator requested that the administrators
of the 45 long-term care facilities send out the
questionnaires to the person who was listed as the
"responsible party" for each of their residents.
A questionnaire was developed by the researcher
consisting of fifteen multiple choice and three open-
ended questions. The questions included the topics
of :
1) Demographic information: a) year of
birth, b) sex, c) length of time
friend/family was in the nursing
center, d) employment status and e)
education level.
2) Interest in attending programs: a)
educational programs, b) support
groups, c) focus groups, d) family
councils and e) community education.
3) Willingness to pay for programs: a)
doctors to lecture and b) family
c ouns e1ing.
4) Best time to attend programs.
28
5) How many other family members would be
interested in attending and their
relationship to the respondent.
6) Interest in programs and services at
the nursing center that are not
already provided.
7) What could be done to help the
respondent enjoy their visit.
A sample is contained in Appendix B. This
questionnaire was used as the research method to study
the program preferences of the relatives and friends
of the institutionalized elderly.
All questionnaires were identical and were
developed by the investigator. All were sent out the
same day. A memorandum asking the administrators to
comply with the research study was enclosed in the
packet of the questionnaires as well as a letter to
all family and friends asking them to participate in
the research study.
The questionnaires were all pre-coded with a number
assigned to each long-term care center. The
questionnaires were returned in their postage paid
envelops to the headquarters of the major corporation.
29
The respondents were asked on November 10, 1986 to
respond to the questionnaire by December 15, 1986. An
enclosed prepaid envelop was included for their
convenience. The respondents were given a phone
number to call if they had any further questions. The
bulk of the questionnaires were returned before
December 30, 19 8 6
Setting and Sample
The questionnaire was sent to the administrators of
32 skilled nursing centers, 6 intermediate care
centers and 7 retirement hotels in five western
states . The number of questionnaires that were sent
out varied in each center due to the b e d ^ size of the
facility. A total of 5,239 questionnaires were mailed
to the centers, however, not all of the administrators
complied with the request to send out the
questionnaires. Therefore, 26 skilled nursing
centers, 5 intermediate care centers and 4 retirement
hotels actually participated in the study. A total of
4,347 questionnaires were distributed.
The investigator requested that the administrators
send out the questionnaires to the person who was
listed as the responsible party for the resident. Of
the 35 facilities that participated in the study, 464
30
responses were received by the investigator. The
percentage of the rate of return for the responses was
10.7. The variation of the rates of return are
displayed in table 1. The lowest rate of return from
one facility was 2 percent and the highest 30 percent.
Characteristics of Sample
There were 36 long-term care centers that
participated in the study. The administrators of the
eight centers missing data did not choose to
participate in the study. A list of the centers that
did not participate is in Appendix C. The highest
frequency of participation in one center was 31
respondents and the lowest was 2. The centers with
over 20 respondents were: Fountain Care Center (31),
Canyon Care Center (23), Palm Grove Care Center (23),
Coronado Care Center (21), Town & Country Manor (20),
Careousel Care Center (20), Hemet Convalescent
Hospital (20) and Valley Convalescent Hospital (20)
(Table 1).
The greatest percent of respondents answering the
questionnaire was 30 and the lowest was 2. The
centers with the greatest response rate were: Silver
Gardens (30%), Evergreen (20%), Palm Grove (20%),
3T
Hemet Convalescent (20%), Valley Convalescent (20%)
and Roya1wood (19%) (Table 1) ,
The ages of the respondents ranged from 22 years
old to 92, However, the respondents between the ages
of 60-79 had the highest frequency of responses in
their individual age categories. The percent of the
total participants from this age category was 33.0%
The second highest percent of responses were from
people 50-59 (26.4%). Respondents between the ages of
90-99 and 20-29 were the least responsive (.4% and .6%
respectively (Table 2).
The mean age of the total 450 respondents was 60.6.
The mean age of the males was 62.5 and the females
59.6. Of the respondents, 33.7% were male and 66.3%
were female (Table 3).
The marital status of the respondents were 78.5%
were currently married and 11.5% were widowed. Small
percentages were never married (3.7%) or divorced
(6.3%) (Table 3).
The relationship between the long-term care
resident and the respondent had a skewed distribution.
Children of the resident responded most frequently
(58.0%). The category with the second highest percent
of respondents were "others" (13.9%). These people
could be legal guardians or conservators. Spouses
T2"
responded at a 9.6 percent rate of return and
relatives at 9.1 percent. All other categories had
between a .4 to a 4.6 percent response rate (Table 3).
The sample studied distinguished respondents by the
length of time their family member had been a resident
of the long-term care facility. Of the 464 responses
received, 151 of the respondents had a relative or
friend in the facility between 2-5 years (32.5%). The
second highest percentage (21.6%) was by respondents
who had a friend or family member in the facility for
one year or more. The third highest percentage 14.7
was by respondents who had a friend in a facility over
5 years. Respondents with friends or family members
in the facility less than a year responded less
frequently (table 3).
Questionnaire Development
The development of the questionnaire was a four part
process. First, a pilot study utilizing the
questionnaire was conducted of the vice-presidents in
charge of each region of the long-term care centers
for the major corporation. Each vice president was
asked to take the questionnaire and make
recommendations for changes. The recommendations were
considered and the questionnaire was edited
33
accordingly. Secondly, the questionnaire was edited
and approved by the president of the long-term care
group of the major corporation. Thirdly, the
questionnaire was reviewed by the thesis chairman and
co-chairman. Finally, the questionnaires were given
out to people randomly chosen who were not in the
given sample. They were asked to fill out the
questionnaires and return them, this data was
discarded from the pilot study.
After the responses were collected, the
questionnaires were coded and re-coded by the
investigator, three questionnaires were selected at
random and re-coded by a professional colleague.
Reliability of the investigator's coding was found to
be 100%. This can be attributed to the fact that most
of the data were objective.
34
CHAPTER IV
RESULTS
Int ro duc t i on
In this section, I am going to look at the
respondents interest in attending educational classes,
support groups, focus groups, family councils and
joining an educational committee. I will examine the
respondents willingness to pay for family counseling
sessions and doctors lectures. The results will
indicate the best time to conduct these groups and
classes. The responses to the two open-ended
questions will also be reported. An overview of the
percent of respondents interested in the various
programs indicates 53% are interested in educational
classes and 51% in support groups. A smaller percent
(40%) were interested in attending focus groups.
However, very few respondents were interested in
paying $10.00 for family counseling and $20.00 for
doctors to speak (16% and 17%) respectively) (table
4) .
Educational Classes
The respondents were asked if they would attend
educational classes on the problems of aging (i.e.,
35
Alzheimer's disease, Parkinson's disease, stroke,
heart disease, cancer). Overall, 53% of the
respondents indicated interest in attending
educational classes (table 4).
There was a significant relationship noted between
gender and interest in attending educational classes
(Table 5) . The female respondents (60%) were
significantly more interested in attending than the
males (40 %) .
There was a significant relationship between the
reported age of the respondent and their interest in
attending educational classes (table 6). Generally,
respondents between the ages of 40-69 were more
interested in attending educational classes than those
under 40 or over 70. Of the respondents aged 50-59,
66% expressed interest in attending educational
classes, while 53% of the respondents who were 60-69
were interested in attending educational classes and
51% of the respondents who were 40-49 replied with
positive interest.
A significant relationship was found between the
respondents relationship to the resident and their
interest in attending educational classes (Table 7).
Children of the resident and the spouses were more
3 6
interested than others in attending educational
classes (60% and 59% respectively) (table 7).
The length of time a resident has been in a long
term care center was significantly related to the
interest of the respondent in attending educational
classes displayed a significant relationship (Table
8) . Sixty-five percent of the respondents whose
friend or relative had been in the nursing home or
retirement hotel for 1 week to 4 months reported an
interest in educational classes. While, 58% of those
with a friend or a relative in the facility for 4
months to 8 months also reported interested in
attending educational classes.
The respondents who had a friend or a relative in
the facility for 8 months to 12 months also reported
interest in attending educational classes (55%). Of
the respondents that had a friend or a relative in the
facility for 1-2 years 61% claimed interest in
attending educational classes.
However, respondents who reported having a relative
or friend in the center for 2-5 years or over 5 years
were uninterested in attending educational classes
(51% and 62% respectively) (Table 8).
37
Support Groups
One-half (50.5%) of the respondents would attend a
support group of people like themselves who had
decided to place their loved one in a nursing center.
There was a significant relationship between gender
and interest in attending support groups. Women were
more interested than men in attending support groups
(55% and 43% respectively) (table 9) . There was no
relationship between the age of the respondent and
interest in attending support groups. There was also
no relationship between the relationship of the
respondent to the patient and their interest in
attending support groups. There were no relationships
found between interest in attending support groups and
the level of the respondents education and the length
of time their friend or family member had been in the
f ac i1i ty.
Focus Groups
The respondents were asked if they were interested
in a focus group which would include participation on
such topics as "enjoying your visit in a nursing
home." Of the people who responded, 60.3% were not
interested in attending a focus group.
38
There was a significant relationship between gender
and interest in attending focus groups and gender
(Table 10). Women were more interested than men in
attending focus groups.
There was no relationship between interest in
attending focus groups and age, relationship to the
patient and level of education of the respondent.
There was a significant relationship between length
of time a resident was in the long-term care center
and the respondents interest level in attending focus
groups. The results indicated that 55% of the
respondents that had a friend or a relative in the
facility for 1 week to 4 months and 53% who had a
relative or friend in for 4-8 months had interest in
attending a focus group. The respondents who had a
friend or relative in the facility over 8 months had
less interest in attending focus groups (table 11).
Family Council Meetings
The results indicated 51.4% of the respondents said
they would be interested in attending family council
meetings and 16.1% said they already attend. There
were eight centers that have respondents who already
attend family council meetings. These same centers
-------------------------- 3 9
also showed that there were additional respondents who
were interested in attending family council meetings.
Joining an Educational Committee
The results indicated 30% of the respondents were
interested in joining an educational committee that
would go into the community and teach the about the
problems of aging. There was an insignificant
relationship between the variables of gender, age ,
relationship to the patient, level of education of the
respondent and the length of time a patient or
resident had been in the facility and the willingness
to join an educational committee.
Family Counseling
The results of this study indicated 16.4% of the
respondents were willing to pay $10.00 a session for
family counseling. There was a significant
relationship between gender and willingness to attend
family counseling sessions. As noted in table 12, 90%
of the males and 80% of the females were not
interested in paying $10.00 for a family counseling
session. There was a significant relationship between
the age of the respondent and their willingness to pay
$10.00 for a family counseling session. Respondents
40
were not willing to pay $10.00 for family counseling.
For example, 78% of the respondents 39-49 years old,
82% (50-69) and 93% (70 and over) were unwilling to
pay for counseling (Table 13).
There was an insignificant relationship between
willingness to attend family counseling sessions and
the respondents relationship to the patient as well as
their level of education.
A significant relationship existed between the
length of time a resident has been in a facility by
their friends or relatives willingness to pay $10.00
for a family counseling session (Table 14).
Respondents who had a friend or family member in a
long-term care facility for 8 months to 12 months were
most interested in attending family counseling
sessions (33%). Respondents who had a friend in the
facility for 1 week to 4 months and those from 4
months to 8 months were both interested in attending
counseling sessions (24% respectively). Respondents
with family members in the facility over one year were
not as interested (table 14).
— - 2 n r
Willingness to Pay $20.00 for a Doctor to Speak
on Special Topics
The majority of the respondents (83.5%) were not
willing to pay $20.00 for a doctor to speak on special
topics. There was an insignificant relationship
between the variables of gender, age, relationship to
the patient, level of education of the respondent and
the length of time a patient had been in the facility
and willingness to pay $20.00 for a doctor to speak on
special topics.
Best Time to Conduct Classes
The best time to conduct classes or counseling
sessions would be weekdays (43.4%), evenings (34.7%)
and weekends (10.9%) (Table 15). There was a
significant relationship between gender and best time
available to attend classes. Women indicated the best
time for them would be on weekdays (51%) and evenings
(29%) . The men indicated their best time would be
evenings (47%) and weekdays (27%).
There was an insignificant relationship between the
best time to conduct classes and the relationship of
the respondent to the patient and the level of
education of the respondent.
42
There was a significant relationship between the
variable of the employment status of the respondent
and the best time to conduct classes (Table 16) .
Retired respondents (69%) and respondents not working
(54%) indicated that weekdays were the best time they
were available to attend classes. However,
respondents who were working indicated the best time
for them to attend would be in the evening.
Open-Ended Questions
There were 288 responses to the question concerning
the types of programs and services the respondents
would like to see at the nursing center. The
categorized responses indicated there were requests
for better personal care (100), increased activity
programs (74), positive comments (53), increased
staffing (34), improved food (16), more furniture
912), decreased noise levels (5) and home care
training classes (3).
Two-hundred and twenty-three responses were
recorded from the question pertaining to what could be
done to help the respondent enjoy their visit. The
respondents wanted better personal care for the
resident (73 responses), 50 respondents gave positive
comments, 29 requested extra space to visit, 20 wanted
— 4 3
more furniture, 8 wanted improvements in laundry
service, 7 requested better food service and 5
requested better volunteer programs.
Summary of Characteristics
A summary of the relationships between the
characteristics of the respondents and whether they
desired to attend a specific program is displayed in
table 17. Women between the ages of 40-69 who were
the child or the spouse of the resident were
interested in attending educational classes. There
was also a relationship between the characteristic of
length of time the resident had been in the facility
(1 week - 2 years) and a positive interest in
attending educational classes.
Women were more interested than men in attending
support groups. However, there was no relationship
between age , relationship and length of time and the
willingness to attend a support group.
A relationship was noted between the characteristic
of length of time a resident had been a facility (1
week - 8 months) and the respondents willingness to
attend a focus groups. There were no relationships
between any of the characteristics paying $10.00 a
44
family counseling or paying $20.00 for a doctor to
lecture on a special topic.
45
CHAPTER V
AN ANALYSIS OF OFFERING SPECIFIC PROGRAMS IN EACH
CENTER
Interest in Programs by Nursing Center
The purpose of this chapter is to analyze the
feasibility of offering specific programs in each
long-term care center. To assess the feasibility,
three separate analyses will be conducted. First, I
will summarize the percentages and numbers of
respondents who were interested in attending
educational classes, support groups, focus groups,
doctors lectures and family counseling (tables 18 and
19) .
Secondly, the interest levels of the respondents in
attending family councils will also be determined.
Since family councils already exist in certain
centers, the centers will be analyzed for percent and
number interested, uninterested and those who already
attend family council meetings (table 20).
Finally, an analysis of the variations by center
for percent and number of respondents interested in
specific programs will be conducted. The significant
variations will be explained using the variables of
4 6
level of care and bed size of the center.
The variable "level of care" was chosen to
exemplify the variations in program interest between
the three types of long-term care centers. Level of
care separates the various types of long-term care
centers into categories and allows analysis to be done
on which specific programs to offer in which type of
center. The variable level of care includes the
categories of retirement hotel, intermediate care
facility and skilled nursing facility. The variations
of level of care will be examined by the percentages
of respondents interested in attending educational
classes, support groups, focus groups, doctors
lectures, family counseling and family councils.
The variable "bed size" was developed to determine
if there was any variance between interest in a
program and the bed size of a long-term care facility.
The variable bed size includes categories of
facilities from 50 to 250 beds in 50 bed increments.
The significance was determined between bed size and
percentage of respondents interested in attending
educational classes, support groups, focus groups,
doctors lectures, family counseling and family
councils. The way the statistical measures were
reported was by using chi - square.
47
Educational Programs
There were 22 long-term care centers where the
respondents reported greater than a 50% interest level
in attending educational classes (Table 18). The
highest percent of interest was 100% and the lowest
was 25%. Of these 22 centers , 16 had over 5 people
interested and 7 had over 10 people interested in
attending educational classes (table 19). The highest
number of respondents interested in educational
classes was 17 and the lowest was 1.
Support Groups
There were also 22 long-term care centers where the
respondents reported over fifty-percent interest in
attending support groups. The highest percent of
respondents interested in attending support groups was
100% and the lowest was 0 (Table 18).
Of these centers, 16 had over 5 people interested
and 6 centers had over 10 people interested in
attending support groups (Table 19) . There were two
centers that had 13 respondents, three that had 11
respondents and one with 10 respondents interested in
attending support groups. There were however, two
centers that had no respondents interested in
attending the support groups.
— — 4 8
Focus Groups
The variations of the percent of a center's
respondents interested in attending focus groups was
between 0 and 100 percent. There were 10 long-term
care centers with greater than a 50% interest in
attending focus groups. Of these centers four had a
50% interest level, one had a 60% interest level, two
a 62% interest level, one a 67% interest level, one a
83% level and one had a 100% interest level in
attending focus groups (Table 18).
Of these centers, 7 had over 5 people interested
and one center had more than 10 people interested in
attending a focus group on how to enjoy your visit
(table 19).
Willingness to Pay $20.00 for a Doctor to Speak on
Special Topics
There was a variation between 0 and 50 percent of
the center's respondents interested in paying $20.00
for a doctor to speak on a special topics. There were
only 2 centers with over a 50% willingness to pay
$20.00 for a doctor to speak on special topics (table
18) . There were no centers with over 5 or 10 people
interested in this program (table 19).
49
Family Counseling
The range of the percent of respondents willing to
pay $10.00 for family counseling varied from 0 to 100
percent. There were six centers that had greater than
a 50% response rate who were willing to pay $10.00 for
family counseling session (table 18). Of these
centers, only one had over 5 people interested and
there were no centers that had more than 10 people
interested in paying for family counseling (table 19).
Family Councils
There were 23 centers with greater than or equal to
a 50% interest in attending family councils. Two
centers had a 100% interest level however, the number
of respondents in these centers were small. Of these
centers, 15 had over 5 people interested and 6 centers
had over 10 people who were interested in attending
family councils (table 20).
The number of respondents in each center interested
in family councils ranged from 0-16 (Table 20). There
were 19 centers that had respondents who were already
attending family councils. These centers had other
respondents who were also interested in attending
these existing meetings.
50
Level of Care
The effect of level of care was analyzed for its
effect on the interest in attending programs.
There was a significant relationship between the
level of care and the percent of the respondents
interested in attending focus groups (Table 21).
Respondents who had a relative or friend in an
intermediate care facility were most interested in
attending a focus group (54%). Respondents who had a
loved one in a retirement hotel and a skilled nursing
facility were less interested (4% and 37%)
respectively.
A significant relationship was found between the
level of care and the percent of respondents willing
to pay $10,00 for family counseling (Table 22).
Respondents who have a friend or relative in a
retirement hotel (48%) were willing to pay $10.00 for
family counseling as compared to respondents who have
relatives in an intermediate care facility (29%) and a
skilled facility (12%).
There was also a significant relationship between
the level of care and interest in attending family
councils (table 23). Respondents who have a loved one
in an intermediate care facility were the most
interested in attending family councils (64%). Family
51
members of retirement hotel residents were also
interested (58%). Respondents who have relatives and
friends in skilled nursing facilities were interested
in attending (48%), in addition however, 20% of the
total respondents already attend family councils.
Therefore, as a total group, the family and friends of
skilled nursing facility residents are extremely
interested in family councils.
The respondents were asked if they would be willing
to join and educational committee which would educate
the community about skilled nursing care. The
respondents who represented intermediate care facility
residents were significantly more interested in
joining an educational committee (46%) than
respondents having relatives in retirement hotels
(21%) and skilled nursing facilities (27%) (table 24).
Bed Size of a Facility
There was a significant relationship between the
bed size of a facility and the interest of family
members in attending family councils (table 25) . In
the category of 200-250 beds, 70% of the respondents
were interested in attending family councils with an
additional 14% already attending family councils in
their centers. Facilities with over 250 beds had 59%
52
of the respondents interested in attending family
councils and an additional 16% already in attendance.
The bed sizes of 150-200 and 100-150 also showed
interest in family councils (55% and 50%
respectively). These categories also had 14% and 16%
(respectively) of their respondents already attending
family councils. The smallest bed category 50-100
were less interested in attending family councils
(47%) (Table 25) .
There was no significance found between bed size
and any of the variables. An insignificant
relationship existed between bed size and interest in
attending educational classes, focus groups, doctors
lectures and family counseling.
Cone lus ions
In conclusion, it is feasible to offer educational
programs, support groups and family councils to the
family and friends of residents in long-term care
facilities. The number and percent of respondents
interested in these programs is sufficient to warrant
development. The programs could be targeted to
centers that have a high number of respondents
interested in participating.
53
The interest level in attending programs varied by
the type of facility. The respondents who had family
members in an intermediate care facility were
significantly more interested in attending focus
groups, family councils and in joining and educational
committee than respondents having a family member in
skilled nursing facility and a retirement center.
However, respondents who represented a family
member in a retirement center were more willing to pay
$10.00 for family counseling than those representing
patients in an intermediate or skilled nursing center.
In general, the respondents were not interested in
attending focus groups, however, it would be feasible
to offer them only to family members and friends of
patients in an intermediate care facility. The
respondents representing intermediate care facility
patients were also interested in joining a educational
committee that would do community service.
Overall, the respondents were not very interested
in paying $10.00 for family counseling, however, this
program was of greater interest to family members in
retirement hotels.
Family councils have been determined as a feasible
type of program to offer to families representing all
levels of care, however it is interesting to note that
54
the larger the facility the greater the interest of
family and friends in attending family councils.
55
CHAPTER VI
SUMMARY AND CONCLUSIONS
Overview of Findings
The results of this study support the hypothesis
that there is a need to offer programs and services to
the adult children, relatives and friends of the
residents in long-term care facilities.
The respondents of this study indicated interest in
attending educational classes on topics related to
aging (53%) . York & Calsyn ( 1977) also found their
respondents to be interested (51%) in attending
classes on aging. Although the sample size and
research design used in these two studies was not
similar, replication of the findings of interest
levels in attending educational classes builds the
case for developing programs that include this type of
course in the future.
The current study found women more interested than
men in attending educational classes. This may be due
to the fact that the cohort of the respondents average
age was 60 years old and they were retired. There
were more women than men who responded to the survey
and they could have more free time to attend these
types of classes. The age cohort (60 years old) and
56
employment status (retired) of the female respondents
could also account for the fact that women were more
interested in attending classes held on the weekdays
(51%) compared to the men who would rather attend in
the evenings (47%).
The interest levels of the respondents in attending
educational classes may be caused by the mean age of
the respondents themselves. The respondents were
senior citizens themselves and may be experiencing
some of the chronic disorders and diseases of aging.
They could be interested in learning not only to help
their parents or spouses but also to help themselves.
The children and the spouses of the residents were
significantly more interested in attending educational
classes than other categories of relationships. This
could be because the closer the family relationship,
the more interest there would be in learning about the
diseases related to aging and the problems of their
loved one s.
The respondents who were interested in attending
classes had their relatives in the center for less
than two years. These people may find they need more
information regarding the disease processes and what
they can expect to encounter in the future. The
people who were not interested had family members in
5 7
the nursing center for over two years and they may
already be adjusted to the placement and no longer be
interested in attending classes or programs.
It would be feasible (from the reported results of
this study) to offer educational classes in the
facilities that have indicated over a 50% interest
level in attending. It is important to take into
consideration not only the highest percent' interest
but also the number of respondents who were interested
in attending. The educational programs could then be
conducted in the facilities with the highest number of
respondents who were interested in attending.
This study also indicated that over 50% of the
respondents were interested in attending support
groups. Once again, women were more interested than
men. This finding does not replicate the findings of
York & Calsyn (1977). They reported a 30% interest in
meeting with families to share concerns. The
differences in the findings may be due to the fact
that this study is wider in scope and covers a much
larger demographic population. It is also possible
that the respondents that they studied may have had
their family members in a facility for over two years
and therefore would not be interested in a support
group. It would be feasible from the results of this
58
study to hold small support groups in targeted
It would not be feasible to offer focus groups,
educational committees, family counseling sessions
that would cost the respondents $10.00 or doctors
lectures that cost $20.00.
Over 51% of the respondents were interested in
attending family councils to at least 23 centers. The
family members of intermediate facility residents were
the most interested (64%) followed by retirement hotel
(58%) and skilled nursing facilities (48%). It is
important to note that the larger the facility the
higher the percentage of respondents interested in
attending.
The best time to offer these programs would be on
weekdays and evenings. Women would be most interested
in attending on weekdays and men in the evening. The
employment status of the respondent effected the best
time to offer the program. Retired and unemployed
people would rather attend on the weekdays and working
people prefer evenings.
Implications and Recommendations
Offering educational programs to the family
members, friends and relatives of skilled nursing
59
patients could have the following results:
1) Family members would be better educated as to
the prognosis and complications of specific
diseases and better understand the treatment of
the patient.
2) The families would have a better understanding
of the care available for specific disorders and
diseases and would not have unreasonable
expectations of the staff to perform "miracles".
3) The educational programs could also teach family
members on how they can help in providing care
and support to their loved one during the time
they are convalescing and therefore being
supportive to the staff.
4) Educating the families and friends of the
patients would improve the communication and
relationship with the facility and may help in
decreasing family complaints to the health
department.
The respondents were also interested in attending
support groups (51%) with other people who had decided
to place a loved one in a nursing center. Once again,
women were more interested than men. This could be
due to the societal norms of the women being the
caretakers of the sick and infirm. It could also be
60
due to the fact that the eldest daughter takes
responsibility for caring for her parent,
York & Calsyn's (1977) study only found a 30%
interest rate in meeting with families to share
concerns and problems. They felt this was a
noteworthy number of respondents. The discrepancies
of the findings between the current study and that of
York & Calsyn may be due to the differences in
research design and sample size.
This study came close to replicating the findings
of York & Calsyn (1977) that 4 7% of the family members
and friends would be interested in getting advice on
how to make their visiting more productive and
enjoyable. Of the respondents who participated in
this current study, only 39,7% were interested in
attending focus groups which would include
participation on such topics as "enjoying your visit
in a nursing home,"
The low interest level may be due to the fact that
the people who were the most interested in this
program had recently admitted their family member or
friend to the nursing center. This may be a
worthwhile program to offer families and friends upon
admission of their loved one to a nursing home.
However, once the resident has been in the nursing
61
center for over 8 months, there would be no reason to
offer this type of program. The respondents in the
York & Calsyn study may have recently admitted their
family or friend and this could account for their
higher interest level in attending a group on how to
make their visiting more productive.
The low interest level in attending focus groups
may also be due to the topic of these programs. The
focus of the program was on how to enjoy your visit in
a nursing home. As indicated by the past literature,
enjoyment of visits is dependent upon the mental
status of the patient. The more mental deterioration
of the patient the less enjoyment experienced by the
family during their visit. Therefore, offering a
program to teach people on how to enjoy their visits
may have little or no effect on their actual enjoyment
if their family member has a high degree of mental
deterioration. Therefore, focus groups might be
helpful for families who have patients in facilities
recovering from physical disabilities (broken hip,
mild strokes and heart attacks). However, focus
groups would not be as beneficial for family members
of patients with Alzheimer's disease or senile
dementia.
_____ 62
The respondents were not willing to pay a fee of
$10.00 for family counseling or $20.00 for doctors to
speak to them on special topics. The causative factor
may be that they believe they are already paying
enough money for long-term care and do not wish to
spend anymore money. However, if the doctors came to
speak at the educational classes at no extra charge to
the families this program could be incorporated.
Also, if a counselor came to a family night or support
group and no extra charge was incurred by the family
member this program could also be included. Since
there was interest in attending educational classes
and support groups it was not the lecturing or support
the respondents objected to, it was paying an extra
fee .
The best time to conduct these classes and support
groups would be weekdays and evening s. The women
indicated the best time for them would be on weekdays.
This may be due to the demographics of the population
sample. The majority were 60 years old, married and
retired. Therefore, the women would have free time
during the day to attend. However, the men preferred
to attend in the evenings and this may be due to the
fact they are working during the day and do not have
the time to attend until evening.
6 3
The best way to offer the programs could be on a
rotating schedule, offering a group of classes in the
evening and repeating these classes on the weekdays.
This would provide all of the interested family
members, friends and relatives the opportunity to
attend the classes and programs.
The majority of the respondents were interested in
attending family council meetings. The development of
family councils has been attempted by some of the
centers owned by the major corporation. A typical
family night includes providing dinner to the families
and then speakers discuss special topics as well as a
time for the family members and friends to discuss
concerns and problems they might be experiencing. The
family council is usually attended by the
administrator, director of nursing, activity director
and social services. Other department heads can
attend especially if there is a problem in that
department (i.e. , maintenance, housekeeping) . The
centers that currently conduct these meetings usually
hold them in the evenings, however, some consideration
may be given to hold them in the day to increase
attendance rates.
The eight centers that showed some respondents who
were interested in attending existing meetings need to
64
increase their methods of notifying family members of
these meetings. A feature article could be written in
the newsletter, the activity calendar should have the
family night in bold print, invitations with
R.S.V.P. 's could be sent and follow-up phone calls
made to families and friends notifying them of the
family council meetings.
The services most often requested by the spouses,
adult children and friends were better personal care
and increased activity programs. Increasing personal
care of the residents could be accomplished by:
1) increasing staff (nurses aides, L.V.N's and
R.N's).
2) increasing volunteer hours.
3) hiring employees who understand the needs of the
elderly and are emp athe t i c to them.
4) training current employees to attend to the
needs of the patient.
5) hiring additional staff from a registry when
nursing employees call in sick.
6) hiring a patient care coordinator who could act
as a liaison between the family members and
nursing center.
7) training the family members to assist in the
personal care of their loved ones.
65
Increased activity programs could be accomplished
by ;
1) increasing the volunteer program and having
volunteers who would not only participate in the
planned activities but would also conduct their
own .
2) including adult education classes in the
activity programming. These are conducted for
free by the local board of education, community
colleges or local universities and colleges.
3) increasing activity program budgets.
4) involving other staff members in activity
programs.
5) increasing activity department staff.
6) requiring each facility to conduct a "special
event" .
7) increase corporate support to activity
departments,
There were a substantial number of respondents who
gave positive comments about the nursing centers.
These people had found the staff to be doing an
excellent job and were content with the programs and
services. This information could be publicized as an
actual fact to help improve the community image of the
major corporation and its facilities.
66
The respondents also believed that they would enjoy
their visits more if their family member or friend
would receive better personal care at the nursing
center. Some of the respondents reported they would
be upset to come in and find their loved one wet,
dirty unwashed and unbrushed. This was unacceptable
to them and they required that at least the basic
personal hygiene needs be taken care of by the staff.
This attention to personal care could be improved by
the suggestions made earlier.
It is important to note that improvements in
personal care was the item listed most frequently in
both open-ended questions. A total of 173 responses
highlighted the need to improve the personal care of
the patients. Attention to this problem is highly
indicated by this study and immediate solutions are
needed to respond to this item.
Many respondents commented that they already
enjoyed their visits and they could not think of any
improvements. They were content with the staff and
the programs and felt the best job possible was being
done .
A smaller number of responses also indicated that
the respondents would be able to enjoy their visits
more if they had additional space provided that they
67
could use for visiting. This could be accomplished by
allowing them to use:
1) a corner of the dining room to visit in.
2) set-up and use an empty room as a small lounge.
3) build a separate area for visiting.
Suggestions for Future Research
The results of this study and previous studies
state the need to develop programs for the family
members and friends of nursing home residents and
improve the services for the patients. Future studies
could be done on the benefit-cost analysis of
implementing educational classes, support groups and
family councils as well as improving the activity
programs and increasing the personal care given to the
patients. In addition, further research could be
developed to target the topics of special interest
when conducting educational programs to families and
friends of the residents in long-term care
-------------------- 6T
BIBLIOGRAPHY
Greenberg, J.N., & Ginn, A. (1979). A multivariate
analysis of the predictors of long-term care
placement. Home Health Services Quarterly. i(l), 75-
99 .
Hatch, R.C. , & Franken, M.L. (1984) . Concerns of
children with parents in nursing homes. Journal of
Gerontological Social Work. 2,(3), 19-30.
Johnson, M.A. & Werner, C. (1982). We had no choice.
Journal of Geronfological Nursing. 2(f1), 641-645.
Johnson, M. (1982). Marketing the nursing home.
Nursing Homes. November/December, 30-36.
Lambert, N. & Thanopoulos, J. (1985). A dynamic
planning framework for nursing homes. Nursing Homes.
March/April, 39-42.
McAuley, W.J. & Blieszner, R. (1985). Selection of
long-term care arrangements by older community
residents. The Gerontologist. 2^(2), 188-193.
Shanas, E. (1979). Social myth as hypothesis: the
case of the family relations of old people. The
Gerontologist . 1_9_( 1 ) , 3-9.
Simos, B.C., (1973). Adult children and their aging
parents. Social Work. 18. 78-85.
Smallegan, M. , (1981) . Decision making for nursing
home admission: a preliminary study. Journal of
Gerontolgical Nursing. 2(5), 280-287.
Smith, K.F. & Bengtson, V.L. (1979). Positive
consequences of institutionalization: solidarity
between elderly patients and their middle-aged
children. The Gerontologist. 19.(5). 438-447.
Smith, S.M., (1984). Family selection of long-term
care services: it's not just the facility that's
important. Health Marketing Quarterly. 2(4), 101-113.
Vivens, S. & Woolfork, C . , (1983). Nursing home
admissions made more rational. Geriatric Nursing.
November/December, 361-364.
69
Vlack, J.E. & C onnolly, M.G., (1979). When a nur s ing
home is the best choice. American Journal of Nursing.
August, 1450-1451.
York, J.L. & Calsyn, R.J., (1977). Family invo1vement
in nursing homes. The Gerontologist. 1%( 6) , 500 - 505.
Table 1
Number of Questionnaires Mailed
70
and Frequency of
N ame
Respondents
N Frequency Percent
C o r onado 235 21 9
Colonial Manor 160 15 9
Town & Country 131 20 15
Lubbock Hospitality 120 6 5
Mountain View 114 19 17
Careousel Care 112 20 18
Glenaire Care 105 13 12
S e asi de Care 100 6 6
Highland Care 92 9 10
Grandview Care 83 10 12
Crestview Care 82 10 12
Eve rgreen 80 16 20
Gold Leaf 80 4 8
Silver Gardens 52 18 30
Clairmont House 60 2 2
Palm Grove 129 23 20
Marina 116 10 9
Royalwo o d 110 19 19
Hemet Convalescent 99 20 20
Anaheim Terrace 99 13 13
Sierra V i ew 98 11 13
EarIwood 87 14 18
Bay Crest 80 13 13
Hemet Retirement 100 6 13
Spring Retirement 48 14 5
Summit Rehabi1itatio 276 3 2
Brier Oak Terrace 159 5 3
Woodland Care 157 16 13
Canyon Care 126 5 5
Valley Convele scent 99 20 20
Valley Palms 99 14 16
Sharon Convalescent 86 7 8
Fountain Retirement 130 2 2
Phoenix Retirement 86 6 7
Fountain Care - Orange 287 31 11
Carehous e 150 23 15
71
Table 2
Frequency and Percent of Responses
by Age of Respondents
Ages Frequency Cumula t ive
Percent
90-99 2 . 4
80-89 27 6 . 0
70-79 73 16 . 4
60-69 148 33.0
50-59 119 26.4
40-49 62 13 . 8
30-39 16 3 . 4
20-29 3 . 6
Total 450 100 . 0
72
Table 3
Demographic of Respondents
Frequency and Percent of Responses by Gender
Sex Fr e quency Percent
Male
Female
155
305
33.7
66 . 3
Frequency and Percent of Responses by Marital Status
Marital Status Frequency Percent
Marrled
Never Married
W i dowe d
D iVO r c e d
362
17
53
29
78 . 5
11 . 5
73
Table 3 (continued)
Frequency and Percent of Responses by Relationship
to the Resident
Relationship Frequency Percent
Child 267 58.0
Sister 21 4 . 6
Brother 9 2 . 0
Spouse 44 9 . 6
Relative 42 9 . 1
Clergy 2 . 4
Friend 11 2 . 4
Other 6 4 13.9
Frequency and Percent o f Respondents by
Length of Time in Fac illty
Length of Time Frequency Percent
1 wk - 4 wks 13 2 . 8
1 month - 4 months 40 8 . 6
4 months - 8 months 48 10 . 3
8 months - 12 months 44 9 . 5
1 year or more 100 21 . 6
2-5 years 151 32.5
over 5 years 68 14 . 7
74
Table 4
Percent of Respondents Interested
in Programs
Pro gram Percent Interested
Educational Classes 53%
Support Groups 51%
Focus Groups 40%
Family Counseling 16%
Doctors Lecture 17%
75
Table 5
Interest in Attending
Educational Classes by Gender
Yes N o
Male
Fema1e
59
169
41
60
84
115
59
40
N=427
Chi - square==12 . 7 27 , *p< . 001
Table 6
Interest in Attending Educational Classes
by Age of Respondent
76
Yes No.
N % N %
Less than 39 15 48 16 52
40 - 49 30 51 29 49
50-59 75 66 38 34
60-69 73 53 65 47
70-79 25 38 41 62
over 80 12 48 13 52
N=432
Chi-square = 14.794
, *p<.05
77
Table 7
Interest in Attending Educational Classes
by Relationship to the Patient
Yes
N %
N o
N %
Child 147 60 100 40
S ib1ings 10 36 18 64
Spous e 23 59 16 41
Re1at ive 16 39 25 61
Frlend 6 46 7 54
0 the r 28 47 32 53
N=428
Chi-square=12.482 *p<.05
78
Table 8
Interes t in Attending Educational Classes
by Length o f Time Patient is in the Fac i1i ty
Yes N o
N % N %
Iwk-4mo s, 31 65 17 35
4mo s. -8mo s. 26 58 19 42
8mo s. - 12mo s. 22 55 18 45
1-2 years 57 61 37 39
2-5 years 69 49 71 51
over 5 years 25 38 40 62
N=432
Chi-square=ll.551 , *P<.05
79
Table 9
Interest in Attending Support Groups
Support Groups by Gender
Yes
N %
No
N %
Male 60 43 81 57
Female 53 55 127 45
N=421
Chi-square=5.483, *p<.0 5
_______ —
Table 10
Interest in Attending a Focus Group
by Gender
Ye s N o
N % N %
Male 41 30 97 70
Female 122 45 151 55
N=411
Chi-square=8.594, *p<.01
81
Table 11
Interest in Attending a Focus Group
by Length of Time the Resident is in the
Long-Term Care Center
Yes
N %
N o
N %
1 wk. - 4mo s. 24 55 20 45
4mos. - 8mos. 24 53 21 47
8mos. - 12mos. 16 37 27 63
1-2 years 35 40 53 60
2-5 years 52 38 84 62
over 5 years 14 23 46 77
N=416
Chi-square = 14.496, *p<.05
82
Table 12
Interest in Attending
Family Counseling Sessions
by Gender
Yes
N %
N o
N %
Male 11 10 100 90
Female 45 20 179 80
N=335
Chi-square = 5.524, *p<.05
gy
Table 13
Interest in Attending Family Counseling Sessions
by Age of
Yes
N
Respondent
%
N o
N %
39-49 16 22 58 78
50-69 3 5 18 159 82
70 and over 5 7 65 93
N=338
Chi -square = 6, .170, *p<.05
84
Table 14
Interest in Attending Counseling Sessions
by Length of Time Resident is in
Long-Term Care Center
Ye s
N %
N o
N %
1 wk, - 4 mo s, 10 24 31 76
4 mo s, - 8 mo s, 8 24 25 76
8 mos, - 12 mos, 10 33 20 67
1-2 years 11 16 59 84
2-5 years 11 10 98 90
over 5 years 6 11 49 89
N=338
Chi-square = l3.939, *p<.05
85
Table 15
Best Time Available to Attend
Classes/C ouns eling Sessions
by Gender
We ekdavs Weekends Evenings Comb ination
N % N % N % N %
Male 21 27 8 10 37 47 12 15
F emale 94 51 21 11 54 29 17 9
N=264
Chi-square = 14.439, *p<.01
86
Table 16
Best Time Available to Attend Classes
by Employment Status
Emulovment Weekdays
N %
Weekends
N %
Evenings
N %
Any
N
Comb .
%
Working 17 15 19 17 64 56 15 13
Not Working 14 54 3 12 6 23 3 12
Retired 80 69 7 6 19 16 10 9
Total 111 138 29 35 89 95 28 34
N=257
Chi - square = 73 . ,527,
*P<
. 001
87
T able 17
Summary of the Relationship Between Characteristics
of Residents and Whether Program is Desired
Pro gram Gender Age Relationship Length
of Time
Educational Women Yes 40-69 Child and 1 wk -
Men No Spouse 2 y r s
Support Women Ye s No N o No
Group s Men No
Focus Groups Women No N o N o 1 wk -
8 mo s
Men No N o N o
F am ily Women No N o N o N o
Couns e1ing Men N o
Doc tors Women N o N o N o N o
Lee ture Men N o N o N o
Table 18
88
Percent Interested in Attending
Programs by Center
Center Education Support Focus Doc tors F amily
N ame Classes Group s Group s Lecture C ouns e1
Coronado 81 65 62 14 25
Colonial Manor 53 67 60 27 27
Town & Country 53 44 29 18 29
Lubbock 83 83 83 50 50
Mountain View 44 47 31 0 0
Careousel 39 37 44 15 6
Glenaire 46 38 25 0 9
Seas ide 67 33 33 20 9
Highland 50 43 29 17 17
Grandvi ew 44 56 43 25 25
Gres tview 30 30 33 10 0
Evergreen 47 54 38 7 9
Gold Leaf 25 25 0 0 25
Silver Gardens 50 43 31 15 9
C1a i rmont 100 100 100 0 100
Palm Grove 42 58 33 11 0
Marina 80 67 38 10 0
Royalwo o d 72 67 39 13 14
Heme t 71 61 44 38 27
Anahe im 50 55 50 25 13
S1erra Vlew 60 50 40 0 22
E arIwo o d 43 64 36 23 10
B ay Crest 27 64 50 20 50
Hemet Retire 60 60 20 20 50
Spring Retire 50 50 50 23 50
Summit Rehab 33 100 67 33 33
Brier Oak 25 50 25 0 0
Woodland 50 44 40 7 7
C anyon 72 0 0 0 0
Valley 65 72 47 25 14
Valley Palms 64 69 62 29 20
Sharon 33 29 43 21 17
Fountain Ret. 50 50 50 50 0
Phoenix Ret. 50 60 20 20 50
Fountain Conv. 59 31 32 21 17
C arehous e 48 26 26 5 5
Table 19
Number of Respondents
in Attending Programs
Interested
by Center
89
Center Education Support F o eus Doctors F amily
N ame Classes Group s Group s Lecture C ouns e1
C o r onado 17 13 13 3 4
Colonial Manor 8 10 9 4 3
Town & Country 10 8 5 3 4
Lubbock 5 5 5 3 2
Mountain View 7 8 5 0 0
Careous el 7 7 8 3 1
Glenaire 6 5 3 0 1
S e a s i de 4 2 2 1 0
Highland 4 3 2 1 1
Grandview 4 5 3 2 2
Cre s tview 3 3 3 I 0
Evergreen 7 7 5 I 1
Gold Leaf 1 1 0 0 1
Silver Gardens 7 6 4 2 1
Clairmont House 1 1 1 0 1
Palm Grove 8 1 6 2 0
Mar ina 8 6 3 I 0
Royalwood 13 1 7 2 2
Heme t 12 1 8 6 3
Anahe im 6 6 6 3 1
Sierra View 6 5 4 0 2
E ar1wo o d 6 9 5 3 1
Bay Cres t 3 6 5 2 4
Hemet Retirement 3 3 1 I 2
Spring Retire 7 7 7 3 5
Summit Rehab 1 3 2 1 1
Brier Oak 1 3 2 I 1
W o o dland 8 7 6 I 1
C anyon 1 1 0 0 0
Valley 13 3 8 4 2
Valley Palms 9 9 8 4 2
Sharon 2 2 3 1 1
Fountain Ret. 1 1 I I 0
Phoenix Ret. 3 3 I I 2
Fountain Conv. 17 9 9 6 4
Carehous e 10 6 6 I 1
Table 20
Number and Percent of Respondents
Interested in Attending Family
Councils by Center
90
Center Yes No Already
Attend
Name N % N % N %
Coronado 15 75 5 25 0 0
Colonial Manor 9 60 6 40 0 0
Town & Country 12 63 7 37 0 0
Lubbock 3 60 2 40 0 0
Mountain View 8 42 7 37 4 21
Careouse1 8 50 2 13 6 38
Glenaire 7 58 5 42 0 0
Seas ide 3 50 2 33 1 17
H i ghland 3 50 3 50 0 0
Grandview 4 44 4 44 1 11
Gres tview 2 22 1 11 6 67
Evergreen 3 25 5 42 4 33
Gold Leaf 1 25 3 75 0 0
Silver Gardens 9 56 7 44 0 0
Clairmont House 1 100 0 0 0 0
Palm Grove 7 39 7 39 4 22
Marina 8 80 2 20 0 0
Royalwood 9 50 3 17 6 33
Hemet 12 75 4 25 0 0
Anahe im 4 33 2 17 6 50
Sierra Vi ew 5 45 3 27 3 27
EarIwood 5 36 6 43 3 21
Bay Crest 1 9 6 55 4 36
Hemet Retirement 3 50 3 50 0 0
Spring Retire. 8 73 3 27 0 0
Summit Rehab 3 100 0 0 0 0
Brier Oak 2 50 1 25 1 25
Woodland 8 50 7 44 1 6
Canyon 0 0 4 100 0 0
Valley 12 67 3 17 3 17
Valley Palms 6 46 4 31 3 23
Sharon 3 43 4 57 0 0
Fountain Ret. 0 0 2 100 0 0
Phoenix Ret. 3 50 2 33 1 17
Fountain Conv. 16 55 8 28 5 17
Carehouse 12 57 3 14 6 29
91
Table 21
Percent of Respondents Interested
in Attending Focus Groups
t>y
Level of Care
Level of Care Yes N o
N % N %
Retirement Hotel 11 41 16 59
Intermediate Care 32 54 27 46
Skilled Nursing 122 37 206 63
N = 414
Chi -square = 6.068, >Vp< . 05
92
Table 22
Percent of Respondents Willing to
Pay $10.00 for Family Counseling
by Level of Care
Level of Care Yes No
N % N %
Retirement Hotel 10 48 11 52
Intermediate Care 13 29 32 71
Skilled Nursing Care 33 12 237 88
N=336
Chi-square=23.166, *p<.001
93
Table 23
Percent Interested in Attending
Family Councils by Level of Care
Level of Care Yes No Already
Attend
N % N % N %
Retirement Hotel 15 58 10 38 1 4
Intermediate Care 38 64 20 34 0 0
Skilled Nursing 161 48 106 32 67 20
N = 419
Chi-square=24.349 , *p<.001
94
Table 24
Interest in Joining an Educational
Committee by Level of Care
Level of Care Ye s N o
N % N
Retirement Hotel 5 21 19 79
Intermediate Care 27 46 32 54
Skilled Nursing Care 87 27 2 31 73
N = 401
Chi-square = 9.508, *p< .05
95
Table 25
Interest In Attending Family Councils
Beds ize
by
Yes
N
Bed Size
%
of a
No
N
Facility
%
Already
Attend
N %
50 - 100 82 47 60 34 34 19
100-150 68 50 46 34 21 16
150-200 31 55 17 30 8 14
200 - 250 14 70 6 30 0 0
over 2 5 0 19 59 8 25 5 16
N = 419
Chi -square =28.368 , *p< .05
. _ _ _ _ _ —
Appendix A
To Whom it May Concern:
We are interested in improving and increasing the
programs offered to the relatives and friends of the
residents at our centers. It would be extremely
helpful to us if you could spend a few moments and
fill out the attached questionnaire.
The results of this questionnaire will be used to help
develop new programs for the friends and family of our
residents. We want to offer services that you would
be interested in and in order to do this we need your
feedback.
We would like to begin planning these programs in the
near future and therefore, it is important to receive
your response by December 15th, 1986. An enclosed
prepaid envelop has been provided for your
convenience.
If you have any questions please do not hesitate to
call me.
Thank you for participating in this study.
S incerely,
Marcia Lambert
Director of Marketing
97
Appendix B
QUESTIONNAIRE
Please put an X next to the
describes your answer.
response that best
1 . What is the year of your birth?
2 . What is your sex?
male female
3 . What is your marital status?
married never married
widow/er divorced
4 . What is your relationship to the patient?
child sister brother
spouse relative clergyman
friend
o ther
5 . How long has your relative or
the nursing center?
friend been in
1 week-4 weeks 1 month-4 months
4 months-8 months 8 months-12 months
1 year or more 2-5 years
over 5 years
6 . Would you attend educational classes on the
problems of aging (i.e. Alzheimer's disease,
Parkinson's disease, stroke, heart disease,
cancer)?
ye s no
98
Would you attend a support group of other
people like yourself who have decided to
place their loved one in a nursing center?
______yes no
Would you be interested in focus groups on
such topics as "enjoying your visit at a
nursing home"?
yes no
Would you be willing to pay a $20.00 fee if
we brought a Doctor in to lecture on special
topics ?
______yes no
or $10.00 a session for family counseling?
______yes no
10. If we offered special groups, counseling or
educational classes, when would be the best time
for you to attend?
______weekdays weekends evenings
11. Would you attend family council meetings that
would allow you to act as a monitor in the
quality of your relatives/friends care?
yes ______no already attend
me e tings
12. Would you be interested in joining a committee
composed of professional staff, family members,
volunteers, and other interested persons which
would educate the community on the purpose,
programs and problems of the skilled nursing
center and the ill elderly people in its care?
______yes ______no
99
13. How many other family members or friends
would be interested in attending these
special programs and what is this persons
relationship to you.
______1 other person ______2 other people
______3 or more other people
______relationship to you
14. What type of programs or services would you
be interested seeing at this nursing center
that they do not already provide?
15. What is your employment status at the
current time?
______working not working and looking for
work .
______unemployed retired
16. What could be done to help you enjoy your
visit?
17. What level of education have you completed?
______grade school ______high school
______college ______graduate school
100
Appendix C
Centers Missing Data
1) Lakeside Care Center
2) Royal Care Center
3) Care Center East
4) Meadow Park Care Center
5) Casa de Belita
6) Carson Retirement Center
7) Villa Mari a
8) Fountain Retirement Hotel
9) Southwood Nursing Center

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Asset Metadata

Creator Lambert, Marcia Ellen (author)

Core Title Programs for the secondary consumer of long-term care services

Degree Master of Science

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Health and Environmental Sciences,OAI-PMH Harvest,Social Sciences

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c37-410125

Unique identifier UC11658032

Identifier EP58937.pdf (filename),usctheses-c37-410125 (legacy record id)

Legacy Identifier EP58937.pdf

Dmrecord 410125

Document Type Thesis

Format application/pdf (imt)

Rights Lambert, Marcia Ellen

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA