2016 REPORT Community Care for the Elderly (CCE) Client Satisfaction Survey

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1 2016 REPORT Community Care for the Elderly (CCE) Client Satisfaction Survey Program Services, Direct Service Workers, and Impact of Program on Lives of Clients

2 i Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

3 Table of Contents Executive Summary... 1 Program Background... 3 CCE Services... 3 Methodology... 4 The Survey... 4 Population and Sample... 4 Survey Results... 4 Scheduling and Reliability... 5 Time of Day and Day of the Week... 5 Length of Visit... 6 Staff Reliability...7 Staff and Service Quality... 8 Treatment and Communication... 8 Knowledge and Skills... 9 Service Quality Needs Service Frequency Information and Support for Chronic Conditions Additional Services Needed Impact of Services Quality of Life Nursing Home Placement Overall Satisfaction with Services Comments Conclusion Appendix A: CCE Client Satisfaction Survey Appendix B: CCE Client Satisfaction Survey Results Multiple Choice Survey Items Open-Ended Survey Items ii Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

4 iii Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

5 Executive Summary In 2015 and 2016, the Florida Department of Elder Affairs (DOEA) Bureau of Planning and Evaluation surveyed a random sample of 2,434 clients enrolled in the Community Care for the Elderly (CCE) program. The purpose of the survey was to assess client satisfaction with program services, the quality of direct service workers, and the impact of program services on the lives of clients. Individuals reported high levels of overall satisfaction with the program, the services received, their quality, the behavior of their direct care workers, and the impact of services on their lives. There was, however, some evidence of clients reporting less satisfaction with aspects of their services than what multiplechoice responses show. These discrepancies in responses were found by comparing multiplechoice responses with open-ended comments offered by individuals (n=610-1,162). Ten individuals expressed serious complaints regarding their services or staff. All of these grievances were resolved by Department staff by the conclusion of the survey period. Overall, 94.6% of individuals reported being satisfied (34.6%) or very satisfied (60.0%) with the services they receive, whereas 2.8% were dissatisfied or very dissatisfied with the services they receive (see Exhibit 1). While individuals reported the highest levels of satisfaction with the way workers treat them (97.5%) and communicate with them (97%), the lowest levels of satisfaction were related to the length of service visits (86.5%) and how often services are received (91.8%). The days of the week (35.7%) and time of day (35.8%) that services were offered had the lowest percentages of individuals who were very satisfied compared to other survey items. Levels of satisfaction with length of service visits and how often services are received may be lower than the results suggest. For example, when examining client responses to the open-ended questions, 37.6% of individuals who were satisfied or very satisfied with the length of service visits commented that additional hours would help fulfill their unmet needs. Exhibit 1: Percent Satisfaction with Overall Services 94.6% of individuals were satisfied or very satisfied with the services they received Very Satisfied Satisfied Neither Satisfied nor Very Data: 2016 CCE Client Satisfaction Survey; Item 17, (n=2,426) 1 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

6 The majority (81.7%) of individuals reported that the services they receive meet their needs, while 14.6% reported that the services meet their needs to some extent. Nearly 4% of individuals reported that the services they receive do not meet their needs. When asked about what unmet needs caregivers had, most comments reflected a need for more hours of service, better trained staff, and respite or companion services. In addition, of the 80.6% of respondents with chronic conditions, 95.4% reported that they receive adequate information and support for their conditions. When asked questions regarding the impact of services, 96.4% of individuals reported that the services they receive maintain or improve their quality of life. Almost all (97.6%) reported that their services help them remain in their home or assisted living facility (ALF). Of those who offered a concluding comment, 56.4% expressed satisfaction with their CCE services, while 21.2% expressed dissatisfaction with either the staff or services (11.7%) or the program, case manager, or Aging and Disability Resource Center (ADRC) (9.5%). Furthermore, about 14.2% of those who were satisfied or very satisfied with their overall services mentioned that they were unsatisfied with aspects of their service when asked for a concluding comment. Consideration: Revise the survey instrument so that the open-ended questions are asked first to encourage unbiased reflection on services. Based on comments provided by clients, some inconsistencies were found between positive categorical responses and negative feedback collected in openended responses. These inconsistencies in client responses could be due to limitations in the survey instrument itself, such as the questions or response options, or in the ordering of how the questions are asked. Improvements to the survey instrument may be necessary to increase accuracy in measuring client satisfaction in the future. For example, previous researchers recommend one way to improve the instrument may be to ask the open-ended questions before the multiple-choice questions. This may increase the personalization of the survey in the beginning and help encourage more meaningful reflection on satisfaction of various services before moving on to less specific questions Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

7 Program Background The Community Care for the Elderly (CCE) program provides community-based services to help elders with functional impairments live in the least restrictive, yet most cost-effective, environment suitable to their needs. The Department administers the CCE program through contracts with Area Agencies on Aging (AAAs), which subcontract with CCE lead agencies. 2 Eligible CCE clients must be age 60 or older and functionally impaired, as determined by an initial comprehensive assessment and annual reassessments. As directed by 1998 revisions to Section (5), Florida Statutes, primary consideration for services is given to elderly persons referred to Adult Protective Services (APS) and determined by APS to be victims of abuse, neglect, or exploitation who are in need of immediate services to prevent further harm. CCE Services CCE is a General Revenue-funded program where the level of funding is determined annually by the legislature during its budget process. State funds appropriated for CCE are used for community-based services that support frail elders quality of life. During State Fiscal Year (SFY) , CCE services served 31,866 individuals. 3 Individuals eligible for enrollment may receive a wide range of goods and services, including the following: Adult Day Care or Adult Day Health Care; Case Management or Case Aid; Chore, Shopping, or Legal Assistance; Counseling (Gerontological); Companionship or Homemaker; Consumable Medical Supplies; Respite; Home-Delivered Meals; Escort or Transportation; Emergency Alert Response or Emergency Home Repair; Home Health Aide, Home Nursing, or Material Aid; Medical Therapeutic Services; Personal Care; and Other Community-Based Services. 2 Sections , Florida Statutes 3 DOEA Summary of Programs and Services, 2016 p.2 3 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

8 Methodology The Survey The CCE Client Satisfaction Survey contained 18 questions for clients receiving CCE services. These questions related to services (5), workers (5), and impact (7). In addition, an open-ended question gave clients an opportunity to make additional comments about the services they received. The complete survey instrument may be found in Appendix A. The survey was conducted in English and Spanish by professional interviewers in DOEA s Computer-Assisted Telephone Interview (CATI) Call Center. Interviewers informed respondents that the survey would take about 15 minutes to complete. Participants were assured that regardless of whether they participated, their DOEA program services would not be affected. Population and Sample Eligible survey participants included clients enrolled solely in the CCE program for at least 90 days and received at least one CCE service other than case management or meals within the last year. The interviewers placed 8,604 calls between June 16, 2015, and October 4, Of these, 3,300 contacts were made, and 2,434 surveys were successfully completed, yielding a 74% response rate. The high response rate can be attributed in part to the nearly sixteen-month duration of the survey. Client responses were recorded in SurveyMonkey and downloaded to the Statistical Package for the Social Sciences (SPSS) software for analysis. Survey Results This report is divided into four sections, each related to some aspect of the client s satisfaction with the Community Care for the Elderly (CCE) program: Scheduling and Reliability, Staff and Service Quality, Needs, and Impact of Services. A summary of findings for each question is presented in graphic and narrative form. Respondents were invited to share comments regarding the CCE services they received, the workers, and their personal care needs at the end of the survey. Both positive and negative comments are presented in the context of the report narrative. An analysis of these open-ended survey items is included in Appendix B. 4 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

9 Survey results were also analyzed by Planning and Service Area (PSA) in order to identify any significant differences in program quality in certain regions of the state. The PSA that makes up the largest proportion of survey respondents is PSA 11, comprised of Miami-Dade and Monroe counties. PSA 1, comprised of Escambia, Santa Rosa, Okaloosa, and Walton counties, makes up the lowest proportion of survey respondents. The distribution of respondents in each PSA is displayed below in Exhibit 2. Exhibit 2: Distribution of Respondents by Planning and Service Area Data: 2016 CCE Client Satisfaction Survey; (n=2,434) Scheduling and Reliability Clients were asked to report their level of satisfaction with various aspects of their service relating to scheduling and reliability, choosing a response of very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, or very dissatisfied. The questions asked about satisfaction with length of service visits, time of day that services are provided, day of the week that services are provided, staff timeliness, and staff consistency. Time of Day and Day of the Week [I] could use some flexibility [with] evening and weekend hours. The majority of individuals were satisfied or very satisfied with the days of the week (96.4%) and the time of day (96.2%) that services were provided. Between % of individuals were dissatisfied or very dissatisfied with these aspects of their service schedules. The days of the week (35.7%) and time of day (35.8%) that services were offered had the lowest percentages of individuals who were very satisfied compared to other survey items. 5 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

10 Although most respondents reported that they were satisfied or very satisfied with the days of the week and time of day services were provided, eight responses to an open-ended question (i.e., What additional services might help with those needs that have not been met? ) suggested that clients would like to receive additional services on the weekends or late evenings. Length of Visit A smaller proportion of respondents were satisfied or very satisfied with the length of service visits (86.5%) than with the days of the week (96.4%) or time of day (96.2%) services were received. Approximately 8.5% of respondents were I need more hours of service in order [for the worker] to complete the job. dissatisfied or very dissatisfied with the length of visits. These results reflect other individuals responses to the open-ended question regarding additional services that may assist with unmet needs. Of those individuals who offered a response, 40.8% wanted additional hours of service. The most cited reasons for more hours of service ranged from unexpected changes in the client s health condition to the need for more time to complete personal care or housekeeping tasks. Responses to the first three items relating to timeliness and scheduling are displayed in Exhibit 3a below. Exhibit 3a: Percent Satisfaction with Scheduling and Reliability Survey Items DAYS OF THE WEEK TIME OF DAY LENGTH OF VISITS Very Satisfied Satisfied Neither Satisfied nor Very Data: 2016 CCE Client Satisfaction Survey; Items 2-4, (n=2,400-2,415) 6 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

11 37.6% of individuals who were satisfied or very satisfied with the length of service visits commented that additional hours would help fulfill their unmet needs. Comments provided by respondents suggest that the number of respondents who are dissatisfied or very dissatisfied with the length of services may be higher. Of individuals who were satisfied or very satisfied with the length of service visits, 37.6% commented that additional hours would help fulfill their unmet needs. There were also some differences in level of satisfaction with length of service visits by PSA. Clients in PSAs 4, 8, 10, and 11 expressed the most dissatisfaction ( %) with the length of service visits. These differences by PSA are displayed in Exhibit 4 on the following page. Exhibit 3b: Percent Satisfaction with Scheduling and Reliability Survey Items Yes No 95.3 Workers Arrive on Time I don t know when to expect them Same Person Comes to Help Yes No 6.0 Staff Reliability Most care recipients reported that their workers usually arrive on time (95.3%), and a slightly smaller proportion reported that they can usually expect the same person to come help (94.0%). Responses to these survey items are displayed in Exhibit 3b to the left. Overall, 4.7% of individuals reported that their workers either did not usually arrive on time or that they did not know when to expect them. About 6.0% of individuals reported that they do not expect the same person to come help. Of those who provided feedback, several care recipients described the high turnover rate of workers. For example, one client commented, [T]he only problem [is] a constant change in workers and hours... Data: 2016 CCE Client Satisfaction Survey; Items 9-10, (n=2,323-2,336) 7 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

12 Exhibit 4: Neutral or with Length of Service by PSA 13.9% 10.4% 11.4% 7.4% 6.6% 4.4% 3.3% 3.5% 2.6% 3% 8.9% 6.3% 5.3% 3.7% 5.4% 5.1% 4.1% 2.9% 1.8% 9.1% 6.7% 3.7% 5.0% 8.0% PSA 01 PSA 02 PSA 03 PSA 04 PSA 05 PSA 06 PSA 07 PSA 08 PSA 09 PSA 10 PSA 11 Statewide Neither Satisfied nor Data: 2016 CCE Client Satisfaction Survey; Items 9-10, (n=2,323-2,336) Staff and Service Quality Client satisfaction with services is in large part determined by the effectiveness of the direct service workers in performing their responsibilities, as well as their ability to interact positively with the care recipient. This section focuses on various aspects of staff and service quality. Clients were asked to rate their level of satisfaction with the knowledge and skills of their worker(s), their treatment by the worker(s), and communication with the worker(s). They were also asked about their overall satisfaction with the quality of services, choosing a response of very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, or very dissatisfied. Treatment and Communication The majority of clients reported being satisfied or very satisfied with the way their workers treat them (97.5%) and the way their workers communicate with them (97%). Between % of individuals were dissatisfied or very dissatisfied with the treatment or communication aspects of the service staff. In both open-ended questions regarding services, between 53 (11.8% of clients who answered) and 120 (11.7% of clients who I am satisfied with how much they have helped me, [but] the worker does not know how to work with a disabled person. answered) clients expressed frustration with the manner in which their workers communicate with them. 8 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

13 Despite most individuals expressing satisfaction with the way their workers communicate with them, there were several clients who commented on the lack of notice in cases where their worker is unavailable. In many of these instances, clients are not informed of a replacement worker or a timeline for which they may receive the delayed services. Additional Comments on Services [The] case manager does not keep [me] informed and does not let [me] know if there is a replacement when [my] regular worker will not be there. [The workers] would not call to let [me] know when they were not able to come in and did not provide a replacement. [The workers] ask me to sign their time sheet for working 3 hours when they might have worked less than 3 hours. Knowledge and Skills A smaller proportion of individuals were satisfied or very satisfied with the knowledge and skills of their workers (93.8%) than with their treatment (97.5%) or communication (97.0%). About 3.2% of individuals were dissatisfied or very dissatisfied with the knowledge and skills of the staff. Additional analysis, however, revealed that 6.6% of those who expressed satisfaction with the knowledge and skills of their workers expressed dissatisfaction with aspects of their worker s About 6.6% of individuals who were satisfied or very satisfied with the knowledge and skills of their worker commented that they were unsatisfied with their worker s performance. performance when asked if there is anything they want the Department to know about the services they receive. Although most clients were content with the knowledge and skills of their workers, a number of comments suggest there is room for improvement. Of clients who provided a comment on additional services that may help with their unmet needs, 11.8% mentioned that the staff should receive more job training. About 11.7% of those who offered a comment on the services they receive at the conclusion of the survey reported dissatisfaction with staff or services. 9 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

14 Service Quality Most clients appeared to be satisfied or very satisfied with the overall quality of service; however, the proportion of individuals who were satisfied or very satisfied with the overall quality of service (93.1%) is the lowest of the four questions pertaining to staff and service quality. Overall, 3.6% of individuals were neither satisfied nor dissatisfied with the quality of services and 3.3% were dissatisfied or very dissatisfied with the quality of services. The distribution of responses to the four components of staff and service quality are displayed in Exhibit 5. Exhibit 5: Percent Satisfaction with Staff and Service Quality Survey Items Very Satisfied Satisfied Neither Satisfied nor Very KNOWLEDGE AND SKILLS TREATMENT COMMUNICATION QUALITY OF SERVICES Data: 2016 CCE Client Satisfaction Survey; Items 5-8, (n=2,382-2,421) The open-ended questions outline some key issues from clients regarding overall service quality. Of the 997 individuals who provided a concluding comment, 11.7% were unsatisfied with aspects of their worker s performance or service quality, describing instances such as staff members not performing or completing the tasks assigned (N=45; 4.5% of clients who answered) and engaging in personal activities instead of caring for the client (N=6; 0.6% of clients who answered). Others also commented on the quality and palatability of home-delivered meals, asking for a greater variety of foods and increased flexibility on delivery times (N=38; 3.8% of clients who answered). 10 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

15 Comments on Home-Delivered Meals [I] would like additional companies which distribute Meals on Wheels to provide more vegetarian meal choices. The Meals on Wheels are hard to chew due to various temperature settings which cause the meals to dry up. The delivered meals are only sent from Monday to Friday, not on Saturday and Sunday. Needs CCE services are intended to help elders with functional impairments live in the least restrictive yet most cost-effective environment suitable to their needs. For that reason, clients were asked to what extent their needs are being met by the services they receive. The survey also asked the client their satisfaction with how often services are received and whether they have received adequate information and support for their chronic conditions. Finally, clients were asked to comment on additional services that may help meet any unmet needs. Exhibit 6: Percent Reporting Services Received Meet Needs Yes To some extent No Data: 2016 CCE Client Satisfaction Survey; Item 11, (n=2,428) As shown in Exhibit 6, 81.7% of individuals reported that the services they receive meet their needs, while 14.6% reported that the services meet their needs to some extent. Approximately 3.7% reported that the services they receive do not meet their needs. Although almost 82% of individuals reported that the services they receive meet their needs, there are significant differences in responses by PSA. PSAs 7, 10, and 11 had the highest proportions of individuals who said that the services they receive meet their needs to some extent ( %). PSA 11 also had the highest proportion of individuals who reported that the services they receive do not meet their needs (7.7%). Results by PSA are shown in Exhibit 7 on the following page. 11 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

16 Exhibit 7: Services Received Meet Needs by PSA 2.2% 1.3% 3% 5.9% 3.4% 2.1% 1.8% 4.1% 3.8% 4% 2.8% 12.1% 8.9% 10% 9.5% 13.2% 15.8% 12.7% 10.4% 16.5% 7.7% 3.7% 29.6% 14.6% 85.7% 92.8% 88.2% 83.3% 87.9% 88.7% 80.1% 83.5% 85.5% 80.7% 62.7% 81.7% PSA 01 PSA 02 PSA 03 PSA 04 PSA 05 PSA 06 PSA 07 PSA 08 PSA 09 PSA 10 PSA 11 Statewide Data: 2016 CCE Client Satisfaction Survey; Item 11, (n=2,428) Service Frequency Yes To some extent No Clients were asked to rate their level of satisfaction with how often services are provided. The majority of individuals reported that they were satisfied or very satisfied with how often services are provided (91.8%), but this proportion is among the smallest of the survey items that reflect satisfaction, such as satisfaction with the days of the week service is provided (96.4%) or treatment by the workers (97.5%). Altogether, 5.5% of individuals were dissatisfied or very dissatisfied with the frequency of service, as displayed in Exhibit 8 below. Exhibit 8: Percent Satisfaction with Frequency of Service Very Satisfied Satisfied Neither Satisfied nor Very Data: 2016 CCE Client Satisfaction Survey; Item 1, (n=2,423) The reason for the relatively low satisfaction with how often services are provided may be similar to the reason for low satisfaction with the length of service visits. In comments concerning additional services needed, 40.8% of respondents cited additional hours of service as their primary suggestion. 12 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

17 Exhibit 9 compares level of satisfaction with length and frequency of service visits by proportion of clients reporting a need for additional service hours in their comments. The results shown in this graph are not comparing level of satisfaction among these two measures; the graph includes only those clients who both rated their level of satisfaction with the two measures and reported a need for additional hours when asked to comment on services (see note below Exhibit 9). The results show that 47.3% of those who were very satisfied with how often services were provided commented that additional hours of service would help meet their unmet needs. About 39.6% of those who reported being very satisfied with the length of visits asked for more hours when asked for a comment on their services. Furthermore, comments at the conclusion of the survey, which are more numerous than those for the additional needs question, also reveal that many people who reported they were satisfied (18.1%) or very satisfied (7.9%) with the frequency of service explained that they were not receiving enough service hours. Exhibit 9: Satisfaction with Length and Frequency of Service by Proportion of Individuals Reporting a Need for Additional Hours 44% 34.3% 50% 31.6% 37.2% 43.3% 39.6% 47.3% 10% 9.1% Very Neither Satisfied nor Satisfied Very Satisfied Length of Visits Frequency of Visits Data: 2016 CCE Client Satisfaction Survey; Items 1, 2, and 12 (n= ) Note: This graph displays the proportion of individuals in each measure of satisfaction on the length and frequency survey items who also asked for additional service hours; it also reflects these stand-alone percentages. 13 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

18 Information and Support for Chronic Conditions A chronic condition is one that is persistent or otherwise long-lasting, such as arthritis, asthma, cancer, or diabetes. Approximately 80.6% of respondents were diagnosed with a chronic condition. These individuals were then asked if they received enough information and support to help them manage their chronic conditions. Most respondents (95.4%) reported that they receive adequate information and support for their chronic conditions, whereas 4.6% of individuals do not. These results are shown in Exhibit 10. Additional Services Needed Exhibit 10: Percentages Regarding Information and Support for Chronic Conditions Individuals were asked, What additional services might help with those needs that have not been met? Of the 18.0% of all individuals who provided a comment, numerous suggestions were made that may contradict some of the responses to prior questions. Responses to the open-ended question were coded into categories and are displayed in Exhibit 11 on the following page. The most cited suggestions for additional services to help with unmet needs were additional hours of service (40.8%), better trained staff (11.8%), and respite or companion services (10.8%) Diagnosed with Chronic Condition Yes 95.4 No Receives Information and Support for Chronic Condition Data: 2016 CCE Client Satisfaction Survey; Items 13-14, (n=1,911-2,381) 14 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

19 Exhibit 11: Percent Needing Additional Services or Improvements to Help with Unmet Needs Additional hours of service 40.8 Better trained staff Respite or companion service Personal care or consumable medical supplies Doctor's visits, nursing, or physical therapy Additional hours of housekeeping Transportation or escort service Additional meals or improved meals Other 2.0 Data: 2016 CCE Client Satisfaction Survey; Item 12, (n=440) Those who reported that their needs were not met or were met to some extent were more willing to provide a comment about additional services that could help with unmet needs. A full breakdown of these responses is displayed in Exhibit 12. Exhibit 12: Additional Services or Improvements Needed to Help with Unmet Needs by Respondents Whose Needs Were Not Met Completely Additional hours of service Respite or companion service Personal care or consumable medical supplies Better trained staff Additional hours of housekeeping Transportation or escort service Doctor's visits, nursing, or physical therapy Additional meals or improved meals Other No 10.1% 10.9% 7.8% 9.6% 8.4% 3.1% 7.8% 6.2% 6.7% 8.5% 6.5% 4.7% 5.5% 3.1% 1.7% To some extent 24% 32.6% 43% Data: 2016 CCE Client Satisfaction Survey; Items 11-12, (n=440) 15 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

20 Impact of Services This survey also aimed to measure the impact of services on the lives of CCE care recipients by asking them whether the services they receive help to maintain or improve their quality of life and if the services help them remain in their homes or Assisted Living Facilities (ALFs). Clients were asked to rate their satisfaction with the overall services they receive, followed by the opportunity to provide additional comments on their services. Quality of Life CCE services are in place to help the care recipient maintain or improve their quality of life. For the caregiver, this may mean they can continue to work, take care of other family responsibilities, and maintain friendships or outside interests. For the care recipient, these services may delay or prevent nursing home placement. As shown in Exhibit 13, 96.4% of individuals reported that the services they receive help them maintain or improve their quality of life. The services also assist the caregivers, providing them with an opportunity to work away from home. One caregiver proxy, answering on behalf of a client, commented, It enhances our quality of life [T]hey are necessary. I am really appreciative of the services she receives. Exhibit 13: Impact of Services Survey Items by Percent of Respondents Yes 96.4 Services Maintain or Improve Quality of Life 97.6 Data: 2016 CCE Client Satisfaction Survey; Items 15-16, (n=2,404-2,412) No Services Help Client Remain in Home or ALF Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

21 Nursing Home Placement CCE services are intended to help individuals with functional impairments remain in their homes and communities for as long as possible. Among those surveyed, 97.6% reported that CCE services did help them remain in the community, either at home or in an ALF. One client explained, however, that while the services may meet their needs now, they will need additional hours of services as their health conditions progress, to ensure they remain in their home. Overall Satisfaction with Services The majority of respondents reported that they were satisfied with the overall services they receive, with 34.6% satisfied and 60.0% very satisfied. Overall, 2.8% of individuals were dissatisfied or very dissatisfied with the CCE services they receive. Of the 81 individuals who expressed neutrality or some level of dissatisfaction with the overall services they received, the top reasons for dissatisfaction appear to be related to the training of staff or receiving too few service hours. For the full breakdown of these responses, see Exhibit 14 below. [I] would not be at home if it wasn t for [my] worker and the wonderful service she provides. Exhibit 14: Additional Needs for Respondents with Low Satisfaction with Overall Services Better trained staff Additional hours of service Doctor's visits, nursing, or physical therapy Personal care or consumable medical supplies 16.7% 9.7% 5.2% 16.7% 9.7% 6.9% 29.0% 25.9% 25.8% 27.6% Respite or companion service 8.1% 8.6% Additional hours of housekeeping 6.5% 5.2% Transportation or escort service 4.8% 8.6% Additional meals or improved meals 4.8% 8.6% Other 1.6% 3.4% Very Neither Satisfied nor 66.7% Data: 2016 CCE Client Satisfaction Survey; Items 12 and 17, (n=81) 17 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

22 Comments Respondents were given the opportunity at the end of the survey to leave additional comments they have regarding the services they receive. About 41.0% of respondents offered a concluding comment, with most (56.4%) expressing satisfaction with their services or minor comments and others reiterating their issues with aspects of their services (21.2%). Comments are displayed in Exhibit 15 below. Results show that 21.2% of those who offered an additional comment were unsatisfied, either with staff or services (11.7%), or with the program, case manager, or ADRC (9.5%). 14.2% of individuals who were satisfied or very satisfied with their services mentioned that they were unsatisfied with aspects of their services when asked for a comment. Additional analyses found inconsistencies in client reports of satisfaction. Of those who are overall satisfied or very satisfied with the services they receive, 14.2% (n=144) reported dissatisfaction with some aspect of their services in the closing comments portion of the survey. In another instance, almost 11.0% (10.9%) of individuals who were satisfied or very satisfied with the length of service visits asked for additional service hours in their comments. Inconsistency in responses may be due to limitations in the survey instrument or insecurity of respondents. Despite reassuring survey participants that their responses would not impact their services, one person commented, [I am] afraid to say anything about the lack of assistance because of possibly losing [my] services. Complete tables for both open-ended survey items, including frequencies and percentages of the responses by theme, can be found in Appendix B. Exhibit 15: Percent Offering Additional Comments on Services Received Satisfied with staff, services, program, or agency 56.4 Additional hours of service needed Unsatisfied with staff or services Unsatisfied with program, case manager, or agency Other Meals should be improved Data: 2016 CCE Client Satisfaction Survey; Item 18, (n=997) 18 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

23 Conclusion An individual s overall satisfaction with services is influenced by various aspects of the services they receive, such as timeliness and scheduling, staff and service quality, the extent to which their needs are met, and impact. Responses to the multiple-choice survey items were overwhelmingly positive, with large proportions of individuals who are satisfied or very satisfied with services. Because of the high levels of satisfaction, meaningful evaluation of the 2016 CCE Client Satisfaction Survey results involved comparing relative proportions of those who were satisfied or very satisfied for each survey item as well as examining the open-ended responses against the multiple-choice responses for consistency. Throughout the course of the survey, the call center identified 10 individuals with serious issues with service delivery or staff. All 10 of the grievances received were resolved by Departmental staff by the conclusion of the survey period. To measure satisfaction with timeliness and scheduling, clients were asked about the time of day and days of the week their services were provided, the length of service visits, staff timeliness, and staff consistency. The questions with the lowest proportions of satisfied or very satisfied responses were related to staff consistency and length of service visits. As many as 94.0% of clients reported that they can usually expect the same person to come help, while about 86.5% reported being satisfied (52.2%) or very satisfied (34.3%) with the length of service visits. Close to 9.0% of individuals in the survey were dissatisfied (8.0%) or very dissatisfied (0.5%) with the length of service visits. Looking only at the percentage of individuals who were very satisfied, the day of the week (35.7%), time of day (35.8%), and length of service visits (34.3%) were among the lowest. Staff and service quality are also important for evaluating overall satisfaction with the CCE program. Clients were asked to rate their level of 81.7% of individuals reported that the services they received met their needs. satisfaction with the knowledge and skills of their worker, their treatment by the worker, communication with the worker, and the overall quality of services. A smaller proportion of individuals were satisfied or very satisfied with the knowledge and skills of their workers (93.8%) than with their treatment (97.5%) or communication (97.0%). Similarly, the proportion of individuals who were satisfied (40.6%) or very satisfied (52.5%) with the overall quality of service (93.1%) is the lowest of the four questions relating to staff and service quality. 19 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

24 About 81.7% of individuals reported that the services they receive meet their needs, while 14.6% reported that the services meet their needs to some extent. Nearly 4.0% of individuals reported that the services they receive do not meet their needs. When asked what kinds of services would help with unmet needs, 40.8% wanted additional hours of service, followed by better trained staff (11.8%) and respite or companion services (10.8%). The majority of individuals reported that they were satisfied (45.9%) or very satisfied (45.9%) with the frequency of service (91.8%), but this proportion is among the smallest of other survey items in the Needs section. In all, 94.6% of respondents indicate they are satisfied (34.6%) or very satisfied (60.0%) with the services they receive, and 2.8% were dissatisfied or very dissatisfied with the services they receive. Responses to this survey reveal not only that clients are satisfied with the services they receive, but that the services have a meaningful impact on their lives. When asked about additional services that may help with unmet needs, the top responses were an increase in service hours, better trained staff, and respite or companion services. The survey items regarding length of service visits and ability of services to meet their needs were among those with the highest levels of dissatisfaction. For each of these items, respondents in PSA 11 expressed greater dissatisfaction relative to those in other PSAs. Upon examining responses to open-ended survey items, there were some inconsistencies in the survey data when compared to responses from the multiple-choice survey items. For example, 37.6% of individuals who were satisfied or very satisfied with the length of service visits commented that additional hours would help fulfill their unmet needs. As many as 7.0% of individuals who were satisfied or very satisfied with the knowledge and skills of their worker reported that they were unhappy with their worker s performance in their concluding comments. About 14.2% of those who were satisfied or very satisfied with their services mentioned that they were unsatisfied with aspects of their service when asked for a comment. These inconsistencies in client responses could be due to limitations in the survey instrument or, as one comment suggests, clients fear of losing their services by providing less positive responses. Improvements to the survey instrument may be necessary in order to improve accuracy in measuring client satisfaction in the future. One way to improve the instrument may be to ask the open-ended questions before the multiple-choice questions. This may increase the personalization of the survey in the beginning and help encourage more meaningful reflection on satisfaction of various services before moving on to less specific questions. 20 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

25 Appendix A: CCE Client Satisfaction Survey Part 1: Services These questions ask about how satisfied you are with the services received. You can answer: Very Satisfied, Satisfied, Neither Satisfied nor,, or Very. You can also tell me if you really don t know. 1. How satisfied are you with how often services are provided? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 2. How satisfied are you with the length of the service visits? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 3. How satisfied are you with the time of day that services are provided? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 4. How satisfied are you with the day(s) of the week services are provided? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 5. Overall, how satisfied are you with the quality of the services you received? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very Part 2: Workers Next, I m going to ask you several questions about how satisfied you are with the workers who come to help you and the care recipient. Again, you can answer: Very Satisfied, Satisfied, Neither Satisfied nor,, or Very. You can also tell me if you really don t know. 6. How satisfied are you with the knowledge and skills of the worker(s) who come to help you? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 7. How satisfied are you with the way the worker(s) treat you? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 8. How satisfied are you with the way you and the worker(s) communicate? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very 21 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

26 9. Do the worker(s) usually arrive at the scheduled time? a. Yes b. No c. I don t know when to expect them 10. Can you usually expect the same person (people) to come help? a. Yes b. No c. Don t Know Part 3: Service Impact The last set of questions focuses on the effect or impact these services have on your life. 11. Overall, would you say that the services received meet your needs? a. Yes b. To some extent c. No d. Don t Know 12. What additional services might help with those needs that have not been met? 13. Have you been diagnosed with one or more chronic conditions? a. Yes b. To some extent c. No d. Don t Know 14. Do you get enough information and support to help you manage your chronic conditions? a. Yes b. To some extent c. No d. Don t Know 15. Do these services help you to maintain or improve your quality of life? a. Yes b. To some extent c. No d. Don t Know 16. Do these services help you to stay at home? a. Yes b. To some extent c. No d. Don t Know 17. Overall, how satisfied are you with the services you received? a. Very Satisfied b. Satisfied c. Neither Satisfied nor d. e. Very Part 4: Comments That s the end of our questions. 22. Is there anything else you would like us to know about the services received? I want to thank you for participating in the survey. Your feedback is important to the Department of Elder Affairs. I hope you have a great day. 22 Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

27 Appendix B: CCE Client Satisfaction Survey Results Multiple Choice Survey Items 1. How satisfied are you with how often services are provided? Count Percent Very Satisfied 1, Satisfied 1, Neither Satisfied nor Very Total 2, How satisfied are you with the length of the service visits? Count Percent Very Satisfied Satisfied 1, Neither Satisfied nor Very Total 2, How satisfied are you with the time of day that services are provided? Count Percent Very Satisfied Satisfied 1, Neither Satisfied nor Very Total 2, How satisfied are you with the day(s) of the week services are provided? Count Percent Very Satisfied Satisfied 1, Neither Satisfied nor Very Total 2, Overall, how satisfied are you with the quality of the services you have received? Count Percent Very Satisfied 1, Satisfied Neither Satisfied nor Very Total 2, How satisfied are you that your worker(s) has (have) the knowledge and skills needed Count Percent to help you? Very Satisfied 1, Satisfied Neither Satisfied nor Very Total 2, Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

28 7. How satisfied are you with the way your worker(s) treat you? Count Percent Very Satisfied 1, Satisfied Neither Satisfied nor Very Total 2, How satisfied are you with the way you and your worker(s) communicate? Count Percent Very Satisfied 1, Satisfied Neither Satisfied nor Very Total 2, Does your worker(s) usually arrive at the scheduled time? Count Percent Yes 2, No I don't know when to expect them Total 2, Can you usually expect the same person (people) to come help? Count Percent Yes 2, No Total 2, Overall, would you say that the services you receive meet your needs? Count Percent Yes 1, To some extent No Total 2, Have you been diagnosed with one or more chronic condition? Count Percent Yes 1, No Total 2, Do you get enough information and support to help you manage your chronic Count Percent conditions? Yes 1, No Total 1, Do these services help you to maintain or improve your quality of life? Count Percent Yes 2, No Total 2, Do these services help you to stay in your home? Count Percent Yes 2, No Total 2, Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

29 17. Overall, how satisfied are you with the services you receive? Count Percent Very Satisfied 1, Satisfied Neither Satisfied nor Very Total 2, Open-Ended Survey Items Two questions on the survey were open-ended, allowing individuals to suggest additional services that are needed and leave comments on the services they receive. These responses were coded into the most frequently cited multiple-response categories, shown below. The count column indicates the number of responses each category received; the total row denotes the total number of multiple-responses, not the total number of people who responded to the question. 18.0% of respondents provided a comment to the first open-ended question, while about 40.9% of respondents provided a comment to the second and final open-ended question. 12. What additional services might help with those needs that have not been met?* Count Percent Additional hours of current or non-specified service Respite or companion services Personal care or consumable medical supplies Additional hours of housekeeping Doctor's visits, nursing, or physical therapy Additional meals or improved meals Better trained staff Transportation or escort service Other *Question was not answered by all respondents. N=440 Total Is there anything else you would like us to know about the services you receive?* Count Percent Additional hours of service needed Satisfied with staff, services, program, or agency Unsatisfied with program, case manager, or agency Unsatisfied with staff or services Meals should be improved Other *Question was not answered by all respondents. N=997 Total 1, Florida Department of Elder Affairs, 2016 CCE Client Satisfaction Survey Report

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