2012 Report. Client Satisfaction Survey PSA 9 RICK SCOTT. Program Services, Direct Service Workers, and. Impact of Programs on Lives of Clients

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1 RICK SCOTT GOVERNOR 2012 Report CHARLES T. CORLEY SECRETARY Client Satisfaction Survey Program Services, Direct Service Workers, and Impact of Programs on Lives of Clients PSA 9 elderaffairs.state.fl.us Bureau of Planning & Evaluation, October 2013

2 Table of Contents Executive Summary... 2 Background... 3 Methodology... 3 Population and Sample... 3 The Survey... 4 Survey Procedures... 4 Analysis... 4 Survey Results... 5 Overall Satisfaction With Services Received and With Their Quality... 5 Client Satisfaction With Program Service Delivery... 6 Client Satisfaction With Direct Service Workers... 8 The Impact of Services on Clients Lives Summary and Conclusions Appendix A: Understanding Your Tables Appendix B: PSA 9 and Statewide Survey Responses Appendix C: Survey Instrument Client Satisfaction Survey: PSA 9

3 Executive Summary In 2012, the Florida Department of Elder Affairs (DOEA) Bureau of Planning and Evaluation surveyed a random sample of clients that was based on their participation in three of the Department s community-based care programs in each of the state s 11 Planning and Service Areas (PSAs). The following report examines responses obtained from PSA 9 clients and compares them to responses for all 11 PSAs surveyed. The purpose of the surveys was to assess the satisfaction of clients with program services, the quality of direct service workers, and the impact of the program on clients lives. Clients selected for the surveys participated in at least one of three DOEA programs serving the largest number of case-managed clients: Aged and Disabled Adult Medicaid Waiver (ADA), Assisted Living Medicaid Waiver (AL), and Community Care for the Elderly (CCE). Program participants in PSA 9 reported high levels of overall satisfaction with program services, their quality and delivery. They also reported high levels of satisfaction with their direct service workers and the impact of services on their lives. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with PSA 9 services received and with their quality (95 and 93%, respectively). The level of satisfaction obtained by clients statewide was 96 percent for both of these service aspects The majority of respondents were satisfied with the aspects of program services queried including frequency and length of services, time of day, and day(s) of the week. Between 91 and 98 percent of ADA, AL, and CCE respondents reported being Very Satisfied or Satisfied with these provisions of program services. The majority of respondents were also Very Satisfied or Satisfied with their direct service workers. Between 91 and 97 percent of respondents surveyed in PSA 9 were Very Satisfied or Satisfied with their direct service workers with the lowest percentage pertaining to the issue of worker knowledge and skills needed to help (91%). Survey respondents reported that program services had a major impact on their lives. Between 95 and 97 percent of respondents said services met their needs, improved their quality of life, and increased the likelihood of their remaining in their homes. When comparing satisfaction levels of PSA 9 respondents to those compiled from responses statewide, PSA 9 results were similar but generally lower by one to four percent Client Satisfaction Survey: PSA 9

4 Background The Florida Department of Elder Affairs operates a variety of programs to meet the special needs of Florida s aging citizens. These programs are designed to provide cost-effective ways of keeping elderly persons in their homes or communities and to prevent, postpone, or reduce inappropriate or unnecessary institutional placements. Individuals served by these programs are frail elders and persons with disabilities who are functionally impaired and at risk of nursing home placement. CARES (Comprehensive Assessment and Review for Long-Term Care Services) is Florida's federally mandated nursing home pre-admission assessment program that determines medical eligibility for the Medicaid waiver programs. Individuals must be age 60 or older and meet the same functional and financial criteria as individuals seeking Medicaid assistance for nursing home placement to qualify for the ADA and AL programs administered by the Department. In addition, for AL eligibility, individuals must meet at least one of the following additional criteria: require assistance with activities of daily living, be diagnosed with Alzheimer's disease or other dementia(s), have a diagnosis of a degenerative or chronic medical condition requiring nursing services, or be waiting for discharge from a nursing home and unable to return to a private residence. Individuals eligible for CCE must be age 60 or older and functionally impaired. Primary consideration for CCE services is given to elderly persons reported 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. Services provided to participants of the above-mentioned programs may include personal care, homemaker, adult day health care, respite, home-delivered meals, companionship, case management, case aide, chore, escort, attendant care, and counseling. Methodology Population and Sample The three DOEA programs selected for the survey (ADA, AL, and CCE) are those which serve the largest number of case-managed clients. The clients selected for the survey received services from one of these programs for at least three months and received a service in addition to case management and home-delivered meals. Samples were taken from each of Florida s 11 PSAs. The samples were stratified to represent the proportion of clients in each PSA and the proportion of clients in each program. The sample size for PSA 9 is large enough to assume a 90 percent confidence level for the representativeness of results DOEA Client Survey PSA 9

5 The Survey The survey contained 15 questions for recipients of program services, of which 11 evaluated services and direct service workers and three addressed the impact of services on respondents lives. Questions assessing satisfaction with services included those on the frequency, length, time of day, day(s) of the week, and quality of services provided. Questions assessing satisfaction with direct service workers focused on adequacy of worker knowledge and skills, communication with workers, treatment of clients, punctuality, and continuity of services conducted by the same worker. Three questions addressing the impact of services on the lives of clients asked respondents whether services met their needs, helped to maintain or improve their quality of life, and helped them continue living in their home. A final question gave respondents the opportunity to volunteer any other information about the services they received. This report includes the survey instrument as Appendix C. Survey Procedures Clients were sent letters notifying them that they might be called to participate in a survey about the services they received. They were assured that, whether or not they participated, their DOEA program services would not be affected. The survey was conducted between June 12, and July 6, 2012, by professional interviewers in the DOEA Computer-Assisted Telephone Interview (CATI) Call Center. Instructions informed respondents that the survey would take an estimated 10 minutes to complete. The calls resulted in 241 completed surveys, yielding a response rate (the number of surveys completed divided by all eligible persons successfully contacted) of 38 percent. A large number of clients were unable to respond to the survey because of unavailability (e.g., hospitalization) or inability to hear, understand, or remember. Analysis The number of completed surveys was weighted within programs in each PSA to compensate for over and under-sampling and to be representative of the PSA 9 client population surveyed. Data were collapsed across programs and analyzed for each PSA and for all 11 PSAs combined. Appendix B contains the response distribution, arithmetic means, and standard deviations for each question, for PSA 9 and across all 11 PSAs. Appendix A offers instructions on how to read the tables and interpret statistical terms included in the report DOEA Client Survey PSA 9

6 Survey Results Overall Satisfaction With Services Received and With Their Quality Clients expressed high overall satisfaction with the services and with the quality of services they received. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with program services by PSA 9 respondents and by all respondents in the 11 PSAs (at least 93% for each question). Overall Client Satisfaction With Services Received PSA 9 survey respondents expressed high levels of overall satisfaction with services received. Fifty percent said they were Very Satisfied, and an additional 44 percent said they were Satisfied. and 96%, respectively). The satisfaction levels of PSA 9 clients were similar to those achieved for all clients surveyed statewide. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with services received by PSA 9 and statewide clients (95% Overall Client Satisfaction With the Quality of Services Received PSA 9 survey respondents expressed high levels of satisfaction with the quality of services received. Fifty-four (54) percent said they were Very Satisfied, and an additional 40 percent said that they were Satisfied. The combined response options of Very Satisfied and Satisfied for PSA 9 clients yielded high overall satisfaction with the quality of services received. Combined satisfaction levels of PSA 8 clients and clients surveyed across all 11 PSAs were 93% and 96%, respectively DOEA Client Survey PSA 9

7 Client Satisfaction With Program Service Delivery Four questions asked survey respondents about their satisfaction with program services. How satisfied are you with how often services are provided? How satisfied are you with the length of service visits? How satisfied are you with the time of day that services are provided? How satisfied are you with the day(s) of the week services are provided? PSA 9 survey respondents expressed high levels of satisfaction with the surveyed aspects of program services, which were very close to those reported by all clients surveyed in the 11 PSAs. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with program services by PSA 9 respondents and by all respondents in the 11 PSAs (at least 91% for each question). Satisfaction With Frequency of Services Provided PSA 9 respondents expressed high levels of satisfaction with frequency of services provided. Fifty percent said they were Very Satisfied, and an additional 44 percent said that they were Satisfied DOEA Client Survey PSA 9

8 The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with service frequency by PSA 9 respondents that were similar to those obtained by clients surveyed across all 11 PSAs (94 and 95%, respectively). Satisfaction With Length of Service Visits PSA 9 survey respondents expressed high levels of satisfaction with the length of service visits. Thirty-three percent said they were Very Satisfied, and an additional 58 percent said that they were Satisfied. The combined response options of Very Satisfied and Satisfied for PSA 9 clients yielded high overall satisfaction with the length of service visits. The PSA 9 percentage was similar to that reported by clients across all PSAs (91% and 92%, respectively). Satisfaction With the Time of Day Services Are Provided PSA 9 survey respondents expressed high levels of satisfaction with the time of the day services were provided. Forty-three percent said they were Very Satisfied, and an additional 54 percent said that they were Satisfied. A larger percentage of PSA 9 clients (43%) than statewide clients (37%) than reported they were Very Satisfied with the time of day their services were provided. Combined satisfaction levels of PSA 9 clients were 97 percent and 96 percent for clients surveyed across all 11 PSAs. Satisfaction With the Day of the Week Services Are Provided PSA 9 survey respondents expressed high levels of satisfaction with the day of the week services were provided. Forty-three percent said they were Very Satisfied, and an additional 55 percent said that they were Satisfied. A larger percentage of PSA 9 clients (43%) than statewide clients (37%) reported they were Very Satisfied. The combined response options of Very Satisfied and Satisfied for PSA 9 and statewide clients yielded high overall satisfaction levels with the day of the week of service delivery (98% and 97%, respectively) DOEA Client Survey PSA 9

9 Client Satisfaction With Direct Service Workers PSA 9 survey respondents expressed high levels of satisfaction with different aspects of their direct service workers. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction that ranged from 91 to 97 percent. Client Satisfaction With the Knowledge and Skills of Direct Service Workers Forty-nine percent said that they were Very Satisfied with the knowledge and skills of their workers, and an additional 42 percent said they were Satisfied. The combined response options of Very Satisfied and Satisfied for PSA 9 clients yielded overall levels of satisfaction with worker knowledge and skills (91%) that were four percent lower than those reported by clients statewide (95%). Client Satisfaction With Treatment by Direct Service Workers Sixty-one percent of PSA 9 clients said they were Very Satisfied, and an additional 35 percent said that they were Satisfied with treatment by workers. A larger percentage of PSA 9 clients (61%) than statewide clients (57%) reported they were Very Satisfied. The combined response options of Very Satisfied and Satisfied for PSA 9 and statewide clients yielded high overall levels of satisfaction with their treatment by workers (97% and 98%, respectively) DOEA Client Survey PSA 9

10 Client Satisfaction With the Ability to Communicate With Direct Service Workers Fifty-two percent of the PSA 9 survey respondents said they were Very Satisfied with worker communication, and an additional 41 percent said they were Satisfied. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with worker communication (93%) that were four percent lower than those reported by clients surveyed across PSAs (97%). Punctuality and Continuity of Direct Service Workers Ninety-four percent of PSA 9 clients said their workers arrived at the scheduled time compared to 95 percent of statewide clients. Even though the proportion of clients who said they did not know when to expect workers was small, PSA 9 clients were approximately twice as likely to give this response than statewide clients (2.5% and 1.2%, respectively). Ninety-six percent of PSA 9 clients said the same worker usually comes to help compared to 93 percent clients statewide DOEA Client Survey PSA 9

11 The Impact of Services on Clients Lives Program recipients were also asked to indicate whether the services met their needs, improved their lives, and helped them stay at home. Ninety-five percent of PSA 9 clients said that services met their needs compared to 97 percent of statewide clients surveyed. In addition, PSA 9 clients were highly likely to say that services helped maintain or improve their quality of life (96% compared to 97% of clients statewide). Approximately 97 percent of PSA 9 clients said that services helped them stay in their home compared to 98 percent of clients statewide. Summary and Conclusions In summary, program participants in PSA 9 reported high levels of overall satisfaction with the services they received through the ADA, AL, and CCE programs and with the quality and delivery of these services. In addition, they were highly satisfied with their direct service workers and the impact of services on their lives. Survey participants combined responses of Very Satisfied and Satisfied yielded overall satisfaction levels with these service aspects ranging from 91 to 98 percent DOEA Client Survey PSA 9

12 When comparing satisfaction levels of PSA 9 respondents to those compiled from responses statewide, PSA 9 results were very similar, even though lower in most cases, by one to four percent DOEA Client Survey PSA 9

13 Appendix A: Understanding Your Tables Percent of clients choosing a response The same information is given for all 11 PSAs combined Answer choices and point value (1-5) for the response The mean or item score. The average of all client responses. Responses Sample PSA Frequency Percent Mean Very Satisfied (5) All PSAs Deviation Frequency Percent Mean 1, Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , Deviation The number of clients choosing this response The variation among the responses. A low standard deviation indicates the responses tend to be very close to the mean. A high standard deviation indicates that the responses are more spread out DOEA Client Survey PSA 9

14 Look At Your Results: 5. Overall, how satisfied are you with the quality of the services you have received? Responses Sample PSA Frequency Percent Mean Very Satisfied (5) All PSAs Deviation Frequency Percent Mean 1, Satisfied (4) , * Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) 1 0.6* Total , *Percentage differences were created by analysis software. Deviation Of the 189 clients who responded to Question 5 in the sample PSA, 93 (49.5%) said they were Very Satisfied with the quality of services they received, 90 (47.7%) were Satisfied, one (0.5%) was Dissatisfied, three (1.7%) were Dissatisfied, and one client (0.6%) was Very Dissatisfied. Overall, a total of 97.2 percent of clients responded that they were Very Satisfied or Satisfied (49.5% plus 47.7%). The mean of the responses, or the Item Score, was The highest score possible is 5 (for Very Satisfied) and the lowest possible is 1 (for Very Dissatisfied). The average client in this sample PSA is more than satisfied with the quality of services he or she receives since the mean is close to 5. There is some variation in the client responses. This can be seen in the standard deviation and by looking at the distribution of frequencies. Compare Your Results to all the PSAs in Florida: The means of both groups are about the same and show overall satisfaction with the quality of services. There are slight differences in how satisfied the clients were. Whereas the sample PSA showed 49.5 percent of clients Very Satisfied, 48.6 percent of clients statewide were Very Satisfied. The sample PSA had one client who was Very Dissatisfied. There were 10 Very Dissatisfied clients statewide, but the total is less than one-half percent DOEA Client Survey PSA 9

15 Responses Appendix B: PSA 9 and Statewide Survey Responses Very Satisfied (5) PSA 9 All PSAs Number Percent Mean Number Percent Mean Deviation 1. How satisfied are you with how often services are provided? 1, Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , How satisfied are you with the length of the service visits? Deviation Very Satisfied (5) Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , How satisfied are you with the time of day that services are provided? Very Satisfied (5) Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , DOEA Client Survey PSA 9

16 Responses PSA 9 All PSAs Number Percent Mean Number Percent Mean Deviation 4. How satisfied are you with the day(s) of the week services are provided? Very Satisfied (5) Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , Overall, how satisfied are you with the quality of the services you have received? Very Satisfied (5) , Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , Deviation How satisfied are you that your worker(s) has (have) the knowledge and skills needed to help you? Very Satisfied (5) , Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , How satisfied are you with the way your worker(s) treat you? Very Satisfied (5) , Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , DOEA Client Survey PSA 9

17 All PSAs PSA 9 Responses Number Percent Mean Deviation Number Percent Mean 8. How satisfied are you with the way you and your worker(s) communicate? Very Satisfied (5) , Satisfied (4) , Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , Do(es) your worker(s) usually arrive at the scheduled time? Yes (2) , No (1) I don't know when to expect them Total , Can you usually expect the same person (people) to come help? Yes (2) , No (1) Total , Overall, would you say that the services you receive meet your needs? Yes (2) , No (1) Total , Do these services help you to maintain or improve your quality of life? Yes (2) , No (1) Total , Deviation Do these services help you to stay in your home? (If at an ALF ask: Do these services help you to avoid moving into a nursing home?) Would you say: Yes (2) , No (1) Total , DOEA Client Survey PSA 9

18 Responses PSA 9 Number Percent Mean Very Satisfied (5) Deviation All PSAs Number Percent Mean 14. Overall, how satisfied are you with the services you receive? 1, Satisfied (4) Dissatisfied (3) Dissatisfied (2) Very Dissatisfied (1) Total , Deviation DOEA Client Survey PSA 9

19 Appendix C: Survey Instrument Client Satisfaction Survey SERVICES These questions ask about how satisfied you are with the services you receive. You can answer: Very Satisfied, Satisfied, Dissatisfied, Dissatisfied, or Very Dissatisfied. 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. Dissatisfied d. Dissatisfied e. Very Dissatisfied 2. How satisfied are you with the length of the service visits? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 3. How satisfied are you with the time of day that services are provided? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 4. How satisfied are you with the day(s) of the week services are provided? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 5. Overall, how satisfied are you with the quality of the services you have received? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied WORKERS Next, I m going to ask you several questions about how satisfied you are with the workers who come to help you. Again, you can answer: Very Satisfied, Satisfied, Dissatisfied, Dissatisfied, or Very Dissatisfied. You can also tell me if you really don t know. 6. How satisfied are you that your worker(s) has (have) the knowledge and skills needed to help you? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 7. How satisfied are you with the way your worker(s) treat you? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 8. How satisfied are you with the way you and your worker(s) communicate? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied 9. Do(es)your worker(s) usually arrive at the scheduled time? a. Yes b. No c. I don t know when to expect them DOEA Client Survey PSA 9

20 10. Can you usually expect the same person (people) to come help? a. Yes b. No c. Don t Know (d. Refused) e. Not Applicable 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 you receive meet your needs? a. Yes b. to some extent c. No d. Don t Know (d. Refused) e. Not Applicable 12. 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 (d. Refused) e. Not Applicable 13. Do these services help you to stay in your home? (If at an ALF ask: Do these services help you to avoid moving into a nursing home?) Would you say: a. Yes b. to some extent c. No d. Don t Know (d. Refused) e. Not Applicable 14. Overall, how satisfied are you with the services you receive? a. Very Satisfied b. Satisfied c. Dissatisfied d. Dissatisfied e. Very Dissatisfied COMMENTS That s the end of our questions. 15. Is there anything else you would like us to know about the services you receive? 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 DOEA Client Survey PSA 9

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