LTC Resident Experience Survey

LTC Resident Experience Survey

Carewest Overview Carewest is a wholly owned subsidiary of Alberta Health Services operating in Calgary Carewest provides programming in 3 service streams long term continuing care, rehabilitation & recovery and community programs Long Term Care 8 sites/1053 beds Designated Assisted Living 2 sites/40 beds

Issue Identification 2007 2008 Health Quality Council of Alberta completed LTC surveys across the province (173 LTC facilities) Interviewed 3415 LTC residents Received written survey feedback from 7943 LTC families Repeated family survey in 2010/11 and 2014/15 HQCA utilized the CAHPS survey format (Consumer Assessment of Healthcare Providers and Systems) HQCA determined following the survey that 24% of the LTC residents were cognitively capable of completing the 1:1 interview and some required several sessions to do so

Issue Identification Because a large proportion of residents are not capable of completing a survey due to cognitive reasons, resident survey results represent the views of cognitively able residents only HQCA Highlights of the Long Term Care Resident and Family Experience Surveys, December 2008

Issue Identification A critical piece of assessing client centred care is the perception of services from the resident receiving the services Well rounded Quality Assurance for LTC would include: RAI Clinical Quality Indicators/outcome scales etc CCHS standards, Accommodation standards, Accreditation Canada audit results, RAI Audits etc. Resident Experience survey results HQCA LTC Family Experience survey results 2010 Quality & Service Improvement Business Plan objective to determine or develop an appropriate survey tool/process that would allow us to score resident experience/satisfaction

Issue Identification Oh, and develop the tool such that the majority of our clients/residents can provide their feedback

Analysis of the Issue October 1 st, 2014 through January 25 th, 2015 = 1001 Carewest RAI MDS assessments completed CPS Score # of Clients Total % Description 0 139 14% Intact 1 132 13% Borderline Intact 2 146 15% Mild Impairment 3 269 27% Moderate Impairment 4 110 11% Moderate/Severe Impairment 5 100 10% Severe Impairment 6 105 10% Very Severe Impairment

Analysis of the Issue As of 2010, 0% of our LTC residents were being surveyed around experience annually Our goal was to pull feedback from > 50% of Carewest LTC residents on an annual basis Approximately 58% of Carewest clients are Moderately to Very Severely Cognitively Impaired There were no survey tools that we were aware of that would support us in achieving our goal

Quality Improvement Steps Review of literature and existing survey tools utilized across Canada and other jurisdictions was completed Carewest identified the Minnesota Nursing Facility Satisfaction Survey as philosophically in alignment with our goals This survey has been completed annually since 2005 They survey 400 Minnesota state nursing home facilities annually = approximately 13,500 residents interviewed during 3 month data collection period Only exclude those with a CPS score of 6 from participation Survey tool has been designed and field tested for use with the population in nursing facilities including those with dementia Note Minnesota Nursing Home Report Card nhreportcard.dhs.mn.gov

Quality Improvement Steps Why not just ask the people with the highest cognitive functioning about their satisfaction? Residents with dementia comprise the largest and most vulnerable group of nursing facility residents. Not only does their inclusion strengthen the reliability of the results, but also it is ethical to try to include all residents perspectives. It provides a more realistic view of Residents experiences in nursing facilities. If the majority of residents are systematically omitted from satisfaction surveys, the information cannot be considered accurate Vital Research FAQ s about the Minnesota Satisfaction Survey

Quality Improvement Steps Characteristics of a survey tool appropriate across cognitive levels: Questions are multi dimensional covering various aspects of daily experience Questions are concrete rather than abstract Questions are short and free of conditional phrases and clauses 1 step questions that a resident can remember the beginning of by the time the surveyor gets to the end Questions are closed ended and there are few response categories Words and phrases used should be typical for the generation being surveyed and easy to hear and see on the lips (hearing loss can accentuate confusion with cognitive loss)

Quality Improvement Steps

Implementation and Results Worked from the framework of the Minnesota tool and re worked the questions to allow opportunities for feedback in areas specific to Alberta standards as well as the Carewest Frame of Reference, Philosophy of Care etc. Current Carewest tool: 38 questions Questions in categories of Comfort, Environment, Care Experience, Activities, Food/Meals, Autonomy, Security, and Overall satisfaction

Implementation and Results 2011 Carewest LTC Resident Experience survey was first delivered by 5 trained surveyors 569 of 970 residents were interviewed = 58.7% 5.7% did not provide consent to participate 35.6% could not participate (CPS score of 6, lower CPS score but confusion with the questioning, language barriers, medically acute, unavailable etc.) Completed surveys in 2012 (61.2%), 2013 (55.7%), and 2014 (55.4%) Approximately 300 surveyor hours annually to complete

Implementation and Results Results are compiled into Carewest site report cards shared with all Managers Directors receive a comprehensive package including aggregate results, site specific results, and trending information Develop a results summary booklet

Implementation and Results Carewest Aggregate 2011 through 2014 Comparison LTC Resident Experience Survey Results Care Experience 100 90 80 70 60 50 40 30 20 10 0 Do the people who work here treat you with kindness? Are you treated with respect here? Can you find Do the a place to be people who alone when work here you want to provide your be? care gently? Do the people who work here respect your modesty? Are people here interested in the things you've done in your life? Do the people here talk with you while providing your care? Do the people who work here listen to what you say? Do the people who work here knock on your door before they enter? Do the people who work here ever get angry at you? 2011 2012 2013 2014

Implementation and Results Utilization of Survey Results to identify and support opportunities for Quality Improvement Driver for Carewest wide review of Recreation and Leisure Services model key set of indicators Driver for Carewest wide review of food services delivery model key set of indicators One of the drivers for Carewest wide RESPECT campaign One of the drivers around the development of the Carewest Philosophy of Care Individual site Quality Improvement initiatives based on site trends vs. other CW sites and CW aggregate

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