Quality Care Focus
Should I Stay or Go?: Rural Aging, a Time for Reflection
Paper Presentation in a Themed Session Emily Anderson, Robin Ray, Sarah Larkins
Studies have shown that older people prefer to continue living in their own home and community as they age; however, this is dependent upon available services and social support. In Australia about two thirds of people will age at home. The Australian government provides home care packages to provide support to age in place; however, in rural areas not all services are available. The lack of employment opportunities in rural areas often results in family residing at a distance reducing available social support. A multiple embedded case study was undertaken in three diverse rural communities. Older rural residents aging in place were interviewed about their aging experience and plans for their future when they review available social support. Social networks were then visually depicted with the use of ecomaps and network members were then interviewed. Results show that aging is a time of change and reflection and there is a need for more discussion within these networks when it comes to future planning. It is hoped that results will inform policies that help support aging in place for rural residents.
Measuring Quality in Long-term Care: Florida Statewide Medicaid Managed Care Program
Paper Presentation in a Themed Session Jean Munn
Quality of life and quality of care are essential issues for older adults receiving long-term care services. Yet, these constructs are difficult to define and measure. This paper describes a mixed-methods examination of quality using data from 124,276 Medicaid enrollees residing in nursing facilities, assisted living communities, and homes across the state of Florida between 2013 and 2016 and interviews with a subsample of enrollees. Following the move of all Medicaid LTC services to a Statewide Medicaid Managed Care program, an interdisciplinary team from the FSU’s Colleges of Medicine and Social Work has conducted an independent assessment. We established quality measures specific to sites of care, using enrollee outcomes as the gold standard and developed a novel measure of unmet need. We interviewed fifty-one enrollees regarding their experiences. Overall, we found that quality had been maintained or improved with the change in implementation. We found anomalies in depression scores across all three sites of care as well as identifying a need for greater interaction with NF enrollees and a deficit in enrollees’ understanding of their rights. This study is unique in presenting findings of a statewide structural change in healthcare delivery and incorporating the voices of enrollees in the findings.
The Relationship between Quality of Life and Service Quality and Control in in Assisted Living and Long Term Care Residences in Canada
Paper Presentation in a Themed Session Helen Kelley, Carla Carnaghan
In this study we examine the role of service quality in residents’ quality of life from the perspective of residents and their families. We go beyond a narrow definition of quality of care focused on outcomes to consider physical, mental, spiritual, environmental, community access, growth, and autonomy subdimensions, as well as how the services were provided (e.g., respect, gentleness). Given philosophical differences between traditional long term care and assisted living, we investigate differences in perceived service quality between respondents living in these two types of residence, as well as by health status. Using survey data from 118 respondents, we find that on a univariate basis, residents in assisted living reported higher service quality across all states of health. On a multivariate basis, controlling for age, gender, education and respondent type, service quality related to physical and mental health; support of daily routines; and autonomy were all significantly associated with quality of life. When considered separately by care model, how the services were provided was significant in quality of life in traditional long term care, while services related to physical and mental health; autonomy; and how the services were provided were significant to quality of life in assisted living. Subdimensions of service quality that were significant to the quality of life for residents with lower states of health were services related to physical and mental health; while subdimensions of service quality that were significant to residents with higher states of health were services related to autonomy. Implications are discussed.
