T Contents - AHCA Home atina esear rratin 6 The 2011-2012 National Survey of Customer and Employee Satisfaction in Assisted Liv-ing Communities (National Research Report)

Table of Contents

© 2012 National Research Corporation

INTRODUCTION

• PopulationProjectionHighlights

OVERVIEWANDDATABASE

• Overview

• Database

• Characteristics

i. Customers

ii. Employees

CUSTOMERSATISFACTION

• Overview

• AreasofGreatestandLeastSatisfaction

WORKFORCESATISFACTION

• Overview


DEEPERANALYSIS

• Overview

• PerformanceRelationships

• UnderstandingtheFeedback

• IdentifyingDriversofRecommendationScores

• RangeofPerformance

CONCLUSION


INTRODUCTION

• Introduction

• PopulationProjectionHighlights


2

Introduction

INTRODUCTION

Assistedlivingcommunitiesareasdiverseastheresidentstheyserve.Whiletheorganiza-tionsrangedramaticallyintermsofsize,opera-tionalmodels,andlicensurerequirements,theresidentsalsohavearangeofsupportneedsandexpectationsfortheirexperienceswiththecommunities.Intheeffortforassistedliv-ingcommunitiestoprovideandimprovetheirapproachtoperson-centeredcareandpositiontheirorganizationstobestservetheshiftingneedsoftheirresidentsandcommunities,aswellastonavigatechangesinthelongtermcarebusinessenvironment,theseorganiza-tionshavemultiplesourcesofinformationfromwhichtodraw.Amongtherichestistheinfor-mationandfeedbackprovideddirectlybytheprofession’smostvaluablestakeholders—theresidents,theirfamilymembers,andassistedlivingemployees.

Thisinsightispresentedinthis2011-2012NationalSurveyofCustomerandEmployeeSatisfactioninAssistedLivingCommunities(theNationalResearchReport).Ithasbeengatheredthroughtheadministrationofsatisfac-tionsurveysthatweredesignedspecificallyforassistedlivingcustomersandemployees.Thisprocessanditsresultantdatacanbeusedtoservemultiplepurposeswithinthelongtermcareprofession.Inadditiontoadeeplookatthesatisfactionlevelsofcustomersandtheassistedlivingworkforce,itoffersadata-richinsideunderstandingoftheexperiencesandpercep-tionsofthesegroups.Theresultscanbeused,therefore,tomodifybehaviors,policies,andstandardsthatimpactemployeeandcustomer

satisfaction,andalsotodirectculturechange,thedevelopmentofworkforcetrainingactivi-ties,familycommunicationandengagementstrategies,andcreationofresidentprograms,tonameafew.

Further,theobjectivedatacansupportawidevarietyofactivitiesinserviceoftheprofession.Itprovidesapictureofthecharacteristicsofemployeesandcustomersinadditiontonum-bersthatrepresenttheopinionsofthesestake-holders,allofwhichcanbeusedforeducation,publicrelations,businessdevelopmentactivi-ties,andadvocacy.

ThissecondannualNationalResearchReportforassistedlivinghasbeenpreparedandpre-sentedbyNationalResearchCorporationtoputitsknowledgeanddataofassistedlivingintothehandsoftheprofession’sleaders,forallofthewidespreadpurposespreviouslylisted,aswellasfortheindividualactivitiesthatgoonatcommunitieseveryday.Itisourintenttofuelconversations,inthesmallestofindividualcommunitiesandthelargestofrepresentativegroups.Theobjectiveisthatthisdatabecomesameaningfulpartofconversationsanddeci-sionsthatwillsupporttheongoingstrategies,health,andsuccessoftheassistedlivingprofes-sionasitcontinuestoserveacriticalroleinthelongtermcareprofileoftheU.S.

ProjectedPopulationTrends

Assistedlivingcommunitiesarewell-positionedtoservethegrowingneedsoftheagingpopulationwhoseektomaintainasmuch


3

Introduction

showsthatthepercentageofseniorsovertheageof65withchronicconditions(specificallyheartdisease,cancer,andstroke)and/orwithactivitylimitationsisalsoincreasing.

Notonlywilltherebemorepeoplelivinglonger,thisnationwillhaveacommunityofindividualsandtheirchildrenwhohavedif-ferentexpectationsforhowthelateryearsoftheirliveswillbelivedout.Seniorswillhavemorehealthissuestomanageandmorelimita-tionsontheirabilitytocareforthemselves.Yetanecdotally,weknowthatseniorswillwanttobefarmoreactivethanpreviousgenerationswhilealsomaintaininglessofaburdentotheirfamilies.

Bytrulylisteningtotheexperiencesandper-spectivesofkeystakeholders—residents,fami-lies,andemployees—assistedlivingcommuni-tieswillbeabletocapablyservethisgrowingcontingent,adapttoshiftingneeds,andsatisfytheevolvingexpectationsofseniors.

independenceaspossiblewhilestillrequir-ingmorecareandasaferenvironmentthanathome.Evenwhenitisdifficulttoaccepttheneedforsomehelponadailybasis,formanyofthisnation’seldersandtheirfamilies,as-sistedlivingpresentsapracticalalternativetoaresidencethatinvolvesmoreintensivecareortomovinginwithlovedones.Weknowthattheagingpopulationisincreasing.Simply,thenumberofpeopleovertheageof65isexpect-edtoincreasefromthe39.4millioncountedin2009to54.2millionprojectedin2020(seefigure1).

Plus,thereisanincreasinglifeexpectancy(seefigure2)andincreasingprevalenceofchronicdiseaseandactivitylimitations(seefigure3)amongthisportionofthenaionalpopulation.

In2009,seniorsaged65and75wereex-pectedtoliveanadditional19.2and12.2years,respectively.Foreachofthosegroups,thisrepresentsanincreaseinlifeexpectancy(specificallyatages65and75)ofaboutoneadditionalyearsincethelastestimatein2004justfiveyearsprevious.Atthesametime,data

Figure 1

POPULATION AGE 65 AND OLDER

30354045505560

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

Actual

Mill

ions

Projected

Source: CMS, National Health Expenditure Projections 2010-2020

Figure 2

LIFE EXPECTANCY

1011121314151617181920

1980

1990

1995

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

at 65 years at 70 years

Add

ition

al li

fe e

xpec

tanc

y (y

ears

)

Source: CDC, Health, United States, 2011


4

Introduction

1997-1998(1997*)

1999-2000(2000*)

2007-2008(2009*)

2009-2010(2010*)

SELF-REPORTED CHRONIC CONDITIONS AND ACTIVITY LIMITATIONS

Figure 3

0% 10% 20% 30% 40%

At least one complexactivity limitation*

At least one basicaction di�cult*

75+ years

65-74 years

75+ years

65-74 years

75+ years

65-74 years

Adu

lts

65

and

olde

rSt

roke

Canc

erH

eart

D

isea

se

Source: CDC, Health, United States, 2011

*Thedatesforthechronicconditionreportingaretherangesshown,thedatesassociatedwiththeactivitylimitationsarethesingleyearsshowninparentheses.


OVERVIEWANDDATABASE

• Overview

• Database

• Characteristics

i. Customers

ii.Employees


6

The2011-2012NationalSurveyofCustomerandEmployeeSatisfactioninAssistedLiv-ingCommunities(NationalResearchReport)presentsfeedbackandinsightsgatheredfromresidents,families,andemployeesofassistedlivingcommunitiesthroughsurveysadminis-teredbyNationalResearchCorporationthroughitsMyInnerViewproductline.

Thesesurveyscollectinformationtosupportassistedlivingorganizationsintheeverydayworktouseanevidence-basedunderstandingtoimprovetheirabilitiestoofferasafe,person-centeredenvironmentforresidents.Theseareoftenreferredtoas“satisfactionsurveys”butincludeafarmorediverseassessmentoftheresident,family,andemployeeexperienceofanassistedlivingcommunitythanbasicsatis-factionmeasurement.Thecustomersurveys,administeredtoresidentsandfamilymembers,include34questionsonavarietyoftypesofinteractionswiththeorganization,frombillingaccuracytocareandconcernofthestaff.Theemployeesurveysinclude21questionsrangingfromcomparisonofpaytoqualityofteamwork.

Overview and Database

OVERVIEWANDDATABASE

Bothsetsofdatacanbeusedbythelongtermcareorganizationstoobjectivelycollectandunderstandtheperspectivesoftheseindividu-als,evaluatetheeffectivenessofstandardsandprogramsinplace,andmeasuretheimpactofchangeswithintheorganization.Communitiesfurtherusetheseinsightstodirectfutureef-fortsaroundperformanceimprovement,em-ployeeengagement,customercommunication,publicoutreach,andmanyothergoals.

NationalResearchCorporationhoststhelargestcollectionofdatareflectiveoftheviewsandopinionsofresidents,families,andemployeesacrossthelongtermcarespectrum,includingskillednursinghomes,assistedandindepen-dentlivingcommunities,adultdayfacilities,homehealthagencies,andcontinuingcareretirementcommunities(CCRCs).Thisreportincludesobservationslimitedtoassistedlivingcommunities,drawingondatafromthe2011MyInnerViewcustomer(residentandfamily)experienceandemployeeengagementproductdatabaseaswellasfrompubliclyavailabledatareleasedfromtheCentersforMedicareand

0 5,,000 10,000 15,000 20,000 25,000

Personal Care

Nurse

Other

Family

Resident43,723Customer Responses

19,581Employee Responses

Figure 4

SURVEY PARTICIPANTS

22,349

21,374

10,329

4,114

5,138


7

CharacteristicsofCustomers

DataonthedemographiccharacteristicsofthecustomersprovidescontextwithwhichtoframeinterpretationoftheresultsoftheNationalRe-searchReportanalysis.Theresidentageandthelengthofresidenceinformourunderstandingoftheindividualslivingintheassistedlivingcom-munitiesandthetenureoftheirrelationshipswiththeorganizations.Theoverviewofthetypeofrelationshipthefamilymembershareswiththeresidentandthefrequencyoftheirvisitstellsmoreabouttheperspectivesofthoserespondingtothesurvey.Thesedemographicsarealmostidenticaltothosereleasedinlastyear’sreport,withjusta1%residentshiftfromthe“under60”agegrouptothe“90orolder”agegroup,andasimilar1%familyshiftfromsiblingtospouserelationships.

• Morethan4outofevery5residents(82%)are80yearsofageorolder(seefigure6).

• Residentsaregroupedrelativelyevenlyintothreecategoriesbasedonhowlongtheyhavelivedinthecommunity—31%


MedicaidServices(CMS)andtheCentersforDiseaseControl(CDC).

Database

InoursecondyearofreleasingthisNationalResearchReportforassistedliving,thevolumeofcommunities,customers,andemployeesrep-resentedcontinuestogrow.Thisyear’sreportincludes1,513assistedlivingcommunities,a12%increasefromthe2010-2011report.Thisalsoincludesresultsfromnearly20,000em-ployees(50%morethaninthepreviousyear)andalmost44,000customers,whichisa23%increase(seefigure4).Residentsmakeupjustoverhalfofthecustomerdatabase,whilenurs-ingandpersonalcarestaffcomprisejustunderhalfoftheworkforcefeedback.

Nearlytwicethenumberofindividualsreceivedsurveysandhadtheopportunitytohavetheirvoicesheard.Theresponserateforthefamilysurveyswas44%,whiletheresponseratesforresidentsandemployeeswereidenticalat58%(seefigure5).

Figure 5

RESPONSE RATES

0

10%

20%

30%

40%

50%

60%

Employee

Resident

Family

44%

58% 58%

Figure 6

RESIDENT AGES

90 or older

80-89

70-79

60-69

less than 6049%

33%

12%

4%2%


8

CharacteristicsofEmployees

Asthecharacteristicsofcustomershelpsusbetterunderstandtheirperspective,knowl-edgeaboutthecompositionoftheworkforcehelpsusunderstandtheemployeesthatserveattheheartofthelongtermcareprofession.

• Workersintheir40’sand50’seachrepre-sent21%oftheassistedlivingemployeebase(seefigure10).Thatpercentagedropsto18%forworkersintheir30’s,butjumpsto29%foremployeesunder30.

• Identicalvolumesofemployeeshavebeenworkingattheircommunityforlessthan1year,andfor5yearsorlonger(28%each,seefigure11).

havebeenthere3ormoreyears,37%1-3years,andtheremaining32%havelivedtherelessthan1year(seefigure7).

• Morethanthree-quarters(76%)offamilyrespondentsvisittheirlovedoneatleastweekly(seefigure8).

• Mostfamilyrespondents(67%)arechil-drenoftheresident(seefigure9).


Figure 7

LENGTH OF RESIDENCE

3+ years

1-3 years

6 mths - 1 yr

3-6 months

less than 3 months

8%8%

16%

37%

31%

Figure 8

FREQUENCY OF FAMILY VISITS

Once per year or less

Once every 3 months

Once per month

Once per week

Daily58%

17%18%

5% 2%

Figure 9

RELATIONSHIP TO FAMILY MEMBER

Other

Friend

Grandchild

Sibling

Child

Spouse

67%

7%

8%

10% 5%

3%

Figure 10

EMPLOYEE AGE

60 +

50-59

40-49

30-39

less than 3018%

29%

11%

21%

21%

Figure 11

LENGTH OF EMPLOYMENT

10 + years

5-10 years

2-5 years

1-2 years

2 months - 1 year

less than 3 months

18%

27%17%

19%

9%10%


9

Thisdemonstratesthatwhileagoodportionoftheassistedlivingworkforceexperiencesturnover,anequalportionhasconsiderabletenureandexperience.

• Oftherespondentswhoprovidedtheirjobcategory,personalcareemployeesarethemostrepresentedasasingleworkgroupinthissurvey(30%),andnursesthesecondmost(24%,seefigure12).


Figure 12

JOB CATEGORY

Other

Activities

Administration

Housekeeping/maintenanceFood

Personal Care

Nurse

24%

17% 30%

9%

10%

4% 6%

Figure 13

HOURS WORKED PER WEEK

Fewer than 10

10-20

20-30

30-40

40 or more57%

14%

10% 15%

4%

• Justoveroneinfouremployees(28%)workfewerthan30hoursperweek(seefigure13).



• Overview



12

CustomerSatisfaction


lowestin2007.Duetothedramaticincreaseinparticipationinstandardizedsatisfactionsurveyingamongassistedlivingcommunitiesinthelasttwoyears,itisplausibletopresentthehistoricalinformationforaframeofreference,butNationalResearchcautionsagainstusingittodrawjudgmentsaboutchangesinresidentandfamilyexperiencesandperceptions.

AreasofGreatestandLeastSatisfaction

Bothresidentsandfamilymembersgaveassist-edlivingcommunitiesanoverallpositiveratingmorethan90%ofthetime.Whenlookingatresidentandfamilyexperiencesandsatisfac-tionwithindividualaspectsoftheircommuni-ties,however,thatratingfluctuates.Atthehighend,96%offamiliesprovidepositivefeedbackabouttherespectfulnessofstaff,butonly72%ofresidents,onthelowend,providepositivefeedbackabouttheappealoffood(28%ofthetimesayingthatitisonlyfairorpoor).

Asawhole,customers(bothresidentsandfami-lies)providehighmarkstotheirassistedlivingcommunitiesinoverallsatisfaction.Morethan90%ofeachgroupsaidoverallsatisfactionis“good”or“excellent”andthattheywouldrecommendtheircommunitiesasa“good”or“excellent”placetolive(seefigure14).Feed-backisslightlymorepositivefromfamilymem-bers,especiallywhenlookingatthe“excellent”rating.

Feedbackfromresidentsandfamilymembershasbeenconsistentlyhighduringthe6yearsthatNationalResearchCorporationhascollect-edinformationfromthiscontingent(seefigure15).Thecumulativepositiveratingof91%fromresidentsisslightlyupfromlastyear’sreport,whilethefamilyrating(92%)isalittledown.Whenreviewingscoresfromeachoftheprevi-ousyears,satisfactionpeakedin2009withnumbersthatarejustslightlyhigherthanwhatwasmeasuredin2011.Satisfactionscoreswere

0%

20%

40%

60%

80%

100%

FamilyResidentFamilyResident

Overall Satisfaction Recommendationto others

Figure 14

OVERALL CUSTOMER SATISFACTIONSCORES

Good Excellent

46%

45%

44%

48%

42%

49%

41%

51%

Figure 15

CUSTOMER SATISFACTION TRENDS

84%86%88%90%92%94%96%98%

100%

*Fewer than 30,000 customers represented2006* 2007* 2008* 2009* 2010 2011

ResidentFamily


13

“Excellent”ratingshelptounderstandwherecommunitiestrulyexcelintheeyesofcustom-ers,whohaveagreatlevelofagreementontheseopinions.Familiesandresidentsalikecited“respectfulnessofstaff,”“safetyoffacil-ity,”and“courteousnessofdiningstaff”asthethreeareaswhereassistedlivingcommunitiesaremostsuccessful(seefigure16).“Excellent”scoresrangedbetween55%and65%forthesethreeitems.

Ontheotherhand,thereisaslightdisagree-mentaboutwherecommunitiesareleastsuc-cessful.Residentsandfamilieswereleastim-pressedwith“comparisonofcharges”(28%and27%,respectively).Residentsprovidedfeedbackthat“adequacyofstoragespace”wastheareasecondtothebottomintermsofexcellenceat28%.Familiesweremoderatelylesstroubledbythisissue,placingitfourth

CustomerSatisfaction

fromthebottomofthelistat34%.“Growasapersonopportunities”wasthesecondleastsuccessfulareaofoperationsfromtheper-spectiveoffamilies(30%excellent)andthirdleastforresidents(alsoat28%).

Thescoresfortheseareasofsatisfactionhavenotchangeddramaticallysincetheresearchconductedforlastyear’sreport.Theresidents’ratingsintopperformingareaswereoneortwopointshigherthisyearthanlast;thefami-lies’ratingswereevenfor“respectfulnessofstaff,”downby1%for“safetyoffacility,”andup1%for“courteousnessofdiningstaff.”Thelowerperformingareashadmoreconsistentimprovement–allofthe“excellent”scoreswereupforbothresidentsandfamiliesby1%or2%,exceptfor“comparisonofcharges,”whereresidents’satisfactionincreasedfrom25%to28%.

Figure 16

AREAS OF HIGHEST AND LOWEST CUSTOMER SATISFACTION

0% 10% 20% 30% 40% 50% 60%

Comparison of charges

Adequacy of storage space

Courteousness of dining sta�

“Grow as a person” opportunities

Respectfulness of sta�

Safety of facilityHighestSatisfaction

LowestSatisfaction

% “Excellent” ScoresResident Family



• Overview



16

AreasofGreatestandLeastSatisfaction

Employeerecommendationsofassistedlivingcommunitiesasaplacetoreceivecareappearsinthe“excellent”and“good”categoriesatahigherlevel.Morethan40%ofallthreegroupswouldrecommendtheircommunitiesasan“excellent”placetoreceivecareandmorethan80%offerapositiverecommendation.

Thedifferentcategoriesofemployeesmaynotsharetheexactsamescores,butthefeedbackisconsistent(seefigure18).Whenlookingattheareasofperformancewhereemployeeshadgiventheircommunitiesthehighestandlowest“excellent”scores,thelistsareidentical.Allthreelistsinclude“senseofaccomplishment,”

WorkforceSatisfaction


Feedbackfromemployeesislessglowingthanthatprovidedbycustomers,yetpositiveinmanyareas.Regardlessofthebusiness,itiscommonforemployeesatisfactiontobelowerthancustomersatisfaction.Itcanbeeasytolookpastthechallengingresponsesthatareof-feredandtodismissthemforonereasonortheother.Theopinionsvoicedthroughthisprocess,however,provideusefulandclearinformationaboutwhatorganizationsandleaderscandotoimprovetheworkingenvironmentandtherelationshipswiththepeoplewhoholdsomuchresponsibilityforthesuccessfuloperationofassistedlivingcommunities.Employeesarenotonlygettingthingsdoneeveryday,theyarecreatingexperiencesforresidentsandfamiliesandtherebyidentifyingtheassistedlivingcom-munityinthemind’seyeforthoseindividuals.

Forthesakeofthisanalysis,employeeshavebeendividedbroadlyintothreegroups:nurses,personalcare,andthefullworkforce.Eachgrouptellsapartofthestorythatcanbecombinedtoinformemployeeengagementandprogramefforts.Feedbackisoftensimilar,butsometimesdifferent.

Nurses,personalcareemployees,andthewhole

workforcehavesimilarlevelsofpositivefeedback(combined“good”and“excellent”responses)foroverallsatisfactionandrecom-mendationofthecommunityasaplacetowork.

Scoresrangefrom66%foroverallsatisfactionofpersonalcareemployees(slightlyhigherat67%forpersonalcareemployees’recom-mendation)to72%fortheentireworkforce’sresponsetobothquestions(seefigure17).

Entir

e w

orkf

orce

Pers

onal

car

e

Nur

ses

Entir

e w

orkf

orce

Pers

onal

car

e

Nur

ses

Entir

e w

orkf

orce

Pers

onal

car

e

Nur

ses

Figure 17

OVERALL EMPLOYEE SATISFACTION SCORES

Overall Satisfaction

Recommendationfor job

Recommendationfor care

Good Excellent

0%

20%

40%

60%

80%

100%

47%

23%

43%

23%

46%

26%

43%

28%

40%

27%

42%

30%

42%

41%

40%

40%

40%

42%

Nursesfellbetweenthetwosetsofscores,of-feringa70%positiveoverallsatisfactionscoreand71%positiverecommendationforthejob.


17

“respectfulnessofstaff,”and“care(concern)ofsupervisor”withthehighest“excellent”scores,rangingfrom35%(“care(concern)ofsupervi-sor”forpersonalcare)to51%(thefullwork-force’s“senseofaccomplishment”).

Thethreegroupsofemployeesarealsochal-lengedbythesamethreeareas:“comparisonofpay,”“assistancewithjobstress,”and“compari-sonofbenefits.”Therangeof“excellent”scores

WorkforceSatisfaction

0% 10% 20% 30% 40% 50% 60%

Comparison of pay

Assistance with job stress

Care (concern) of supervisor

Sense of Accomplishment

Figure 18

AREAS OF HIGHEST AND LOWEST EMPLOYEE SATISFACTION

HighestSatisfaction

LowestSatisfaction

% “Excellent” ScoresNurses Personal Care Entire Workforce

forthesethreeitemsspansfrom9%(“compar-isonofpay”forpersonalcare)to16%(“com-parisonofbenefits”fortheentireworkforce).Despitetheverylowscoresineachoftheseareas,asdiscussedinthenextsection,noneareamongthosemosttightlytiedtotheglobalsat-isfaction“recommendationasaplacetowork,”whichmayprovideinsightintotherelativeimportanceoftheseareastoemployees.


DEEPERANALYSIS

• Overview

• PerformanceRelationships

• UnderstandingtheFeedback

• IdentifyingDriversofRecommendationScores

• RangeofPerformance


20

DeeperAnalysis

DEEPERANALYSIS

Thiswasevaluatedthisbygroupingassistedlivingcommunitiesintofourquartilesbasedoneitheremployeeorfamilyscoresandthencalculatingtheaveragefamilyorresident

satisfactionscoreforeachgroup.Thisanaly-sisprovidestwoaffirmations.First,organiza-tionsthattendtoexcelinoneareaalsotendtoexcelintheother.Second,thereisevidencetoemphasizetheimportanceoffocusingonemployeesatisfactionandengagement,evenifanorganization’spriorityisresidentandfamilysatisfaction.

UnderstandingtheFeedbackofSpecificGroupsofIndividuals

Anotherwaytodigintothedataistoevaluatetrendsinsatisfactionbysubsetsofthecus-tomeroremployeepopulation.Forexample,satisfactiontendstopeakwhentheresident

Asweseektobetterunderstandresident,fam-ily,andemployeeexperienceswithassistedlivingcommunities,thereareseveralwaystodelveintothedatatofurtherexploretherelationshipsandthestorieshiddeninsidethenumbers.

PerformanceRelationships

Thefirstthingaboutsatisfactionscores,ingeneral,isthattheytendtomovetogetherandtheytendtomovewithotherqualityindicators.Wehaveseenthisphenomenoninmultipleset-tingsofhealthcare.

Intheassistedlivingprofessionspecifically,thesametrendsexist.Communitieswithhigheraverageemployeesatisfactionscorestendtohavehigheraveragefamilysatisfactionscores,andcommunitieswithhigherfamilysatisfactionscorestendtohavehighercustomersatisfac-tionscores(seefigures19and20).

COMMUNITIES WITH HIGHER EMPLOYEE SATISFACTION HAVE HIGHER

FAMILY SATISFACTION

Communities Grouped By AverageEmployee Satisfaction

Aver

age

Fam

ily S

atis

fact

ion

68

72

76

80

4th Quartile

3rd Quartile

2nd Quartile

1st Quarti

le

77

8183

73

70

74

78

8284

Figure 19

COMMUNITIES WITH HIGHER FAMILYSATISFACTION HAVE HIGHER

RESIDENT SATISFACTION

Communities Grouped By AverageFamily Satisfaction

Aver

age

Resi

dent

Sat

isfa

ctio

n68

72

76

80

4th Quartile

3rd Quartile

2nd Quartile

1st Quarti

le

7981

84

75

70

74

78

8284

Figure 20


21

IdentifyingDriversofRecommendationScores

Perhapsthemostmeaningfulwaytotrulyun-derstandexperienceandsatisfactiondata,andtohoneinonareasofinteractionandsupportthataremostmeaningfultokeystakeholders,istocorrelateanalysisthatidentifiesthedriversofoverallsatisfaction.Thatis,findthespecificareasofmeasurementthattrendmostcon-sistentlywithglobalmeasuresofsatisfaction.Thiscanrevealwheretofocusperformanceimprovementeffortsonareasthatwillhavethegreatestimpact.

ToconductthisanalysisfortheNationalReseachReport,individualquestionsinthesur-veyswerecorrelatedwithtwoglobalmeasures:recommendationasaplacetoreceivecareforcustomers(residentsandfamilies),andrecom-mendationasaplacetoworkforemployees.

DeeperAnalysis

hasbeeninthecommunitybetween1and3months(seefigures21and22),whichappliestoeitherresidentorfamilysatisfaction.Bothgroupsprovidethehighestpercentof“excel-lent”overallsatisfactionratingsatthattime(55%forresidentsand58%forfamilies).Wheretheresidentpositivesatisfactionscorealsopeaksduringthatwindow(at96%,drop-pingdownto92%formostotherlengthsofstay),thesamedropisnotseeninfamilyscores(thoseareandremainat93%,untilthepeak94%scoreat1-3years,andaslightdropto92%inthe3ormoreyearsgroup).

Thissortofsubsetanalysisshowssimilarlylimitedvariationinscoreswhenevaluatedatthenationallevel.Whenreviewedatthecom-munitylevel,however,itmayhighlightstrongorweakareasofperformancewithcertainpor-tionsofthecustomeroremployeepopulation,whichmayleadtoidentificationofrootcausesofdisappointmentsinsatisfactionscores.

0%

20%

40%

60%

80%

100%

3 or more years

1-3 years

6 mth

s - 1 year

3-6 month

s

1-3 month

s

less th

an 1 mth

Figure 21

RESIDENT SATISFACTION BY LENGTHOF RESIDENCE

Good Excellent

45%

44%

41%

55%

44%

48%

46%

44%

46%

46%

46%

46%

0%

20%

40%

60%

80%

100%

3 or more years

1-3 years

6 mth

s - 1 year

3-6 month

s

1-3 month

s

less th

an 1 mth

Figure 22

FAMILY SATISFACTION BY LENGTHOF RESIDENCE

Good Excellent

45%

43%

35%

58%

42%

51%

41%

51%

45%

49%

45%

47%


22

Interestingly,neitherthehighestcorrelateditemsnorthelowestcorrelateditemsarerepetitiveoftheareasthatreceivethehighestandlowest“excellent”scoresonthesatisfac-tionsurvey.Itmaynotbeeasy,butthereisalmostcertainlyopportunitytofocusonthetopdriversofsatisfaction,improveinthoseareas,andindoingsoimprovecustomerrecommen-dationscores.

Thesameactivitywasappliedtounderstandwhatreallydrivesemployeesatisfactionwithassistedlivingcommunitiesasemployers,andleadsstafftobemorelikelytorecommendtheircommunitiesasaplacetowork.Again,therewasconsiderableconsistencyamongthedifferentgroupsofemployeesandallthreeidentifiedthesametopfourdriversofoverallsatisfaction:“care(concern)ofmanagement,”“attentivenessofmanagement,”“assistancewithjobstress,”and“clearexpectationsofmanagement”(seefigure24).Thesamethreeitemsarealsoseenasthoseleastcorrelatedwithoverallsatisfaction:“senseofaccomplish-ment,”“qualityofteamwork,”and“respectful-nessofstaff.”

Whilelookingatresidentsandfamilymembersseparately,itwasfoundthatthetopdriversofoverallsatisfactionwerealmostidentical.Thetopthreelistsforbothincluded“competencyofstaff,”“responsivenessofmanagement,”and“choices/preferences”(seefigure23).“Care(concern)ofstaff”wasfourthforresidentsandfifthforfamilies.Theitemsthatroundouteachlistofthetopfivediffer:“home-likeatmosphere”wasfifthforresidents(seventhforfamilies)and“responsivenessofstaff”wasfourthforfamilies(seventhforresidents).

Theitemsthatwereleastassociatedwithrec-ommendationwerethesameforbothgroups(althoughinslightlydifferentorders)andalsoprovidefurtherinsightintotheaspectsoftherelationshipsbetweenassistedlivingcommuni-tiesandtheircustomers(residentsandfami-lies)thatarelessmeaningfultothecustomersthemselves.Thisdoesn’tmakethemunimport-ant,justlesslikelytoinfluencehowacustomerthinksaboutanassistedlivingcommunityinaglobalway.Thethreeitemswiththelowestcorrelationscoreswere:“religious/spiritualop-portunities,”“adequacyofstoragespace,”and“controlofroomtemperature.”

DeeperAnalysis

Figure 24

TOP DRIVERS OF EMPLOYEE RECOMMENDATION

- Care (concern) of management

- Attentiveness of management

- Assistance with job stress

- Clear expectations by management

TOP DRIVERS OF CUSTOMER RECOMMENDATION

Figure 23

- Competency of staff

- Responsiveness of management

- Choices/preferences

- Care (concern) of staff

- Home-like atmosphere (5th for residents, 7th for families)

- Responsiveness of staff (4th for families, 7th for residents)


23

DeeperAnalysis

Oneofthemostusefulthingsaboutunder-standingthebiggestdriversofsatisfactionisusingthoseareasasprioritiesforperformanceimprovementefforts.Especiallyforanorgani-zationoraleaderthatisunsurewheretostart,evaluatingperformanceinthesefourmeasuresandidentifyingwhichofferthemostopportu-nityforimprovement(eitherduetolowrelativescoreswithintheorganizationorlowscorescomparedagainstabenchmark)canhelpfocuseffortsnotonlyonmeasuresthatcouldbenefitfromimprovement,butthosethatwillalsohavethegreatestimpactonanindividual’soverallsatisfactionwiththecommunity.

RangeofPerformance

Onefrequentquestionandsubjectofconversa-tionwhenitcomestoperformanceimprove-mentactivitiesisaroundthepossiblescoresorlevelsofimprovementsthatorganizationscanreasonablyexpecttoachieve.Inthisyear’sNationalResearchReportforassistedliving,weprovidepartialanswerstothosequestionsintheformofdataaroundthe“topquartile”levelofperformanceamongindividualcommunitiesincludedinthesurveydatabase.Thatistosay,wehaveidentifiedthescoresthatatleastoneoutofeveryfourcommunitieshaveachievedorexceeded(seefigures25and26).Whenitcomestoemployeesatisfaction,25%ofcom-munitiesearnedatleasta35%“excellent”scoreandan86%“excellent”or“good”scoretotheoverallsatisfactionquestion.Theposi-tivebenchmarkisidenticalforthe“recommen-dationforjob”question,butthe“excellent”benchmarkis42%.

Unlikewiththecustomers,thereisconsiderableoverlapbetweenthetopandbottomdriversofsatisfactionandtheitemswiththehighestandlowestpercentof“excellent”scores.Infact,oneofthetopdriversofsatisfactionisoneareainwhichemployeesaremostsatisfied—“care(concern)ofmanagement”—andoneofthetopdriversofsatisfactionisoneoftheareasinwhichemployeesareleastsatisfied–“as-sistancewithjobstress.”Alsoworthnoting,twooftheitemsthatreceivethehighestpercent“excellent”scoresfromcustomersareactuallyamongthoseleastassociatedwithrecommen-dationscores—“senseofaccomplishment”and“respectfulnessofstaff.”

Again,justbecauseitemsarelesscorrelatedwithrecommendationresultsdoesn’tmeanthattheyareunimportant.Butitishelpfultoun-derstandthatsomeoftheareaswhereassistedlivingcommunitiesexcelasemployersarenotthesamefunctionsthataremostlikelytoresultinanemployeerecommendingtheorganizationasaplacetowork.

Theconsistentthemeinthetopdriversofem-ployeerecommendationistheroleofmanage-ment—concern,attentiveness,clearexpecta-tions,andsupportorassistancewithjobstressallspeaktotherelationshipthatemployeesfeeltheyhavewithmanagers.Itemphasizestheopportunitythatimprovedmanagementskills,activities,andbehaviorhavetoimpacttheworkenvironmentforemployees,therebyimprovingsatisfactionandcommitmenttotheorganiza-tion,andinturnhavingapositiveeffectonresidentexperienceswiththecommunity.


24

Forcustomersatisfaction,atleastoneoutofeveryfourassistedlivingcommunitiesearneda100%positiveresponsefrombothresidentsandfamilymemberstoboththeoverallsatis-factionandtherecommendationmeasures.Forthehigher-levelscoreof“excellent”alone,thebenchmarksforthetopquartileperformersare57%fromresidentsforoverallsatisfactionand63%forrecommendationforcare,and63%fromfamiliesforoverallsatisfactionand67%forrecommendationforcare.

Thesescoresarenotseenasexclusivetoanelitefeworganizations—theyareveryreason-ablegoalsforcommunitiesthatalreadyexceedthenationalaveragebutdon’tmeettheselev-

elsofperformance.Itisalsoreasonableandadmirableforleaderstostriveforanevenmoreelitestandard.The90thpercentilesofperfor-mance—thelevelthatonly10%ofallassistedlivingcompaniesachieveorexceed—raisethebarto50%forexcellentand95%forpositiveoverallsatisfactionscoresfromemployees,andto54%excellentand96%positiverecom-mendationscoresfromemployees.The90thpercentilesofperformanceforcustomersatis-factionare75%excellentoverallsatisfactionfrombothresidentsandfamilies,and78%and79%excellentrecommendationscoresfromresidentsandfamilies,respectively,forrecom-mendationforcarescores.

Figures 25, 26

TOP QUARTILE EMPLOYEE SATISFACTION SCORES

0% 20% 40% 60% 80% 90%

Recommendationfor job


86%

42%

86%

35%

Excellent & Good

Excellent

TOP QUARTILE CUSTOMER SATISFACTION SCORES

Excellent & Good

Excellent


Recommendationfor care

Resident Family 20% 40% 60% 80% 100%

100%100%

100%100%

67%63%

63%57%

0%

Excellent & Good

Excellent

Excellent & Good

Excellent


CONCLUSION


26

Conclusion

Assistedlivingorganizationsplayauniqueandvitalroleinthelongtermcarecontinuum.Providingahome,services,andacommunitytoapproximately1millionpeople,givingthemaplacetomaintaintheirindependencealongwiththesupporttodoso,thesecommunitiesareoftenanoptimaloptionforseniorsandtheirfamilies.

Feedbackfromresidents,families,andem-ployeesprovidesleadersandadvocatesoftheassistedlivingprofessionunparalleledinsightintothevalueoftheirservices,plusopportu-nitiestocontinuetoimprovethoseservices,increasevalue,andboostconsumerperceptionsgoingforward.Thedevelopmentofanationaldatabaseofstandardizedsurveyresponsesforassistedlivingcommunitiesoffersasourceofknowledgeforcomparingtheresultsofindi-vidualorganizationsagainstpeers,offeringdata-richinsightsintothissegmentoflongtermcare,anddeeperlevelsofresearchintotheexpectationsandvaluesofassistedlivingcustomersandemployees.

Theentiretyofthisreportcreatestheopportu-nitytofuelimprovement.Individualcommuni-

CONCLUSION

tiescandiscoverwhatispossible,inadditiontowhattheyshouldbestrivingforincomparisontotheperformanceoftheirpeers.Managerscanidentifyhowimportanttheirroleandrelation-shipswithcustomersandemployeesareinthebiggerpicture,astimeandagainweseethatthewaymanagersandleadersinteractandre-spondtobothcustomersandemployeesdrivesoverallsatisfactionwithcommunities.Thoselookingoutforandleadingthedirectionoftheprofessionasawholegainmoredata,aclearerpictureofthepeopleaffectedbyassistedliving,andusethisinformationtoreinforceorganiza-tionaldecisionsandconversations.

Withamorecompleteunderstandingoftheexperiencesandperceptionsofemployeesandcustomers,assistedlivingproviderswillbebet-terpreparedbothtomaximizeeffortsaroundcreatingculturesofperson-centeredcareandadaptingtoshiftsinthehealthcarelandscapeduetoavarietyoffactorsthatimpacttheprofession.Inaddition,thisinformationcanbeusedtofurtherthecausesoftheassistedlivingprofession,fromstaffandcustomerengagementtopublicrelationsandadvocacy.

© 2012 National Research Corporation. All rights reserved. My InnerView is a product of National Research Corporation. My InnerView, the My InnerView logo, and the National Research Corporation logo are trademarks of National Research Corporation. All other trademarks mentioned herein are the property of their respective holders. All original data, analy-ses, and intellectual property presented herein cannot be duplicated or claimed as source material by parties other than National Research Corporation.

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T Contents - AHCA Home atina esear rratin 6 The 2011-2012 National Survey of Customer and Employee Satisfaction in Assisted Liv-ing Communities (National Research Report)