In recent months, news headlines have included numerous investigations into cases of nursing home staff shortages and resident maltreatment — many of which were reported by the families of vulnerable residents.

“Residents often can’t advocate for themselves — especially those with dementia and cognitive impairment, who are at highest risk for injury and premature death,” says Associate Professor Tetyana Shippee from the School of Public Health. “Congress and other legislative bodies are recognizing that we need additional eyes on nursing home residents in order to protect them — and family members can provide that.”

Given the newly-recognized role of family members, Shippee recently completed a unique comparative study in collaboration with colleagues at Miami University of Ohio. The goal was to use data from Minnesota and Ohio to compare factors that impact family member satisfaction with nursing home care across both states. The study, which was co-authored by PhD student Weiwen Ng and Miami University faculty Amy Roberts and John Bowblis, was published in the Journal of Applied Gerontology.

For the study, Shippee compared nursing home family satisfaction surveys from Minnesota and Ohio and linked it to federal data on facility characteristics. Shippee looked at Minnesota and Ohio because they are among the few states with validated measures of family satisfaction collected from a representative sample of residents. She also selected Ohio and Minnesota because they are very different in terms of their nursing home occupancy rates, percentage of for-profit vs. non-profit providers, reimbursement rates, and other key factors and policies.

The study found that despite differences across these states in their long-term care policies, a number of factors were consistent in impacting family satisfaction. Specifically, among families in both states, higher nursing home satisfaction was associated with:

• Facilities that have higher RN, CNA and activities staffing.
• Higher Medicare payer-mix and less need for intensive nursing care among patients.
• Facilities that are smaller in size, located in rural areas, not owned by a for-profit company or affiliated with a chain, and have higher percentages of their beds occupied.

“The findings show that facility-level factors associated with higher family satisfaction are rather similar to the ones we already know predict resident satisfaction as well. Now, seeing the results in two states that have good quality data gives us even more trust in the findings,” says Shippee. “This report reinforces that the role of family members is so important — and that they can be those missing eyes we need to help keep watch on nursing homes and ensure quality of care for residents.”

Shippee is continuing her research by looking at measures of family satisfaction and how facility characteristics influence them, and the ways those scores can be used in developing nationwide nursing home assessment tools.