An Analysis of a Statewide Survey and the Assessment of Needs within the Long Term Care Delivery System in the State of Texas
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This needs assessment study addressed the needs of various components of the nursing home industry in Texas - those involved in management of long term care facilities, those involved in direct care of long tern care residents, owners of long term care facilities, those involved in regulatory aspects of long term care, and those involved consumers - direct and indirect - of services in long term care facilities. The assessment addressed structural, process, and educational needs of nursing homes. Ten key items were identified via several pretests and utilized in the final survey through a closed format Lilcert-type instrument and a narrative component which also allowed for an open-ended expression of ideas or concerns. The ten key items utilized in the final survey were: (1) Management training for all supervisors, (2) More geriatric nursing skills, (3) Increased physician involvement, (4) Greater consistency in the survey process, (5) Requirement for improved nurse aide to resident ratio, (6) More sensitivity by staff to resident needs, (7) Improvement in food quality and the dining environment, (8) Greater family involvement, (9) More homelike environment, and (10) More educational requirements in long term care for initial licensure as a nursing home administrator. Subjects were asked to rank these ten key items as well as to indicate how much should be done to address each item. In addition to the ten items included in the instrument, subjects were also given an opportunity to identify one additional specific concern in long term care. These comments were assembled and presented in the final report.
Respondents gave an overall rating to the quality of care in nursing homes at 5.37 on a ten point scale. Consumers ranked care with a low of 2.6, while administrators recorded the highest rating of 6.8. The highest priority ranked item by the survey respondents was more sensitivity by staff to resident needs. The highest priority items were also grouped as structural, process, and educational needs, and analyzed with the following results. The structural item ranked highest in importance by the survey group was the requirement for improved nurse aide to resident ratio. The highest priority ranked process item was more sensitivity by staff to resident needs. Two educational needs emerged with highest priority rankings: the highest ranked was that of more geriatric nursing skills. Management training for all supervisors was ranked slightly lower. When the importance of the ranking of the ten items was contrasted with the desire to take action on each of the ten items, these same items appeared as the major four items to be addressed.
The results varied when the rankings of the ten key items were analyzed by region of Texas or by position of the respondent. Consumers, regulators, and directors of nurses agreed that the highest priority of concern was the requirement for improved nurse aide to resident ratio. Owners and administrators believed the highest priority issue to be greater consistency in the survey process.
An analysis of the highest ranked issues by region of Texas indicated that the east and west regions agreed that the highest ranked item was more geriatric nursing skills; central and south regions of Texas rated more sensitivity by staff to resident needs at the top rank; and the metropolitan areas of Texas indicated the requirement for improved nurse aide to resident ratio as the highest ranked item.