2016 experience & satisfaction survey report · 2016 experience & satisfaction survey...

Michael Bremseth, Project ResearcherTommy Edwards, Project ManagerKristie Marr, Report Developer

2016 Experience & Satisfaction Survey Report

An inquiry of participant experiences with Community Choices, HIV, and Mechanical Ventilator waiver services provided through South Carolina Healthy Connections Medicaid, Bureau of Long Term Care and Behavioral Health Services.

SC DHHS 2016 Experience and Satisfaction Report - Clemson University - OROD ©2016 2

Ron Green Director

This survey was a collaborative effort between the staff of the Office of Research & Organizational Development (OROD) of the Youth Learning Institute at Clemson University and the Division of Community Long Term Care (CLTC), South Carolina Department of Health and Human Services.

Justine GradillasAssociate Director, Programs

Tommy EdwardsProject Manager

Tori CharlesResearch Associate

Regina Guy Administrative Coordinator

Mike BremsethAssociate Director, Research

Kristie MarrProject Manager

Lauretta GibbonsCall Center Manager

Stacy Wright Research Associate

Research AssistantsJustin RoeLead RA

Jamie ButlerCourtney Heutess

Paige JordanRebecca Lenti

Melissa Pehling

Creighton CulvernMatt Jordan

Alexa KramerTeylor Newsome

Charity Shaw

OROD Staff

SC DHHS 2016 Experience and Satisfaction Report 3

This study was supported through the contract with the CLTC Division of SCDHHS, Bureau of Long Term Care and Behavioral Health Services. OROD would like to thank all the staff at CLTC as they provided excellent support and guidance to ensure the survey produced evidence-based findings to improve program services.

Roy SmithDivision Director

Mary FlemingPhoenix Data

Lisa RaglandQA Coordinator

Belinda AdamsQA Coordinator

Vanessa BusbeeDepartment Head,

CLTC, QA, and Training

The Office of Research and Organizational Development and the South Carolina Department of Health and Human Services Healthy Connections Medicaid Bureau of Long Term Care and Behavioral Health Services would like to thank all Community Choices, HIV, and Mechanical Ventilator waiver participants and primary contacts for their participation in the 2016 Experience and Satisfaction Survey. The information collected will be utilized to better program services offered to waiver participants.

Acknowledgments


Introduction...........................................................................................................................................................

Researcher’s Note..................................................................................................................................................

Population Demographics...................................................................................................................................

Performance Measure Quick Reference Guide.................................................................................................

Experience & Satisfaction Survey Findings Survey Participation................................................................................................................................ Satisfaction................................................................................................................................................ Case Manager........................................................................................................................................... Participant Choices.................................................................................................................................. Personal Care Aides.................................................................................................................................. Program Services...................................................................................................................................... Health and Welfare................................................................................................................................... Program Impacts......................................................................................................................................

Adult Day Healthcare Oversample......................................................................................................................

Contact Information.............................................................................................................................................

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Table of Contents


Working in partnership with our contract administrators and other staff from the Bureau of Long Term Care and Behavioral Health Services, the Office of Research and Organizational Development (OROD) assessed consumer experience and satisfaction of participants in the three distinct waiver populations of the Community Long Term Care program (CLTC). All three waiver populations, Community Choices (CC), HIV, and Mechanical Ventilator (Vent), received the same instrument for data collection. Most questions were pre-coded with fixed responses to facilitate

data collection and analysis while some responses were open-ended in order to gain direct experiences from the waiver consumers. The goal of the study is provide continuous program improvements for waiver participants and ensure participants have a representative voice when measuring program effectiveness. Program improvements made based on study data assists CLTC in program goals to provide support aging in place with fewer inpatient hospital stays and admissions into skilled nursing facilities.

Introduction

Study Objectives The study design focused on exploring the nature and extent of CLTC participant experience and satisfaction with waiver services. Part of this year's study was focused on identifying participant experience with Adult Day Health Care (ADHC) Services. In order to explore this area more in depth, an oversample of CC waiver participants was drawn and interviews were conducted with specific focus on their experience with ADHC. The instrument was designed to allow for as many issues as could be covered in a one-time contact with participants. Given the potential for limited understanding from a substantial percentage of the participants, the questions were written to be relatively straight-forward and to the point.Methodology Because the active population size in each waiver is dynamic, the samples are representative of the populations as existed on June 1, 2016. As was the case in previous annual surveys, statewide surveys of the three waiver populations were conducted by telephone. Every CC and Vent waiver participant randomly drawn as part of the sample received a letter of introduction to the survey from Clemson University. Given the potential for accidental disclosure of HIV status, letters were not sent to HIV waiver participants. For CC and Vent waiver participants, the participant

was interviewed if possible; otherwise the primary contact was interviewed. Interviews for the HIV waiver were only conducted with the participant unless otherwise directed by the participant to speak with the primary contact. Over a two month period, student research assistants from the OROD interviewed participants using a computer assisted telephone interviewing program until the desired number of interviews was obtained. Data for all waivers were analyzed using the SPSS statistics software.Sample Parameters Sample sizes for the CC and HIV waivers were chosen to guarantee a margin of error of no more than ±4.5% with a 95% confidence level. Given the small size of the Vent waiver, no meaningful statistical claim of representativeness can be made – all who could be reached were interviewed.

Researcher’s Note

Waiver Population Sample Size

Community Choices 15,645 473

ADHC Oversample 2,075 203

HIV 699 233

Mechanical Ventilator 43 22

Survey Sample Sizes


Population Demographics

Age

Gender

0%

10%

20%

30%

40%

50%

18-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 >100

CC Waiver

0%

10%

20%

30%

40%

50%

18-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 >100

HIV Waiver

31%

65%

51%

CC Waiver

HIV Waiver

Vent Waiver

10,454

257

21

69%

35%

49%

4,669

480

22

0%

10%

20%

30%

40%

50%

18-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 >100

Vent Waiver

10,979

73%

CC Waiver

196

25%

HIV Waiver

31

72%

Vent Waiver

Enrolled Less Than 5 Years


College Graduate

Third through Eighth Grades

SomeHigh School

High SchoolDiploma

Some College

CC Waiver

Race

HIV Waiver Vent Waiver

Less than Third Grade

Education Level

CC Waiver HIV Waiver Vent Waiver

22%(8)

31%(11)

31%(11)

8%(3)

3%(1)

6%(2)

8%(163)

29%(210)

38%(226)

18%(69)

7%(29)

1%(40)

22.1%(3,314)

28.5%(4,279)

30.7%(4,608)

9.4%(1,409)

4.0%(599)

5.4%(818)

Black White OtherBlack White Other Black White Other


The following appendix items are performance measures (PM) for the CC and HIV waivers. These PM and sub-assurances (SA) will be found through-out sections of the report when applicable to survey questions and participant responses.

Performance Measure Quick Reference Guide

Appendix D: Service Plan Performance Measures Measures Defined

SA #1 PM #1

Number and percent of participants reviewed whose needs and personal goals identified in the assessment were addressed in the service plan

SA #1 PM #3Number and percent of participants reviewed whose home environmental needs were addressed in the service plan

SA #4 PM #2Number and percent of participants who received all services identified in his/her service plan

SA#5 PM #2 Number and percent of participants afforded choice of all qualified wavier service providers

Appendix G: Health and Welfare Performance Measures Measures Defined

SA #1 PM #1

Number of abuse, neglect and/or exploitation complaints reported in the compliant system and the percentage of those complaints resulting in referrals to APS


Survey Participation

Percentages of surveys completed by program participant (PP) versus primary contact (PC)

Responses CC HIV Vent

PP 56.7% 99% 59%

PC 43.3% 1% 41%

Percentages of respondents by area office

Area Office CC HIV Vent*

Aiken 4.9% 1% --

Anderson 10.8% 5% --

Charleston 7.2% 12% --

Columbia 10.6% 14% --

Conway 12.7% 9% --

Florence 14.6% 13% --

Greenville 14.6% 17% --

Greenwood 5.5% 6% --

Orangeburg 3.4% 5% --

Ridgeland 3.2% 2% --

Rock Hill 5.9% 8% --

Spartanburg 6.8% 8% --

*Vent percentages of respondents by area office were not included to help protect confidentiality.


Respondents were asked to rate their responses to the following question on a 9 point scale:

Satisfaction

CC Waiver

HIV Waiver

Vent Waiver

275 respondents

Average rating 8.52 out of 9


473 respondents


22 respondents

Thinking about your last 3 months in the CLTC program, how would you rate your level of satisfaction with the Quality of Care you receive?


The similarity of satisfaction responses – and the same pattern throughout this report – is expected. While the services offered to the three waivers may differ, the same structure and people are offering the services under a common expectation of performance. Therefore, experience and satisfaction data will be provided for all three waivers together in this single report. Finding both a ‘true’ level of satisfaction and reasons for such satisfaction is a major concern. Knowing that people are reluctant to reveal problems, great care has been taken to actually encourage responses away from the most positive, including:1. Using a 9 point scale2. Having interviewers actively try to have respondents select a lesser satisfaction3. Placing the satisfaction question after questions about potentially negative experiences Consequently, all of these factors should encourage the reporting of any dissatisfaction the participants harbored. The fact then that satisfaction is so high in spite of all the efforts to encourage lesser satisfaction levels is a compelling reason to believe such a high percentage of the participants are actually extremely satisfied.

Implications

The participants’ satisfaction is crucial to a well-run program. Knowing why they are or are not satisfied is important for program quality assurance. However, these high satisfaction levels make statistical analysis of the reasons for their satisfaction difficult. An overriding obvious factor is that CLTC services are keeping them out of a nursing home, which is a crucial goal. However, analysis of many annual surveys indicate that there are several other reasons why participants are satisfied:1. Their options to make choices about services2. Their experiences in how they are treated by the case manager3. Their experience in how they are treated by their personal care aide In short – not surprisingly – if they are satisfied with their case manager and their personal care aide, even in the event of bad service experiences, they are still satisfied. With the above in mind, the program must continue to ensure that it continues to maintain high levels of professionalism and care in these two roles.

Recommendations

In the remainder of the report, the population numbers are derived from percentages of a representative sample. Consequently, in order to not claim a level of precision that is not there, the formulas to transform the sample percentages to population numbers takes this into account – all CC population numbers in the results are rounded down to the nearest 200 people, all HIV population numbers are rounded to the nearest 50 people. Therefore, the totals may not add up to the actual population totals. Due to the small population size of Vent, response percentages are rounded to the nearest 10 and population numbers are not provided to maintain confidentiality (denoted by **).

Researcher's Note:


Case Manager

97.5% 93%

HIV Waiver

100%

Vent WaiverCC Waiver

In the last three months, case manager ALWAYS treated participant with respect and dignity.

In the last three months, case manager ALWAYS respected participant's home.

In the last three months, case manager NEVER talked to others in the family concerning participant when they should have spoken with the participant.

15,200 650

100%99.2%

15,400

100%

700

**

**

97.9% 97%

HIV Waiver

100%


15,200 650 **

HIV Waiver Vent WaiverCC Waiver


"Every time I call her with concerns, she

always takes care of it"

“Because she keeps me out of the hospital and she always responds to my needs. She treats me very well

and does an A1 job.”

"Recently I needed something, and she returned my call while

she was away at a conference, and that made me really happy"

"I can talk to her, she understands, she helps pull me up. She never

puts me down"

"Every time she comes to see me, she asks me how I'm feeling. She's

concerned with my health and well-being"

Why do you feel this way about your case manager?

In the last 3 months, when you needed to talk with your case manager, how long did it take before you could talk to her/him?

CC Waiver52%

(8,000)

HIV Waiver63%(450)

Vent Waiver 60%(**)

Immediately

CC Waiver22%

(3,400)

HIV Waiver16%(100)

Vent Waiver 10%(**)

Hours


65.8% 78% 30%10,200 550 **

28.1% 20% 60%4,200 150 **

Extremely Happy Happy Extremely Happy Happy Extremely Happy Happy

How would you describe how you feel about your case manager?


Appendix D details performance measures directly related to survey questions asked to participants and primary contacts about developing the service plan and participant choices

Participant Choices

Sub-Assurances Assurances Defined Performance Measures Measures Defined

SA #1

Service Plans address all participants’ assessed needs.(Including health and safety risk factors and personal goals, either by provision or waiver services or through other means)

PM #1

Number and percent of participants reviewed whose needs and personal goals identified in the assessment were addressed in the service plan

SA #4

Services are delivered in accordance with service plan including the type, scope, amount, duration and frequency specified in the service plan.

PM #2

Number and percent of participants who received all services identified in his/her service plan

SA#5

Participants are afforded choice: Between waiver services and institutional care; and between/among waiver services and providers.

PM #2

Number and percent of participants afforded choice of all qualified wavier service providers

Participant Case Manager

95%At least of CC, HIV, and Vent participants

desire to be an equal partner in all decision making, service planning, and delivery


Did your case manager...

Yes 77% - 12,000 71% - 500 90%

Discuss with you that you should be involved in developing your current service plan?


Yes 75.1% - 11,600 79% - 550 90%

Discuss with you ways to achieve your personal goals?


Yes 73.6% - 11,400 76% - 550 90%

Provide information on places, people or services in the community that could help you reach your personal goals?


Yes 91.5% - 14,200 88% - 600 90%

Discuss with you that you had choices of services you qualified for?


Yes 92.2% - 14,400 87% - 600 90%

Advise you that you had a choice of providers?


Yes 85.6% - 13,200 82% - 550 90%

Tell you that you have the choice of when your aide delivers your services?


Yes 85.6% - 13,200 82% - 550 90%

Advise you that you could change aides or providers or case managers if you are unhappy with services being delivered?



Personal Care Aides

Percentages of waiver participants who receive personal care support services

How would you describe how you feel about the personal care aide?

84.8%

27%

90%

CC Waiver

HIV Waiver

Vent Waiver


66.2% 77% 70%8,600 150 **

27.6% 20% 30%3,600 Fewer than 50 **

Extremely Happy Happy Extremely Happy Happy Extremely Happy Happy


In the last three months, participant's personal care aide ALWAYS...

...treated participant with respect and dignity.

...really listened to what the participant said.

...showed respect for the participant's home.

95.7%

12,600

96%

200

90%

**



94.7%

12,400

95%

200

100%

**


90%97%96.0%

12,600 200 **


Within the last three months, participant has not been unhappy enough to request another personal care aide.

Within the last three months, participant has not been unhappy enough to request another agency.

Program Services

Appendix D details performance measures directly related to survey questions asked to participants and primary contacts about developing the service plan and participant choices.


SA #1

Service Plans address all participants’ assessed needs.(Including health and safety risk factors and personal goals, either by provision or waiver services or through other means)

PM #3

Number and percent of participants reviewed whose home environmental needs were addressed in the service plan

86.7% 92%

HIV Waiver

90%


13,400 650 **

93.9% 97%

HIV Waiver

90%


14,600 700 **


What are the top CLTC services that most help you meet your needs? (Participant could list up to three)Note: Reference page 23 for data related to CC participants who receive ADHC services.

Top Services PercentPersonal Care 79.1%Home Delivered Meals 41.4%Case Management 31.9%Incontinence Supplies 27.1%Environmental Modification 12.7%Specialized Medical Equipment 4.4%

Top Services PercentCase Management 44%Home Delivered Meals 38%Personal Care 31%Environmental Modification 29%Nutritional Supplements 21%Prescriptions 18%

Top Services PercentPersonal Care 90%Incontinence Supplies 59%Home Delivered Meals 36%Case Management 14%Environmental Modification 14%Specialized Medical Equipment 14%

CC Waiver

HIV Waiver

Vent Waiver


Health and WelfareAppendix G details performance measures directly related to survey questions asked to participants and primary contacts about health and welfare


SA #1

The state, on an ongoing basis, identifies, addresses and seeks to prevent the occurrence of abuse, neglect and exploitation.

PM #1

Number of abuse, neglect and/or exploitation complaints reported in the compliant system and the percentage of those complaints resulting in referrals to APS

Participant wears a medical identification tag, bracelet, or necklace.

Participant wears a personal alarm to use for help if unable to get to a phone.

Participant or someone they have daily contact with knows what to do when someone is choking such as the Heimlich maneuver.


35.7% 9% 50%

5,400 50 **


2,000 Fewer than 50 **


80.3% 77%

13.7% 6% 20%

12,400 550 **90%


Participant or someone they have daily contact with knows how to do CPR.HIV Waiver Vent WaiverCC Waiver

67% 66% 100%

10,400 450 **

Participant follows a plan for fitness or regular exercise.

Within the last year, participant's case manager told participant about Adult Protective Services.

Within the last year, case manager told participant what s/he should do if abuse, neglect, or exploitation is suspected.

The 2016 Experience and Satisfaction Survey results indicate that 70% or less of participants across all three waivers were informed by their case manager about Adult Protective Services and know what they should do if they experience abuse, neglect, or exploitation. These results imply that if participants were to experience abuse, neglect, or exploitation they may not be knowledgeable about individuals or agencies that are available to provide protective services and emergency health and welfare consultation.

It is recommended that CLTC address this concern through the following steps:1. Ensure all contracting agencies and case managers have contact information for SCDSS county offices and Adult Protective Services divisions.2. Update trainings and expectations for case managers related to health and welfare performance measures3. Measure across all three waivers for improvements and effectiveness of trainings in the 2018 Experience and Satisfaction Survey

45.7% 46%

7,000 300 **


65.3% 64%

10,200 450 **


45.5% 58% 60%

7,000 400 **


70%

70%

Implications Recommendations


Program Impacts

Get along and still stay in my home alone BUT with family supports

Without CLTC services in your home, what do you think would happen to you?

Get along and still stay in my home alone without family supports

Would have to move in with a family member/friend

Get along and still stay with a family member/friends in my home

Would have to go to a nursing home

5.9%800

18%150

0%**

22.2%3,400

16%100

30%**

13.5%2,000

5%Fewer than 50

0%**

12.1%1,800

7%Fewer than 50

20%**

29.8%4,600

9%50

50%**


"Other" responses:

"I wouldn’t be able to do anything around the house

or outside of the house.

“He would not be functioning, he would be useless. CLTC

gives him purpose"

"I don't know how I would function honestly"

"I would be dead"

"I feel like I'd be in danger" "I don't even want to think about it"


Adult Day Health Care

The CLTC program wished to know more about participant experience with Adult Day Health Care (ADHC) Services. As fewer than 12% of CC participants had ADHC services, an oversample of participants receiving that service was contacted. Combining the responses of those in the representative sample with those in the oversample gave a working sample of 203 participants. This section applies to the CC waiver only.

Top Services Percent ADHC* Rank Non-ADHC** RankADHC 81% 1 --Personal Care 63% 2 1Case Management 36% 3 3Incontinence Supplies 25% 4 4Home Delivered Meals 16% 5 2

Environmental Modification 6% 6 5

90%feel that ADHC is a great benefit in allowing the participant to remain in the community

92%are always given opportunities to participate in activities within the ADHC

Participants are given opportunities to participate in outings while attending the ADHC

66% 6%4% 9% 14%

Often Rarely NeverMost of the TimeAlways

94% feel they are always treated with respect and dignity at the ADHC 93%

are always allowed to choose not to participate in ADHC activities and outings

What are the top CLTC services that the CC waiver provides that most help you meet your needs? (Participant could list up to three)

*Those who receive ADHC services.**Those who do not receive ADHC services.


General questions or inquiries about the 2016 Experience and Satisfaction Survey instrument, data frequencies, presentation, or report should be directed to:

Contact Information

Tommy Edwards, MBA, MSW Project ManagerOffice of Research and Organizational Development698 Concord Church RoadPickens, SC 29671Phone: 864-878-1103Email: [email protected]

2016 experience & satisfaction survey report · 2016 experience & satisfaction survey...

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