2010-2011 MSW Fellows in Aging
Four MSW students were part of the 2010-2011 cohort of MSW Fellows in Aging: Lauren Cleary, Amy Florence, Jennifer Smejkal, and Myrna Gomez (from left to right, pictured above).
In partnership with the Rutgers School of Social Work and their field education agencies, the Fellows implemented leadership projects at their respective agencies. Congratulations to the Fellows on their success!
"An Evaluation of the Family Caregiver Support Program: Caregiver Satisfaction Survey"
by Lauren Cleary at the Philadelphia Corporation for Aging (Philadelphia, PA)
Background: Historically, the Family Caregiver Support Program (FCSP) has conducted annual caregiver satisfaction surveys. In the past few years, however, this standard of evaluation has fallen out of practice. As a program that is federally funded, FCSP is mandated to report on how its dollars are being spent and in what capacity to ensure continued funding. While evaluating the program in these terms is important, it does not consider the consumers' point of view on program adequacy.
Project aims: In an effort to re-incorporate consumer involvement in the program evaluation process, this project aims to create and implement a consumer satisfaction survey instrument in conjunction with the Director of FCSP. Distribution of the instrument via USPS mail in November 2010 yielded a near 50 percent response rate (out of approximately 950 potential respondents) as of February 2011. Following this success, I am in the process of coding, analyzing, and evaluating the quantitative and qualitative responses to the survey. My goal is to determine which areas of the program consumers are most satisfied and dissatisfied with, and to generate ideas for improvement in areas that consumers perceive as lacking. Once areas of satisfaction, dissatisfaction, and needs are established, FCSP will be equipped to begin to prioritize changes to the program that will most benefit the needs of our consumers.
Findings: A total of 951 surveys were distributed to the caregivers of FCSP. Returned surveys (n = 377) yielded a response rate of approximately 41%. Considering that the survey was distributed only once and the agency did not utilize follow-up reminder phone calls or mailings, this response rate is very high.
The major findings of the survey were:
- Overall, the goals of the program are being met, as 87% of respondents report reduced stress or burden as a result of being involved with the program.
- Burden is most reduced by reimbursement for respite and contact with FCSP care managers.
- Personal care is the service most often reimbursed with FCSP funds, with 70% of caregivers reporting this is how they use their reimbursement funds.
- 100% of caregivers report that FCSP helps them to be a better caregiver.
- 72% of respondents say training sessions would make the program better, and of those respondents, 52% said they would attend training on stress management.
- Most respondents report that more money toward respite and supplies would increase their satisfaction with the program.
Conclusions: Having completed the implementation and analysis of this survey, I identified several limitations and recommendations for future survey implementation. A major limitation of coding and analyzing this data was due to apparent respondent confusion on certain questions, which may be a result of too much variety in the types of questions asked. For example, some questions asked for a "yes", "no", or "sometimes" answer; some asked respondents to select only one answer from several choices; and still others had respondents selecting "all that apply". So many different types of questions led to confusion among respondents who selected more than one answer on questions where they were only supposed to make one selection. Furthermore, this made analyzing the data difficult because the researcher was not able to extrapolate exactly how the caregiver intended to respond. One recommendation for next year's survey would be to change the format of the questions to include only one or two "types" of responses or to group questions with like responses together. I believe this will reduce respondent confusion and increase validity.
Another concern is that the Russian translation of the survey does not reflect the English version closely enough. It asks only who the caregiver is and not the care recipient. Also, the order of some of the possible responses did not coincide with the English version, which made coding the data difficult. Lastly, one question asked if caregivers would attend meetings and/or conferences, but it is unclear exactly what "meetings and/or conferences" means. Would these meetings/conferences be different than a support group or training session? If so, it would be helpful to clarify or remove that choice from next year's survey.
Personally and professionally, I feel that having been involved in this project and playing a role in revamping FCSP's satisfaction survey process proved to be successful both for myself and for the agency. It is my hope that by following the recommendations above and using the codebook that I provided to the program director, that the survey will continue to be distributed and analyzed annually so that FCSP can make evidence-based decisions about how the program is operating. Leading this project allowed me to further develop skills learned in research courses while allowing me also to work collaboratively with members of other disciplines in the agency. Both skill sets are sure to be of use to me in the future, and this project gave me an opportunity to really hone them while also producing something of concrete usefulness to the agency.
"Inclement Weather Project"
by Amy Florence at the Karen Ann Quinlan Hospice (Newton, NJ)
Background: Severe weather poses a risk for many people; however, seniors who are in a vulnerable state of health are even more at risk. Every winter news reports tell of the unnecessary deaths of older adults who are unprepared for power outages and severe winter storms. Older adults and other individuals at the end-of-life are especially vulnerable.
Project aims: My project is an enhancement of a project previously designed to bring awareness to the essential items that are needed for people enrolled in hospice care to survive a severe winter storm. "Blizzard Packs" are kits that are distributed to the hospice patients living in private homes. The Blizzard Pack contains ten representative objects that serve as a prompt to gather necessary items, such as a one gallon bottle of water and a three-day supply of non-perishable foods. Also included is a laminated list of alternative items on one side with emergency contact information on the other side. Additionally, it instructs patients who depend on oxygen how to contact their electric company to be placed on a priority list. My contribution to this project was to organize it so that it would be more efficient and to evaluate the effectiveness of the project. With the help of my leadership, the agency distributed packs to 145 households this past winter.
Evaluation: A focus group was held with the social workers and nurses who delivered "Blizzard Packs" to the hospice patients in March, and a report was given at the April team meeting. The consensus was that it was a successful project and worth the time and effort. Comments included: "It is nice to give the patient something other than paperwork and instructions. They are so pleased to get the bag of goodies." Another comment was: "The caregiver was happy to receive the contact numbers. She felt better knowing who to contact in case they needed help." Since this focus group was held in early March, it was asked if we could make up a second set of "Blizzard Packs" for patients who just came into the program. Due to the overwhelming positive response by the hospice staff, ten more "Blizzard Packs" were made for each of the three counties.
The focus group also discussed some changes that might be considered for next year. Those changes include using a reusable water bottle instead of a bottle with water in it. The reason for this was some of the staff members took the "Blizzard Packs" home with them in the evening for delivery the next morning. Since the water might freeze overnight, they could not leave them in the car. Using empty reusable plastic bottles would also help reduce the transportation weight. It was also recommended that we use plastic bottles with the agency logo imprinted on them.
Reflections on my leadership development process: This project has shown me the importance of documenting the steps of a project so that it can be sustainable year after year. A large percentage of time was spent recreating the project. Through proper documentation this project will be able to be continued by following the steps and the timeline that was developed and placed in a computer database. This will make the work more efficient, thus improving the chance that it will be continued in the future, even if there are staffing changes. The focus group evaluations confirmed that staff members feel this is a good project to continue and provided feedback to improve the project in the future.
"Client Satisfaction Program Evaluation: Intermissions"
by Jennifer Smejkal at the Cedar Crest Continuing Care Retirement Community (Monroe, NJ)
Background: Cedar Crest Continuing Care Retirement Community is located in Monroe, NJ, and offers independent living, assisted living, nursing care, rehabilitation, Alzheimer's care, and respite care. The Intermissions program is a socialization program for Cedar Crest residents with cognitive difficulties. Intermissions is available five days a week, 11 a.m. to 3 p.m., and participants attend a minimum of two days per week. It offers activities designed to sustain participants' highest level of functioning possible and enhance their cognitive abilities. It also gives participants an opportunity to engage with others in recreational activities that relate to their prior life roles, such as cooking and gardening. Intermissions participants take field trips, go to lunch together, and attend activities on campus as a group. An additional benefit of the Intermissions program is that it provides respite to the caregivers. For spouses who live with a cognitively impaired person, the constant care can be stressful and tiring. For family members who do not live with the person, there is still the constant worry over the safety and functioning of their loved one. Intermissions offers a solution to both these issues.
Project aims: An evaluation of Intermissions had never been conducted prior to this project. A client satisfaction survey was distributed to spouses of current and former Intermissions participants. Based on the responses, I aim to improve Intermissions to better meet the needs of the participants and their spouses.
Findings: The survey responses were extremely positive. However, two respondents commented that they wish they were able to learn about their spouses' participation during the day. Due to cognitive difficulties, Intermissions participants may not remember their day, and therefore the spouses are unable to hear about it. In some cases, an individual may be actively participating and socializing all day, only to tell his or her spouse that they did nothing during the program. To meet this need, I created a "report card" that Intermissions employees will fill out at the end of the day. This card will give an indication of the individual's level of participation, socialization, eating, toileting, and physical or behavioral issues. This card will ensure that each spouse receives an individual report for the day. Also, I delivered the client satisfaction survey instrument to the Director of the Intermission program so that it can be used on an annual basis to ensure that the Intermissions program continues to meet its goals and best serve its clients. This sustainability will allow my project to continually benefit the agency, even after my field placement is over, and help Intermissions to strengthen and grow.
Reflections on my leadership development process: This project has been a great learning experience for me because I did not know what to expect when the survey began. There was no way of knowing how people would respond to the survey, which required me to be flexible in my plans. The overwhelmingly positive response was great news for Intermissions and validated the program's success in achieving its objectives. However, this project demonstrated that there is always room for improvement and growth, as I found useful suggestions from the respondents, even with the high level of satisfaction. The addition of "report cards" to the program will strengthen it and help it to better meet the participants' needs. Additionally, I found that there is a lack of literature concerning the use of these "report cards" in dementia day programs. I found this gap in research to be interesting, as it shows a potential untapped area of investigation. Listening to what caregivers want from a dementia socialization program is an important component of ensuring that the program meets the needs of its participants. By conducting an evaluation and hearing the concerns of participants, Intermissions was able to strengthen its program and provide even better services.
"What are your clients saying about you? A client satisfaction survey"
by Myrna M. Gomez, The Daughters of Miriam Center (Clifton, NJ)
Background: The Daughters of Miriam Center for the Aged/The Gallen Institute, located in Clifton, NJ, is a long-term and sub-acute care facility providing broad-based services. On its 13-acre campus are skilled nursing facility, a sub-acute care wing, a dementia/Alzheimer's care pavilion, a rehabilitation program, a medical adult day care center with a dementia day care program, a sheltered workshop, hospice care, and a respite care program as well as senior apartments with supportive programs. Since nursing homes are regulated by several regulatory agencies, such as the Joint Commission, one of the requirements is to obtain and document clients' input into the development of services that meet their needs.
Project aims: To meet this requirement, the project consisted of a client satisfaction survey to determine older adult consumers' and their family members' level of satisfaction with the services provided by the center. Each section of the survey tool addressed a different type of service at the center, including admissions, room accommodations, meals, physician and nursing services, religious services, social services, transportation and a special section specific to family member/caregivers. A total of 440 surveys were distributed to residents and family members of long-term and sub-acute residents and adult day care clients. A total of 172 surveys were returned for an approximate return rate of 38%. All participants were asked to rate 50 variables on a scale of 1 through 5 with 1 = strongly disagree and 5 = strongly agree. Assistance was provided by social workers for those elders who had difficulty in reading the survey in English and/or wished to be interviewed in English or Spanish as part of the process.
Findings: Generally speaking, 91.9% of seniors and family members were highly satisfied with the services provided and would recommend the facility to others. Other than the identification of key departmental staff as being highly courteous, the top three variables identified by all respondents as the organization's strengths were a feeling of the center being safe and secure, cleanliness of the room and facility, and respect for privacy. Additionally, since research has identified a strong correlation between client's level of satisfaction and food, it was not surprising that the survey also identified food preferences, variety of choices and flavorfullness/tastiness as an area for improvement.
Plans for future/Evidence of success: As part of the future planning process, a presentation will be given to management and the center's Board of Directors outlining the qualitative results of the survey. The presentation will also include a qualitative analysis of the comments for each section as reported by the respondents, and comparisons will be made as to the identification of the sections that most highly correlate with overall satisfaction. Management may then form teams to further drill down the data and recommend action plans. A second survey is scheduled for 2012 in order to determine the level of improvement based on level of client satisfaction.
Reflection on my leadership development process: This project enhanced my leadership skills in a number of ways. First, in assessing the appropriate variables to measure and determining the most effective survey methodology to use, I exercised critical thinking skills. Second, because of the size of the project, I was granted the use of additional social work students, and, as such, I needed to utilize effective communication and teamwork skills. Lastly, after analyzing the data, I needed to prepare a succinct presentation to individuals in positions of organizational change. My efforts did not go unnoticed. The organization offered me a full-time position of employment, and I accepted: A successful outcome to a successful field placement and project!