MEDIA CONTACT: Maureen Mickus
(517) 432-1737 or
Kristan Tetens
University Relations
(517) 355-2281
EAST LANSING, Mich. - Results of a survey released today by Michigan State University's Institute for Public Policy and Social Research show that public perceptions regarding nursing home quality have become consistently more negative since 1997, despite increased satisfaction with the State of Michigan's role in ensuring good quality care.
Persons living in southeastern Michigan are significantly less satisfied with the quality of nursing home care than are individuals from other parts of the state. Public support is evenly split between the various legislative approaches for increasing nursing home quality, although there is widespread support for a state bill that would allow a nursing home resident to withhold payment for care that does not meet public standards.
The survey was directed by Maureen Mickus, assistant professor of psychiatry, and Andrew Hogan, associate professor of medicine. They asked more than 1,400 Michigan residents their opinion about nursing home quality and their support of a number of different reform options.
The survey was one in a series of "State of the State" surveys conducted by the Institute for Public Policy and Social Research. The overall sampling error is plus or minus 3.2 percent.
The researchers found that concern about the quality of nursing home care is higher in some regions of the state than in others.
"The relatively high level of concern shown by Michigan residents living in the "thumb" area of the state may be a result of a number of criminal and civil charges against nursing home providers there. We also found that residents of southeastern Michigan are relatively more concerned about the quality of nursing home care, perhaps because of some highly publicized nursing home closings in the greater Detroit area over the past few years," Mickus said.
"Women under 65 living in southeastern Michigan have the least favorable views of nursing home quality," she said. "Given our understanding of the typical family caregiver, we speculate that this survey group probably represents adult daughters concerned about the care their aging parents receive or may receive in the future."
The survey revealed that Michigan support measures to improve the quality of nursing home care. While a moderate level of support exists for increasing the state sales tax for this purpose, a large number of Michigan citizens expect nursing homeowners to pay for-or at least to share-the financing of improvements. Michigan adults (82 percent) believe that withholding payment for care in an escrow account would be effective in improving quality of care for long-term nursing home residents.
Efforts to improve care in Michigan's 450 nursing homes have met with heated controversy. Advocates claim that care for nursing home residents is far less than adequate, citing a recent report by the U.S. General Accounting Office (GAO), the investigative arm of Congress. The GAO report concluded that one-fourth of the nation's nursing homes has serious deficiencies that place residents at high risk of severe injury or death. The report also concluded that efforts by state governments designed to correct deficiencies within facilities are currently ineffective.
Nursing home providers, on the other hand, claim that family members of nursing home residents express high levels of satisfaction with care. Furthermore, they contend that the funds needed to improve care are lacking due to the 1997 Balanced Budget Act, which resulted in serious financial setbacks for nursing homes.
Key findings from the survey:
o Public perceptions regarding nursing home quality have become more negative since 1997. The percentage of Michigan citizens who believe that nursing home quality was "excellent," "very good" or "good" decreased while the proportion of those who believe quality was "fair" or "poor" increased during this two-year period. Results differed by gender and age. Females are significantly more dissatisfied than males, with 65 percent rating nursing homes "poor" or "fair" compared to only 50 percent of the males surveyed. Additionally, persons under age 65 are much more likely to rate nursing home quality "fair" or "poor" (63 percent) compared to individuals 65 years and older (45 percent).
o Persons living in southeastern Michigan are significantly more dissatisfied with the quality of nursing home care than are individuals from other parts of the state. Almost one-third (32 percent) of persons from the southeast Michigan area rate nursing homes "poor," the lowest possible rating, compared to 16 percent of residents in all other regions.
o Quality ratings for Michigan nursing homes are significantly below ratings for hospitals. More than three times as many respondents rate nursing home quality "fair" or "poor" (58 percent) compared with similar ratings for hospitals (18 percent). Conversely, hospitals are four times more likely to receive "excellent" or "very good" ratings (42 percent) compared to nursing homes (11 percent).
o Satisfaction with the State of Michigan's role in ensuring good quality care in nursing homes has markedly improved since 1997, although residents from southeastern Michigan hold the least favorable views. In 1997, 45 percent of respondents rated state government "very effective" or "somewhat effective" versus 55 percent in 1999. Only one-half of individuals from southeastern Michigan (50 percent) perceive the state as either "very effective" or "somewhat effective," compared to 65 percent from other regions.
o Only 23 percent of residents are aware of the recent report issued by the U.S. General Accounting Office (GAO) regarding state nursing home inspections. (Moreover, many of these individuals are misinformed about the actual conclusions of this investigation). Among persons who recall the report, only about half (45 percent) understand that it identified serious problems with state inspections. More than one-third (36 percent) incorrectly believe the report concludes that state inspections are either "very effective" or "somewhat effective."
Directions for Reform
o Public support is evenly split between the various approaches for increasing nursing home quality. One-fifth of Michigan citizens (21 percent) thought the best way to improve quality was to increase the number of state inspectors, followed closely by adding more nursing home staff (19 percent) and increasing staff wages (18 percent). Twenty-eight percent said all three approaches would be effective.
o Willingness among the general public to pay for improved quality by reducing staff turnover is also evenly split and has remained constant during the past two years. The proportion of individuals willing to pay increased sales tax for purposes of reducing staff turnover increased slightly from 49 percent in 1997 to 52 percent in 1999. Fewer individuals were uncertain in 1999 (10 percent vs. 14 percent), but the percentage opposing increased sales taxes was unchanged (38 percent vs. 37 percent).
o Michigan taxpayers are not willing to shoulder the entire cost of nursing home reform. Nearly half of the sample (48 percent) believes that nursing home owners should be responsible for financing improvements in patient care. One-quarter of respondents (24 percent) indicated that the public should bear this cost, while nearly the same proportion (28 percent) sees the public and nursing home owners jointly responsible. Four-fifths (79 percent) of all citizens, however, are willing to use funds from the settlement between the tobacco companies and the state to improve care.
o There is widespread support for a state bill that would allow a nursing home resident the right to withhold payment for care if a nursing home fails to meet public standards. The vast majority of Michigan adults (82 percent) believe that withholding payment for care-funds would be held in an escrow account-would be either "very effective" (34 percent) or "somewhat" effective (48 percent) in improving the quality of care for long-term care residents.
o The majority of Michigan residents do not envision themselves ever spending any time in a nursing home. Overall, only one-quarter of Michigan adults rate their chances of residing in a nursing home at some point in their lives as "very likely" (6 percent) or "somewhat unlikely" (18 percent). These findings contrast somewhat with the estimated 40 percent lifetime risk of spending time in a nursing home.
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