Factors in Care Satisfaction Scores—Is It Personal?

Maximizing the satisfaction of older adults is a primary concern of today’s care providers, and great efforts are taken to provide older adults with care that results in high reported levels of satisfaction. As a result, predictors of satisfaction with care are of great interest to the aging services industry. A number of potential factors could impact the satisfaction ratings given by older adults; some of these related directly to the care received, but others related to personal factors such as anxiety, health, and loneliness. A recent study in the Gerontologist examined the relative contributions of personal- and care-related factors in predicting satisfaction scores, as well as the interplay of these factors impacted satisfaction with care. This study also looked at how the contributions of these factors might differ across care settings.

This study employed data from the Swedish National Board of Health and Welfare’s annual Open Comparisons report, which reported the findings from 95,000 individuals over 65 using care services. Of these individuals, 61,600 were receiving home care and 33,400 were receiving care in nursing homes. The surveys administered to these individuals asked about overall satisfaction with care, as well as questions pertaining to both personal characteristics and the care process. The personal characteristics analyzed were anxiety, self-rated health, and loneliness. Aspects of the care process examined included perceptions of safety, staff treatment, staff availability, and time spent by staff on care.

Overall, before taking care and personal factors into account, the study found that older adults in home care were more satisfied with their care than individuals in nursing homes. Individuals in nursing homes also had higher levels of anxiety and loneliness than individuals in home care, and, not surprisingly, also reported being in poorer health. In terms of care received, staff in nursing homes were perceived as having less time for care than home care staff, and the quality of staff treatment was perceived as lower in nursing homes. On the other hand, in nursing homes safety and staff availability were rated higher than in home care settings.

Turning to the contribution of personal factors on satisfaction scores, the researchers found that anxiety, low self-reported health, and loneliness all moderately correlated with lower overall satisfaction scores. In nursing homes in particular, higher loneliness was more strongly associated with low satisfaction scores than in home care settings. These person-related factors were also associated with lower scores given to the aspects of the care process examined in this study. Additionally, lower scores on all the examined aspects of care were associated with lower overall satisfaction scores. In nursing homes, the researchers found that safety and staff availability were more strongly associated with overall satisfaction ratings than in home care.

When the researchers looked at the relative contributions of the person-related factors and the care-related factors, they found that in home care, person-related variables accounted for 9 percent of the variation in satisfaction scores, while variables related to the care process accounted for 45 percent of the observed variance. It is unclear from this data what accounted for the rest of the observed variation in scores. For nursing homes, a greater amount of the variance was associated with person-related variables; these accounted for 21 percent of the variance, and care-related variables accounted for 39 percent. This also shows that, taken together, the variables of interest in the study explained more of the overall variance in nursing homes (60 percent) than in home care (54 percent). A closer examination of the data showed that staff treatment had a larger impact on satisfaction in home care, while loneliness and safety had a larger impact in nursing homes. An analysis of the nursing home data also showed that higher ratings on safety and staff treatment decreased the impact of loneliness on overall satisfaction scores.

Since the aspects of the care process are shown here to account for a large part of the variance in satisfaction ratings, optimizing these aspects of care should remain a priority for care providers and administrators in both home care and nursing home settings. In particular, treatment by staff in both settings seems especially consequential for satisfaction, which suggests that those in the aging services industry should train staff to treat those receiving care in the way that they want to be treated.

Even though aspects of the care process play a larger role in overall satisfaction, the researchers also caution that person-related factors should not be overlooked by caregivers. Moreover, some of these personal characteristics such as loneliness and anxiety can potentially be impacted by interactions with caregivers or through other efforts of aging service providers.

This study also suggests that observed differences between home care and nursing home care illustrate that individuals in these different settings may have different types of personal needs. The researchers conclude that, “Older people in nursing homes have weaker health and feel satisfied with care when they feel safe and not lonely. In contrast, in home care satisfaction is more strongly anchored in the way they are treated, and loneliness is not considered as important.” The authors also note that this data surprisingly shows that individuals in nursing homes show greater loneliness than those in home care. This may run counter to some common conceptions about being around a larger number of older adults decreasing loneliness, and suggests that nursing homes need to attend to residents’ perceived loneliness despite their physical proximity to many others.


Kajonius PJ and Kazemi A. Safeness and treatment mitigate the effect of loneliness on satisfaction with elderly care. The Gerontologist. (2015). gnu170 DOI:10.1093/geront/gnu170

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