2012 REPORT Client Satisfaction Survey CHARLES T. CORLEY SECRETARY

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1 RICK SCOTT GOVERNOR 2012 REPORT Client Satisfaction Survey CHARLES T. CORLEY SECRETARY Program Services, Direct Service Workers, and Impact of Programs on Lives of Clients elderaffairs.state.fl.us Bureau of Planning & Evaluation, October 2013

2 Table of Contents Executive Summary... 1 Background... 3 Methodology... 4 Population and Sample... 4 Survey... 4 Survey Procedures... 5 Analysis... 5 Survey Results... 6 Overall Satisfaction With Services Received and With Their Quality... 6 Client Satisfaction With Aspects of Program Services... 8 Client Satisfaction With Direct Service Workers The Impact of Services on Clients Lives Summary and Conclusions Appendix A: 2012 Survey Responses by Program Participation Appendix B: 2012 Survey Responses by Program Participation, Combined Satisfaction Categories Appendix C: Client Satisfaction Survey... 22

3 Executive Summary In 2012, the Florida Department of Elder Affairs (DOEA) Bureau of Planning and Evaluation surveyed a random sample of clients in four of the Department s community-based care programs in each of the state s 11 Planning and Service Areas (PSAs). The following report examines responses obtained from the 11 PSAs. The purpose of the surveys was to assess the satisfaction of clients with program services, the quality of direct service workers, and the impact of the program on clients lives. Clients selected for the surveys participated in at least one of four DOEA programs serving the largest number of case managed clients: the Long-Term Care Community Diversion Pilot Project, also known as Nursing Home Diversion Medicaid Waiver (NHD), Aged and Disabled Adult Medicaid Waiver (ADA), Assisted Living Medicaid Waiver (AL), and Community Care for the Elderly (CCE). Program participants reported high levels of overall satisfaction with the services they received and their quality, with aspects of program services, their direct service workers, and the impact of services on their lives. Overall satisfaction levels including Very Satisfied and Satisfied ranged from 92 percent to 100 percent. The lowest satisfaction level (79%) was expressed by AL program participants with regard to direct service worker continuity. A small number of program participants responded that they were, Dissatisfied, or Very Dissatisfied, or responded No to a question addressing their satisfaction, ranging from zero to five percent. In comparison to the other programs participants, NHD program clients generally reported the highest combined satisfaction levels and their levels of dissatisfaction ranged from zero to five percent. They were also more likely to state that they were Very Satisfied than Satisfied with the different aspects of services evaluated. In addition, they were more likely to say that their direct service workers were punctual and that the same worker usually comes to help them. AL clients tended to choose the Satisfied over the Very Satisfied response option more often than the other program participants and they were significantly less likely to say that the same worker came to help them. Client Satisfaction With Services Received and Quality of Services The majority of respondents surveyed across the four programs reported high levels of being Very Satisfied or Satisfied with the services they received and with their quality. Between 94 and 98 percent were Very Satisfied or Satisfied with services received, including frequency and length of services, time of day, and day(s) of the week; and Client Satisfaction Survey

4 Between 93 and 97 percent were Very Satisfied or Satisfied with the quality of services received. Client Satisfaction With Aspects of Program Services The majority of respondents surveyed across the four programs reported high levels of being Very Satisfied or Satisfied with aspects of program services: Between 92 and 96 percent were Very Satisfied or Satisfied with the frequency of services, Between 92 and 96 percent were Very Satisfied or Satisfied with the length of services, and Between 96 and 99 percent were Very Satisfied or Satisfied with the time of day services were provided. Client Satisfaction With Direct Service Workers The majority of respondents were also Very Satisfied or Satisfied with their direct service workers: Between 94 and 96 percent were Very Satisfied or Satisfied with their workers knowledge and skills needed to help them, Between 95 and 98 percent said that they were Very Satisfied or Satisfied with the way their workers treat them, Between 96 and 97 percent said that they were Very Satisfied or Satisfied with the communication with their workers Between 94 and 98 percent said that they were Very Satisfied or Satisfied with the punctuality of their worker, and Between 79 and 100 percent said that they can usually expect that the same person will come to help them. While AL clients are exclusively served in ALFs, over 50 percent of clients in the NHD program and all clients in the CCE and ADA programs are served in home-based settings. The Impact of Services on Clients Lives The reported impact of services on program participants needs, quality of life, and ability to stay in their homes was high as well: Between 96 to 97 percent of participants said that services met their needs. Between 95 to 98 percent said that services helped them maintain or improve their quality of life. Between 95 to 100 percent said that services helped them stay in their homes Client Satisfaction Survey

5 In 2010 and 2011, the Department surveyed clients participating in the same four programs included in the present study, but not at the program-specific level. Consequently, comparisons of the 2012 survey results to those of previous years cannot be made at the program-specific level but can be made to response averages across combined programs. Between 2010 and 2012, the average satisfaction scores (Very Satisfied and Satisfied combined) of program participants increased slightly and continuously, ranging from a two to six percent increase. The largest increase in satisfaction (6%) was reported for worker punctuality. Responses to several survey items increased by four percent between 2010 and These include satisfaction with the frequency and length of services, days of the week services were provided, worker knowledge and skills, and communication with workers. Background The Florida Department of Elder Affairs operates a variety of programs to meet the special needs of Florida s aging citizens. These programs are designed to provide cost-effective ways of keeping elderly persons in their homes or communities and to prevent, postpone, or reduce inappropriate or unnecessary institutional placements. Individuals served by these programs are frail elders and persons with disabilities who are functionally impaired and at risk of nursing home placement. CARES (Comprehensive Assessment and Review for Long-Term Care Services) is Florida's federally mandated nursing home pre-admission assessment program that determines medical eligibility for the Medicaid waiver programs. Individuals must be age 60 or older and must meet the same functional and financial criteria as individuals seeking Medicaid assistance for nursing home placement to qualify for the ADA and AL programs administered by the Department. In addition, for AL and NHD eligibility, individuals must meet at least one of the following additional criteria: require assistance with activities of daily living (ADL), be diagnosed with Alzheimer's disease or other dementia, or have a diagnosis of a degenerative or chronic medical condition requiring nursing services. A further eligibility criterion for AL clients includes that they are awaiting discharge from a nursing home and unable to return to a private residence. Additional eligibility for the NHD program requires clients to be age 65 or older, be enrolled in Medicare, and be eligible for Medicaid. Individuals eligible for CCE must be age 60 or older and functionally impaired. Primary consideration for CCE services is given to elderly persons referred to Adult Protective Services (APS) and determined by APS to be victims of abuse, neglect, or exploitation who are in need of immediate services to prevent further harm. Services provided to participants of the above-mentioned programs may include direct service, homemaker, adult day health care, respite, home-delivered meals, companionship, case management, case aide, chore, escort, respite, attendant care, and counseling Client Satisfaction Survey

6 The number of clients served in Fiscal Year ranged from 4,593 in AL to over 24,500 in NHD (see the following exhibit). The CCE Program is funded solely by state General Revenue with a appropriation of over $40 million. Funding for the NHD, ADA, and AL programs is supplied by Medicaid and the state; appropriations ranged from over $35 million for AL to approximately $356 million for NHD. Enrollment and Funding for Three Department-Administered Programs, Program Clients Funding Community Care for the Elderly (CCE) Served 13,459 $40,479,617 Aged and Disabled Adult Medicaid Waiver (ADA) 11,018 $103,823,694 Assisted Living Medicaid Waiver (AL) 4,593 $35,083,803 Nursing Home Diversion Medicaid Waiver (NHD) 24,593 $355,766,698 Source: 2013 Summary of Programs & Services, DOEA Methodology Population and Sample The four DOEA programs selected for the survey (NHD, ADA, AL, and CCE) are those which serve the largest number of case-managed clients. The clients selected for the survey received services from one of these programs for at least three months and received a service in addition to case management and home-delivered meals. The sample size was large enough to assure a 95 percent confidence level for the representativeness of results at the state level. Survey The survey contained 15 questions for recipients of program services, of which 11 evaluated services and direct service workers and three addressed the impact of services on respondents lives. Questions assessing satisfaction with services included those on the frequency, length, time of day, day(s) of the week, and quality of services provided. Questions assessing satisfaction with direct service workers focused on adequacy of worker knowledge and skills, communication with workers, treatment of clients, punctuality, and continuity of services conducted by the same worker. Three questions addressing the impact of services on the lives of clients asked respondents whether services met their needs, helped to maintain or improve their quality of life, and helped them continue living in their home. A final question gave respondents the opportunity to volunteer any other information about the services they received. This report includes the survey instrument as Appendix C Client Satisfaction Survey

7 Survey Procedures Clients were sent letters notifying them that they might be called to participate in a survey about the services they received. They were assured that, whether or not they participated, their DOEA program services would not be affected. The survey was conducted by professional interviewers in the DOEA Computer-Assisted Telephone Interview (CATI) Call Center. Instructions informed respondents that the survey would take an estimated 10 minutes to complete. The interviewers placed 7,064 calls to clients of the AL, CCE, and ADA programs between March 9, and November 8, In addition, interviewers placed 963 calls to clients of the NHD program between October 30, and December 19, The NHD clients contacted resided in a private residence or assisted living facility and did not include those residing in nursing homes. A large number of clients were unable to respond to the survey because of unavailability (e.g., hospitalization) or the inability to hear, understand, or remember. In total, 3,221 surveys were successfully completed, yielding a 40 percent response rate. Analysis The 3,221 responses to the survey were analyzed by program enrollment. A summary chart containing percentages of all survey responses (Very Satisfied, Satisfied, nor Dissatisfied, Dissatisfied, and Very Dissatisfied, as well as Yes and No) is included in Appendix A. Combined percentages of Very Satisfied and Satisfied responses, as well as Dissatisfied and Very Dissatisfied responses to items, are presented in Appendix B. In addition, current survey results were compared to those obtained in 2010 and Since these prior surveys were not designed for program-level analysis, the comparison of findings is based on averages for the four programs evaluated Client Satisfaction Survey

8 Survey Results Overall Satisfaction With Services Received and With Their Quality Clients expressed high overall satisfaction with the services and with the quality of services they received. The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with program services by respondents across PSAs (at least 93% for each question). Overall Satisfaction With Current Services Respondents of the NHD program reported the highest degree of being Very Satisfied (60.4%) compared to those participating in the CCE (59%), ADA (55%), and AL (46%) programs. AL clients were more likely to be Satisfied (48%) than Very Satisfied (46%), in contrast to the other program participants. With the exception of AL clients, program participants were more likely to say that they were Very Satisfied than Satisfied with currently receiving services. Respondents overall satisfaction with the services they were receiving at the time of the survey was high, as reflected by the combined Very Satisfied and Satisfied ratings of 98 percent for clients of the NHD program, followed by 97 percent each for CCE and ADA clients, and 94 percent for AL clients (see Appendix B). For 2012, an average of 96 percent of clients in the four programs combined was Very Satisfied or Satisfied with currently receiving services compared to an average of 95 percent in 2011, and 92 percent of all clients surveyed in Client Satisfaction Survey

9 Overall Satisfaction With the Quality of Services Received Clients of the NHD program also reported the highest incidence of being Very Satisfied with the quality of services they received (59%) compared to 53 percent or less for other program respondents. With the exception of AL clients, program participants were more likely to say that they were Very Satisfied than Satisfied with the quality of services received. Combining the responses to the Very Satisfied and Satisfied options, NHD clients expressed the highest satisfaction levels (97%), followed by CCE and ADA clients (both 96%), and clients of the AL program (93%) (see Appendix B). For 2012, an average of 96 percent of clients in the four programs combined was Very Satisfied or Satisfied with the quality of services received compared to an average of 95 percent in 2011, and 94 percent of all clients surveyed in Client Satisfaction Survey

10 Client Satisfaction With Aspects of Program Services Four questions asked survey respondents about their satisfaction with program services. How satisfied are you with how often services are provided? How satisfied are you with the length of service visits? How satisfied are you with the time of day that services are provided? How satisfied are you with the day(s) of the week services are provided? The combined response options of Very Satisfied and Satisfied yielded high overall levels of satisfaction with aspects of program services by respondents, ranging from an average of 93 to 97 percent across programs. Satisfaction With the Frequency of Services Provided Clients of the NHD program were more likely to be Very Satisfied with the frequency of services provided (58%) compared to 46 percent or less for clients of the other programs. Other program respondents were more likely to say that they were Satisfied than Very Satisfied. For example, 50 percent of AL program clients said they were Satisfied with the frequency of services compared to 42 percent who said they were Very Satisfied Client Satisfaction Survey

11 The majority of clients of each of the four programs surveyed expressed high levels of being Very Satisfied or Satisfied with service frequency, ranging between 92 and 96 percent (see Appendix B). The highest level of Very Satisfied and Satisfied with service frequency responses combined was reported by clients of the NHD Program (96%), followed by those in the ADA and CCE (95% for both), and AL (92%). For 2012, an average of 95 percent of clients in the four programs combined was Very Satisfied or Satisfied with the frequency of services compared to an average of 92 percent in 2011, and 91 percent of all clients surveyed in Satisfaction With the Length of Service Visits Clients of the NHD program reported the highest levels of being Very Satisfied with the length of service visits by their direct service worker (46%) compared to 34 percent or lower for clients of the other programs. Program participants were more likely to say that they were Satisfied than Very Satisfied with the length of service visit. For example, 62 percent of AL clients said they were Satisfied compared to 33 percent who said they were Very Satisfied with the length of service visits. Between 91 and 95 percent of survey respondents said they were Very Satisfied or Satisfied with the length of service visits (see Appendix B). The highest percentage of these combined satisfaction responses was expressed by clients of the AL program (95%), followed by those in NHD (94%), ADA (93%), and CCE (91%) Client Satisfaction Survey

12 For 2012, an average of 93 percent of clients in the four programs combined was Very Satisfied or Satisfied with the length of service visits compared to an average of 87 percent in 2011, and 89 percent of all clients surveyed in Satisfaction With the Time of Day Services Are Provided Clients of the NHD program stated more often that they were Very Satisfied with the time of day services were provided (50%) compared to 39 percent or less for the other program participants. With the exception of NHD participants, clients of the other programs were more likely to say that they were Satisfied than Very Satisfied with the time of day services were provided. For example, 68 percent of AL clients said they were Satisfied compared to 31 percent who said they were Very Satisfied with the time of day of service visits. None of the respondents said they were Very Dissatisfied with this aspect of services. Between 96 and 99 percent of all respondents said that they were Very Satisfied or Satisfied with the time of the day services were provided (see Appendix B). The highest proportion of responses to the combined satisfaction options was reported by AL clients (99%), followed by NHD (98%), and ADA and CCE clients (96% for both). For 2012, an average of 97 percent of clients in the four programs combined was Very Satisfied or Satisfied with the time of day services were provide compared to an average of 95 percent in 2011, and 94 percent of all clients surveyed in Client Satisfaction Survey

13 Satisfaction With the Days of the Week Services Are Provided Participants of the NHD program reported the highest frequency of being Very Satisfied with the day(s) of the week services were provided (49%) compared to 38 percent or less for the other program respondents. With the exception of NHD participants, clients of the other programs were more likely to say that they were Satisfied than Very Satisfied with the day(s) of the week services were provided. For example, 68 percent of AL clients said they were satisfied compared to 30 percent who said they were Very Satisfied with the day(s) of service visits. None of the clients surveyed were Very Dissatisfied with this aspect of service delivery. When combining the response options of Very Satisfied and Satisfied, an equal proportion of AL, CCE, and NHD program participants were satisfied (97%) followed by 96 percent of ADA clients (see Appendix B). For 2012, an average of 97 percent of clients in the four programs combined was Very Satisfied and Satisfied with the day(s) of the week services were provided compared to an average of 93 percent of all clients surveyed in 2011 and Client Satisfaction Survey

14 Client Satisfaction With Direct Service Workers Clients expressed high overall satisfaction with different aspects of their direct service workers across all 11 PSAs. Satisfaction rates with direct service workers ranged from 79 to 100 percent. Satisfaction With Direct Service Workers Knowledge and Skills Participants of the NHD program reported the highest incidence of being Very Satisfied with the knowledge and skills of their workers (60%) compared to 50 percent or less for participants of the other programs. AL clients were more likely to say they were Satisfied than Very Satified (56% and 38%, respectively). The combined responses of Very Satisfied and Satisfied on this question resulted in satisfaction rates ranging from 96 percent for NHD and ADA participants to 94 percent for those in the AL and CCE programs. For 2012, an average of 95 percent of clients in the four programs combined was Very Satisfied or Satisfied with their workers knowledge or skills compared to an average of 94 percent in 2011, and 91 percent of all clients surveyed in Client Satisfaction With Direct Service Workers Treatment Clients of the NHD program reported the highest rates of being Very Satisfied with the way direct service workers treated them (67%) compared to response rates of 60 percent or less for the other program clients. With the exception of AL clients, program participants were more Client Satisfaction Survey

15 likely to say that they were Very Satisfied than Satisfied with the way their workers treated them. Forty-four (44) percent of AL respondents said they were Very Satisfied with their direct service workers treatment compared to 52 percent who said they were Satisfied. The combined responses of Very Satisfied and Satisfied ranged from 98 percent for clients of both the CCE and ADA programs, to 97 percent for NHD, and 96 percent for AL clients (see Appendix B). For 2012, an average of 97 percent of clients in the four programs combined were Very Satisfied or Satisfied with the way their worker(s) treated them compared to an average of 98 percent in 2011, and 95 percent of all clients surveyed in Satisfaction With the Ability to Communicate With Direct Service Workers Florida s population is characterized by a mix of ethnic groups speaking different languages. For this reason, communication between clients and direct service workers of different backgrounds may be challenging. However, survey findings show that few clients were dissatisfied with their ability to communicate with workers. Clients of the NHD program reported the highest levels of being Very Satisfied with communication with their workers (65%) compared to those of other programs. With the exception of AL clients, program participants were more likely to say that they were Very Satisfied than Satisfied Client Satisfaction Survey

16 NHD and ADA program respondents showed a high incidence of being Very Satisfied and Satisfied combined (97% for each), followed by AL and CCE clients (96% for each, see Appendix B). For 2012, an average of 96 percent of clients in the four programs combined was Very Satisfied or Satisfied with the communication with workers compared to an average of 96 percent in 2011 and 92 percent of all clients surveyed in Punctuality of Direct Service Workers Between 94 and 98 percent of respondents said that their direct service workers arrive at the scheduled time. The highest response rate to this question was obtained from NHD clients (98%), followed by ADA clients (96%) and those in the CCE and AL programs (94% for each). One percent or fewer of the clients said they did not know when to expect workers. For 2012, an average of 95 percent of clients in the four programs combined said that their worker arrived at the scheduled time compared to an average of 94 percent in 2011 and 89 percent of all clients surveyed in Client Satisfaction Survey

17 Continuity of Direct Service Workers Whether the same direct service worker comes to assist a program participant may have an impact on client trust and ease of interaction with workers. In addition, continuity of workers may avoid the need for participants to repeat instructions to workers to explain what they require. A high proportion of survey respondents said that they usually have the same worker come to help 100 percent of NHD clients, 95 percent of ADA clients, and 94 percent of CCE clients. In comparison, 79 percent of AL clients reported continuity of workers. For 2012, an average of 91 percent of clients in the four programs combined said that they can usually expect the same worker for assistance compared to an average of 92 percent of all clients surveyed in 2011 and Client Satisfaction Survey

18 The Impact of Services on Clients Lives Program participants across PSAs reported high levels of satisfaction with the impact of services on their needs, quality of life, and ability to stay in their homes, ranging between 94 and 100 percent. Services Meet Client Needs A high percentage of program participants, between 96 and 97 percent, said that services met their needs. For 2012, an average of 97 percent of clients in the four programs combined said that services met their needs compared to an average of 95 percent of all clients surveyed in 2011 and Services Help Maintain or Improve Clients Quality of Life Ninety-eight percent of clients participating in the NHD and ADA programs reported that the services they receive helped to maintain the quality of their life, followed by 97 percent of CCE and 95 percent of AL clients. For 2012, an average of 97 percent of clients in the four programs combined said that services helped maintain or improve their quality of life compared to an average of 96 percent of all clients surveyed in 2011 and Client Satisfaction Survey

19 Services Help Clients Stay in Their Homes One of the main goals of participation in the programs studied is to enable clients to stay in their homes or in the least restrictive setting. This goal seems to be largely achieved for the clients who participated in the survey: 100 percent of NHD clients, 99 percent of ADA clients, 98 percent of CCE clients, and 95 percent of AL clients said that services helped them stay in their homes or least restrictive setting. For 2012, an average of 98 percent of clients in the four programs combined said that services helped them stay in their homes compared to an average of 99 percent of all clients surveyed in 2011 and Summary and Conclusions In summary, program participants reported high levels of overall satisfaction with the services they received through the NHD, ADA, AL, and CCE programs and the quality and aspects of these services. In addition, they were highly satisfied with their direct service workers and the impact of services on their lives. Survey participants combined responses of Very Satisfied and Satisfied yielded average satisfaction levels with these service aspects ranging from 91 to 98 percent. Clients of the AL program reported the lowest levels of satisfaction with the continuity of workers coming to help them (79%), which was between 15 and 20 percent lower than the responses collected from clients participating in the other programs. Apart from worker continuity, satisfaction levels of program participants were similar and differed by less than one to five percent. In general, average satisfaction levels of clients surveyed in 2010 through 2012 increased by one to six percent. While six percent more program participants in 2012 than in 2010 said that their workers were punctual, the positive evaluation of worker continuity and program impact on their ability to stay in their homes decreased by one percent across these survey periods Client Satisfaction Survey

20 Appendix A: 2012 Survey Responses by Program Participation Survey Question Percent of Responses by Program AL CCE ADA NHD Average across programs 1. How satisfied are you with how often services are provided? Very Satisfied 42.4% 45.7% 44.9% 58.1% 47.8% Satisfied 50.0% 49.0% 50.6% 37.7% 46.8% 2.2% 1.8% 1.8% 0.0% 1.5% Dissatisfied 3.9% 2.9% 2.6% 1.9% 2.8% Very Dissatisfied 1.5% 0.6% 0.2% 2.3% 1.1% 2. How satisfied are you with the length of the service visits? Very Satisfied 33.2% 33.2% 33.6% 45.8% 36.4% Satisfied 61.6% 57.4% 58.8% 48.1% 56.5% 1.5% 4.3% 3.2% 0.0% 2.3% Dissatisfied 2.6% 4.6% 4.2% 4.2% 3.9% Very Dissatisfied 1.1% 0.4% 0.1% 1.9% 0.9% 3. How satisfied are you with the time of day that services are provided? 4. How satisfied are you with the day(s) of the week services are provided? 5. Overall, how satisfied are you with the quality of the services you have received? Very Satisfied 31.3% 39.4% 36.6% 50.2% 39.4% Satisfied 67.6% 56.6% 59.6% 47.9% 57.9% 0.0% 1.7% 2.1% 0.0% 0.9% Dissatisfied 1.2% 2.2% 1.6% 1.5% 1.6% Very Dissatisfied 1.1% 0.4% 0.1% 1.9% 0.9% Very Satisfied 29.7% 38.2% 37.3% 48.8% 38.5% Satisfied 67.7% 58.9% 58.6% 48.4% 58.4% 1.1% 1.3% 1.9% 0.0% 1.1% Dissatisfied 1.1% 1.4% 2.0% 2.3% 1.7% Very Dissatisfied 0.4% 0.1% 0.2% 0.4% 0.3% Very Satisfied 40.5% 53.2% 49.9% 58.9% 50.6% Satisfied 52.5% 43.1% 45.9% 38.1% 44.9% 3.6% 1.7% 1.9% 0.0% 1.8% Dissatisfied 2.9% 1.7% 1.7% 1.9% 2.1% Very Dissatisfied 0.5% 0.2% 0.5% 1.1% 0.6% Client Satisfaction Survey

21 Survey Question 6. How satisfied are you that your worker(s) has (have) the knowledge and skills needed to help you? 7. How satisfied are you with the way your worker(s) treat you? 8. How satisfied are you with the way you and your worker(s) communicate? 9. Do(es) your worker(s) usually arrive at the scheduled time? 10. Can you usually expect the same person (people) to come help? 11. Overall, would you say that the services you receive meet your needs? 12. Do these services help you to maintain or improve your quality of life? 13. Do these services help you to stay in your home? (If at an ALF ask: Do these services help you to avoid moving into a nursing home?) Would you say: 14. Overall, how satisfied are you with the services you receive? Percent of Responses by Program AL CCE ADA NHD Average across programs Very Satisfied 38.3% 49.9% 47.0% 60.0% 48.8% Satisfied 55.6% 44.5% 48.8% 35.5% 46.1% 2.7% 2.3% 2.1% 0.0% 1.8% Dissatisfied 2.7% 3.0% 1.7% 3.0% 2.6% Very Dissatisfied 0.7% 0.3% 0.5% 1.5% 0.7% Very Satisfied 44.0% 59.5% 58.9% 66.5% 57.2% Satisfied 52.4% 38.3% 39.2% 30.8% 40.2% 1.3% 0.8% 1.1% 0.0% 0.8% Dissatisfied 1.6% 1.1% 0.5% 1.9% 1.3% Very Dissatisfied 0.7% 0.2% 0.3% 0.8% 0.5% Very Satisfied 42.5% 52.5% 51.5% 65.2% 52.9% Satisfied 53.6% 43.0% 45.7% 31.8% 43.5% 1.6% 2.6% 1.5% 0.0% 1.4% Dissatisfied 1.6% 1.8% 1.0% 2.3% 1.7% Very Dissatisfied 0.7% 0.2% 0.2% 0.8% 0.5% Yes 93.6% 94.3% 95.6% 98.4% 95.5% No 5.1% 4.6% 3.2% 1.2% 3.5% I don't know when 1.3% 1.1% 1.2% 0.4% 1.0% to expect them Yes 79.1% 94.2% 94.9% 99.6% 91.9% No 20.9% 5.8% 5.1% 0.4% 8.1% Yes 97.0% 96.6% 96.9% 95.5% 96.5% No 3.0% 3.4% 3.1% 4.5% 3.5% Yes 94.7% 97.0% 98.2% 97.7% 96.9% No 5.3% 3.0% 1.8% 2.3% 3.1% Yes 95.1% 98.0% 98.5% 99.6% 97.8% No 4.9% 2.0% 1.5% 0.4% 2.2% Very Satisfied 45.8% 59.1% 55.0% 60.4% 55.1% Satisfied 48.1% 37.6% 41.8% 37.7% 41.3% 3.0% 1.8% 1.5% 0.0% 1.6% Dissatisfied 1.6% 1.4% 1.3% 0.4% 1.2% Very Dissatisfied 1.4% 0.1% 0.4% 1.5% 0.9% Client Satisfaction Survey

22 Appendix B: 2012 Survey Responses by Program Participation, Combined Satisfaction Categories Survey Question Percent of Responses by Program AL CCE ADA NHD Average across programs Number of Responses 1. How satisfied are you with how often services are provided? 2. How satisfied are you with the length of the service visits? 3. How satisfied are you with the time of day that services are provided? 4. How satisfied are you with the day(s) of the week services are provided? 5. Overall, how satisfied are you with the quality of the services you have received? 6. How satisfied are you that your worker(s) has (have) the knowledge and skills needed to help you? Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied 92.4% 94.7% 95.4% 95.8% 94.6% 2, % 1.8% 1.8% 0.0% 1.5% % 3.5% 2.8% 4.2% 3.9% % 90.6% 92.4% 93.8% 92.9% 2, % 4.3% 3.2% 0.0% 2.3% % 5.1% 4.4% 6.2% 4.8% % 96.0% 96.2% 98.1% 97.3% 2, % 1.7% 2.1% 0.0% 0.9% % 2.6% 1.7% 3.5% 2.5% % 97.1% 95.9% 97.3% 96.9% 2, % 1.3% 1.9% 0.0% 1.1% % 1.5% 2.2% 2.7% 2.0% % 96.3% 95.8% 97.0% 95.5% 3, % 1.7% 1.9% 0.0% 1.8% % 1.9% 2.3% 3.0% 2.7% % 94.4% 95.7% 95.5% 94.9% 3, % 2.3% 2.1% 0.0% 1.8% % 3.3% 2.1% 4.5% 3.3% Client Satisfaction Survey

23 Survey Question 7. How satisfied are you with the way your worker(s) treat you? 8. How satisfied are you with the way you and your worker(s) communicate? 9. Do(es) your worker(s) usually arrive at the scheduled time? 10. Can you usually expect the same person (people) to come help? 11. Overall, would you say that the services you receive meet your needs? 12. Do these services help you to maintain or improve your quality of life? 13. Do these services help you to stay in your home? (If at an ALF ask: Do these services help you to avoid moving into a nursing home?) Would you say: 14. Overall, how satisfied are you with the services you receive? Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied Percent of Responses by Program AL CCE ADA NHD Average across programs Number of Responses 96.4% 97.8% 98.1% 97.4% 97.4% 3, % 0.8% 1.1% 0.0% 0.8% % 1.3% 0.8% 2.6% 1.8% % 95.5% 97.2% 97.0% 96.5% 3, % 2.6% 1.5% 0.0% 1.4% % 2.0% 1.2% 3.0% 2.1% 55 Yes 93.6% 94.3% 95.6% 98.4% 95.5% 2,797 No 5.1% 4.6% 3.2% 1.2% 3.5% 106 I don't know when to expect them 1.3% 1.1% 1.2% 0.4% 1.0% 33 Yes 79.1% 94.2% 94.9% 99.6% 91.9% 2,776 No 20.9% 5.8% 5.1% 0.4% 8.1% 192 Yes 97.0% 96.6% 96.9% 95.5% 96.5% 3,068 No 3.0% 3.4% 3.1% 4.5% 3.5% 104 Yes 94.7% 97.0% 98.2% 97.7% 96.9% 3,063 No 5.3% 3.0% 1.8% 2.3% 3.1% 85 Yes 95.1% 98.0% 98.5% 99.6% 97.8% 3,057 No 4.9% 2.0% 1.5% 0.4% 2.2% 63 Very Satisfied or Satisfied Dissatisfied or Very Dissatisfied 94.0% 96.7% 96.8% 98.1% 96.4% 2, % 1.8% 1.5% 0.0% 1.6% % 1.5% 1.7% 1.9% 2.0% Client Satisfaction Survey

24 Appendix C: 2012 Client Satisfaction Survey Average percentage of clients of the ADA, AL, CCE, and NHD programs who were Very Satisfied or Satisfied (questions 1-8 and 14) or who answered Yes (questions 9-13). Clients receiving these services were surveyed in SERVICES 1. How satisfied are you with how often services are provided? 95% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 2. How satisfied are you with the length of the service visits? 93% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 3. How satisfied are you with the time of day that services are provided? 97% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 4. How satisfied are you with the day(s) of the week services are provided? 97% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 5. Overall, how satisfied are you with the quality of the services you have received? 96% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied WORKERS Next, I m going to ask you several questions about how satisfied you are with the workers who come to help you. Again, you can answer: Very Satisfied, Satisfied,, Dissatisfied, or Very Dissatisfied. You can also tell me if you really don t know. 6. How satisfied are you that your worker(s) has (have) the knowledge and skills needed to help you? 95% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 7. How satisfied are you with the way your worker(s) treat you? 97% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied 8. How satisfied are you with the way you and your worker(s) communicate? 96% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied Client Satisfaction Survey

25 9. Do(es)your worker(s) usually arrive at the scheduled time? 95% a. Yes b. No c. I don t know when to expect them 10. Can you usually expect the same person (people) to come help? 92% a. Yes b. No c. Don t Know (d. Refused) (e. Not Applicable) SERVICE IMPACT 11. Overall, would you say that the services you receive meet your needs? 97% a. Yes b. to some extent c. No d. Don t Know (e. Refused) (f. Not Applicable) 12. Do these services help you to maintain or improve your quality of life? 97% a. Yes b. to some extent c. No d. Don t Know (e. Refused) (f. Not Applicable) 13. Do these services help you to stay in your home? (If at an ALF ask: Do these services help you to avoid moving into a nursing home?) Would you say: 98% a. Yes b. to some extent c. No d. Don t Know (e. Refused) (f. Not Applicable) 14. Overall, how satisfied are you with the services you receive? 96% a. Very Satisfied b. Satisfied c. d. Dissatisfied e. Very Dissatisfied COMMENTS 15. Is there anything else you would like us to know about the services you receive? Client Satisfaction Survey

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