✨ Governance of CCRC/LifePlan Communit

Confidential resident surveys are an urgent necessity for institutional health and resident protection. A satisfaction loop with documented accountability transforms the facility from a "closed system" into a transparent community. The more serious problems of human living can be addressed openly and not remain unspoken.

Elder mistreatment is rampant anywhere elders live together in community. Empirical data suggests that approximately 10 to 30% of residents experience some form of maltreatment annually, a figure thought to be grossly underestimated. Decades of research indicates a staggering reporting gap: for every single incident reported, an estimated 23 cases remain undocumented.

The absence of standardized, anonymous satisfaction forms effectively strips residents of a safe channel to disclose concerns. Without these formal feedback loops, the "dark figure" of elder abuse—particularly psychological mistreatment, which affects an estimated 33.4% of the institutionalized population—continues to grow unchecked. 

Maura Conry

NaCCRA

Forum Facilitator

I've lived in two different CCRCs (in different states) and have had experience with Resident Satisfaction Surveys in both places. The second of the two brought in a Holleran survey about 10 years ago. The first CCRC used a different national survey firm. Personally I was surprised a survey wasn't done right when our management was outsourced 8 years ago, or when we were sold 4 years ago, or when we merged with a larger organization 2 years ago. Those surveys could have provided "base line" stats to hopefully show comparative improvement when another survey was done down the line.

I also served on a Holleran Focus Group to get resident feedback on a new product they were considering. This group was to meet at a LeadingAge national convention, but COVID intervened, so it had to be done by Zoom. When there was some extra time, I asked a question about resident surveys in general, which I mention below in #3. My question at the time: in an anonymous survey, how are write-in comments presented to management? --- by individual survey or "batched" by subject matter? Answer at the time: the former. More on that below.

From what I've ascertained, these resident satisfaction surveys have followed this formula:

1) Standard, generic statements regarding CCRC life on a numerical scale, a la Strongly Disagree being "1" to Strongly Agree "5." Since these don't vary and have the survey company's "stock" language, an organization's results can numerically be compared against national results.

2) Then, there is a part of the survey with customized subjects that management chose to include in order to "pick up on" participants' opinions about situations/conditions unique to their community or corporation. For example, management may want to ask how people view the merger; or a CCRCs may want to determine how residents view their Portal; or if waiting for meal deliveries is about right, or if new move-in's are given adequate information to help them integrate into the community.

3) Then, space is often provided for a survey participant to provide their own write-in comments. Since our organization recently announced (finally!) a Holleran survey in late April or early May. I'm trying to find out if Holleran changed how they present the write-in comments, as I had asked in the above-mentioned Zoom meeting a few years ago. To me, presenting the write-ins individually can jeopardize anonymity, if that is important to the participant. For example, let's say that one particular apartment resident contends there should be more handicapped parking spaces, and mentions this every chance he gets. If he put that in his survey as a write-in, his survey could easily be identified, even though it is touted as anonymous. The answer I've gotten upon calling Holleran is that "it depends on the contract." Right now our organization's contract hasn't been finalized.

I can't tell you all the times a dinner conversation brought up a subject that someone feels strongly about. Say that someone wishes there were more outings to area museums. I'd say, "Did you write-in your opinion in the resident satisfaction survey?" Answer: "no, I didn't think of it." (Sigh)

I think all-in-all these surveys are better than nothing. Lots of people don't like to speak out in the town hall type of meeting. I'd like to think management pays attention.

Do your satisfactions forms have depth? By that I mean do they include more than the typical food, grounds, activities, housekeeping, etc. concerns?

Some of the newer satisfaction forms used by service industries ask questions like. Were you greeted and made to feel that your needs would be met? Do you know that you can depend on your service providers? Do you feel that you are treated with care and compassion? Have you been treated rudely by anyone? These types of questions go to the deeper issues and address resident's perception of the quality of care they are receiving.

One excuse we get for not allowing satisfaction surveys is that the residents would complain so much that the staff would be overwhelmed. There is more than a whiff of ageism in that.

Maura Conry

NaCCRA

Forum Facilitator

Unfortunately, your situation is a manifestation of the attitudes by which our culture treats older individuals. It's called agism and it plays out in the daily lives of elders in many ways. Agism is so severe that the government recognizes it as one of the major illegal discriminations.

For starts, I'm including resources that may be helpful to your committee. From what I see, you are a high functioning and aware group of people. Keep doing this important work for us all.

1) Book: Disrupting the Status Quo of Senior Living: A Mindshift, by jill Vitale-Aussem. This is excellent and describes strategies that have been helpful to many retirement communities.

2) Conry M 2023 - Ageism: The Last Socially Acceptable Discrimination. This is an overview of the industry and, among other things, addresses the lack of resident satisfaction forms. Satisfaction forms which are used as a business tool in every other service industry, are denied retired seniors. This is an example of ageist attitudes that keep elders voices silent and unheard. It is available on NaCCRA website in the 2023 Lifeline issues.

3) Web: Google Scholar has hundreds of articles on elder treatment in our society for the research inclined.

4) AARP has scores of articles on this also.

The work you are doing is important as things will never change unless we roll up our sleeves and try.

Good luck to you all,

Maura Conry

NaCCRA

Forum Facilitator

My for profit CCRC does an annual resident satisfaction survey. Some questions are consistent year to year, others vary based current conditions. The results are presented to residents in a public meeting conducted by our ED.

Over the years I have been able to record results and track trends (things like satisfaction with F&B). Management uses the survey results to form action plans for staff for the next year. Overall, the process has worked well.

This forum is a great place for getting input...

Our CCRC has done Halloran surveys regularly but shares only sanitized results. So a workgroup of the Planning Committee decided to see about a resident-run survey.

Before we got really started, we stated that if the administration would be more transparent with results (something we asked for in the new CEO) we didn't really need to do our own. The COO shared a tiny bit with only the chair of the planning committee...

Now the work group is reconvening and one member wrote this:

"I think that the horns on whose dilemma we are stuck is that, legally, the residents have no power. We can, through RAEB and Committees, exert a measure of influence. We cannot make the administration fork over the full Halloran data and even if we could mount a properly constituted resident survey we have no basis for asking, let along demanding, that the administration pay any attention to it."

Are we residents (aka stakeholders) really that powerless?

Any thoughts would be helpful. Thanks