FlexCare Quality of Life Evaluation

Executive Summary

  • This study attempted to measure perceptions of quality of life issues of Medicaid recipients and their families who chose to affiliate with a new Medicaid long-term demonstration project called FlexCare.
  • FlexCare individualizes the care plan of each program participant in order to assist them to live in the least-restrictive setting and maintain as much independence as possible.
  • This study evaluated quality of life issues of 42 program participants, 31 designated family members/friends and 36 primary providers of care.
  • All participants in this study were being assisted by FlexCare and had transitioned from nursing homes to assisted living centers.
  • All participants were interviewed while they were living in nursing homes and then after they had enrolled in FlexCare and had lived in the assisted living centers for four months. Family members/friends were asked to respond to mailed pre and post questionnaires, while providers were asked to respond to only a post questionnaire.
  • This study utilizes the Assisted Living Facility—Quality of Life/Quality of Care Index (ALF-QoL/QoC) instrument, which attempts to measure 14 domains of perceived quality of life issues for participants and 12 domains for family members/friends and providers.
  • Participants scored significantly higher in the following seven domains after joining FlexCare and moving from a nursing home to an assisted living center.
    • Importance of environment
    • Satisfaction with the environment
    • Satisfaction with staff and care
    • Satisfaction with activities and social relations
    • Satisfaction with choice
    • Satisfaction with facility
    • Improved life satisfaction
  • Participants rated several single-item factors as very important to their quality of life. The top three single-item factors were “ability to care for self,” “physical health,” and “feelings about self.”
  • Participants seemed to have improved perceptions of quality of life issues after moving from a nursing home to an assisted living center with the support of individualized FlexCare case management.
  • Family members/friends reported they were more involved in the help and support of participants while the latter lived in the nursing home. Family members/friends reported significantly fewer visits to participants in assisted living centers as compared to nursing homes, but numbers of phone calls increased.
  • Family members/friends scored significantly higher in the following five domains after joining FlexCare and having the participant move from a nursing home to an assisted living center.
    • Satisfaction with the environment
    • Satisfaction with staff and care
    • Satisfaction with activities and social relations
    • Satisfaction with choice
    • Satisfaction with facility
  • Family members/friends rated several single-item factors as very important to the participants’ quality of life. The top four single-item factors were “mental health,” “feelings about self,” “physical health,” and “being treated as a person.”
  • Providers were only asked to rate selected domains of the participants one time; therefore, no pre and post comparisons could be made. The providers indicated that participants had:
    • Few drug/alcohol problems
    • High cognitive patterns
    • Good communication skills
    • Positive mood patterns
    • Positive behavior patterns
    • Little depression
    • Good general quality of life and functional status.
  • In rating the top single-item factors, the providers judged as very important these quality of life issues for the participants: “ability to care for self,” “mental health,” “family/friends,” and “ability to make own decisions.”
  • The FlexCare placement process seems to have been successful in moving appropriate participants from nursing homes to assisted living centers.
  • In addition to measuring participant, family member/friend, and provider perceptions of quality of life issues, the study included a program satisfaction questionnaire. The responses of 24 participants were matched with those of their family members/friends and providers. Even though the N was small, the concordance between the three groups gives a strong sense of validity.
  • The findings from the three group comparisons indicated that in all areas of program satisfaction there was a pronounced positive trend. The individualized FlexCare case management and the new living arrangements in assisted living seemed to improve the quality of life of the participants. All three groups believed that FlexCare was meeting its goals.
  • Areas that the three groups suggested for improvement in FlexCare were better communication, better problem solving, and more consumer information about the program.
  • While this study is exploratory in nature and is limited to only four months, it demonstrates that quality of life issues can be addressed and that changes in these issues can be measured.
  • Investigations such as this hold promise as our society struggles to provide quality care for increasing numbers of elderly people.