Myths, legends, proverbs, and folklore—each nation, community, and profession uses them to dress up its history, filter reality, and color facts. Whether benign or malignant, they permeate all aspects of modern health care, nowhere more so than in long term care and nowhere as negatively as in nursing facility care.
Along with the prevalence of stories about the long term care profession, there is also an astounding amount of data. It is with the intent of discovering the true narrative of nursing facilities today that the team at My InnerView has developed the “2010-2011 National Survey of Consumer and Workforce Satisfaction for Nursing Facilities” (National Report).
This rapidly expanding repository of data offers ample evidence that complements both legend and practical wisdom to better understand the long term care industry and the insight to be gained from the voice of its customers and employees.
While our analyses have led to several discoveries and more than a few surprises, we will focus on only a couple of interesting points in this brief article, highlighting what the data tell us about some of the most important, and often most misunderstood, parts of the story—the perceptions of residents, their families, and employees from approximately 5,500 nursing facilities. The full National Report contains a more in-depth and comprehensive compilation of information about the voice of residents, families, and caregivers, as well as data-driven insights about the long term care profession. 

Residents, Families Rate Nursing Facilities Favorably 

One fact about nursing facilities is indisputable and has been reaffirmed year after year by a variety of sources: Residents and families hold their nursing facilities in high regard.
The My InnerView national data repository includes resident and family feedback on 22 areas of experience across three broad categories, including quality of life (safety, privacy, dignity, choice, and other aspects of well-being), quality of care (staff and care practices in regard to adequacy, competence, and a caring attitude), and quality of services (meals, laundry, maintenance, and more).
The responses pose a direct challenge to a negative popular belief about nursing facilities. Four out of five families and an even greater proportion of residents rate their nursing facilities as “Good” or “Excellent” (see Chart 1). Similarly, in overwhelming numbers, both families and residents say they would recommend their nursing facility to others as an “Excellent” place to receive care (see Chart 1).

And for the most part, this high praise remains consistent throughout the resident’s stay (see Chart 2).

Such soaring accolades, so out of step with popular preconceptions, have engendered doubts at times. The message of the customer has often been sidelined by skeptics as uninformed or compromised. But skepticism loses its credibility when faced with the power of simple evidence. 
First, it is unconscionable to question the authenticity of nearly 150,000 families and almost 100,000 residents who voluntarily responded to the survey, answered it privately, and were promised confidentiality by an independent third party conducting the survey.
Second, responding families were far from being uninformed and unengaged; two out of three had visited multiple nursing facilities before choosing one for their relative and, after placement, four out of five families visit their relative at least weekly. We also can gain insights from the data about what drives satisfaction, which further reinforces the importance of looking to information rather than anecdotes. For both families and residents, the top two factors that influence the likelihood to recommend a facility are the competency of staff and the care (concern) of staff. Clearly, employees are another key piece of the puzzle to better understand the true picture of the nursing facility profession. 

Commitment Of Caregivers

Unfortunately, a Google search on nursing home quality will result in references to more negative information than positive. Directly and by implication, nursing facility staffs are routinely depicted in all-too-familiar negative stereotypes—detached, apathetic, uncaring, and abusive. But the question remains, what evidence supports the common belief that nursing facility staffs provide unloving care?
Popular opinion may give these caregivers a bad reputation, but evidence supports that beneficiaries of their care have a considerably different view. In rating 22 areas of experience on a Poor to Excellent scale, residents and families score caregivers with much higher than a passing grade across the board.
Families and residents agree on two of the strongest areas of performance among nursing facility staffs: the respect that they demonstrate and the quality of care provided, specifically by registered nurses (RNs) and licensed practical nurses (LPNs) (see Chart 3).

These caregivers also have a higher level of overall job satisfaction and a greater opinion of their employers, both as a place to work and as a place to receive care, than uninformed observers might imagine (see Chart 4). For both certified nurse assistants (CNAs) and RNs, the attentiveness and concern (care) of management rank as the top two drivers that affect the likelihood to recommend the facility as a place to work. As an indication of the value that nurses and CNAs place in their work and their commitment to residents, 85% of RNs and 86% of CNAs rate the sense of accomplishment associated with their jobs as Good or Excellent.

This data point, especially partnered with families’ and residents’ rating of the care (or concern) of the staff (88% and 89%, respectively, for combined Excellent and Good scores), debunks the myth that nursing facility staffs are detached from the importance of their role and from the residents and other customers that they interact with on a daily basis. 


The consumer age has demystified the sacred, the mysterious, and the forbidden in religion, politics, and professions. All of us cling to some beliefs and practices and often resist testing them against evidence. But as data become more available and more accessible, rationality challenges dogma and questions the authority of tradition. We may be inching toward a data-driven, evidence-based approach to life.
Respect for facts, pursuit of evidence, and grounding practice on proven protocols—this is the heart of the evidence-based approach. By listening to caregivers, it is possible to tune in to the perspectives of the communities at the heart of long term care and better inform decisions for organizational success.
By listening to our customers, we understand their messages and formulate proper responses that will put us on a definite road to evidence-based excellence.
This article was written by Vivian Tellis-Nayak and Christine Lang of My InnerView (, a division of National Research Corp. and an applied research company that promotes evidence-based management practices in U.S. senior care organizations.