Caregiver Qualities and Resident Satisfaction in Long-Term Care: Mediating Roles of Spending Time and Environment

Background: Caregiver interactions and resident interactions are important to resident satisfaction with long-term care (LTC). However, these are variously operationalized, and caregiver -resident interactions of "spending time" (activity and autonomy) and environmental quality are less well investigated modifiable factors to inform LTC resident support policies for health aging. Methods: This quantitative, cross-sectional study analyzed secondary survey data from 326 long-term care facility (LTCF) residents (aged ≥60) across Shanghai, Nanjing, and Changsha, China. Satisfaction was measured using the Chinese version of the Ohio Long-Term Care Resident Satisfaction Survey. Caregiver evaluations served as the primary predictor, with spending time and environment as parallel mediators. Analysis adjusted for age cohort, functional independence, and length of stay. Results: Personal and care service factors explained 26.1% of the variance in satisfaction. Caregiver qualities were positively associated with overall satisfaction (β = 0.30, p < 0.01). Spending time (effect = 0.14, 95% CI: -0.01 to 0.30) and environment quality (effect = 0.05, 95% CI: -0.03 to 0.15) showed small positive pathways between caregiver qualities and satisfaction, and the combined indirect effect of these domains was statistically significant (effect = 0.19, 95% CI: 0.04 to 0.36). It indicates partial mediation, although each specific indirect path was not significant when considered separately. The direct association between caregiver qualities and satisfaction remained significant after accounting for these mediators (effect = 0.36, 95% CI: 0.11 to 0.61). Conclusions: These findings clarify how caregiver interactions are important to resident satisfaction both directly and indirectly through spending time activity engagement and environmental perceptions. To promote longevity and healthy aging in LTCFs, providers should prioritize caregiver training that fosters resident autonomy, supports daily activity, and maintains age-responsive care environments.