The Change in Nursing Home Residents' Preferences Over Time

How Do We Achieve Person-Centered Care across Health Care Settings? Expanding Ideological Perspectives into Practice to Advance Person-Centered Care

Person or patient-centered care (PCC) is touted as the gold standard in geriatric medical care across care settings. However, despite more than 3 decades of research and practice initiatives, it remains a challenge to consistently implement PCC that fully places the individual at the center of care planning and the delivery process. The lack of universal implementation of PCC, we argue, may be in large part due to the use of multiple terms and ideologies leading to an inability to coordinate efforts across medical settings. This article reviews recent ideological PCC movements ("What Matters to You," the Age Friendly Health Systems 4 Ms/5 Ms, "Whole Health," Patient Priorities Care, and Medicare/Medicaid person-centered care initiatives), provides a discussion of how these ideologies are implemented in a nursing home setting through preference-based care and provides implications for coordinated integration of PCC across all care settings now and into the future. We argue for the need to draw on known information and validated methodologies for assessing and implementing PCC to collectively move beyond an ideological representation of the concept into an integrated model of PCC for all older adults receiving care.

Preferences and Quality of Life in Nursing Home Residents: A Mixed Methods Study

PURPOSE

Delivery of person-centered care (PCC) is the standard in nursing homes (NHs) and demonstrates a positive impact on resident quality of life (QOL). PCC inherently recognizes and prioritizes resident preferences; however, preferences, and their degree of importance among residents, demonstrate a variable relationship with QOL that remains underexplored. Therefore, the current study examined the association between preferences and QOL among NH residents.

METHOD

A mixed methods study incorporating surveys was conducted among 144 residents, with semi-structured follow-up interviews with 11 residents.

RESULTS

Findings confirm a variable relationship between resident preferences and QOL. Higher order preferences not captured within the preference assessment may influence QOL. High numbers of unimportant and can't do/no choice preferences were linked to resident acclimatization to the NH. QOL was at risk if care was not consistent with preferences.

CONCLUSION

In-depth assessments and robust measures of preferences and QOL should be integrated into care delivery and future research. [Journal of Gerontological Nursing, 50(5), 7-13.].

Nursing Home Resident Preferences for Daily Care and Activities: A Latent Class Analysis of National Data

BACKGROUND AND OBJECTIVES

Uncovering subgroups of nursing home residents sharing similar preference patterns is useful for developing systematic approaches to person-centered care. This study aimed to (i) identify preference patterns among long-stay residents, and (ii) examine the associations of preference patterns with resident and facility characteristics.

RESEARCH DESIGN AND METHODS

This study was a national cross-sectional analysis of Minimum Data Set assessments in 2016. Using resident-rated importance for 16 preference items in the Preference Assessment Tool as indicators, we conducted latent class analysis to identify preference patterns and examined their associations with resident and facility characteristics.

RESULTS

We identified 4 preference patterns. The high salience group (43.5% of the sample) was the most likely to rate all preferences as important, whereas the low salience group (8.7%) was the least likely. The socially engaged (27.2%) and the socially independent groups (20.6%) featured high importance ratings on social/recreational activities and maintaining privacy/autonomy, respectively. The high salience group reported more favorable physical and sensory function than the other 3 groups and lived in facilities with higher staffing of activity staff. The low salience and socially independent groups reported a higher prevalence of depressive symptoms, whereas the low salience or socially engaged groups reported a higher prevalence of cognitive impairment. Preference patterns also varied by race/ethnicity and gender.

DISCUSSION AND IMPLICATIONS

Our study advanced the understanding of within-individual variations in preferences, and the role of individual and environmental factors in shaping preferences. The findings provided implications for providing person-centered care in NHs.

Creating age-friendly nursing homes: The time is now

The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.

Measuring Nursing Home Quality of Life: Validated Measures Are Poorly Correlated With Proxies From MDS and Quality of Life Deficiency Citationsl

OBJECTIVES

Ensuring quality of life (QoL) is an important goal of person-centered nursing home care. The provision of person-centered care relies on information captured in the Minimum Data Set 3.0 (MDS). It is unclear to what extent MDS items or QoL-related facility deficiency citations correlate with validated measures of nursing home residents' QoL. This study evaluated correlation among MDS items, facility deficiency citations, and residents' QoL from 2 states that currently collect these measures.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 11,487 long-stay residents in 356 facilities in Minnesota and 13,835 long-stay residents in 851 facilities in Ohio in 2015.

METHODS

The outcome, QoL, was measured using validated instruments (Minnesota QoL survey and Ohio Resident Satisfaction Survey). Predictor variables included scores for Preference Assessment Tool (Section F), Patient Health Questionnaire-9 (Section D) for depressive symptoms from MDS, and count of QoL-related facility deficiency citations from the Certification and Survey Provider Enhanced Reporting database. Spearman's ranked test assessed correlation between predictor and outcome variables. Mixed effects models evaluated associations of QoL summary scores with predictor variables, adjusting for resident- and facility-level characteristics, accounting for clustering at the facility level.

RESULTS

In Minnesota and Ohio, predictor variables (Section F and D items, and facility deficiency citations) correlated significantly but poorly with QoL (coefficients ranging from 0.003 to 0.3, P < .001). In the fully adjusted mixed effects model, all predictor variables, demographics, and functional status explained <21% of the total variance in QoL among residents. These findings were consistent in sensitivity analyses stratified by 1-year length of stay and by diagnosis of dementia.

CONCLUSIONS AND IMPLICATIONS

MDS items and facility deficiency citations encapsulate a significant but very small proportion of variance in residents' QoL. This indicates the need to measure QoL directly among residents, to plan person-centered care, and to evaluate its performance in nursing home facilities.

Comparing Resident, Proxy, and Staff Respondents for Nursing Home Residents' Preferences for Everyday Living

To encourage person-centered care, the Centers for Medicare and Medicaid require nursing homes to measure resident preferences using the Preferences Assessment Tool (PAT). No known research has examined the implications of respondent type (i.e., resident, proxy, staff) on preference importance; therefore, the purpose of this study was to compare the importance of preferences depending on which respondent completed the PAT. Participants included 16,111 Veterans discharged to community-based skilled nursing facilities after hospitalization for heart failure. A majority (95%) of residents completed the PAT compared to proxy (3%) and staff (2%). Proxy responders were both more and less likely to indicate individual preferences as important compared to residents. Staff members were consistently less likely to indicate all preferences as important compared to residents. Findings from this study emphasize the need for proxy and staff to find methods to better understand residents' preferences when residents are not able to participate in assessments.

Preference Importance Ratings among African American and White Nursing Home Residents

OBJECTIVES

The Preferences for Everyday Living Inventory (PELI-NH) assesses psychosocial preferences of nursing home (NH) residents. This study explored the association of race with importance ratings of self-dominion preferences (i.e., preferences for control).

METHODS

PELI-NH interviews were conducted with 250 NH residents. Tests of mean differences compared African American (n = 57) and White (n = 193) residents on demographic (age, gender, education, length of stay) and clinical attributes (self-rated health, depressive symptoms, anxiety, functional limitations, hearing, vision, cognition). Stepwise multiple regression accounted first for associations of demographic and clinical attributes then for the unique association of race with total importance of self-dominion preferences to determine whether African American and White residents differ. For between group demographic/clinical differences, interaction effects were tested.

RESULTS

African Americans were younger and more functionally impaired. After accounting for the effects of gender (female), age (younger), anxiety (greater), and functional impairment (less) with higher reports of importance of self-dominion preferences, race was significant. There were no significant moderating effects.

CONCLUSIONS

African American residents reported greater importance of self-dominion preferences than Whites.

CLINICAL IMPLICATIONS

Cultural sensitivity is critical; it may be more important to provide opportunities for autonomous decision-making for African American than for White residents.

A systematic review to identify the use of stated preference research in the field of older adult care

In the design of long-term care systems, preferences can serve as an essential indication to better tailor services to the needs, wishes and expectations of its consumers. The aim of this systematic review was to summarize and synthesize available evidence on long-term care preferences that have been elicited by quantitative stated-preference methods. The databases PubMed and Web of Science were searched for the period 2000 to 2020 with an extensive set of search terms. Two independent researchers judged the eligibility of studies. The final number of included studies was 66, conducted in 19 different countries. Studies were systematized according to their content focus as well as the survey method used. Irrespective of the heterogeneity of studies with respect to research focus, study population, sample size and study design, some consistent findings emerged. When presented with a set of long-term care options, the majority of study participants preferred to "age in place" and make use of informal or home-based care. With increasing severity of physical and cognitive impairments, preferences shifted toward the exclusive use of formal care. Next to the severity of care needs, the influence on preferences of a range of other independent variables such as income, family status and education were tested; however, none showed consistent effects across all studies. The inclusion of choice-based elicitation techniques provides an impression of how studies operationalized long-term care and measured preferences. Future research should investigate how preferences might change over time and generations as well as people's willingness and realistic capabilities of providing care.

What information about choosing a nursing home is available on YouTube?

This study aimed to identify YouTube videos focused on choosing a nursing home. The contents of the videos were analyzed using 19 items from the guidelines proposed by the Donabedian model. An analysis of 57 videos showed that informal presentations for format (54.39%), laypersons for speaker (36.84%), and personal channel for uploader (61.40%) exhibited the highest frequency. According to the analysis of video content, most videos included the environment (49.12%), programs (38.63%), and cost (35.09%). However, fewer videos focused on care protocols (5.26%), participation (5.26%) and health outcomes (5.26%). More informal presentations, laypersons, and personal channels than health providers, professional groups, and mass media were included in videos focused on choosing nursing homes. It is necessary to provide information regarding the philosophy, care, and health outcomes of residents in addition to the information regarding environment and cost provided by reliable suppliers, such as health professionals, the government, and mass media.

Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review

OBJECTIVE

This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).

METHODS

The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs.

RESULTS

Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment.

CONCLUSION

A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs.

PRACTICE IMPLICATIONS

A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals.

Applying Agile Methodology to Reengineer the Delivery of Person-Centered Care in a Nursing Home: A Case Study

Nursing home (NH) providers would benefit from adopting evidence-based measures for gathering and utilizing resident preference information in their daily care activities. However, providers face barriers when implementing assessment tools used to promote person-centered care (PCC). Although Agile methodology is not commonly used in NH settings, this case study shows how it can be used to achieve the goal of delivering preference-based, PCC, within a large NH. We present a road map for breaking down care processes, prioritizing, and implementing iterative plan, do, study, act cycles using Agile methodology to enhance group collaboration on quality improvement cycles, to achieve our goal of providing preference-based PCC. We first determined if care plans reflected each resident's important preferences, developed a method for tracking whether residents attended activities that matched their preferences, and determined if residents were satisfied that their preferences were being met. These efforts had positive effects throughout the NH particularly when COVID-19 limited visitors and significantly modified staff workflow. Specifically, Agile processes helped staff to know how to honor preferences during quarantines which necessitated a shift to individualized (and not group) approaches for meeting preferences for social contact, comfort, and belonging. The ready availability of preference-based reporting was critical to quickly informing new staff on how to meet residents' most important preferences. Based on lessons learned, we describe a developmental approach that other providers can consider for adoption. Implications of this work are discussed in terms of the need for provider training in Agile methodologies to support iterative improvements, the need for policies that reimburse providers for their efforts, and additional research around workflow processes.

Wishes and Needs of Nursing Home Residents: A Scoping Review

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where person-centered care is implemented, residents report greater satisfaction and quality of life. This approach is based on the wishes and needs of the residents. Therefore, the purpose of this scoping review is to explore the wishes and needs of nursing home residents. A scoping review of the literature was conducted in which 12 databases were systematically searched for relevant articles according to PRISMA-ScR guidelines. Both quantitative and qualitative study designs were considered. A total of 51 articles met the inclusion criteria. Included articles were subjected to thematic analysis and synthesis to categorize findings into themes. The analysis identified 12 themes to which the wishes and needs were assigned: (1) Activities, leisure, and daily routine; (2) Autonomy, independence, choice, and control; (3) Death, dying, and end-of-life; (4) Economics; (5) Environment, structural conditions, meals, and food; (6) Health condition; (7) Medication, care, treatment, and hygiene; (8) Peer relationship, company, and social contact; (9) Privacy; (10) Psychological and emotional aspects, security, and safety; (11) Religion, spirituality; and (12) Sexuality. Nursing home residents are not a homogeneous group. Accordingly, a wide range of needs and wishes are reported in the literature, assigned to various topics. This underscores the need for tailored and person-centered approaches to ensure long-term well-being and quality of life in the nursing home care setting.

The Stability of Nursing Home Residents' Ratings of Importance of Recreation Preferences Over One Year

Long-term stability of nursing home (NH) residents' everyday preference remains unknown. We examined 1-year stability in reports of importance of 34-recreational activity preferences (8-MDS 3.0 Section F items; 26-Preferences for Everyday Living Inventory-NH items) by NH residents (N = 161). We examined mean differences on demographic and clinical characteristics of residents for preferences showing change. Importance ratings of preferences were highly stable over 1-year, with 91% of items retaining the same valence of importance for the majority of the sample (<20% change). Three preferences showed greater change. More functionally able residents were more likely to change their importance on "being with groups of people," and older residents were more likely to change their preferences for being "involved in religious practices" and "around animals such as pets". Overall, annual assessments of recreational activity preferences capture an accurate representation of preferences with reassessment only needed in a few circumstances.

Evaluating the Implementation of a Pragmatic Person-Centered Communication Tool for the Nursing Home Setting: PAL Cards

OBJECTIVES

The purpose of this quality improvement project was to evaluate the implementation of a person-centered communication tool in nursing homes (NH). The Preferences for Activity and Leisure (PAL) Cards were developed to communicate residents' preferences for activities across care team members.

METHODS

Providers were recruited to assess resident important preferences and create PAL Cards for 15-20 residents and collected data aligned with the RE-AIM framework.

RESULTS

Reach and Adoption: A total of 43 providers registered and 26 (60%) providers completed the project. Effectiveness and Implementation: Participants attempted 424 PAL Cards and completed 406. For the 26 providers, the average acceptability of the intervention measure was 4.7 (SD 0.4), intervention appropriateness measure was 4.5 (SD 0.5), and feasibility of intervention measure was 4.6 (SD 0.5) (all out of 5). Maintenance: Providers were able to complete 82% of PAL Card placement over the course of 5 months.

CONCLUSIONS

The majority of providers were successful in implementing PAL Cards for residents and reported the intervention as highly acceptable, appropriate, and feasible providing necessary data to inform future effectiveness trials.

CLINICAL IMPLICATIONS

The intervention can assist nursing home providers in meeting PCC regulations and contribute to building relationships between residents, family, and staff.

Predictors of change over time in satisfaction with outdoor activities ratings among long-term care services and supports recipients

OBJECTIVES

To identify predictors of change in older adults' satisfaction with outdoor activities ratings over the first two years of enrollment in long-term services and supports (LTSS).

METHODS

Self-rated satisfaction with outdoor activities (not at all satisfied to extremely satisfied) was the primary outcome of this secondary data analysis. Mixed-effects linear regression modeling with a backward elimination process was used for analyses.

RESULTS

In the final model (N = 453) older LTSS recipients at baseline had lower ratings of satisfaction with outdoor activities over time, whereas younger recipients had higher ratings over time. Those who moved into a residential facility at baseline had an increase in outdoor activity satisfaction ratings over time compared to older adults who received home and community-based services that had a decrease.

DISCUSSION

LTSS clinicians can use these findings to support older adults with decision-making around enrollment into LTSS, address preferences, and develop person-centered care interventions for outdoor activity.

Assessing Social Functioning During COVID-19 and Beyond: Tools and Considerations for Nursing Home Staff

Social functioning is defined as how a person operates in their unique social environment (ie, engagement in activities, connectedness with others, and contributions to social roles). Healthy social functioning is important for nursing home residents as they are at increased risk for loneliness and isolation. Social functioning has long been an underacknowledged aspect of nursing home residents' health, but now, with the COVID-19 pandemic, residents' risk for decreased social functioning is increased. Several reliable and well-validated tools are available to supplement routine care planning and delivery and track and improve changes in social functioning over time. The overarching aim of this article is to provide resources and recommendations for interdisciplinary team assessment related to social functioning for nursing home residents. We describe 2 domains of social functioning measures, care-planning measures and outcome measures, and provide recommendations for how to integrate said measures into practice. Healthy social functioning is needed to maintain nursing home residents' well-being and quality of life. Measures and recommendations outlined in this article can be used by nursing home staff to understand residents' social preferences and address social functioning during COVID-19 and beyond.

Longitudinal differences in everyday preferences: Comparisons between people with cognitive impairment and their care partners

OBJECTIVES

Persons with progressive cognitive impairment (CI) increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about changes in everyday preferences over time or about concordance between persons with CI and their care partners regarding longitudinal changes.

METHODS

The sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥0.5) and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI at baseline and follow-up (mean 486 days). Care partners separately completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners.

RESULTS

There were significant gender differences regarding importance ratings of "autonomous choice" and "social engagement" preferences over time: women with CI rated these preferences as more important across time as a whole. Higher levels of neuropsychiatric symptoms were associated with less importance of "social engagement" preferences across time as a whole for persons with CI and a more negative discrepancy between persons with CI and care partner proxy assessments as time went on.

CONCLUSION

This study yields new insights into predictors of longitudinal change in everyday preferences among persons with CI and their care partners. Although preferences were largely stable over time, there is increasing support for the relationship between differences in "social engagement" preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment.

What defines quality of care for older people in aged care? A comprehensive literature review

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765-778.

Lessons Learned From Ohio's Statewide Implementation of the Preferences for Everyday Living Inventory as a Pay for Performance Initiative to Enhance Person-Centered Care

Person-centered care (PCC) in nursing homes is an elusive organizational goal that has attracted the attention of pay-for-performance (P4P) programs. P4P programs are used to incentivize providers to improve the quality of care delivered. However, P4P programs have both overarching policy initiatives (big "P") that must incorporate an implementation framework that is adaptable in practice (little "p"). The purpose of this paper is to apply six key factors that are central to P4P design in long-term care settings: financial incentives, measurement, stakeholder involvement and alignment, feasibility, education and awareness, and reporting and transparency as a framework for a case study of a P4P initiative conducted in Ohio between 2015 and 2019. Notably, the case study is focused on PCC and how the Ohio Department of Medicaid selected the Preferences for Everyday Living Inventory (PELI) for nursing home providers to use with all of their residents. Although inclusion of the PELI met some of the key factors, such as measurement, its implementation did not meet other key factors, such as reporting and transparency. Based on lessons learned from the Ohio P4P, recommendations are presented for use of the PELI as both a process and outcome measure in future P4P initiatives.

A Study of the Factors Influencing the Residential Preferences of the Elderly in China

The global aging problem has a serious impact on the sustainable development of society. China has become the country with the largest aging population in the world, 1.75 times that of the EU and 3.01 times that of the United States. Therefore, the question of how to develop elderly care services and institutions in China is critical. Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this paper details the residential preferences of the elderly, and uses a multinomial logistic regression model to analyze the influence of education level, health status, and income level on the residential preferences of the elderly in China. The results of the study are as follows: (1) From a spatial point of view, the residential preference of “living together” gradually increases from the northeast to the southwest. As for the choice of “nursing home”, northerners prefer to live in nursing homes more than southerners, especially in the northeast. (2) There are many personal factors that significantly affect housing preferences, such as education level, health status, income level, etc. (3) The development of socialized elderly care institutions should fully consider the preferences of the elderly. There are big differences in residential preferences in different regions and different cities, so the development of elderly care services should be adapted to local conditions.

Self-Reported Satisfaction of Older Adult Residents in Nursing Homes: Development of a Conceptual Framework

BACKGROUND AND OBJECTIVES

Resident satisfaction is an integral part of nursing home (NH) quality of care. However, there is no uniform categorization framework to classify self-reported satisfaction of older adult residents in NHs. This scoping review systematically investigated the studies reporting data on older residents' satisfaction to evaluate the quality of NH service and to create a conceptual model for older residents' satisfaction.

RESEARCH DESIGN AND METHODS

We used Donabedian's structure-process-outcome model as a theoretical framework. In three electronic databases (PubMed, Scopus, and CINAHL), potential studies were searched using specific inclusion criteria identifying original studies that investigated older adult residents' satisfaction in NHs.

RESULTS

Fifteen studies, including 264,133 residents and 15,577 NHs, were selected for this review. Although a wide variety of resident satisfaction measures were used in the included studies, all these indicators reflect five primary domains: Psychological, Clinical, Social, Environmental, and Spiritual, with the common focus of improving the quality of life of residents. Though technical competence is a fundamental aspect of healthcare service, we found autonomy, environment, meaningful activities, and interpersonal quality of professionals as the most important predictors for the resident's satisfaction.

DISCUSSION AND IMPLICATIONS

The current review has synthesized a broad range of satisfaction measures, which will help future researchers and policymakers provide guidance for further improvement of NH care services and as a heuristic device to spur research. Future research is needed to apply this conceptual framework for comparisons of self-reported resident satisfaction in other institutional settings across countries.

Präferenzen von Menschen mit Pflegebedarf

Hintergrund

Die Beachtung von Präferenzen des alltäglichen Lebens wird in der pflegerischen Versorgung mit einer Vielzahl von positiven Versorgungsergebnissen assoziiert. Derzeit ist unbekannt, ob in bundesdeutschen Pflegeeinrichtungen Präferenzen von Menschen mit Pflegebedarf systematisch erhoben werden, und inwiefern diese in der Pflegedokumentation auffindbar sind.

Ziel

Das Ziel der Studie bestand darin zu untersuchen, welche und wie viele Präferenzen von Menschen mit Pflegebedarf in der Pflegedokumentation in verschiedenen pflegerischen Settings dokumentiert werden.

Methode

Eine explorative Analyse von Pflegedokumentationen (n = 24) wurde in 4 Settings der pflegerischen Versorgung durchgeführt. Die erhobenen Daten wurden inhaltsanalytisch induktiv sowie quantitativ ausgewertet.

Ergebnis

Es konnten 20 verschiedene Präferenzen identifiziert werden, die sich 5 Oberkategorien zuordnen ließen. Die Analyse zeigte in allen einbezogenen Settings, dass am häufigsten Präferenzen zu den Themen Pflege und Alltag in der Pflegedokumentation dokumentiert waren.

Schlussfolgerung

Die Verschriftlichung von Präferenzen in der Pflegedokumentation ist in allen Settings unsystematisch, zugleich wird die Beachtung von Präferenzen des alltäglichen Lebens als relevant für die Pflege erachtet. Hier bietet die Verwendung eines Instruments zur systematischen Erfassung von Präferenzen die Möglichkeiten, einerseits die Sensibilisierung für dieses Thema zu stärken und andererseits die Zufriedenheit der Menschen mit Pflegebedarf zu steigern.

Unmet and Unimportant Preferences Among Nursing Home Residents: What Are Key Resident and Facility Factors?

OBJECTIVES

The Preferences Assessment Tool (PAT) in the Minimum Data Set (MDS) 3.0 assesses 16 resident preferences for daily routines and activities. Although integrating important preferences into care planning is essential to provide person-centered care in nursing homes (NHs), preferences rated as important but unmet or unimportant may not receive much attention. This study aims to (1) identify the prevalence of unmet preferences and unimportant preferences, and (2) examine their associations with resident and facility-level characteristics.

DESIGN

This is a longitudinal study of residents in NHs.

SETTINGS AND PARTICIPANTS

We used data from 2012-2017 MDS assessments of long-stay residents aged 65 or older in 295 Minnesota NHs. In total, 51,859 assessments from 25,668 residents were included.

METHODS

Generalized linear mixed models were used to analyze resident and facility-level characteristics associated with having any unmet preferences, and with the number of unimportant preferences.

RESULTS

Across all years for both daily routine preferences and activity preferences, 3.3% to 5.1% of residents reported that at least 1 or more preference was important but unmet, and 10.0% to 16.6% reported that 4 or more out of the 8 preferences were unimportant. Residents with higher depressive symptoms, and poorer physical and sensory function were more likely to report unmet preferences. Residents with poorer physical and sensory function, and living in rural facilities and facilities having fewer activity staff hours per resident day were more likely to report unimportant preferences.

CONCLUSIONS AND IMPLICATIONS

Residents with functional and sensory limitations and living in underresourced NHs are more likely to report that preferences are unimportant, or that they are important but unmet. It is important for staff to elicit preferences that truly matter for residents, and to enable residents to meet their preferences.

The impact of nursing home residents' characteristics on ratings of importance of autonomy preferences in daily care over time

Objective: Nursing home (NH) residents' preferences for everyday living are the foundation for delivering individualized care. Yet, work has not examined the impact of demographic and clinical characteristics of NH residents on the stability of their preferences over time.Method: This study examined the rate of change in reports of importance of 27 autonomy-related everyday preferences from the Preferences for Everyday Living Inventory over 3-months and the demographic and clinical characteristics associated with change for nursing home residents (N = 255). Descriptive frequencies and tests of mean difference were utilized to examine differences between individuals reporting change in importance over time compared to those that did not report change.Results: Autonomy preferences in daily care remained stable over 3-months for the majority of residents. For residents that did report change on autonomy preferences, no systematic associations of demographic or clinical characteristics were found to be associated with change. Rather, change was associated with differential characteristics based on the preference.Conclusion: This study indicates that knowing a person's demographic or clinical characteristics in care will not uniformly inform a caretaker's understanding of the individual's reports of importance for autonomy related preferences over time. Future work should explore the role of care environment on change in preference ratings over time.

Preference Consistency: Veteran and Non-Veteran Nursing Home Resident Self-Reported Preferences for Everyday Living

Understanding patient preferences is core to person-centered care. The consistency of everyday preference reporting was assessed comparing responses of Veteran (VA) and non-VA nursing home (NH) residents on the Preferences for Everyday Living Inventory (PELI) at baseline and 5 to 7 days later. Non-VA NH residents demonstrated higher perfect agreement than VA residents (66% vs. 56%, respectively) and higher acceptable agreement (95% vs. 88%, respectively). Multiple regression analyses examined significant predictors of reliability using demographics, cognitive functional variables, and interviewer ratings. In the VA group, higher perfect agreement was associated with residents who were less likely to have hearing deficits, better cognition, and better interviewer ratings related to energy, attention, and comprehension. In the non-VA group, higher perfect agreement was associated with residents who were younger and more independent with walking. Overall, higher agreement was associated with being female, non-VA, and having better cognition. Implications for future research and clinical practice are highlighted. [Journal of Gerontological Nursing, 46(3), 15-25.].

Exploring Patterns in Preferences for Daily Care and Activities Among Nursing Home Residents

Nursing homes have shifted from task-focused to person-centered care (PCC) environments. Understanding resident preferences for daily care and activities is fundamental to PCC. Examining resident similarities based on preferences may be useful for group or community-wide PCC planning. The aims of the current study were to group residents according to similarities in preferences and determine the factors that predict membership in these groups. A latent class analysis of resident preferences using data from the Minimum Data Set (N = 244,718) was conducted. Resident function, depression, cognitive impairment, and sociodemographics were used as predictors of class membership. The four-class model showed residents cluster around overall interest or disinterest in having choices about daily care and activities or specific interest in either care or activity preferences. Race and ethnicity, cognitive impairment, and depression predicted class membership. Findings suggest that residents can be grouped by preferences and knowledge of resident group membership could help direct efforts to systematically meet resident preferences. [Journal of Gerontological Nursing, 45(8), 7-13.].

"A Bone of Contention…": Perceived Barriers and Situational Dependencies to Food Preferences of Nursing Home Residents

This study investigated barriers to fulfilling food preferences from nursing home (NH) residents' perspectives, and the reasons preferences changed (situational dependencies). Interviews were completed with 255 residents in 28 NHs across greater Philadelphia, PA using six food items from the Preferences for Everyday Living Inventory-NH (PELI-NH). Participants were predominantly white (77%), female (67.8%), and widowed (44%) with high school educations (48%). Content analysis was used to identify n = 386 barriers and n = 57 situational dependencies. Participants reported provider policies and staff proficiency as environmental barriers to preference fulfillment regarding what, when, and where to eat. Perceived health and personal resources were barriers to obtaining snacks, take-out, and dining out. Situational dependencies resulted from residents' perceived health and quality of family relationships. Results have implications for providers to centralize food preference fulfillment in care planning, and to use food preferences to address dining quality concerns.