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Talmage AA, Heid AR, Kinney JM, Van Haitsma K, Abbott KM. Sustainability of the Preferences for Everyday Living Inventory Use in Ohio Nursing Homes Over Time. J Am Med Dir Assoc 2024; 25:105224. [PMID: 39163988 DOI: 10.1016/j.jamda.2024.105224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVES In 2015, the Ohio Department of Medicaid incentivized use of the Preferences for Everyday Living Inventory (PELI) as a quality initiative. The pay-for-performance (P4P) program, however, was then deimplemented in 2019. This study investigated the sustainability of use of the PELI in Ohio nursing homes (NHs) from 2017 to 2021 and examined barriers to PELI implementation. DESIGN This study analyzed 2 waves of Ohio Biennial Survey of Long-Term Care Facilities data. SETTING AND PARTICIPANTS Data were drawn from 433 NHs in Ohio that reported on PELI implementation efforts between 2017 and 2021. METHODS This study examined the change in proportion of NHs implementing the PELI (ie, conducted for all residents, used in care planning) and change in proportion of NHs using different PELI assessment formats (ie, the full 72-item PELI, MDS 3.0 Section F items only). Frequencies of reported barriers to PELI implementation by NH administrators were tabulated. RESULTS Results indicate that although use of the full 72-item PELI decreased over time, only a small percentage discontinued its use despite possible impacts of P4P changes in 2019 and challenges posed by the COVID-19 pandemic. NHs adapted their PELI assessment formats likely in response to perceived barriers of PELI use (ie, length of the full PELI, time constraints, and residents' level of cognitive impairment). CONCLUSIONS AND IMPLICATIONS Findings suggest that Ohio NHs sustained PELI implementation over time in the context of large systemic changes in P4P financial incentives and COVID-19 safeguards. Barriers were reported at the organizational level, yet NHs continued to prioritize PCC with the PELI. Policy/P4P mandates may serve as effective implementation incentives that encourage sustainability of quality care practices. Future research should explore long-term sustainability and stakeholder perspectives on PELI utilization.
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Affiliation(s)
- Alexis A Talmage
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | | | - Jennifer M Kinney
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, Program for Person Centered Living Systems of Care, The Pennsylvania State University, University Park, PA, USA; The Polisher Research Institute at Abramson Senior Care, Blue Bell, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA.
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Deprez L, Van Durme T, Bruyère O, Adam S. The Impact of Nursing Home Culture Change: An Integrative Review. J Am Med Dir Assoc 2024; 25:105172. [PMID: 39079679 DOI: 10.1016/j.jamda.2024.105172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES The Nursing Home Culture Change (NHCC) movement promotes a person- and relationship-centered approach and a small-scale, homelike model for NHs. The present study aimed to integrate the most recent empirical findings regarding the impact of NHCC on resident, staff, family, and organizational outcomes. DESIGN Integrative review. SETTING AND PARTICIPANTS Not applicable. METHODS OVID MEDLINE, PsycINFO, Embase, and CINAHL databases were searched for quantitative or mixed studies published in English between 2018 and 2022 and examining the effect of NHCC on resident, staff, family, and/or organizational outcomes. A narrative and tabular synthesis of the results is provided. RESULTS A total of 1687 references were identified. Following duplicate removal, title and abstract screening, and full-text screening, 75 studies were retained for synthesis and suggest a positive impact of NHCC on resident (eg, quality of life and neuropsychiatric function), staff (eg, job satisfaction and stress), family (eg, satisfaction and depressive symptoms), and organizational (eg, NH attractiveness and occupancy rate) outcomes. CONCLUSIONS AND IMPLICATIONS NHCC shows promising results in all studied outcome categories. Future research should further investigate obstacles to NHCC implementation, conduct cost-benefit analyses supported by appropriate statistical tests, and define ways to improve NH staff education as well as NH policies and regulations to better support NHCC initiatives.
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Affiliation(s)
- Laura Deprez
- Psychology of Aging Unit, Department of Psychology, University of Liège, Liège, Belgium.
| | - Thérèse Van Durme
- Faculty of Public Health, Institute of Health and Society, Catholic University of Louvain, Brussels, Belgium
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Aging, University of Liège, Liege, Belgium
| | - Stéphane Adam
- Psychology of Aging Unit, Department of Psychology, University of Liège, Liège, Belgium
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Kunkel MC, Bowblis JR, Straker J, Van Haitsma K, Abbott KM. Can Implementing Person-Centered Care Tools Reduce Complaints? Evidence from the Implementation of PELI in Ohio Nursing Homes. J Aging Soc Policy 2024; 36:141-155. [PMID: 37796766 DOI: 10.1080/08959420.2023.2265775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 10/07/2023]
Abstract
Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P < .05) and any substantiated complaints by 11.5% points (P < .001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
- Department of Economics, Miami University Farmer School of Business, Oxford, OH, USA
| | - Jane Straker
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, PA, USA
- The Polisher Research Institute at Abramson Senior Care, Blue Bell, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
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Kunkel MC, Bowblis JR, Straker JK, Van Haitsma K, Abbott KM. Exploring the Relationship Between Extent of Person-Centered Care Implementation and Staffing Levels in Ohio Nursing Homes. J Appl Gerontol 2023; 42:2189-2197. [PMID: 37338331 DOI: 10.1177/07334648231185274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Background: The Preferences for Everyday Living Inventory (PELI) is a person-centered care (PCC) tool that uncovers/honors older adults' important preferences. PCC implementation in nursing homes (NHs) often requires additional resources, such as staff time. We explored if PELI implementation is associated with NH staffing levels. Methods: Using NH-year as the unit of observation (n = 1307), 2015 and 2017 data from Ohio NHs was used to examine the relationship between complete versus partial PELI implementation and staffing levels, measured in hours per resident day, for various positions and total nursing staff. Results: Complete PELI implementation was associated with higher nursing staff levels in both for-profits and not-for-profits; however, total nursing staff levels in not-for-profits were higher than for-profits (0.16 vs. 0.09 hours per resident day). The specific nursing staff associated with PELI implementation varied by ownership. Discussion: For NHs to fully implement PCC, a multifaceted approach to improve staffing is needed.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
- Department of Economics, Miami University Farmer School of Business, Oxford, OH, USA
| | - Jane K Straker
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Program for Person Centered Living Systems of Care, University Park, PA, USA
- The Polisher Research Institute at Abramson Senior Care, 5 Sentry Parkway East, Blue Bell PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
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Tandan M, Kaup ML, Cornelison LJ, Zimmerman S. The relationship between person-centered care in nursing homes and COVID-19 infection, hospitalization, and mortality rates. Geriatr Nurs 2023; 51:253-257. [PMID: 37028151 PMCID: PMC10075075 DOI: 10.1016/j.gerinurse.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES This cohort study compared rates of COVID-19 infections, admissions/readmissions, and mortality among a statewide person-centered model known as PEAK and non-PEAK NHs. METHODS Rates per 1000 resident days were derived for COVID-19 cases and admissions/readmissions, and per 100 positive cases for mortality. A log-rank test compared rates between PEAK (n = 109) and non-PEAK NHs (n = 112). RESULTS Rates of COVID-19 cases, admission, and mortality were higher in non-PEAK compared to PEAK NHs. The median rates for all indicators had a zero value for all NHs, but in NHs above 90th percentiles, the non-PEAK case rate was 3.9 times more and the admission/readmission rate was 2.5 times more. CONCLUSIONS AND IMPLICATIONS COVID-19 case, and mortality rates were lower in PEAK than non-PEAK NHs. Although PEAK and non-PEAK NHs may differ in other ways as well, person-centered care may be advantageous to promote infection control and improve outcomes.
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Affiliation(s)
- Meera Tandan
- Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA
| | - Migette L Kaup
- Department of Interior Design & Fashion Studies, College of Health and Human Sciences, Kansas State University, KS, USA.
| | - Laci J Cornelison
- Center on Aging, College of Health and Human Sciences, Kansas State University, KS, USA
| | - Sheryl Zimmerman
- Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kunkel MC, Bowblis JR, Straker J, Van Haitsma K, Abbott KM. Impact of Implementing the Preferences for Everyday Living Inventory on Nursing Home Survey Deficiencies. J Am Med Dir Assoc 2023; 24:113-118. [PMID: 36442538 DOI: 10.1016/j.jamda.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study is to expand on previous work testing the relationship between person-centered care (PCC) and quality outcomes in the nursing home (NH) setting. We explore if the Preferences for Everyday Living Inventory (PELI) implementation is a predictor of NH quality, as defined by deficiencies. DESIGN Secondary data analysis of repeated cross-sections. SETTING AND PARTICIPANTS Data from 6 sources on Ohio NHs were merged to examine 1300 NH-year observations. METHODS Logistic regression techniques were used to evaluate the relationship between PELI implementation and 3 survey deficiency outcomes: whether the NH had a 4- or 5- deficiency star rating, deficiency score, and whether the NH had a deficiency score of 0. RESULTS NHs with complete PELI implementation increased the probability of having a 4- or 5- deficiency star rating by 6 percentage points (P = .039). Results also show complete PELI implementation is related to lower deficiency scores and an increased probability of having a deficiency score of 0, but only a 0 deficiency score was marginally significant. CONCLUSIONS AND IMPLICATIONS The findings indicate PCC stands to improve quality outcomes; however, benefits take time to show. Future research should seek to help improve NHs level of commitment to PCC and buy-in from policymakers.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
| | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, OH, USA; Department of Economics, Miami University Farmer School of Business, Oxford, OH, USA
| | - Jane Straker
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- The Pennsylvania State University, Program for Person Centered Living Systems of Care, University Park, PA, USA; The Polisher Research Institute at Abramson Senior Care, Blue Bell, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA
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The Key to Wanting to Live in a Nursing Home. J Am Med Dir Assoc 2022; 23:1439-1441. [PMID: 36087957 DOI: 10.1016/j.jamda.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022]
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Kunkel MC, Madrigal C, Moore R, Bowblis JR, Straker J, Nelson M, Van Haitsma K, Abbott KM. Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures. J Appl Gerontol 2022; 41:2542-2548. [PMID: 35930796 DOI: 10.1177/07334648221117528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures. METHODS Using data from Ohio-based NHs (n = 771), logistic regression techniques demonstrated the relationship between the PELI Implementation Indicator and two validated culture change measures, the Resident Preferences for Care (RPC) and Certified Nursing Assistant (CNA) Empowerment scales. RESULTS There was a significant relationship between the two scales and complete PELI implementation holding all other variables constant. The RPC and CNA Empowerment scales were significantly associated with complete PELI implementation. DISCUSSION Findings suggest that the PELI Implementation Indicator can be used as a pragmatic indicator of a community's adoption of person-centered care and culture change.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA
| | - Caroline Madrigal
- Center of Innovation in Long Term Services and Supports, 20100Providence VA Medical Center, Providence, RI, USA
| | - Reese Moore
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA
| | - John R Bowblis
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA.,Department of Economics, Farmer School of Business, 6403Miami University, Oxford, OH, USA
| | - Jane Straker
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Matt Nelson
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Program for Person Centered Living Systems of Care.,The Polisher Research Institute at Abramson Senior Care, 201 Nursing Sciences Building, University Park, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA.,Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
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Lima JC, Gozalo P, Clark MA, Schwartz ML, Miller SC. The Benefits of Culture Change in Nursing Homes-Obtaining Nationally Representative Evidence. J Am Med Dir Assoc 2022; 23:156-160.e9. [PMID: 34425098 PMCID: PMC9271781 DOI: 10.1016/j.jamda.2021.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite face validity and regulatory support, empirical evidence of the benefit of culture change practices in nursing homes (NHs) has been inconclusive. We used rigorous methods and large resident-level cohorts to determine whether NH increases in culture change practice adoption in the domains of environment, staff empowerment, and resident-centered care are associated with improved resident-level quality outcomes. DESIGN We linked national panel 2009-2011 and 2016-2017 survey data to Minimum Data Set assessment data to test the impact of increases in each of the culture change domains on resident quality outcomes. SETTING AND PARTICIPANTS The sample included 1584 nationally representative US NHs that responded to both surveys, and more than 188,000 long-stay residents cared for in the pre- and/or postsurvey periods. METHODS We used multivariable logistic regression with robust standard errors and a difference-in-differences methodology. Controlling for the endogeneity between increases in culture change adoption and NH characteristics that are also related to quality outcomes, we tested whether pre-post quality outcome differences (ie, improvements in outcomes) were greater for residents in NHs with culture change increases vs in those without such increases. RESULTS NH performance on most quality indicators improved, but improvement was not significantly different by whether NHs increased or did not increase their culture change domain practices. CONCLUSIONS AND IMPLICATIONS This study found that increases in an NH's culture change domain practices were not significantly associated with improved resident-level quality. It describes a number of potential limitations that may have contributed to the null findings.
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Affiliation(s)
- Julie C Lima
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA.
| | - Pedro Gozalo
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
| | - Melissa A Clark
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
| | - Margot L Schwartz
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA; Division of Health and Environment, Abt Associates, Cambridge, MA, USA
| | - Susan C Miller
- Brown University School of Public Health, Department of Health Services, Policy & Practice, Providence, RI, USA
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Abbott KM, Elliot A, Van Haitsma K. 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. J Am Med Dir Assoc 2021; 22:2074-2078. [PMID: 34237257 DOI: 10.1016/j.jamda.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/23/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Katherine M Abbott
- Department of Sociology and Gerontology, Scripps Gerontology Center, Miami University, Oxford, OH, USA.
| | - Amy Elliot
- The John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Kimberly Van Haitsma
- The Polisher Research Institute at Abramson Senior Care, College of Nursing, The Pennsylvania State University, University Park, PA, USA
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Alves JF, Mendes CPG, Valadares VF, Bernardes JG, Gutierrez BAO, Silva HSD. Cross-cultural adaptation of the PEAK 2.0 instrument for the measurement of satisfaction and quality of care for institutionalized older adults. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To perform the Brazilian Portuguese cross-cultural adaptation of scales of satisfaction, quality of care, and quality of service constructed by the Promoting Excellent Alternatives in Kansas (PEAK 2.0) program for the measurement of person-centered care practices in the context of institutionalized older persons. METHODS: Cross-cultural adaptation was performed according to the following steps: translation; back translation; semantic, idiomatic, experiential, and conceptual equivalence; validation by an expert panel; and pre-test. This is an instrument with 32 individual items grouped into 4 subscales: overall satisfaction, quality of life, quality of care, and quality of service. RESULTS: The highest disagreement between experts was observed regarding verb conjugation and/or agreement aspects, which were adjusted. The pre-test, performed with 10 residents of long-term care facilities for older adults, showed that the “quality of life” and “quality of care” items had low levels of satisfaction. Although the residents demonstrated increased concern with the objective aspects of care, such as security and cleanliness, subjective aspects such as spirituality showed the lowest satisfaction levels. CONCLUSION: After cross-cultural adaptation, the overall satisfaction, quality of life, quality of care, and quality of service instruments of the PEAK 2.0 program were well understood by older adults and interviewers. The pre-test assessment showed that these instruments have a quick and easy application and can be used in Brazilian institutions.
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Yeh SC, Tsay SF, Wang WC, Lo YY, Shi HY. Determinants of Successful Nursing Home Accreditation. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059998. [PMID: 34812691 PMCID: PMC8640283 DOI: 10.1177/00469580211059998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examined the factors associated with better accreditation outcomes among nursing homes. METHOD A total of 538 nursing homes in Taiwan were included in this study. Measures included accreditation scores, external factors (household income, Herfindahl-Hirschman Index, old-age dependency ratio, population density, and number of older adult households), organizational factors (hospital-based status, chain-affiliated status, occupancy rate, the number of registered nurses or nurse aides per bed, and bed size), and internal factors (accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care). RESULTS Bed size, hospital-based status, accountability, deficiencies, person-centered care, nursing skills, quality control, and integrated care were found to predict accreditation. CONCLUSION Among all variables in this study, the quality indicators contributed to the most variation, followed by organizational factors. External environmental factors played a minor role in predicting accreditation. A focus on quality of care would benefit not only the residents of a nursing home but also facilitate its accreditation.
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Affiliation(s)
- Shu-Chuan Yeh
- Institute of Health Care Management & Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shwu-Feng Tsay
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen Chun Wang
- Director-General, Department of Nursing and Health Care, Ministry of Health and Welfare, Taiwan
| | - Ying-Ying Lo
- Adjunct Associate Professor, Department of Health Services Administration, College of Public Health, China Medical University, Taiwan
| | - Hon-Yi Shi
- Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Lepore MJ, Lima JC, Miller SC. Nursing Home Culture Change Practices and Survey Deficiencies: A National Longitudinal Panel Study. THE GERONTOLOGIST 2020; 60:1411-1423. [PMID: 32478393 PMCID: PMC7681213 DOI: 10.1093/geront/gnaa063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH) adoption of culture change practices has substantially increased in recent decades. We examined how increasing adoption of culture change practices affected the prevalence of health, severe health, and quality of life (QoL) deficiencies. RESEARCH DESIGN AND METHODS Novel data on culture change practice adoption from a nationally representative NH panel (N = 1,585) surveyed in 2009/2010 and 2016/2017 were used to calculate change in practice adoption scores in 3 culture change domains (resident-centered care, staff empowerment, physical environment). These data were linked to data on health, severe health, and QoL deficiencies and facility-level covariates. Multinomial logistic regression models, with survey weights and inverse probability of treatment weighting, examined how increased culture change practice adoption related to change in deficiencies. RESULTS We generally observed less increase in deficiencies when culture change practices increased. However, after weighting and controlling for baseline deficiencies and culture change scores, we found few statistically significant effects. Still, results show increased physical environment practices resulted in a higher likelihood of decreases or no change (vs increases) in QoL deficiencies; increased resident-centered care practices resulted in decreases or no change (vs increases) in health deficiencies; and increased staff empowerment practices resulted in a higher likelihood of no change (vs increases) in severe health deficiencies. DISCUSSION AND IMPLICATIONS This study provides some evidence that culture change practices can help reduce the risk of increasing some types of deficiencies, but the impact of increases in each culture change domain related differently to different types of deficiencies.
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Affiliation(s)
- Michael J Lepore
- LiveWell Institute, Southington, Connecticut
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Julie C Lima
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Susan C Miller
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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Lima JC, Schwartz ML, Clark MA, Miller SC. The Changing Adoption of Culture Change Practices in U.S. Nursing Homes. Innov Aging 2020; 4:igaa012. [PMID: 32529051 PMCID: PMC7272786 DOI: 10.1093/geroni/igaa012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The study aimed to: (i) describe whether culture change (CC) practice implementation related to physical environment, resident-centered care, and staff empowerment increased within the same nursing homes (NHs) over time; and (ii) identify factors associated with observed increases. RESEARCH DESIGN AND METHODS This was a nationally representative panel study of 1,584 U.S. NHs surveyed in 2009/2010 and 2016/2017. Survey data were merged with administrative, NH, and market-level data. Physical environment, staff empowerment, and resident-centered care domain scores were calculated at both time points. Multivariate logistic regression models examined factors associated with domain score increases. RESULTS Overall, 22% of NHs increased their physical environment scores over time, 32% their staff empowerment scores, and 44% their resident-centered care scores. However, 32%-68% of NHs with below median baseline scores improved their domain scores over time compared with only 11%-21% of NHs with baseline scores at or above the median. Overall, NHs in states with Medicaid pay-for-performance (with CC components), in community care retirement communities, with special care units and higher occupancy had significantly higher odds of increases in physical environment scores. Only baseline domain scores were associated with increases in staff empowerment and resident-centered care scores. DISCUSSION AND IMPLICATIONS This is the first nationally representative panel study to assess NH CC adoption. Many NHs increased their CC practices, though numerous others did not. While financial incentives and indicators of financial resources were associated with increase in physical environment scores, factors associated with staff empowerment and resident-centered care improvements remain unclear. Studies are needed to assess whether the observed increases in CC adoption are associated with greater quality of life and care gains for residents and whether there is a threshold effect beyond which the efficacy of additional practice implementation may be less impactful.
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Affiliation(s)
- Julie C Lima
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Margot L Schwartz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Susan C Miller
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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Cornelison LJ, Syme ML, Dell-Isola R, Doll G. Engagement and Adoption of Person-Centered Care: Participant Experiences in the Kansas PEAK 2.0 Program. J Gerontol Nurs 2019; 45:5-10. [PMID: 31651983 DOI: 10.3928/00989134-20191011-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Promoting Excellent Alternatives in Kansas (PEAK) 2.0 program provides training, evaluation, and support in person-centered care (PCC) for nursing homes across Kansas. To represent the participant voice, nursing home employees (N = 141) provided feedback on their experiences and their home's level of engagement in PEAK 2.0 as well as achievement of PCC adoption. Analyses were conducted to capture the positive/negative valence and specificity of their comments and examine how engagement in PEAK 2.0 relates to the process and outcome of PEAK 2.0. Qualitatively, staff participants demonstrated that PEAK 2.0 is viewed positively overall, with approximately twice as many participants with more positive (e.g., community support, satisfaction with resources) than negative (e.g., over-regulation, too structured) comments. Employees reporting moderate engagement in PCC provided the majority of specific suggestions for improvement. In addition, higher levels of engagement were significantly associated with higher levels of PCC achievement. Based on these results, suggestions are offered to enhance nursing staff experiences and engagement that will help support PCC adoption. [Journal of Gerontological Nursing, 45(11), 5-10.].
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Kaup ML, Poey JL, Corneilson L, Doll G. Environmental Attributes of Person-Centered Care. JOURNAL OF AGING AND ENVIRONMENT 2019. [DOI: 10.1080/02763893.2019.1627266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Migette L. Kaup
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Judith L. Poey
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Laci Corneilson
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Gayle Doll
- College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
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