Poster Presented at AMDA – Society for Post-Acute & and Long-Term Care Medicine, Virtual Annual Conference, March 2021

Abbott, K., Heppner, A., Corpora, M., Kelley, M., Kasler, K., Cinfio, B., VanHaitsma, K.

Covid-19’s impact on residents and staff was profound. Along with fearing the virus itself, many residents felt lonely and isolated — without visits from family or volunteers; without group dining and social and recreational activities; and with long hours spent alone in their room. Staff workloads intensified and it was difficult to meet residents’ social and emotional needs.

In June 2020, 15 nursing homes joined our Tennessee PAL Card Quality Improvement Project (QIP) and 7 completed the project even amidst the mounting pressures of Covid-19. Those that succeeded reported that PAL Cards helped to blunt the pandemic’s impact on residents and staff. 

QIP Design

  • Participating providers aimed to develop Preferences for Activity and Leisure (PAL) Cards for 10 to 15 residents in their community. PAL Cards provide an easy way to share important resident preferences across care team members and shifts, and personalize care accordingly.
  • The Preference Based Living team offered monthly virtual coaching for participants. During coaching sessions, project champions from each site shared their successes and challenges and problem solved together.
  • Communities collected data aligned with the RE-AIM translational research framework.


  • Providers reported that using PAL Cards helped to blunt some of the challenges associated with Covid-19.
  • For staff under pressure, and rotating into new roles or settings, the cards offered a way to quickly learn about a resident’s background and important preferences. This helped them individualize services and adjust to change, such as when therapies shifted from group settings to resident rooms.
  • Activities professionals and social workers in the 7 communities developed PAL Cards for an average of 13 residents each. Providers that succeeded in completing the project also involved staff from other departments.
  • Virtual coaching was a valued ingredient of the QIP.
  • More providers would have liked to participate in the PAL Card project but couldn’t due to priorities and pressures related to the pandemic. Most of those who did succeed plan to expand the PAL Card initiative within their communities.

We are grateful to the Tennessee Department of Health for supporting this project. We also appreciate support from the Ohio Department of Medicaid and Ohio Department of Aging for two related PAL Card QIPs, one in progress and the other completed in 2018.