At this year’s Gerontological Society of America Annual Meeting, the Preference Based Living team presented papers on key issues, including: preference assessment, Covid, the need for long-term services supports reform, and a national study to improve care for people living with dementia in nursing homes. Conference attendees can view the presentations via the links below (through December 31, 2021).
For more information about our research, or if you would like to arrange a presentation for your organization, contact: Dr. Katy Abbott, firstname.lastname@example.org, or Dr. Kimberly VanHaitsma, email@example.com.
R. Applebaum, K. Abbott, G. Alkema
Before the COVID-19 pandemic, long-term services and supports (LTSS) in the US struggled to coordinate, deliver, and finance quality, person-centered long-term services and supports. The pandemic further exposed and exacerbated these challenges, as well as brought attention to the underpaid and overworked LTSS career force. In order to improve cost and quality outcomes, as well as to address the issues that were exposed during the pandemic, the LTSS system needs to be reimagined and innovation needs to be embraced, all while centering these systems on both care recipients and caregivers.
Preferences for Everyday Living Inventory (PELI) and Preferences for Activity and Leisure (PAL) Cards help nursing home providers assess resident preferences. This presentation identifies the factors that helped or impeded providers in Ohio, Missouri, and Colorado while implementing PAL Cards during the COVID-19 pandemic. Among the findings include:
- The experience was mixed: Some providers struggled while others succeeded in putting PAL Cards into place. Those that succeeded found that PAL Cards promoted person-centered care and communication between residents and staff.
- External coaching was an important ingredient for providers launching a PAL Card project, especially during the pandemic.
- PAL Cards provide an efficient way to integrate preference information into care delivery, and can be incorporated easily into admission workflow processes.
Global and Cultural Perspectives
J. Bergmann, T. Stacke, M. Rommerskirch-Manietta, D., D. Purwins, C. Manietta, A. Stroebel, M. Roes
This project translated the Preferences for Everyday Living Inventory (PELI) into German and pilot tested the new instrument, the PELI-D in nursing care, home care, and adult day care settings in Germany. The project found that residents’ top preferences varied by care setting. However, across all settings, four types of preferences consistently were important: daily care activities, contact with family and friends, staff showing respect, and concern by professionals. The new PELI-D is the first comprehensive German language tool to assess everyday preferences of people receiving care.
V. Peters-Nehrenheim, H. Tezcan-Guentekin, M. Roes
In order to provide person-centered care, it is important for health care providers to recognize the personal background of older adult immigrants, who face special barriers and challenges in terms of unmet preferences. This presentation discusses a search of the international literature on preferences of older adult immigrants and finds that differences among immigrants’ preferences are related to: the age of the person at the time of immigration; cultural differences; and how preference concepts are understood in the country of origin.
Using photographs to support verbal assessments can help older adults living with cognitive-communication challenges to better comprehend and express their choices. This study assessed the content validity of photographs that can be used to supplement the Preferences for Everyday Living Inventory-Nursing Home version. Based on cognitive interviews with older adults, a total of 46 photographs were tested and found to have content validity. Factors that influenced participants’ preferences for the photographs include: image quality, context, subject diversity, and relevance to long-term care.
Instruments to identify and assess preferences for everyday living are important tools for health professionals as well as for research purposes — for example, to develop new care approaches based on the preferences of the older adults. This study conducted an evidence map to identify: 1) preference assessment instruments that exist in English and German; 2) tools that focus on everyday living; and 3) the methods used to assess preferences. Focusing on 67 instruments, the project found that preferences are assessed in a variety of ways (using direct questions, frequencies, sorting, stimuli or scores) and categorized instruments that cover multiple domains (e.g., function and leisure activities) or only one topic (e.g., food). The next step is to study the psychometric properties of these instruments.
Honoring preferences is a central aspect of person-centered care. Yet, nursing home staff perceptions of the risks that residents’ preferences may pose for safety and health can create a barrier to delivering person-centered care. This study used focus groups to gain insight into staff perceptions of honoring risky preferences. Results indicated that pervasive, risk-avoiding attitudes are present throughout organizations, during care, and when attempting to honor resident preferences. This suggests that such “risk-phobic” attitudes, apparent at all levels within nursing homes, as well as written into organizational policies, may impede person-centered care.
- B. Resnick, A. Kolanowski, K. Van Haitsma, E. Galik, M. Boltz, J. Ellis, L. Behrens, K. Riley, K. Eshraghi
- K. Van Haitsma
Up to 90% of nursing home residents living with dementia exhibit behavioral and psychological symptoms of dementia (BPSD). These symptoms can lead to negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD, yet fewer than 2% of nursing homes consistently apply these approaches.
This study tested a novel implementation approach, based on the Evidence Integration Triangle (EIT) framework, to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. The 55 nursing homes in the study were randomized to EIT-4-BPSD or education only. This symposium describes the value of the Evidence Integration Triangle as an implementation framework; outcomes of EIT-4-BPSD at the setting and resident levels; and recruitment and measurement challenges and future solutions.