1
|
Heid AR, Talmage A, Abbott KM, Madrigal C, Behrens LL, Van Haitsma KS. How Do We Achieve Person-Centered Care Across Health Care Settings? Expanding Ideological Perspectives Into Practice to Advance Person-Centered Care. J Am Med Dir Assoc 2024:105069. [PMID: 38851211 DOI: 10.1016/j.jamda.2024.105069] [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: 01/29/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 06/10/2024]
Abstract
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.
Collapse
Affiliation(s)
| | - Alexis Talmage
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Katherine M Abbott
- Scripps Gerontology Center, Miami University, Oxford, OH, USA; Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Caroline Madrigal
- Geriatrics & Extended Care, VA Boston Healthcare System, Boston, MA, USA
| | - Liza L Behrens
- College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | | |
Collapse
|
2
|
Roberts T, Block L, Madrigal C. Preferences and Quality of Life in Nursing Home Residents: A Mixed Methods Study. J Gerontol Nurs 2024; 50:7-13. [PMID: 38691119 DOI: 10.3928/00989134-20240416-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
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.].
Collapse
|
3
|
Liu Z, Li Z, Zhang J, Feng Q, Chen J. A new scale for older resident satisfaction with residential integrated care in China: Development and validation. Geriatr Nurs 2024; 57:224-231. [PMID: 38696880 DOI: 10.1016/j.gerinurse.2024.04.023] [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: 12/13/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/04/2024]
Abstract
The factors that affect resident satisfaction with emerging residential integrated care for older people in China have been unclear due to a lack of validated instruments. Based on psychometric assessment procedures, we developed a new scale for older resident satisfaction with residential integrated care (SORSRIC). The scale was developed using a two-step process and a sample of 16 Chinese institutions and 333 residents. Exploratory and confirmatory factor analysis was used to evaluate reliability and validity. Principal component analysis and maximum variance methods were used to orthogonally rotate the items to extract seven factors. These were: resident expectations, perceived quality (physical care), perceived quality (mental care), perceived value, resident satisfaction, resident complaints, and resident loyalty. The CR value of each dimension of the pre-tested, formal scale was greater than 0.80, and the AVE value was greater than 0.50. This 24-item instrument showed good reliability and structural validity and can be applied to improve the experience and outcomes for older people in residential care.
Collapse
Affiliation(s)
- Zhihan Liu
- School of Public Administration, Central South University, China.
| | - Zhiqi Li
- School of Public Administration, Central South University, China
| | - Jiaheng Zhang
- School of Public Administration, Central South University, China
| | - Qiuping Feng
- School of Public Administration, Central South University, China
| | - Juan Chen
- School of Public Administration, Central South University, China
| |
Collapse
|
4
|
Rommerskirch-Manietta M, Manietta C, Hoffmann-Hoffrichter AL, Purwins D, Van Haitsma K, Abbott KM, Roes M. The PELI-D II Study: Development and Preliminary Validation of the Preferences for Leisure Activities Inventory (P-LAI) for Adult Day Services. Clin Gerontol 2024:1-14. [PMID: 38594970 DOI: 10.1080/07317115.2024.2341110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES The current study aimed to develop and preliminarily validate an initial version of an instrument to assess the leisure activity preferences of people receiving adult day services (ADS). METHODS Based on previously conducted concept mapping steps, we identified 12 clusters of preferences for leisure activities. We adopted the structure of the Preferences for Everyday Living Inventory and phrased our cluster labels as questions to develop a first draft of the Preferences for Leisure Activities Inventory (P-LAI). We conducted cognitive interviews (n = 8) to revise, preliminarily validate, and preliminarily finalize the P-LAI. RESULTS The draft of the P-LAI included 25 questions. Based on the results of the cognitive interviews, the number of questions was reduced to 21, three questions were rephrased, and evidence to support the preliminary validity of the P-LAI based on the response processes was provided. CONCLUSIONS The P-LAI is the first instrument to assess preferences for leisure activities in the ADS environment. CLINICAL IMPLICATIONS The preliminary results of the P-LAI allow ADS providers and healthcare professionals to assess the preferences for leisure activities of people who receive ADS in a structured way. Based on these results, preference-based services can be designed and planned, and the person-centered philosophy of care can be further operationalized in the ADS environment.
Collapse
Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Anna Louisa Hoffmann-Hoffrichter
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Diakonie Osnabrück, Stadt und Land gGmbh, Osnabrück, Germany
| | - Kimberly Van Haitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
5
|
Behrens LL, Anderson HL, Kowalchik KH, Mogle J, Roman Jones J, Van Haitsma K, Hodgson N, Boltz M. " I'm not a risk taker " : Risk Perceptions of Nursing Home Residents With Dementia. Alzheimer Dis Assoc Disord 2024; 38:168-177. [PMID: 38651790 PMCID: PMC11141213 DOI: 10.1097/wad.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Persons living with Alzheimer disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences. METHODS As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living. RESULTS Residents generally self-identified as risk avoiders ( M =3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care. DISCUSSION Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.
Collapse
Affiliation(s)
- Liza L Behrens
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Nursing Sciences Building, University Park
| | | | - Kaléi H Kowalchik
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Nursing Sciences Building, University Park
| | - Jacqueline Mogle
- Clemson University College of Behavioral, Social and Health Sciences, Clemson, SC
| | - Joanne Roman Jones
- Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, MA
| | - Kimberly Van Haitsma
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Nursing Sciences Building, University Park
| | - Nancy Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Marie Boltz
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Nursing Sciences Building, University Park
| |
Collapse
|
6
|
Jiang MM, Xiao MF, Zhang JW, Yang MF. Middle-aged and older people's preference for medical-elderly care integrated institutions in China: a discrete choice experiment study. BMC Nurs 2024; 23:32. [PMID: 38200515 PMCID: PMC10777634 DOI: 10.1186/s12912-023-01696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND With the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years. OBJECTIVES To explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions. METHODS In this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants' willingness to pay for each attribute was also calculated. RESULTS Data from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p < 0.001, 95% CI 1.343 ~ 2.071) and high medical technology level (vs. low medical technology level: β = 1.535, p < 0.001, 95% CI 1.240 ~ 1.830) were the most important attributes to middle-aged and older people, followed by monthly cost, environmental facilities, the convenience of transportation, and entertainment activities. Regarding the willingness to pay, participants were more willing to pay for service quality and medical technology level than for other attributes. They were willing to pay $3156 and $2838 more for "poor service quality" and "low medical technology level," respectively, to receive "moderate service quality " (p = 0.007, 95% CI 963 ~ 5349) and "high medical technology level" (p = 0.005, 95% CI 852 ~ 4824). CONCLUSIONS The state should attach great importance to the development of medical-elderly care integrated services industry, actively optimize the model of the medical-elderly care integrated service, improve the facilities, and create a healthy environment. At the same time, give full play to the role of medical insurance, long-term care insurance, and commercial insurance, so as to improve the comprehensive quality of life of the elderly. PUBLIC CONTRIBUTION The design of the experimental selection was guided by 10 experts in the field, 5 Chinese government officials, and interviews and focus group discussions, without whose participation this study would not have been possible.
Collapse
Affiliation(s)
- Mao-Min Jiang
- School of Public Affairs, Xiamen University, Xiamen, Fujian province, China
| | - Mei-Fang Xiao
- School of Nursing, Gannan Medical University, Ganzhou, Jiangxi province, China
| | - Jia-Wen Zhang
- Xiamen Institute of Software Technology, Xiamen, China, Fujian province.
- School of Education, Silliman University, Negros Oriental province, Dumaguete, Philippines.
| | - Mei-Fang Yang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan province, China.
| |
Collapse
|
7
|
Kunicki ZJ, Madrigal C, Quach LT, Riester MR, Jiang L, Duprey MS, Bozzay M, Zullo AR, Singh M, McGeary J, Wu WC, Rudolph JL. Comparing Resident, Proxy, and Staff Respondents for Nursing Home Residents' Preferences for Everyday Living. J Appl Gerontol 2023; 42:28-36. [PMID: 36029016 DOI: 10.1177/07334648221123059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Zachary J Kunicki
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Caroline Madrigal
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Lien T Quach
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Gerontology, The University of Massachusetts Boston, Boston, MA, USA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| | - Melissa R Riester
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA
| | - Matthew S Duprey
- Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Melanie Bozzay
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA.,VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA
| | - Andrew R Zullo
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Health Services, Policy, and Practice, 174610Brown University School of Public Health, Providence, RI, USA
| | - Mriganka Singh
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Medicine, 12321Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - John McGeary
- Department of Psychiatry and Human Behavior, 12321Alpert Medical School of Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Department of Medicine, 12321Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - James L Rudolph
- VA Center of Innovation in Long Term Services, 20100Providence VA Medical Center, Providence, RI, USA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
| |
Collapse
|