Abstract
Objectives
Person-centered care (PCC), which considers nursing home resident preferences in care
delivery, has been linked to important outcomes such as improved quality of life,
resident satisfaction with care, and mood and reduced behavioral symptoms for residents
with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences.
The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized,
abbreviated assessment that facilitates systematic examination of preferences from
a population of nursing home residents. However, it is unknown how well the PAT discriminates
preferences across residents or items. The purpose of this study was to use MDS 3.0
PAT data to describe (1) overall resident preferences, (2) variation in preferences
across items, and (3) variation in preferences across residents.
Data
Data from admission MDS assessments between October 1, 2011 and December 31, 2011
were used for this study.
Sample
A nationally representative sample of 244,718 residents over the age of 65 years who
were able to complete the resident interview version of preference, cognition, and
depression assessments were included.
Measurements
Importance ratings of 16 daily care and activity preferences were the primary outcome
measures. Resident factors including function (MDS Activities of Daily Living-Long
Form), depression (Patient Health Questionnaire-9), cognitive impairment (Brief Interview
for Mental Status), and sociodemographics (age, race, sex, and marital status) were
used as predictors of important preferences.
Analysis
Overall preferences were examined using descriptive statistics. Proportional differences
tests were used to describe variation across items. Logistic regression was used to
describe variation in preferences across residents.
Results
The majority of residents rated all 16 preferences important. However, there was variation across
items and residents. Involvement of family in care and individualizing daily care and
activities were rated important by the largest proportion of residents. Several resident
factors including cognitive impairment, depression, sex, and race were significant
predictors of preferences.
Conclusions
Findings demonstrate the PAT captures variation in preferences across items and residents.
Residents with possible depression and cognitive impairment were less likely to rate
preferences important than residents without those conditions. Non-Caucasian and male
residents reported some preferences differently than Caucasian and female residents.
Additional assessment and care planning may be important for these residents. More
research is needed to determine the factors that influence preferences and the ways
to incorporate them into care.
Keywords
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References
- Next steps for achieving person-centered care in nursing homes.J Am Med Dir Assoc. 2014; 15: 615
- Culture change practice in US nursing homes: Prevalence and variation by state Medicaid reimbursement policies.Gerontologist. 2014; 54: 434-445
- Person-centered care for nursing home residents: The culture-change movement.Health Aff. 2010; 29: 312-317
Pioneer Network. What is culture change. n.d.; Available at: https://www.pioneernetwork.net/culture-change/what-is-culture-change/. Accessed July 27, 2017.
- Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House program.J Am Geriatr Soc. 2007; 55: 832-839
- Tangling with the barriers to culture change: Creating a resident-centered nursing home environment.J Gerontol Nurs. 2006; 32: 19
- Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial.J Am Geriatr Soc. 2004; 52: 1795-1804
- Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: A cluster-randomised trial.Lancet Neurol. 2009; 8: 317-325
- A “recipe” for culture change? Findings from the THRIVE survey of culture change adopters.Gerontologist. 2014; 54: S17-S24
- Making the investment count: Revision of the Minimum Data Set for nursing homes, MDS 3.0.J Am Med Dir Assoc. 2012; 13: 602-610
- Minimum data set 3.0: A giant step forward.J Am Med Dir Assoc. 2013; 14: 1-3
- Why not just ask the resident? Refinement of a preference assessment tool for nursing homes.J Gerontol Nurs. 2009; 35: 40-49
- Functional improvement among short-stay nursing home residents in the MDS 3.0.J Am Med Dir Assoc. 2015; 16: 470-474
- Scaling ADLs within the MDS.J Gerontol A Bio Sci Med Sci. 1999; 54: M546-M553
- Testing the PHQ-9 interview and observational versions (PHQ-9 OV) for MDS 3.0.J Am Med Dir Assoc. 2012; 13: 618-625
- Overview of significant changes in the Minimum Data Set for nursing homes version 3.0.J Am Med Dir Assoc. 2012; 13: 595-601
- The PHQ-9: Validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- MDS 3.0: Brief interview for mental status.J Am Med Dir Assoc. 2012; 13: 611-617
- “Make me feel at ease and at home”: Differential care preferences of nursing home residents.Gerontologist. 2016; 56: 702-713
- Beyond the medical model: The culture change revolution in long-term care.J Am Med Dir Assoc. 2009; 10: 370-378
- Meaningful activities in the nursing home.J Am Med Dir Assoc. 2014; 15: 79
Eden Alternative. The principles of the Eden Alternative. n.d.; Available at: http://www.edenalt.org/about-the-eden-alternative/mission-vision-values/. Accessed July 27, 2017.
- Proxy sources for information on nursing home residents' quality of life.J Gerontol B Psychol Sci Soc Sci. 2005; 60: S318-S325
- The accuracy of surrogate decision makers: A systematic review.Arch Intern Med. 2006; 166: 493-497
- Religion, health and medicine in African Americans: Implications for physicians.J Natl Med Assoc. 2005; 97: 237
- Prayer and spiritual practices for health reasons among American adults: The role of race and ethnicity.J Relig Health. 2010; 49: 283-295
- The clinical significance of adaptation to changing health: A meta-analysis of response shift.Qual Life Res. 2006; 15: 1533-1550
- “It depends”: Reasons why nursing home residents change their minds about care preferences.Gerontologist. 2016; 56: 243-255
- Resident-directed long-term care: Staff provision of choice during morning care.Gerontologist. 2011; 51: 867-875
- Resident characteristics related to the lack of morning care provision in long-term care.Gerontologist. 2012; 53: 151-161
- Resident choice and the survey process: The need for standardized observation and transparency.Gerontologist. 2009; 49: 517-524
- Finding Gertrude: The resident's voice in Minimum Data Set 3.0.J Am Med Dir Assoc. 2014; 15: 802-806
- The effect of staff care practices on nursing home residents' preferences: Implications for individualizing care.J Nutr Health Aging. 2006; 10: 216
Article info
Publication history
Published online: August 23, 2017
Footnotes
Support for Veterans Affairs (VA)/Centers for Medicare and Medicaid Services data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Postdoctoral training support and traineeship support was provided during the conduct of this study by the William S. Middleton Veterans Affairs Hospital in Madison, WI and the VA Office of Academic Affairs. The views and content expressed in this article is solely the responsibility of the authors and does not necessarily reflect the official views of the Department of Veteran Affairs or the US government.
Identification
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Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
