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The purpose of this study was to examine changes in and predictors of perceived tangible social support over a 2-year period among older adults new to LTSS. Linear mixed effects models were used to model repeated measures of tangible social support as a function of LTSS type [NH, AL, HCBS], personal, clinical, and health-related quality of life variables. AL residents reported greater initial tangible social support, but NH and HCBS residents improved more over time. Predictors of increased tangible social support over time included greater positive affect, sense of aesthetics, education, satisfaction with family relationships, and total number of close friends and family. Decreased tangible support over time was associated with greater depressive symptoms. Findings indicate the positive influence of NH and HCBS services on perception of tangible social support, and the importance of addressing depressive symptoms and assisting with the maintenance of important relationships.

Background: Enhancing the capacity of researchers, providers and older adults to collaborate in research is critical for promoting relevant, useful research findings., Objectives: The Sages in Every Setting project aimed to disseminate a flexible model for developing research advisory boards (RABs) comprised of older adults receiving long-term services and supports (LTSS) via partnerships between academic researchers and LTSS providers., Methods: Process evaluation assessed the feasibility of using resources to develop RABs. Partners sought regular feedback from facilitators and RAB members, which was shared with the evaluator. The evaluator conducted regular debriefings with academic partners and observed some RAB meetings., Lessons Learned: The development of RABs was impacted by pre-existing collaborations, characteristics of providers, flexible use of the resources, facilitator capacity, member capacity, and researcher capacity., Conclusions: Developing RABs was feasible. Long-term partnerships between research institutions and LTSS providers that serve diverse populations could improve successful dissemination of this model.

Background and Objectives: U.S. Nursing homes (NH) are shifting toward a person-centered philosophy of care, where staff understand each residents preferences, goals and values, and seek to honor them throughout the care delivery process. Social interactions are a major component of life and while low rates of social interactions are typically found among NH residents, little research has examined resident preferences for specific types of social interactions. The purpose of this study is to explore, from the perspective of the NH resident, barriers to social contact preferences and situations when social preferences change., Research Design and Methods: Two interviews were conducted with 255 NH residents 3 months apart, recruited from 32 NHs using 13 social-contact items from the Preferences for Everyday Living Inventory-NH., Results: Content analysis of 1,461 spontaneous comments identified perceived barriers to preference fulfillment along with reasons why residents would change their mind about the importance of a preference (situational dependencies). Nearly 50% of social preferences for choosing a roommate, having regular contact with friends, giving gifts, and volunteering were associated with barriers. Social preferences were likely to change based upon the quality of the social interaction and the resident's level of interest., Discussion and Implications: Knowledge of barriers regarding social preferences can inform care efforts vital to advancing the delivery of person-centered care. In addition, understanding the reasons why NH resident preferences change based upon context can help providers with staff training leading to individualized care and develop meaningful social programs that are in line with resident preferences.

Objectives: Although assessing individual consumer preferences are an important first step in providing person-centered care, the purpose of this study was to identify the top 10 shared preferences that are important to a majority of consumers receiving long-term services and supports., Design: A cross-sectional survey design was used., Setting and Participants: Preference assessment interviews were conducted with 255 nursing home (NH) residents and 528 older adults receiving home and community-based services (HCBS)., Measurements: The Preferences for Everyday Living Inventory (PELI) was used to collect consumer preference information. Two versions of the PELI were used-the PELI-NH for NH residents and the PELI-HC for clients receiving HCBS and analysis focused on 41 shared items between the 2 versions. All respondents answered PELI questions independently and rated the importance of psychosocial preference items on a scale from not at all to a lot/very important., Results: Ten preferences were shared as being important or very important by NH residents and older adults receiving HCBS. Most notably, more than 90% of respondents in each group rated "having regular contact with family" as an important priority. Having privacy, choices about what to eat, when to bathe, and activity options also were important preferences for a majority (77%-93%) in both settings., Conclusion: Providers seeking to incorporate preference-based care can utilize study results as a foundation to incorporating important preferences into the care delivery process at the organizational level across care settings. For example, assessing all consumers on this core set of 10 shared preferences can assist with relationship building, transitions in care, and quality improvement. However, preferences with aggregate low-rated levels of importance in this study should not be discredited or eliminated. It is important for providers to understand the unique preference inventory of each older adult, which can then be targeted toward meeting goals for preference fulfillment. This can aid in bringing preferences into practice to improve the quality of care and quality of life to best meet the psychosocial needs of each person., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Among older adults receiving long-term services and supports (LTSS), debilitating hospitalizations is a pervasive clinical and research problem. Multiple chronic conditions (MCCs) are prevalent in LTSS recipients. However, the combination of MCCs and diseases associated with hospitalizations of LTSS recipients is unclear., Objective: The purpose of this analysis was to determine the association between classes of MCCs in newly enrolled LTSS recipients and the number of hospitalizations over a 1-year period following enrollment., Methods: This report is based on secondary analysis of extant data from a longitudinal cohort study of 470 new recipients of LTSS, 60 years and older, receiving services in assisted living facilities, nursing homes, or through home- and community-based services. Using baseline chronic conditions reported in medical records, latent class analysis was used to identify classes of MCCs and posterior probabilities of membership in each class. Poisson regressions were used to estimate the relative ratio between posterior probabilities of class membership and number of hospitalizations during the 3-month period prior to the start of LTSS (baseline) and then every 3 months forward through 12 months., Results: Three latent MCC-based classes named Cardiopulmonary, Cerebrovascular/Paralysis, and All Other Conditions were identified. The Cardiopulmonary class was associated with elevated numbers of hospitalizations compared to the All Other Conditions class (relative ratio [RR] = 1.88, 95% CI [1.33, 2.65], p < .001)., Conclusion: Older LTSS recipients with a combination of MCCs that includes cardiopulmonary conditions have increased risk for hospitalization., Competing Interests: The authors have no conflicts of interest to report.

Objectives: Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings., Design: A prospective, observational, longitudinal cohort design., Setting: Nursing homes (NHs), assisted living facilities (ALFs), community., Participants: A total of 470 older adults who were first-time recipients of LTSS., Measurement: Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments., Results: Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001)., Conclusions: Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL) concept that encompasses aspects of QOL that affect health such as function, physical, and emotional health. Examining existing theoretical constructs and indicators of HRQoL among LTSS recipients led us to posit a revised conceptual framework for studying HRQoL among LTSS recipients. We adapted the Wilson and Cleary HRQoL model by expanding function to specifically include cognition, adding behavior and LTSS environmental characteristics in order to create a more robust HRQoL conceptual framework for older adults receiving LTSS. This refined conceptual model allows for the measurement of a mix of structural, process, and outcome measures. Continued development of a multidimensional conceptual framework with specific HRQoL measures that account for the unique characteristics of older adults receiving LTSS will contribute significantly to LTSS research, policy, and planning efforts.

Recipients of long-term services and supports (LTSS) frequently transition between LTSS settings (e.g., assisted living facilities, nursing homes) and hospitals for acute changes in health. In this qualitative study, we analyzed findings from interviews with 57 recently hospitalized LTSS recipients and their family caregivers and described barriers and facilitators to high-quality care to support older adults through these care transitions. The themes that emerged strongly suggest that LTSS recipients and family caregivers do not receive needed information about the reasons for their transfers to hospitals, medical diagnoses, and planned treatments to address acute changes in health. Our findings indicate an urgent need for nurses and other health care team members to talk with LTSS recipients (and family caregivers) and ensure they are engaged and informed participants in care. We also found the need for research to test evidence-based transitional care for high-risk LTSS recipients and their family caregivers., (Copyright 2012, SLACK Incorporated.)

Background: Although most staff in long-term care services and support (LTSS) are nursing care personnel, a method for measuring the provision of nursing care has not yet been developed., Purpose/methods: We sought to understand the challenges of measuring nursing care across different types of LTSS using a qualitative approach that included the triangulation of data from three unique sources., Results: Six primary challenges to measuring nursing care across LTSS emerged. These included (a) level of detail about time of day, amount of time, or type of tasks varied by type of nursing and organization; (b) time and tasks were documented across clinical records and administrative databases; (c) data existed in both paper and electronic formats; (d) several sources of information were needed to create the fullest picture of nursing care; (e) data were inconsistently available for contracted providers; and (f) documentation of informal caregiving was unavailable. Differences were observed between assisted living facilities and home- and community-based services compared with nursing homes. Differences were also observed across organizations within a setting. A commonality across settings and organizations was the availability of an electronically stored care plan specifying individual needs, but not necessarily how these would be met., Conclusions: Findings demonstrate the variability of data availability and specificity across three distinct LTSS settings. This study is an initial step toward establishing a process for measuring the provision of nursing care across LTSS in order to explore the range of nursing care needs of LTSS recipients and how these needs are currently fulfilled.

Social networks play an important role in helping older adults monitor symptoms and manage chronic conditions. People use verbal discussions to make sense of symptoms, determine their seriousness, and decide whether to seek medical care. In this study, problem-specific social networks called health discussion networks (HDNs) are examined over time among older adults receiving long-term services and supports (LTSS). Data were gathered from older adults who had recently moved into a nursing home (NH) or assisted-living facility (ALF) or who had started to receive home- and community-based services (H&CBS). LTSS recipients identified people with whom they discussed symptoms or disease information, talked over what their physician said, and considered consulting other health-care providers. Data were analyzed for 216 adults with Mini Mental State Examination (MMSE) baseline scores of 20 or higher, and these individuals were interviewed quarterly over a 12-month period. Generalized estimated equations (GEE) were used to model repeated measures of HDN size and composition as a function of baseline age, gender, race, ethnicity, marital status, education, quality of life, setting, number of adult children, and cognitive status. GEE modeling demonstrated that HDN size decreased over time (p = .01) and that the probability of mentioning formal care providers as part of that network increased over time (p = .003). Multivariate predictors of increased HDN size were lower ratings of quality of life (p = .001), having more adult children (p = .04), and higher MMSE scores (p < .0001) after controlling for covariates. Older adults new to receiving LTSS had relatively small HDNs that were mixed networks including family, friends, and formal care providers. This suggests an opportunity for interventions aimed at maintaining and enhancing the HDNs of older adults beyond family members.

Background and Objectives Providing preferred leisure activities appears to be an important approach to support and empower people receiving adult day services (ADS) allowing them to age in place. To provide the conceptualization for a preference instrument, we actively involved people receiving ADS in exploring the content and structure of their preferences for leisure activities. Research Design and Methods We chose a concept mapping methodology and involved 16 people receiving ADS. We systematically reviewed the literature and conducted semistructured interviews to generate a set of 80 preferences. Analysis of structuring these preferences resulted in a 3-dimensional cube with 12 clusters. A graphical representation was then interpreted , and the clusters were labeled. Results Our conceptualization divides preferences for leisure activities into the following: 1. Take a trip , 2. Revel in memories and catch up on the news (most important), 3. Do something for yourself and come to rest , 4. Play intelligence and parlor games , 5. Make/produce and try something alone or in a group , 6. Keep fit and cheer others on in sports (least important), 7. Learn, educate, and share knowledge , 8. Have contact with other people , 9. Attend at entertainment, cultural, and amusement events , 10. Enjoy music, your homeland, or other countries , 11. Engage in outdoor activities , and 12. Get involved, offer support, and provide companionship. Discussion and Implications Our results may lead to the development of instruments and thus opens the field for further research and theory building on preferences for leisure activities of people receiving ADS. [ABSTRACT FROM AUTHOR]

Currently it is unknown what people receiving adult day services (ADS) understand as leisure and the activities they prefer remain unknown. To address these gaps, we investigated the understanding of leisure of people receiving ADS. We conducted semistructured interviews with 15 people receiving ADS in Germany. Interviews were analyzed using reflexive thematic analysis. The sweet bitter symphony emphasizes the sensations that shape participant's understanding of leisure. Young, wild & free ! describes the types of preferred activities. Is this our last tango? refers to the barriers. Anchors aweigh! the [ongoing] voyage describes the process by which leisure is transferred from private domain to the ADS environment. The beginning is the end is the beginning illustrates the paradox of understanding the ADS as offering a form of leisure and the adaptation to engage in nonpreference-based activities. Our findings indicate the importance in offering leisure activities that enable preference-based engagement in the ADS. [ABSTRACT FROM AUTHOR]

Background and Objectives Person-centered care practices are essential to providing high-quality care for nursing home (NH) residents. A key component of implementing person-centered care is the assessment and fulfillment of residents' preferences. However, few NHs consistently assess and implement residents' preferences into care. From 2015 to 2019, the Ohio Department of Medicaid added the Preference for Everyday Living Inventory (PELI), a scientifically validated tool to assess residents' preferences, as a quality indicator to improve the person centeredness of Ohio's NHs. In this study, we sought to identify the associations between resident and organizational characteristics and PELI implementation in Ohio NHs. Research Design and Methods We constructed an NH-level database that merged data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, the Certification and Survey Provider Enhanced Reports data, the WWAMI Rural Health Research Center, and the Minimum Data Set. Freestanding NHs were included if they were owned by a for-profit or not-for-profit organization, and had data collected in 1 of 2 years (n = 1,320; year 2015, n = 814; year 2017, n = 506). Descriptive statistics and multiple logistic regression were used to understand the relationships between resident demographics, NH organizational characteristics, and partial versus complete PELI implementation. Results Most NHs (71.2%) reported complete implementation of the PELI over 2 years with implementation increasing over time. There was a relationship between complete PELI implementation and for-profit status, higher number of beds, higher Medicare funding, higher certified nursing assistants and activity staff hours, and urban location. Discussion and Implications This work has important implications for the implementation of person-centered care interventions in NHs and our understanding of what NH characteristics are related to successful implementation. The next steps should include a continued, detailed assessment of PELI implementation and an exploration of the potential impact of PELI implementation on residents, staff, and organizational outcomes. [ABSTRACT FROM AUTHOR]

The Preferences for Everyday Living Inventory (PELI-NH) assesses psychosocial preferences of nursing home (NH) residents. This study explored the association of race with importance ratings of self-dominion preferences (i.e., preferences for control). PELI-NH interviews were conducted with 250 NH residents. Tests of mean differences compared African American (n = 57) and White (n = 193) residents on demographic (age, gender, education, length of stay) and clinical attributes (self-rated health, depressive symptoms, anxiety, functional limitations, hearing, vision, cognition). Stepwise multiple regression accounted first for associations of demographic and clinical attributes then for the unique association of race with total importance of self-dominion preferences to determine whether African American and White residents differ. For between group demographic/clinical differences, interaction effects were tested. African Americans were younger and more functionally impaired. After accounting for the effects of gender (female), age (younger), anxiety (greater), and functional impairment (less) with higher reports of importance of self-dominion preferences, race was significant. There were no significant moderating effects. African American residents reported greater importance of self-dominion preferences than Whites. Cultural sensitivity is critical; it may be more important to provide opportunities for autonomous decision-making for African American than for White residents. [ABSTRACT FROM AUTHOR]

Long-term stability of nursing home (NH) residents' everyday preference remains unknown. We examined 1-year stability in reports of importance of 34-recreational activity preferences (8-MDS 3.0 Section F items; 26- Preferences for Everyday Living Inventory-NH items) by NH residents (N = 161). We examined mean differences on demographic and clinical characteristics of residents for preferences showing change. Importance ratings of preferences were highly stable over 1-year, with 91% of items retaining the same valence of importance for the majority of the sample (<20% change). Three preferences showed greater change. More functionally able residents were more likely to change their importance on "being with groups of people," and older residents were more likely to change their preferences for being "involved in religious practices" and "around animals such as pets". Overall, annual assessments of recreational activity preferences capture an accurate representation of preferences with reassessment only needed in a few circumstances. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine the relationship between high wages and empowerment practices on certified nursing assistant (CNA) retention, necessary for providing high-quality care for nursing home (NH) residents. Methods: Measures of provider-level CNA empowerment and wages from the 2015 Ohio Biennial Survey were used to estimate two regression models on retention (n = 719), one without and one with an interaction term of high wages and high empowerment. Results: Only in the context of the interacted model were NHs that provided both high wages and high empowerment associated with a 7.09 percentage-point improvement in the CNA retention rate (p =.0003). Individually, high wages and a high empowerment score were not statistically significant in either regression model. Discussion: Retaining CNAs in NH communities requires a combination of empowerment practices (e.g., involving CNAs in decision-making about hiring other staff) and high hourly wages. [ABSTRACT FROM AUTHOR]

Keywords: Consolidated Framework for Implementation Science; Evidence-based practices; Evidence-based interventions; Implementation and dissemination science; Long-term care EN Consolidated Framework for Implementation Science Evidence-based practices Evidence-based interventions Implementation and dissemination science Long-term care 6 12 7 02/03/22 20220101 NES 220101 At the time of this writing, at least 186,000 nursing home (NH) residents and staff have succumbed to coronavirus disease 2019 (COVID-19; [1]), and countless others have suffered the mental anguish of limited visits from family and isolation. For instance, many NH staff are unfamiliar with evidence-based methods of implementation, including pre-implementation planning, selecting the optimal staff to deliver an intervention, and studying the outcomes of the intervention. In addition, staff engagement across the entire community facilitates implementation, including staff not traditionally included in implementation efforts, such as housekeeping and maintenance ([23]). [Extracted from the article]

Knowledge of individuals' everyday preferences is a cornerstone of person-centered care (PCC). Initial evidence demonstrates the positive impact of honoring preferences in care for older adults receiving long-term services and supports (LTSS). Yet, the mechanisms through which preference-based care affects individual well-being remain poorly understood. This article proposes a theoretical model of PCC entitled the Preference-Based Model of Care that integrates the Theory of Human Motivation, Self-determination Theory, the Competence-Press Model of person and environment fit, the Living Systems Framework, and the Broaden-and-Build theory of positive emotions to deepen our understanding of the processes through which preference-based care affects well-being among older adults receiving LTSS. The Preference-Based Model of Care illustrates how goal-directed behaviors facilitate need fulfillment through the expression of individual preferences and how these behaviors mediate the relationship between person–environment fit and affect balance within a particular social, cultural, and political context. The Preference-Based Model of Care can advance research on PCC in LTSS and can inform LTSS clinical practice guidelines for older adults, regardless of functional or cognitive capacity. [ABSTRACT FROM AUTHOR]

• Nursing home and assisted living residents are at greater risk for excessive daytime sleepiness (EDS). • Depressive and greater number of bothersome symptoms were significant predictors of EDS. • Interventions for managing EDS must be specific to the setting in which LTSS is received. Excessive daytime sleepiness (EDS) is prevalent in older adults; however, data are lacking that examine EDS across living environments. The aims of this secondary data analysis were to identify the prevalence and predictors of EDS among older adults receiving long-term services and supports (LTSS) in assisted living communities (ALCs), nursing homes (NHs), and the community. Participants (n = 470) completed multiple measures including daytime sleepiness. Logistic regression modeling was used to identify EDS predictors. Participants were primarily female and white with a mean age of 81 ± 9 years. The overall prevalence of EDS was 19.4%; the prevalence differed across living environment. Older adults in ALCs and NHs had higher odds of EDS than those living in the community. Also, depressive symptoms and number of bothersome symptoms predicted EDS. Upon admission for LTSS, evaluating older adults, especially those in ALCs and NHs, for depression and bothersome symptoms may reveal modifiable factors of EDS. [ABSTRACT FROM AUTHOR]

This study investigated barriers to fulfilling food preferences from nursing home (NH) residents' perspectives, and the reasons preferences changed (situational dependencies). Interviews were completed with 255 residents in 28 NHs across greater Philadelphia, PA using six food items from the Preferences for Everyday Living Inventory-NH (PELI-NH). Participants were predominantly white (77%), female (67.8%), and widowed (44%) with high school educations (48%). Content analysis was used to identify n = 386 barriers and n = 57 situational dependencies. Participants reported provider policies and staff proficiency as environmental barriers to preference fulfillment regarding what, when, and where to eat. Perceived health and personal resources were barriers to obtaining snacks, take-out, and dining out. Situational dependencies resulted from residents' perceived health and quality of family relationships. Results have implications for providers to centralize food preference fulfillment in care planning, and to use food preferences to address dining quality concerns. [ABSTRACT FROM AUTHOR]

Background and Objectives Nursing homes (NHs) using the Preferences for Everyday Living Inventory (PELI-NH) to assess important preferences and provide person-centered care find the number of items (72) to be a barrier to using the assessment. Research Design and Methods Using a sample of n = 255 NH resident responses to the PELI - NH, we used the 16 preference items from the MDS 3.0 Section F to develop a machine learning recommender system to identify additional PELI-NH items that may be important to specific residents. Much like the Netflix recommender system, our system is based on the concept of collaborative filtering whereby insights and predictions (e.g. filters) are created using the interests and preferences of many users. The algorithm identifies multiple sets of "you might also like" patterns called association rules, based upon responses to the 16 MDS preferences that recommends an additional set of preferences with a high likelihood of being important to a specific resident. Results In the evaluation of the combined apriori and logistic regression approach, we obtained a high recall performance (i.e. the ratio of correctly predicted preferences compared with all predicted preferences and nonpreferences) and high precision (i.e. the ratio of correctly predicted rules with respect to the rules predicted to be true) of 80.2% and 79.2%, respectively. Discussion and Implications The recommender system successfully provides guidance on how to best tailor the preference items asked of residents and can support preference capture in busy clinical environments, contributing to the feasibility of delivering person-centered care. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical implicationsThe 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).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.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.The P-LAI is the first instrument to assess preferences for leisure activities in the ADS environment.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. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical ImplicationsThe Individualized Positive Psychosocial Interaction (IPPI) is a non-pharmacological, person-centered, intervention for nursing home (NH) residents living with moderate to severe dementia. The purpose of this study was to assess the pragmatic implementation of the IPPI by leveraging Ohio’s Nursing Home Quality Improvement Program (QIP).Implementation teams collected resident mood ratings pre- and post-IPPI and completed virtual interviews to assess their Organizational Readiness for Implementing Change as well as the acceptability, feasibility, and appropriateness of the IPPI. Implementation strategies included: providing ongoing consultation; identifying and preparing champions; assessing for readiness and identifying barriers; and developing and distributing effective educational materials.Fifteen NHs completed the QIP (65% completion rate) and reported high organizational commitment to change and high change efficacy. NHs engaged n = 65 residents in n = 638 IPPIs. Residents experienced a positive mood change after 47% of IPPIs. NHs found the IPPI program to be highly acceptable, feasible, and appropriate.Overall, 65% of NHs successfully implemented the IPPI QIP with people living with moderate to severe dementia.Given the positive mood changes and high staff satisfaction, results suggest that these brief, individualized activities can be effective strategies to address the communication of distress among PLWD. [ABSTRACT FROM AUTHOR]