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Small surface-release dams are prevalent across North American watersheds and can alter stream flow, thermal regimes, nutrient dynamics, and sediment transport. These dams are often implicated as a cause of negative water quality impacts—including reduced dissolved oxygen (DO)—and dam removal is increasingly employed to restore natural stream processes and improve DO. Published impacts of small dams on DO vary widely across sites, and even less is known about the extent and timescale of DO recovery following removal. Therefore, we sought to quantify the effects of small dams and dam removal on DO and determine the dam, stream, and watershed characteristics driving inter-site variation in responses. We deployed continuous data loggers for 3 weeks during summer months in upstream (reference), impoundment, and downstream reaches at each of 15 dammed sites and collected equivalent data at 10 of those sites following dam removal. Prior to dam removal, most sites (60%) experienced a decrease in DO (an average of 1.15 mg/L lower) within the impoundment relative to upstream, but no consistent impacts on diel ranges or on downstream reaches. Before dam removal, 5 impacted stream reaches experienced minimum DO levels below acceptable water quality standards (<5 mg/L); after dam removal, 4 of 5 of these reaches met DO standards. Sites with wider impoundments relative to upstream widths and sites located in watersheds with more cultivated land experienced the greatest decreases in impoundment DO relative to upstream. Within one year following dam removal, impoundment DO recovered to upstream reference conditions at 80% of sites, with the magnitude of recovery strongly related to the magnitude of pre-removal impacts. These data suggest that broadly, small dams negatively affect stream DO, and the extent of effects are modulated by impoundment geometry and watershed characteristics. These results may help practitioners to prioritize restoration efforts at those sites where small dams are having outsized impacts, and therefore where the greatest water quality benefits may occur. [ABSTRACT FROM AUTHOR]

Nursing home (NH) providers would benefit from adopting evidence-based measures for gathering and utilizing resident preference information in their daily care activities. However, providers face barriers when implementing assessment tools used to promote person-centered care (PCC). Although Agile methodology is not commonly used in NH settings, this case study shows how it can be used to achieve the goal of delivering preference-based, PCC, within a large NH. We present a road map for breaking down care processes, prioritizing, and implementing iterative plan, do, study, act cycles using Agile methodology to enhance group collaboration on quality improvement cycles, to achieve our goal of providing preference-based PCC. We first determined if care plans reflected each resident's important preferences, developed a method for tracking whether residents attended activities that matched their preferences, and determined if residents were satisfied that their preferences were being met. These efforts had positive effects throughout the NH particularly when COVID-19 limited visitors and significantly modified staff workflow. Specifically, Agile processes helped staff to know how to honor preferences during quarantines which necessitated a shift to individualized (and not group) approaches for meeting preferences for social contact, comfort, and belonging. The ready availability of preference-based reporting was critical to quickly informing new staff on how to meet residents' most important preferences. Based on lessons learned, we describe a developmental approach that other providers can consider for adoption. Implications of this work are discussed in terms of the need for provider training in Agile methodologies to support iterative improvements, the need for policies that reimburse providers for their efforts, and additional research around workflow processes. [ABSTRACT FROM AUTHOR]

The purpose of this quality improvement project was to evaluate the implementation of a person-centered communication tool in nursing homes (NH). The Preferences for Activity and Leisure (PAL) Cards were developed to communicate residents' preferences for activities across care team members. Providers were recruited to assess resident important preferences and create PAL Cards for 15–20 residents and collected data aligned with the RE-AIM framework. Reach and Adoption: A total of 43 providers registered and 26 (60%) providers completed the project. Effectiveness and Implementation: Participants attempted 424 PAL Cards and completed 406. For the 26 providers, the average acceptability of the intervention measure was 4.7 (SD 0.4), intervention appropriateness measure was 4.5 (SD 0.5), and feasibility of intervention measure was 4.6 (SD 0.5) (all out of 5). Maintenance: Providers were able to complete 82% of PAL Card placement over the course of 5 months. The majority of providers were successful in implementing PAL Cards for residents and reported the intervention as highly acceptable, appropriate, and feasible providing necessary data to inform future effectiveness trials. The intervention can assist nursing home providers in meeting PCC regulations and contribute to building relationships between residents, family, and staff. [ABSTRACT FROM AUTHOR]

Person-centered care (PCC) in nursing homes is an elusive organizational goal that has attracted the attention of pay-for-performance (P4P) programs. P4P programs are used to incentivize providers to improve the quality of care delivered. However, P4P programs have both overarching policy initiatives (big "P") that must incorporate an implementation framework that is adaptable in practice (little "p"). The purpose of this paper is to apply six key factors that are central to P4P design in long-term care settings: financial incentives, measurement, stakeholder involvement and alignment, feasibility, education and awareness, and reporting and transparency as a framework for a case study of a P4P initiative conducted in Ohio between 2015 and 2019. Notably, the case study is focused on PCC and how the Ohio Department of Medicaid selected the Preferences for Everyday Living Inventory (PELI) for nursing home providers to use with all of their residents. Although inclusion of the PELI met some of the key factors, such as measurement, its implementation did not meet other key factors, such as reporting and transparency. Based on lessons learned from the Ohio P4P, recommendations are presented for use of the PELI as both a process and outcome measure in future P4P initiatives. [ABSTRACT FROM AUTHOR]

Objective: Nursing home (NH) residents' preferences for everyday living are the foundation for delivering individualized care. Yet, work has not examined the impact of demographic and clinical characteristics of NH residents on the stability of their preferences over time. Method: This study examined the rate of change in reports of importance of 27 autonomy-related everyday preferences from the Preferences for Everyday Living Inventory over 3-months and the demographic and clinical characteristics associated with change for nursing home residents (N = 255). Descriptive frequencies and tests of mean difference were utilized to examine differences between individuals reporting change in importance over time compared to those that did not report change. Results: Autonomy preferences in daily care remained stable over 3-months for the majority of residents. For residents that did report change on autonomy preferences, no systematic associations of demographic or clinical characteristics were found to be associated with change. Rather, change was associated with differential characteristics based on the preference. Conclusion: This study indicates that knowing a person's demographic or clinical characteristics in care will not uniformly inform a caretaker's understanding of the individual's reports of importance for autonomy related preferences over time. Future work should explore the role of care environment on change in preference ratings over time. [ABSTRACT FROM AUTHOR]

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]

In recent years, Ohio nursing homes (NHs) have received an increasing number of complaints. The current study aims to gain a better understanding of the relationship between NH organizational characteristics and the number of complaints. Secondary data analysis was used. Four data sources on Ohio NHs were merged. Ohio NH complaints data reported in 2018 and 2019 was linked with the 2017 Ohio Biennial Survey of Long-Term Care Facilities, 2017 Ohio Nursing Home Resident Satisfaction Survey, and 2018 Ohio Nursing Home Family Satisfaction Survey. Descriptive analysis, bivariate tests (ie, analysis of variance and χ2 test), and multinomial logistic regression analyses were conducted. Findings included that urban location, NH administrator (NHA) and director of nursing (DON) turnover in the previous 3 years, NH size, occupancy rate, certified nursing assistant (CNA) retention, and overall family satisfaction were significantly associated with total complaints. NHA and DON turnover, NH size, CNA retention, and overall family satisfaction were found to be significantly associated with substantiated complaints. The importance of leadership (ie, NHA and DON) turnover, CNA retention, and family satisfaction indicates that specifically targeted efforts to improve in these areas can have a positive impact on NH quality. [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]

Abstract Objectives Nursing home (NH) residents' preferences for everyday living are the foundation for delivering individualized person-centered care. Yet, work has not examined what the most and least important preferences of nursing home residents are and if those preferences change over time. Design This study examined the change in nursing home residents' (n = 255) preferences for everyday living over a 3-month period. Participants were recruited from 28 NHs in the suburbs of a major metropolitan East Coast area of the United States. Measures Residents were interviewed face-to-face using the Preferences for Everyday Living Inventory–Nursing Home version at baseline (T1) and 3 months later (T2). Change was analyzed in 2 ways: (1) percentage exact agreement (eg, respondent stated "very important" at both time points) and (2) percentage of preferences that remained either important or not important between T1 and T2. Results Sixteen preferences were rated as very or somewhat important by 90% or more of NH residents. With regard to the stability of preference ratings, findings demonstrate an average exact agreement of 59%, and an average important versus not important agreement of 82%. In addition, 68 of the 72 preferences had 70% or higher stability over time. In other words, the preference either remained "important" or "not important" to the NH resident 3 months later. Preferences in the domain of enlisting others in care had the least amount of change. Conclusion/Implications This study highlights the most important everyday living preferences of NH residents and provides assurance to care providers that the majority of preferences assessed via the PELI are both important to NH residents and stable over time. Preference-based care plans can be designed and used over a 3-month period with confidence by providers. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: This article examines the natural history of changes in emotional status as measured through emotional well-being and depressive symptoms over a two-year period among older adults new to long-term services and supports (LTSS). Method: In-person interviews were conducted with 470 older adults within sixty days of entry into LTSS and then quarterly through twenty-four months. Results: Multivariate generalized estimating equation models indicate improvements in emotional status, with depressive symptoms decreasing and overall emotional wellbeing improving. Independent predictors of depressive symptoms and emotional well-being are described. Discussion: Older adults who have transitioned to LTSS experience changes in emotional status over time. Significant contributors to emotional status are identified that can be addressed and supported through LTSS programs. [ABSTRACT FROM AUTHOR]

Knowledge of a nursing home resident’s everyday living preferences provides the foundation for ongoing individualized care planning. Objective:The purpose of this study is to identify nursing home (NH) staff perceptions of facilitators and barriers to learning about and meeting residents’ preferences and reasons why staff feel residents change their minds about preferences. Methods:Focus group sessions and interviews were conducted with 36 NH staff members working in a facility that has been actively assessing resident preferences for five years. Results:Thematic codes classifying facilitators, barriers, and dependencies were identified. Staff shared ways they are able to help meet residents’ preferences as well as barriers to fulfilling resident preferences through their own behaviors, facility characteristics, the social environment, and resident characteristics. In addition, staff believe that residents change their minds about important preferences ‘depending on’ several factors including; global environmental characteristics, social environment, resident characteristics, and general staff perceptions. Conclusions:This work identifies key facilitators and barriers to consider when implementing quality improvement efforts designed to improve the person-centered nature of care in nursing homes and is intended to further inform the culture change movement, which aims to transform NHs by empowering staff and delivering person-centered care. [ABSTRACT FROM AUTHOR]

Social integration of older adults residing in assisted living facilities (ALF) is not well understood. The purpose of this study is to describe the experience of friendship among ALF residents. Four focus groups with 13 participants were held. The analysis was completed through directed content analysis. The facilitator themes identified are having early connections, positive attitudes, and shared experiences. The barrier themes identified the transitional nature of the environment and policies regarding the protection of privacy (HIPAA). Creating meaningful activity programs and determining how to disseminate health information within federal guidelines are needed to facilitate more meaningful interactions among residents. [ABSTRACT FROM AUTHOR]

Social integration of older adults residing in assisted living facilities (ALF) is not well understood. The purpose of this study is to describe the experience of friendship among ALF residents. Four focus groups with 13 participants were held. The analysis was completed through directed content analysis. The facilitator themes identified are having early connections, positive attitudes, and shared experiences. The barrier themes identified the transitional nature of the environment and policies regarding the protection of privacy (HIPAA). Creating meaningful activity programs and determining how to disseminate health information within federal guidelines are needed to facilitate more meaningful interactions among residents. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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]

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]

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]

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]

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]

Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P <.05) and any substantiated complaints by 11.5% points (P <.001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The purpose of this study is to expand on previous work testing the relationship between person-centered care (PCC) and quality outcomes in the nursing home (NH) setting. We explore if the Preferences for Everyday Living Inventory (PELI) implementation is a predictor of NH quality, as defined by deficiencies. Secondary data analysis of repeated cross-sections. Data from 6 sources on Ohio NHs were merged to examine 1300 NH-year observations. Logistic regression techniques were used to evaluate the relationship between PELI implementation and 3 survey deficiency outcomes: whether the NH had a 4- or 5- deficiency star rating, deficiency score, and whether the NH had a deficiency score of 0. NHs with complete PELI implementation increased the probability of having a 4- or 5- deficiency star rating by 6 percentage points (P =.039). Results also show complete PELI implementation is related to lower deficiency scores and an increased probability of having a deficiency score of 0, but only a 0 deficiency score was marginally significant. The findings indicate PCC stands to improve quality outcomes; however, benefits take time to show. Future research should seek to help improve NHs level of commitment to PCC and buy-in from policymakers. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To explore differences in having an advance directive among older adults newly transitioned to long term services and support (LTSS) settings (ie, nursing homes [NHs]; assisted living facilities [ALFs]; home and community-based services). Design: Cross sectional survey. Setting: LTSS in New York and Pennsylvania. Participants: Participants were 470 older adults who recently started receiving LTSS. Included in this analyses, N = 442 (ALF: n = 153; NH: n = 145; home and community-based services: n = 144). Measurements: Interviews consisted of questions about advance directives (living will and health care power of attorney), significant health changes in the 6 months before the start of long term care support services, Mini-Mental State Examination, and basic demographics. Results: Sixty-one percent (270/442) of older adults receiving LTSS reported having either a living will and/or an health care power of attorney. ALF residents reported having an advance directive more frequently than NH residents and older adults receiving LTSS in their own home (living will: χ2[2]= 120.9; P < .001; health care power of attorney: χ2[2]= 69.1; P < .001). In multivariate logistic regression models, receiving LTSS at an ALF (OR = 5.01; P < .001), being white (OR = 2.87; P < .001), having more than 12 years of education (OR = 2.50; P < .001), and experiencing a significant health change in past 6 months (OR = 1.97; P = .007) were predictive of having a living will. Receiving LTSS at an ALF (OR = 4.16; P < .001), having more than 12 years of education (OR = 1.74, P = .022), and having had a significant change in health in the last 6 months (OR = 1.61; P = .037) were predictive in having an health care power of attorney in this population of LTSS recipients. Conclusions: These data provide insight into advance directives and older adults new to LTSS. Future research is needed to better understand the barriers to completing advance directives before and during enrollment in LTSS as well as to assess advance directive completion changes over time for this population of older adults. [Copyright &y& Elsevier]

Purpose: Preference assessment is integral to person-centered treatment planning for older adults with communication impairments. There is a need to validate photographs used in preference assessment for this population. Therefore, this study aimed to establish preliminary face validity of photographs selected to enhance comprehension of questions from the Preferences for Everyday Living Inventory-Nursing Home (PELI-NH) and describe themes in older adults' recommendations for revising photographic stimuli. Method: This qualitative, cognitive interviewing study included 21 participants with an average age of 75 years and no known cognitive or communication deficits. Photographic stimuli were randomized and evaluated across one to two interview sessions. Participants were asked to describe what the preference stimuli represented to them. Responses were scored to assess face validity. Participants were then shown the PELI-NH written prompt and asked to evaluate how well the photograph(s) represented the preference. A semideductive thematic analysis was conducted on interview transcripts to summarize themes in participant feedback. Results: Forty-six (64%) stimuli achieved face validity criteria without revisions. Six (8%) stimuli achieved face validity after one partial revision. Twenty (28%) stimuli required multiple revisions and reached feedback saturation, requiring team review for finalization. Thematic analysis revealed challenges interpreting stimuli (e.g., multiple meanings) and participant preferences for improving photographs (e.g., aesthetics). Conclusions: Cognitive interviewing was useful for improving face validity of stimuli pertaining to personal care topics. Abstract and subjective preferences (e.g., cultural traditions) may be more challenging to represent. This study provides a framework for further testing with older adults with cognitive, communication, and hearing impairments. [ABSTRACT FROM AUTHOR]

Objectives. This randomized controlled study tested the effectiveness of individualized activities, led by certified nursing assistants (CNAs), to increase positive and reduce negative affect and behavior among nursing home residents with dementia.Method. Nursing home residents with mild to advanced dementia (N = 180) were randomly assigned to usual care (UC, n = 93) or 1 of 2 experimental conditions. Residents in the attention control group (AC, N = 43) participated in standardized one-to-one activities with their CNAs. Individualized Positive Psychosocial Intervention (IPPI) participants (n = 44) received a CNA-led activity matched to their interests and ability. Outcomes were residents’ positive and negative affect and verbal and nonverbal behavior.Results. The IPPI and AC groups experienced similar benefits—more pleasure, alertness, engagement, positive touch, and positive verbal behavior—compared with UC. The AC group displayed more anger, uncooperativeness, and very negative verbal behavior than UC or IPPI.Discussion. This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia. [ABSTRACT FROM PUBLISHER]

Research needs to further understand care preferences in home health care. The present quality improvement (QI) study convened an expert panel with key stakeholders. Methods included a modified Delphi card sort to (1) rank the Preferences for Everyday Living Inventory (PELI) categories from most to least important, and (2) select one PELI item from each category most relevant to the setting. The purpose was to determine which items from the Preferences for Everyday Living Inventory nursing home residents (PELI-NH) were most salient to home health care. Categories selected as most important were Health Care Decision Making and Who Delivers Care. Differences were seen across item and preference categories based on stakeholder groups. Results highlight the potential for incorporating the PELI into home health care practice, and the need for additional research. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]