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This study examined the stability over time of psychosocial preferences, measured using the Preferences for Everyday Living Inventory (PELI). We interviewed 107 persons with the PELI at six and twelve months following an initial assessment, and compared item responses at each administration to assess response stability. At each follow-up, subjects also were surveyed regarding the occurrence of 'milestone' events (e.g., loss of spouse, increase in home health services, relocation, etc.). Preferences were remarkably stable overall, with some variability depending on particular content domain and demographic and background characteristics. Supported by the Leslie R. and Fan Fox Samuels Foundation.

DISCUSSANTS: S. Stahl (NIA, Bethesda, MD), M. Calkins (IDEAs, Inc., Kirtland, OH). 'Culture Change' is the process through which an organization realigns its core systems and values. It has come to mean, for example, the replacement of an institutional mode with a personal, homelike mode, thus making a facility more attractive to its residents. Known to many, the Eden Alternative is one such attempt at culture change. But, what are the impacts of such programs? First is a consideration fo actually has become implemented. Then, what is the impact of the intervention, e.g., what are associated changes in Quality of Care and of Life? Having long been concerned with dementia care, the researchers and practitioners brought together in this group are in a unique position to comment on these issues, i.e, to define, and to assess the impact of culture change, in long-term care.

This review article reports on methods of direct observation of behaviors for use in long-term care settings, particularly with older adults who have dementia. This article provides information on the theoretical roots, administration methods, and psychometric properties of measures of direct observation of individual behavior. It is hoped that this review will help gerontological nurses make informed choices about the direct observation measures that suit their specific needs, highlight the role of direct observation in quality improvement for dementia care, and facilitate a balance between identifying a gold standard and allowing flexibility to assess project-specific behaviors. [ABSTRACT FROM AUTHOR]

Although depression and dementia are common comorbid illnesses among long-term care residents, psychotherapeutic services for these individuals have not been tailored for their particular needs and circumstances. In this article we present a new model for brief individual psychotherapy -Restore, Empower, Mobilize, or R-E-M-to treat depression in long-term care residents who have mild to moderate dementia. R-E-M treatment has three goals: (1) restore self-esteem and support a positive self-concept, (2) empower residents to make use of their existing abilities, and (3) mobilize residents and the environment to achieve and maintain long-term mental health. We describe the interventions of R-E-M treatment, the construction of a treatment manual, and a pilot evaluation of the treatment with three nursing home residents. Positive outcomes in the pilot have encouraged us to pursue additional treatment development and evaluation. Standardized treatments, such as R-E-M, that yield measurable gains are needed to ensure that long-term care residents with depression and dementia receive the mental health services they require and deserve. [ABSTRACT FROM AUTHOR]

Recently, models such as the Eden Alternative have presented a theoretical basis for attempting to create a therapeutic environment by bringing live-in animals and plants into the nursing home. This article reports on the implementation and assessment of an intervention termed the 'Living Habitat,' which borrows concepts from the Eden Alternative model. Implemented on a 32-bed unit of a large urban nursing home, the Living Habitat offered numerous plants, a parakeet to any resident who requested one, and two cats and a dog for the unit. A baseline assessment of residents (N = 26) was conducted prior to the introduction of the animals and plants, and followup data were obtained 6 months after the intervention began. Results indicate that, following the introduction of the Living Habitat, residents higher in cognitive status became more positively engaged with their environment but reported a decreased sense of control. Residents who had greater affinity for pets also became more positively engaged with their environment. Qualitative impressions and challenges in implementing a systemic intervention are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The current study explored the association of nursing home (NH) residents' demographic and clinical attributes and NH characteristics with resident-reported satisfaction with NH communities., Method: Pearson correlations and multiple linear regression were used to test the association of demographic and clinical attributes of residents and NH characteristics with resident-reported NH satisfaction with 197 NH residents from 28 NHs., Results: Correlational analysis and regressions indicated an association among residents' demographic and clinical characteristics, NH characteristics, and self-reported NH satisfaction. Higher age, higher education, and race (minority status) were associated with greater resident-reported NH satisfaction. Greater NH staffing and for-profit ownership status were associated with less NH satisfaction. Greater resident depressive symptoms and dressing assistance were associated with lower resident-reported NH satisfaction., Conclusion: Administrators and staff should look beyond NH characteristics and consider their residents' diverse personal characteristics to create an environment that promotes satisfaction and well-being. [ Journal of Gerontological Nursing, 50 (11), 6-12.].

Objectives: The study evaluated the feasibility of implementing Dementia Collaborative Coaching (DCC) into the routine workflow of speech-language pathologists (SLPs) working in nursing homes (NHs). DCC is an intervention delivered by SLPs to train nursing assistants (CNAs) in communication strategies to support people living with dementia (PLWD)., Methods: We assessed the feasibility of identifying eligible PLWD; estimated intervention fidelity; evaluated suitability of outcome measures; and determined the preliminary impact on behavioral and psychological symptoms of distress (BPSD) among PLWD. SLPs completed a semi-structured interview to collect further acceptability data., Results: Four SLPs in four NHs completed DCC with 10 CNAs and 15 eligible PLWD that they appropriately identified from their caseloads. SLPs conducted 90 DCC sessions with 64% fidelity and billed Medicare for all sessions. The outcome measure of Minimum Data Set item E0200B: Rejection of Care did not vary enough to be useful, but positive changes were noted on the Cohen-Mansfield Agitation Inventory , t(14) = 10.51, p  < .001, Cohen's d = 2.76. Interviews further indicated feasibility., Conclusions: It is feasible to implement DCC into the workflow of SLPs in NHs., Clinical Implications: Given the feasibility and preliminary positive impacts, SLPs could consider implementing DCC in routine care.

Background and Objectives: The Individualized Positive Psychosocial Interaction (IPPI) program is an adaptable, evidence-based intervention. IPPI trains nursing home care partners to engage residents living with moderate to severe dementia in preference-based, one-to-one interactions using emotion-focused communication. We sought to understand provider-driven adaptations made to the IPPI program and whether the adaptations made were fidelity-consistent., Research Design and Methods: Data were collected from n = 78 interviews with n = 23 nursing home provider champions who led a quality improvement project to implement the IPPI program with 3-5 residents per care community. Using content analysis, we report quantitative data on the adaptation characteristics according to the Framework for Reporting Adaptations and Modifications-Expanded core modules and participant quotes to illustrate adaptations., Results: Champions reported 34 adaptations, with an average of 2.6 adaptations per nursing home. The majority of IPPI adaptations pertained to implementation (65%; n = 22), whereas 17% (n = 6) were content and 17% (n = 6) were context. Some adaptations were motivated by the organization (e.g., time constraints), while others were motivated by the recipient (e.g., cognitive capacity). Most adaptations made to the IPPI protocol by care partners were fidelity-consistent (92%; n = 33)., Discussion and Implications: Care partners' adaptations to the IPPI made the intervention more resident-centric. Future healthcare intervention providers must consider the user perspective and encourage adaptations that further tailor to the user, as long as the adaptations are fidelity-consistent., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: In 2015, the Ohio Department of Medicaid incentivized use of the Preferences for Everyday Living Inventory (PELI) as a quality initiative. The pay-for-performance (P4P) program, however, was then deimplemented in 2019. This study investigated the sustainability of use of the PELI in Ohio nursing homes (NHs) from 2017 to 2021 and examined barriers to PELI implementation., Design: This study analyzed 2 waves of Ohio Biennial Survey of Long-Term Care Facilities data., Setting and Participants: Data were drawn from 433 NHs in Ohio that reported on PELI implementation efforts between 2017 and 2021., Methods: This study examined the change in proportion of NHs implementing the PELI (ie, conducted for all residents, used in care planning) and change in proportion of NHs using different PELI assessment formats (ie, the full 72-item PELI, MDS 3.0 Section F items only). Frequencies of reported barriers to PELI implementation by NH administrators were tabulated., Results: Results indicate that although use of the full 72-item PELI decreased over time, only a small percentage discontinued its use despite possible impacts of P4P changes in 2019 and challenges posed by the COVID-19 pandemic. NHs adapted their PELI assessment formats likely in response to perceived barriers of PELI use (ie, length of the full PELI, time constraints, and residents' level of cognitive impairment)., Conclusions and Implications: Findings suggest that Ohio NHs sustained PELI implementation over time in the context of large systemic changes in P4P financial incentives and COVID-19 safeguards. Barriers were reported at the organizational level, yet NHs continued to prioritize PCC with the PELI. Policy/P4P mandates may serve as effective implementation incentives that encourage sustainability of quality care practices. Future research should explore long-term sustainability and stakeholder perspectives on PELI utilization., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Objectives: The 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)., Methods: 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., Results: 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., Conclusions: Overall, 65% of NHs successfully implemented the IPPI QIP with people living with moderate to severe dementia., Clinical Implications: 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.

Objectives: This study assessed the readiness of The Individualized Positive Psychosocial Interaction (IPPI) program in the nursing home (NH) setting from the perspective of NH providers implementing the IPPI. The evidence-based IPPI program is designed to help remediate distress and improve mood for residents living with dementia. NH staff are trained to engage residents in brief (i.e. 10-min) one-to-one, preference-based activities to alleviate emotional distress and enhance quality of life., Method: NH providers ( n  = 15) who championed the IPPI implementation completed an exit interview based on the nine domains of the Readiness Assessment for Pragmatic Trials (RAPT). Interviews were audio-recorded, transcribed, and coded by RAPT domains, then scored by the research team to reflect an average for each domain., Results: Providers rated the IPPI program's readiness high on the domains of alignment, impact, risk, implementation protocol, evidence, cost, and acceptability. The domains of measurement and feasibility scored lower, likely due to broader contextual issues and require particular attention., Conclusion: Results illustrate that the IPPI program successfully aligns with stakeholder priorities, is a safe intervention with minimal risk, and has beneficial outcomes. The IPPI's low cost, design, and alignment with organizational goals also facilitated implementation while measuring outcomes and staffing considerations impacted organizational capacity for implementation.

There are 200+ tested interventions for care partners (family, friends, and fictive kin) of people living with dementia (PLWD). But these interventions do not systematically cover relevant settings. Nor do these interventions affect all relevant outcomes that matter to people and healthcare systems. We present an evidence map of settings and outcomes from translated interventions to identify gaps. Of 190 studies identified, 31 unique interventions were retained in the evidence map. Identified setting gaps included studies set solely in hospitals/medical centers or set in multiple settings. Identified outcome gaps included interventions that improved care partner beliefs about providing care, care partner negative coping strategies, PLWD resources (e.g., social support), and PLWD coping strategies. Armed with an understanding of present gaps, we call on researchers to fill the identified gaps to ensure systematic coverage of settings and evaluation of outcomes that matter to people and healthcare systems., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward., Design: This was a cross-sectional, parallel convergent mixed methods study., Setting and Participants: This study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15)., Methods: Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display., Results: NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities., Conclusion and Implications: NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take and scale-up of evidence-based dementia care practices across settings, diverse populations, and disease trajectories. Organizational readiness for implementation is a salient consideration when planning and conducting embedded pragmatic trials, in which interventions are implemented by provider staff. The current article examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of this construct. We offer a preliminary conceptual model for explicating and measuring organizational readiness and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. [ Research in Gerontological Nursing, 17 (3), 149-160.].

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.

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Sexual wellness plays a crucial role in an individual's quality of life, interpersonal relationships, and self-concept, particularly among older adults residing in residential aged care facilities, including those with dementia. However, there is currently a limited person-centered approach to understanding the unique preferences of each older person regarding their intimate and sexual behaviors. To address this gap, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed to facilitate meaningful discussions between healthcare professionals or workers and older individuals about their intimacy and sexuality needs and preferences. This paper explores the use of the ISEP tool with residents in long-term aged care, including those with dementia via a user-centric case study., Methods: ISEP tool interviews were conducted with 14 residents in a single residential aged care facility in Queensland, Australia., Results: The study presented valuable insights and contextual information from using the ISEP tool, including an example of a resident's response, which provided recommendations for better supporting the resident. This involves engaging in supportive conversations to facilitate the exploration, implementation, and assessment of practical and actionable strategies to meet intimacy and sexuality needs and preferences., Discussion: The ISEP tool shows promise in improving care practices and addressing the intimacy and sexuality needs of older individuals in aged care facilities. However, it is important to acknowledge that the study was conducted in a single aged care facility with a small group of residents, potentially limiting the generalisability of the findings. Further large-scale studies are necessary to establish the tool's broader applicability across different care settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Jones, Moyle, Van Haitsma and Hudson.)

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.

Background: The Preferences for Everyday Living Inventory (PELI) is a person-centered care (PCC) tool that uncovers/honors older adults' important preferences. PCC implementation in nursing homes (NHs) often requires additional resources, such as staff time. We explored if PELI implementation is associated with NH staffing levels. Methods: Using NH-year as the unit of observation ( n = 1307), 2015 and 2017 data from Ohio NHs was used to examine the relationship between complete versus partial PELI implementation and staffing levels, measured in hours per resident day, for various positions and total nursing staff. Results: Complete PELI implementation was associated with higher nursing staff levels in both for-profits and not-for-profits; however, total nursing staff levels in not-for-profits were higher than for-profits (0.16 vs. 0.09 hours per resident day). The specific nursing staff associated with PELI implementation varied by ownership. Discussion: For NHs to fully implement PCC, a multifaceted approach to improve staffing is needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1 ) type 2 diabetes diagnosis competes with other complex life challenges, 2 ) difficulty in performing behavior modification actions, 3 ) lack of support, 4 ) emergence of emotional and psychological issues, and 5 ) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition., Competing Interests: No potential conflicts of interest relevant to this article were reported., (© 2023 by the American Diabetes Association.)

The diagnosis of type 2 diabetes initiates a new health-illness transition. However, little is known about the immediate support that people need to successfully cope with this diagnosis. This qualitative study explored the experiences and immediate support needed at the point of diagnosis among individuals with type 2 diabetes. The findings suggest the need for health care professionals to render immediate emotional support in the form of reassurance and partnership to manage the condition together. Pre- and post-counseling sessions can minimize the emotional and psychological strain associated with the new diagnosis. Individuals should be given information on available resources, as well as an immediate connection with a health care partner who can provide guidance and help with the transition., Competing Interests: No potential conflicts of interest relevant to this article were reported., (© 2023 by the American Diabetes Association.)

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., Competing Interests: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objectives: 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., Design: Secondary data analysis of repeated cross-sections., Setting and Participants: Data from 6 sources on Ohio NHs were merged to examine 1300 NH-year observations., Methods: 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., Results: 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., Conclusions and Implications: 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., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures., Methods: Using data from Ohio-based NHs ( n = 771), logistic regression techniques demonstrated the relationship between the PELI Implementation Indicator and two validated culture change measures, the Resident Preferences for Care (RPC) and Certified Nursing Assistant (CNA) Empowerment scales., Results: There was a significant relationship between the two scales and complete PELI implementation holding all other variables constant. The RPC and CNA Empowerment scales were significantly associated with complete PELI implementation., Discussion: Findings suggest that the PELI Implementation Indicator can be used as a pragmatic indicator of a community's adoption of person-centered care and culture change.

The Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress (BPSD) in Care Plans was developed to assess the person-centeredness of care plans for nursing home residents living with behavioral and psychological symptoms associated with dementia. The purpose of the current study was to evaluate the reliability and validity of a revised version of the Checklist. Data from a larger randomized clinical trial testing the implementation of the Evidence of Integration Triangle for BPSD were used. One hundred seventy-nine care plans for 103 residents were examined. Descriptive statistics, Rasch analysis, and inter-rater reliability were used. The Checklist demonstrated evidence of inter-rater reliability and validity based on model fit and acceptable INFIT and OUTFIT statistics. This study serves as pilot work for future Checklist use and validation efforts on a larger scale. Findings encourage a discourse on the inclusion of BPSD and person-centered approaches in care plans for those living with dementia. [ Research in Gerontological Nursing, 15 (6), 303-311.].

Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff , Potential Harms to Residents , and Positive Shared Outcomes . These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [ Research in Gerontological Nursing, 15 (6), 271-281.].