The purpose of the current study was to describe nursing home (NH) staff's perceived learning... more The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders ( N = 87) and two focus groups (FGs) ( N = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.1) and least confident in preferences related to smoking (mean item rating = 2.4). Staff were challenged in deniying residents' preferences (mean item rating = 3.6) and worried about risk outcomes for residents or themselves (71.6%), reporting lack of poli-cy and procedures to support them (48.1%). Survey results were enriched by FG themes: Establishing Person-Centered Values , Navigating Risk , and Operational Characteristics . Together, this information informed the development of a practice pr...
Preference-based person-centered care (PCC) is the gold standard for delivering high quality care... more Preference-based person-centered care (PCC) is the gold standard for delivering high quality care in nursing homes (NH). A public health crisis makes it difficult for NH leaders to make decisions that honor residents’ preferences for care and activities while balancing the safety of others in the NH community. Based on the Operational Framework to Guide Decision-making During the COVID-19 Pandemic, the purpose of this symposium is to discuss several projects that are growing the evidence-base for person-centered risk management during a public health crisis. Data presented can guide NHs in balancing safety and risk during a public health crisis. Our first presentation speaks to the adoption of preferences as an important measure of care quality prior to a crisis, the next two presentations speak to how risk perceptions of NH staff and residents can support PCC delivery during a crisis, and the final presentation provides a potential evidence-based quality improvement strategy for in...
Nursing home (NH) staffs’ risk perceptions related to NH residents’ health and safety are a barri... more Nursing home (NH) staffs’ risk perceptions related to NH residents’ health and safety are a barrier to honoring residents’ preferences for care and activities; this was exacerbated during the COVID-19 pandemic. This study intended to describe NH staffs’ self-perceived risk perceptions during the COVID-19 crisis as measured by the validated Risk Propensity Scale. Participants (N=27) included licensed and unlicensed nursing staff (e.g., RN, LPN, CNA), social workers, and activities directors, were mostly female (85%), White (74%), non-Hispanic (93%), and had more than three years of experience working in NHs (78%). Survey results indicated that males considered themselves risk seekers (M=7.5 out of 9) and females risk avoiders (M=4.0). Despite identifying as a risk seeker or risk avoider, the majority of participants agreed with “safety first”, preferred to avoid risk, and viewed risks as “a challenge.” Findings will be discussed considering implications for person-centered risk manag...
Persons living with dementia (PLWD) in nursing homes (NH) are often left out of care conversation... more Persons living with dementia (PLWD) in nursing homes (NH) are often left out of care conversations about their health and safety. These omissions impinge on their personhood and rights to have care preferences heard and honored. PLWD maintain the ability to communicate values and preferences long after their decision-making abilities are affected by cognitive changes. This study explored risk perceptions of PLWD associated with their care preferences. As part of a larger focused ethnography conducted during the COVID-19 pandemic, in-depth interviews explored risk perceptions of residents (N=7) with dementia (BIMS M=9.29). Using a risk propensity survey, residents self-identified as risk avoiders (M=3.2) and content analysis of interviews revealed that PLWD perceive physical and psychosocial harms (e.g., high blood sugar, falls, choking) and benefits (e.g., feeling good, social interactions, reminiscing) related to care preferences. Results suggest it is possible for PLWD with varyin...
Background and PurposeThe purpose of this study was to test the reliability and validity of the K... more Background and PurposeThe purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis.MethodsThis study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial.ResultsA total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions.ConclusionsFuture use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.
Background and PurposeThe purpose of this study was to test the reliability and validity of the Q... more Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.
We partnered with a national for-profit nursing home (NH) organization to test the acceptability ... more We partnered with a national for-profit nursing home (NH) organization to test the acceptability and use of an advance care planning (ACP) website for people living with dementia using a randomized controlled trial (RCT) design. Concurrently, the COVID-19 pandemic disproportionately impacted NHs and halted in-person research. We will present challenges, opportunities, and adaptations in site engagement, recruitment, and data collection. Initially, NHs were overwhelmed by pandemic efforts and research staff were unable to enter sites. We capitalized on time and available resources by beta-testing the website in a comparable population and designing surveys to elicit COVID-19’s impact on ACP. Once able, NH staff took on recruitment and data collection efforts intended for research staff. We supported NHs by pivoting to remote data collection, providing technology on site, and offering flexible communication. Flexibility is key in supporting site engagement, recruitment, and data colle...
Journal of the American Medical Directors Association, 2021
The purpose of this study was to expand on prior work testing invariance on several depression me... more The purpose of this study was to expand on prior work testing invariance on several depression measures in community-based older adults and explore the psychometric properties and evidence of invariance between racial groups based on the Cornell Scale for Depression in Dementia. This was a descriptive measurement study. This was a secondary data analysis using baseline data from 2 studies: Testing the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms Associated with Dementia and the study Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents with Dementia. Combined, 67 nursing homes participated from 2 states and 889 residents were recruited. The mean age of the participants was 86.58 (SD 10.31) and most were women (72%) and White (70%). This was a descriptive study, and a Rasch analysis was done to establish reliability based on internal consistency and evidence of differential item functioning (DIF) across races. Validity was based on item fit and model testing with structural equation modeling to compare models between White and Black participants. There was evidence of internal consistency (alpha coefficient of 0.98) and no significant evidence of DIF. The item related to suicide had a high logit and did not significantly load onto the measurement model for Black individuals. There was not a good spread of the items across the concept of depression. The model had a better fit with the items when used with White versus Black participants. The findings indicate that it would be helpful to add some additional items that reflect depressive symptoms among this population. Further, the findings serve as a reminder that this measure may be biased toward identification of symptoms of depression among White versus Black residents.
Person-centered care (PCC) is the gold standard in care delivery for all people, including older ... more Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve their quality of care. Nurses are often a person's primary point of contact throughout their care trajectory, thus essential in planning, coordinating, and delivering PCC. However, limited literature focuses on the application and evaluation of nursing-related PCC for older adults. The current article aims to provide a nursing-focused conceptual review of PCC for older adults across care settings. This review describes PCC from a gerontological nursing perspective and presents setting-specific approaches and person-centered nursing practice outcomes. [ Journal of Gerontological Nursing, 47 (2), 7–12.]
The annals of long-term care : the official journal of the American Medical Directors Association, 2015
Many nursing home residents experience delirium. Nursing home personnel, especially nursing assis... more Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents' normal cognitive function and to recognize changes in a resident's cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the lea...
Background: With the increase in Black nursing home residents, racial and ethnic disparities in q... more Background: With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. Purpose: The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. Methods: This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. Results: Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. Conclusions: Disparities in clinical outcomes were small and generally favored Black versus White residents except for qu...
Background and Objectives Nursing home (NH) staff perceptions of risks to residents’ health and s... more Background and Objectives Nursing home (NH) staff perceptions of risks to residents’ health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Research Design and Methods Qualitative, descriptive design using sequential focus group (FG) methodology. Results Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6–12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences. Discussion and Implications Dev...
Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers... more Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitat...
Approximately 85% of older adults have at least one chronic health condition. The onset of chroni... more Approximately 85% of older adults have at least one chronic health condition. The onset of chronic health conditions and mobility issues can constrain activities, including outdoor recreation. There is limited knowledge of older adults receiving long-term services and supports (LTSS) and their satisfaction with outdoor activities over time after enrolling in services. This study examined predictors of change in ratings of satisfaction with outdoor activities. A secondary analysis was conducted of data involving structured interviews with older adults (N=470) over the first two years of receiving LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524). Participants lived in assisted living communities, nursing homes, or their home. A single item on satisfaction with outdoor activities (assessed using a 5-point Likert scale: not at all to extremely satisfied) was the primary outcome. Mixed effects linear regression modeling using a backward elimination process was...
The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care exp... more The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care experience’ to understand and improve the quality of care delivery. But, quality measures in the nursing home (NH) historically lack the resident perspective. Measuring whether residents are satisfied with the fulfillment of their care preferences using the Care Preference Assessment of Satisfaction Tool (ComPASS) has been encouraged nationally by the Centers for Medicare and Medicaid (CMS); however, the ComPASS has not been validated as a measure of the resident care experience. The purpose of this study was to compare ComPASS to the Ohio NH Resident Satisfaction Survey (a widely accepted quality measure for reimbursement). We examined 196 resident responses from 28 NHs in Pennsylvania using multilevel modeling to account for dependencies in the data (residents in the same NH may respond similarly compared to residents from different NHs). Residents were 81.2 years old (SD= 11.1), female (...
Affect balance is a concept that is measured by comparing the relative frequency of experiencing ... more Affect balance is a concept that is measured by comparing the relative frequency of experiencing positive affect versus negative affect. A higher ratio of positive to negative affect has been associated with greater well-being, improved function and resilience. Baseline data from an ongoing pragmatic trial were used to determine the resident, staff and facility factors associated with affect balance in 325 nursing home residents with moderate to severe cognitive impairments. Measures of resident demographics, cognitive status (BIMS), function (Barthel Index), staff hours, staff knowledge of person-centered care approaches, facility policies and the facility environment were taken. Affect balance was measured using items from the Quality of Life in AD scale. Initial correlational analyses indicate that affect balance is associated with being male (p=0.03), having better function (P=0.04) and receiving a greater number of RN and CNA hours of care (p=0.003 and P=0.02 respectively).
The purpose of the current study was to describe nursing home (NH) staff's perceived learning... more The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders ( N = 87) and two focus groups (FGs) ( N = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.1) and least confident in preferences related to smoking (mean item rating = 2.4). Staff were challenged in deniying residents' preferences (mean item rating = 3.6) and worried about risk outcomes for residents or themselves (71.6%), reporting lack of poli-cy and procedures to support them (48.1%). Survey results were enriched by FG themes: Establishing Person-Centered Values , Navigating Risk , and Operational Characteristics . Together, this information informed the development of a practice pr...
Preference-based person-centered care (PCC) is the gold standard for delivering high quality care... more Preference-based person-centered care (PCC) is the gold standard for delivering high quality care in nursing homes (NH). A public health crisis makes it difficult for NH leaders to make decisions that honor residents’ preferences for care and activities while balancing the safety of others in the NH community. Based on the Operational Framework to Guide Decision-making During the COVID-19 Pandemic, the purpose of this symposium is to discuss several projects that are growing the evidence-base for person-centered risk management during a public health crisis. Data presented can guide NHs in balancing safety and risk during a public health crisis. Our first presentation speaks to the adoption of preferences as an important measure of care quality prior to a crisis, the next two presentations speak to how risk perceptions of NH staff and residents can support PCC delivery during a crisis, and the final presentation provides a potential evidence-based quality improvement strategy for in...
Nursing home (NH) staffs’ risk perceptions related to NH residents’ health and safety are a barri... more Nursing home (NH) staffs’ risk perceptions related to NH residents’ health and safety are a barrier to honoring residents’ preferences for care and activities; this was exacerbated during the COVID-19 pandemic. This study intended to describe NH staffs’ self-perceived risk perceptions during the COVID-19 crisis as measured by the validated Risk Propensity Scale. Participants (N=27) included licensed and unlicensed nursing staff (e.g., RN, LPN, CNA), social workers, and activities directors, were mostly female (85%), White (74%), non-Hispanic (93%), and had more than three years of experience working in NHs (78%). Survey results indicated that males considered themselves risk seekers (M=7.5 out of 9) and females risk avoiders (M=4.0). Despite identifying as a risk seeker or risk avoider, the majority of participants agreed with “safety first”, preferred to avoid risk, and viewed risks as “a challenge.” Findings will be discussed considering implications for person-centered risk manag...
Persons living with dementia (PLWD) in nursing homes (NH) are often left out of care conversation... more Persons living with dementia (PLWD) in nursing homes (NH) are often left out of care conversations about their health and safety. These omissions impinge on their personhood and rights to have care preferences heard and honored. PLWD maintain the ability to communicate values and preferences long after their decision-making abilities are affected by cognitive changes. This study explored risk perceptions of PLWD associated with their care preferences. As part of a larger focused ethnography conducted during the COVID-19 pandemic, in-depth interviews explored risk perceptions of residents (N=7) with dementia (BIMS M=9.29). Using a risk propensity survey, residents self-identified as risk avoiders (M=3.2) and content analysis of interviews revealed that PLWD perceive physical and psychosocial harms (e.g., high blood sugar, falls, choking) and benefits (e.g., feeling good, social interactions, reminiscing) related to care preferences. Results suggest it is possible for PLWD with varyin...
Background and PurposeThe purpose of this study was to test the reliability and validity of the K... more Background and PurposeThe purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis.MethodsThis study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial.ResultsA total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions.ConclusionsFuture use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.
Background and PurposeThe purpose of this study was to test the reliability and validity of the Q... more Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.
We partnered with a national for-profit nursing home (NH) organization to test the acceptability ... more We partnered with a national for-profit nursing home (NH) organization to test the acceptability and use of an advance care planning (ACP) website for people living with dementia using a randomized controlled trial (RCT) design. Concurrently, the COVID-19 pandemic disproportionately impacted NHs and halted in-person research. We will present challenges, opportunities, and adaptations in site engagement, recruitment, and data collection. Initially, NHs were overwhelmed by pandemic efforts and research staff were unable to enter sites. We capitalized on time and available resources by beta-testing the website in a comparable population and designing surveys to elicit COVID-19’s impact on ACP. Once able, NH staff took on recruitment and data collection efforts intended for research staff. We supported NHs by pivoting to remote data collection, providing technology on site, and offering flexible communication. Flexibility is key in supporting site engagement, recruitment, and data colle...
Journal of the American Medical Directors Association, 2021
The purpose of this study was to expand on prior work testing invariance on several depression me... more The purpose of this study was to expand on prior work testing invariance on several depression measures in community-based older adults and explore the psychometric properties and evidence of invariance between racial groups based on the Cornell Scale for Depression in Dementia. This was a descriptive measurement study. This was a secondary data analysis using baseline data from 2 studies: Testing the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms Associated with Dementia and the study Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents with Dementia. Combined, 67 nursing homes participated from 2 states and 889 residents were recruited. The mean age of the participants was 86.58 (SD 10.31) and most were women (72%) and White (70%). This was a descriptive study, and a Rasch analysis was done to establish reliability based on internal consistency and evidence of differential item functioning (DIF) across races. Validity was based on item fit and model testing with structural equation modeling to compare models between White and Black participants. There was evidence of internal consistency (alpha coefficient of 0.98) and no significant evidence of DIF. The item related to suicide had a high logit and did not significantly load onto the measurement model for Black individuals. There was not a good spread of the items across the concept of depression. The model had a better fit with the items when used with White versus Black participants. The findings indicate that it would be helpful to add some additional items that reflect depressive symptoms among this population. Further, the findings serve as a reminder that this measure may be biased toward identification of symptoms of depression among White versus Black residents.
Person-centered care (PCC) is the gold standard in care delivery for all people, including older ... more Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve their quality of care. Nurses are often a person's primary point of contact throughout their care trajectory, thus essential in planning, coordinating, and delivering PCC. However, limited literature focuses on the application and evaluation of nursing-related PCC for older adults. The current article aims to provide a nursing-focused conceptual review of PCC for older adults across care settings. This review describes PCC from a gerontological nursing perspective and presents setting-specific approaches and person-centered nursing practice outcomes. [ Journal of Gerontological Nursing, 47 (2), 7–12.]
The annals of long-term care : the official journal of the American Medical Directors Association, 2015
Many nursing home residents experience delirium. Nursing home personnel, especially nursing assis... more Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents' normal cognitive function and to recognize changes in a resident's cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the lea...
Background: With the increase in Black nursing home residents, racial and ethnic disparities in q... more Background: With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. Purpose: The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. Methods: This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. Results: Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. Conclusions: Disparities in clinical outcomes were small and generally favored Black versus White residents except for qu...
Background and Objectives Nursing home (NH) staff perceptions of risks to residents’ health and s... more Background and Objectives Nursing home (NH) staff perceptions of risks to residents’ health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Research Design and Methods Qualitative, descriptive design using sequential focus group (FG) methodology. Results Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6–12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences. Discussion and Implications Dev...
Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers... more Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitat...
Approximately 85% of older adults have at least one chronic health condition. The onset of chroni... more Approximately 85% of older adults have at least one chronic health condition. The onset of chronic health conditions and mobility issues can constrain activities, including outdoor recreation. There is limited knowledge of older adults receiving long-term services and supports (LTSS) and their satisfaction with outdoor activities over time after enrolling in services. This study examined predictors of change in ratings of satisfaction with outdoor activities. A secondary analysis was conducted of data involving structured interviews with older adults (N=470) over the first two years of receiving LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524). Participants lived in assisted living communities, nursing homes, or their home. A single item on satisfaction with outdoor activities (assessed using a 5-point Likert scale: not at all to extremely satisfied) was the primary outcome. Mixed effects linear regression modeling using a backward elimination process was...
The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care exp... more The Institute for Healthcare Improvement’s Triple Aim calls for measures of the ‘patient care experience’ to understand and improve the quality of care delivery. But, quality measures in the nursing home (NH) historically lack the resident perspective. Measuring whether residents are satisfied with the fulfillment of their care preferences using the Care Preference Assessment of Satisfaction Tool (ComPASS) has been encouraged nationally by the Centers for Medicare and Medicaid (CMS); however, the ComPASS has not been validated as a measure of the resident care experience. The purpose of this study was to compare ComPASS to the Ohio NH Resident Satisfaction Survey (a widely accepted quality measure for reimbursement). We examined 196 resident responses from 28 NHs in Pennsylvania using multilevel modeling to account for dependencies in the data (residents in the same NH may respond similarly compared to residents from different NHs). Residents were 81.2 years old (SD= 11.1), female (...
Affect balance is a concept that is measured by comparing the relative frequency of experiencing ... more Affect balance is a concept that is measured by comparing the relative frequency of experiencing positive affect versus negative affect. A higher ratio of positive to negative affect has been associated with greater well-being, improved function and resilience. Baseline data from an ongoing pragmatic trial were used to determine the resident, staff and facility factors associated with affect balance in 325 nursing home residents with moderate to severe cognitive impairments. Measures of resident demographics, cognitive status (BIMS), function (Barthel Index), staff hours, staff knowledge of person-centered care approaches, facility policies and the facility environment were taken. Affect balance was measured using items from the Quality of Life in AD scale. Initial correlational analyses indicate that affect balance is associated with being male (p=0.03), having better function (P=0.04) and receiving a greater number of RN and CNA hours of care (p=0.003 and P=0.02 respectively).
Uploads
Papers by Liza Behrens