Assisted living (AL), an alternative to nursing homes, provides housing, meals, 24-hour supervision, and, in some cases, health and supportive services. Unlike other healthcare settings, AL uses a social rather than medical model of care emphasizing a person-centered approach. However, while AL strives for person-centered care, resident acuity has been rising (e.g., functional decline; dementia), creating tension between supporting autonomy and minimizing risks from medication errors, infections, falls, and in cases of dementia, elopement and injuries. Similarly, the focus on person-centered practices (e.g., aging in place, well-being, quality of life) can be at odds with safety risks such as injury, elopement, or worsening chronic conditions. Discrepancies between the goals of residents/family and AL staff may result in disagreements, dissatisfaction with care, unnecessary treatments or hospital transfers. Thus, the core challenge of AL care lies in balancing person-centeredness with safety risks. A highly promising method for achieving this balance is person and family engagement (PFE). PFE refers to the person and family?s desire, ability, and activation as a partner with an individual (e.g., staff or healthcare provider), team, and/or setting to maximize outcomes and experience of care. Although PFE research is beginning to address non-hospital settings such as primary care and nursing homes, very little has been conducted in AL settings. Given the uniqueness of AL, one cannot assume that the approaches applicable to hospitals will directly apply to AL; therefore, in the proposed research, we will explore how to translate and adapt existing PFE work to the AL setting and develop a comprehensive toolkit to increase PFE in AL safety. Through a stakeholder-engaged, mixed methods study we will complete the following aims:
AIM 1 : Identify common AL safety problems. We will use structured interviews and surveys to identify AL safety problems (including how safety risks are balanced with person-centered care factors) and determining strategies to increase PFE in AL from the perspectives of: a) AL residents and family caregivers; and b) professional stakeholders;
AIM 2 : Rank AL safety problems and evaluate existing PFE interventions, tools, and strategies applied to other healthcare settings for their fit with AL. We will first do a web-based Delphi panel with a stakeholder panel to rank the AL safety problems and reconcile differences across stakeholder type. Our study team will then evaluate PFE interventions and tools that may apply to AL. The stakeholder panel will then reconvene to review these strategies and evaluate the fit with AL;
and AIM 3 : Develop a testable toolkit to improve PFE in AL safety. Using web-based focus groups with the AL stakeholder panel from Aim 2, we will match the ranked AL safety problems with the most promising PFE strategies (from Aim 2), identify new PFE strategies for AL safety, and identify and create essential components of the toolkit.

Public Health Relevance

In the proposed study, we address AHRQ?s priority for safer health care by translating existing strategies for improving patient safety to AL residences and by developing an evidence-based tool for implementing these strategies in AL. This research will form the foundation for a large-scale efficacy study to test the implementation and impact of an AL safety-focused PFE toolkit on the safety of AL residents. The goal of this project is to make AL safer.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Healthcare Patient Safety and Quality Improvement Research (HSQR)
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Haugstetter, Monika
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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