Offering nursing home (NH) residents choices about their daily life activities is intuitively important for both residents'psychological well-being and their quality of life. Recognizing this, federal regulations require that NH staff offer choices to residents during daily care provision.1 However, there is little data about how to train staff to offer residents'choice and the associated labor costs of adding this component to daily care provision (e.g., is more staff time needed to offer and comply with residents'choices?). In addition, there are sparse data that describe the resident outcomes associated with staff provision of choice during daily care (e.g., effects on psychological well-being, quality of life, depression). In this proposal, we will present preliminary data that illuminate challenges to offering and complying with NH residents'choices, including the prevalence of cognitive impairment among residents and apathy in the NH population. In addition, we will present data from a nationwide sample of NHs that suggests two underlying problems: 1) documentation of residents'preferences for daily care is often absent from care plans, and 2) staff do not consistently communicate with residents during care delivery in a manner that encourages active choice. It should be noted that only limited conclusions about care quality can be drawn from these preliminary data for two reasons. First, it is unclear how many residents are capable of stating stable preferences for daily care useful for care planning purposes. Second, it is unclear how many residents actually want to be offered choices about their daily care activities. The purpose of the proposed study is to develop assessment and intervention strategies that NH staff can use to increase resident involvement in making choices about four activities of daily living that occur during morning care. We targeted morning care because it offers staff the opportunity to encourage residents to make choices about four distinct areas: when to get out of bed, what clothes to wear, use of the toilet, and where to have breakfast. Morning care also typically occurs during a predictable time period, so supervisors can readily observe the quality of communication between residents and direct care staff regarding choice. Such observations-and the data they generate-are essential for effective staff training and management.
Quality of life outcomes are important considerations for most medical interventions but for frail nursing home residents they are perhaps the most important outcomes to measure and improve. This proposal describes a replicable intervention to improve residents' quality of life.
| Cohn, Joshua A; Shah, Avantika S; Goggins, Kathryn M et al. (2018) Health literacy, cognition, and urinary incontinence among geriatric inpatients discharged to skilled nursing facilities. Neurourol Urodyn 37:854-860 |
| Simmons, Sandra F; Durkin, Daniel W; Rahman, Annie N et al. (2014) The value of resident choice during daily care: do staff and families differ? J Appl Gerontol 33:655-71 |
| Schnelle, John F; Rahman, Annie; Durkin, Daniel W et al. (2013) A controlled trial of an intervention to increase resident choice in long term care. J Am Med Dir Assoc 14:345-51 |
| Simmons, Sandra F; Durkin, Daniel W; Rahman, Anna N et al. (2013) Resident characteristics related to the lack of morning care provision in long-term care. Gerontologist 53:151-61 |
| Simmons, Sandra F; Rahman, Annie; Beuscher, Linda et al. (2011) Resident-directed long-term care: staff provision of choice during morning care. Gerontologist 51:867-75 |
