AGREEMENT ON SEVERITY OF DEMENTIA AND PRESENCE OF ADVANCE CARE PLAN IN NURSING HOME RESIDENTS

Abstract Organizations in seven states have been participating in the Center for Medicare and Medicaid Innovation (CMMI) initiative aimed at reducing potentially avoidable hospitalizations among long-stay nursing home (NH) residents. The purpose of this study was to identify market and policy factors that may have affected the initiative in those states. Forty-seven interviews were conducted with key stakeholders in the seven states (e.g., representatives from state departments of health, state Medicaid offices, and nursing, hospital and nursing home associations) and qualitatively analyzed to identify themes across states. Few policies or programs were found that may have affected the initiative; only New York (NY) was found to have state policies or programs specifically aimed at reducing hospitalizations. Market pressures reported in most states were similar. For example, stakeholders reported that the increased availability of home and community-based services and the growing presence of managed care are contributing to higher acuity among both long and short stay residents and that reimbursement rates and staffing have not kept up. Stakeholders suggested greater presence of physicians and nurse practitioners in NHs, better training around behavioral health issues for frontline staff, and more advance care planning and education of families about end of life may help further reduce NH hospitalizations. We also found that all states, except NY, had regional coalitions of health care related organizations focused on improving some aspect of care, such as reducing hospital readmissions. These coalitions may suggest ways that organizations can work together to reduce hospitalizations among NH residents.

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Improving Quality of Life in Nursing Homes: The Structured Resident Interview Approach

Journal of Aging Research ◽

10.1155/2014/892679 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Howard B. Degenholtz ◽

Abby L. Resnick ◽

Natalie Bulger ◽

Lichun Chia

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

Planning Process ◽

Intervention Group ◽

Nursing Home Residents ◽

Care Plan ◽

Control Group ◽

Improvement Programs

The quality of life (QOL) of the approximately 1.5 million nursing facility (NF) residents in the US is undoubtedly lower than desired by residents, families, providers, and policy makers. Although there have been important advances in defining and measuring QOL for this population, there is a need for interventions that are tied to standardized measurement and quality improvement programs. This paper describes the development and testing of a structured, tailored assessment and care planning process for improving the QOL of nursing home residents. The Quality of Life Structured Resident Interview and Care Plan (QOL.SRI/CP) builds on a decade of research on measuring QOL and is designed to be easily implemented in any US nursing home. The approach was developed through extensive and iterative pilot testing and then tested in a randomized controlled trial in three nursing homes. Residents were randomly assigned to receive the assessment alone or both the assessment and an individualized QOL care plan task. The results show that residents assigned to the intervention group experienced improved QOL at 90- and 180-day follow-up, while QOL of residents in the control group was unchanged.

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The effects of a care plan based on the roy adaptation model on depression among nursing home residents

Nursing and Midwifery Studies ◽

10.4103/nms.nms_51_19 ◽

2021 ◽

Vol 10 (2) ◽

pp. 87

Author(s):

Esmaiel Maghsoodi ◽

Nishteman Alidoost ◽

Omid Naseri ◽

Aylin Jahanban ◽

MasumehHemmati Maslakpak ◽

...

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Care Plan ◽

Roy Adaptation Model ◽

Adaptation Model

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Treatment choice when faced with high risk of poor outcome – and response to decisions made by surrogates on their behalf

Medical Research Archives ◽

10.18103/mra.v8i11.2277 ◽

2020 ◽

Vol 8 (11) ◽

Author(s):

Charlie Corke ◽

Stella-May Gwini ◽

Sharyn Milnes ◽

Ben Jong ◽

Neil Orford

Keyword(s):

Online Survey ◽

Treatment Choice ◽

Decision Makers ◽

Care Plan ◽

Poor Outcome ◽

Advance Care Plan ◽

Hypothetical Scenario ◽

Surrogate Decision Makers ◽

Advance Care ◽

Surrogate Decision

Faced with a high likelihood of poor outcome treatment choice is difficult and few people are certain about what they would, or would not, want. Recognising this we sought to explore how individuals react to hypothetical choices made on their behalf by surrogate decision-makers. We used an online survey, using a hypothetical scenario involving a 95% chance of poor outcome and 5% chance of good outcome. There were 510 participants. Most (63%) expressed uncertainty regarding preference for treatment. 37% expressed certainty (12% certainly wanting treatment and 25% certainly not wanting treatment). Seventy seven percent indicated they would be understanding or pleased if the surrogate chose to treat, while 92% were understanding or pleased with a decision not to treat by a surrogate decision maker. Patients who had expressed ‘certain’ wishes when presented with the scenario (either certainly wanting or certainly not wanting treatment) were more likely to be angry/upset when surrogates made the opposite decision. Those who had completed an Advance Care Plan (ACP) were more likely to be angry/upset when these wishes were not followed. This finding suggests it may be unrealistic to expect surrogate decision-makers to identify ‘what the patient would want’ as a binary choice between consenting to treatment or refusing treatment when chances are poor and the decision is difficult. Asking surrogates to identify choices that they believe would be likely to make the person angry or upset might be more appropriate and more effective. Most people were understanding of decisions made by surrogates (whether these matched their preference or not). This finding should be used to reassure surrogates who are required to make difficult decisions. Additionally, factors associated with patient upset/anger at surrogate treatment decisions were identified. This most commonly included those patients who had documented wishes in an Advance Care Plan that was not followed.

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