Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

Poey, Judith L.; Hermer, Linda; Cornelison, Laci; Kaup, Migette L.; Drake, Patrick N; Stone, Robyn; Doll, Gayle

doi:10.1016/j.jamda.2017.06.007

Cited by 65 publications

(50 citation statements)

References 27 publications

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“…However, it is widely acknowledged that culture change is meant to be comprehensive in nature rather than limited to individual components or practices [7]. A recent study has shown that the intended benefits to residents’ satisfaction with quality of life, as well as improvements to residents’ health, primarily accrue after comprehensive rather than partial adoption of culture change via PCC practices [8]. Thus, comprehensive adoption of culture change is the ultimate goal of the movement, with current research suggesting that 87% of nursing homes have not met this mark [6].…”

Section: Introductionmentioning

confidence: 99%

Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention

et al. 2019

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Background Comprehensive adoption of culture change via person-centered care (PCC) practices in nursing homes has been slow. Change such as this, requires transformation of organizational culture, frequently generating resistance and slow moving change. This study examined how nursing homes perceive their adoption of PCC practices across seven domains and how these perceptions change in response to an educational intervention embedded in a statewide program, Promoting Excellent Alternatives in Kansas nursing homes (PEAK 2.0). Given perception is an important feature of the change process, it was hypothesized that pre-adopters engaging in PEAK 2.0’s initial Foundation year (level 0) would have lower perceived PCC adoption following a year of education and exposure to PCC, whereas adopters (PEAK 2.0 level 1–5 homes) would have higher perceived PCC adoption following a year of participation in their respective level in the program. Methods A multi-arm, pre/post intervention study was conducted during the 2014 and 2015 years of the PEAK 2.0 program comparing pre-PCC adopters to adopters. Outcomes were self-ratings of perceived PCC implementation across seven domains of PCC at the beginning and end of the 2014–15 program year, after pre-adopters had received PCC education and adopters had implemented a year of PCC. Paired t-tests and mixed repeated-measures linear models, controlling for potential confounders, were employed to test the study hypotheses. Results Across all seven domains of PCC, pre-adopters rated their PCC implementation as significantly higher on pre-test (2014) than on post-test (2015). In contrast, adopters rated their PCC achievement as higher on post-test (2015) than on pre-test (2014). Conclusions Pre-adopters’ lower score following a year of education and exposure to PCC may reflect a shift in perceptions of PCC as a concept or a deeper conceptualization of PCC. Since perceptions or assumptions can serve as a source of resistance to change, redefinition or “unlearning” to make way for more accurate definitions of PCC could aid in reducing organizational resistance to implementation of PCC and thus improve the rate of adoption. Electronic supplementary material The online version of this article (10.1186/s12877-019-1121-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention

et al. 2019

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“…(6) While more rigorous research supporting the efficacy of culture change transformation is needed,(7, 8) panel studies have found NH culture change adoption is associated with reductions in Medicare/Medicaid survey deficiencies, decreases in the prevalence of feeding tubes, restraints and pressure ulcers, and higher resident satisfaction with the quality-of-care and quality-of-life. (9–11)…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Culture Change Practice in US Nursing Homes

et al. 2018

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Background and Objectives: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/17 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. Research Design and Methods: We administered a nationwide survey to 2,142 NH Administrators (NHA) at NHs previously responding to a 2009/10 survey. Seventy-four percent of administrators (1,583) responded (with no detectable non-response bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores. Results: Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6 /100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures. Conclusion: The relatively higher resident-centered care scores (compared to other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.

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“…The results suggest that when facility staff understand PCC and hold an accurate view of their progress with implementation, PCC may markedly improve resident care. Recently, it was also shown that higher PEAK stages were associated with greater resident satisfaction with their quality of life and care (Poey et al, 2017). With the PEAK program’s successes, it could serve as a model for other states.…”

Section: Discussionmentioning

confidence: 99%

“…The nursing home culture change movement aims primarily to improve residents’ quality of life while not diminishing the quality of the care, whereas various nursing home P4P programs, typically funded by Medicaid, have targeted quality of life, quality of care, and other dimensions of nursing home operations (Arling, Job, & Cooke, 2009; Stone, Bryant, & Barbarotta, 2009; Weissert & Frederick, 2013). Recent reviews and large-scale studies suggest that some of these efforts have begun to improve residents’ quality of life (Kim & Park, 2017) and satisfaction with their nursing homes (Poey et al, 2017). However, it remains unclear whether either culture change or P4P programs consistently improve residents’ quality of care.…”

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confidence: 99%

Person-Centered Care as Facilitated by Kansas’ PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes

Hermer

Cornelison

Kaup

et al. 2018

Innovation in Aging

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Purpose of the StudyPerson-centered care (PCC) is intended to improve nursing home residents’ quality of life, but the closer bonds it engenders between residents and staff may also facilitate improvements to residents’ clinical health. Findings on whether adoption ameliorates resident clinical outcomes are conflicting, with some evidence of harm as well as benefit. To provide clearer evidence, the present study made use of Kansas’ PEAK 2.0 Medicaid pay-for-performance (P4P) program, which incents the adoption of PCC. The program is distinctive in training facilities’ staff on adopting PCC through a series of well-defined stages and providing regular feedback about their progress.Design and MethodsA retrospective cohort study was performed with 349 Kansas facilities spread across several well-defined PCC adoption stages, ranging from nonadoption to comprehensive adoption. The outcomes were thirteen 2014–2016 Nursing Home Compare long-stay resident clinical measures and a composite measure incorporating only nonimputed data for those 13 outcomes. Observed facility demographic differences were controlled for with propensity score adjustment. Treatment effect analyses were run with each outcome, with the predictor variable of program stage.ResultsSeven of the 13 clinical measures plus the composite measure indicated better health for residents in homes at higher program stages, relative to those in nonparticipating homes, including a 49% lower prevalence of major depressive symptoms in strongly adopting facilities.ImplicationsThe findings suggest that greater PCC adoption through PEAK participation is associated with better quality of care. Policymakers in other states may want to consider implementing a program modeled on PEAK 2.0.

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Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

Cited by 65 publications

References 27 publications

Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention

Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention

The Prevalence of Culture Change Practice in US Nursing Homes

Person-Centered Care as Facilitated by Kansas’ PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes

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