Can Implementing Person-Centered Care Tools Reduce Complaints? Evidence from the Implementation of PELI in Ohio Nursing Homes.

Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P < .05) and any substantiated complaints by 11.5% points (P < .001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool.

Exploring the Relationship Between Extent of Person-Centered Care Implementation and Staffing Levels in Ohio Nursing Homes.

Background: The Preferences for Everyday Living Inventory (PELI) is a person-centered care (PCC) tool that uncovers/honors older adults' important preferences. PCC implementation in nursing homes (NHs) often requires additional resources, such as staff time. We explored if PELI implementation is associated with NH staffing levels. Methods: Using NH-year as the unit of observation (n = 1307), 2015 and 2017 data from Ohio NHs was used to examine the relationship between complete versus partial PELI implementation and staffing levels, measured in hours per resident day, for various positions and total nursing staff. Results: Complete PELI implementation was associated with higher nursing staff levels in both for-profits and not-for-profits; however, total nursing staff levels in not-for-profits were higher than for-profits (0.16 vs. 0.09 hours per resident day). The specific nursing staff associated with PELI implementation varied by ownership. Discussion: For NHs to fully implement PCC, a multifaceted approach to improve staffing is needed.

Organizational and Resident Characteristics of Nursing Homes Associated With Partial and Complete Implementation of the Preferences for Everyday Living Inventory.

Background and Objectives: Person-centered care practices are essential to providing high-quality care for nursing home (NH) residents. A key component of implementing person-centered care is the assessment and fulfillment of residents' preferences. However, few NHs consistently assess and implement residents' preferences into care. From 2015 to 2019, the Ohio Department of Medicaid added the Preference for Everyday Living Inventory (PELI), a scientifically validated tool to assess residents' preferences, as a quality indicator to improve the person centeredness of Ohio's NHs. In this study, we sought to identify the associations between resident and organizational characteristics and PELI implementation in Ohio NHs. Research Design and Methods: We constructed an NH-level database that merged data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, the Certification and Survey Provider Enhanced Reports data, the WWAMI Rural Health Research Center, and the Minimum Data Set. Freestanding NHs were included if they were owned by a for-profit or not-for-profit organization, and had data collected in 1 of 2 years (n = 1,320; year 2015, n = 814; year 2017, n = 506). Descriptive statistics and multiple logistic regression were used to understand the relationships between resident demographics, NH organizational characteristics, and partial versus complete PELI implementation. Results: Most NHs (71.2%) reported complete implementation of the PELI over 2 years with implementation increasing over time. There was a relationship between complete PELI implementation and for-profit status, higher number of beds, higher Medicare funding, higher certified nursing assistants and activity staff hours, and urban location. Discussion and Implications: This work has important implications for the implementation of person-centered care interventions in NHs and our understanding of what NH characteristics are related to successful implementation. The next steps should include a continued, detailed assessment of PELI implementation and an exploration of the potential impact of PELI implementation on residents, staff, and organizational outcomes.

Impact of Implementing the Preferences for Everyday Living Inventory on Nursing Home Survey Deficiencies.

OBJECTIVES: The purpose of this study is to expand on previous work testing the relationship between person-centered care (PCC) and quality outcomes in the nursing home (NH) setting. We explore if the Preferences for Everyday Living Inventory (PELI) implementation is a predictor of NH quality, as defined by deficiencies. DESIGN: Secondary data analysis of repeated cross-sections. SETTING AND PARTICIPANTS: Data from 6 sources on Ohio NHs were merged to examine 1300 NH-year observations. METHODS: Logistic regression techniques were used to evaluate the relationship between PELI implementation and 3 survey deficiency outcomes: whether the NH had a 4- or 5- deficiency star rating, deficiency score, and whether the NH had a deficiency score of 0. RESULTS: NHs with complete PELI implementation increased the probability of having a 4- or 5- deficiency star rating by 6 percentage points (P = .039). Results also show complete PELI implementation is related to lower deficiency scores and an increased probability of having a deficiency score of 0, but only a 0 deficiency score was marginally significant. CONCLUSIONS AND IMPLICATIONS: The findings indicate PCC stands to improve quality outcomes; however, benefits take time to show. Future research should seek to help improve NHs level of commitment to PCC and buy-in from policymakers.

Strategies to Address COVID-19 Vaccine Hesitancy Among Ohio Nursing Home Staff.

BACKGROUND AND OBJECTIVES: Despite federal legislation requiring nursing home (NH) staff members to be vaccinated against coronavirus disease 2019 (COVID-19), unvaccinated staff pose an ongoing public health risk. The research question guiding this study is as follows: What is the relationship between strategies to address vaccine hesitancy and vaccination rates among staff? We used the diffusion of innovation (DOI) theory as a theoretical framework. RESEARCH DESIGN AND METHODS: The sample (N = 627) included Ohio-based NHs. Using national and state NH data, multivariable linear regression techniques demonstrated the relationship between strategies to address vaccine hesitancy and vaccination rates among NH staff. RESULTS: Peer counseling and providing sick time or time off for vaccine symptoms were both statistically significant strategies. Compared to facilities that did not engage in peer counseling, those that did saw an average increase of 3.2% of their staff vaccinated. Those that provided sick time or time off saw an average increase of 3.9% of their staff vaccinated. There was no statistically significant relationship between hiring full- or part-time facility infection preventionists and vaccination rates. DISCUSSION AND IMPLICATIONS: In order to foster vaccine confidence among long-term services staff, peer counseling, and providing sick time or time off are examples of strategies that can affect vaccination rates among staff. According to DOI, these strategies target the communication channels and social systems of an organization. While this study focuses on NHs, results remain critically important to the remainder of the long-term services system, which does not have vaccine requirements similar to the NH industry.

Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures.

BACKGROUND: Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures. METHODS: Using data from Ohio-based NHs (n = 771), logistic regression techniques demonstrated the relationship between the PELI Implementation Indicator and two validated culture change measures, the Resident Preferences for Care (RPC) and Certified Nursing Assistant (CNA) Empowerment scales. RESULTS: There was a significant relationship between the two scales and complete PELI implementation holding all other variables constant. The RPC and CNA Empowerment scales were significantly associated with complete PELI implementation. DISCUSSION: Findings suggest that the PELI Implementation Indicator can be used as a pragmatic indicator of a community's adoption of person-centered care and culture change.