Leslie Walker

Assessing capacity to participate in discussions of advance directives in nursing homes: findings from a study of the Patient Self Determination Act.

OBJECTIVE: To better understand the implementation of the Patient Self‐Determination Act (PSDA) in long‐term care, with a focus on the informing process as it affects advance directives.

Developing Individualized Care in Nursing Homes

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Education and Advance Care Planning in Nursing Homes: The Impact of Ownership Type

The study examined the association between ownership type and community benefit as measured by organizational approaches to patient, family, and community education. As a case study of the broader class of educational efforts, the inquiry focused on educational efforts regarding a central patient care issue for nursing homes: the use of life-sustaining medical treatment. Results indicated that nonprofit and for-profit nursing homes were equally likely to conduct educational efforts concerning advance care planning. However, nonprofit nursing homes were more likely than for-profit nursing homes to have ongoing, rather than sporadic, discussions about advance care planning; to broaden such discussions beyond life-support wishes; and to have ethics committees to support advance care planning. Other empirical research has demonstrated ownership differences in both cost and quality of care. This study offers new evidence regarding additional ways in which nonprofit long-term care facilities may be distinguished from their for-profit counterparts.

Institutional Efforts to Promote Advance Care Planning in Nursing Homes: Challenges and Opportunities

In an empirical study of Connecticut-area for-profit and nonprofit nursing homes, authors examine use of institution-specific advance care planning forms among nursing home residents.