Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI.
Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
J Am Med Dir Assoc. 2018 May;19(5):415-421. doi: 10.1016/j.jamda.2018.01.004. Epub 2018 Mar 10.
Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment.
Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial.
A total of 292 NHs from 1 large for-profit NH system.
Long-stay NH residents in 2016.
We identified all care planning assessments conducted in 2016 for long-stay NH residents. Cognitive functioning was defined using the Cognitive Function Scale. The Minimum Data Set was used to determine whether a resident, family member, and/or legal guardian participated in the assessment process. Certification and Survey Provider Enhance Reporting system data was used to identify facility-level correlates of family participation. Bivariate and multivariable hierarchical regression results are presented.
The analytic sample included 18,552 long-stay NH residents. Family member/representative participation varied by degree of resident cognitive impairment; 8% of residents with no cognitive impairment had family or representative participation in care planning during 2016, compared with 26% of residents with severe impairment. NHs with more social workers had greater family participation in care planning. Available NH characteristics do not explain most of the variation in family participation between NHs (residual intraclass correlation = .57).
Only a minority of family members and surrogates participate in NH care planning, even for residents with severe cognitive impairment. The association between social work staffing and participation suggests family involvement may be a measure of quality improvement capacity. Our findings suggest a lack of voice for a vulnerable population that may have implications on the quality of care received at the end of life.
联邦授权对养老院（NH）居民进行评估，以推动个性化护理计划。有认知障碍的居民在这个过程中可能无法有意义地传达他们的护理需求和偏好——这一差距可以通过引入代理人来部分解决。我们描述了在认知障碍程度不同的长期 NH 居民的护理计划过程中，家属参与的普遍程度。
使用作为正在进行的实用集群随机对照试验的一部分提供的行政数据进行的回顾性研究。
来自 1 个大型营利性 NH 系统的总共 292 个 NH。
2016 年长期 NH 居民。
我们确定了 2016 年对长期 NH 居民进行的所有护理计划评估。认知功能使用认知功能量表定义。最小数据集用于确定居民、家庭成员和/或法定监护人是否参与评估过程。认证和调查提供者增强报告系统数据用于识别设施层面与家庭参与相关的因素。呈现了单变量和多变量层次回归结果。
分析样本包括 18552 名长期 NH 居民。家庭成员/代表的参与程度因居民认知障碍程度而异；2016 年，没有认知障碍的居民中有 8%的人在护理计划中有家属或代表参与，而严重障碍的居民中有 26%的人有家属或代表参与。有更多社工的 NH 更有可能让家属参与护理计划。现有的 NH 特征并不能解释 NH 之间家庭参与度的大部分差异（残差组内相关系数=0.57）。
只有少数家属和代理人参与 NH 护理计划，即使是对认知障碍严重的居民也是如此。社工人员配备与参与之间的关联表明，家属参与可能是质量改进能力的一个衡量标准。我们的研究结果表明，弱势群体缺乏发言权，这可能对临终关怀的质量产生影响。
