Person-directed care planning in long term care: A comparative perspective on policy trends and policy-relevant implementation factors
Michael Lepore | RTI International
Engaging long-term care (LTC) residents in planning their own care is an essential feature of person-centred approaches to LTC. While engagement in care planning has been related to improved quality of care and decreased costs in other care settings, little research addresses policies and practices to effectively engage residents in care-planning in LTC.
Objectives: Thus, the objectives of this presentation are to describe how LTC policies address resident engagement in care-planning and to discuss how LTC providers engage residents in care-planning, with reference to policy-relevant barriers, facilitators, and outcomes.
Data and methods: Two data sources inform this presentation: (1) an international scoping review focused on policies and strategies for engaging individuals in planning their care across various types of care contexts (642 articles included; 245 retained; 70 assigned primary relevance); and (2) focus groups about resident engagement in care-planning with a diverse group of U.S. nursing home stakeholders (N = 66), including LTC administrators, nurses and nurse aides, clients, and clients’ families. The scoping review and focus groups were conducted by an interdisciplinary team who used thematic content analysis to identify prominent themes.
Results: Across nations, policies promote LTC resident engagement in care-planning, with emphasis on principles of autonomy, choice, and human rights; policies differ, however, in their specificity and scope (with regards to the level of prescriptiveness and the type of facilities and residents covered). In alignment with policy requirements, LTC providers implement a variety of strategies, such as assessing residents’ treatment goals upon admission, integrating residents’ preferences into care-plans, posting key care-plan elements in residents’ rooms, and implementing bed-side care-plan discussions. Barriers to engaging residents in care-planning include difficulty changing existing processes, limited time for care-planning activities, limited staff awareness regarding the value of and processes for engaging residents, and heterogeneity of LTC populations. Facilitators include leadership support and resident empowerment in the broader organisational culture. Outcomes are consistently found to be favourable, but inconsistently assessed, and include improved resident health and enhanced staff satisfaction. Focus group findings highlighted strategies for operationalising client engagement in culturally and setting-specific ways, highlighting the importance of leadership and relationships.
Policy implications: While person-centred care is a consistent policy goal across the body of international research reviewed, meaningfully engaging residents in care-planning requires attention to local factors and processes as well as national guidance. Findings highlight elements of a policy agenda to support LTC resident engagement in care-planning. For example, policies requiring collection of core data elements would support consistent assessment of resident engagement in care-planning and related outcomes. As evidence grows regarding the effectiveness of care-planning strategies, policies can more prescriptively guide providers how to engage residents in care-planning. Furthermore, policies that remove barriers to resident engagement in care-planning may be needed, such as by reimbursing LTC providers for more care-planning time. Ultimately, LTC policy can help translate universal concepts, such as those of choice and human rights, into meaningful care-planning practices resulting in quality outcomes.