Developing a Toolkit of Person-Centered Care Quality for Assisted Living

描述(由申请人提供)：在美国，100万老年人和受抚养的成年人在辅助生活(AL)中生活和接受护理，这些环境得到各州许可，每天至少提供两餐，计划和非计划的支持性护理，以及24小时监督。在过去的20年里，AL床位的数量增加了97%(达到近120万张床位)，而疗养院床位的数量只增长了7%(达到170万张床位)，这一过程在很大程度上是因为人们认为搬到养老院是一件“可怕的事情”。因此，AL如雨后春笋般涌现，作为养老院护理机构性质的一种意向解决方案，其数量还在继续上升。AL与疗养院护理的不同之处在于，它融入了包间、地毯、小厨房和餐桌上的食物，而不是托盘上的食物。然而，与此同时，大多数AL设置采用了养老院分层的、以任务为导向的运营文化和劳动力做法。因此，随着AL环境的发展，人们也越来越担心他们的护理是客观的和监护的，无法促进承诺的最佳福祉。此外，关于不适当护理、忽视和强迫转移等问题的报告已经变得司空见惯。因此，对AL将成为我国老年人长期护理的里程碑式改进的希望已经让位于对质量的担忧。辅助生活最初是作为以人为中心的疗养院的替代方案。不幸的是，随着该行业的发展，以及要求更严格监管的呼声越来越高，缺乏有效、可靠、广为接受的以人为本的护理措施，正促使监管机构采用养老院使用的传统、以医疗模式为重点的质量措施。我们现在正处于AL护理的转折点，开发和推广能够促进AL开发商最初设想的有前途的替代方案的措施是及时和紧迫的。这项研究项目的目标是通过开发一套有效和可靠的以人为中心的护理和结果测量工具来满足这一迫切需求，供AL管理人员、工作人员、居民、他们的家人和其他人使用，以改善护理和结果。该项目将使用以社区为基础的参与性研究方法来实现以下目标：(1)从概念和操作上确定以人为中心的护理的结构、过程和结果；(2)与AL管理人员、工作人员、居民及其家人一起对项目进行认知测试，并根据指示修改项目；以及(3)测试修订项目的工具包，以确定可行性、进行探索性因素分析、评估信度和效度、获得估计，并确定利益相关者之间的一致性。

DESCRIPTION (provided by applicant): One million older and dependent adults in the United States live and receive care in assisted living (AL), those settings licensed by states to provide at least two meals a day, scheduled and unscheduled supportive care, and 24-hour oversight. Over the last twenty years, the number of AL beds increased 97% (to almost 1.2 million beds), while the number of nursing home beds grew by only 7% (to 1.7 million beds), a process that was largely fueled by the perception that moving to a nursing home is a "dreaded event". Thus, AL mushroomed as an intended solution to the institutional nature of nursing home care, and its numbers continue to rise. AL has differed from nursing home care by incorporating homelike features such as private rooms, carpeting, kitchenettes, and meals served on table linens as opposed to on trays. However at the same time, most AL settings adopted the hierarchical, task-oriented operational culture and workforce practices of nursing homes. Consequently, as AL settings have grown, so too have concerns that their care is impersonal and custodial and fails to promote the optimal well-being that was promised. Further, reports have become commonplace of matters such as improper care, neglect, and forced transfer. As a result, hopes that AL would be a landmark improvement in long-term care for our nation's older adults have given way to concerns about quality. Assisted living began as an alternative to nursing homes that would be person-centered. Unfortunately, as the industry has grown, and as calls for stricter regulation have become more strident, the lack of valid, reliable, well-accepted measures of person-centered care is driving regulators to adopt the traditional, medical-model- focused quality measures used in nursing homes. We now are at a tipping point in AL care, wherein it is timely and urgent to develop and promote measures that can foster the promising alternative that was initially envisioned by AL developers. The goal of this research project is to address this urgent need by developing a toolkit of valid and reliable measures of person-centered care and outcomes for use by AL administrators, staff, residents, their families, and others to improve care and outcomes. The project will use a community-based participatory research approach to achieve the following aims: (1) determine the structures, processes, and outcomes of person-centered care, both conceptually and operationally; (2) conduct cognitive testing of the items with AL administrators, staff, residents, and their families, and modify the items as indicated; and (3) test the toolkit of revised items to determine feasibility, conduct exploratory factor analysis, assess reliability and validity, obtain estimates, and determine agreement among stakeholders.