4 types of LTC resident preferences ID’ed, making the case for more tailored care: study 

A new study has identified four distinct preference groups among long-term care residents, shedding new light on the importance of comprehensive, person-centered care.

Researchers looked at the Centers for Medicare & Medicaid Services’ Minimum Data Set to examine how important residents rated 16 key elements of daily care and activities, such as participating in group activities, getting fresh air, involving family in care, and caring for one’s own belongings.

“We found that 16 preference items … can group residents into four groups,” the authors wrote. “The finding can guide the development of systematic approaches to care planning for diverse groups of residents while maintaining a high level of individualization.”

The largest of the four groups — almost 44% — was labeled the “high salience” group because they rated all 16 criteria as important. The “low salience” group was less than 9% of the sample and notably rated few items as important. 

The other groups were the “socially engaged” and “socially independent” groups — 27% and 21% respectively. These groups labeled most activities as important, but the socially engaged group placed far more emphasis on group activities while the socially independent group prioritized personal privacy over social engagement.

Distinct challenges

The research — published in the February issue of The Gerontologist — drew special attention to the low salience group. Though a small portion of the nursing home population, its members typically have elevated levels of cognitive impairment and depressive symptoms as well as difficulties with physical and sensory functions. 

“Our findings substantiate the need for a more attentive and comprehensive approach to assessing care preferences in the low salience group,” the authors claimed.

The authors recommended conducting regular assessments of these residents and their personal histories to determine why they rated so few factors as important and if anything can be done to meet unaddressed care needs.

“It is critical to discern the mismatch between residents’ real needs and expression of preferences,” the researchers said, “as the real needs may be suppressed due to perceptions of [their own] incompetency in pursuing these needs.” 

Similar challenges exist for the socially independent group, which reported higher levels of depressive symptoms and hearing loss. The study’s authors could not determine whether the lack of group activities was causing the symptoms or whether the reverse might be true, but they recommended that care providers remain aware of the correlation.

“The results underscore the importance of tailored social and recreational activities that are suitable for the socially independent group, as well as continuous monitoring of their mental and functional health,” they said.

Provider takeaways

The three groups that view some or all key areas as “less important” should receive more attention from care providers, according to the study’s lead author, Yinfei Duan, PhD, of the University of Alberta.

“These individuals often exhibit challenges in functional, cognitive, and emotional domains and are found in nursing homes with fewer activity staff,” she told McKnight’s. “It’s crucial for the providers to develop more thorough preference assessments and adopt more sensitive approaches to evaluating the preferences of these groups of residents.”

The researchers noted that person-centered care is already becoming more prevalent in nursing homes. They highlighted several key ways facilities can provide for residents while keeping these four preference groups in mind. 

Perhaps most straightforward would be increasing the level of activities staff at facilities. Low staffing in this area is “significantly associated” with residents falling into the three lower-salience categories, the researchers noted.

Other possible steps include asking residents about other preferences beyond the 16 included in the MDS and regularly keeping track of how preferences and health indicators change over time. The researchers also suggested that examining how changing preferences and changing health indicators are related to each other would be ripe for further study. 

Co-authors were Weiwen Ng and Odichinma Akosionu, doctoral students at the University of Minnesota, Tetyana Shippee, PhD, professor at the University of Minnesota and John Bowblis, PhD, professor at Miami University.