Integrating Person-Centered Care Practices in SNFs

As patient-centered care becomes more integral to the health care field, care settings will need to begin implementing practices and quality improvement projects to meet higher standards. In fact, the Centers for Medicare & Medicaid Services emphasized resident-centered care planning in their recently revised regulations for long-term care facilities. With more emphasis on patients’ and residents’ care goals and personal wishes, providers will, ideally, be better positioned to make and plan medical decisions that will improve patient outcomes. For example, improved communication about advance care directives may reduce unnecessary hospital transfers and unwanted medical procedures or even halt unnecessary medication prescriptions. 

The practice of individualized goal setting is one method of improving patient involvement in care, yet most studies implementing goal setting practice are not in skilled nursing settings (SNFs). Yun Cai, MSN, AGNP, and colleagues recently piloted an innovative, patient-centered model of care within a SNF and then performed a content analysis specifically of the patient responses, in order to better understand patient perspectives and determine the usefulness of the statements. In collaborative care meetings, patients were encouraged to express not only their most important care goals but also their most important medical concerns—a small but helpful distinction. A key feature of this project is an emphasis on allowing patients to communicate their goals and concerns using their own words, which staff then wrote down verbatim. This is in contrast to other projects that provided patients with predefined categories of goals. 

Another facet of person-centered care involves taking into account potential health issues that patients have not even voiced themselves, such as end-of-life care and palliative measures. Abuse or risky use of alcohol and other substances also falls into this category. Although this is an often-forgotten medical concern for providers, screening for these potential health risks contribute to better health and successful outcomes in the long term and may reduce care transfers. However, relatively few alcohol and drug screening assessments have been conducted in older adults and even less in nursing facilities. Randi Berkowitz, MD, and colleagues sought to assess the feasibility of integrating alcohol and drug screening and interventions into a SNF, focusing on short-term patients. Working with nurse partners from the Commonwealth Care Alliance organization, authors used the Screening, Brief Intervention, and Referral to Treatment approach to measure the prevalence of high-risk drug and/or alcohol use among this population.

Improving person-centered care does not always, however, mean behavioral interventions or patient interviews; it also applies to the enhancement of pharmacologic treatments for long-standing diseases affecting patients’ quality of life. Parkinson disease is one of the most common neurologic disorders worldwide and is prevalent in older adults. The effects of the disease can be further complicated for patients who develop Parkinson disease psychosis (PDP), a symptom that can mimic dementia or delirium and can distress patients, increase caregiver burden, and lead to greater health costs. With no cure for such a common disease in the older population and limited treatment options for PDP, improving quality of life for these patients may seem a daunting task. Fortunately, the development of pimavanserin, approved in 2016, may provide a novel treatment option for PDP, according to Lindsy M Meadowcraft, PharmD, BCACP, CDE, and coauthors, who reviewed the drug to determine its safety and effectiveness. Specifically, Dr Meadowcraft and colleagues conducted a review of pimavanserin’s pharmacology, pharmacokinetics, clinical trial data, adverse effects, and its potential role in the treatment of hallucinations and delusions associated with PDP. Authors assert that pimavanserin may not only significantly improve elders’ quality of life in care facilities but may be able to delay their placement into such care facilities. 

Together, these articles discuss various methods that integrate patients’ individual care goals and needs into standard care practices, ideally making patient-centered care more the status quo rather than a rarity in the field of long-term and skilled nursing care.