Representation in the Care Planning Process for Nursing Home Residents With Dementia.
Ellen McCreedy, Lacey Loomer, Jennifer A Palmer and 3 others
PMID 29534863WHAT IT FOUND
Family or representative participation occurred in 16.0% of long-stay nursing home residents.
It rose with cognitive impairment, but 56% of residents with severe impairment had no one representing them during 2016 care planning assessments.
Key findings
01Family, significant other, or legal representative participation occurred in 16.0% of long-stay nursing home residents.
02Participation rose with cognitive impairment: 8.0% with no impairment, 14.7% with mild, 20.3% with moderate, and 26.3% with severe impairment.
03Nursing homes with more on-staff social workers per 100 resident beds were more likely to have family involvement.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data came from one large for-profit nursing home organization, so the findings may not apply to other chains, ownership types, or regions. The participation item was ambiguous: it was unclear whether it referred only to the care planning assessment or to the broader care planning process, and nursing homes may have documented it differently. Residents without complete cognitive status information or without any existing family or legal representative to contact were excluded, so the sample may not reflect residents who are truly without family. The study used one observation per resident from existing assessment data, so it can show associations but cannot prove that social work staffing or other factors caused family participation. The analysis did not measure whether family participation improved resident outcomes, including quality of life or end-of-life care.
Declared interests
The authors reported no conflicts of interest. The paper is listed as supported by NIH extramural research, and the data were provided by a large, for-profit nursing home organization participating in a pragmatic trial.
The easy way to misread this
Do not conclude that involving family members improves resident outcomes or that adding social workers causes more family participation. This was an observational analysis of assessment data from one nursing home chain, and it did not test whether participation changed quality of care.