IDENTIFYING, DEVELOPING, AND IMPLEMENTING CARE PLANS CONSISTENT WITH GOALS, PRIORITIES, AND PREFERENCES

Abstract NASEM’s first recommendation to reform nursing home (NH) care is to deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety, promotes autonomy, and manages risks. The NH Code of Federal Regulations requires person-centered care (PCC). However, while there are existing structures (i.e. MDS 3.0) to support care planning clinical needs, most NHs lack tools and procedures to systematically identify and provide care that aligns with resident goals, priorities, and preferences (GPPs). This is especially true for GPPs that reflect personhood and the human desire for autonomy. Our subcommittee aims to change the culture of care planning in NHs to integrate residents and families in co-developing holistic, person-centered care plans that centralize residents’ GPPs in ways that promote and support personhood. Our subcommittee will develop and test a) a standardized GPP care planning process that includes enhanced approaches to identification, documentation, communication, and implementation of resident GPPs; b) a repository of tools to support identification and documentation of resident GPPs; and c) training to prepare staff to understand and recognize resident GPPs. We will collaborate with other Moving Forward Committees to develop approaches to evaluating and measuring quality in care planning with inclusion of health information technology . When completed, the proposed work will provide evidence of successful and feasible quality improvement approaches to care planning resident GPPs that can augment existing federal requirements and can inform future policy changes or guidance to surveyors.

The Moving Forward Nursing Home Quality Coalition advances the goals outlined by the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report aimed at improving nursing home (NH) quality.Over two years, Coalition committee members -along with a network of national leaders, nursing home residents, and the general public -will develop, test and promote action plans that will improve the way the United States finances, delivers, and regulates care in Nursing Homes.The Coalition is comprised of a steering committee and working committees that align with and advance the seven NASEM goals including; 1) advancing delivery of person-centered care; 2) ensuring a well-prepared and compensated workforce; 3) increasing financial transparency and accountability; 4) creating a rational and robust financing system; 5) designing more effective and responsive quality assurance; 6) expanding quality measurement and continuous quality improvement; and 7) adopting health information technology.Coalition committees have engaged in three of four phases of their two-year work plan including convening stakeholders to prioritize and develop action plans to test and promote change.Throughout the work, committee collaboration has ensured action plans are refined and expanded in synergistic ways to shape state and national policy.This presentation will provide an overview of the broader Coalition work and give context for the other presentations which provide an example of collaborative work leading to proposed recommendations for critical policy and regulatory change around person-centered care planning.
Richardson, Texas, United States,4. ADVION,Washington D.C.,District of Columbia,United States,5. Massachusetts,United States The Moving Forward Coalition established a health information technology (HIT) committee to develop action plans to advance the adoption of HIT in all nursing facilities.Currently, more than 70% of nursing facilities in the US have some HIT, although the levels of utilization vary greatly.Few facilities, however, have successfully implemented the capabilities required to survive in a Value Based Payment (VBP) model which Medicare will mandate by 2030.Fewer still have HIT that collects the resident's goals, preferences, and priorities (GPPs) efficiently and in detail despite current CMS requirements for person-centered care.To the best of our knowledge, no nursing facilities possess an HIT-enabled capability to determine whether the care provided aligns with the individual's GPPs.In this presentation, members of the HIT Committee of the Moving Forward Coalition will discuss the rationale for adopting the following three HIT priorities to realize the target goals of the Coalition and will review progress made to date: 1) develop a benchmarking tool that enables nursing facilities to understand and plan for the HIT capabilities needed to meet upcoming regulatory requirements and for successful participation in a VBP model, 2) create a taxonomy of GPPs and an HIT-based process to collect them, and 3) develop and test an HIT-enabled process to measure the concordance of care provided with an individual's GPPs.Although the Moving Forward Coalition and the NASEM report focus on nursing facilities, the HIT tools being developed here will benefit all sites of care.

MEASURING AND IMPLEMENTING PERSON-CENTERED LONG-TERM CARE: GLOBAL PERSPECTIVES
Chair: Tonya Roberts Co-Chair: Franziska Zuniga Discussant: Michael Lepore Person-centered care (PCC) is internationally recognized as an essential strategy for achieving high quality care and quality of life for older adults who need long-term care (LTC).Despite international endorsement, our understanding of PCC is largely derived from research and practice in western countries.It is less clear whether PCC practices and benefits are generalizable on a global scale.PCC may vary structurally across healthcare contexts and cultures where values, experiences, and needs of older adults differ.Understanding how to culturally adapt or extend the concept, measurement, and implementation of PCC is needed to better inform care and improve outcomes for a diverse and international population of older adults.The purpose of this symposium is to present theory and research across healthcare settings and from countries across multiple continents to comparatively analyze the cultural implications of PCC concepts and discuss the implications for implementation, measurement, and research.The first presentation will contextualize the concept of PCC from an international perspective, summarizing and comparing what is known about PCC from existing literature.The second presentation will compare barriers and facilitators of PCC implementation during mealtimes in three European countries.The third will highlight variations in PCC definitions from qualitative research conducted with providers in middle-and low-income countries.The fourth presentation will report on the development and implementation of a system of PCC and LTC in Brazil.The final presentation will use secondary data to compare the measurement and LTC needs of family caregivers across the US and China.This is a Common Data Elements for International Research in Residential Long-term Care Interest Group Sponsored Symposium.

PERSON-CENTERED CARE: SETTING THE INTERNATIONAL SCENE FROM A CONCEPTUAL PERSPECTIVE
Tonya Roberts 1 , and Annica Backman 2 , 1. University of Wisconsin, Madison, Wisconsin, United States, 2. Umea University, Umea, Vasterbottens Lan, Sweden Over 142 million older persons worldwide need assistance with meeting basic needs, often requiring some level of long-term support and services.Person-centered care (PCC) is internationally recognized as an essential strategy for achieving high quality care and quality of life for older adults who need long-term care.Rather than focusing only on disease management or preventing morbidity, PCC results in positive outcomes for older people and their caregivers by focusing care on the whole person in their unique environment and aligning care with what is holistically meaningful to older people.Although PCC has become the gold standard for care of older adults, its widespread implementation has led to theoretical, conceptual, and practical inconsistencies that make it challenging to compare or evaluate its application or effectiveness globally.This is particularly problematic given our understanding of PCC is largely derived from research and practice in western cultures.Despite positive outcomes, the wide spectrum of person-centered interventions introduces variation which has made global comparisons difficult and ability to identify needs for cultural adaptation largely absent.To be able to compare PCC internationally, and reflect on potential needs for cultural adaptation, more conceptual clarity of the concept of PCC, its measurement, and implementation is needed.The purpose of this presentation is to review the use, value, and implementation of PCC concepts in international literature and present possible future directions for extending PCC to be more culturally inclusive for a global older adult population.

RESIDENT EXPERIENCES OF PERSON-CENTRED CARE AT MEALTIMES IN LONG-TERM RESIDENTIAL CARE: A RAPID ETHNOGRAPHY
Megan Davies 1 , Franziska Zuniga 2 , Hilde Verbeek 3 , and Sandra Staudacher 4 , 1. Medical Faculty, University of Basel,Basel,Switzerland,2. University of Basel,Basel,Switzerland,3. Maastricht University,Maastricht,Limburg,Netherlands,4. Universität Basel,Basel,Switzerland Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life.Previous research has concluded that the content of