Top Preferences Across LTSS Settings

Identifying Top Preferences as a Starting Point for Planning Care

What are the top preferences of older adults receiving long-term services and support? Do preferences differ by care setting? The answers to these questions can be useful for organizations seeking a starting point to enhance person-centered care in a variety of settings.

This tip sheet highlights top daily living preferences among nursing home residents and older adults who receive home and community-based services. Findings from a recent study reveal areas of shared priorities between the two groups.  The findings also highlight the diversity of older adults’ preferences and the importance of asking each individual about his or her wishes for everyday life. The answers to these questions provide the foundation for person-centered care.

Data on Top Preferences Support Shared Priorities

The research is based on responses to the Preferences for Everyday Living Inventory (PELI) from two different samples of older adults: 255 individuals living in nursing homes, and 528 receiving home and community-based services. All respondents answered PELI questions independently and rated psychosocial preferences items on a scale from “not at all” to “a lot” or “very important.”

Ten preferences were rated as important or very important by 75% of nursing home residents as well as by consumers receiving home and community-based services. Most notably, more than 90% of respondents in each group rated “having regular contact with family” as an important priority. Having privacy, choosing what to eat and when to bathe as well as having activity options also were important preferences for most in both groups.

Top 10 Preferences

• Having regular contact with family
• Choosing what to eat
• Going outside
• Having privacy
• Music
• Having regular contact with friends
• Giving gifts
• Traveling or doing things away from here
• Choosing the time to bathe or shower
• Watching or listening to TV

One caveat: This list represents only the top preferences for older adults in the two survey samples. Of course, each person has unique priorities that should be explored and honored to promote a satisfying daily life. (Note that the list above is not presented in rank order.)

Preference Differences: Nursing Home vs. Home and Community-Based Services

An additional analysis highlights nuances in preferences expressed by nursing home residents versus individuals who receive home and community-based services. When researchers looked at the top 10 priorities for each care setting separately, one preference – the desire for family contact — was at or near the top of both lists.

Among nursing home residents only, top preferences focused on:

• Relationships with staff and those involved in care — staff show you respect, staff show they care about you, choose who you would like involved in discussions about your care and choose your medical professional.
• Personal care – how to care for your mouth and how frequently to bathe.
• Aspects of the environment — take care of your personal belongings or things and keep your room at a certain temperature.
• Emotional concerns – doing what feels better when you are upset.

Top concerns among the home and community-based services group centered on:

• Activities — spending time outside, being active at certain times of the day, music, giving gifts, and traveling.
• Aspects of the environment – privacy and keeping possessions in a certain place.
• Meals — choosing what to eat.

This summary of priorities may help providers plan next steps in enhancing person-centered care within and across care settings.

Recommendations for Practice

This research suggests that organizations should consider focusing on fostering opportunities for older adults to connect with family and friends – through visits, email, letter writing and video. Other priorities might include meeting preferences for meals; activities such as spending time outdoors, enjoying music or creating small gifts for others; privacy; and choice in bathing schedules.

The findings also highlight the diversity of older adults’ preferences and the importance of exploring each individual’s priorities for everyday life, and the need to capture and be responsive to changing priorities as people move across settings of care.  

Conversations prompted by the PELI are an effective way to gather this information. More importantly, these conversations build and strengthen meaningful relationships among individuals and caregivers across diverse settings. When people of any age feel that their wishes are heard, understood and respected, this reinforces their sense of connection, competence, independence and quality of life.

Gathering results from PELI interviews can help focus your organization’s Quality Assurance and Performance Improvement initiatives. For example, if having regular contact with family, and spending time outside, are key issues for your clientele, a task force might explore: How well are we meeting these preferences? And how might we improve? You can track trends over time to see your progress.

We gratefully acknowledge support from The Patrick and Catherine Weldon Donaghue Medical Research Foundation