Using the PELI in Short Stay Settings

Time: The Preference Assessment Challenge in Short-Stay Settings

Preference assessment in long-term settings often takes place during a series of conversations with a person over several days, whether in a nursing home, personal care/assisted living, adult day, or a home care setting. In short-term settings, time is compressed and treatment schedules are busy. Still, it is important to learn about and honor preferences in order to maximize recovery and wellbeing. This tip sheet presents strategies to conduct timely, efficient preference interviews that promote a person’s functioning and satisfaction with care.

Benefits of Honoring Individual Preferences in Short-Stay Settings

Advantages for individuals receiving care – comfort, caring, and motivation

• When services are aligned with preferences, people are more likely to achieve their highest possible level of physical, mental and psychosocial wellbeing according to recent research.
• In fast-paced rehabilitation settings, most people concentrate on recovery and see their preferences as secondary. Yet when offered the chance to reflect on their likes and dislikes, they welcome the conversation and appreciate that their preferences are respected.
• When the care team takes the time to ask about and respect preferences, individuals feel more comfortable, trusting, and positive about their relationships with caregivers.
• They are more likely to become engaged in managing chronic conditions. This can be empowering to the individual and contribute to faster recovery.
• Meeting preferences can increase motivation to work hard in therapy – which, in turn, may lead to a shorter length of stay, improved adherence to care plans after discharge to home or another care setting, and reduced likelihood of re-hospitalization.

Advantages for provider communities — customer satisfaction and reputation for quality

• Clients are likely to be more satisfied and have fewer complaints when preferences are respected. Also, they may be more apt to express any concerns with care early on, before problems spiral into major dissatisfaction.
• Federal regulations require preference assessment and evidence that preferences are respected.
• Team members find their work is more rewarding when individuals and families are satisfied with care.
• Organizations gain new customers through positive reviews and word of mouth.

When is the Right Time for a Preference Interview?

When lengths of stay are brief, teams need to be strategic in finding opportunities to explore preferences.  Try to:

• Consult the care team to find open space in the individual’s schedule so that the preference interview does not compete with other appointments.
• Schedule preference assessments when individuals are likely to be refreshed, physically and cognitively. People in intensive short-term treatment need time to rest and recuperate.
• Complete assessments within 72 hours of an individual’s arrival, or sooner if possible. By meeting this timetable, your team can provide more person-centered care from the outset, enhance individual outcomes and meet federal regulations early in the person’s stay.
• At the start of an interview, explain the purpose: To learn about each person’s preferences in order to make their time in the program as comfortable and successful as possible, as well as to support their long-term health and wellbeing after discharge.  Also, see the Sample Introduction to the PELI with Short-Stay Residents at https://preferencebasedliving.com/?q=peli-tools.

Recommended Strategies for Designing Preference Interviews

Given the time and scheduling pressures facing individuals and staff during short-stays, a carefully planned preference assessment process is key. Using the 72-item Preferences for Everyday Living Inventory (PELI) provides the most comprehensive approach to understanding individual preferences across the domains of everyday life, while also covering MDS 3.0 – Section F – Customary Routines and Activities.

If time and resources do not permit using the full PELI, programs can create a hybrid process. Taking this approach provides a richer picture of a person’s preferences than the MDS 3.0 – Section F alone, yet the assessment is concise. Providers can tailor their strategy to organizational goals and resources, such as staffing.

Three alternatives to the full PELI are:

Option 1: Use A Subset of PELI Items

• Ask PELI questions that also appear on the MDS 3.0-Section F, plus an additional subset of PELI items.
• Convene a group of staff – including administrators, activity directors, physical and occupational therapists, nurses, direct care workers – as well as individuals and families. Review the full 72 PELI items and choose a core set of questions to ask each person receiving services.
• See the PELI Tip Sheet: How to Get Started for details on ways to prioritize and select preference items.
• If your organization has a home health or home care component, see the Tip Sheet: Top Preferences Across LTSS Settings, which identifies the top 10 preferences rated as very important to LTSS recipients.

Option 2: Enhance Your Current Preference Assessment Tool With PELI Items

• If your organization already uses a preference assessment tool along with the MDS, consider exploring whether to add PELI questions, prompts or rankings.
• Adding even a few well-chosen questions might reveal important information about an individual’s wishes.

Option 3: Use the MDS 3.0 Plus An Interest Tracker

Continue to use MDS 3.0-Section F questions to assess individual preferences but add an “Interest Tracker” or simple checklist to capture more of the activities each person enjoys (see below).

SAMPLE INTEREST TRACKER USING MDS QUESTION: FAVORITE ACTIVITIES 

• Customize the sample Interest Tracker to suit your program and clientele. Given the different ages, diagnoses and schedules of those in rehabilitation settings, be sure to plan options that people can pursue on their own or one-to-one with a team member.

• The Interest Tracker provides an easy tool to communicate preferences across disciplines, days and shifts. At a glance, team members can see which individuals may want to attend daily activities. Also, recreation therapists can use preference information to guide leisure education and discharge planning. The goal is to raise awareness that continuing to pursue favorite leisure activities helps to improve and maintain recovery, and enhance overall health and wellbeing. Moreover, new research shows that effective, preference-based recreation therapy can support prevention of, and recovery from, delirium in individuals post-hospitalization. 

When using the Interest Tracker:

• Be sure to include activities that can be “self-initiated” – that is, with the right resources, people can pursue leisure interests independently. Some programs send an activity cart to resident rooms in the morning or evening when people have time on their own. The cart has books, magazines, puzzles, simple crafts or devices to listen to favorite music or watch movies. Also, staff can provide health education literature so that individuals can read up on ways to manage chronic conditions and promote recovery.

• Staff conducting preference interviews should ask the MDS 3.0-Section F question, “How important is it to you to do your favorite activities?” and then follow up by saying: “Can you tell me what your favorite activities are?” Some people will respond easily to this open-ended question while others may need a prompt. Interviewers can go through the list of Interest Tracker activities and suggest that the individual respond either “yes” or “no” regarding their interest. Another alternative is to ask whether each type of activity is “very important,” “somewhat important,” “not very important,” “not important at all” or “Important, but can’t do.”

• Encourage interviewers to follow-up each time an individual chooses the response “I can’t do.” Probe for details so the team can get a better sense of the person’s interests, as well as ways to adapt activities so they are doable and a source of enjoyment. This is critical as people often assume that a new disability will prevent them from pursuing longstanding preferences and restrict their activities unnecessarily.

Final Thoughts To Keep In Mind…

Whichever approach your organization decides to use, we recommend asking people about a wide range of preferences. Ideally, questions should be open ended and encourage a genuine dialogue about what is most important to each person during their short-term stay. You might say: What is most important to you while you are cared for here? You never know where an individual’s answer will go! The person might reveal new likes or dislikes that are significant for the way you plan daily care and activities.

Often, providers wonder whether they should only ask questions about activities they already offer, or whether they should explore preferences outside the usual menu of options. Keep in mind that focusing only on current activities leads to more facility-centered care. Whenever possible, it’s best to listen to an individual’s full range of wishes. Your care team may discover creative new ways to honor preferences and deepen effectiveness in providing truly person-centered care.