Journal of Gerontological Nursing

Public Policy Free

Feasibility of a Family-Centered Hospital Intervention

Susan C. Reinhard, PhD, RN, FAAN; Elizabeth Capezuti, PhD, RN, FAAN; Barbara Bricoli, MPA; Rita B. Choula, MA

Abstract

Approximately one half of the 40 million family caregivers in the United States are regularly performing medical/nursing tasks, with very little training from clinicians. The goal of the current project was to encourage health care and social service professionals to proactively engage family caregivers as partners in care. The phases of the Professional Partners Supporting Family Caregivers project and results of an intervention are presented. Five hospitals were selected to develop a family-centered intervention. Patients' and family caregivers' hospital experience was examined, as well as nurses' perception of their work environment specific to care of older adults and caregivers. The sample included five intervention sites in which patients, family caregivers, and nurses provided baseline post-intervention data. The four comparison sites included post-intervention data from patients, family caregivers, and nurses. The family-centered intervention shows promise in improving patients' hospital experience and nurses' perception of caring for older adults and their families. [Journal of Gerontological Nursing, 43(6), 9–16.]

Abstract

Approximately one half of the 40 million family caregivers in the United States are regularly performing medical/nursing tasks, with very little training from clinicians. The goal of the current project was to encourage health care and social service professionals to proactively engage family caregivers as partners in care. The phases of the Professional Partners Supporting Family Caregivers project and results of an intervention are presented. Five hospitals were selected to develop a family-centered intervention. Patients' and family caregivers' hospital experience was examined, as well as nurses' perception of their work environment specific to care of older adults and caregivers. The sample included five intervention sites in which patients, family caregivers, and nurses provided baseline post-intervention data. The four comparison sites included post-intervention data from patients, family caregivers, and nurses. The family-centered intervention shows promise in improving patients' hospital experience and nurses' perception of caring for older adults and their families. [Journal of Gerontological Nursing, 43(6), 9–16.]

There are approximately 40 million family caregivers in the United States (AARP & National Alliance for Caregiving, 2015). Approximately one half of these caregivers are performing medical/nursing tasks, which can include managing complex medication schedules, giving injections, providing wound care, inserting catheters, giving tube feedings, and many others. Responsibilities often involve tasks that nurses and other clinicians spend several years in training learning to perform (Reinhard, Levine, & Samis, 2012). The shift to greater family responsibility for complex care has been accelerated by value-based payment policies that encourage earlier discharge to home, sometimes in lieu of short-term discharges to post-acute care.

Family caregivers are performing these medical/nursing tasks “home alone,” with few visits from home care providers and very little training from clinicians. At the same time, these family caregivers are typically helping with myriad other activities ranging from bathing, dressing, and toileting to transporting to health appointments and paying bills. And most of them are also employed outside the home.

Family caregivers are rarely asked, “How are you doing? How are you managing?” Inadequate support for family caregivers by health care and social service professionals, both in the hospital and at home, not only risks turning family caregivers into patients themselves, but also threatens the quality of care provided to older adults (Reinhard & Choula, 2011).

The situation is particularly harsh for those who provide intensive levels of help, manage complex chronic care, or need financial relief. These strains on caregivers take their toll. Insecurity, stress, and burnout result in health and mental health disparities for caregivers, who are prone to higher rates of chronic disease, depression, and social isolation than their non-caregiving peers (National Academies of Sciences, Engineering, and Medicine, 2016).

Family caregivers are the first line of support for older family members and individuals of all ages who need help with activities of daily living (ADLs), instrumental ADLs, and medical/nursing tasks. They need guidance from health care and social service professionals across settings—clinician offices, hospitals, outpatient surgical centers, home care, rehabilitation and nursing homes, and other locations. But hospitalization is a critical time and location for this guidance for several reasons. First, today individuals are only hospitalized for serious conditions that typically require post-hospital treatment and care—often at home. Patients and their family caregivers are expected to manage several medications, often by different routes, and perform many other medical/nursing tasks (National Academies of Science, Engineering, and Medicine, 2016). Second, hospitalization is a time when care issues often become apparent and guidance becomes essential. Third, the focus on reducing unnecessary hospitalizations raises interest in ensuring the patient and family are well prepared to perform all post-hospital instructions so the patient does not require readmission (Naylor & Keating, 2008).

Professionals in the health care and social service sectors can play an important role in supporting family caregivers. With policy makers and private sector leaders, they can work to develop programs that educate and support family caregivers. These initiatives can help sustain family caregiving as well as focus on caregivers' well-being.

Background

Building the Foundation for the Professional Partners Supporting Diverse Family Caregivers Project

The Professional Partners Supporting Diverse Family Caregivers project is the result of funding from The John A. Hartford Foundation and Jacob & Valeria Langeloth Foundation to build on previously funded work. In 2007, the AARP Foundation and AARP Public Policy Institute, with funding from The John A. Hartford Foundation and Jacob & Valeria Langeloth Foundation, launched a caregiving initiative, Professional Partners Supporting Family Caregiving. Collaborators included the Family Caregiver Alliance, American Journal of Nursing, Council on Social Work Education, and the Rutgers Center for State Health Policy. The project was developed in an effort to provide nursing and social workers with tools to better communicate with and support family caregivers who often report feeling invisible, particularly in hospital settings. This previously funded work served as a foundation by building consensus, understanding diverse family views, and developing tools.

Building a Consensus Among Stakeholders

The initiative helped facilitate collaboration among nurses, social workers, and family caregiving advocates. This collaboration focused on discussing existing promising practices in family caregiving and outlining strategies for professionals to work together to support family caregivers at varying levels across settings. An invitational “State of the Science” symposium produced the first national consensus document on the role of professional caregivers in supporting the growing number of families caring for older adults. In addition to developing recommendations for encouraging best practices to support family caregivers, participants identified barriers to nursing and social worker involvement in such family support and ways to overcome barriers. The papers presented at the symposium were published in a supplemental issue of the American Journal of Nursing (access http://journals.lww.com/ajnonline/fulltext/2008/09001/professional_partners_supporting_family_caregivers.3.aspx) and a special issue of the Journal of Social Work Education. The report concluded that professionals must recognize family caregivers as partners in care and become better prepared to work with caregivers to make the partnership successful.

Understanding the Views of Family and Professional Caregivers—A New Initiative

The Professional Partners Supporting Diverse Family Caregivers Across Settings initiative was launched in summer 2009. Focus groups were conducted to ascertain the caregiving experience from the perspective of family caregivers as well as nurses and social workers (Reinhard & Choula, 2012). Findings from these groups were used to inform the intervention with hospitals as discussed in the current article.

A total of seven focus groups were completed in California, Maryland, Virginia, and Illinois. When working with nurses and social workers, African American and Hispanic family caregivers expressed frustrations similar to those of their Caucasian counterparts. However, they also expressed important differences, including stereotyping based on skin color, language, or dress; lack of access to accurate translation services (both verbal and written); and lack of knowledge pertaining to diverse cultures (family structure, foods, and perceptions).

Nurses and social workers discussed the challenges of working with culturally diverse populations for many of the same reasons cited by the family caregivers themselves. There seemed to be a disconnect between what nurses and social workers say they are doing for family caregivers and what the caregivers actually perceive as support (Reinhard & Choula, 2012).

Developing Tools to Support Caregivers' Participation

Based on the findings from the focus groups, along with consensus recommendations from the stakeholders, the Professional Partners Supporting Family Caregivers project team convened a group of five hospitals participating in the Nurses Improving Care for Health-system Elders (NICHE) Program to create, pilot, and test family-centered practices. NICHE, an innovative senior care program, supports more than 600 member sites to build the leadership capabilities necessary to integrate evidence-based geriatric knowledge into practice (Capezuti, Bricoli, & Boltz, 2013). All NICHE hospitals received an e-mail describing the project and inviting them to propose projects targeting intensive organizational change, such as eliminating barriers that prevent nurses and social workers from implementing family-centered practices.

The NICHE central office at New York University Rory Meyers College of Nursing reviewed the proposals and chose five sites to be designated the NICHE–Family Centered Project Sites (intervention group). They were selected based on their proposed innovations and capacity to participate. The office also considered the diversity of the institution (i.e., bed size, teaching status, and location) as well as the population they served. Each received funding (approximately $9,000) to facilitate implementation of their organizational change project.

An additional four sites that were not chosen were asked to be part of the project as comparison sites. Each site provided data; however, one site dropped out from data collection. Table 1 summarizes the institutional characteristics of the eight participating hospitals as well as population estimates for their immediate community. Considering that the average proportion of Americans is 78% White, these numbers show that the comparison hospitals are located in neighborhoods with an above-average population of White individuals, whereas four of the five intervention sites have a low percentage (range = 22.4% to 59%) of White individuals.


Institutional Characteristics of Participating Niche Hospitals

Table 1:

Institutional Characteristics of Participating Niche Hospitals

Phase 2

A NICHE collaborative project coordinator, a nurse administrator at a major Midwestern academic medical center with >10 years' experience working in NICHE sites, facilitated the work of the five intervention sites. Using webinars, monthly conference calls, and four in-person meetings, the group developed a family-centered intervention including (a) education to heighten hospital staff awareness of the caregiver experience, (b) caregiver assessment to foster inclusion of caregivers' needs within the overall goals of care, and (c) communication tools to facilitate meaningful interaction between care-givers and professionals.

Data from the focus groups were used to develop several resources. First, the AARP Public Policy Institute produced a video featuring the stories of family caregivers as they faced challenges with nurses and social workers, particularly in hospital settings. The video titled, “In Their Own Words: Caregivers' Experiences in the Hospital” (access http://www.nicheprogram.org/family_caregivers), highlights the experiences of four family caregivers, including both the challenges they faced with their loved one in the hospital and their successes.

The American Journal of Nursing facilitated the development of articles and training videos for health care professionals (particularly nurses, but other professionals including social workers and pharmacists) to help them attain skills to better support family caregivers in hospital settings. The articles/videos were highlighted in a three-part series in the American Journal of Nursing titled, “Professional Partners Supporting Diverse Family Caregivers” (access http://journals.lww.com/ajnonline/pages/collectiondetails.aspx?TopicalCollectionId=16). The videos and articles were the primary training tools used by each of the five NICHE sites to educate staff of the participating units.

To meet the communication and caregiver assessment goals, the sites chose to use a “Leave a Message Notebook,” which included scripted questions to ask caregivers, referred to as “Ask Me Too.” The latter is meant to be analogous to the widely used Ask Me 3® tool (access http://www.npsf.org/?page=askme3) for promoting patient–provider communication. The latter is trademarked by the National Patient Safety Foundation and is supported by The Joint Commission (access http://www.jointcommission.org/assets/1/18/improving_health_literacy.pdf). Each staff member was expected to use the following scripted questions with each interaction. The goal was to ensure consistency with “Ask Me Too” questions to be addressed with caregivers:

  1. What questions do you have regarding care today?

  2. What questions do you have about care at home?

One important aspect of the “Ask Me Too” questions is the focus on how the caregiver is doing as an individual. What are his/her needs? How can providers reduce the feeling that many caregivers express of being “invisible,” as well as assess their level of stress?

The purpose of the “Leave a Message Notebook” was to provide a structured approach for accurate communication between families and the clinical team. The communication notebook is similar to the “whiteboard” method that has been promoted by the Agency for Healthcare Research and Quality (2013); however, it reduces the concerns regarding patient privacy when a board is visible to anyone entering the room. The notebook created a forum for all care participants to communicate with each other throughout the hospital stay. It provided consistency in communication and served as a “checklist” of tasks and questions to be answered throughout the stay. The process implemented in all sites started on admission and/or the first interaction with the family. The clinical team introduced the notebook. After obtaining permission from the patient or individual with power of attorney, the notebook would be used by all care team members. All caregiver questions were written and answered in the notebook. The notebook went home with the patient and family as a reference for post-discharge care.

Each intervention site worked with its marketing department to create the notebooks and develop processes to ensure they were delivered to caregivers on a routine basis. It was decided that each hospital would have some leeway in how these notebooks would look (e.g., health system logo), although all would be standardized to include items such as Caregiver Welcome, Things to Know About the Hospital, Contacts, Internal Resources, External Resources, and Ask Me Too.

Each intervention site team worked to integrate the Caring Communication Notebooks and Ask Me Too questions into daily practice by frontline staff. Mobilizing commitment from administrators, unit managers, practice councils, and staff facilitated development and implementation for all sites. Prior to launching the communication tools, all staff were educated on why and how these tools should be used. Staff were also taught how to educate patients and families about the notebook. Units identified an area to store the notebooks. Specific caregiver communication competencies were developed. To ensure widespread adoption and consistent use, the site coordinator implemented frequent monitoring and follow up with frontline staff and key interdisciplinary team members. A notebook reminder was added to the electronic documentation flags and shift-to-shift reports.

Based on findings from the initial phase, the overall goal of the NICHE intervention project was to support family caregivers during care recipients' hospitalization by expanding the knowledge, communication skills, and resources to frontline professionals. The objective was to evaluate the acceptability and feasibility of a family-centered intervention by examining patients' hospital experience, caregivers' hospital experience, and nurses' perspectives of their work environment specific to care of older adults and caregivers in five sites that implemented the intervention and four comparison sites, as well as describe the challenges and facilitators for successful implementation from the intervention site coordinators' perspective.

Method

A one-group pre–post design and posttest-only design with a nonequivalent control group were used to evaluate the acceptability and feasibility of the family-centered intervention. Data were obtained from three perspectives: the older patient, caregiver, and nurse (RN/licensed practical nurse). Table 2 provides a description of each measure: purpose, number and content of items, and source.


Measures Used to Evaluate Patients', Caregivers', and Nurses' Experiences and Views

Table 2:

Measures Used to Evaluate Patients', Caregivers', and Nurses' Experiences and Views

The Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Survey measured patients' experience (Elliott et al., 2010). Five subscales (38 items) from the Geriatric Institutional Assessment Profile, a valid and reliable tool (Boltz, Capezuti, Kim, Fairchild, & Secic, 2009, 2010; Kim et al., 2007) were used to measure nurses' perspectives. Each of the items is rated on a 5-point Likert-type scale, ranging from 0 (not very satisfied) to 4 (very satisfied) for a potential total score ranging from 0 to 73 for the Geriatric Care Environment scale and 0 to 40 for the Aging-Sensitive Care Delivery and Staff/Family/Patient Disagreements subscales (Boltz et al., 2008). Higher scores indicate better outcomes.

Data collection began June 2012 and ended June 2013. Each intervention site submitted patient and care-giver data monthly to the NICHE Benchmarking Service (Capezuti, Boltz, et al., 2013), whereas the comparison sites only provided complete data for the last quarter. Patient data were derived from the hospitals' databases for the participating units. Caregiver data came from questionnaires, which were distributed to caregivers when patients were discharged, and returned by mail or phone follow up by nursing staff. For nurse-level data, nurses working on study units completed a web-based survey twice: prior to (June/July 2012) and following (June/July 2013) the implementation of the intervention. After all site data were received, phone interviews were conducted with each site to capture the perceptions of the barriers and facilitators for successful implementation of the family-centered intervention.

Due to low numbers per site, patient, caregiver, and nurse data were aggregated by participating site type: intervention (n = 5) versus comparison (n = 3). Meaningful statistical testing was not possible with the aggregated data because site differences could not be controlled. Data were also unavailable from all comparison sites for the baseline data collection period. Thus, the aggregated patient-, caregiver-, and nurse-level data from the intervention sites prior (baseline) and following the implementation of the family-centered intervention were compared. Because post-intervention data were available from all comparison sites, the aggregated patient-, caregiver-, and nurse-level data were used to compare the intervention and comparison site results. The findings from the post-intervention phone interviews were summarized into major themes.

Results

Table 3 provides the results of the comparison of the aggregated data from baseline to post-implementation for the intervention sites. These sites have higher (better) patient experience scores, compared to baseline, in all six composite areas. These sites have better scores for caregiver experience in one of three areas and reduced scores in two of three areas; however, the scores were all ≥90%. Nurses' views of their work environment in care of older adults and caregivers were better following implementation of the family-centered intervention.


Comparison of Baseline to Post-Implementation Quarter for Intervention Sites

Table 3:

Comparison of Baseline to Post-Implementation Quarter for Intervention Sites

Table 4 summarizes the aggregated data for the intervention and comparison sites, following implementation of the family-centered intervention. The intervention sites have higher scores than the comparison sites in all six composite areas of the HCAHPS patient experience. The caregiver experience was similar in intervention and comparison sites, with all receiving scores ≥90%. Nurses' view of their work environment in care of older adults and caregivers were better in the intervention sites.


Comparison of Intervention Versus Comparison Sites Following Implementation (4th Quarter)

Table 4:

Comparison of Intervention Versus Comparison Sites Following Implementation (4th Quarter)

All pilot sites identified the importance of support from the hospital administration, point-of-service staff, and multidisciplinary team in implementing a new practice and culture change. This support was deemed critical to success. Nurses believed they needed more tools to perform this essential work. There was consensus by the participating sites for a consumer-oriented application (app) version of the “Leave a Message Notebook,” available on Android and iOS mobile platforms. As hospitals, patients, and family caregivers increasingly incorporate technology into all aspects of care and daily living, a digital, mobile-friendly version of the notebook could greatly increase the efficacy of this tool.

A challenge was educating the staff at the point of service. All sites created in-service training for staff. Staff who tended to feel overburdened with daily work were resistant to a new practice; however, most site leads reported that, after engaging staff and family members, staff were receptive. Most sites reported concerns about continuing the program beyond the pilot units. Overall, the participating sites viewed this project as adding to their organizations' missions to provide better care to older adults.

Discussion

The data support the acceptability and feasibility of the Professional Partners Supporting Diverse Family Caregivers project and thus provide preliminary support for its expansion. It is likely that the collaborative approach in developing tools and resources contributed to the success of this pilot project. The developed products shared common elements across sites; however, the process supported local adaptation that facilitated implementation and use in each facility's unique population (i.e., patient/caregivers and providers) and environment (e.g., organizational, physical, external). The collaborative provided the structure for sites to share successes and failures and make adjustments that eventually led to the positive findings found in the evaluation.

Policy Implications

The current pilot study of how nurses could incorporate practical, systematic ways to focus more on the needs of family caregivers of older adults who will provide care and support after hospitalization influenced public policy. The findings of the Home Alone research made the voice of family caregivers louder: More help from nurses and other professionals is needed to address family caregiving to meet patient care needs. The nurses in the five NICHE sites responded: The Caregiver Advise, Record and Enable (CARE) Act translates both the Home Alone and NICHE research into policy. As of this writing, 38 states, territories, and the District of Columbia have passed legislation that require hospitals to identify family caregivers (with the patient's permission), record those names in the health record, teach them the medical/nursing tasks that they are expected to perform, and notify them of the discharge plans as soon as possible. The goal is patient- and family-centered care—what nurses have been taught for decades.

References

  • AARP & National Alliance for Caregiving. (2015). Caregiving in the United States 2015. Retrieved from http://www.aarp.org/ppi/info-2015/caregiving-in-the-united-states-2015.html
  • Agency for Healthcare Research and Quality. (2013). Strategy 2: Communicating to improve quality (implementation handbook). Retrieved from http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy2/Strat2_Implement_Hndbook_508.pdf
  • Boltz, M., Capezuti, E., Bower-Ferres, S., Norman, R., Secic, M., Kim, H. & Fulmer, T. (2008). Changes in the geriatric care environment associated with NICHE. Geriatric Nursing, 29, 176–185. doi:10.1016/j.gerinurse.2008.02.002 [CrossRef]
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  • National Academies of Sciences, Engineering, and Medicine. (2016). Families caring for an aging America. Washington, DC: The National Academies Press.
  • Naylor, M. & Keating, S. (2008). Transitional care: Moving patients from one care setting to another. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768550
  • Reinhard, S.C. & Choula, R. (2011). Lifting the cloak of invisibility: Nurses and social workers supporting family caregivers. Retrieved from http://journal.aarpinternational.org/a/b/2011/08/Lifting-the-Cloak-of-Invisibility-Nurses-and-Social-Workers-Supporting-Family-Caregivers
  • Reinhard, S.C. & Choula, R. (2012). Meeting the needs of diverse family caregivers. Retrieved from http://www.aarp.org/home-family/caregiving/info-09-2012/meeting-the-needs-of-diverse-family-caregivers-insight-AARP-ppi-ltc.html
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Institutional Characteristics of Participating Niche Hospitals

GroupBed SizeaTeaching StatusbLocationcPopulationd (Race [%])
Intervention
  Hospital 1MediumAcademic medical centerUrban, Midwest/East North CentralBlack (65.4)White (22.4)Hispanic (2)
  Hospital 2SmallTeachingUrban, South AtlanticWhite (93.4)Black (2.7)Hispanic (2.5)
  Hospital 3LargeTeachingSuburban, South AtlanticWhite (49.6)Black (28.8)Hispanic (11.3)
  Hospital 4MediumNon-teachingUrban, South AtlanticWhite (46.2)Black (45.6)Hispanic (4.5)
  Hospital 5LargeTeachingUrban, Midwest/East North CentralWhite (59)Black (30.7)Hispanic (2.1)
Comparison
  Hospital 6MediumTeachingSuburban, East North CentralWhite (92.5)Black (2.2)Hispanic (1.8)
  Hospital 7MediumNon-teachingUrban, East North CentralWhite (89)Hispanic (3.7)Black (2.1)
  Hospital 8MediumTeachingUrban, East North CentralWhite (86.2)Hispanic (2.2)Black (0.5)

Measures Used to Evaluate Patients', Caregivers', and Nurses' Experiences and Views

LevelPurposeItems/ContentSource
PatientTo assess inpatients' “experiences” of hospital care22 core questions reported as six composites: communication with nurses, communication with physicians, responsiveness of hospital staff, pain management, communication about medicines, and discharge informationHospital Consumer Assessment of Healthcare Providers & Systems Survey (Elliott et al., 2010). All participating hospitals in the United States use the same standardized questions and administration protocols.
CaregiverTo evaluate caregiver's perspectiveThree items:

How well did staff prepare/train you in the skills necessary for caretaking at home?

How well did staff provide you with information you could understand?

How well did staff communicate to you in a respectful way?

As part of the intervention, three questions (Family/Caregiver Experience Survey) were developed by the NICHE Caregiver Collaborative.
NurseTo capture nurses' perception of their work environment specific to care of older adultsFive subscales (total of 38 questions) were used from the Geriatric Institutional Assessment Profile (GIAP): Geriatric Care Environment Scale - composite of four subscales (28 questions): Institutional Values Regarding Older Adults and Staff; Capacity for Collaboration; Resource Availability; and Aging-Sensitive Care Delivery. Staff/Family/Patient Disagreement scale measures nurse's perception of the level of conflict between staff and patients/families regarding treatment of common geriatric syndromes (10 questions).GIAP is a valid and reliable tool used by NICHE sites to evaluate staff perceptions of the work environment and other components of organizational structure compared with other NICHE sites and, as they initiate the NICHE implementation process, evaluate progress over time (Boltz et al., 2008).

Comparison of Baseline to Post-Implementation Quarter for Intervention Sites

DataBaseline (Quarter 1)Post-Implementation (Quarter 4)
Patient-Level DataN = 251N = 326
  HCAHPS composite subscales (% always)a
    Communication with nurses7784
    Communication with physicians7886
    Responsiveness of hospital staff6567
    Pain management7073
    Communication about medicines5373
    Discharge information8690
Caregiver-Level DataN = 247N = 184
  Family/Caregiver Experience (% always)a
    Staff prepare/train you in the skills necessary for caretaking at home9091
    Staff provide you with information you could understand9690
    Staff communicate to you in a respectful way9896
Nurse-Level DataN = 132N = 59
  GIAP scale/subscaleb
    Aging-Sensitive Care Delivery29.2133.83
    Institutional Values19.9224.40
    Capacity for Collaboration6.939.50
    Resource Availability17.6122.20
    Total: Geriatric Care Environment44.4656.10
  Staff/Family/Patient Disagreementsc2.552.05

Comparison of Intervention Versus Comparison Sites Following Implementation (4th Quarter)

DataInterventionComparison
Patient-Level DataN = 326N = 370
  HCAHPS composite subscales (% always)a
    Communication with nurses8477
    Communication with physicians8678
    Responsiveness of hospital staff6763
    Pain management7361
    Communication about medicines7354
    Discharge information9084
Caregiver-Level DataN = 184N = 69
  Family/caregiver experience (% always)a
  Staff prepare/train you in the skills necessary for caretaking at home9191
    Staff provide you with information you could understand9093
    Staff communicate to you in a respectful way9696
Nurse-Level DataN = 59N = 85
  GIAP Scale/Subscaleb
    Aging-Sensitive Care Delivery33.8329.07
    Institutional Values24.4019.67
    Capacity for Collaboration9.508.61
    Resource Availability22.2018.23
  Total: Geriatric Care Environment44.4656.10
Staff/Family/Patient Disagreementsc2.052.42
Authors

Dr. Reinhard is Senior Vice President and Director, and Ms. Choula is Senior Advisor, AARP Public Policy Institute, Washington, DC; Dr. Capezuti is WR Hearst Foundation Chair in Gerontology and Associate Dean for Research, Hunter College School of Nursing, City University of New York, New York, New York; and Ms. Bricoli is Founder and Principal, B2 Advisory Group, Cedar Grove, New Jersey. Dr. Reinhard is also Chief Strategist, Center to Champion Nursing in America, Washington, DC.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Susan C. Reinhard, PhD, RN, FAAN, Senior Vice President and Director, AARP Public Policy Institute, 601 E Street, NW, Washington, DC 20049; e-mail: sreinhard@aarp.org.

10.3928/00989134-20160516-01

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