Advance Care Planning Study Seeks to Help SNFs Help Themselves

Academic studies abound in nursing homes, but once the grant money runs out and the researchers pack up their notebooks, the positive effects on localized care can disappear as well.

That’s why a team from Indiana University—Purdue University Indianapolis (IUPUI) elected to develop a study on the effects of advance care planning that seeks to reap rewards long after the research period ends.

“A lot of really carefully constructed research interventions are evaluated, they have successful outcomes, and then nobody does anything with them,” Indiana School of Nursing professor Susan Hickman told Skilled Nursing News. “The findings get published in a journal, and it doesn’t change practice. The idea is to work directly with the nursing homes and have them roll this out as part of their clinical operations without our direct involvement.”


Hickman, who also serves as the co-director of the IUPUI Research in Palliative and End-of-Life Communication and Training (RESPECT) Signature Center, and her colleagues will soon roll out their program at three to four nursing homes. The goal, according to Hickman, is to train  staff on how to develop advance care planning strategies — and then create materials that will allow them to train other employees throughout their networks going forward.

Most nursing home administrators already know the importance of advance care planning —  which involves carefully setting individualized goals and expectations for each resident’s long-term care — Hickman said, but they don’t always have one person in charge of it. For instance, in her previous research, Hickman said she’d call skilled nursing facilities and ask who was in charge of advance care planning.

“There is always someone who is deemed the internal expert or the champion on that, even if they aren’t described that way,” she said, adding that her team intends to emphasize the importance of having an official chief of advance care planning.


Hickman and research partner Kathleen Unroe — an associate professor of medicine at the Indiana University School of Medicine and scientist at the IU Center for Aging Research — received a $400,000 grant from the National institute on Aging to carry out the study. If all goes well during the initial pilot program, the IUPUI team will get an additional $3 million to expand the project to 200 nursing homes.

Of those, 100 will receive the advance care planning training while 100 will not, and the team from IUPUI will analyze billing, medical, and other records to figure out the exact impact of their intervention. Previous studies have shown that advance care planning boosts resident satisfaction, reduces rehospitalizations and prevents unwanted medical procedures, Hickman said.

The project, which will reserve a special focus for residents with Alzheimer’s and dementia, is indicative of a growing trend toward more practical and pragmatic research, Hickman said.

“We know there’s a lot of expertise and knowledge out in the field, in nursing homes specifically, and we really want to work collaboratively with our partners to blend that more academic expertise with their real-world expertise on how things operate — and what’s practical and what’s realistic,” Hickman said.

Written by Alex Spanko

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