PROVIDENCE, R.I. [Brown University] — Advance directives help to clarify appropriate care for elderly nursing home residents at critical moments for their health, but the process of having the necessary conversations between residents, family members, and home staff is hardly routine. With a new grant from the National Institutes of Health, Vincent Mor of the Brown University School of Public Health and two Harvard-affiliated colleagues plan a big test of whether a suite of videos can help.
“Nursing homes have an obligation to have a discussion with patients about their goals of care, and it’s always a difficult discussion,” said Mor, the Florence Pirce Grant Professor of Health Services Policy and Practice. “It’s done relatively ad hoc without a lot of training and without a lot of structure. This suite of videos provides a stimulant and a structure around which the conversation can more readily proceed.”
The videos cover a range of sensitive but important topics, including an introduction to advance directives as well as specific situations where they are important, such as when and whether to accept a feeding tube, receive CPR, or be sent to the hospital.
The grant provides up to $4.5 million over five years, starting with a $500,000 pilot project in the spring. Mor, Dr. Susan Mitchell of Hebrew Senior Life, and Dr. Angelo Volandes of Massachusetts General Hospital plan to work with the Pruitt Health and Genesis nursing home chains to provide the videos in 80 nursing homes. All residents, families, and workers in the homes will have access to the videos. The researchers will be most interested, however, in measuring video viewership, advance directive adoption and, most importantly, whether hospitalizations are lower among residents either with advanced dementia or congestive heart failure or COPD along with other conditions. That will be compared against hospitalizations among similar residents in 80 similar homes where the videos are not made available.
The project is the first one to get underway since Brown established the Long Term Care Quality and Innovation Center in April. Mor said the framework established by this project could be extended to other projects in the center as well.