title: A measure of person-centered practices in assisted living: the PC-PAL.
abstract: OBJECTIVE
  Develop self-administered questionnaires of person-centeredness for completion by residents and staff in assisted living (AL), in response to concerns that AL is not person-centered; also, demonstrated person-centeredness is necessary for Medicaid support as a home- and community-based services provider.
  
  
  METHODS
  Community-based participatory research partnership among a research team, a consortium of 11 stakeholder organizations, and others. Methods included literature review, item generation and reduction, cognitive testing, field testing, exploratory factor analysis, and convergent and discriminant validity testing.
  
  
  METHODS
  Cognitive testing conducted in 2 AL residences and field testing conducted in 19 diverse, stratified AL residences in 6 states.
  
  
  METHODS
  Eight residents and staff participated in cognitive testing, and 228 residents and 123 staff participated in field testing.
  
  
  METHODS
  Feasibility and psychometric testing of draft questionnaires that included 75 items (resident version) and 102 items (staff version), with parallel items on both versions as appropriate.
  
  
  RESULTS
  The final resident questionnaire included 49 items and 4 factors: well-being and belonging, individualized care and services, social connectedness, and atmosphere. The staff questionnaire included 62 items and 5 factors: workforce practices, social connectedness, individualized care and services, atmosphere, and caregiver-resident relationships. Staff scored person-centeredness higher than did residents, reflecting their different perspectives.
  
  
  CONCLUSIONS
  The Person-Centered Practices in Assisted Living (PC-PAL) questionnaires measure person-centeredness from the perspectives of residents and staff, meaning that they reflect the concepts and items considered to be important to these key stakeholders. Use of these instruments to describe, assess, quantify, ensure, and ultimately improve person-centeredness in AL is feasible and appropriate for all AL settings, and supported by numerous national organizations.
authors.affiliation: Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: Sheryl_Zimmerman@unc.edu.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: Center for Excellence in Assisted Living, Oakton, VA.
authors.forename: Josh
authors.initials: J
authors.lastname: Allen
authors.affiliation: Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.affiliation: Center for Excellence in Assisted Living, Oakton, VA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Pinkowitz
authors.affiliation: Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: LeadingAge, Atlanta, Georgia.
authors.forename: Walter O
authors.initials: WO
authors.lastname: Coffey
authors.affiliation: Sanford Center for Aging, University of Nevada, Reno, Nevada.
authors.forename: Peter
authors.initials: P
authors.lastname: Reed
authors.affiliation: RTI International, Washington, DC.
authors.forename: Michael
authors.initials: M
authors.lastname: Lepore
authors.affiliation: Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000458:organization & administration*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055812:Community-Based Participatory Research; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D018802:Patient-Centered Care / Q000458:organization & administration*; D011594:Psychometrics; D058996:Quality Improvement; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
keywords: Assisted living; HCBS; measurement; person-centered; quality improvement