Instrument O

Title: California POLST Assisted Living Survey

Designer: Neil Wenger, MD, MPH. Please credit him in any future work.

Suitable for Quality Improvement? Yes, modified to fit your state.

Suitable for research? Yes. A more refined version may be available from Dr. Wenger.

Description of Instrument:Thistelephone survey is the only instrument designed specifically for assisted living facilities. It was designed to produce research quality data about POLST utilization to assess the effectiveness of a major grass roots effort promoting POLST use in California. The survey was not done in isolation, but as follow up to an extensive educational outreach. It is a telephone surveyaddressed to the assisted-living administrator or knowledgeable designee.

How to use:

Step 1: Modify the form to suit your purposes. Note that RCFE stands for ‘residential care facilities for the elderly’.Decide whether you really need each item and keep items that you have a planned use for or believe may be important to have even though you are not sure what to do with them. Similarly, you may add items that are missing or that address questions that you are trying to answer. You may find items in other instruments elsewhere in the toolkit and want to include them and that is fine.

Step 2: Select which assisted living or residential care facilities you will survey. You may wish to survey all of them, or just a cross-section. See the FAQ section on ‘Sampling’. In general, as long as you choose facilities in a random fashion (for example, by choosing numbers out of a hat) and survey enough facilities so that you get20-30 usable responses, that may be enough for most QA purposes.

Step 3:Call the programs/facilities and record the data. For some, you may not find someone who is willing or able to answer your questions—that is expected; just do the best you can. You will need to tabulate your results in a paper or software spreadsheet or statistical software program.

Step 4: Analyze the results. Some of the results that you will get from this survey include:

  1. Awareness of POLST
  2. Previous education about POLST for staff
  3. Location of POLST in the facilities
  4. Whether residents are completing POLST before or after coming to the facility
  5. Proportion of residents who have a POLST
  6. Interest in having future education about POLST
  7. Some demographic questions about the facility