Evaluating the importance and feasibility of the Preferences for Everyday Living Inventory-Korean (PELI-K): A cross-sectional study using the nursing home stakeholder advisory panel

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J Korean Gerontol Nurs. 2025;27(1):1-9

Publication date (electronic) : 2025 February 28

doi : https://doi.org/10.17079/jkgn.2024.00563

Jenny Hyosun Kwon¹, So Young Shin^,2,3

¹Research Assistant, Department of Sociology and Gerontology, Miami University, Oxford, OH, USA

²Associate Professor, College of Nursing, Inje University, Busan, Korea

³Atlantic Fellow for Equity in Brain Heath, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA

Corresponding author: So Young Shin College of Nursing, Inje University, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea TEL: +82-51-890-6934 E-mail: syshin@inje.ac.kr

Received 2024 September 5; Revised 2025 January 4; Accepted 2025 February 5.

Abstract

INTRODUCTION

Person-centered care (PCC) is a bio-psycho-social approach that recognizes the individuality of nursing home (NH) residents [1]. Understanding the preferences of residents with their various care needs is vital in planning and providing PCC [2]. Previous studies have reported that honoring residents’ preferences contributes to improvements in their clinical care outcomes [3], life satisfaction [4], and well-being [5]. Furthermore, care providers can have better respect, more empathy, and a stronger appreciation of residents’ uniqueness [6].

The Preferences for Everyday Living Inventory (PELI) is a structured tool to elicit NH residents’ preferences in American NH settings [7]. Using the PELI in care planning can increase residents’ quality of life, satisfaction, and independence, as well as lower aggression or agitation [8,9]. In Korean NH settings, however, compared to the increasing attention paid to good quality of care and quality of life, preference-based PCC has not been widely implemented [10]. There was no existing evidence-based instrument to assess the preferences and values of residents using the Korean language in a Korean cultural context. As a response to these needs, the Korean version of the PELI (PELI-K) was invented [11].

The purpose of this pilot study was to identify the ranking of the PELI-K items selected as most important/feasible from the original PELI-K 72 items by NH stakeholder advisory panel and to establish the foundation for creating a short version of the instrument including the top-ranked items. The importance and feasibility were foci of this study. The two concepts were rated separately because the tension between ‘what is good for residents? (i.e., importance)’ and ‘what can we actually do for residents? (i.e., feasibility)’ is a long-lasting debate in practicing PCC [12]. Given the ongoing staffing shortages in Korean NHs [10], it is necessary to consider the delivery of preference-based care within the realities of a limited workforce. The study originally planned to list the top 10 items, but because of the items with tie-in scores that were given the same ranking, it finally ended up producing the top 10 for importance and the top 11 for feasibility.

Previous studies related to PCC in Korea largely focused on residents’ perspectives [13-15]. While it is vital to listen to the primary consumers’ opinions, a diverse group of people is involved in NH care delivery, including families, friends, staff, regulators, funders, and the general public [16]. They all have different views, experiences, or expectations of NH services. At the very earliest stage of tool development, particularly, it is beneficial to hear their varying perspectives. To fill the knowledge gap and have a balanced point of view, this study focuses on two NH stakeholder advisory panel groups: 1) experts group and 2) family group.

METHODS

RESULTS

The characteristics of the participants are reported in Table 1. Panel A shows the total of the 34 participants’ demographic information. The mean age of the participants was 47.01±17.41 years. The majority of participants were female (79.4%) and had a bachelor’s degree (50.0%). Experts group had 6.1 years of clinical experience and 6.5 years of work experience on average (Panel B). The majority of family members were daughters (50.0%), and they visited their loved ones an average of 9.2 days per month (Panel C).

Table 1.

Demographic Characteristics of Participants (n=34)

Table 2 lists the ranking and score of the top 10 most important PELI-K items selected by experts group (Panel A) and family group (Panel B). In Panel A, Setting bed for comfort (#18) and Having regular contact with family (#24) were tied as the most important items, receiving a score of 60 out of 66. The second important items were Having privacy (#32) and Locking up things safely (#33). Helping residents feel better when they are upset (#27), Going outside to get fresh air (#55), and Doing favorite activities (#72) were tied at 58 and ranked third important items. Lastly, Choosing own bedtime (#16), Staff showing respect (#30), and Doing hobbies (#71) were tied as the fourth.

Table 2.

Top 10 PELI-K Items Ranking in Order of Importance

In Panel B, Setting bed for comfort (#18) was the most important item, receiving a score of 35 out of 36. Seven items were tied at 34 and ranked second: Keeping a room at a certain temperature (#14), Choosing the sex of daily caregiver (#20), Caregiver knowing bathroom needs (#21), Talking to a mental health professional if needed (#28), Locking up things safely (#33), Going outside to get fresh air (#55), and Doing favorite activities (#72). Lastly, Staff showing respect (#30) and Doing exercises (#62) were tied at 33 as the third.

Table 3 shows the ranking and score of the top 11 most feasible PELI-K items selected by experts group (Panel A) and family group (Panel B). In Panel A, Listening to favorite music (#69) was the most feasible item, receiving a score of 61 out of 66. The second most feasible items were Having regular contact with family (#24) and Keeping up with the news (#59). Choosing the name you would like to be greeted by (#1) was scored 58 and ranked third. Staff showing that they care about you (#29) was scored 57 and ranked fourth. Lastly, six items were tied at 56 and ranked fifth: Taking a nap when you want (#11), Staff showing respect (#30), Being able to use a phone in private (#31), Participating in religious services/practices (#48), Going outside to get fresh air (#55), and Watching or listening to TV (#67).

Table 3.

Top 11 PELI-K Items Ranking in Order of Feasibility

In Panel B, Watching or listening to TV (#67) was the most feasible item, receiving a score of 32 out of 36. The second most feasible items were Keeping a room at a certain temperature (#14), Having regular contact with family (#24), Being able to use a phone in private (#31), and Locking up things safely (#33), receiving a score of 31. Adjusting the lighting in the room (#15) ranked third. Setting bed for comfort (#18), Staff showing that they care about you (#29), and Going outside to get fresh air (#55) were tied at 29 and ranked fourth. Lastly, Choosing the name you would like to be greeted by (#1) and Taking a nap when you want (#11) were tied at 28 and ranked fifth. The detailed comments from the panel for selected items were reported in Table 4.

Table 4.

The NH Stakeholder Advisory Panel’s Comments on the selected PELI-K Items

DISCUSSION

The results of the study reported the 10 most important PELI-K items and the 11 most feasible items separately selected by the NH experts group and family group. Items identified as the most important from both groups were: #18, #30, #33, #55, and #72. These items are related to basic needs of human being such as sleeping (#18) and safety (#33) that can directly affect residents’ clinical outcomes. Receiving respect (#30) reflects residents’ psychosocial needs. Items regarding residents’ favorites, such as going outside (#55) and doing favorite activities (#72), were also ranked.

Items identified as the most feasible from both groups were: #1, #11, #24, #29, #55, and #67. Items identified as having the most feasibility are those that can be realized without fundamental changes in NHs. For example, items such as #1, #11, #24, and #67 are already in practice in many NHs in Korea. However, there are some items showing discrepancies between experts and family groups. Items regarding residents’ basic needs such as safety (#33) and setting bed (#18) and physical environment settings such as temperature (#14) and lighting (#15) were ranked by family but not experts. The possible reason behind this gap is explained by comments from experts group. For example, for item #18, they expressed concerns about the additional burden on caregivers and the cost of washing different types of bedding. This suggests that careful consideration between increasing individualization and efficiency should be undertaken before implementation.

To address residents’ needs while accounting for operational constraints in NHs, a comprehensive approach is essential. One potential solution for balancing residents’ preferences and staff efficiency is the integration of cost-effective environmental adjustments or affordable technologies For example, some NHs in Japan have implemented adjustable lighting systems that allow residents to customize settings, such as temperature (#14) and lighting (#15), to suit their preferences [18]. Similarly, affordable technologies like wearable devices or monitoring systems that detect unusual activities can enhance safety (#33), streamline operations, and reduce caregivers’ physical workload [19]. Incorporating such technological innovations could make meeting residents’ basic needs more feasible by enhancing safety, honoring residents’ preferences at minimal cost, and optimizing staff efficiency—ultimately boosting both resident satisfaction and NH operational performance.

From an international perspective, the results of the current study align with findings from previous studies conducted in the U.S., as most of the items identified in Table 2 are consistent with those observed in earlier research. The majority of American older residents found regularly contacting family, securing safety and privacy, and having a choice of bedding and bathing to be important preference items [20]. Similarly, #24 and #30 were identified as the two most important items by the American NH expert panel [21]. These findings suggest that the universal concepts of PCC might be drawn upon in long-term care settings worldwide, despite subtle cultural differences across the world.

Six items (i.e., #14, #18, #24, #30, #33, and #55) were selected as having both importance and feasibility. These items are salient in planning care in Korean NHs and can easily be practiced with little or no additional cost. NH providers could benefit from widely implementing these items to improve residents’ quality of life and family members’ satisfaction. In addition, these items should be put on top priority when creating a short version of PELI-K.

The major limitation of this study is that residents were not included in the participants. While this study produces a ranking of PELI-K items drawn by nursing home stakeholder advisory panel, what is lacking is individual residents’ lived voices. This approach seems to be at odds with the foundations of PCC. Despite the researchers’ best efforts to recruit residents, it resulted in unsuccessful attempts. Due to the safety concerns after the pandemic, Korean NHs were still reluctant to have outsiders talk to residents. Future research should examine residents’ perspectives on PELI-K. Then, residents’ opinions could be given greater weight than those of other NH stakeholders, prioritizing their voices in the development of a short version of the instrument. Gathering input from a broader range of NH stakeholders, including long-term care providers and ombudsmen, with a larger and more diverse sample—groups that were excluded from the current study—will also contribute to establishing a more robust standard for measuring the items importance and feasibility. In addition, a qualitative study design, such as in-depth interviews, could help capture the subjective nature of preferences.

This study has significant implications in the context of clinical practice. Recently, public interest in improving the quality of long-term care and residents’ rights has been largely growing in Korea [22]. Considering the increasing need for a good quality of care, person-centeredness and responsiveness should be put into practice with evidence-based instruments to improve both clinical outcomes and residents’ quality of life [23]. However, given the long-lasting issues in Korean NHs such as staffing shortages and low staff empowerment [10], the original PELI-K 72 items may be too long and less practical to use in real situations. This trial is the first step to developing the short version of the PELI-K and preparing it for wider use. Developing and implementing more user-friendly tools in clinical practice will contribute to NH care quality improvement by delivering personalized care that reflects residents’ preferences and needs.

CONCLUSION

The current study is one of the first trials to examine the importance and feasibility of preference items in the Korean NH setting. It provides unique contributions by establishing the foundation for implementing the PELI-K in practice. Inputs from diverse groups of stakeholders help calibrate the PELI-K. Developing a short version of the PELI-K instrument based on the results of this study is the next step so that care providers can take advantage of the assessment of preferences in care planning and delivery.

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