# Adapting Advance Care Planning Tools for Permanent Supportive Housing Residents

> **NIH NIH R34** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $297,353

## Abstract

PROJECT ABSTRACT
Background: The homeless population is aging, with increasing proportions over age 50. People experiencing
chronic homelessness, defined as prolonged or multiple homeless episodes with a disabling condition, have
accelerated aging and high rates of mortality. Due to fragmented interactions with the health care system and
social isolation, chronically homeless older adults are at high risk of not having their wishes for medical care
documented or followed. Advance care planning (ACP) aims to elicit patients' medical wishes; yet, older
homeless adults have low rates of ACP. Significant policy attention has focused on rehousing chronically
homeless people into Permanent Supportive Housing (PSH). While PSH represents a unique setting to initiate
ACP, there are no studies of ACP in PSH. Our team has created easy-to-use, evidenced-based ACP tools,
such as an easy-to-read advance directive (AD) and a web-based educational program with video stories
(PrepareForYourCare.org) to be used in group visits or with a one-on-one facilitator. However, these ACP
interventions require adaptation for PSH settings. The objective of this proposal is to adapt, pilot, and
demonstrate the feasibility of evidenced-based ACP interventions for a unique population (formerly chronically
homeless older adults) in a novel setting (PSH). Aims: We will adapt the easy-to-read AD (Aim 1), the group
visit guide (Aim 2), and the one-on-one facilitator guide (Aim 3) to meet the needs of older (≥ 50 years of age)
PSH residents. Then, we will pilot the adapted ACP interventions to assess the feasibility of delivering the ACP
interventions in the PSH setting and obtain feedback on the intervention and processes. (Aim 4). Methods: In
Aims 1-3, we will conduct three focus groups for each Aim, with 6-10 older (≥ 50) PSH residents each. We will
apply the Behavior Change Wheel (BCW) framework, which uses the Capability Opportunity Motivation
Behavior (COM-B) model to understand targeted behaviors (i.e., ACP engagement) in context, the barriers to
use of the ACP interventions, and strategies to overcome them. We will conduct thematic content analysis to
determine needed adaptations to overcome these barriers and create additional material to meet PSH
residents' needs. We will adapt both materials and processes based on this input. In Aim 4, we will assess the
feasibility of our recruitment procedures, our survey materials, and the group visit and facilitator interventions.
We will assess satisfaction using validated questionnaires and obtain feedback about feasibility of the
interventions and our study procedures in the PSH setting. A Community Advisory Board of key PSH leaders,
residents and staff will work with the investigators to guide the study. Relevance to NIH and public health:
The proposed project will develop ACP interventions for use in PSH, which we will test in a future R01-funded
efficacy randomized trial. These interventions may reduce health disparities in ACP ...

## Key facts

- **NIH application ID:** 9875293
- **Project number:** 1R34AG065600-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Margot B Kushel
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $297,353
- **Award type:** 1
- **Project period:** 2020-03-01 → 2021-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9875293

## Citation

> US National Institutes of Health, RePORTER application 9875293, Adapting Advance Care Planning Tools for Permanent Supportive Housing Residents (1R34AG065600-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9875293. Licensed CC0.

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