IMPLEMENTATION AND SUSTAINABILITY OF AUTONOMY INITIATIVES IN LONG-TERM CARE SETTINGS - Issue S2 - Abstract

Sep 29, 2026

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Resident autonomy is a core element of person-centered nursing home care, yet autonomy-focused interventions often struggle with implementation and long-term sustainability. This secondary data analysis evaluates changes in resident collective autonomy during Montessori staff training within a cluster randomized study across 8 US Veterans Health Administration Community Living Centers. Collective autonomy was assessed using the Montessori Organizational Self-Assessment (MOST) across four domains over five timepoints, showing significant overall gains by 12 months, with sustained improvement only in Domain 1.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Resident autonomy and rationale

Study design and setting

MOST domains and measurement

Findings across timepoints

Sustainability implications and future research

Innovation in Aging, 2025, Vol. 9, No. S2 703 autonomy domains across 5 timepoints: 1) Ask the Resident, 2) Connecting with Others, 3) Prepare the Environment, and 4) Create Community, rated on a scale from 0 (Not There) to 2 (In Action). At baseline, sites rated themselves below the midpoint in all domains, with the highest scores in Domain 1 (M = .88, SD =.07) and Domain 3 (M = . 82, SD = . 10) . Linear mixed-effects models showed significant increases from baseline to 12 months across all domains. However, only Domain 1 demonstrated sustained improvement at each follow-up. Other domains improved by 12 months but showed variability across intermediate timepoints. To our knowledge, this is one of the first studies to examine MOST scores as an indicator of collective autonomy over time after implementation of a complex intervention. Findings suggest collective autonomy progress may be challenging to sustain. Future research should investigate strategies to reinforce autonomy across all domains and the relationship between environmental and process-related autonomy initiatives. Abstract citation ID: igaf122.2396 IMPLEMENTATION AND SUSTAINABILITY OF AUTONOMY INITIATIVES IN LONG-TERM CARE SETTINGS Ashley Smith1, A. Lynn Snow1, and Michelle Hilgeman2, 1. The University of Alabama, Tuscaloosa, Alabama, United States, 2. Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, United States Resident autonomy is a core component of person-centered care in nursing homes yet autonomy-focused interventions face implementation and sustainability challenges (Boumans et al., 2021) . The Montessori approach promotes autonomy through individualized choice, engagement, and environmental modifications and is increasingly applied in long-term care settings (Yan & Traynor, 2023). Collective autonomy (e.g., shared decision-making) represents an important but often underexplored aspect of autonomy. This secondary data analysis examines changes in resident autonomy during implementation of Montessori staff training ina cluster randomized study in 8 US Veterans Health Administration Community Living Centers (VA nursing homes). The Montessori Organizational Self-Assessment (MOST) was used to assess four

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What do the findings suggest about sustaining autonomy initiatives?

Progress in collective autonomy may be difficult to maintain, indicating a need for future research on strategies that reinforce autonomy across all domains and on links between environmental and process-related initiatives.

Sep 29, 2026

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