Table 1.

Measures of Social Functioning for Nursing Home Residents

Tool (Citation) and Source	Type	Validated in Nursing Home Setting	Description of Tool	Example Questions	Suggestions for How to Use the Tool in Practice
Care planning measures
Preference Assessment Tool (PAT; Housen et al 200917) Available for free at cms.gov; preferencebasedliving.com	Self, staff, or proxy report	Yes (Housen et al 200917)	16-item measure of residents’ daily routines and activity preferences	“How important is it… -To choose who you would like involved in discussions about your care -To do things with groups of people”	Typically administered by recreational therapy, social services, or nursing; can be administered by staff with assessment experience. Interdisciplinary care team should work together to implement resident preferences into care planning and delivery. Especially during COVID-19, consider the use of technology and how to meet preferences within social distancing guidelines.
Preference for Everyday Living Inventory (nursing home version; PELI-NH; Curyto et al 201618) Available for free at preferencebasedliving.com	Self or proxy report	Yes (Curyto et al 201618; Abbott et al 201819)	72-item measure of residents’ important preferences across 5 domains (ie, self-dominion; enlisting others in care; social contact; growth activities; leisure and diversionary activities)	“How important is it… -To have regular contact with family -To spend time one-on-one with someone”	Typically administered by recreational therapy, social services, or nursing; can be administered by staff with assessment experience. Consider divvying up assessment among team members based on domains (eg, social function for psychology; leisure and diversionary activities for recreational therapy; self-dominion for nursing). Interdisciplinary care team should work together to implement resident preferences into care planning and delivery. Recreational therapy can use preferences to plan individualized or group activities. Especially during COVID-19, consider the use of technology and how to meet preferences within social distancing guidelines.
The Activity Card Sort (Baum and Edwards 200820) Available for purchase at aota.org	Self or proxy report	Yes (Law et al 200521)	55-89-item (dependent on version) measure of residents’ participation in social, instrumental, and leisure preferences that involves sorting photographs of older adults engaged in a variety of activities	Photo-based assessment	Typically administered by occupational therapy; can be administered by staff with assessment experience. Residents could be asked to sort pictures of activities into 2 categories: (1) those currently doing and (2) those stopped since COVID. They can also be asked to identify their preferred activities to aid in care planning.
Care Preference Assessment of Satisfaction tool (ComPASS; Heid et al 201922) Available for free at: compass.linkedsenior.com	Self-report	Yes (Bangerter et al 201723)	Measure that accompanies the PAT and/or PELI-NH, which tracks residents’ satisfaction with care related to their important preferences	“How satisfied are you with this preference being met in the past week?”	Typically administered by recreational therapy, social services, or nursing; can be administered by staff with assessment experience. ComPASS is especially useful to understand how residents feel about the individualization of their care during COVID and beyond. Interdisciplinary care team should work with resident to adjust care delivery to meet their preferences, as needed.
Outcome measures
World Health Organization measures -Disability Assessment Schedule (WHODAS) -Quality of Life Measure (WHOQOL) Available for free at who.int/tools	Self-report	Measures have been validated for use with a variety of specific populations of older adults (eg, specific conditions/cultures), but not nursing homes	Variety of measures that include domains/questions on a person’s social participation and relationships	Items vary by measure: -“How much of a problem did you have in doing things by yourself for relaxation or pleasure?” (WHODAS) -“How satisfied are you with your personal relationships?” (WHOQOL)	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use these assessments to understand how a resident perceives her or his level of function (WHODAS) and quality of life (WHOQOL) both of which can be discussed with the resident to plan care and relevant social activities.
Patient-Reported Outcomes Measurement Information System (PROMIS) measures -Ability to participate in social roles/activities -Companionship -Emotional support -Informational support -Instrumental support -Satisfaction with participation in discretionary social activities -Satisfaction with participation in social roles -Satisfaction with social roles and activities -Social isolation (Cella et al 201924) Available for free at healthmeasures.net	Self-report	Some measures have been validated for use with older adults, but not nursing homes	Variety of measures focused on a person’s social functioning and social health	Items vary by measure: -“I have someone who will listen to me when I need to talk” (Emotional Support) -“I am satisfied with my ability to do things for my friends” (Satisfaction with Participation in Social Roles)	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use PROMIS assessments to understand residents’ perspectives on their social health. These measures could easily be used for longitudinal assessment because of their short and straightforward nature. Results should be considered in planning social activities and, also, in considering how staff can support residents.
UCLA Loneliness Scale (Russell 199625) See citation for tool	Self-report	Validated for use in older adults, not nursing homes	20-item (dependent on version) measure of subjective feelings of loneliness and social isolation	-“I feel completely alone” -“I am unhappy doing so many things alone”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool to understand how lonely or isolated a resident may feel and identify areas to support their participation in social activities and social interactions.
Three-Item Loneliness Scale (Hughes et al 200426) Available for free at: campaigntoendloneliness.org	Self-report	Validated for use in older adults, not nursing homes	3-item measure of subjective feelings of loneliness and social isolation	-“How often do you feel left out?”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool, especially when short on time, to screen for social isolation and loneliness. Then, staff can follow up with a more comprehensive assessment to identify areas to support residents’ participation in social interactions and events and facilitate social connection with others.
Lubben Social Network Scale (Lubben and Gironda 200427) See citation for tool	Self-report	Yes (Munn et al 201828)	6-18-item (dependent on version) measure of a person’s size and type of social network	-“How many friends do you feel close to such that you could call on them for help?” -“How many relatives do you feel at ease with that you can talk about private matters?”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool to identify how residents perceive their social connections and relationships. Staff can use responses to identify areas residents might need support in fostering connection and relationships with others.
The Interpersonal Needs Questionnaire (INQ; Van Orden et al 201229; Parkhurst et al 201630) Available for free at https://psy.fsu.edu/∼joinerlab/resources.html	Self-report	Validated for use in older adults, not nursing homes	10-25-item (dependent on version) measure of social functioning constructs (eg, belongingness and burdensomeness); shortened response version available that is recommended for use with older adults	-“These days, I rarely interact with people who care about me” -“These days, I have at least 1 satisfying interaction every day”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool to evaluate residents’ self-perceived social deficits and use these as areas for goal-setting and planning care. However, this tool can also be used to assess residents’ risk for suicide and, therefore, is an important multifaceted social functioning assessment for staff to consider using.
Questionnaire for Assessing the Impact of the COVID -19 Pandemic on Older Adults (Cawthon et al 202031) See citation for tool	Self-report	No	17-item measure of social functioning in light of the COVID-19 pandemic; includes the 3-item loneliness scale	-“How often are you communicating with others?” -“How are you continuing to stay in touch with others?”	Currently used in research; can be administered by staff with experience in assessment and interpretation. During COVID-19, this tool can be used as a baseline to understand how the pandemic has impacted residents and their typical social roles and interactions. Some questions/wording of questions will need to be adapted for the nursing home population.
Quality of Life in Alzheimer’s Disease (QOL-AD; Logsdon et al 200232) Available for purchase at apta.org	Self or proxy report specific to older adults with Alzheimer’s disease and other dementias	Yes (Edelman et al 200533)	13-15-item (dependent on version) measure of physical health, mood, relationships, activities, and ability to complete tasks	-“How about your family and your relationship with family members? Would you describe it as poor, fair, good, or excellent?” -“How do you feel about your marriage? How is your relationship with (spouse’s name)? Do you feel it’s poor, fair, good, or excellent?”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool to assess a person’s quality of life when living with Alzheimer’s disease. Responses from resident or proxy will help aid in care planning that aligns with a resident’s cognitive ability and functional status, specifically related to social activities and social interactions.
The Social Functioning in Dementia Scale (SF-DEM; Sommerlad et al 201734) See citation for tool	Self- or proxy report specific to older adults with Alzheimer’s disease and other dementias	Validated for use in older adults, not nursing homes	20-item measure of engagement in social activities and relationships	“Thinking about the past month, how often have you… -Contacted friends or family by phone or computer -Found you don’t want to do things you would usually do”	Typically administered by social services, nursing, or mental health; can be administered by staff with experience in assessment and interpretation. Interdisciplinary staff can use this tool to understand the level of social functioning for a resident who lives with dementia—especially what types of social activities they might prefer and how well they or their proxy feel the resident connects with others.