NURSING HOME RESIDENTS WITH AD-- A QUALITY CARE PROGRAM

George Washington University, Washington DC

Investigators

Abstract

The Alzheimer's Association advocates three key elements of quality care for individuals with AD. They are: environmental modifications, staff training, and programming that builds on the abilities of residents. The intervention proposed in this pilot study addresses two of those key elements - staff training and programming. Specifically, we seek to test the effectiveness of a Montessori-based approach to care that is designed, implemented and refined by facility staff. This care approach is characterized by standardized protocols, based in a conceptual foundation, that can be reproduced in a number of settings and acids a range of cognitive impairment. The intervention, targeting 60 special care unit (SCU) staff members in two nursing facilities, involves a 20-week program that consists of an assessment, implementation, and refinement phase. Each phase is comprised of an educational and activities component. Data are collected for staff and the residents they care for at baseline and immediately post-intervention. In addition, SCU staff in one facility will be tested again at 3 months post- intervention to determine the short-term effects of the program. The purpose of this pilot is twofold. First, we seek to examine the feasibility and effectiveness of a staff-developed and implemented program to improve AD residents' health. Second, as a result of conducting this study, we will describe and refine study procedures, gather pilot data and develop hypotheses to support future controlled studies of quality care in late-stage dementia. A quasi-experimental design is proposed to examine the effect of the intervention. The specific aims of this pilot are to: 1. Test the immediate effect of the intervention on staff use of Montessori principles and positive regard for caregiving. 2. Test the immediate effect of the intervention on the quality of care provided by staff. 3. Describe intervention costs and perceived benefits of the intervention. There are also four secondary study aims. One, we plan to examine the short-term effect of the intervention, as it appears 3-4 months after its conclusion. We anticipate that the effect of the intervention will diminish quickly. For these reasons, we also propose to explore potentially effective and efficient maintenance and booster strategies. Third, we will explore the effect on residents' quality of life associated with staff exposure to the intervention. Fourth, we seek to describe specific aspects of the intervention process, such as learning strategies, procedures developed by staff, and effectiveness and efficiency of each.