Optimizing the Daily Care Interactions Between Direct Care Staff and Assisted Living Residents with Dementia

PROJECT SUMMARY About 25% of daily care interactions between staff and residents in long-term care including Assisted Living Facilities (ALFs) comprise of poor care interactions. Individuals with Alzheimer’s disease and related dementias (ADRD) are especially at risk for poor care interactions related to ineffective staff approaches such as negative touching, being overprotective, and lack of verbal or non-verbal contact during care. Poor care interactions have a negative impact on both resident and staff well-being and therefore, need to be replaced with positive care interactions. Use of positive care approaches such as identifying resident’s abilities and preferences, understanding resident’s responses and non-verbal cues, appreciating resident’s effort, managing self-responses to resident, and using a calm and respectful approach can promote positive care interactions in ALFs and further improve outcomes for both residents (e.g., less behavioral distress) and staff (e.g., greater competence in dementia care). Yet, we continue to see poor care interactions in ALFs due to resident’s ADRD-related communication challenges and behaviors, staff’s limited knowledge and skills in caring for residents with ADRD, and organization’s limited support and engagement in initiating and sustaining positive approaches. Therefore, the purpose of this study is to pilot test the Promoting Positive Care Interactions (PPCI) intervention with the goal of establishing a feasible and culturally responsive approach to optimize care interactions between staff (nursing, activity, housekeeping, and dining service) and residents with ADRD in ALFs, and further improve select resident, staff, and organizational outcomes. PPCI is a theory-based four-step intervention consisting of 1) stakeholder engagement in developing facility specific goals; (2) environment and policy assessments; (3) flexible staff education; and (4) ongoing mentorship, motivation, and support (in-person visits and text messages) for staff to optimize care interactions in ALFs. Aim 1 will examine the feasibility and acceptability of PPCI. We will also explore the cultural responsiveness of PPCI. Aim 2 will test the preliminary efficacy of PPCI on select resident outcomes (primary: quality of life; secondary: agitation, resistiveness to care), staff outcomes (primary: quality of care interactions; secondary: knowledge, perceived competence related to care and communication, stress, relationship quality), and organizational outcomes (environment and policies). Aim 1 will use a convergent parallel mixed-method design with surveys and focus groups completed at six months. For Aim 2, repeated (resident, staff, and facility) measures will be evaluated at baseline and six months. Data will be analyzed using mixed methods for aim 1 and count models for aim 2. This study will support to establish a feasible and culturally responsive approach to optimize care interactions and further improve ADRD care in ALFs. Findings will inform future implementation of PPCI.