Elsevier

Geriatric Nursing

Volume 30, Issue 3, May–June 2009, Pages 153-163
Geriatric Nursing

Feature Article
Improving Dementia Care in Assisted Living Residences: Addressing Staff Reactions to Training

https://doi.org/10.1016/j.gerinurse.2008.07.002Get rights and content

More than 1 million older adults, many with significant cognitive impairment, receive care in assisted living residences (ALRs), and their numbers are increasing. Despite this, ALR staff are often inadequately trained to manage the complex emotional, behavioral, and functional impairments characteristic of these residents. Nurses are in a unique position to improve this situation by training and supervising ALR staff. To facilitate such training, an understanding of staff reactions to receiving training as well as a systematic yet flexible method for training is needed. This article provides information on one such program (STAR—Staff Training in Assisted-living Residences), discusses challenges that arose when offering this program across 3 states in 6 diverse ALRs (rural, urban, for-profit, and not-for-profit sites), and describes how these challenges were addressed. We illustrate how nurses can successfully train ALR staff to improve resident and staff outcomes and offer guidance for those interested in providing such training.

Section snippets

Overall Plan and Design

After success in conducting STAR in 1 geographic area (Seattle, Washington),12 we sought to investigate whether this training would be feasible and relevant to other areas of the country. Specifically, we were interested in investigating STAR in an urban multicultural site (Chicago, Illinois/C. Farran, site principal investigator [PI]) and a rural, predominantly African American/minority site (Little Rock, Arkansas/C. Beck, site PI) as well as replicating the success at various sites in the

Trainer Data

Three trainers, 1 from each state, conducted STAR in the 8 ALRs. Each had specialized training in dementia care, but the level of this training varied from a master's-level degree in social work to a Ph.D. in nursing. There were 2 women and 1 man; age ranged from 38 to 52, with 2 to 8 years experience in long-term care.

ALR Data

ALRs enrolled in this phase were as diverse as the larger population of ALRs across the country; for profit, not-for-profit, chains, and independently owned residences were

Discussion

This article presents issues that affected the implementation and response to STAR (Staff Training in Assisted-living Residences), an on-site training program specifically designed to improve care of persons with dementia in assisted living residences. We discuss how UAPs responded to this program and how we addressed staff concerns and the challenges that arose during training.

As more diverse sites and trainers became involved, we were struck by the almost universality of issues that arose at

Acknowledgments

This study was supported in part by a Pioneer Award from the Alzheimer's Association and Grant No. 5 R21 MH069651 from the National Institute of Mental Health. Appreciation is extended to the staff of the STAR and STAR21 programs for their hard work and diligence in conducting this trial; to the residents, families, and staff in the assisted living residences that participated in this study; and to Lisa Bancroft, MSW, for her helpful comments on earlier versions of this article. The complete

LINDA TERI, PhD, is a Professor and Interim Vice-Chair at the Department of Psychosocial and community Health, and the Director of Northwest Research Group on Aging, University of Washington School of Nursing; Adjunct Professor in the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and the Department of Psychology, Seattle, WA.

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Cited by (0)

LINDA TERI, PhD, is a Professor and Interim Vice-Chair at the Department of Psychosocial and community Health, and the Director of Northwest Research Group on Aging, University of Washington School of Nursing; Adjunct Professor in the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and the Department of Psychology, Seattle, WA.

GLENISE L. MCKENZIE, PhD, RN, is a Research Assistant at the University of Washington School of Nursing, Seattle, WA.

DAVID LAFAZIA, MSW is a Research Assistant at the University of Washington School of Social Work, Seattle, WA.

CAROL J. FARRAN, DNSc, RN, FAAN Director, PhD Program, is a Professor and Nurses Alumni Association Chair, Health and the Aging Process, Community & Mental Health Nursing, Rush University Medical Center, Chicago, IL.

CORNELIA BECK, PhD, RN, FAAN, is a Professor at the Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

PIRUZ HUDA, MN, ARNP, is a Nurse Practitioner Research Assistant at the University of Washington School of Nursing, Seattle, WA.

JUNE VAN LEYNSEELE, MA, is a Research Coordinator at the Northwest Research Group on Aging, Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA.

KENNETH C. PIKE, PhD, is a Research Scientist, Reconnecting Youth Prevention Program, Dept. Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA.

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