DIMENSIONS Autumn 2002

Spotlight on Research: An Innovative Staff-Training Program Improves Care and Quality of Life in Assisted-Living Facilities

by Cheryl Dawes

photo of STAR staff

A new training program developed by ADRC researchers helps staff of assisted living facilities better understand how to provide care for older adults with dementia. The program, known as Staff Training in Assisted-Living Residences (STAR), emphasizes realistic expectations of older adults with dementia, effective communication, and how to manage behavioral problems that can result from depression and anxiety.

Depression and anxiety are prevalent in people with dementia. Research has shown that these conditions adversely affect the quality of life for the person with dementia, the well-being of caregivers and the standards of care. The STAR program is aimed at reducing depression and anxiety among assisted-living residents with dementia. Funded by a five-year Pioneer Grant from the Alzheimer's Association, STAR is the first study to look at whether staff training can reduce depression and anxiety in residents and improve the quality of life for them, explains Dr. Linda Teri, professor of psychosocial and community health and principal investigator on the project.

The training aims to increase staff understanding of what residents with dementia are experiencing. Staff members learn the best ways to communicate with older adults who are having confusion and memory problems and how such problems can affect residents' abilities to articulate what they want. The training also guides staff members in adopting problem-solving strategies they can use in their daily interactions with residents.

"It's really a collaboration between psychologists, nurses, administrators, and long-term care providers to develop effective ways of training staff and improving care," says Teri. "We're trying to promote an interactive experience between staff and residents. The premise to our training and study is that if we can improve the residents' care then we will improve the working environment of the staff. If we can improve the staff's sense that they know what to do, we will improve the resident care."

Teri, with UW researchers Piruz Huda, Heather Young, and June van Leynseele, developed and pilot-tested the STAR training program in seven assisted-living facilities in Seattle. A controlled trial conducted in four of those facilities compared function in a study group of residents who received care from STAR-trained staff members and a control group of residents who received care from staff members trained in the facility's usual method. Results of the trial showed statistically significant improvements in resident and staff outcomes.

"When we started this project, we had no idea how we would be received," says Teri. "We've been very encouraged that we have much to offer and that staff and administration are open to the training program. We've collected pre- and post-test data, analyzed that data, and it looks like the program is improving residents' mood and staff satisfaction with their jobs, which are major components of what we were hoping to achieve."

STAR trainers make informal, interactive presentations. Staff members participate during training sessions in a hands-on approach to building problem-solving skills for use in their jobs. The program starts with an introduction to dementia and how it affects day-to-day life. It continues with training in verbal and non-verbal skills for communicating with residents with dementia. The next aspect of the training involves learning how to observe and identify the three components of a particular behavior. Staff members focus on problem behaviors, which are commonly related to anxiety or depression. They learn to identify the Activator, the event or situation that triggers the behavior; the Behavior; and the Consequences of the behavior.

Training in the ABCs of identifying behavior leads into techniques for managing problem behaviors. Staff members learn that once they have identified a Behavior and determined its Activator and Consequences, they can "get active" to change the behavior, by either changing the situation that triggered it or, in some cases, the event that follows it.

Helping staff identify and introduce pleasant events into residents' daily lives is a key component of STAR. Pleasant events decrease anxiety and depression. Staff members learn that although pleasant events are often planned, every planned or unplanned interaction with a resident can be a pleasant event.

The response of trainees to the training program has been excellent, according to Teri. "We've been pleasantly surprised at how amenable administration and staff of the assisted-living facilities have been-giving us a chance to try, instead of saying 'no thank you, we know what we're doing.' They know what they're doing and yet they're still open other ideas."

To further test and refine the STAR training program, Teri and her colleagues are working to take it to assisted-living facilities throughout Washington and eventually to facilities around the nation.

They are also in the process of evaluating the efficacy of a related training program they have developed, called STAR-C. This program, which comprises the same major elements as STAR, is designed for families that are caring for a relative with dementia at home. Administrators interested in learning more about STAR should contact June at 206-221-3857. Family members interested in learning more about STAR-C can contact Amy at 206-685-9169.

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