Abstract
BackgroundAs the demand for nursing home (NH) services increases, older adults and their families expect exceptional services. Neighbourhood Team Development (NTD) is a multi-component intervention designed to train team members (staff) in the implementation of resident-centered care in NH settings. A neighbourhood is a 32-resident home area within a NH. This paper presents the protocol used to implement and evaluate NTD. The evaluation aimed to 1) examine fidelity with which the NTD was implemented across NHs; 2) explore contextual factors associated with implementation and outcomes of the NTD; and 3) examine effects of NTD on residents, team members, family, and organizational outcomes, and the association between level of implementation fidelity and outcomes.MethodsThe study employed a repeated measure, mixed method design. NTD consisted of a 30-month standardised training and implementation plan to modify the physical environment, organize delivery and services and align staff members to promote inter-professional team collaboration and enhanced resident centeredness. Training was centred in each 32-resident neighbourhood or home area. Quantitative and qualitative data were collected with reliable and valid measures over the course of 3 years from residents (clinical outcomes, quality of life, satisfaction with care, perception of person centeredness, opportunities for social engagement), families (satisfaction with care for relative, person centeredness, relationship opportunities), team members (satisfaction with job, ability to provide person centered care, team relationships) and organizations (retention, turnover, staffing, events) in 6 NHs. Mixed models were used for the analysis.DiscussionThe advantages and limitations of the NTD intervention are described. The challenges in implementing and evaluating this multi-component intervention are discussed as related to the complexity of the NH environment.Trial registrationClinicalTrials.gov ID: NCT03415217 (January 30, 2018 – Retrospectively registered).
Highlights
As the demand for nursing home (NH) services increases, older adults and their families expect exceptional services
Training for management and neighbourhood coordinators (NCs) was delivered by Neighbourhood Team Development (NTD) experts over the course of two consecutive days, twice per year, followed a training manual, and included competencies in care coordination, care and service delivery for the neighbourhoods, team’s interpersonal skills and care competencies, care decision support based on group processes, awareness and knowledge to promote residents’ choices, and skills for ongoing supervision and stewardship of the team
This study brings an innovative intervention, NTD, to enhance resident centred care in Nursing Homes (NH), consistent with the urgent priorities highlighted in previous research, that is, the redesign of NH services to fit the need and expectations of NH residents and addressing the spectrum of care for older persons with complex needs involving dementia [3, 5]
Summary
As the demand for nursing home (NH) services increases, older adults and their families expect exceptional services. The number of older persons living with complex comorbidities and dementia worldwide is approximately 47.5 million, with a projected increase to 75.6 million by 2030, and more than triple by 2050 [1]. Older adults with dementia often move to residential environments, such as nursing homes (NHs) to receive 24-h care to address their needs [3]. Older people residing in NHs and their families expect excellent care and services from the care team. Literature and anecdotal evidence indicate that the quality of care in NHs is not necessarily resident and family centred, and that staff do not always collaborate as a team in providing appropriate and tailored care; instead they are task focused and work in silos, which may compromise the residents’ quality of life [4, 5]. Two main barriers that limit the ability of a care team to support residents’ care and quality of life are a) the traditional organizational NH design that does not account for resident centeredness and b) major skills misalignment so staff function independently as opposed to working as a team
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