Quality Of Dementia Care Research Articles

TOWARD A GLOBAL DEFINITION OF PERSON-CENTERED DEMENTIA CARE

Abstract Person-centeredness is instrumental to quality dementia care, yet there remains inconsistency surrounding its definition and attempts to unify disparate conceptualizations are often based on high-income and Eurocentric perspectives. To address this, we surveyed 39 Alzheimer’s Disease International members on their perspectives and experiences with quality of dementia care, definitions of person-centered dementia care, and the challenges and successes of person-centered dementia care in their countries. Overall, respondents describe a lack of global quality dementia care, naming several barriers to its successful implementation. Respondents also agreed the creation of a universal definition of person-centered dementia care is necessary for furthering high quality dementia care globally. Five core tenets representative of the geographically and economically diverse sample were identified to be included in such a definition: individualize care, value the individual, empower the individual, acknowledge the importance of caregivers, and address dimensions of wellness. Discussion will focus on recommendations for practitioners, researchers, and policy advocates on how to embody global tenets of person-centered dementia care. Additionally, internationally common barriers to person-centered dementia care are identified for further study and advocacy efforts.

WHAT MATTERS MOST FOR PERSON-CENTERED DEMENTIA CARE: PERSPECTIVES FROM STAKEHOLDERS IN LOW-RESOURCE LONG-TERM CARE

Abstract One of the initial steps in supporting quality dementia care for residents living with dementia (RLWD) in low-resource long-term care (LTC) settings is to elucidate stakeholder perspectives on what matters most for providing person-centered dementia care in such settings. We conducted community-based, participatory research across four LTC facilities situated in federally designated medically underserved areas (two rural and two urban) to describe what matters most to key stakeholders in achieving person-centered dementia care in low-resource LTC settings through their own journeys. In-depth semi-structured interviews were conducted with administrative leaders (n=7), direct care staff (n=20), RLWD (n=16), and family/care partners (n=16), with transcripts thematically analyzed using NVivo14 software. Administrators and staff members acquaint themselves with dementia care principles, participate in daily huddles, and establish rapport with residents and families. As they progress, they acquire skills to observe residents’ behaviors, empathize with their experiences, cultivate trust, delivering intuitive care that honors individual preferences, routines, and past experiences. RLWD transitioning to LTC settings seek environments resembling private homes that foster self-advocacy and rely on staff members who understand their needs and promote a sense of belonging. For family members, the journey involves supporting their loved ones’ transition, advocating for their preferences, and maintaining open communication with staff. They play a crucial role in reinforcing resident preferences and ensuring the delivery of quality care. Throughout these journeys, stakeholders identify key quality measures, including odor, cleanliness, resident happiness, and the quality of relationships, as benchmarks for assessing person-centered care.

A COMMUNITY-ENGAGED APPROACH TO CULTURAL ADAPTATION OF BEHAVIORAL INTERVENTIONS: ENGAGING LATINOS IN RESEARCH

Abstract Latinos are 1.5 times more likely to develop Alzheimer’s disease and related dementias (ADRD) than non-Hispanic white Americans. Latinos also have the highest prevalence of caring for a loved one with ADRD. They spend more time in caregiving-related activities, have limited social support and access to quality dementia care, and have significantly worse physical and mental health. The paucity of culturally congruent interventions to improve Latino ADRD caregivers’ psychological well-being continues to perpetuate poorer outcomes and disparities among Latino caregivers. While several effective psychoeducation and skill-building caregiver programs have been developed, these interventions lack representation of Latino caregivers. Thus, culturally attuned adaptations and implementation of available interventions for Latinos are needed to address this critical gap. This study engaged community-dwelling older Latinos, including Latino caregivers, and Latino community organization leaders, to collaborate in cultural adaptation of the Tele-Savvy program and clinical trial design. Employing community-engaged approaches, we combined a staged cultural adaptation framework and a locally developed training program to engage Latinos in caregiving research. Nine Latino community members served on a community advisory board (CAB). Members first engaged in a training program to develop knowledge about ADRD and skills in conducting research and cultural adaptation. Following the training, members engaged in cultural adaptation of Tele-Savvy and the design of a future clinical trial to test the adapted intervention with Latino ADRD caregivers. We will discuss preliminary findings from the cultural adaptation work with CAB members and future directions to inform the testing of the adapted Tele-Savvy and its refinement.

How Innovative Designs Can Help Ease Ethical Tension in Good Dementia Caregiving and Decision-Making.

Internationally, there is a long history of improving dementia care quality by focusing on patients' strengths and supporting environments that normalize their daily routines. The European dementia village is a pioneering health care site: 4 acres of integrated housing and amenities that include large exterior walkways around gardens, restaurants, and shops. A US-based conceptual model is the dementia friendly city center, which integrates health care service delivery into adaptive reuse and urban revitalization. This article discusses how these models envision structures and spaces of caregiving and habitation.

A systematic review of depressive and anxiety symptoms in caregivers of dementia patients.

The current number of dementia cases in Europe stands at 7.7 million, a figure projected to double by 2050. Caregivers of individuals with dementia experience a heightened burden compared to those caring for other chronically ill individuals, increasing the risk of depression and stress disorders. This systematic literature review, following PRISMA guidelines, explores the prevalence of anxiety and depressive symptoms in dementia caregivers. Searches in academic databases, restricted to studies from the last 15 years, identified 85 articles with 16 meeting the inclusion criteria. Results indicate significant caregiver burden, diminished self-reported quality of life, and a propensity for clinical depression. Depression and anxiety symptoms were more pronounced among female caregivers. Caregiver depression correlated with increased emergency department utilization by dementia patients, with a surge in depressive symptoms reported during the COVID-19 pandemic. Caregiving for dementia patients was associated with burnout, adversely impacting caregiver quality of life. Depression and anxiety symptoms in caregivers correlated with substance use. Sociodemographic variables, including low socioeconomic status, high urbanization levels, and older age, were associated with caregiver depression. Caregivers of individuals with Alzheimer's disease reported higher anxiety, burden, and depression scores compared to those assisting individuals with other dementias, particularly when neuropsychiatric symptoms were evident. The identification of the factors that are linked to the mental burden of caregivers allows mental health professionals to enhance symptom detection and provide tailored support, ultimately alleviating caregiver burden and improving dementia care quality. Systematic professional assistance and training opportunities through health policies can effectively alleviate caregiver burden.

Advancing Dementia Care in Austria: developing a Dementia Registry using a multimethod approach

Abstract Background Austria faces an increasing demand for dementia care in an ageing population. However, a lack of representative data hampers evidence-based policy development and evaluation of care. To address this gap, the Austrian National Institute of Public Health is undertaking the task of developing the Austrian Dementia Quality Registry (ÖDQR). Methods Based on the AIHTA Good Practice Framework for Dementia Registries, the development and testing of the ÖDQR has unfolded in 4 distinct phases: 1) planning; 2) registry design (including definition of quality indicators and minimum data set, recruitment, and governance); 3) definition of data collection, sources, and management; 4) pilot testing. A steering committee of government representatives and dementia care experts was convened to oversee the project. A scientific committee provided oversight and ensured methodological rigor. Working groups of national and international dementia care experts focused on standards for diagnosis and therapy, activities of daily living and quality of life, legal aspects, and technical implementation, thus contributing to the content development of the ÖDQR. Results An initial systematic literature review informed the selection of quality indicators in the working groups. A conceptual framework of 15 descriptive and 30 quality indicators was developed. Preliminary results of pilot testing indicate feasibility and content validity. As a result, the ÖDQR will be established as a longitudinal survey-based registry, based on an instrument comprising 163 variables and emphasizing data collection across care settings. Legal and technical frameworks are being developed. Conclusions The öDQR holds the promise of informing evidence-based policy and improving the quality of dementia care in Austria. Careful planning and collaboration have laid the foundation for a data repository that will inform policy and improve care for people with dementia and their caregivers. Key messages • Dementia registries require a complex development to assure validity and adherence. • The Austrian Dementia Registry aims to establish best practice by focusing on the life situation of those affected by this condition.

Let home care be the GUIDE: Integrating quality dementia care into existing home care teams.

Let home care be the GUIDE: Integrating quality dementia care into existing home care teams.

Evaluation of an innovative dementia care competency model among physical and occupational therapy students

ABSTRACT The rising prevalence of dementia calls for a competent workforce capable of delivering quality dementia care. A standard for assessing dementia-care-specific competencies is necessary to guide curriculum development and implementation in a competency-based educational framework during academic training. This study evaluated the psychometric properties of the Dementia Care Competency Model (DCCM) among students enrolled in physical (PT) and occupational therapist (OT) programs. Eighty PT and OT students completed the DCCM by rating the 11 sub-competencies using the National Institute of Health Proficiency Likert Scale. The Exploratory Factor Analysis yielded a Kaiser-Meyer-Olkin of 0.878 and Bartlett’s test significance value of < 0.001, which indicates that the data were very good for factor analysis. The Eigenvalues and scree plot derived two factors with an excellent internal consistency (Cronbach’s alpha = 0.936). When examining the grouping of sub-competencies, the two factors that emerged were patient-centered and interprofessional collaborative care. The DCCM version 2.0 can guide educators in designing learning experiences that target the essential competencies in dementia care, ensuring that PT and OT graduates are well-prepared to work with individuals living with dementia. Future research should refine the model by exploring additional sub-competencies within each domain and expanding the model’s applicability across multiple healthcare disciplines.

FC27: Caring for people living with dementia in their own homes: A qualitative study exploring the role and experiences of registered nurses within a district nursing service in the UK

Objectives: In the UK, district nursing services (DNS) deliver care to people in their own homes and have regular contact with people living with dementia. Research conducted with nurses working in similar roles outside the UK suggests their contribution to high quality dementia care is limited by compassion fatigue, lack of dementia training and low levels of confidence. However, there is a paucity of research exploring the role and learning and support needs of nurses within DNS. The aim was to gain insight into the role and experiences of nurses caring for people living with dementia at home.Methods: The study was informed by a descriptive phenomenological approach. Semi- structured interviews were conducted with a purposive sample of ten nurses working in DNS. Data were analysed using a thematic approach.Results: Participants described having considerable contact with people with dementia and managing increasingly complex situations despite little training in this field. Care was provided across the illness trajectory from detection and diagnosis of dementia through to end-of-life and the involvement of DNS was instrumental across all stages. Five main themes were identified: ‘Home as a care setting’ reflected how delivering home-based care shaped participants experiences of caring for people with dementia; ‘Taking it in their stride’ revealed how participants adapted and responded to the complexity of care needs for people with dementia; ‘Complexity and unpredictability’ related to the unpredictable nature of people with dementia’s care needs and the impact this had on participants’ workloads; ‘Expertise and support within the wider team’ detailed which networks nurses used for advice and support to manage the complex needs of people living with dementia at home; ‘Specialist support’ identified the need for structural changes and resources to enable the nurses to deliver the care needed.Conclusions: This study enables better understanding of the role of DNS in supporting people with dementia to live at home. This is important for defining how dementia care can become effectively integrated into primary care. Recommendations include improved models of care, which factor in specialist nurses, additional time for home visits and greater emphasis on education and training.

Motivators for family carers of persons with dementia in Kenya.

The number of people with dementia is on the rise in Kenya and across Africa. Although family carers act as the main providers of dementia care in Kenya, there is still a significant knowledge gap regarding why family members care for someone with dementia. This study explores perceived drivers of care for people with dementia in a rural Kenyan context. Participants were recruited in Makueni County, Kenya. Primary data were derived from a focus group discussion (FGD) and five individual interviews with family carers of people with dementia. To complement interpretation, triangulation occurred through using data from FGDs with healthcare workers and members of the general public. All audio recordings were transcribed verbatim and inductive thematic analysis performed using NVIVO 12. Using the Positioning Theory, we sought to generate information pertaining to motivation for becoming a family carer. Five themes emerged from the analysis and included: (i) self-fulfillment, (ii) familial obligation, (iii) cultural and religious beliefs, (iv) reciprocity, and (v) societal pressures. These themes described the nature of care given to people with dementia, based on what the participants perceived as compelling and/or motivating factors. Our findings describe the unique motivators of family carers for people with dementia in Kenya. The ability to find meaning in the caregiving experience could contribute to development of effective support systems, interventions and policies for dementia carers with the aim of improving the overall quality of dementia care in Kenya.

Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community.

Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.

Help-seeking behavior in difficult situations among long-term care facility staff: a comparison with general citizens

ABSTRACT Although help-seeking research is useful to improve the quality of dementia care and mental health of care staff, most studies have focused on family caregivers. The details of help-seeking behavior among care staff remain unclear. This study investigated the features of help-seeking behavior among staff working in long-term care facilities. Two online surveys were conducted, targeting individuals working in long-term care facilities in Kinki Region, as well as general citizens who are users of crowdsourcing services across all regions of Japan. Four hypothetical difficult caregiving situations were developed to examine staff help-seeking behavior, including older people’s going-home behavior, care resistance, apathy, and depression. When confronted with difficult situations, participants responded regarding whether they sought help from other staff, the timing of help-seeking when they chose to seek help from others, and the level of burden to deal with the situations. A total of 505 participants (273 care staff and 232 general citizens) were analyzed. Two-way analysis of variance (ANOVA) revealed that the burden in all situations experienced by general citizens was higher than that among care staff. Three-way ANOVA also showed that excessive help-seeking styles were associated with difficult care situations. Finally, care staff engaged in help-seeking behavior more quickly than general citizens. The current findings showed that, compared to general citizens, care staff exhibited more frequent help-seeking behavior, which would be helpful to support problem-solving or alleviate the burden of care. Additional research is necessary to clarify the functions of help-seeking behavior in dementia care.

Post-diagnostic support for persons with young-onset dementia – a retrospective analysis based on data from the Swedish dementia registry SveDem

BackgroundApproximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support.MethodsThis retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support.ResultsInformation and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor.ConclusionThis study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.

Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed-methods systematic review.

To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia. People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive. A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach. Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care. Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers. Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed. The review followed the PRISMA 2020 checklist. No.

The effectiveness of virtual passport, an app-based intervention, for dementia care.

This study aimed to confirm the effectiveness of the virtual passport for dementia care. The virtual passport is an application (app) tool connecting healthcare professionals, dementia care sites, and people living with dementia (PLWD) and their family caregivers. This tool assists case managers in hospitals by providing individualized care plans and health education to PLWD and their caregivers. The dementia quality indicator achievement rates, care needs investigation and fulfillment, severity of behavioral and psychological symptoms of dementia (BPSD), and changes in caregiver burden and depression are measured at the initial interview and 6 and 12 months after the intervention. We enrolled 57 and 54 patients and their caregivers in the virtual passport and routine care groups, respectively. Compared to the control group, six quality indicators in the passport group showed significantly higher achievement at 6 months after using the virtual passport. Case managers addressed more care needs at 6 months (1.37 vs 0, p < 0.001) and 12 months (1.32 vs 0, p < 0.001). Improvement in severity of neuropsychiatric symptoms (neuropsychiatric inventory (NPI) irritability/lability difference: -0.58 vs 0.22, p = 0.044; NPI agitation/aggression difference =-0.78 vs 0.00, p = 0.042) were also observed. No obvious influence was found in caregiver burden and depression after using the virtual passport. The virtual passport is an effective information technology tool in improving the quality of dementia care, assisting case management in identifying more care needs, and reducing the severity of BPSD.

Dementia, nurse staffing, and health outcomes in nursing homes.

To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality. A national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus. Retrospective, regression analyses. We estimated separate linear models predicting six long-term facility-level outcomes. Independent variables included staffing hours per resident-day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics. Hospital-based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded. We found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low-census dementia facilities, although, high- and low-dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome. These findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low- and high-dementia census facilities.

PROVIDING DEMENTIA CARE ACROSS LOW-RESOURCE COMMUNITIES

Abstract The growing number of persons living with dementia (PLWD) require ongoing care and supportive services, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Across low-resource communities—including poorer urban and rural settings—health resources tend to be limited and PLWD are predominantly socioeconomically disadvantaged and have few personal financial resources to contribute to care provision. Although there is growing evidence about the consequences of care inequities for PLWD, less is known about key issues and opportunities for improving dementia care in low-resource communities. This symposium features presentations that highlight unique social and economic challenges and opportunities for providing dementia care in low-resource communities. The first presenter reports results from a community-based, participatory research study in four long-term care settings in federally designated medically underserved areas (two rural, two urban) that highlights strategies used by long-term care providers to recruit and retain dementia care staff and describes their perspectives on quality dementia care. The second presenter shares findings from an innovative pilot program of case management services to address challenges of PLWD who are living alone in the community through collaboration with local paramedicine services. The third presenter provides an overview of the Person-Centered Options Counseling Certification program with a discussion on strategies for implementing person-centered dementia care initiatives in low-resource communities. This symposium reveals complexities in providing care for PLWD in diverse low-resource communities and generates directions for addressing dementia care inequities.

EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY

Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.

STAKEHOLDER PERSPECTIVES ON QUALITY DEMENTIA CARE IN LOW-RESOURCE LONG-TERM CARE SETTINGS

Abstract Having dementia care staff who are knowledgeable about the needs and preferences of residents living with dementia (RLWD) in long-term care (LTC) settings holds promise for supporting quality of care. However, staff who work in low-resource LTC settings tend to have fewer opportunities to get to know the residents, who in turn experience increased risk of adverse outcomes. Low-resource LTC settings can experience barriers in providing quality dementia care due to their limited ability to capture pertinent information about residents’ needs and preferences and ensuring that information is known by dementia care staff. We sought to describe stakeholder perspectives regarding the collection and sharing of information about RLWD in four low-resource LTC settings (two nursing home; two assisted living) that serve RLWD. All four settings were in medically underserved areas with two rural settings in New Hampshire and two urban settings in Maryland. Preliminary site visits conducted revealed strategies used by LTC providers to recruit and retain dementia care staff. In-depth semi-structured interviews were conducted with a purposive sample of stakeholders (administrative leaders, direct care staff, RLWD and family members). Interviews were transcribed and thematically analyzed in NVivo12. Themes were identified in four core topic areas: 1) identifying information about RLWD to support quality care; 2) finding and accessing information by the care team; 3) sharing information with RLWD; and 4) describing quality measures most relevant for RLWD. Findings shed light on practical strategies used by low-resource LTC settings and motivate future research on measuring dementia care quality.

NURSING HOME WORKFORCE EDUCATION: DOES ONE SIZE FIT ALL? EVIDENCE FROM THE CHATO NATIONAL TRIAL

Abstract Educating the nursing home workforce to provide quality dementia care is a national priority. Staff education is usually provided to all staff in communities that vary in size, location, ownership, and resources with little consideration for diversity. To evaluate suitability for diverse staff, we compared learning outcomes for White, non-Hispanic staff and staff of diverse races and ethnicities who completed CHATO in year one. White non-Hispanic staff (N=402) scored higher on knowledge assessments than staff self-reporting other races and ethnicities (N=201) at baseline (mean=57.1% vs. 49.1%, p&amp;lt;.001). Both groups improved on post-assessment (by 19.0 and 23.1 percentage points, respectively, p&amp;lt;.001), Communication ratings indicated that at baseline White, non-Hispanic staff were more knowledgeable about effective (p&amp;lt;.001), appropriate (p=.008), and person-centered communication (p&amp;lt;.001) than diverse staff; while the latter recognized elderspeak better (p=.002). Both groups improved their communication ratings post-CHATO (p from .001 to &amp;lt;.001). While confidence in providing dementia care was similar between groups at baseline (p=.754), it improved only for White, non-Hispanic staff (p&amp;lt;.001). Intention to use learned skills in practice was higher for staff in the diverse group (p&amp;lt;.001). Diverse staff rated their satisfaction with the intervention lower (p &amp;lt;.001), suggesting that it was not tailored to their needs. These findings support the value of CHATO in increasing communication knowledge among diverse NH staff. However, lower satisfaction suggests the need to adapt CHATO to be more inclusive and culturally appropriate. Tailoring education may increase impact on outcomes and overcome disparities in dementia care common in NHs serving diverse populations.