Elderly/Long-term Care

Encouraging nursing home residents to participate in their care helps them maintain function and physical performance

When nursing assistants (NAs) are trained to encourage long stay nursing home residents to participate in their self-care and other activities, the residents improve functioning and feel better about themselves, families feel better about their care, and the NAs are more satisfied and less stressed by their jobs, according to a study supported in part by the Agency for Healthcare Research and Quality (HS13372).

Researchers tested the impact of the Res-Care Intervention, which used a self-efficacy based approach to implement a restorative care philosophy to restore and/or maintain the residents' physical function. Implementing a restorative care philosophy means moving beyond simply providing care for a resident. The NAs learn to set goals for and with residents and help them to perform their daily activities at their highest level. Providing care for residents (bathing or dressing an individual) rather than helping them complete as much of their own care as possible may actually cultivate functional decline and cause further deconditioning and disability.

The researchers analyzed discussions of 12 focus groups including a total of 179 NAs who were trained to provide Res-Care and to motivate residents to participate. The NAs mentioned several resident-related factors that facilitated restorative care. These ranged from encouraging residents to do more, giving them choices, and bonding with them to individualizing motivators and rewards. Facility/team/family-related facilitators ranged from comprehensive evaluation of underlying ability and integrating restorative care into daily activities to family involvement and education. Resident barriers ranged from learned dependency, cognitive impairment, pain, and fatigue to refusal and some medications. Facility/team/family-related barriers ranged from lack of nursing support and just needing to get the care done to family expectations of total nursing care and doubt that the residents could perform the tasks.

See "Barriers and benefits to implementing a restorative care intervention in nursing homes," by Barbara Resnick, Ph.D., C.R.N.P., F.A.A.N., Ingrid Petzer-Aboff, Ph.D., Elizabeth Galik, Ph.D., C.R.N.P., and others, in the February 2008 Journal of the American Medical Directors Association 9, pp. 102-108.

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