Care Interactions Between Staff and Nursing Home Residents with Dementia

Abstract

Background: The quality of staff-resident care interactions is critical to residents living with dementia. Limited work has focused on understanding the quality of care interactions among nursing home (NH) residents and examining what factors are associated with the quality of staff-resident care interactions. Purpose: The purpose of this dissertation was to: (1) comprehensively describe staff-resident care interactions; (2) assess racial and gender differences in the quality of care interactions between staff and residents living with dementia; and (3) test the resident and community factors that are associated with the quality of care interactions between NH residents living with dementia and staff. Methods: Utilizing baseline data from a randomized pragmatic trial that included 553 residents from 55 NH facilities, Aim 1 used descriptive statistics to describe the characteristics of care interactions in NHs and a multiple linear regression to determine differences in the quality of care interactions between actively engaged and passively engaged residents, Aim 2 used analyses of covariance to examine racial and gender differences in the quality of care interactions, and Aim 3 used structural equation modeling to test the resident and community factors that were associated with quality of care interactions and test for invariance between model fit based on resident race and gender. Results: Although the majority of care interactions were positive, 21% of the interactions were negative and neutral. Active engagement was significantly associated with more positive care interactions than passive engagement. There was a racial difference in the quality of care interactions such that Black residents received significantly more positive care interactions than White residents. Increased pain and comorbidities were associated with more negative care interactions, while higher community star rating and for-profit communities were associated with more positive care interactions. Conclusions: Understanding the quality of staff-resident care interactions in NHs and the factors that are related to the quality of care is important to guide future interventions and training curricula for NH care staff. Using this information to improve care interactions is important so that all NH residents living with dementia experience positive interactions regardless of pain, comorbidities, race, or community characteristics.