Implementation of Function Focused Care to Change Practice Behaviors of Staff

Abstract

in an assisted living community by implementing a Function Focused Care philosophy. Function focused care involves teaching direct care workers to evaluate older adults’ underlying capability with regard to function and physical activity and optimize their participation in all activities. Background: Assisted living communities are home to over 830,000 adults, who are mostly 85 years and older. Residents spend the majority of their waking time sedentary and experience more decline in functional performance compared to nursing home residents. Decreased physical activity and functional impairment are strong predictors of adverse outcomes, institutionalization, and decreased quality of life. Routine care provided by direct care workers traditionally focuses on task completion, which limits residents’ function and physical activity. Task-focused care is perceived to be safer and more time efficient. Conversely, examples of function focused care interactions include: modeling behavior for residents (i.e. oral care, eating), providing verbal cues during dressing, walking a resident to the dining room rather than transporting via wheelchair, doing resistance exercises with resident prior to meals, and providing recreational physical activity. Prior research supported the benefits of Function Focused Care, which have included improving or maintain function, mood, and behavior, and decreasing falls and transfers to the hospital for non-fall related events. Function Focused Care is implemented using a four-step approach, which includes: (1) Assessment of environment and policies, (2) Education of staff, residents, and/or families, (3) Development of Function Focused Care goals in service plans for residents, and (4) Mentoring and motivating the staff and residents. Quality improvement methods: This quality improvement project was implemented over a 16week period using the Evidence Integration Triangle, the Social Ecological Model, and Social Cognitive Theory. A stakeholder team and champion within the setting were identified and monthly meetings were held with the stakeholder team and setting champions to implement the four steps of the intervention. The site was an 81-bed assisted living community with 25 direct care workers. Outcomes were obtained at baseline and 4 months post-baseline and included knowledge of Function Focused Care and evidence of Function Focused Care behaviors provided by direct care workers. Results: A total of 19 out of 25 direct care workers were exposed to education and demonstrated evidence of knowledge of Function Focused Care based on an average of 82% correct score on the knowledge quiz. The mean number of Function Focused Care behaviors performed by direct care workers increased from 3.55 (SD=2.5) to 9.22 (SD=4.81) out of a total of 19 possible activities. Conclusions: Function Focused Care in assisted living was successfully implemented. Changes were noted in DCWs with regard to knowledge post education. Also, the mentoring and motivating of FFC champions increased the direct care workers’ performance of Function Focused Care activities during care interactions with residents.