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Randomized Controlled Trial
. 2021 Aug;22(8):1706-1713.e1.
doi: 10.1016/j.jamda.2020.09.026. Epub 2020 Oct 31.

Testing the Implementation of Function-focused Care in Assisted Living Settings

Barbara Resnick  1 , Marie Boltz  2 , Elizabeth Galik  3 , Steven Fix  3 , Sarah Holmes  4 , Shijun Zhu  3 , Eric Barr  3
Affiliations
Randomized Controlled Trial

Testing the Implementation of Function-focused Care in Assisted Living Settings

Barbara Resnick et al. J Am Med Dir Assoc. 2021 Aug.

Abstract

Objectives: The purpose of this study was to evaluate the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention.

Design: FFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794 residents.

Intervention: FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function-Focused Care Service Plans; and (Step IV) Mentoring and Motivating.

Setting and participants: The age of participants was 89.48 years [standard deviation (SD) = 7.43], and the majority were female (n = 561; 71%) and white (n = 771; 97%).

Methods: Resident measures, obtained at baseline, 4, and 12 months, included function, physical activity, and performance of function-focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans.

Results: Reach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities as or more than expected, and direct care workers providing function-focused care (63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as intended, and education was received based on a mean knowledge test score of 88% correct. Evidence of maintenance from 12 to 18 months was noted in treatment site environments (P = .35) and policies continuing to support function-focused care (P = .28)].

Conclusions and implications: The Evidence Integration Triangle is an effective implementation approach for assisted living. Future work should continue to consider innovative approaches for measuring RE-AIM outcomes.

Keywords: Function; assisted living; implementation; physical activity.

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Figures

Figure 1.
Figure 1.
Flow of Subjects Through Dissemination and Implementation of FFC for AL
See this image and copyright information in PMC

References

    1. Resnick B, Galik E, Gruber-Baldini A, Zimmerman S. Perceptions and Performance of Function and Physical Activity in AL Communities. Journal of the American Medical Directors Association. 2010;11(6):406–414. - PubMed
    1. Król-Zielińska M, Kusy K, Zieliński J, Osiński W. Physical activity and functional fitness in institutionalized vs. independently living elderly: A comparison of 70–80-year-old city-dwellers. Archives of Gerontology & Geriatrics. 2011;53(1):e10–e16. - PubMed
    1. Chung G Understanding nursing home worker conceptualizations about good care. The Gerontologist. 2013; 53(2): 246–254. - PubMed
    1. Resnick B, Galik E. Impact of care settings on residents’ functional and psychosocial status, physical activity and adverse events. International Journal of Older People Nursing. 2015; 10 (4), 273–283. - PubMed
    1. Resnick B, Boltz M, Galik E, et al. The Impact of function focused care and physical activity on falls in assisted living residents. The Canadian Journal of Nursing Research. In press. - PMC - PubMed

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