This study proposes a multi-level approach to test training interventions for direct-care workers and their supervisors in VA Community Living Centers (CLCs). We posit that successful translation of learning into practice happens when clinical knowledge is combined with communication skills and managerial support that enable exercising new knowledge. We propose testing a set of complementary training interventions to address knowledge, skills, and managerial support. One of the interventions will focus on the supervisory skills of unit managers and supervisors, and the second intervention will provide content-focused knowledge and communication skills to direct-care workers. We will recruit 20 CLCs to this study. Five of these will serve as a control group. The other 15 will receive the education interventions in various combinations: five will receive training for nurse managers only, five will receive trainin for direct-care workers only, and five will receive both training interventions. The proposed study draws on existing interventions that have already been demonstrated to improve skills and knowledge and will assess the extent of learning. Using a pre-test and post-test design with a control group, it will also examine the extent to which the combinations of training interventions lead to any change in practice, particularly in terms of care coordination, relational coordination and control over work. We will also utilize Resident Assessment Instrument Minimum Data Set (MDS) data to examine whether these changes in practice lead to positive changes in health outcomes for residents, including problem behaviors, weight loss, pressure ulcers, physical functioning, or antipsychotic/antihypnotic use (in the absence of a related diagnosis).
The VA is committed to providing high quality care in its Community Living Centers (CLCs). Thus, monitoring and continually improving the quality of care provided in CLCs is an important goal. One way in which care quality is being improved is through a cultural transformation aimed at making CLCs more person-centered and less institutional by providing residents with more choice and autonomy. While focused on residents, a cultural transformation of this type is also reliant on changes to staff roles and responsibilities. Central to this is the idea of increasing the human capital of direct-care workers by, for example, improving their decision-making abilities and autonomy. The expected impact of this project, which would identify ways to enhance the human capital of CLC staff thereby improving their care giving capabilities, would be improved quality of care and quality of life for the veterans who receive care in VA CLCs.