Assisted living (AL) settings provide homelike environments for individuals who need help with activities of daily living (ADL) or instrumental ADLs (e.g., medication management) but for whom 24-hour nursing care is not necessary. Nearly 40% of residents in AL settings require assistance with three or more ADLs and most need help with meal preparation and medication management. They tend to experience even more functional decline and spend less time in physical activity than residents in nursing facilities. This decline is not completely related to disease progression. Rather, it is due to the way care is provided and the tendency caregivers have to perform the care task for the resident rather than allowing him or her to do the activity. In addition, there is an excessive fear among older adults, families and caregivers that engaging in physical activity will result in adverse events (e.g., falls). The persistent decrease in function and physical activity in residents actualy increases their risk for falls, pain, pressure ulcers, further functional decline, hospitalizations nursing home placement, and decreases quality of life. Function Focused Care for AL (FFC-AL) is an approach to care such that residents are helped to participate in functional and physical activity throughout the course of the day. FFC-AL is a four-step theory-based approach including: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Resident Service Plans; and (4) Mentoring and Motivating Direct Care Workers and Residents. In efficacy trials, FFC-AL was implemented over 12 months by a Research Nurse Facilitator working with an identified setting champion. Residents in settings exposed to FFC-AL maintained or improved function, spent more time in physical activity and were less likely to be transferred to acute care facilities. Unfortunately, implementing effective care approaches like FFC-AL into AL settings is challenging due to setting and resident related factors. To overcome these challenges we developed a theory based approach using Social Cognitive Theory, the Social Ecological Model and the Evidence Integration Triangle (EIT). This approach, referred to as FFC-AL-EIT, includes the involvement of setting stakeholders, uses resources currently available in AL settings and allows for an individualized focus on setting specific challenges. This study will test the dissemination and implementation of FFC-AL-EIT across 96 AL settings in Maryland, Pennsylvania and Massachusetts and will include 960 residents. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model will be used to evaluate outcomes. By using a theory based approach and building off prior experience in disseminating and implementing function focused care, this study will add to what is known about dissemination and implementation of effective interventions in AL settings and serve as a model for other care approaches.
Function focused care is an approach to care in which nurses acknowledge older adults' physical and cognitive capabilities and integrate physical activity into all care interactions. This care approach prevents the common decline in function and physical activity seen in assisted living residents. Our goal in this work is to establish a practical and effective way to disseminate and implement function focused care, referred to as FFC-AL-EIT, across a large number of assisted living settings.
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