(APPLICATION ABSTRACT): Approximately 1.56 million Americans over age 65 reside in nursing homes and 8% of our national health budget is spent on nursing home care. However, nursing homes are far from ideal in terms of the quality of care provided and the quality of life for residents. Although not always preventable, residents' injury and morbidity, such as pressure ulcers, injury from restraints and falls, malnutrition, dehydration and depression have been attributed, in large part, to the skill and motivation of the caregivers. The proposed study will evaluate the impact of a global organizational intervention aimed at enhancing the ability as well as the motivation of all nursing home employees at two facilities in order to improve residents care and safety. Ability will be enhanced for all staff via a unique computer-based training program that provides a comprehensive curriculum of individual, self- paced education through Inter-active video documentaries. Motivation will be enhanced via a two pronged approach aimed at: (1) empowering employees using role structuring techniques developed following a total quality management (TQM) paradigm, and (2) changing employee attitudes by introducing them to market orientation techniques that enable them to balance the priorities of all constituents: self, resident and nursing home. This TQM process will require 18 months of active intervention. Outcome measures will be obtained at quarterly and at bi-annually. Quality of care will be based on the Facility Quality of Care Index and frequency of resident complaints. Quality of Life will be assessed with a new instrument that has been developed in a multi- center study. Staff outcomes will include objective data of injury rate, retention and days off work. Subjective staff measures will include the Job Satisfaction Scale and the Sheltered Care Environment Scale. Outcomes from the administrative perspective will include a """"""""gap analysis which assesses how closely the desired goals of a program are achieved, as well as some financial markers of cost savings.
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