The majority of older adults living in nursing homes require some assistance with activities of daily living (ADL). There are many causes of functional impairments, among these nursing care that create dependency and lack of motivation on the part of the older adult to perform self-care activities. Restorative care, however, is a philosophy of care that focuses on the restoration and/or maintenance of physical function, and helps the older adult to compensate for functional impairments so that the highest level of function is obtained. Restorative care places an important emphasis on prevention of the secondary sequelae of physical dependence, inactivity, and immobility. Although there are some anecdotal reports of benefits of these programs (Koroknay et al., 1995; Orth, 1991; Farnham & Moffett, 1988), there is little quantitative evidence to support the widespread use of these programs, and few well described and developed programs. The primary aims of this study are to implement an investigator developed two tiered restorative care program, the Nursing Assistants Resident Care Activities Intervention (NARCAI). The NARCAI incorporates self-efficacy based interventions for both nursing assistants and residents to improve functional performance, maintain or decrease the number of contractures, maintain or improve muscle strength, decreased falls and fall related injuries, and improve quality of life in long-term care residents. The secondary aims related to residents focus on understanding the mechanism by which residents engage in functional activities, i.e. the mediating effect of self- efficacy and outcome expectations. The secondary aims related to nursing assistants focus on understanding the mechanism by which nursing assistants change behavior to facilitate restorative care activities, and how the NARCAI impacts nursing assistants performance of restorative care activities, employment status and job satisfaction. A total of 520 residents and 560 nursing assistants in 8 long-term care facilities owned and managed by Erickson Life Care Communities will participate in the study. The facilities will be randomly assigned to receive the NARCAI or routine care. A 2(group) by 3(time) repeated measure analysis of covariance will be done to address both the primary and secondary aims. Testing will be done at baseline, 4 and 12 months following implementation of the program. This study will help determine the effectiveness of restorative care programs and provide a realistic model for how to integrate these programs into all long-term care facilities. The ultimate goal is to alter the current philosophy of care in long-term care to focus on function, improve clinical outcomes, and inform policy makers on the effectiveness of restorative care programs.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Quality and Effectiveness Research (HQER)
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Hubbard, Henrietta
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University of Maryland Baltimore
Schools of Nursing
United States
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Liu, Wen; Galik, Elizabeth; Resnick, Barbara (2015) The Self-Efficacy for Functional Abilities Scale for older adults in long-term care: two-level exploratory and confirmatory factor analysis. J Nurs Meas 23:112-26
Liu, Wen; Unick, Jay; Galik, Elizabeth et al. (2015) Barthel Index of activities of daily living: item response theory analysis of ratings for long-term care residents. Nurs Res 64:88-99
Galik, E; Resnick, B (2013) Psychotropic medication use and association with physical and psychosocial outcomes in nursing home residents. J Psychiatr Ment Health Nurs 20:244-52
Flannery, Kelly; Resnick, Barbara; Galik, Elizabeth et al. (2012) Reliability and validity assessment of the job attitude scale. Geriatr Nurs 33:465-72
Sabol, Valerie K; Resnick, Barbara; Galik, Elizabeth et al. (2011) Exploring the factors that influence functional performance among nursing home residents. J Aging Health 23:112-34
Gruber-Baldini, Ann L; Resnick, Barbara; Hebel, J Richard et al. (2011) Adverse events associated with the Res-Care Intervention. J Am Med Dir Assoc 12:584-589
Sabol, Valerie K; Resnick, Barbara; Galik, Elizabeth et al. (2010) Anemia evaluation and management in nursing home residents. West J Nurs Res 32:447-61
Resnick, Barbara; Sabol, Valerie; Galik, Elizabeth et al. (2010) The impact of anemia on nursing home residents. Clin Nurs Res 19:113-30
Adler, Efrat; Resnick, Barbara (2010) Reliability and validity of the Dementia Quality of Life measure in nursing home residents. West J Nurs Res 32:686-704
Resnick, Barbara; Gruber-Baldini, Ann L; Zimmerman, Sheryl et al. (2009) Nursing home resident outcomes from the Res-Care intervention. J Am Geriatr Soc 57:1156-65

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