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.
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