Research has demonstrated that caregivers typically maintain close ties to institutionalized family members. However, many family members experience distress regarding the relative's transition to the nursing home, in part due to difficulties in relationships with facility staff. Similarly, studies of nursing home staff indicate that relationships with families can be a significant source of stress. Little is known, however, about the most effective ways to promote such cooperation and communication. Because of the potential benefits to families, staff, and residents, a need exists for the development and rigorous evaluation of programs that foster these goals. The proposed project will conduct a randomized, controlled intervention study of a program designed to increased cooperation and effective communication between family members of nursing home residents and staff, and to reduce interpersonal conflict. This program is the result of four years of extensive pilot-testing, conducted in cooperation with a major association of long-term care providers. The study will test whether the program leads to positive outcome for family members, staff, and residents, and will examine differences in effectiveness for various subgroups (for example., by gender, rural versus urban location). Also evaluated will be the degree to which the institutional environment affects the intervention, and whether changes in facility policies and practices resulted. The study will recruit 1200 subjects from 20 randomly selected nursing homes in New York state, and assign them to treatment and control groups. Parallel training sessions on communication and conflict resolution techniques will be conducted with families and staff ont he intervention units. A pretest interview and two post-test interviews will be conducted to measure outcomes for family, staff, and residents. In addition, facility-level data will be collected to assess the impact of the intervention on outcomes such as family complaints and staff turnover. The investigators will work closely with state and national nursing home associations and other groups to disseminate information and promote programs based on the study findings.
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