We propose to establish a Center of Research on Applied Gerontology within the HRCA Research and Training Institute, part of the Hebrew Rehabilitation Center for Aged (a Harvard affiliate), for the purpose of translating basic social and organizational research theories and findings into practical outcomes to benefit the lives of older people. Studies proposed will focus on strategies to improve quality of life, functional performance outcomes, enhance productivity, and minimize the need for care, with emphasis placed on organizational and psycho-social approaches. A convincing case can be made that nursing homes face tremendous difficulties in trying to achieve the functional independence objective specified under a HCFA mandate. Factors that play a role in governing how homes currently behave are: 1) Facilities need to ensure that residents facility adapt to their environment; 2) Professional guidelines on appropriateness of rehabilitative services for long-stay residents are little understood; 3) Families and residents have only begun to become active participants in the assessment and care planning process; 4) Families tend to be uninformed on expected rates of decline and improvement following admission; 5) Staff may try to expedite the transition by making it easy for families to relinquish responsibility; 6) Physician attentiveness is often lacking and compensatory skills of other professionals may be deficient; and 7) Establishment of rehab goals and programs is rare. Based on these concerns, we propose to carry out two related studies. Each study intervention represents a systems approach to changing caregiving behaviors and attitudes in the nursing home setting, and will draw on a common understanding of the steps necessary to introduce these significant rehabilitative-based interventions in nursing homes and of a sharing of data collection and other resources. Each study will have the following common features: 1) The facility will openly acknowledge restructuring their approach to rehabilitative care; it will become a central tenet in the day-to-day life of the facility. 2) Direct care staff at all levels will be properly trained; 3) Explicit written guidelines will be promulgated, disseminated, and reinforced. 4) Specific residents will be targeted for participation in the program. 5) Resident care plans will specifically acknowledge this participation. 6) The facility will establish an operational institutional program to support the intervention. 7) Confounding health and motivational problems that preclude or hinder resident participation will be addressed. 8) As confounding problems are lessened, staff will make regular efforts to enroll residents in the program. 9) As residents improve, it will be interpreted as a sign to seek new ways to maintain and build on this improvement. The Management Core will monitor both projects specified under this program directive, coordinate data collection and provide technical support and guidance to the individual projects, and recommend applications that may arise from these projects.
| Koehler, Melissa; Rabinowitz, Terry; Hirdes, John et al. (2005) Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr 5:1 |
| Kiely, D K; Morris, J N; Algase, D L (2000) Resident characteristics associated with wandering in nursing homes. Int J Geriatr Psychiatry 15:1013-20 |
| Burrows, A B; Morris, J N; Simon, S E et al. (2000) Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing 29:165-72 |
| Morris, J N; Fiatarone, M; Kiely, D K et al. (1999) Nursing rehabilitation and exercise strategies in the nursing home. J Gerontol A Biol Sci Med Sci 54:M494-500 |
| Morris, J N; Fries, B E; Morris, S A (1999) Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci 54:M546-53 |
