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A bstractObservations of the quality of interaction between staff and residents were m ade to assess the impact of training and support provided to care staff in nursing and residential homes. Assessments were m ade before, during and at the end of the training intervention using an adaptation of the Quality of Interactions Schedule (QUIS: Dean et al., 1993a) modi® ed to avoid the ceiling effect of the original version. A signi® cant increase in the proportion of time staff spent in positive interactions with residents was observed, both in terms of direct care (p , 0.002) and social contact (p , 0.05) at the end of the training schedule. Levels of resident activity were also found to increase immediately after completion of training (p , 0.001). The results suggest that changes in the quality of interaction between staff and residents can be obtained by providing regular training and support to care workers. These ® ndings suggest that the training schedule used in the present study may have a positive impact on the quality of care provided in nursing and residential homes for the elderly.

Background: The results of a randomized controlled trial have indicated that a training and educational programme for staff in nursing or residential homes may result in reductions in levels of depression and levels of cognitive impairment for residents presenting with an active management problem. The training and educational intervention consisted of members of a hospital outreach team who presented a series of 1 hour seminars on topics which staff had indicated would improve their knowledge and skills. Aims of the study: The aim of this study was to present an exploratory analysis of the impact on costs associated with providing an old age psychiatry outreach team giving training and education for staff in nursing and residential homes. Method: For the economic study, a societal perspective was employed. Measures of resource use and costs to the health service, social and community services and the nursing and residential homes were analysed for 120 residents from 12 nursing or residential homes, as part of a randomized controlled trial to assess a training package provided in residential and nursing homes. Cost estimates were based on estimates from generalized estimated equations. To allow for clustering effects within homes, the unit of randomization was the home as opposed to the individual. To ensure models were correctly specified, several tests including the Ramsey RESET test were employed. Results: There were no significant differences in the total cost per person in the homes that received the intervention and the control homes. This study has shown that the additional cost of providing the specialist outreach team was likely to be covered by reductions in the use of other resources such as GP visits to nursing and residential homes. Therefore, though the study had limitations, it appeared that improved care could be provided at little or no extra cost. Implications for Health Care Provision and Use: The evidence presented suggests that the specialist outreach team was unlikely to add to the total cost of caring for residents in nursing and residential homes. This finding combined with the benefits in terms of lower levels of depression and cognitive impairment suggested that the intervention was good value for money. The intervention should be considered for use in other nursing and residential homes.

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