A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Abstract

Efforts to translate efficacious interventions into longterm care practice have had limited success due to the lack of consideration of key translational intervention components. A multi-faceted intervention was implemented in two veteran affairs facilities to improve feeding assistance care. There were three study phases: baseline, intervention, and follow-up. During each phase, trained research staff conducted standardized observations of 12 meals/participant to assess feeding assistance care quality. The staff received three initial training sessions followed by six consecutive weeks of feedback sessions wherein the observation-based care process measures were shared with the staff. There were significant, but modest, improvements in mealtime feeding assistance care processes, and most of the improvements were maintained during follow-up. A multi-faceted intervention resulted in significant, but modest, improvements in mealtime feeding assistance care quality. Organizational (staff schedules, communication) and environmental (dining location) barriers were identified that interfered with improvement efforts.

Interventions for Improving Mealtime Experiences in Long-Term Care

“…However, social interactions between routine staff and residents only occurred about half of the time during meals in the intervention group and although significantly (P < 0.05) different, was only a small increase from baseline (89). The second study, which attempted to transfer skills and knowledge to staff, was less successful than the first where the researchers were the interventionists (89). Both studies had a small amount of attrition; the first study had 24 of 148 dropout (63), and the second study had 17 of 147 dropout (89).…”

“…The crossover demonstrated that benefits continued after the intervention (63). However, social interactions between routine staff and residents only occurred about half of the time during meals in the intervention group and although significantly (P < 0.05) different, was only a small increase from baseline (89). The second study, which attempted to transfer skills and knowledge to staff, was less successful than the first where the researchers were the interventionists (89).…”

“…Post-training audits (53,83) and support by research staff or project leaders (40,45,57,83) promoted sustained effects of the training. However, education specifically on individualized approaches to providing eating assistance was limited and most studies to date came from a single group (63,(87)(88)(89). Only one study from this group included significant training of regular staff (89) and did not show as positive effects as prior studies with research staff (87,88).…”

“…The same researchers then completed two subsequent RCT studies (63,89). The first offered either snacks or the individualized mealtime graduated prompting and assistance to residents with low intake in the intervention group, then conducted a crossover between control and intervention facilities (63).…”

“…In the second study, which used a waitlist control, only the graduated prompting and mealtime assistance was provided and as required residents were provided assistance one-on-one or in small groups ($3) (89). Additionally, routine staff were trained to assess food intake and understand the value of individualized prompting and assistance (89). Overall, residents in the intervention groups had weight gain or stable body weight and an increase in total daily calories consumed; researchers (63) and staff (89) spent more time providing assistance as compared to those in the control groups.…”