Testing the Effect of Function-Focused Care in Assisted Living

OBJECTIVES: To develop and test the Function-Focused Care in Assisted Living (FFC-AL) intervention so as to alter the decline that older adults in AL experience. DESIGN: Cluster-randomized controlled trial using repeated measures to test the effect of FFC-AL. SETTING: Four AL facilities with at least 100 beds. PARTICIPANTS: One hundred seventy-one residents and 96 direct care workers (DCWs) were recruited. Ninety-five of the DCWs were female (99%), and 59 were black (62%), with a mean age of 41.7 +/- 13.8. The residents were mostly female (80%), white (93%), and widowed (80%), with a mean age of 87.7 +/- 5.7. INTERVENTION: FFC-AL included four components implemented by a research-supported function focusedcare nurse (FFCN) and a site-identified champion over a 12-month period. Control sites were exposed to FFC education only. MEASUREMENTS: Outcomes for residents included psychosocial domains (mood, resilience, self-efficacy, and outcome expectations for function and physical activity), function, gait and balance, and actigraphy. Outcomes for DCWs included knowledge, performance, and beliefs associated with FFC. RESULTS: DCWs in treatment sites provided more FFC by 12 months than those in control sites. Residents in treatment sites demonstrated less decline in function, a greater percentage returned to ambulatory status, and there were positive trends demonstrating more time in moderate-level physical activity at 4 months and more overall counts of activity at 12 months than for residents in control sites. CONCLUSION: Using a function-focused approach in AL may help prevent some of the functional decline commonly noted in these settings. J Am Geriatr Soc 59: 2233-2240, 2011.