How Co-worker Support Builds High-Quality Dementia Caregiving

1. How Co-worker Support Builds High-Quality Dementia Caregiving Jacoba Lilius Organizational Psychology University of Michigan

2. Motivations for the Research • Practical • Increasing elderly population and dementia sufferers • Wide variation in quality of care • Theoretical • Understanding variation beyond structural factors • Limited model linking support to care quality • Rethinking ‘quality of care’

3. Key Assumptions of Dissertation • Outcome-based definitions of care quality overlook the process of dementia caregiving • Individual skill • Collective competence • Relational factors key to high-quality caregiving • Mechanisms linking co-worker support to care quality not well articulated

4. Current Definitions of Care Quality • Dominant measures of care quality • Minimum data set (MDS) indicators • Basic physiological needs • Recent calls for expanded measures • Focus on higher-order needs • E.g. individuality, dignity • Difficult to assess in residents with dementia

5. Rethinking ‘Care Quality’ as Process • High-quality caregiving • Individuality a key higher-order need • Quality is in the discerning and meeting of individual residents’ needs

6. Structural Factors Resident Outcomes Turnover Social Support Broad Overview of Model and Where it Fits In… High-Quality Dementia Caregiving Individual and Social Resources

7. Key Challenges of Dementia Care • Decreased capacity for language • Unpredictable resistance to care attempts • Unpredictable changes in openness to particular caregivers

8. Theoretical framework • Social support (House, 1981) • Individual and collective resources built in practice (Orlikowski, 2000; Feldman, 2004) • Caregiving (Kahn, 1993) • Emotional resources necessary for care replenished/depleted in interactions with co-workers • Social capital (Nahapiet & Ghoshal, 1998)

9. High-Quality Caregiving Enablers Individual Resources Perseverance Self-Efficacy Broadened care approaches Positive Emotion Quality of Care Outcomes (MDS, QOL Indicators) Perceived Co-worker Support Empathy Social Resources Information Sharing Trust Cooperation Resource-based model of the relationship between perceived co-worker support, high-quality dementia caregiving, and quality of care outcomes.

10. Overall Research Aims • Define high-quality dementia caregiving • Identify key challenges of caregiving • Test a model linking helping and care quality

11. Proposed Methods • Part I • Case study of one dementia special care unit • Perspectives of nurse aides and family members • Part II • Survey study of multiple nursing homes • Range of quality (MDS indicators) • Measure support, resources, high-quality caregiving enablers

12. Key Contributions • Articulate theoretical mechanisms for the relationship between co-worker support and care quality • Highlights the individual and collective competence in caregiving • Extend structural explanations of variation in care quality • Link micro-interactions to a unit-level capability