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Cornell program is found to vastly improve communication between nursing home staff and families

Nursing staff and family members of residents in nursing homes often distrust and misunderstand each other, feel powerless to improve communication and feel distressed by the situation, according to a Cornell University study.

"Yet, the better the communication and interaction are between nursing staff and relatives of residents, the better off the nursing home residents will fare," said Karl Pillemer, associate professor of human development at Cornell and co-director of the Cornell Applied Gerontology Research Institute.

To foster such communication, Pillemer had developed a unique training program for nursing staff and family members called Partners in Caregiving. In a case-comparison study, the program has been shown to improve the attitudes and behavior of the two groups.

The program offers both nursing staff and family members a series of almost identical training sessions, with the major difference being in the types of case studies used. The workshops teach participants how to: get their concerns out in the open in nonjudgmental ways; communicate with mutual respect and across cultural and ethnic differences; use active listening techniques; and handle blame, criticism and conflict. They also offer techniques for understanding differences in values. After three two-hour sessions, the two groups participate in a joint session with the facility administrator, where they prioritize concerns in a productive and non-confrontational way and then brainstorm solutions together.

The study, authored by Pillemer with CAGRI researcher Bonnie Albright and Carol Hegeman, director of research and education at the Foundation for Long Term Care (FLTC) in Albany, N.Y., will be presented to the Galaxy Summit, a national summit for cooperative extension educators, Oct. 16 in Cincinnati and to the national conference of the American Health Care Association for long-term care professionals, Oct. 29 in San Antonio.

In addition, the authors have published a manual, Partners in Caregiving (Cornell University, 1997, $24), to make the training program easily accessible to nursing homes across the nation.

In six nursing homes of diverse sizes in New York state locations and populations, facilitators -- usually a social worker from the nursing home -- were trained in how to conduct the program. They brought the program to their nursing homes with two co-facilitators -- a direct care staff person and a family member. The program, which was developed in collaboration with the FLTC, the research and educational arm of the New York Association of Homes and Services for the Aging, was administered four times in each facility.

"Through mini-lectures, structured exercises and role-plays, participants practice how to use respectful communication skills that bridge cultural and ethnic barriers and resolve differences without blame and criticism," said Pillemer, who based the program on three years of joint research by Cornell and the FLTC, including surveys of the directors of social services in 218 nursing homes in central New York, as well as on more than a decade of experience in developing communication programs at Cornell University and working with nursing homes.

"Unlike most long-term care arrangements that make family and staff feel powerless, this program uses an empowerment model that allows participants to be trained by 'one of their own' and to develop their own skills," Pillemer added. "Both staff and families report greater comfort in relations with one another and an improved sense of being partners, rather than adversaries in the care-giving process."

The program is specially designed so that reading and writing skills are not necessary for participants.

"There has been very little done on family and staff interaction, which is important for resident care," said Hegeman, of FLTC. "We have long looked for a way to increase collaboration between families and staff, and this project effectively does that."

"Satisfaction with the program has been high," said Pillemer, a social gerontologist. "Ninety-nine percent of the participants who evaluated the program said they could relate what they had learned on a day-to-day basis and would recommended the training to others."

In addition, the program has resulted in changes in nursing home policies, such as regular meetings with family members in every unit of the nursing home, the development of a family handbook and family council, a bulletin board with staff names and photos and a monthly support group for families.

The work was funded by the van Ameringen Foundation and the National Institute on Aging.

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