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• The quality of staff care has pervasive effects on resident quality of life • Increasing relevance and applicability of staff training and qualifications is key • Staff upskilling is required in empathic care, communication and restraint reduction • Mealtime assistance and increased recreational activities improve QOL • Experienced nurse managers and rotating staff shifts improve QOC : Despite the integral role residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia. : Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of NSW/ACT. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors. : Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables. : The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals. [Display omitted] [ABSTRACT FROM AUTHOR]

• What staff do and the way they do it has a real impact on the overall quality of life of residents with dementia. • The impact of staff care has a lasting effect on resident quality of life (at least 6 months). • Eradicating physical restraint is a worthwhile, affordable and achievable target in order to improve resident quality of life. • Care staff need to be upskilled to treat and interact empathetically and humanely with residents to improve quality of life. • Ongoing support and mentoring is required in order for any upskilling of care staff to take effect and be sustained. Residential dementia care staff are often the most important people in a resident's social world. It is a symbiotic relationship and the work can involve highly emotional interactions as well as physical and technical demands. This study focused on narrowing down the most useful targets for intervention in quality of care (QOC) in order to improve quality of life (QOL) for people with dementia in residential care. Over six months we followed: 247 older adults with dementia from 12 residential care facilities, their families/care partners (n = 225), managers (n = 12) and staff (n = 232). Facilities ranged from 10 to 137 beds, located across remote, rural and metropolitan areas. Measures: Staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. The QOC provided had an immediate impact on resident's pain, depression, QOL scale score, Body Mass Index, ease/engagement with staff, and food and fluid intake. This influence was still evident six months later, with baseline QOC leading to improved ease and engagement with staff, QOL scores, and fluid intake. Restraint use featured heavily as a predictor of poor outcomes for residents. QOC did not significantly impact agitated behaviours, frailty, nor physical/verbal expressions of well-being. What staff do and the way they do it has a real and lasting impact on the QOL of residents. The most useful targets for improving QOL are: eradicating physical restraint and supporting and upskilling care staff so that they treat and interact empathetically and humanely with residents. [ABSTRACT FROM AUTHOR]

Objectives: People with dementia often have decreased opportunities to engage in higher level intellectual or sensory activities. This programme investigated the effect of taking people with dementia to discuss artworks at the National Gallery of Australia (NGA). Method: Fifteen people from the community and eight from residential care attended the gallery once a week for 6 weeks. They discussed artworks with NGA Educators trained in dementia skills. Sessions were filmed and the level of engagement analysed using time sampling methods. Focus groups with participants, carers, and educators provided qualitative data. Results: Participants were engaged from the outset and remained engaged. They became animated, gained confidence and were able to discuss and interact with the artworks and the social process. This included the more impaired RACF groups, who were more withdrawn or behaviourally disturbed in their usual environment, raising the concept of excess disability. In focus groups these participants had impoverished memory for the programme but community participants remembered it with pleasure and wanted it to continue. Carers confirmed these sentiments but reported no lasting change in participants. Educators spoke mostly about what they had learned, including new ways to present to other clients. Conclusion: The programme went beyond many dementia activities. Despite no evidence for lasting effects, all involved wanted the programme to continue. A carer quote: You do it for the moment encapsulates a sense that an activity is worthwhile even if it gives benefit only whilst running. The programme is continuing and expanding. [ABSTRACT FROM AUTHOR]