Improving PERsoN-Centred DementiA Care

In Switzerland, about 65% of the residents of long-term-care facilities (LTCFs) have dementia, which is associated with individual suffering and an overall high level of care needs. There is an international consensus that so-called “person-centred care” is the optimal form of care provision for this group. The complex challenges posed by the behavioural and psychological symptoms associated with dementia make a person-centred care approach indispensable. Remarkably, no extensive systematic effort has been undertaken in German-speaking countries to advance the implementation of this approach in LTCFs. In the context of the socio-political challenges related to long-term care, such as underfunding and workforce retention issues, care provided for dementia patients demands immediate attention. ERNA will address this by promoting person-centred practice in LTCFs, with the aim of enhancing team functionality and ultimately improving the quality of life for those living with dementia.

The objective of this study is to empower dementia care teams to carry out person-centred care in Swiss LTCFs. The aims are as follows:

1) To test an intervention that promotes person-centred care in Swiss LTCFs for team functioning based on the four subscales of the Team Climate Inventory (TCI), secondary endpoints (IPOS-Dem, QUALIDEM, Person-Centred Practice Inventory [PCPI], and the Maslach Burnout Inventory [MBI])

2) To create a Swiss framework for person-centred care implementation in LTCFs through patient and public involvement (PPI)

Therefore, the primary aim of the ERNA study is to test the functioning of the long-term-care team.

ERNA consists of two work packages:

• Work Package 1 (WP1): A clinical trial investigating whether promoting person-centred care in long-term-care teams improves team functioning
• Work Package 2 (WP2): Patient and public involvement based on the development of a Swiss framework for person-centred care implementation in LTCFs (by means of group discussions)

The ERNA study uses a simple crossover randomised controlled trial (RCT) to investigate its endpoints during WP1. Long-term dementia care teams are randomised to one of two possible sequences (N = 44). In WP1, a linear mixed model will be fitted to each of the four co-primary endpoints, using period, treatment and period:treatment interaction as fixed effects and subject as random intercepts. In the crossover analysis, the period:treatment interaction effect is confounded with the sequence (group) effect. Following the principles of action research, PPI focus groups will assess the clinical relevance of the intervention intended to promote person-centred care in WP2. The focus groups will be analysed using the content analysis approach of Mayring. The trial will be conducted over 36 months.