WITHDRAWN: Characteristics of Nursing Facilities and Staff's Willingness to Implement a Non-Pharmacological Intervention

Background: Recruiting nursing facilities to participate in research is challenging even when research offers an easy to implement, non-pharmacological intervention that could positively impact residents’ mood and behaviors. The use of non-pharmacological interventions has been encouraged as an alternative to antipsychotic medications to treat some challenging symptoms experienced by some nursing facility residents with dementia. However, some nursing facilities are less open to adopting new, non-pharmacological interventions than others. This study investigates characteristics of nursing facilities that are associated with their staff’s willingness to implement a personalized music intervention for residents living with dementia.

Methods: The study compares characteristics of nursing facilities in Virginia where staff have implemented or are implementing a personalized music intervention (n=58) and those where staff have declined or shown no interest in such an intervention (n=217). This study also investigates the representativeness of the study sample to the Virginia nursing facility population (n=275). The facility-level characteristics (e.g., rehospitalization rate, Medicare-supported resident rate, successful discharge rate) are downloaded from the Long-Term Care: Facts on Care in the U.S. website (http://LTCfocus.org). Only Medicare and Medicaid certified nursing facilities are included in the study, and a series of bivariate analyses are conducted.

Results: The results showed that participating nursing facilities are more likely to have at least one Alzheimer's disease special care unit (P < 0.05), a lower number of licensed practical nurse (LPN) hours per resident day (P < 0.05), and a higher occupancy rate (P < 0.05), compared to non-participating nursing facilities.

Regarding study sample representativeness, the findings revealed that participating nursing facilities have a lower number of LPN hours per resident per day (P < 0.01), a higher occupancy rate (P < 0.05), a lower Medicare resident rate (P < 0.05), and a lower proportion of facility residents who were restrained (P < 0.01), compared to the general Virginia nursing facility population.

Conclusions/Implications: The findings indicate that facility staff willingness to implement a personalized music intervention is positively correlated with having at least one Alzheimer’s disease special care unit, lower numbers of LPN hours per resident per day, higher occupancy rates, lower Medicare resident rates, and lower restraint rates. The presence of an Alzheimer’s disease unit, lower LPN staffing, and higher bed occupancy rates suggest a busy work environment. In such settings, a personalized music intervention might be perceived as a useful tool to adopt given its wide and effective use among people with dementia and reported to be effective in improving their mood and behaviors. Interest in the intervention among facility staff with a lower restraint rate might be associated with a culture of respecting residents’ autonomy and dignity, which is consistent with the personalized music intervention’s goal of person-centered care. Because Medicare does not cover long-term care stays, having fewer Medicare-supported residents may be associated with having more residents with chronic conditions who are more likely to be benefit by this type of intervention. These findings can inform recruitment efforts to reach facilities that have not been previously interested in non-pharmacological interventions.