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The article identifies the key factors relating to care staff that lead to good quality of care and quality of life for residents with dementia. Topics discussed include importance of the quality of care provided by staff to the quality of residents' lives, the need to scrutinize the focus, timeliness and quality of the qualifications or training courses, and recommendations to the Royal Commission into Aged Care Quality and Safety.

Objective: This study examined the feasibility of providing older adults living in residential aged care with group‐based cognitive behavioural therapy (CBT) for depression and anxiety. Method: Eighteen participants with subclinical to mild anxiety and/or depression were divided equally into a treatment group and a control group, with treatment consisting of a manualised CBT program for older adults with depression and anxiety. The residents who participated in the group program provided an accurate representation of “real‐world” residential aged care facilities (RACF) populations; many with comorbid physical problems, mild cognitive impairment and functional decline, and a mean age of almost 80 years. Results: The residents showed that not only could they successfully engage in psychotherapy, they were able to experience the benefits such as building their skills and resilience, receiving validation and emotional support from their fellow residents and fostering friendships and social networks. Encouragingly, the treatment group also showed fewer depressive symptoms post‐treatment. Conclusions: Group‐based psychotherapy should continue to be explored as a strategy to promote good mental health in RACFs, with further studies focusing on the feasibility of recruiting and treating clinical populations in this setting. [ABSTRACT FROM AUTHOR]

Mental health practices are not working for older people with anxiety in residential care, as there is a persistent lack of recognition and treatment. This suggests that alternative ways of reaching and meeting the needs of this population need to be explored. One possibility involves enabling older adults themselves to seek help. The current work explored various factors impacting on help-seeking behaviours. In total, 105 participants from independent living units in a residential care setting completed a questionnaire focusing on attitudes and stigma towards anxiety, likelihood to seek help, help-seeking barriers and literacy around the symptoms of anxiety. Participants in the main did not hold negative attitudes towards other people with anxiety, despite concerns that other people could view them negatively if they were experiencing anxiety. Barriers to help-seeking included: difficulties recognising physical anxiety symptoms as being indicative of anxiety; the effectiveness of treatments; costs; misdiagnosis; privacy; medication usage and the associated side-effects; and, uneasiness about the skills and knowledge of health professionals. Although concerns were not held by all participants, the fact remains that anxiety is largely undiagnosed and untreated for this population and these stoppages to appropriate care must be addressed. [ABSTRACT FROM AUTHOR]

• 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]