1. How Co-worker Support Builds High-Quality Dementia Caregiving Jacoba Lilius Organizational Psychology University of Michigan

2. Motivations for the Research Practical  Increasing elderly population and dementia sufferers  Wide variation in quality of care Theoretical  Understanding variation beyond structural factors  Limited model linking support to care quality  Rethinking ‘quality of care’

3. Key Assumptions of Dissertation Outcome-based definitions of care quality overlook the process of dementia caregiving  Individual skill  Collective competence Relational factors key to high-quality caregiving Mechanisms linking co-worker support to care quality not well articulated

4. Current Definitions of Care Quality Dominant measures of care quality  Minimum data set (MDS) indicators  Basic physiological needs Recent calls for expanded measures  Focus on higher-order needs E.g. individuality, dignity  Difficult to assess in residents with dementia

5. Rethinking ‘Care Quality’ as Process High-quality caregiving Individuality a key higher-order need Quality is in the discerning and meeting of individual residents’ needs

6. Broad Overview of Model and Where it Fits In… Structural Factors Turnover Resident Outcomes Social Support High-Quality Dementia Caregiving Individual and Social Resources

7. Key Challenges of Dementia Care Decreased capacity for language Unpredictable resistance to care attempts Unpredictable changes in openness to particular caregivers

8. Theoretical framework Social support (House, 1981) Individual and collective resources built in practice (Orlikowski, 2000; Feldman, 2004) Caregiving (Kahn, 1993)  Emotional resources necessary for care replenished/depleted in interactions with co- workers Social capital (Nahapiet & Ghoshal, 1998)

9. Perceived Co-worker Support Quality of Care Outcomes (MDS, QOL Indicators) Trust Resource-based model of the relationship between perceived co-worker support, high-quality dementia caregiving, and quality of care outcomes. Positive Emotion Self-Efficacy Cooperation Perseverance Broadened care approaches Information Sharing High-Quality Caregiving Enablers Individual Resources Social Resources Empathy

10. Overall Research Aims Define high-quality dementia caregiving Identify key challenges of caregiving Test a model linking helping and care quality

11. Proposed Methods Part I  Case study of one dementia special care unit  Perspectives of nurse aides and family members Part II  S urvey study of multiple nursing homes  Range of quality (MDS indicators)  Measure support, resources, high-quality caregiving enablers

12. Key Contributions Articulate theoretical mechanisms for the relationship between co-worker support and care quality Highlights the individual and collective competence in caregiving Extend structural explanations of variation in care quality Link micro-interactions to a unit-level capability