The following are projects which have been funded and successfully completed by
the Texas Long Term Care Institute: 

A Qualitative Study of Perceptions Among Nursing Assistants in Long Term Care
George C. Burke, III, Dr. P.H.
Carmen Adams, M.S.H.P., A.B.D.
Ram Shanmugan, Ph.D.
The research team conducted a qualitative analysis of an open-ended survey question: "What would make the quality of work like better in this facility?" A sample of 1,216 nurse assistants from 91 facilities located in 24 different states was used. Interpreting the answers, the team identified and categorized the perceptions of CNAs toward their work life .

Evaluation of Aromatherapy in Institutional Elder Care Settings
Sandy Ransom RN, MSHP (Director)
Carmen Adams, MSHP
The purpose of this study was to assess the introduction of aromatherapy in the nursing home setting. This study demonstrated significant differences in specific behavioral characteristics exhibited by persons suffering from dementia after introduction by inhalation of the essential oil blend “Restore Peace. in long term care. The oil blend used was developed by Ms. Jackie Farnell, who was associated with the research team.

The Practitioner's Guide to Culturally Sensitive Practice for Death & Dying
Merri Cohoe, BSW
Sue Ellen Contreras, BSW
Dede L. Sparks, BSW
This project produced a practitioner's manual for increasing religious sensitivity for health care professionals during end-of-life situations. The manual is available to social workers, physicians, nurses, chaplains, long term care facility administrators, and hospice personnel. In many situations, culturally and religiously insensitive practice is the result of being uninformed, not from being unconcerned. This manual is a valuable resource for all professionals working in the health care field.

Impact of the Eden Alternative on Texas Nursing Home Residents'
Quality of Life: A Psychosocial Perspective
Mr. Rich Wyllie, LMSW
Studies regarding the Eden Alternative offer promising results. However, the indicators under scrutiny assess medical and administrative issues. This was the first study in the nation to view elders' quality of life from a psychosocial perspective. During the in-depth study, nursing home elders, staff members, and families were interviewed using a survey designed to evaluate the psychosocial quality of resident life. Interviews took place every six months over a two-year period of time and results were compared and contrasted with results obtained concurrently from control facilities.

The Eden Alternative: The Texas Project
Conducted by the Institute and Sandy Ransom with oversight by the Texas Eden Alternative Task Force
The Institute initiated the Texas Eden Alternative Research Project in the summer of 1995. Six facilities participated in the project. Resident animals, plants, daily interaction between elders and children, team management, validation therapy, and family friendly personnel policies form the components of the Texas project. These six facilities, through embodiment of the Eden principles, serve as models for others interested in learning about the concept. A drop in the number of anti-psychotic medication given elders; decreased antidepressant use; and reduced in-house pressure sores was observed during the research

A Focus Group Study of Perceptions of Quality of Care
Among Nursing Assistants
George C. Burke III, Dr. P.H.
Jim Summers, PhD
Quality in long term care is typically measured by customer perceptions. Most often, customers represent elders, families, and external stockholders. Studies, however, have neglected one important component: staff perceptions. This research project sought to define quality from the perspective of staff members currently working in long term care facilities. Qualitative data in the form of open-ended questions were gathered from certified nurse aides through the use of focus groups.

Alzheimer's Disease Education Program
Ms. Julie Johnson, Executive Director
This project developed an educational curriculum on dementia in partnership with the
Texas Long Term Health Care Institute, to broaden quality care techniques in Texas
and nationwide.

Validation Therapy Training Curriculum
Naomi Feil, Executive Director
Ms. Feil, internationally known for the development of a theory and method of communication known as Validation Therapy, has developed a standardized curriculum and accompanying videos which will be utilized in teaching the method to professionals, paraprofessionals, and family members.

A Mutual Adoption Pact
Oren Renick, JD, MPH, FACHE
Carl Dolezal, Initial Project Director
Tim Marlow, Current Project Director
This research project developed and implemented a collaborative, creative service excellence initiative to deliver high quality services to the elderly. Churches, a senior association, university students, community high school youth, health care practitioners, and other San Marcos organizations collaborated on services for senior citizens in the community.

Quality Long Term Care: The Role of the Volunteer Ombudsmen
Sharon K. Ostwald, PhD, RN
This study developed a better understanding of the volunteer ombudsmen's training and experiences. It identified barriers to volunteer effectiveness and an understanding of their ongoing educational and support needs. Two separate monographs are available; one monograph deals with focus groups that were conducted and the other monograph deals with a survey of Texas nursing home ombudsmen.

The Impact of a Unit Clerk on Nurse Effectiveness in a
Long Term Care Facility
Sandy Ransom, RN, MSHP
The Institute provided funding for placement of a ward clerk at a busy nurses' station in a 120 bed long term care facility. The study was undertaken to determine if utilization of a ward clerk would effectively allow more elder contact for the nurses and nursing assistants. The results were published in Provider, a journal of the American Health Care Association.

Guidelines for Nursing Home Social Workers
John S. McNeil, DSW
Ann Wolens
Based on a critical need for training of social workers geared specifically to nursing home practice, Dr. McNeil compiled a text authored by social work practitioners and educators. Topics include bio-psychosocial changes in aging, the role of the social workers in nursing homes, regulatory issues, measurement of cognitive impairment, ethical decision-making, and end-of-life issues. The text has been advertised in the National Association of Social Workers newsletter and is one of the Institute’s best selling monographs.

A Guide to Volunteering in the Long Term Care Settings
Sandy Ransom, RN, MSHP (Director)
Yvette Murray, PhD
A “how-to” manual for people who volunteer in a long term care setting. The reader is guided through topics such as ageism, self-determination, advocacy, dignity issues, communication, isolation, and impoverished living environments. Practical ideas are offered that can help the volunteer understand the complexities of institutionalized living and the specific problems that plague people living in these institutions

Animal Welfare Guidelines
Sandy Young, DVM
John Pitts, DVM
The Institute published this practical manual. The Pet Care Trust Foundation provided funding for development of the Guidelines. The manual gives a comprehensive overview of care practices for animals residing in long term care homes. A vast array of information is covered, including zoonoses, necessary documentation, selection of breeds, temperament requirements, health issues, nutrition, behavior training, resources, and websites, among others.

Human-Animal Bond Study
Sandy Ransom, RN, MSHP
Carmen Adams, MSHP
The Institute received a grant for $20,000 to analyze data resulting from a study conducted by the Center for Growing and Becoming. The study examined the strength of the human-animal bond relating to two groups of people: those living in a nursing home with resident animals and those living in a nursing home without animals. Influenza titers were drawn in both groups before and after flu shots. Comparisons were made over several variables.

Project Certain
Carmen Adams, MSHP
“Project Certain” was a program involving the placement of computers for use by residents in two long term care facilities in the Central Texas area. The project addressed the existing digital divide experienced by seniors in long term care. It was found that providing computer and Internet access to these Elders resulted in a meaningful and creative activity. E-mail services enhanced the Elders’ ability to communicate with friends and family. The two homes continue to provide computer and Internet access for their residents with staff and volunteers maintaining the program stated as “Project Certain”. Both facilities actively use the computers as a marketing tool for new residents and their families.

Volunteer Management and Computer Activities in Texas Nursing Homes
Scott Archer
The Institute undertook a telephone survey of 167 randomly chosen homes from a total sampling frame of 1145 licensed nursing homes in Texas. The survey covered the scope of volunteer management programs in Texas nursing homes and the number of homes with computer access for the residents. A summary of significant finding on volunteer management: 93.2% of homes have a volunteer program, 100% offered some form of volunteer preparation (85% actual training program and 15% orientation), and only 8.9% had a hard copy manual for volunteers. The survey revealed that only 6.9% of the homes surveyed had computer access for their residents. Survey results confirm national statistics on the tremendous digital divide experienced by residents of nursing home facilities and support the belief that a comprehensive manual for volunteers working in the long term care field would prove to be a useful resource.

Working with the Long Term Care Resident: A Guide for Compassionate Volunteers – Giving Elders a Helping Hand
Rich Wyllie, LMSW
Due to a lack of volunteer training manuals, and because the volunteer has become a vital contributing component to the long term health care process, Rich Wyllie, under contract with the Texas Long Term Care Institute, developed this volunteer manual as a guide to provide the volunteer with important information and strategies that will help create a better understanding of the long term care resident and the issues they face in the long term care setting. Some of the topics included are: long term care environment, physiological changes of aging, ageism, and psychosocial needs of long term care residents.

Austin Bell Ringers Presents Bell Ringing for Seniors
Linda Wilson, ADC
Mr. James Wagner
This was an investigation into the effect of a regular therapeutic music oriented program on the emotional, social, and physical well-being of selected elders in a care facility. Groups of elders in eight Central Texas nursing homes participated in practice sessions which concluded with a performance for families, staff, and community. Ms. Wilson and Mr. Wagner developed a training manual with an accompanying audiotape and videotape.

The Perceptions of Texas Nursing Home Administrators as to the Adequacy of Preparations in Key Job Responsibilities as Defined by the NAB Domains of Practice
Mary Anne Franklin, MSA, NFA
Through a self-administered survey, the researcher answered questions about how well Texas nursing home administrators perceived they were trained for domains of practice. It established a relationship between administrators’ opinions and their education levels

World of Wisdom: Age of Innocence - An Intergenerational
Exchange Program
Oren Renick, JD, MPH, FACHE
Sue Williams, PhD
A year long program between Texas State's Child Development Center and The Arboretum of San Marcos involved visitation on a weekly basis between preschool children and institutionalized elderly. The child and nursing home elders took field trips, visited with each other in the nursing home, and worked on projects together.


Geriatric Social Work Education in Texas
Yvette Murray, PhD
Federal regulations (OBRA 1987) mandate the presence of social workers in nursing homes. This venture was undertaken to evaluate gerontological educational offerings within the field of social work in Texas institutions of higher learning. It also addresses the educational experience and needs of social workers practicing in the field. Dr. Murray presented the findings from the project to the Annual National Conference of the Bachelor's in Social Work Program Directors.

Needs Assessment: Regulatory, Service and Consumer Needs of the Long Term Care Industry
Marian Upchurch, PhD
Beth Knox, EdD
Surveys were provided to a random sample of consumers, regulators, administrators, and
directors of nursing of Texas nursing homes. Data on needs assessment were analyzed and a final report was completed.

The Effect of Validation Therapy Training on Satisfaction with Communication and Quality of Relationship Between Staff and Family Caregivers and Demented Residents in Long Term Care
Robert Canon, MSW
Staff in five nursing homes and family members of nursing home elders were trained in Validation Therapy techniques. The techniques were utilized with numerous communication dementia elders. Impact on elders and on the caregivers was measured.

A Profile of Nursing Assistants Employed in Central Texas
Nursing Home
Sandy Ransom, RN, MSHP
Nancy Fox, BAAS
As a first step in addressing the problem of turnover among nursing assistants in Texas, a pilot study was undertaken in Central Texas. Questionnaires were mailed to all nursing homes in a 12 county area. The most significant finding discovered while coding and analyzing the data is that the people who are providing the basic care for nursing home elders are working in long term care facilities because they love their clients. In spite of many barriers, the nursing assistants who responded are working in nursing homes because that is where they want to be.