Building Bridges: Improving Relations between Family Members & Staff in Assisted Living

The Partners in Care in Assisted Living (PICAL) program was created to address conflicts between family members of assisted living residents and their staff caregivers due to differing perceptions of responsibilities, communication barriers, and cultural differences. In the PICAL intervention, family and staff meet separately with a program administrator for about three hours to learn and practice communication skills such as active listening, saying what you mean, and handling conflicts. After the session, family and staff meet with an administrator in a joint session in which they discuss concerns, identify issues, and plan for change.

To assess the effectiveness of the intervention, researchers recruited 576 staff members and 295 family members from 19 assisted living communities across the US. All participants completed a measure of interpersonal conflict and a measure of depression up to one month before the intervention and one month after the intervention. Family members also rated staff on care provided, communication, and empathy, while staff completed a measure of burnout and rated family members on friendliness and empathy. During the evaluation, the intervention was offered at nine communities, while ten communities were used as controls and did not receive the intervention until after the evaluation was completed.

Overall, family members and staff tended to have positive perceptions of each other, but reported experiencing occasional conflict. After completing the intervention, staff reported significant decreases in conflict with family members, as well as moderate decreases in burnout and depression, compared to the control group. Unfortunately, no significant changes were observed for family members, but the researchers pointed out that this is still meaningful because interventions occasionally have a negative effect on family member perceptions.

Communities also identified several implementation issues, such as the time commitment for busy staff and difficulty recruiting family members. In response to this, the researchers created a condensed version of the program that lasts only one hour.

In all, the intervention was successful in enhancing quality of family and staff interactions in assisted living communities, and may be beneficial for communities to implement.



Pillemer K, Schultz L, Tillema Cope M, et al. Partners in care in assisted living: Fostering cooperative communication between families and staff. Seniors Housing & Care Journal (2018); 26(1): 3-15.


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