Enhancing the quality of life of cognitively impaired older adults : the role of organizational strategy and human resource management

China has 9 million elderly individuals with dementia, which places it first in the world. Although family care remains the major source of support for people with dementia, residential care has become an indispensable choice in recent years. The biggest concern is the quality of life of the elderly with cognitive impairment or dementia (QOL-ECI) in residential care facilities (RCFs). Previous studies have explored many individual-level factors associated with QOL-ECI; however, less discussion has been conducted on how to improve it from an organizational-level perspective. China serves as a good research setting for this issue. The present study aims to establish an organizational-level framework to investigate QOL-ECI in RCFs. The Person-centered Care (PCC) Approach serves as an organizational strategy, and the High Commitment Work System (HCWS) is used as a human resource management practice. The study exposes the QOL-ECI status of RCFs in Xi’an China; and examines the relationship between PCC/HCWS and QOL-ECI respectively and jointly. A quantitative research method, survey in particular has been designed to achieve the research objectives, and has been conducted in two phases. Phase one of the study aims to validate a Chinese Version of the Person-centered care Assessment Tool (P-CATC), which is designed to measure the extent to which formal caregivers rate their facility as being person-centered. The resulting 24-item P-CAT-C is validated among a sample of full-time employees (n=330) in all 34 RCFs in urban Xi’an, a city in China. Phase two is a survey conducted among the same 34 RCFs. Full-time employees (n=330) evaluated the HCWS level for each RCF; residents with cognitive impairment (n=307) and their respective personal care workers (n=207) were invited to evaluate QOL-ECI. Hierarchical Linear Modeling (HLM) has been adopted to test the hypothesis. In phase one study, Confirmatory Factor Analysis (CFA) shows that a three-factor 15-item solution of the P-CAT-C provided adequate fit indices to the data (χ2 = 145.69, df = 81, p< 0.001, CFI = 0.93, TLI=0.91; RMSEA = 0.05). The internal consistency coefficient (Cronbach’s α=0.68) is satisfactory. The inter scale correlation shows good construct validity. The result of Phase two study shows that the total mean patient-rated QOL-ECI score is 36.06 (SD=8.16) and the caregiver-rated score is 34.09 (SD=6.88). Using caregiver-rated QOL-ECI as the dependent variable, the HLM regression analysis shows that PCC and HCWS are statistically significant with QOL-ECI respectively, and that the HCWS has a positive moderate effect on the relationship between PCC and QOL-ECI. Using patient-rated QOL-ECI as the dependent variable, the hypotheses are partially supported. This study is among the first to report the QOL-ECI status of RCFs in China. It initially demonstrates that PCC and HCWS are positively associated with QOL-ECI both respectively and jointly. It also primarily establishes an organizational-level framework to examine QOL-ECI. This will generate valuable implications and insight into research, practice and policy-making. Finally, this study further develops the PCC theory from an organizational perspective, and contributes to both management and social work literature by first adopting the HCWS for service organizations for the elderly.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph