Table 1.

Example of Qualitative Interview Domains and Sample Questions for Nursing Home Leadership

Nursing Home Culture Domain	Proposed Questions
Home/physical environment	Does your facility have a special dementia unit?
	If so, please describe.
	Does your facility have a home-like environment introducing plants, pets, children and surroundings that are reminiscent of past lives?
Resident-directed care and activities	How many hours of activities are available to residents with dementia each day?
Decision-making processes	Is there a protocol for direct care staff to respond to patients who exhibit challenging behaviors?
	Imagine that a patient at your facility begins to display behavior problems. This patient begins to become loud, shouting or swearing at staff and other residents. He or she starts to throw things occasionally, and struggles when staff try to help dress, bathe or feed him or her. Imagine this has been going on for about a week, and seems to be getting worse rather than better.
	How would staff in your facility respond?
	Would there be an interdisciplinary team meeting to develop a management plan? Who would attend the meeting?
	Who would develop (write) the behavior management plan?
Staffing	Does your facility aim for consistency of CNA and nurse staffing for difficult patients on each shift?
Staff training	Is there behavior management training beyond the 8 hours of required training about dementia care for direct care staff?
Staff empowerment	Describe the process to develop a behavior management plan? [Is it interdisciplinary? Who is involved?
Relationships with staff, family, resident and community	At what point is the family contacted?
	If an antipsychotic medication is initiated, is informed consent required? ◦Is there a protocol for contacting the family? ◦What is the family told? ◦Are the risks and benefits of antipsychotics discussed? [I think best to ask whoever talks to the family this and prior question] ◦Who contacts the family?
Readiness to change	What would it take for your facility to implement a program to improve antipsychotic prescribing?
	Under what circumstances would your facility put additional resources for staff training and time to improve behavioral management and improve understanding of antipsychotic risks?
Dissemination and Communication	What forms of materials would be helpful for you to communicate with families about behavior management and antipsychotic use?
	What forms of materials would be helpful for you to communicate with direct care staff and prescribers about behavior management and antipsychotic use?