Barriers and facilitators to implementation of evidence-based, non-pharmacologic programs for residents with dementia in va skilled nursing facilities

Background: Implementation of non-pharmacologic programs for people with dementia is often challenging in skilled nursing facilities (SNFs) We previously implemented Preventing Loss of Independence through Exercise (PLIE)-an integrative, group movement program for SNF residents with dementia-at the San Francisco VA This study aimed to identify barriers and facilitators to implementing PLIE in VA SNFs nationally Methods: We conducted a formative evaluation using semi-structured interviews with key stakeholder groups (SNF staff, SNF directors, and VA health system leaders) Questions focused on PLIE's fit with current dementia programs and VA policies, characteristics of individual SNFs, and training and implementation strategies We used rapid qualitative analyses to identify key barriers and facilitators to inform implementation activities Results: We interviewed 23 people from geographically diverse VA SNFs and national program offices (SNF staff, n=14;SNF directors, n=3;Health system leaders, n=7) Barriers to implementing PLIE included: 1) Staff turnover and limited dementia experience;2) Space restrictions and limits on group size (e g quarantine periods);and 3) technical issues with training staff remotely Implementation facilitators for PLIE included: 1) compatibility with SNF needs and goals (e g maintaining function, reducing disruptive behavior);2) adaptability (e g , engaging residents with limited mobility, using individual instruction during the COVID-19 pandemic);3) engaging and training interprofessional staff;and 4) alignment with national VA priorities and programs for dementia care Conclusions: Successful implementation of evidence-based, non-pharmacologic programs such as PLIE is facilitated by compatibility, adaptability, interprofessionalism and alignment with VA priorities while barriers are related to staff, space, and technology PLIE's adaptability suggests it is a scalable model for increasing access to non-pharmacologic dementia programs that can serve large numbers of SNF residents These findings will inform the development of a remote training program for SNF staff to become instructors and facilitate national spread to other VA SNFs