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Staff Training in Assisted Living Residences (STAR) is a training programme developed in the USA for care home staff working with people with dementia. It aims to improve understanding of the needs of people with dementia, strengthen the principles of treating people with dignity and respect, develop communication skills and improve job satisfaction.

Key points

  • there is some evidence to suggest the STAR program may help to reduce depression in people with dementia living in care homes
  • further research is needed to find out if the STAR programme improves the quality of life of people with dementia and the skills and expertise of care home staff.

Download Full Summary (including tables and references)

Download Short Summary

Evidence Snapshot

Does it work for people with dementia?



Strength of evidence

Implemented in the UK?

What is STAR?

The STAR programme was developed by Dr Linda Teri and colleagues at the University of Washington, USA(1). The programme focuses on the values, dignity and rights of the person with dementia and the strengths of staff members. It was taught by a variety of health and social care professionals including psychologists, occupational therapists and trainee nurses. STAR is an eight week training programme of two half day workshops and 4 individual sessions. The workshops include a variety of activities such as lectures, group discussion, case studies and videos.

The programme covers the following skills and topics:

  • understanding dementia as an illness and the way it affects people and families
  • communication skills including listening with respect to people with dementia and their families
  • managing behaviour that challenges and identifying signs of anxiety and depression
  • understanding why the person with dementia has challenging behaviour, exploring different factors which may contribute to this behaviour and how to work with the person to find effective solutions. The programme calls this identifying activators, behaviours and consequences (ABCs) of behavioural distress
  • understanding the influence that the environment can have on behaviour. For example changes in staff or surroundings, noise, being uncomfortable, not having any personal space
  • identifying and planning activities for people with dementia to enjoy. The programme calls these pleasant events.

Why is STAR important?

In the UK an estimated 285,000 people with dementia live in care homes(2), this is 67% of the total number of adults who live in care homes(3). Depression and anxiety are common in people with dementia and their behaviour can change as their condition progresses. The National Dementia Strategy for England (4) recommends that specialist dementia care training should be available for all care home staff. However we don’t know how many care home staff have the opportunity to attend specialist training and there is no information on which of the training programmes work best.

Does STAR work?

Two out of the three studies we looked at for this summary found that the STAR programme helps to reduce depression in some people with dementia living in care homes. However the results need to be interpreted cautiously as both studies were small (less than 65 people with dementia in total took part in them) and only one was a randomised control trial (RCT).

The first was a small RCT in the USA carried out by the team that developed STAR (1). The study involved 25 staff and 31 people with dementia from four care homes. The care homes were divided into two groups, Staff in the first group were trained using the STAR programme and the second group received usual care home training.

People with dementia were assessed before the training started and again eight weeks after the training had finished: The assessments covered:

  • signs of anxiety and depression
  • memory and thinking skills
  • challenging or unusual behaviour.

Staff were asked about their job satisfaction and if they felt confident that they had the skills they needed to work with people with dementia.

The research found that the anxiety and depression improved among people with dementia when staff had completed the STAR training programme, and there were fewer reports of challenging behaviour among people with dementia. In the care homes where staff did not receive STAR training these symptoms either stayed the same or became worse.

There was no difference in job satisfaction and confidence between the two groups of staff.

The other two small studies, one in the UK and the other in Brazil, looked at the difference the STAR training programme made. However, they did not compare their results with those of care homes where staff only received their usual care home training.

The UK study (6). found that, compared to before the training, the people with dementia were less depressed and there were fewer reports of challenging behavior after staff completed the training.

The study in Brazil (7) did not find that STAR training made a difference, although there were slightly fewer reports of challenging behaviour, the quality of life of the people with dementia was lower after staff received training. Because the study did not compare the results to those of people in care homes where the staff had not received the training, it is not possible to tell whether some of the changes observed would have happened irrespective of the STAR training.

Is STAR cost-effective?

We are not aware of any studies that have looked at how much STAR costs and if it offers value for money (is cost effective).

What people say about STAR?

Care home staff participating in the STAR programme in the UK-based study(6) wrote the following comments on feedback forms:

“I didn’t only learn about dementia but I also learnt things which have helped me in my day-to-day living. I learnt to communicate and meet different people” (p. 917)

“It was a great experience. It gave me loads of knowledge and understanding“ (p.917)

“It gave me more understanding of dementia and how we should treat people with dementia the same as any other person by respecting and valuing them” (p.917)

Find out more about STAR

Further information on STAR in the USA is available here

We don’t currently have any information on STAR training programmes being run in the UK.

Find out more about organisations that have information or offer support to people with dementia and their families.


et al

Randomised controlled trial USA, 31 people with dementia and 25 staff

Cost Effectiveness

Strength of Evidence


et al

Before and after study, Brazil, 57 people with dementia and 25 staff

Does it Work for Carers?

Cost Effectiveness

Strength of Evidence


1. , ; ,

2. , ; ,

3. Knapp, M; Comas-Herrera, A; Wittenberg, R; King, D et al (2014) Scenarios of dementia care: What are the impacts on cost and quality of life? Personal Social Services Research Unit, London School of Economics and Political Science.

4. Laing and Buisson (2014) Care of Elderly People Market Survey 2013/14.

5. Department of Health (2009). Living Well with Dementia: A National Dementia Strategy. London: Department of Health.

6. , ; ,

7. , ; ,

About this summary

Authors: Daniel Lombard

Edited by: Helen Hayes and Adelina Comas-Herrera

Summary First Published: Friday, July 15th, 2016

Summary Last Updated: Monday, July 25th, 2016

The support of the Economic and Social Research Council (ESRC) and National Institute for Health Research (NIHR) is gratefully acknowledged. The views expressed in this publication are those of the author(s) and not necessarily those of the ESRC, NIHR or Department of Health.