The project is a prospective study of 300 intermediate care nursing home patients. The objective of the study is to measure the effects of mental illness on the quantities of nursing care received and the outcomes of that care. The study design is as follows: 1. Assessment of health status. Two surveyors will independently assess the cognitive ability of 300 residents using the Mini-Mental State Examination. Two surveyers will be interviewed independently to assess behavioral problems and functional ability. Nursing diagnoses will also be assigned. In addition, nursing acuity and nursing intensity will also be measured. 2. Measurement of nursing time. After the assessment of health status, 10% of the minutes of direct patient care provided by each type of staff during one 24-hour period will be recorded. At the same time, recent participation in routine and therapeutic group activity will be collected. Indirect time will be collected from diaries maintained by staff. Patterns of nursing activity, will be measured by unit type (i.e., Alzheimers Unit) and staffing ratios. 3. Followup. Patient assessments will be repeated at three month intervals cover a two year period. Nursing time measurement will also be repeated at three month intervals. 4. Analysis. LlSREL and logistical repression will be used to measure the relationships among quantities of nursing care. Physical dysfunction, behavioral problem, cognition, nursing diagnoses, nursing acuity, nursing intensity, staffing patterns and the outcomes of care.
