The long-term objective of this application is to furnish information on several levels of analysis about the inter-relation of care structures, care processes, and care outcomes associated with a Special Care Unit (SCU) designed for persons with Alzheimer's disease (AD). The SCU to be studied is located in an intermediate care facility, Budd Terrace. The study focuses on individuals: AD residents cared for on SCU and non-SCU floors, primary family caregivers of these residents, and staff persons providing services on SCU- and non-SCU-floors of the facility. Individual data will include clinical and social-psychological variables. A second level of analysis concerns group processes and individual behavior patterns as observed by an ethnographer. These phenomena are influenced by norms and values that in turn reflect institutional philosophy and wider cultural systems. Finally, the research addresses Budd Terrace and the Wesley Woods Geriatric Center (which includes Budd Terrace and 3 related facilities) as organizational systems, and considers how organizational characteristics impact SCU- and non-SCU participants. These varying levels of analysis require multidisciplinary perspectives: clinical medicine, nursing, psychology, sociology, anthropology, and health services research. The research site includes a well-established SCU serving 90 AD residents who are physically located on two adjacent floors of the Budd Terrace intermediate care facility. AD residents are also located on non-SCU floors, providing control conditions within the same facility. Residents, primary family caregivers, and staff affiliated with the two SCU floors and with two non-SCU floors will be described and compared, and the relative effectiveness of the SCU for participant outcomes will be assessed by multivariate statistical analyses. A panel of clinician experts will validate dementia diagnoses, assess the co-existence of depression, apply dementia staging criteria, and monitor residents' dementia status over time. Ethnographic observation of resident and staff behavior will be analyzed in relation to these clinical assessments. Staffing and other organizational variables that differentiate SCU and non-SCU floors will be assessed from nursing and health services delivery perspectives, and attention will be given to a potential Hawthorne effect on the research site. Additional research goals include developing useful measurement tools, tracking residents' long-term care careers, and deriving cost- benefit estimates of SCU-related outcomes.
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