Outcomes of nursing home care among patients with Alzheimer's disease and related disorders. Dementia will be evaluated in all nursing homes and Special Care Units (SCUs) in five states: Kansas, Maine, Mississippi, South Dakota, and Wisconsin. The study states are currently participating in HCFA's Multi-State Nursing Home Case Mix and Quality Demonstration Project (CMQD), a five-year longitudinal study of all of the approximately 40,000 nursing home residents in those states, which is collecting standardized data on all augmented by primary data on the approximately 35 SCUs in the study states, using questionnaires and site visits. The proposed study will: 1) compare outcomes of care for SCU residents with dementia with outcomes of similar residents in non-specialized nursing home settings; 2) compare nondemented residents of homes that have SCUs with similar nondemented residents of homes without specialized units in terms of selected measures of well-being; and 3) identify elements of the structure and process of care that characterize the SCUs whose resident outcomes are the most favorable. The outcome dimensions to be studied include physiologic function, basic self-care, cognition, affect, social function, problem behaviors, and freedom from restraint. Nursing home residents with dementia will be categorized into stages, with outcome analyses being stage-appropriate. Implications of the study include: a) the development of a standardized outcome evaluation system for patients with dementia that could have national applicability; b) identification of norms for the progression of dementia, which can be used to compare resident outcomes in other studies of dementia care; c) comparison of outcomes of SCU and non-SCU care; and d) identification of features that characterize successful SCUs.
