Proposed is a 12-month longitudinal study of SCU impact on cognitively impaired patients and non-cognitively impaired patients living in residential health care facilities in five Northeastern States. Central research goals are to: 1. Identify and assess the impacts associated with placement of cognitively impaired persons in Special Care Unites (SCUs) within a nursing facility. 2. Identify and assess the impacts on non-cognitively impaired LTC patients associated with their living and/or functioning in close proximity to cognitively impaired patients (with the rationale that the availability of special care will reduce commingling of impaired and non-impaired patients). A concomitant research product will be the identification and definition of meaningful elements of Special Care. Delineation and operational definition of program attributes will occur as a preliminary to the formal analyses of data; a focus of subsequent analyses will be the relationship between each attribute and SCU impact. Using a two-stage sampling design, 960 patients (320 non-cognitively impaired, 320 cognitively-impaired non- SCU, and 320 SCU) will be selected from among new admissions at 32 sites. Comprehensive data, including a number of standardized measures of mental status, ADL, depression, behavior patterns and morale will be collected at two points in time during site visits. Information will be collected through chart reviews with key informants (usually nurses) and screening interviews and, where indicated, extended interviews, with patients. Multivariate analyses, including LISREL, will be used to identify direct and indirect relationships among the data. The project will relate directly to concerns of facility administrators regarding optimal placement of patients, as well as outcomes associated with specific elements of special programs for cognitively impaired individuals. Central hypotheses and predictions test assumptions regarding the positive/adverse effects of SCU placement and, among non-cognitively impaired, of placement in close proximity to cognitively impaired persons.
