This is a longitudinal study that will measure the outcomes and effectiveness of Alzheimer's disease Special Care Units (SCUs) for residents, family caregivers, and staff. In recent years there has been a proliferation of nursing homes claiming to provide """"""""specialized"""""""" care to residents with Alzheimer's disease (AD) or related dementias. Little is known about the characteristics, services, patient outcomes, and costs of these facilities beyond case studies and descriptive reports. Because there is increasing pressure to develop national and state regulatory controls for these facilities, as well as create reimbursement differentials for facilities providing """"""""specialized"""""""" care for dementia patients, study will evaluate the outcomes, effectiveness, and costs of providing care in these settings. The proposed research will employ a quasi-experimental design with data collected on SCU residents and non-SCU residents at pre- and post- admission (6, 12, 18, and 24 months) to nursing homes. Data will be obtained on a minimum of: 172 institutionalized AD patients residing in SCUs and 172 controls randomly selected from AD patients institutionalized in non-SCUs. Each cohort will consist of admissions to nursing homes located in California (25 SCUs and 15 non-SCU comparison homes), who have been diagnosed as having moderate to severe AD or a related dementia. Information will be obtained using data collection instruments developed from the researchers' previous work, and will include: demographics; facility characteristics; problem behaviors; physical and pharmacological restraints; health, functional, and cognitive status; caregiver stress and satisfaction; staff stress and satisfaction; staff activity; non-demented resident satisfaction; and costs of medical, social service, and informal care. Data will be collected through facility staff and family caregiver questionnaires, direct observations of residents and facilities, time and motion studies, and review of medical charts. We intend to examine: 1) whether the number or severity of problem behaviors of dementia patients decreases after admission to an SCU; 2) whether the use of physical restraints and pharmacological restraints decreases after admission to an SCU; 3) the extent to which health status, functional level, and cognitive status of SCU residents is maintained or stabilized; 4) the extent to which family caregiver stress and satisfaction is positively related to admission to an SCU; 5) the extent to which staff stress and satisfaction is positively related to an SCU; 6) the effect of SCUs on non-demented residents; and 7) the cost- effectiveness of formal and informal care related to SCUs.
| Sloane, Philip D; Mitchell, C Madeline; Weisman, Gerald et al. (2002) The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia. J Gerontol B Psychol Sci Soc Sci 57:S69-78 |
