The Quality of Advanced Dementia Care in the Nursing Home

Abstract

Background The quality of nursing home care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor is the impact of special care units (SCUs) for dementia for residents at the end-stage of this disease. Objective To examine the association between residence in an SCU and the quality of end-of-life care for nursing home residents with advanced dementia. Research Design This study employed longitudinal data on 323 nursing home residents with advanced dementia living in 22 Boston-area facilities. Using multivariate methods, we analyzed the association between residence in an SCU and measures of quality of end-of-life care including: treatment of pain and dyspnea, prevalence of pressure ulcers, hospitalization, tube feeding, antipsychotic drug use, advance care planning, and health care proxy (HCP) satisfaction with care. Results A total of 43.7% residents were cared for in an SCU. After multivariate adjustment, residents in SCUs were more likely to receive treatment for dyspnea, had fewer hospitalizations, were less likely to be tube fed, and more likely to have a do-not-hospitalize order, compared to non-SCU residents. However, non-SCU residents were more likely to be treated for pain, had fewer pressure ulcers, and less frequent use of antipsychotic drugs than SCU residents. HCPs of SCU residents reported greater satisfaction with care than HCPs of non-SCU residents. Conclusions Residence in an SCU is associated with some, but not all, markers of better quality end-of-life care among nursing home residents with advanced dementia.

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“…; Cadigan et al. ). Specifically, in each person‐quarter, we analyzed the presence of inappropriate antipsychotic use and the use of physical restraints, both of which have been shown to be especially dangerous for patients with dementia (Foebel et al.…”

Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia

“…It is difficult to know whether these results indicate a true difference in practice (greater proxy communication) or simply represent better chart documentation, but in the case of special care units, there is prior work documenting an association with some markers of better quality of care in this population. 19 This study has certain limitations. First, the majority of participants were white and female, and all came from Boston-area NHs.…”

“…In addition, documentation of discussions was associated with greater proxy visitation, as well as the infection occurring just before the resident's death. It is difficult to know whether these results indicate a true difference in practice (greater proxy communication) or simply represent better chart documentation, but in the case of special care units, there is prior work documenting an association with some markers of better quality of care in this population …”

Empirical development of a typology on residential long-term care units in Germany - results of an exploratory multivariate data analysis

“…Finally, a comparison of the "dementia special care units" cluster in Table 4 with more recent research shows that empirical studies that investigate the in uence of a Dementia Special Care Unit on residents' outcomes often do not use multiple indicators to de ne them but rely on single indicators such as the availability of specially trained staff [38], SCU placement variable of the MDS 2.0 [39] or the US OSCAR reporting system [40,41]. Other studies combine several indicators based on an a priori set de nition [42].…”

“…unit is not additionally financed by a special agreement (Finance 0)84% (87)Living unit is additionally financed by a special agreement (Finance 1)16%(16) Integrative living concept (Segregative 0) 61% (63) Segregated living concept(Segregative 1)39%(40) …”