Home and Community Care Digest

Home and Community Care Digest May 2006 : 0-0

Assisted living facilities: How is care provided to these residents'?


Housing with supportive care services is an important sector in long-term care and is becoming increasingly popular. Physical and cognitive functioning have the greatest impact on the amount of direct care time received by people in supportive housing. This study aimed to determine the role of individual characteristics versus facility identity in determining how care is provided to these residents.
Background: A growing number of elders are residing under assisted living arrangements (such as assisted living facilities, board and care homes, and retirement homes) instead of nursing homes. Information about care provision to residents and the role of individual characteristics versus facility identity in determining how care is provided in these settings is completely unexplored. This study investigated whether the amount of care provided is predicted by individual or facility characteristics by considering two types of care: one-on-one time spent by staff caring for residents and time spent cueing (prompting or reminding a cognitively impaired resident to complete an action) residents to assist them with self-care.

Methods: A total of 921 residents aged 55 and older at 60 in assisted living settings in four areas of North Carolina were analyzed. Health and functional status data on the residents were collected using the Minimum Data Set - Residential Assessment Instrument for assisted care living. Staff recorded the amount of time spent providing care to the resident over a 3-day period. This included both direct care time (eg. helping a resident bathe) and indirect staff time (eg. administrative duties), as well as care time provided by individuals from outside the facility (home health nurses, family members, and volunteers). Resident characteristics were measured using the Cognitive Performance Scale and the Activities of Daily Living (ADL) scale.

Findings: The average resident received 181 minutes of care over the 3-day period, about 1 hour each day, with about 5 minutes spent on cues. Those who needed no assistance with ADL's, such as dressing and bathing, received 87 minutes of direct care time during the 3-day period. Residents requiring supervision with multiple ADL's received nearly four times as much direct care time (343 minutes) as those who required no assistance. Direct care increased with each level of impairment. The type of facility was found to have some effect on time required to care for residents' ADL, but the effect was much larger when considering dementia-specific care.

Conclusion: This study suggests that more direct care time is spent on residents who are severely cognitively impaired or who need assistance with a greater number of tasks. Dementia specific care, however, was more affected by the type of facility than by care needs. Cueing the residents rather than doing the task for them is a vital component of dementia care. These results suggest that the provision of dementia-specific care is much more a function of staff practice in supportive housing arrangements than it is a function of individual need. Therefore, this study suggests that consumers should look into finding facilities that can provide care that maintains resident independence, especially for advanced cases of dementia. Staff should emphasize cueing the residents, thereby encouraging their independence, even when it is quicker to complete the task for the resident. Also, policy makers should reconsider their support of adult care homes for those with impaired cognitive status. Although housing with support services is more cost effective, this study suggests that considerable training is needed so that supportive housing is a consistently valuable setting for those with cognitive impairment.

Reference: Hawes C, Phillips C. "Care provision in housing with supportive services: the importance of care type, individual characteristics and care site". Journal of Applied Gerontology, 2005, 24: 55-67.


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