Original Study
Dementia Care Redesigned: Effects of Small-Scale Living Facilities on Residents, Their Family Caregivers, and Staff

https://doi.org/10.1016/j.jamda.2010.08.001Get rights and content

Objective

The purpose of this study was to evaluate the effects of small-scale living facilities in dementia care on residents, family caregivers, and staff.

Design

This was a quasi-experimental study including 2 types of institutional nursing care: small-scale living facilities (experimental group), and regular psychogeriatric nursing home wards (control group). Three measures were conducted: at baseline and follow-ups after 6 and 12 months.

Setting

Twenty-eight houses in small-scale living facilities and 21 regular psychogeriatric nursing home wards.

Participants

In total, 259 residents were included in the study: 124 in small-scale living facilities and 135 controls, matched on cognitive and functional status. Furthermore, 229 family caregivers were included and 305 staff members.

Measurements

For residents, main outcome measures were quality of life, neuropsychiatric symptoms, and agitation. Main outcome measures for family caregivers included perceived burden, satisfaction, and involvement with care. Main outcome measures for staff were job satisfaction and motivation.

Results

No effects were found for residents’ total quality of life, neuropsychiatric symptoms, and agitation. Family caregivers in small-scale living reported significantly less burden (adjusted mean difference 0.8, 95% CI 0.1–1.5) and were more satisfied with nursing staff (0.3, 0.2–0.5) than family caregivers in regular wards. No differences were found in their involvement with care. Overall, no significant differences were found for staff’s job satisfaction and motivation, although subgroup analyses using contrast groups (regarding typical small-scale living and regular wards) revealed more job satisfaction (2.0, 0.5–3.5) and motivation (0.6, 0.0–1.3) in small-scale living compared with regular wards.

Conclusion

This study was unable to demonstrate convincing overall effects of small-scale living facilities. Because governmental policies and, in some countries, financial support, are increasingly aimed at providing small-scale, homelike care, it is suggested that this may not be a final solution to accomplish high-quality dementia care and that other options should be considered.

Section snippets

Design and Sample

A quasi-experimental study was conducted from April 2008 to January 2010 (recruitment period April 2008–December 2008), including 3 measurements: at baseline and follow-ups after 6 and 12 months. A detailed report of the rationale and study design was published elsewhere.14

Two types of long-term institutional nursing care settings were included: small-scale living facilities and regular psychogeriatric wards in nursing homes. The experimental condition consisted of 28 houses in small-scale

Results

Figure 1 describes the number of participants at each stage of the study, including reasons for nonparticipation. In total, 259 residents were included, 124 in small-scale living and 135 in regular wards. Family caregivers were available for 253 residents, of whom 229 were willing to participate: 114 in small-scale living and 115 in regular wards. Finally, 305 nursing staff members participated in the study, 114 from small-scale living and 191 from regular wards.

Participants’ baseline

Discussion

We were unable to demonstrate convincing overall effects of small-scale living facilities for our primary outcome measures. No difference in residents’ total QoL was found and only few dimensions significantly differed. No effects were found for neuropsychiatric symptoms and agitation. Family caregivers in small-scale living were less burdened and were more satisfied with nursing staff contact than family caregivers in regular wards. No effect was found for nursing staff’s job satisfaction and

References (30)

  • R. Woods

    Institutional care

  • H. Verbeek et al.

    Small, homelike care environments for older people with dementia: A literature review

    Int Psychogeriatr

    (2009)
  • J.E. Morley et al.

    Putting the “home” back in nursing home

    J Gerontol A Biol Sci Med Sci

    (2002)
  • R.A. Kane et al.

    Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial green house program

    J Am Geriatr Soc

    (2007)
  • S. te Boekhorst et al.

    The effects of group living homes on older people with dementia: A comparison with traditional nursing home care

    Int J Geriatr Psychiatry

    (2009)
  • Cited by (101)

    • “Bring me sunshine, bring me (physical) strength”: The case of dementia. Designing and implementing a virtual reality system for physical training during the COVID-19 pandemic

      2022, International Journal of Human Computer Studies
      Citation Excerpt :

      In particular, within the next thirty years, this number is expected to rise to about 139 million people (WHO, 2021). This expected growth makes imperative the need for better hospitalization and increased support towards PwD (Verbeek et al., 2010) who exhibit impairments in cognitive and motor functions, while also suffering from other co-existing symptoms, such as depression, apathy, lack of motivation, and loss of interest in oneself and others (Brett and Murnion, 2015; Kitching, 2015; Muliyala and Varghese, 2010). These symptoms become most obvious during the late stages of the disease with PwD having difficulty performing basic functions and experiencing more drastic cognitive and behavioural changes.

    View all citing articles on Scopus

    This research was funded by Maastricht University, the Province of Limburg, and 5 health care organizations (i.e. MeanderGroep, Orbis, Sevagram, Vivre, de Zorggroep), all located in the Netherlands. None of the authors have any conflicts of interest or financial interests in the study described.

    View full text