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Dementia and the Nursing Home: Association with Care Needs
Author(s) -
Aronson Miriam K.,
Cox Donna,
Guastadisegni Paul,
Frazier Cynthia,
Sherlock Lila,
Grower Ronnie,
Barbera Arlene,
Sternberg Marc,
Breed Joseph,
Koren Mary Jane
Publication year - 1992
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1992.tb01825.x
Subject(s) - medicine , dementia , reimbursement , psychological intervention , nursing homes , activities of daily living , gerontology , cognition , cognitive impairment , long term care , nursing , family medicine , health care , physical therapy , psychiatry , disease , pathology , economics , economic growth
Objective To determine whether RUG reimbursement categories accurately predict requirements for care in nursing homes. Design Prospective descriptive study of residents in lower reimbursement categories according to RUG. Setting Three nursing homes in New York City. Participants Convenience sample of 173 residents who agreed to participate, not significantly different from 201 who did not agree to participate. Main Measures Chart review; assessment of residents' cognitive and functional abilities; nursing assistants' ratings of residents' functional abilities, behavioral problems, the amount of effort required in care; and time‐motion studies of staff‐resident interactions. Results Both the residents' RUG classification ( P < 0.01) and the level of ADL independence ( P < 0.001) had significant impacts on the staff effort required in their care, with more dependent residents requiring greater effort. The residents' level of cognitive impairment also had a significant impact on the staff effort, with the severely impaired requiring greater effort ( P < 0.05). The time‐motion analysis indicated that residents within the same RUG category differed in the number of staff‐resident interactions based on their level of cognitive impairment. Conclusions Cognitive impairment is a significant morbidity (or co‐morbidity) in determining the quantity of staff effort required by the resident, and behavioral interventions are an important care component. There is marked heterogeneity within lower (RUG) reimbursement categories which translates into strikingly different care requirements.