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A growing number of elders are dodging nursing homes to reside in assisted living facilities, board and care homes, continuing care retirement communities, and other types of supportive housing. Physical and cognitive functioning have the greatest impact on the amount of direct care time received by people in supportive housing. However, the amount of dementia-oriented care received is more strongly affected by the type of supportive housing facility, according to a study supported by the Agency for Healthcare Research and Quality (HS10315).
Charles D. Phillips, Ph.D., M.P.H., and Catherine Hawes, Ph.D., of the Texas A&M Health Science Center, analyzed care of 921 residents aged 55 and older at 60 facilities in four areas of North Carolina. Staff members provided resident health and functional status and recorded the amount of time they spent over a 3-day period providing care to residents. This included both direct care time (for example, helping a resident bathe) and indirect staff time (for example, administrative duties), as well as care time provided by individuals from outside the facility (home health nurses, family members, volunteers).
The average resident received 181 minutes of direct care from facility staff during the 3-day period, about 1 hour each day, with about 5 minutes spent on cues (cueing a cognitively impaired resident to do something rather than doing it for him or her). Those who needed no assistance with activities of daily living (ADLs) such as dressing and bathing received 87 minutes of direct care time during the 3-day period. Those who needed at least supervision in all seven ADLs received nearly four times as much direct care time (343 minutes) as those who required no ADL assistance. Also, residents with no cognitive problems received about a quarter of the direct care time received by the most cognitively impaired residents. However, while adding facility indicators to the models predicting care time increased somewhat the variation explained in assistance with ADLs, the addition of facility indicators more than tripled the variation explained in dementia-specific care (cueing). These results imply that the provision of dementia-specific care is much more a function of staff practice in supportive housing that it is a function of individual need.
See "Care provision in housing with supportive services: The importance of care type, individual characteristics, and care site," by Drs. Phillips and Hawes, in the February 2005 Journal of Applied Gerontology 24(1), pp. 55-67.
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