Effects of two types of nursing homes on the behaviors of their residents with dementia : a descriptive comparative analysis

The purpose of this descriptive comparative study was to simultaneously and systematically assess and evaluate two representative types of nursing home environments [an integrated nursing home (INH) in Central Louisiana and a dementia-specific setting (DSS) in Central Texas] and their effects on the behaviors exhibited by residents with dementia. A convenience sample of 22 residents from the INH and 29 residents from the DSS who had a diagnosis of dementia, were residents four or more months, were mobile, and could communicate verbally were chosen for study. Five resident/guardian pairs from each facility sample were interviewed. Twenty-nine of 36 staff (81 percent) from the INH and 20 of 39 staff (51 percent) from the DSS returned completed questionnaires. The Multiphasic Environmental Assessment Procedure (MEAP), an investigator-prepared interview guide, and direct observations of resident behaviors were used to examine similarities and differences in four environmental domains measured by the MEAP: physical and architectural, policy and program, resident and staff, and social climate resources. Also, investigator impressions of the physical environment and resident and staff characteristics were related to resident output behaviors. Descriptive analysis of the data indicated that both facilities were generally successful in meeting their goals in association with their individual philosophies--high structure and low stimulation in the INH and freedom in a controlled yet 'rule-free', high stimulus DSS. Both facilities were effective in meeting the residents' daily living assistance and physical comfort needs and staff and caring were ranked as the most effective facility features by the resident/guardian pairs. Formal staff training was advantageous in the DSS whereas in the INH longevity of employment of the staff team and mutual on-the-job learning was responsible for their success. It appears that residents with dementia can be managed successfully in either type of facility, even if some differences exist in program implementation, as long as residents' individual needs are met, staff richness is at least moderate, and staff functioning is high.