Dementia Care and Quality of Life in Assisted Living and Nursing Homes

TLDR

Few empirical studies have examined how long‑term care components affect quality of life for residents with dementia. This study investigates the relationship between dementia‑care elements in assisted‑living and nursing‑home settings and resident quality of life to inform practice and policy. The authors collected cross‑sectional on‑site data and a 6‑month telephone follow‑up from 421 residents in 35 assisted‑living facilities and 10 nursing homes, using multiple report and observational measures of care structure and process and 11 standardized quality‑of‑life instruments. Facilities that employed a specialized worker model, provided extensive dementia‑specific staff training, encouraged activity participation, and involved staff in care planning with positive attitudes reported higher resident quality of life, while better resident–staff communication was also linked to higher quality‑of‑life ratings and stable staff assignments were associated with lower provider‑reported quality of life.

Abstract

Purpose: There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care/assisted living (RC/AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy. Design and Methods: We used a variety of report and observational measures of the structure and process of care and 11 standardized measures of quality of life to evaluate the care for and quality of life of 421 residents with dementia in 35 RC/AL facilities and 10 nursing homes in four states. Data were collected cross sectionally on-site, and we conducted a 6-month follow-up by telephone. Results: Change in quality of life was better in facilities that used a specialized worker approach, trained more staff in more domains central to dementia care, and encouraged activity participation. Residents perceived their quality of life as better when staff was more involved in care planning and when staff attitudes were more favorable. Better resident–staff communication was related to higher quality of life as observed and reported by care providers. Also, more stable resident–staff assignment was related to care providers' lower quality-of-life ratings. Implications: Improvement in resident quality of life may be achieved by improved training and deployment of staff.