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

Originally Published:
2010
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Key Point Summary
Key Point Summary Author(s):
Keys, Yolanda
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Verbeek et al.-2010-CHD-KPS.pdf  |  279.01 KBpdf
Key Concepts/Context

Small-scale environments are increasing in popularity for the care of dementia patients. This study aims to evaluate the effectiveness of this strategy. 

Objectives

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

Methods

This study investigated the effects of small-scale living compared with regular care in nursing homes in the Netherlands. A quasi-experimental study was conducted from April 2008-January 2010. Measurements were done at baseline with follow-ups after six and 12 months. Two types of long-term institutional nursing care settings were included.
 
Experimental condition consisted of 28 houses in small-scale living which met the following criteria:

  • Eight residents or fewer per house
  • A joint household with activities centered around daily life
  • Staff performing multiple tasks
  • A small, fixed team of staff
  • Organization of daily living mainly by residents 

Control conditions consisted of 21 regular wards that met the following criteria:

  • At least 20 residents per ward
  • Staff had differentiated tasks
  • Organization of daily routines were largely dictated by the nursing home 

The primary outcome measures for residents were quality of life, neuropsychiatric symptoms, and agitation.
 
Differences in characteristics between the two groups at baseline were tested for categorical variables, t-tests were used for normally distributed continuous variables, and Kruskal-Wallis tests were used for continuous variables with skewed distributions. Study hypotheses were tested with mixed-model multilevel analyses according to the intention-to-treat principle. 

Design Implications
The authors recommended further study in this area because the push for small-scale living facilities for dementia patients may not have sufficient evidence to warrant generalized adoption. 
Findings

This study did not convincingly demonstrate benefits to small-scale living facilities for dementia patients.  Family caregivers whose family was in a small-scale facility experienced less burden and greater satisfaction with nursing staff. Only subgroup analysis using contrast groups revealed greater job satisfaction and higher motivation in nurses working in small-scale environments. 

Limitations

Small homogeneous sample. 

Design Category
Building location/site optimization|Unit configuration and layout
Setting
Non-healthcare settings
Outcome Category
Environmental impact|Patient / resident health outcomes|Staff satisfaction|Job satisfaction|Patient satisfaction|Patient / resident satisfaction and comfort
Environmental Condition Category
Patient Satisfaction and Comfort
Key Point Summary Author(s):
Keys, Yolanda
Primary Author
Verbeek, H.
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