Is Dementia Special Care Really Special? A New Look at an Old Question

To quantify differences in care provided to nursing home residents with dementia living on and off dementia special care units (SCUs), data are analyzed to establish a baseline for future research.

Abstract

OBJECTIVES: To quantify differences in care provided to nursing home (NH) residents with dementia living on and off dementia special care units (SCUs). DESIGN: Cross-sectional study using propensity score adjustment for resident and NH characteristics. SETTING: Free-standing NHs in nonrural U.S. counties that had an SCU in 2004 (N=1,896). PARTICIPANTS: Long-stay (> or = 90 days) NH residents with a diagnosis of Alzheimer's disease or dementia and at least moderate cognitive impairment (N=69,131). MEASUREMENTS: Resident-level NH care processes such as physical restraints, bed rails, feeding tubes, psychotropic medications, and incontinence care. RESULTS: There was no difference in the use of physical restraints (adjusted odds ratio (AOR)=0.94, 95% confidence interval (CI)=0.79-1.11), but SCU residents were less likely to have had bed rails (AOR=0.55, 95% CI=0.46-0.64) and to have been tube fed (AOR=0.36, 95% CI=0.30-0.43). SCU residents were more likely to be on toileting plans (AOR=1.23, 95% CI=1.08-1.39) and less likely to use pads or briefs in the absence of a toileting plan (AOR=0.73, 95% CI=0.61-0.88). SCU residents were more likely to have received psychotropic medications (AOR=1.23, 95% CI=1.05-1.44), primarily antipsychotics (SCU=44.9% vs non-SCU=30.0%). CONCLUSION: SCU residents received different care than comparable non-SCU residents. Most strikingly, SCU residents had greater use of antipsychotic medications.