Study finds dementia care lacking in SNFs and ALFs.

Nursing homes are not providing adequate care for residents with Mzheimer's disease and related dementias--and assisted living facilities are no better. That's according to a study presented at the 56th Annual Scientific Meeting of the Gerontological Society of America. The study found, for example, that among cognitively impaired long-term care residents with mobility limitations, only 19% in assisted living facilities and 40% in nursing homes received treatment.

"Currently, little is known about the quality of life of long-term care residents with Alzheimer's and related disorders, as well as what treatment constitutes better quality of care," commented principal investigator Sheryl Zimmerman, PhD, an associate professor of social work and codirector of the Program on Aging, Disability, and Long-Term Care at the University of North Carolina at Chapel Hill. "Most of the research that has been done in this area relates to nursing home care and has primarily focused on defining characteristics of the care environment for residents in a particular stage of the disease process."

Other results: In both nursing homes and assisted living facilities, 40% of the study residents with recognized pain were not receiving pain medication and nearly one-third were not receiving ongoing professional care. Residents of for-profit facilities were found to have a higher prevalence of pain, but were less likely to undergo professional pain assessments or receive pain medication than those in not-for profit facilities.

For profit nursing homes also had higher rates of resident depression than the not for-profits and all of the assisted living facilities. Overall, only 28% of depressed residents were receiving professional treatment, and only 52% were taking antidepressants.

The researchers observed that 54.1% of cognitively impaired residents had low food intake and 51.3% had low fluid intake, compared to much lower staff reports of eating and drinking difficulties among residents.

Dr. Zimmerman said the project was designed to give providers useful in formation: "For example, many of the indicators of unmet need are based on staff responses to standardized measures. Using these measures, staff noted that almost 20% of the residents they scored as 'in pain' were not receiving any treatment. Was this lack of treatment intentional, or was the facility's assessment strategy less sensitive and so the need was not detected? That is, while staff typically did assess and treat those detected to be in pain (and depressed, and in need in other ways), there may be room for additional or different assessment and treatment."

"We hope the results of this study are an eye opener to long-term care providers," said Sheldon Goldberg, president and CEO of the Alzheimer's Association, which funded the study, and a Nursing Homes/Long Term Care Management Editorial Board member. "They challenge everyone involved in long-term care to step up and truly meet the needs of their residents all the time and in everything they do. The industry must take responsibility for the quality of service it provides. And individuals and the marketplace must hold the industry accountable, and flush those who provide poor service out of business."

Goldberg added that the Alzheimer's Association wants to work with the industry to improve care: "This will include drafting updated quality dementia care guidelines; developing tools to assist consumers in making good, informed decisions about long-term care; and advocating for appropriate dementia care training, particularly for direct care staff. Further, we are committed to advocating for a regulatory environment that supports high-quality care and to fight for adequate reimbursement to enable these kinds of cultural changes to take place in the long-term care industry."

For more information, visit www.alz.org/Media/newsreleases/current/112403study.htm.