Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents' characteristics

<p>Abstract</p> <p>Background</p> <p>Nursing home care for people with dementia is increasingly organized in small-scale and homelike care settings, in which normal daily life is emphasized. Despite this increase, relatively little is known about residents' characteristics and whether these differ from residents in traditional nursing homes. This study explored and compared characteristics of residents with dementia living in small-scale, homelike facilities and regular psychogeriatric wards in nursing homes, focusing on functional status and cognition.</p> <p>Methods</p> <p>A cross-sectional study was conducted, including 769 residents with dementia requiring an intensive level of nursing home care: 586 from regular psychogeriatric wards and 183 residents from small-scale living facilities. Functional status and cognition were assessed using two subscales from the Resident Assessment Instrument Minimum Data Set (RAI-MDS): the Activities of Daily Living-Hierarchy scale (ADL-H) and the Cognitive Performance Scale (CPS). In addition, care dependency was measured using Dutch Care Severity Packages (DCSP). Finally, gender, age, living condition prior to admission and length of stay were recorded. Descriptive analyses, including independent samples t- tests and chi-square tests, were used. To analyze data in more detail, multivariate logistic regression analyses were performed.</p> <p>Results</p> <p>Residents living in small-scale, homelike facilities had a significantly higher functional status and cognitive performance compared with residents in regular psychogeriatric wards. In addition, they had a shorter length of stay, were less frequently admitted from home and were more often female than residents in regular wards. No differences were found in age and care dependency. While controlling for demographic variables, the association between dementia care setting and functional status and cognition remained.</p> <p>Conclusions</p> <p>Although residents require a similar intensive level of nursing home care, their characteristics differ among small-scale living facilities and regular psychogeriatric wards. These differences may limit research into effects and feasibility of various types of dementia care settings. Therefore, these studies should take resident characteristics into account in their design, for example by using a matching procedure.</p

Broken deal: Devolution, development, and civil society in Newark, New Jersey, 1960–1990

This dissertation explores the enduring conflicts over race, federalism, and local self-determination in postwar U.S. cities through the experience of Newark, New Jersey. Newark epitomized the urban crisis decades before the city erupted in one of the most deadly uprisings of the 1960s, but its story is not solely a chronicle of local decay amid federal retrenchment. Newark\u27s residents and their suburban neighbors mounted imaginative challenges to the city\u27s decline, many of which resonated nationally among policymakers and residents of similarly distressed cities. Newark\u27s black nationalists built a movement that elected African-Americans to office in unprecedented numbers. Catholic priests joined with community leaders to pioneer methods of financing low-income housing that were later incorporated into federal policy. An alliance of corporate leaders, civil rights activists, union members provoked a showdown with white trade unions over the implementation of affirmative action in organized labor. Their alliance eventually achieved one of the country\u27s most successful plans for the integration of local construction trades. Residents of the Stella Wright Homes protested the mismanagement and decline of their buildings with the longest public housing rent strike in U.S. history and launched their own experiments in self-management. Participants in these conflicts were guided by a new generation of urban leaders, whose strength lay in their ability to leverage subtle divisions among white power brokers and achieve unity of purpose among blacks and Puerto Ricans. These individuals often avoided traditional urban electoral politics, acting instead as behind-the-scenes mediators among corporate leaders, union leaders, black power advocates, government officials, and foundation executives to legitimize confrontational demands and ease the implementation of controversial policies. This dissertation shifts between the local and the national levels, illustrating the means through which Newark residents adapted or rejected state and federal policies. It analyzes the fleeting victories, frequent defeats, and constant compromises through which residents institutionalized aspects of the civil rights and black power movements. It offers a synthetic analysis of grassroots responses to the urban crisis in Newark, and illustrates how residents\u27 strategies alternately hindered and enabled the retreat of the New Deal welfare state

Broken deal: Devolution, development, and civil society in Newark, New Jersey, 1960–1990

This dissertation explores the enduring conflicts over race, federalism, and local self-determination in postwar U.S. cities through the experience of Newark, New Jersey. Newark epitomized the urban crisis decades before the city erupted in one of the most deadly uprisings of the 1960s, but its story is not solely a chronicle of local decay amid federal retrenchment. Newark\u27s residents and their suburban neighbors mounted imaginative challenges to the city\u27s decline, many of which resonated nationally among policymakers and residents of similarly distressed cities. Newark\u27s black nationalists built a movement that elected African-Americans to office in unprecedented numbers. Catholic priests joined with community leaders to pioneer methods of financing low-income housing that were later incorporated into federal policy. An alliance of corporate leaders, civil rights activists, union members provoked a showdown with white trade unions over the implementation of affirmative action in organized labor. Their alliance eventually achieved one of the country\u27s most successful plans for the integration of local construction trades. Residents of the Stella Wright Homes protested the mismanagement and decline of their buildings with the longest public housing rent strike in U.S. history and launched their own experiments in self-management. Participants in these conflicts were guided by a new generation of urban leaders, whose strength lay in their ability to leverage subtle divisions among white power brokers and achieve unity of purpose among blacks and Puerto Ricans. These individuals often avoided traditional urban electoral politics, acting instead as behind-the-scenes mediators among corporate leaders, union leaders, black power advocates, government officials, and foundation executives to legitimize confrontational demands and ease the implementation of controversial policies. This dissertation shifts between the local and the national levels, illustrating the means through which Newark residents adapted or rejected state and federal policies. It analyzes the fleeting victories, frequent defeats, and constant compromises through which residents institutionalized aspects of the civil rights and black power movements. It offers a synthetic analysis of grassroots responses to the urban crisis in Newark, and illustrates how residents\u27 strategies alternately hindered and enabled the retreat of the New Deal welfare state

Culture Change in Long-term Care: Participatory Action Research and the Role of the Resident

Purpose: This study's purpose was to advance the process of culture change within long-term care (LTC) and assisted living settings by using participatory action research (PAR) to promote residents’ competence and nourish the culture change process with the active engagement and leadership of residents. Design and Methods: Seven unit-specific PAR groups, each consisting of 4–7 residents, 1–2 family members, and 1–3 staff, met 1 hour per week for 4 months in their nursing home or assisted living units to identify areas in need of improvement and to generate ideas for community change. PAR groups included residents with varied levels of physical and cognitive challenges. Residents were defined as visionaries with expertise based on their 24/7 experience in the facility and prior life experiences. Results: All PAR groups generated novel ideas for creative improvements and reforms in their communities and showed initiative to implement their ideas. Challenges to the process included staff participation and sustainability. Implications: PAR is a viable method to stimulate creative resident-led reform ideas and initiatives in LTC. Residents’ expertise has been overlooked within prominent culture change efforts that have developed and facilitated changes from outside-in and top-down. PAR may be incorporated productively within myriad reform efforts to engage residents’ competence. PAR has indirect positive quality of life benefits as a forum of meaningful social engagement and age integration that may transform routinized and often ageist modes of relationships within LTC