Small-scale environments are increasing in popularity for the care of dementia patients. This study aims to evaluate the effectiveness of this strategy.
The purpose of this study was to evaluate the effects of small-scale living facilities in dementia care on residents, family caregivers, and staff.
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.
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.
Small homogeneous sample.