Goals for Alzheimer's care in nursing homes: What kind of differences do special care units expect to make?

Special Care Units (SCUs) for people with dementia have been enthusiastically promoted although many residents with dementia live elsewhere in their nursing home. In response to open-ended questions during personal interviews, coordinators of all 64 SCUs in Minnesota nursing homes described their goals and criteria for success. They then rated the importance of a list of possible goals and their unit's success in achieving them. Unit coordinators of 173 nursing home units in facilities with SCUs and 135 units in facilities without SCUs answered the same questions about people with dementia in their own units. When unprompted, respondents both in and outside SCUs were varied, sparse (averaging 3.1 goals per person), vague, process-oriented rather than outcome-oriented, and sometimes unrealistic. Yet, respondents later strongly endorsed most of the 24 goals the researchers suggested. ANOVA and regression analyses revealed few statistically significant differences according to unit type, although SCU coordinators were more likely to aspire to fewer medications, reduced disruptive behavior, and reduced agitation and anxiety, and were less likely to want residents to sleep through the night. Some differences were only between SCUs and non- SCUs in facilities without SCUs. Characteristics of facilities, coordinators, and case mix (e.g., proportion of dementia on the unit) were as predictive of goals and perceptions of success as SCU units. Findings reinforce the lack of conceptual clarity about expectations for direct and indirect effects of SCUs.