Small scale living facilities for older people with dementia.

In dementia care, interest has been raised in small, domestic style care settings. The effects of these small-scale living facilities are not clear yet. Positive as well as negative influences have been suggested. The aim of the current study is to examine the effects of small-scale living arrangements on residents, family caregivers and professional caregivers.
A longitudinal quasi-experiment study is carried out in the south of the Netherlands (2008-2010). The intervention consists of small-scale living arrangements, regular nursing home care is the control condition. Residents (n=200), family caregivers (n=160) and professional caregivers (n=300) are compared on several outcome measures. The primary outcome measure for residents is quality of life; in addition behavioral problems, medication, functional status and use of physical restraints are measured. Family caregivers are compared on involvement with care, care burden and health. Job satisfaction is the primary outcome measure for professional caregivers; secondary measures include health status and autonomy. Measurements are performed at baseline, after 6 and 12 months.

It is hypothesized that residents in small scale living facilities, compared to those in regular nursing home care, have a higher quality of life and functioning. In addition, it is hypothesized that their family caregivers experience less burden and have a higher care satisfaction. Profesional caregivers are expected to have a higher job satisfaction.

3 measurements: baseline, after 6 months (T1) and after 1 year (T2).

Small scale living facilities have a maximum of 8 residents per house or unit. Residents and professional caregivers form a household: activities of daily life are central and they cook together. Professional caregivers have integrated tasks: e.g. personal/medical care, cooking, cleaning, activities. Residents and family care givers have a large amount of control over their daily life. In addition, the physical setting resembles a homelike, archetype house and household.
Control group: regular psychogeriatric wards in a large nursing home, with 15 ore more residents per ward. Professional caregivers have differentiated tasks: they only provide personal and medical care. Residents and family caregivers have little control over the daily life: this is largely determined by the nursing home's organisation.