Dementia and the Nursing Home: Association with Care Needs

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Abstract
To determine whether RUG reimbursement categories accurately predict requirements for care in nursing homes. Prospective descriptive study of residents in lower reimbursement categories according to RUG. Three nursing homes in New York City. Convenience sample of 173 residents who agreed to participate, not significantly different from 201 who did not agree to participate. Chart review; assessment of residents' cognitive and functional abilities; nursing assistants' ratings of residents' functional abilities, behavioral problems, the amount of effort required in care; and time-motion studies of staff-resident interactions. Both the residents' RUG classification (P less than 0.01) and the level of ADL independence (P less than 0.001) had significant impacts on the staff effort required in their care, with more dependent residents requiring greater effort. The residents' level of cognitive impairment also had a significant impact on the staff effort, with the severely impaired requiring greater effort (P less than 0.05). The time-motion analysis indicated that residents within the same RUG category differed in the number of staff-resident interactions based on their level of cognitive impairment. Cognitive impairment is a significant morbidity (or co-morbidity) in determining the quantity of staff effort required by the resident, and behavioral interventions are an important care component. There is marked heterogeneity within lower (RUG) reimbursement categories which translates into strikingly different care requirements.