A comparison of cognitive and functional care differences in four long-term care settings

Matching residential setting with cognitive and physical abilities is crucial for the provision of a supportive long-term care (LTC) environment. This study compares the cognitive and functional care differences of LTC residents on skilled nursing units designed for dementia care, chronic care, or ambulatory care, and an assisted living setting using the Minimum Data Set (MDS) Texas Index of Level for Effort (TILE) clinical categories (heavy care, rehabilitation/restorative, clinically unstable, clinically stable), MDS Activities of Daily Living (ADL), and Mini-Mental State Examination (MMSE). The goal of the comparison was to find a parsimonious approach for determining resident placement in LTC using the MDS and MMSE. Using a descriptive comparative design, the study took place at a not-for-profit, urban, continuing care retirement center (CCRC) with a 120-bed skilled nursing facility and a 34-unit assisted living facility. Sixty residents, 15 from each of the 3 skilled nursing units and assisted living unit, consented to participate. To understand the differences in the MDS and MMSE scores between units, a Level of Care Algorithm was constructed to analyze resident placement. Results revealed that MDS and MMSE scores placed greater than 75% of elders who had extremely poor cognitive or physical function but did not discriminate well for residents with moderate cognitive and/or physical impairment. For these residents, interaction between institutional philosophy (aging in place versus moving to a new location); resource availability; and elder, family, and staff values and preferences may have influenced placement.