Objective: This study quantifies the effect of a new dementia special care unit (D-SCU) on the provision of care to all residents in a nursing home (NH). Method: The authors use data from the On-line Survey Certification and Reporting system to identify free-standing NHs that first reported a D-SCU between 1996 and 2003 (N = 1,519). Fixed-effects models estimate the effect of a new D-SCU on the prevalence of each outcome (physical restraints, feeding tubes, and psychotropic medications) while controlling for secular trends. Results: For all NHs, the use of physical restraints declined, the use of antipsychotics increased, and other measures remained relatively constant. The introduction of a D-SCU was not associated with changes in trends for any measure. Discussion: Differences in care processes between NHs with and without D-SCUs are the result of differences in their underlying approach to care, not the result of care practice diffusion from the D-SCU.
Agency for Healthcare Research and Quality. ( 2000). Research findings no. 6: Special care units in nursing homes-Selected characteristics, 1996. Rockville, MD: Author.
2.
American Health Care Association. (2004). CMS OSCAR data. Washington, DC: Author.
3.
Arling, G., & Williams, A.R. (2003). Cognitive impairment and resource use of nursing home residents: A structural equation model. Medical Care, 41(7), 802-812.
4.
Banaszak-Holl, J., Zinn, J.S., & Mor, V. (1996). The impact of market and organizational characteristics on nursing care facility service innovation: A resource dependency perspective . Health Services Research, 31(1), 97-117.
5.
Beardsley, R.S., Larson, D.B., Burns, B.J., Thompson, J.W., & Kamerow, D.B. (1989). Prescribing of psychotropics in elderly nursing home patients. Journal of the American Geriatrics Society , 37(4), 327-330.
6.
Capezuti, E., Evans, L., Strumpf, N., & Maislin, G. (1996). Physical restraint use and falls in nursing home residents. Journal of the American Geriatrics Society, 44(6), 627-633.
7.
Capezuti, E., Strumpf, N.E., Evans, L.K., Grisso, J.A., & Maislin, G. (1998). The relationship between physical restraint removal and falls and injuries among nursing home residents. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 53(1), M47-M52.
8.
Castle, N.G. (2000). Differences in nursing homes with increasing and decreasing use of physical restraints. Medical Care, 38(12), 1154-1163.
9.
Castle, N.G. (2001). Innovation in nursing homes: Which facilities are the early adopters? Gerontologist, 41(2), 161-172.
10.
Castle, N.G., & Fogel, B. (1998). Characteristics of nursing homes that are restraint free. Gerontologist, 38(2), 181-188.
11.
Castle, N.G., Fogel, B., & Mor, V. (1997). Risk factors for physical restraint use in nursing homes: pre- and post-implementation of the Nursing Home Reform Act. Gerontologist, 37(6), 737-747.
12.
Castle, N.G., & Mor, V. (1998). Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987. Medical Care Research and Review, 55(2), 139-170; 171-176 [discussion].
13.
Chafetz, P.K. (1991). Behavioral and cognitive outcomes of SCU care . Clinical Gerontologist, 11, 19-38.
14.
Department of Justice/Antitrust. (2007). The Herfindahl-Hirschman Index. Washington, DC: Author.
15.
Eastaugh, S.R. (2001). Hospital costs and specialization: benefits of trimming product lines. Journal of Health Care Finance, 28(1), 61-71.
16.
Feng, Z., Grabowski, D.C., Intrator, O., & Mor, V. (2006). The effect of state Medicaid case-mix payment on nursing home resident acuity. Health Services Research , 41(4,Pt.1), 1317-1336.
17.
Feng, Z., Katz, P.R., Intrator, O., Karuza, J., & Mor, V. (2005). Physician and nurse staffing in nursing homes: The role and limitations of the Online Survey Certification and Reporting (OSCAR) system. Journal of the American Medical Directors Association, 6(1), 27-33.
18.
Finucane, T.E., Christmas, C., & Travis, K. (1999). Tube feeding in patients with advanced dementia: A review of the evidence. Journal of the American Medical Association, 282(14), 1365-1370.
19.
Grant, L.A., Kane, R.A., Potthoff, S.J., & Ryden, M. (1996). Staff training and turnover in Alzheimer special care units: Comparisons with non-special care units. Geriatric Nursing, 17(6), 278-282.
20.
Grant, L.A., Potthoff, S.J., Ryden, M., & Kane, R.A. (1998). Staff ratios, training, and assignment in Alzheimer's special care units. Journal of Gerontological Nursing, 24(1), 9-16, 59.
21.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581-629.
22.
Gruneir, A., Lapane, K.L., Miller, S.C., & Mor, V. (2006, November). Dementia special care units in U.S. nursing homes: A current description of distribution and major features. Paper presented at the 59th annual scientific meeting of the Gerontological Society of America, Dallas, TX.
23.
Gruneir, A., Miller, S.C., Intrator, O., & Mor, V. (2007). Hospitalization of nursing home residents with cognitive impairments: The influence of organizational features and state policies. Gerontologist, 47(4), 447-456.
24.
Holmes, D., & Teresi, J. (1994). Characteristics of special care units in the Northeast Five-State Survey: Implications of different definitional criteria. Alzheimer Disease and Associated Disorders, 8(Suppl. 1), S97-S105.
25.
Holmes, D., Teresi, J., Weiner, A., Monaco, C., Ronch, J., & Vickers, R. (1990). Impacts associated with special care units in long-term care facilities. Gerontologist, 30(2), 178-183.
26.
Hughes, C.M., Lapane, K.L., & Mor, V. (2000). Influence of facility characteristics on use of antipsychotic medications in nursing homes. Medical Care, 38(12), 1164-1173.
27.
Intrator, O., & Mor, V. (2004). Effect of state Medicaid reimbursement rates on hospitalizations from nursing homes. Journal of the American Geriatrics Society, 52(3), 393-398.
28.
Lapane, K.L., & Hughes, C.M. (2004). Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes? Medical Care, 42(10), 992-1000.
29.
Leon, J. (1994). The 1990/1991 National Survey of Special Care Units in Nursing Homes. Alzheimer Disease and Associated Disorders , 8(Suppl. 1), S72-S86.
30.
Leon, J., Cheng, C., & Alvarez, R.J. (1997). Trends in special care: Changes in SCU from 1991 to 1995 (`95/96 TSC). Journal of Mental Health and Aging, 3(2), 149-168.
31.
Maas, M.L., Swanson, E., Specht, J., & Buckwalter, K.C. (1994). Alzheimer's special care units. Nursing Clinics of North America, 29(1), 173-194.
32.
Maslow, K. (1994). Current knowledge about special care units: Findings of a study by the U.S. Office of Technology Assessment. Alzheimer Disease and Associated Disorders, 8(Suppl. 1), S14-S40.
McCann, J.J., Bienias, J.L., & Evans, D.A. (2000). Change in performance tests of activities of daily living among residents of dementia special care and traditional nursing home units. In D. Holmes, J. Teresi, & M. G. Ory (Eds.), Special care units (pp. 141-150). New York: Springer.
35.
Mehr, D.R., & Fries, B.E. (1995). Resource use on Alzheimer's special care units . Gerontologist, 35(2), 179-184.
36.
Miles, S.H., & Irvine, P. (1992). Deaths caused by physical restraints. Gerontologist, 32(6), 762-766.
37.
Mitchell, S.L. (2003). Financial incentives for placing feeding tubes in nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 51(1), 129-131.
38.
Mitchell, S.L., Kiely, D.K., & Gillick, M.R. (2003). Nursing home characteristics associated with tube feeding in advanced cognitive impairment. Journal of the American Geriatrics Society, 51(1), 75-79.
39.
Mitchell, S.L., Teno, J.M., Roy, J., Kabumoto, G., & Mor, V. (2003). Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. Journal of the American Medical Association, 290(1), 73-80.
40.
Morris, J.N., & Emerson-Lombardo, N. (1994). A national perspective on SCU service richness: Findings from the AARP Survey. Alzheimer Disease and Associated Disorders, 8(Suppl. 1), S87-S96.
41.
Nallamothu, B.K., Wang, Y., Magid, D.J., McNamara, R.L., Herrin, J., Bradley, E.H., et al. (2006). Relation between hospital specialization with primary percutaneous coronary intervention and clinical outcomes in ST-segment elevation myocardial infarction: National Registry of Myocardial Infarction-4 analysis. Circulation, 113(2), 222-229.
42.
Phillips, C.D., Sloane, P.D., Hawes, C., Koch, G., Han, J., Spry, K., et al. (1997). Effects of residence in Alzheimer disease special care units on functional outcomes. Journal of the American Medical Association, 278(16), 1340-1344.
43.
Phillips, C.D., Spry, K.M., Sloane, P.D., & Hawes, C. (2000). Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes. American Journal of Public Health, 90(1), 92-96.
44.
Phillips, V.L., Potter, S.J., & Simon, S.L. (1998). Special care units for Alzheimer's patients: Their role in the nursing home market. Journal of Health and Human Services Administration, 20(3), 300-310.
45.
Porell, F.W., & Carter, M. (2005). Discretionary hospitalization of nursing home residents with and without Alzheimer's disease: A multilevel analysis. Journal of Aging and Health, 17(2), 207-238.
46.
Sanson-Fisher, R.W. (2004). Diffusion of innovation theory for clinical change . Medical Journal of Australia, 180(Suppl. 6), S55-S56.
47.
Schneider, L.S., Dagerman, K., & Insel, P.S. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14(3), 191-210.
48.
Schneider, L.S., Tariot, P.N., Dagerman, K.S., Davis, S.M., Hsiao, J.K., Ismail, M.S., et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355(15), 1525-1538.
49.
Sorensen, L., Foldspang, A., Gulmann, N.C., & Munk-Jorgensen, P. (2001). Determinants for the use of psychotropics among nursing home residents. International Journal of Geriatric Psychiatry, 16(2), 147-154.
50.
Teresi, J.A., Grant, L.A., Holmes, D., & Ory, M.G. (1998). Staffing in traditional and special dementia care units. Preliminary findings from the National Institute on Aging Collaborative Studies. Journal of Gerontological Nursing, 24(1), 49-53.
51.
Volicer, L. (2000). Goals of dementia special care units. In D. Holmes, J. Teresi, & M. G. Ory (Eds.), Special care units (pp. 93-103). New York: Springer.
52.
Volicer, L., Collard, A., Hurley, A., Bishop, C., Kern, D., & Karon, S. (1994). Impact of special care unit for patients with advanced Alzheimer's disease on patients' discomfort and costs. Journal of the American Geriatrics Society, 42(6), 597-603.
53.
Weiner, A.S., & Reingold, J. (1989). Special care units for dementia: Current practice models. Journal of Long Term Care Administration, 17(1), 14-19.
54.
Wilson, I.B., Landon, B.E., Ding, L., Zaslavsky, A.M., Shapiro, M.F., Bozzette, S.A., et al. (2005). A national study of the relationship of care site HIV specialization to early adoption of highly active antiretroviral therapy. Medical Care, 43(1), 12-20.
55.
Wu, N., Miller, S.C., Lapane, K., Roy, J., & Mor, V. (2005). The quality of the quality indicator of pain derived from the Minimum Data Set. Health Services Research, 40(4), 1197-1216.
56.
Zimmerman, S.I., Sloane, P.D., Gruber-Baldini, A., Calkins, M., Leon, J., Magaziner, J., et al. (1997). The philosophy of special care in Alzheimer's special care units. Journal of Mental Health and Aging, 3(2), 169-181.
57.
Zinn, J.S., & Mor, V. (1994). Nursing home special care units: Distribution by type, state, and facility characteristics. Gerontologist , 34(3), 371-377.
58.
Zinn, J.S., Mor, V., Feng, Z., & Intrator, O. (2007). Doing better to do good: The impact of strategic adaptation on nursing home performance. Health Services Research , 42(3,Pt.1), 1200-1218.
