Abstract

Person-centered care approaches continue to evolve in long-term care (LTC). At the same time, these settings have faced increased challenges due to a more diverse and complex population, including persons with intellectual and developmental disabilities (IDD) and serious mental illness (SMI). This study examined the mental, social, and physical wellbeing of residents with different diagnoses, within a person-centered care model. It was hypothesized that individual wellbeing would be comparable among all residents, regardless of primary diagnosis. The study cohort was drawn from all admissions to long-term care facilities in the USA from 2011 to 2013. Data are based on admission, 3 and 6 month follow-up Minimum Data Set (MDS) 3.0 assessments. The groups examined included: schizophrenia, other psychotic disorders, IDD, dementia, and all others (i.e., none of the above diagnoses). The wellbeing outcomes were depression (mental), pain (physical), and behaviors (social). All residents experienced improvements in pain and depression, though the group without the examined diagnoses experienced the greatest gains. Behaviors were most prevalent among those with psychotic disorders; though marked improvements were noted over time. Improvement also was noted among persons with dementia. Behavior worsened over time for the three other groups. In particular, those with IDD experienced the highest level of worsening at 3-month follow-up, and continued to worsen. The results suggest person-centered care in US nursing homes provides the necessary foundation to promote mental and physical wellbeing in persons with complex needs, but less so for social wellbeing.

Highlights

  • As health care systems struggle to evolve and transform to meet changing needs of the population, long term care settings face increased challenges to support an increasingly diverse and frail adult population—many, but by no means all of whom, can be classified as elderly

  • The new admissions sample was grouped according to the following diagnoses, recorded in the assessment: schizophrenia, mental health disorder other than schizophrenia, intellectual and developmental disability (i.e., Down syndrome, autism, epilepsy, other organic condition related to intellectual and developmental disabilities (IDD), IDD with no organic condition), dementia (i.e., Alzheimer’s disease, vascular or multiinfarct dementia, mixed dementia, frontotemporal dementia, r/t stroke, Parkinson’s disease dementia, and CreutzfeldtJakob disease dementia; note: without schizophrenia, psychotic disorder, or IDD diagnosis), and all others

  • 29.8% of admissions to long-term care (LTC) facilities in the study period had a diagnosis of dementia, 2.9% with schizophrenia, 4.3% with a mental health disorder, and 1.0% with an IDD

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Summary

Introduction

As health care systems struggle to evolve and transform to meet changing needs of the population, long term care settings face increased challenges to support an increasingly diverse and frail adult population—many, but by no means all of whom, can be classified as elderly. A recent systematic review identified 99 different measures of wellbeing designed for adults (18 years or more) that touched on nearly 200 different dimensions [9]. They noted that definitions and measures most commonly used included consideration of mental, social, and physical wellbeing

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