Low‐resource long‐term dementia care settings: Identifying key features and strategies for research recruitment

Abstract

AbstractBackgroundLow‐resource long‐term care (LTC) settings serve older adults who are at high risk for health inequities in dementia care, including individuals who are socioeconomically disadvantaged and live in rural areas. With the growing demand for dementia care and increasing diversity of LTC residents, identifying and partnering with low‐resource LTC settings is critical for dementia care research. However, low‐resource LTC settings are not well defined or understood. Drawing on data from a larger study of person‐centered dementia care, this study describes key features of low‐resource long‐term dementia care settings in two U.S. states and processes for identifying and recruiting these settings for research engagement.MethodPrimary and secondary data and purposive sampling with maximum variation were used to identify low‐resource LTC settings that serve residents with dementia in two states and to target sites for recruitment. Input from local ombudsmen and publicly available data were used to identify sites that served residents with dementia, accepted Medicaid, and were located in federally designated medically underserved areas. Sites were recruited via phone and email contacts. Following study orientation site visits, researchers developed site descriptions which were verified by each site.ResultFour LTC settings (two nursing home; two assisted living) that serve residents with dementia participated. All four settings were in federally designated medically underserved areas with two settings each in rural and urban areas. Facility size ranged from 19 to 105 residents. The assisted living settings accepted Medicaid waivers and at least one‐third of their residents received financial assistance through Medicaid or other subsidies. Most residents in the nursing homes were Medicaid beneficiaries. Residents at the sites had a wide range of socio‐demographic characteristics and physical and cognitive impairments. All settings noted staffing challenges and considerable variation in retention strategies were reported.ConclusionIdentifying and partnering with low‐resource LTC settings is critical for research on equity in dementia care. This presentation describes key features of low‐resource LTC settings that serve residents with dementia and strategies for identifying and recruiting them for research. Additional work is needed to expand on these descriptive findings and to broaden generalizability to other LTC settings.