Abstract
BackgroundMany countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia.MethodsA cross-sectional design was used. Three types of nursing homes were included: (1) green care farms; (2) regular small-scale living facilities; (3) traditional nursing homes. All participating nursing homes were non-profit, collectively funded nursing homes in the south of the Netherlands. One hundred and fifteen residents with a formal diagnosis of dementia were included in the study. Data on quality of care was gathered and consisted of outcome indicators (e.g. falling incidents, pressure ulcers), structure indicators (e.g. hours per resident per day), and process indicators (e.g. presence, accessibility and content of protocols on care delivery). Furthermore, questionnaires on cognition, dependence in activities of daily living, quality of life, social engagement, neuropsychiatric symptoms, agitation, and depression were used.ResultsData showed that quality of care was comparable across settings. No large differences were found on clinical outcome measures, hours per resident per day, or process indicators. Higher quality of life scores were reported for residents of green care farms in comparison with residents of traditional nursing homes. They scored significantly higher on the Quality of Life – Alzheimer’s disease Scale (p < 0.05, ES = 0.8) indicating a better quality of life. In addition, residents of green care farms scored higher on three quality of life domains of the Qualidem: positive affect, social relations and having something to do (p < 0.05, ES > 0.7). No differences with regular small-scale living facilities were found.ConclusionsGreen care farms seem to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments.
Highlights
Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia
18 nursing home locations participated in the study, five green care farms, nine regular small-scale living facilities, and four traditional nursing homes
Descriptive data show that there are more female residents at regular smallscale living facilities compared with green care farms and traditional nursing homes (87% vs. 68% and 62% respectively)
Summary
Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. In recent years there has been more emphasis on a psychosocial and more homelike care concept with an increased interest in values such as quality of life, autonomy and striving to allow residents of nursing homes to continue the life they had before admission as much as possible [3, 4]. This change in care concept can be seen in policies, strategies or frameworks launched in many countries aimed at improving the quality of care and quality of life for people with dementia living in nursing homes. Barthel index scores range from 0 to 20 and higher scores indicate greater independence in ADL
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