Recording care time in nursing homes: development and validation of the “RUD-FOCA” (Resource Utilization in Dementia – Formal Care)

Abstract

Currently there is no standardized procedure for recording direct care time of dementia patients in a nursing home. Recording the direct care time, however, provides an important component of both cost estimates for time-dependent reimbursement of nursing activities and for recording the degree of dependency as an outcome measure for the efficiency of new treatment methods for dementia patients. The purpose of this study is thus to develop and validate the "RUD-FOCA" (Resource Utilization in Dementia - Formal Care), based on the RUD lite, as a standardized tool to measure the direct care time actually required in the nursing home. Based on four hypotheses, construct validity was tested within a randomized controlled trial in a sample of 148 residents in six German nursing homes. The RUD-FOCA records the care time in three areas: activities of daily living (ADL), instrumental activities of daily living (IADL) and supervision. For validation, the residents' capabilities were examined using the Barthel Index, the Nurses' Observation Scale on Geriatric Patients (NOSGER), the Alzheimer Disease Assessment Scale (ADAS), the Erlangen Test on Activities of Daily Living (E-ADL) and the Mini-mental State Examination (MMSE). The hypotheses assume relationships between the time required for care in the three areas and the limitations involved in these areas. The retest reliability was also determined. ADL care accounts for two-thirds of total care time in the homes. The hypotheses which refer to total time, ADL and supervision are supported by differentiated correlation profiles. The IADL hypothesis is not supported owing to even, low correlations. The retest reliability was r = 0.76 for the entire care time. Overall time and the times for ADL care and supervision can be considered valid estimates. The validity is lowest for recording IADL times. Thus, the RUD-FOCA is suitable as an instrument to determine the direct care time in the nursing home. Recording IADL times should be improved by detailed operationalization.