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Special Care Units for AD

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By 1999 Progress Report by the NIA/NIH • • December 13, 1999

As the population ages and the number of people with AD grows, the issues surrounding caring for dementia patients in nursing homes become ever more important. Special care units (SCUs) are separate sections in nursing homes for residents with dementia. It is estimated that in the U.S. today there are 16,840 nursing homes, with 1.65 million residents (Rhoades et al., 1998). The past decade has witnessed a tremendous growth in the number of SCUs in licensed nursing facilities; as of 1996, nearly one in four nursing homes had at least one organized dementia care unit, wing, or program. The idea behind SCUs is that people with dementia might benefit from specially designed programs or environments that are different from those provided in a traditional nursing home setting. Dementia-oriented programs include small group activities, short programs, and activities arranged by functional or cognitive ability levels. Dementia-oriented environmental design features include secured exits, small dining rooms, single-occupancy rooms, and special indoor or outdoor areas for wandering.

The rapid proliferation of SCUs has underscored the need for research into their organization, services, and effectiveness. In 1991, NIA began an SCU Initiative, a set of collaborative research projects located at ten sites around the country. These projects were designed to examine the nature and effectiveness of SCU care in institutional settings using state-of-the-art research methods. Results from these studies have made a significant contribution to current knowledge about the organization and impact of these settings. For example, the lack of a standard definition of what constitutes an SCU has meant an enormous variability in the care provided by units that identify themselves as SCUs. A recent study supported through the SCU Initiative has addressed this problem by developing and testing a method for classifying unit types that serve dementia residents in nursing homes (Grant, 1998). This classification system will help to standardize the attributes that define SCUs and will serve as a useful tool for researchers to use in comparing different models of Alzheimer's care in nursing homes. It contains seven attributes of care that distinguish SCUs from other types of care: 1) a greater degree of separation between dementia residents and cognitively intact residents in physical space and social activities; 2) a greater effort to eliminate noxious auditory stimulation, such as radios and door alarms; 3) a greater number of simple activities planned for residents; 4) a greater tolerance of problematic behaviors; 5) a greater degree of dementia patient participation in organized recreational programs; 6) less participation by residents in therapeutic programs aimed at promoting activities of daily living, such as eating and dressing; and 7) more methods used to train staff about dementia care.

National Institutes of Health
National Institute on Aging

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