Background
Shared-housing arrangements
Staff in SHAs
Methods
Staff
Quality of life
Challenging behaviour
Severity of dementia
Data analysis
Results
Sample characteristics
Residents (n = 396) | |
---|---|
Age in years; mean (SD; Min-Max) | 78.4 (11.1; 45–102) |
Women in % (n) | 69.4 (275) |
Time being in the SHA in years; mean (SD) | 2.7 (2.3) |
Medical diagnosis of dementia in % (n) | 71.0 (281) |
Cognitive decline (GDS; 0–7) in % (n) | |
≤ 5 (moderately severe cognitive decline) | 15.9 (63) |
6 (severe cognitive decline) | 42.2 (167) |
7 (very severe cognitive decline) | 38.4 (152) |
Challenging behavior (CMAI) in % (n) | |
Physically nonaggressive behavior | 34.3 (136) |
Verbally agitated behavior | 37.9 (150) |
Aggressive behavior | 15.9 (63) |
At least one challenging behavior | 57.8 (229) |
Level of care dependency in % (n; 0-III) a | |
0 | 7.3 (27) |
Level I | 21.7 (80) |
Level II | 49.3 (182) |
Level III | 21.7 (80) |
Quality of Life (QUALIDEM; 0–100); mean (SD; Min-Max) | |
Total QoL | 69.5 (14.1; 24,5-97,2) |
Care relationship | 72.1 (21.0; 4,8–100) |
Positive affect | 73.1 (23.6; 0–100) |
Negative affect | 71.6 (23.7; 0–100) |
Restless tense behavior | 63.2 (30.1; 0–100) |
Positive self-imageb | 75.5 (23.1; 0–100) |
Social relationship | 68.8 (21.9; 0–100) |
Social isolation | 69.4 (22.4; 0–100) |
Feeling at homeb | 80.7 (18.2; 16,7–100) |
Having something to dob | 56.2 (26.5; 0–100) |
Staffing in SHAs
Absolut mean (SD) | Staff-resident ratio mean (SD) | |
---|---|---|
Total staff | 7.1 (5.2) | 0.9 (0.2) |
Registered Nurses | 1.3 (1.3) | 0.2 (0.2) |
Certified Nursing Assistance | 4.7 (3.9) | 0.6 (0.5) |
Housekeeping | 1.3 (1.5) | 0.2 (0.2) |
Associations between staffing and residents’ QoL
Dependent Variable | p-Value Model | R2 | Independent (Co-)Variable | p-Value Variable | Estimate | 95% CI |
---|---|---|---|---|---|---|
QUALIDEM: total Score |
< 0.001
|
0.216
|
Intercept
|
< 0.001
|
37.99
|
24.65:51.34
|
Sex: femalea | 0.253 | 1.84 | − 1.32;5.01 | |||
At least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−10.40
|
− 13.22;- 7.58
| |||
Cognitive decline (GDS)
c
| ||||||
≤ 5
|
0.008
|
6.75
|
1.77;11.73
| |||
6 | 0.195 | 2.29 | −1.18;5.76 | |||
Level of care dependencyd | ||||||
0 | 0.111 | 6.06 | −1.40;13.52 | |||
I | 0.054 | 5.17 | −0.09;10.43 | |||
II | 0.737 | −0.68 | −4.63;3.28 | |||
Age*
|
0.001
|
0.27
|
0.12;0.42
| |||
Length of ataye,* | 0.230 | 0.39 | −0.245;1.02 | |||
Ratio total-staff per resident* | 0.804 | 0.25 | −1.75;2.25 | |||
QUALIDEM: care relationship |
< 0.001
|
0.163
|
Intercept
|
< 0.001
|
46.96
|
26.08;67.85
|
Sex: female
a
|
0.043
|
5.11
|
0.154;10.07
| |||
At least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−14.51
|
− 18.93;-10.10
| |||
Cognitive decline (GDS)c | ||||||
≤ 5 | 0.188 | 5.23 | −2.57;13.02 | |||
6 | 0.140 | 4.08 | −1.35;9.51 | |||
Level of care dependencyd | ||||||
0 | 0.296 | −6.21 | −17.88;5.47 | |||
I | 0.239 | −4.93 | −13.17;3.30 | |||
II
|
0.017
|
−7.57
|
−13.76;-1.39
| |||
Age*
|
0.032
|
0.26
|
0.02;0.50
| |||
Length of staye,* | 0.281 | −0.54 | −1.53;0.47 | |||
Ratio total-staff per resident * | 0.442 | −1.23 | −4.36;1.91 | |||
QUALIDEM: positive affect | 0.133 | 0.045 |
Intercept
|
0.001
|
40.61
|
16.08;65.13
|
Sex: femalea | 0.140 | 4.38 | − 1.44;10.20 | |||
at least 1 challenging behaviour (CMAI)b | 0.123 | −4.08 | −9.26;1.11 | |||
Cognitive decline (GDS)c | ||||||
≤ 5 | 0.147 | 6.76 | −2.40;18.39 | |||
6 | 0.070 | 5.89 | −0.49;12.27 | |||
Level of care dependencyd | ||||||
0 | 0.502 | 4.68 | −9.03;18.39 | |||
I | 0.688 | 1.98 | −7.69;11.65 | |||
II | 0.630 | −1.78 | −9.04;5.48 | |||
Age* | 0.053 | 0.27 | −0.01;0.55 | |||
Length of staye,* | 0.680 | 0.24 | −0.92;1.40 | |||
Ratio total-staff per resident * | 0.305 | 1.92 | −1.76;5.59 | |||
QUALIDEM: negative affect |
< 0.001
|
0.149
|
Intercept
|
< 0.001
|
57.00
|
33.32;80.69
|
Sex: female
a
|
0.006
|
−7.95
|
−13.57;-2.33
| |||
At least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−12.25
|
−17.26;-7.24
| |||
Cognitive decline (GDS)c | ||||||
≤ 5 | 0.211 | 5.63 | −3.21;14.47 | |||
6 | 0.169 | −4.31 | −10.47;1.85 | |||
Level of care dependencyd | ||||||
0 | 0.222 | 8.23 | −5.01;21.47 | |||
I | 0.077 | 8.43 | −0.91;17.76 | |||
II | 0.403 | 2.99 | −4.03;10.00 | |||
Age* | 0.360 | 0.125 | −0.14;0.39 | |||
Length of staye,* | 0.112 | 0.91 | −0.21;2.03 | |||
Ratio total-staff per resident * | 0.937 | −0.143 | −3.69;3.41 | |||
QUALIDEM: restless tense behavior |
< 0.001
|
0.186
| Intercept | 0.899 | 1.85 | −26.86;30.56 |
Sex: femalea | 0.592 | −1.86 | −8.67;4.96 | |||
At least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−13.99
|
− 20.06;-7.92
| |||
Cognitive decline (GDS)
c
| ||||||
≤ 5
|
0.009
|
14.24
|
3.53;24.96
| |||
6
|
0.001
|
13.30
|
5.84;20.77
| |||
Level of care dependencyd | ||||||
0 | 0.111 | 13.03 | −3.02;29.08 | |||
I | 0.013 | 14.39 | − 3.07;25.71 | |||
II | 0.094 | 7.26 | −1.25;15.76 | |||
Age*
|
0.001
|
0.54
|
0.21;0.86
| |||
Length of staye,* | 0.259 | 0.78 | −0.58;2.14 | |||
Ratio total-staff per resident * | 0.182 | −2.93 | −7.23;1.37 | |||
QUALIDEM: positive self-image |
0.001
|
0.145
|
Intercept
|
0.014
|
47.02
|
9.63;84.41
|
Sex: femalea | 0.106 | −5.56 | −13.19;-1.28 | |||
At least 1 challenging behaviour (CMAI)
b
|
0.005
|
−9.42
|
−2.82;-16.02;
| |||
Cognitive decline (GDS)
c
| ||||||
≤ 5
|
0.030
|
8.79
|
0.86;16.72
| |||
Level of care dependencyd | ||||||
0 | 0.349 | 9.62 | −10.61;29.86 | |||
I | 0.845 | −1.75 | − 19.30;15.81 | |||
II | 0.549 | −5.00 | −21.41;11.42 | |||
Age* | 0.057 | 0.36 | −0.01;0.73 | |||
Length of staye,* | 0.454 | −0.60 | −2.17;0.98 | |||
Ratio total-staff per resident * | 0.391 | 2.21 | −2.85;7.27 | |||
QUALIDEM: social relationship |
< 0.001
|
0.176
|
Intercept
|
< 0.001
|
42.58
|
20.75;64.40
|
Sex: femalea | 0.298 | 2.74 | −2.44;7.92 | |||
At least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−16.38
|
−21.00;11.77
| |||
Cognitive decline (GDS)c | ||||||
≤ 5 | 0.084 | 7.17 | −0.98;15.31 | |||
6 | 0.182 | −3.86 | −1.82;19.53 | |||
Level of cared | ||||||
0 | 0.219 | 7.63 | −4.57;19.84 | |||
I | 0.297 | 4.57 | −4.04;13.17 | |||
II | 0.565 | −1.89 | −8.36;4.57 | |||
Age* | 0.158 | 0.178 | − 0.07;0.43 | |||
Length of staye,* | 0.456 | 0.39 | −0.64;1.42 | |||
Ratio total-staff per resident * | 0.688 | −0.668 | −3.94;2.60 | |||
QUALIDEM: social isolation | 0.148 | 0.176 |
Intercept
|
< 0.001
|
42.58
|
20.75;64.40
|
Sex: femalea | 0.298 | 2.74 | −2.44;7.92 | |||
at least 1 challenging behaviour (CMAI)
b
|
< 0.001
|
−16.38
|
−11.77;-0.80
| |||
Cognitive decline (GDS)
c
| ||||||
≤ 5
|
0.084
|
7.165
|
−0.98;15.31
| |||
6 | 0.182 | 3.86 | −1.82;9.53 | |||
Level of care dependencyd | ||||||
0 | 0.219 | 7.63 | −4.57;19.84 | |||
I | 0.297 | 4.57 | −4.04;13.17 | |||
II | 0.565 | −1.89 | −8.36;4.57 | |||
Age* | 0.158 | 0.178 | −0.07;0.43 | |||
Length of staye,* | 0.456 | 0.39 | −0.64;1.42 | |||
Ratio total-staff per resident * | 0.688 | −0.668 | −3.94;2.60 | |||
QUALIDEM: feeling at home | 0.148 | 0.070 |
Intercept
|
< 0.001
|
69.33
|
38.27;100.39
|
Sex: femalea | 0.662 | −1.33 | −7.34;4.68 | |||
at least 1 challenging behaviour (CMAI)
b
|
0.025
|
−6.28
|
−11.77;0.80
| |||
Cognitive decline (GDS)
f
| ||||||
≤ 5 | 0.276 | −3.65 | −10.23;2.94 | |||
Level of care dependencyd | ||||||
0 | 0.970 | 0.32 | −16.49;17.13 | |||
I | 0.478 | −5.26 | −19.84;9.33 | |||
II | 0.802 | −1.73 | − 15.37;11.90 | |||
Age* | 0.407 | 0.129 | −0.18;0.44 | |||
Length of staye,* | 0.176 | 0.90 | −0.41;2.21 | |||
Ratio total-staff per resident * | 1.00 | −0.01 | −4.20;4.20 | |||
QUALIDEM: having something to do |
< 0.001
|
0.157
|
Intercept
|
0.041
|
43.81
|
1.87;85.76
|
Sex: femalea | 0.483 | 2.89 | −5.23;11.00 | |||
at least 1 challenging behaviour (CMAI)b | 0.088 | −6.44 | −13.84;0.97 | |||
Cognitive decline (GDS)
f
| ||||||
≤ 5
|
0.004
|
13.01
|
4.11;21.90
| |||
Level of caredependencyd | ||||||
0 | 0.512 | 7.56 | −15.14;30.26 | |||
I | 0.328 | 9.80 | −9.90;29.49 | |||
II | 0.709 | −3.49 | −21.90;14.93 | |||
Age* | 0.987 | 0.210 | −0.42;0.41 | |||
Length of staye,* | 0.439 | −0.69 | −2.46;1.07 | |||
Ratio total-staff per Resident * | 0.152 | 4.14 | −1.54;9.82 |