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Research evaluates options for long-term care


For some people, the days of aging in the comfort of your family's care are all but over. As baby boomers approach their twilight years, long-term care providers are searching for options to accommodate overwhelming demand. Just how is the quality of life being provided by the nursing homes, which are licensed to provide medical care, and assisted-living settings, which often are not?

"There is so much variation in the kind of care that is provided with very little research attention going in that direction," said Sheryl Zimmerman, assistant professor of social work. She and Philip Sloane, professor of family medicine, are co-directors of the program on Aging, Disablement and Long-Term Care at the Sheps Center for Health Services Research. Nine different interrelated studies are involved in the program.

Spanning four states and 250 facilities, researchers identified and recruited 3,000 long-term care residents to be studied over time. Researchers are studying how well various kinds of care serve the individual needs of the residents.

"At this moment it is premature to say which options are better or worse. Ultimately, that's what we hope to look for," Zimmerman said. The residents in the chosen population are similar in the levels of care they need, allowing researchers to determine if people who require comparable care do equally well over the course of a year, whether in a nursing home or assisted-living setting. "If so, one might think you could take those people in a nursing home and put them in a less restrictive environment," Zimmerman said. Settings in the study range from small personal-care homes to large modern facilities that have 300 or more beds.

The study so far has revealed that the number of people who are very impaired, both cognitively and physically, is large enough to make lack of access to treatment the gravest fear of all. Approximately 40 percent have Alzheimer's Disease or related dementias, Zimmerman said.

As concerns over the quality of care mount, state regulations increase. While the intention is to improve care, small "Mom and Pop" alternatives, which may offer a more "homey" feel, Zimmerman says, have a hard time abiding by or adapting to such regulations. An already overwrought staff, for example, will find increased training requirements nearly impossible. As small operations go under, fewer options are available. Zimmerman said that the number of workers in the field does not nearly provide for the demand. As a result, staff injuries--often caused by the need to move impaired residents--rank third among all occupations. Past research indicated that staff turnover leads to worse outcomes for residents.

"Preliminary results of the study suggest that care involves an interplay between the personnel who provide the care, the environment of the facility, and the administrative structure that operates the home," Sloane said.

Zimmerman is a member and Sloane is on the support staff of a task force mandated by the North Carolina legislature to propose methods of reforming the state's long-term care system. While their perspective may be rooted in academia, both hope to play an active role in such state efforts. As the study reveals which components of care residents benefit from, the researchers may develop interventions incorporating such components into the type of care offered in every facility.

"This whole field is about the development of long-term models of care that have a more social homelike humanistic component to them and that provide high quality care," Zimmerman said.

Provided by Graduate Studies and Research

Writer: Jill Aitoro

Editor: Neil Caudle


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