Kelsey Susan G, Laditka Sarah B, Laditka James N
Department of Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA.
Am J Alzheimers Dis Other Demen. 2008 Aug-Sep;23(4):355-62. doi: 10.1177/1533317508315992. Epub 2008 Mar 28.
Our study examined the process of transitioning residents of assisted living facilities (ALFs) who have Alzheimer's disease or a related disorder to memory care units (MCUs). In-depth surveys with 10 ALF administrators in South Carolina were conducted. Grounded theory identified major themes; thematic analysis organized content. Most administrators used a preadmission screening process to assess cognitive status. About half reported that they discussed the possibility of future transfer to another level of care with the family at admission. Most administrators said that their facilities had transfer policies in place; of these, only two-thirds discussed their policies with families on admission. Transfer triggers included leaving the facility without anyone's knowledge, disturbing behaviors, and increased care needs. Challenges included family resistance and greater costs of MCUs. Assisted living facilities that were part of continuing care retirement communities used more multidisciplinary transfer decision-making than free-standing ALFs. Suggested improvements stressed educating families about dementia and MCUs.
我们的研究调查了患有阿尔茨海默病或相关疾病的辅助生活设施(ALF)居民向记忆护理单元(MCU)过渡的过程。我们对南卡罗来纳州的10名ALF管理人员进行了深入调查。扎根理论确定了主要主题;主题分析对内容进行了组织。大多数管理人员采用入院前筛查程序来评估认知状态。约半数管理人员报告称,他们在居民入院时与家属讨论过未来转至另一护理级别的可能性。大多数管理人员表示,他们的设施制定了转院政策;其中,只有三分之二在居民入院时与家属讨论了这些政策。转院触发因素包括在无人知晓的情况下离开设施、出现干扰行为以及护理需求增加。挑战包括家属的抵触情绪以及MCU更高的成本。作为持续护理退休社区一部分的辅助生活设施,比独立的ALF更多地采用多学科转院决策。建议的改进措施强调要让家属了解痴呆症和MCU。