Andreas Worch

Quality of care and its impact on quality of life for care-dependent persons with dementia in shared-housing arrangements: results of the Berlin WGQual-study.

AIM The aim of study was to evaluate setting-specific quality indicators (QIs) for shared-housing arrangements (SHA) regarding effects of a guided quality development process on residents quality of life (QoL). BACKGROUND SHA are a specific German kind of small-scale living facilities for care-dependent persons with dementia. SHA are disconnected from residential facilities and served by community care services. METHOD In a longitudinal cluster-randomised design 104 residents of 34 SHA were surveyed for 1 year; the intervention group took part in a quality development process. QIs, physical and psychological health outcomes including QoL were surveyed. RESULTS During the 1 year follow-up, analyses show a positive trend regarding QI-outcomes in the intervention group, but no statistically significant differences could be proved regarding QoL. CONCLUSIONS Setting-sensitive QIs are absolutely essential to measure quality of care in multi-professional settings like SHA. Further research as well as longer study intervals is essential.

Influence of living situation on vulnerable elderly: Focus on nutritional status

OBJECTIVES We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements). DESIGN For this secondary analysis, a cross-sectional study was performed. SETTING For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study. PARTICIPANTS The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs. MEASUREMENTS Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE). RESULTS Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting. CONCLUSION Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings.

Nutritional status of care-dependent people with dementia in shared-housing arrangements – a one-year follow-up

BACKGROUND Malnutrition in the elderly is an important nursing challenge. Persons with dementia disease are often affected by malnutrition. During recent years, shared-housing arrangements (SHA) for older care-dependent people, frequently with dementia disease, have evolved in Germany. SHA can be an alternative to traditional residential care in nursing homes. The prevalence of malnutrition in SHA is compared to the prevalence in community dwellings and lower than the prevalence of malnutrition in nursing homes. There are no scientific data about the development of the nutritional status of older care-dependent people in SHA over one year. The aim of this study is to describe the nutritional status of care-dependent people with dementia disease living in SHA and to investigate changes over a period of one year. METHOD A longitudinal study with a one-year follow-up was performed. Standardised interviews with nurses were conducted concerning nutritional status (Mini Nutritional Assessment--MNA), cognitive capacities (Mini Mental State Examination--MMSE), activities of daily living (Extended Barthel-Index--EBI) and socio-demographic characteristics. Nutritional data were available for 45 residents at baseline and 36 residents at follow-up. RESULTS At baseline, 45 residents with an average age of 78.4 years living in SHA in the state of Berlin, Germany, were included in the study. Predominantly, residents were female (73.3%) and diagnosed with dementia (88.9%), with a moderate to severe cognitive impairment (MMSE: 10.8) and low daily living abilities (EBI: 33.7). Most residents (80.6%) have a risk of malnutrition regarding the MNA. The average MNA score did decline slightly within one year (t0 = 20.8 vs. t1 = 19.7). CONCLUSION Regular screenings for malnutrition using validated standardised assessments, which are easy to apply, should be implemented in SHA to avoid nutritional and health-related problems arising from malnutrition. Flexible structures for care, as in SHA, can facilitate coping with nutritional problems.

[Shared-housing arrangements for care-dependent people in Germany. A literature overview of structures, outcomes and quality management].

ZusammenfassungEine der Haupttriebfedern für die Entwicklung von ambulant betreuten Wohngemeinschaften (WG) ist die zunehmende gesellschaftliche Forderung nach Selbstbestimmung im Alter. Seit Januar 2013 erfahren WG eine bundesweite finanzielle Förderung im Rahmen des Pflege-Neuausrichtungs-Gesetzes (PNG). Bislang ist jedoch weitgehend unklar, wie sich die Situation von WG derzeit in Deutschland überhaupt darstellt. Im Rahmen einer systematischen Literatursuche (Datenbanken CareLit, CINAHL, GeroLit, PubMed) wurden Publikationen zu Bewohner- und Versorgungsstrukturen, Versorgungsoutcomes und zum Setting-spezifischen Qualitätsmanagement in WG analysiert. Die derzeitig frei verfügbare Wissensbasis ist insgesamt nur wenig aussagekräftig. Die vorliegenden Ergebnisse weisen darauf hin, dass die Versorgung in WG hinsichtlich der allgemeinen Lebensqualität nicht förderlicher ist als die in stationären Pflegeeinrichtungen. Verlässliche Studien zur Versorgungsqualität im Bereich WG fehlen derzeit weitgehend, was nicht zuletzt in fehlenden konzeptionellen Grundlagen zur Bewertung von Versorgungsqualität begründet ist. Es bleibt festzustellen, dass die angestrebte Ausweitung dieses Versorgungssettings im Rahmen des PNG gleichzeitig einer umfassenden Begleitung durch eine fundierte Versorgungsforschung bedarf.AbstractA main factor for the development of shared-housing arrangements (SHA) was the wish of more self-determination in old age. Since January 2013 SHA is government-funded through the “Pflege-Neuausrichtungs-Gesetz” (PNG). Yet, an overview of the situation of SHA in Germany is not available. Therefore, a systematic literature search (databases CareLit, CINAHL, GeroLit, PubMed) was conducted in order to identify publications regarding resident- and care-specific characteristics, resident-related health outcomes and setting-specific quality management systems. The currently available knowledge in these fields is not exhaustive and further research is needed. The results indicate that care in SHA is not more efficient regarding residents’ quality of life than in institutional care settings. Valid studies regarding the quality of care provision in SHA and conceptual basics concerning quality assessment are widely lacking. Thus, the goal of expanding SHA within the framework of the PNG has to be accompanied by in-depth health services research.

Comparison of the nutritional status of residents in shared-housing arrangements and nursing homes

Malnutrition and weight loss are special challenges in the care of older people particularly with dementia. In Germany, shared-housing arrangements (SHA) for older care-dependent people evolved in the last years. SHA are an alternative to traditional nursing homes. Despite of the increase of SHA in number it remains unclear if this setting is especially beneficial in terms of (mal-)nutrition. Therefore the nutritional status of older people with and without dementia living in SHA and traditional nursing homes will be compared. From 2010 to 2011 data was collected in various SHA in Berlin and in a nursing home in Schkeuditz/Saxony using standardized face-to-face interviews with nurses. In addition to socio-demographic data the nutritional status using the Mini Nutritional Assessment (MNA) and the cognitive capacities usingthe Mini Mental State Examination (MMSE) were examined. In the secondary data analysis, data from 129 residents (60 residents from 29 SHA and 69 from a nursing home) were included in the analysis. The residents of both settings were mostly female (76.7%) and on average 80.4 years old and with a moderate to severe cognitive decline (MMSE: 13.2). The average MNA score of residents from both settings is 19.7, indicating a risk for malnutrition. Residents of SHA have a significantly higher (and therefore better) MNA score (21.2) on average than residents in the nursing home (18.3; t-Test p<0.001). The present study shows that residents in SHA show a better nutritional status than residents in the nursing home even when taking into account differences concerning age, gender, care dependency, a medical diagnosis of dementia and the MMSE. Further studies should evaluate the concept of food intake in both settings and evaluate differences.

Ambulant betreute Wohngemeinschaften für pflegebedürftige Menschen in Deutschland

ZusammenfassungEine der Haupttriebfedern für die Entwicklung von ambulant betreuten Wohngemeinschaften (WG) ist die zunehmende gesellschaftliche Forderung nach Selbstbestimmung im Alter. Seit Januar 2013 erfahren WG eine bundesweite finanzielle Förderung im Rahmen des Pflege-Neuausrichtungs-Gesetzes (PNG). Bislang ist jedoch weitgehend unklar, wie sich die Situation von WG derzeit in Deutschland überhaupt darstellt. Im Rahmen einer systematischen Literatursuche (Datenbanken CareLit, CINAHL, GeroLit, PubMed) wurden Publikationen zu Bewohner- und Versorgungsstrukturen, Versorgungsoutcomes und zum Setting-spezifischen Qualitätsmanagement in WG analysiert. Die derzeitig frei verfügbare Wissensbasis ist insgesamt nur wenig aussagekräftig. Die vorliegenden Ergebnisse weisen darauf hin, dass die Versorgung in WG hinsichtlich der allgemeinen Lebensqualität nicht förderlicher ist als die in stationären Pflegeeinrichtungen. Verlässliche Studien zur Versorgungsqualität im Bereich WG fehlen derzeit weitgehend, was nicht zuletzt in fehlenden konzeptionellen Grundlagen zur Bewertung von Versorgungsqualität begründet ist. Es bleibt festzustellen, dass die angestrebte Ausweitung dieses Versorgungssettings im Rahmen des PNG gleichzeitig einer umfassenden Begleitung durch eine fundierte Versorgungsforschung bedarf.AbstractA main factor for the development of shared-housing arrangements (SHA) was the wish of more self-determination in old age. Since January 2013 SHA is government-funded through the “Pflege-Neuausrichtungs-Gesetz” (PNG). Yet, an overview of the situation of SHA in Germany is not available. Therefore, a systematic literature search (databases CareLit, CINAHL, GeroLit, PubMed) was conducted in order to identify publications regarding resident- and care-specific characteristics, resident-related health outcomes and setting-specific quality management systems. The currently available knowledge in these fields is not exhaustive and further research is needed. The results indicate that care in SHA is not more efficient regarding residents’ quality of life than in institutional care settings. Valid studies regarding the quality of care provision in SHA and conceptual basics concerning quality assessment are widely lacking. Thus, the goal of expanding SHA within the framework of the PNG has to be accompanied by in-depth health services research.

Ambulant betreute Wohngemeinschaften für pflegebedürftige Menschen in Deutschland@@@Shared-housing arrangements for care-dependent people in Germany: Eine Literaturübersicht zu Strukturen, Versorgungsoutcomes und Qualitätsmangagement@@@A literature overview of structures, outcomes and quality management

ZusammenfassungEine der Haupttriebfedern für die Entwicklung von ambulant betreuten Wohngemeinschaften (WG) ist die zunehmende gesellschaftliche Forderung nach Selbstbestimmung im Alter. Seit Januar 2013 erfahren WG eine bundesweite finanzielle Förderung im Rahmen des Pflege-Neuausrichtungs-Gesetzes (PNG). Bislang ist jedoch weitgehend unklar, wie sich die Situation von WG derzeit in Deutschland überhaupt darstellt. Im Rahmen einer systematischen Literatursuche (Datenbanken CareLit, CINAHL, GeroLit, PubMed) wurden Publikationen zu Bewohner- und Versorgungsstrukturen, Versorgungsoutcomes und zum Setting-spezifischen Qualitätsmanagement in WG analysiert. Die derzeitig frei verfügbare Wissensbasis ist insgesamt nur wenig aussagekräftig. Die vorliegenden Ergebnisse weisen darauf hin, dass die Versorgung in WG hinsichtlich der allgemeinen Lebensqualität nicht förderlicher ist als die in stationären Pflegeeinrichtungen. Verlässliche Studien zur Versorgungsqualität im Bereich WG fehlen derzeit weitgehend, was nicht zuletzt in fehlenden konzeptionellen Grundlagen zur Bewertung von Versorgungsqualität begründet ist. Es bleibt festzustellen, dass die angestrebte Ausweitung dieses Versorgungssettings im Rahmen des PNG gleichzeitig einer umfassenden Begleitung durch eine fundierte Versorgungsforschung bedarf.AbstractA main factor for the development of shared-housing arrangements (SHA) was the wish of more self-determination in old age. Since January 2013 SHA is government-funded through the “Pflege-Neuausrichtungs-Gesetz” (PNG). Yet, an overview of the situation of SHA in Germany is not available. Therefore, a systematic literature search (databases CareLit, CINAHL, GeroLit, PubMed) was conducted in order to identify publications regarding resident- and care-specific characteristics, resident-related health outcomes and setting-specific quality management systems. The currently available knowledge in these fields is not exhaustive and further research is needed. The results indicate that care in SHA is not more efficient regarding residents’ quality of life than in institutional care settings. Valid studies regarding the quality of care provision in SHA and conceptual basics concerning quality assessment are widely lacking. Thus, the goal of expanding SHA within the framework of the PNG has to be accompanied by in-depth health services research.