Residential care

The paper describes the findings of a geographical mapping and analysis of residential care facilities in four regions of Ghana. The mapping exercise study identified 24 residential facilities with 944 children, amounting to 22% of residential facilities and 27% of children in residential facilities in Ghana. Most of the residential facilities were privately run with their budgets funded by international donors. Seventy-five percent of the residential facilities were unlicensed because they did not meet the national standards for residential care facilities. Most of the children in the 24 residential facilities were male and aged 11 to 17 years. Nine percent of the children in the residential facilities were 0-3 years, but 28% had been admitted aged 0 to three years. The average length of time the children spent in the residential facilities ranged between three and five years. In many of the residential facilities, the main reason for children's admission was poverty-related without involvement of social welfare officers. The implications for future service development emerging out of the study include ensuring that the residential facilities are licensed and have functional administrative systems to enumerate the children in their care, screen volunteers before they work in the facilities and reunify children in care because of poverty.

Aims: to investigate the prevalence of and interrelationship between cognitive impairment and behavioural problems in older people in residential care. Subjects: all those aged 65 years and over resident on one night in any type of residential care within the Leicestershire District Health Authority. Methods: an assessment form for each resident was completed by care staff. The assessment included demographic information and functioning (both mental and physical) during the previous week. Cognitive impairment was measured by the confusion sub-scale of the Crichton Royal Behavioural Rating Scale. Results: 6079 people were enumerated in 241 establishments, including hospitals, homes and hostels provided by the National Health Service (NHS), local authority social services and private and voluntary agencies. Thirty-eight percent (2219) were moderately or severely cognitively impaired and behavioural problems were present in 11.5%, most being associated with the presence of cognitive impairment. Compared •with elderly people in private residential homes, residents in local authority (part HI) homes had significantly higher odds of demonstrating offensive behaviour of 1.40 (95% confidence interval 1.11-1.78) after adjustment for age, sex and cognitive impairment. No significant association between number of patients in the home and the proportion exhibiting offensive behaviour was found in any of the non-NHS facilities. Conclusions: this survey of old people in institutional care found that most of those with behavioural problems were cognitively impaired. This has implications for staff training in the management of behavioural problems in demented people

acute and residential care settings Objectives. The objective of this review was to investigate physical restraint minimization in acute and residential care settings. The first aim was to determine the effectiveness of attempts to minimize the use of physical restraint, and the second was to generate a description of the characteristics of restraint minimization programmes. Method. A comprehensive search was undertaken involving all major databases and the reference lists of all relevant papers. To be included in the review studies had to be an evaluation of restraint minimization in an acute or residential care setting. As only a single randomized controlled trial (RCT) was identified, it was not possible statistically to pool the findings of different studies on the effectiveness of restraint minimization. To generate a description of the characteristics of restraint minimization programmes, the reported components of these programmes were identified and categorized. Results. A total of 16 studies evaluating restraint minimization were identified: three in acute care and 13 in residential care. Of these, only one was an RCT, with the most common approach being the before and after study design. Based on the findings of the single RCT, education supported by expert consultation effectively reduced the use of restraint in residential care. There has been little evaluation of restraint minimization in acute care settings. The common approach to restraint minimization has involved a programme of multiple activities, with restraint education being the characteristic common to most programmes. Discussion. Evidence suggests that physical restraint can be safely reduced in residential care settings through a combination of education and expert clinical consultation. There is little information on restraint minimization in acute care settings. The major finding of this review is the need for further investigation into all aspects of restraint minimization.

To determine the incidence and consequences of falls in elderly people living in hostels, and the role of comorbidity, orthostatic hypotension and medications as risk factors for falls. Methods: Cross-sectional prevalence and event association was studied in eight aged-care hostels (Canberra, ACT, 1999) of 179 residents aged 65 years and older (83 ± 7 years (mean ± standard deviation), 80% women) independent in activities of daily living. History of falls and injuries on falling, comorbidity, medications and mobility data were obtained. Measurements of blood pressure and heart rate were made supine after waking from overnight sleep and after standing for 1 and 3 min. Results: Forty-three per cent of subjects had fallen in the last year (1.3 ± 2.6 falls per person per year) and 29% of these had sustained a fracture, 53% of fallers had recurrent falls. In multivariate analysis, four factors were associated independently with falling within a year: using a walking device, history of cancer, taking selective serotonin reuptake inhibitors (SSRI) and cigarette smoking. For recurrent falls, cerebrovascular disease and using nitrates were also independent risk factors. In univariate analysis, reversible inhibitors of monoamine oxidase and potassium-sparing diuretics were negatively associated with falls. There were no differences between fallers and non-fallers in blood pressure in supine and standing positions, although one-third of residents had orthostatic hypotension. Conclusions: Falls in elderly hostel residents are common and often have serious consequences. Living in an institution is associated with an increased risk of fractures. The study identified several novel potential risk factors for falls in this population: using a walking device, history of falls, presence of cancer, presence of cerebrovascular disease, taking SSRIs, taking nitrates and cigarette smoking. These can be used to identify hostel residents at high risk of falling who can then be targeted for monitoring, specific treatment and prevention strategies.

This article deals with the problem of breakdown in different types of out-of-home care (foster care/residential care) for Swedish teenagers. How often are such placements prematurely terminated against the wishes and intentions of child welfare authorities? Which factors appear to increase or decrease the risk of placement breakdown? The sample consists of a national cohort of 776 youths who started 922 placements during 1991. Every placement was followed in municipal case files for a maximum period of five years.

Risk and protective factors of psychosocial development in children in different residential care settings need to be further studied internationally, in order to develop working methods for social and health care services. Standardized methods of the CBCL, TRF, and CGAS, were used to evaluate psychosocial functioning of children in children's homes in Finland. Further, data on sociodemographic situations and traumatic events in their lives were assembled. The percentage of behavioural and emotional problems within clinical or borderline range in the different ratings was 55–80%. Combined traumatization, sexual abuse, school difficulties, male sex, older age (>11 years) and older age at first and on-going placement (>7 years), as well as difficulties in relationships with parents are likely to be associated with more severe behaviour problems and lower general functioning. The results of this study show that children and adolescents in social service residential settings are a highly vulnerable group and that these children have extensive mental health needs.

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OBJECTIVES: To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance. DESIGN: Preplanned subgroup analyses of a randomized controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months. MEASUREMENTS: Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 3601. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle. RESULTS: The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P 5.65, .65, .51, .78, .09, .67, respectively) or 6 (P 5.69, .62, .20, .94, .48, .85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P 5.28, .47, respectively) or number of depressive symptoms (P 5.85, .49, respectively).

Like many other countries in the world, Australia is grappling with a chronic shortage of registered nurses (RNs). All areas of nursing are currently affected by shortages and high care residential aged care services are no exception. Selection, recruitment and retention of suitable staff to meet the complex needs of residents in aged care facilities are becoming increasingly challenging and must be addressed as a matter of priority. This paper explores the current nursing shortage, looks ahead to identify future threats to a viable nursing workforce in residential aged care, and raises some issues for future consideration.

The increase of violence in present-day society calls for adequate crisis interventions for students with behavioral problems. Life Space Crisis Intervention (LSCI) is a systematic and formatted response to a student's crisis, based on cognitive, behavioral, psychodynamic and developmental theory. The following research article evaluates a LSCI Program with students referred to special schools with residential treatment because of severe behavioral problems. The evaluation was conducted using a quasi experimental pre-test-post-test control group design. Thirty-one match paired students were pre-tested before the interventions started and post-tested after a period of 11 months. Five standardized questionnaires were examined to assess the effectiveness of the LSCI Program. General Linear Model (GLM) with repeated measures was used to analyze all data. For the total group of subjects (n = 62) it was found that students' perception about their athletic competence decrease significantly after 11 months in residential care. A positive effect of LSCI was found on direct aggression and social desirability.

We report findings from an intervention study that investigates the impact of group reminiscence (GR) and individual reminiscence (IR) activities on older adults living in care settings. This research aimed to provide a theory-driven evaluation of reminiscence based on a social identity framework. This framework predicts better health outcomes for group-based interventions as a result of their capacity to create a sense of shared social identification among participants. A total of 73 residents, living in either standard or specialized (i.e., dementia) care units, were randomly assigned to one of three interventions: GR (n ϭ 29), IR (n ϭ 24), and a group control activity (n ϭ 20). The intervention took place over 6 weeks, and cognitive screening and well-being measures were administered both pre-and post-intervention. Results indicated that only the group interventions produced effective outcomes and that these differed as a modality-specific function of condition: Collective recollection of past memories enhanced memory performance, and engaging in a shared social activity enhanced well-being. Theoretically, these findings point to the important role that group membership plays in maintaining and promoting health and well-being.

Background Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.

Aim:  Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it.Methods:  Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process.Results:  Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds.Conclusion:  Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Although often associated with older age, loneliness and social isolation are not well understood in terms of their prevalence, risk and protective factors. Evidence suggests that only a minority of community-dwelling older people are "severely" lonely or isolated, however a number of factors need to be considered to fully understand the extent and significance of the problem. Community-based studies have identified a variety of risk factors for loneliness/isolation including widowhood, no (surviving) children, living alone, deteriorating health, and life events (eg, loss and bereavement). Having a confidant has been identified as a protective factor for loneliness. However, evidence is often unclear or inconclusive, especially within residential settings. We identified the need to conduct more residential care-focused research; the importance of addressing a variety of methodological concerns; and the need for practitioners to develop intervention programs that are appropriately targeted, evidence-based and Aust Health Rev 2008: 32(3): 468-478 evaluated.

Group homes fall into the broad category of residential care, a category that also includes half-way homes, campus based homes, emergency shelters, self-contained settings, and staff secured setting. In general, residential care services represent an option of last resort. In the current study we use administrative records from a large urban county and propensity score matching to investigate the relationship between group home placements in child welfare and the risk of delinquency (n = 8226). The results indicate that the relative risk of delinquency is approximately two and one half times greater for adolescents with at least one group home placement as compared with youth in foster care settings. This finding raises serious questions about the use of group homes for victims of physical abuse and neglect.

This review examined risk and protective factors associated with placement breakdown across k = 26 studies of 20,650 children in foster families. A series of meta-analyses were performed to assess the average effect sizes across multiple studies on the same factors. Older age at placement (k = 15), behavior problems (k = 13), a history of residential care (k = 7) and previous placements (k = 6) showed significant small to moderate associations with placement breakdown. A large combined effect size was found for behavior problems when analyzed in multivariate models. Unexpectedly, kinship care (k = 6) did not show a significant association with placement breakdown. Other potential protective factors of placement breakdown referred to the quality of foster caregiving and other foster care related aspects, which showed small to large effect sizes. However, findings were contradictory when univariate and multivariate results were compared. Results of multivariate studies suggested mediating and moderating effects of variables related to the children's background. This might suggest that more insight in the processes leading up to placement breakdown may be derived from causal models.

Aim.  To integrate the research evidence on quality of life of older people living in a residential care home setting.Background.  Residential care is provided for older people who are unable to live in their own home due to various health and social reasons. A number of studies have been published that have focused on diverse quality of life issues of residential care home elders. Consolidating the evidence from these studies may provide insights into enhancing quality of life of this particular group of older people.Design.  A literature review of research evidence on quality of life issues among residential care home elders.Method.  A systematic search of the literature published between 1994–January 2008 was undertaken to identify research evidence on quality of life of older people living in residential care home. Information about the study design, research objectives, study setting, sample characteristics, and key findings were extracted for comparison and integration. Three aspects about quality of life of the residential care home elders were identified: views of residential care home elders on quality of life, factors affecting quality of life of residential care home elders and methods to improve quality of life in residential care home elders.Results.  Eighteen publications were identified. Older people perceived their ability to maintain independence, autonomy and individuality as the most important criteria for determining quality of life. Interventions designed to improve quality of life of older people living in residential facilities corresponded to these criteria. A range of interventions including a walking program, mental stimulation and environmental modification were proposed and evaluated to improve quality of life of residential care home elders. Among these interventions, environmental modification that targeted at improving the residential care homes and quality of services appears to be promising.Conclusion.  Quality of life in residential care home elders is a complex issue that may be determined by the elders’ independence, individuality and autonomy, and influenced by quality of residential care and facilities. Environmental modification appears to be a way to improve the quality of life of residential care home elders.Relevance to clinical practice.  The knowledge of understanding quality of life of residential care home elders provides insights into the implementation of appropriate residential care services. Programs that aim to de-institutionalise the residential care home settings are important to the enhancement of residential care services.

This special issue of The Gerontologist is sponsored through a generous grant from the Alzheimer's Association. Recognition and thanks are sent to the staff, residents, and families participating in the Collaborative Studies of Long-Term Care (CS-LTC) and to all of those who devote their efforts to the quality of life and quality of care in assisted living and nursing homes.

This report provides an introduction to the approach to child care known as social pedagogy and an evaluation of a social pedagogy training programme delivered to a group of child care staff employed in Sycamore Services. It is a 1st stage evaluation which gathers information from participants during the training programme and over the first few months following the training. This was a pilot programme and the Sycamore Services management have decided that the programme will be run again, and will eventually be offered to all staff. A further evaluation will be carried out in order to identify benefit and impact one year on from the end of the pilot.

In the past twenty years, the importance of the physical and social environments in supporting the person with dementia has gained a much higher profile in dementia care. Despite efforts to move aged care away from the medical model to a more balanced social model of care, we still struggle with the dominance of an institutional context which impedes individuality and choice. This article argues that the experience of the person with dementia should frame the perspective brought to built design and the philosophy of care -in essence, 'looking out from the inside'. Shifting the emphasis from condition to experience encourages the culture change needed to create environments that allow the person with dementia to be an active participant in everyday life rather than a passive recipient of care. Based on the development of a resource for residential and respite facilities in Australia, seven living experiences are identified: the presentation of self-experience, eating experience, personal enjoyment experience, bedroom experience, family and community connections experience, end-of-life experience and the staff experience. Each is discussed to show how consideration of the living experiences provides a way to focus thinking for design of the built environment to practically support the person with dementia, thereby addressing the wider spectrum of issues in creating a dementia friendly physical and social environment from the perspective of the person with dementia.

El acogimiento residencial en nuestro país sigue cumpliendo una función esencial en la protección de niños, niñas y en especial, adolescentes, en situación de desamparo. La necesaria atención a problemas emergentes como la llegada de menores extranjeros no acompañados, el incremento de los casos de violencia familiar ejercida por los hijos, la necesidad de atención terapéutica a niños con problemas emocionales y de salud mental, entre otros, han provocado una gran crisis e importantes cambios en la estructura y objetivos de los hogares de acogida. Hoy en día, el trabajo de los profesionales se ha especializado en la intervención con adolescentes y problemáticas como las descritas. Aunque siguen existiendo unidades dedicadas a los más pequeños, éstas tienden a desaparecer a medida que el acogimiento familiar recibe el impulso necesario. Desde los años 90, el modelo de atención especializado configurado por recursos diferenciados se ha ido implantando de manera muy desigual en las diferentes comunidades autónomas. Ahora bien, como se verá a lo largo del artículo, aún son muchas las dificultades y los retos por alcanzar en los hogares de protección. Palabras clave: Protección Infantil, Acogimiento Residencial, Hogares y Centros de Protección, Maltrato Infantil Residential care continues to play an important role in Spain in the provision of care for children and adolescents in situations of abuse or neglect. Some newly-emerging issues, such as the arrival of unaccompanied minor asylum-seekers, the increase in child-to-parent violence, or the need for therapeutic attention in children with emotional and mental health problems, have given rise to a great crisis and substantial changes in the structure and objectives of children's homes. Currently, child care work in children's homes is focused on intervention with adolescents and the new problems described. Although resources for younger children continue to exist, these tend to disappear as foster care becomes adequately established. Since the 1990s, the specialized child care model involving differentiated resources has been implemented in a highly inequitable way across Spain's different Autonomous Regions. As will be discussed in the present article, there remain many difficulties to overcome and challenges to be met in the area of residential child care.

Purpose: This article presents an overview of what is known about dementia services in assisted living settings and suggests areas for future research. Design and Methods: We undertook a search of Medline, the Journals of Gerontology, and The Gerontologist. We then organized publications dealing with the target subject into 10 topic areas and reviewed them. Results: The article describes the demographic characteristics of cognitively impaired residents in assisted living and related residential settings in the United States, the services they receive, and process and structural elements both in specialized dementia units and in integrated assisted living settings. Finally, we review the literature on methodological issues regarding research in this area. Implications: It is important to generate research on processes as well as outcomes, such as dignity, individualized and pleasurable experiences, and freedom from pain and discomfort. We make recommendations for both content areas that would benefit from further research as well as methodological approaches that will yield important information in this field.

Mr. Siddhartha Kaul’s longstanding experience on child care and protection in Asia and around the world allowed to divide the interview into four sections. He starts sharing some of his views on the general situation of children. Mr. Kaul also talks about some of the experiences of SOS’s Children’s Villages International in that regard. Then, he gives interesting recommendations on care and protection of children. Finally, he expresses some of his thoughts on how to promote care and protection for children without parental care in South Asia.

The need for scrutinizing and implementing childcare rights in the SAARC is imperative. It has become quite apparent in recent years, that for children living in non family environments, this may indeed be a preferred care option as laws exist that protect their rights and secure their living situations. However, the institutions are overcrowded and a large number or children await the services. Within South Asia, only a few countries have been able to put in place new laws and guidelines that protect the placement of children in these institutions. However, the implementation of new laws and guidelines does not guarantee a better outcome. What remains to be conducted are sound studies examining the adjustment of children in these homes and the implementation of preventive measures with respect to the violations of children's rights. It is also imperative that the standards of care for caregivers be explored conscientiously to help in the delivery of services to insitutionalised children. Collaborative efforts between different agencies, policy makers and those in charge of such institutions can only ensure that the rights of children are protected and their care is maximized in ever way. This article focuses on one aspect of raising standards and building child protection systems by exploring the existence of best care practices, any existing evidence of replication of such care practices, the ability to monitor and standardize care practices in a facility and the provision of state accountability during these steps. A survey of the research literature and over ten years of experience in the field has informed this article. The process included focus groups discussions and extensive review of related material. The article concludes by identifying certain changes that when implemented in these homes will raise the standards of care.

Growing older is hard to make sense of. Opposing perspectives are presented on everything from individual to population ageing, and there is widespread ambivalence towards many aspects of ageing. Positioning theory is a research approach that can tolerate such ambiguity and provides a clear, useful framework to make sense of research data, while doing justice to its complexity. It is starting to be used in gerontology; the aim of this paper is to give gerontologists the tools and impetus to use it more. The positioning triad is outlined, comprising positions (how we position ourselves and others within a single conversation or across a lifetime), storylines (the individual and social narratives which furnish those positions), and the speech acts (and acts of research) through which storylines and positions are enacted. In addition, considering the rights and duties associated with different positions and storylines can usefully illuminate some of the tensions around competing positions on ageing. Worked examples from a qualitative study on childless older people (38 participants aged 63 to 93) in terms of their positioning of childlessness, views on residential care, and positioning of emotional support show how the complexity of such diverse topics can be usefully studied using a positioning theory framework.

Within a comprehensive mental health service array for youth, Intensive Home Based Services (IHBS) are designed to meet the needs of youth with significant emotional and behavioral problems in their home communities, avoiding the need for out-of-home services, particularly residential care. We examined youth receiving IHBS as their first service in the state of Hawaii system of care (N = 163) to determine how successful IHBS were in preventing the need for more restrictive services within 12 months of intake. Subsequently, we investigated characteristics that might be predictive of a youth's need for service intensification within 12 months. Logistic regression analyses found that greater age, level of service need, and functional impairment at intake predicted use of more restrictive services within 12 months of intake, whereas gender, ethnicity, diagnosis, service intensity, and clinician credentials did not. Overall, our findings suggested that IHBS were reasonably successful in preventing residential placements, and provided some basis for determining characteristics of youth likely to require more restrictive placements within a one year period.

Research on bullying has grown very rapidly in the last two decades, initially in schools but also in a variety of other settings and relationships; and there has been relatively little communication between the different groups of researchers. We describe the nature of bullying in schools, between siblings, in children's residential care homes, in prisons, and in the workplace. Commonalities and differences in the phenomenon, and the ways in which it is exhibited and experienced are explored. The role of individual and organizational factors in the development and maintenance of these behaviors across contexts is compared. We then examine a number of theoretical approaches which have been suggested as relevant to our understanding of bullying. Integrative approaches from different research traditions are proposed which view these behaviors as being influenced by a combination of situational and individual factors.

This study examines loneliness and its correlates-health, residential care, partner status, and network size-over a seven-year period among adults born between 1908 and 1937. The four waves of data are from the Dutch "Living Arrangements and Social Networks of Older Adults" and the "Longitudinal Aging Study of Amsterdam" programs. Data from at least two waves are available for 2,925 respondents. Results show that older adults generally become lonelier as time passes. The increase is greater for the oldest, the partnered, and those with a better functional capacity at baseline. Older adults who lose their partner by death show the greatest increase in loneliness. Not all older adults become more lonely: Improvement in functional capacity and network expansion lead to less loneliness. Entry into residential care does not affect loneliness. The longitudinal design provides new insights into factors that protect against loneliness compared to cross-sectional studies.

The principal purpose of the study was to investigate the day-long patterns of activity of residents and staff in five similar care centers for people with Alzheimer's disease. The Therapeutic Environment Assessment Scale provided an architectural basis for assessing the significance of activity data gathered through behavior mapping. Slight architectural differences contributed to effects that were large and enduring, producing as much as a 50% differences between sites in the portion of residents involved. Taken together, the results suggest that resident status, use patterns, and architectural design details of a homelike residential setting have significant effects on the daily activities of residents.

Every floorplan may be regarded as a reflection of the goals and activities of the users as interpreted by the architect. By comparing a wide range of building layouts for similar organizations one may achieve a good understanding of the ways in which goals and values can be expressed in spatial solutions. It offers the opportunity to develop a spatiofunctional typology of design solutions. Postoccupancy evaluations focusing on underlying arguments and user experiences with different design solutions give insight into relevant points of decision, (dis)advantages for use and perception, and (dis)congruencies between spatial systems and social systems. This article demonstrates how an integration of ,comparative floorplan-analysis and postoccupancy evaluation may contribute to more soundly based solutions in programming and architectural design. The relationship between spatial and social configurations is illuminated by an analysis of the floorplans of two schools with different educational systems and the spatial implications of a shift from a medical care concept into a residential care concept in nursing homes. © 1997 Elsevier Science Ltd. 1 Mlchelson, M M~In and his urban environment: ~ sociological approach Addison-Wesley, MA (1970) ELSEVIER B

OBJECTIVES: To estimate the sensitivity, specificity, and reliability of the Minimum Data Set Cognition Scale (MDS-COGS) in screening for undetected dementia when completed by direct care staff in residential care/assisted living (RC/AL) facilities and secondarily to determine the prevalence of dementia in the sample. DESIGN: A cross-sectional study in which staff were trained to complete the MDS-COGS. Research interviewers and a neuropsychologist obtained information on each participant. Two neurologists reviewed the data and examined the participant, rendering a probable diagnosis of dementia/non-dementia diagnosis. MDS-COGS results were compared with the neurologists' determination. SETTING: Fourteen RC/AL facilities in North Carolina. PARTICIPANTS: Data were collected from 50 staff on 166 residents without a diagnosis of dementia. MEASUREMENTS: In addition to the MDS-COGS, measures included a comprehensive neuropsychological battery. Depression and other neuropsychiatric symptoms were also assessed. RESULTS: Neurologists determined that 38% of participants had probable dementia. An MDS-COGS cutpoint of 2 was highly specific (0.97) but not very sensitive (0.49) for dementia. Test-retest and interrater agreement for a negative screen were high (88% and 93%, respectively). CONCLUSION: The MDS-COGS is a simple, brief screen that RC/AL staff can complete. It will identify with high specificity a subset of residents with undetected dementia, allowing rapid identification of those likely to need dementia care. Caution needs to be exercised in light of its low sensitivity, because some with milder dementia will not be detected. Further work is needed to determine whether staff can and will use the MDS-COGS as a trigger for morethorough assessment and to guide care and improve outcomes. J Am Geriatr Soc 55: 1349-1355, 2007.

The increase in the number of people with dementia will lead to greater demand for residential care. Currently, large nursing homes are trying to transform their traditional care for residents with dementia to a more home-like approach, by developing small-scale living facilities. It is often assumed that small-scale living will improve the quality of life of residents with dementia. However, little scientific evidence is currently available to test this. The following research question is addressed in this study: Which (combination of) changes in elements affects (different dimensions of) the quality of life of elderly residents with dementia in long-term care settings over the course of one year?

Objective: This descriptive study examines 45 child and adolescent fatalities related to restraints in residential (institutional) placements in the United States from 1993 to 2003. Method: The study team used common Internet search engines as its primary case discovery strategy to determine the frequency and the nature of the fatalities, as well as the characteristics of the children and the adolescents involved. Results: Male children and adolescents were over-represented in the study sample. Thirty-eight of the fatalities occurred during or after a physical restraint, and 7 fatalities occurred during the use of mechanical restraints. Twenty-eight of the deaths occurred in a prone restraint. In 25 of the fatalities, asphyxia was the cause of death. Conclusion: In the 23 cases in this study where information is available, none of the child behaviors or conditions that prompted the restraint would meet the standard of danger to self or others: the commonly accepted criteria for the use of a restraint. The study points to deficiencies in fatality reporting, recommends reporting fatalities to established state child fatality review boards, and reinforces that restraints be governed by strict protocol and monitoring. The study also urges caution to policymakers in substituting or changing restraint procedures based on the incomplete data reported in this study.