Family oversight and the quality of nursing home care for residents with advanced dementia.
BACKGROUND
The quality of nursing home (NH) care for residents with advanced dementia has been described as suboptimal. One relatively understudied factor in the provision of NH care is the role of private oversight and monitoring by family members and friends.


OBJECTIVE
To examine the association between private oversight and the quality of end-of-life care for NH residents with advanced dementia.


METHODS
This study employed longitudinal data on 323 NH residents with advanced dementia living in 22 Boston area facilities. Using bivariate and multivariate methods, we analyzed the association between visit time by the resident's health care proxy (HCP) and measures of quality of end-of-life care.


RESULTS
The relationship between visit time and quality was nonlinear. Residents who were visited 1 to 7 h/wk had less pain, fewer pressure ulcers, less dyspnea, and fewer hospital transfers compared with residents who had no visits or who were visited >7 h/wk. After adjusting for covariates, residents who were visited >7 h/wk had more pressure ulcers, more pain, greater dyspnea, fewer do-not-hospitalize orders, and lower HCP satisfaction with care compared with residents who were visited 1 to 7 h/wk.


CONCLUSIONS
Several measures of quality of NH care for end-stage dementia exhibit a nonlinear relationship with the degree of HCP oversight, such that no visiting or very high levels of visiting are associated with worse quality. Future research will need to address whether families with greater oversight tend to make decisions that promote worse quality of care, or whether worse quality of care promotes greater family oversight.
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. grabowski@med.harvard.edu
David C
DC
Grabowski
Susan L
SL
Mitchell
D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D003704:Dementia / Q000145:classification* / Q000188:drug therapy; D005190:Family; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards; D014789:Visitors to Patients / Q000706:statistics & numerical data*