title: Living at the farm, innovative nursing home care for people with dementia - study protocol of an observational longitudinal study.
abstract: BACKGROUND
  In nursing home care, new care environments directed towards small-scale and homelike environments are developing. The green care farm, which provides 24-h nursing home care for people with dementia, is one such new care environment. Knowledge is needed on the relation between environmental features of green care farms such as nature, domesticity and offering care in small groups and the influence on the daily lives of residents. The aim of this study is to explore (1) the daily lives of residents, (2) the quality of care and (3) the experiences of caregivers on green care farms compared with other nursing home care environments.
  
  
  METHODS
  An observational longitudinal study including a baseline and a six-month follow-up measurement is carried out. Four types of nursing home care environments are included: (1) large scale nursing home ward, (2) small scale living facility on the terrain of a larger nursing home (3) stand-alone small scale living facility and (4) green care farm. Quality of care is examined through structure, process and outcome indicators. The primary outcome measure is the daily life of residents, assessed by ecological momentary assessments. Aspects of daily life include (1) activity (activity performed by the resident, the engagement in this activity and the degree of physical effort); (2) physical environment (the location of the resident and the interaction with the physical environment); (3) social environment (the level and type of social interaction, and with whom this social interaction took place) and (4) psychological well-being (mood and agitation). In addition, social engagement, quality of life, behavioral symptoms and agitation are evaluated through questionnaires. Furthermore, demographics, cognitive impairment, functional dependence and the severity of dementia are assessed. Semi-structured interviews are performed with caregivers regarding their experiences with the different nursing home care environments.
  
  
  CONCLUSIONS
  This is the first study investigating green care farms providing 24-h nursing home care for people with dementia. The study provides valuable insight into the daily lives of residents, the quality of care, and the experiences of caregivers at green care farms in comparison with other nursing home care environments including small-scale care environments and large scale nursing home wards.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. b.deboer@maastrichtuniversity.nl.
authors.forename: B
authors.initials: B
authors.lastname: de Boer
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. jph.hamers@maastrichtuniversity.nl.
authors.forename: J P H
authors.initials: JP
authors.lastname: Hamers
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. h.beerens@maastrichtuniversity.nl.
authors.forename: H C
authors.initials: HC
authors.lastname: Beerens
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. s.zwakhalen@maastrichtuniversity.nl.
authors.forename: S M G
authors.initials: SM
authors.lastname: Zwakhalen
authors.affiliation: Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. frans.tan@maastrichtuniversity.nl.
authors.forename: F E S
authors.initials: FE
authors.lastname: Tan
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. h.verbeek@maastrichtuniversity.nl.
authors.forename: H
authors.initials: H
authors.lastname: Verbeek
mesh_terms: D000368:Aged; D000383:Agriculture; D001526:Behavioral Symptoms / Q000517:prevention & control*; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000523:psychology / Q000628:therapy; D005260:Female; D006272:Health Facility Environment / Q000379:methods; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D009735:Nursing Homes / Q000458:organization & administration*; D011788:Quality of Life / Q000523:psychology*; D012931:Social Environment; D011795:Surveys and Questionnaires