A Cottage Model for Eldercare

Abstract

Objective: An overview of medical, cognitive, and affective changes experienced by geriatric long-term care residents during a migration from traditional healthcare delivery to a cottage-based model. Background: New architectural models hold great promise for improving health and social outcomes for residents. New studies must explore the resident, family, and staff outcomes across transformations, as well as the business case for change. Methods: A longitudinal, quasi-experimental design was employed, with an emphasis on regularly acquired institutional data, including the Minimum Data Set, as well as commonly available survey instruments including the MOSES, the 2005 NSWHN, and Castle's Job Satisfaction Questionnaire. Descriptive statistics, McNemar's Exact Test, repeated measures ANOVA, and t-tests were used as well as narratives from families, staff, and management. Results: Staff perceived enhanced institutional respect ( t(72) = 2.38, p = 0.02) and work environment, and families perceived more staff cooperation and a better bond between staff and residents. No changes were discerned in a resident's prevalence of pain (odds ratio 0.43, p = .34, 95% CI [0.07, 1.88]), mobility (odds ratio 0.50, p =.19, 95% CI [0.17, 1.32]), range of motion(odds ratio 0.57, p = .55, 95% CI [0.12, 2.25]), or depression and anxiety (odds ratio 2.33, p =.11, 95% CI [0.84, 7.41]). A modest decline in residents' systolic ( t (101) = 3.74, p < .001) and diastolic ( t (101) = 2.870, p < .01) blood pressures was demonstrated. The rate at which a resident's Activities of Daily Living score declined was attenuated ( t (57) = 3.37, p <.001). Operational costs remained constant across the move. Conclusions: Cottage settings were aesthetically appealing to residents, family, and staff. Modest improvements in health outcomes were observed, and operational costs remained stable.