A Description of Board and Care Facilities, Operators, and Residents. 6.4 Cognitive and Functional Status

12/01/1995

6.4.1 Cognitive Impairment

In the early 1980s, Dittmar and Smith (1983) found 30 percent of the residents were “confused,” while Sherwood and colleagues (1981) found 24 percent were cognitively impaired (Exhibit 6-4). A prevalence rate of 40 percent with moderate to severe cognitive impairment in this study indicates a significant increase in cognitive impairment among board and care residents in the past decade.

The difference in cognitive status between residents in licensed and unlicensed homes was substantial. The proportion of residents in licensed homes who were moderately to severely cognitively impaired was over two and a half times greater than that seen in unlicensed homes (42 percent compared to 16 percent).

Similarly, there was a difference in cognitive impairment between residents in homes in extensively regulated States compared to those residing in board and care facilities in States with more limited regulations. Almost half of the residents in extensively regulated States were cognitively impaired, compared to slightly over one-fourth of the residents in homes subjected to limited regulations.

EXHIBIT 6-5. Resident Mental and Functional Status
  Total Population Licensure Status
Licensed Homes Unlicensed Homes
  %     SE     %     SE     %     SE     pa  
Functional Status
Received any help with
Bathing 46 3.6 49 4.1 14 2.9  
Dressing 21 2.1 22 2.4 8 1.6  
Toileting 12 1.3 13 1.6 4 0.9  
Locomotion 9 1.4 9 1.6 4 0.8  
Transferring 8 1.1 9 1.3 4 0.9  
Eating 5 1.0 5 1.1 3 1.0  
Received help with
0-1 ADLs 80 2.5 78 2.8 93 1.7  
2-3 ADLs 13 2.3 14 2.5 4 1.2  
4-5 ADLs 7 0.7 12 0.8 2 0.7  
Cognitive Impairment b
None 60 3.5 58 3.9 87 1.9  
Moderate 19 3.1 20 3.3 9 1.7  
Severe 20 2.2 22 2.5 7 1.2  
Mental Status
Mental/emotional/nervous condition 33 3.2 35 3.3 17 3.2 b
MR/DD 11 2.6 11 2.8 4 1.2 b
Incontinence
Any incontinence 29 2.0 30 2.3 19 2.2 b
  1. Significance level of licensure effect.
  2. p < .0.1.
  3. .01 < p < .05.

6.4.2 Functional Impairments

Exhibit 6-4 and Exhibit 6-5 also summarize the significant levels of functional impairment among residents. Twenty-nine percent of residents were incontinent. Seven percent were bedfast or chairfast, and 15 percent used a wheelchair as a primary model of locomotion. Further, 45 percent of the residents received assistance from another person with bathing. Approximately 20 percent received assistance with dressing, with over one-third of these receiving extensive help or being totally dependent on others do dress them. Nine percent received assistance with locomotion. Nearly 20 percent of the residents received help from another person with two or more activities of daily living (ADLs included dressing, bathing, locomotion, toileting, transferring, and eating).

The differences in physical functioning between residents of homes by licensure status was particularly stark. Residents of licensed homes were more impaired in virtually all ADLs (including incontinence) than were residents of unlicensed homes. On the other hand, probably related to the older age of the licensed extensively regulated sample, those residents were more likely to be incontinent and to have multiple ADL limitations than was the case for residents of licensed homes in limited regulation States.

EXHIBIT 6-6. Resident Health Status and Health Care Use
  Total Population
  %     SE  
HEALTH STATUS
Diabetes 11 0.9
Arthritis/rheumatism 42 1.2
High blood pressure 28 1.5
Asthma 11 1.1
Stroke (past 12 months) 6 0.9
Heart attack (past 12 months) 3 0.7
Other 19 1.0
Fell in past 12 months 32 0.9
Self-rated health
Poor 9 0.9
Fair 32 2.6
Good 39 1.7
Very good 15 1.9
Excellent 6 0.9
Use of assistive devices
Dentures 50 2.5
Glasses 73 1.8
Hearing aid 13 1.1
Cane 19 1.6
Walker 23 1.5
Wheelchair 15 1.0
Continence pads 15 2.5
Pressure relieving devices 6 2.0
Urinary catheter 0 0.3
Ostomy 1 0.5
Other 1 0.3
HEALTH CARE USE
Physician visit in past 12 months 89 1.4
Overnight hospital stay in last 12 months 32 1.1
Number of hospital stays in last 12 months
0 68 1.1
1 20 0.9
2+ 12 1.2
ER treatment in last 12 months 28 2.0
Use of psychotropic drug 41  
Psychiatric treatment in last 12 months 30 2.0

The impairment among residents in this study was much higher than the levels found by Dittmar and Smith (1983) in the DRI study and by Sherwood and her colleagues in their study (Mor et al., 1986; Sherwood et al., 1981). For example, both found only 7 percent of the residents had urinary incontinence, compared to 23 percent in this study. Dittmar and Smith (1983) found only 2 percent of the residents in the elderly/mixed homes were bedfast or chairfast (vs. 7 percent); 27 percent received help in bathing (vs. 45 percent); and 43 percent received help with medications (vs. 75 percent). Surprisingly, the rates of psychotropic drug use were also higher. Forty-one percent of the residents in this study received one or more psychotropic drugs, compared to about one-third of residents in the other two studies.

Although these findings are not directly comparable because none of the studies produced generalizations to the entire population of homes and residents, they probably represent an essentially accurate picture of the increasing age and disability of board and care homes residents. However, we also should note that the age distribution and levels of functional impairment for these study residents were lower than the national estimates produced by the 1987 National Medical Expenditure Survey (NMES). Because the personal care homes included in NMES were restricted to those that provided hands-on assistance with ADLs and also excluded many small categories of homes, this probably explains their somewhat higher estimates of functional impairment in ADLs (Lair and Lefkowitz, 1990).

EXHIBIT 6-7. Resident Health Status by Facility Licensure Status
Health Status Licensure Status
Licensed Homes Unlicensed Homes
  %     SE     %     SE     pa  
Diabetes 11 1.0 11 1.4  
Arthritis/rheumatism 41 1.0 52 1.9 b
High blood pressure 28 1.7 36 1.7 b
Asthma 11 1.2 10 0.9  
Stroke 6 1.0 3 0.4 b
Heart attack 4 0.7 2 0.5 c
Self-rated health b
Poor 9 1.1 7 1.3  
Fair 33 3.0 24 1.5  
Good 39 2.0 38 2.0  
Very good 14 2.2 22 2.3  
Excellent 5 1.0 9 1.6  
  1. Significance level of licensure effect.
  2. p <.01.
  3. .01 < p <.05.

 

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