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Time and costs of managing specific disruptive behaviors in long-term care facilities: A descriptive study

Kleinman L, Schmeir J, Rothman M, Frank L, Beck CK. Time and costs of managing specific disruptive behaviors in long-term care facilities: A descriptive study. The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists. 2002 Jun 15; 17:497-507.

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Introduction: Nursing home staff are commonly challenged by behavioral problems and their management. Cognitive disorders and, consequently, proglematic disruptive behaviors are common among residents. Objective: While staff burden of these behaviors is widely acknowledged, descriptive information on the time and frequency of actual management strategies used in practive and an estimate of associated staff costs is lacking. Study Design and Methods: Through detailed semi-structured interviews with nursing staff from 5 nursing homes in the Northeast US, we identified the range of management strategies employed by staff and estimated staff costs for each individual strategy. Nurse reports on behavioral frequency and intensity of staff involvement (ratio of staff-level to CNA-level) were obtained and used in cost calculations. Results: The most frequently-observed behaviors (average of 84 times/month) included physical agitation, care refusal, and requests for attention. Re-orienting and calming the resident, removing from immediate surroundings, and notifying family were common strategies used to manage these behaviors. Physical aggression, psychotic symptoms, sexual disinhibition, and depressive symptoms precipitated the most costly management strategies, ranging from $5 to $23 per occurrence. The highest monthly care costs ($75 to $344 based on median US wages) resulted from physical agitation, care refusal and depressive symptoms, based on staff mix and estimated frequency of occurrence. Conclusions: Common disruptive behaviors in nursing homes require moderate to high staff time and cost burden. Key Words: nursing home, dementia, disruptive behaviors, economics

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