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The Gerontologist 45:133-146 (2005)
© 2005 The Gerontological Society of America

Dementia Care and Quality of Life in Assisted Living and Nursing Homes

Sheryl Zimmerman, PhD1,, Philip D. Sloane, MD, MPH2, Christianna S. Williams, PhD3, Peter S. Reed, PhD, MPH4, John S. Preisser, PhD5, J. Kevin Eckert, PhD6, Malaz Boustani, MD, MPH7 and Debra Dobbs, PhD8

Correspondence: Address correspondence to Sheryl Zimmerman, PhD, Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC 27514. E-mail: Sheryl_Zimmerman{at}

Purpose: There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care/assisted living (RC/AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy. Design and Methods: We used a variety of report and observational measures of the structure and process of care and 11 standardized measures of quality of life to evaluate the care for and quality of life of 421 residents with dementia in 35 RC/AL facilities and 10 nursing homes in four states. Data were collected cross sectionally on-site, and we conducted a 6-month follow-up by telephone. Results: Change in quality of life was better in facilities that used a specialized worker approach, trained more staff in more domains central to dementia care, and encouraged activity participation. Residents perceived their quality of life as better when staff was more involved in care planning and when staff attitudes were more favorable. Better resident–staff communication was related to higher quality of life as observed and reported by care providers. Also, more stable resident–staff assignment was related to care providers' lower quality-of-life ratings. Implications: Improvement in resident quality of life may be achieved by improved training and deployment of staff.

Key Words: Long-term care • Residential care • Staff practices • Training • Observation

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Copyright © 2005 by The Gerontological Society of America.