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Rapid Overview
The objective of the report is to summarize the evidence regarding the clinical effectiveness, cost-effectiveness, and guidelines regarding homelike models of care for residents of long-term care facilities.
Quality of Life Findings were mixed for quality of life in the three studies that assessed this outcome. Results from two studies indicated that residents of small-scale homelike care and traditional care facilities did not statistically differ with respect to quality of life from baseline up to 1 year follow-up.Quality of life was assessed in multiple ways in a third study that provided mixed findings.In this study, self-reported quality of life did not differ between residents in Green Care Farms and those in traditional facilities. Specific sub-domains of quality of life were also shown not to differ significantly between groups (i.e., negative affect, restless tense behaviour, or social isolation).However, when assessed by proxy-report, residents of Green Care facilities had higher global quality of life scores, as well as higher scores on the positive affect and social relations sub-domains relative to those in traditional nursing homes.
Social engagement and communication Findings were a mix of null and favourable (i.e., favouring homelike models) for social engagement and communication outcomes in the six studies that reported these outcomes. One study reported significantly greater social engagement at baseline and 6-month, but not 12-month follow up in small-scale homelike facilities compared with traditional facilities.This is in contrast with three studies that reported no statistically significant differences between residents in Green Homes or small-scale homelike care facilities versus those in traditional nursing homes cross-sectionally or up to one year in social engagement and communication. However, while engaged socially, there was a greater level of social interaction for those living in Green Homes compared with those in traditional nursing homes in the cross-sectional study. Using a growth curve model one study showed that residents in Green Homes had a smaller increase in the probability of not being socially engaged over time compared with residents in traditional homes and there was no difference between the groups for the rate of increase in social engagement level. One study on small-scale homelike care showed there were no differences in social withdrawal over the course of a year when compared with traditional facility residents.
When examining cognitive engagement, residents in a household model facility spent less time idle than those living in comparator facilities.There were no significant differences between the groups for time displaying active engagement in activities, time engaged in socioexpressive activities, time staring blankly, or time sleeping during the day. There were no significant differences over one year in communication patterns or activity pursuits between those living in small-scale homelike care facilities versus those living in traditional long-term care.
This report identified evidence on the clinical effectiveness of homelike models of care for residents of long-term care facilities. No evidence-based guidelines or evidence for the cost-effectiveness of homelike models of care for residents of long-term care facilities were identified. Evidence from nine non-randomized studies provided mixed results regarding the clinical effectiveness of homelike models of care for a variety of outcomes. There were no studies that reported statistically significant differences between homelike models of care and traditional models of care for depression or affective state. For the remaining outcomes of cognitive function, quality of life, neuropsychiatric outcomes, social engagement and communication, and functional status, findings were mixed, with most studies suggesting no difference between groups. There is a substantial amount of uncertainty regarding the conclusions based on the inconsistency in the evidence, the lack of randomized studies, and the lack of consistency in the models of homelike care included in this report. A previous CADTH report published in 2010 identified three studies that examined the effectiveness of one of two specific models of homelike care – the Eden Alternative and Greenhouse Concepts of Care — for residents in long-term care. One study showed few statistical differences between the Greenhouse facility and other long-term care facilities for quality of life indicators. Another showed lower levels of boredom and helplessness in the Eden Alternative facility compared to a traditional long-term care facility, and a third study reported no differences between the Eden Alternative and a traditional model for functional status, infection rate, or cost of care. Although a larger number of studies were identified in the current report, there remains substantial uncertainty regarding the effectiveness of homelike models of care given the limitations inherent in the included studies. Current evidence for the clinical and cost-effectiveness of homelike models of care is limited and additional research is needed to inform clinical practice.