Aim: To examine factors associated with family caregivers’ choice of care setting (own home vs. nursing home) for their relatives with dementia. Methods: Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer’s association. Caregivers completed a questionnaire containing demographics of the person with dementia (PWD) and caregiver, their choice of care setting and the following scales: Gain in Alzheimer Care Instrument, General Health Questionnaire, Short Sense of Competence Questionnaire, Revised Memory and Behavioral Problems Checklist and Zarit Burden Interview. Multiple logistic regression was performed to identify significant variables associated with the outcome of interest. Results: The final sample comprised 266 caregivers, the majority of whom were Chinese, female and children of PWD. Most (85.7%) preferred care at home, only 38 (14.3%) chose institutionalization. Four factors were associated with choice of nursing home: caregiver working (OR = 6.363, 2.120–19.086), no domestic maid (OR = 3.27, 1.458–7.331), lower caregiver gain (OR = 0.935, 0.882–0.992) and behavioral problems in PWD (OR = 1.011, 1.005–1.018). Conclusion: Strategies to minimize institutionalization must first address the provision of a dedicated caregiver at home. Consequently, interventions to help caregivers cope with behavioral problems in PWD and enhance caregiver gain are relevant.

The ageing population in Singapore poses a growing challenge and need to realign current health services and care management pathways to treat older adults with complex medical conditions. 1,2 This group of patients typically have multiple comorbidities and disabilities and are at risk of poor outcomes after they are discharged home from hospitals. Consequently, they require frequent admissions to hospitals. To address the issue of frequent readmissions of older adults with complex care needs, transitional care (TC) is offered as a care management model that can help to ameliorate this situation. [1][2][3] Studies on TC have primarily targeted frail older patients and focused on health education, self-management and care coordination of social and community services that are nurseled. [4][5][6][7][8] Since only care coordination is involved, frail patients with exacerbations or unresolved medical conditions had to be referred back to primary care or hospital-based physicians while patients with functional needs were referred to homeor community-based rehabilitative services. 4 A TC model that appears to hold much promise is one that employs a multidisciplinary team comprising a medical social worker (MSW), nurse, physician and therapist to deliver comprehensive home-based care to older adults. 5,9 In the literature, the findings on the impact of TC on acute hospital utilisation, costs and mortality are mixed and inconclusive. 8,10 A local study of an integrated model of home TC had shown a reduction in readmissions to hospitals, inpatient stay and visits to the hospital emergency department (ED). However, its findings were limited by a lack of economic evaluation. 5 Our study aimed to examine the impact of a TC programme on cost, hospitalisation and mortality in frail patients with complex functional, medical and social needs who were discharged home from a hospital located in the northern region of Singapore. Materials and MethodsThe intervention was a 3-month posthospitalisation, nurseled home visit programme. Using an inter-disciplinary team approach, the care management team comprised a MSW, nurse, occupational therapist, physician, physiotherapist and speech therapist. The nurse was designated care manager

Background: Literature emphasises the benefits of person-centred approaches in nursing homes. Objectives: To describe the quality of life, well/ill being and person-centred care of residents, and explore relationship between person-centred care and well/ill being in 7 nursing homes. Design: A cross-sectional study. Setting: Seven nursing homes of different built period and design typologies in Singapore. Participants: 696 nursing home residents. Measurements: Measures used were EQ-5D for quality of life, Dementia Care Mapping for well/ill being, Resident Satisfaction Score and Person-Directed Dementia Care Assessment Tool as measure of person-centred care. Results: Mean EQ-5D-5L index was 0.096 (SD=0.45). Most residents had at least moderate problems in mobility (66.5%), self-care (63.6%) and usual activities (63.0%). Mean well/ill being score was 1.69 (SD=0.98). A state of neutrality (WIB=+1) (48%) was most observed, followed by well-being (WIB>+1) (29%) and ill-being (WIB<+1) (6%). High positive potential behaviors were recorded 37% of the time, while low/no positive potential behaviors amount to 39%. The overall resident satisfaction score was 3.43/5 with borderline satisfaction with environment, food and activities, and low satisfaction with lifestyle and quality of interaction. The overall level of person-centred care was modest 2.3/4. Activities scored highest while the weakest domain was Environment. The overall level of person-centred care was positively correlated with resident well/ill being score (F=4.43, p<0.001). Conclusions: A higher level of person-centred care is associated with better resident well-being. Beyond their physical and custodial needs, the residents’ psychosocial needs can be better fulfilled. The areas of person-centred care amenable to improvement relate to environment, staff knowledge and training. These findings can inform resident care planning, policy development, and future research to support nursing homes in their endeavour to move towards more holistic and person-centric care.

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