An objective scale for measuring discomfort in noncommunicative patients with advanced Alzheimer's disease was empirically generated from the perspectives of nursing staff practicing on special care Alzheimer units and was judged to have content validity. On the basis of a pilot test, the discomfort scale was reduced to nine items. Quantifiable scoring procedures and a rater training program were developed. The scale (DS-DAT) was tested longitudinally for 6 months with 82 subjects at two sites. Psychometric properties, measurement issues, and recommendations for use in practice and research are discussed.

Reliable and valid longitudinal residential histories are needed to assess interventions to reduce homelessness and increase community tenure. This study examined the test-retest reliability, sensitivity to change, and concurrent validity of the Residential Time-Line Follow-Back (TLFB) Inventory, a method used to record residential histories in the Collaborative Program to Prevent Homelessness (n ϭ 1,381). The Residential TLFB Inventory yielded temporally stable aggregate measures of duration in residential categories, and it revealed significant differences in change over time when contrasting study groups. A comparison of agency and participant data at one site A R T I C L EThis research was supported by the Center for Mental Health Services (CMHS) and Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA) (contract number 280-94-0008). This work is a result of the collaborative effort of the participants of the project's Residential Measures Subcommittee, whose contributions we gratefully acknowledge. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the views of the funding agency. For the SPSS syntax to compute the variables described in this paper, please contact Francine Williams at Policy Research Associates, Inc., Delmar, NY 12054 (phone: 518-439-7415, e-mail: fwilliams@prainc.com Increasing rates of homelessness attest to the continual challenges faced by service providers (National Coalition for the Homeless, 2001; U.S. Conference of Mayors, 2001). Individuals with psychiatric disabilities-an estimated 20-25% of the single adult homeless population, 30-70% of whom have substance use disorders-present agencies with complex needs (Fischer & Breakey, 1991;Koegel, Sullivan, Burnham, Morton, & Wenzel, 1999;Rahav & Link, 1995). Due to the cyclic nature of long-term homelessness often experienced by this dually diagnosed population, longitudinal research is necessary to investigate patterns of homelessness and residential instability and the services that are best suited to address their needs (Hopper, Jost, Hay, Welber, & Haugland, 1997). To this end, it is necessary to obtain reliable and valid data regarding histories of residential stability and homelessness in order to assess the effectiveness of any intervention directed at reducing homelessness.Studies on homelessness have differed, unfortunately, in their methods of measuring the key variables of homelessness and housing stability. Definitions of homelessness and housing stability have varied widely (Abdul Hamid, Wykes, & Stansfeld, 1993;Morrison, 1989), and the methodologies used to obtain data, as well as the samples studied, have been inconsistent (Newman, 2001). Studies of homelessness primarily use self-report and/or observer report to assess participants' homelessness or residential histories. Although several studies use institutional records or residential databases to supplement individual reports, such resources are often no...

Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.

A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospices care unfeasible. Similarly, the high proportion of for-profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end-stage dementia.