Aim: Determine which of three types of settings most cost effectively offer acceptable Quality of Life for persons with DS and AD.
Background: Providers have responded to AD among persons with DS by supporting ageing in place, creating specialized units or encouraging transfer to more restrictive settings with greater medical supports. However the question remains as to what specific care settings may be most useful in addressing and responding to dementia care needs of this increasingly at risk population in terms of both cost effectiveness and quality of life outcomes.
Method: Carers completed a battery of instruments on 92 persons with DS and AD drawn from 22 providers and served in community group homes, specialized dementia units or institutional and campus based settings. A three factor Quality of Life measure consisted of measures of confirmed dementia, functional, health and psychosocial status, and leisure participation (Factor 1), perceived difficulty in care (Factor 2) and the home environment (Factor 3). Cost of care over a three month period was also calculated. Cost and quality of life findings were then compared by type of setting.
Results: Quality of life was found to be higher in community and specialist dementia settings. Significant quality of life differences were found in the home environment. Costs were lower in institutional settings and comparable for community and specialist dementia settings.
Conclusions: All three types of settings appeared to be supporting comparable levels of need among persons with DS and AD. Historical concerns with more institutional settings remained, community settings were more challenged by changing staffing needs and specialist settings offered quality care but not dramatic improvements.