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OTA hopes that these) Tj -0.5384 -12.2018 TD 0.0409 Tc 1.2295 Tw (reports help to define and clarify the problems raised by Alzheimer\222s and other dementias and) Tj ET BT 0.934 0 0 0.9835 94.8 243.84 Tm -0.0213 Tc 0.8385 Tw (identify ways in which the Federal Government can assist in solving them.) Tj ET BT 0.8915 0 0 0.9835 117.12 225.84 Tm 0.0322 Tc 1.2021 Tw (OTA was aided in the preparation of this report by members and staff of the Alzheimer\222s) Tj ET BT 0.9835 0 0 0.9835 94.8 214.08 Tm 0.0263 Tc 0.3032 Tw (Association, staff of the National Institute on Aging, special care unit researchers, State) Tj ET BT 0.934 0 0 0.9835 95.04 202.08 Tm -0.0264 Tc 1.1799 Tw (officials, and others. OTA wishes to thank all these individuals. 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Tj ET BT 0.8915 0 0 0.9835 503.28 444.24 Tm 0.2243 Tc 0 Tw (23) Tj ET BT 0.934 0 0 0.9835 118.8 432.48 Tm -0.0232 Tc 1.3973 Tw (Findings From Research on Special Care Units) Tj ET BT 0.8491 0 0 0.9835 333.12 432.24 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 503.52 432.48 Tm 0.2182 Tc 0 Tw (24) Tj ET BT 0.9835 0 0 0.9835 108 420.72 Tm -0.0071 Tc -0.0319 Tw (THE REGULATORY ENVIRONMENT FOR SPECIAL CARE UNITS . . . . . . . . . . . . . . 32) Tj 11.2256 -12.2018 TD 0.0277 Tc 0.2814 Tw (The Nursing Home Reform Provisions of OBRA-87) Tj ET BT 0.8491 0 0 0.9835 357.12 408 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 504 408.48 Tm 0.0897 Tc 0 Tw (33) Tj ET BT 0.934 0 0 0.9835 119.04 396.48 Tm -0.02 Tc 0.7515 Tw (Existing State Regulations for Special Care Units) Tj ET BT 0.8491 0 0 0.9835 341.52 396.24 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 504.24 396.48 Tm 0.2243 Tc 0 Tw (34) Tj ET BT 0.934 0 0 0.9835 108 384.96 Tm 0.0163 Tc 0.7662 Tw (POLICY IMPLICATIONS . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 266.88 384.48 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 279.5434 0 TD 0.231 Tc 0 Tw (35) Tj ET BT 0.934 0 0 0.9835 119.28 372.72 Tm -0.0023 Tc 0.3424 Tw (Implications for Consumer Education About Special Care Units . . . . . . . . . . . . . . . . . . . 35) Tj 0.257 -12.4458 TD -0.0277 Tc 1.4878 Tw (Implications for Research on Special Care Units) Tj ET BT 0.8491 0 0 0.9835 338.4 360 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 504.72 360 Tm 0.0897 Tc 0 Tw (37) Tj ET BT 0.934 0 0 0.9835 119.52 348.24 Tm -0.0043 Tc 0.1646 Tw (Implications for Government Regulation of Special Care Units . . . . . . . . . . . . . . . . . . . . . 39) Tj 0 -12.2018 TD 0.0031 Tc 0.0945 Tw (Implications for Reimbursement for Special Care Units . . . . . . . . . . . . . . . . . . . . . . . . . . . 42) Tj ET BT 0.9835 0 0 0.9835 108.72 324.48 Tm -0.0187 Tc -0.0084 Tw (LEGAL AND ETHICAL ISSUES IN SPECIAL CARE UNITS . . . . . . . . . . . . . . . . . . . . ..43) Tj ET BT 0.934 0 0 0.9835 119.76 312.72 Tm -0.0404 Tc 2.0924 Tw (Issues With Respect to Locked Units) Tj ET BT 0.8491 0 0 0.9835 291.12 312 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 504.24 312.72 Tm 0.0497 Tc 0 Tw (44) Tj ET BT 0.934 0 0 0.9835 120 300.72 Tm -0.031 Tc 1.5341 Tw (Issues With Respect to Admission and Discharge) Tj ET BT 0.8491 0 0 0.9835 342.48 300 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 504.48 300.48 Tm 0.0497 Tc 0 Tw (44) Tj ET BT 0.934 0 0 0.9835 120 288.48 Tm -0.0075 Tc 0.0529 Tw (Issues With Respect to Consent for Research Participation . . . . . . . . . . . . . . . . . . . . . . . . . 45) Tj -11.563 -12.2018 TD 0.0075 Tc 2.0558 Tw (OTHER ISSUES OF IMPORTANCE TO NURSING HOME RESIDENTS) Tj 11.306 -11.9577 TD 0.0247 Tc 0.0184 Tw (WITH DEMENTIA . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 310.56 264.48 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 169.0262 0.244 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 504.72 264.96 Tm 0.2182 Tc 0 Tw (47) Tj ET BT 0.9835 0 0 0.9835 119.76 252.96 Tm 0.0177 Tc 0.3119 Tw (The Availability of Physicians\222 Services) Tj ET BT 0.8491 0 0 0.9835 305.28 252.48 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 504.72 253.2 Tm 0.2182 Tc 0 Tw (47) Tj -411.6428 -12.2018 TD -0.0219 Tc 1.5073 Tw (The Availability of Mental Health Services) Tj ET BT 0.8491 0 0 0.9835 315.36 240.96 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 504.72 241.2 Tm 0.0897 Tc 0 Tw (48) Tj -411.6428 -12.4458 TD -0.0388 Tc 2.5918 Tw (The Use of Psychotropic Medications) Tj ET BT 0.8491 0 0 0.9835 291.36 228.72 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 504.96 229.2 Tm 0.2182 Tc 0 Tw (49) Tj ET BT 0.9835 0 0 0.9835 109.2 216.96 Tm 0.0203 Tc 3.4207 Tw (ALTERNATES TO SPECIAL CARE UNITS) Tj ET BT 0.8491 0 0 0.9835 329.04 216.96 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 504.96 217.2 Tm 0.2182 Tc 0 Tw (49) Tj -411.6428 -12.4458 TD -0.0269 Tc 1.0817 Tw (Initiatives To Reduce The Use of Physical Restraints for All Nursing Home Residents. 50) Tj 0 -12.2018 TD 0.0079 Tc 0.1465 Tw (Dementia Training Programs for Nursing Home Staff Members . . . . . . . . . . . . . . . . . . . . 50) Tj 0.5139 -12.2018 TD -0.0289 Tc 1.4569 Tw (Specialized Programs for Residents With Dementia in Nonspecialized Nursing) Tj 11.563 -12.2018 TD -0.0276 Tc 2.644 Tw (Home Units) Tj ET BT 0.8491 0 0 0.9835 191.76 168.72 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 253.2567 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . .) Tj 116.4529 0.244 TD 0.231 Tc 0 Tw (51) Tj ET BT 0.934 0 0 0.9835 120.96 156.72 Tm 0.0018 Tc 0.0429 Tw (Specialized Living Arrangements Outside Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . 51) Tj -11.563 -11.9577 TD 0.0322 Tc 0.0104 Tw (CONCLUSION . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 249.36 144.96 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 242.2333 0.244 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . .) Tj ET BT 0.8104 0 0 0.9795 505.68 145.2 Tm /F7 12 Tf 0.512 Tc 0 Tw (52) Tj ET BT 0.9795 0 0 0.9795 303.6 117.6 Tm 0.074 Tc (Boxes) Tj ET BT 0.9444 0 0 0.9835 109.68 105.12 Tm /F5 10 Tf -0.0136 Tc (B) Tj ET BT 0.9445 0 0 1.0281 115.2 105.12 Tm /F5 7 Tf 0.1609 Tc (OX) Tj ET BT 0.9444 0 0 0.9835 497.04 106.08 Tm /F5 10 Tf 0.0063 Tc (Page) Tj ET BT 0.934 0 0 0.9835 111.12 93.36 Tm /F4 10 Tf -0.012 Tc 1.7095 Tw (l-A. A Special Care Unit in Lynden, Washington) Tj ET BT 0.8491 0 0 0.9835 334.32 93.6 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.7642 0 0 0.9835 511.44 94.08 Tm 0.0897 Tc 0 Tw (5) Tj ET BT 0.934 0 0 0.9835 111.12 81.6 Tm -0.0251 Tc 1.2576 Tw (l-B. The Development of Excess Disability in a Nursing Home Resident With Dementia. 14) Tj 0 -12.4458 TD -0.0214 Tc 0.6607 Tw (l-C. The Use of Behavioral Interventions With a Nursing Home Resident With Dementia. 18) Tj ET endstream endobj 20 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 21 0 obj <>stream 1.68 w 1 j 0 0 0 RG 61.92 640.56 m 540.72 640.56 l S 0.72 w 64.32 56.16 m 314.64 56.16 l S 313.2 55.92 m 543.36 55.92 l S BT 0.9341 0 0 0.9939 480.24 677.04 Tm 0 0 0 rg /F6 14 Tf -0.0647 Tc 0.1653 Tw (Chapter ) Tj ET BT 0.925 0 0 0.99 530.4 677.04 Tm /F8 16 Tf 0.0009 Tc 0 Tw (1) Tj ET BT 0.9857 0 0 0.9857 280.56 653.28 Tm /F6 18 Tf 0.03 Tc 0.7402 Tw (Overview and Policy Implications) Tj ET BT 0.9663 0 0 0.9939 126 596.16 Tm /F6 14 Tf 0.2862 Tc 0 Tw (INTRODUCTION) Tj ET BT 0.934 0 0 0.9835 73.44 578.64 Tm /F4 10 Tf -0.023 Tc 0.8689 Tw (At least half of all nursing home residents in the) Tj ET BT 0.9835 0 0 0.9835 62.88 566.4 Tm 0.0367 Tc 2.4279 Tw (United States have dementia. As awareness of) Tj ET BT 0.934 0 0 0.9835 62.64 554.4 Tm -0.0269 Tc 2.3862 Tw (Alzheimer\222s disease and other diseases that cause) Tj ET BT 0.9835 0 0 0.9835 62.88 542.64 Tm 0.0284 Tc 1.1987 Tw (dementia has increased in recent years, so have) Tj 0 -12.4458 TD 0.0263 Tc 2.2351 Tw (complaints and concerns about the quality and) Tj ET BT 0.934 0 0 0.9835 63.12 518.4 Tm -0.0463 Tc 1.0366 Tw (appropriateness of the care provided for individuals) Tj -0.257 -11.9577 TD -0.0171 Tc 1.0542 Tw (with dementia by most nursing homes. In response) Tj ET BT 0.9835 0 0 0.9835 63.12 494.4 Tm 0.0188 Tc 1.5106 Tw (to these complaints and concerns, some nursing) Tj ET BT 0.934 0 0 0.9835 63.12 482.4 Tm -0.0165 Tc 1.4942 Tw (homes have established a special care unit-that is,) Tj 0.257 -11.9577 TD -0.0112 Tc 0.6671 Tw (a physically separate unit in the nursing home that) Tj ET BT 0.9835 0 0 0.9835 63.12 458.88 Tm 0.0287 Tc -0.1264 Tw (provides, or claims to provide, care that meets the) Tj 0.4881 -12.4458 TD 0.0334 Tc 0.6416 Tw (special needs of individuals with dementia. Such) Tj ET BT 0.8915 0 0 0.9835 63.36 434.88 Tm 0.0603 Tc 0.5605 Tw (units are referred to generically as ) Tj ET BT 0.9014 0 0 0.9812 214.56 434.88 Tm /F5 11 Tf -0.0359 Tc 2.0809 Tw (special care units,) Tj ET BT 0.9443 0 0 0.9812 63.6 422.64 Tm 0.0121 Tc 1.5563 Tw (dedicated care units, Alzheimer\222s units,) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 238.56 422.64 Tm /F4 10 Tf -0.0976 Tc 0.1494 Tw (or ) Tj ET BT 0.9443 0 0 0.9812 250.32 422.64 Tm /F5 11 Tf 0.2302 Tc 0 Tw (dementia) Tj ET BT 0.9812 0 0 0.9812 63.84 410.88 Tm 0.0909 Tc -0.1536 Tw (units. ) Tj ET BT 0.9835 0 0 0.9835 90.72 410.88 Tm /F4 10 Tf 0.018 Tc 0.0066 Tw (OTA uses the term ) Tj ET BT 0.9812 0 0 0.9812 180.24 410.88 Tm /F5 11 Tf 0.0955 Tc -0.0361 Tw (special care units in ) Tj ET BT 0.9835 0 0 0.9835 272.4 410.88 Tm /F4 10 Tf 0.0062 Tc 0 Tw (this) Tj ET BT 0.8915 0 0 0.9835 63.36 399.12 Tm 0.0267 Tc (report.) Tj ET BT 0.934 0 0 0.9835 74.64 377.04 Tm -0.0251 Tc 1.5768 Tw (The number of special care units for individuals) Tj -11.563 -12.4458 TD -0.0316 Tc 1.7673 Tw (with dementia has increased rapidly over the past) Tj 0.257 -11.7137 TD -0.022 Tc 1.3532 Tw (few years. No comprehensive data are available on) Tj ET BT 0.9835 0 0 0.9835 64.08 341.28 Tm 0.0313 Tc 0.4506 Tw (the number of special care units before 1987, but) Tj ET BT 0.934 0 0 0.9835 64.08 329.52 Tm -0.0266 Tc 1.4866 Tw (information from several studies indicates that the) Tj ET BT 0.9835 0 0 0.9835 64.08 317.28 Tm 0.0253 Tc 0.5744 Tw (great majority of existing special care units were) Tj 0 -11.9577 TD 0.0345 Tc 2.845 Tw (established after 1983 \(181,413,485\). The frost) Tj 0 -12.2018 TD 0.0273 Tc 0.9558 Tw (comprehensive data on special care units in this) Tj T* 0.0336 Tc 2.7666 Tw (country were collected in 1987, as part of the) Tj ET BT 0.934 0 0 0.9835 64.08 269.76 Tm -0.0161 Tc 1.2955 Tw (National Medical Expenditure Survey. That survey) Tj ET BT 0.9835 0 0 0.9835 64.08 258 Tm 0.0313 Tc 0.8472 Tw (found that 1668 nursing homes\2278 percent of all) Tj ET BT 0.8915 0 0 0.9835 127.92 245.28 Tm 0.0409 Tc 1.1207 Tw (\227had a special care unit for individu-) Tj -71.6057 0.244 TD 0.0527 Tc 2.2739 Tw (nursing homes) Tj 0.5384 -11.9577 TD 0.0392 Tc 0.285 Tw (als with dementia in 1987, and that these special care) Tj ET BT 0.934 0 0 0.9835 64.08 221.52 Tm -0.0033 Tc 0.5623 Tw (units accounted for more than 53,000 nursing home) Tj 0 -12.4458 TD -0.0061 Tc 0.3726 Tw (beds \(249\). The survey also found that an additional) Tj 1.5417 -11.9577 TD -0.0088 Tc 1.4124 Tw (1444 nursing homes planned to establish a special) Tj ET BT 0.8915 0 0 0.9835 64.56 185.28 Tm 0.0458 Tc 0.6934 Tw (care unit by 1991, and 535 of the nursing homes that) Tj ET BT 0.934 0 0 0.9835 64.8 173.04 Tm -0.0126 Tc 1.3717 Tw (already had a special care unit in 1987 planned to) Tj ET BT 0.9835 0 0 0.9835 64.56 161.28 Tm 0.0391 Tc 1.49 Tw (expand the unit by 1991. If all these plans had) Tj -0.244 -11.9577 TD 0.0206 Tc 0.1748 Tw (materialized, more than 3100 nursing homes\22714) Tj ET BT 0.934 0 0 0.9835 64.08 137.52 Tm -0.0235 Tc 0.873 Tw (percent of all nursing homes in the United States\227) Tj ET BT 0.9835 0 0 0.9835 64.8 125.76 Tm 0.0328 Tc 1.0083 Tw (would have had a special care unit in 1991, and) Tj ET BT 0.934 0 0 0.9835 64.8 113.76 Tm -0.0002 Tc 0.3754 Tw (almost 100,000 nursing home beds would have been) Tj -0.257 -11.9577 TD -0.0262 Tc 0.5012 Tw (in special care units.) Tj ET BT 0.9835 0 0 0.9835 75.36 79.92 Tm 0.0278 Tc 1.2342 Tw (When published in 1990, the figures from the) Tj -9.7614 -12.2018 TD 0.0338 Tc 1.1375 Tw (1987 National Medical Expenditure Survey sur-) Tj 251.8448 540.783 TD 0.0368 Tc 0.7603 Tw (prised researchers and others because they were) Tj 0.244 -12.2018 TD 0.0123 Tc 2.0866 Tw (much higher than any previous estimates. Two) Tj ET BT 0.934 0 0 0.9835 314.16 575.76 Tm -0.0361 Tc 1.3683 Tw (studies conducted since then indicate that the true) Tj ET BT 0.9835 0 0 0.9835 313.92 564 Tm 0.0267 Tc 1.0959 Tw (number and proportion of nursing homes with a) Tj 0.4881 -12.6899 TD 0.033 Tc 2.3503 Tw (special care unit are probably somewhat lower) Tj 0.244 -11.9577 TD 0.0314 Tc 2.9039 Tw (\(194,247\). On the basis of these studies, OTA) Tj ET BT 0.934 0 0 0.9835 314.16 527.52 Tm -0.0088 Tc 0.6325 Tw (estimates that 10 percent of all U.S. nursing homes) Tj -0.257 -11.7137 TD -0.0103 Tc 1.0516 Tw (had at least one special care unit in 1991.) Tj ET BT 0.9557 0 0 1.08 500.88 520.8 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (1 ) Tj ET BT 0.934 0 0 0.9835 504.24 516 Tm /F4 10 Tf 0.1925 Tc 0 Tw (Regard-) Tj ET BT 0.8915 0 0 0.9835 314.4 503.76 Tm 0.0362 Tc 0.2734 Tw (less of the precise figures, however, it is clear that the) Tj ET BT 0.9835 0 0 0.9835 314.16 491.76 Tm 0.0267 Tc 1.0959 Tw (number and proportion of nursing homes with a) Tj ET BT 0.934 0 0 0.9835 314.88 479.52 Tm -0.0334 Tc 0.7486 Tw (special care unit are growing rapidly.) Tj ET BT 0.8915 0 0 0.9835 325.44 461.28 Tm 0.0526 Tc 1.0434 Tw (The proliferation of special care units creates both) Tj ET BT 0.9835 0 0 0.9835 314.4 449.28 Tm 0.0369 Tc 1.5736 Tw (problems and opportunities for individuals with) Tj ET BT 0.8915 0 0 0.9835 314.64 437.04 Tm 0.0335 Tc 1.4494 Tw (dementia, their families, and many other people and) Tj 0.2692 -12.2018 TD 0.0413 Tc 0.4024 Tw (organizations that have an interest in the quality and) Tj 0.2692 -12.2018 TD 0.0451 Tc 1.116 Tw (appropriateness of nursing home care for individuals) Tj ET BT 0.9835 0 0 0.9835 315.12 401.28 Tm 0.0336 Tc 0.1534 Tw (with dementia. These other interested parties in-) Tj ET BT 0.934 0 0 0.9835 314.88 389.28 Tm -0.0087 Tc 0.825 Tw (clude: nursing home administrators and staff mem-) Tj 0 -12.2018 TD -0.0394 Tc 0.6744 Tw (bers who provide care for individuals with dementia) Tj ET BT 0.9835 0 0 0.9835 315.12 365.28 Tm 0.023 Tc 0.8861 Tw (both in and out of special care units; physicians,) Tj ET BT 0.934 0 0 0.9835 315.12 353.52 Tm -0.0298 Tc 1.1046 Tw (nurses, social workers, hospital discharge planners,) Tj 0.257 -11.9577 TD -0.0182 Tc 1.4776 Tw (community agencies, Alzheimer\222s Association chap-) Tj ET BT 0.9835 0 0 0.9835 315.36 329.76 Tm 0.0259 Tc 0.0392 Tw (ters, and other voluntary organizations that refer) Tj ET BT 0.934 0 0 0.9835 314.88 317.76 Tm -0.0325 Tc 1.3644 Tw (people with dementia and their families to nursing) Tj ET BT 0.8915 0 0 0.9835 315.36 306 Tm 0.0501 Tc 1.7384 Tw (homes; and nursing home licensing and certification) Tj ET BT 0.9835 0 0 0.9835 315.6 294 Tm 0.016 Tc 1.1556 Tw (officials, nursing home surveyors, and long-term) Tj ET BT 0.934 0 0 0.9835 315.36 282 Tm -0.0285 Tc 0.7606 Tw (care ombudsmen who are responsible for regulating) Tj 0.257 -11.7137 TD -0.0132 Tc 0.683 Tw (and monitoring the quality of nursing home care.) Tj ET BT 0.9835 0 0 0.9835 326.16 251.76 Tm 0.0413 Tc 2.586 Tw (The problems created by the proliferation of) Tj -10.2495 -12.4458 TD 0.0269 Tc 0.2822 Tw (special care units are due primarily to the lack of) Tj ET BT 0.8915 0 0 0.9835 315.84 227.52 Tm 0.0523 Tc 0.4199 Tw (agreement about what a special care unit is or should) Tj ET BT 0.9835 0 0 0.9835 315.6 215.04 Tm 0.0441 Tc 1.0171 Tw (be and the related lack of standards to evaluate) Tj ET BT 0.934 0 0 0.9835 316.08 203.28 Tm -0.0236 Tc 1.6853 Tw (special care units. Existing special care units vary) Tj ET BT 0.9835 0 0 0.9835 316.08 191.04 Tm 0.019 Tc 1.4698 Tw (greatly in every respect, including their guiding) Tj ET BT 0.934 0 0 0.9835 315.6 179.04 Tm -0.0221 Tc 0.788 Tw (philosophy, physical design, staff composition, staff-) Tj ET BT 0.8915 0 0 0.9835 316.08 167.04 Tm 0.0266 Tc 1.5404 Tw (to-resident ratio, activity programs, and patient care) Tj ET BT 0.934 0 0 0.9835 315.6 155.52 Tm 0.0531 Tc 0.3735 Tw (practices \(64,181,194,199,232,256,275,332,4 13,485,) Tj 0 -11.9577 TD -0.0261 Tc 1.4677 Tw (494\). Despite this variation, the operators of virtu-) Tj ET BT 0.9835 0 0 0.9835 316.08 131.76 Tm 0.0313 Tc 0.4288 Tw (ally all special care units express confidence that) Tj 0 -11.9577 TD 0.0382 Tc -0.0314 Tw (they are providing appropriate care for their resi-) Tj 0 -12.2018 TD 0.0319 Tc 1.2533 Tw (dents. According to researchers who studied the) Tj ET BT 0.934 0 0 0.9835 316.08 96.24 Tm -0.0287 Tc 1.1676 Tw (differences among special care units:) Tj ET BT 0.8491 0 0 0.9835 336.48 78.48 Tm 0.0514 Tc 0.3478 Tw (The differences are of such significance that they) Tj -12.1541 -11.2256 TD 0.0213 Tc 0.9384 Tw (appear to place special units in direct opposition to) Tj ET q 0.96 0 0 -4.32 78.96 50.16 cm BI /W 9 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID {?>>>>>>>>>>>~~ EI Q BT 0.1698 0 0 0.9835 78.96 43.92 Tm 3 Tr 0.0897 Tc 0 Tw (1) Tj 0 Tr ET BT 0.6368 0 0 0.9835 79.92 43.92 Tm -0.0625 Tc 1.8389 Tw ( As discussed later in the chapter, tbis number includes nursing homes that place some of their residents with dementia in a physically distinct group) Tj ET BT 0.6793 0 0 0.9835 64.56 34.8 Tm 0.0237 Tc 0.01 Tw (or cluster ) Tj ET q 4.08 0 0 -5.28 96.48 40.08 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>?>>>???????~?@ EI Q BT 0.4245 0 0 0.9835 96.48 34.8 Tm 3 Tr 0.1723 Tc 0 Tw (in) Tj 0 Tr ET BT 0.6793 0 0 0.9835 100.56 34.8 Tm -0.0321 Tc 0.7546 Tw ( a unit that also serves some nondemented residents.) Tj ET BT 0.8915 0 0 0.9835 295.92 16.32 Tm 0.0897 Tc 0 Tw (\2263\226) Tj ET endstream endobj 22 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 23 0 obj <>stream 0.72 w 1 j 0 0 0 RG 68.16 686.4 m 546.72 686.4 l S BT 0.9835 0 0 0.9835 68.16 692.64 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (4 ) Tj ET BT 0.9598 0 0 0.9598 75.6 692.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 81.84 692.64 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 135.6 692.64 Tm /F5 11 Tf 0.0681 Tc -0.0693 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 234.24 692.64 Tm /F5 10 Tf 0.0229 Tc 0.1597 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.8491 0 0 0.9835 78.48 653.52 Tm /F4 10 Tf 0.0543 Tc 2.1855 Tw (each other. Nevertheless, without exception, their) Tj 0.2827 -11.2256 TD 0.0418 Tc 0.4196 Tw (proponents have hailed the success of the units \(332\).) Tj ET BT 0.9835 0 0 0.9835 79.92 622.8 Tm 0.0365 Tc 0.2492 Tw (Many people have told OTA that some nursing) Tj ET BT 0.8915 0 0 0.9835 68.88 611.28 Tm 0.038 Tc 0.1368 Tw (homes that have a special care unit just use the words) Tj ET BT 0.9014 0 0 0.9812 69.12 599.04 Tm /F5 11 Tf -0.0377 Tc 1.2842 Tw (special care) Tj 0 Tc -0.0889 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 121.92 599.04 Tm /F4 10 Tf 0.0421 Tc 1.0744 Tw (as a marketing tool and actually provide) Tj ET BT 0.934 0 0 0.9835 69.12 587.28 Tm -0.039 Tc 0.9309 Tw (no special services for their residents. Most nursing) Tj ET BT 0.8915 0 0 0.9835 69.36 575.52 Tm 0.0706 Tc 0.7883 Tw (homes charge more for care in their special care unit) Tj 0.2692 -11.9577 TD 0.0293 Tc 0.5953 Tw (than in other parts of the facility \(413,494\). In special) Tj 0.2692 -12.2018 TD 0.037 Tc 1.5609 Tw (care units that provide no special services, individu-) Tj ET BT 0.934 0 0 0.9835 70.08 540 Tm -0.0154 Tc 0.8322 Tw (als with dementia and their families may pay more) Tj ET BT 0.8915 0 0 0.9835 69.84 528 Tm 0.0596 Tc 0.5313 Tw (but receive no better care than they would in another) Tj ET BT 0.9835 0 0 0.9835 69.84 516.24 Tm 0.0172 Tc 0.9531 Tw (unit in that nursing home or a different nursing) Tj 0.244 -12.2018 TD 0.0238 Tc 1.2208 Tw (home. At worst, they may pay more and receive) Tj ET BT 0.934 0 0 0.9835 70.32 492.24 Tm -0.0376 Tc 0.5134 Tw (inferior care in the special care unit.) Tj 11.563 -19.7669 TD -0.0174 Tc 2.0335 Tw (Many families of individuals with dementia are) Tj ET BT 0.8915 0 0 0.9835 70.56 460.8 Tm 0.0466 Tc 1.2488 Tw (extremely concerned about the quality and appropri-) Tj ET BT 0.934 0 0 0.9835 70.8 448.56 Tm -0.0302 Tc 0.7839 Tw (ateness of services they may use for these individu-) Tj ET BT 0.8915 0 0 0.9835 70.8 436.8 Tm 0.0315 Tc 1.1132 Tw (als \(166,5 13\). As a result, they are likely to respond) Tj ET BT 0.9835 0 0 0.9835 70.56 424.8 Tm 0.0167 Tc 0.4436 Tw (enthusiastically to claims of \223special care. \222 With-) Tj ET BT 0.8915 0 0 0.9835 71.04 413.04 Tm 0.0378 Tc 0.4062 Tw (out standards by which to evaluate special care units,) Tj 0 -11.9577 TD 0.0377 Tc 1.2588 Tw (families and individuals and organizations that refer) Tj ET BT 0.934 0 0 0.9835 70.56 389.28 Tm -0.0185 Tc 0.652 Tw (patients and their families to nursing homes cannot) Tj ET BT 0.9835 0 0 0.9835 70.56 377.28 Tm 0.0184 Tc 1.941 Tw (know with any certainty whether the units are) Tj ET BT 0.8915 0 0 0.9835 70.8 365.52 Tm 0.0461 Tc 1.0507 Tw (providing better care than other nursing home units.) Tj ET BT 0.934 0 0 0.9835 82.08 346.08 Tm -0.0495 Tc 1.9393 Tw (Despite these problems, the proliferation of spe-) Tj ET BT 0.8915 0 0 0.9835 71.28 333.84 Tm 0.0418 Tc 1.5554 Tw (cial care units also creates opportunities for individ-) Tj ET BT 0.934 0 0 0.9835 71.52 321.84 Tm -0.0222 Tc 1.4268 Tw (uals with dementia, their families, and others who) Tj ET BT 0.8915 0 0 0.9835 71.76 309.6 Tm 0.0501 Tc 1.2 Tw (are concerned about the quality and appropriateness) Tj -0.2692 -12.2018 TD 0.0484 Tc 0.9664 Tw (of the nursing home care available to these individu-) Tj 0.5384 -12.2018 TD 0.0307 Tc 0.7844 Tw (als. Even without standards by which to evaluate the) Tj ET BT 0.934 0 0 0.9835 71.52 273.6 Tm -0.0291 Tc 0.3901 Tw (units, it is obvious to all observers that some special) Tj ET BT 0.8915 0 0 0.9835 71.76 261.36 Tm 0.0511 Tc 0.1558 Tw (care units are providing better care for their residents) Tj ET BT 0.934 0 0 0.9835 71.76 249.36 Tm -0.0342 Tc 0.8523 Tw (with dementia than these individuals would receive) Tj ET BT 0.8915 0 0 0.9835 72 237.6 Tm 0.0412 Tc 1.21 Tw (inmost nursing homes. One such unit is described in) Tj ET BT 0.9835 0 0 0.9835 71.76 225.6 Tm 0.039 Tc 4.0118 Tw (box l-A.) Tj ET BT 0.934 0 0 0.9835 82.8 205.92 Tm -0.0282 Tc 0.589 Tw (The proliferation of special care units means that) Tj ET BT 0.9835 0 0 0.9835 72 193.68 Tm 0.031 Tc 1.1729 Tw (for the first time in the United States there are) Tj ET BT 0.934 0 0 0.9835 72 182.16 Tm -0.0126 Tc 2.3195 Tw (numerous nursing homes in which administrators) Tj 0.5139 -12.4458 TD -0.0236 Tc 1.1408 Tw (and staff members are concentrating on developing) Tj ET BT 0.9835 0 0 0.9835 72 157.92 Tm 0.0358 Tc 2.272 Tw (better methods of care for their residents with) Tj 0.4881 -11.9577 TD 0.0383 Tc 1.4327 Tw (dementia. This attention to the special needs of) Tj ET BT 0.934 0 0 0.9835 72.24 134.4 Tm -0.0341 Tc 1.1092 Tw (nursing home residents with dementia reverses the) Tj ET BT 0.9835 0 0 0.9835 72.48 122.64 Tm 0.0138 Tc 1.5157 Tw (long-standing reality in many nursing homes in) Tj ET BT 0.934 0 0 0.9835 72.48 110.88 Tm -0.0401 Tc 1.212 Tw (which the special needs of these residents have not) Tj 0 -12.2018 TD -0.0302 Tc 2.0044 Tw (been recognized and the residents frequently have) Tj 0 -11.9577 TD -0.0326 Tc 0.7405 Tw (not even been identified as individuals with demen-) Tj ET BT 0.8066 0 0 0.9835 72.72 75.12 Tm 0.0206 Tc 0 Tw (tia.) Tj ET BT 0.9835 0 0 0.9835 83.52 55.92 Tm 0.0234 Tc 0.8552 Tw (This OTA report discusses the complaints and) Tj ET BT 0.934 0 0 0.9835 72.48 43.68 Tm -0.0346 Tc 1.4768 Tw (concerns about the care provided for nursing home) Tj ET BT 0.8915 0 0 0.9835 319.44 652.56 Tm 0.022 Tc 0.8278 Tw (residents with dementia that have led to the develop-) Tj ET BT 0.934 0 0 0.9835 319.68 640.56 Tm -0.0392 Tc 1.6285 Tw (ment of special care units, the theoretical concepts) Tj ET BT 0.9835 0 0 0.9835 319.92 628.56 Tm 0.0369 Tc 0.3185 Tw (that underlie their design and operation, and the) Tj ET BT 0.8915 0 0 0.9835 320.16 616.8 Tm 0.021 Tc 1.848 Tw (findings of studies that describe and evaluate them.) Tj ET BT 0.934 0 0 0.9835 319.92 604.8 Tm -0.0348 Tc 0.7673 Tw (The report analyzes the problems and opportunities) Tj ET BT 0.8915 0 0 0.9835 320.4 592.8 Tm 0.0473 Tc 1.3378 Tw (created by the proliferation of special care units and) Tj ET BT 0.9835 0 0 0.9835 320.64 580.8 Tm 0.0197 Tc 1.0681 Tw (discusses the ways in which government has re-) Tj 0.244 -12.2018 TD 0.0529 Tc 0.9298 Tw (sponded or could respond to these problems and) Tj ET BT 0.8915 0 0 0.9835 320.64 557.28 Tm 0.0148 Tc 0 Tw (opportunities.) Tj ET BT 0.9795 0 0 0.9795 375.12 533.52 Tm /F7 12 Tf 0.0467 Tc 1.1165 Tw (Congressional Requests) Tj ET BT 0.9835 0 0 0.9835 331.92 515.52 Tm /F4 10 Tf 0.036 Tc 2.3473 Tw (This report was requested by Senator David) Tj ET BT 0.8915 0 0 0.9835 321.12 503.52 Tm 0.0446 Tc 1.3215 Tw (Pryor, chairman of the Senate Special Committee on) Tj ET BT 0.9835 0 0 0.9835 321.12 491.76 Tm 0.021 Tc 2.3219 Tw (Aging, and Congresswoman Olympia J. Snowe,) Tj ET BT 0.934 0 0 0.9835 321.12 479.52 Tm -0.0145 Tc 2.0304 Tw (ranking minority member of the Subcommittee on) Tj 0 -11.9577 TD -0.0344 Tc 1.3665 Tw (Human Services of the House Select Committee on) Tj 0.257 -12.4458 TD -0.0352 Tc 1.9914 Tw (Aging. The congressional letters of request for the) Tj 0 -12.2018 TD -0.04 Tc 1.1155 Tw (report stress the need for information about special) Tj 0.257 -12.2018 TD -0.0475 Tc 1.798 Tw (care units to inform Federal policy with respect to) Tj ET BT 0.8915 0 0 0.9835 321.84 419.76 Tm 0.0531 Tc 1.9504 Tw (consumer education, research, regulation, and reim-) Tj ET BT 0.9835 0 0 0.9835 321.84 407.52 Tm 0.0216 Tc 0.0273 Tw (bursement for special care units. Congresswoman) Tj ET BT 0.934 0 0 0.9835 322.08 396 Tm -0.0289 Tc 1.2321 Tw (Snowe noted the lack of information about the cost) Tj 0 -12.4458 TD -0.0353 Tc 1.4775 Tw (and effectiveness of special care units and stressed) Tj 0 -11.7137 TD -0.0241 Tc 1.2591 Tw (the need for quality standards to help families and) Tj ET BT 0.8915 0 0 0.9835 322.32 360 Tm 0.0305 Tc 0.9192 Tw (others evaluate the units and assess their options for) Tj ET BT 0.934 0 0 0.9835 322.08 348 Tm -0.0186 Tc 0.6888 Tw (nursing home care for an individual with dementia.) Tj ET BT 0.9835 0 0 0.9835 322.56 335.76 Tm 0.0417 Tc 0.976 Tw (Senator Pryor noted the problem of overuse and) Tj ET BT 0.934 0 0 0.9835 322.56 324 Tm -0.0145 Tc 0.9781 Tw (misuse of physical restraints in nursing homes and) Tj ET BT 0.9835 0 0 0.9835 322.56 311.76 Tm 0.0342 Tc 1.6809 Tw (asked whether restraints are used less often in) Tj 0.244 -12.4458 TD 0.0258 Tc 0.5782 Tw (special care units and, if so, what alternatives to) Tj ET BT 0.8915 0 0 0.9835 322.32 288 Tm 0.04 Tc 0.9422 Tw (restraints are being used.) Tj ET BT 0.9795 0 0 0.9795 399.6 263.52 Tm /F7 12 Tf 0.0735 Tc 1.5791 Tw (Policy Context) Tj ET BT 0.934 0 0 0.9835 333.6 245.52 Tm /F4 10 Tf -0.0239 Tc 0.8413 Tw (Nursing home care for individuals with dementia) Tj ET BT 0.8915 0 0 0.9835 323.04 234 Tm 0.0424 Tc 1.175 Tw (is an important public policy issue for three reasons.) Tj 0.2692 -12.4458 TD 0.0513 Tc 1.2286 Tw (One reason is that a large number and proportion of) Tj ET BT 0.9835 0 0 0.9835 323.04 209.76 Tm 0.0248 Tc 0.1623 Tw (nursing home residents have dementia. The 1985) Tj ET BT 0.8915 0 0 0.9835 323.04 197.52 Tm 0.0451 Tc 1.3851 Tw (National Nursing Home Survey, a large-scale survey) Tj ET BT 0.9835 0 0 0.9835 323.28 185.76 Tm 0.0345 Tc 1.1286 Tw (of a nationally representative sample of nursing) Tj ET BT 0.8915 0 0 0.9835 323.28 173.76 Tm 0.0329 Tc 1.4885 Tw (homes, found that 696,800 nursing home residents\227) Tj ET BT 0.934 0 0 0.9835 323.28 162 Tm -0.0179 Tc 1.0918 Tw (47 percent of all residents-had dementia \(469\). The) Tj 1.2848 -11.9577 TD 0.0157 Tc 1.0559 Tw (1985 survey also found that 922,500 nursing home) Tj ET BT 0.9835 0 0 0.9835 323.28 138.24 Tm 0.0449 Tc 3.0296 Tw (residents--62 percent of all residents\227were so) Tj ET BT 0.8915 0 0 0.9835 323.76 126.72 Tm 0.0336 Tc 2.5107 Tw (disoriented or memory-impaired that their perform-) Tj ET BT 0.9835 0 0 0.9835 324 115.2 Tm 0.0338 Tc 0.326 Tw (ance of the activities of daily living was impaired) Tj ET BT 0.934 0 0 0.9835 323.76 103.2 Tm 0.0004 Tc 1.2925 Tw (nearly every day \(467\). The 1987 National Medical) Tj 0 -11.9577 TD -0.0231 Tc 1.6541 Tw (Expenditure Survey, which also included a nation-) Tj 0.257 -12.4458 TD -0.0241 Tc 1.1413 Tw (ally representative sample of nursing homes, found) Tj -0.257 -12.2018 TD -0.0063 Tc 1.8503 Tw (that 637,600 nursing home residents-42 percent of) Tj ET BT 0.9835 0 0 0.9835 324 55.44 Tm 0.0286 Tc 0.5082 Tw (all nursing home residents\227had dementia \(237\).) Tj -0.4881 -12.4458 TD 0.0236 Tc 0.3669 Tw (These figures are based on judgments by nursing) Tj ET endstream endobj 24 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 25 0 obj <>stream 0.48 w 1 j 0 0 0 RG 62.4 675.12 m 540.72 675.12 l S 0.72 w 69.36 656.88 m 538.56 656.88 l S 64.32 657.6 m 64.32 33.6 l S 0.48 w 541.92 657.12 m 541.92 31.68 l S 0.72 w 69.12 32.64 m 538.56 32.64 l S BT 0.9835 0 0 0.9835 334.8 680.4 Tm 0 0 0 rg /F5 10 Tf 0.0087 Tc 4.0787 Tw (Chapter l-Overview and Policy Implications .5) Tj ET BT 0.8875 0 0 0.9795 177.12 632.88 Tm /F7 12 Tf -0.003 Tc 1.3282 Tw (Box 1-A\227A Special Care Unit in Lynden, Washington) Tj ET BT 0.8104 0 0 0.9795 94.56 613.2 Tm 0.0231 Tc 0.5237 Tw (The Christian ) Tj ET BT 0.8066 0 0 0.9835 155.28 613.2 Tm /F4 10 Tf 0.0526 Tc 0.986 Tw (Rest Home, a 150-bed nursing home in Lynden, WA has had a special care unit since 1988. The) Tj -98.7793 -10.9816 TD 0.055 Tc 1.4731 Tw (15-bed special care unit was established because of staff concerns about the safety and well-being of residents with) Tj ET BT 0.8491 0 0 0.9835 74.88 591.36 Tm 0.0433 Tc 0.2236 Tw (dementia who wander or have other behavioral symptoms that cannot be handled on the facility\222s regular units.) Tj ET BT 0.8066 0 0 0.9835 95.04 577.2 Tm 0.046 Tc 1.2474 Tw (The special care unit consists of resident bedrooms, an activity/dining area, and an enclosed outdoor courtyard.) Tj ET BT 0.8491 0 0 0.9835 77.52 566.4 Tm 0.0391 Tc 0.2276 Tw (Three physical changes were made to the building to create the unit: 1\) a set of doors was installed in an existing) Tj -3.1092 -10.9816 TD 0.0408 Tc 0.4914 Tw (unit to partition off the resident bedrooms and the activity/dining area; 2\) a door was made in an exterior wall to) Tj 0.5653 -10.9816 TD 0.0333 Tc 0.3381 Tw (give the residents access to the enclosed courtyard; and 3\) keypad-operated locks were installed on the exit doors;) Tj ET BT 0.8066 0 0 0.9835 75.12 533.52 Tm 0.0494 Tc 0.9966 Tw (the doors open when a number code is punched in on the keypad; the doors open automatically if the fire alarm goes) Tj ET BT 0.8491 0 0 0.9835 75.12 522.48 Tm 0.0394 Tc 0.8464 Tw (off. These physical changes cost less than $5000.) Tj ET BT 0.8915 0 0 0.9835 95.04 508.8 Tm 0.0352 Tc 0.6942 Tw (The special care unit functions as a self-contained entity, but technically it is part of an adjacent unit.) Tj ET BT 0.8066 0 0 0.9835 75.36 497.76 Tm 0.062 Tc 1.1023 Tw (Washington State regulations require each nursing home unit to have a separate nurses\222 station, a separate shower,) Tj ET BT 0.8491 0 0 0.9835 75.6 486.72 Tm 0.0367 Tc 0.0909 Tw (a separate bathroom for staff, and a separate utility room. To avoid the cost of these separate facilities, the special) Tj ET BT 0.8066 0 0 0.9835 75.6 475.68 Tm 0.0481 Tc 1.1382 Tw (care unit is considered part of the adjacent unit. Medications, medical treatments, and rehabilitative services for the) Tj 0.5951 -10.9816 TD 0.0553 Tc 1.4754 Tw (special care unit residents are delivered from the nurses\222 station on the adjacent unit.) Tj 24.6948 -14.3981 TD 0.0507 Tc 1.0703 Tw (Some residents of the special care unit have been transferred to the unit from other parts of the nursing home,) Tj ET BT 0.8491 0 0 0.9835 75.6 440.16 Tm 0.0399 Tc 0.3636 Tw (usually because they wander or have other behavioral symptoms that are more easily handled on the special care) Tj 0 -11.2256 TD 0.037 Tc 1.2026 Tw (unit. Other residents have been admitted directly from home. Although all the special care unit residents have) Tj 0.2827 -11.2256 TD 0.0345 Tc 0.4989 Tw (dementia in the opinion of the facility staff, a few have not had a diagnosis of dementia in their medical records,) Tj 23.4602 -14.1541 TD 0.0368 Tc 0.201 Tw (The objectives of the unit are to assure the residents\222 safety, to reduce agitation and behavioral symptoms, to) Tj ET BT 0.8066 0 0 0.9835 76.08 393.6 Tm 0.0457 Tc 1.3866 Tw (maintain independent functioning, and to improve the residents\222 quality of life. The staff members perceive resident) Tj ET BT 0.8915 0 0 0.9835 76.32 382.08 Tm 0.0275 Tc 0.3986 Tw (agitation and behavioral symptoms as meaningful expressions of feelings and unmet needs. They attempt to) Tj ET BT 0.8491 0 0 0.9835 76.32 370.8 Tm 0.0357 Tc 0.4938 Tw (understand and respond to those feelings and needs, in the belief that by doing so, they will reduce agitation and) Tj 0 -11.2256 TD 0.0173 Tc 0.9077 Tw (behavioral symptoms and improve the residents\222 quality of life.) Tj ET BT 0.8066 0 0 0.9835 96.48 345.84 Tm 0.0405 Tc 1.6869 Tw (The unit has a relaxed atmosphere. The residents appear calm and contented. They wander freely around the) Tj ET BT 0.8491 0 0 0.9835 76.32 335.04 Tm 0.029 Tc 0.2934 Tw (unit and respond to and sometimes initiate verbal interactions with staff members and visitors, Although many of) Tj 0 -10.9816 TD 0.0373 Tc 1.2729 Tw (the residents exhibited severe behavioral symptoms before coming to the unit, the unit staff reports that these) Tj 0.848 -10.7376 TD 0.0201 Tc 0.2096 Tw (symptoms are relatively easily managed in the special care unit.) Tj 22.8949 -14.3981 TD 0.0418 Tc 0.4324 Tw (The only type of physical restraint that is used on the unit is a geriatric chair with a tray table that keeps a) Tj -23.1775 -10.9816 TD 0.0313 Tc 0.114 Tw (resident from getting up. These \221geri-chairs\222 are used only temporarily and only with a doctor\222s order. Psychotropic) Tj ET BT 0.8066 0 0 0.9835 76.8 277.68 Tm 0.0551 Tc 1.1405 Tw (medications are used sparingly. They are used in low doses and only after other, behavioral interventions have been) Tj ET BT 0.8491 0 0 0.9835 76.56 266.88 Tm 0.0397 Tc 0.8991 Tw (tried. On Jan. 13, 1992,7 of the 15 residents were receiving psychotropic medications, including 4 residents who) Tj 0.5653 -11.7137 TD 0.0326 Tc 1.1371 Tw (were receiving antipsychotic medications.) Tj 23.4602 -13.91 TD 0.0439 Tc 0.7351 Tw (Formal and informal activity programs are conducted on the unit. Each afternoon there is a formal activity) Tj ET BT 0.8915 0 0 0.9835 77.04 230.4 Tm 0.0421 Tc 0.2668 Tw (program, such as a weekly Bible study and music group, a weekly reminiscence group, a weekly \223validation\224) Tj ET BT 0.9835 0 0 0.9835 77.04 219.36 Tm 0.0267 Tc 0.6078 Tw (group, and \223high tea\224-) Tj ET BT 0.8491 0 0 0.9835 179.28 219.12 Tm 0.0492 Tc 0.3348 Tw (a Monday afternoon event with real china and lace tablecloths. Other activities, such as) Tj ET BT 0.8066 0 0 0.9835 77.04 208.56 Tm 0.0486 Tc 0.9764 Tw (food preparation and singing, take place informally on the unit. One resident who likes to fold laundry is encouraged) Tj 0 -11.2256 TD -0.0305 Tc 0.5289 Tw (to do SO.) Tj ET BT 0.8491 0 0 0.9835 96.96 183.36 Tm 0.0382 Tc 0.5652 Tw (Each morning, there is a half-hour hymn sing for all residents of the nursing home. Most of the special care) Tj ET BT 0.8066 0 0 0.9835 77.04 172.56 Tm 0.0505 Tc 0.0885 Tw (unit residents are taken to this activity. In the afternoons, a few of the special care unit residents are taken to whatever) Tj ET BT 0.8491 0 0 0.9835 77.52 161.76 Tm 0.0287 Tc 0.5764 Tw (activity program is scheduled for the facility as a whole.) Tj ET BT 0.8066 0 0 0.9835 97.2 147.6 Tm 0.0529 Tc 0.7396 Tw (Family members are welcome on the unit at any time. The staff knows the residents\222 families and involves them) Tj -24.3973 -10.7376 TD 0.0474 Tc 1.2588 Tw (indecisions about the residents\222 care. The staff reports that family members often thank them for the help they give) Tj ET BT 0.8491 0 0 0.9835 77.28 126 Tm 0.0299 Tc 0.2169 Tw (the residents and the emotional support they give the family members. Two formal events-a Thanksgiving potluck) Tj 0.5653 -11.2256 TD 0.0275 Tc 0.732 Tw (supper and a summer barbecue-involve all the unit residents and their families.) Tj 22.8949 -14.3981 TD 0.0463 Tc 0.5556 Tw (During the day, the staff on the special care unit consists of one registered nurse, who functions as the unit) Tj ET BT 0.8066 0 0 0.9835 77.52 90 Tm 0.0458 Tc 0.7632 Tw (coordinator, and two muse aides. A licensed practical nurse and two other nurse aides take over for the evening shift.) Tj 0.2975 -11.2256 TD 0.0472 Tc 0.945 Tw (Since staff consistency is considered important for the unit, the unit staff members generally are not rotated to other) Tj ET BT 0.8491 0 0 0.9835 77.28 68.16 Tm 0.0414 Tc 0.3595 Tw (units, although staff rotation is the norm in the rest of the facility. The special care unit staff members work as a) Tj ET BT 0.8066 0 0 0.9835 77.04 57.36 Tm 0.0475 Tc 1.3519 Tw (team, with little apparent difference in status between the nurses and aides.) Tj ET BT 0.8027 0 0 0.9835 445.68 48.24 Tm /F5 10 Tf 0.0287 Tc 1.3499 Tw (\(Continued on next page\)) Tj ET endstream endobj 26 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 27 0 obj <>stream 0.48 w 1 j 0 0 0 RG 68.88 684 m 546.48 684 l S 0.72 w 69.12 662.4 m 544.56 662.4 l S 545.76 662.64 m 545.76 240.96 l S 70.8 662.16 m 70.8 241.68 l S 72 241.44 m 547.2 241.44 l S 72.72 71.76 m 550.32 71.76 l S BT 0.9835 0 0 0.9835 69.12 690.24 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (6 ) Tj ET BT 0.9598 0 0 0.9598 76.56 690.24 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 82.8 690.24 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 136.32 690.24 Tm /F5 11 Tf 0.0681 Tc -0.1305 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 234.72 690.24 Tm /F5 10 Tf 0.0229 Tc -0.0843 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.9261 0 0 0.9795 150.48 643.68 Tm /F7 12 Tf 0.0125 Tc 0.8724 Tw (Box l-A\227A Special Care Unit in Lynden, Washington-\(Continued\)) Tj ET BT 0.8066 0 0 0.9835 101.04 623.76 Tm /F4 10 Tf 0.0283 Tc 0.9415 Tw (Until recently, the unit had no separate staff for the night shift \(11:00 p.m. to 7:O0 &m.\). Before being admitted) Tj -24.3973 -11.4697 TD 0.0425 Tc 0.9889 Tw (to the special care unit, many of the residents had been awake, agitated, and difficult to manage at night. Once they) Tj 0.2975 -11.2256 TD 0.0556 Tc 0.8388 Tw (came onto the unit, these individuals began to sleep through the night, and the facility found it was possible to leave) Tj ET BT 0.8915 0 0 0.9835 81.6 590.88 Tm 0.0296 Tc 0.2454 Tw (the unit doors open and have the unit supervised by a staff member on the adjacent unit. Nevertheless, as of) Tj ET BT 0.8491 0 0 0.9835 81.6 579.6 Tm 0.0424 Tc 0.3129 Tw (December 1991, the facility had decided to assign an aide to the unit for the night shift.) Tj ET BT 0.8066 0 0 0.9835 101.52 565.92 Tm 0.0461 Tc 1.1084 Tw (The unit administrator and the facility\222s staff development coordinator stress the importance of training for the) Tj -24.0998 -10.7376 TD 0.0488 Tc 1.3407 Tw (special care unit staff, but they place greater emphasis on staff attitudes. The unit administrator believes there are) Tj ET BT 0.8491 0 0 0.9835 82.08 544.8 Tm 0.0449 Tc 0.2248 Tw (people who cannot be trained to work effectively on the special care unit because their attitudes and personalities) Tj 0.2827 -11.2256 TD 0.0442 Tc 0.1564 Tw (are not suited to the unit. Both the unit administrator and the staff development coordinator stress the need for a) Tj 0 -10.7376 TD 0.0289 Tc 0.8412 Tw (flexible, \223trial and error,\224 approach to dealing with an individual resident\222s problems and for staff members who) Tj ET BT 0.8066 0 0 0.9835 82.32 512.16 Tm 0.0464 Tc 2.2188 Tw (can implement this approach.) Tj 24.9924 -14.3981 TD 0.0516 Tc 1.5123 Tw (Several individuals besides the unit staff members are involved in the care of the residents. The weekly Bible) Tj ET BT 0.8491 0 0 0.9835 82.8 487.2 Tm 0.0442 Tc 0.7654 Tw (study and reminiscence groups are run by staff of the facility\222s Therapeutic Recreation Department. The weekly) Tj -0.2827 -10.9816 TD 0.032 Tc 0.1956 Tw (validation group is run by the director of the facility\222s Social Services Department, who is a psychiatric nurse. She) Tj 0.2827 -11.2256 TD 0.0383 Tc 1.0971 Tw (also works with the geriatric mental health team from the local community mental health center to assess and) Tj 0 -11.2256 TD 0.0156 Tc 0.8412 Tw (respond to residents\222 mental health needs. A monthly staff meeting is held to discuss problems and ideas among) Tj T* 0.0351 Tc 0.2659 Tw (the special care unit staff and other individuals who are involved in the residents\222 care.) Tj ET BT 0.8066 0 0 0.9835 102.96 429.12 Tm 0.0542 Tc 0.4405 Tw (Special care unit residents are discharged from the unit when the staff considers that the residents can no longer) Tj -24.9924 -10.7376 TD 0.0485 Tc 1.241 Tw (benefit from the unit. The unit discharge poilcies are explained to family members when a resident is admitted, but) Tj ET BT 0.8491 0 0 0.9835 83.04 407.52 Tm 0.0255 Tc 0.2032 Tw (many family members are upset when their relative is moved to a different unit, Several spouses of former special) Tj 0 -10.7376 TD 0.0295 Tc 0.5255 Tw (care unit residents have created an informal support group that meets almost daily in the facility, presumably to) Tj 0.2827 -10.9816 TD 0.0347 Tc 0.3715 Tw (replace the emotional support they previously received from the unit staff.) Tj ET BT 0.8915 0 0 0.9835 102.96 372 Tm 0.0359 Tc 0.0442 Tw (Discharges are hard on the unit staff members, since they often become attached to the resident and the) Tj ET BT 0.8491 0 0 0.9835 83.28 361.2 Tm 0.0344 Tc 0.4912 Tw (resident\222s family. The facility believes, however, that it is important to make space available in the unit for other) Tj 0.2827 -10.9816 TD 0.0306 Tc 0.5907 Tw (individuals who will benefit from it. Priority is given to individuals who are at risk because of wandering.) Tj ET BT 0.8066 0 0 0.9835 103.2 336 Tm 0.0437 Tc 0.9096 Tw (The Christian Rest Home is a private, nonprofit facility. The specia1 care unit serves both Medicaid and private) Tj ET BT 0.8491 0 0 0.9835 83.28 325.2 Tm 0.0517 Tc 0.3451 Tw (pay residents. Until January 1992, there was no additional charge for care in the unit. Starting in January 1992,) Tj ET BT 0.8066 0 0 0.9835 83.52 314.16 Tm 0.0505 Tc 0.5702 Tw (private pay residents are charged $10 more per day in the special care unit than they would be charged in other units) Tj ET BT 0.8491 0 0 0.9835 83.76 303.36 Tm 0.0349 Tc 0.2864 Tw (in the facility. The special care unit has a waiting list, as does the facility as a whole.) Tj ET q 32.64 0 0 -5.76 84 290.88 cm BI /W 184 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID "2!3>{?'?>~?|"|8? 8?@?>~~?>0?p?~~~>??????7ߌD@ D@ EI Q BT 0.6368 0 0 0.9835 84 284.88 Tm 3 Tr 0.0097 Tc 0 Tw (SfXJRC!E:) Tj 0 Tr ET BT 0.934 0 0 0.9835 116.64 284.88 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 19.2 0 0 -7.44 119.04 290.88 cm BI /W 109 /H 43 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?# ?`~?"~?x??@x_??~?_~>~>D@?~??~?~G??}G|?x~>???@ ?|~~|8 EI Q BT 0.6793 0 0 0.9835 119.04 284.88 Tm 3 Tr -0.0735 Tc 0 Tw (Angie) Tj 0 Tr ET BT 0.934 0 0 0.9835 138.24 284.88 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 29.04 0 0 -7.2 140.64 291.12 cm BI /W 164 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |Op"?? |?~>?????~~sG~~x??x?<>??<~O?>????0#9q_ @D EI Q BT 0.6368 0 0 0.9835 140.64 284.88 Tm 3 Tr -0.0262 Tc 0 Tw (Brouwer,) Tj 0 Tr ET BT 0.934 0 0 0.9835 169.68 284.88 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 26.64 0 0 -5.76 172.08 290.88 cm BI /W 151 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ~??~/?~?G~?O?#~??~~~???~??0???x~??~?|~?~=??/qN?p@`@  ?>???~~>@ EI Q BT 0.6368 0 0 0.9835 172.08 284.88 Tm 3 Tr -0.0148 Tc 0 Tw (Adtmms) Tj 0 Tr ET BT 0.7642 0 0 0.9835 188.64 284.64 Tm -0.1569 Tc 0.2501 Tw (\221 ) Tj ET BT 0.8495 0 0 1.08 192.24 289.44 Tm /F4 4 Tf 0.0804 Tc -0.0767 Tw (- ) Tj ET q 15.12 0 0 -6.24 194.16 289.68 cm BI /W 105 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>r" ???????~|?>?~ ?~~?~??~??~??~????~?G~??~?~?~????q~~?> EI Q BT 0.467 0 0 0.9835 194.16 284.64 Tm 3 Tr /F4 10 Tf 0.1167 Tc 0 Tw (trator,) Tj 0 Tr ET BT 0.7642 0 0 0.9835 209.28 284.64 Tm -0.0117 Tc 0.9239 Tw ( Christian Rest Home, ) Tj ET q 20.88 0 0 -7.2 294 290.4 cm BI /W 145 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  0<>/ f???????~?>~p??~~~~x<<~~>~>~>>???????B ?  EI Q BT 0.5519 0 0 0.9835 294 284.64 Tm 3 Tr -0.0305 Tc 0 Tw (Lynde~) Tj 0 Tr ET BT 0.7642 0 0 0.9835 314.88 284.64 Tm -0.0108 Tc 0.6871 Tw ( WA, personal ) Tj ET q 41.52 0 0 -7.92 368.88 290.64 cm BI /W 285 /H 43 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   @'D F~ p /???????~??σ>???_~??~~?~~~~~~?~~?~|?~|?~|??~>??}?~????_?|~00~1~@~ >@ EI Q BT 0.5519 0 0 0.9835 368.88 284.64 Tm 3 Tr -0.0221 Tc 0 Tw (communicatio~) Tj 0 Tr ET BT 0.7642 0 0 0.9835 410.4 284.64 Tm 0.0275 Tc 0.5113 Tw ( Jan. 13, 1992; Linda ) Tj ET q 15.12 0 0 -7.68 490.08 290.64 cm BI /W 104 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 7? t?| ?#O?~?=>?<_????????????|???7 EI Q BT 0.5094 0 0 0.9835 490.08 284.64 Tm 3 Tr 0.0015 Tc 0 Tw (Jager,) Tj 0 Tr ET BT 0.7642 0 0 0.9835 505.2 284.64 Tm 0.0182 Tc 0.0211 Tw ( RN, ) Tj ET q 12.72 0 0 -6.24 523.68 290.4 cm BI /W 89 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 80?????_?~?~?|~?p~? ?????? ?~????0?|???x????ϟp0D" EI Q BT 0.5519 0 0 0.9835 523.68 284.64 Tm 3 Tr 0.0377 Tc 0 Tw (Staff) Tj 0 Tr ET BT 0.7217 0 0 0.9835 119.52 275.76 Tm -0.0301 Tc 0.5854 Tw (Development Coordinator, Christian Rest Home, ) Tj ET q 18.96 0 0 -7.2 286.08 281.52 cm BI /W 145 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  0<?>? ????>?~?8???@~x?|<<||???>??????`" ???| EI Q BT 0.467 0 0 0.9835 286.08 275.76 Tm 3 Tr -0.0101 Tc 0 Tw (Lynde&) Tj 0 Tr ET BT 0.7217 0 0 0.9835 305.04 275.76 Tm -0.0136 Tc 0.2602 Tw ( WA, personal communications, Oct. 19, 1990, Dec. 30, 1991, Jam 13,) Tj -255.3862 -9.0293 TD 0.0394 Tc 0.1565 Tw (1992; Betty L) Tj ET BT 0.7279 0 0 1.0281 166.56 266.88 Tm /F4 7 Tf 0.0271 Tc -0.0058 Tw (OU ) Tj ET q 10.8 0 0 -6.48 176.16 272.64 cm BI /W 82 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <@!????????>?~??gp>?>??????r EI Q BT 0.467 0 0 0.9835 176.16 266.88 Tm 3 Tr /F4 10 Tf -0.0247 Tc 0 Tw (Rau,) Tj 0 Tr ET BT 0.7217 0 0 0.9835 186.96 266.88 Tm -0.0242 Tc 0.3872 Tw ( RN, Day Charge Nurse, Special Care ) Tj ET q 11.76 0 0 -6.96 316.32 272.4 cm BI /W 88 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @`x|>???|??|??????????????????? >??> EI Q BT 0.467 0 0 0.9835 316.32 266.88 Tm 3 Tr 0.0356 Tc 0 Tw (Uni$) Tj 0 Tr ET BT 0.7217 0 0 0.9835 328.08 266.88 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 21.36 0 0 -5.76 330 272.88 cm BI /W 161 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  &d"30??????~??|??~A?~~?~~?~?_?~~?~~?~?~80~|?~x~~|?x~~?~~?~>???a??D#`?>0 EI Q BT 0.4245 0 0 0.9835 330 266.88 Tm 3 Tr 0.0963 Tc 0 Tw (Cbristiart) Tj 0 Tr ET BT 0.7217 0 0 0.9835 351.36 266.88 Tm 0.0119 Tc 0.0838 Tw ( Rest Home, ) Tj ET q 19.2 0 0 -7.2 394.56 272.4 cm BI /W 145 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>" @D???????????~~|?~~|`?|~x~|x~~|<~~>~>>|~??|??|??????? EI Q BT 0.5094 0 0 0.9835 394.56 266.88 Tm 3 Tr -0.0135 Tc 0 Tw (Lyndeq) Tj 0 Tr ET BT 0.7217 0 0 0.9835 413.76 266.88 Tm -0.0427 Tc 0.9354 Tw ( WA, personal communications, Oct.) Tj ET BT 0.7642 0 0 0.9835 120.48 258 Tm 0.0112 Tc 0.5117 Tw (19, 1990, Dec. 30, 1991; Jennifer Johnson, RN, Director of Social Services, Christian Rest Home, ) Tj ET q 20.64 0 0 -7.68 470.16 263.76 cm BI /W 146 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID " ;"1?cs????????????~~~~`~~~|x||~x|D~<~|<~~>~>~?/????????w@B`  EI Q BT 0.5519 0 0 0.9835 470.16 258 Tm 3 Tr -0.0305 Tc 0 Tw (Lynde~) Tj 0 Tr ET BT 0.7642 0 0 0.9835 490.8 258 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.8 0 0 -6.96 492.72 263.76 cm BI /W 76 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   1>>/???|?|?<?<~?>xx" 1( EI Q BT 0.5944 0 0 0.9835 492.72 258 Tm 3 Tr -0.0405 Tc 0 Tw (WA) Tj 0 Tr ET BT 0.7642 0 0 0.9835 503.52 258 Tm -0.0103 Tc 1.0005 Tw ( personal) Tj ET BT 0.7217 0 0 0.9835 119.76 248.88 Tm -0.026 Tc 1.411 Tw (communications, Oct. 19,1990,) Tj 0 Tc -0.1214 Tw ( ) Tj ET q 9.12 0 0 -5.52 226.56 254.64 cm BI /W 68 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 31????}?#@0?? EI Q BT 0.5094 0 0 0.9835 226.56 248.88 Tm 3 Tr 0.0633 Tc 0 Tw (Jan) Tj 0 Tr ET BT 0.7217 0 0 0.9835 235.68 248.88 Tm 0.0369 Tc 0.3262 Tw ( 13, 1992.) Tj ET BT 0.9835 0 0 0.9835 72 226.56 Tm 0.0265 Tc 1.0147 Tw (home staff members about the residents\222 mental) Tj ET BT 0.8915 0 0 0.9835 72.72 214.56 Tm 0.0247 Tc 1.6772 Tw (status. Several small-scale studies based on compre-) Tj ET BT 0.9835 0 0 0.9835 72 202.56 Tm 0.0265 Tc 0.0223 Tw (hensive medical and psychiatric evaluations have) Tj ET BT 0.8915 0 0 0.9835 72.48 190.56 Tm 0.0376 Tc 0.7766 Tw (found that an even higher proportion of residents \(67) Tj ET BT 0.934 0 0 0.9835 72.48 178.56 Tm -0.0232 Tc 1.226 Tw (to 78 percent\) have clinically diagnosable dementia) Tj 0.5139 -12.6899 TD 0.0669 Tc 0 Tw (\(82,389,390\).) Tj 11.306 -24.4036 TD -0.0324 Tc 0.5934 Tw (The second reason nursing home care for individ-) Tj ET BT 0.9835 0 0 0.9835 72.72 130.08 Tm 0.0247 Tc 0.6796 Tw (uals with dementia is an important public policy) Tj ET BT 0.934 0 0 0.9835 72.72 118.32 Tm -0.0265 Tc 2.0004 Tw (issue is that government expenditures for nursing) Tj ET BT 0.8915 0 0 0.9835 72.48 106.32 Tm 0.0414 Tc 0.556 Tw (home care for individuals with dementia are substan-) Tj ET BT 0.9835 0 0 0.9835 72.72 94.56 Tm 0.0268 Tc -0.0198 Tw (tial. In 1990, total expenditures for nursing home) Tj 0.244 -12.2018 TD 0.0235 Tc 0.611 Tw (care from all sources were $53.1 billion. Federal,) Tj ET BT 0.8915 0 0 0.9835 323.28 225.6 Tm 0.0379 Tc 2.0213 Tw (State, and local government expenditures accounted) Tj ET BT 0.9835 0 0 0.9835 323.04 214.08 Tm 0.0319 Tc 1.9448 Tw (for slightly more than half \(52 percent\) of that) Tj ET BT 0.934 0 0 0.9835 323.28 202.08 Tm 0.0389 Tc 1.8019 Tw (amount \(250\).) Tj ET BT 0.9557 0 0 1.08 385.68 206.88 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (2 ) Tj ET BT 0.934 0 0 0.9835 389.04 202.08 Tm /F4 10 Tf -0.0404 Tc 1.8868 Tw (Excluding expenditures for the care) Tj ET BT 0.8915 0 0 0.9835 323.28 189.84 Tm 0.0327 Tc 1.6425 Tw (of individuals in facilities for the mentally retarded,) Tj ET BT 0.9835 0 0 0.9835 323.28 177.84 Tm 0.0284 Tc 0.8989 Tw (total government expenditures for nursing home) Tj ET BT 0.934 0 0 0.9835 323.28 165.84 Tm -0.019 Tc 1.9067 Tw (care were $22.8 billion. Individuals with dementia) Tj 0.257 -12.4458 TD -0.0199 Tc 0.6372 Tw (tend to be among those who stay longest in nursing) Tj -0.257 -11.9577 TD -0.0398 Tc 1.1724 Tw (homes and so are most likely to become eligible for) Tj ET BT 0.9835 0 0 0.9835 323.52 129.84 Tm 0.0211 Tc 5.1689 Tw (government reimbursement through Medicaid) Tj 0.244 -11.9577 TD 0.0241 Tc 1.3425 Tw (\(229,258,465\). As a result, government probably) Tj ET BT 0.934 0 0 0.9835 323.28 106.32 Tm -0.0174 Tc 0.526 Tw (pays for more than half of all nursing home care for) Tj 0 -11.9577 TD -0.0224 Tc 2.6384 Tw (individuals with dementia. Since individuals with) Tj ET BT 0.8915 0 0 0.9835 323.52 82.56 Tm 0.0347 Tc 1.2173 Tw (dementia constitute at least half of all nursing home) Tj ET BT 0.7217 0 0 0.9835 86.4 59.28 Tm -0.032 Tc 0 Tw (zTotalgov) Tj ET q 19.44 0 0 -5.04 120.72 63.84 cm BI /W 145 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  x?????ߏ>>|>>8|~>>8|>>|G>>|>>|>>|>>|>>|>>|?>|~?>~|?><|?߃?>>p0 EI Q BT 0.467 0 0 0.9835 120.72 59.04 Tm 3 Tr 0.0888 Tc (ernment) Tj 0 Tr ET BT 0.7217 0 0 0.9835 140.16 59.04 Tm -0.0504 Tc 0.9669 Tw ( expenditures for nursing home care were $27.7 billion in 1990. This amount included $17.2 billion ) Tj ET q 4.32 0 0 -5.28 479.52 65.28 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID =߀??~~~>>>>>?>>>>?~@ EI Q BT 0.4245 0 0 0.9835 479.52 59.04 Tm 3 Tr 0.1723 Tc 0 Tw (in) Tj 0 Tr ET BT 0.7217 0 0 0.9835 483.84 59.04 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 17.76 0 0 -5.52 485.76 64.56 cm BI /W 133 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0>p`???~?|~?~?s~>3? ~>~>~ >~>~\?~?~~??<x~? |0????????? EI Q BT 0.467 0 0 0.9835 485.76 59.04 Tm 3 Tr -0.0064 Tc 0 Tw (Fedeml) Tj 0 Tr ET BT 0.7041 0 0 0.9835 503.52 59.04 Tm /F2 10 Tf 0 Tc -0.1157 Tw ( ) Tj ET q 30.24 0 0 -7.2 505.2 64.56 cm BI /W 225 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? xp@x???????>??~<?>~{|~s>~??|~#>~@?||?>?~|?>~|?>~|>>?|>>?>>?>>>>>??>~?|?|~???`0x0 EI Q BT 0.6572 0 0 0.9835 505.2 59.04 Tm 3 Tr 0.0116 Tc 0 Tw (expemhms) Tj 0 Tr ET BT 0.7041 0 0 0.9835 535.44 59.04 Tm 0 Tc -0.1157 Tw ( ) Tj ET q 11.76 0 0 -6.96 537.12 64.56 cm BI /W 88 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?>>|Ǐx|||>||>|>>>>>~||?<<>>|| ~烎~燎??x??? EI Q BT 0.5164 0 0 0.9835 537.12 59.04 Tm 3 Tr 0.0142 Tc 0 Tw (\($2.5) Tj 0 Tr ET BT 0.6793 0 0 0.9835 72.72 50.4 Tm /F4 10 Tf 0.0222 Tc 0.7894 Tw (billion from Medicare, $13.7 billion ) Tj ET q 10.8 0 0 -5.52 188.64 55.92 cm BI /W 86 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?~~|~|~|>|>|>|>|~|>|>|>|>~?ǀ~ EI Q BT 0.5094 0 0 0.9835 188.64 50.4 Tm 3 Tr 0.0414 Tc 0 Tw (ffom) Tj 0 Tr ET BT 0.6793 0 0 0.9835 199.44 50.4 Tm -0.006 Tc 1.072 Tw ( Medicaid, and $1.0 billion from other sources, e.g., the Department of Veterans Affairs\) and $10.5 billion in) Tj -186.1979 -8.7853 TD -0.0108 Tc 0.7674 Tw (State and local government expenditures, virtually all of which are Medicaid expenditures \(250\).) Tj ET endstream endobj 28 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 29 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.68 676.56 m 540 676.56 l S 65.76 75.36 m 544.08 75.36 l S BT 0.9835 0 0 0.9835 334.08 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 3.0427 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 526.8 681.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 533.52 681.6 Tm /F4 10 Tf 0.0497 Tc 0 Tw (7) Tj ET BT 0.934 0 0 0.9835 61.68 643.2 Tm -0.0297 Tc 1.0017 Tw (residents, OTA estimates that government expendi-) Tj ET BT 0.9835 0 0 0.9835 62.4 630.96 Tm 0.0219 Tc 0.9962 Tw (tures for nursing home care for individuals with) Tj 0 -11.9577 TD 0.0331 Tc 1.5426 Tw (dementia amounted to more than $11 billion in) Tj ET BT 0.8491 0 0 0.9835 63.36 606.96 Tm 0.0822 Tc 0 Tw (1990.3) Tj ET BT 0.934 0 0 0.9835 73.44 584.64 Tm -0.0276 Tc 0.8453 Tw (The third reason nursing home care for individu-) Tj ET BT 0.8915 0 0 0.9835 62.64 572.16 Tm 0.0352 Tc 0.9812 Tw (als with dementia is an important public policy issue) Tj ET BT 0.934 0 0 0.9835 62.64 560.4 Tm -0.0279 Tc 1.3595 Tw (is that government is extensively involved in regu-) Tj ET BT 0.9835 0 0 0.9835 62.64 548.4 Tm 0.0149 Tc 1.8888 Tw (lating nursing homes. The Federal Government) Tj 0 -12.4458 TD 0.0227 Tc 1.7507 Tw (regulates nursing homes that participate in the) Tj ET BT 0.934 0 0 0.9835 62.64 524.4 Tm -0.0199 Tc 0.8799 Tw (Medicare or Medicaid programs. In 1985,75 percent) Tj ET BT 0.9835 0 0 0.9835 63.12 512.4 Tm 0.0342 Tc 1.1797 Tw (of all nursing homes participated in one or both) Tj -0.244 -12.2018 TD 0.0248 Tc 2.7573 Tw (programs, and these participating facilities ac-) Tj 0.4881 -11.9577 TD 0.0372 Tc 1.2072 Tw (counted for 89 percent of all nursing home beds) Tj ET BT 0.934 0 0 0.9835 63.6 476.88 Tm -0.0054 Tc 0.8215 Tw (\(467\). All States also regulate nursing homes.) Tj ET BT 0.9835 0 0 0.9835 74.64 454.56 Tm 0.0301 Tc -0.1277 Tw (Complaints and concerns about the quality and) Tj ET BT 0.934 0 0 0.9835 63.84 442.56 Tm -0.0409 Tc 1.5447 Tw (appropriateness of the nursing home care provided) Tj -0.257 -11.7137 TD -0.0307 Tc 1.5338 Tw (for individuals with dementia are pervasive. Given) Tj ET BT 0.9835 0 0 0.9835 63.84 418.8 Tm 0.0218 Tc 0.6616 Tw (these complaints and concerns and government\222s) Tj 0.244 -12.2018 TD 0.0239 Tc 1.8715 Tw (extensive role in regulating nursing homes and) Tj -0.4881 -12.2018 TD 0.0212 Tc 0.0643 Tw (paying for nursing home care, the claim of special) Tj ET BT 0.8915 0 0 0.9835 64.08 382.8 Tm 0.0461 Tc 0.7671 Tw (care unit operators and others that special care units) Tj ET BT 0.9835 0 0 0.9835 63.84 371.04 Tm 0.038 Tc 0.3929 Tw (provide better care for individuals with dementia) Tj ET BT 0.934 0 0 0.9835 64.32 359.04 Tm -0.0388 Tc 1.1142 Tw (deserves the attention of policymakers.) Tj ET BT 0.9835 0 0 0.9835 75.12 336.96 Tm 0.0402 Tc 0.9601 Tw (The existence and proliferation of special care) Tj -11.2256 -12.4458 TD 0.0288 Tc 2.5987 Tw (units raise four policy questions. One question) Tj 0 -12.2018 TD 0.0213 Tc 0.7597 Tw (pertains to consumer education. The Alzheimer\222s) Tj 0.4881 -11.9577 TD 0.0359 Tc 0.4032 Tw (Association and several other organizations have) Tj ET BT 0.934 0 0 0.9835 64.8 288.96 Tm -0.0365 Tc 3.3601 Tw (developed informational brochures and guidelines) Tj ET BT 0.9835 0 0 0.9835 64.8 276.96 Tm 0.0301 Tc 0.0815 Tw (to assist families and others in evaluating special) Tj 0 -12.2018 TD -0.0013 Tc 2.5885 Tw (care units.) Tj ET BT 1.08 0 0 1.08 115.44 269.76 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (4 ) Tj ET BT 0.9835 0 0 0.9835 119.04 264.96 Tm /F4 10 Tf 0.018 Tc 1.6416 Tw (New Hampshire has also taken this) Tj ET BT 0.934 0 0 0.9835 65.04 252.96 Tm -0.0081 Tc 0.9529 Tw (approach \(325\). The policy question is what, if any,) Tj 0 -12.2018 TD -0.0311 Tc 1.7483 Tw (additional steps government should take to inform) Tj 0.257 -12.2018 TD -0.0197 Tc 0.7083 Tw (consumers about special care units.) Tj ET BT 0.9835 0 0 0.9835 76.08 206.64 Tm 0.0435 Tc 0.1027 Tw (The second policy question pertains to the ade-) Tj ET BT 0.8915 0 0 0.9835 65.28 194.64 Tm 0.056 Tc 1.5395 Tw (quacy of government funding for research on special) Tj ET BT 0.9835 0 0 0.9835 65.52 182.64 Tm 0.0164 Tc 1.7165 Tw (care units. Until recently, Federal agencies had) Tj ET BT 0.934 0 0 0.9835 65.52 170.88 Tm -0.0339 Tc 1.1411 Tw (funded very little research on special care units. In) Tj ET BT 0.8915 0 0 0.9835 65.52 158.88 Tm 0.0255 Tc 1.093 Tw (the fall 1991, the National Institute on Aging funded) Tj ET BT 0.9835 0 0 0.9835 65.52 146.88 Tm 0.0262 Tc 0.0853 Tw (nine special care unit studies through its \223Special) Tj ET BT 0.934 0 0 0.9835 66 134.88 Tm -0.0127 Tc 1.6001 Tw (Care Units Initiative,\222) Tj ET BT 0.8915 0 0 0.9835 167.76 134.64 Tm 0.0019 Tc 0.4465 Tw (and a tenth study was funded) Tj ET BT 0.934 0 0 0.9835 65.76 122.88 Tm -0.0144 Tc 1.3772 Tw (through the initiative in 1992. When the results of) Tj 0.257 -12.4458 TD -0.0247 Tc 0.8707 Tw (these studies are available in a few years, they will) Tj 0.257 -11.9577 TD -0.0285 Tc 1.2745 Tw (greatly expand knowledge about special care units.) Tj ET BT 0.8915 0 0 0.9835 66.24 86.88 Tm 0.0309 Tc 1.087 Tw (In the meantime, it is important to consider whether) Tj ET BT 0.934 0 0 0.9835 313.2 642.72 Tm -0.0356 Tc 3.1022 Tw (additional government-funded research is needed,) Tj 0.257 -12.2018 TD -0.023 Tc 0.8404 Tw (and if so, on what topics.) Tj ET BT 0.8915 0 0 0.9835 324.24 611.52 Tm 0.0426 Tc 1.4392 Tw (The third policy question pertains to regulation of) Tj ET BT 0.9835 0 0 0.9835 313.92 599.52 Tm 0.0263 Tc 1.0048 Tw (special care units. As of early 1992, six States\227) Tj 0 -12.4458 TD 0.0282 Tc 2.0705 Tw (Colorado, Iowa, Kansas, Tennessee, Texas, and) Tj -0.4881 -12.4458 TD 0.037 Tc 1.6955 Tw (Washington-had added requirements for special) Tj ET BT 0.8915 0 0 0.9835 313.92 562.8 Tm 0.0592 Tc 0.7524 Tw (care units to their general regulations for all nursing) Tj ET BT 0.9835 0 0 0.9835 313.68 551.04 Tm 0.0112 Tc 2.2098 Tw (homes. Five States\227Nebraska, North Carolina,) Tj 0.244 -12.2018 TD 0.0328 Tc 1.2361 Tw (New Jersey, Oklahoma, and Oregon-were devel-) Tj 0.244 -12.4458 TD 0.0273 Tc -0.0203 Tw (oping regulations for special care units, and more) Tj ET BT 0.934 0 0 0.9835 314.4 515.04 Tm -0.0374 Tc 1.7734 Tw (States were considering doing so. The policy ques-) Tj ET BT 0.9835 0 0 0.9835 314.4 503.04 Tm 0.0317 Tc 0.4632 Tw (tion is whether the Federal Government or other) Tj ET BT 0.8915 0 0 0.9835 314.64 491.04 Tm 0.0351 Tc 1.9347 Tw (States should develop special regulations for special) Tj 0 -11.9577 TD 0.0433 Tc 0.1309 Tw (care units.) Tj 11.8446 -19.7669 TD 0.0436 Tc 1.0391 Tw (Many special care unit operators and others say it) Tj ET BT 0.9835 0 0 0.9835 314.64 448.32 Tm 0.0334 Tc 1.2518 Tw (costs more to operate a special care unit than a) Tj ET BT 0.8491 0 0 0.9835 314.64 436.32 Tm 0.0475 Tc 2.9568 Tw (nonspecialized nursing home unit \(12,64,377,477,485\).) Tj ET BT 0.934 0 0 0.9835 314.64 424.32 Tm -0.0282 Tc 1.0661 Tw (Thus, the fourth policy question is whether govern-) Tj ET BT 0.9835 0 0 0.9835 315.12 412.56 Tm 0.0384 Tc 2.8532 Tw (ment should pay more for the care of eligible) Tj ET BT 0.8915 0 0 0.9835 315.36 400.32 Tm 0.0499 Tc 0.1572 Tw (individuals in special care units than in other nursing) Tj -0.2692 -11.9577 TD 0.0253 Tc 2.0354 Tw (home units.) Tj ET BT 0.9835 0 0 0.9835 326.16 368.88 Tm 0.0309 Tc 0.7865 Tw (Until the publication in 1990 of figures on the) Tj ET BT 0.8915 0 0 0.9835 315.36 357.12 Tm 0.0496 Tc 0.4529 Tw (number of nursing homes that had a special care unit) Tj 0.2692 -11.9577 TD 0.0426 Tc 1.3238 Tw (in 1987, most commentators believed there might be) Tj ET BT 0.9835 0 0 0.9835 316.08 333.12 Tm 0.0287 Tc 0.7452 Tw (several hundred special care units in the United) Tj ET BT 0.8915 0 0 0.9835 316.08 321.12 Tm 0.0392 Tc 1.2123 Tw (States. It was reasonable then to regard special care) Tj ET BT 0.9835 0 0 0.9835 315.6 309.36 Tm 0.03 Tc 2.1733 Tw (units as a relatively small phenomenon and to) Tj ET BT 0.934 0 0 0.9835 315.84 297.36 Tm -0.0458 Tc 2.0211 Tw (consider government policies for special care units) Tj ET BT 0.9835 0 0 0.9835 316.08 285.6 Tm 0.0245 Tc 1.6908 Tw (in that context. Recent data suggesting that 10) Tj ET BT 0.934 0 0 0.9835 315.84 273.6 Tm -0.0248 Tc 0.5854 Tw (percent of all nursing homes had a special care unit) Tj ET BT 0.8915 0 0 0.9835 316.08 261.6 Tm 0.0506 Tc -0.0657 Tw (in 1991 indicate that special care units are not a small) Tj ET BT 0.934 0 0 0.9835 315.84 249.6 Tm -0.0408 Tc 1.0308 Tw (phenomenon. The rapid proliferation of special care) Tj 0.257 -12.2018 TD -0.0121 Tc 0.4861 Tw (units means such units are likely to become a much) Tj ET BT 0.8915 0 0 0.9835 316.32 225.84 Tm 0.0573 Tc 2.2687 Tw (larger phenomenon. Government policies for special) Tj ET BT 0.934 0 0 0.9835 316.32 213.6 Tm -0.0383 Tc 1.1137 Tw (care units should be considered in this new context) Tj ET BT 0.9835 0 0 0.9835 316.56 201.6 Tm 0.0387 Tc 0.0029 Tw (and in relation to the long-range possibilities and) Tj ET BT 0.934 0 0 0.9835 316.8 189.84 Tm -0.0367 Tc 1.3689 Tw (societal objectives for special care units.) Tj 11.563 -19.7669 TD -0.0374 Tc 2.86 Tw (Various long-range possibilities for special care) Tj -11.82 -12.2018 TD -0.0255 Tc 1.0037 Tw (units can be imagined. One possibility would be for) Tj ET BT 0.8915 0 0 0.9835 316.8 146.64 Tm 0.0451 Tc 0.6672 Tw (all nursing home residents with dementia to be cared) Tj ET BT 0.934 0 0 0.9835 317.04 134.64 Tm -0.0309 Tc 0.7632 Tw (for in special care units \(or in whole nursing homes) Tj ET BT 0.9835 0 0 0.9835 317.04 122.64 Tm 0.034 Tc 2.5527 Tw (devoted exclusively to serving individuals with) Tj ET BT 0.934 0 0 0.9835 317.04 110.64 Tm -0.033 Tc 2.1787 Tw (dementia\). To OTA\222s knowledge, no one advocates) Tj ET BT 0.8915 0 0 0.9835 317.04 98.64 Tm 0.0449 Tc 1.3405 Tw (this alternative, in part because of the huge number) Tj ET BT 0.9835 0 0 0.9835 317.28 86.64 Tm 0.0398 Tc 1.4893 Tw (of individuals involved< 37,600 to 922,500 indi-) Tj ET BT 0.7217 0 0 0.9835 79.92 64.32 Tm 0.0143 Tc -0.1413 Tw (S ) Tj ET q 13.2 0 0 -5.76 86.4 70.08 cm BI /W 99 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p0x~?~?|>|<`||@|x||?|>|>>???~`@|||>> EI Q BT 0.5094 0 0 0.9835 86.4 64.32 Tm 3 Tr 0.0584 Tc 0 Tw (Some) Tj 0 Tr ET BT 0.7217 0 0 0.9835 99.6 64.32 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 8.4 0 0 -5.76 101.52 70.08 cm BI /W 63 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?|||||?<|>>~>|>|>|>|0?|x|||||~?~?; EI Q BT 0.467 0 0 0.9835 101.52 64.32 Tm 3 Tr 0.0175 Tc 0 Tw (and) Tj 0 Tr ET BT 0.7217 0 0 0.9835 109.92 64.32 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 18.24 0 0 -7.2 111.84 69.84 cm BI /W 138 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? 3???<?<~ |||?|<>8?|?p|>?x?>??>>?g EI Q BT 0.5519 0 0 0.9835 111.84 64.32 Tm 3 Tr 0.0192 Tc 0 Tw (per~ps) Tj 0 Tr ET BT 0.7217 0 0 0.9835 130.08 64.32 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 12.72 0 0 -5.76 132 67.44 cm BI /W 97 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 2?????>??????>p?>|x>>|8>>8><>>>?>?>|?x EI Q BT 0.8915 0 0 0.9835 132 64.32 Tm 3 Tr -0.0007 Tc 0 Tw (my) Tj 0 Tr ET BT 0.7217 0 0 0.9835 144.72 64.32 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 17.52 0 0 -7.2 146.64 70.08 cm BI /W 133 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`ppx?|Ϗ???????~<||||?|?|>|>|||||||<|<|Ã<???< EI Q BT 0.467 0 0 0.9835 146.64 64.32 Tm 3 Tr -0.0604 Tc 0 Tw (nmsing) Tj 0 Tr ET BT 0.7217 0 0 0.9835 164.16 64.32 Tm -0.0353 Tc 0.3709 Tw ( home residents ) Tj ET q 10.56 0 0 -5.76 220.08 69.84 cm BI /W 79 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <`???xx><><~~??~??~p0? EI Q BT 0.467 0 0 0.9835 220.08 64.32 Tm 3 Tr 0.032 Tc 0 Tw (with) Tj 0 Tr ET BT 0.7217 0 0 0.9835 230.64 64.32 Tm -0.0209 Tc 0.4987 Tw ( dementia are admitted for reasons other than or ) Tj ET q 4.08 0 0 -5.52 399.12 70.08 cm BI /W 33 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?~~>>>~~~>~~>>~?|?> EI Q BT 0.4245 0 0 0.9835 399.12 64.32 Tm 3 Tr 0.1723 Tc 0 Tw (in) Tj 0 Tr ET BT 0.7217 0 0 0.9835 403.2 64.32 Tm -0.0363 Tc 0.594 Tw ( addition to their dementia. OTA\222S ) Tj ET q 19.44 0 0 -5.76 522.96 70.08 cm BI /W 146 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pc??߁???~|?|>8?|?x|?x|x<>><??p  EI Q BT 0.467 0 0 0.9835 522.96 64.32 Tm 3 Tr 0.0706 Tc 0 Tw (estimate) Tj 0 Tr ET BT 0.6793 0 0 0.9835 66.24 54.24 Tm -0.0168 Tc 0.6478 Tw (refers to the overall cost to government of nursing home care for residents with dementia regardless of the primary reason for their admission.) Tj ET q 2.64 0 0 -4.08 79.92 48.72 cm BI /W 16 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||||x|8x<||||x8 EI Q BT 0.467 0 0 0.9835 79.92 44.4 Tm 3 Tr 0.0897 Tc 0 Tw (4) Tj 0 Tr ET BT 0.8915 0 0 0.9835 82.56 44.4 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 11.76 0 0 -6.48 84.96 49.68 cm BI /W 72 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<xx??~|?<8>~|G|`x~?<<??`~~>> EI Q BT 0.5944 0 0 0.9835 84.96 44.4 Tm 3 Tr -0.0283 Tc 0 Tw (See,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 96.72 44.4 Tm 0.0479 Tc -0.1434 Tw ( for ) Tj ET q 26.16 0 0 -7.2 113.28 49.68 cm BI /W 159 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID !?@`x<x0~aǼ??~??~p8??>8~>|`w>>|?>x>>x?>>}??~~>|?~<~?~~?~q>||~~~~ EI Q BT 0.6793 0 0 0.9835 113.28 44.4 Tm 3 Tr -0.0381 Tc 0 Tw (exmple,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 139.44 44.4 Tm 0.0778 Tc -0.177 Tw ( Mace ) Tj ET q 10.32 0 0 -5.52 166.56 49.92 cm BI /W 63 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?~~|~|~<~>~~?~~>|<|<|>> EI Q BT 0.5519 0 0 0.9835 166.56 44.4 Tm 3 Tr -0.0088 Tc 0 Tw (and) Tj 0 Tr ET BT 0.8915 0 0 0.9835 176.88 44.4 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 27.12 0 0 -7.2 179.28 51.12 cm BI /W 164 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?pp880?08?x<?|>~||?||>|||a?|||??||||||~||x~p|||p||x||?8||><||<?<|~?>?~~0p?pp< ??? EI Q BT 0.8491 0 0 0.9835 179.28 44.4 Tm 3 Tr -0.0029 Tc 0 Tw (@@er>) Tj 0 Tr ET BT 0.7217 0 0 0.9835 210.24 42.24 Tm -0.0258 Tc 1.286 Tw (\223Selecting a Nursing Home With a Dedicated Dementia Care) Tj 0 Tc -0.1214 Tw ( ) Tj ET q 15.6 0 0 -6.24 423.12 47.52 cm BI /W 115 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>~?||?|0?|?|?|?|>|>|>|>|?|?|?<|?||x EI Q BT 0.5094 0 0 0.9835 423.12 42.24 Tm 3 Tr 0.022 Tc 0 Tw (UniG\224) Tj 0 Tr ET BT 0.7217 0 0 0.9835 438.72 42.24 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 29.76 0 0 -5.28 440.64 47.28 cm BI /W 219 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID o!????????~|??p????8?>?>?>>>>>>>>>>?`??>???>?|?>x|>x~>?~x@<p|<~?|8 EI Q BT 0.5519 0 0 0.9835 440.64 42.24 Tm 3 Tr 0.061 Tc 0 Tw (Akheimer\222s) Tj 0 Tr ET BT 0.7217 0 0 0.9835 470.4 42.24 Tm -0.0188 Tc 1.4565 Tw ( Disease and Related) Tj ET BT 0.6793 0 0 0.9835 66.24 33.6 Tm -0.0048 Tc 3.0551 Tw (Disorders Association \(276\).) Tj ET endstream endobj 30 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 31 0 obj <>stream 0.72 w 1 j 0 0 0 RG 70.8 674.4 m 548.88 674.4 l S BT 0.9835 0 0 0.9835 70.8 680.88 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (8 ) Tj ET BT 0.9598 0 0 0.9598 78.24 680.88 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 84.48 680.88 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 138.24 680.88 Tm /F5 11 Tf 0.0681 Tc -0.1305 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 236.64 680.88 Tm /F5 10 Tf 0.0229 Tc 0.0784 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 71.04 640.8 Tm /F4 10 Tf -0.0221 Tc 2.1669 Tw (viduals according to national surveys-and the cost) Tj 0.5139 -11.9577 TD -0.033 Tc 0.9978 Tw (and other implications of creating a whole separate) Tj -0.257 -11.9577 TD -0.0203 Tc 0.3749 Tw (nursing home industry to serve them.) Tj ET BT 0.9835 0 0 0.9835 82.32 599.04 Tm 0.0444 Tc 1.4265 Tw (A second possibility would be for special care) Tj -10.9816 -12.2018 TD 0.0261 Tc 0.4559 Tw (units to serve only certain types of nursing home) Tj 0 -12.2018 TD 0.0336 Tc 1.0279 Tw (residents with dementia\227for example, residents) Tj ET BT 0.934 0 0 0.9835 72 563.04 Tm -0.0243 Tc 0.4747 Tw (with behavioral symptoms or residents in a particu-) Tj 0 -11.9577 TD -0.0301 Tc 1.839 Tw (lar stage of their dementing illness. To implement) Tj 0 -12.2018 TD -0.0379 Tc 0.9664 Tw (this alternative would require a rationale for deter-) Tj ET BT 0.9835 0 0 0.9835 72 527.52 Tm 0.0264 Tc 2.113 Tw (mining which types of residents with dementia) Tj 0.4881 -12.2018 TD 0.0291 Tc 2.1001 Tw (should be in special care units and criteria for) Tj ET BT 0.934 0 0 0.9835 72 503.76 Tm -0.0259 Tc 1.2289 Tw (identifying these individuals.) Tj 12.0769 -18.3027 TD -0.04 Tc 0.7943 Tw (A third possibility would be for special care units) Tj -11.563 -12.4458 TD -0.0237 Tc 1.4285 Tw (to serve: 1\) individuals with dementia whose fami-) Tj 0 -11.7137 TD -0.0317 Tc 0.6698 Tw (lies choose to place them in the unit for any reason,) Tj ET BT 0.9835 0 0 0.9835 72.72 449.76 Tm 0.0291 Tc 2.0696 Tw (including ability to pay, and 2\) individuals the) Tj -0.244 -12.2018 TD 0.0271 Tc 0.2549 Tw (nursing home chooses to place in the unit for any) Tj ET BT 0.8915 0 0 0.9835 72.24 426 Tm 0.038 Tc 1.3819 Tw (reason, including ability to pay. In this scenario, the) Tj ET BT 0.934 0 0 0.9835 72.72 413.76 Tm -0.0163 Tc 1.5077 Tw (total number of special care units and the number) Tj ET BT 0.9835 0 0 0.9835 72.96 401.76 Tm 0.04 Tc 1.1869 Tw (and types of individuals with dementia who are) Tj ET BT 0.934 0 0 0.9835 72.72 390 Tm -0.0414 Tc 0.9172 Tw (cared for in these units would be determined in the) Tj 0 -12.2018 TD -0.0087 Tc 0.5966 Tw (future, as they are now, by market demand and the) Tj ET BT 0.8915 0 0 0.9835 72.96 366.24 Tm 0.0393 Tc 2.1813 Tw (decisions of individual nursing home administrators) Tj 0.2692 -11.7137 TD 0.0037 Tc 2.3288 Tw (and staff members.) Tj ET BT 0.9835 0 0 0.9835 84 336.72 Tm 0.0404 Tc 1.7094 Tw (A fourth possibility would be for special care) Tj ET BT 0.8915 0 0 0.9835 72.72 324.48 Tm 0.0304 Tc 1.525 Tw (units to function as research settings to develop and) Tj ET BT 0.9835 0 0 0.9835 73.2 312.24 Tm 0.0366 Tc 3.3228 Tw (evaluate methods of care for individuals with) Tj ET BT 0.934 0 0 0.9835 73.2 300.24 Tm -0.0345 Tc 1.4767 Tw (dementia. Once shown to be effective, the methods) Tj ET BT 0.9835 0 0 0.9835 73.2 288.48 Tm 0.0466 Tc 1.6552 Tw (of care developed in special care units could be) Tj 0.244 -12.2018 TD 0.0285 Tc 0.1179 Tw (incorporated into the care practices of all nursing) Tj ET BT 0.8915 0 0 0.9835 73.2 264.24 Tm 0.028 Tc 1.8081 Tw (homes, thus potentially benefiting all residents with) Tj 0.2692 -11.9577 TD 0.0171 Tc 0 Tw (dementia.) Tj ET BT 0.934 0 0 0.9835 84.24 234.24 Tm -0.0576 Tc 1.1343 Tw (Government policies adopted now with respect to) Tj ET BT 0.8915 0 0 0.9835 73.44 222.24 Tm 0.0531 Tc 1.9504 Tw (consumer education, research, regulation, and reim-) Tj 0 -11.9577 TD 0.059 Tc 1.0362 Tw (bursement for special care units will influence which) Tj ET BT 0.934 0 0 0.9835 73.44 198.48 Tm -0.0349 Tc 1.2813 Tw (of these long-range possibilities becomes the future) Tj ET BT 0.9835 0 0 0.9835 73.44 186.72 Tm 0.0272 Tc 2.3562 Tw (reality. Which of the long-range possibilities is) Tj 0.244 -12.2018 TD 0.0408 Tc 2.6678 Tw (desirable depends on several factors, the most) Tj ET BT 0.934 0 0 0.9835 73.68 162.96 Tm -0.0237 Tc 0.7554 Tw (important of which are:) Tj ET BT 0.8632 0 0 0.9598 85.2 145.68 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.9207 0 0 0.9598 85.2 109.92 Tm -0.0556 Tc (l) Tj 0 -37.5062 TD -0.0556 Tc (l) Tj ET BT 0.8915 0 0 0.9835 95.28 144.24 Tm /F4 10 Tf 0.047 Tc 1.0497 Tw (the effectiveness of special care units in general) Tj ET BT 0.9835 0 0 0.9835 96 132.48 Tm 0.0328 Tc 1.2523 Tw (and for particular types of individuals with) Tj ET BT 0.8915 0 0 0.9835 95.76 120.48 Tm 0.0171 Tc 0 Tw (dementia;) Tj ET BT 0.934 0 0 0.9835 95.76 108.48 Tm -0.0353 Tc 1.4408 Tw (the relative cost of caring for individuals with) Tj 0.257 -12.2018 TD -0.0256 Tc 1.7853 Tw (dementia in special care units vs. nonspecial-) Tj 0 -11.7137 TD -0.0074 Tc 0.5025 Tw (ized nursing home units; and) Tj ET BT 0.8915 0 0 0.9835 95.76 72.48 Tm 0.0261 Tc 1.7653 Tw (the impact of the different long-range possibili-) Tj 0 -10.9816 TD 0.0355 Tc 2.0779 Tw (ties on nondemented nursing home residents.) Tj -12.1137 -18.0586 TD 0.0341 Tc 1.3525 Tw (By definition, special care units segregate individ-) Tj ET BT 0.934 0 0 0.9835 73.92 32.16 Tm -0.0236 Tc 1.8689 Tw (uals with dementia from other nursing home resi-) Tj 265.6921 618.8744 TD -0.0283 Tc 1.5141 Tw (dents. Some commentators believe this segregation) Tj 0 -12.6899 TD -0.0246 Tc 2.281 Tw (benefits both demented and nondemented nursing) Tj ET BT 0.9835 0 0 0.9835 322.32 616.8 Tm 0.0259 Tc 0.0718 Tw (home residents. Other commentators believe that) Tj 0.244 -12.4458 TD 0.0365 Tc 2.062 Tw (although segregation may benefit nondemented) Tj ET BT 0.934 0 0 0.9835 322.32 592.8 Tm -0.055 Tc 1.6134 Tw (residents, it will result in poorer care for residents) Tj ET BT 0.9835 0 0 0.9835 322.56 580.8 Tm 0.0319 Tc 0.0796 Tw (with dementia who will, in effect, be warehoused\222) Tj ET BT 0.934 0 0 0.9835 322.8 568.8 Tm -0.0238 Tc 0.5842 Tw (in segregated units. In the view of these commenta-) Tj 0 -12.4458 TD -0.0318 Tc 1.4064 Tw (tors, the anticipated negative effects of segregating) Tj ET BT 0.8915 0 0 0.9835 323.04 545.04 Tm 0.0399 Tc 1.3461 Tw (nursing home residents with dementia outweigh any) Tj ET BT 0.9835 0 0 0.9835 322.8 533.04 Tm 0.0464 Tc 0.6183 Tw (possible positive effects of the units. Some of the) Tj ET BT 0.8915 0 0 0.9835 323.28 521.04 Tm 0.041 Tc 0.5372 Tw (latter commentators are particularly disturbed by the) Tj ET BT 0.934 0 0 0.9835 323.28 509.52 Tm -0.038 Tc 0.4853 Tw (fact that most special care units are either locked or) Tj 0.7709 -12.4458 TD -0.0382 Tc 1.21 Tw (\223secured\224 in some other way so that residents with) Tj ET BT 0.9835 0 0 0.9835 323.28 485.28 Tm 0.032 Tc 1.4391 Tw (dementia cannot get out. The reactions of these) Tj ET BT 0.934 0 0 0.9835 323.28 473.52 Tm -0.0502 Tc 2.6168 Tw (commentators to proposed government policies for) Tj ET BT 0.8915 0 0 0.9835 323.76 461.28 Tm 0.0549 Tc 0.7235 Tw (special care units are likely to reflect their objections) Tj ET BT 0.8491 0 0 0.9835 323.52 449.04 Tm 0.0409 Tc 1.1273 Tw (to locked units rather than to special care units per se.) Tj ET BT 0.9835 0 0 0.9835 334.56 424.8 Tm 0.0217 Tc 0.8081 Tw (Finally, in considering government policies for) Tj -10.7376 -11.9577 TD 0.0244 Tc 0.0679 Tw (special care units, it is important to note that the) Tj ET BT 0.934 0 0 0.9835 323.52 401.04 Tm -0.0387 Tc 0.6966 Tw (proliferation of special care units is occurring at the) Tj ET BT 0.9835 0 0 0.9835 324 388.8 Tm 0.0207 Tc 2.3628 Tw (same time as numerous other government and) Tj ET BT 0.8915 0 0 0.9835 323.76 377.28 Tm 0.0437 Tc 1.5213 Tw (nongovernment initiatives that are likely to improve) Tj 0.2692 -12.2018 TD 0.0456 Tc 1.2051 Tw (the care of nursing home residents with dementia or) Tj -0.2692 -12.2018 TD 0.0424 Tc 0.7472 Tw (provide them with alternatives to nursing home care.) Tj ET BT 0.934 0 0 0.9835 324 341.76 Tm -0.0366 Tc 1.5615 Tw (These initiatives include the following:) Tj ET BT 0.9207 0 0 0.9598 335.52 317.76 Tm /F9 6 Tf -0.0556 Tc 0 Tw (l) Tj ET BT 0.8632 0 0 0.9598 335.76 215.52 Tm -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 336.24 102 Tm -0.0556 Tc (l) Tj ET BT 0.934 0 0 0.9835 345.6 316.56 Tm /F4 10 Tf -0.0423 Tc 1.8888 Tw (initiatives intended to improve the care of all) Tj ET BT 0.8915 0 0 0.9835 346.08 304.8 Tm 0.0487 Tc 0.6094 Tw (nursing home residents, including nursing home) Tj ET BT 0.9835 0 0 0.9835 345.6 292.8 Tm 0.0189 Tc 0.3717 Tw (residents with dementia, e.g., the regulatory) Tj ET BT 0.8915 0 0 0.9835 346.32 280.56 Tm 0.0346 Tc 1.4866 Tw (and other changes associated with implementa-) Tj ET BT 0.934 0 0 0.9835 346.32 268.56 Tm -0.035 Tc 1.8443 Tw (tion of the nursing home reform provisions of) Tj ET BT 0.9835 0 0 0.9835 346.32 256.56 Tm 0.0333 Tc 2.7486 Tw (the Omnibus Budget Reconciliation Act of) Tj 0.9761 -12.2018 TD 0.051 Tc 1.9985 Tw (1987 \(OBRA-87\), and separate but related) Tj ET BT 0.934 0 0 0.9835 346.32 232.8 Tm -0.0319 Tc 1.1583 Tw (efforts to create \221restraint-flee\222 nursing homes;) Tj ET BT 0.9835 0 0 0.9835 346.08 214.32 Tm 0.0404 Tc 2.3021 Tw (initiatives intended to improve the care of) Tj ET BT 0.8915 0 0 0.9835 346.32 202.56 Tm 0.0424 Tc 1.2536 Tw (individuals with dementia in any nursing home) Tj ET BT 0.934 0 0 0.9835 346.32 190.8 Tm -0.0026 Tc 0.69 Tw (unit, e.g., tr) Tj 56.2733 -0.244 TD -0.0114 Tc 1.3418 Tw (aining programs for nursing home) Tj -55.5024 -11.9577 TD -0.0237 Tc 1.6548 Tw (staff members, special activity and other pro-) Tj -0.257 -12.2018 TD -0.0289 Tc 1.6175 Tw (grams for residents with dementia in nonspe-) Tj ET BT 0.8915 0 0 0.9835 346.56 155.04 Tm 0.0275 Tc 1.9432 Tw (cialized units, and the development of effective) Tj ET BT 0.934 0 0 0.9835 347.04 142.8 Tm -0.03 Tc 2.1326 Tw (strategies for resident assessment, care plan-) Tj -0.257 -11.9577 TD -0.0066 Tc 2.1076 Tw (ning, and treatment of behavioral symptoms;) Tj ET BT 0.8491 0 0 0.9835 347.04 119.28 Tm 0.0347 Tc 0 Tw (and) Tj ET BT 0.8915 0 0 0.9835 346.32 100.8 Tm 0.0355 Tc 1.9163 Tw (initiatives intended to provide appropriate care) Tj ET BT 0.9835 0 0 0.9835 347.04 88.8 Tm 0.0264 Tc 1.7306 Tw (outside nursing homes for individuals with) Tj ET BT 0.8915 0 0 0.9835 346.8 76.8 Tm 0.034 Tc 2.1872 Tw (dementia, e.g., specialized residential care pro-) Tj 0.2692 -11.9577 TD 0.0455 Tc 1.2501 Tw (grams inboard and care facilities, group homes,) Tj ET BT 0.934 0 0 0.9835 347.04 53.04 Tm -0.0291 Tc 1.7719 Tw (and assisted living facilities; specialized adult) Tj ET BT 0.9835 0 0 0.9835 347.04 41.52 Tm 0.0333 Tc 0.113 Tw (day programs; and specialized in-home serv-) Tj ET BT 0.8915 0 0 0.9835 347.04 30.72 Tm 0.0355 Tc 0 Tw (ices.) Tj ET endstream endobj 32 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 33 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.92 683.28 m 540 683.28 l S BT 0.9835 0 0 0.9835 334.32 688.56 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 3.0427 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 527.04 688.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 533.76 688.56 Tm /F5 10 Tf 0.122 Tc 0 Tw (9) Tj ET BT 0.934 0 0 0.9835 73.2 649.68 Tm /F4 10 Tf -0.0378 Tc 1.4665 Tw (This OTA report focuses on special care units in) Tj ET BT 0.9835 0 0 0.9835 62.4 637.68 Tm 0.0258 Tc -0.1234 Tw (nursing homes. A full evaluation of the initiatives) Tj 0.244 -11.9577 TD 0.0509 Tc 2.3525 Tw (listed above is beyond the scope of the report,) Tj ET BT 0.934 0 0 0.9835 62.88 613.68 Tm -0.0159 Tc 2.0319 Tw (although the implications of OBRA-87 for nursing) Tj -0.257 -12.4458 TD -0.0346 Tc 0.9628 Tw (home residents with dementia are discussed in this) Tj ET BT 0.8915 0 0 0.9835 62.88 589.68 Tm 0.0418 Tc 0.8505 Tw (chapter and at greater length in chapter 5, and some) Tj ET BT 0.934 0 0 0.9835 62.88 577.68 Tm -0.0359 Tc 1.7535 Tw (of the other initiatives are discussed briefly at the) Tj 0 -12.4458 TD -0.0318 Tc 0.7213 Tw (end of this chapter. Ultimately, government policies) Tj ET BT 0.9835 0 0 0.9835 63.12 553.92 Tm 0.0373 Tc 0.5055 Tw (for special care units should be considered in the) Tj ET BT 0.934 0 0 0.9835 63.36 541.68 Tm -0.0382 Tc 0.7098 Tw (context of these other initiatives which may provide) Tj ET BT 0.8915 0 0 0.9835 63.36 530.16 Tm 0.0487 Tc 1.4323 Tw (alternate or even better ways of accomplishing some) Tj ET BT 0.934 0 0 0.9835 63.6 518.16 Tm -0.023 Tc 0.9138 Tw (of the same objectives as special care units.) Tj ET BT 0.9795 0 0 0.9795 110.4 494.16 Tm /F7 12 Tf 0.0493 Tc 0.7871 Tw (Organization of the Report) Tj ET BT 0.934 0 0 0.9835 74.64 476.4 Tm /F4 10 Tf -0.019 Tc 0.5791 Tw (The remainder of this chapter summarizes OTA\222s) Tj ET BT 0.8915 0 0 0.9835 63.84 464.64 Tm 0.0343 Tc 0.7563 Tw (findings with respect to the characteristics of nursing) Tj ET BT 0.934 0 0 0.9835 63.84 452.88 Tm -0.0306 Tc 1.2522 Tw (home residents with dementia and problems in the) Tj ET BT 0.9835 0 0 0.9835 64.08 440.64 Tm 0.0132 Tc 2.8179 Tw (care they receive in many nursing homes, the) Tj 0 -12.2018 TD 0.0176 Tc 1.2679 Tw (characteristics of existing special care units, the) Tj ET BT 0.934 0 0 0.9835 64.32 416.4 Tm -0.0169 Tc 1.0908 Tw (available information about their effectiveness, and) Tj ET BT 0.9835 0 0 0.9835 64.56 404.4 Tm 0.0216 Tc -0.1191 Tw (the regulatory environment for special care units.) Tj -0.244 -11.9577 TD 0.029 Tc -0.086 Tw (The implications of these findings for government) Tj ET BT 0.934 0 0 0.9835 64.08 380.64 Tm -0.0357 Tc 1.5147 Tw (policies about special care units are discussed. The) Tj 0.7709 -12.2018 TD -0.0442 Tc 1.6768 Tw (chapter also discusses several topics not addressed) Tj ET BT 0.9835 0 0 0.9835 64.8 356.88 Tm 0.0308 Tc 0.4003 Tw (elsewhere in the report, including the theoretical) Tj 0 -12.2018 TD 0.0391 Tc 1.4899 Tw (concepts of specialized care for individuals with) Tj 0.244 -12.2018 TD 0.0405 Tc 1.0819 Tw (dementia and legal and ethical issues related to) Tj ET BT 0.8915 0 0 0.9835 65.28 320.88 Tm 0.0457 Tc 1.4741 Tw (special care units.) Tj 12.3829 -18.0586 TD 0.0395 Tc 1.2119 Tw (Chapter 2 discusses the prevalence of dementia in) Tj ET BT 0.934 0 0 0.9835 65.04 290.88 Tm -0.0178 Tc 1.1346 Tw (nursing homes, the characteristics of nursing home) Tj ET BT 0.9835 0 0 0.9835 65.04 278.88 Tm 0.0295 Tc 0.0356 Tw (residents with dementia, and the most frequently) Tj 0.4881 -12.4458 TD 0.0217 Tc 0.8976 Tw (cited complaints and concerns about the nursing) Tj ET BT 0.934 0 0 0.9835 65.52 254.88 Tm -0.0395 Tc 1.4148 Tw (home care provided for these individuals. Chapters) Tj 0.5139 -12.6899 TD -0.0155 Tc 0.5753 Tw (3 and 4 analyze the results of the available descrip-) Tj ET BT 0.9835 0 0 0.9835 65.76 230.64 Tm 0.033 Tc 0.9501 Tw (tive and evaluative studies of special care units.) Tj ET BT 0.8915 0 0 0.9835 66 218.4 Tm 0.0334 Tc 1.2188 Tw (Chapter 5 discusses the government regulations that) Tj ET BT 0.9835 0 0 0.9835 66 206.4 Tm 0.0275 Tc 1.0602 Tw (apply to special care units, including the special) Tj ET BT 0.8915 0 0 0.9835 65.52 194.88 Tm 0.0299 Tc 0.7441 Tw (requirements that are now in effect in six States, and) Tj ET BT 0.934 0 0 0.9835 66.24 182.64 Tm -0.0278 Tc 1.0703 Tw (the guidelines for special care units that have been) Tj 0 -12.2018 TD -0.0258 Tc 2.2994 Tw (developed by various public and private organiza-) Tj ET BT 0.8915 0 0 0.9835 66.24 158.64 Tm 0.0403 Tc 1.0572 Tw (tions. Chapter 6 analyzes the problem of government) Tj -0.2692 -11.7137 TD 0.0446 Tc 1.7894 Tw (regulations that discourage innovation in the design) Tj ET BT 0.934 0 0 0.9835 66.48 134.88 Tm -0.0333 Tc 0.8 Tw (and operation of special care units.) Tj ET BT 0.9939 0 0 0.9939 119.52 108.96 Tm /F6 14 Tf 0.0129 Tc 0.3494 Tw (NURSING HOMES) Tj ET BT 0.9663 0 0 0.9939 124.8 93.36 Tm 0.0602 Tc 2.3968 Tw (AND DEMENTIA) Tj ET BT 0.934 0 0 0.9835 77.76 75.84 Tm /F4 10 Tf -0.0177 Tc 1.5092 Tw (Because of the aging of the U.S. population, the) Tj -12.3339 -12.6899 TD -0.0208 Tc 0.7523 Tw (number of individuals with Alzheimer\222s disease and) Tj ET BT 0.9835 0 0 0.9835 66.72 51.36 Tm 0.032 Tc 2.6767 Tw (other diseases that cause dementia is growing) Tj ET BT 0.8915 0 0 0.9835 66.24 39.84 Tm 0.0317 Tc 1.6693 Tw (rapidly. The proportion of individuals with dementia) Tj ET BT 0.9835 0 0 0.9835 313.44 649.68 Tm 0.0221 Tc 1.4178 Tw (that is in nursing homes now or will ever be in) Tj ET BT 0.8915 0 0 0.9835 313.44 637.68 Tm 0.0253 Tc 0.501 Tw (nursing homes is not known, but it is likely that most) Tj ET BT 0.934 0 0 0.9835 313.92 625.92 Tm -0.0334 Tc 1.4755 Tw (individuals with dementia will spend some time in) Tj 0 -12.4458 TD -0.0285 Tc 0.8463 Tw (a nursing home in the course of their illness. These) Tj T* -0.042 Tc 1.6316 Tw (individuals constitute the pool of potential users of) Tj ET BT 0.8915 0 0 0.9835 314.4 589.44 Tm 0.0457 Tc 1.2049 Tw (special care units.) Tj ET BT 0.9835 0 0 0.9835 324.72 571.92 Tm 0.0241 Tc 1.6476 Tw (This section provides background information) Tj -10.4935 -12.6899 TD 0.0316 Tc 1.3001 Tw (about the clinical syndrome of dementia and its) Tj ET BT 0.934 0 0 0.9835 314.64 547.44 Tm -0.0271 Tc 1.7119 Tw (causes, the prevalence of dementia, and the use of) Tj ET BT 0.9835 0 0 0.9835 314.4 535.92 Tm 0.0199 Tc 1.5909 Tw (nursing homes by individuals with dementia. It) Tj ET BT 0.934 0 0 0.9835 314.64 523.68 Tm -0.0334 Tc 2.0506 Tw (describes the characteristics of nursing home resi-) Tj 0 -11.9577 TD -0.0291 Tc 1.1039 Tw (dents with dementia and discusses the problems in) Tj ET BT 0.8915 0 0 0.9835 314.64 499.92 Tm 0.0571 Tc 0.6538 Tw (the care they receive in many nursing homes and the) Tj ET BT 0.9835 0 0 0.9835 314.64 487.92 Tm 0.0324 Tc 1.1947 Tw (impact of those problems on the residents, their) Tj ET BT 0.934 0 0 0.9835 314.88 476.16 Tm -0.0059 Tc 1.7642 Tw (families, nursing home staff members, and nonde-) Tj ET BT 0.8915 0 0 0.9835 314.64 464.4 Tm 0.0318 Tc 2.2075 Tw (mented nursing home residents.) Tj ET BT 0.9795 0 0 0.9795 339.6 443.52 Tm /F7 12 Tf 0.0291 Tc 0.5831 Tw (The Clinical Syndrome of Dementia) Tj ET BT 0.934 0 0 0.9835 326.16 425.28 Tm /F4 10 Tf -0.024 Tc 0.7558 Tw (Dementia is a clinical syndrome characterized by) Tj -11.563 -12.4458 TD -0.0371 Tc 1.1446 Tw (the decline of cognitive abilities in an alert individ-) Tj 0 -11.9577 TD -0.0346 Tc 0.6692 Tw (ual. By definition, dementia involves some degree of) Tj ET BT 0.9835 0 0 0.9835 315.36 389.04 Tm 0.0022 Tc 2.585 Tw (memory loss.) Tj 71.5024 0 TD 0.0276 Tc 1.766 Tw (Other cognitive abilities that are) Tj -71.2584 -11.9577 TD 0.0319 Tc 0.0331 Tw (frequently diminished or lost in dementia include) Tj ET BT 0.934 0 0 0.9835 315.12 365.28 Tm -0.0127 Tc 1.022 Tw (judgment, learning capacity, reasoning, comprehen-) Tj ET BT 0.8915 0 0 0.9835 316.32 353.28 Tm 0.031 Tc 0.7167 Tw (sion, attention, and orientation to time and place and) Tj ET BT 0.934 0 0 0.9835 316.08 341.52 Tm -0.0149 Tc 0.5748 Tw (to oneself. Language functions, including the ability) Tj 0 -12.2018 TD -0.0264 Tc 1.7434 Tw (to express oneself meaningfully and to understand) Tj 0 -11.9577 TD -0.0171 Tc 0.4914 Tw (what others communicate, are usually also affected.) Tj ET BT 0.9835 0 0 0.9835 327.36 299.76 Tm 0.0327 Tc 0.3577 Tw (Dementia can be caused by many diseases and) Tj -11.2256 -12.4458 TD 0.039 Tc -0.0322 Tw (conditions \(see app. A\). Alzheimer\222s disease is the) Tj ET BT 0.934 0 0 0.9835 316.56 275.52 Tm -0.0139 Tc 1.2344 Tw (most common cause of dementia, accounting for 50) Tj 0.257 -12.2018 TD -0.0055 Tc 0.3362 Tw (to 80 percent or more of all cases \(131,227,448\). The) Tj 0.257 -12.4458 TD -0.0303 Tc 1.2153 Tw (second most common cause of dementia is multiple) Tj ET BT 0.8915 0 0 0.9835 317.04 239.28 Tm 0.0187 Tc 1.5493 Tw (small strokes that lead to multi-infarct dementia.) Tj ET BT 0.934 0 0 0.9835 327.6 221.52 Tm -0.0287 Tc 1.2747 Tw (Alzheimer\222s disease and most other diseases and) Tj ET BT 0.8915 0 0 0.9835 317.04 209.52 Tm 0.0422 Tc 1.0743 Tw (conditions that cause dementia are progressive. Over) Tj ET BT 0.934 0 0 0.9835 316.8 197.52 Tm -0.0268 Tc 1.3584 Tw (time, as individuals with these diseases and condi-) Tj 0.7709 -11.9577 TD -0.0355 Tc 2.3954 Tw (tions lose cognitive abilities, they become increas-) Tj -0.257 -12.2018 TD -0.0308 Tc 1.7909 Tw (ingly unable to care for themselves independently.) Tj 0 -12.2018 TD -0.0236 Tc 1.3548 Tw (Eventually most individuals with dementia require) Tj ET BT 0.9835 0 0 0.9835 317.52 150 Tm 0.0287 Tc 2.9486 Tw (24-hour supervision and assistance with every) Tj ET BT 0.934 0 0 0.9835 317.52 138 Tm -0.0381 Tc 0.9207 Tw (aspect of their daily lives.) Tj ET BT 0.9795 0 0 0.9795 360.72 117.6 Tm /F7 12 Tf 0.0228 Tc 0.5691 Tw (The Prevalence of Dementia) Tj ET BT 0.9835 0 0 0.9835 328.8 99.6 Tm /F4 10 Tf 0.0289 Tc 1.9652 Tw (OTA estimates that there are now about 1.8) Tj -11.2256 -11.9577 TD 0.0437 Tc 0.1838 Tw (million people with ) Tj ET BT 0.9812 0 0 0.9812 409.68 87.84 Tm /F5 11 Tf 0.0658 Tc 0.1776 Tw (severe dementia in the ) Tj ET BT 0.9835 0 0 0.9835 511.92 87.84 Tm /F4 10 Tf 0.0258 Tc 0 Tw (United) Tj ET BT 0.934 0 0 0.9835 318 75.84 Tm -0.0256 Tc 1.1572 Tw (States and an additional 1 to 5 million people with) Tj ET BT 0.9812 0 0 0.9812 317.52 63.84 Tm /F5 11 Tf 0.0642 Tc 0.5584 Tw (mild or moderate dementia \(458\). ) Tj ET BT 0.9835 0 0 0.9835 472.08 63.84 Tm /F4 10 Tf 0.0294 Tc 0.5237 Tw (The results of a) Tj ET BT 0.934 0 0 0.9835 318.24 52.08 Tm -0.0182 Tc 1.4134 Tw (study conducted in East Boston in the early 1980s) Tj ET BT 0.9835 0 0 0.9835 318.24 40.32 Tm 0.0231 Tc 0.581 Tw (suggest that as many as 3.75 million people may) Tj ET endstream endobj 34 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 35 0 obj <>stream 0.72 w 1 j 0 0 0 RG 68.4 684.72 m 546.72 684.72 l S BT 0.9444 0 0 0.9835 68.88 691.2 Tm 0 0 0 rg /F5 10 Tf 0.0803 Tc -0.0449 Tw (10 ) Tj ET BT 0.9207 0 0 0.9598 81.12 691.2 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.9444 0 0 0.9835 87.12 691.2 Tm /F5 10 Tf -0.0146 Tc 0.3098 Tw (Special Care ) Tj ET BT 0.9443 0 0 0.9812 139.68 691.2 Tm /F5 11 Tf -0.0026 Tc 0.8603 Tw (Units for People With Alzheimer\222s ) Tj ET BT 0.9444 0 0 0.9835 290.4 691.2 Tm /F5 10 Tf -0.019 Tc 1.5851 Tw (and Other Dementias) Tj ET BT 0.9835 0 0 0.9835 68.88 651.36 Tm /F4 10 Tf 0.0384 Tc 0.8399 Tw (have Alzheimer\222s disease at all levels of severity) Tj ET BT 0.934 0 0 0.9835 69.36 639.12 Tm -0.0207 Tc 1.2661 Tw (\(129\), but some researchers and clinicians consider) Tj ET BT 0.8915 0 0 0.9835 69.12 627.12 Tm 0.0122 Tc 1.3772 Tw (this estimate high.) Tj ET BT 0.934 0 0 0.9835 80.16 609.12 Tm -0.0309 Tc 2.1849 Tw (The prevalence of dementia increases dramatic-) Tj -11.563 -12.4458 TD -0.0252 Tc 0.8427 Tw (ally with age. OTA estimates that the prevalence of) Tj 0 -12.4458 TD -0.0703 Tc 0.1201 Tw (severe ) Tj ET BT 0.9443 0 0 0.9812 100.8 584.64 Tm /F5 11 Tf 0.0078 Tc 0.0359 Tw (dementia ) Tj ET BT 0.934 0 0 0.9835 142.8 584.64 Tm /F4 10 Tf -0.029 Tc 1.3607 Tw (increases from less than 1 percent) Tj -78.3714 -11.9577 TD -0.0364 Tc 1.3173 Tw (of people under age 65, to about 1 percent of those) Tj 0.257 -12.2018 TD -0.0004 Tc 0.602 Tw (age 65 to 74,7 percent of those age 75 to 84, and 25) Tj ET BT 0.9835 0 0 0.9835 69.6 548.64 Tm 0.0474 Tc 1.8611 Tw (percent of those over age 85 \(458\). It has been) Tj 0.244 -11.9577 TD 0.0451 Tc 1.6698 Tw (hypothesized that the incidence of new cases of) Tj ET BT 0.934 0 0 0.9835 70.08 524.88 Tm -0.0186 Tc 1.7029 Tw (dementia may level off in individuals over age 85,) Tj -0.257 -12.2018 TD -0.0194 Tc 1.6074 Tw (but followup data from the East Boston study and) Tj ET BT 0.8915 0 0 0.9835 70.08 501.36 Tm 0.0451 Tc 1.0903 Tw (other sources indicate that the incidence of dementia) Tj ET BT 0.934 0 0 0.9835 70.32 489.36 Tm -0.0037 Tc 1.5906 Tw (continues to increase \(130,495\).) Tj 11.82 -18.0586 TD -0.0187 Tc 0.4824 Tw (The U.S. population over age 65 is growing faster) Tj -11.563 -12.4458 TD -0.0062 Tc 0.9652 Tw (than younger age groups, and the 85+ age group is) Tj ET BT 0.9835 0 0 0.9835 70.56 447.6 Tm 0.0337 Tc 1.298 Tw (growing faster than other segments of the older) Tj ET BT 0.934 0 0 0.9835 70.32 435.36 Tm -0.0282 Tc 1.1763 Tw (population. As a result, the number and proportion) Tj 0.257 -12.4458 TD -0.0304 Tc 1.6192 Tw (of individuals with dementia in the population are) Tj 0.5139 -11.9577 TD -0.0317 Tc 2.1344 Tw (growing rapidly.) Tj ET BT 0.9795 0 0 0.9795 99.36 383.28 Tm /F7 12 Tf 0.0296 Tc 0.8889 Tw (Nursing Home Use by Individuals) Tj 49.0063 -14.2118 TD 0.0199 Tc 0.4087 Tw (With Dementia) Tj ET BT 0.934 0 0 0.9835 82.08 352.08 Tm /F4 10 Tf -0.0338 Tc 0.9804 Tw (The proportion of individuals with dementia that) Tj -11.563 -11.7137 TD -0.0105 Tc 0.7569 Tw (is in a nursing home at any one time is not known.) Tj -0.257 -12.4458 TD -0.0378 Tc 0.7598 Tw (Nor is it known what proportion of individuals with) Tj ET BT 0.8915 0 0 0.9835 71.28 316.32 Tm 0.0637 Tc 0.2426 Tw (dementia will ever be in a nursing home in the course) Tj ET BT 0.934 0 0 0.9835 71.28 304.56 Tm -0.0402 Tc 0.8588 Tw (of their illness.) Tj ET BT 0.9835 0 0 0.9835 82.8 286.32 Tm 0.0306 Tc 0.4208 Tw (On the basis of figures from the 1985 National) Tj ET BT 0.934 0 0 0.9835 71.28 274.08 Tm 0.0072 Tc 2.0928 Tw (Nursing Home Survey--i.e., 696,800 nursing home) Tj ET BT 0.9835 0 0 0.9835 71.04 262.32 Tm 0.0332 Tc 1.1938 Tw (residents who had senile dementia or chronic or) Tj ET BT 0.934 0 0 0.9835 71.52 250.08 Tm 0.0062 Tc 1.1945 Tw (organic brain syndrome and 922,500 nursing home) Tj ET BT 0.9835 0 0 0.9835 71.28 238.32 Tm 0.0403 Tc 2.7903 Tw (residents who were so disoriented or memory-) Tj ET BT 0.934 0 0 0.9835 71.76 226.08 Tm -0.0363 Tc 1.4786 Tw (impaired that their performance of the activities of) Tj ET BT 0.9835 0 0 0.9835 71.76 214.08 Tm 0.0306 Tc 0.7666 Tw (daily living was impaired nearly every day\227and) Tj 0.244 -12.2018 TD 0.0379 Tc 2.3454 Tw (OTA\222s estimates of the prevalence of dementia) Tj -0.244 -11.9577 TD 0.0181 Tc 0.1285 Tw (nationwide\227i.e., 1.8 million Americans who have) Tj ET BT 0.934 0 0 0.9835 72.24 178.56 Tm -0.0243 Tc 1.2414 Tw (severe dementia, and 1 to 5 million who have mild) Tj ET BT 0.9835 0 0 0.9835 72 166.32 Tm 0.0416 Tc 2.3009 Tw (or moderate dementia--one could estimate that) Tj ET BT 0.934 0 0 0.9835 72 154.08 Tm -0.0241 Tc 0.97 Tw (anywhere from 10 to 33 percent of individuals with) Tj 0 -11.9577 TD -0.0272 Tc 0.9876 Tw (dementia of any degree of severity are in a nursing) Tj -0.257 -12.2018 TD -0.0183 Tc 0.3214 Tw (home now. If one surmi) Tj ET BT 0.8915 0 0 0.9835 174.72 130.08 Tm 0.0225 Tc 0.3562 Tw (ses that only individuals with) Tj ET BT 0.934 0 0 0.9835 72.48 118.08 Tm -0.0281 Tc 0.7601 Tw (severe dementia are likely to be in a nursing home,) Tj ET BT 0.9835 0 0 0.9835 72 106.32 Tm 0.0353 Tc 0.9651 Tw (one could estimate that anywhere from 39 to 51) Tj ET BT 0.934 0 0 0.9835 72 94.32 Tm -0.0364 Tc 0.5977 Tw (percent of individuals with severe dementia are in a) Tj 0 -11.9577 TD -0.0104 Tc 1.2123 Tw (nursing home now.) Tj ET BT 0.9835 0 0 0.9835 83.28 64.8 Tm 0.029 Tc 1.8663 Tw (A much larger proportion of individuals with) Tj ET BT 0.934 0 0 0.9835 72.24 52.56 Tm -0.029 Tc 0.3899 Tw (dementia are likely to spend some time in a nursing) Tj ET BT 0.9835 0 0 0.9835 72 40.8 Tm 0.0255 Tc -0.0011 Tw (home in the course of their illness, although some) Tj ET BT 0.8915 0 0 0.9835 319.92 651.36 Tm 0.0495 Tc 1.0997 Tw (individuals with dementia will never be in a nursing) Tj ET BT 0.9835 0 0 0.9835 319.68 639.36 Tm 0.0363 Tc 2.8351 Tw (home. Recent projections from data on elderly) Tj ET BT 0.8915 0 0 0.9835 320.16 627.12 Tm 0.034 Tc 1.0162 Tw (individuals who died in 1986 suggest that 43 percent) Tj ET BT 0.9835 0 0 0.9835 320.16 614.88 Tm 0.0349 Tc 0.3555 Tw (of all Americans who reached age 65 in 1990 will) Tj ET BT 0.934 0 0 0.9835 320.64 602.64 Tm -0.0305 Tc 0.9911 Tw (spend some time in a nursing home before they die) Tj ET BT 0.8915 0 0 0.9835 320.64 590.88 Tm 0.0365 Tc 1.6384 Tw (\(230\). Individuals with dementia are far more likely) Tj 0 -12.4458 TD 0.0372 Tc 1.2818 Tw (than elderly individuals in general to be admitted to) Tj ET BT 0.9835 0 0 0.9835 320.64 566.64 Tm 0.0153 Tc 2.0022 Tw (a nursing home, and it may be that almost all) Tj ET BT 0.934 0 0 0.9835 320.64 554.64 Tm -0.0334 Tc 1.5122 Tw (individuals with dementia will spend some time in) Tj 0.5139 -12.4458 TD -0.0273 Tc 0.6201 Tw (a nursing home in the course of their illness.) Tj 11.563 -17.8146 TD -0.0338 Tc 0.9804 Tw (The proportion of individuals with dementia that) Tj ET BT 0.9835 0 0 0.9835 321.12 512.88 Tm 0.0187 Tc 1.3481 Tw (is in a nursing home at any given time and the) Tj -0.244 -11.9577 TD 0.0287 Tc -0.045 Tw (proportion that will be in a nursing home at some) Tj ET BT 0.934 0 0 0.9835 321.12 489.12 Tm -0.0469 Tc 1.3798 Tw (time in the course of their illness could increase or) Tj 0 -12.4458 TD -0.0342 Tc 0.6596 Tw (decrease as a result of several factors. These factors) Tj ET BT 0.9835 0 0 0.9835 321.36 465.12 Tm 0.0408 Tc 0.1054 Tw (include the availability of appropriate residential) Tj 0 -12.4458 TD 0.0229 Tc 0.2152 Tw (care in alternate settings, such as board and care) Tj ET BT 0.8915 0 0 0.9835 321.6 440.88 Tm 0.0362 Tc 1.3502 Tw (facilities; the availability of appropriate in-home and) Tj ET BT 0.9835 0 0 0.9835 321.6 428.64 Tm 0.02 Tc -0.1174 Tw (community services; and Medicaid eligibility, cov-) Tj ET BT 0.8915 0 0 0.9835 321.84 416.64 Tm 0.0586 Tc 1.2354 Tw (erage, and reimbursement policies that encourage or) Tj ET BT 0.934 0 0 0.9835 321.84 404.64 Tm -0.0261 Tc 1.409 Tw (discourage nursing home placement for individuals) Tj ET BT 0.8915 0 0 0.9835 322.08 392.88 Tm 0.016 Tc 1.7767 Tw (with dementia.) Tj ET BT 0.9795 0 0 0.9795 327.6 365.04 Tm /F7 12 Tf 0.0358 Tc 0.8825 Tw (Characteristics of Nursing Home Residents) Tj 72.0393 -13.9668 TD 0.0199 Tc 0.4087 Tw (With Dementia) Tj ET BT 0.934 0 0 0.9835 333.12 333.6 Tm /F4 10 Tf -0.0196 Tc 0.6312 Tw (Available information about the characteristics of) Tj -11.82 -11.9577 TD -0.0359 Tc 1.154 Tw (nursing home residents with dementia is presented) Tj ET BT 0.8915 0 0 0.9835 322.56 309.84 Tm 0.0377 Tc 1.0793 Tw (in chapter 2. As noted there, nursing home residents) Tj ET BT 0.9835 0 0 0.9835 322.56 297.6 Tm 0.0379 Tc 1.8863 Tw (with dementia are older on average than other) Tj ET BT 0.8915 0 0 0.9835 322.32 285.84 Tm 0.0455 Tc 1.7885 Tw (nursing home residents. The 1985 National Nursing) Tj ET BT 0.934 0 0 0.9835 322.56 273.6 Tm -0.0244 Tc 1.3879 Tw (Home Survey found that half of the residents with) Tj ET BT 0.8915 0 0 0.9835 322.56 261.6 Tm 0.0467 Tc 1.2038 Tw (dementia were over age 85, compared with one-third) Tj ET BT 0.934 0 0 0.9835 322.56 249.6 Tm -0.024 Tc 1.4838 Tw (of the other residents \(469\). The survey also found) Tj 0 -12.2018 TD -0.0302 Tc 1.7902 Tw (that three-quarters of the residents with dementia) Tj ET BT 0.9835 0 0 0.9835 322.8 225.36 Tm 0.0456 Tc -0.1029 Tw (were female. Although a preponderance of female) Tj -0.244 -11.7137 TD 0.0417 Tc 1.6733 Tw (residents with dementia is to be expected since) Tj ET BT 0.934 0 0 0.9835 323.04 201.6 Tm -0.0195 Tc 2.2755 Tw (female nursing home residents greatly outnumber) Tj ET BT 0.8915 0 0 0.9835 322.56 189.84 Tm 0.0275 Tc 1.6484 Tw (male residents, the survey data indicate that female) Tj ET BT 0.934 0 0 0.9835 322.8 178.08 Tm -0.0379 Tc 1.0276 Tw (nursing home residents were somewhat more likely) Tj ET BT 0.8915 0 0 0.9835 323.04 165.6 Tm 0.0317 Tc 0.8506 Tw (than male residents to have dementia \(48 percent vs.) Tj ET BT 0.934 0 0 0.9835 323.04 154.08 Tm -0.0221 Tc 1.8672 Tw (40 percent, respectively\) \(469\).) Tj 11.563 -18.3027 TD -0.0299 Tc 1.276 Tw (Nursing home residents with dementia are more) Tj ET BT 0.9835 0 0 0.9835 323.28 124.56 Tm 0.0294 Tc 0.4656 Tw (likely than other nursing home residents to need) Tj ET BT 0.934 0 0 0.9835 323.28 112.32 Tm -0.016 Tc 1.567 Tw (assistance with activities of daily living \(i.e., bath-) Tj 0 -12.2018 TD -0.0234 Tc 0.4736 Tw (ing, dressing, using the toilet, transferring from bed) Tj ET BT 0.8915 0 0 0.9835 323.28 88.56 Tm 0.0472 Tc 1.3187 Tw (to chair, remaining continent, and eating\). The 1985) Tj ET BT 0.934 0 0 0.9835 323.28 76.56 Tm -0.0134 Tc 0.8301 Tw (National Nursing Home Survey found, for example,) Tj 0.257 -12.2018 TD -0.0386 Tc 1.7381 Tw (that 69 percent of residents with dementia needed) Tj ET BT 0.9835 0 0 0.9835 323.76 52.56 Tm 0.0219 Tc -0.1194 Tw (assistance to remain continent, compared with 37) Tj -0.7321 -12.2018 TD 0.0429 Tc -0.0187 Tw (percent of the other residents \(469\) \(see fig. l-l\).) Tj ET endstream endobj 36 0 obj <>/ProcSet 565 0 R/XObject 37 0 R>>/Rotate 0/Type/Page>> endobj 37 0 obj <> endobj 38 0 obj [39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R] endobj 39 0 obj <>stream q 41.76 0 0 -148.32 72.48 600.24 cm /im6 Do endstream endobj 40 0 obj <>stream Q q 104.64 0 0 -38.16 330.48 600.48 cm /im7 Do endstream endobj 41 0 obj <>stream Q q 101.28 0 0 -111.36 333.84 562.32 cm /im8 Do endstream endobj 42 0 obj <>stream Q q 111.12 0 0 -1.44 324 450.72 cm BI /W 618 /H 8 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?#??Hx EI Q q 37.44 0 0 -133.92 114.24 585.84 cm /im9 Do endstream endobj 43 0 obj <>stream Q q 36 0 0 -115.2 151.68 567.36 cm /im10 Do endstream endobj 44 0 obj <>stream Q q 36 0 0 -108 187.68 560.16 cm /im11 Do endstream endobj 45 0 obj <>stream Q q 36 0 0 -106.56 223.68 558.96 cm /im12 Do endstream endobj 46 0 obj <>stream Q q 33.12 0 0 -84.96 259.92 537.6 cm /im13 Do endstream endobj 47 0 obj <>stream Q q 30 0 0 -15.84 477.36 465.6 cm BI /W 166 /H 90 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID G8 EI Q 0.48 w 1 j 0 0 0 RG 443.04 391.92 m 462.24 391.92 l S 59.04 677.52 m 537.6 677.52 l S 73.44 602.88 m 295.2 602.88 l S 323.52 602.64 m 539.04 602.64 l S 327.12 602.4 m 327.12 450.96 l S 541.44 602.64 m 541.44 449.52 l S 0.72 w 294.96 600.96 m 294.96 454.8 l S 0.48 w 391.44 552 m 391.44 450.72 l S 434.88 544.08 m 462.96 544.08 l S 462.96 543.6 m 462.96 450.48 l S 0.24 w 506.88 454.8 m 534.96 454.8 l S 0.48 w 424.56 450.24 m 488.16 450.24 l S 0.72 w 496.8 450 m 539.28 450 l S BT 0.9835 0 0 0.9835 326.88 683.04 Tm 0 0 0 rg /F5 10 Tf 0.0184 Tc 1.8725 Tw (Chapter 1--Overview and Policy Implications . 11) Tj ET BT 0.9863 0 0 0.9863 60.96 644.16 Tm /F3 9 Tf 0.021 Tc 1.0445 Tw (Figure I-1\227impairments in Activities of Daily Living) Tj 13.1398 -10.2198 TD 0.0637 Tc 0.0117 Tw (in Demented and Nondemented Nursing Home) Tj 34.5527 -10.2198 TD 0.0463 Tc 0.2888 Tw (Residents, United States, 1985) Tj -48.9091 -18.493 TD 0.1038 Tc -0.175 Tw (100 ) Tj ET BT 0.9939 0 0 0.9939 80.16 605.76 Tm /F2 7 Tf 1.0858 Tc 0 Tw (96) Tj -0.0393 Tc (%) Tj ET BT 0.7217 0 0 0.9835 63.6 570.72 Tm /F4 10 Tf 0.4222 Tc (80) Tj 0.3325 -30.0164 TD 0.4222 Tc (60) Tj 0 -30.0164 TD 0.4222 Tc (40) Tj 0.3325 -30.0164 TD 0.256 Tc (20) Tj 5.9856 -30.2604 TD 0.0897 Tc (0) Tj ET BT 0.5944 0 0 0.9835 117.84 587.76 Tm 0.0693 Tc (87%\222.) Tj ET BT 0.7217 0 0 0.9835 154.08 568.32 Tm 0.2743 Tc (74%) Tj 49.8801 -6.589 TD 0.2743 Tc (70%) Tj ET BT 0.9189 0 0 0.99 226.32 559.92 Tm /F3 8 Tf 0.1498 Tc (69%) Tj ET BT 0.9939 0 0 0.9939 262.32 538.32 Tm /F2 7 Tf 1.0858 Tc (54) Tj -0.0393 Tc (%) Tj ET BT 0.99 0 0 0.99 81.84 443.28 Tm /F3 8 Tf -0.034 Tc 0.5252 Tw (Bathing Dressing Using Transferring Continence Eating) Tj ET BT 0.8648 0 0 0.99 149.52 432.96 Tm 0.0519 Tc 0.977 Tw (the toilet bed to chair) Tj ET q 17.52 0 0 -10.32 81.36 421.92 cm BI /W 103 /H 58 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~ EI Q BT 6.4322 0 0 0.99 81.36 413.76 Tm 3 Tr -0.0149 Tc 0 Tw (-) Tj 0 Tr ET BT 0.9189 0 0 0.99 98.88 413.76 Tm 0.0124 Tc 0.636 Tw ( Demented residents) Tj ET q 17.04 0 0 -10.08 190.08 421.44 cm BI /W 102 /H 56 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|xp<<><>x>x>x>>>x>x>x> x>x>x~?xxx>|><><>>>>>?>>>>xp EI Q BT 0.8645 0 0 0.9939 126.24 369.6 Tm 3 Tr -0.0364 Tc 0 Tw (\(PHS\)) Tj 0 Tr ET BT 0.9262 0 0 0.9939 144 369.6 Tm 0.011 Tc 0.5031 Tw ( 89-1758, ) Tj ET q 33.36 0 0 -6.96 174.96 374.88 cm BI /W 187 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x~||?||??|?|??x|?x||<|>|>|?>|?>?`<||>|~??|?>|?>|?<?>>>>>>>|?x EI Q BT 0.8645 0 0 0.9939 174.96 369.6 Tm 3 Tr -0.0272 Tc 0 Tw (Hyattsville,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 208.32 369.6 Tm 0.0684 Tc 0.8298 Tw ( MD, February 1991.) Tj ET BT 0.934 0 0 0.9835 73.2 348.96 Tm /F4 10 Tf -0.0142 Tc 2.1157 Tw (Psychiatric symptoms are more common among) Tj -12.0769 -12.4458 TD -0.0136 Tc 1.0016 Tw (nursing home residents with dementia than among) Tj ET BT 0.9835 0 0 0.9835 62.16 324.48 Tm 0.0213 Tc 0.2472 Tw (other nursing home residents. The 1987 National) Tj -0.244 -12.2018 TD 0.0375 Tc 0.8897 Tw (Medical Expenditure Survey found, for example,) Tj 0.4881 -12.2018 TD 0.0379 Tc 1.6423 Tw (that 36 percent of residents with dementia had) Tj ET BT 0.934 0 0 0.9835 62.16 288.24 Tm -0.0109 Tc 0.9987 Tw (psychiatric symptoms, such as delusions and hallu-) Tj ET BT 0.9835 0 0 0.9835 62.64 276.24 Tm 0.0315 Tc -0.0595 Tw (cinations, compared with 26 percent of other resi-) Tj ET BT 0.934 0 0 0.9835 62.64 264.24 Tm 0.0004 Tc 1.3292 Tw (dents \(464\) \(see ch. 2\).) Tj ET BT 0.9835 0 0 0.9835 73.68 244.56 Tm 0.0232 Tc 2.3684 Tw (Behavioral symptoms are also more common) Tj ET BT 0.934 0 0 0.9835 62.88 232.56 Tm -0.0136 Tc 1.0016 Tw (among nursing home residents with dementia than) Tj ET BT 0.9835 0 0 0.9835 63.12 220.56 Tm 0.0199 Tc 1.7535 Tw (among other nursing home residents. The 1987) Tj ET BT 0.8915 0 0 0.9835 62.64 208.32 Tm 0.0337 Tc 1.9363 Tw (National Medical Expenditure Survey found that 59) Tj ET BT 0.934 0 0 0.9835 62.64 196.32 Tm -0.0459 Tc 0.897 Tw (percent of residents with dementia had one or more) Tj 0.7709 -12.2018 TD -0.0163 Tc 1.604 Tw (of ten behavioral symptoms \(wandering, physically) Tj -0.257 -12.2018 TD -0.0228 Tc 1.3541 Tw (hurting others, physically hurting oneself, dressing) Tj 0.257 -12.2018 TD -0.0357 Tc 2.6526 Tw (inappropriately, crying for long periods, hoarding,) Tj 0 -12.4458 TD -0.0187 Tc 0.8786 Tw (getting upset, not avoiding dangerous things, steal-) Tj ET BT 0.9835 0 0 0.9835 63.36 136.32 Tm 0.0356 Tc 0.7208 Tw (ing, and inappropriate sexual behavior\) \(464\). In) Tj ET BT 0.8915 0 0 0.9835 63.36 124.08 Tm 0.0418 Tc 1.3247 Tw (contrast, 40 percent of other nursing home residents) Tj ET BT 0.934 0 0 0.9835 63.36 112.56 Tm -0.0233 Tc 1.3831 Tw (had one or more of these symptoms \(see fig. 1-2\).) Tj ET BT 0.9835 0 0 0.9835 74.4 93.12 Tm 0.0261 Tc 1.5846 Tw (Although these data show that nursing home) Tj ET BT 0.934 0 0 0.9835 63.36 81.12 Tm -0.0371 Tc 1.2225 Tw (residents with dementia are more likely than other) Tj ET BT 0.9835 0 0 0.9835 63.36 69.6 Tm 0.0193 Tc 1.6322 Tw (nursing home residents to have impairments in) Tj ET BT 0.934 0 0 0.9835 64.08 57.36 Tm -0.0171 Tc 0.9809 Tw (activities of daily living and psychiatric and behav-) Tj ET BT 0.8915 0 0 0.9835 63.6 46.08 Tm 0.0322 Tc 1.4894 Tw (ioral symptoms, not all nursing home residents with) Tj ET BT 0.9835 0 0 0.9835 63.6 34.32 Tm 0.0308 Tc 1.3357 Tw (dementia have these problems. The survey data) Tj ET BT 0.9863 0 0 0.9863 313.2 643.92 Tm /F3 9 Tf 0.0507 Tc 0.0735 Tw (Figure 1-2\227Behavioral Symptoms in Demented and) Tj 9.9765 -10.4631 TD 0.0543 Tc 0.0577 Tw (Nondemented Nursing Home Residents, United) Tj 75.6753 -10.4631 TD 0.0525 Tc 0.607 Tw (States, 1987) Tj ET BT 0.9189 0 0 0.99 339.84 605.28 Tm /F3 8 Tf 0.1498 Tc 0 Tw (59%) Tj ET BT 0.8648 0 0 0.99 313.92 599.52 Tm 0.2703 Tc (60) Tj ET BT 0.8491 0 0 0.9835 314.16 549.12 Tm /F4 10 Tf 0.0797 Tc (40-) Tj ET BT 0.8915 0 0 0.9835 327.6 549.12 Tm -0.1017 Tc (-) Tj ET BT 0.7642 0 0 0.9835 441.12 547.68 Tm 0.108 Tc (37%) Tj ET BT 0.8066 0 0 0.9835 314.64 498.24 Tm 0.2384 Tc (20-) Tj ET BT 1.08 0 0 1.08 327.6 503.04 Tm /F4 4 Tf 0.0009 Tc (-) Tj ET BT 0.9189 0 0 0.99 485.04 467.76 Tm /F3 8 Tf 0.2282 Tc (6%) Tj 32.1258 -8.0002 TD 0.0977 Tc (2%) Tj ET BT 0.8648 0 0 0.99 318.96 447.12 Tm -0.0072 Tc (0) Tj ET q 0.96 0 0 -4.32 534.24 455.04 cm BI /W 6 /H 26 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<888<<<<<<|<<<<<<<<< EI Q BT 0.2702 0 0 0.99 534.24 450.48 Tm 3 Tr 0.4422 Tc ({) Tj 0 Tr ET BT 0.8648 0 0 0.99 347.76 438 Tm 0.0268 Tc 0.3817 Tw (1 or more) Tj 89.9136 -0.2424 TD 0.0512 Tc 0.2147 Tw (1 to 4) Tj ET BT 0.9189 0 0 0.99 496.8 437.52 Tm 0.0005 Tc 0.1265 Tw (5 to 10) Tj ET BT 0.8648 0 0 0.99 346.32 428.16 Tm 0.0228 Tc 0 Tw (behavioral) Tj 81.5882 -0.2424 TD 0.0228 Tc (behavioral) Tj 85.7509 -0.2424 TD 0.0228 Tc (behavioral) Tj -167.3391 -9.6973 TD 0.0642 Tc (symptoms) Tj 81.8657 -0.2424 TD 0.0642 Tc (symptoms) Tj 85.4734 -0.4849 TD 0.0642 Tc (symptoms) Tj ET q 18.96 0 0 -10.8 330.24 402.72 cm BI /W 110 /H 61 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ! EI Q BT 5.5492 0 0 0.9835 330.24 390.72 Tm 3 Tr /F1 10 Tf -0.0015 Tc (-) Tj 0 Tr ET BT 0.9189 0 0 0.99 349.2 390.72 Tm /F3 8 Tf 0.0124 Tc 1.1583 Tw ( Demented residents) Tj ET q 18.96 0 0 -10.8 443.04 402.24 cm BI /W 112 /H 61 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  p?E?@  @@ @ @ @ @   ??? EI Q BT 2.5404 0 0 0.99 443.04 392.88 Tm 3 Tr -0.031 Tc 0 Tw (~]) Tj 0 Tr ET BT 0.9189 0 0 0.99 462 392.88 Tm 0.0218 Tc 0.2339 Tw ( Nondemented residents) Tj ET BT 0.9262 0 0 0.9939 312.96 372 Tm /F3 7 Tf 0.0598 Tc 0.0618 Tw (SOURCE: Adapted from U.S. Department of Health and Human Services,) Tj ET BT 0.8645 0 0 0.9939 347.04 364.08 Tm -0.0564 Tc 2.9769 Tw (published and unpublished datafromthe 1987 National Medical) Tj 0 -8.2103 TD -0.0561 Tc 3.8926 Tw (Expenditure Survey, Institutional Population Component, Cur-) Tj ET BT 0.9262 0 0 0.9939 347.04 348.24 Tm 0.0619 Tc 0.2215 Tw (rent Residents, Agency for Health Care Policy and Research,) Tj ET q 29.04 0 0 -6.24 347.04 345.36 cm BI /W 162 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |?>?|?|>ǀ~>~ǁ>|>|ǁ|>~|>?|>?>|>?߀>~Ǐ|~||?<?>>>?>>~ EI Q BT 0.8645 0 0 0.9939 347.04 340.32 Tm 3 Tr -0.0212 Tc 0 Tw (Rockville,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 376.08 340.32 Tm -0.0225 Tc 0.1279 Tw ( MD, 1991.) Tj ET BT 0.9835 0 0 0.9835 313.2 321.12 Tm /F4 10 Tf 0.0377 Tc 2.2439 Tw (indicate that 4 to 46 percent of residents with) Tj 0 -12.2018 TD 0.0313 Tc -0.0244 Tw (dementia do not have impairments in activities of) Tj ET BT 0.8915 0 0 0.9835 313.44 297.12 Tm 0.0276 Tc 0.8215 Tw (daily living, depending on the activity, and that more) Tj ET BT 0.934 0 0 0.9835 313.68 284.88 Tm -0.0331 Tc 1.6863 Tw (than 40 percent of residents with dementia do not) Tj -0.257 -11.9577 TD -0.0027 Tc 1.0756 Tw (have behavioral symptoms.) Tj ET BT 0.8915 0 0 0.9835 324.48 254.64 Tm 0.0302 Tc 1.8056 Tw (Nursing home residents with dementia also differ) Tj ET BT 0.934 0 0 0.9835 313.92 242.88 Tm -0.0327 Tc 1.7929 Tw (in their coexisting medical conditions and physical) Tj 0 -12.2018 TD -0.0144 Tc 1.2349 Tw (impairments. OTA is not aware of any information) Tj T* -0.032 Tc 1.731 Tw (from national studies on the proportion of nursing) Tj 0 -11.9577 TD -0.0331 Tc 1.4079 Tw (home residents with dementia who have coexisting) Tj ET BT 0.9835 0 0 0.9835 313.92 194.88 Tm 0.0192 Tc 2.226 Tw (medical conditions or physical impairments. As) Tj ET BT 0.8915 0 0 0.9835 314.16 182.64 Tm 0.0349 Tc 1.3854 Tw (discussed in chapter 2, data on the characteristics of) Tj ET BT 0.9835 0 0 0.9835 314.64 170.64 Tm 0.0267 Tc 0.5032 Tw (3427 residents of New York nursing homes show) Tj -0.244 -11.9577 TD 0.0222 Tc 0.3683 Tw (that residents with dementia vary greatly in this) Tj ET BT 0.8915 0 0 0.9835 313.92 146.64 Tm 0.0398 Tc 1.7116 Tw (respect \(283\). Some are relatively healthy except for) Tj ET BT 0.934 0 0 0.9835 314.4 134.88 Tm -0.0235 Tc 0.8409 Tw (their dementia, and others have numerous diseases) Tj ET BT 0.8915 0 0 0.9835 314.64 123.12 Tm 0.0294 Tc 0.5695 Tw (and physical impairments in addition to their demen-) Tj ET BT 0.8066 0 0 0.9835 314.64 111.36 Tm 0.0206 Tc 0 Tw (tia.) Tj ET BT 0.9835 0 0 0.9835 325.44 93.6 Tm 0.0238 Tc 1.7496 Tw (The diversity of nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 314.64 81.84 Tm 0.0412 Tc 1.3894 Tw (dementia has important implications for special care) Tj ET BT 0.934 0 0 0.9835 314.64 70.08 Tm -0.0198 Tc 0.2659 Tw (units. First, it is unlikely any particular type of unit) Tj ET BT 0.9835 0 0 0.9835 314.88 58.08 Tm 0.0399 Tc 0.6859 Tw (will be appropriate for all types of nursing home) Tj ET BT 0.8915 0 0 0.9835 314.4 46.56 Tm 0.0192 Tc 1.5808 Tw (residents with dementia. Second, with respect to the) Tj ET BT 0.934 0 0 0.9835 314.64 34.56 Tm -0.0411 Tc 1.5022 Tw (long-range possibilities discussed earlier, it is clear) Tj ET endstream endobj 48 0 obj <>/Filter/CCITTFaxDecode/Height 640/Length 1536/Name/im10/Subtype/Image/Type/XObject/Width 200>>stream &/@(rr q ]J TWo3ai&#eC_ @!!?A A\ `Xu)C(m@1+qkR CQA~!86^A{r  ?2 hA49 .!0? 0? 8qא7qhAC\`w܃P(GR 膘< ?>6 a.?AH 9 ?}G14q$85 AqCl\# A.??C4r _!.8?e9r 9 < ?'G =Ar ?AhA ? $8?_=q X?3?7AX3AAw㿐?(!? d0? f a.??q.?\q Adu ? c@r 5GA,?+!,]Ԃ5"?k?3 A8אn8C\C_ 8 ; `q!?AiB =xߐ ?cX !;~ALGeA0j.?q 8A\5~Au \qX"?c׏3~CPr hA7k | 7G"A` #A膘(!8ߐU Cc58q.:A \qhG^.8dXe?A`h!?_ X qA` >_ ?W5\w ?cq, 5 C4r n8C\ 08?e(Ch?$u싅Q;D|cd`AJ<6Ogv"_Ak%mv_G>ސt~Nw?ko~^߽߻ii [ci ve 5# y .W  endstream endobj 49 0 obj <>/Filter/CCITTFaxDecode/Height 600/Length 1250/Name/im11/Subtype/Image/Type/XObject/Width 200>>stream &/d'dx&9P{8lH0;)G\9r89.Gˣ ޿?_ yUW_#{ ?]S _AH _CXw k]?j yQ3~A~6 ?#(|XAhlk8)ߏ@zq ? q @`UG?בXG ?CT1 ^.+!?=8א ?@/ ?m}~@ ?C\c?~AL 8A8A\ ! ?q yq&8A|?@ȣ6 ?ؿD4Q \#w_ ? 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Mӹ>tf$nU_۵UpjR-5QA mk Sտ 'm ^+W~Xa~ B"?_ZޗG"8fGd2As_@ endstream endobj 56 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 57 0 obj <>stream 0.48 w 1 j 0 0 0 RG 71.28 688.32 m 549.36 688.32 l S 0.72 w 74.64 58.08 m 552.96 58.08 l S BT 0.9835 0 0 0.9835 71.52 694.8 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (12 ) Tj ET BT 0.9598 0 0 0.9598 84 694.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 90.24 694.8 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 143.76 694.8 Tm /F5 11 Tf 0.0681 Tc -0.1305 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 242.16 694.8 Tm /F5 10 Tf 0.0229 Tc -0.0843 Tw (Alzheimer\222s and Other Dementias) Tj -173.2653 -40.2659 TD /F4 10 Tf 0.0377 Tc -0.0745 Tw (that if special care units were designated to serve) Tj -0.244 -12.2018 TD 0.0227 Tc 1.8808 Tw (only individuals with behavioral symptoms, the) Tj ET BT 0.934 0 0 0.9835 71.76 631.44 Tm -0.0303 Tc 0.8481 Tw (units would not serve all individuals with dementia) Tj 0.257 -11.9577 TD -0.0147 Tc 0.6066 Tw (who need nursing home care, because more than 40) Tj ET BT 0.8915 0 0 0.9835 71.76 607.44 Tm 0.0362 Tc 1.6002 Tw (percent of nursing home residents with dementia do) Tj ET BT 0.934 0 0 0.9835 72 595.68 Tm -0.0065 Tc 0.994 Tw (not have behavioral symptoms.) Tj ET BT 0.9795 0 0 0.9795 78.24 567.36 Tm /F7 12 Tf 0.0308 Tc 0.6835 Tw (Problems in the Care Provided for Nursing) Tj 28.6687 -14.2118 TD 0.0313 Tc 0.8055 Tw (Home Residents With Dementia) Tj ET BT 0.9835 0 0 0.9835 83.52 535.68 Tm /F4 10 Tf 0.0317 Tc 1.4976 Tw (Many complaints and concerns have been ex-) Tj ET BT 0.8915 0 0 0.9835 72.24 523.68 Tm 0.028 Tc 1.3018 Tw (pressed about the quality and appropriateness of the) Tj ET BT 0.9835 0 0 0.9835 72.72 511.92 Tm 0.0312 Tc 2.5962 Tw (care provided for nursing home residents with) Tj 0 -12.4458 TD 0.0247 Tc 0.1625 Tw (dementia. These complaints and concerns are the) Tj ET BT 0.934 0 0 0.9835 72.72 488.16 Tm -0.0378 Tc 2.0553 Tw (primary reason for the development and prolifera-) Tj ET BT 0.9835 0 0 0.9835 72.96 475.92 Tm 0.0301 Tc 0.4146 Tw (tion of special care units. They explain to a great) Tj ET BT 0.934 0 0 0.9835 73.2 464.16 Tm -0.0356 Tc 0.7681 Tw (degree why there is a market for special care units.) Tj -0.257 -11.9577 TD -0.0291 Tc 1.1038 Tw (They are also the rationale for many of the specific) Tj ET BT 0.9835 0 0 0.9835 73.44 440.4 Tm 0.026 Tc 0.7306 Tw (changes in physical design features, patient care) Tj ET BT 0.934 0 0 0.9835 72.96 428.4 Tm -0.0212 Tc 1.3951 Tw (practices, and staff training that are recommended) Tj 0.5139 -12.2018 TD -0.0335 Tc 0.7659 Tw (for special care units.) Tj ET BT 0.9835 0 0 0.9835 84.24 398.16 Tm 0.0296 Tc 1.337 Tw (Table 1-1 lists the most frequently cited com-) Tj -11.2256 -12.2018 TD 0.038 Tc 0.9101 Tw (plaints and concerns about the care provided for) Tj ET BT 0.934 0 0 0.9835 73.44 374.16 Tm -0.0253 Tc 1.5036 Tw (nursing home residents with dementia. This list is) Tj ET BT 0.9835 0 0 0.9835 73.44 362.16 Tm 0.0301 Tc 0.9529 Tw (based on OTA\222s review of numerous articles and) Tj 0 -12.2018 TD 0.0249 Tc 0.9583 Tw (books on nursing home care for individuals with) Tj 0.4881 -11.9577 TD 0.0248 Tc 0.0132 Tw (dementia \(see ch. 2\). The inclusion of items in the) Tj ET BT 0.8915 0 0 0.9835 73.92 326.64 Tm 0.0292 Tc 0.712 Tw (list does not imply that there is evidence to prove the) Tj 0 -12.2018 TD 0.0297 Tc 0.3077 Tw (items are true but rather that the items are aspects of) Tj ET BT 0.934 0 0 0.9835 74.16 302.4 Tm -0.0466 Tc 0.7799 Tw (what is believed to be wrong with the care provided) Tj ET BT 0.9835 0 0 0.9835 73.92 290.88 Tm 0.0185 Tc 2.1211 Tw (for individuals with dementia in many nursing) Tj ET BT 0.934 0 0 0.9835 73.92 278.64 Tm -0.0088 Tc 0 Tw (homes.) Tj ET BT 0.9835 0 0 0.9835 85.44 260.4 Tm 0.0316 Tc 0.9514 Tw (Some of the complaints and concerns listed in) Tj ET BT 0.8915 0 0 0.9835 74.16 248.4 Tm 0.0291 Tc 1.2236 Tw (table 1-1 apply particularly to residents with demen-) Tj ET BT 0.934 0 0 0.9835 74.4 236.4 Tm -0.0286 Tc 1.5071 Tw (tia, and others apply equally to nondemented resi-) Tj 0 -12.2018 TD -0.0426 Tc 1.1917 Tw (dents. To differentiate these two types of problems,) Tj ET BT 0.8915 0 0 0.9835 74.64 212.16 Tm 0.0316 Tc 1.8041 Tw (OTA compared the most frequently cited complaints) Tj ET BT 0.9835 0 0 0.9835 74.64 200.64 Tm 0.025 Tc 3.1893 Tw (and concerns about the care of nursing home) Tj ET BT 0.934 0 0 0.9835 74.16 188.64 Tm -0.0228 Tc 0.7759 Tw (residents with dementia, as listed in table 1-1, with) Tj 0.5139 -11.9577 TD -0.0378 Tc 0.8562 Tw (the problems identified by the Institute of Medicine) Tj 0 -11.9577 TD -0.0153 Tc 0.7678 Tw (in its 1986 report, ) Tj ET BT 0.9443 0 0 0.9812 158.16 165.12 Tm /F5 11 Tf 0.0167 Tc 1.094 Tw (Improving the Quality of Care in) Tj -88.9539 -12.2296 TD 0.0263 Tc 0.0163 Tw (Nursing Homes, ) Tj ET BT 0.934 0 0 0.9835 144.48 153.12 Tm /F4 10 Tf -0.0244 Tc 0.5335 Tw (which dealt with nursing home care) Tj ET BT 0.9835 0 0 0.9835 74.88 141.12 Tm 0.0303 Tc 0.9528 Tw (for all types of residents \(318\). This comparison,) Tj 0 -12.2018 TD 0.0241 Tc 0.641 Tw (which is discussed in greater detail in chapter 2,) Tj 0.244 -12.2018 TD 0.0248 Tc 2.6027 Tw (shows that the complaints and concerns about) Tj ET BT 0.8915 0 0 0.9835 74.88 105.12 Tm 0.0443 Tc 1.2834 Tw (nursing home care for residents with dementia focus) Tj ET BT 0.934 0 0 0.9835 74.88 93.6 Tm -0.0213 Tc 0.8706 Tw (more on the physical aspects of nursing homes that) Tj ET BT 0.9835 0 0 0.9835 75.12 81.36 Tm 0.0478 Tc 0.749 Tw (are perceived to be inappropriate for individuals) Tj ET BT 0.8915 0 0 0.9835 75.12 69.12 Tm 0.0225 Tc 0.7525 Tw (with dementia \(e.g., the lack of cues to help residents) Tj ET BT 0.934 0 0 0.9835 322.56 655.2 Tm -0.0356 Tc 0.7967 Tw (find their way and the lack of appropriate space for) Tj ET BT 0.8915 0 0 0.9835 322.56 643.44 Tm 0.0225 Tc 1.4666 Tw (residents to wander\) and the lack of staff knowledge) Tj ET BT 0.9835 0 0 0.9835 323.04 631.44 Tm 0.0351 Tc 0.0763 Tw (about how to respond to behavioral symptoms. In) Tj 0 -12.4458 TD 0.0343 Tc 0.4781 Tw (contrast, the Institute of Medicine report focuses) Tj ET BT 0.934 0 0 0.9835 323.04 607.44 Tm -0.0365 Tc 0.63 Tw (more on the lack of sufficient attention to residents\222) Tj 0 -12.2018 TD -0.0364 Tc 0.9281 Tw (rights and the lack of choices for residents.) Tj ET BT 0.9835 0 0 0.9835 334.32 577.44 Tm 0.0413 Tc 0.2095 Tw (Both the Institute of Medicine\222s report and the) Tj ET BT 0.8915 0 0 0.9835 323.28 565.2 Tm 0.0543 Tc 1.426 Tw (literature on nursing home care for individuals with) Tj ET BT 0.934 0 0 0.9835 323.28 553.2 Tm -0.0204 Tc 0.8697 Tw (dementia cite the failure of many nursing homes to) Tj 0.257 -11.9577 TD -0.032 Tc 0.85 Tw (create a home-like environment and their failure to) Tj ET BT 0.9835 0 0 0.9835 323.52 529.44 Tm 0.0279 Tc 2.5995 Tw (identify and treat residents\222 acute and chronic) Tj ET BT 0.934 0 0 0.9835 323.76 517.44 Tm -0.0391 Tc 1.8487 Tw (diseases and conditions. Both sources also cite the) Tj ET BT 0.9835 0 0 0.9835 323.76 505.44 Tm 0.0251 Tc 0.7488 Tw (lack of adequately trained staff in many nursing) Tj ET BT 0.8915 0 0 0.9835 323.76 493.68 Tm 0.0333 Tc 1.7572 Tw (homes. The Institute of Medicine\222s report focuses on) Tj 0.2692 -12.4458 TD 0.0551 Tc 0.4204 Tw (the lack of training in general, whereas the literature) Tj ET BT 0.934 0 0 0.9835 324 469.68 Tm -0.0247 Tc 0.6586 Tw (on nursing home care for individuals with dementia) Tj 0 -11.9577 TD -0.0174 Tc 1.2198 Tw (focuses on the lack of training about dementia and) Tj ET BT 0.8915 0 0 0.9835 324.24 445.68 Tm 0.0303 Tc 1.4915 Tw (the care of residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 335.28 427.68 Tm 0.0413 Tc 0.2444 Tw (Both the Institute of Medicine\222s report and the) Tj ET BT 0.8915 0 0 0.9835 324.24 415.68 Tm 0.0543 Tc 1.4645 Tw (literature on nursing home care for individuals with) Tj ET BT 0.934 0 0 0.9835 324.48 403.44 Tm -0.0398 Tc 1.4824 Tw (dementia cite the overuse and inappropriate use of) Tj ET BT 0.9835 0 0 0.9835 324.24 391.2 Tm 0.021 Tc 0.0645 Tw (psychotropic medications and physical restraints.) Tj 0.244 -11.9577 TD 0.0305 Tc 2.0682 Tw (Although these two problems affect all nursing) Tj ET BT 0.934 0 0 0.9835 324.48 367.44 Tm -0.0481 Tc 0.6423 Tw (home residents to some degree, they are more likely) Tj ET BT 0.8915 0 0 0.9835 324.72 355.2 Tm 0.013 Tc 1.9146 Tw (to affect residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 335.76 337.68 Tm 0.0249 Tc 2.989 Tw (From 35 to 65 percent of all nursing home) Tj ET BT 0.934 0 0 0.9835 324.72 325.92 Tm -0.0477 Tc 1.4542 Tw (residents are prescribed and/or receive at least one) Tj ET BT 0.9835 0 0 0.9835 324.72 313.68 Tm 0.037 Tc 1.5386 Tw (psychotropic medication? and 9 to 26 percent of) Tj 0 -12.2018 TD 0.0322 Tc -0.0892 Tw (residents are prescribed and/or receive more than) Tj 0.4881 -12.2018 TD 0.0174 Tc 3.0576 Tw (one such medication \(18,19,52,366,425,429,433,) Tj -0.244 -11.9577 TD 0.0231 Tc 0.8555 Tw (461\). Nursing home residents with dementia are) Tj 0.244 -12.4458 TD 0.0231 Tc 0.2629 Tw (more likely than other nursing home residents to) Tj -0.244 -11.9577 TD 0.0307 Tc 0.1156 Tw (receive these medications \(19,389,425,429\). Often) Tj 0.4881 -12.4458 TD 0.0358 Tc 2.4695 Tw (the medications are used to control behavioral) Tj ET BT 0.934 0 0 0.9835 325.68 229.68 Tm -0.0228 Tc 1.0971 Tw (symptoms in residents with dementia, even though) Tj -0.5139 -11.9577 TD -0.0176 Tc 1.8257 Tw (many of the frequently used medications have not) Tj 0.257 -12.2018 TD -0.0454 Tc 2.1124 Tw (been demonstrated to be effective for this purpose) Tj ET BT 0.8915 0 0 0.9835 325.92 194.16 Tm 0.0368 Tc 0 Tw (\(l8,l9,l80,208,277,285,339,381,389,397,406,414,425\).) Tj -0.5384 -11.9577 TD 0.0344 Tc 1.6022 Tw (Moreover, some of the most frequently used medica-) Tj ET BT 0.934 0 0 0.9835 325.92 170.4 Tm -0.0305 Tc 1.5336 Tw (tions are known to cause confusion, disorientation,) Tj ET BT 0.9835 0 0 0.9835 325.92 158.4 Tm 0.0532 Tc -0.0597 Tw (and oversedation in older people and are likely to) Tj 0 -11.7137 TD 0.0287 Tc 1.826 Tw (worsen the fictional impairments of individuals) Tj ET BT 0.8915 0 0 0.9835 325.92 134.88 Tm 0.016 Tc 2.0459 Tw (with dementia.) Tj ET BT 0.9835 0 0 0.9835 336.96 117.36 Tm 0.0249 Tc 3.05 Tw (From 25 to 59 percent of all nursing home) Tj ET BT 0.934 0 0 0.9835 325.68 105.12 Tm -0.03 Tc 1.2516 Tw (residents are physically restrained at any one time) Tj 0.7709 -11.9577 TD 0.0032 Tc 0.4526 Tw (\(133,446,520\). Nursing home residents with demen-) Tj ET BT 0.9835 0 0 0.9835 326.16 81.36 Tm 0.0196 Tc 1.2556 Tw (tia are far more likely than other nursing home) Tj ET BT 0.934 0 0 0.9835 325.68 69.36 Tm -0.0074 Tc 1.3889 Tw (residents to be physically restrained \(133,389,446\).) Tj ET q 1.92 0 0 -4.08 88.8 51.84 cm BI /W 14 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`<<<<<<<|??? EI Q BT 0.2972 0 0 0.9835 88.8 46.56 Tm 3 Tr 0.1568 Tc 0 Tw (S) Tj 0 Tr ET BT 0.8491 0 0 0.9835 90.72 46.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 36.48 0 0 -7.2 92.88 52.08 cm BI /W 232 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID =?????<<??????>?>?<<x>x<?||?|<?~~<|>>|>>|>>x>>px>>xx~>x|~~<<~~<>?>???~?>???߿??????:??3???0 EI Q BT 0.5944 0 0 0.9835 92.88 46.56 Tm 3 Tr -0.0561 Tc 0 Tw (Psycho@opic) Tj 0 Tr ET BT 0.8491 0 0 0.9835 129.36 46.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 33.6 0 0 -5.76 131.52 52.08 cm BI /W 214 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x@>???~|~|||~|<|?s?~|>#?~|>?|>~|>|?|>~|<x||>|~?|<<|>|>?|<|>|>|<?|>>|<|>>|>>8||?8?||x>|?????|?߀?x0||?||||8| EI Q BT 0.6368 0 0 0.9835 131.52 46.56 Tm 3 Tr -0.041 Tc 0 Tw (m~ications) Tj 0 Tr ET BT 0.8491 0 0 0.9835 165.12 46.56 Tm 0.0283 Tc 0.0115 Tw ( include ) Tj ET q 38.4 0 0 -7.2 198.96 52.08 cm BI /W 243 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??pxwx<??~<???~|<|??~x>~>>?>x>~~>~?>xp>~~>x`~||~|>|||~|?>||~??>|~>|||x|?||~>x|?|~>0?>||>>x>~||>>|~||>>|~?|x<?>|~>??<>???`?x0 EI Q BT 0.5519 0 0 0.9835 198.96 46.56 Tm 3 Tr -0.0268 Tc 0 Tw (antipsychotic,) Tj 0 Tr ET BT 0.8491 0 0 0.9835 237.36 46.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 41.04 0 0 -7.2 239.52 52.08 cm BI /W 260 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?|???|???>?<>?>~?~>>|~~>|>||C~f~><>|| ~>>>|?x|>>|?||>>|?>>||>?>|??>8>??~>|>|?> >?|><~>p>?~?~ǃp<?>>?x|?????08 ?` |?||||8 EI Q BT 0.5519 0 0 0.9835 239.52 46.56 Tm 3 Tr 0.0373 Tc 0 Tw (antidepressan~) Tj 0 Tr ET BT 0.8491 0 0 0.9835 280.56 46.56 Tm 0.0441 Tc 0.0872 Tw ( antianxiety, and ) Tj ET q 48.72 0 0 -7.2 351.12 52.08 cm BI /W 310 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????x?<??g?>>x~?????x?x<|x??~>pxp>?~?<??~>8`>~|<?~>~|~<~>|o~~>|~~>x~~>?x~>>?x>p>>>?p>>~>>8>>8|>>>8>?||<~~?><~?|????????>~~<>~ y~ ??~?>0 EI Q BT 0.5944 0 0 0.9835 351.12 46.56 Tm 3 Tr -0.0408 Tc 0 Tw (se&tive/hypnOtk) Tj 0 Tr ET BT 0.8491 0 0 0.9835 399.84 46.56 Tm 0.0394 Tc 0.2811 Tw ( agents.) Tj ET endstream endobj 58 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 59 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.72 681.12 m 537.84 681.12 l S 0.96 w 67.68 659.76 m 538.56 659.76 l S 0.24 w 539.04 660.48 m 539.04 421.44 l S 540.24 660.48 m 540.24 145.68 l S 0.72 w 63.12 659.52 m 63.12 147.84 l S 64.56 146.16 m 542.16 146.16 l S BT 0.9443 0 0 0.9812 327.6 686.64 Tm 0 0 0 rg /F5 11 Tf 0.0035 Tc 0.8538 Tw (Chapter l-Overview and Policy Implications ) Tj ET BT 0.9207 0 0 0.9598 520.08 686.64 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.9443 0 0 0.9812 526.08 686.64 Tm /F5 11 Tf 0.2155 Tc 0 Tw (13) Tj ET BT 0.9261 0 0 0.9795 108 638.4 Tm /F7 12 Tf 0.0156 Tc 2.4239 Tw (Table 1-1\227Frequently Cited Complaints and Concerns) Tj 0 Tc 0.1085 Tw ( ) Tj ET BT 0.933 0 0 0.9863 379.44 638.4 Tm /F10 9 Tf -0.0006 Tc 0 Tw (About ) Tj ET BT 0.9261 0 0 0.9795 410.64 638.4 Tm /F7 12 Tf 0.0101 Tc 1.9115 Tw (the Care Provided for) Tj ET BT 0.8875 0 0 0.9795 206.64 626.16 Tm -0.0014 Tc 1.8672 Tw (Nursing Home Residents With Dementia) Tj ET BT 0.8632 0 0 0.9598 93.6 606 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 99.12 606 Tm /F4 10 Tf 0.03 Tc 0.6879 Tw (Dementia in nursing home residents often is not carefully or accurately diagnosed and sometimes is not) Tj ET BT 0.8066 0 0 0.9835 103.44 595.2 Tm 0.0451 Tc 1.9228 Tw (diagnosed at all.) Tj -12.1987 -13.666 TD 0.0528 Tc 1.4458 Tw (\215 Acute and chronic illnesses, depression, and sensory impairments that can exacerbate cognitive impairment) Tj 12.7937 -11.9577 TD 0.0484 Tc 1.5618 Tw (in an individual with dementia frequently are not diagnosed or treated.) Tj -12.7937 -14.1541 TD 0.0606 Tc 1.0441 Tw (\215There is a pervasive sense of nihilism about nursing home residents with dementia; that is, a general feeling) Tj 12.7937 -12.4458 TD 0.0562 Tc 1.5201 Tw (among nursing home administrators and staff that nothing can be done for these residents.) Tj ET BT 0.8491 0 0 0.9835 94.08 528.96 Tm 0.0396 Tc 0.8259 Tw (\215 Nursing home staff members frequently are not knowledgeable about dementia or effective methods of) Tj 11.8714 -10.9816 TD 0.0429 Tc 0.522 Tw (caring for residents with dementia. They generally are not aware of effective methods of responding to) Tj ET BT 0.8066 0 0 0.9835 104.16 507.36 Tm 0.053 Tc 2.2106 Tw (behavioral symptoms in residents with dementia.) Tj ET BT 0.8491 0 0 0.9835 94.32 492.24 Tm 0.0288 Tc 0.435 Tw (\215 Psychotropic medications are used inappropriately for residents with dementia, particularly to control) Tj 11.3061 -11.7137 TD 0.0078 Tc 2.0142 Tw (behavioral symptoms.) Tj ET BT 0.8066 0 0 0.9835 94.32 467.04 Tm 0.0482 Tc 1.9877 Tw (\215 Physical restraints are used inappropriately for residents with dementia, particularly to control behavioral) Tj 13.0912 -12.2018 TD 0.2795 Tc 0 Tw (symptoms.) Tj ET BT 0.8491 0 0 0.9835 95.04 439.92 Tm 0.0305 Tc 0.3248 Tw (\215 The basic needs of residents with dementia, e.g., hunger, thirst, and pain relief, sometimes are not met) Tj 11.3061 -11.2256 TD 0.0306 Tc 0.1501 Tw (because the individuals cannot identify or communicate their needs, and nursing home staff members may) Tj ET BT 0.8066 0 0 0.9835 104.64 418.08 Tm 0.0454 Tc 1.3274 Tw (not anticipate the needs.) Tj ET BT 0.8491 0 0 0.9835 95.04 403.44 Tm 0.0252 Tc 0.7748 Tw (\215 The level of stimulation and noise in many nursing homes is confusing for residents with dementia) Tj ET BT 0.8632 0 0 0.9598 95.04 390 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 100.32 390 Tm /F4 10 Tf 0.0296 Tc 0.6622 Tw (Nursing homes generally do not provide activities that are appropriate for residents with dementia) Tj -6.2184 -15.3742 TD 0.029 Tc 0.9293 Tw (\215 Nursing homes generally do not provide enough exercise and physical movement to meet the needs of) Tj ET BT 0.8066 0 0 0.9835 104.88 362.88 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj ET BT 0.8056 0 0 0.9598 95.28 349.2 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 100.56 349.2 Tm /F4 10 Tf 0.0337 Tc 0.2878 Tw (Nursing homes do not provide enouqh continuity in staff and daily routines to meet the needs of residents) Tj ET BT 0.8066 0 0 0.9835 105.36 337.2 Tm 0.0345 Tc 2.531 Tw (with dementia.) Tj ET BT 0.8491 0 0 0.9835 95.52 322.32 Tm 0.0275 Tc 0.46 Tw (\215 Nursing home staff members do not have enough time or flexibility ) Tj ET BT 0.8441 0 0 0.9863 375.6 322.32 Tm /F10 9 Tf 0.0008 Tc -0.0001 Tw (to ) Tj ET BT 0.8491 0 0 0.9835 389.52 322.32 Tm /F4 10 Tf 0.0217 Tc 0.8107 Tw (respond to the individual needs of) Tj ET BT 0.8066 0 0 0.9835 105.36 311.28 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj -11.9011 -15.1302 TD 0.046 Tc 1.7943 Tw (. Nursing home staff members encourage dependency in residents with dementia by performing personal care) Tj 12.4962 -11.4697 TD 0.0554 Tc 1.3522 Tw (functions, such as bathing and dressing, for them instead of allowing and assisting the residents to perform) Tj -0.2975 -10.9816 TD 0.0621 Tc 3.092 Tw (these functions themselves.) Tj ET BT 0.8915 0 0 0.9835 95.76 259.44 Tm 0.0326 Tc 0.3761 Tw (. The physical environment of most nursing homes is too \223institutional\224 and not \223home-like\224 enough for) Tj ET BT 0.8066 0 0 0.9835 105.84 248.88 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj ET BT 0.8491 0 0 0.9835 95.76 234 Tm 0.0221 Tc 0.6929 Tw (\215 Most nursing homes do not provide cues to help residents find their way.) Tj 0.5653 -15.3742 TD 0.0231 Tc 0.63 Tw (\215 Most nursing homes do not provide appropriate space for residents to wander.) Tj 0 -14.1541 TD 0.0227 Tc 0.2819 Tw (\215o Most nursing homes do not make use of design features that could support residents\222 independent) Tj 11.3061 -12.4458 TD 0.0554 Tc 0 Tw (functioning.) Tj -11.0235 -15.1302 TD 0.0263 Tc 0.5039 Tw (\215 The needs of families of residents with dementia are not met in many nursing homes.) Tj ET q 31.2 0 0 -6.24 76.32 163.92 cm BI /W 186 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ @'_ ??????_??CD/????>}@|x |?|/?x~/x?~|?||xx~??G?_???p?@t#_????_??G? ????? D`  EI Q BT 0.8066 0 0 0.9835 76.32 157.68 Tm 3 Tr -0.0878 Tc 0 Tw (SOUR=:) Tj 0 Tr ET BT 0.8915 0 0 0.9835 107.52 157.68 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 19.2 0 0 -6.24 109.92 163.68 cm BI /W 115 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID D@ @?/?|?=#????????????????????/~?~?~?> "9??D?@?>~<| EI Q BT 0.9835 0 0 0.9835 109.92 157.68 Tm 3 Tr 0.0326 Tc 0 Tw (~lce) Tj 0 Tr ET BT 0.8915 0 0 0.9835 129.12 157.68 Tm 0.005 Tc 0.0393 Tw ( of ) Tj ET q 34.8 0 0 -7.92 141.84 163.92 cm BI /W 207 /H 44 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|?~>#>?1DD|<<?~/C~????>?q~??!~?~?~?>~??B~~~??D??~?~_???/y_?@_w?`p? `p@?p??DDd  EI Q BT 0.6368 0 0 0.9835 141.84 157.68 Tm 3 Tr -0.0247 Tc 0 Tw (\221I&bnolOgy) Tj 0 Tr ET BT 0.8915 0 0 0.9835 176.64 157.68 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 36.72 0 0 -6.96 179.04 163.44 cm BI /W 219 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  @D7#|???~?|?>~??~?|||??~8|x<~8??x??<0?p| # ~? |_?|?|??|??~???~?8?>|~?x>|>>??8~?>><????~~?>p @p  EI Q BT 0.6368 0 0 0.9835 179.04 157.68 Tm 3 Tr -0.077 Tc 0 Tw (Assessment) Tj 0 Tr ET BT 0.8915 0 0 0.9835 215.76 157.68 Tm 0.0538 Tc 0.3883 Tw ( 1992.) Tj ET BT 0.934 0 0 0.9835 64.8 127.92 Tm -0.0182 Tc 1.4133 Tw (A study of restraint use in 12 Connecticut nursing) Tj ET BT 0.9835 0 0 0.9835 315.36 127.68 Tm 0.0333 Tc 0.6011 Tw (of bone and muscle mass and other physiological) Tj -254.7732 -12.6899 TD 0.0361 Tc 0.5677 Tw (homes found, for example, that 51 percent of the) Tj 254.7732 -0.244 TD 0.0256 Tc 1.097 Tw (effects of immobility; increased agitation; aggra-) Tj ET BT 0.8915 0 0 0.9835 64.8 102.48 Tm 0.0458 Tc 1.2497 Tw (disoriented residents were newly restrained over the) Tj ET BT 0.9835 0 0 0.9835 315.36 102.24 Tm 0.0113 Tc 1.8436 Tw (vated behavioral symptoms, such as screaming,) Tj -253.309 -12.6899 TD 0.0314 Tc -0.007 Tw (l-year course of the study, compared with only 17) Tj ET BT 0.8915 0 0 0.9835 315.36 89.76 Tm 0.037 Tc 1.5993 Tw (hitting, and biting; decreased social behavior; loss of) Tj ET BT 0.9835 0 0 0.9835 64.8 77.04 Tm 0.0473 Tc -0.0058 Tw (percent of the residents who were not disoriented) Tj ET BT 0.8915 0 0 0.9835 315.84 76.8 Tm 0.0315 Tc 2.2977 Tw (self-esteem; emotional withdrawal; and injuries and) Tj ET BT 0.9835 0 0 0.9835 65.28 64.56 Tm 0.0405 Tc 1.7326 Tw (\(446\). The potential negative effects of physical) Tj 254.2852 -0.4881 TD 0.0418 Tc 1.2025 Tw (death due to improper use of the restraints and) Tj ET BT 0.934 0 0 0.9835 64.8 51.6 Tm -0.0336 Tc 2.008 Tw (restraint use for both demented and nondemented) Tj ET BT 0.9835 0 0 0.9835 315.36 51.6 Tm 0.0276 Tc 0.7696 Tw (residents\222 attempts to escape from them \(30,133,) Tj -255.0173 -12.9339 TD 0.028 Tc 0.0208 Tw (residents include the following: incontinence; loss) Tj ET BT 0.934 0 0 0.9835 316.8 38.64 Tm 0.0768 Tc 0 Tw (139,182,208,300,305,383,427,446,490,498\).) Tj ET endstream endobj 60 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 61 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.72 681.84 m 550.8 681.84 l S 73.2 660.24 m 550.8 660.24 l S 551.52 660.72 m 551.52 432.96 l S 74.4 660.24 m 74.4 434.16 l S 0.96 w 75.12 433.92 m 552.96 433.92 l S BT 0.9835 0 0 0.9835 73.44 688.32 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (14 ) Tj ET BT 0.9598 0 0 0.9598 85.92 688.32 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 92.16 688.32 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 145.92 688.32 Tm /F5 11 Tf 0.0745 Tc -0.0147 Tw (Units for People with ) Tj ET BT 0.9835 0 0 0.9835 243.12 688.32 Tm /F5 10 Tf 0.0229 Tc 0.1597 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.8875 0 0 0.9795 98.88 639.36 Tm /F7 12 Tf -0.0035 Tc 1.5992 Tw (Box I-B\227The Development of Excess Disability in a Nursing Home Resident With Dementia) Tj ET BT 0.8491 0 0 0.9835 105.6 619.2 Tm /F4 10 Tf 0.0395 Tc 0.6468 Tw (One evening an elderly man with dementia who had recently been admitted to a nursing home was picking) Tj -23.4602 -11.2256 TD 0.034 Tc 0.2428 Tw (up his newspaper at the receptionist\222s desk Abruptly, he threatened to hit the receptionist with his cane if she did) Tj 0 -11.2256 TD 0.0464 Tc 0.8382 Tw (not call him a cab, so he could \223go to town.\222) Tj ET BT 0.8066 0 0 0.9835 264.24 596.88 Tm 0.0509 Tc 0.6066 Tw (The receptionist contacted the nurses\222 station and kept the man talking) Tj ET BT 0.8491 0 0 0.9835 85.68 586.08 Tm 0.0365 Tc 1.5035 Tw (until help arrived. Three staff members responded. They attempted to calm the man verbally, but when these) Tj 0.5653 -11.2256 TD 0.0356 Tc 0.8037 Tw (attempts failed, they snatched the cane and forcefully placed him in a \223geri-chair.\224 He was wheeled to his room,) Tj -0.5653 -10.9816 TD 0.0265 Tc 0.6876 Tw (yelling and kicking. Several visitors and other residents stood by, wide-eyed, watching this scene.) Tj 24.0255 -13.91 TD 0.0303 Tc 0.1089 Tw (A negative pattern developed with the new resident. He did well during the day with minimal assistance, but) Tj -23.7428 -11.4697 TD 0.0329 Tc 0.0375 Tw (every evening he became very confused, agitated, and disruptive. The nursing home staff met with his family, and) Tj 0.2827 -11.2256 TD 0.0415 Tc 0.4357 Tw (the family agreed to visit him each evening for a few weeks, until he adjusted to the new environment.) Tj ET BT 0.8066 0 0 0.9835 106.56 514.56 Tm 0.0498 Tc 0.7666 Tw (Several weeks passed, the agitation and confusion continued, and the family requested sedation, in part because) Tj ET BT 0.8491 0 0 0.9835 86.4 503.52 Tm 0.0373 Tc 1.4794 Tw (they were embarrassed about his behavior. An antipsychotic medication was prescribed. Different dosages and) Tj ET BT 0.8066 0 0 0.9835 86.64 492.48 Tm 0.0425 Tc 1.7476 Tw (administration times were tried to determine a therapeutic level. Several more weeks passed. The resident became) Tj 0 -10.9816 TD 0.0533 Tc 0.9419 Tw (less disruptive, but he also began to walk unsteadily, drool, and slur his words. He became incontinent, and he could) Tj ET BT 0.8491 0 0 0.9835 86.4 470.88 Tm 0.0151 Tc 0.8751 Tw (no longer dress himself.) Tj ET BT 0.6793 0 0 0.9835 87.12 453.12 Tm -0.0369 Tc 2.3957 Tw (SOURCE: Adapted from M. Bowsher,) Tj ET BT 0.7217 0 0 0.9835 214.08 453.12 Tm -0.029 Tc 1.8309 Tw (\223A Unique and Successful Approach to Care for Moderate) Tj 0 Tc -0.1214 Tw ( ) Tj ET q 13.2 0 0 -7.2 418.32 458.88 cm BI /W 97 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x||x8`:>?~?????~??|?x~~p~?`????"~?~O~~~~~~>????0~>??t` EI Q BT 0.467 0 0 0.9835 418.32 453.12 Tm 3 Tr 0.0148 Tc 0 Tw (Stage) Tj 0 Tr ET BT 0.7217 0 0 0.9835 431.52 453.12 Tm 0 Tc -0.1214 Tw ( ) Tj ET q 30.24 0 0 -5.76 433.44 458.88 cm BI /W 219 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @D@D ?~?~|?q~|?~~?~>?~~>~?~~?|??~??~~xÃ?~|Á~?<>~9|@"~>@>?|@8 EI Q BT 0.5519 0 0 0.9835 433.44 453.12 Tm 3 Tr 0.0394 Tc 0 Tw (Alzbeimer\222s) Tj 0 Tr ET BT 0.7217 0 0 0.9835 463.68 453.12 Tm -0.0556 Tc 1.9509 Tw ( Victims,\224 Green Hills) Tj -472.1985 -8.7853 TD -0.0437 Tc 0.6707 Tw (Center, West Liberty, OH, unpublished ) Tj ET q 27.36 0 0 -7.2 258.24 450 cm BI /W 206 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???x 0| 8?@sO??~|~??~?<>`???~|?~??~~~~?>~~?~?>~??~~?~?~~~?~?>~~?~?x?~~????~?????x?@n?N?|~?>|< EI Q BT 0.5094 0 0 0.9835 258.24 444.48 Tm 3 Tr -0.023 Tc 0 Tw (manuscript) Tj 0 Tr ET BT 0.7217 0 0 0.9835 285.6 444.48 Tm -0.026 Tc 0.4135 Tw ( no date.) Tj ET BT 0.9835 0 0 0.9835 86.4 419.04 Tm 0.0411 Tc 0.3491 Tw (Overuse and inappropriate use of psychotropic) Tj ET BT 0.8915 0 0 0.9835 326.16 418.32 Tm 0.0469 Tc 0.9008 Tw (functional impairments that are caused by his or her) Tj ET BT 0.934 0 0 0.9835 75.12 407.04 Tm -0.0253 Tc 0.6287 Tw (medications and physical restraints are problems in) Tj ET BT 0.8915 0 0 0.9835 326.16 406.08 Tm 0.0448 Tc 1.9238 Tw (dementing disease or condition and other functional) Tj ET BT 0.934 0 0 0.9835 75.6 395.04 Tm -0.0377 Tc 1.1865 Tw (themselves. They are also perceived by special care) Tj ET BT 0.8915 0 0 0.9835 75.36 383.04 Tm 0.0292 Tc 1.4927 Tw (unit advocates and others as manifestations of other) Tj ET BT 0.9835 0 0 0.9835 75.12 370.8 Tm 0.0318 Tc 1.4394 Tw (problems in the nursing home care provided for) Tj 0.4881 -11.9577 TD 0.0349 Tc 0.1114 Tw (individuals with dementia\227notably the failure of) Tj 0 -12.2018 TD 0.0259 Tc 3.171 Tw (many nursing homes to use more appropriate) Tj ET BT 0.934 0 0 0.9835 75.6 335.04 Tm -0.0322 Tc 2.135 Tw (methods of responding to the individuals\222 physical) Tj 0.257 -11.9577 TD -0.015 Tc 0.8318 Tw (and emotional needs and behavioral symptoms.) Tj 11.82 -18.0586 TD -0.0423 Tc 1.2464 Tw (Reduction in the use of psychotropic medications) Tj -11.563 -11.9577 TD -0.0092 Tc 0.5686 Tw (and physical restraints is a major objective of many) Tj ET BT 0.8915 0 0 0.9835 76.32 281.52 Tm 0.0441 Tc 0.3655 Tw (special care units. Evidence cited later in this chapter) Tj 0 -12.2018 TD 0.0363 Tc 0.4079 Tw (and discussed at greater length in chapter 3 indicates) Tj -0.2692 -12.2018 TD 0.0538 Tc 1.1958 Tw (that in general special care units have been success-) Tj 0.2692 -12.2018 TD 0.0327 Tc 0.7709 Tw (ful in reducing the use of physical restraints but that) Tj ET BT 0.934 0 0 0.9835 76.08 233.28 Tm -0.0337 Tc 0.7875 Tw (use of psychotropic medications is as high or higher) Tj ET BT 0.8915 0 0 0.9835 76.32 221.28 Tm 0.0457 Tc 1.4742 Tw (in special care units than in nonspecialized units.) Tj ET BT 0.9795 0 0 0.9795 83.28 194.16 Tm /F7 12 Tf 0.0297 Tc 0.8887 Tw (Negative Consequences for Nursing Home) Tj 1.7152 -14.4569 TD 0.0381 Tc 0.7577 Tw (Residents With Dementia, Their Families,) Tj 17.1522 -14.7019 TD 0.0103 Tc 1.2149 Tw (Nursing Home Staff Members, and) Tj -10.5364 -13.9668 TD 0.0298 Tc 1.1337 Tw (Nondemented Nursing Home Residents) Tj ET BT 0.934 0 0 0.9835 87.6 133.92 Tm /F4 10 Tf -0.0353 Tc 1.7345 Tw (Problems in the care provided for nursing home) Tj -12.0769 -11.7137 TD -0.0212 Tc 0.71 Tw (residents with dementia have many negative conse-) Tj ET BT 0.9835 0 0 0.9835 76.56 110.16 Tm 0.035 Tc 1.0875 Tw (quences for the residents. These negative conse-) Tj -0.244 -12.2018 TD 0.039 Tc 1.6121 Tw (quences include reduced quality of life, reduced) Tj 0 -11.9577 TD 0.0208 Tc 1.956 Tw (physical safety, and excess disability. The term) Tj ET BT 0.8915 0 0 0.9835 76.56 74.64 Tm 0.0424 Tc -0.1373 Tw (excess ) Tj ET BT 0.9014 0 0 0.9812 106.08 74.64 Tm /F5 11 Tf -0.0504 Tc -0.033 Tw (disability ) Tj ET BT 0.8915 0 0 0.9835 147.36 74.64 Tm /F4 10 Tf 0.0335 Tc 1.3533 Tw (refers to functional impairment that) Tj ET BT 0.9835 0 0 0.9835 76.56 63.12 Tm 0.0219 Tc 1.9374 Tw (is greater than is warranted by an individual\222s) Tj ET BT 0.934 0 0 0.9835 76.56 51.12 Tm -0.0308 Tc 1.2158 Tw (disease or condition \(47,219\). The concept of excess) Tj ET BT 0.9835 0 0 0.9835 76.56 39.36 Tm 0.0248 Tc 1.3419 Tw (disability implies that an individual has certain) Tj ET BT 0.934 0 0 0.9835 326.4 394.32 Tm -0.0176 Tc 1.5687 Tw (impairments that are caused by other factors. The) Tj ET BT 0.8915 0 0 0.9835 326.4 382.32 Tm 0.0228 Tc 2.2401 Tw (latter impairments constitute excess disability.) Tj ET BT 0.934 0 0 0.9835 337.68 363.12 Tm -0.0297 Tc 1.567 Tw (Inappropriate or poor-quality nursing home care) Tj ET BT 0.9835 0 0 0.9835 326.64 350.88 Tm 0.0313 Tc -0.0243 Tw (can lead to excess disability in cognitive function-) Tj 0.244 -11.7137 TD 0.0215 Tc 0.1947 Tw (ing, mood, activities of daily living, and behavior.) Tj 0 -11.9577 TD 0.0461 Tc 3.0691 Tw (Box 1-B illustrates the development of excess) Tj ET BT 0.8915 0 0 0.9835 326.88 315.36 Tm 0.036 Tc 1.1005 Tw (disability in a nursing home resident with dementia.) Tj 0 -11.7137 TD 0.0387 Tc 1.1792 Tw (The immediate cause of excess disability in this case) Tj 0 -12.2018 TD 0.0355 Tc 1.452 Tw (was a psychotropic medication. Box 1-C later in this) Tj 0.2692 -12.2018 TD 0.029 Tc 1.7621 Tw (chapter describes an alternate set of staff responses) Tj ET BT 0.934 0 0 0.9835 326.88 267.84 Tm -0.0211 Tc 1.6413 Tw (in the same situation that solved the problem and) Tj ET BT 0.8915 0 0 0.9835 327.12 255.6 Tm 0.0319 Tc 1.6435 Tw (avoided the use of psychotropic medications and the) Tj ET BT 0.934 0 0 0.9835 327.12 243.6 Tm -0.0277 Tc 1.6162 Tw (excess disability.) Tj ET BT 0.9835 0 0 0.9835 338.16 224.64 Tm 0.0263 Tc 1.9329 Tw (In practice, it is often difficult to distinguish) Tj -10.9816 -12.4458 TD 0.0211 Tc 1.9801 Tw (fictional impairments caused by an individual\222s) Tj -0.244 -11.7137 TD 0.0368 Tc 3.0867 Tw (dementing disease or condition and functional) Tj ET BT 0.8915 0 0 0.9835 327.36 188.64 Tm 0.0405 Tc 1.2647 Tw (impairments caused by inappropriate or poor-quality) Tj ET BT 0.9835 0 0 0.9835 327.36 176.64 Tm 0.0112 Tc 0.1843 Tw (nursing home care. Many commentators contend,) Tj -0.244 -12.2018 TD 0.0335 Tc 3.0413 Tw (however, that some and perhaps many of the) Tj ET BT 0.934 0 0 0.9835 327.6 152.64 Tm -0.0206 Tc 2.2767 Tw (functional impairments of nursing home residents) Tj 0 -12.2018 TD -0.0348 Tc 0.7959 Tw (with dementia are due to problems in the care they) Tj ET BT 0.9835 0 0 0.9835 327.12 128.88 Tm 0.0328 Tc 0.3575 Tw (receive rather than to their dementing disease or) Tj ET BT 0.8915 0 0 0.9835 327.6 117.12 Tm 0.0427 Tc 0.5802 Tw (condition \(107,1 15,125,165,171 241,263,359,385,386\).) Tj ET BT 0.934 0 0 0.9835 338.4 98.4 Tm -0.0353 Tc 1.7345 Tw (Problems in the nursing home care provided for) Tj ET BT 0.9835 0 0 0.9835 327.6 86.4 Tm 0.0349 Tc 1.7221 Tw (individuals with dementia have negative conse-) Tj ET BT 0.934 0 0 0.9835 327.36 74.88 Tm -0.0216 Tc 0.6553 Tw (quences for the residents\222 families. Many families of) Tj ET BT 0.9835 0 0 0.9835 327.6 62.88 Tm 0.0292 Tc 1.8742 Tw (individuals with dementia feel intensely guilty,) Tj ET BT 0.8915 0 0 0.9835 327.6 51.12 Tm 0.0372 Tc 0.6088 Tw (anxious, and sad about having to place the individual) Tj ET BT 0.9835 0 0 0.9835 327.6 39.6 Tm 0.0237 Tc 2.2886 Tw (in a nursing home. These feelings may be due) Tj ET endstream endobj 62 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 63 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.16 675.12 m 534.96 675.12 l S BT 0.9835 0 0 0.9835 324 680.16 Tm 0 0 0 rg /F5 10 Tf 0.0123 Tc 2.8548 Tw (Chapter I-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516.48 680.16 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 523.2 680.16 Tm /F5 10 Tf 0.488 Tc 0 Tw (15) Tj ET BT 0.8915 0 0 0.9835 56.16 641.52 Tm /F4 10 Tf 0.0353 Tc 1.4473 Tw (primarily to the patient\222s condition and other factors) Tj ET BT 0.934 0 0 0.9835 56.88 629.76 Tm -0.0104 Tc 0.4842 Tw (that have made nursing home placement necessary,) Tj ET BT 0.8915 0 0 0.9835 56.64 618.24 Tm 0.0366 Tc 1.4508 Tw (but the feelings are intensified if the family believes) Tj ET BT 0.9835 0 0 0.9835 56.88 606 Tm 0.0394 Tc 0.5136 Tw (the individual is receiving inappropriate or poor-) Tj ET BT 0.934 0 0 0.9835 56.88 594 Tm 0.0037 Tc 1.032 Tw (quality care \(84,162,263\). In addition, the failure of) Tj ET BT 0.9835 0 0 0.9835 56.88 582.24 Tm 0.0241 Tc 3.0915 Tw (many nursing homes to facilitate and support) Tj 0.244 -11.9577 TD 0.0214 Tc 1.8334 Tw (families\222 ongoing involvement in their relative\222s) Tj ET BT 0.934 0 0 0.9835 57.12 558.48 Tm -0.0368 Tc 0.7267 Tw (care may result in the development of a competitive) Tj ET BT 0.8915 0 0 0.9835 57.36 546.72 Tm 0.039 Tc 1.2124 Tw (or adversarial relationship between the staff and the) Tj ET BT 0.934 0 0 0.9835 57.36 534.96 Tm -0.0136 Tc 0.6162 Tw (family which further increases the family members\222) Tj 0.257 -12.4458 TD 0.0531 Tc 4.8702 Tw (anxiety \(45,50,55,167,349,418\).) Tj ET BT 0.8915 0 0 0.9835 68.64 498.96 Tm 0.0444 Tc 1.0526 Tw (Problems in the care provided for individuals with) Tj ET BT 0.934 0 0 0.9835 57.6 486.96 Tm -0.022 Tc 0.7537 Tw (dementia also have negative consequences for nurs-) Tj 0 -12.2018 TD -0.0188 Tc 2.035 Tw (ing home staff members. Residents with dementia) Tj ET BT 0.9835 0 0 0.9835 57.84 462.96 Tm 0.0373 Tc 1.8782 Tw (are often difficult for staff members to care for) Tj -0.244 -12.2018 TD 0.0218 Tc 1.4913 Tw (because of their communication deficits, impair-) Tj 0 -11.7137 TD 0.0251 Tc 0.5049 Tw (ments in activities of daily living, and behavioral) Tj ET BT 0.8915 0 0 0.9835 58.32 427.44 Tm 0.026 Tc 6.8802 Tw (symptoms \(60,107,167,170,181,191,263,352,359,385\).) Tj ET BT 0.934 0 0 0.9835 57.84 415.68 Tm -0.0339 Tc 1.3293 Tw (The difficulty of caring for residents with dementia) Tj 0.257 -12.2018 TD -0.0304 Tc 0.6876 Tw (is said to cause stress, lowered morale, and burnout) Tj ET BT 0.9835 0 0 0.9835 58.32 391.68 Tm 0.0238 Tc 2.746 Tw (for staff members \(191,263,346,352,398\). These) Tj ET BT 0.934 0 0 0.9835 57.84 379.68 Tm -0.0247 Tc 0.4751 Tw (reactions may in turn lead to increased absenteeism) Tj ET BT 0.9835 0 0 0.9835 58.32 367.68 Tm 0.0271 Tc 1.0955 Tw (and staff turnover. To the extent that residents\222) Tj ET BT 0.934 0 0 0.9835 58.32 355.44 Tm -0.0258 Tc 1.0146 Tw (impairments are caused or exacerbated by inappro-) Tj -0.257 -12.4458 TD -0.0234 Tc 0.7766 Tw (priate or poor-quality care, the job of staff members) Tj 0.257 -11.7137 TD -0.0187 Tc 1.7351 Tw (is unnecessarily difficult, and any resulting stress,) Tj ET BT 0.8915 0 0 0.9835 58.8 319.44 Tm 0.043 Tc 0.2081 Tw (absenteeism, and turnover are also attributable to the) Tj -0.2692 -12.4458 TD 0.0494 Tc 2.2776 Tw (inappropriate care.) Tj 12.6521 -24.1595 TD 0.0315 Tc 1.7593 Tw (Lastly, nondemented nursing home residents may) Tj ET BT 0.934 0 0 0.9835 59.04 271.2 Tm -0.0378 Tc 2.1923 Tw (experience negative consequences because of prob-) Tj 0 -11.7137 TD -0.0464 Tc 0.8654 Tw (lems in the care provided for residents with demen-) Tj 0 -12.2018 TD -0.0263 Tc 1.4006 Tw (tia. Behavioral symptoms of residents with demen-) Tj T* -0.0259 Tc 1.3573 Tw (tia, e.g., restlessness, screaming, repetitive verbali-) Tj ET BT 0.8915 0 0 0.9835 59.04 223.92 Tm 0.0283 Tc 1.6283 Tw (zations, and combativeness, are upsetting for nonde-) Tj 0 -12.4458 TD 0.0313 Tc 4.0926 Tw (mented residents \(46,220,241,263,268,352,373\). The) Tj ET BT 0.9835 0 0 0.9835 59.04 199.44 Tm 0.0291 Tc 1.5815 Tw (cognitive and fictional impairments of residents) Tj 0 -11.9577 TD 0.0384 Tc 1.1886 Tw (with dementia may also be upsetting for nonde-) Tj ET BT 0.8915 0 0 0.9835 59.04 175.68 Tm 0.0329 Tc 1.3988 Tw (mented residents. Experts disagree about the overall) Tj ET BT 0.934 0 0 0.9835 59.28 163.44 Tm -0.0302 Tc 1.8759 Tw (impact on nondemented nursing home residents of) Tj ET BT 0.8915 0 0 0.9835 59.28 151.68 Tm 0.0315 Tc 1.6439 Tw (living in close proximity to residents with dementia,) Tj 0 -12.4458 TD 0.0139 Tc 0.6484 Tw (but the two studies OTA is aware of that address this) Tj ET BT 0.9835 0 0 0.9835 59.52 127.68 Tm 0.0365 Tc 2.7128 Tw (issue found significant negative effects for the) Tj ET BT 0.934 0 0 0.9835 59.28 115.68 Tm -0.002 Tc 1.6622 Tw (nondemented residents \(438,507\). In a study of 72) Tj 0 -11.7137 TD -0.0328 Tc 1.536 Tw (nondemented nursing home residents, Teresi et al.) Tj ET BT 0.8915 0 0 0.9835 59.52 92.16 Tm 0.028 Tc 1.7632 Tw (found that the nondemented residents who shared a) Tj -0.5384 -11.9577 TD 0.0441 Tc 1.2666 Tw (room or had a room adjacent to a demented resident) Tj 0.5384 -12.4458 TD 0.0486 Tc 1.5863 Tw (were significantly more likely than the other nonde-) Tj -0.2692 -11.7137 TD 0.0182 Tc 1.0115 Tw (mented residents to express dissatisfaction with their) Tj ET BT 0.9835 0 0 0.9835 59.76 44.88 Tm 0.0417 Tc 0.196 Tw (life and their environment and to be perceived as) Tj -0.244 -12.2018 TD 0.0398 Tc -0.1376 Tw (depressed by staff members \(438\). They were also) Tj 252.8209 618.6304 TD 0.0285 Tc 0.7454 Tw (significantly less likely to receive visits or phone) Tj ET BT 0.934 0 0 0.9835 307.92 629.52 Tm -0.0234 Tc 1.2905 Tw (calls from family or friends.) Tj ET BT 0.9835 0 0 0.9835 318.96 611.76 Tm 0.0343 Tc 2.0643 Tw (It is unclear whether the negative effects on) Tj -11.2256 -12.2018 TD 0.03 Tc 0.5231 Tw (nondemented nursing home residents of living in) Tj ET BT 0.934 0 0 0.9835 308.4 587.76 Tm -0.0449 Tc 1.4878 Tw (close proximity to residents with dementia are due) Tj ET BT 0.9835 0 0 0.9835 308.16 575.76 Tm 0.0267 Tc 0.4858 Tw (primarily to characteristics of the demented resi-) Tj ET BT 0.8915 0 0 0.9835 308.4 564 Tm 0.0357 Tc 0.5582 Tw (dents that are caused by their dementing illness or to) Tj ET BT 0.9835 0 0 0.9835 308.4 552 Tm 0.026 Tc 1.5359 Tw (characteristics that are caused by inappropriate) Tj ET BT 0.934 0 0 0.9835 308.64 540.24 Tm -0.0203 Tc 1.0623 Tw (nursing home care. To the extent that the negative) Tj 0 -12.2018 TD -0.0345 Tc 0.7425 Tw (effects are due to characteristics caused by inappro-) Tj ET BT 0.8915 0 0 0.9835 308.4 516.24 Tm 0.0512 Tc 0.8912 Tw (priate care, the inappropriate care is also responsible) Tj ET BT 0.9835 0 0 0.9835 308.88 504.24 Tm 0.0509 Tc 0.0341 Tw (for the reduced quality of life of the nondemented) Tj ET BT 0.8915 0 0 0.9835 308.64 492.24 Tm 0.0096 Tc 0 Tw (residents.) Tj ET BT 0.9835 0 0 0.9835 319.92 474.24 Tm 0.0386 Tc 2.7107 Tw (Special care units promise to provide better) Tj -11.2256 -12.2018 TD 0.0167 Tc 0.4785 Tw (nursing home care than is currently available for) Tj ET BT 0.8915 0 0 0.9835 309.12 450.48 Tm 0.0325 Tc 1.6685 Tw (individuals with dementia. By providing better care,) Tj ET BT 0.934 0 0 0.9835 309.36 438.48 Tm -0.0384 Tc 1.2851 Tw (they expect to benefit residents, residents\222 families,) Tj ET BT 0.9835 0 0 0.9835 309.36 426.72 Tm 0.0187 Tc 0.1279 Tw (and nursing home staff members. Better care can) Tj 0 -12.2018 TD 0.0247 Tc 1.2199 Tw (only reduce impairments that are not inevitably) Tj 0.244 -12.2018 TD 0.036 Tc 2.9574 Tw (caused by the residents\222 dementing disease or) Tj 0 -12.2018 TD 0.0254 Tc 0.7718 Tw (condition. Likewise, better care for residents can) Tj 0 -12.4458 TD 0.0285 Tc 2.9244 Tw (only alleviate that portion of family members\222) Tj ET BT 0.934 0 0 0.9835 309.6 366.72 Tm -0.0183 Tc 0.7211 Tw (feelings of guilt, anxiety, and sadness that is due to) Tj 0 -12.2018 TD -0.0447 Tc 1.1206 Tw (inappropriate care, not the portion of those feelings) Tj ET BT 0.9835 0 0 0.9835 309.84 342.48 Tm 0.0216 Tc 1.6937 Tw (that is caused by the residents\222 impairments or) Tj ET BT 0.8915 0 0 0.9835 309.84 330.48 Tm 0.0403 Tc 2.0186 Tw (deteriorating condition. Similar considerations apply) Tj ET BT 0.9835 0 0 0.9835 310.08 318.72 Tm 0.0328 Tc 0.8762 Tw (to the potential impact of better care on nursing) Tj ET BT 0.8915 0 0 0.9835 309.84 306.48 Tm 0.0288 Tc 1.9418 Tw (home staff members. Research findings with respect) Tj ET BT 0.9835 0 0 0.9835 310.08 294.72 Tm 0.0379 Tc 2.2132 Tw (to the effect of special care units on residents,) Tj ET BT 0.8915 0 0 0.9835 310.08 282.72 Tm 0.0329 Tc 1.5654 Tw (families, and nursing home staff members should be) Tj ET BT 0.934 0 0 0.9835 310.32 270.48 Tm -0.0411 Tc 1.9976 Tw (considered in the context of these inherent limita-) Tj 0 -11.7137 TD -0.0433 Tc 1.6329 Tw (tions on potential positive outcomes.) Tj 11.563 -18.0586 TD -0.0315 Tc 1.5346 Tw (The situation is different for nondemented nurs-) Tj -11.563 -12.2018 TD -0.0342 Tc 1.8802 Tw (ing home residents. Placing demented residents in) Tj ET BT 0.8915 0 0 0.9835 310.8 216.96 Tm 0.0314 Tc 1.544 Tw (separate units eliminates for nondemented residents) Tj ET BT 0.934 0 0 0.9835 310.32 204.96 Tm -0.0365 Tc 0.7906 Tw (the negative effects of living in close proximity with) Tj ET BT 0.9835 0 0 0.9835 310.32 192.96 Tm 0.0399 Tc 0.391 Tw (demented residents regardless of the factors that) Tj 0.244 -11.9577 TD 0.0278 Tc 2.3149 Tw (cause the negative effects. Some commentators) Tj -0.244 -12.2018 TD 0.0316 Tc 0.3588 Tw (believe that placing individuals with dementia in) Tj ET BT 0.8915 0 0 0.9835 310.32 157.2 Tm 0.0397 Tc 1.2117 Tw (physically separate units may be justifiable solely on) Tj 0.2692 -12.4458 TD 0.0189 Tc 2.1772 Tw (the grounds that it benefits nondemented residents,) Tj 0.5384 -12.2018 TD 0.0276 Tc 1.4944 Tw (assuming the placements do not harm the demented) Tj ET BT 0.934 0 0 0.9835 310.32 121.44 Tm 0.009 Tc 1.834 Tw (residents \(221,356\).) Tj ET BT 0.9663 0 0 0.9939 349.2 98.16 Tm /F6 14 Tf 0.0382 Tc 2.047 Tw (SPECIAL CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 321.84 80.4 Tm /F4 10 Tf 0.0175 Tc -0.054 Tw (The first special care units in this country were) Tj -11.2256 -11.9577 TD 0.0367 Tc 2.8986 Tw (established in the mid 1960s and early 1970s) Tj ET BT 0.934 0 0 0.9835 311.04 56.64 Tm 0.0161 Tc 0.3703 Tw (\(413,485,494\). In the mid to late 1970s and the first) Tj ET BT 0.9835 0 0 0.9835 310.8 45.12 Tm 0.0315 Tc 0.9515 Tw (half of the 1980s, interest in specialized nursing) Tj 0 -11.9577 TD 0.0301 Tc 2.7194 Tw (home care for individuals with dementia grew) Tj ET endstream endobj 64 0 obj <>/Rotate 0/Type/Page>> endobj 65 0 obj <>stream 0.48 w 1 j 0 0 0 RG 73.92 673.68 m 552.48 673.68 l S 0.72 w 77.28 81.84 m 556.08 81.84 l S BT 0.9863 0 0 0.9863 74.4 679.68 Tm 0 0 0 rg /F3 9 Tf 0.1038 Tc -0.175 Tw (16 ) Tj ET BT 0.9598 0 0 0.9598 86.88 679.68 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 93.12 679.68 Tm /F5 10 Tf 0.011 Tc 0.2024 Tw (Special Care Units for People With Alzheimer\222s and ) Tj ET BT 0.9812 0 0 0.9812 304.56 679.68 Tm /F5 11 Tf 0.0448 Tc 0.8717 Tw (Other Dementias) Tj ET BT 0.934 0 0 0.9835 74.16 640.32 Tm /F4 10 Tf -0.0269 Tc 1.9151 Tw (rapidly because of increasing general awareness of) Tj ET BT 0.8915 0 0 0.9835 74.64 628.32 Tm 0.0434 Tc 1.3614 Tw (Alzheimer\222s disease and the special needs of nursing) Tj ET BT 0.934 0 0 0.9835 74.64 616.8 Tm -0.0238 Tc 0.9514 Tw (home residents with dementia \(273\). In this period,) Tj 0.7709 -12.4458 TD -0.0225 Tc 0.8826 Tw (some nursing homes established special care units.) Tj ET BT 0.9557 0 0 1.08 299.76 609.36 Tm /F4 4 Tf 0.0359 Tc 0 Tw (6) Tj ET BT 0.9835 0 0 0.9835 75.12 592.56 Tm /F4 10 Tf 0.0233 Tc 0.7577 Tw (Other nursing homes established special activity) Tj ET BT 0.934 0 0 0.9835 74.88 580.8 Tm -0.0355 Tc 0.8023 Tw (programs for their residents with dementia.) Tj ET BT 0.9557 0 0 1.08 266.88 585.6 Tm /F4 4 Tf 0.0359 Tc 0 Tw (7) Tj ET BT 0.9835 0 0 0.9835 86.16 562.8 Tm /F4 10 Tf 0.0377 Tc 1.5379 Tw (Reports on these early special care units and) Tj ET BT 0.934 0 0 0.9835 74.88 551.04 Tm -0.0329 Tc 1.6646 Tw (programs reflect each facility\222s search for workable) Tj 0.7709 -12.2018 TD -0.0266 Tc 1.4009 Tw (approaches in caring for individuals with dementia) Tj ET BT 0.8915 0 0 0.9835 75.84 527.28 Tm 0.0358 Tc 1.3314 Tw (\(273\). The reports are primarily descriptive. Many of) Tj ET BT 0.9835 0 0 0.9835 75.6 515.04 Tm 0.0261 Tc 2.4387 Tw (them include case examples that illustrate the) Tj ET BT 0.8915 0 0 0.9835 75.6 503.04 Tm 0.0477 Tc 1.2796 Tw (behavioral and other resident problems the unit was) Tj 0 -12.2018 TD 0.0051 Tc 2.731 Tw (designed to address.) Tj ET BT 0.9835 0 0 0.9835 86.64 472.8 Tm 0.0283 Tc 2.663 Tw (Much of the literature on special care units) Tj -10.9816 -11.9577 TD 0.0305 Tc 0.6039 Tw (consists of descriptive reports of this kind. These) Tj -0.244 -11.9577 TD 0.0351 Tc -0.1329 Tw (reports generally cite one or more theoretical con-) Tj ET BT 0.8915 0 0 0.9835 76.08 437.28 Tm 0.0346 Tc 0.679 Tw (cepts as the rationale for the physical design features) Tj ET BT 0.9835 0 0 0.9835 76.32 425.28 Tm 0.0357 Tc 0.7032 Tw (and patient care practices that have been imple-) Tj ET BT 0.8491 0 0 0.9835 76.32 413.52 Tm 0.0351 Tc 1.3225 Tw (mented in a particular unit and make that unit special) Tj ET BT 0.8915 0 0 0.9835 76.32 401.52 Tm 0.0334 Tc 0.5458 Tw (in the view of the report authors. Many of the reports) Tj ET BT 0.934 0 0 0.9835 76.56 389.52 Tm -0.0327 Tc 1.673 Tw (also provide nonquantitative, anecdotal evidence of) Tj -0.257 -12.4458 TD -0.0287 Tc 1.1034 Tw (the beneficial outcomes of the unit.) Tj 12.0769 -18.3027 TD -0.0386 Tc 0.6 Tw (Reports on early special care units do not suggest) Tj ET BT 0.9835 0 0 0.9835 76.32 347.52 Tm 0.0228 Tc 1.5066 Tw (marketing interests, but some recent reports do) Tj ET BT 0.934 0 0 0.9835 76.32 335.28 Tm -0.0267 Tc 0.7159 Tw (reflect such interests. In the past few years, market) Tj 0.5139 -12.2018 TD -0.018 Tc 1.6059 Tw (demand has clearly become an important factor in) Tj 0 -11.9577 TD -0.0125 Tc 0.7434 Tw (the establishment of special care units \(273\).) Tj 11.563 -18.0586 TD -0.0454 Tc 1.6351 Tw (This section discusses the theoretical concepts of) Tj ET BT 0.8915 0 0 0.9835 77.04 281.76 Tm 0.0463 Tc 0.7428 Tw (specialized dementia care that are frequently cited in) Tj ET BT 0.934 0 0 0.9835 77.04 269.76 Tm -0.0367 Tc 1.6993 Tw (the special care unit literature. It briefly describes) Tj ET BT 0.9835 0 0 0.9835 77.28 258 Tm 0.0334 Tc 0.7056 Tw (several ideas about special care units from other) Tj ET BT 0.934 0 0 0.9835 77.04 246 Tm -0.0343 Tc 2.3942 Tw (countries that have influenced the development of) Tj 0.257 -12.4458 TD -0.0101 Tc 0.5053 Tw (special care units in this country. Lastly, it summa-) Tj -0.5139 -11.9577 TD -0.0265 Tc 0.5872 Tw (rizes the findings from the available descriptive and) Tj 0.257 -12.4458 TD -0.0281 Tc 0.7944 Tw (evaluative studies of special care units.) Tj ET BT 0.9835 0 0 0.9835 92.88 188.64 Tm 0.0193 Tc -0.1168 Tw (Six ) Tj ET BT 0.9795 0 0 0.9795 110.4 188.64 Tm /F7 12 Tf 0.0521 Tc 1.356 Tw (Theoretical Concepts of Specialized) Tj -25.9734 -13.9668 TD 0.0426 Tc 0.8756 Tw (Dementia Care and Their Implications for) Tj 5.8808 -14.7019 TD 0.0464 Tc 0.7738 Tw (Staff Composition and Training and the) Tj 38.225 -14.2118 TD 0.0573 Tc 0.6156 Tw (Individualization of Care) Tj ET BT 0.8915 0 0 0.9835 88.56 128.88 Tm /F4 10 Tf 0.0436 Tc 0.983 Tw (Six interrelated concepts pervade the literature on) Tj ET BT 0.934 0 0 0.9835 77.76 117.12 Tm -0.0342 Tc 0.7238 Tw (special care units. The six concepts are discussed at) Tj 0 -11.9577 TD -0.0375 Tc 1.3377 Tw (some length in this report because OTA\222s review of) Tj 0 -12.2018 TD -0.0323 Tc 1.3642 Tw (the literature on special care units and discussions) Tj ET BT 0.9835 0 0 0.9835 325.68 639.84 Tm 0.0346 Tc -0.1323 Tw (with experts on dementia care indicate that these) Tj ET BT 0.934 0 0 0.9835 326.16 627.84 Tm -0.045 Tc 1.1779 Tw (concepts constitute the core of what is or should be) Tj ET BT 0.9835 0 0 0.9835 326.4 616.08 Tm 0.025 Tc -0.0921 Tw (special about special care units, more so than any) Tj ET BT 0.934 0 0 0.9835 325.92 604.08 Tm -0.0282 Tc 1.1457 Tw (particular physical design features or other charac-) Tj ET BT 0.9835 0 0 0.9835 326.16 592.08 Tm 0.029 Tc 1.5002 Tw (teristics of the units. Although experts disagree) Tj ET BT 0.934 0 0 0.9835 326.4 580.32 Tm -0.0221 Tc 1.0963 Tw (about particular physical design features and other) Tj ET BT 0.8915 0 0 0.9835 326.64 568.32 Tm 0.0501 Tc 1.4308 Tw (special care unit characteristics, there appears to be) Tj ET BT 0.934 0 0 0.9835 326.4 556.32 Tm -0.0312 Tc 1.106 Tw (considerable agreement about the concepts.) Tj ET BT 0.9835 0 0 0.9835 337.68 538.32 Tm 0.0367 Tc -0.104 Tw (The six theoretical concepts apply to the care of) Tj -10.9816 -11.9577 TD 0.0331 Tc 0.9673 Tw (individuals with dementia generally and are not) Tj ET BT 0.8915 0 0 0.9835 326.88 514.32 Tm 0.0502 Tc 0.9905 Tw (limited to special care units or even to nursing home) Tj ET BT 0.9835 0 0 0.9835 326.88 502.32 Tm 0.0326 Tc 2.3372 Tw (care. One or more of the concepts are cited in) Tj 0 -12.4458 TD 0.0278 Tc 0.3627 Tw (virtually all articles and books about special care) Tj 0 -12.2018 TD 0.015 Tc 2.7114 Tw (units, although few sources cite them all. The) Tj 0.244 -12.2018 TD 0.0412 Tc 0.3186 Tw (concepts are often used to explain and justify the) Tj ET BT 0.934 0 0 0.9835 326.88 454.32 Tm -0.0252 Tc 0.8427 Tw (particular physical design features and patient care) Tj ET BT 0.9835 0 0 0.9835 326.88 442.56 Tm 0.0267 Tc 3.1702 Tw (practices used in a given special care unit or) Tj ET BT 0.934 0 0 0.9835 326.88 430.32 Tm -0.0362 Tc 2.0536 Tw (recommended for special care units generally. The) Tj 0.7709 -12.2018 TD -0.027 Tc 1.9152 Tw (concepts also have important implications for staff) Tj 0 -11.9577 TD -0.0202 Tc 1.6082 Tw (composition and training and the individualization) Tj 0 -12.4458 TD -0.0354 Tc 1.3675 Tw (of care.) Tj ET BT 0.9835 0 0 0.9835 328.32 372 Tm 0.0309 Tc 0.9173 Tw (1. Something can be done for individuals with) Tj ET BT 0.934 0 0 0.9835 339.84 359.76 Tm 0.2115 Tc 0 Tw (dementia.) Tj -1.2848 -18.3027 TD -0.0219 Tc 1.7813 Tw (This concept argues against the pervasive nihil-) Tj ET BT 0.9835 0 0 0.9835 327.84 329.76 Tm 0.0256 Tc -0.0186 Tw (ism that has characterized the care of individuals) Tj 0.244 -12.2018 TD 0.0315 Tc -0.0246 Tw (with dementia. It posits instead that even though) Tj -0.244 -11.7137 TD 0.0376 Tc 2.2004 Tw (most of the diseases and conditions that cause) Tj ET BT 0.934 0 0 0.9835 328.08 294.24 Tm -0.0288 Tc 1.5807 Tw (dementia are incurable at present, some aspects of) Tj 0 -12.4458 TD -0.0277 Tc 0.9739 Tw (dementia are treatable, and treatment will improve) Tj ET BT 0.9835 0 0 0.9835 328.32 270.48 Tm 0.0302 Tc 2.9226 Tw (the individual\222s functioning and quality of life) Tj 0.4881 -12.4458 TD 0.0217 Tc 1.589 Tw (\(91,125,165,268,353,364,371,403\). The other five) Tj ET BT 0.934 0 0 0.9835 328.32 246.48 Tm -0.0325 Tc 1.1074 Tw (concepts discussed in this section can be thought of) Tj ET BT 0.9835 0 0 0.9835 328.56 234.48 Tm 0.0354 Tc 1.8192 Tw (as ways of operationalizing the first concept. A) Tj ET BT 0.8915 0 0 0.9835 328.32 222.48 Tm 0.0395 Tc 1.2119 Tw (corollary to the first concept that is implicit in much) Tj 0 -12.2018 TD 0.0364 Tc 0.6433 Tw (of the special care unit literature but explicitly stated) Tj ET BT 0.934 0 0 0.9835 328.32 198.48 Tm -0.0115 Tc 1.4704 Tw (by only a few commentators is the value judgment) Tj 0.5139 -11.9577 TD -0.0189 Tc 0.868 Tw (that individuals with dementia have a right to care) Tj ET BT 0.9835 0 0 0.9835 328.8 174.72 Tm 0.0289 Tc -0.1265 Tw (that improves their functioning and quality of life) Tj 0 -12.4458 TD 0.0374 Tc 0.6884 Tw (even if the disease or condition that causes their) Tj ET BT 0.934 0 0 0.9835 328.8 150.48 Tm -0.0165 Tc 0.8334 Tw (dementia is irreversible and progressive \(33,66,170,) Tj 0.257 -11.9577 TD 0.0645 Tc 0 Tw (399\).) Tj ET BT 0.9835 0 0 0.9835 328.8 116.64 Tm 0.0239 Tc 0.7734 Tw (2. Many factors cause excess disability in) Tj 11.9577 -11.9577 TD 0.0308 Tc 0.9087 Tw (individuals with dementia. Identifying and) Tj 0 -12.2018 TD 0.0257 Tc 0.8528 Tw (changing these factors will reduce excess) Tj ET q 15.12 0 0 -6.48 91.44 75.84 cm BI /W 87 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????|??~??~> ?~>?~??~??~?><?|>?x?? x~??> EI Q BT 0.6793 0 0 0.9835 91.44 71.52 Tm 3 Tr 0.0556 Tc 0 Tw (6For) Tj 0 Tr ET BT 0.934 0 0 0.9835 106.56 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 28.8 0 0 -6.96 108.96 74.64 cm BI /W 166 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????8π  ??????????~??~y~?~9?~?@?~??~>??~>??~????~?~?~ ~??|p||x>?|||?|~?p:| ||~| EI Q BT 0.7642 0 0 0.9835 108.96 71.52 Tm 3 Tr -0.0382 Tc 0 Tw (~xmple,) Tj 0 Tr ET BT 0.934 0 0 0.9835 137.76 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6.72 0 0 -5.52 140.16 74.88 cm BI /W 39 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~~~~~~~~~~~|~|~|~~~>~?~~~>>~ EI Q BT 0.7642 0 0 0.9835 140.16 71.52 Tm 3 Tr 0.0723 Tc 0 Tw (of) Tj 0 Tr ET BT 0.934 0 0 0.9835 146.88 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 21.12 0 0 -7.2 149.28 74.88 cm BI /W 122 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~`?gpA?|?<߇~?>x~?~8~>߀~>߀~>~>~>?~?~>~>p~>~><?|>x|?>???~?? ~??>>x||||~8 EI Q BT 0.6793 0 0 0.9835 149.28 71.52 Tm 3 Tr -0.0139 Tc 0 Tw (~peci~) Tj 0 Tr ET BT 0.934 0 0 0.9835 170.4 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 12.48 0 0 -4.08 172.8 73.44 cm BI /W 72 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??||||||||||||~|y~>???? EI Q BT 0.5944 0 0 0.9835 172.8 71.52 Tm 3 Tr -0.0588 Tc 0 Tw (~me) Tj 0 Tr ET BT 0.934 0 0 0.9835 185.28 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 14.64 0 0 -5.52 187.68 74.88 cm BI /W 85 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|?|||?|||||`~????<8??@ EI Q BT 1.1887 0 0 0.9835 187.68 71.52 Tm 3 Tr -0.0068 Tc 0 Tw (~~) Tj 0 Tr ET BT 0.934 0 0 0.9835 202.32 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 34.08 0 0 -5.52 204.72 76.8 cm BI /W 197 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <??χ???ǃ?ǃ?8~?~ @?|<|<?|<?>~0~px8??0 EI Q BT 0.5944 0 0 0.9835 204.72 71.52 Tm 3 Tr -0.0085 Tc 0 Tw (~~~bli~hed) Tj 0 Tr ET BT 0.934 0 0 0.9835 238.8 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6 0 0 -5.52 241.2 75.36 cm BI /W 35 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID :?????????????>~0 EI Q BT 0.9835 0 0 0.9835 241.2 71.52 Tm 3 Tr 0.0375 Tc 0 Tw (~) Tj 0 Tr ET BT 0.934 0 0 0.9835 247.2 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.56 0 0 -5.52 249.6 75.12 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |??|?>|????????>>?>>?>?>?>?>8?~x?~x?}?`? EI Q BT 0.8491 0 0 0.9835 249.6 71.52 Tm 3 Tr -0.1279 Tc 0 Tw (~~) Tj 0 Tr ET BT 0.934 0 0 0.9835 260.16 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 21.12 0 0 -7.2 262.56 75.36 cm BI /W 122 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??????|>?߀߀߀߀ππ???|????? EI Q BT 0.5944 0 0 0.9835 262.56 71.52 Tm 3 Tr -0.0199 Tc 0 Tw (~eri~d,) Tj 0 Tr ET BT 0.934 0 0 0.9835 283.68 71.52 Tm -0.0831 Tc 0.2623 Tw ( see ) Tj ET q 20.88 0 0 -7.2 302.88 76.8 cm BI /W 121 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|x|8|<<|??????x?x~x?????????? EI Q BT 0.6368 0 0 0.9835 302.88 71.52 Tm 3 Tr -0.0348 Tc 0 Tw (Berger) Tj 0 Tr ET BT 0.934 0 0 0.9835 323.76 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 13.92 0 0 -6.24 326.16 76.8 cm BI /W 81 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 008?>>?~?|~?|<xxx|||xxxxx||>|><>x>|?|?|~>|0?p EI Q BT 0.6368 0 0 0.9835 326.16 71.52 Tm 3 Tr 0.0311 Tc 0 Tw (\(27\),) Tj 0 Tr ET BT 0.934 0 0 0.9835 340.08 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 36 0 0 -5.28 342.48 76.8 cm BI /W 207 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`<x ????~?~x|?~8|?~||?~||?~|?~|~|~|0~|x?~|?~??>~?|>~|~~??||<|||p~ EI Q BT 0.9835 0 0 0.9835 342.48 71.52 Tm 3 Tr 0.0504 Tc 0 Tw (Bl~en~) Tj 0 Tr ET BT 0.934 0 0 0.9835 378.48 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 20.88 0 0 -5.52 380.88 77.04 cm BI /W 121 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |08?x?||~>}|p||?8|?|?||>?||>>?||>~||?~~|?|~|~|~||?|8x|?|?|x EI Q BT 0.6368 0 0 0.9835 380.88 71.52 Tm 3 Tr -0.0359 Tc 0 Tw (Jewish) Tj 0 Tr ET BT 0.934 0 0 0.9835 401.76 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 18.72 0 0 -5.28 404.16 76.8 cm BI /W 108 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????~?~|>p~|~ ~~|~|||?~?>?>?~?px ???> EI Q BT 0.6793 0 0 0.9835 404.16 71.52 Tm 3 Tr -0.0078 Tc 0 Tw (Home) Tj 0 Tr ET BT 0.934 0 0 0.9835 422.88 71.52 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 13.92 0 0 -6.72 425.28 77.04 cm BI /W 81 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pp<>>?><||?|>?|x|||<>>>>~<?x`` EI Q BT 0.6368 0 0 0.9835 425.28 71.52 Tm 3 Tr 0.0311 Tc 0 Tw (\(32\),) Tj 0 Tr ET BT 0.9021 0 0 0.9598 439.2 71.52 Tm /F6 5 Tf 0 Tc 0.0799 Tw ( ) Tj ET q 21.12 0 0 -7.2 440.16 76.8 cm BI /W 122 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????~?x||~??|??8 EI Q BT 1.9845 0 0 0.9598 440.16 71.52 Tm 3 Tr 0.0325 Tc 0 Tw (Bohg) Tj 0 Tr ET BT 0.9021 0 0 0.9598 461.28 71.52 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 10.8 0 0 -5.52 462.24 77.04 cm BI /W 63 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?~~?|~?|~?>~?~?~?~?8~?>?~>?||| ||?|||||||||<x>|=>|?||><08` EI Q BT 1.4433 0 0 0.9598 496.08 71.52 Tm 3 Tr 0.0125 Tc 0 Tw (\(34\),) Tj 0 Tr ET BT 0.934 0 0 0.9835 510 71.52 Tm /F4 10 Tf -0.0537 Tc 1.3871 Tw ( Bowsher) Tj ET BT 0.7217 0 0 0.9835 77.76 60.48 Tm -0.0058 Tc 0.7935 Tw (\(38\), Bnce \(44\), Clarke \(87\), Goodman \(158\), Grossman et al. \(163\), ) Tj ET q 18.48 0 0 -5.52 308.64 66 cm BI /W 138 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?????~???~??|????????????????|??|???~?>~?~????px<>?H EI Q BT 0.5094 0 0 0.9835 308.64 60.48 Tm 3 Tr 0.0621 Tc 0 Tw (Kromm) Tj 0 Tr ET BT 0.7217 0 0 0.9835 327.12 60.48 Tm -0.0429 Tc 0.1043 Tw ( and ) Tj ET q 18.48 0 0 -5.52 344.16 66 cm BI /W 137 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8 ;????~~|??~|?~|?||?||?||?||?||?||?||?~|?~|?||~??>~|>??? EI Q BT 0.5094 0 0 0.9835 344.16 60.48 Tm 3 Tr 0.0621 Tc 0 Tw (Kromm) Tj 0 Tr ET BT 0.7217 0 0 0.9835 362.64 60.48 Tm 0.0224 Tc 0.0138 Tw ( \(234\), ) Tj ET q 24.24 0 0 -5.52 386.16 66 cm BI /W 179 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?| x<?~?????`qC|||||||~~?x|??x0?<~|?8?~|????pp p P EI Q BT 0.5094 0 0 0.9835 386.16 60.48 Tm 3 Tr 0.0732 Tc 0 Tw (Liebowitz) Tj 0 Tr ET BT 0.7217 0 0 0.9835 410.4 60.48 Tm -0.0043 Tc 0.8821 Tw ( et al. \(253\), Peppard \(345\), Wallace \(478\),) Tj ET BT 0.6793 0 0 0.9835 77.76 51.6 Tm -0.01 Tc 0.8545 Tw (and Wilson and Patterson \(505\).) Tj ET q 2.4 0 0 -4.32 91.44 45.84 cm BI /W 16 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx8<@<? EI Q BT 0.3396 0 0 0.9835 91.44 40.8 Tm 3 Tr -0.3143 Tc 0 Tw (T) Tj 0 Tr ET BT 0.8066 0 0 0.9835 93.84 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 10.8 0 0 -6.48 96 46.56 cm BI /W 72 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>0p?~|?<>x~|g|`xx|~>߁??`?`~>>@ EI Q BT 0.5519 0 0 0.9835 96 40.8 Tm 3 Tr 0.0105 Tc 0 Tw (See,) Tj 0 Tr ET BT 0.8066 0 0 0.9835 106.8 40.8 Tm 0.0054 Tc 0.0382 Tw ( for ) Tj ET q 24 0 0 -7.2 121.92 46.56 cm BI /W 158 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~~~x>| 1|?????????>?>x`>>8>>8>>?>?>~??~?>?>|?||??|?||q| EI Q BT 0.7642 0 0 0.9835 121.92 40.8 Tm 3 Tr -0.0108 Tc 0 Tw (~wple,) Tj 0 Tr ET BT 0.8066 0 0 0.9835 145.92 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 29.28 0 0 -7.2 148.08 46.32 cm BI /W 193 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~@?????~>x?>>8><~?|@???0??? EI Q BT 0.934 0 0 0.9835 148.08 40.8 Tm 3 Tr -0.0007 Tc 0 Tw (H~c~k) Tj 0 Tr ET BT 0.8066 0 0 0.9835 177.36 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 9.36 0 0 -5.52 179.52 46.56 cm BI /W 63 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>>?>?|>>~>>>?>>>>>>>>8?>?x>|>~~~>? EI Q BT 0.7642 0 0 0.9835 179.52 40.8 Tm 3 Tr -0.0935 Tc 0 Tw (~d) Tj 0 Tr ET BT 0.8066 0 0 0.9835 188.88 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 18.72 0 0 -5.52 191.04 46.32 cm BI /W 123 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x >??|~?|?>|x>|>?~? p?|>>?~~????? EI Q BT 0.9835 0 0 0.9835 191.04 40.8 Tm 3 Tr 0.0614 Tc 0 Tw (Ba~) Tj 0 Tr ET BT 0.8066 0 0 0.9835 209.76 40.8 Tm 0.0435 Tc 0.6072 Tw ( \(173\), Johnson and Chapman \(21 1\), ) Tj ET q 44.4 0 0 -5.52 354.72 46.32 cm BI /W 291 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?8??<??<?<~|???~?~>~?~>?~~~?~|?~|?~|??~|????|>?=???~~???>~??>????|?|~?>????????? 8p<?<????8 EI Q BT 0.5944 0 0 0.9835 354.72 40.8 Tm 3 Tr -0.0525 Tc 0 Tw (McGrowder-Lin) Tj 0 Tr ET BT 0.8066 0 0 0.9835 399.12 40.8 Tm 0.0194 Tc 0.467 Tw ( and Bhatt \(299\), ) Tj ET q 20.16 0 0 -7.2 467.28 46.56 cm BI /W 132 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px ~??~???|y|9<?>?x?~x><~x>|~~@~???? p<9~>>? EI Q BT 0.6793 0 0 0.9835 467.28 40.8 Tm 3 Tr 0.0455 Tc 0 Tw (Sawer) Tj 0 Tr ET BT 0.8066 0 0 0.9835 487.44 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 9.6 0 0 -5.52 489.6 46.56 cm BI /W 64 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????|??|??>??????????8??|?~?~>??x EI Q BT 0.7642 0 0 0.9835 489.6 40.8 Tm 3 Tr -0.0935 Tc 0 Tw (~d) Tj 0 Tr ET BT 0.8066 0 0 0.9835 499.2 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 34.32 0 0 -5.76 501.36 46.56 cm BI /W 226 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?`p?????~~?~|?~|~~?~~?||~~?||~|?~|~|?~~~|?~|LJ~~?~|~>?|?~>??~??|??~?<?,??|||8 EI Q BT 0.5944 0 0 0.9835 501.36 40.8 Tm 3 Tr -0.0752 Tc 0 Tw (Mendolovi~) Tj 0 Tr ET BT 0.8066 0 0 0.9835 535.68 40.8 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 15.6 0 0 -6.48 537.84 48.24 cm BI /W 103 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|~?|<~~8>|>||||||~||>x|~?x???|~~~~~|~|~x|~||~|><~~|~>~>????>~>>||p< | EI Q BT 0.5094 0 0 0.9835 537.84 40.8 Tm 3 Tr 0.0464 Tc 0 Tw (\(400\)s) Tj 0 Tr ET BT 0.7217 0 0 0.9835 77.76 30.72 Tm -0.0215 Tc 0.13 Tw (and Schwab et ) Tj ET q 5.28 0 0 -5.52 128.88 36.24 cm BI /W 40 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ???>??x|?>?x|?|?|>|~?0 0 EI Q BT 0.4245 0 0 0.9835 128.88 30.72 Tm 3 Tr 0.1248 Tc 0 Tw (al.) Tj 0 Tr ET BT 0.7217 0 0 0.9835 134.16 30.72 Tm 0.0224 Tc 0.1801 Tw ( \(403\).) Tj ET endstream endobj 66 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 67 0 obj <>stream 0.72 w 1 j 0 0 0 RG 54.96 680.88 m 533.52 680.88 l S BT 0.9835 0 0 0.9835 322.56 686.64 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 3.1037 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 515.52 686.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.24 686.64 Tm /F5 10 Tf 0.488 Tc 0 Tw (17) Tj -462.2035 -40.0218 TD /F4 10 Tf 0.0298 Tc 1.3978 Tw (disability and improve the individuals\222) Tj 0 -11.9577 TD 0.0286 Tc 1.1549 Tw (functioning and quality of life.) Tj -1.2202 -18.3027 TD 0.0292 Tc 2.4355 Tw (As discussed earlier, excess disability is fuc-) Tj ET BT 0.8491 0 0 0.9835 56.16 605.76 Tm 0.0396 Tc 1.3761 Tw (tional impairment that is greater than is warranted by) Tj ET BT 0.9835 0 0 0.9835 56.16 593.76 Tm 0.0348 Tc 0.7623 Tw (an individual\222s disease or condition \(47,219\). Ex-) Tj ET BT 0.934 0 0 0.9835 56.16 581.76 Tm -0.0219 Tc 1.4632 Tw (cess disability in individuals with dementia can be) Tj ET BT 0.9835 0 0 0.9835 56.16 570 Tm 0.0244 Tc 2.3591 Tw (caused by untreated acute or chronic illnesses,) Tj 0.244 -12.2018 TD 0.0271 Tc 0.6074 Tw (depression, and sensory impairments; overuse or) Tj ET BT 0.934 0 0 0.9835 56.4 546.24 Tm -0.0484 Tc 2.1523 Tw (inappropriate use of psychotropic or other medica-) Tj ET BT 0.8915 0 0 0.9835 56.64 534.24 Tm 0.0439 Tc 1.7454 Tw (tions or physical restraints; excessive environmental) Tj ET BT 0.934 0 0 0.9835 56.4 522.48 Tm -0.033 Tc 1.7504 Tw (noise; lack of stimulation and exercise; inappropri-) Tj ET BT 0.9835 0 0 0.9835 56.88 510.24 Tm 0.0337 Tc 0.1126 Tw (ate caregiver responses to individuals\222 behavioral) Tj 0.244 -11.9577 TD 0.0185 Tc 2.2431 Tw (symptoms, and other factors. The literature on) Tj 0 -12.2018 TD 0.0256 Tc 0.2429 Tw (special care units contains numerous examples of) Tj 0.244 -12.4458 TD 0.0137 Tc 2.155 Tw (situations in which changing a factor that was) Tj -0.244 -11.7137 TD 0.0199 Tc 0.1267 Tw (causing excess disability resulted in dramatic im-) Tj ET BT 0.8915 0 0 0.9835 56.88 450.72 Tm 0.0429 Tc 1.3875 Tw (provement in an individual\222s functioning and quality) Tj ET BT 0.9835 0 0 0.9835 57.36 438.72 Tm 0.0511 Tc 0.339 Tw (of life.) Tj 0 -18.0586 TD 0.0305 Tc 0.6039 Tw (3. Individuals with dementia have residual) Tj 12.4458 -11.7137 TD 0.0195 Tc 0.3222 Tw (strengths. Building on these strengths will) Tj 0 -11.9577 TD 0.0277 Tc 1.2169 Tw (improve their functioning and quality of life.) Tj ET BT 0.934 0 0 0.9835 68.64 379.44 Tm -0.0164 Tc 1.9125 Tw (Although individuals with dementia are usually) Tj -11.563 -12.4458 TD -0.0354 Tc 0.8537 Tw (described in terms of their impairments, even those) Tj ET BT 0.8915 0 0 0.9835 57.84 355.2 Tm 0.0354 Tc 0.8576 Tw (with severe impairments have residual strengths and) Tj ET BT 0.934 0 0 0.9835 58.32 343.2 Tm 0.0237 Tc 2.332 Tw (abilities \(125,328,353,399,519\). It has been noted,) Tj ET BT 0.9835 0 0 0.9835 58.08 331.2 Tm 0.0303 Tc -0.0873 Tw (for example, that some individuals with dementia) Tj ET BT 0.934 0 0 0.9835 58.08 318.96 Tm -0.0376 Tc 0.9131 Tw (who are no longer able to speak coherently can still) Tj ET BT 0.8915 0 0 0.9835 58.56 307.2 Tm 0.0386 Tc 1.0036 Tw (sing, and some can remember the words to old songs) Tj ET BT 0.934 0 0 0.9835 58.56 295.44 Tm 0.0146 Tc 1.7422 Tw (\(295,487,491\). By building on this strength, music) Tj ET BT 0.8915 0 0 0.9835 58.32 283.44 Tm 0.0383 Tc 0.9056 Tw (programs and music therapy are intended to improve) Tj ET BT 0.934 0 0 0.9835 58.56 271.2 Tm -0.025 Tc 1.5812 Tw (these individuals\222 quality of life and allow them to) Tj 0 -11.9577 TD -0.0526 Tc 1.2575 Tw (interact on some level with other people.) Tj ET BT 0.9835 0 0 0.9835 69.6 241.2 Tm 0.0391 Tc 0.2292 Tw (Another example of the implementation of this) Tj -10.9816 -11.9577 TD 0.0257 Tc 2.8051 Tw (concept is the use of familiar activities. Many) Tj ET BT 0.8915 0 0 0.9835 59.04 217.2 Tm 0.0316 Tc 0.9516 Tw (individuals with dementia remember how to do tasks) Tj ET BT 0.9835 0 0 0.9835 59.04 204.96 Tm 0.0234 Tc 1.2517 Tw (they did earlier in their lives. Activities such as) Tj ET BT 0.934 0 0 0.9835 59.04 192.72 Tm -0.0304 Tc 2.2616 Tw (cooking and laundry-folding for women and wood-) Tj ET BT 0.9835 0 0 0.9835 59.04 180.72 Tm 0.0386 Tc 1.4803 Tw (working for men are intended to build on these) Tj ET BT 0.8915 0 0 0.9835 59.04 168.72 Tm 0.0471 Tc 1.0496 Tw (remaining abilities and give the individuals a feeling) Tj ET BT 0.9835 0 0 0.9835 59.28 156.96 Tm 0.0396 Tc 0.3506 Tw (of competence \(108,518\).) Tj 0.4881 -17.8146 TD 0.0311 Tc 0.9694 Tw (4. The behavior of individuals with dementia) Tj 11.9577 -11.9577 TD 0.0419 Tc 0.2873 Tw (represents understandable feelings and needs,) Tj 0 -12.2018 TD 0.0414 Tc 0.4882 Tw (even if the individuals are unable to express) Tj 0 -11.9577 TD 0.0416 Tc 0.5927 Tw (the feelings or needs. Identifying and) Tj 0.244 -12.2018 TD 0.0471 Tc 0.587 Tw (responding to those feelings and needs will) Tj 0.244 -12.2018 TD 0.0295 Tc 1.337 Tw (reduce the incidence of behavioral symptoms.) Tj -1.4642 -18.3027 TD 0.033 Tc 1.8623 Tw (The behavior of individuals with dementia is) Tj ET BT 0.8915 0 0 0.9835 59.76 50.16 Tm 0.0469 Tc 1.7869 Tw (frequently regarded as an inevitable and essentially) Tj ET BT 0.9835 0 0 0.9835 59.52 38.4 Tm 0.0329 Tc 0.6015 Tw (meaningless consequence of their dementing dis-) Tj 251.3567 619.1184 TD 0.0431 Tc 3.0925 Tw (ease or condition, and little effort is made to) Tj 0 -12.2018 TD 0.0245 Tc 1.2375 Tw (understand or explain it. In contrast, experts in) Tj ET BT 0.8915 0 0 0.9835 306.96 623.52 Tm 0.0349 Tc 1.1834 Tw (dementia care point out that the behavior of individ-) Tj ET BT 0.9835 0 0 0.9835 306.72 611.52 Tm 0.0335 Tc 2.2604 Tw (uals with dementia often expresses meaningful) Tj ET BT 0.934 0 0 0.9835 307.2 599.52 Tm 0.0154 Tc 0.7992 Tw (feelings, intentions, and needs \(60,125,273,287,353,) Tj ET BT 0.9835 0 0 0.9835 307.44 587.28 Tm 0.021 Tc 3.3591 Tw (361,385,403,408,482,517\). They contend that if) Tj 0 -11.7137 TD 0.0201 Tc -0.0769 Tw (nursing home staff members and other caregivers) Tj 0 -12.2018 TD 0.0262 Tc 2.5606 Tw (can figure out the meaning of the individuals\222) Tj ET BT 0.8915 0 0 0.9835 307.44 552 Tm 0.0456 Tc 0.6282 Tw (behavior and respond to that meaning, the caregivers) Tj ET BT 0.9835 0 0 0.9835 307.44 540.24 Tm 0.0423 Tc 3.4855 Tw (may be able to prevent or resolve behavioral) Tj ET BT 0.934 0 0 0.9835 308.16 528 Tm -0.0401 Tc 2.4004 Tw (symptoms without resorting to psychotropic medi-) Tj -0.257 -12.2018 TD -0.0301 Tc 0.6644 Tw (cations or physical restraints. Box 1-C describes the) Tj ET BT 0.8915 0 0 0.9835 308.4 504.24 Tm 0.0436 Tc 1.14 Tw (same elderly man with dementia who is described in) Tj ET BT 0.934 0 0 0.9835 307.92 492 Tm -0.0171 Tc 1.4121 Tw (box 1-B and illustrates the way in which interven-) Tj ET BT 0.8915 0 0 0.9835 308.16 480.24 Tm 0.0384 Tc 0.4056 Tw (tions based on an understanding of the meaning of an) Tj ET BT 0.934 0 0 0.9835 308.4 468.48 Tm -0.0276 Tc 1.3592 Tw (individual\222s behavior may prevent the development) Tj ET BT 0.9835 0 0 0.9835 308.4 456.24 Tm 0.0417 Tc 3.4861 Tw (of behavioral symptoms and avoid the use of) Tj -0.244 -11.9577 TD 0.021 Tc 0.1865 Tw (psychotropic medications and physical restraints.) Tj 0.244 -11.9577 TD 0.0173 Tc 2.5697 Tw (The special care unit literature contains many) Tj ET BT 0.8915 0 0 0.9835 308.88 420.72 Tm 0.0465 Tc 2.8192 Tw (similar accounts.) Tj ET BT 0.9835 0 0 0.9835 319.68 400.8 Tm 0.037 Tc 1.3701 Tw (The first efforts to explain specific behavioral) Tj ET BT 0.934 0 0 0.9835 309.12 389.04 Tm -0.025 Tc 1.5277 Tw (symptoms in individuals with dementia focused on) Tj ET BT 0.9835 0 0 0.9835 309.12 377.04 Tm 0.0257 Tc 2.1137 Tw (wandering. Beginning in the 1970s, several re-) Tj 0.244 -12.4458 TD 0.0342 Tc 1.5275 Tw (searchers have studied wandering behavior and) Tj ET BT 0.934 0 0 0.9835 309.36 352.56 Tm -0.0246 Tc 2.2981 Tw (concluded that although the behavior often seems) Tj -0.257 -11.9577 TD -0.0209 Tc 0.8381 Tw (meaningless on the surface, it actually represents a) Tj ET BT 0.9835 0 0 0.9835 309.12 328.8 Tm 0.0358 Tc 2.4695 Tw (variety of meaningful intentions and needs for) Tj ET BT 0.934 0 0 0.9835 309.6 316.8 Tm -0.0313 Tc 1.877 Tw (different individuals \(e.g., a search for someone or) Tj 0.257 -12.2018 TD -0.0207 Tc 0.4952 Tw (something, a search for security, a wish to go home,) Tj -0.257 -12.2018 TD 0.0036 Tc 1.4543 Tw (or a lifelong coping style\) \(106,306,361,417\). Based) Tj ET BT 0.9835 0 0 0.9835 309.6 281.28 Tm 0.023 Tc 1.9712 Tw (on this conclusion, a number of innovative and) Tj ET BT 0.934 0 0 0.9835 309.36 269.28 Tm -0.0487 Tc 1.9385 Tw (reportedly effective methods of responding to wan-) Tj 0.257 -12.4458 TD -0.038 Tc 1.6915 Tw (dering behavior have been developed.) Tj ET BT 0.9835 0 0 0.9835 320.88 237.12 Tm 0.2892 Tc 3.0253 Tw (Two books-Care) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 406.56 237.12 Tm /F5 11 Tf 0.2877 Tc 2.9885 Tw (of Alzheimer\222s Patients: A) Tj -98.8153 -12.4742 TD 0.083 Tc 0.3435 Tw (Manual for Nursing Home Staff ) Tj ET BT 0.9795 0 0 0.9795 454.56 224.88 Tm /F7 12 Tf 0.0429 Tc -0.1048 Tw (\(165\) ) Tj ET BT 0.9835 0 0 0.9835 483.6 224.88 Tm /F4 10 Tf 0.0503 Tc -0.1483 Tw (and ) Tj ET BT 0.9812 0 0 0.9812 503.76 224.88 Tm /F5 11 Tf 0.0426 Tc 0 Tw (Under-) Tj -197.1414 -12.2296 TD 0.3264 Tc 3.2752 Tw (standing Difficult Behaviors \(385\)-discuss the) Tj ET BT 0.8915 0 0 0.9835 310.08 200.64 Tm /F4 10 Tf 0.0397 Tc 1.9295 Tw (many possible reasons for behavioral symptoms and) Tj ET BT 0.934 0 0 0.9835 310.8 188.4 Tm -0.0293 Tc 1.9483 Tw (suggest ways of responding to the problems based) Tj ET BT 0.9835 0 0 0.9835 310.32 176.64 Tm 0.0344 Tc 3.203 Tw (on these reasons. Both books recommend and) Tj 0 -11.9577 TD 0.0392 Tc 0.3999 Tw (exemplify a flexible, problem-solving approach to) Tj ET BT 0.934 0 0 0.9835 310.32 152.88 Tm -0.0057 Tc 5.19 Tw (behavioral symptoms.) Tj ET BT 0.9835 0 0 0.9835 417.6 153.12 Tm 0.0174 Tc 0.3732 Tw (Other commentators have) Tj ET BT 0.934 0 0 0.9835 310.8 141.36 Tm -0.0327 Tc 1.1077 Tw (also noted that responding effectively to the behav-) Tj 0 -11.9577 TD -0.0276 Tc 1.9159 Tw (ioral symptoms of individuals with dementia often) Tj ET BT 0.9835 0 0 0.9835 311.04 117.84 Tm 0.0325 Tc 0.4276 Tw (involves a flexible, trial and error approach \(353,) Tj ET BT 0.934 0 0 0.9835 311.04 106.08 Tm 0.0707 Tc 0 Tw (399,516\).) Tj 11.563 -20.255 TD -0.0361 Tc 0.8544 Tw (Rader refers to wandering and other behaviors of) Tj -11.563 -12.2018 TD -0.0195 Tc 0.5154 Tw (individuals with dementia as ) Tj ET BT 0.9443 0 0 0.9812 441.6 74.16 Tm /F5 11 Tf 0.0363 Tc 0.1328 Tw (agenda behavior; ) Tj ET BT 0.934 0 0 0.9835 519.12 74.16 Tm /F4 10 Tf 0.0168 Tc 0 Tw (that) Tj ET BT 0.9835 0 0 0.9835 311.04 62.16 Tm 0.0258 Tc 2.9096 Tw (is, behavior by which a person with dementia) Tj ET BT 0.934 0 0 0.9835 311.04 50.16 Tm -0.0073 Tc 1.2732 Tw (attempts to meet his or her own agenda \(359,361\).) Tj ET BT 0.8915 0 0 0.9835 311.04 38.16 Tm 0.0386 Tc 1.2129 Tw (She urges caregivers of individuals with dementia to) Tj ET endstream endobj 68 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 69 0 obj <>stream 0.48 w 1 j 0 0 0 RG 73.68 673.68 m 551.52 673.68 l S 0.72 w 73.92 652.08 m 551.28 652.08 l S 75.12 652.32 m 75.12 415.2 l S 552.24 652.8 m 552.24 413.28 l S 75.6 414.24 m 553.2 414.24 l S BT 0.9835 0 0 0.9835 74.16 680.16 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (18 ) Tj ET BT 0.9598 0 0 0.9598 86.64 680.16 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 92.88 680.16 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 146.64 680.16 Tm /F5 11 Tf 0.0745 Tc -0.0147 Tw (Units for People with ) Tj ET BT 0.9835 0 0 0.9835 243.84 680.16 Tm /F5 10 Tf 0.0229 Tc 0.1597 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.8875 0 0 0.9795 95.76 629.76 Tm /F7 12 Tf -0.004 Tc 1.5321 Tw (Box 1-C\227The Use of Behavioral Interventions With a Nursing Home Resident With Dementia) Tj ET BT 0.8491 0 0 0.9835 106.08 611.04 Tm /F4 10 Tf 0.0395 Tc 0.6468 Tw (One evening an elderly man with dementia who had recently been admitted to a nursing home was picking) Tj -23.4602 -11.2256 TD 0.0341 Tc 0.0939 Tw (up his newspaper at the receptionist\222s desk. Abruptly, he threatened to hit the receptionist with his cane if she did) Tj ET BT 0.8915 0 0 0.9835 86.16 589.44 Tm 0.0444 Tc 0.1296 Tw (not call him a cab, so he could \223go to town, \222) Tj ET BT 0.8066 0 0 0.9835 270.72 589.2 Tm 0.0403 Tc 1.4149 Tw (The receptionist stood up, looked directly at the resident and said in) Tj -228.5016 -11.2256 TD 0.0165 Tc 2.8509 Tw (a respectful, matter-of-fact tone,) Tj ET BT 0.8915 0 0 0.9835 217.92 577.92 Tm 0.0365 Tc 0.0846 Tw (\223I see something is bothering you.\222) Tj ET BT 0.8491 0 0 0.9835 363.6 577.92 Tm 0.0468 Tc -0.0103 Tw (The resident answered in a low, harsh voice,) Tj ET BT 0.8066 0 0 0.9835 87.12 567.36 Tm 0.0523 Tc 1.3188 Tw (\223I should be working, not being lazy.\224 The receptionist asked him about his work and listened intently as he talked) Tj ET BT 0.8491 0 0 0.9835 86.4 556.32 Tm 0.0587 Tc 0.3054 Tw (about the work he used to do.) Tj 23.7428 -13.91 TD 0.0345 Tc 0.9608 Tw (A pattern developed with the new resident. He did well during the day with) Tj 369.7096 -0.7321 TD 0.0187 Tc 0.7765 Tw (minimal assistance, but every) Tj -392.8871 -10.4935 TD 0.0362 Tc 0.1577 Tw (evening he became very confused and agitated. A nurse aide was assigned to take a walk with him at these times.) Tj 0 -11.2256 TD 0.0399 Tc 0.3969 Tw (As they walked together around the facility, they often talked about the past and the resident\222s busy professional) Tj 0 -10.7376 TD 0.0355 Tc 0.0502 Tw (life. Sometimes they just walked. When the resident showed sorrow, the nurse aide shared the sorrow with him by) Tj 0.2827 -11.4697 TD 0.0376 Tc 0.142 Tw (active listening and gently touching him on the arm.) Tj ET BT 0.8915 0 0 0.9835 107.28 484.56 Tm 0.0364 Tc 0.6052 Tw (Several weeks passed, The resident became less agitated and more content to wander around the unit,) Tj ET BT 0.8491 0 0 0.9835 87.6 473.52 Tm 0.0388 Tc 0.2985 Tw (sometimes stopping to take imaginary measurements of a doorway or a piece of furniture. The intervention of the) Tj ET BT 0.8066 0 0 0.9835 87.36 462.72 Tm 0.0455 Tc 0.7819 Tw (familiar nurse aide prevented the development of a behavioral problem that might have led to the use of psychotropic) Tj 0 -11.2256 TD 0.0551 Tc 2.208 Tw (medications or physical restraints.) Tj ET BT 0.6793 0 0 0.9835 87.84 434.88 Tm -0.0369 Tc 2.3957 Tw (SOURCE: Adapted from M. Bowsher,) Tj ET BT 0.7217 0 0 0.9835 214.56 434.4 Tm -0.0235 Tc 1.0418 Tw (\223A Unique and Successful Approach to Care for Moderate Stage ) Tj ET q 29.28 0 0 -5.76 436.32 440.16 cm BI /W 217 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID #D;3????????>??~/?>>><?><????'|c?|~?|???|??F??ˀ????~?>??~?_?x???}????ys@'@"x?@ |??? ??~ EI Q BT 0.5094 0 0 0.9835 436.32 434.4 Tm 3 Tr 0.0158 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.7217 0 0 0.9835 465.6 434.4 Tm -0.0556 Tc 1.2858 Tw ( Victims,\224 Green Hills) Tj -473.8612 -9.0293 TD -0.0437 Tc 0.6707 Tw (Center, West Liberty, OH, unpublished ) Tj ET q 27.36 0 0 -7.2 258.96 431.28 cm BI /W 206 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x|<>D|??|???????>???????????>??>????~???~|??~|????????~??~>?>>> EI Q BT 0.467 0 0 0.9835 258.96 425.52 Tm 3 Tr 0.034 Tc 0 Tw (manuscrip~) Tj 0 Tr ET BT 0.7217 0 0 0.9835 286.32 425.52 Tm -0.026 Tc 0.4135 Tw ( no date.) Tj ET BT 0.9835 0 0 0.9835 76.08 395.04 Tm 0.0343 Tc 0.9835 Tw (try to understand the agenda that underlies the) Tj ET BT 0.934 0 0 0.9835 76.08 383.52 Tm -0.0268 Tc 1.1014 Tw (individual\222s behavior and to allow the individual to) Tj ET BT 0.8915 0 0 0.9835 75.6 371.52 Tm 0.0325 Tc 0.3524 Tw (play out that agenda as much as possible, rather than) Tj ET BT 0.934 0 0 0.9835 76.56 359.52 Tm -0.0263 Tc 1.4862 Tw (superimposing the caregiver\222s own agenda.) Tj ET BT 0.9835 0 0 0.9835 87.36 341.52 Tm 0.0394 Tc -0.083 Tw (On the basis of the concept that the behavior of) Tj ET BT 0.934 0 0 0.9835 76.32 330 Tm -0.0303 Tc 2.6469 Tw (individuals with dementia represents understand-) Tj ET BT 0.8915 0 0 0.9835 76.32 317.76 Tm 0.0417 Tc 0.9403 Tw (able feelings and needs, Feil and others advocate the) Tj ET BT 0.934 0 0 0.9835 76.32 305.76 Tm -0.0375 Tc 0.342 Tw (use of ) Tj ET BT 0.9443 0 0 0.9812 105.12 305.76 Tm /F5 11 Tf 0.0399 Tc 1.781 Tw (validation therapy \(120,136,407\).) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 254.88 305.76 Tm /F4 10 Tf 0.2061 Tc 0 Tw (Validation) Tj -191.1749 -11.9577 TD -0.0163 Tc 1.604 Tw (therapy involves understanding and validating the) Tj -0.257 -12.4458 TD -0.0129 Tc 1.6004 Tw (personal meaning of an individual\222s behavior. It is) Tj ET BT 0.9835 0 0 0.9835 76.32 269.76 Tm 0.0343 Tc 3.4065 Tw (an alternative to) Tj 0 Tc -0.0972 Tw ( ) Tj 91.0253 0 TD /F5 10 Tf 0.237 Tc 2.6264 Tw (reality orientation,) Tj 0 Tc -0.061 Tw ( ) Tj 88.0969 0 TD /F4 10 Tf 0.2487 Tc 3.7986 Tw (a therapy) Tj ET BT 0.934 0 0 0.9835 76.08 258.24 Tm -0.0385 Tc 0.8997 Tw (method which requires the caregiver to consistently) Tj ET BT 0.8915 0 0 0.9835 76.08 246.24 Tm 0.0484 Tc 0.7789 Tw (reorient the confused person to current reality. Many) Tj ET BT 0.9835 0 0 0.9835 76.32 234.24 Tm 0.025 Tc 0.756 Tw (commentators contend that reality orientation is) Tj 0 -11.9577 TD 0.028 Tc -0.0768 Tw (frustrating and usually ineffective for individuals) Tj ET BT 0.8915 0 0 0.9835 76.32 210.48 Tm 0.0387 Tc 1.4147 Tw (with dementia, except perhaps early in the course of) Tj ET BT 0.934 0 0 0.9835 76.32 198.48 Tm -0.0112 Tc 1.9069 Tw (their dementing disease or condition \(120,170,273,) Tj 0.7709 -12.4458 TD 0.0744 Tc 3.0487 Tw (359,361, 436,483\).) Tj ET BT 0.9795 0 0 0.9795 76.56 156 Tm /F7 12 Tf 0.031 Tc -0.0927 Tw (5. ) Tj ET BT 0.9835 0 0 0.9835 88.56 156 Tm /F4 10 Tf 0.0349 Tc 0.6402 Tw (Many aspects of the physical and social) Tj 0 -12.2018 TD 0.0299 Tc 1.3977 Tw (environment affect the functioning of) Tj 0 -11.9577 TD 0.0219 Tc 1.3448 Tw (individuals with dementia. Providing) Tj 0.244 -12.4458 TD 0.0311 Tc 1.4574 Tw (appropriate environments will improve their) Tj -0.244 -11.7137 TD 0.0286 Tc 1.0939 Tw (functioning and quality of life.) Tj ET BT 0.8915 0 0 0.9835 87.6 90.72 Tm 0.0494 Tc 0.7072 Tw (The relationship between the environment and the) Tj ET BT 0.9835 0 0 0.9835 76.56 78.96 Tm 0.0531 Tc 1.0996 Tw (functioning of older people has been the topic of) Tj ET BT 0.934 0 0 0.9835 76.56 67.2 Tm -0.028 Tc 1.925 Tw (empirical research and theory-building in environ-) Tj -0.257 -12.2018 TD -0.0004 Tc 1.0731 Tw (mental psychology for 30 years \(183,242\). It is now) Tj 0 -12.4458 TD -0.0323 Tc 1.5355 Tw (generally accepted that the interaction between an) Tj ET BT 0.8915 0 0 0.9835 76.32 31.2 Tm 0.053 Tc 1.78 Tw (older person\222s environment and the person\222s charac-) Tj ET BT 0.9835 0 0 0.9835 326.88 394.32 Tm 0.0183 Tc 1.2439 Tw (teristics can affect his or her functioning, either) Tj ET BT 0.934 0 0 0.9835 326.4 382.56 Tm -0.0377 Tc 2.1409 Tw (positively or negatively. According to Lawton:) Tj ET BT 0.9835 0 0 0.9835 347.52 363.6 Tm 0.0418 Tc 2.5099 Tw (The quality of the outcome of a person-) Tj ET BT 0.8491 0 0 0.9835 336.72 352.56 Tm 0.0518 Tc 0.5491 Tw (environment transaction is a function of the degree) Tj 0 -10.9816 TD 0.0296 Tc 0.2573 Tw (of environmental demand or press. . and the compe-) Tj 0 -11.2256 TD 0.046 Tc 0.9329 Tw (tence of the person. When the degree of demand is) Tj ET BT 0.934 0 0 0.9835 336.96 319.92 Tm -0.0417 Tc 1.2458 Tw (matched to the person\222s competence, a positive) Tj ET BT 0.8491 0 0 0.9835 336.96 308.64 Tm 0.0334 Tc 1.4996 Tw (outcome in terms of affective response or adaptive) Tj ET BT 0.8066 0 0 0.9835 336.96 297.6 Tm 0.0718 Tc 0.5509 Tw (behavior is the rule. When press is high in relation to) Tj ET BT 0.8491 0 0 0.9835 336.96 286.8 Tm 0.035 Tc 1.9257 Tw (competence, psychological disturbance in the form) Tj ET BT 0.934 0 0 0.9835 336.96 275.52 Tm -0.0422 Tc 0.5012 Tw (of strain is likely to occur. When press is low in) Tj ET BT 0.8915 0 0 0.9835 336.96 264.96 Tm 0.0433 Tc 1.7461 Tw (relation to competence, sensory deprivation and) Tj ET BT 0.8491 0 0 0.9835 337.2 253.92 Tm 0.0257 Tc 0.806 Tw (atrophy of skills are likely \(243\).) Tj ET BT 0.9835 0 0 0.9835 338.4 234.48 Tm 0.0134 Tc -0.062 Tw (In this theory, the terms ) Tj ET BT 0.9812 0 0 0.9812 453.12 234.48 Tm /F5 11 Tf 0.059 Tc 0.368 Tw (environmental demand) Tj ET BT 0.934 0 0 0.9835 327.6 222.48 Tm /F4 10 Tf 0.0175 Tc 0.0261 Tw (and ) Tj ET BT 0.9443 0 0 0.9812 347.28 222.48 Tm /F5 11 Tf 0.02 Tc 2.0563 Tw (environmental press) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 438.72 222.48 Tm /F4 10 Tf -0.0404 Tc 1.7583 Tw (refer to the motivating or) Tj -118.9704 -11.9577 TD -0.016 Tc 1.2366 Tw (activating quality for a particular individual of the) Tj ET BT 0.9835 0 0 0.9835 326.88 198.72 Tm 0.0307 Tc 2.8001 Tw (physical and other aspects of that individual\222s) Tj ET BT 0.934 0 0 0.9835 327.6 186.24 Tm 0.0004 Tc 0.644 Tw (environment \(242\). The ) Tj ET BT 0.9388 0 0 0.9812 434.4 186.24 Tm /F2 11 Tf -0.0594 Tc 0.1233 Tw (term ) Tj ET BT 0.9443 0 0 0.9812 456.24 186.24 Tm /F5 11 Tf 0.0134 Tc 2.5715 Tw (person-environment fit) Tj ET BT 0.934 0 0 0.9835 327.6 174.48 Tm /F4 10 Tf -0.05 Tc 1.6401 Tw (denotes the degree of congruence between environ-) Tj ET BT 0.8915 0 0 0.9835 327.36 162.72 Tm 0.0399 Tc 0.2885 Tw (mental demand or environmental press and the needs) Tj ET BT 0.9835 0 0 0.9835 327.6 150.24 Tm 0.0209 Tc 1.5899 Tw (and characteristics of an individual. The theory) Tj -0.4881 -11.7137 TD 0.0358 Tc 1.1273 Tw (proposes that person-environment fit can be im-) Tj ET BT 0.934 0 0 0.9835 327.6 126.72 Tm 0.0017 Tc 1.3792 Tw (proved by changing the environment \(218,242\).) Tj ET BT 0.9835 0 0 0.9835 338.4 107.04 Tm 0.0388 Tc -0.0146 Tw (The theory also proposes that the impact of the) Tj -10.9816 -12.2018 TD 0.0275 Tc 1.7051 Tw (environment is greater for individuals with low) Tj -0.244 -12.2018 TD 0.0223 Tc -0.1198 Tw (competence, including individuals with dementia,) Tj ET BT 0.934 0 0 0.9835 327.36 71.28 Tm -0.0419 Tc 1.4173 Tw (than for other people. According to Lawton:) Tj ET BT 0.8491 0 0 0.9835 347.76 52.08 Tm 0.0318 Tc 0.3466 Tw (As individual competence decreases, the environ-) Tj ET BT 0.8066 0 0 0.9835 336.96 41.28 Tm 0.0659 Tc 1.8376 Tw (ment assumes increasing importance in determining) Tj ET BT 0.8491 0 0 0.9835 336.96 30.24 Tm 0.0359 Tc 1.2543 Tw (well-being. One corollary of this hypothesis is that) Tj ET endstream endobj 70 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 71 0 obj <>stream 0.48 w 1 j 0 0 0 RG 55.2 678.96 m 534 678.96 l S BT 0.9835 0 0 0.9835 323.04 684.48 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 2.9817 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 515.52 684.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.24 684.48 Tm /F5 10 Tf 0.488 Tc 0 Tw (19) Tj ET BT 0.934 0 0 0.9835 65.52 646.32 Tm /F4 10 Tf -0.0399 Tc 1.2695 Tw (the low-competent are increasingly sensitive to) Tj 0 -10.9816 TD -0.0341 Tc 2.137 Tw (noxious environments. The opposite and more) Tj 0.257 -11.4697 TD -0.0261 Tc 0.6296 Tw (positive corollary is that a small environmental) Tj ET BT 0.8066 0 0 0.9835 66 613.44 Tm 0.0368 Tc 1.1001 Tw (improvement may produce a disproportionate amount) Tj ET BT 0.8915 0 0 0.9835 66.24 602.4 Tm 0.0463 Tc 1.2043 Tw (of improvement in affect or behavior in the low-) Tj ET BT 0.8491 0 0 0.9835 66.24 591.36 Tm 0.0289 Tc 1.5654 Tw (competent individual \(241\).) Tj ET BT 0.934 0 0 0.9835 67.2 572.88 Tm -0.039 Tc 2.3992 Tw (The concept that appropriate environments will) Tj ET BT 0.9835 0 0 0.9835 56.4 561.12 Tm 0.037 Tc 3.3863 Tw (improve the functioning and quality of life of) Tj ET BT 0.8915 0 0 0.9835 56.64 549.12 Tm 0.0334 Tc 1.802 Tw (individuals with dementia appears frequently in the) Tj ET BT 0.9835 0 0 0.9835 56.88 537.12 Tm 0.0286 Tc 0.8499 Tw (special care unit literature. In the context of the) Tj ET BT 0.934 0 0 0.9835 56.88 525.36 Tm -0.0338 Tc 0.5093 Tw (theory, the term ) Tj ET BT 0.9443 0 0 0.9812 131.52 525.36 Tm /F5 11 Tf 0.012 Tc 0.0314 Tw (environment ) Tj ET BT 0.934 0 0 0.9835 187.2 525.36 Tm /F4 10 Tf -0.0366 Tc 1.2832 Tw (includes all aspects of) Tj ET BT 0.9835 0 0 0.9835 57.12 513.36 Tm 0.0226 Tc 0.9606 Tw (a person\222s surroundings, but the concept is cited) Tj ET BT 0.8915 0 0 0.9835 56.88 501.6 Tm 0.0311 Tc 1.2886 Tw (most often in connection with physical aspects of the) Tj ET BT 0.9835 0 0 0.9835 56.88 489.36 Tm 0.0198 Tc 1.6956 Tw (units. Many articles and books that discuss the) Tj 0.244 -11.9577 TD 0.0381 Tc 1.1148 Tw (design of special care units identify one or more) Tj ET BT 0.934 0 0 0.9835 57.36 466.08 Tm -0.03 Tc 1.4046 Tw (impairments or needs of individuals with dementia) Tj 0.257 -12.2018 TD -0.037 Tc 0.8981 Tw (and propose physical design features to compensate) Tj ET BT 0.9835 0 0 0.9835 57.6 442.08 Tm 0.0345 Tc 0.7829 Tw (for or respond to the impairments or needs. Two) Tj -0.244 -12.2018 TD 0.0315 Tc 0.2979 Tw (books exemplify this approach: ) Tj ET BT 0.9812 0 0 0.9812 203.28 430.08 Tm /F5 11 Tf 0.066 Tc 0.4832 Tw (Designing for De-) Tj -148.4675 -12.2296 TD 0.0687 Tc 0.2358 Tw (mentia: Planning Environments for the Elderly and) Tj 0.2446 -12.2296 TD 0.0821 Tc -0.0225 Tw (Confused \(67\) ) Tj ET BT 0.9835 0 0 0.9835 123.36 406.08 Tm /F4 10 Tf 0.0503 Tc -0.1483 Tw (and ) Tj ET BT 0.9812 0 0 0.9812 143.28 406.08 Tm /F5 11 Tf 0.0496 Tc 0.133 Tw (Holding Onto Home: Designing) Tj -87.3194 -11.7404 TD 0.054 Tc 0.3731 Tw (Environments for People With Dementia \(93\).) Tj ET BT 0.934 0 0 0.9835 69.12 375.84 Tm /F4 10 Tf -0.027 Tc 2.1294 Tw (Physical design features are seen as potentially) Tj -11.82 -12.4458 TD -0.0331 Tc 1.1509 Tw (compensating for or responding to the impairments) Tj ET BT 0.9835 0 0 0.9835 58.32 351.84 Tm 0.0404 Tc 2.3718 Tw (and needs of individuals with dementia in the) Tj ET BT 0.934 0 0 0.9835 58.32 339.84 Tm -0.0278 Tc 2.7726 Tw (following general ways:) Tj 12.3339 -19.0348 TD -0.0013 Tc 1.331 Tw (. by assuring safety and security;) Tj 0 -12.6899 TD -0.0161 Tc 2.182 Tw (. by supporting functional abilities;) Tj T* -0.0096 Tc 1.5969 Tw (. by assisting with way-finding and orientation;) Tj ET BT 0.9835 0 0 0.9835 69.84 284.16 Tm 0.0015 Tc 1.0402 Tw (. by prompting memory;) Tj ET BT 0.934 0 0 0.9835 70.08 271.2 Tm -0.0051 Tc 1.0414 Tw (. by establishing links with the familiar, healthy) Tj ET BT 0.8491 0 0 0.9835 80.64 258.96 Tm 0.2258 Tc 0 Tw (past;) Tj ET BT 0.9835 0 0 0.9835 70.32 246.48 Tm 0.028 Tc 1.9894 Tw (. by conveying expectations and eliciting and) Tj ET BT 0.934 0 0 0.9835 80.64 234.48 Tm -0.0367 Tc 1.7543 Tw (reinforcing appropriate behavior;) Tj ET BT 0.9835 0 0 0.9835 70.56 221.52 Tm 0.0119 Tc 0.3788 Tw (. by reducing agitation;) Tj ET BT 0.9598 0 0 0.9598 70.56 209.04 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 76.8 209.04 Tm /F4 10 Tf 0.0113 Tc 0.5014 Tw (by facilitating privacy;) Tj ET BT 0.934 0 0 0.9835 70.56 196.56 Tm -0.0183 Tc 2.2486 Tw (. by facilitating social interactions;) Tj 0.257 -12.4458 TD -0.0145 Tc 1.2424 Tw (. by stimulating interest and curiosity;) Tj ET BT 0.9835 0 0 0.9835 70.8 171.84 Tm 0.0301 Tc 1.5805 Tw (. by supporting independence, autonomy, and) Tj ET BT 0.934 0 0 0.9835 81.36 159.84 Tm -0.0315 Tc 2.1342 Tw (control; and) Tj ET BT 0.9835 0 0 0.9835 71.04 147.6 Tm 0.0254 Tc 3.2121 Tw (. by facilitating the involvement of families) Tj ET BT 0.934 0 0 0.9835 82.08 136.8 Tm 0.0669 Tc 0 Tw (\(62,67,93,184\).) Tj -12.3339 -18.5467 TD -0.0185 Tc 0.6214 Tw (Many different physical design features are justi-) Tj ET BT 0.9835 0 0 0.9835 59.76 106.56 Tm 0.048 Tc 0.9217 Tw (fied on the basis of the concept that appropriate) Tj 0 -11.9577 TD 0.0233 Tc 2.3683 Tw (environments will improve the functioning and) Tj 0.244 -11.9577 TD 0.0352 Tc -0.133 Tw (quality of life of individuals with dementia. These) Tj 0 -12.2018 TD 0.038 Tc 0.3174 Tw (design features range from the overall shape and) Tj 0.244 -11.9577 TD 0.0497 Tc 1.4496 Tw (floor plan of the unit \(see fig. 1-3\) to the use of) Tj 0 -12.2018 TD 0.0207 Tc -0.0484 Tw (environmental cues, such as color coding of rooms) Tj ET BT 0.934 0 0 0.9835 60.48 35.04 Tm -0.0401 Tc 1.5653 Tw (and corridors to help residents find their way, and) Tj 263.6364 620.8267 TD -0.0334 Tc 0.6373 Tw (personal markers, such as residents\222 pictures placed) Tj 0.5139 -12.2018 TD -0.0367 Tc 0.7587 Tw (near their rooms to help them identify the rooms.) Tj 11.82 -18.3027 TD -0.0367 Tc 0.9284 Tw (Physical design features are often referred in the) Tj ET BT 0.8915 0 0 0.9835 307.92 603.36 Tm 0.0565 Tc 0.3315 Tw (special care unit literature as ) Tj ET BT 0.9014 0 0 0.9812 435.84 603.36 Tm /F5 11 Tf -0.0358 Tc -0.0492 Tw (prosthetic ) Tj ET BT 0.8915 0 0 0.9835 479.52 603.36 Tm /F4 10 Tf 0.0576 Tc 1.1916 Tw (because they) Tj ET BT 0.9835 0 0 0.9835 307.92 591.36 Tm 0.0284 Tc 0.1181 Tw (are intended to compensate for, rather than cure,) Tj ET BT 0.934 0 0 0.9835 307.68 579.36 Tm -0.0155 Tc 1.3891 Tw (impairments that are believed to be unchangeable.) Tj ET BT 0.9835 0 0 0.9835 307.92 567.84 Tm 0.0179 Tc 2.8131 Tw (Since the impairments are unchangeable, it is) Tj 0.244 -12.4458 TD 0.044 Tc 1.9324 Tw (assumed the prosthetic features will be needed) Tj ET BT 0.8915 0 0 0.9835 307.68 543.84 Tm 0.0304 Tc 2.3527 Tw (permanently. Physical design features that compen-) Tj ET BT 0.934 0 0 0.9835 308.4 531.84 Tm -0.026 Tc 1.518 Tw (sate for functional impairments are said to be cost) Tj ET BT 0.9835 0 0 0.9835 308.16 519.84 Tm 0.0378 Tc 0.3525 Tw (effective because the design features act continu-) Tj 0.244 -12.2018 TD 0.0259 Tc 2.6654 Tw (ously and may substitute for more costly staff) Tj ET BT 0.934 0 0 0.9835 308.4 496.08 Tm 0.0074 Tc 2.0926 Tw (interventions \(185,243\).) Tj ET BT 0.9835 0 0 0.9835 319.68 478.08 Tm 0.022 Tc 0.8972 Tw (Sometimes very strong claims are made about) Tj ET BT 0.934 0 0 0.9835 308.4 466.32 Tm -0.0332 Tc 1.9219 Tw (particular physical design features for special care) Tj 0.257 -12.2018 TD -0.0461 Tc 1.6931 Tw (units, as if there were proof of the effectiveness or) Tj ET BT 0.9835 0 0 0.9835 308.88 442.56 Tm 0.0319 Tc 2.2294 Tw (lack of effectiveness of the features. Numerous) Tj ET BT 0.934 0 0 0.9835 309.12 430.56 Tm -0.0308 Tc 1.069 Tw (articles state with certainty, for example, that floor) Tj -0.257 -12.2018 TD -0.0339 Tc 0.4987 Tw (patterns with dark areas or dark borders should not) Tj ET BT 0.9835 0 0 0.9835 308.88 406.56 Tm 0.0332 Tc 0.7058 Tw (be used in special care units because individuals) Tj ET BT 0.934 0 0 0.9835 309.36 395.04 Tm -0.0387 Tc 0.8572 Tw (with dementia will perceive the dark areas as holes) Tj ET BT 0.8915 0 0 0.9835 309.6 382.8 Tm 0.0423 Tc 0.964 Tw (and be afraid to walk on or over them. Likewise it is) Tj ET BT 0.934 0 0 0.9835 309.6 370.56 Tm -0.0321 Tc 0.6895 Tw (often said that certain types of art work, wallpaper,) Tj 0 -12.2018 TD -0.0181 Tc 1.2206 Tw (and carpet patterns cause delusions and hallucina-) Tj 0 -12.4458 TD -0.0268 Tc 1.4317 Tw (tions in nursing home residents with dementia. To) Tj ET BT 0.9835 0 0 0.9835 309.84 334.56 Tm 0.0333 Tc 0.2757 Tw (OTA\222s knowledge, there is no research-based evi-) Tj ET BT 0.934 0 0 0.9835 309.84 322.8 Tm -0.038 Tc 1.1134 Tw (dence for these claims.) Tj ET BT 0.8915 0 0 0.9835 321.12 304.8 Tm 0.0431 Tc 0.849 Tw (OTA has heard particular physical design features) Tj ET BT 0.9835 0 0 0.9835 309.12 292.8 Tm 0.0206 Tc 3.634 Tw (justified on the basis of claims, such as that) Tj 0.9761 -11.9577 TD 0.0191 Tc 2.1204 Tw (individuals with dementia may mistake a light) Tj ET BT 0.934 0 0 0.9835 309.84 269.04 Tm -0.0182 Tc 0.4754 Tw (reflected from a shiny floor as a blob that is chasing) Tj 0.5139 -12.4458 TD -0.027 Tc 0.4735 Tw (them, that they feel threatened by the person in the) Tj 0 -12.2018 TD -0.0459 Tc 1.2181 Tw (mirror who does not respond to their greeting, that) Tj 0 -12.4458 TD -0.037 Tc 1.7731 Tw (they sometimes mistake their shadows for pools of) Tj 0.257 -12.4458 TD -0.0264 Tc 0.3534 Tw (water and try to jump over, that they try to pick the) Tj 0 -11.9577 TD -0.0415 Tc 1.8879 Tw (flowers in floral-print wallpaper, etc. One suspects) Tj ET BT 0.8915 0 0 0.9835 310.8 196.32 Tm 0.0325 Tc 1.066 Tw (that these claims arise from anecdotes about individ-) Tj ET BT 0.934 0 0 0.9835 310.56 184.56 Tm -0.0343 Tc 0.7056 Tw (ual residents or someone\222s guess about the response) Tj 0.5139 -12.2018 TD -0.0277 Tc 1.3593 Tw (of individuals with dementia to a particular design) Tj ET BT 0.8915 0 0 0.9835 311.04 161.04 Tm 0.0331 Tc 1.3873 Tw (feature and that the anecdotes and guesses are then) Tj 0 -12.4458 TD 0.0362 Tc 1.7541 Tw (generalized to all residents with dementia.) Tj 12.1137 -17.8146 TD 0.0432 Tc 0.3404 Tw (In reality, very little research has been done to test) Tj ET BT 0.934 0 0 0.9835 311.04 119.76 Tm -0.0264 Tc 0.844 Tw (the impact of particular physical design features on) Tj ET BT 0.9835 0 0 0.9835 311.04 108 Tm 0.0276 Tc 0.4117 Tw (individuals with dementia. Moreover, the conclu-) Tj ET BT 0.8915 0 0 0.9835 311.76 95.76 Tm 0.0346 Tc 1.2847 Tw (sions of several of the existing studies are contradic-) Tj ET BT 0.934 0 0 0.9835 311.28 84.24 Tm -0.0397 Tc 0.8582 Tw (tory. Some of these studies are described in chapter) Tj -0.257 -11.9577 TD -0.0183 Tc 2.1201 Tw (4. Unfortunately, some nursing homes incorporate) Tj 0 -12.2018 TD -0.0259 Tc 0.5865 Tw (physical design features for which strong claims are) Tj ET BT 0.9835 0 0 0.9835 311.28 48.72 Tm 0.0434 Tc 1.567 Tw (made and believe they have thereby created an) Tj 0.4881 -12.4458 TD 0.0337 Tc 0.5519 Tw (appropriate environment for their residents with) Tj ET endstream endobj 72 0 obj <>/Rotate 0/Type/Page>> endobj 73 0 obj <> endobj 74 0 obj [75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R 91 0 R 92 0 R 93 0 R 94 0 R] endobj 75 0 obj <>stream q 180 0 0 -20.16 72.24 537.36 cm /im14 Do endstream endobj 76 0 obj <>stream Q q 234.72 0 0 -76.08 72.48 517.2 cm /im15 Do endstream endobj 77 0 obj <>stream Q q 198.72 0 0 -5.76 108.72 441.12 cm /im16 Do endstream endobj 78 0 obj <>stream Q q 214.56 0 0 -55.92 92.88 435.12 cm /im17 Do endstream endobj 79 0 obj <>stream Q q 187.2 0 0 -11.52 120.24 378.96 cm /im18 Do endstream endobj 80 0 obj <>stream Q q 148.32 0 0 -8.64 159.12 367.44 cm /im19 Do endstream endobj 81 0 obj <>stream Q q 224.64 0 0 -10.08 82.8 358.8 cm /im20 Do endstream endobj 82 0 obj <>stream Q q 47.52 0 0 -11.52 72.96 378.96 cm BI /W 264 /H 64 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  EI Q q 86.4 0 0 -8.64 72.96 367.44 cm BI /W 480 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|?|><x?p~~8x|><xxp>>8||>>|x>><||>>|~?|>>|x EI Q q 27.36 0 0 -31.68 70.56 232.08 cm BI /W 152 /H 176 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>><<<<<<<<<<<>>>><>>>>>>>>>>>>>>>>>>>>>>>>>>??88  EI Q q 14.4 0 0 -24.48 59.28 200.16 cm BI /W 80 /H 136 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x||xxx||||||xxx||||x|||||||||||xxx|||||||||||||||<<<||<<<|<<<<<<<<<<<>>>><<<<<<<<<<<<<<<<<<<>> EI Q q 172.8 0 0 -24.48 137.04 200.64 cm /im21 Do endstream endobj 83 0 obj <>stream Q q 250.56 0 0 -46.08 59.28 175.68 cm /im22 Do endstream endobj 84 0 obj <>stream Q q 10.08 0 0 -298.08 682.8 539.76 cm /im23 Do endstream endobj 85 0 obj <>stream Q q 11.52 0 0 -14.4 681.36 241.68 cm BI /W 64 /H 80 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>?8x<<?0>p  `p0?p EI Q q 6.48 0 0 -12.96 74.88 530.4 cm BI /W 37 /H 74 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??<0><x<x>|xxxxxxxxxxxxxxx88xxxxxxxxxxxxxxxxx||? 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EI Q 0.72 w 1 j 0 0 0 RG 678.72 534.48 m 678.72 56.4 l S 0.96 w 77.04 529.92 m 247.68 529.92 l S 0.72 w 262.32 494.4 m 262.32 445.92 l S 69.12 491.76 m 69.12 376.32 l S 263.04 490.8 m 307.2 490.8 l S 312.48 490.56 m 312.48 382.08 l S 209.28 445.44 m 307.44 445.44 l S 268.8 438.72 m 307.44 438.72 l S 261.84 435.84 m 261.84 382.8 l S 262.08 382.56 m 307.68 382.56 l S 132 351.6 m 153.84 351.6 l S 191.04 351.36 m 221.76 351.36 l S 0.96 w 154.08 271.92 m 172.08 271.92 l S 0.72 w 253.44 271.68 m 272.16 271.68 l S 0.48 w 162.72 271.2 m 162.72 234.48 l S 228.96 270.96 m 228.96 234.24 l S 0.24 w 261.6 270.96 m 261.6 234.48 l S 0.72 w 97.92 264 m 117.6 264 l S 133.2 264 m 154.08 264 l S 0.48 w 106.56 263.28 m 106.56 234.48 l S 0.72 w 271.44 263.76 m 299.52 263.76 l S 0.48 w 142.08 263.28 m 142.08 234.48 l S 211.68 263.28 m 211.68 234.24 l S 0.24 w 245.28 263.28 m 245.28 234.48 l S 0.48 w 277.92 263.28 m 277.92 243.84 l S 0.72 w 74.16 253.92 m 97.44 253.92 l S 73.2 253.44 m 73.2 232.8 l S 0.48 w 88.56 252.96 m 88.56 234.48 l S 0.72 w 308.4 252 m 308.4 233.04 l S 73.68 234 m 98.64 234 l S 108 234 m 154.08 234 l S 308.16 176.88 m 308.16 151.68 l S 0.24 w 228 171.6 m 228 132.72 l S 0.48 w 210.96 171.36 m 210.96 140.4 l S 244.56 171.6 m 244.56 140.16 l S 0.72 w 260.88 171.12 m 260.88 133.2 l S 64.08 162.24 m 105.12 162.24 l S 0.48 w 277.2 161.76 m 277.2 140.16 l S 0.96 w 270.24 139.68 m 298.8 139.68 l S 0.72 w 251.52 132 m 270.72 132 l S BT 0.9189 0 0 0.99 62.4 332.4 Tm 0 0 0 rg /F3 8 Tf 0.0361 Tc 0.0878 Tw (John Douglas French Center, Los Angeles, CA) Tj ET BT 0.8108 0 0 0.99 62.16 317.28 Tm 0.0852 Tc 1.1156 Tw (The building is structured in a \223butterfly\224 shape with 4 units maintaining) Tj ET BT 0.8648 0 0 0.99 62.4 307.44 Tm 0.03 Tc 0.6832 Tw (rooms for \223families\224 of 12-13 residents located around a shared nurses\222) Tj -0.555 -9.6973 TD 0.0389 Tc 0.8344 Tw (station. Each family unit includes a mix of private and semi-private rooms.) Tj 0 -10.1821 TD 0.0198 Tc 1.0438 Tw (There is direct access to a secure courtyard.) Tj ET q 1.92 0 0 -11.52 96.48 264.72 cm BI /W 11 /H 63 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~><<<<<<<<<<<<<<<<<<<>><<>>>>>>>>>>>>>>>>>>>>>>??????? 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The open plan of the 40-bed unit allows staff easy visual) Tj 0 -10.1821 TD 0.0357 Tc 0.8381 Tw (access to all residents and provides a continuous path for wanderers. The) Tj 0 -9.9397 TD 0.04 Tc 1.3377 Tw (unit has a therapeutic kitchen for residents.) Tj ET BT 0.9863 0 0 0.9863 351.6 530.4 Tm /F3 9 Tf 0.0417 Tc 0.4287 Tw (Figure 1-3\227Alternate Shapes and Floor Plans for Special Care Units) Tj ET BT 0.8648 0 0 0.99 371.04 355.44 Tm /F3 8 Tf 0.0268 Tc 1.8154 Tw (Corinne DoIan Alzheimer\222s Center, Heather Hill, Chardon,OH) Tj -0.2775 -15.7581 TD 0.0448 Tc 0.3987 Tw (The building is comprised of 2 triangular units with a shared support) Tj 0.2775 -9.9397 TD 0.074 Tc -0.0892 Tw (and bathing ) Tj ET BT 0.8491 0 0 0.9835 412.8 330 Tm /F4 10 Tf 0.0841 Tc 0.0871 Tw (core. The ) Tj ET BT 0.8648 0 0 0.99 452.4 330 Tm /F3 8 Tf 0.0399 Tc 0.1353 Tw (open plan of each 12-bed unit allows staff easy visual) Tj -94.3537 -9.2124 TD 0.0318 Tc 1.1202 Tw (access to all residents, and provides a continuous path for wanderers. Each) Tj 0 -9.9397 TD 0.0339 Tc 0.9285 Tw (unit has a fully equipped residential-style kitchen. There is direct access to a) Tj 0 -9.4548 TD 0.0271 Tc 0.9363 Tw (secure courtyard, as well as to several paved paths beyond the yard for) Tj T* 0.0272 Tc 0.5199 Tw (residents and visitors.) Tj ET q 33.12 0 0 -26.64 486.96 280.56 cm BI /W 185 /H 149 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxxxxxxxxxxxxxxxxxx||xxxxxxxxxx|xxx|x|||||||xxx|||||||||||<<|||<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<>>>>??8???????py?????????>>>>@ EI Q BT 1.0585 0 0 0.9963 486.96 253.92 Tm 3 Tr /F3 51 Tf 0.0886 Tc 0 Tw (n) Tj 0 Tr ET BT 0.8648 0 0 0.99 370.08 103.44 Tm /F3 8 Tf 0.039 Tc 1.4776 Tw (Friendship House, West Bend, IN) Tj -1.11 -15.2732 TD 0.0391 Tc 0.6449 Tw (The building is comprised of 2 units with 4 \223households\224 each. A nurses\222) Tj 0.2775 -10.1821 TD 0.0363 Tc 0.7638 Tw (station, elevator and services are located at the center of each unit of) Tj -0.2775 -9.9397 TD 0.0516 Tc 0.6935 Tw (4 households. A protected outdoor courtyard is defined by the two units.) Tj ET BT 0.9262 0 0 0.9939 60 49.2 Tm /F3 7 Tf 0.0517 Tc 0.0706 Tw (SOURCE: ) Tj ET q 12.72 0 0 -5.28 92.64 54.48 cm BI /W 75 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??|?x???? 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the) Tj ET BT 0.9835 0 0 0.9835 57.12 633.84 Tm 0.0388 Tc 1.6124 Tw (specifc features are effective. 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Tj ET BT 0.9835 0 0 0.9835 68.88 528.24 Tm 0.0414 Tc 1.0809 Tw (As noted earlier, the concept that appropriate) Tj -10.9816 -11.9577 TD 0.0233 Tc 2.3683 Tw (environments will improve the functioning and) Tj ET BT 0.934 0 0 0.9835 58.08 504.72 Tm -0.0318 Tc 1.5243 Tw (quality of life of individuals with dementia is cited) Tj ET BT 0.9835 0 0 0.9835 58.08 492.96 Tm 0.0272 Tc 3.3324 Tw (most often in connection with physical design) Tj 0.244 -12.2018 TD 0.0239 Tc -0.1215 Tw (features for special care units, but it is sometimes) Tj ET BT 0.934 0 0 0.9835 58.8 469.2 Tm -0.0368 Tc 0.8551 Tw (also cited in connection with other unit characteris-) Tj ET BT 0.9835 0 0 0.9835 58.8 456.96 Tm 0.0108 Tc 0.5194 Tw (tics, such as activity programs and daily routine.) 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Tj ET BT 0.9557 0 0 1.08 263.52 299.76 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (8 ) Tj ET BT 0.934 0 0 0.9835 266.88 294.96 Tm /F4 10 Tf 0.1888 Tc 0 Tw (This) Tj ET BT 0.8915 0 0 0.9835 60 282.72 Tm 0.0326 Tc 1.4888 Tw (model was demonstrated for several years at Wesley) Tj ET BT 0.9835 0 0 0.9835 60.24 270.48 Tm 0.0177 Tc -0.0338 Tw (Hall, a special care unit in a retirement facility in) Tj ET BT 0.934 0 0 0.9835 60.48 258.72 Tm -0.0013 Tc 1.331 Tw (Chelsea, MI.) Tj ET BT 0.9835 0 0 0.9835 71.28 239.04 Tm 0.0491 Tc 0.9918 Tw (A different model of care, referred to as a low) Tj ET BT 0.9812 0 0 0.9812 60.48 227.28 Tm /F5 11 Tf 0.0886 Tc -0.029 Tw (stimulus unit, ) Tj ET BT 0.9835 0 0 0.9835 122.88 227.28 Tm /F4 10 Tf 0.0528 Tc 0.1339 Tw (has been developed by Hall and her) Tj -63.2052 -12.4458 TD 0.0356 Tc 1.0868 Tw (colleagues \(170,171\). 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Addressing the) Tj 0 -11.9577 TD 0.0341 Tc -0.0098 Tw (needs of the families and involving them in the) Tj 0.244 -12.2018 TD 0.0323 Tc 1.2366 Tw (individuals\222 care will benefit both the) Tj 0 -11.7137 TD 0.0278 Tc 0.5253 Tw (individuals and the families.) Tj ET BT 0.934 0 0 0.9835 323.28 161.76 Tm -0.0279 Tc 2.1304 Tw (Families of individuals with dementia are often) Tj -11.563 -12.4458 TD -0.031 Tc 1.4484 Tw (said to be the second victim of the dementia. They) Tj 0 -12.2018 TD -0.0413 Tc 0.8599 Tw (are generally perceived by experts in dementia care) Tj 0.257 -11.9577 TD -0.025 Tc 0.7911 Tw (as part of the client unit. As a result, meeting their) Tj -0.257 -12.4458 TD -0.0386 Tc 1.9277 Tw (needs becomes a legitimate objective of specialized) Tj ET BT 0.8915 0 0 0.9835 312.48 102 Tm 0.0478 Tc 1.7409 Tw (dementia care.) 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EI Q BT 0.6793 0 0 0.9835 78.96 36.48 Tm 3 Tr -0.0595 Tc 0 Tw (me) Tj 0 Tr ET BT 0.7642 0 0 0.9835 89.04 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 20.16 0 0 -6.48 90.96 41.28 cm BI /W 139 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~~?>>?~??~~|?|~|??|||~?||~?x~?||>?|x>||>||>|~???|>??|<  EI Q BT 0.5519 0 0 0.9835 90.96 36.48 Tm 3 Tr 0.0521 Tc 0 Tw (Con=pt) Tj 0 Tr ET BT 0.7642 0 0 0.9835 111.12 36.48 Tm 0.0723 Tc -0.0497 Tw ( of ) Tj ET q 29.04 0 0 -7.2 122.16 42.24 cm BI /W 201 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??888~~?<| a?>0||~??|~>|?~>|?>>||>>|~?>~|>>||>|?>|?||?~|~߁?|?~???|???>??~>>8 ? @|?|?x EI Q BT 0.5094 0 0 0.9835 122.16 36.48 Tm 3 Tr -0.0117 Tc 0 Tw (therapeutic) Tj 0 Tr ET BT 0.7642 0 0 0.9835 151.2 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 15.6 0 0 -5.52 153.12 42.24 cm BI /W 109 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @88>~~>|>|||>?~||>>>>>?>>?>>?|||~|~>~??|????|?x?|8|~>>?? EI Q BT 0.5094 0 0 0.9835 153.12 36.48 Tm 3 Tr 0.0836 Tc 0 Tw (m-lieu) Tj 0 Tr ET BT 0.7642 0 0 0.9835 168.72 36.48 Tm 0.0782 Tc -0.0575 Tw ( was ) Tj ET q 10.32 0 0 -5.76 187.2 42.24 cm BI /W 71 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID g?? ????@ EI Q BT 0.5519 0 0 0.9835 187.2 36.48 Tm 3 Tr 0.0857 Tc 0 Tw (f~st) Tj 0 Tr ET BT 0.7642 0 0 0.9835 197.52 36.48 Tm -0.0359 Tc 1.1038 Tw ( used in the treatment of mentally ill persons ) Tj ET q 4.8 0 0 -5.28 366.72 42.72 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~~~?~?~~?~~~?~?>?~~?a??? EI Q BT 0.5094 0 0 0.9835 366.72 36.48 Tm 3 Tr 0.0781 Tc 0 Tw (in) Tj 0 Tr ET BT 0.7642 0 0 0.9835 371.52 36.48 Tm -0.0352 Tc 0.719 Tw ( psychiatric ) Tj ET q 22.56 0 0 -6.96 416.4 41.76 cm BI /W 157 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |||~8?~|~|||||||||?|||0|`|pp~??????????? EI Q BT 0.5944 0 0 0.9835 416.4 36.48 Tm 3 Tr -0.0481 Tc 0 Tw (hospitis) Tj 0 Tr ET BT 0.7642 0 0 0.9835 438.96 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 15.12 0 0 -6.72 440.88 41.76 cm BI /W 104 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8|>?????>>>>~|@||||||||~~>>?>????><x8 EI Q BT 0.5519 0 0 0.9835 440.88 36.48 Tm 3 Tr 0.065 Tc 0 Tw (\(215\).) Tj 0 Tr ET endstream endobj 116 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 117 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.72 684.72 m 551.52 684.72 l S BT 0.9835 0 0 0.9835 72.72 691.2 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (22 ) Tj ET BT 0.9598 0 0 0.9598 85.2 691.2 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 91.44 691.2 Tm /F5 10 Tf 0.0065 Tc 0.0544 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 145.44 691.2 Tm /F5 11 Tf 0.0745 Tc 0.0465 Tw (Units for People with ) Tj ET BT 0.9835 0 0 0.9835 242.88 691.2 Tm /F5 10 Tf 0.0229 Tc 0.4038 Tw (Alzheimer\222s and Other Dementias) Tj -172.2892 -40.754 TD /F4 10 Tf 0.0332 Tc 2.6999 Tw (who often cannot provide accurate information) Tj 0 -12.4458 TD 0.028 Tc 1.6233 Tw (about themselves. As Hegeman and Tobin have) Tj 0 -11.9577 TD 0.0314 Tc 1.2306 Tw (noted, families can \221\221help to preserve the unique) Tj 0.244 -12.4458 TD 0.0463 Tc 1.6555 Tw (identity of residents and help the staff and the) Tj -0.244 -12.2018 TD 0.0504 Tc -0.0264 Tw (resident be ) Tj ET BT 0.9863 0 0 0.9863 127.44 602.88 Tm /F3 9 Tf 0.0534 Tc -0.1239 Tw (aware ) Tj ET BT 0.9835 0 0 0.9835 155.52 602.88 Tm /F4 10 Tf 0.0287 Tc 0.2398 Tw (of that identity\224 \(178\). Families) Tj -82.9721 -12.2018 TD 0.029 Tc 2.4601 Tw (can also provide physical assistance, emotional) Tj ET BT 0.8915 0 0 0.9835 74.16 578.64 Tm 0.037 Tc 1.0994 Tw (support, and advocacy. Their presence helps to make) Tj ET BT 0.9835 0 0 0.9835 74.16 566.88 Tm 0.0271 Tc 1.3396 Tw (any setting more home-like and familiar for the) Tj ET BT 0.934 0 0 0.9835 73.68 555.36 Tm 0.031 Tc 4.123 Tw (resident \(174,296,358,418\).) Tj ET BT 0.9835 0 0 0.9835 84.96 537.6 Tm 0.0391 Tc 0.6649 Tw (Meeting the needs of families of nursing home) Tj ET BT 0.8915 0 0 0.9835 74.16 525.6 Tm 0.0261 Tc 1.8102 Tw (residents with dementia means providing them with) Tj ET BT 0.9835 0 0 0.9835 74.4 513.6 Tm 0.0267 Tc 0.1197 Tw (information, emotional support, and ) Tj ET BT 0.99 0 0 0.99 243.6 513.6 Tm /F3 8 Tf -0.0327 Tc 0.233 Tw (a structure that) Tj ET BT 0.934 0 0 0.9835 74.4 502.08 Tm /F4 10 Tf -0.0329 Tc 1.8788 Tw (facilitates their involvement in the residents\222 care.) Tj 0.257 -12.2018 TD -0.0491 Tc 2.1531 Tw (Families are perceived) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 180 490.08 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.934 0 0 0.9835 189.36 490.08 Tm /F4 10 Tf -0.0215 Tc 3.1514 Tw (benefit from information) Tj -122.5678 -12.2018 TD -0.0042 Tc 1.0772 Tw (about dementia and ways of communicating with a) Tj ET BT 0.9835 0 0 0.9835 74.4 466.32 Tm 0.0319 Tc 2.2062 Tw (person with dementia, as well as from support) Tj 0.4881 -12.4458 TD 0.0268 Tc 0.7297 Tw (groups, counseling, and other forms of emotional) Tj ET BT 0.934 0 0 0.9835 75.12 442.08 Tm 0.0488 Tc -0.0074 Tw (support \(55,128,168,296,358,41 8,5 16\).) Tj ET BT 0.9835 0 0 0.9835 85.92 424.56 Tm 0.0324 Tc 0.602 Tw (To facilitate the involvement of families in the) Tj -11.2256 -12.4458 TD 0.03 Tc 1.4281 Tw (residents\222 care, it is necessary to provide both a) Tj ET BT 0.8915 0 0 0.9835 75.36 400.32 Tm 0.0416 Tc 1.748 Tw (welcoming atmosphere and administrative and care-) Tj ET BT 0.9835 0 0 0.9835 75.6 388.56 Tm 0.0126 Tc 0.2561 Tw (giving practices ) Tj ET BT 0.99 0 0 0.99 151.2 388.56 Tm /F3 8 Tf -0.0302 Tc -0.012 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 168 388.56 Tm /F4 10 Tf 0.0308 Tc 0.7664 Tw (recognize the families\222 legiti-) Tj -94.1978 -11.9577 TD 0.0206 Tc 1.1021 Tw (mate role in the residents\222 care. Families can be) Tj ET BT 0.934 0 0 0.9835 75.6 364.8 Tm -0.0361 Tc 1.2655 Tw (involved, for example, in care pl) Tj ET BT 0.8915 0 0 0.9835 218.64 364.56 Tm 0.0739 Tc 3.5961 Tw (anning conferences) Tj ET BT 0.9835 0 0 0.9835 75.6 353.04 Tm 0.0283 Tc 0.3622 Tw (and other situations in which decisions are being) Tj 0 -12.2018 TD 0.0267 Tc 0.2723 Tw (made about the residents\222 care. They may also be) Tj ET BT 0.934 0 0 0.9835 75.6 329.04 Tm -0.0144 Tc 1.2808 Tw (encouraged to act as volunteers on the unit \(46,55,) Tj 1.5417 -12.2018 TD 0.0744 Tc 0 Tw (125,168,174,418\).) Tj ET BT 0.8915 0 0 0.9835 86.88 299.04 Tm 0.0298 Tc 2.2458 Tw (By providing information, emotional support, and) Tj ET BT 0.934 0 0 0.9835 76.08 286.56 Tm -0.018 Tc 0.7983 Tw (a structure that facilitates the involvement of fami-) Tj ET BT 0.9835 0 0 0.9835 76.08 274.32 Tm 0.04 Tc 0.757 Tw (lies, it may be possible to lessen their feelings of) Tj 0.244 -12.2018 TD 0.0456 Tc 0.375 Tw (anxiety and guilt and avoid the development of a) Tj ET BT 0.934 0 0 0.9835 76.32 250.32 Tm -0.0419 Tc 1.1689 Tw (competitive or adversarial relationship between the) Tj 0.257 -12.2018 TD -0.0186 Tc 0.6521 Tw (staff and the families. Families differ, however, and) Tj -0.257 -11.9577 TD -0.0275 Tc 0.992 Tw (the best ways of providing information and support) Tj 0 -12.2018 TD 0.0063 Tc 1.9909 Tw (and involving families also differ \(128,168,358\).) Tj ET BT 0.9835 0 0 0.9835 76.56 190.56 Tm 0.0307 Tc 1.2871 Tw (Implications for Staff Composition and Training) Tj ET BT 0.934 0 0 0.9835 87.36 172.56 Tm -0.0289 Tc 1.0179 Tw (The six concepts discussed above have important) Tj ET BT 0.8915 0 0 0.9835 76.56 160.32 Tm 0.022 Tc 1.6803 Tw (implications for staff composition and training. With) Tj ET BT 0.9835 0 0 0.9835 76.32 148.32 Tm 0.035 Tc 0.1113 Tw (respect to staff composition, the concepts indicate) Tj ET BT 0.8915 0 0 0.9835 76.8 136.08 Tm 0.0471 Tc 1.1361 Tw (the need for a multidisciplinary approach to care. To) Tj ET BT 0.9835 0 0 0.9835 77.04 124.56 Tm 0.0302 Tc 0.4299 Tw (identify and change the factors that cause excess) Tj -0.244 -12.2018 TD 0.0312 Tc 0.1559 Tw (disability requires the involvement of health care) Tj ET BT 0.8915 0 0 0.9835 76.32 100.8 Tm 0.0376 Tc 2.0665 Tw (professionals capable of diagnosing and treating the) Tj ET BT 0.9835 0 0 0.9835 76.8 89.04 Tm 0.0178 Tc 0.1985 Tw (causes of excess disability, e.g., acute and chronic) Tj 0 -12.2018 TD 0.032 Tc 0.6024 Tw (illnesses, depression,) Tj 107.1316 0 TD 0.0137 Tc 1.1091 Tw (and sensory impairments.) Tj ET BT 0.934 0 0 0.9835 76.56 65.28 Tm -0.034 Tc 0.6685 Tw (Likewise, to provide activity programs that build on) Tj ET BT 0.9835 0 0 0.9835 76.32 53.76 Tm 0.0227 Tc 1.8321 Tw (residents\222 residual strengths, support functional) Tj ET BT 0.934 0 0 0.9835 76.8 41.76 Tm -0.0294 Tc 2.3889 Tw (abilities, and facilitate social interactions requires) Tj ET BT 0.9835 0 0 0.9835 324.72 651.12 Tm 0.034 Tc 0.4609 Tw (the involvement of individuals who are skilled in) Tj ET BT 0.934 0 0 0.9835 324.48 639.12 Tm -0.0352 Tc 1.2388 Tw (various therapeutic recreation specialties. Although) Tj ET BT 0.8915 0 0 0.9835 324.96 626.88 Tm 0.0383 Tc 1.9311 Tw (these health care professionals and other therapists) Tj ET BT 0.9835 0 0 0.9835 324.96 614.64 Tm 0.0408 Tc 2.4916 Tw (do not necessarily have to be part of the unit) Tj 0.4881 -12.4458 TD 0.0369 Tc 1.0313 Tw (staff-and to make them part of the staff may be) Tj -0.7321 -11.7137 TD 0.0359 Tc 1.3305 Tw (prohibitively expensive-some means of involving) Tj ET BT 0.934 0 0 0.9835 325.2 578.64 Tm -0.0336 Tc 1.5262 Tw (them in the residents\222 ongoing care is essential for) Tj 0.257 -12.2018 TD -0.0403 Tc 1.9509 Tw (effective implementation of the concepts.) Tj ET BT 0.8915 0 0 0.9835 336.24 549.12 Tm 0.0094 Tc 0.9092 Tw (With respect to staff trainin) Tj 133.5204 0 TD 0.051 Tc 0.9298 Tw (g, the concepts require) Tj ET BT 0.9835 0 0 0.9835 325.68 537.12 Tm 0.0325 Tc 2.6762 Tw (a change for all staff members in widely held) Tj -0.244 -11.9577 TD 0.0226 Tc 0.612 Tw (nihilistic attitudes about nursing home residents) Tj ET BT 0.8915 0 0 0.9835 325.92 513.12 Tm 0.0242 Tc 1.1282 Tw (with dementia. In addition, since the concepts do not) Tj ET BT 0.9835 0 0 0.9835 325.44 501.6 Tm 0.0292 Tc 1.012 Tw (provide precise formulas for care, staff members) Tj ET BT 0.934 0 0 0.9835 325.68 489.6 Tm -0.0219 Tc 1.4815 Tw (must not only understand the concepts but also be) Tj ET BT 0.9835 0 0 0.9835 326.16 477.84 Tm 0.0313 Tc 2.1719 Tw (able to interpret and apply them in caregiving) Tj ET BT 0.934 0 0 0.9835 326.16 465.84 Tm -0.0104 Tc 0.7947 Tw (situations. In most special care units, as in nursing) Tj ET BT 0.9835 0 0 0.9835 326.16 453.84 Tm 0.0354 Tc 0.4595 Tw (homes generally, nurse aides provide most of the) Tj ET BT 0.8915 0 0 0.9835 326.16 441.84 Tm 0.0411 Tc 1.0007 Tw (daily care. These aides must be able to interpret and) Tj ET BT 0.9835 0 0 0.9835 326.64 429.84 Tm 0.0307 Tc 1.043 Tw (apply the concepts\227sometimes in difficult, emo-) Tj ET BT 0.8915 0 0 0.9835 326.4 417.6 Tm 0.0411 Tc 1.5242 Tw (tionally-charged situations. To do so requires knowl-) Tj ET BT 0.934 0 0 0.9835 326.64 405.6 Tm -0.0201 Tc 1.3511 Tw (edge, problem-solving skills, and judgment. Special) Tj ET BT 0.9835 0 0 0.9835 326.64 393.84 Tm 0.0359 Tc 1.3305 Tw (care units that adopt the concept of therapeutic) Tj ET BT 0.8491 0 0 0.9835 326.4 382.08 Tm 0.0416 Tc 1.8802 Tw (milieu often regard housekeepers and other nonprofes-) Tj ET BT 0.8915 0 0 0.9835 327.12 370.08 Tm 0.0306 Tc 1.1023 Tw (sional staff members as part of the care team. These) Tj ET BT 0.934 0 0 0.9835 326.88 358.56 Tm -0.0219 Tc 1.3959 Tw (individuals also must understand the concepts and) Tj 0 -12.4458 TD -0.0166 Tc 0.6408 Tw (be able to apply them.) Tj ET BT 0.9835 0 0 0.9835 326.88 328.56 Tm 0.04 Tc 1.2776 Tw (Implications for the Individualization of Care) Tj 11.2256 -18.3027 TD 0.0329 Tc 0.0088 Tw (Three of the six concepts clearly emphasize the) Tj -10.9816 -12.6899 TD 0.0319 Tc 1.7413 Tw (individualization of care. They require the staff) Tj ET BT 0.934 0 0 0.9835 327.12 286.08 Tm -0.0124 Tc 0.8611 Tw (members to: 1\) identify and change the factors that) Tj ET BT 0.9835 0 0 0.9835 327.12 273.84 Tm 0.0296 Tc 0.5235 Tw (cause excess disability in individual residents; 2\)) Tj 0.244 -12.2018 TD 0.0371 Tc 2.4101 Tw (identify and build on the residual strengths of) Tj ET BT 0.934 0 0 0.9835 327.36 250.08 Tm -0.0305 Tc 0.9585 Tw (individual residents; and 3\) identify and respond to) Tj 0.257 -12.2018 TD -0.0411 Tc 1.0846 Tw (the feelings arid needs expressed in the behavior of) Tj ET BT 0.8915 0 0 0.9835 327.6 226.32 Tm 0.0412 Tc 1.7933 Tw (individual residents. As noted earlier, nursing home) Tj ET BT 0.9835 0 0 0.9835 327.12 214.32 Tm 0.0324 Tc 2.4322 Tw (residents with dementia are diverse, and their) Tj 0.4881 -12.4458 TD 0.0193 Tc 1.1441 Tw (characteristics and needs change over time. The) Tj ET BT 0.8915 0 0 0.9835 327.6 190.32 Tm 0.0363 Tc 2.5076 Tw (three concepts that emphasize the individualization) Tj 0.2692 -12.2018 TD 0.0225 Tc 0.8541 Tw (of care fit well, at least in theory, with this diversity.) Tj ET BT 0.934 0 0 0.9835 338.64 160.32 Tm -0.039 Tc 2.3992 Tw (The concept that appropriate environments will) Tj ET BT 0.9835 0 0 0.9835 328.08 148.08 Tm 0.037 Tc 3.2818 Tw (improve the functioning and quality of life of) Tj ET BT 0.8915 0 0 0.9835 328.08 136.32 Tm 0.0347 Tc 0.8808 Tw (individuals with dementia may also fit well in theory) Tj ET BT 0.9835 0 0 0.9835 328.08 124.56 Tm 0.0285 Tc 1.4078 Tw (with the diverse and changing needs of nursing) Tj ET BT 0.8915 0 0 0.9835 327.84 112.8 Tm 0.0354 Tc 1.6203 Tw (home residents with dementia. In practice, however,) Tj 0.5384 -12.2018 TD 0.0341 Tc 1.4871 Tw (the concept is probably more difficult to apply, since) Tj ET BT 0.9835 0 0 0.9835 328.32 89.04 Tm 0.0319 Tc 0.5415 Tw (special care units must be designed and built for) Tj ET BT 0.934 0 0 0.9835 328.32 77.28 Tm -0.0313 Tc 0.9961 Tw (groups of individuals. The objectives in special care) Tj ET BT 0.9835 0 0 0.9835 327.84 65.28 Tm 0.0311 Tc 0.3593 Tw (unit design include flexibility and the capacity to) Tj 0 -11.9577 TD 0.0303 Tc -0.128 Tw (adapt to resident change \(10,67,287,296,358\). Ne-) Tj T* 0.0245 Tc -0.0814 Tw (vertheless, given the extreme diversity of nursing) Tj ET endstream endobj 118 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 119 0 obj <>stream 0.48 w 1 j 0 0 0 RG 55.2 680.88 m 533.52 680.88 l S 0.72 w 307.44 49.68 m 537.36 49.68 l S 59.04 49.44 m 308.88 49.44 l S BT 0.9835 0 0 0.9835 322.56 686.16 Tm 0 0 0 rg /F5 10 Tf 0.0123 Tc 2.6108 Tw (Chapter I-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 513.84 686.16 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 520.32 686.16 Tm /F5 11 Tf 0.3671 Tc 0 Tw (23) Tj ET BT 0.934 0 0 0.9835 55.44 647.52 Tm /F4 10 Tf -0.0327 Tc 1.7684 Tw (home residents with dementia, it would seem that) Tj ET BT 0.9835 0 0 0.9835 55.92 635.28 Tm 0.0298 Tc 2.0689 Tw (the more closely the physical environment of a) Tj ET BT 0.8915 0 0 0.9835 56.16 623.28 Tm 0.0459 Tc 0.9019 Tw (special care unit matches the needs of one individual) Tj ET BT 0.9835 0 0 0.9835 56.16 611.04 Tm 0.0396 Tc 0.6862 Tw (or one type of individual with dementia, the less) Tj ET BT 0.934 0 0 0.9835 56.16 599.28 Tm -0.04 Tc 1.3725 Tw (likely the unit would provide the best environment) Tj ET BT 0.9835 0 0 0.9835 56.16 587.28 Tm 0.0341 Tc 0.3563 Tw (for other types of individuals with dementia. The) Tj ET BT 0.934 0 0 0.9835 56.64 575.28 Tm -0.0313 Tc 0.6887 Tw (same concern may apply to other features of special) Tj -0.257 -11.9577 TD -0.0091 Tc 0.3115 Tw (care units, such as activity programs.) Tj ET BT 0.9835 0 0 0.9835 67.68 545.52 Tm 0.022 Tc 1.7108 Tw (This concern has led a few nursing homes to) Tj -10.9816 -12.2018 TD 0.0326 Tc 1.3746 Tw (establish several special care units that provide) Tj ET BT 0.934 0 0 0.9835 56.88 521.76 Tm -0.0394 Tc 0.9863 Tw (different levels and types of care intended to match) Tj ET BT 0.8915 0 0 0.9835 56.88 509.76 Tm 0.0329 Tc 0.8348 Tw (the characteristics and needs of residents in different) Tj 0.5384 -11.9577 TD 0.0295 Tc 1.4923 Tw (stages of their illness \(34,473\). A second alternative,) Tj ET BT 0.9835 0 0 0.9835 57.36 485.76 Tm 0.0359 Tc 2.2021 Tw (adopted by some nursing homes with only one) Tj ET BT 0.934 0 0 0.9835 57.6 474 Tm -0.0366 Tc 1.0798 Tw (special care unit, is to discharge residents from the) Tj ET BT 0.9835 0 0 0.9835 57.12 462 Tm 0.0298 Tc 0.4652 Tw (unit-usually to a nonspecialized unit in the same) Tj ET BT 0.934 0 0 0.9835 57.36 450.24 Tm -0.0421 Tc 1.3747 Tw (facility-when the level and type of care provided in) Tj ET BT 0.8915 0 0 0.9835 57.6 438 Tm 0.0497 Tc 0.5611 Tw (the special care unit no longer matches the residents\222) Tj ET BT 0.934 0 0 0.9835 57.6 426 Tm -0.0295 Tc 2.5946 Tw (characteristics and needs. Both these alternatives) Tj -0.257 -12.2018 TD -0.0377 Tc 0.5991 Tw (require moving residents, which is likely to increase) Tj ET BT 0.9835 0 0 0.9835 57.6 401.76 Tm 0.0263 Tc 1.0149 Tw (their confusion. Moving residents also may have) Tj 0 -11.9577 TD 0.033 Tc 0.8454 Tw (negative consequences for the residents\222 families) Tj ET BT 0.934 0 0 0.9835 57.84 378 Tm -0.0259 Tc 0.8756 Tw (who are often emotionally attached to the unit staff) Tj ET BT 0.9835 0 0 0.9835 57.84 366.24 Tm 0.026 Tc 0.4255 Tw (members and for the unit staff members who are) Tj 0.4881 -12.2018 TD 0.039 Tc 0.2118 Tw (often attached to the residents and their families) Tj ET BT 0.934 0 0 0.9835 58.56 342.24 Tm 0.0669 Tc 0 Tw (\(40,375,473\).) Tj ET BT 0.9835 0 0 0.9835 69.12 324.48 Tm 0.0313 Tc 0.2981 Tw (A third alternative is to allow special care unit) Tj ET BT 0.8915 0 0 0.9835 58.08 312.24 Tm 0.0158 Tc 0.1617 Tw (residents to ) Tj ET BT 0.9014 0 0 0.9812 109.92 312.24 Tm /F5 11 Tf -0.0173 Tc 0.1078 Tw (age in place, ) Tj ET BT 0.8915 0 0 0.9835 163.92 312.24 Tm /F4 10 Tf 0.0285 Tc 0.1474 Tw (that is, to remain on the unit) Tj ET BT 0.9835 0 0 0.9835 58.32 300 Tm 0.0334 Tc 1.3331 Tw (until they die. Anecdotal evidence suggests that) Tj 0.4881 -12.4458 TD 0.0314 Tc 2.9039 Tw (some special care units that adopt this policy) Tj ET BT 0.934 0 0 0.9835 58.32 275.76 Tm -0.0255 Tc 1.4533 Tw (become, in effect, terminal care settings as most of) Tj 0.5139 -12.2018 TD -0.0437 Tc 1.3443 Tw (the residents progress into the later stages of their) Tj ET BT 0.9835 0 0 0.9835 58.8 252 Tm 0.027 Tc 2.4785 Tw (illness \(40,419\). This creates problems for new) Tj ET BT 0.934 0 0 0.9835 58.32 240 Tm -0.0304 Tc 0.9054 Tw (residents who are admitted to a unit in which most) Tj 0.5139 -12.2018 TD -0.0443 Tc 2.1113 Tw (of the other residents are severely cognitively and) Tj ET BT 0.9835 0 0 0.9835 58.56 216.48 Tm 0.026 Tc 2.9094 Tw (physically impaired. OTA is not aware of any) Tj ET BT 0.8915 0 0 0.9835 58.56 204.48 Tm 0.0429 Tc 1.3427 Tw (research that compares these three alternatives, and) Tj 0.5384 -11.9577 TD 0.0414 Tc 1.3251 Tw (the special care unit literature contains little discus-) Tj ET BT 0.934 0 0 0.9835 59.76 180.48 Tm -0.0245 Tc 0.585 Tw (sion of this important issue.) Tj ET BT 0.9795 0 0 0.9795 94.56 152.4 Tm /F7 12 Tf 0.0537 Tc 0.6193 Tw (Ideas About Special Care Units) Tj 22.788 -14.2118 TD 0.0247 Tc 1.0164 Tw (From Other Countries) Tj ET BT 0.934 0 0 0.9835 70.56 120.24 Tm /F4 10 Tf -0.0413 Tc 1.1169 Tw (Special care units for people with dementia exist) Tj ET BT 0.9835 0 0 0.9835 59.76 108.48 Tm 0.0228 Tc 0.1644 Tw (in many other countries. Information about these) Tj ET BT 0.934 0 0 0.9835 59.52 96.24 Tm -0.0196 Tc 1.7789 Tw (units reaches the United States primarily through) Tj ET BT 0.8915 0 0 0.9835 59.28 84.72 Tm 0.0508 Tc 1.9171 Tw (reports from foreign visitors who are knowledgeable) Tj ET BT 0.934 0 0 0.9835 59.76 72.72 Tm -0.0317 Tc 1.46 Tw (about the special care units in their own countries) Tj 0 -12.2018 TD -0.0295 Tc 1.0676 Tw (and through reports of Americans who have visited) Tj ET BT 0.9835 0 0 0.9835 306.72 647.28 Tm 0.0242 Tc 3.0812 Tw (the units in other countries. There are a few) Tj ET BT 0.8915 0 0 0.9835 306.72 635.28 Tm 0.0427 Tc 0.9391 Tw (descriptive studies on special care units in particular) Tj ET BT 0.934 0 0 0.9835 306.96 623.28 Tm 0.196 Tc 0 Tw (countries,) Tj ET BT 0.9557 0 0 1.08 351.36 628.08 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (9 ) Tj ET BT 0.934 0 0 0.9835 354.72 623.28 Tm /F4 10 Tf -0.0115 Tc 1.3847 Tw (but most of the available information is) Tj -50.6202 -12.2018 TD -0.0226 Tc 0.7115 Tw (anecdotal. OTA is not aware of any formal research) Tj -0.257 -12.2018 TD -0.0327 Tc 0.8935 Tw (comparing special care units in different countries.) Tj ET BT 0.9835 0 0 0.9835 318.24 579.36 Tm 0.028 Tc 1.8267 Tw (Information about special care units in other) Tj -10.9816 -12.2018 TD 0.0222 Tc 1.735 Tw (countries influences thinking about special care) Tj 0 -12.2018 TD 0.0142 Tc 0.468 Tw (units in the United States in several ways. First,) Tj 0.7321 -12.2018 TD 0.0258 Tc 0.4053 Tw (special care units in other countries demonstrate) Tj 0 -12.2018 TD 0.0245 Tc 0.366 Tw (alternate models of care. For example, a primary) Tj ET BT 0.8915 0 0 0.9835 307.92 519.36 Tm 0.0493 Tc 1.1113 Tw (objective of special care units in some countries is to) Tj ET BT 0.9835 0 0 0.9835 307.68 507.36 Tm 0.0328 Tc 0.1135 Tw (provide a comfortable, home-like environment for) Tj 0.4881 -11.9577 TD 0.0279 Tc 1.6524 Tw (their residents. These units have few rules and) Tj ET BT 0.8915 0 0 0.9835 307.92 483.6 Tm 0.041 Tc 1.5948 Tw (maintain a flexible daily schedule that is responsive) Tj 0.2692 -12.2018 TD 0.031 Tc 1.1061 Tw (to the habits and preferences of individual residents.) Tj ET BT 0.9835 0 0 0.9835 308.4 459.84 Tm 0.0197 Tc 0.8996 Tw (In visiting these units, American observers have) Tj ET BT 0.934 0 0 0.9835 308.16 447.6 Tm -0.0381 Tc 1.5417 Tw (been impressed with their relaxed atmosphere and) Tj ET BT 0.9835 0 0 0.9835 308.64 435.6 Tm 0.0384 Tc 0.6366 Tw (the apparent contentment of the residents \(273\).) Tj 0 -11.9577 TD 0.0327 Tc 0.0594 Tw (Reports on special care units of this kind in other) Tj ET BT 0.8915 0 0 0.9835 308.64 411.6 Tm 0.0487 Tc 0.8171 Tw (countries create an incentive for the establishment of) Tj 0.2692 -12.4458 TD 0.0349 Tc 1.0152 Tw (similar units in this country.) Tj 12.1137 -20.0109 TD 0.0446 Tc 1.2831 Tw (Physical restraints are used less frequently or not) Tj ET BT 0.934 0 0 0.9835 309.36 367.68 Tm -0.0326 Tc 1.4217 Tw (at all in special care units in some other countries) Tj ET BT 0.9835 0 0 0.9835 309.6 355.92 Tm 0.0274 Tc 0.2817 Tw (\(273,498\). The knowledge that restraints are less) Tj ET BT 0.8915 0 0 0.9835 309.36 343.92 Tm 0.0566 Tc 1.361 Tw (often used in other countries has been one incentive) Tj 0 -12.2018 TD 0.0265 Tc 1.3034 Tw (for reducing their use in the United States.) Tj ET BT 0.9835 0 0 0.9835 320.4 311.52 Tm 0.0262 Tc 0.9569 Tw (Special care units in some other countries are) Tj ET BT 0.934 0 0 0.9835 309.36 299.76 Tm -0.0234 Tc 0.6694 Tw (more able to innovate than special care units in the) Tj ET BT 0.9835 0 0 0.9835 309.6 287.52 Tm 0.0411 Tc 0.3898 Tw (United States \(273\). Awareness of this difference) Tj 0 -12.2018 TD 0.0298 Tc 2.0689 Tw (calls attention to the factors that encourage or) Tj ET BT 0.8915 0 0 0.9835 309.6 263.52 Tm 0.0481 Tc 1.1125 Tw (constrain innovation in different countries. One such) Tj ET BT 0.934 0 0 0.9835 309.6 251.76 Tm -0.0237 Tc 1.2082 Tw (factor is nursing home regulations. As discussed in) Tj 0.257 -12.4458 TD -0.0184 Tc 1.4962 Tw (chapter 6, nursing home regulations in the United) Tj ET BT 0.8915 0 0 0.9835 310.08 228 Tm 0.0232 Tc 2.0916 Tw (States sometimes interfere with the implementation) Tj ET BT 0.934 0 0 0.9835 309.84 216.24 Tm -0.0253 Tc 1.4669 Tw (of innovative physical design and other features in) Tj ET BT 0.9835 0 0 0.9835 310.32 204.24 Tm 0.0129 Tc 0.1337 Tw (special care units. Nursing homes are less tightly) Tj ET BT 0.934 0 0 0.9835 309.84 192.72 Tm -0.0407 Tc 1.1162 Tw (regulated in most other countries and are therefore) Tj ET BT 0.9835 0 0 0.9835 310.32 180.48 Tm 0.0157 Tc 1.0722 Tw (more able to innovate. Public programs in many) Tj ET BT 0.8915 0 0 0.9835 310.32 168.24 Tm 0.0425 Tc 0.3673 Tw (other countries also make a less rigid distinction than) Tj 0 -11.9577 TD 0.0314 Tc 1.0287 Tw (public programs in the United States between health) Tj ET BT 0.9835 0 0 0.9835 310.56 144.24 Tm 0.0248 Tc 3.1895 Tw (care and social services, and the same public) Tj -0.244 -12.2018 TD 0.0366 Tc 0.5164 Tw (programs are more likely to pay for both types of) Tj 0.7321 -11.7137 TD 0.0209 Tc 0.4612 Tw (services in other countries. As a result, there are) Tj ET BT 0.8915 0 0 0.9835 310.8 108.72 Tm 0.0465 Tc 0.9349 Tw (fewer artificial barriers to the development of special) Tj ET BT 0.934 0 0 0.9835 310.8 96.72 Tm -0.0253 Tc 1.2426 Tw (care units that provide a mix of medical and social) Tj 0.257 -11.9577 TD -0.0287 Tc 1.2319 Tw (services. Lastly, public funding is more likely to be) Tj ET BT 0.9835 0 0 0.9835 310.8 72.96 Tm 0.034 Tc 0.1529 Tw (available for nonmedical residential care in other) Tj ET BT 0.8915 0 0 0.9835 310.56 60.96 Tm 0.0214 Tc 1.4678 Tw (countries than in the United States. When the same) Tj ET q 2.4 0 0 -4.32 73.2 43.44 cm BI /W 15 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p~xx?>>>??σ|88|π O ?x<??`~||<> EI Q BT 0.99 0 0 0.99 77.28 37.92 Tm 3 Tr 0.0365 Tc 0 Tw (see,) Tj 0 Tr ET BT 0.934 0 0 0.9835 89.76 37.92 Tm /F4 10 Tf -0.0623 Tc 0.24 Tw ( for ) Tj ET q 28.08 0 0 -7.2 107.52 43.44 cm BI /W 159 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`p<>????|?>x~>>88>>8s>>>?>>>?>?> >|>|><?>>>}>>>>>~> EI Q BT 0.8066 0 0 0.9835 107.52 37.92 Tm 3 Tr -0.0135 Tc 0 Tw (ex~ple,) Tj 0 Tr ET BT 0.934 0 0 0.9835 135.6 37.92 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 27.12 0 0 -6.72 138 42.96 cm BI /W 154 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?p|~?|?>?|>>|>~|~|||~||>?~?||?>||>||~p|| ~p>|p?~p>|x~p>~|~p~>~p>>ppxpppp~ EI Q BT 1.6133 0 0 0.9835 138 37.92 Tm 3 Tr 0.0077 Tc 0 Tw (No-) Tj 0 Tr ET BT 0.9266 0 0 0.99 165.12 37.92 Tm /F7 8 Tf 0.0198 Tc 0.7416 Tw ( Severe Dementia: ) Tj ET BT 0.9448 0 0 0.99 226.56 37.92 Tm /F5 8 Tf 0.0322 Tc 0.3367 Tw (The Provision of ) Tj ET q 28.32 0 0 -6.96 281.04 43.92 cm BI /W 161 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|??|x?>>????>?>?~>>~|||||>~||>~|<|><?>>?|>?~@|8<  EI Q BT 0.9448 0 0 0.99 281.04 37.92 Tm 3 Tr 0.048 Tc 0 Tw (Longstay) Tj 0 Tr 29.9733 0 TD 0 Tc 0.0321 Tw ( ) Tj ET q 15.36 0 0 -5.52 311.04 43.44 cm BI /W 87 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~?8?8>~~~|>|?|||x|~|<~>|>?>?`p?x EI Q BT 0.99 0 0 0.99 311.04 37.92 Tm 3 Tr 0.0819 Tc 0 Tw (care) Tj 0 Tr ET BT 0.9448 0 0 0.99 326.4 37.92 Tm 0 Tc 0.0321 Tw ( ) Tj ET q 18 0 0 -6.96 328.08 43.68 cm BI /W 102 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px<|x<<<||xx|80x8x<x<>x<>|<>|~~|?||||||?||x?||x<|x<|<x<|<<>|><>x>>>~<x?p? EI Q BT 0.8858 0 0 0.99 328.08 37.92 Tm 3 Tr 0.0301 Tc 0 Tw (\(330\).) Tj 0 Tr ET endstream endobj 120 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 121 0 obj <>stream 0.72 w 1 j 0 0 0 RG 73.68 688.32 m 552.24 688.32 l S BT 0.9863 0 0 0.9863 73.68 694.56 Tm 0 0 0 rg /F3 9 Tf 0.1038 Tc -0.175 Tw (24 ) Tj ET BT 0.9598 0 0 0.9598 86.4 694.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 92.64 694.56 Tm /F5 10 Tf 0.0116 Tc 0.4695 Tw (Special Care Units for People With Alzheimer\222s and Other ) Tj ET BT 0.9812 0 0 0.9812 332.4 694.56 Tm /F5 11 Tf 0.0419 Tc 0 Tw (Dementias) Tj ET BT 0.9835 0 0 0.9835 74.16 655.2 Tm /F4 10 Tf 0.0298 Tc 1.1973 Tw (public programs pay for both medical and social) Tj ET BT 0.8915 0 0 0.9835 74.64 642.96 Tm 0.0466 Tc 1.55 Tw (services and public funding is available for nonmed-) Tj ET BT 0.9835 0 0 0.9835 74.64 631.44 Tm 0.0221 Tc 1.9372 Tw (ical residential care, there is a strong financial) Tj -0.244 -12.2018 TD 0.0327 Tc 0.6017 Tw (incentive for government agencies to support the) Tj ET BT 0.934 0 0 0.9835 74.4 607.2 Tm -0.0446 Tc 1.8399 Tw (development of nonmedical residential care models) Tj 0.5139 -12.2018 TD -0.0018 Tc 0.2395 Tw (that are less costly than nursing homes. Since 1986,) Tj ET BT 0.9835 0 0 0.9835 74.64 583.2 Tm 0.0286 Tc 0.5245 Tw (for example, the Australian government has pro-) Tj ET BT 0.8915 0 0 0.9835 74.88 570.96 Tm 0.0217 Tc 1.6164 Tw (vided grants to stimulate the development of special) Tj ET BT 0.9835 0 0 0.9835 74.88 558.96 Tm 0.0206 Tc 0.5835 Tw (care units in hostels as an alternative to nursing) Tj ET BT 0.934 0 0 0.9835 74.88 547.2 Tm -0.0141 Tc 1.2934 Tw (homes for individuals with dementia \(101\).) Tj 11.82 -18.3027 TD -0.0337 Tc 2.1794 Tw (Despite these advantages in other countries, no) Tj ET BT 0.8915 0 0 0.9835 75.12 516.96 Tm 0.0454 Tc 1.34 Tw (country has the answers with respect to special care) Tj ET BT 0.9835 0 0 0.9835 74.88 505.2 Tm 0.0222 Tc 2.3512 Tw (units or problems in the care of nursing home) Tj ET BT 0.934 0 0 0.9835 74.88 493.44 Tm -0.019 Tc 1.1358 Tw (residents with dementia \(273\). Questions about the) Tj 0.5139 -12.6899 TD -0.0359 Tc 2.3102 Tw (effectiveness of various models and components of) Tj 0.257 -11.7137 TD -0.0299 Tc 1.1475 Tw (care are pervasive. Clinicians and researchers from) Tj ET BT 0.8915 0 0 0.9835 75.6 457.44 Tm 0.0329 Tc 1.2963 Tw (other countries frequently come to the United States) Tj 0 -12.2018 TD 0.0402 Tc 1.0429 Tw (in search of ideas about physical design features and) Tj ET BT 0.9835 0 0 0.9835 75.36 433.44 Tm 0.032 Tc 0.463 Tw (patient care practices for special care units. Ade-) Tj 0.244 -11.9577 TD 0.0332 Tc -0.0264 Tw (quately trained staff and sufficient funding are in) Tj ET BT 0.8915 0 0 0.9835 76.08 409.44 Tm 0.0372 Tc 2.9643 Tw (short supply everywhere.) Tj ET BT 0.9795 0 0 0.9795 118.8 385.68 Tm /F7 12 Tf 0.0406 Tc 0.6327 Tw (Findings From Research on) Tj 24.7482 -14.4569 TD 0.0475 Tc 0.6256 Tw (Special Care Units) Tj ET BT 0.8915 0 0 0.9835 87.12 354.24 Tm /F4 10 Tf 0.0561 Tc 0.5951 Tw (Research on special care units is in an early stage,) Tj ET BT 0.9835 0 0 0.9835 75.84 342.24 Tm 0.0371 Tc 0.2718 Tw (but some descriptive and evaluative studies have) Tj 0 -11.9577 TD 0.0322 Tc 3.6004 Tw (been conducted in the past few years. OTA\222s) Tj 0.244 -12.4458 TD 0.031 Tc -0.0798 Tw (conclusions from the available descriptive studies) Tj 0.244 -11.7137 TD 0.0325 Tc 1.8526 Tw (are listed in table 1-2. The findings from these) Tj ET BT 0.8915 0 0 0.9835 76.32 294.48 Tm 0.0299 Tc 0.6244 Tw (studies are discussed in detail in chapter 3, and some) Tj ET BT 0.934 0 0 0.9835 76.32 282.24 Tm -0.0376 Tc 1.9939 Tw (of the most important findings for policy purposes) Tj 0 -12.2018 TD -0.0352 Tc 1.4316 Tw (are reviewed in this section. The findings from the) Tj ET BT 0.8915 0 0 0.9835 76.56 258.24 Tm 0.0424 Tc 0.6703 Tw (available evaluative studies are discussed in detail in) Tj ET BT 0.934 0 0 0.9835 76.32 246 Tm -0.0345 Tc 0.8527 Tw (chapter 4 and reviewed briefly in this section.) Tj ET BT 0.9835 0 0 0.9835 76.56 224.16 Tm 0.0143 Tc 0.9342 Tw (Number of Nursing Homes That Have a Special) Tj 0.244 -12.2018 TD 0.0173 Tc 0.8614 Tw (Care Unit) Tj 11.2256 -18.3027 TD 0.0199 Tc 0.1876 Tw (OTA estimates that in 1991, 10 percent of U.S.) Tj ET BT 0.934 0 0 0.9835 76.32 182.64 Tm -0.0075 Tc 0.3741 Tw (nursing homes had a special care unit. This number) Tj ET BT 0.9835 0 0 0.9835 76.56 170.64 Tm 0.0234 Tc 0.7507 Tw (includes nursing homes that group some of their) Tj ET BT 0.934 0 0 0.9835 76.32 158.4 Tm -0.031 Tc 1.4056 Tw (residents with dementia in physically distinct clus-) Tj ET BT 0.9835 0 0 0.9835 76.8 146.16 Tm 0.0328 Tc 1.4383 Tw (ters in units that also serve some nondemented) Tj ET BT 0.8915 0 0 0.9835 76.32 134.4 Tm 0.0096 Tc 0 Tw (residents.) Tj ET BT 0.934 0 0 0.9835 87.36 116.4 Tm -0.0333 Tc 1.3332 Tw (As noted earlier, OTA\222s estimate is based on the) Tj -11.563 -12.4458 TD -0.0363 Tc 1.3685 Tw (findings of two recent studies. One of the studies-a) Tj ET BT 0.9835 0 0 0.9835 77.76 92.4 Tm 0.0125 Tc 0.4392 Tw (1991 survey of all U.S. nursing homes with more) Tj ET BT 0.934 0 0 0.9835 76.56 80.16 Tm -0.0092 Tc 1.5 Tw (than 30 beds\227found that 9 percent of the nursing) Tj 0 -11.9577 TD -0.0383 Tc 1.1459 Tw (homes reported having either a special care unit or) Tj 0 -12.2018 TD -0.0313 Tc 1.3952 Tw (a special program for residents with dementia in a) Tj ET BT 0.9835 0 0 0.9835 76.32 44.88 Tm 0.0258 Tc 1.3408 Tw (physically distinct part of the facility \(246\). The) Tj 253.553 620.0945 TD 0.029 Tc 0.6055 Tw (second study-a 1990 survey of all nursing homes) Tj ET BT 0.934 0 0 0.9835 325.44 642.96 Tm -0.0227 Tc 1.7822 Tw (in five northeastern States\227found that seven per-) Tj 0.257 -12.4458 TD -0.0295 Tc 0.6867 Tw (cent of the nursing homes reported having a special) Tj ET BT 0.8915 0 0 0.9835 325.44 618.96 Tm 0.0363 Tc 0.307 Tw (care unit, and an additional five percent reported that) Tj ET BT 0.934 0 0 0.9835 325.92 606.96 Tm -0.019 Tc 0.6362 Tw (although they did not have a special care unit, they) Tj -0.257 -12.4458 TD -0.0438 Tc 1.6978 Tw (did place some of their residents with dementia in) Tj ET BT 0.9835 0 0 0.9835 325.44 582.48 Tm 0.0147 Tc -0.1121 Tw (physically distinct groups or clusters in units that) Tj 0.7321 -12.2018 TD 0.0445 Tc 2.0539 Tw (also served some nondemented residents \(194\).) Tj -0.244 -11.9577 TD 0.026 Tc 0.8796 Tw (Thus, a total of 12 percent of the nursing homes) Tj -0.244 -12.2018 TD 0.0338 Tc 1.2514 Tw (reported using some method to physically group) Tj 0 -12.4458 TD 0.0348 Tc 0.8843 Tw (residents with dementia--either in a special care) Tj ET BT 0.8915 0 0 0.9835 326.16 522.48 Tm 0.0432 Tc 0.6021 Tw (unit or a cluster unit.) Tj ET BT 0.9835 0 0 0.9835 337.2 498.24 Tm 0.0379 Tc 1.0844 Tw (The lack of an accepted definition of the term) Tj ET BT 0.9812 0 0 0.9812 326.4 486.48 Tm /F5 11 Tf 0.0904 Tc 2.782 Tw (special care unit) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 411.12 486.48 Tm /F4 10 Tf 0.0425 Tc 3.5812 Tw (makes it difficult to develop) Tj -85.6565 -11.9577 TD 0.0324 Tc 0.2186 Tw (accurate figures on the number and proportion of) Tj -0.4881 -12.2018 TD 0.0154 Tc 0.4973 Tw (nursing homes that have a special care unit. The) Tj 0.244 -12.2018 TD 0.043 Tc 0.9747 Tw (figures cited above are based on self-report. The) Tj 0.244 -12.2018 TD 0.0288 Tc -0.0218 Tw (figures from the 1991 survey generally reflect the) Tj ET BT 0.8915 0 0 0.9835 326.88 426.48 Tm 0.0568 Tc 1.2694 Tw (opinion of each nursing home administrator or other) Tj 0.2692 -11.9577 TD 0.0411 Tc 1.3111 Tw (survey respondent about what a special care unit is.) Tj ET BT 0.9835 0 0 0.9835 326.88 402.48 Tm 0.0318 Tc 1.3754 Tw (According to the researchers who conducted the) Tj 1.2202 -12.2018 TD 0.0165 Tc 1.0249 Tw (1990 survey, however, some nursing homes that) Tj ET BT 0.934 0 0 0.9835 326.64 378.96 Tm -0.0295 Tc 1.1777 Tw (place residents with dementia in a physically sepa-) Tj 0.257 -11.9577 TD -0.0399 Tc 0.7728 Tw (rate unit and provide special services in the unit do) Tj ET BT 0.9835 0 0 0.9835 326.88 355.2 Tm 0.0236 Tc 0.5805 Tw (not use the term \221\221special care\222 for these arrange-) Tj ET BT 0.934 0 0 0.9835 326.88 343.44 Tm -0.0236 Tc 1.2264 Tw (ments and therefore may not respond affirmatively) Tj ET BT 0.9835 0 0 0.9835 327.36 331.44 Tm 0.0341 Tc 1.2104 Tw (to a survey question about whether they have a) Tj ET BT 0.8915 0 0 0.9835 327.6 319.68 Tm 0.0462 Tc 1.3838 Tw (special care unit \(436\). Surprisingly, the researchers) Tj 0 -12.2018 TD 0.0279 Tc 1.1576 Tw (also found that in some nursing homes, the adminis-) Tj ET BT 0.934 0 0 0.9835 327.36 295.68 Tm -0.0334 Tc 1.9894 Tw (trator and the director of nursing disagreed about) Tj 0 -12.2018 TD -0.0156 Tc 0.6076 Tw (whether the facility had a special care unit \(194\).) Tj ET BT 0.9835 0 0 0.9835 338.64 259.2 Tm 0.0558 Tc 0.4318 Tw (Some people believe the term ) Tj ET BT 0.9812 0 0 0.9812 479.04 259.2 Tm /F5 11 Tf 0.0904 Tc 0.8252 Tw (special care unit) Tj ET BT 0.934 0 0 0.9835 327.6 247.2 Tm /F4 10 Tf -0.0088 Tc 1.7062 Tw (should mean more than just a physically separate) Tj 0.257 -11.9577 TD -0.0214 Tc 0.5817 Tw (space and the nursing home\222s claim that it provides) Tj ET BT 0.9835 0 0 0.9835 328.32 223.2 Tm 0.2322 Tc 3.0832 Tw (\221\221special care.) Tj ET BT 0.8915 0 0 0.9835 397.92 223.2 Tm 0.0468 Tc 1.4729 Tw (Depending on the additional criteria) Tj -78.8739 -11.9577 TD 0.0299 Tc 0.5945 Tw (that are used, some and perhaps many of the nursing) Tj 0 -11.9577 TD 0.0316 Tc 1.0114 Tw (homes included in the figures just cited might not be) Tj ET BT 0.934 0 0 0.9835 327.6 187.68 Tm -0.0146 Tc 0.4888 Tw (counted as having a special care unit.) Tj ET BT 0.9835 0 0 0.9835 338.4 163.92 Tm 0.0285 Tc 2.6628 Tw (To OTA\222s knowledge, the 1990 survey of all) Tj ET BT 0.934 0 0 0.9835 327.6 151.92 Tm -0.0161 Tc 1.4203 Tw (nursing homes in five northeastern States was the) Tj ET BT 0.8915 0 0 0.9835 327.6 139.68 Tm 0.0334 Tc 0.8823 Tw (first to identify large numbers of nursing homes with) Tj ET BT 0.9835 0 0 0.9835 327.84 127.92 Tm 0.0095 Tc 1.0785 Tw (cluster units. It is unclear whether cluster units) Tj ET BT 0.8915 0 0 0.9835 328.08 115.92 Tm 0.0404 Tc 1.2707 Tw (should be counted as special care units. Many of the) Tj ET BT 0.934 0 0 0.9835 327.84 103.68 Tm -0.0288 Tc 1.4338 Tw (cluster units identified in the 1990 survey incorpo-) Tj ET BT 0.8915 0 0 0.9835 327.6 92.16 Tm 0.0481 Tc 1.0485 Tw (rated features that are recommended for special care) Tj ET BT 0.9835 0 0 0.9835 327.6 79.92 Tm 0.0231 Tc 1.0182 Tw (units \(e.g., physical design features, special staff) Tj 0.244 -12.2018 TD 0.0187 Tc 2.8122 Tw (training, and family support groups\), although) Tj ET BT 0.934 0 0 0.9835 327.6 56.16 Tm -0.0354 Tc 0.5646 Tw (cluster units were less likely than special care units) Tj ET BT 0.8915 0 0 0.9835 327.84 44.4 Tm 0.0342 Tc 2.16 Tw (to incorporate these features \(194\).) Tj ET endstream endobj 122 0 obj <>/Rotate 0/Type/Page>> endobj 123 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.16 678.72 m 533.52 678.72 l S 0.96 w 63.6 658.8 m 531.6 658.8 l S 0.72 w 58.8 658.8 m 58.8 35.76 l S 535.44 659.76 m 535.44 329.52 l S 0.48 w 536.64 349.68 m 536.64 320.88 l S 0.72 w 537.36 320.88 m 537.36 41.52 l S 60.24 36.48 m 538.56 36.48 l S BT 0.9835 0 0 0.9835 323.04 684 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 2.7377 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 514.32 684 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 521.04 684 Tm /F4 10 Tf 0.4158 Tc 0 Tw (25) Tj ET BT 0.8875 0 0 0.9795 132 632.4 Tm /F7 12 Tf -0.0086 Tc 2.4499 Tw (Table 1-2-Conclusions From Descriptive Studies of Special Care Units) Tj ET BT 0.8915 0 0 0.9835 68.64 613.2 Tm /F4 10 Tf 0.0415 Tc 0.133 Tw (Number of ) Tj ET BT 0.9017 0 0 0.9812 116.16 613.2 Tm /F6 11 Tf -0.0111 Tc 0.6829 Tw (Nursing Homes That Have a Special Care Unit) Tj ET BT 0.8607 0 0 0.9812 89.28 596.64 Tm 0.0394 Tc -0.0091 Tw (\215 OTA estimates that in 1991, 10 percent ) Tj ET BT 0.8491 0 0 0.9835 256.56 596.64 Tm /F4 10 Tf 0.0306 Tc 0.3685 Tw (of all nursing homes in the United States had a special care) Tj ET BT 0.8066 0 0 0.9835 98.88 584.4 Tm 0.0591 Tc 0.698 Tw (unit. In at least some States, this figure includes nursing homes that place some of their residents with) Tj ET BT 0.8491 0 0 0.9835 99.36 573.84 Tm 0.0276 Tc 0.5149 Tw (dementia in \223clusters\224 in units that also serve nondemented residents.) Tj -11.5888 -15.6183 TD 0.0428 Tc 0.1986 Tw (\215 The proportion of nursing homes that have a special care unit varies in different parts of the country) Tj ET BT 0.8066 0 0 0.9835 99.84 547.68 Tm 0.0288 Tc 1.2488 Tw (and in different States,) Tj ET BT 0.8491 0 0 0.9835 90 533.28 Tm 0.0387 Tc 0.1949 Tw (\215 Many nursing homes that do not have a special care unit are plannin) Tj 333.8127 -0.244 TD 0.0271 Tc 0.6348 Tw (g to establish one, and some) Tj ET BT 0.8066 0 0 0.9835 99.6 522.24 Tm 0.062 Tc 1.1009 Tw (nursing homes that have a special care unit are planning to expand the unit.) Tj ET BT 0.9017 0 0 0.9812 70.08 505.2 Tm /F6 11 Tf -0.0133 Tc 0.4572 Tw (Characteristics of Nursing Homes That Have a Special Care Unit) Tj ET BT 0.8632 0 0 0.9598 90 491.28 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 95.28 491.28 Tm /F4 10 Tf 0.0349 Tc 0.4371 Tw (Larger nursing homes are more likely than smaller nursing homes to have a special care unit.) Tj -5.9357 -15.1302 TD 0.0368 Tc 0.2999 Tw (\215 As of late 1987, most nursing homes that had a special care unit were private, for-profit facilities. At) Tj ET BT 0.8066 0 0 0.9835 100.08 465.6 Tm 0.0528 Tc 1.3395 Tw (that time, multi-facility nursing home corporations owned about one-third of all the facilities that had) Tj ET BT 0.8491 0 0 0.9835 100.32 454.56 Tm 0.0386 Tc 0.335 Tw (a special care unit. There is no evidence, however, that ownership of special care units is dominated) Tj -0.2827 -10.9816 TD 0.0281 Tc 0.683 Tw (by a small number of multi-facility nursing home corporations.) Tj ET BT 0.9017 0 0 0.9812 70.8 426.48 Tm /F6 11 Tf -0.0239 Tc 0.602 Tw (Characteristics of Special Care Units) Tj ET BT 0.8632 0 0 0.9598 90.72 413.04 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 96.24 413.04 Tm /F4 10 Tf 0.0269 Tc 1.0308 Tw (Special care units are extremely diverse.) Tj -6.501 -15.1302 TD 0.0447 Tc 0.5575 Tw (\215 Most special care units have been established since 1983, although a few have been in operation for) Tj 11.8714 -11.2256 TD 0.0579 Tc 0.4478 Tw (20 to 25 years.) Tj ET BT 0.8066 0 0 0.9835 90.96 372.48 Tm 0.0507 Tc 1.2052 Tw (\215 The goals of special care units differ. For some units, the primary goal is to maintain residents\222 ability) Tj ET BT 0.8491 0 0 0.9835 100.8 361.44 Tm 0.0274 Tc 0.7394 Tw (to perform activities of daily living. Other units focus on maintaining residents\222 quality of life,) Tj 0 -10.7376 TD 0.0114 Tc 0.8389 Tw (eliminating behavioral symptoms, or meeting residents\222 physical needs,) Tj -11.3061 -15.3742 TD 0.0317 Tc 0.5446 Tw (. Most existing special care units were not originally constructed ) Tj ET BT 0.8646 0 0 0.9863 353.76 335.76 Tm /F3 9 Tf -0.0102 Tc 0.0067 Tw (as ) Tj ET BT 0.8491 0 0 0.9835 364.8 335.76 Tm /F4 10 Tf 0.0301 Tc 0.5747 Tw (special care units, and at least) Tj -310.6352 -11.2256 TD 0.0419 Tc 0.4666 Tw (one-fifth were neither originally constructed nor remodeled for this purpose.) Tj -11.8714 -14.8862 TD 0.0278 Tc 0.6905 Tw (\215 The use of specific physical design and other environmental features varies in existing special care) Tj ET BT 0.8066 0 0 0.9835 101.04 298.32 Tm 0.0561 Tc 1.3935 Tw (units. Many of the physical design and other environmental features cited as important in the special) Tj ET BT 0.8491 0 0 0.9835 101.28 287.76 Tm 0.0364 Tc 0.0672 Tw (care unit literature are used in only a small proportion of special care units.) Tj -11.5888 -15.6183 TD 0.0259 Tc 0.2793 Tw (\215 The most extensively used environmental feature in special care units is an alarm or locking system,) Tj 11.8714 -10.7376 TD 0.0463 Tc -0.0096 Tw (found in more than three-fourths of existing units.) Tj ET BT 0.8066 0 0 0.9835 91.92 246.24 Tm 0.0555 Tc 1.4637 Tw (\215 On average, special care units probably have fewer residents than nonspecialized nursing home units.) Tj -0.5951 -15.3742 TD 0.0519 Tc 1.121 Tw (\215 On average, special care units probably have more staff per resident than nonspecialized nursing home) Tj ET BT 0.7642 0 0 0.9835 101.52 220.32 Tm 0.2109 Tc 0 Tw (units.) Tj ET BT 0.8491 0 0 0.9835 91.68 205.68 Tm 0.0308 Tc 0.1583 Tw (\215 Although the majority of existing special care units provide special training for the unit staff, at least) Tj 11.8714 -11.7137 TD 0.0466 Tc 0.5553 Tw (one-fourth of existing units do not.) Tj -11.3061 -15.3742 TD 0.0253 Tc 0.492 Tw (\215 Less than half of existing special care units provide a support group for unit staff members.) Tj ET BT 0.8632 0 0 0.9598 92.16 163.92 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 97.68 163.92 Tm /F4 10 Tf 0.0248 Tc 0.8825 Tw (The types of activity programs provided by special care units vary greatly, but existing special care) Tj 5.0877 -11.2256 TD 0.03 Tc 0.5143 Tw (units are probably no more likely than nonspecialized units to provide activity programs for their) Tj ET BT 0.8066 0 0 0.9835 102 142.32 Tm 0.0422 Tc 0 Tw (residents.) Tj ET BT 0.8491 0 0 0.9835 92.4 127.44 Tm 0.0237 Tc 0.9456 Tw (* About half of existing special care units provide a support group for residents\222 families.) Tj ET BT 0.8056 0 0 0.9598 92.4 112.32 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8066 0 0 0.9835 97.68 112.32 Tm /F4 10 Tf 0.061 Tc 1.0105 Tw (Special care unit residents areas likely or more likely than other nursing home residents with dementia) Tj ET BT 0.8491 0 0 0.9835 102.24 101.52 Tm 0.0271 Tc 1.7089 Tw (to receive psychotropic medications.) Tj -11.8714 -13.666 TD 0.0283 Tc 0.3884 Tw (\215 Special care unit residents we probably less likely than other nursing home residents with dementia) Tj 11.8714 -12.2018 TD 0.0241 Tc 1.0906 Tw (to receive medications of all types.) Tj ET BT 0.8027 0 0 0.9835 416.88 53.52 Tm /F5 10 Tf 0.0287 Tc 1.3499 Tw (\(Continued on next page\)) Tj ET endstream endobj 124 0 obj <>/Rotate 0/Type/Page>> endobj 125 0 obj <>stream 0.72 w 1 j 0 0 0 RG 76.32 687.36 m 553.68 687.36 l S 84.48 666.72 m 548.64 666.72 l S 78.24 666.24 m 78.24 315.12 l S 554.88 666.24 m 554.88 313.92 l S 84.24 314.64 m 549.36 314.64 l S BT 0.9835 0 0 0.9835 76.32 693.12 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (26 ) Tj ET BT 0.9598 0 0 0.9598 88.8 693.12 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 95.04 693.12 Tm /F5 10 Tf 0.0026 Tc 0.0757 Tw (Special Care Units for People With Alzheimer\222s ) Tj ET BT 0.9812 0 0 0.9812 287.52 693.12 Tm /F5 11 Tf 0.0585 Tc 0.124 Tw (and Other Dementias) Tj ET BT 0.9261 0 0 0.9795 119.04 642 Tm /F7 12 Tf 0.0114 Tc 1.5215 Tw (Table l-2-Conclusions From Descriptive Studies of Special Care Units-\(Continued\)) Tj ET BT 0.8632 0 0 0.9598 108.96 620.64 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.849 0 0 0.9795 115.92 620.64 Tm /F7 12 Tf 0.0573 Tc 0.359 Tw (Special care unit residents are less ) Tj ET BT 0.8687 0 0 0.99 273.12 620.64 Tm /F7 8 Tf -0.034 Tc 0.249 Tw (likely than other ) Tj ET BT 0.8491 0 0 0.9835 322.56 620.64 Tm /F4 10 Tf 0.033 Tc 0.9011 Tw (nursing home residents with dementia to be) Tj ET BT 0.8066 0 0 0.9835 118.8 608.4 Tm 0.0483 Tc 4.0017 Tw (physically restrained.) Tj ET BT 0.8491 0 0 0.9835 109.44 593.04 Tm 0.0284 Tc 0.5591 Tw (o Special care units vary greatly in their admission and discharge policies and practices. About half of) Tj ET BT 0.8066 0 0 0.9835 119.28 582.48 Tm 0.0674 Tc 0.6001 Tw (all special care units admit residents with the intention that the residents will remain on the unit until) Tj 0.2975 -11.4697 TD 0.0161 Tc 1.9588 Tw (they die.) Tj ET BT 0.8632 0 0 0.9598 109.44 556.32 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 114.96 556.32 Tm /F4 10 Tf 0.0407 Tc 0.5622 Tw (The cost of special care units varies depending on the cost of new construction or remodeling, if any,) Tj ET BT 0.8066 0 0 0.9835 120 545.28 Tm 0.0482 Tc 0.8479 Tw (and ongoing operating costs. On average, existing special care units probably cost more to operate than) Tj -0.5951 -10.9816 TD 0.0613 Tc 1.7654 Tw (nonspecialized nursing home units, primarily because of the higher average staffing levels on special) Tj 0 -10.9816 TD 0.0574 Tc 0.7175 Tw (care units.) Tj ET BT 0.8915 0 0 0.9835 109.92 510.24 Tm 0.0553 Tc 0.3194 Tw (\215 Special care units ) Tj ET BT 0.8687 0 0 0.99 196.56 510.24 Tm /F7 8 Tf -0.0366 Tc 1.7255 Tw (generally have a higher) Tj 0 Tc -0.0664 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 271.44 510.24 Tm /F4 10 Tf 0.0327 Tc 1.8118 Tw (proportion of private-pay residents than nonspecialized) Tj ET BT 0.8066 0 0 0.9835 119.52 498 Tm 0.0499 Tc 1.3033 Tw (nursing home units, and the private-pay residents are often charged more for their care in the special) Tj ET BT 0.8491 0 0 0.9835 119.76 486.96 Tm 0.0483 Tc 0.0507 Tw (care unit than they would be in a nonspecialized unit.) Tj ET BT 0.9017 0 0 0.9812 90.24 470.16 Tm /F6 11 Tf -0.0252 Tc 0.63 Tw (Characteristics of Special Care Unit Residents) Tj ET BT 0.8197 0 0 0.9812 110.64 451.92 Tm 0.0259 Tc 0.2418 Tw (\215 Special care ) Tj ET BT 0.8395 0 0 0.9835 166.32 451.92 Tm /F8 10 Tf -0.0006 Tc 0.0001 Tw (unit ) Tj ET BT 0.8066 0 0 0.9835 192 451.92 Tm /F4 10 Tf 0.058 Tc 1.1382 Tw (residents are younger than other nursing home residents, and they are more likely) Tj -88.9609 -10.9816 TD 0.0602 Tc 1.21 Tw (than other nursing home residents to be male and white.) Tj ET BT 0.8056 0 0 0.9598 110.64 426.24 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 115.92 426.24 Tm /F4 10 Tf 0.0334 Tc 0.4765 Tw (Special care unit residents are more likely than other nursing home residents to have a specific) Tj 5.0877 -10.9816 TD 0.0134 Tc 0.5237 Tw (diagnosis for their dementing illness.) Tj -11.3061 -14.3981 TD 0.0226 Tc 0.6705 Tw (\215 Special care unit residents are probably somewhat more cognitively impaired and somewhat less) Tj 11.3061 -11.7137 TD 0.0285 Tc 0.3223 Tw (physically and functionally impaired than other nursing home residents with dementia) Tj ET BT 0.8056 0 0 0.9598 110.64 375.12 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8066 0 0 0.9835 115.92 375.12 Tm /F4 10 Tf 0.0589 Tc 1.3532 Tw (Special care unit residents are probably somewhat more likely than other nursing home residents with) Tj 6.2481 -11.9577 TD 0.0336 Tc 1.9372 Tw (dementia to participate in activity programs.) Tj ET BT 0.8491 0 0 0.9835 111.12 348.24 Tm 0.0342 Tc 0.2166 Tw (* Special care unit residents are more likely than other nursing home residents with dementia to fall.) Tj ET q 28.08 0 0 -6.24 91.44 334.8 cm BI /W 184 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @D 0 ?B>px?@?~???~??????? z ?<? ???>>D!??>? # ?~?_? ~?~??????? ???@#DD@ EI Q BT 0.6368 0 0 0.9835 91.44 328.56 Tm 3 Tr 0.0188 Tc 0 Tw (SOulmr!:) Tj 0 Tr ET BT 0.8066 0 0 0.9835 119.52 328.56 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 17.28 0 0 -5.76 121.68 334.32 cm BI /W 114 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID D ???>y???? ????D??? ?_??#~?~?~~?_~?<~??~?.?????O>χ'ߟ>?<G3 EI Q BT 0.467 0 0 0.9835 121.68 328.56 Tm 3 Tr -0.0037 Tc 0 Tw (CM%ce) Tj 0 Tr ET BT 0.8066 0 0 0.9835 138.96 328.56 Tm -0.0021 Tc 0.0475 Tw ( of ) Tj ET q 31.44 0 0 -7.2 150.48 334.56 cm BI /W 206 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID $2~<~>>>x@b ?||?o|?|~~~?~?~~~s?|??q~~~?|~?~_?~?_|~?~~??~?~??~??~~O???py@@fpDxp?;  EI Q BT 0.6368 0 0 0.9835 150.48 328.56 Tm 3 Tr -0.0657 Tc 0 Tw (\221lk@nology) Tj 0 Tr ET BT 0.8066 0 0 0.9835 181.92 328.56 Tm 0.0518 Tc 1.3195 Tw ( Assessment, 1992.) Tj ET BT 0.9835 0 0 0.9835 90.24 296.16 Tm 0.025 Tc -0.0683 Tw (In this context, it is interesting to note that the) Tj 243.7916 -0.7321 TD 0.033 Tc 2.5536 Tw (Because of this diversity, no single descriptive) Tj -254.2852 -11.7137 TD 0.0378 Tc 3.2504 Tw (special care unit described in box 1-A at the) Tj ET BT 0.8915 0 0 0.9835 330.48 283.2 Tm 0.0326 Tc 1.0658 Tw (statement is true of all special care units.) Tj -281.8465 -11.2256 TD 0.0451 Tc 0.4653 Tw (beginning of this chapter is technically not a separate) Tj ET BT 0.934 0 0 0.9835 79.44 260.16 Tm -0.0146 Tc 0.8314 Tw (unit, because it does not have a nurses\222 station and) Tj ET BT 0.8915 0 0 0.9835 79.92 247.92 Tm 0.0469 Tc 1.1363 Tw (other features the State requires for a nursing home) Tj -0.5384 -12.4458 TD 0.0239 Tc 0.9938 Tw (unit. That unit is viewed by the facility\222s administra-) Tj ET BT 0.934 0 0 0.9835 79.92 223.92 Tm -0.0151 Tc 0.9283 Tw (tors as a separate entity. A similar arrangement in) Tj ET BT 0.9835 0 0 0.9835 79.92 211.92 Tm 0.0235 Tc 2.8074 Tw (another nursing home might be viewed by its) Tj 0 -12.2018 TD 0.0222 Tc 1.5886 Tw (administrators as a clustering of residents with) Tj 0.244 -12.2018 TD 0.0339 Tc 0.3836 Tw (dementia in one section of a larger unit that also) Tj ET BT 0.8915 0 0 0.9835 80.4 175.92 Tm 0.0261 Tc 0.8231 Tw (serves nondemented residents, and they might report) Tj ET BT 0.934 0 0 0.9835 80.16 164.4 Tm -0.0102 Tc 0.3127 Tw (it as such on a survey questionnaire.) Tj ET BT 0.9835 0 0 0.9835 80.64 146.64 Tm 0.0306 Tc 0.0344 Tw (Characteristics of Special Care Units and Special) Tj ET BT 0.9812 0 0 0.9812 80.64 134.64 Tm /F6 11 Tf 0.0033 Tc -0.0644 Tw (Care ) Tj ET BT 0.9835 0 0 0.9835 106.08 134.64 Tm /F4 10 Tf 0.031 Tc -0.1287 Tw (Unit Residents) Tj ET BT 0.8915 0 0 0.9835 90.96 116.88 Tm 0.0291 Tc 1.0553 Tw (All studies of special care units show that existing) Tj -12.1137 -12.4458 TD 0.0459 Tc 0.7337 Tw (units are extremely diverse. They vary in their goals,) Tj ET BT 0.9835 0 0 0.9835 80.16 93.12 Tm 0.0331 Tc 1.2724 Tw (physical design features, staff-to-resident ratios,) Tj ET BT 0.8915 0 0 0.9835 80.64 80.88 Tm 0.016 Tc 1.3152 Tw (staff training programs, provision of staff and family) Tj ET BT 0.9835 0 0 0.9835 80.64 68.88 Tm 0.0234 Tc 2.9295 Tw (support groups, activity programs, use of psy-) Tj ET BT 0.934 0 0 0.9835 80.64 57.12 Tm -0.0275 Tc 2.0785 Tw (chotropic medications and physical restraints, and) Tj ET BT 0.9835 0 0 0.9835 80.64 45.12 Tm 0.0276 Tc 1.9735 Tw (admission and discharge policies and practices.) Tj 265.0227 223.7807 TD 0.0282 Tc 1.7451 Tw (On average, special care units probably have) Tj -10.9816 -11.7137 TD 0.0406 Tc 0.5936 Tw (fewer residents and more staff per resident than) Tj ET BT 0.934 0 0 0.9835 330.24 241.44 Tm -0.0056 Tc 2.3635 Tw (nonspecialized nursing home units \(291\). Staff-to-) Tj 0 -12.4458 TD -0.0228 Tc 0.5832 Tw (resident ratios vary greatly among units, however.) Tj ET BT 0.9835 0 0 0.9835 341.28 211.2 Tm 0.0314 Tc -0.0884 Tw (Most special care units provide special training) Tj ET BT 0.8915 0 0 0.9835 330.48 199.68 Tm 0.0158 Tc 0.4908 Tw (for their staff, but at least one-fourth of existing units) Tj ET BT 0.934 0 0 0.9835 330.96 187.68 Tm -0.0429 Tc 1.8895 Tw (do not provide special training. In response to the) Tj ET BT 0.9835 0 0 0.9835 331.92 175.92 Tm 0.034 Tc 2.0158 Tw (1987 National Medical Expenditure Survey, 26) Tj ET BT 0.8915 0 0 0.9835 330.48 164.16 Tm 0.0484 Tc 0.6934 Tw (percent of the nursing homes with a special care unit) Tj 0 -11.9577 TD 0.0343 Tc 1.1504 Tw (reported they did not provide special training for the) Tj ET BT 0.9835 0 0 0.9835 330.96 140.64 Tm 0.0328 Tc 0.022 Tw (unit staff \(248\). Likewise, in response to the 1990) Tj ET BT 0.8915 0 0 0.9835 331.2 128.64 Tm 0.0386 Tc 0.6745 Tw (survey of all nursing homes in 5 northeastern States,) Tj ET BT 0.934 0 0 0.9835 331.2 116.64 Tm -0.0336 Tc 1.4513 Tw (30 percent of the facilities with a special care unit) Tj ET BT 0.9835 0 0 0.9835 331.2 104.64 Tm 0.0301 Tc 0.035 Tw (and 47 percent of the facilities with a cluster unit) Tj ET BT 0.8915 0 0 0.9835 330.96 93.12 Tm 0.0343 Tc 1.1841 Tw (reported they did not provide special training for the) Tj 0.2692 -12.2018 TD 0.0135 Tc 1.1402 Tw (unit staff \(194\). Given the emphasis on staff training) Tj ET BT 0.934 0 0 0.9835 331.2 69.36 Tm -0.0263 Tc 1.5505 Tw (in the special care unit literature, the finding that) Tj ET BT 0.8915 0 0 0.9835 330.96 57.36 Tm 0.0321 Tc 0.951 Tw (more than one-fourth of existing units do not provide) Tj ET BT 0.934 0 0 0.9835 331.44 45.12 Tm -0.0215 Tc 1.0956 Tw (special training is surprising. The finding is proba-) Tj ET endstream endobj 126 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 127 0 obj <>stream 0.72 w 1 j 0 0 0 RG 56.4 687.84 m 534.96 687.84 l S BT 0.9835 0 0 0.9835 324.48 693.36 Tm 0 0 0 rg /F5 10 Tf 0.0095 Tc 2.1866 Tw (Chapter l--Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516.48 693.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 522.96 693.36 Tm /F5 11 Tf 0.2448 Tc 0 Tw (27) Tj ET BT 0.9835 0 0 0.9835 56.88 654.24 Tm /F4 10 Tf 0.0133 Tc 3.6719 Tw (bly correct, however,) Tj 111.5243 -0.244 TD 0.0133 Tc 2.3297 Tw (since nursing homes are) Tj ET BT 0.934 0 0 0.9835 56.88 642.48 Tm -0.0378 Tc 1.3701 Tw (unlikely to underreport the provision of staff train-) Tj ET BT 0.8915 0 0 0.9835 57.36 630.72 Tm 0.0193 Tc 0 Tw (ing.) Tj ET BT 0.934 0 0 0.9835 68.4 612.72 Tm -0.0317 Tc 1.5104 Tw (The most widely used physical design feature in) Tj ET BT 0.9835 0 0 0.9835 57.84 600.72 Tm 0.0101 Tc 0.9298 Tw (special care units is an alarm or locking system,) Tj ET BT 0.934 0 0 0.9835 57.6 588.72 Tm -0.0212 Tc 1.9397 Tw (found in more than three-fourths of existing units) Tj 0.5139 -11.9577 TD 0.0106 Tc 2.1534 Tw (\(181,194,247\). Although numerous physical design) Tj ET BT 0.9835 0 0 0.9835 57.6 564.96 Tm 0.0405 Tc 0.3904 Tw (features have been recommended for special care) Tj ET BT 0.8915 0 0 0.9835 57.6 552.96 Tm 0.0308 Tc 1.3227 Tw (units, most of the recommended features are used in) Tj ET BT 0.8491 0 0 0.9835 58.08 540.96 Tm 0.0354 Tc 1.6991 Tw (only a small proportion of existing units \(194,485,494\).) Tj ET BT 0.9835 0 0 0.9835 69.36 522.96 Tm 0.0285 Tc 1.2567 Tw (Some special care units have formal \(written\)) Tj ET BT 0.8915 0 0 0.9835 58.32 511.2 Tm 0.036 Tc 1.8889 Tw (admission and discharge policies, but most probably) Tj ET BT 0.9835 0 0 0.9835 58.32 498.96 Tm 0.0484 Tc 0.537 Tw (do not \(194\). In response to the 1990 study of all) Tj 0 -12.2018 TD 0.0238 Tc 0.1634 Tw (nursing homes in five northeastern States, three-) Tj T* 0.0295 Tc 1.7641 Tw (fourths of the facilities with a special care unit) Tj ET BT 0.934 0 0 0.9835 58.32 463.2 Tm -0.0535 Tc 1.7402 Tw (reported using each of three criteria to select their) Tj ET BT 0.8915 0 0 0.9835 58.32 450.96 Tm 0.0258 Tc 1.458 Tw (residents: 1\) the degree of the individual\222s dementia;) Tj ET BT 0.934 0 0 0.9835 59.04 439.2 Tm -0.0236 Tc 1.4834 Tw (2\) the individual\222s need for supervision; and 3\) the) Tj 0 -12.2018 TD -0.0083 Tc 0.7389 Tw (individual\222s behavioral symptoms \(194\). Most of the) Tj ET BT 0.9835 0 0 0.9835 59.04 415.44 Tm 0.0343 Tc 0.0307 Tw (facilities reported that they seek individuals with) Tj ET BT 0.934 0 0 0.9835 59.04 403.44 Tm -0.0223 Tc 1.1394 Tw (more rather than less severe behavioral symptoms,) Tj 0 -12.2018 TD -0.0335 Tc 1.7326 Tw (but 15 percent reported that they seek individuals) Tj ET BT 0.8915 0 0 0.9835 59.04 379.68 Tm 0.0364 Tc 1.6384 Tw (with less severe behavioral symptoms for their unit.) Tj ET BT 0.934 0 0 0.9835 59.52 367.44 Tm -0.0331 Tc 1.4935 Tw (One-third reported that the individuals they admit) Tj ET BT 0.8915 0 0 0.9835 59.28 355.44 Tm 0.0323 Tc 1.9738 Tw (must be able to ambulate independently.) Tj ET BT 0.9835 0 0 0.9835 70.56 337.92 Tm 0.0299 Tc 1.2147 Tw (Reported admission practices may or may not) Tj -11.2256 -12.4458 TD 0.0245 Tc 1.0981 Tw (reflect actual admission practices in special care) Tj ET BT 0.934 0 0 0.9835 59.76 313.68 Tm -0.0117 Tc 0.6141 Tw (units. Findings from the Multi-State Nursing Home) Tj ET BT 0.9835 0 0 0.9835 60 301.68 Tm 0.0359 Tc 3.5269 Tw (Case-Mix and Quality Demonstration-a 5-year) Tj ET BT 0.934 0 0 0.9835 60 289.92 Tm -0.0233 Tc 1.9199 Tw (congressionally mandated study that includes spe-) Tj ET BT 0.9835 0 0 0.9835 60 278.16 Tm 0.0189 Tc 1.2084 Tw (cial care unit residents among the 6800 nursing) Tj -0.244 -11.9577 TD 0.0286 Tc 0.7686 Tw (home residents in the study sample-suggest that) Tj 0.4881 -12.2018 TD 0.0184 Tc 1.2264 Tw (the major factor distinguishing special care unit) Tj ET BT 0.8915 0 0 0.9835 60 242.4 Tm 0.0274 Tc 1.7639 Tw (residents from individuals with dementia in nonspe-) Tj ET BT 0.934 0 0 0.9835 60.48 229.92 Tm -0.0301 Tc 1.4582 Tw (cialized nursing home units is the severity of their) Tj -0.5139 -11.7137 TD 0.0038 Tc 0.5976 Tw (physical impairments \(382\). Data from a subsample) Tj 0.5139 -12.4458 TD -0.0225 Tc 0.8719 Tw (of 127 special care unit residents and 103 residents) Tj 0 -12.4458 TD -0.0232 Tc 1.6114 Tw (with dementia in nonspecialized units in the same) Tj ET BT 0.8915 0 0 0.9835 60.48 182.4 Tm 0.028 Tc 1.5389 Tw (facilities indicate that individuals with severe physi-) Tj ET BT 0.9835 0 0 0.9835 60.72 170.16 Tm 0.0261 Tc 0.469 Tw (cal impairments and physical care needs are less) Tj 0 -12.2018 TD 0.0337 Tc 0.2482 Tw (likely to be admitted to special care units than to) Tj 0 -11.7137 TD 0.0328 Tc 1.773 Tw (nonspecialized units. Once other variables were) Tj 0.244 -12.4458 TD 0.032 Tc 1.0092 Tw (controlled, there was no significant difference in) Tj ET BT 0.934 0 0 0.9835 60.96 122.64 Tm -0.0259 Tc 1.3573 Tw (behavioral symptoms between the special care unit) Tj ET BT 0.9835 0 0 0.9835 60.72 110.88 Tm 0.0351 Tc 0.5644 Tw (residents and the residents with dementia in the) Tj ET BT 0.934 0 0 0.9835 60.96 98.88 Tm -0.0264 Tc 1.8718 Tw (nonspecialized units.) Tj ET BT 0.9835 0 0 0.9835 72.24 80.88 Tm 0.0307 Tc 0.7432 Tw (About half of existing special care units admit) Tj ET BT 0.934 0 0 0.9835 60.96 68.88 Tm -0.0333 Tc 1.665 Tw (residents with the expectation that the individuals) Tj ET BT 0.9835 0 0 0.9835 61.44 56.88 Tm 0.023 Tc 0.0421 Tw (will remain in the unit until they die \(194\). Other) Tj ET BT 0.934 0 0 0.9835 61.92 44.88 Tm -0.0349 Tc 0.7429 Tw (special care units admit residents with the expecta-) Tj ET BT 0.9835 0 0 0.9835 74.88 18.24 Tm 0.0585 Tc 0.5755 Tw (328-405 - 92 - 2 ) Tj ET BT 0.9939 0 0 0.9939 152.4 18.24 Tm /F2 7 Tf 0.0403 Tc -0.1013 Tw (QL ) Tj ET BT 0.99 0 0 0.99 163.92 18.24 Tm /F5 8 Tf 0.1206 Tc 0 Tw (3) Tj ET BT 0.9835 0 0 0.9835 308.4 654 Tm /F4 10 Tf 0.0275 Tc 0.2816 Tw (tion that they will be discharged from the unit at) Tj ET BT 0.8915 0 0 0.9835 308.88 642.48 Tm 0.0244 Tc 0.3674 Tw (some time prior to their death. In the latter units, the) Tj -0.8076 -12.2018 TD 0.0397 Tc 1.1444 Tw (reported reasons for discharge are: 1\) that a resident) Tj ET BT 0.9835 0 0 0.9835 308.4 618.48 Tm 0.0256 Tc 0.3648 Tw (has become nonresponsive, physically abusive, or) Tj 0.244 -12.4458 TD 0.0378 Tc 2.5895 Tw (unable to ambulate independently; 2\) that the) Tj ET BT 0.8915 0 0 0.9835 308.4 594.48 Tm 0.0344 Tc 0.612 Tw (resident needs intensive medical care; and 3\) that the) Tj 0.2692 -11.9577 TD 0.0269 Tc 1.4952 Tw (resident\222s private funds are exhausted \(194,485,492\).) Tj ET BT 0.934 0 0 0.9835 319.92 564.72 Tm -0.0281 Tc 1.2312 Tw (As noted in table 1-2, special care unit residents) Tj ET BT 0.9835 0 0 0.9835 309.36 552.72 Tm 0.0228 Tc 0.3678 Tw (are as likely or more likely than individuals with) Tj -0.244 -11.9577 TD 0.0394 Tc 1.2456 Tw (dementia in nonspecialized units to receive psy-) Tj ET BT 0.934 0 0 0.9835 309.36 528.72 Tm -0.0002 Tc 0.4562 Tw (chotropic medications \(256,292,413\). They are much) Tj ET BT 0.9835 0 0 0.9835 309.36 516.72 Tm 0.0304 Tc 2.2309 Tw (less likely to be physically restrained, however) Tj ET BT 0.934 0 0 0.9835 309.84 504.72 Tm 0.0154 Tc 2.1354 Tw (\(256,292,391,413\). A University of North Carolina) Tj ET BT 0.8915 0 0 0.9835 310.08 492.48 Tm 0.037 Tc 1.3493 Tw (study of 31 randomly selected special care units and) Tj ET BT 0.934 0 0 0.9835 309.84 480.24 Tm -0.0104 Tc 1.1939 Tw (32 matched, nonspecialized units in 5 States found) Tj ET BT 0.8915 0 0 0.9835 309.84 468.24 Tm 0.0417 Tc 0.5813 Tw (that only 16 percent of the special care unit residents) Tj ET BT 0.9835 0 0 0.9835 309.84 456.48 Tm 0.0297 Tc 1.4415 Tw (were physically restrained at one point in time,) Tj 0.4881 -12.2018 TD 0.0365 Tc 1.5739 Tw (compared with 36 percent of the residents with) Tj ET BT 0.934 0 0 0.9835 310.08 432.48 Tm -0.013 Tc 1.0866 Tw (dementia in nonspecialized units \(413\).) Tj ET BT 0.9835 0 0 0.9835 321.12 414.96 Tm 0.0229 Tc -0.0507 Tw (Finally, five studies show that special care unit) Tj -11.2256 -12.2018 TD 0.0254 Tc -0.0184 Tw (residents are significantly more likely to fall than) Tj 0.244 -12.4458 TD 0.0257 Tc 4.7087 Tw (other nursing home residents with dementia) Tj ET BT 0.934 0 0 0.9835 311.04 378.48 Tm 0.0165 Tc 0.9265 Tw (\(99,265,292,497,521\). In one study, the special care) Tj -0.7709 -11.9577 TD -0.0401 Tc 1.4296 Tw (unit residents were not only more likely to fall but) Tj 0.7709 -12.2018 TD -0.0386 Tc 0.6572 Tw (also more likely to be hospitalized for a hip fracture) Tj 0 -12.2018 TD -0.0043 Tc 1.4628 Tw (\(99\). In another study, the increase in falls among) Tj ET BT 0.9835 0 0 0.9835 311.04 330.96 Tm 0.0303 Tc 2.0074 Tw (special care unit residents did not result in an) Tj ET BT 0.8915 0 0 0.9835 311.04 319.2 Tm 0.0473 Tc 1.2032 Tw (increase in injuries due to the falls \(54\). The greater) Tj ET BT 0.934 0 0 0.9835 311.04 307.2 Tm -0.0338 Tc 1.3658 Tw (incidence of falls among special care unit residents) Tj ET BT 0.8915 0 0 0.9835 310.8 295.44 Tm 0.0365 Tc 1.1479 Tw (has received little attention thus far, in part because) Tj ET BT 0.934 0 0 0.9835 311.04 283.2 Tm -0.0293 Tc 0.6186 Tw (the relevant data from three of the studies have not) Tj ET BT 0.9835 0 0 0.9835 311.04 271.92 Tm 0.037 Tc 1.5735 Tw (yet been published. The reasons for the greater) Tj ET BT 0.934 0 0 0.9835 311.52 259.92 Tm -0.0339 Tc 1.2632 Tw (incidence of falls are not known.) Tj ET BT 0.9835 0 0 0.9835 311.76 235.68 Tm 0.0261 Tc 1.0965 Tw (Costs, Charges, and Payment Methods) Tj ET BT 0.934 0 0 0.9835 322.56 217.68 Tm -0.0246 Tc 0.6953 Tw (Very little information is available about the cost) Tj -11.563 -12.4458 TD -0.0334 Tc 1.5367 Tw (of special care units. The cost of creating a special) Tj 0 -12.2018 TD -0.0308 Tc 1.2158 Tw (care unit obviously varies, depending on the extent) Tj ET BT 0.8915 0 0 0.9835 311.76 181.68 Tm 0.039 Tc 1.3135 Tw (of new construction or remodeling, if any. One study) Tj ET BT 0.934 0 0 0.9835 311.76 169.68 Tm -0.0296 Tc 0.8107 Tw (of 12 nonrandomly selected special care units found) Tj ET BT 0.9835 0 0 0.9835 312 157.92 Tm 0.0325 Tc 0.9506 Tw (that the reported costs for new construction and) Tj -0.244 -11.9577 TD 0.0358 Tc 0.2732 Tw (remodeling ranged from $4100 to $150,000 \(275\).) Tj ET BT 0.934 0 0 0.9835 312 134.16 Tm -0.0258 Tc 1.4307 Tw (Another unit was created for $1300, which covered) Tj 0.257 -12.2018 TD -0.0221 Tc 0.6595 Tw (the cost of an alarm system, color coding, and a few) Tj 0.257 -11.9577 TD -0.0133 Tc 0.7014 Tw (other physical changes to the unit \(70\).) Tj ET BT 0.9835 0 0 0.9835 323.28 92.88 Tm 0.0306 Tc -0.0063 Tw (Most\227but not all-special care units report that) Tj ET BT 0.934 0 0 0.9835 312.48 80.88 Tm -0.0313 Tc 1.3264 Tw (their operating costs are higher than the operating) Tj ET BT 0.9835 0 0 0.9835 312.48 68.64 Tm 0.0349 Tc 1.2503 Tw (costs of nonspecialized units \(70,477,485\). Of 13) Tj ET BT 0.934 0 0 0.9835 312.48 57.12 Tm -0.0349 Tc 1.4098 Tw (nonrandomly selected special care units in Florida,) Tj ET BT 0.9835 0 0 0.9835 312.72 44.88 Tm 0.0361 Tc 0.1102 Tw (for example, 7 reported that their operating costs) Tj ET endstream endobj 128 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 129 0 obj <>stream 0.72 w 1 j 0 0 0 RG 73.2 678.24 m 551.28 678.24 l S BT 0.9835 0 0 0.9835 72.96 684.48 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (28 ) Tj ET BT 0.9598 0 0 0.9598 85.68 684.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.99 0 0 0.99 91.92 684.48 Tm /F7 8 Tf 0.0435 Tc 0.2588 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 137.28 684.48 Tm /F5 11 Tf 0.0681 Tc 0.5422 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 239.04 684.48 Tm /F5 10 Tf 0.0229 Tc 1.6239 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 73.92 644.64 Tm /F4 10 Tf -0.0347 Tc 1.1098 Tw (were higher than the operating costs of nonspecial-) Tj ET BT 0.9835 0 0 0.9835 73.92 632.64 Tm 0.033 Tc 3.1332 Tw (ized units in the same facility; 5 reported no) Tj ET BT 0.8915 0 0 0.9835 74.16 620.4 Tm 0.045 Tc 1.3595 Tw (difference in operating costs, and one reported lower) Tj ET BT 0.934 0 0 0.9835 74.4 608.4 Tm -0.0186 Tc 1.735 Tw (operating costs \(64\).) Tj ET BT 0.9835 0 0 0.9835 85.44 590.64 Tm 0.0278 Tc 1.3388 Tw (The Multi-State Nursing Home Case-Mix and) Tj -10.7376 -12.4458 TD 0.0315 Tc -0.0885 Tw (Quality Demonstration found that on average the) Tj ET BT 0.934 0 0 0.9835 74.88 566.64 Tm -0.0248 Tc 0.6816 Tw (amount of staff time spent caring for residents with) Tj ET BT 0.8915 0 0 0.9835 74.88 554.88 Tm 0.0474 Tc 0.1562 Tw (dementia was greater in the special care units than in) Tj ET BT 0.934 0 0 0.9835 74.88 542.64 Tm -0.0142 Tc 1.0879 Tw (the nonspecialized units in the study sample \(143\).) Tj 0 -11.7137 TD -0.017 Tc 0.6871 Tw (The University of North Carolina study had similar) Tj ET BT 0.9835 0 0 0.9835 74.88 518.88 Tm 0.0293 Tc 1.2327 Tw (findings \(413\). The greater amount of staff time) Tj ET BT 0.8915 0 0 0.9835 75.6 506.88 Tm 0.0395 Tc 1.3658 Tw (spent caring for special care unit residents undoubt-) Tj -0.5384 -11.9577 TD 0.0444 Tc 0.7834 Tw (edly translates into higher average operating costs in) Tj 0.2692 -12.2018 TD 0.0422 Tc 1.2089 Tw (the special care units.) Tj ET BT 0.9835 0 0 0.9835 86.4 465.6 Tm 0.0199 Tc 1.8349 Tw (Many-but not all-nursing homes charge more) Tj -10.9816 -12.2018 TD 0.0207 Tc 1.8341 Tw (for care in their special care unit than in their) Tj 0 -11.9577 TD 0.0301 Tc 0.8484 Tw (nonspecialized units \(247,256,413,477,494\). Most) Tj ET BT 0.934 0 0 0.9835 76.32 429.6 Tm -0.0347 Tc 1.8164 Tw (special care units also have a higher proportion of) Tj ET BT 0.8915 0 0 0.9835 75.6 418.08 Tm 0.0138 Tc 1.4202 Tw (private-pay residents \(292,413,477\). It is the private-) Tj 0 -12.2018 TD 0.0605 Tc 1.0089 Tw (pay residents who are charged more for their care in) Tj ET BT 0.9835 0 0 0.9835 76.32 394.32 Tm 0.0313 Tc 3.6671 Tw (a special care unit than they would be in a) Tj -0.244 -12.4458 TD 0.0276 Tc 4.5115 Tw (nonspecialized unit. To OTA\222s knowledge, no) Tj 0 -12.2018 TD 0.0181 Tc 0.7385 Tw (public program currently pays more for care in a) Tj 0.4881 -12.4458 TD 0.0254 Tc -0.123 Tw (special care unit than in a nonspecialized nursing) Tj ET BT 0.8915 0 0 0.9835 76.32 346.08 Tm 0.0344 Tc 2.2944 Tw (home unit.) Tj ET BT 0.9835 0 0 0.9835 87.36 328.08 Tm 0.028 Tc 1.8673 Tw (According to preliminary data from the 1991) Tj ET BT 0.934 0 0 0.9835 77.04 316.32 Tm -0.0015 Tc 0.3605 Tw (survey of all U.S. nursing homes with more than 30) Tj ET BT 0.8915 0 0 0.9835 76.32 304.32 Tm 0.0436 Tc 1.14 Tw (beds, about half the nursing homes with special care) Tj ET BT 0.934 0 0 0.9835 76.56 292.32 Tm -0.0299 Tc 1.1047 Tw (units charged their private-pay residents more in a) Tj ET BT 0.8915 0 0 0.9835 77.04 280.56 Tm 0.0495 Tc 0.9652 Tw (special care unit than the residents would have been) Tj 0 -11.9577 TD 0.0481 Tc 1.3032 Tw (charged in a nonspecialized unit in the same facility) Tj ET BT 0.934 0 0 0.9835 77.28 256.8 Tm 0.006 Tc 1.1305 Tw (\(246\). The excess charge averaged $9.24 a day and) Tj -0.5139 -12.2018 TD 0.0108 Tc 0.7185 Tw (ranged from $1 to $83 a day.) Tj ET BT 0.9835 0 0 0.9835 77.28 226.56 Tm 0.0411 Tc 0.5321 Tw (Effectiveness of Special Care Units) Tj 11.4697 -18.7907 TD 0.0381 Tc 1.3588 Tw (OTA is aware of 15 studies that evaluate the) Tj ET BT 0.934 0 0 0.9835 77.28 196.32 Tm -0.0399 Tc 1.4825 Tw (effectiveness of special care units for residents and) Tj 0.5139 -12.4458 TD -0.0286 Tc 0.8464 Tw (a few additional studies that evaluate the effective-) Tj -0.7709 -11.9577 TD -0.0316 Tc 0.8817 Tw (ness of special care units for residents\222 families and) Tj 0.257 -12.4458 TD -0.0217 Tc 1.463 Tw (unit staff members. These studies are discussed in) Tj ET BT 0.8915 0 0 0.9835 77.52 148.08 Tm 0.0372 Tc 1.1248 Tw (detail in chapter 4.) Tj ET BT 0.934 0 0 0.9835 88.56 130.08 Tm -0.0345 Tc 0.5443 Tw (Nine of the 15 studies did not use a control group) Tj ET BT 0.9835 0 0 0.9835 78 118.56 Tm 0.0217 Tc 1.589 Tw (\(22,24,56,88,160,171,245,297,312\). Each of these) Tj ET BT 0.934 0 0 0.9835 78 106.32 Tm -0.0422 Tc 1.5033 Tw (studies found some positive outcomes. The positive) Tj -0.257 -11.9577 TD -0.0238 Tc 0.7127 Tw (outcomes vary from one study to another, and some) Tj 0 -12.2018 TD -0.0304 Tc 0.8911 Tw (of the studies\222 findings are contradictory. Excluding) Tj ET BT 0.9835 0 0 0.9835 77.76 70.56 Tm 0.0319 Tc -0.0808 Tw (these contradictory findings, the positive resident) Tj ET BT 0.8915 0 0 0.9835 78 58.8 Tm 0.0408 Tc 1.1207 Tw (outcomes found in more than one of the nine studies) Tj ET BT 0.9835 0 0 0.9835 78.24 47.28 Tm 0.0312 Tc 2.0674 Tw (are decreased nighttime wakefulness, improved) Tj ET BT 0.8915 0 0 0.9835 77.76 35.28 Tm 0.0227 Tc 1.2607 Tw (hygiene, and weight gain. A few of the studies found) Tj ET BT 0.934 0 0 0.9835 324.72 645.12 Tm -0.0296 Tc 1.7896 Tw (improvements in the important areas of residents\222) Tj ET BT 0.9835 0 0 0.9835 325.2 632.64 Tm 0.032 Tc 2.3106 Tw (ability to perform activities of daily living and) Tj ET BT 0.934 0 0 0.9835 324.72 620.88 Tm -0.0015 Tc 0.9458 Tw (residents\222 behavioral symptoms, but an equal num-) Tj 0.257 -12.4458 TD -0.032 Tc 1.0702 Tw (ber of studies did not find such improvements.) Tj ET BT 0.8915 0 0 0.9835 336.24 588.72 Tm 0.0404 Tc 1.2445 Tw (All nine studies suffer from one or more methodo-) Tj ET BT 0.9835 0 0 0.9835 325.68 576.48 Tm 0.0365 Tc 1.3299 Tw (logical problems that could affect the validity of) Tj 0 -11.9577 TD 0.0184 Tc 0.442 Tw (their findings. One such problem is small sample) Tj ET BT 0.934 0 0 0.9835 326.16 552.72 Tm -0.0079 Tc 0.5929 Tw (sizes: 6 of the 9 studies had fewer than 12 subjects.) Tj -0.7709 -11.9577 TD -0.0353 Tc 2.6522 Tw (Another methodological problem is inadequate re-) Tj ET BT 0.9835 0 0 0.9835 326.16 528.96 Tm 0.0317 Tc 1.5788 Tw (search design and implementation. Some of the) Tj ET BT 0.934 0 0 0.9835 326.16 516.72 Tm -0.0498 Tc 0.7222 Tw (studies are more like descriptive reports than rigor-) Tj ET BT 0.9835 0 0 0.9835 326.16 504.72 Tm 0.0191 Tc 0.4412 Tw (ous research from which valid conclusions can be) Tj ET BT 0.8915 0 0 0.9835 326.16 492.96 Tm 0.0384 Tc 1.0113 Tw (drawn; in these studies, the outcomes are not clearly) Tj ET BT 0.9835 0 0 0.9835 326.4 481.2 Tm 0.033 Tc 2.3503 Tw (defined, and the measurement process is more) Tj ET BT 0.8915 0 0 0.9835 326.4 469.2 Tm 0.0348 Tc 2.2401 Tw (impressionistic than objective or standardized. Only) Tj 0.2692 -11.7137 TD 0.022 Tc 1.6017 Tw (four of the nine studies report the statistical signifi-) Tj ET BT 0.9835 0 0 0.9835 326.88 445.44 Tm 0.0211 Tc 0.9796 Tw (cance of their findings. Lack of control groups is) Tj 0 -12.2018 TD 0.0299 Tc 0.8486 Tw (another methodological problem, since without a) Tj 0 -11.9577 TD 0.0258 Tc 0.6087 Tw (control group, the impact of the special care unit) Tj ET BT 0.8915 0 0 0.9835 326.88 409.68 Tm 0.0346 Tc 1.251 Tw (cannot be separated from the impact of other factors) Tj ET BT 0.934 0 0 0.9835 327.12 397.92 Tm -0.01 Tc 0.7897 Tw (that may affect resident outcomes. Finally, many of) Tj ET BT 0.8915 0 0 0.9835 327.12 385.68 Tm 0.0292 Tc 1.3581 Tw (the studies were conducted by unit staff members or) Tj ET BT 0.934 0 0 0.9835 327.36 373.68 Tm -0.0375 Tc 1.223 Tw (other individuals who were involved in planning or) Tj 0 -12.2018 TD -0.0122 Tc 1.8994 Tw (administering the unit. These individuals have an) Tj ET BT 0.9835 0 0 0.9835 327.36 349.68 Tm 0.0296 Tc -0.1272 Tw (obvious interest in finding positive outcomes. The) Tj -0.244 -12.2018 TD 0.0443 Tc 1.3708 Tw (potentially powerful effect of their expectations,) Tj ET BT 0.934 0 0 0.9835 327.6 325.68 Tm -0.0297 Tc 1.3293 Tw (coupled with small sample sizes, lack of a rigorous) Tj ET BT 0.8915 0 0 0.9835 327.12 314.16 Tm 0.0499 Tc 1.032 Tw (research design, and lack of control groups mean the) Tj ET BT 0.9835 0 0 0.9835 327.84 301.92 Tm 0.0354 Tc 2.1242 Tw (studies\222 results\227both positive and negative-are) Tj ET BT 0.8915 0 0 0.9835 327.6 289.92 Tm 0.0497 Tc 0 Tw (questionable.) Tj ET BT 0.934 0 0 0.9835 338.88 270.24 Tm -0.0209 Tc 0.9115 Tw (Six of the 15 studies evaluating the effectiveness) Tj ET BT 0.8915 0 0 0.9835 328.08 258.24 Tm 0.0455 Tc 0.6967 Tw (of special care units for their residents used a control) Tj ET BT 0.934 0 0 0.9835 328.32 246.24 Tm -0.0367 Tc 1.369 Tw (group. Four of the six studies with a control group) Tj ET BT 0.9835 0 0 0.9835 328.08 234.24 Tm 0.031 Tc 0.0666 Tw (found no statistically significant positive resident) Tj ET BT 0.8915 0 0 0.9835 328.08 222 Tm 0.0394 Tc 1.2793 Tw (outcomes that could be attributed to the special care) Tj ET BT 0.934 0 0 0.9835 328.08 210 Tm 0.0066 Tc 0.9629 Tw (units \(80,99,195,489\). The resident outcomes meas-) Tj ET BT 0.9835 0 0 0.9835 328.08 198 Tm 0.0446 Tc 1.864 Tw (ured in one or more of these four studies were) Tj ET BT 0.934 0 0 0.9835 328.32 185.76 Tm -0.0312 Tc 0.8492 Tw (cognitive functioning, ability to perform activities of) Tj ET BT 0.8915 0 0 0.9835 328.32 174 Tm 0.0287 Tc 1.6085 Tw (daily living, mood, behavioral symptoms, and rate of) Tj 0 -11.9577 TD 0.0263 Tc 0 Tw (hospitalization.) Tj ET BT 0.934 0 0 0.9835 339.36 142.32 Tm -0.0382 Tc 0.771 Tw (Two of the six studies with a control group found) Tj ET BT 0.9835 0 0 0.9835 328.32 130.08 Tm 0.0348 Tc 0.3555 Tw (positive resident outcomes. One study found that) Tj ET BT 0.934 0 0 0.9835 328.8 118.56 Tm -0.0441 Tc 0.6916 Tw (over a l-year period, 14 residents of one special care) Tj ET BT 0.9835 0 0 0.9835 328.56 106.8 Tm 0.028 Tc 0.6471 Tw (unit declined significantly less than 14 residents) Tj ET BT 0.934 0 0 0.9835 328.8 94.8 Tm -0.0255 Tc 1.6873 Tw (with dementia in nonspecialized units of the same) Tj 0 -11.7137 TD -0.034 Tc 1.1412 Tw (facility in their ability to perform activities of daily) Tj ET BT 0.8915 0 0 0.9835 329.04 71.04 Tm 0.0232 Tc 1.2638 Tw (living \(392\). The other study found that 13 residents) Tj 0 -11.9577 TD 0.0487 Tc 1.5862 Tw (of one special care unit exhibited significantly fewer) Tj T* 0.0346 Tc 1.8904 Tw (catastrophic reactions than 9 residents with demen-) Tj T* 0.0304 Tc 1.3231 Tw (tia in nonspecialized units of the same facility \(265\).) Tj ET endstream endobj 130 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 131 0 obj <>stream 0.48 w 1 j 0 0 0 RG 58.8 685.68 m 536.4 685.68 l S BT 0.9835 0 0 0.9835 325.68 691.2 Tm 0 0 0 rg /F5 10 Tf 0.0133 Tc 1.7314 Tw (Chapter 1--Overview and Policy Implications .) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 524.4 691.2 Tm /F5 11 Tf 0.2448 Tc 0 Tw (29) Tj ET BT 0.8915 0 0 0.9835 58.56 652.8 Tm /F4 10 Tf 0.0292 Tc 0.2065 Tw (In the latter study, the special care unit residents also) Tj ET BT 0.9835 0 0 0.9835 58.8 640.8 Tm 0.0179 Tc 0.1287 Tw (interacted significantly more with staff members,) Tj ET BT 0.934 0 0 0.9835 58.56 629.04 Tm -0.0336 Tc 0.8774 Tw (but there was no effect of the unit on the residents\222) Tj 0.5139 -12.2018 TD -0.0308 Tc 1.4055 Tw (ability to perform activities of daily living.) Tj ET BT 0.8915 0 0 0.9835 69.84 597.36 Tm 0.0254 Tc 0.8688 Tw (The samples for the six studies that used a control) Tj -11.5754 -12.2018 TD 0.0419 Tc 0.1325 Tw (group are larger than the samples for the nine studies) Tj ET BT 0.9835 0 0 0.9835 59.28 573.6 Tm 0.0241 Tc 1.2816 Tw (that did not use a control group. Their research) Tj ET BT 0.934 0 0 0.9835 59.28 561.36 Tm -0.0266 Tc 1.6579 Tw (design and implementation are more rigorous, and) Tj 0 -12.2018 TD -0.0428 Tc 1.5957 Tw (the study outcomes are more precisely defined and) Tj 0 -11.7137 TD -0.0327 Tc 0.9793 Tw (measured. Use of a control group also increases the) Tj ET BT 0.9835 0 0 0.9835 59.04 525.6 Tm 0.0304 Tc 0.6737 Tw (presumed validity of their findings. On the other) Tj ET BT 0.934 0 0 0.9835 59.52 513.84 Tm -0.0292 Tc 0.7613 Tw (hand, each of the studies has one or more methodo-) Tj 0.257 -12.2018 TD -0.032 Tc 1.2676 Tw (logical problems that could affect the validity of its) Tj 0 -12.4458 TD -0.014 Tc 1.3446 Tw (findings. Although the study samples are, on aver-) Tj ET BT 0.8915 0 0 0.9835 60 477.6 Tm 0.028 Tc 0.3276 Tw (age, larger than the study samples in the nine studies) Tj -0.2692 -11.9577 TD 0.0251 Tc 0.8512 Tw (that did not use a control group, some of the samples) Tj ET BT 0.9835 0 0 0.9835 60.24 454.08 Tm 0.0259 Tc 2.8747 Tw (are still quite small. Selection bias is another) Tj ET BT 0.934 0 0 0.9835 59.76 442.08 Tm -0.0312 Tc 0.7206 Tw (problem that could affect the validity of the studies\222) Tj 0.5139 -11.9577 TD -0.0263 Tc 1.7111 Tw (findings. If the special care unit residents and the) Tj ET BT 0.8915 0 0 0.9835 60 418.32 Tm 0.0324 Tc 1.4891 Tw (control group subjects differed in significant ways at) Tj 0.5384 -12.2018 TD 0.0187 Tc 0.6969 Tw (the start of the studies, these differences, rather than) Tj ET BT 0.934 0 0 0.9835 60.24 394.32 Tm -0.0329 Tc 0.3941 Tw (the impact of the special care unit, could account for) Tj 0.257 -12.2018 TD -0.0231 Tc 2.5363 Tw (the observed outcomes. Randomization of subjects) Tj ET BT 0.8915 0 0 0.9835 60.48 370.08 Tm 0.0558 Tc 0.7898 Tw (to the special care unit or control group would be the) Tj ET BT 0.9835 0 0 0.9835 60.48 358.56 Tm 0.0315 Tc 2.9038 Tw (ideal way to address this problem, but family) Tj ET BT 0.934 0 0 0.9835 60.24 346.32 Tm -0.0582 Tc 0 Tw (preferences,) Tj 65.7806 -0.4881 TD -0.0138 Tc 3.657 Tw (subject attrition,) Tj ET BT 0.9835 0 0 0.9835 205.44 345.6 Tm 0.0345 Tc 1.942 Tw (and other factors) Tj -147.1535 -11.4697 TD 0.0413 Tc 1.3251 Tw (interfered with randomization in one of the two) Tj ET BT 0.934 0 0 0.9835 61.2 322.32 Tm -0.0108 Tc 1.1944 Tw (studies in which it was attempted \(265,489\). Other) Tj -0.7709 -12.2018 TD -0.0325 Tc 0.8505 Tw (methodological problems that could affect the valid-) Tj 0.5139 -12.2018 TD -0.0323 Tc 1.2678 Tw (ity of the studies\222 findings are discussed in chapter) Tj ET BT 0.8915 0 0 0.9835 60.48 286.56 Tm 0.1346 Tc 0 Tw (4.) Tj ET BT 0.9835 0 0 0.9835 72 266.64 Tm 0.0404 Tc 0.4893 Tw (Four studies evaluate the effect of special care) Tj -11.2256 -12.4458 TD 0.0294 Tc 1.1473 Tw (units on the unit staff over time. Three of these) Tj 0.244 -12.2018 TD 0.0302 Tc 2.2637 Tw (studies found no statistically significant effects) Tj 0.244 -12.2018 TD 0.023 Tc 0.8963 Tw (\(81,88,195\). The fourth study found a significant) Tj ET BT 0.934 0 0 0.9835 60.72 218.64 Tm -0.0202 Tc 1.1906 Tw (reduction in stress among 15 special care unit staff) Tj ET BT 0.8915 0 0 0.9835 61.2 206.64 Tm 0.0489 Tc 1.235 Tw (members and a significant difference on one of three) Tj ET BT 0.9835 0 0 0.9835 61.2 194.4 Tm 0.0369 Tc 0.3185 Tw (indicators of burnout between the 15 special care) Tj 0 -12.2018 TD 0.0256 Tc 3.6071 Tw (unit staff members and 49 staff members on) Tj ET BT 0.8915 0 0 0.9835 61.2 170.64 Tm 0.0319 Tc 1.8934 Tw (nonspecialized nursing home units \(265\). This study) Tj 0.2692 -12.4458 TD 0.0306 Tc 1.9398 Tw (also found a statistically significant improvement in) Tj ET BT 0.934 0 0 0.9835 61.44 146.64 Tm -0.0301 Tc 0.905 Tw (the scores of the special care unit staff members on) Tj ET BT 0.9835 0 0 0.9835 61.44 134.64 Tm 0.0317 Tc 0.1757 Tw (one of six indicators of job satisfaction. The study) Tj ET BT 0.934 0 0 0.9835 61.44 122.88 Tm -0.0358 Tc 0.9825 Tw (found no other significant effects of the special care) Tj -0.257 -12.2018 TD -0.009 Tc 0.5317 Tw (unit on staff stress, burnout, or job satisfaction.) Tj ET BT 0.9835 0 0 0.9835 72.48 90.96 Tm 0.0382 Tc 0.4985 Tw (Three studies measured staff knowledge about) Tj -10.9816 -12.2018 TD 0.0318 Tc 0.9513 Tw (dementia \(81,88,265\). In each of the studies, the) Tj 0.244 -12.2018 TD 0.0243 Tc 0.5289 Tw (special care unit staff members received training) Tj 0 -11.9577 TD 0.0393 Tc 1.8152 Tw (about dementia. None of the studies found any) Tj ET BT 0.934 0 0 0.9835 61.92 43.2 Tm -0.0233 Tc 1.3032 Tw (statistically significant effect of the trainin) Tj 204.2797 0.4881 TD -0.025 Tc 0.971 Tw (g on the) Tj ET BT 0.9835 0 0 0.9835 310.32 652.32 Tm 0.0283 Tc 0.2401 Tw (special care unit staff members\222 knowledge about) Tj ET BT 0.934 0 0 0.9835 309.84 640.56 Tm -0.0151 Tc 0.8319 Tw (dementia \(see ch. 4\).) Tj ET BT 0.9835 0 0 0.9835 321.12 619.92 Tm 0.0404 Tc 0.4544 Tw (Four studies evaluate the effect of special care) Tj -11.2256 -12.4458 TD 0.0265 Tc 0.5165 Tw (units on residents\222 families over time. Two of the) Tj ET BT 0.934 0 0 0.9835 310.32 595.92 Tm -0.0264 Tc 0.7583 Tw (four studies found no statistically significant effects) Tj ET BT 0.9835 0 0 0.9835 310.8 583.92 Tm 0.0339 Tc 2.0299 Tw (\(76,265\). One of the remaining studies found a) Tj ET BT 0.934 0 0 0.9835 310.8 571.92 Tm -0.0119 Tc 1.0854 Tw (significant increase in family members\222 satisfaction) Tj ET BT 0.9835 0 0 0.9835 310.56 560.16 Tm 0.0354 Tc 3.1439 Tw (with the care provided for their relative with) Tj ET BT 0.934 0 0 0.9835 310.32 548.16 Tm -0.0354 Tc 0.8537 Tw (dementia over the 3-month period after the individ-) Tj ET BT 0.9835 0 0 0.9835 310.56 536.16 Tm 0.0303 Tc 0.6583 Tw (ual was admitted to a special care unit \(88\). The) Tj ET BT 0.934 0 0 0.9835 310.8 524.16 Tm -0.02 Tc 1.4978 Tw (other study found a significant reduction in family) Tj -0.257 -11.9577 TD -0.0225 Tc 1.2252 Tw (members\222 feelings of anxiety, depression, guilt, and) Tj ET BT 0.8915 0 0 0.9835 311.04 499.92 Tm 0.0283 Tc 1.0322 Tw (grief after their relative with dementia was admitted) Tj ET BT 0.9835 0 0 0.9835 311.04 487.92 Tm 0.0335 Tc 0.0213 Tw (to a special care unit \(489\). One descriptive study) Tj 0 -11.9577 TD 0.0343 Tc 0.7047 Tw (found that families of special care unit residents) Tj 0 -12.2018 TD 0.0247 Tc 2.9688 Tw (were significantly more likely than families of) Tj ET BT 0.934 0 0 0.9835 311.04 452.4 Tm -0.0306 Tc 2.1333 Tw (residents with dementia in nonspecialized nursing) Tj ET BT 0.8915 0 0 0.9835 311.04 440.64 Tm 0.0344 Tc 0.7391 Tw (home units to visit their relative regularly \(413\). It is) Tj 0 -12.2018 TD 0.0397 Tc 0.9426 Tw (not clear whether the latter finding is attributable to) Tj ET BT 0.934 0 0 0.9835 311.28 416.64 Tm -0.0452 Tc 1.2923 Tw (the effect of the special care units or to preexisting) Tj ET BT 0.9835 0 0 0.9835 311.52 404.64 Tm 0.0434 Tc 1.9737 Tw (differences between the two groups of families,) Tj ET BT 0.934 0 0 0.9835 311.28 392.64 Tm -0.049 Tc 0 Tw (however.) Tj ET BT 0.9835 0 0 0.9835 322.56 371.52 Tm 0.0475 Tc -0.115 Tw (A few of the 15 evaluative studies had negative) Tj -10.9816 -12.2018 TD 0.0304 Tc 0.116 Tw (findings. Maas and Buckwalter report a trend for) Tj 0 -12.2018 TD 0.0323 Tc 0.3987 Tw (individuals with dementia to become more active) Tj ET BT 0.8915 0 0 0.9835 312 335.52 Tm 0.0315 Tc 0.6825 Tw (after being admitted to a special care unit \(265\). This) Tj ET BT 0.934 0 0 0.9835 312 323.52 Tm -0.0317 Tc 1.6719 Tw (increased activity includes both positive behaviors,) Tj ET BT 0.8915 0 0 0.9835 312.24 311.28 Tm 0.0287 Tc 0.9549 Tw (such as interacting with staff members, and negative) Tj ET BT 0.8491 0 0 0.9835 311.76 299.52 Tm 0.0162 Tc 2.0514 Tw (behaviors, such as noisiness, restlessness, and scream-) Tj ET BT 0.934 0 0 0.9835 312 287.76 Tm -0.0141 Tc 0.4597 Tw (ing. Bullock et al. found an increase in verbal abuse) Tj 0.257 -12.2018 TD -0.033 Tc 1.4383 Tw (and resistiveness over time among the special care) Tj ET BT 0.8915 0 0 0.9835 312 263.76 Tm 0.0057 Tc 1.9228 Tw (unit residents they studied \(56\).) Tj ET BT 0.9835 0 0 0.9835 323.28 242.64 Tm 0.0227 Tc 0 Tw (Ins) Tj ET BT 0.8915 0 0 0.9835 338.4 242.64 Tm 0.0274 Tc 1.1101 Tw (ummary, only two of the six evaluative studies) Tj -29.073 -12.2018 TD 0.0319 Tc 0.9849 Tw (that used a control group found any positive resident) Tj ET BT 0.934 0 0 0.9835 312.48 218.88 Tm -0.0267 Tc 1.7115 Tw (outcomes. Only one of the four studies that evalu-) Tj 0 -12.2018 TD -0.0301 Tc 0.7451 Tw (ated the effect of special care units on the unit staff) Tj ET BT 0.9835 0 0 0.9835 312.48 195.12 Tm 0.0404 Tc 0.5328 Tw (found any positive outcomes, and only two of the) Tj ET BT 0.934 0 0 0.9835 312.48 183.12 Tm -0.0349 Tc 0.7567 Tw (four studies that evaluated the effect of special care) Tj ET BT 0.9835 0 0 0.9835 312.48 171.12 Tm 0.0322 Tc 2.7171 Tw (units on residents\222 families found any positive) Tj ET BT 0.934 0 0 0.9835 312.72 159.12 Tm -0.0346 Tc 1.4095 Tw (outcomes. For most outcomes, the positive findings) Tj ET BT 0.8915 0 0 0.9835 312.72 147.12 Tm 0.0326 Tc 0.9505 Tw (of one study are contradicted by the findings of other) Tj ET BT 0.934 0 0 0.9835 312.96 135.36 Tm -0.0319 Tc 1.8777 Tw (studies. Moreover, some of the statistically signifi-) Tj -0.257 -11.7137 TD -0.0344 Tc 0.7424 Tw (cant positive findings in these studies are relatively) Tj ET BT 0.9835 0 0 0.9835 312.72 111.6 Tm 0.0383 Tc 2.8228 Tw (trivial, and a few of the studies had negative) Tj ET BT 0.8915 0 0 0.9835 312.72 100.08 Tm 0.2376 Tc 0 Tw (findings.) Tj ET BT 0.9835 0 0 0.9835 323.76 79.2 Tm 0.0372 Tc 1.1897 Tw (The limited positive findings in some of these) Tj ET BT 0.934 0 0 0.9835 312.96 67.2 Tm -0.0277 Tc 1.4327 Tw (evaluative studies and the lack of positive findings) Tj 0.257 -11.9577 TD -0.0397 Tc 1.4823 Tw (in other studies are surprising. After reporting the) Tj ET BT 0.9835 0 0 0.9835 312.96 43.92 Tm 0.0375 Tc 1.0036 Tw (lack of positive findings in a study of families of) Tj ET endstream endobj 132 0 obj <>/Rotate 0/Type/Page>> endobj 133 0 obj <>stream 0.48 w 1 j 0 0 0 RG 73.44 678.72 m 551.52 678.72 l S 0.72 w 78.96 47.76 m 557.28 47.76 l S BT 0.9835 0 0 0.9835 73.44 684.72 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (30 ) Tj ET BT 0.9598 0 0 0.9598 85.92 684.72 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 92.16 684.72 Tm /F5 10 Tf 0.0065 Tc 0.0544 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 146.16 684.72 Tm /F5 11 Tf 0.0745 Tc 0.0465 Tw (Units for People with ) Tj ET BT 0.9835 0 0 0.9835 243.6 684.72 Tm /F5 10 Tf 0.0229 Tc 0.4038 Tw (Alzheimer\222s and Other Dementias) Tj -172.0451 -41.242 TD /F4 10 Tf 0.0259 Tc 1.5848 Tw (special care unit residents, one researcher com-) Tj ET BT 0.8915 0 0 0.9835 74.16 632.16 Tm -0.0021 Tc 0 Tw (mented:) Tj 23.4199 -17.8146 TD 0.0258 Tc -0.0514 Tw (Finally, I am left ) Tj ET BT 0.8719 0 0 0.9939 167.76 614.64 Tm /F2 7 Tf 0.0107 Tc -0.1111 Tw (trying ) Tj ET BT 0.8915 0 0 0.9835 184.8 614.64 Tm /F4 10 Tf 0.0481 Tc 0.0358 Tw (to reconcile these results,) Tj -111.9848 -11.2256 TD 0.0449 Tc 0.0906 Tw (showing no special care unit superiority, with the) Tj ET BT 0.934 0 0 0.9835 84.48 592.56 Tm -0.0267 Tc 0.6975 Tw (palpable sense of excitement, of mission, and of) Tj ET BT 0.8491 0 0 0.9835 84.48 581.52 Tm 0.0437 Tc 0.2132 Tw (relief that the special care unit families, but not the) Tj 0.5653 -11.2256 TD 0.0297 Tc 1.2818 Tw (other families, show) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.8971 0 0 0.9835 170.4 570.48 Tm /F5 10 Tf -0.0352 Tc 0 Tw (\(76\).) Tj ET BT 0.9835 0 0 0.9835 85.92 552 Tm /F4 10 Tf 0.0134 Tc 2.4516 Tw (This comment mirrors the response of many) Tj ET BT 0.934 0 0 0.9835 74.88 540 Tm -0.032 Tc 0.7536 Tw (researchers and others to whom OTA has spoken in) Tj ET BT 0.9835 0 0 0.9835 75.6 528 Tm 0.0193 Tc 0.2899 Tw (the course of this study: that is, surprise that the) Tj ET BT 0.934 0 0 0.9835 75.6 516 Tm -0.0298 Tc 1.9183 Tw (evaluative studies conducted thus far generally do) Tj ET BT 0.8915 0 0 0.9835 75.6 504.48 Tm 0.0219 Tc 1.3326 Tw (not show the positive outcomes they expected to find) Tj ET BT 0.934 0 0 0.9835 75.84 492 Tm -0.0138 Tc 0.6249 Tw (and thought they had observed informally.) Tj 11.563 -19.0348 TD -0.0286 Tc 1.0177 Tw (Methodological problems may account in part for) Tj ET BT 0.9835 0 0 0.9835 75.84 461.28 Tm 0.0487 Tc 0.6396 Tw (the failure of some of the studies to find positive) Tj 0.4881 -12.4458 TD 0.0213 Tc 2.9723 Tw (outcomes. Small sample sizes are a particular) Tj -0.244 -11.7137 TD 0.0273 Tc 0.1598 Tw (problem because studies with very small samples) Tj 0.244 -12.2018 TD 0.024 Tc 3.0509 Tw (lack the statistical power to detect small, but) Tj ET BT 0.934 0 0 0.9835 76.56 413.52 Tm -0.0198 Tc 2.5071 Tw (clinically significant, positive outcomes \(279\).) Tj 12.0769 -19.0348 TD -0.0307 Tc 2.3903 Tw (In addition to methodological problems, numer-) Tj -11.82 -12.2018 TD -0.0342 Tc 2.7024 Tw (ous difficult conceptual and methodological issues) Tj 0 -11.9577 TD -0.0367 Tc 1.4974 Tw (complicate the process of designing and conducting) Tj ET BT 0.9835 0 0 0.9835 77.52 359.04 Tm 0.0217 Tc 0.0638 Tw (special care unit research. Table 1-3 lists many of) Tj -0.244 -12.4458 TD 0.0279 Tc 0.027 Tw (these issues, some of which are discussed in more) Tj ET BT 0.934 0 0 0.9835 77.28 335.28 Tm -0.0328 Tc 0.7652 Tw (detail in appendix B.) Tj ET BT 0.9835 0 0 0.9835 88.56 316.32 Tm 0.0375 Tc 0.304 Tw (Citing these methodological problems and con-) Tj ET BT 0.8915 0 0 0.9835 77.52 304.32 Tm 0.0355 Tc 2.3471 Tw (ceptual and methodological issues, some commenta-) Tj ET BT 0.934 0 0 0.9835 77.76 292.8 Tm -0.0252 Tc 1.8338 Tw (tors discount the findings of the available studies.) Tj -0.257 -12.4458 TD -0.0296 Tc 0.7511 Tw (They imply that no credible research has been done) Tj 0.257 -12.2018 TD -0.0246 Tc 0.4823 Tw (on special care units or that the studies that had no) Tj 0 -11.9577 TD -0.0186 Tc 0.8785 Tw (positive findings had no findings at all.) Tj ET BT 0.9835 0 0 0.9835 89.04 238.32 Tm 0.0206 Tc -0.0266 Tw (In contrast, OTA concludes that at least the six) Tj -11.2256 -12.2018 TD 0.035 Tc 1.0874 Tw (evaluative studies that used a control group are) Tj ET BT 0.8915 0 0 0.9835 78.24 214.32 Tm 0.0632 Tc 0.9759 Tw (credible studies in an area in which good research is) Tj ET BT 0.934 0 0 0.9835 78.24 202.08 Tm -0.04 Tc 1.5928 Tw (difficult to design and conduct. These studies were) Tj ET BT 0.9835 0 0 0.9835 78.24 190.08 Tm 0.0342 Tc 0.7466 Tw (carefully designed and implemented. The special) Tj ET BT 0.8915 0 0 0.9835 78.48 178.08 Tm 0.0378 Tc 1.2139 Tw (care units they studied incorporated the patient care) Tj ET BT 0.934 0 0 0.9835 78.24 166.08 Tm -0.0159 Tc 1.8606 Tw (philosophies, staff training, activity programs, and) Tj ET BT 0.8915 0 0 0.9835 78.48 153.84 Tm 0.0411 Tc 1.5242 Tw (physical design features recommended in the special) Tj 0.2692 -12.2018 TD 0.038 Tc 1.4155 Tw (care unit literature. Only one of the studies success-) Tj 0 -12.2018 TD 0.0395 Tc 0.6736 Tw (fully randomized subjects to the special care unit and) Tj 0 -11.7137 TD 0.0309 Tc 0.5486 Tw (the control group, but the other studies used accepted) Tj ET BT 0.934 0 0 0.9835 79.2 106.32 Tm -0.0447 Tc 0.992 Tw (statistical methods to correct for pre-existing differ-) Tj ET BT 0.9835 0 0 0.9835 78.96 94.32 Tm 0.029 Tc 2.4183 Tw (ences among the subjects that could affect the) Tj ET BT 0.8915 0 0 0.9835 79.2 82.56 Tm 0.0263 Tc 1.7651 Tw (outcomes. Although each of the studies has method-) Tj ET BT 0.934 0 0 0.9835 79.2 70.56 Tm -0.0402 Tc 1.4369 Tw (ological problems, it is unlikely the lack of positive) Tj 0 -12.2018 TD -0.0434 Tc 1.89 Tw (findings is due entirely to these problems. Despite) Tj 262.8655 595.9351 TD -0.0322 Tc 2.6489 Tw (methodological problems, the studies\222 findings are) Tj ET BT 0.9835 0 0 0.9835 325.2 632.64 Tm 0.0333 Tc 0.8451 Tw (meaningful and deserve careful consideration by) Tj ET BT 0.934 0 0 0.9835 325.2 620.88 Tm -0.0302 Tc 0 Tw (policymakers,) Tj ET BT 0.9835 0 0 0.9835 394.8 621.12 Tm 0.0298 Tc 3.045 Tw (special care unit advocates, and) Tj ET BT 0.8915 0 0 0.9835 325.44 608.88 Tm 0.0235 Tc 0 Tw (others.) Tj ET BT 0.934 0 0 0.9835 336.72 590.16 Tm -0.0214 Tc 0.9243 Tw (It is important to note that none of the available) Tj -11.306 -12.4458 TD -0.0397 Tc 0.7114 Tw (studies directly measured the impact of special care) Tj ET BT 0.9835 0 0 0.9835 325.92 566.16 Tm 0.0279 Tc 0.0779 Tw (units on residents\222 quality of life. ) Tj ET BT 0.9812 0 0 0.9812 480.24 566.16 Tm /F5 11 Tf 0.0845 Tc 0.0159 Tw (Quality of life ) Tj ET BT 0.9835 0 0 0.9835 544.56 566.16 Tm /F4 10 Tf 0.0124 Tc 0 Tw (is) Tj -222.0724 -12.2018 TD 0.0387 Tc 1.523 Tw (difficult to define operationally and particularly) Tj ET BT 0.934 0 0 0.9835 326.16 541.92 Tm -0.0254 Tc 2.299 Tw (difficult to measure in individuals with dementia.) Tj ET BT 0.8915 0 0 0.9835 326.64 530.4 Tm 0.0514 Tc 0.963 Tw (Several of the clinicians who reviewed this report for) Tj ET BT 0.9835 0 0 0.9835 326.88 518.16 Tm 0.0271 Tc 0.2821 Tw (OTA pointed out, however, that improvements in) Tj ET BT 0.934 0 0 0.9835 326.16 506.4 Tm -0.0273 Tc 0.8082 Tw (residents\222 quality of life maybe the primary positive) Tj 0.7709 -12.2018 TD -0.0353 Tc 1.3032 Tw (outcome of special care units.) Tj ET BT 0.8915 0 0 0.9835 337.68 475.68 Tm 0.0262 Tc 1.0249 Tw (Finally, for policy purposes, it is important to note) Tj -12.1137 -12.4458 TD 0.0373 Tc 1.2914 Tw (that the available evaluative studies provide little or) Tj ET BT 0.934 0 0 0.9835 327.12 451.68 Tm -0.0317 Tc 2.263 Tw (no information about the effectiveness of different) Tj 0.257 -12.2018 TD -0.0344 Tc 1.3986 Tw (types of special care units or particular features in) Tj ET BT 0.9835 0 0 0.9835 327.84 427.44 Tm 0.0285 Tc 1.5517 Tw (special care units. In each of the six evaluative) Tj ET BT 0.934 0 0 0.9835 327.84 415.68 Tm -0.0355 Tc 1.3034 Tw (studies with a control group, the special care units) Tj ET BT 0.9835 0 0 0.9835 327.6 403.68 Tm 0.0303 Tc 2.8005 Tw (differed in many ways from the control group) Tj ET BT 0.934 0 0 0.9835 328.08 393.36 Tm -0.0177 Tc 0 Tw (settings.) Tj ET BT 0.9557 0 0 1.08 365.52 398.16 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (10 ) Tj ET BT 0.934 0 0 0.9835 371.28 393.36 Tm /F4 10 Tf -0.0354 Tc 0.7067 Tw (It is unclear whether the overall milieu of) Tj ET BT 0.9835 0 0 0.9835 327.84 379.92 Tm 0.0248 Tc 0.3657 Tw (the special care units or their particular features) Tj 0.4881 -12.4458 TD 0.0214 Tc 3.2976 Tw (account for the studies\222 findings. If particular) Tj ET BT 0.8915 0 0 0.9835 328.32 355.92 Tm 0.0436 Tc 1.3419 Tw (features account for the findings, it is unclear which) Tj ET BT 0.8491 0 0 0.9835 328.32 343.92 Tm 0.0559 Tc 0 Tw (features.) Tj ET BT 0.9835 0 0 0.9835 339.12 325.2 Tm 0.0274 Tc 0.2584 Tw (The only evaluative study with a control group) Tj ET BT 0.8915 0 0 0.9835 328.32 313.2 Tm 0.031 Tc 0.9523 Tw (that found a significant effect of the special care unit) Tj 0.2692 -12.2018 TD 0.033 Tc 1.2529 Tw (on the residents\222 ability to perform activities of daily) Tj ET BT 0.9835 0 0 0.9835 328.56 289.68 Tm 0.0298 Tc -0.0461 Tw (living focused on a unit that was created with the) Tj 0.4881 -12.2018 TD 0.0315 Tc 0.1149 Tw (addition of an activity room but no other physical) Tj ET BT 0.934 0 0 0.9835 328.8 265.68 Tm -0.0065 Tc 0.7713 Tw (design changes \(392\). The distinguishing character-) Tj ET BT 0.8915 0 0 0.9835 329.04 253.92 Tm 0.0409 Tc 0.6988 Tw (istics of the unit, in the view of the researchers, were) Tj ET BT 0.9835 0 0 0.9835 329.04 242.16 Tm 0.0346 Tc 3.813 Tw (the staff\222s efforts to accomplish the following) Tj ET BT 0.934 0 0 0.9835 329.04 230.16 Tm -0.0247 Tc 0 Tw (objectives:) Tj 12.3339 -19.2788 TD -0.0415 Tc 2.3163 Tw (. to identify residents\222 specific cognitive impair-) Tj ET BT 0.8915 0 0 0.9835 350.88 199.68 Tm -0.0154 Tc 0 Tw (ments,) Tj ET BT 0.9835 0 0 0.9835 340.8 186.24 Tm 0.0296 Tc 0.5236 Tw (. to treat depression, delusions, and hallucina-) Tj ET BT 0.8915 0 0 0.9835 351.36 174.72 Tm -0.0003 Tc 0 Tw (tions,) Tj ET BT 0.9835 0 0 0.9835 341.04 161.76 Tm 0.0372 Tc 0.1091 Tw (. to identify medication side effects,) Tj ET BT 0.9207 0 0 0.9598 341.04 148.8 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.934 0 0 0.9835 347.04 148.8 Tm /F4 10 Tf -0.0154 Tc 1.4746 Tw (to maintain residents\222 physical health,) Tj -6.4239 -12.6899 TD -0.0299 Tc 1.1368 Tw (. to reduce the use of physical restraints, and) Tj 0 -12.6899 TD -0.0388 Tc 1.6281 Tw (. to increase residents\222 participation in activities) Tj 11.82 -10.7376 TD 0.0551 Tc 0 Tw (\(392\).) Tj -12.0769 -18.7907 TD -0.0244 Tc 0.952 Tw (The ongoing involvement of a psychiatrist on the) Tj ET BT 0.9835 0 0 0.9835 330.48 82.56 Tm 0.0331 Tc 1.0405 Tw (staff also seems to be unique to this study. It is) Tj -0.4881 -11.7137 TD 0.0135 Tc 0.4469 Tw (unclear which, if any, of these characteristics are) Tj 0.244 -12.4458 TD 0.0293 Tc 1.8253 Tw (different enough from the characteristics of the) Tj ET BT 0.9266 0 0 0.99 93.6 36.48 Tm /F7 8 Tf -0.1145 Tc 0.1958 Tw (10 ) Tj ET q 16.8 0 0 -5.28 103.2 40.08 cm BI /W 97 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|?<?>??|?<?>????0???8??|???|~?>x?>>???? ???????8 EI Q BT 0.8687 0 0 0.99 103.2 36.48 Tm 3 Tr -0.0313 Tc 0 Tw (Table) Tj 0 Tr ET BT 0.9266 0 0 0.99 120 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 9.84 0 0 -5.04 121.68 40.08 cm BI /W 58 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>$<|<px<??? EI Q BT 0.9266 0 0 0.99 121.68 36.48 Tm 3 Tr -0.0522 Tc 0 Tw (4.2) Tj 0 Tr 10.6193 0 TD 0 Tc 0.0723 Tw ( ) Tj ET q 5.76 0 0 -5.28 133.2 40.08 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>>>>>>>>>>>~? EI Q BT 1.2162 0 0 0.99 133.2 36.48 Tm 3 Tr -0.0216 Tc 0 Tw (~) Tj 0 Tr ET BT 0.9266 0 0 0.99 138.96 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 8.64 0 0 -5.28 140.64 40.08 cm BI /W 50 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~?|~||||||~~|x|||<|>@?? EI Q BT 0.6949 0 0 0.99 140.64 36.48 Tm 3 Tr -0.0137 Tc 0 Tw (Ch.) Tj 0 Tr ET BT 0.9266 0 0 0.99 149.28 36.48 Tm -0.1145 Tc 0.1958 Tw ( 4 ) Tj ET q 11.76 0 0 -5.28 156.96 40.08 cm BI /W 69 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ;?>><<88?0???>0>p<p>??p? EI Q BT 0.8687 0 0 0.99 156.96 36.48 Tm 3 Tr -0.0154 Tc 0 Tw (fists) Tj 0 Tr ET BT 0.9266 0 0 0.99 168.72 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 8.88 0 0 -5.28 170.4 42 cm BI /W 52 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |7?>>>>>>?p>>>p>>>>>>>><>><>>?>>?>>?>>>>||~> EI Q BT 1.1003 0 0 0.99 170.4 36.48 Tm 3 Tr -0.0744 Tc 0 Tw (he) Tj 0 Tr ET BT 0.9266 0 0 0.99 179.28 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 24.48 0 0 -6.96 180.96 41.76 cm BI /W 140 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?????|??~|>?|>?|>a|<|<|><|?|||??|??x?>`|><~ ?? EI Q BT 0.99 0 0 0.99 180.96 36.48 Tm 3 Tr 0.048 Tc 0 Tw (ch~ges) Tj 0 Tr ET BT 0.9266 0 0 0.99 205.44 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 11.04 0 0 -5.28 207.12 42 cm BI /W 64 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?>~>|||~|||||<||>||||||||||?||<||>||>~|< p0?? EI Q BT 1.6216 0 0 0.99 207.12 36.48 Tm 3 Tr -0.0037 Tc 0 Tw (tit) Tj 0 Tr ET BT 0.9266 0 0 0.99 218.16 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 14.64 0 0 -3.84 219.84 40.32 cm BI /W 84 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0`8p?>p?|0?|Cx>ppx8<><<>>~~~ ~`@ EI Q BT 0.8687 0 0 0.99 219.84 36.48 Tm 3 Tr -0.0208 Tc 0 Tw (were) Tj 0 Tr ET BT 0.9266 0 0 0.99 234.48 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 16.56 0 0 -5.04 236.16 41.76 cm BI /W 95 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|?x?>|?? EI Q BT 1.2741 0 0 0.99 236.16 36.48 Tm 3 Tr -0.0184 Tc 0 Tw (~de) Tj 0 Tr ET BT 0.9266 0 0 0.99 252.72 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 5.28 0 0 -4.8 254.4 41.28 cm BI /W 31 /H 26 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>|<|<>>>>>>>~>|><><~<~~|~~?>> EI Q BT 0.8108 0 0 0.99 254.4 36.48 Tm 3 Tr 0.1444 Tc 0 Tw (to) Tj 0 Tr ET BT 0.9266 0 0 0.99 259.68 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 18 0 0 -4.32 261.36 40.8 cm BI /W 104 /H 25 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8 ???~c|s|>1|>|>x|>|>?x|~<|~<xǏx???c8 EI Q BT 0.8687 0 0 0.99 261.36 36.48 Tm 3 Tr -0.0172 Tc 0 Tw (create) Tj 0 Tr ET BT 0.9266 0 0 0.99 279.36 36.48 Tm 0 Tc 0.0723 Tw ( ) Tj ET q 8.88 0 0 -5.28 281.04 42 cm BI /W 52 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x??'~>~>|p<|p>|?0>|>>|>>|>>|>>|?`<|||<|~|~x~>  EI Q BT 1.1003 0 0 0.99 281.04 36.48 Tm 3 Tr -0.0744 Tc 0 Tw (he) Tj 0 Tr ET BT 0.934 0 0 0.9835 289.92 36.48 Tm /F4 10 Tf 0 Tc 0.0449 Tw ( ) Tj ET q 20.88 0 0 -6.96 292.32 41.76 cm BI /W 120 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~>>>>>g?????x?|>|>~>>|>~`<>|>>|>|>|>|><><8>~>8?~>x}??xpp8 EI Q BT 0.5944 0 0 0.9835 292.32 36.48 Tm 3 Tr 0.0221 Tc 0 Tw (Special) Tj 0 Tr ET BT 0.934 0 0 0.9835 313.2 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 12.24 0 0 -3.84 315.6 40.32 cm BI /W 71 /H 21 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID }?||||||||||||x|~||<}?? EI Q BT 0.5519 0 0 0.9835 315.6 36.48 Tm 3 Tr 0.0617 Tc 0 Tw (Cme) Tj 0 Tr ET BT 0.934 0 0 0.9835 327.84 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 14.64 0 0 -5.28 330.24 41.28 cm BI /W 84 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ß~><||<>|>|>|>|>|>|`>~>~? ??`  EI Q BT 0.8915 0 0 0.9835 330.24 36.48 Tm 3 Tr -0.0563 Tc 0 Tw (tits) Tj 0 Tr ET BT 0.934 0 0 0.9835 344.88 36.48 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6 0 0 -5.04 347.28 41.52 cm BI /W 35 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>q EI Q BT 0.6368 0 0 0.9835 347.28 36.48 Tm 3 Tr -0.1103 Tc 0 Tw (in) Tj 0 Tr ET BT 0.934 0 0 0.9835 353.28 36.48 Tm -0.0131 Tc 0.1873 Tw ( each ) Tj ET BT 0.9388 0 0 0.9835 378.72 36.48 Tm /F2 10 Tf 0.0291 Tc 0.024 Tw (of the ) Tj ET BT 0.9021 0 0 0.9598 403.2 36.48 Tm /F6 5 Tf -0.0956 Tc 0.1858 Tw (Six ) Tj ET BT 0.9388 0 0 0.9835 410.64 36.48 Tm /F2 10 Tf 0.0156 Tc 0 Tw (studies.) Tj ET endstream endobj 134 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 135 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.68 685.44 m 539.76 685.44 l S 64.32 664.08 m 64.32 45.36 l S 62.4 664.08 m 540 664.08 l S 542.16 664.56 m 542.16 45.36 l S 66.24 45.36 m 544.56 45.36 l S BT 0.9835 0 0 0.9835 329.04 691.2 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 2.7987 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 520.56 691.2 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 527.28 691.2 Tm /F5 10 Tf 0.488 Tc 0 Tw (31) Tj ET BT 0.9261 0 0 0.9795 145.44 642.96 Tm /F7 12 Tf 0.0084 Tc 1.0249 Tw (Table l-3-Conceptual and Methodological Issues in Designing and) Tj ET BT 0.8875 0 0 0.9795 210.48 630.72 Tm 0.0054 Tc 1.3863 Tw (Conducting Special Care Unit Research) Tj ET BT 0.8104 0 0 0.9795 94.32 611.04 Tm -0.0562 Tc 0.0292 Tw (\215 ) Tj ET BT 0.8491 0 0 0.9835 100.32 611.04 Tm /F4 10 Tf 0.023 Tc 0.3181 Tw (Special care units are extremely diverse. It is difficult to determine which units should be included m) Tj ET BT 0.8066 0 0 0.9835 104.64 600.24 Tm 0.0478 Tc 0.4319 Tw (a study sample and which of the many possible unit characteristics are important to study. For purposes) Tj -0.2975 -11.4697 TD 0.0505 Tc 1.2096 Tw (of evaluative research, it is difficult to determine whether the intervention to be studied should be the) Tj 0.2975 -10.9816 TD 0.0531 Tc 1.541 Tw (unit\222s overall milieu or its particular features and, if particular features, which features.) Tj ET BT 0.8491 0 0 0.9835 95.04 564.24 Tm 0.0215 Tc 0.5849 Tw (\215 Individuals with dementia are extremely diverse. It is difficult to determine which of their) Tj ET BT 0.8066 0 0 0.9835 105.12 553.2 Tm 0.0415 Tc 1.4811 Tw (characteristics are important to study.) Tj ET BT 0.8491 0 0 0.9835 95.52 539.04 Tm 0.0397 Tc -0.0019 Tw (\215 The characteristics of individuals with dementia are interrelated and changeover time. In the context) Tj ET BT 0.8066 0 0 0.9835 105.12 528 Tm 0.0473 Tc 1.3065 Tw (of an evaluative study, it is difficult to determine whether these changes reflect the progression of the) Tj ET BT 0.8491 0 0 0.9835 105.36 516.96 Tm 0.0282 Tc 0.4356 Tw (residents\222 dementing disease or the effects of the special care units.) Tj -11.5888 -12.6899 TD 0.0207 Tc 0.7271 Tw (. Residents\222 families and special care unit and other nursing home staff members are diverse. It is) Tj ET BT 0.8632 0 0 0.9598 95.76 479.76 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.9835 0 0 0.9835 96 455.28 Tm /F6 10 Tf -0.0854 Tc (\215) Tj 0.4881 -47.3429 TD -0.0854 Tc (\216) Tj 0 -25.3797 TD -0.0854 Tc (\215) Tj ET BT 0.8116 0 0 0.9835 96.48 370.08 Tm 0.0253 Tc (*) Tj ET BT 0.8056 0 0 0.9598 96.96 334.08 Tm /F9 6 Tf 0.0203 Tc (l) Tj ET BT 0.9835 0 0 0.9835 96.96 320.4 Tm /F6 10 Tf -0.0854 Tc (\215) Tj ET BT 0.8056 0 0 0.9598 97.2 284.4 Tm /F9 6 Tf 0.0203 Tc (l) Tj ET BT 0.8567 0 0 0.9835 97.2 248.16 Tm /F6 10 Tf 0.0392 Tc (e) Tj ET BT 0.9207 0 0 0.9598 97.2 223.2 Tm /F9 6 Tf -0.0556 Tc (l) Tj ET BT 0.4509 0 0 0.9835 97.92 186.96 Tm /F6 10 Tf 0.0056 Tc (\215o) Tj ET BT 0.8056 0 0 0.9598 97.92 172.8 Tm /F9 6 Tf 0.0203 Tc (l) Tj ET BT 0.7665 0 0 0.9835 97.92 158.88 Tm /F6 10 Tf 0.0075 Tc (*) Tj ET BT 0.8056 0 0 0.9598 98.16 123.12 Tm /F9 6 Tf 0.0203 Tc (l) Tj 0 -25.7543 TD 0.0203 Tc (l) Tj ET BT 0.8491 0 0 0.9835 105.36 492 Tm /F4 10 Tf 0.0385 Tc 0.0278 Tw (difficult to determine which of their characteristics are important to study.) Tj ET BT 0.8066 0 0 0.9835 105.36 478.56 Tm 0.0487 Tc 0.6489 Tw (Many of the potentially important characteristics of the units, the residents, their families, and the staff) Tj ET BT 0.8491 0 0 0.9835 105.84 468 Tm 0.0334 Tc 0.6736 Tw (members are conceptually vague, difficult to define operationally, and difficult to measure.) Tj ET BT 0.8066 0 0 0.9835 105.36 454.32 Tm 0.0611 Tc 0.7358 Tw (The available assessment instruments do not include all the potentially important characteristics of the) Tj ET BT 0.8491 0 0 0.9835 105.84 443.28 Tm 0.026 Tc 0.4205 Tw (units, the residents, their families, or the unit staff members. The reliability and validity of some of) Tj ET BT 0.8066 0 0 0.9835 105.84 432.24 Tm 0.0641 Tc 1.4873 Tw (the available instruments has not been demonstrated, and many of the available instruments exhibit) Tj ET BT 0.8491 0 0 0.9835 105.84 421.44 Tm 0.0451 Tc 0.6418 Tw (ceiling or floor effects that obscure the full range of responses.) Tj ET BT 0.8066 0 0 0.9835 105.6 407.52 Tm 0.0527 Tc 1.5167 Tw (There is insufficient baseline information about many potentially important resident, family, and staff) Tj 0.5951 -11.7137 TD 0.0509 Tc 0 Tw (characteristics.) Tj ET BT 0.8491 0 0 0.9835 105.84 382.56 Tm 0.0274 Tc 0.6061 Tw (It is difficult to identify an appropriate control or comparison group.) Tj 0 -14.3981 TD 0.0326 Tc 0.2185 Tw (Preexisting differences between special care unit residents and individuals with dementia in other) Tj 1.1306 -11.2256 TD 0.0281 Tc 0.106 Tw (settings are likely to bias a study\222s findings. Because of family preferences and other factors, random) Tj 0 -11.2256 TD 0.031 Tc 0.6746 Tw (assignment of subjects to a special care unit or a control group setting maybe impractical.) Tj -0.848 -13.666 TD 0.0525 Tc 0.2656 Tw (Researchers often cannot control the services that subjects in the control group receive.) Tj 0 -14.1541 TD 0.0333 Tc 0.3535 Tw (There is disagreement about the outcomes to be studied. This disagreement reflects different values) Tj ET BT 0.8066 0 0 0.9835 106.8 308.16 Tm 0.0564 Tc 0.4398 Tw (in the care of nursing home residents with dementia and different expectations about the areas in which) Tj ET BT 0.8491 0 0 0.9835 106.8 296.88 Tm 0.0238 Tc 1.4301 Tw (positive outcomes may be found.) Tj ET BT 0.8066 0 0 0.9835 106.56 282.96 Tm 0.0415 Tc 1.6086 Tw (Many potentially important resident outcomes, e.g., quality of life and satisfaction with care, are very) Tj 0.8926 -11.4697 TD 0.0532 Tc 1.4665 Tw (difficult to measure in persons with dementia. The outcomes that are easiest to measure are likely to) Tj -0.2975 -11.2256 TD 0.0471 Tc 1.9204 Tw (be trivial.) Tj ET BT 0.8491 0 0 0.9835 107.04 246.96 Tm 0.0434 Tc 0.2057 Tw (There are many conceptual and practical difficulties in obtaining consent for research participation) Tj 0.2827 -11.2256 TD 0.0147 Tc 0.216 Tw (from individuals with dementia and their families.) Tj -0.2827 -14.3981 TD 0.039 Tc 0.2816 Tw (Because of their cognitive impairments, nursing home residents with dementia are often unable to) Tj 0.2827 -11.2256 TD 0.0435 Tc 0.0707 Tw (participate in conventional research interviews or to provide accurate information about themselves.) Tj 0.2827 -11.4697 TD 0.0135 Tc 0.4328 Tw (Sensory impairments and physical illnesses exacerbate this problem.) Tj -0.2827 -13.91 TD 0.0335 Tc 0.7322 Tw (Proxy-derived information may not be reliable or valid.) Tj 0 -14.3981 TD 0.029 Tc 0.3447 Tw (It is difficult to effectively blind interviewers to the subjects\222 treatment status.) Tj 0.5653 -14.3981 TD 0.0284 Tc 0.4354 Tw (Sample attrition is very high. Some special care unit studies have lost one-third or more of their) Tj 0.5653 -11.2256 TD 0.0295 Tc 0.4695 Tw (subjects in a year. Although longer studies may be more likely to find significant effects, attrition is) Tj 0 -11.2256 TD 0.0353 Tc 0.3512 Tw (so great that the final sample may be too small to show the effects.) Tj -0.848 -13.91 TD 0.0339 Tc 0.1745 Tw (The findings of small studies conducted in different special care units often cannot be pooled because) Tj 0.5653 -10.9816 TD 0.0457 Tc 0.1525 Tw (of differences in the characteristics of the units.) Tj -0.2827 -13.91 TD 0.0251 Tc 0.1213 Tw (It is unclear when measurements should be made. New admissions to a special care unit may exhibit) Tj 0.2827 -11.4697 TD 0.0318 Tc 0.8554 Tw (temporary negative effects of the move. Long-time residents may have experienced any positive) Tj 0.2827 -11.2256 TD 0.0555 Tc 0.3563 Tw (effects of the unit before the beginning of the study.) Tj ET BT 0.7217 0 0 0.9835 78.48 55.2 Tm 0.027 Tc -0.1588 Tw (SOURCE: ) Tj ET q 14.88 0 0 -5.76 114.96 60.72 cm BI /W 113 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID g????~??~y~?9??>???>?>?~>?|>@~|?>~~~~?~~?~?|~??>~?????? ?<_Ϗ> EI Q BT 0.5519 0 0 0.9835 114.96 55.2 Tm 3 Tr 0.1411 Tc 0 Tw (Offke) Tj 0 Tr ET BT 0.7217 0 0 0.9835 129.84 55.2 Tm -0.0146 Tc 0.9796 Tw ( of Technology Assessment, 1992.) Tj ET endstream endobj 136 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 137 0 obj <>stream 0.48 w 1 j 0 0 0 RG 71.04 675.84 m 549.6 675.84 l S BT 0.9835 0 0 0.9835 71.04 681.84 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (32 ) Tj ET BT 0.9598 0 0 0.9598 84.96 681.84 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 91.2 681.84 Tm /F5 11 Tf 0.0882 Tc -0.151 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 126.96 681.84 Tm /F5 10 Tf 0.0128 Tc 0.597 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 72 642.24 Tm /F4 10 Tf 0.042 Tc 0.9736 Tw (special care units in the other five evaluative studies) Tj ET BT 0.934 0 0 0.9835 72 630.24 Tm -0.0406 Tc 1.4052 Tw (with a control group to account for their contradic-) Tj 0 -12.2018 TD -0.0202 Tc 1.3512 Tw (tory findings.) Tj ET BT 0.9663 0 0 0.9939 120 583.68 Tm /F6 14 Tf 0.0706 Tc 1.6409 Tw (THE REGULATORY) Tj -38.2492 -15.9376 TD 0.0358 Tc 2.7946 Tw (ENVIRONMENT FOR SPECIAL) Tj 62.5896 -15.9376 TD 0.0519 Tc 1.1635 Tw (CARE UNITS) Tj ET BT 0.934 0 0 0.9835 83.52 533.52 Tm /F4 10 Tf -0.0361 Tc 0.9507 Tw (Because of the diversity of special care units, the) Tj ET BT 0.8915 0 0 0.9835 72.72 521.76 Tm 0.0315 Tc 1.3363 Tw (fact that existing units frequently do not incorporate) Tj ET BT 0.9835 0 0 0.9835 72.48 510 Tm 0.0321 Tc 0.0166 Tw (recommended physical design and other features,) Tj 0.4881 -12.2018 TD 0.0244 Tc -0.0174 Tw (and pervasive claims that some special care units) Tj ET BT 0.934 0 0 0.9835 72.96 486 Tm -0.038 Tc 1.2847 Tw (actually provide nothing special for their residents,) Tj ET BT 0.9835 0 0 0.9835 72.72 474.24 Tm 0.0253 Tc 1.3413 Tw (many Alzheimer\222s advocates, State officials, and) Tj ET BT 0.8915 0 0 0.9835 72.96 462 Tm 0.0561 Tc 1.1549 Tw (others believe there should be special regulations for) Tj ET BT 0.934 0 0 0.9835 73.44 450 Tm -0.018 Tc 1.1883 Tw (special care units. As of early 1992, special regula-) Tj -0.257 -11.9577 TD -0.0447 Tc 1.4346 Tw (tions were in place or in various stages of develop-) Tj ET BT 0.8915 0 0 0.9835 73.2 426.48 Tm 0.0042 Tc 1.431 Tw (ment in many States:) Tj ET BT 0.8632 0 0 0.9598 84.72 408.96 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.9207 0 0 0.9598 84.96 372.24 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 85.2 323.52 Tm -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 85.2 286.56 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 85.68 225.84 Tm -0.0185 Tc (l) Tj ET BT 0.9835 0 0 0.9835 95.04 407.52 Tm /F4 10 Tf 0.0344 Tc 1.2711 Tw (Six States-Colorado, Iowa, Kansas, Tennes-) Tj ET BT 0.934 0 0 0.9835 95.76 395.52 Tm -0.0133 Tc 1.6008 Tw (see, Texas, and Washington-had special regu-) Tj -0.257 -11.9577 TD -0.0307 Tc 0.6559 Tw (lations for special care units.) Tj ET BT 0.9835 0 0 0.9835 95.04 371.04 Tm 0.0141 Tc 3.8541 Tw (Five States-Nebraska, New Jersey, North) Tj ET BT 0.934 0 0 0.9835 95.76 359.04 Tm -0.0207 Tc 2.174 Tw (Carolina, Oklahoma, and Oregon-were in the) Tj ET BT 0.8915 0 0 0.9835 95.28 347.28 Tm 0.0403 Tc 1.7943 Tw (process of drafting or approving special regula-) Tj ET BT 0.934 0 0 0.9835 95.76 335.28 Tm -0.034 Tc 0.7237 Tw (tions for special care units.) Tj ET BT 0.9835 0 0 0.9835 95.76 322.08 Tm 0.0407 Tc 1.9764 Tw (One additional State-Arkansas-had legisla-) Tj 0 -12.2018 TD 0.0412 Tc 2.0573 Tw (tion mandating the development of special) Tj ET BT 0.934 0 0 0.9835 95.52 298.08 Tm -0.0306 Tc 0.7842 Tw (regulations for special care units.) Tj ET BT 0.9835 0 0 0.9835 95.28 285.36 Tm 0.0236 Tc 5.0036 Tw (Two States\227Kentucky and Michigan-had) Tj ET BT 0.934 0 0 0.9835 96.48 272.88 Tm -0.0395 Tc 2.1428 Tw (special requirements for special care units or) Tj 0 -11.9577 TD -0.0232 Tc 1.1617 Tw (special Alzheimer\222s nursing homes established) Tj -0.257 -12.4458 TD -0.0338 Tc 1.4087 Tw (with exemptions from the States\222 certificate of) Tj -0.257 -11.7137 TD -0.0608 Tc 2.4226 Tw (need process.) Tj -0.257 -12.9339 TD -0.0081 Tc 2.3662 Tw (In three additional States\227Arizona, Indiana,) Tj ET BT 0.9835 0 0 0.9835 96.48 212.64 Tm 0.0572 Tc 1.0648 Tw (and Rhode Island, the State-appointed Alz-) Tj ET BT 0.934 0 0 0.9835 96 200.88 Tm -0.0357 Tc 1.5392 Tw (heimer\222s task force or long-term care advisory) Tj 0.257 -12.4458 TD -0.0439 Tc 2.4045 Tw (council had recommended the development of) Tj -0.257 -11.9577 TD -0.0182 Tc 1.0922 Tw (regulations, and in two of the States\227Arizona) Tj ET BT 0.9835 0 0 0.9835 96.48 164.88 Tm 0.0625 Tc 1.1205 Tw (and Rhode Island-the State-appointed body) Tj ET BT 0.8915 0 0 0.9835 96.24 153.84 Tm 0.0258 Tc 2.7527 Tw (had developed draft regulations.) Tj ET BT 0.934 0 0 0.9835 85.44 135.36 Tm -0.0318 Tc 1.8409 Tw (At the State level, interest in regulating special) Tj ET BT 0.9835 0 0 0.9835 74.64 123.36 Tm 0.0173 Tc -0.0843 Tw (care units is growing rapidly. In some States, this) Tj ET BT 0.934 0 0 0.9835 74.64 111.6 Tm -0.0343 Tc 1.7196 Tw (interest is unopposed. In other States, the issue of) Tj ET BT 0.9835 0 0 0.9835 74.88 99.84 Tm 0.0246 Tc 0.1218 Tw (special regulations for special care units is highly) Tj ET BT 0.8915 0 0 0.9835 74.88 88.08 Tm 0.0572 Tc 0 Tw (controversial.) Tj ET BT 0.934 0 0 0.9835 85.68 69.6 Tm -0.024 Tc 0.5845 Tw (State regulations for special care units have been) Tj -11.82 -12.2018 TD -0.0426 Tc 1.8525 Tw (or will be superimposed on the existing regulatory) Tj 0.257 -11.9577 TD -0.0179 Tc 1.9141 Tw (structure for nursing homes\227a complex, multifac-) Tj -0.257 -12.2018 TD -0.0301 Tc 0.7451 Tw (eted structure with six major components:) Tj ET BT 0.8066 0 0 0.9835 334.8 642 Tm 0.164 Tc 0 Tw (1\)) Tj ET BT 0.9014 0 0 0.9812 334.08 617.28 Tm /F5 11 Tf 0.0755 Tc (2\)) Tj ET BT 0.8585 0 0 0.9812 334.32 604.32 Tm 0.1687 Tc (3\)) Tj ET BT 0.9014 0 0 0.9812 334.08 580.08 Tm 0.2086 Tc (4\)) Tj 0.2663 -25.6822 TD 0.2086 Tc (5\)) Tj 0.5325 -25.193 TD 0.0755 Tc (6\)) Tj ET BT 0.8585 0 0 0.9812 334.8 500.64 Tm 0.1687 Tc (In) Tj ET BT 0.9835 0 0 0.9835 348.48 642 Tm /F4 10 Tf 0.0399 Tc 2.5955 Tw (the Federal regulations for Medicare and) Tj ET BT 0.934 0 0 0.9835 348.72 630 Tm -0.0302 Tc 1.8759 Tw (Medicaid certification of nursing homes,) Tj 0 -12.9339 TD -0.0183 Tc 0.527 Tw (State licensing regulations for nursing homes,) Tj ET BT 0.8915 0 0 0.9835 348.72 604.32 Tm 0.0399 Tc 0.7179 Tw (State certificate of need regulations for nursing) Tj ET BT 0.934 0 0 0.9835 348.96 592.56 Tm -0.0088 Tc 0 Tw (homes,) Tj -0.257 -12.9339 TD -0.0252 Tc 1.3566 Tw (other State and local government regulations) Tj ET BT 0.8915 0 0 0.9835 349.2 567.84 Tm 0.0205 Tc 1.9511 Tw (that affect nursing homes,) Tj -0.2692 -13.1779 TD 0.0448 Tc 1.9058 Tw (the survey and certification procedures associ-) Tj ET BT 0.934 0 0 0.9835 349.68 543.12 Tm -0.0261 Tc 0.6295 Tw (ated with each type of regulations, and) Tj -0.5139 -12.9339 TD -0.0333 Tc 0.7229 Tw (the oversight procedures of each State\222s Long-) Tj ET BT 0.8915 0 0 0.9835 349.44 519.6 Tm 0.0515 Tc 2.1855 Tw (Term Care Ombudsman Program.) Tj ET BT 0.9835 0 0 0.9835 349.92 500.88 Tm 0.0339 Tc 1.5278 Tw (addition to these six components, Federal,) Tj ET BT 0.934 0 0 0.9835 324 488.64 Tm -0.0175 Tc 0.7489 Tw (State, and local government regulations for nursing) Tj -0.257 -11.9577 TD -0.0282 Tc 1.1029 Tw (homes incorporate standards established by private) Tj 0.257 -12.2018 TD -0.0163 Tc 0.7475 Tw (organizations, such as the National Fire Prevention) Tj ET BT 0.9835 0 0 0.9835 324 452.64 Tm 0.039 Tc 0.4977 Tw (Association\222s Life Safety Code standards. Special) Tj ET BT 0.8915 0 0 0.9835 324.24 440.64 Tm 0.0232 Tc 0.961 Tw (care units must comply with these standards, as well) Tj ET BT 0.9835 0 0 0.9835 324.72 428.88 Tm 0.0213 Tc 1.3861 Tw (as the regulations and survey, certification, and) Tj -0.244 -12.4458 TD 0.0406 Tc 0.0243 Tw (oversight procedures listed above and any special) Tj ET BT 0.8915 0 0 0.9835 324 405.12 Tm 0.0211 Tc 1.771 Tw (regulations that may apply.) Tj ET BT 0.9835 0 0 0.9835 335.52 385.92 Tm 0.0401 Tc 2.5872 Tw (Special care unit operators and others often) Tj ET BT 0.934 0 0 0.9835 324.72 374.16 Tm -0.0199 Tc 1.0084 Tw (complain that the regulations and survey, certifica-) Tj ET BT 0.9835 0 0 0.9835 324.72 362.4 Tm 0.0252 Tc 0.3653 Tw (tion, and oversight procedures for nursing homes) Tj 0 -12.2018 TD 0.026 Tc 3.0895 Tw (discourage innovation in special care units by) Tj ET BT 0.8915 0 0 0.9835 324.72 338.4 Tm 0.0376 Tc 1.2477 Tw (interfering with the use of physical design and other) Tj 0 -12.2018 TD 0.0398 Tc 1.3654 Tw (features they believe would be effective for residents) Tj 0.2692 -12.4458 TD 0.0358 Tc 0.8459 Tw (with dementia. OTA has been told about instances in) Tj ET BT 0.934 0 0 0.9835 324.96 301.92 Tm -0.0375 Tc 1.5946 Tw (which special care units could not get approval for) Tj ET BT 0.9835 0 0 0.9835 324.96 289.92 Tm 0.0336 Tc 1.6815 Tw (the use of innovative features of various kinds;) Tj ET BT 0.934 0 0 0.9835 325.2 277.92 Tm -0.0233 Tc 1.2904 Tw (instances in which approval was held up for years,) Tj 0 -12.4458 TD -0.0231 Tc 1.6848 Tw (thus adding enormously to the cost of establishing) Tj 0 -11.9577 TD -0.0135 Tc 0.3484 Tw (the unit; and instances in which approval was given) Tj ET BT 0.9835 0 0 0.9835 324.96 241.92 Tm 0.0377 Tc 2.026 Tw (by one government agency and later denied by) Tj 0.4881 -12.2018 TD 0.0232 Tc 0.6114 Tw (another government agency, sometimes after the) Tj 0 -11.9577 TD 0.0266 Tc 2.874 Tw (special care unit opened. Thus, while there is) Tj -0.4881 -11.9577 TD 0.0403 Tc 1.2041 Tw (pressure on the one hand for more regulation of) Tj ET BT 0.8915 0 0 0.9835 325.44 194.16 Tm 0.0429 Tc 1.4773 Tw (special care units, some people advocate less regula-) Tj ET BT 0.9835 0 0 0.9835 325.44 182.64 Tm 0.033 Tc 0.1676 Tw (tion, at least on a selective basis, to allow greater) Tj ET BT 0.8915 0 0 0.9835 325.44 170.64 Tm 0.0455 Tc 0 Tw (innovation.) Tj ET BT 0.9835 0 0 0.9835 336.24 151.92 Tm 0.0115 Tc 1.152 Tw (The regulatory structure for nursing homes is) Tj -10.9816 -12.2018 TD 0.029 Tc 2.4183 Tw (currently in flux due to implementation of the) Tj 0 -12.2018 TD 0.0352 Tc 0.5992 Tw (nursing home reform provisions of OBRA-87 and) Tj ET BT 0.934 0 0 0.9835 325.44 116.4 Tm -0.0333 Tc 1.1511 Tw (related legislation. The nursing home reform provi-) Tj 0.5139 -11.9577 TD -0.0255 Tc 1.6567 Tw (sions of OBRA-87 changed the Federal regulations) Tj 0 -11.9577 TD -0.0356 Tc 2.1387 Tw (for Medicare and Medicaid certification of nursing) Tj -0.257 -11.9577 TD -0.0353 Tc 1.8813 Tw (homes and the survey and certification procedures) Tj 0.257 -12.2018 TD -0.0267 Tc 1.5124 Tw (associated with those regulations. Many provisions) Tj ET BT 0.9835 0 0 0.9835 325.68 57.36 Tm 0.0474 Tc 1.284 Tw (of OBRA-87 are relevant to the frequently cited) Tj ET BT 0.8915 0 0 0.9835 325.68 45.36 Tm 0.0471 Tc 1.0495 Tw (complaints about the care provided for nursing home) Tj ET BT 0.934 0 0 0.9835 325.2 33.6 Tm -0.0237 Tc 2.28 Tw (residents with dementia. This section summarizes) Tj ET endstream endobj 138 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 139 0 obj <>stream 0.48 w 1 j 0 0 0 RG 61.2 683.28 m 540 683.28 l S BT 0.9835 0 0 0.9835 329.04 688.56 Tm 0 0 0 rg /F5 10 Tf 0.0115 Tc 2.8964 Tw (Chapter l-Overview and Policy Implications . 33) Tj -271.3676 -39.7778 TD /F4 10 Tf 0.03 Tc -0.0231 Tw (OTA\222s findings with respect to the relevant provi-) Tj ET BT 0.8915 0 0 0.9835 62.64 637.68 Tm 0.0263 Tc 1.5728 Tw (sions of OBRA-87 and the existing State regulations) Tj ET BT 0.9835 0 0 0.9835 62.16 625.92 Tm 0.0361 Tc 2.3675 Tw (for special care units. Both of these topics are) Tj ET BT 0.8915 0 0 0.9835 62.4 613.68 Tm 0.0344 Tc 1.2625 Tw (discussed at greater length in chapter 5.) Tj 12.3829 -18.5467 TD 0.0382 Tc 0.5067 Tw (On the basis of the information presented here and) Tj ET BT 0.9835 0 0 0.9835 62.64 583.44 Tm 0.0335 Tc 1.1935 Tw (in chapter 5, OTA concludes that OBRA-87 pro-) Tj ET BT 0.934 0 0 0.9835 62.64 571.68 Tm -0.0357 Tc 0.8172 Tw (vides a better framework for regulating special care) Tj ET BT 0.8915 0 0 0.9835 62.64 559.68 Tm 0.0307 Tc 1.132 Tw (units than any of the existing State special care unit) Tj ET BT 0.934 0 0 0.9835 62.64 547.92 Tm -0.0265 Tc 1.0643 Tw (regulations or any special regulations that could be) Tj ET BT 0.8915 0 0 0.9835 63.12 535.68 Tm 0.0323 Tc 0.797 Tw (devised at this time. This conclusion and alternatives) Tj ET BT 0.9835 0 0 0.9835 63.36 523.68 Tm 0.0486 Tc 0.6466 Tw (to address the concerns that lead some people to) Tj 0 -12.2018 TD 0.0331 Tc -0.0902 Tw (advocate special regulations for special care units) Tj ET BT 0.8915 0 0 0.9835 63.6 499.92 Tm 0.0403 Tc 0.6189 Tw (are discussed in a later section of this chapter, as are) Tj ET BT 0.934 0 0 0.9835 63.36 488.16 Tm -0.0369 Tc 1.3324 Tw (methods to allow greater innovation in special care) Tj ET BT 0.8491 0 0 0.9835 63.36 475.92 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.9795 0 0 0.9795 81.6 453.36 Tm /F7 12 Tf 0.0221 Tc 0.8353 Tw (The Nursing Home Reform Provisions) Tj 66.8937 -14.4569 TD 0.0125 Tc 0.6613 Tw (of OBRA-87) Tj ET BT 0.934 0 0 0.9835 74.88 421.2 Tm /F4 10 Tf -0.0175 Tc 2.1193 Tw (Through OBRA-87, Congress sought to create a) Tj -11.563 -12.2018 TD -0.0306 Tc 1.8763 Tw (comprehensive regulatory structure that would as-) Tj ET BT 0.8915 0 0 0.9835 64.56 397.2 Tm 0.05 Tc 1.3796 Tw (sure high-quality, individualized care for all nursing) Tj ET BT 0.9835 0 0 0.9835 64.08 385.44 Tm 0.0241 Tc 0.041 Tw (home residents. Under OBRA-87, a nursing home) Tj 0 -12.2018 TD 0.0313 Tc 0.8472 Tw (must now meet the following requirements to be) Tj ET BT 0.934 0 0 0.9835 64.56 361.2 Tm -0.0562 Tc 2.2892 Tw (certified for Medicare or Medicaid:) Tj ET BT 0.9207 0 0 0.9598 76.08 344.4 Tm /F9 6 Tf -0.0556 Tc 0 Tw (l) Tj 0.2607 -49.7583 TD -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 76.56 248.64 Tm -0.0185 Tc (l) Tj 0.5561 -49.7583 TD -0.0185 Tc (l) Tj ET BT 0.7481 0 0 0.9598 77.52 129.12 Tm 0.065 Tc (l) Tj ET BT 0.9835 0 0 0.9835 87.12 343.44 Tm /F4 10 Tf 0.0197 Tc 0.798 Tw (\223The facility must care for its residents in a) Tj ET BT 0.934 0 0 0.9835 86.88 331.68 Tm -0.0108 Tc 1.2128 Tw (manner and in an environment that promotes) Tj ET BT 0.8915 0 0 0.9835 86.88 319.68 Tm 0.0603 Tc 1.4578 Tw (maintenance or enhancement of each resident\222s) Tj ET BT 0.9835 0 0 0.9835 86.88 307.68 Tm 0.0338 Tc 0.9667 Tw (quality of life.\224) Tj ET BT 0.8915 0 0 0.9835 87.36 295.92 Tm 0.0428 Tc 1.1698 Tw (\221\221The facility must promote care for residents in) Tj -0.2692 -12.4458 TD 0.0485 Tc 0.2404 Tw (a manner and in an environment that maintains) Tj 0 -12.4458 TD 0.0468 Tc 1.5178 Tw (or enhances each resident\222s dignity and respect) Tj ET BT 0.934 0 0 0.9835 87.12 259.68 Tm -0.0328 Tc 1.2042 Tw (in full recognition of his or her individuality. \222) Tj 0.5139 -12.2018 TD -0.0263 Tc 0.587 Tw (\221\221The facility must conduct initially and period-) Tj ET BT 0.8915 0 0 0.9835 87.36 235.68 Tm 0.0441 Tc 2.1489 Tw (ically a comprehensive, accurate, standardized,) Tj ET BT 0.9835 0 0 0.9835 87.12 223.92 Tm 0.0339 Tc 2.7969 Tw (reproducible assessment of each resident\222s) Tj 0.244 -12.2018 TD 0.009 Tc 1.602 Tw (functional capacity.\222) Tj 0.4881 -12.2018 TD 0.0306 Tc 1.1407 Tw (\223The facility must develop a comprehensive) Tj ET BT 0.934 0 0 0.9835 87.84 187.92 Tm -0.0273 Tc 0.4778 Tw (care plan for each resident that includes meas-) Tj ET BT 0.9835 0 0 0.9835 87.84 175.68 Tm 0.037 Tc 2.0616 Tw (urable objectives and timetables to meet a) Tj -0.244 -11.9577 TD 0.0122 Tc -0.0608 Tw (resident\222s medical, nursing, mental, and psy-) Tj 0.244 -12.2018 TD 0.0419 Tc 3.1547 Tw (chosocial needs that are identified in the) Tj ET BT 0.934 0 0 0.9835 87.84 139.92 Tm -0.0232 Tc 2.2538 Tw (comprehensive assessment. \222) Tj ET BT 0.9835 0 0 0.9835 88.32 128.16 Tm 0.0272 Tc 0.7293 Tw (\223Each resident must receive and the facility) Tj ET BT 0.8915 0 0 0.9835 87.84 116.16 Tm 0.0443 Tc 1.0527 Tw (must provide the necessary care and services to) Tj 0.5384 -12.2018 TD 0.0366 Tc 0.3178 Tw (attain or maintain the highest practicable physi-) Tj ET BT 0.9835 0 0 0.9835 88.08 92.16 Tm 0.0195 Tc 1.5913 Tw (cal, mental, and psychosocial well-being, in) Tj ET BT 0.8915 0 0 0.9835 88.32 80.16 Tm 0.0468 Tc 2.0113 Tw (accordance with the comprehensive assessment) Tj ET BT 0.9835 0 0 0.9835 88.08 69.6 Tm 0.0417 Tc 0.2875 Tw (and plan of care\224 \(463\).) Tj ET BT 0.934 0 0 0.9835 77.04 51.6 Tm -0.0272 Tc 0.9183 Tw (Chapter 5 lists other provisions of OBRA-87 that) Tj ET BT 0.8915 0 0 0.9835 66 39.6 Tm 0.0432 Tc 1.1693 Tw (are relevant to the frequently cited complaints about) Tj ET BT 0.934 0 0 0.9835 313.2 649.44 Tm -0.0421 Tc 1.8886 Tw (the care provided for nursing home residents with) Tj ET BT 0.9835 0 0 0.9835 313.2 637.68 Tm 0.0307 Tc -0.1284 Tw (dementia. These other provisions deal with main-) Tj ET BT 0.934 0 0 0.9835 313.2 625.68 Tm -0.0245 Tc 4.4393 Tw (taining residents\222) Tj ET BT 0.9835 0 0 0.9835 401.04 625.92 Tm 0.0264 Tc 1.9503 Tw (functional abilities, providing) Tj -88.829 -12.4458 TD 0.0288 Tc 2.4604 Tw (activities that meet residents\222 needs, providing) Tj ET BT 0.934 0 0 0.9835 313.92 601.44 Tm -0.0268 Tc 2.9643 Tw (specialized rehabilitative services, minimizing the) Tj ET BT 0.9835 0 0 0.9835 313.68 589.68 Tm 0.0335 Tc 0.967 Tw (use of psychotropic medications and physical re-) Tj ET BT 0.8915 0 0 0.9835 314.16 577.44 Tm 0.0359 Tc 1.6005 Tw (straints, allowing residents to use their own belong-) Tj ET BT 0.934 0 0 0.9835 313.92 565.68 Tm -0.0246 Tc 1.613 Tw (ings, involving residents and their families in care) Tj ET BT 0.8915 0 0 0.9835 313.68 553.68 Tm 0.0556 Tc 0 Tw (plannin) Tj 37.418 -2.4404 TD 0.0326 Tc 1.2966 Tw (g, training for nurse aides, and other issues.) Tj ET BT 0.9835 0 0 0.9835 324.96 535.68 Tm 0.0372 Tc 4.16 Tw (The provisions of OBRA-87 rarely mention) Tj ET BT 0.8915 0 0 0.9835 314.4 523.44 Tm 0.0117 Tc 1.4225 Tw (dementia, but the resident assessment system devel-) Tj ET BT 0.934 0 0 0.9835 314.64 511.2 Tm -0.0254 Tc 0.8857 Tw (oped to implement OBRA-87 emphasizes the evalu-) Tj ET BT 0.9835 0 0 0.9835 314.64 499.68 Tm 0.0325 Tc 3.4955 Tw (ation of a resident\222s cognitive status and the) Tj -0.244 -12.2018 TD 0.0273 Tc 0.0146 Tw (problems and care needs that are common among) Tj ET BT 0.8915 0 0 0.9835 314.64 475.92 Tm 0.0283 Tc 0.9553 Tw (nursing home residents with dementia \(see ch. 5\). As) Tj ET BT 0.9835 0 0 0.9835 313.92 463.68 Tm 0.0253 Tc 0.1619 Tw (just noted, the regulations require that residents\222) Tj ET BT 0.8915 0 0 0.9835 314.64 452.16 Tm 0.0334 Tc 0.5906 Tw (needs must be assessed and that once their needs are) Tj ET BT 0.934 0 0 0.9835 315.12 439.92 Tm -0.0503 Tc 1.1694 Tw (identified, appropriate services must be provided to) Tj ET BT 0.8915 0 0 0.9835 314.88 427.92 Tm 0.0168 Tc 1.5066 Tw (meet the needs.) Tj ET BT 0.934 0 0 0.9835 326.16 410.16 Tm -0.027 Tc 1.4013 Tw (If fully implemented, the provisions of OBRA-87) Tj ET BT 0.9835 0 0 0.9835 315.36 397.92 Tm 0.0278 Tc 1.0947 Tw (would greatly improve the care of nursing home) Tj ET BT 0.8915 0 0 0.9835 315.36 385.92 Tm 0.0277 Tc 1.6097 Tw (residents with dementia. Two factors could limit the) Tj ET BT 0.934 0 0 0.9835 315.36 373.68 Tm -0.0228 Tc 0.9686 Tw (benefits of OBRA-87 for individuals with dementia.) Tj ET BT 0.9835 0 0 0.9835 315.84 361.68 Tm 0.0338 Tc 1.0277 Tw (One obvious factor is a failure to implement the) Tj -0.244 -12.4458 TD 0.0238 Tc 3.5392 Tw (provisions, which could occur for a variety of) Tj ET BT 0.934 0 0 0.9835 315.36 337.92 Tm -0.0172 Tc 1.862 Tw (reasons, including insufficient government funding) Tj ET BT 0.9835 0 0 0.9835 316.08 326.16 Tm 0.021 Tc 3.5071 Tw (for nursing home care, for inspections, or for) Tj 0.244 -12.4458 TD 0.0181 Tc 2.6734 Tw (surveyor training. The second factor is lack of) Tj ET BT 0.934 0 0 0.9835 315.84 302.4 Tm -0.0051 Tc 1.5406 Tw (knowledge among many nursing home administra-) Tj ET BT 0.9835 0 0 0.9835 316.32 290.16 Tm 0.0189 Tc 2.324 Tw (tors, staff members, and surveyors about what) Tj -0.244 -12.2018 TD 0.0332 Tc 0.894 Tw (constitutes appropriate care for individuals with) Tj 0.244 -11.9577 TD 0.0164 Tc 1.5944 Tw (dementia-e. g.,) Tj 78.0914 0 TD 0.0366 Tc 3.5262 Tw (lack of knowledge about what) Tj ET BT 0.8915 0 0 0.9835 316.56 254.4 Tm 0.0416 Tc 1.6134 Tw (activities and rehabilitative services would meet the) Tj -0.5384 -11.9577 TD 0.0227 Tc 4.1919 Tw (residents\222 needs.) Tj ET BT 0.9795 0 0 0.9795 354.72 214.8 Tm /F7 12 Tf 0.0564 Tc 0.8615 Tw (Existing State Regulations for) Tj 29.1588 -14.2118 TD 0.0475 Tc 0.6256 Tw (Special Care Units) Tj ET BT 0.9835 0 0 0.9835 327.84 183.12 Tm /F4 10 Tf 0.0445 Tc 3.03 Tw (As noted above, six States\227Colorado\222 Iowa,) Tj -11.2256 -12.4458 TD 0.02 Tc 1.6517 Tw (Kansas, Tennessee, Texas, and Washington-had) Tj 0 -11.9577 TD 0.0294 Tc -0.0966 Tw (regulations for special care units as of early 1992.) Tj 0.4881 -12.2018 TD 0.0356 Tc 2.1036 Tw (Each of the States\222 regulations address several) Tj ET BT 0.934 0 0 0.9835 317.28 134.88 Tm -0.0097 Tc 1.1258 Tw (common areas, e.g., admission criteria, safety, staff) Tj ET BT 0.8915 0 0 0.9835 317.52 123.12 Tm 0.0389 Tc 0.8537 Tw (training, and physical design, but their requirements) Tj ET BT 0.934 0 0 0.9835 317.52 111.6 Tm -0.0212 Tc 0.4958 Tw (in these areas differ \(see ch. 5\). Each State requires) Tj ET BT 0.9835 0 0 0.9835 317.52 99.36 Tm 0.0413 Tc -0.0476 Tw (some features that are not addressed in the other) Tj ET BT 0.934 0 0 0.9835 317.52 87.36 Tm -0.0088 Tc 1.5104 Tw (States\222 regulations, e.g., Iowa\222s requirement that a) Tj ET BT 0.8915 0 0 0.9835 317.04 75.36 Tm 0.0304 Tc 0.1723 Tw (unit and its outdoor area must have no steps or slopes) Tj 0.2692 -12.2018 TD 0.0349 Tc 1.9349 Tw (and Washington\222s requirement that the units floors\222) Tj ET BT 0.9835 0 0 0.9835 317.04 51.36 Tm 0.017 Tc 0.7222 Tw (walls, and ceilings must be of contrasting colors.) Tj ET BT 0.934 0 0 0.9835 317.28 39.36 Tm -0.0349 Tc 0.6389 Tw (Some of the requirements are very detailed.) Tj ET endstream endobj 140 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 141 0 obj <>stream 0.48 w 1 j 0 0 0 RG 67.68 674.88 m 546 674.88 l S BT 0.9835 0 0 0.9835 67.44 681.12 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (34 ) Tj ET BT 0.9598 0 0 0.9598 79.92 681.12 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 86.16 681.12 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 139.92 681.12 Tm /F5 11 Tf 0.0681 Tc -0.0693 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 238.56 681.12 Tm /F5 10 Tf 0.0229 Tc 0.1597 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 78.96 641.28 Tm /F4 10 Tf -0.0187 Tc 1.1662 Tw (Thus far, State regulations for special care units) Tj -11.563 -12.4458 TD -0.0424 Tc 1.3751 Tw (have been developed largely without regard for the) Tj ET BT 0.9835 0 0 0.9835 67.92 616.8 Tm 0.0418 Tc 1.9173 Tw (provisions of OBRA-87. Some of the six States\222) Tj ET BT 0.934 0 0 0.9835 68.16 604.56 Tm -0.0368 Tc 0.9836 Tw (requirements for special care units duplicate OBRA) Tj 0.257 -12.4458 TD -0.0151 Tc 0.3914 Tw (requirements that apply to all nursing homes. Some) Tj ET BT 0.9835 0 0 0.9835 68.64 579.6 Tm 0.0206 Tc 1.1021 Tw (of the special care unit requirements, e.g., those) Tj 0 -12.4458 TD 0.0226 Tc -0.0504 Tw (dealing with residents\222 rights to have visitors, are) Tj ET BT 0.934 0 0 0.9835 68.88 555.36 Tm -0.0226 Tc 0.7886 Tw (weaker than the comparable OBRA requirements.) Tj ET BT 0.9835 0 0 0.9835 80.4 528.24 Tm 0.022 Tc 2.3615 Tw (OTA\222s analysis of the six States\222 regulations) Tj ET BT 0.934 0 0 0.9835 69.12 516.24 Tm -0.0352 Tc 0.5322 Tw (indicates several problems that are likely to arise in) Tj ET BT 0.9835 0 0 0.9835 69.36 504 Tm 0.0274 Tc 2.1759 Tw (any special care unit regulations that could be) Tj 0 -12.4458 TD 0.0184 Tc 0.7789 Tw (devised at present. First, by requiring particular) Tj ET BT 0.934 0 0 0.9835 69.36 479.76 Tm -0.0199 Tc 0.5158 Tw (features in special care units, the six States\222 regula-) Tj ET BT 0.8915 0 0 0.9835 69.6 467.76 Tm 0.0423 Tc 0.8199 Tw (tions imply that those features are unique to or more) Tj 0.2692 -12.2018 TD 0.0322 Tc 0.3789 Tw (important in the care of residents with dementia than) Tj 0 -12.4458 TD 0.043 Tc 0.5499 Tw (in the care of other nursing home residents. Yet some) Tj ET BT 0.9835 0 0 0.9835 69.84 431.52 Tm 0.0425 Tc 2.056 Tw (of the required features probably are not more) Tj ET BT 0.8915 0 0 0.9835 69.84 419.52 Tm 0.0299 Tc 1.1842 Tw (important for residents with dementia than for other) Tj ET BT 0.9835 0 0 0.9835 69.6 408 Tm 0.0316 Tc 1.579 Tw (residents. Examples are Iowa\222s and Tennessee\222s) Tj ET BT 0.934 0 0 0.9835 69.84 395.76 Tm -0.0261 Tc 1.1007 Tw (requirements for an interdisciplinary care planning) Tj 0.257 -12.2018 TD -0.0286 Tc 1.7457 Tw (team, Colorado\222s requirement for sufficient staff to) Tj -0.257 -12.2018 TD -0.0388 Tc 0.8206 Tw (provide for the residents\222 needs, and Texas\222 require-) Tj 0.5139 -12.2018 TD -0.0408 Tc 1.4018 Tw (ment for a social worker to assess the residents on) Tj 0.257 -12.2018 TD -0.0227 Tc 1.5595 Tw (admission, conduct family support group meetings,) Tj 0 -12.2018 TD -0.0162 Tc 1.3149 Tw (and identify and arrange for the use of community) Tj ET BT 0.9835 0 0 0.9835 70.08 323.76 Tm 0.0322 Tc 1.0554 Tw (resources. If these features are important for all) Tj ET BT 0.934 0 0 0.9835 70.56 311.52 Tm -0.0247 Tc 0.8421 Tw (nursing home residents, it is misleading and poten-) Tj ET BT 0.8915 0 0 0.9835 70.56 299.28 Tm 0.0325 Tc 1.5659 Tw (tially harmful to residents of nonspecialized units to) Tj ET BT 0.9835 0 0 0.9835 70.32 287.52 Tm 0.0385 Tc 0.2297 Tw (require the features differentially for special care) Tj ET BT 0.8491 0 0 0.9835 70.56 275.28 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.8915 0 0 0.9835 82.08 247.92 Tm 0.0529 Tc 1.2418 Tw (Second, by requiring particular features in special) Tj ET BT 0.9835 0 0 0.9835 71.04 235.92 Tm 0.0153 Tc 0.968 Tw (care units, the six States\222 regulations imply that) Tj 0 -12.4458 TD 0.0339 Tc 0.9666 Tw (those features are more important in the care of) Tj ET BT 0.8915 0 0 0.9835 70.56 211.68 Tm 0.0314 Tc 1.1825 Tw (residents with dementia than other features that are) Tj ET BT 0.9835 0 0 0.9835 70.8 199.68 Tm 0.0319 Tc 2.1364 Tw (not required by the regulations. Yet experts in) Tj 0.4881 -12.4458 TD 0.0345 Tc 0.6405 Tw (dementia care disagree about which features are) Tj ET BT 0.934 0 0 0.9835 71.28 175.44 Tm -0.0332 Tc 1.6864 Tw (most important in the care of these residents. The) Tj ET BT 0.8915 0 0 0.9835 71.28 163.2 Tm 0.0365 Tc 1.2153 Tw (existing special care unit regulations emphasize staff) Tj ET BT 0.934 0 0 0.9835 71.28 150.96 Tm -0.0166 Tc 1.2006 Tw (training and physical design features and place far) Tj 0 -12.2018 TD -0.0257 Tc 1.4 Tw (less emphasis on specialized activity programs and) Tj 0 -12.4458 TD -0.0318 Tc 0.7213 Tw (programs to involve and support residents\222 families.) Tj 0 -12.2018 TD -0.031 Tc 2.1336 Tw (Although there is no research-based evidence that) Tj ET BT 0.8915 0 0 0.9835 71.76 102.48 Tm 0.0459 Tc 0.9655 Tw (any of these features are more likely than the others) Tj ET BT 0.934 0 0 0.9835 71.76 90.48 Tm -0.0556 Tc 1.0037 Tw (to produce positive resident outcomes, some experts) Tj ET BT 0.9835 0 0 0.9835 71.52 78.72 Tm 0.0345 Tc 1.454 Tw (in dementia care would undoubtedly argue that) Tj 0.244 -12.2018 TD 0.0292 Tc 0.6541 Tw (specialized activity programs and family support) Tj -0.7321 -12.4458 TD 0.0219 Tc 1.2054 Tw (programs are as important as staff training and) Tj -0.244 -11.9577 TD 0.0362 Tc 0.3846 Tw (physical design features in the care of these resi-) Tj ET BT 0.8491 0 0 0.9835 71.04 30.96 Tm 0.2519 Tc 0 Tw (dents.) Tj ET BT 0.934 0 0 0.9835 330 641.28 Tm -0.0233 Tc 1.2261 Tw (Third, by requiring particular features in special) Tj ET BT 0.8915 0 0 0.9835 319.44 629.04 Tm 0.0232 Tc 1.4994 Tw (care units, the six States\222 regulations imply that the) Tj ET BT 0.934 0 0 0.9835 319.2 617.28 Tm -0.0355 Tc 1.6246 Tw (resources available to the unit should be expended) Tj ET BT 0.8915 0 0 0.9835 319.68 605.04 Tm 0.0458 Tc 1.4741 Tw (for the required features rather than other features.) Tj 0.2692 -12.6899 TD 0.0456 Tc 1.0897 Tw (Since most special care units have limited resources,) Tj -0.2692 -11.9577 TD 0.0558 Tc 1.0013 Tw (features not required in special care unit regulations) Tj ET BT 0.934 0 0 0.9835 320.16 568.56 Tm -0.0493 Tc 1.0613 Tw (are likely to be neglected.) Tj 11.82 -20.0109 TD -0.023 Tc 1.654 Tw (The six States\222 requirements for physical design) Tj -11.563 -12.2018 TD -0.031 Tc 0.7633 Tw (features are especially troublesome, in part because) Tj ET BT 0.9835 0 0 0.9835 320.4 524.88 Tm 0.0437 Tc 1.2311 Tw (they are so detailed. To incorporate some of the) Tj -0.244 -12.4458 TD 0.0352 Tc 1.0873 Tw (required features involves extensive remodeling,) Tj 0.244 -12.2018 TD 0.0214 Tc 0.5319 Tw (with obvious cost implications. In some facilities,) Tj ET BT 0.934 0 0 0.9835 320.64 488.64 Tm -0.0373 Tc 1.7978 Tw (the required features cannot be incorporated, even) Tj 0 -11.9577 TD -0.0354 Tc 2.3097 Tw (with extensive remodeling. For such facilities, the) Tj -0.257 -12.2018 TD -0.0385 Tc 1.0037 Tw (requirements can lead to costly new construction or) Tj ET BT 0.9835 0 0 0.9835 321.12 452.88 Tm 0.0297 Tc 0.3878 Tw (a decision by the nursing home not to establish a) Tj ET BT 0.934 0 0 0.9835 321.36 440.88 Tm -0.0349 Tc 0.5962 Tw (special care unit \(337\). If there were evidence of the) Tj -0.257 -12.2018 TD -0.0307 Tc 1.5167 Tw (effectiveness of particular physical design features,) Tj ET BT 0.9835 0 0 0.9835 321.12 417.36 Tm 0.0314 Tc 0.1759 Tw (it might be reasonable to require the features. To) Tj ET BT 0.8915 0 0 0.9835 320.88 405.36 Tm 0.0488 Tc 1.586 Tw (require the features without such evidence is proba-) Tj 0.2692 -12.4458 TD 0.0352 Tc 3.1011 Tw (bly inappropriate.) Tj ET BT 0.9835 0 0 0.9835 332.16 373.44 Tm 0.0237 Tc 1.0989 Tw (The impact of the six States\222 special care unit) Tj -10.9816 -12.2018 TD 0.028 Tc 0.4234 Tw (regulations on the growth of special care units in) Tj ET BT 0.934 0 0 0.9835 321.6 349.68 Tm -0.0276 Tc 1.7446 Tw (each State is unclear. Anecdotal evidence suggests) Tj 0.257 -12.4458 TD -0.0198 Tc 0.58 Tw (that the regulations have discouraged some nursing) Tj ET BT 0.9835 0 0 0.9835 321.6 325.68 Tm 0.0181 Tc 1.6334 Tw (homes from establishing special care units. The) Tj ET BT 0.8915 0 0 0.9835 321.84 313.68 Tm 0.0395 Tc 0.9427 Tw (States vary in the extent to which they are enforcing) Tj ET BT 0.9835 0 0 0.9835 321.84 301.68 Tm 0.0166 Tc -0.114 Tw (their regulations, but several nursing homes in at) Tj ET BT 0.8915 0 0 0.9835 321.84 289.68 Tm 0.0364 Tc 1.3051 Tw (least two of the States have closed their special care) Tj ET BT 0.9835 0 0 0.9835 321.84 277.68 Tm 0.0328 Tc 1.9133 Tw (unit because the unit could not meet the State) Tj 0 -12.2018 TD 0.0312 Tc 0.1558 Tw (requirements \(169,267\). It is possible that special) Tj ET BT 0.8915 0 0 0.9835 322.08 253.44 Tm 0.0522 Tc 1.0631 Tw (care unit regulations could cause the closing of units) Tj ET BT 0.9835 0 0 0.9835 322.08 241.68 Tm 0.04 Tc 1.7796 Tw (that provide good care for their residents, even) Tj 0 -12.4458 TD 0.0439 Tc 0.2242 Tw (though they do not meet one or more of the State) Tj -0.244 -11.9577 TD 0.0308 Tc 0.8884 Tw (requirements. There is no evidence to determine) Tj ET BT 0.8915 0 0 0.9835 322.32 205.68 Tm 0.0501 Tc 1.3795 Tw (whether this has occurred.) Tj ET BT 0.934 0 0 0.9835 333.36 186 Tm -0.0345 Tc 1.024 Tw (As noted earlier, Oklahoma is developing regula-) Tj ET BT 0.9835 0 0 0.9835 322.56 173.76 Tm 0.0236 Tc 1.5871 Tw (tions for special care units. The regulations are) Tj ET BT 0.8915 0 0 0.9835 322.56 162 Tm 0.0278 Tc 1.1914 Tw (intended by their supporters to set a\221 \221basic standard) Tj ET BT 0.934 0 0 0.9835 322.56 150.24 Tm -0.0301 Tc 0.905 Tw (of care,\224 rather than to define what would be \221\221ideal) Tj ET BT 0.9835 0 0 0.9835 322.56 138 Tm 0.0194 Tc 2.0794 Tw (or high-quality care\224) Tj 106.8876 0.244 TD 0.0468 Tc 1.3195 Tw (\(118\). In the development) Tj ET BT 0.934 0 0 0.9835 322.32 126 Tm -0.0297 Tc 1.2758 Tw (process, the draft regulations have become increas-) Tj ET BT 0.8915 0 0 0.9835 322.56 114.24 Tm 0.034 Tc 1.1845 Tw (ingly detailed, moving away from what some of their) Tj ET BT 0.934 0 0 0.9835 323.04 102 Tm -0.035 Tc 1.0245 Tw (supporters first envisioned as broad, general guide-) Tj ET BT 0.9835 0 0 0.9835 322.8 90.24 Tm 0.0178 Tc 1.9997 Tw (lines that would inform families, nursing home) Tj ET BT 0.934 0 0 0.9835 322.8 78.24 Tm -0.0175 Tc 2.1193 Tw (administrators, and others about what constitutes) Tj ET BT 0.9835 0 0 0.9835 322.56 66 Tm 0.0335 Tc 2.8582 Tw (basic care. In the spring of 1992, a telephone) Tj 0 -11.9577 TD 0.0252 Tc 1.8295 Tw (followup to the 1991 survey of all U.S. nursing) Tj -0.4881 -12.2018 TD 0.0327 Tc 1.2728 Tw (homes with more than 30 beds found that some) Tj ET BT 0.8915 0 0 0.9835 322.32 30.24 Tm 0.0486 Tc 0.3942 Tw (Oklahoma nursing homes that had a special care unit) Tj ET endstream endobj 142 0 obj <>/Rotate 0/Type/Page>> endobj 143 0 obj <>stream 0.72 w 1 j 0 0 0 RG 62.64 677.04 m 541.2 677.04 l S 66.48 46.08 m 544.8 46.08 l S BT 0.9835 0 0 0.9835 330.48 682.32 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 2.9207 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 522.72 682.32 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 529.44 682.32 Tm /F5 10 Tf 0.488 Tc 0 Tw (35) Tj ET BT 0.8915 0 0 0.9835 63.12 643.68 Tm /F4 10 Tf 0.0389 Tc 0.734 Tw (in 1991 reported they had since closed the unit \(246\).) Tj ET BT 0.934 0 0 0.9835 62.88 631.44 Tm -0.0366 Tc 1.2724 Tw (When asked why they had closed their special care) Tj ET BT 0.9835 0 0 0.9835 63.12 619.44 Tm 0.0394 Tc 1.4185 Tw (unit, most of the respondents declined to give a) Tj 0 -12.2018 TD 0.0332 Tc 1.6994 Tw (reason, but one respondent said the unit in his) Tj 0.244 -12.2018 TD 0.0377 Tc 2.3746 Tw (facility had been closed in anticipation of very) Tj ET BT 0.8915 0 0 0.9835 63.6 583.44 Tm 0.0439 Tc 1.7903 Tw (detailed regulatory requirements the unit would not) Tj ET BT 0.934 0 0 0.9835 63.36 571.44 Tm -0.0147 Tc 1.0884 Tw (be able to meet. OTA has no information about the) Tj ET BT 0.9835 0 0 0.9835 63.84 559.44 Tm 0.0361 Tc 0.2566 Tw (quality of care provided by this unit or any of the) Tj 0 -11.9577 TD 0.0235 Tc 1.6918 Tw (other special care units in Oklahoma that were) Tj ET BT 0.934 0 0 0.9835 64.08 535.68 Tm -0 Tc 1.5866 Tw (closed between 1991 and 1992.) Tj ET BT 0.9663 0 0 0.9939 96.72 509.28 Tm /F6 14 Tf 0.0213 Tc 2.6854 Tw (POLICY IMPLICATIONS) Tj ET BT 0.9835 0 0 0.9835 75.12 491.52 Tm /F4 10 Tf 0.0273 Tc -0.0842 Tw (Findings from the available research on special) Tj ET BT 0.934 0 0 0.9835 64.32 479.28 Tm -0.019 Tc 0.6892 Tw (care units and the information just presented about) Tj ET BT 0.8915 0 0 0.9835 64.32 467.76 Tm 0.0531 Tc 0.6583 Tw (the regulatory environment for special care units and) Tj ET BT 0.9835 0 0 0.9835 64.08 455.52 Tm 0.0279 Tc 0.014 Tw (problems with the existing State special care unit) Tj ET BT 0.934 0 0 0.9835 64.08 443.28 Tm -0.0323 Tc 1.4376 Tw (regulations have implications for each of the policy) Tj 0.7709 -11.9577 TD -0.0345 Tc 0.8526 Tw (areas addressed in this report: consumer education,) Tj ET BT 0.8915 0 0 0.9835 64.32 419.52 Tm 0.0516 Tc 2.1854 Tw (research, regulation, and reimbursement.) Tj ET BT 0.9795 0 0 0.9795 66.96 394.8 Tm /F7 12 Tf 0.0468 Tc 1.1164 Tw (Implications for Consumer Education About) Tj 66.6486 -14.7019 TD 0.0475 Tc 0.6256 Tw (Special Care Units) Tj ET BT 0.9261 0 0 0.9795 76.08 362.64 Tm 0.0319 Tc 0.074 Tw (The ) Tj ET BT 0.934 0 0 0.9835 97.68 362.64 Tm /F4 10 Tf -0.0288 Tc 2.0028 Tw (diversity of existing special care units sub-) Tj ET BT 0.8915 0 0 0.9835 65.52 350.88 Tm 0.0383 Tc 1.0787 Tw (stantiates the need for consumer education. Families) Tj ET BT 0.934 0 0 0.9835 65.52 338.88 Tm -0.0206 Tc 0.6542 Tw (and others who make decisions about nursing home) Tj 0 -12.2018 TD -0.0285 Tc 0.7178 Tw (care for individuals with dementia could reasonably) Tj ET BT 0.9835 0 0 0.9835 65.76 314.88 Tm 0.0181 Tc 0.281 Tw (assume that all special care units are alike. They) Tj ET BT 0.8915 0 0 0.9835 65.52 302.88 Tm 0.0449 Tc 0.7273 Tw (need to know that special care units vary in virtually) Tj 0 -12.4458 TD 0.0402 Tc 0.7882 Tw (every respect, including the number of residents they) Tj 0.5384 -12.2018 TD 0.04 Tc 0.8268 Tw (serve, their patient care philosophies and goals, their) Tj ET BT 0.934 0 0 0.9835 65.52 266.88 Tm -0.0269 Tc 2.2835 Tw (physical design features, their staff-to-resident ra-) Tj ET BT 0.9835 0 0 0.9835 66 254.64 Tm 0.0265 Tc 1.2181 Tw (tios, their admission and discharge policies, and) Tj ET BT 0.8915 0 0 0.9835 66 242.4 Tm 0.0439 Tc 0.8993 Tw (their charges. Ideally families and others would have) Tj ET BT 0.9835 0 0 0.9835 66 230.16 Tm 0.0364 Tc 2.3759 Tw (easy access to information about each of these) Tj 0.244 -12.2018 TD 0.0209 Tc 0.5789 Tw (characteristics for the special care units they are) Tj 0 -11.9577 TD 0.0214 Tc 0.9792 Tw (considering. If such information is not available,) Tj ET BT 0.934 0 0 0.9835 66.24 194.4 Tm -0.0308 Tc 0.8487 Tw (families and others need to know what questions to) Tj 0.257 -12.4458 TD -0.0236 Tc 0.3841 Tw (ask to obtain the information when they call or visit) Tj ET BT 0.8915 0 0 0.9835 66.48 170.4 Tm 0.0543 Tc 1.1055 Tw (a special care unit.) Tj ET BT 0.9835 0 0 0.9835 77.28 152.64 Tm 0.0313 Tc 1.2539 Tw (To compile information about the special care) Tj -11.2256 -12.2018 TD 0.0261 Tc -0.0966 Tw (units in a given jurisdiction would be more or less) Tj 0.244 -12.2018 TD 0.032 Tc 0.1144 Tw (difficult, depending on the number of units in the) Tj -0.7321 -11.9577 TD 0.0159 Tc 1.3916 Tw (jurisdiction. In jurisdictions with more than one) Tj ET BT 0.934 0 0 0.9835 66.96 104.88 Tm -0.0331 Tc 1.622 Tw (special care unit, definitional issues would have to) Tj ET BT 0.8915 0 0 0.9835 66.48 93.12 Tm 0.0327 Tc 1.4888 Tw (be resolved so that information about different units) Tj ET BT 0.934 0 0 0.9835 66.72 81.36 Tm -0.0301 Tc 1.7473 Tw (would be comparable. Since the units are likely to) Tj ET BT 0.9835 0 0 0.9835 66.72 69.36 Tm 0.0154 Tc 2.5716 Tw (change over time,) Tj 94.6858 0 TD 0.0493 Tc 3.1472 Tw (an ongoing effort would be) Tj ET BT 0.8915 0 0 0.9835 66.24 57.6 Tm 0.0357 Tc 1.8892 Tw (required to update the information.) Tj ET BT 0.9835 0 0 0.9835 325.44 643.44 Tm 0.0331 Tc 0.162 Tw (Compiling and updating information about the) Tj ET BT 0.934 0 0 0.9835 314.64 631.2 Tm -0.0265 Tc 1.1867 Tw (special care units in a given jurisdiction could be a) Tj ET BT 0.9835 0 0 0.9835 314.16 619.2 Tm 0.0281 Tc 3.73 Tw (project of an Alzheimer\222s Association chapter,) Tj ET BT 0.8915 0 0 0.9835 314.88 606.96 Tm 0.0494 Tc 0.4942 Tw (another private agency, or a public agency .11 Inmost) Tj ET BT 0.9835 0 0 0.9835 313.92 594.96 Tm 0.0242 Tc 2.3186 Tw (jurisdictions, a local agency would be the most) Tj ET BT 0.934 0 0 0.9835 315.12 582.96 Tm -0.0312 Tc 2.1339 Tw (appropriate organization to perform this task. Be-) Tj ET BT 0.9835 0 0 0.9835 314.88 571.2 Tm 0.0444 Tc 1.932 Tw (cause of the amount of detail involved and the) Tj ET BT 0.8915 0 0 0.9835 314.88 559.2 Tm 0.0326 Tc 1.3542 Tw (necessity for frequent updates, the information could) Tj ET BT 0.9835 0 0 0.9835 315.12 547.44 Tm 0.0519 Tc 2.151 Tw (not be effectively compiled and updated at the) Tj ET BT 0.934 0 0 0.9835 315.36 535.44 Tm -0.0372 Tc 1.8466 Tw (Federal level. In States with relatively few special) Tj ET BT 0.9835 0 0 0.9835 315.36 523.44 Tm 0.0327 Tc 3.1815 Tw (care units, it probably could be compiled and) Tj ET BT 0.8915 0 0 0.9835 315.36 511.68 Tm 0.0026 Tc 1.1188 Tw (updated at the State level.) Tj ET BT 0.934 0 0 0.9835 326.4 494.16 Tm -0.0316 Tc 1.235 Tw (Descriptive information about the characteristics) Tj ET BT 0.9835 0 0 0.9835 315.6 481.92 Tm 0.0339 Tc 0.1124 Tw (of particular special care units would be useful to) Tj 0 -12.2018 TD 0.0275 Tc 0.4036 Tw (families and others because the characteristics of) Tj ET BT 0.8915 0 0 0.9835 316.08 457.92 Tm 0.0213 Tc 1.3477 Tw (some units \(e.g., the units\222 patient care philosophies,) Tj ET BT 0.934 0 0 0.9835 315.84 445.92 Tm -0.0361 Tc 1.4968 Tw (discharge policies, or design features\) would match) Tj ET BT 0.9835 0 0 0.9835 316.08 433.68 Tm 0.0318 Tc -0.1294 Tw (their individual needs, preferences, and values. It) Tj 0.244 -11.9577 TD 0.0361 Tc 0.1102 Tw (should be recognized, however, that the available) Tj ET BT 0.8915 0 0 0.9835 315.84 410.16 Tm 0.036 Tc 1.9337 Tw (research findings do not provide objective standards) Tj ET BT 0.9835 0 0 0.9835 316.08 397.92 Tm 0.0394 Tc 0.839 Tw (to help families and others evaluate special care) Tj ET BT 0.934 0 0 0.9835 316.08 386.16 Tm -0.014 Tc 0.4881 Tw (units. Although some unit characteristics may seem) Tj 0 -12.2018 TD -0.0286 Tc 1.6172 Tw (right intuitively and match the needs, preferences,) Tj 0.5139 -12.4458 TD -0.0162 Tc 1.2002 Tw (and values of some families, the available research) Tj ET BT 0.9835 0 0 0.9835 316.56 350.4 Tm 0.0278 Tc 2.6636 Tw (findings do not prove that any particular unit) Tj ET BT 0.934 0 0 0.9835 316.56 338.16 Tm -0.04 Tc 2.7086 Tw (characteristics are associated with better resident) Tj 0.257 -12.2018 TD -0.0318 Tc 0 Tw (outcomes.) Tj 11.563 -18.3027 TD -0.0139 Tc 1.2161 Tw (Based on the available information, the message) Tj ET BT 0.8915 0 0 0.9835 316.8 296.4 Tm 0.0422 Tc 1.0407 Tw (for consumers is that special care units vary greatly;) Tj ET BT 0.934 0 0 0.9835 316.8 284.16 Tm -0.0427 Tc 0.8614 Tw (that there is little research-based evidence of better) Tj ET BT 0.9835 0 0 0.9835 316.8 272.16 Tm 0.024 Tc 1.9701 Tw (resident outcomes in special care units than in) Tj ET BT 0.934 0 0 0.9835 316.8 260.4 Tm -0.0264 Tc 4.6983 Tw (nonspecialized units;) Tj ET BT 0.9835 0 0 0.9835 419.28 260.16 Tm 0.0261 Tc 1.5236 Tw (and that although a given) Tj ET BT 0.8915 0 0 0.9835 317.52 247.92 Tm 0.0477 Tc 1.4719 Tw (special care unit may have better resident outcomes) Tj ET BT 0.934 0 0 0.9835 317.28 235.92 Tm -0.0277 Tc 1.9833 Tw (than another special care unit or a nonspecialized) Tj -0.257 -12.2018 TD -0.0378 Tc 0.8562 Tw (unit, there is no research-based evidence to identify) Tj ET BT 0.9835 0 0 0.9835 317.28 211.92 Tm 0.0257 Tc 0.2835 Tw (the unit characteristics that explain the different) Tj 0.244 -12.2018 TD 0.0301 Tc -0.0464 Tw (outcomes. On the positive side, it can be said that) Tj ET BT 0.934 0 0 0.9835 317.76 188.16 Tm -0.0429 Tc 0.8938 Tw (special care units are likely to have fewer residents) Tj 0 -12.2018 TD -0.0234 Tc 1.2446 Tw (and more staff members per resident than nonspe-) Tj ET BT 0.8915 0 0 0.9835 317.52 164.16 Tm 0.0416 Tc 1.0557 Tw (cialized nursing home units; that in comparison with) Tj ET BT 0.9835 0 0 0.9835 317.52 152.4 Tm 0.0364 Tc 0.1099 Tw (the residents of nonspecialized units, special care) Tj 0 -12.2018 TD 0.0296 Tc 3.3589 Tw (unit residents are less likely to be physically) Tj 0 -11.9577 TD 0.0292 Tc 1.9649 Tw (restrained; and that even though there is little) Tj ET BT 0.8915 0 0 0.9835 317.52 117.12 Tm 0.0463 Tc 2.2811 Tw (research-based evidence of better resident outcomes) Tj ET BT 0.9835 0 0 0.9835 317.76 104.88 Tm 0.0236 Tc -0.0165 Tw (in special care units than in nonspecialized units,) Tj 0.244 -11.9577 TD 0.0317 Tc 0.5417 Tw (there is much less evidence of worse outcomes in) Tj ET BT 0.934 0 0 0.9835 318.24 81.36 Tm -0.0325 Tc 1.9518 Tw (special care units. Consumers need to know, how-) Tj ET BT 0.8915 0 0 0.9835 317.76 69.36 Tm 0.0239 Tc 0.1526 Tw (ever, that these statements refer to averages that may) Tj ET BT 0.9835 0 0 0.9835 317.52 57.36 Tm 0.0264 Tc 0.6386 Tw (not apply to a given unit. Although this message) Tj ET q 3.6 0 0 -4.08 80.88 39.84 cm BI /W 26 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>>>>>>~~ EI Q BT 0.3286 0 0 0.9835 80.88 34.56 Tm 3 Tr /F2 10 Tf 0.1087 Tc 0 Tw (11) Tj 0 Tr ET BT 0.798 0 0 0.9835 84.48 34.56 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 5.52 0 0 -5.28 86.4 39.12 cm BI /W 39 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????????? EI Q BT 0.4694 0 0 0.9835 86.4 34.56 Tm 3 Tr 0.0885 Tc 0 Tw (IU) Tj 0 Tr ET BT 0.798 0 0 0.9835 91.92 34.56 Tm 0.0586 Tc -0.1685 Tw ( some ) Tj ET q 33.84 0 0 -7.2 112.8 40.08 cm BI /W 231 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px<< >|q>??~>?ǃ<??ǁ~?x?p>>ǁx|x8>>|p?>>>| >>||>>||>>?|>>|>?>||>>||?>>||?p>~@|>x>>|<>>|<~?> ~<0>`0 ` EI Q BT 0.7041 0 0 0.9835 112.8 34.56 Tm 3 Tr -0.0237 Tc 0 Tw (jfis&ctions,) Tj 0 Tr ET BT 0.798 0 0 0.9835 146.64 34.56 Tm 0.0694 Tc -0.182 Tw ( a ) Tj ET BT 0.7642 0 0 0.9835 154.08 34.56 Tm /F4 10 Tf -0.03 Tc 0.5551 Tw (public or ) Tj ET BT 0.798 0 0 0.9835 188.64 34.56 Tm /F2 10 Tf 0.0421 Tc -0.1478 Tw (private agency compiles and updates similar types ) Tj ET BT 0.7642 0 0 0.9835 352.08 34.56 Tm /F4 10 Tf -0.0142 Tc 1.7907 Tw (of information about) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 12.24 0 0 -5.76 430.56 40.8 cm BI /W 84 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|3p?x?<?>~s~?1~??|?|?x~?<~???@|~?~>~~||?>?????? EI Q BT 0.467 0 0 0.9835 430.56 34.56 Tm 3 Tr -0.0393 Tc 0 Tw (IOCd) Tj 0 Tr ET BT 0.7642 0 0 0.9835 442.8 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 19.2 0 0 -7.2 444.72 40.08 cm BI /W 133 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??ppx 8????~?~||||?|?|?|~|~~|~|~>?~>????0|p EI Q BT 0.5094 0 0 0.9835 444.72 34.56 Tm 3 Tr -0.0198 Tc 0 Tw (nursing) Tj 0 Tr ET BT 0.7642 0 0 0.9835 463.92 34.56 Tm -0.0136 Tc 1.6329 Tw ( homes.) Tj ET endstream endobj 144 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 145 0 obj <>stream 0.48 w 1 j 0 0 0 RG 69.36 677.52 m 547.92 677.52 l S BT 0.9835 0 0 0.9835 69.36 683.28 Tm 0 0 0 rg /F5 10 Tf 0.0142 Tc 0.315 Tw (36 . Special Care Units for People With Alzheimer\222s and ) Tj ET BT 0.9812 0 0 0.9812 299.76 683.28 Tm /F5 11 Tf 0.0448 Tc 1.3609 Tw (Other Dementias) Tj ET BT 0.9835 0 0 0.9835 69.84 643.92 Tm /F4 10 Tf 0.0496 Tc 0.3099 Tw (does not meet the need for objective standards to) Tj ET BT 0.8915 0 0 0.9835 70.32 631.92 Tm 0.0487 Tc 1.5862 Tw (evaluate special care units, it does accurately repre-) Tj 0.2692 -12.2018 TD 0.0224 Tc 1.2311 Tw (sent what is known about the units.) Tj ET BT 0.9835 0 0 0.9835 81.36 602.4 Tm 0.0418 Tc 0.697 Tw (A few States have or are developing consumer) Tj ET BT 0.934 0 0 0.9835 70.56 590.16 Tm -0.0222 Tc 2.1243 Tw (education materials about special care units. New) Tj ET BT 0.9835 0 0 0.9835 70.56 578.16 Tm 0.0379 Tc 1.6945 Tw (Hampshire has published an 8-page booklet in-) Tj 0 -12.2018 TD 0.0298 Tc 3.1845 Tw (tended for family members who are trying to) Tj ET BT 0.8915 0 0 0.9835 70.56 554.4 Tm 0.053 Tc 1.4275 Tw (evaluate special care units and nursing home opera-) Tj 0.5384 -12.4458 TD 0.0512 Tc 1.0305 Tw (tors who are interested in establishing a special care) Tj ET BT 0.934 0 0 0.9835 70.8 530.64 Tm -0.0255 Tc 0.8859 Tw (unit \(325\). The booklet describes the characteristics) Tj ET BT 0.8915 0 0 0.9835 71.04 518.4 Tm 0.0367 Tc 1.715 Tw (of an individual with Alzheimer\222s disease, the needs) Tj 0.2692 -11.9577 TD 0.0327 Tc 0.9167 Tw (of the individual and the family, and the characteris-) Tj ET BT 0.934 0 0 0.9835 71.28 494.64 Tm -0.038 Tc 1.8475 Tw (tics of specialized dementia care. It provides ques-) Tj ET BT 0.8915 0 0 0.9835 71.28 482.88 Tm 0.0376 Tc 0.4363 Tw (tions and a checklist that families can use to evaluate) Tj ET BT 0.934 0 0 0.9835 71.52 470.88 Tm -0.0306 Tc 1.2156 Tw (special care units. For nursing home operators, the) Tj -0.257 -12.2018 TD -0.0262 Tc 1.2934 Tw (booklet lists reasons for having a special care unit,) Tj ET BT 0.8915 0 0 0.9835 71.52 447.12 Tm 0.0339 Tc 0.6798 Tw (questions the nursing home operator and staff should) Tj ET BT 0.9835 0 0 0.9835 71.52 434.88 Tm 0.0242 Tc 1.3424 Tw (consider in establishing a special care unit, and) Tj ET BT 0.934 0 0 0.9835 71.76 422.88 Tm -0.028 Tc 0.7494 Tw (factors that will influence the success of the unit.) Tj ET BT 0.9835 0 0 0.9835 82.56 405.12 Tm 0.0305 Tc 3.0443 Tw (The American Association of Homes for the) Tj ET BT 0.934 0 0 0.9835 71.76 393.12 Tm -0.0168 Tc 2.0671 Tw (Aging, the Massachusetts Alzheimer\222s Disease Re-) Tj ET BT 0.9835 0 0 0.9835 72 380.88 Tm 0.0214 Tc 1.1013 Tw (search Center, the National Institute on Aging\222s) Tj ET BT 0.8915 0 0 0.9835 72 369.36 Tm 0.0523 Tc 2.0051 Tw (Alzheimer\222s Disease Education and Referral Center,) Tj ET BT 0.934 0 0 0.9835 72 357.12 Tm -0.0217 Tc 2.1238 Tw (the University of South Florida\222s Suncoast Geron-) Tj ET BT 0.9835 0 0 0.9835 72.24 345.12 Tm 0.0263 Tc 1.6251 Tw (tology Center, and the University of Wisconsin-) Tj -0.244 -11.9577 TD 0.0239 Tc 1.5868 Tw (Milwaukee\222s Center for Architecture and Urban) Tj 0 -11.9577 TD 0.0428 Tc 0.3474 Tw (Planning Research have developed guidelines for) Tj 0.7321 -12.4458 TD 0.0158 Tc 2.0831 Tw (special care units,) Tj 96.3941 -0.244 TD 0.0357 Tc 1.5748 Tw (and other organizations are) Tj -96.8821 -11.7137 TD 0.0352 Tc 1.645 Tw (developing such guidelines \(see ch. 5\). The Alz-) Tj -0.244 -11.9577 TD 0.0289 Tc -0.0045 Tw (heimer\222s Association released its special care unit) Tj 0.7321 -12.4458 TD 0.037 Tc 0.7368 Tw (guidelines in July 1992. Some of these organiza-) Tj 0 -11.9577 TD 0.0294 Tc 0.8491 Tw (tions\222 guidelines are intended primarily to assist) Tj ET BT 0.934 0 0 0.9835 72.48 249.84 Tm -0.0203 Tc 1.7184 Tw (families in evaluating special care units and other) Tj 0.257 -12.4458 TD -0.0313 Tc 1.8771 Tw (organizations\222 guidelines are intended primarily to) Tj ET BT 0.9835 0 0 0.9835 72.72 225.6 Tm 0.0236 Tc 2.2379 Tw (assist nursing home operators in planning and) Tj ET BT 0.8915 0 0 0.9835 72.96 213.6 Tm 0.0341 Tc 1.1103 Tw (setting up a special care unit.) Tj ET BT 0.9835 0 0 0.9835 84 195.84 Tm 0.031 Tc 0.1153 Tw (OTA\222s review of the various organizations\222 spe-) Tj ET BT 0.8915 0 0 0.9835 72.72 183.6 Tm 0.0458 Tc 0.8203 Tw (cial care unit guidelines indicates that the guidelines) Tj 0.2692 -11.7137 TD 0.0382 Tc 1.0211 Tw (are quite similar in content, despite some differences) Tj ET BT 0.934 0 0 0.9835 72.96 160.08 Tm -0.0039 Tc 1.9762 Tw (in emphasis, format, and wording. Each organiza-) Tj -0.257 -12.2018 TD -0.0306 Tc 1.6193 Tw (tion\222s guidelines cite numerous unit characteristics) Tj 0 -12.2018 TD -0.0234 Tc 1.6117 Tw (the organization considers desirable. This informa-) Tj 0 -12.4458 TD -0.0282 Tc 0.7317 Tw (tion is useful for families and others who are trying) Tj ET BT 0.8915 0 0 0.9835 72.96 111.84 Tm 0.0439 Tc 0.9378 Tw (to evaluate special care units, but consumers need to) Tj ET BT 0.934 0 0 0.9835 72.72 100.08 Tm -0.0192 Tc 0.9831 Tw (know that statements about the desirability of par-) Tj ET BT 0.8915 0 0 0.9835 72.96 87.84 Tm 0.0491 Tc 1.278 Tw (ticular unit characteristics are based on expert opin-) Tj 0.2692 -11.9577 TD 0.0243 Tc 1.1905 Tw (ion and that experts disagree about these matters.) Tj ET BT 0.9835 0 0 0.9835 84.24 58.08 Tm 0.0371 Tc 2.0614 Tw (Information about the theoretical concepts of) Tj ET BT 0.934 0 0 0.9835 73.44 46.08 Tm -0.0412 Tc 2.059 Tw (specialized dementia care discussed earlier in this) Tj -0.257 -12.2018 TD -0.0201 Tc 1.576 Tw (chapter may also be useful for families and others) Tj 265.4351 620.0945 TD -0.0256 Tc 1.2607 Tw (who are trying to evaluate special care units. They) Tj ET BT 0.9835 0 0 0.9835 321.36 631.92 Tm 0.0339 Tc 0.3869 Tw (need to know, however, that the concepts are not) Tj ET BT 0.934 0 0 0.9835 321.6 619.92 Tm -0.0249 Tc 1.6453 Tw (implemented in all special care units and that the) Tj 0.257 -12.2018 TD -0.0295 Tc 0.8901 Tw (same concept may be implemented differently, with) Tj ET BT 0.8915 0 0 0.9835 321.36 595.68 Tm 0.0114 Tc 1.7819 Tw (different results, in different units.) Tj ET BT 0.934 0 0 0.9835 332.64 576.72 Tm -0.0255 Tc 1.4671 Tw (Given the availability of special care unit guide-) Tj ET BT 0.8915 0 0 0.9835 321.84 564.72 Tm 0.0488 Tc 1.4707 Tw (lines developed by various organizations, there is no) Tj ET BT 0.9835 0 0 0.9835 321.6 552.96 Tm 0.0562 Tc 1.8387 Tw (need for Federal agencies to develop additional) Tj ET BT 0.934 0 0 0.9835 322.32 540.96 Tm -0.0446 Tc 1.2918 Tw (guidelines. Federal agencies that serve elderly peo-) Tj ET BT 0.9835 0 0 0.9835 321.84 529.2 Tm 0.0369 Tc 0.7499 Tw (ple and their families could play a valuable role,) Tj ET BT 0.934 0 0 0.9835 321.84 517.2 Tm -0.0228 Tc 1.8679 Tw (however, in disseminating the available guidelines) Tj ET BT 0.8915 0 0 0.9835 322.56 505.44 Tm 0.0331 Tc 1.4883 Tw (and promoting their use.) Tj ET BT 0.9835 0 0 0.9835 333.12 486 Tm 0.033 Tc 3.1115 Tw (As noted earlier, the task of compiling and) Tj -11.2256 -11.9577 TD 0.0253 Tc 0.5604 Tw (updating information about the characteristics of) Tj ET BT 0.934 0 0 0.9835 322.56 462.24 Tm -0.0231 Tc 0.7441 Tw (special care units in a given jurisdiction is probably) Tj ET BT 0.9835 0 0 0.9835 322.56 450.24 Tm 0.0345 Tc 1.3726 Tw (most effectively performed by local agencies, in-) Tj ET BT 0.934 0 0 0.9835 322.56 438 Tm -0.0249 Tc 2.4355 Tw (cluding Alzheimer\222s Association chapters. In some) Tj ET BT 0.9835 0 0 0.9835 321.84 426 Tm 0.0228 Tc 0.3677 Tw (jurisdictions, however, local agencies that receive) Tj 0.9761 -12.2018 TD 0.0235 Tc 1.0991 Tw (Federal funding, such as area agencies on aging) Tj 0.244 -12.2018 TD 0.0376 Tc 0.4747 Tw (\(AAAs\), might be the most appropriate organiza-) Tj ET BT 0.934 0 0 0.9835 323.04 390.24 Tm -0.0349 Tc 0.8531 Tw (tions to perform the function.) Tj 11.82 -19.5229 TD -0.0035 Tc 1.3334 Tw (In thes) Tj ET BT 0.8915 0 0 0.9835 366 371.04 Tm 0.0441 Tc 1.3863 Tw ( summer of 1992, the Alzheimer\222s Associa-) Tj ET BT 0.934 0 0 0.9835 323.04 359.28 Tm -0.0333 Tc 0.5623 Tw (tion contracted for a study to identify and document) Tj ET BT 0.9835 0 0 0.9835 323.28 347.04 Tm 0.0156 Tc 1.5952 Tw (consumer problems with special care units. The) Tj ET BT 0.934 0 0 0.9835 323.04 335.28 Tm -0.0214 Tc 1.1527 Tw (results of this study, which will be available in the) Tj ET BT 0.9835 0 0 0.9835 323.52 323.28 Tm 0.0332 Tc 2.4315 Tw (spring of 1993, will provide useful information) Tj ET BT 0.934 0 0 0.9835 323.52 311.52 Tm -0.022 Tc 0.5181 Tw (about the extent and types of problems families and) Tj -0.257 -12.2018 TD -0.0353 Tc 1.4775 Tw (others encounter in dealing with special care units) Tj 0 -11.9577 TD -0.023 Tc 1.0973 Tw (and may indicate a need for additional government) Tj ET BT 0.8915 0 0 0.9835 323.52 275.76 Tm 0.0349 Tc 0.6787 Tw (initiatives in this area.) Tj ET BT 0.9795 0 0 0.9795 364.32 242.88 Tm /F7 12 Tf 0.0429 Tc 0.6303 Tw (Implications for Research on) Tj 26.4634 -14.9469 TD 0.0475 Tc 0.6256 Tw (Special Care Units) Tj -56.8474 -19.1125 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 356.88 209.52 Tm /F4 10 Tf 0.0347 Tc 0.8437 Tw (findings of the available special care unit) Tj -33.4329 -11.7137 TD 0.028 Tc 2.0707 Tw (studies confirm the need for research on many) Tj -0.244 -12.2018 TD 0.0288 Tc 0.1583 Tw (unresolved issues. For public policy purposes, the) Tj ET BT 0.8915 0 0 0.9835 323.76 174.24 Tm 0.0399 Tc 1.7499 Tw (most important research issues are those pertaining) Tj ET BT 0.9835 0 0 0.9835 324 162.24 Tm 0.0431 Tc 0.2657 Tw (to effectiveness. Evaluative research is needed to) Tj ET BT 0.8915 0 0 0.9835 324 150.48 Tm 0.0424 Tc 1.9265 Tw (answer three interrelated questions about the effec-) Tj ET BT 0.934 0 0 0.9835 324 138.24 Tm -0.0407 Tc 0.7125 Tw (tiveness of special care units for their residents:) Tj ET BT 0.7642 0 0 0.9835 336 119.52 Tm 0.2632 Tc 0 Tw (1\)) Tj ET BT 0.8915 0 0 0.9835 335.04 94.56 Tm 0.2632 Tc (2\)) Tj 0.5384 -49.7833 TD 0.1286 Tc (3\)) Tj ET BT 0.9835 0 0 0.9835 349.44 119.76 Tm 0.0342 Tc 0.7629 Tw (Do special care units improve resident out-) Tj 0.244 -12.4458 TD 0.0065 Tc 0 Tw (comes?) Tj ET BT 0.934 0 0 0.9835 349.44 94.8 Tm -0.0315 Tc 0.6781 Tw (If so, is it the overall milieu or particular unit) Tj ET BT 0.9835 0 0 0.9835 349.92 82.8 Tm 0.0232 Tc 0.1931 Tw (characteristics that are effective, and if it is) Tj ET BT 0.934 0 0 0.9835 349.68 70.56 Tm -0.0189 Tc 1.7995 Tw (particular unit characteristics, which charac-) Tj ET BT 0.8915 0 0 0.9835 349.92 58.8 Tm 0.0309 Tc 0 Tw (teristics?) Tj ET BT 0.934 0 0 0.9835 349.44 46.08 Tm -0.0355 Tc 1.0006 Tw (Are special care units effective for all nursing) Tj 0.257 -12.2018 TD -0.0377 Tc 1.113 Tw (home residents with dementia or only certain) Tj ET endstream endobj 146 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 147 0 obj <>stream 0.48 w 1 j 0 0 0 RG 59.28 676.32 m 537.84 676.32 l S 0.72 w 63.6 110.88 m 541.68 110.88 l S BT 0.9835 0 0 0.9835 326.88 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 3.1037 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 519.84 681.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 526.56 681.6 Tm /F5 10 Tf 0.488 Tc 0 Tw (37) Tj ET BT 0.934 0 0 0.9835 85.92 642.24 Tm /F4 10 Tf -0.0322 Tc 1.5109 Tw (types of residents with dementia, and if only) Tj 0.257 -11.2256 TD -0.0351 Tc 1.0246 Tw (certain types, which types?) Tj ET BT 0.8915 0 0 0.9835 71.28 610.8 Tm 0.0474 Tc 1.3184 Tw (Research on the effectiveness of special care units) Tj ET BT 0.9835 0 0 0.9835 60.48 598.8 Tm 0.0202 Tc 2.2414 Tw (for residents\222 families, unit staff members, and) Tj ET BT 0.8915 0 0 0.9835 60.24 586.8 Tm 0.0369 Tc 1.3494 Tw (nondemented nursing home residents is also needed.) Tj ET BT 0.9835 0 0 0.9835 71.76 566.4 Tm 0.0453 Tc 0.7109 Tw (Descriptive information is needed to provide a) Tj ET BT 0.934 0 0 0.9835 60.48 554.16 Tm -0.0301 Tc 2.304 Tw (better general understanding of special care units) Tj 0.7709 -11.9577 TD -0.0526 Tc 2.1997 Tw (and to develop descriptive topologies. Such typolo-) Tj ET BT 0.9835 0 0 0.9835 61.2 530.64 Tm 0.037 Tc 0.9939 Tw (gies, which would be based on unit and perhaps) Tj ET BT 0.8915 0 0 0.9835 60.72 518.88 Tm 0.0397 Tc 2.2347 Tw (resident characteristics, are important for designing) Tj 0.5384 -12.4458 TD 0.0354 Tc 1.7011 Tw (evaluative studies and understanding and generaliz-) Tj ET BT 0.9835 0 0 0.9835 61.2 494.88 Tm 0.0244 Tc 2.0439 Tw (ing from their findings. To be useful for public) Tj ET BT 0.934 0 0 0.9835 61.2 482.88 Tm -0.0575 Tc 2.5732 Tw (policy purposes, descriptive topologies must repre-) Tj 0.7709 -12.4458 TD -0.0188 Tc 0.4504 Tw (sent the full range of existing units.) Tj 11.563 -20.743 TD -0.0302 Tc 0.6554 Tw (Information is needed about the cost of caring for) Tj -11.82 -11.9577 TD -0.0239 Tc 1.5755 Tw (individuals with dementia in special care units vs.) Tj 0 -11.9577 TD -0.0236 Tc 1.7831 Tw (nonspecialized nursing home units. Because of the) Tj 0.257 -12.4458 TD -0.0329 Tc 1.218 Tw (diversity of special care units, this information will) Tj 0 -11.9577 TD -0.0389 Tc 0.9976 Tw (be useful only if it is developed in the context of an) Tj 0.257 -11.7137 TD -0.0296 Tc 1.6183 Tw (inclusive typology of the units.) Tj ET BT 0.9835 0 0 0.9835 73.44 370.56 Tm 0.0308 Tc 0.0808 Tw (OTA is aware of several sources of forthcoming) Tj ET BT 0.8915 0 0 0.9835 62.4 358.8 Tm 0.0304 Tc 1.722 Tw (descriptive information that will meet some of these) Tj ET BT 0.934 0 0 0.9835 62.16 347.28 Tm -0.0186 Tc 1.007 Tw (needs. One source is the 1991 survey of all nursing) Tj ET BT 0.9835 0 0 0.9835 62.4 335.28 Tm 0.0166 Tc 3.5117 Tw (homes with more than 30 beds. The survey\222s) Tj 0.244 -12.4458 TD 0.0336 Tc 0.1127 Tw (findings with respect to the proportion of nursing) Tj ET BT 0.8915 0 0 0.9835 62.4 311.04 Tm 0.0523 Tc 0.5516 Tw (homes that had a special care unit in 1991 were cited) Tj ET BT 0.9835 0 0 0.9835 62.64 299.04 Tm 0.0226 Tc 1.1 Tw (earlier in this chapter. The survey also included) Tj ET BT 0.934 0 0 0.9835 62.64 286.8 Tm -0.0166 Tc 1.8247 Tw (questions about the physical features of the units,) Tj ET BT 0.8915 0 0 0.9835 62.88 275.04 Tm 0.0362 Tc 1.4848 Tw (their admission and discharge criteria, staff training) Tj ET BT 0.934 0 0 0.9835 62.64 263.04 Tm -0.019 Tc 2.1208 Tw (programs, staff support groups, activity programs,) Tj 0.5139 -12.2018 TD -0.0154 Tc 0.8835 Tw (family programs, and sources of reimbursement.) Tj ET BT 0.9835 0 0 0.9835 73.92 230.64 Tm 0.0348 Tc 4.3089 Tw (A second source of forthcoming descriptive) Tj ET BT 0.8915 0 0 0.9835 63.36 218.4 Tm 0.0217 Tc 1.0075 Tw (information is the resident assessments mandated by) Tj ET BT 0.9835 0 0 0.9835 63.36 206.4 Tm 0.0312 Tc 0.3999 Tw (the nursing home reform provisions of OBRA-87.) Tj ET BT 0.934 0 0 0.9835 63.36 194.4 Tm -0.0358 Tc 1.4194 Tw (All Medicare and Medicaid-certified nursing homes) Tj 0.257 -12.4458 TD -0.04 Tc 1.6615 Tw (are now required to assess each of their residents,) Tj -0.257 -11.9577 TD -0.0318 Tc 1.2674 Tw (including special care unit residents, at the time of) Tj ET BT 0.9835 0 0 0.9835 63.6 158.16 Tm 0.0255 Tc 0.121 Tw (the residents\222 admission to the nursing home and) Tj ET BT 0.934 0 0 0.9835 63.84 145.92 Tm -0.0145 Tc 1.0883 Tw (annually thereafter. OBRA-87 mandated the devel-) Tj 0 -12.2018 TD -0.0456 Tc 0.8646 Tw (opment of a set of core items to be addressed in the) Tj ET BT 0.8915 0 0 0.9835 63.36 122.16 Tm 0.0466 Tc 0.8194 Tw (required assessment, and the core items include each) Tj ET BT 0.9835 0 0 0.9835 311.28 642.24 Tm 0.0244 Tc 1.9524 Tw (of the resident characteristics discussed in this) Tj ET BT 0.8491 0 0 0.9835 311.28 630.24 Tm 0.0572 Tc 0 Tw (chapter.) Tj ET BT 0.934 0 0 0.9835 322.32 612.24 Tm -0.0157 Tc 1.1323 Tw (Lastly, as noted earlier, the Multi-State Nursing) Tj ET BT 0.9835 0 0 0.9835 311.52 600.24 Tm 0.0317 Tc 1.8717 Tw (Home Case-Mix and Quality Demonstration in-) Tj 0.244 -12.4458 TD 0.0301 Tc -0.1277 Tw (cludes special care unit residents among the 6800) Tj ET BT 0.934 0 0 0.9835 311.76 576.24 Tm -0.0199 Tc 1.2041 Tw (nursing home residents in the study sample. Infor-) Tj ET BT 0.9835 0 0 0.9835 311.76 564.24 Tm 0.0348 Tc 3.772 Tw (mation has been collected on more than 300) Tj ET BT 0.8915 0 0 0.9835 311.76 552.24 Tm 0.0308 Tc 0.5756 Tw (residents of 20 special care units in 6 States \(137\). To) Tj ET BT 0.934 0 0 0.9835 312.24 540.24 Tm -0.036 Tc 1.6894 Tw (OTA\222s knowledge, this study is the first to include) Tj ET BT 0.9835 0 0 0.9835 312.48 528.48 Tm 0.0318 Tc 3.165 Tw (a time-and-motion analysis of resource use in) Tj ET BT 0.8915 0 0 0.9835 312.48 516.48 Tm 0.0457 Tc 1.2049 Tw (special care units.) Tj ET BT 0.9835 0 0 0.9835 323.28 498.72 Tm 0.0274 Tc 1.8272 Tw (Given the pervasive complaints and concerns) Tj ET BT 0.934 0 0 0.9835 312.72 486.48 Tm -0.0364 Tc 1.0015 Tw (about the care provided for nursing home residents) Tj ET BT 0.8915 0 0 0.9835 312.48 474.48 Tm 0.0334 Tc 1.6226 Tw (with dementia, the extensive involvement of govern-) Tj ET BT 0.9835 0 0 0.9835 312.48 462.72 Tm 0.0173 Tc 0.2339 Tw (ment in regulating nursing homes and paying for) Tj 0.244 -12.2018 TD 0.0169 Tc 1.3499 Tw (nursing home care, and the competing claims of) Tj 0.4881 -12.2018 TD 0.0205 Tc 0.2306 Tw (special care unit advocates and critics, one might) Tj -0.244 -12.2018 TD 0.0439 Tc 0.997 Tw (expect that Federal agencies would have funded) Tj 0 -11.7137 TD 0.0154 Tc 0.2837 Tw (many special care unit studies. In 1984, the Task) Tj 0.244 -12.2018 TD 0.0279 Tc 0.4672 Tw (Force on Alzheimer\222s Disease of the U.S. Depart-) Tj ET BT 0.934 0 0 0.9835 313.2 391.44 Tm -0.0277 Tc 0.5241 Tw (ment of Health and Human Services noted the need) Tj 0 -12.2018 TD -0.001 Tc 0.413 Tw (for this research \(470\). In 1986, Congress mandated) Tj ET BT 0.8915 0 0 0.9835 313.92 367.68 Tm 0.0395 Tc 1.558 Tw (special care unit research \(P.L. 99-660\), but funding) Tj ET BT 0.934 0 0 0.9835 313.44 355.92 Tm -0.0462 Tc 2.3213 Tw (for the research was never appropriated. Between) Tj ET BT 0.9835 0 0 0.9835 314.64 343.92 Tm 0.0402 Tc 0.3152 Tw (1986 and 1990, seven Federal agencies each pro-) Tj -0.9761 -12.2018 TD 0.0344 Tc 0.8136 Tw (vided funding for one special care unit study .12) Tj ET BT 0.8915 0 0 0.9835 313.68 320.16 Tm 0.0235 Tc 0.6018 Tw (Three of the studies were small pilot studies, and two) Tj ET BT 0.9835 0 0 0.9835 313.92 307.92 Tm 0.0334 Tc 2.0652 Tw (were relatively small components of large-scale) Tj ET BT 0.8915 0 0 0.9835 313.92 295.92 Tm 0.023 Tc 1.7304 Tw (nursing home studies. Two of the National Institute) Tj ET BT 0.9835 0 0 0.9835 313.92 283.92 Tm 0.0295 Tc 0.1169 Tw (on Aging\222s Alzheimer\222s Disease Research Centers) Tj 0 -12.2018 TD 0.0397 Tc 1.7799 Tw (each provided funding for one special care unit) Tj ET BT 0.934 0 0 0.9835 314.4 259.92 Tm -0.0305 Tc 2.1846 Tw (study. The Alzheimer\222s Association, the Brookdale) Tj ET BT 0.9835 0 0 0.9835 314.16 248.16 Tm 0.036 Tc 2.7134 Tw (Foundation, the State of California, and three) Tj -0.244 -12.4458 TD 0.0399 Tc -0.097 Tw (universities each provided funding for one special) Tj ET BT 0.934 0 0 0.9835 314.4 224.16 Tm -0.0311 Tc 1.1631 Tw (care unit study. Most of the other special care unit) Tj ET BT 0.8915 0 0 0.9835 314.64 211.92 Tm 0.026 Tc 0.6887 Tw (studies have been small pilot studies with no funding) Tj ET BT 0.9835 0 0 0.9835 314.64 199.92 Tm 0.0055 Tc 0 Tw (source.) Tj ET BT 1.08 0 0 1.08 347.52 204.72 Tm /F4 4 Tf -0.0024 Tc (13) Tj ET BT 0.8915 0 0 0.9835 325.44 181.92 Tm /F4 10 Tf 0.0569 Tc 1.327 Tw (In 1990, the Alzheimer\222s Disease Research Center) Tj ET BT 0.934 0 0 0.9835 314.64 169.68 Tm -0.0164 Tc 1.4206 Tw (at Washington University in St. Louis sponsored a) Tj ET BT 0.8915 0 0 0.9835 314.88 157.68 Tm 0.0514 Tc 1.1089 Tw (special care unit conference that included workshops) Tj ET BT 0.934 0 0 0.9835 314.64 145.68 Tm -0.0403 Tc 0.9552 Tw (for researchers. The intent of the workshops was to) Tj ET BT 0.8915 0 0 0.9835 314.88 134.16 Tm 0.0322 Tc 1.3996 Tw (identify the problems that were obstructing progress) Tj ET BT 0.9835 0 0 0.9835 314.88 122.16 Tm 0.0237 Tc 1.3836 Tw (in special care unit research. Many interrelated) Tj ET q 4.08 0 0 -4.08 78.24 103.44 cm BI /W 29 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>x>8>>>>>>>>>>>>~~> EI Q BT 0.3755 0 0 0.9835 78.24 99.12 Tm 3 Tr /F2 10 Tf 0.1101 Tc 0 Tw (12) Tj 0 Tr ET BT 0.798 0 0 0.9835 82.32 99.12 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 10.08 0 0 -5.52 84.24 104.88 cm BI /W 68 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?~?~?~??~>p?~~0?~~?~|?~|?>~?~??~??~>?~?~????|@?G???? EI Q BT 0.6102 0 0 0.9835 84.24 99.12 Tm 3 Tr 0.0585 Tc 0 Tw (The) Tj 0 Tr ET BT 0.798 0 0 0.9835 94.32 99.12 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 15.12 0 0 -3.84 96.24 102.96 cm BI /W 101 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~|>?>?p|~x|`~8|`?|??|~?|?x|p|?|x|x|<|<>x<>||????<<~ EI Q BT 0.6572 0 0 0.9835 96.24 99.12 Tm 3 Tr 0.0438 Tc 0 Tw (seven) Tj 0 Tr ET BT 0.798 0 0 0.9835 111.36 99.12 Tm 0.0553 Tc -0.014 Tw ( agencies ) Tj ET BT 0.8066 0 0 0.9835 143.76 99.12 Tm /F4 10 Tf 0.0577 Tc 0.1221 Tw (and the studies ) Tj ET BT 0.798 0 0 0.9835 204.96 99.12 Tm /F2 10 Tf 0.0398 Tc 0.5769 Tw (for which they provided full ) Tj ET BT 0.8066 0 0 0.9835 300.96 99.12 Tm /F4 10 Tf 0.0447 Tc -0.0105 Tw (or partial ) Tj ET q 20.4 0 0 -6.96 339.36 104.64 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x????||xx|xx??????p8 EI Q BT 0.5519 0 0 0.9835 339.36 99.12 Tm 3 Tr -0.0406 Tc 0 Tw (funding) Tj 0 Tr ET BT 0.8066 0 0 0.9835 359.76 99.12 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 9.36 0 0 -3.84 361.92 103.2 cm BI /W 63 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?>~~?>x<8|>>?8<>>>>>~~<c EI Q BT 0.5094 0 0 0.9835 361.92 99.12 Tm 3 Tr 0.0277 Tc 0 Tw (are:) Tj 0 Tr ET BT 0.8066 0 0 0.9835 371.28 99.12 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 4.32 0 0 -6.24 373.44 105.6 cm BI /W 30 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08||<8 EI Q BT 0.467 0 0 0.9835 373.44 99.12 Tm 3 Tr -0.0794 Tc 0 Tw (1\)) Tj 0 Tr ET BT 0.8066 0 0 0.9835 377.76 99.12 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 19.92 0 0 -5.52 379.92 105.84 cm BI /W 132 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >??~??~~??||>?||??||??||??~|?>~|?>||?>||?>||~?>||~??||??x9??~???|||?|8 EI Q BT 3.2265 0 0 0.9835 379.92 99.12 Tm 3 Tr 0.0364 Tc 0 Tw (~) Tj 0 Tr ET BT 0.8066 0 0 0.9835 394.32 98.64 Tm -0.0245 Tc -0.0736 Tw (\223 ) Tj ET q 21.36 0 0 -5.76 399.84 104.16 cm BI /W 141 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ^?x??~<8|~8|??~0?|??~||??~||?>~||?~~|~?~~|~~?|~~??>~>|?|>~>?|?~>?~>???x?|?|xx0 EI Q BT 0.5094 0 0 0.9835 399.84 98.64 Tm 3 Tr -0.0079 Tc 0 Tw (\223stration) Tj 0 Tr ET BT 0.8066 0 0 0.9835 421.2 98.64 Tm 0.0277 Tc 0.7543 Tw ( on Aging:) Tj ET BT 0.6793 0 0 0.9835 464.4 99.12 Tm 0.0006 Tc 2.3994 Tw (\223Special Care Units for) Tj ET q 28.56 0 0 -5.76 63.84 96 cm BI /W 218 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x???||||?q ||>1~|>?|>?||<|>|?|?|?~|~x|8?=??<~0x?8?<?|??0 EI Q BT 0.5094 0 0 0.9835 63.84 89.52 Tm 3 Tr 0.0158 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.6793 0 0 0.9835 92.4 89.52 Tm -0.0244 Tc 2.0997 Tw ( Disease Patients: An Exploratory Study of Dementia) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 18.48 0 0 -7.2 272.4 94.8 cm BI /W 142 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||||| p {?|~~??|??x|><|>|>|>|>|>|>|>|>|>8|>x<~??~~`0?|||>>< EI Q BT 0.5094 0 0 0.9835 272.4 89.52 Tm 3 Tr -0.0075 Tc 0 Tw (Speciilc) Tj 0 Tr ET BT 0.6793 0 0 0.9835 290.88 89.52 Tm -0.0023 Tc 1.7853 Tw ( Units\224 \(64\); 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6\) National Center for Nursing Research:) Tj 277.7069 0.244 TD -0.0163 Tc 3.072 Tw (\223Nursing Evaluation Research:) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 28.56 0 0 -5.76 358.32 59.52 cm BI /W 218 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?}?>|||||||?s ~||>s?||>?||>||||||||>?||?~||?~?|x|Á?p|?x?=?xp#xx|?? EI Q BT 0.5094 0 0 0.9835 358.32 53.76 Tm 3 Tr 0.0158 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.6793 0 0 0.9835 386.88 53.76 Tm -0.0132 Tc 1.7426 Tw ( Care Unit\224 \(265\); and 7\) National Institute on) Tj -475.2109 -9.2734 TD -0.019 Tc 2.0514 Tw (Aging: \223Five-State Study of Special Care Units in Nursing Homes\224 \(194\).) Tj ET q 4.56 0 0 -4.32 78.48 38.88 cm BI /W 27 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0~>>><<<<<<?<<<<<|| EI Q BT 0.5094 0 0 0.9835 78.48 34.56 Tm 3 Tr 0.1227 Tc 0 Tw (Is) Tj 0 Tr ET BT 0.934 0 0 0.9835 83.04 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 19.44 0 0 -5.52 85.44 37.92 cm BI /W 114 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?|??<?>?|?|?<??>??????8??|??|~?~x~?>|????@???????p EI Q BT 0.5944 0 0 0.9835 85.44 34.56 Tm 3 Tr -0.017 Tc 0 Tw (\221r\222ables) Tj 0 Tr ET BT 0.934 0 0 0.9835 104.88 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 14.88 0 0 -6.72 107.28 38.16 cm BI /W 87 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p8<?>8xp~|p@?>~px??` EI Q BT 0.6368 0 0 0.9835 107.28 34.56 Tm 3 Tr 0.0488 Tc 0 Tw (3-1%) Tj 0 Tr ET BT 0.934 0 0 0.9835 122.16 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 5.52 0 0 -6.48 124.56 37.92 cm BI /W 32 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 088?|8||<||~~ EI Q BT 0.6368 0 0 0.9835 124.56 34.56 Tm 3 Tr -0.0269 Tc 0 Tw (b,) Tj 0 Tr ET BT 0.934 0 0 0.9835 130.08 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.8 0 0 -5.28 132.48 37.92 cm BI /W 63 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?~||~|~?|~?>~?~?~?~??~8~<~~|>|>~0 EI Q BT 0.5944 0 0 0.9835 132.48 34.56 Tm 3 Tr -0.0192 Tc 0 Tw (and) Tj 0 Tr ET BT 0.934 0 0 0.9835 143.28 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 2.88 0 0 -3.84 145.68 36.48 cm BI /W 18 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~@x|> EI Q BT 0.6368 0 0 0.9835 145.68 34.56 Tm 3 Tr 0.0798 Tc 0 Tw (c) Tj 0 Tr ET BT 0.934 0 0 0.9835 148.56 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 5.76 0 0 -5.28 150.96 37.92 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `????>>>>>>>>>>~ EI Q BT 0.5944 0 0 0.9835 150.96 34.56 Tm 3 Tr 0.0108 Tc 0 Tw (in) Tj 0 Tr ET BT 0.934 0 0 0.9835 156.72 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.4 0 0 -5.28 159.12 39.84 cm BI /W 50 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID π??>~>>>>>>>>>>x>|><~> EI Q BT 0.9835 0 0 0.9835 159.12 34.56 Tm 3 Tr -0.1013 Tc 0 Tw (&) Tj 0 Tr ET BT 0.934 0 0 0.9835 167.52 34.56 Tm 0.0897 Tc -0.0512 Tw ( 3 ) Tj ET q 10.56 0 0 -5.52 177.84 38.4 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?~?>>?~>x?>~|>~>?>~?>>>>~>0?>>x?<x?>|>||>>| EI Q BT 0.5944 0 0 0.9835 177.84 34.56 Tm 3 Tr -0.0192 Tc 0 Tw (and) Tj 0 Tr ET BT 0.934 0 0 0.9835 188.4 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 17.28 0 0 -5.52 190.8 40.08 cm BI /W 101 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0<|?>~<~~|||<|q|<|1|||><||>~||>~<|>?~<|>~<|?<||<|| <~|p||p~|||~<|x?~~|>|||| ||| EI Q BT 0.5944 0 0 0.9835 190.8 34.56 Tm 3 Tr 0.0091 Tc 0 Tw (tables) Tj 0 Tr ET BT 0.934 0 0 0.9835 208.08 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 9.12 0 0 -5.28 210.48 38.4 cm BI /W 54 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|x<ǀ?? EI Q BT 0.467 0 0 0.9835 210.48 34.56 Tm 3 Tr 0.0021 Tc 0 Tw (L&l) Tj 0 Tr ET BT 0.934 0 0 0.9835 219.6 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.56 0 0 -5.52 222 40.08 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??>|>|><>>p<>>p>>>>>>>?>8>|>|>>~>>p EI Q BT 0.8491 0 0 0.9835 222 34.56 Tm 3 Tr -0.1092 Tc 0 Tw (~d) Tj 0 Tr ET BT 0.934 0 0 0.9835 232.56 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 9.6 0 0 -5.28 234.96 40.08 cm BI /W 57 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x<x8<x|<>>π???~ EI Q BT 0.5519 0 0 0.9835 234.96 34.56 Tm 3 Tr 0.0964 Tc 0 Tw (A-Z) Tj 0 Tr ET BT 0.934 0 0 0.9835 244.56 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 5.76 0 0 -5.28 246.96 38.64 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>>>>>>>>>>>?>@ EI Q BT 0.5944 0 0 0.9835 246.96 34.56 Tm 3 Tr 0.0108 Tc 0 Tw (in) Tj 0 Tr ET BT 0.934 0 0 0.9835 252.72 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.16 0 0 -5.28 255.12 39.84 cm BI /W 49 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|~||||||||||x|||<>?? EI Q BT 0.467 0 0 0.9835 255.12 34.56 Tm 3 Tr -0.0628 Tc 0 Tw (Ch.) Tj 0 Tr ET BT 0.934 0 0 0.9835 263.28 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 3.6 0 0 -5.04 265.68 38.64 cm BI /W 22 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<ǀ?? EI Q BT 0.467 0 0 0.9835 265.68 34.56 Tm 3 Tr -0.0295 Tc 0 Tw (A) Tj 0 Tr ET BT 0.934 0 0 0.9835 269.28 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.88 0 0 -5.52 271.68 40.08 cm BI /W 52 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x?|><>|>>>>>?>>>??8>8>xx>|>?>?>>>~? EI Q BT 0.5094 0 0 0.9835 271.68 34.56 Tm 3 Tr -0.0809 Tc 0 Tw (~St) Tj 0 Tr ET BT 0.934 0 0 0.9835 280.56 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.88 0 0 -5.52 282.96 40.08 cm BI /W 52 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>>p>0>>>>>>>>>>?~|~>` EI Q BT 0.7217 0 0 0.9835 282.96 34.56 Tm 3 Tr -0.0254 Tc 0 Tw (tie) Tj 0 Tr ET BT 0.934 0 0 0.9835 291.84 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 23.52 0 0 -7.2 294.24 40.08 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~@?x??>?>><|><|>>|>>|>>|x>>|x>>|8>>||>>||>>||>>|>~~`|?~>>>À~ǀ>> EI Q BT 0.6368 0 0 0.9835 294.24 34.56 Tm 3 Tr -0.0737 Tc 0 Tw (funding) Tj 0 Tr ET BT 0.934 0 0 0.9835 317.76 34.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 22.08 0 0 -3.84 320.16 38.64 cm BI /W 129 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xϏ?x??|~??<|p~|>|8|@>|<|||||<|?<|<||>|>|p|?8|xx8|8?|x???|1? EI Q BT 0.5944 0 0 0.9835 320.16 34.56 Tm 3 Tr -0.0583 Tc 0 Tw (Sources) Tj 0 Tr ET BT 0.9388 0 0 0.9835 342.24 34.56 Tm /F2 10 Tf 0.031 Tc 0.022 Tw ( for ) Tj ET q 6.96 0 0 -5.28 358.08 39.12 cm BI /W 42 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????x?|??>??????p?>x|?|><~??>@?????@ EI Q BT 0.6572 0 0 0.9835 358.08 34.56 Tm 3 Tr 0.0861 Tc 0 Tw (~1) Tj 0 Tr ET BT 0.9388 0 0 0.9835 365.04 34.56 Tm 0 Tc 0.055 Tw ( ) Tj ET q 8.64 0 0 -5.52 367.2 40.08 cm BI /W 51 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>~~|?~|?||>||~`||| <||<||<||<|~`||||?||>||~|߀~p>  EI Q BT 0.7041 0 0 0.9835 367.2 34.56 Tm 3 Tr 0.0142 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9388 0 0 0.9835 375.84 34.56 Tm 0 Tc 0.055 Tw ( ) Tj ET q 20.64 0 0 -7.2 378 40.08 cm BI /W 121 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|@?||?~||?~|p|~0|~|~?|~|~?|~|~|~|~?|~8?~|x?~xx>~~}~??~?|~~~~~xx0 EI Q BT 0.798 0 0 0.9835 378 34.56 Tm 3 Tr 0.0324 Tc 0 Tw (speci~) Tj 0 Tr ET BT 0.9388 0 0 0.9835 398.64 34.56 Tm 0 Tc 0.055 Tw ( ) Tj ET q 12.48 0 0 -4.08 400.8 38.64 cm BI /W 72 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p??|~|||||||||x||~~<y~>?0` EI Q BT 0.7511 0 0 0.9835 400.8 34.56 Tm 3 Tr -0.0175 Tc 0 Tw (cme) Tj 0 Tr ET BT 0.9388 0 0 0.9835 413.28 34.56 Tm 0 Tc 0.055 Tw ( ) Tj ET q 11.76 0 0 -5.28 415.44 40.08 cm BI /W 69 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|||?????<0?` EI Q BT 0.7511 0 0 0.9835 415.44 34.56 Tm 3 Tr 0.1023 Tc 0 Tw (unit) Tj 0 Tr ET BT 0.9388 0 0 0.9835 427.2 34.56 Tm 0.0041 Tc 0.0507 Tw ( studies discussed ) Tj ET q 5.76 0 0 -5.28 496.8 40.08 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~>>>>>>>>>>?~~? EI Q BT 0.7041 0 0 0.9835 496.8 34.56 Tm 3 Tr 0.0272 Tc 0 Tw (in) Tj 0 Tr ET BT 0.9021 0 0 0.9598 502.56 34.56 Tm /F6 5 Tf 0 Tc 0.0799 Tw ( ) Tj ET q 10.56 0 0 -5.52 503.52 40.08 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????|>?|>?>>~?>?~>>>?>?0>?x>?x~?~>p EI Q BT 2.0747 0 0 0.9598 503.52 34.56 Tm 3 Tr -0.0297 Tc 0 Tw (~S) Tj 0 Tr ET BT 0.9021 0 0 0.9598 514.08 34.56 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 19.44 0 0 -6.48 515.04 39.36 cm BI /W 114 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??<??|~|?|>?|>~|>~|?~|?~~?~|?~~>~~~>|?~?~x??p<??a|< EI Q BT 1.3531 0 0 0.9598 515.04 34.56 Tm 3 Tr -0.0075 Tc 0 Tw (RpOfi.) Tj 0 Tr ET endstream endobj 148 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 149 0 obj <>stream 0.48 w 1 j 0 0 0 RG 69.12 681.84 m 547.68 681.84 l S BT 0.9835 0 0 0.9835 69.12 688.32 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (38 ) Tj ET BT 0.9598 0 0 0.9598 82.08 688.32 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.99 0 0 0.99 88.56 688.32 Tm /F7 8 Tf 0.0435 Tc 0.38 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 134.4 688.32 Tm /F5 11 Tf 0.0702 Tc 0.9681 Tw (Units for People) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 212.64 688.32 Tm /F5 10 Tf 0.0166 Tc 1.7523 Tw (With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 69.36 648.48 Tm /F4 10 Tf -0.0418 Tc 1.6314 Tw (problems were identified, including the difficulty of) Tj 0.5139 -12.2018 TD 0.1483 Tc 0 Tw (obt) Tj 15.1604 0 TD -0.0228 Tc 0.4731 Tw (aining funding for special care unit research, the) Tj ET BT 0.9835 0 0 0.9835 69.84 624.48 Tm 0.0272 Tc 3.2917 Tw (difficulty of getting special care unit research) Tj ET BT 0.934 0 0 0.9835 69.84 612.24 Tm -0.0211 Tc 1.6092 Tw (published, and numerous conceptual and methodo-) Tj 0.257 -11.9577 TD -0.0241 Tc 0.915 Tw (logical issues in designing and conducting this kind) Tj 0 -12.2018 TD -0.0408 Tc 1.9974 Tw (of research \(see app. B\). Following the conference,) Tj ET BT 0.9835 0 0 0.9835 70.32 576.72 Tm 0.0297 Tc 3.6726 Tw (the researchers formed an ad hoc group, the) Tj ET BT 0.934 0 0 0.9835 70.32 564.72 Tm -0.0273 Tc 2.0441 Tw (Workgroup on Research and Evaluation of Special) Tj 0.257 -11.9577 TD -0.0351 Tc 1.7343 Tw (Care Units, to address the identified problems. By) Tj ET BT 0.9835 0 0 0.9835 70.56 540.72 Tm 0.0416 Tc 2.85 Tw (the end of 1991, the workgroup had over 100) Tj 0 -11.9577 TD 0.0308 Tc 1.0917 Tw (members \(193\). It has no formal sponsor and no) Tj ET BT 0.8915 0 0 0.9835 70.8 516.96 Tm 0.2406 Tc 0 Tw (funding.) Tj ET BT 0.934 0 0 0.9835 82.08 496.8 Tm 0.0005 Tc 1.1043 Tw (In the fall 1991, the National Institute on Aging) Tj ET BT 0.8915 0 0 0.9835 71.04 484.8 Tm 0.0308 Tc 1.4909 Tw (funded nine studies under anew \223Special Care Units) Tj ET BT 0.934 0 0 0.9835 71.28 472.8 Tm -0.0115 Tc 1.3419 Tw (Initiative, \222) Tj 57.0441 -0.4881 TD -0.0104 Tc 0.68 Tw (and the agency funded a tenth study in) Tj -57.0441 -11.7137 TD -0.0414 Tc 1.1813 Tw (early 1992. Two of the studies will develop descrip-) Tj ET BT 0.9835 0 0 0.9835 71.28 449.04 Tm 0.0375 Tc 2.3051 Tw (tive topologies of special care units. Two other) Tj 0.4881 -12.2018 TD 0.0315 Tc 2.7993 Tw (studies will compare service use and costs for) Tj ET BT 0.8915 0 0 0.9835 72 425.28 Tm 0.0352 Tc 1.1014 Tw (special care unit residents and demented and nonde-) Tj -0.8076 -12.2018 TD 0.0327 Tc 1.085 Tw (mented residents in nonspecialized units in a total of) Tj ET BT 0.9835 0 0 0.9835 71.76 401.04 Tm 0.0194 Tc 2.2421 Tw (24 nursing homes. Another study will compare) Tj -0.244 -11.9577 TD 0.0297 Tc 1.79 Tw (resident outcomes in the special care units and) Tj 0.244 -12.2018 TD 0.0268 Tc 1.5839 Tw (nonspecialized units in the Multi-State Nursing) Tj ET BT 0.934 0 0 0.9835 72 365.04 Tm -0.0183 Tc 1.5419 Tw (Home Case-Mix and Quality Demonstration.) Tj 11.563 -20.499 TD -0.0163 Tc 1.9038 Tw (The National Institute on Aging\222s \223Special Care) Tj -11.306 -12.2018 TD -0.0204 Tc 0.8804 Tw (Units Initiative\224 represents a major commitment to) Tj ET BT 0.9835 0 0 0.9835 72.72 321.12 Tm 0.0233 Tc 1.2824 Tw (special care unit research. The results of the 10) Tj ET BT 0.8915 0 0 0.9835 72.72 309.36 Tm 0.0362 Tc 2.0232 Tw (studies will greatly expand knowledge about special) Tj -0.2692 -12.2018 TD 0.0392 Tc 1.4815 Tw (care units. Moreover, the studies were funded under) Tj 0.2692 -12.2018 TD 0.0572 Tc 1.1537 Tw (an arrangement that requires the 10 research teams) Tj ET BT 0.9835 0 0 0.9835 72.72 273.36 Tm 0.0439 Tc 3.4374 Tw (to collaborate on the development of common) Tj ET BT 0.934 0 0 0.9835 72.48 261.36 Tm -0.0271 Tc 2.1723 Tw (definitions and assessment procedures so that, al-) Tj ET BT 0.9835 0 0 0.9835 72.72 249.6 Tm 0.0312 Tc 0.0803 Tw (though the studies focus on different issues, their) Tj ET BT 0.934 0 0 0.9835 72.72 237.6 Tm -0.0219 Tc 1.8669 Tw (findings will be comparable.) Tj 11.82 -20.499 TD -0.0471 Tc 1.38 Tw (As noted earlier, the effectiveness of special care) Tj ET BT 0.8915 0 0 0.9835 72.72 205.2 Tm 0.0356 Tc 1.3172 Tw (units is the most important research issue for public) Tj ET BT 0.9835 0 0 0.9835 72.72 193.44 Tm 0.0351 Tc 0.2739 Tw (policy purposes. Although several of the National) Tj 0.244 -12.2018 TD 0.0392 Tc 0.0722 Tw (Institute on Aging studies will evaluate the effec-) Tj ET BT 0.8915 0 0 0.9835 73.44 169.68 Tm 0.0199 Tc 1.4021 Tw (tiveness of the units they are studying, the complex-) Tj ET BT 0.9835 0 0 0.9835 73.2 157.92 Tm 0.0475 Tc 0.0986 Tw (ity of the policy-related questions about effective-) Tj 0 -12.2018 TD 0.035 Tc 0.4773 Tw (ness means more research will be needed on this) Tj ET BT 0.934 0 0 0.9835 73.44 133.92 Tm -0.0289 Tc 1.3239 Tw (issue. Some researchers believe that a clinical trial) Tj 0 -12.2018 TD -0.0345 Tc 1.44 Tw (with a randomized case control design will eventu-) Tj ET BT 0.9835 0 0 0.9835 73.44 109.92 Tm 0.0555 Tc 1.4501 Tw (ally be needed to determine the effectiveness of) Tj ET BT 0.8915 0 0 0.9835 73.92 97.92 Tm 0.0273 Tc 1.4948 Tw (special care units \(143,41 1\). Currently funded stud-) Tj ET BT 0.9835 0 0 0.9835 73.44 86.16 Tm 0.0335 Tc 2.4922 Tw (ies will provide the basis for designing such a) Tj ET BT 0.934 0 0 0.9835 73.44 73.92 Tm -0.0286 Tc 1.1033 Tw (clinical trial. The legal and ethical issues discussed) Tj ET BT 0.9835 0 0 0.9835 73.44 61.92 Tm 0.0275 Tc 1.0602 Tw (later in this chapter also raise important policy-) Tj 0 -11.7137 TD 0.0432 Tc 1.8112 Tw (related questions that are not addressed in the) Tj ET BT 0.8915 0 0 0.9835 73.68 37.92 Tm 0.0146 Tc 2.2493 Tw (National Institute on Aging studies.) Tj 289.6531 620.8267 TD 0.048 Tc 1.5164 Tw (To complement special care unit research, studies) Tj -12.1137 -12.4458 TD 0.0538 Tc 1.2497 Tw (are needed in two broad areas:) Tj ET BT 0.7217 0 0 0.9835 333.36 615.6 Tm 0.1504 Tc 0 Tw (1.) Tj ET BT 0.8585 0 0 0.9812 332.4 589.2 Tm /F5 11 Tf 0.0663 Tc (2.) Tj ET BT 0.934 0 0 0.9835 345.6 615.6 Tm /F4 10 Tf -0.0283 Tc 1.0173 Tw (physical design features and care methods for) Tj 0 -12.2018 TD -0.0356 Tc 1.2393 Tw (people with dementia generally; and) Tj ET BT 0.9835 0 0 0.9835 346.32 588.96 Tm 0.0209 Tc 0.9066 Tw (alternatives to special care units, including) Tj ET BT 0.934 0 0 0.9835 346.56 576.96 Tm -0.032 Tc 2.1862 Tw (special programs for nursing home residents) Tj -0.257 -11.9577 TD -0.0295 Tc 0.8473 Tw (with dementia in nonspecialized units, special) Tj ET BT 0.8915 0 0 0.9835 346.08 553.44 Tm 0.0598 Tc 0.6957 Tw (residential care programs inboard and care and) Tj ET BT 0.934 0 0 0.9835 346.8 540.96 Tm -0.0244 Tc 0.7561 Tw (assisted living facilities, and special adult day) Tj 0 -11.2256 TD -0.0237 Tc 1.4835 Tw (and in-home services.) Tj ET BT 0.9835 0 0 0.9835 333.36 509.76 Tm 0.0325 Tc 1.7611 Tw (Studies in the first area can be conducted in) Tj ET BT 0.8915 0 0 0.9835 322.56 497.52 Tm 0.0549 Tc 0.6227 Tw (special care units or in other residential and nonresi-) Tj ET BT 0.9835 0 0 0.9835 322.32 485.52 Tm 0.029 Tc 1.063 Tw (dential care settings. It may be easier and more) Tj ET BT 0.934 0 0 0.9835 322.56 473.28 Tm -0.0445 Tc 1.2809 Tw (efficient to conduct some of these studies in special) Tj 0 -12.2018 TD -0.0274 Tc 1.359 Tw (care units, however, because all the residents have) Tj ET BT 0.8915 0 0 0.9835 322.56 449.52 Tm 0.0171 Tc 0 Tw (dementia.) Tj ET BT 0.934 0 0 0.9835 333.84 429.12 Tm -0.034 Tc 1.623 Tw (Research on specific design features and patient) Tj ET BT 0.9835 0 0 0.9835 322.8 416.88 Tm 0.0373 Tc 0.597 Tw (care methods may help to explain the findings of) Tj ET BT 0.8915 0 0 0.9835 323.28 404.64 Tm 0.0491 Tc 1.4703 Tw (special care unit research. If certain design features) Tj ET BT 0.9835 0 0 0.9835 323.28 392.64 Tm 0.0427 Tc 3.2759 Tw (or care methods are shown to be effective or) Tj 0 -11.9577 TD 0.0395 Tc 0.7474 Tw (ineffective in general or for certain types of resi-) Tj 0 -12.4458 TD 0.0312 Tc 1.5445 Tw (dents, those findings may explain the results of) Tj ET BT 0.8915 0 0 0.9835 323.52 356.64 Tm 0.031 Tc 1.6253 Tw (special care unit studies. More importantly perhaps,) Tj ET BT 0.934 0 0 0.9835 323.76 344.64 Tm -0.0369 Tc 0.7084 Tw (studies of specific design features and care methods) Tj ET BT 0.8915 0 0 0.9835 323.28 332.88 Tm 0.0273 Tc 1.764 Tw (can identify features and methods that will improve) Tj 0.2692 -12.2018 TD 0.0419 Tc 0.8246 Tw (the care of residents with dementia in nonspecialized) Tj ET BT 0.9835 0 0 0.9835 323.28 308.88 Tm 0.0279 Tc 0.1998 Tw (units and other settings as well as in special care) Tj ET BT 0.8491 0 0 0.9835 323.52 297.36 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.9835 0 0 0.9835 334.8 276.48 Tm 0.0426 Tc 0.3883 Tw (The Robert Wood Johnson Foundation and the) Tj -10.9816 -11.9577 TD 0.0425 Tc 2.056 Tw (Cleveland Foundation have funded research on) Tj ET BT 0.934 0 0 0.9835 323.76 252.72 Tm -0.0252 Tc 0.549 Tw (various design features and patient care methods in) Tj ET BT 0.9835 0 0 0.9835 324 240.48 Tm 0.0368 Tc 0.9026 Tw (two special care units at the Corinne Dolan Alz-) Tj ET BT 0.8915 0 0 0.9835 324 228.96 Tm 0.0293 Tc 0.8532 Tw (heimer\222s Center in Chardon, OH. Studies of this kind) Tj 0 -12.4458 TD 0.0569 Tc 1.2223 Tw (have also been conducted in some of the special care) Tj T* 0.0481 Tc 1.0004 Tw (units at VA medical centers \(159\). Three special care) Tj 0.2692 -11.9577 TD 0.007 Tc 1.1138 Tw (units that constitute the Dementia Study Unit at the) Tj ET BT 0.9835 0 0 0.9835 324.48 180.72 Tm 0.0423 Tc 0.0124 Tw (VA medical center in Bedford, MA, have been the) Tj ET BT 0.934 0 0 0.9835 324.72 168.96 Tm -0.0335 Tc 0.8516 Tw (site for numerous studies on the care of individuals) Tj -0.257 -12.2018 TD -0.031 Tc 0.9916 Tw (with dementia in the late stages of their illness. To) Tj 0.257 -11.9577 TD -0.0245 Tc 1.7229 Tw (OTA\222s knowledge, the Dementia Study Unit is the) Tj ET BT 0.8915 0 0 0.9835 324.48 133.2 Tm 0.0418 Tc 0.8504 Tw (only research group in the country to focus its efforts) Tj ET BT 0.934 0 0 0.9835 324.72 121.68 Tm -0.0291 Tc 1.2323 Tw (on the difficult, emotionally charged, clinical issues) Tj 0 -12.2018 TD -0.0225 Tc 1.0601 Tw (in late-stage and terminal care for individuals with) Tj 0 -12.4458 TD -0.0302 Tc 1.0193 Tw (dementia. The research group has studied swallow-) Tj ET BT 0.9835 0 0 0.9835 324.72 85.68 Tm 0.0448 Tc 2.7044 Tw (ing and feeding difficulties \(476\), tube feeding) Tj 0.4881 -11.9577 TD 0.0308 Tc 0.1156 Tw (\(475\), use of antibiotics vs. palliative measures to) Tj ET BT 0.934 0 0 0.9835 325.2 61.44 Tm -0.0133 Tc 0.7443 Tw (treat fever in late-stage patients \(135\), and use of a) Tj -0.5139 -11.7137 TD -0.0393 Tc 1.0291 Tw (hospice-like approach to care for late-stage patients) Tj 0.7709 -11.9577 TD 0.0551 Tc 0 Tw (\(474\).) Tj ET endstream endobj 150 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 151 0 obj <>stream 0.72 w 1 j 0 0 0 RG 59.28 675.12 m 537.6 675.12 l S BT 0.9835 0 0 0.9835 326.88 680.64 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 2.7987 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 518.4 680.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 525.12 680.64 Tm /F5 11 Tf 0.3671 Tc 0 Tw (39) Tj ET BT 0.9795 0 0 0.9795 65.04 639.6 Tm /F7 12 Tf 0.0424 Tc 1.3658 Tw (Implications for Government Regulation of) Tj 63.2182 -14.4569 TD 0.0475 Tc 0.6256 Tw (Special Care Units) Tj ET BT 0.9261 0 0 0.9795 70.8 605.76 Tm 0.0319 Tc 0.074 Tw (The ) Tj ET BT 0.934 0 0 0.9835 92.4 605.76 Tm /F4 10 Tf -0.0274 Tc 1.616 Tw (diversity of special care units, the fact that) Tj -34.432 -12.4458 TD -0.0378 Tc 1.3701 Tw (existing units often do not incorporate the features) Tj -0.257 -11.9577 TD -0.0355 Tc 1.9244 Tw (recommended for special care units, and pervasive) Tj ET BT 0.8915 0 0 0.9835 60.48 569.76 Tm 0.0327 Tc 0.412 Tw (claims that some special care units just use the words) Tj ET BT 0.9014 0 0 0.9812 60.48 557.76 Tm /F5 11 Tf -0.0377 Tc 1.2842 Tw (special care) Tj 0 Tc -0.0889 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 113.28 557.76 Tm /F4 10 Tf 0.0421 Tc 1.1192 Tw (as a marketing tool and actually provide) Tj ET BT 0.9835 0 0 0.9835 60.48 546.24 Tm 0.0344 Tc -0.0276 Tw (nothing special for their residents lead many Alz-) Tj 0 -12.2018 TD 0.0298 Tc 1.1334 Tw (heimer\222s advocates, State officials, and others to) Tj ET BT 0.934 0 0 0.9835 61.2 522.24 Tm -0.0452 Tc 2.2774 Tw (support the development of special regulations for) Tj ET BT 0.9835 0 0 0.9835 61.2 510.48 Tm 0.0222 Tc 0.5581 Tw (special care units. On the other hand, the lack of) Tj ET BT 0.934 0 0 0.9835 61.2 498.48 Tm -0.0173 Tc 1.6479 Tw (agreement among experts about what features are) Tj ET BT 0.8915 0 0 0.9835 60.96 486.48 Tm 0.0256 Tc 1.4968 Tw (most important in the care of residents with demen-) Tj ET BT 0.934 0 0 0.9835 61.2 474.48 Tm -0.0291 Tc 0.7001 Tw (tia and the lack of research-based evidence showing) Tj ET BT 0.8915 0 0 0.9835 61.2 462.48 Tm 0.0379 Tc 0.0985 Tw (that any particular features are associated with better) Tj ET BT 0.9835 0 0 0.9835 60.96 450.48 Tm 0.0276 Tc 0.9904 Tw (resident outcomes make it difficult to justify the) Tj 0.7321 -12.2018 TD 0.0371 Tc 0.3184 Tw (selection of particular features that should be re-) Tj ET BT 0.934 0 0 0.9835 61.44 426.48 Tm -0.0284 Tc 0.5249 Tw (quired in special care units.) Tj ET BT 0.9835 0 0 0.9835 72.48 406.56 Tm 0.0419 Tc -0.091 Tw (The Alzheimer\222s Association has developed leg-) Tj -10.7376 -12.2018 TD 0.0356 Tc 1.1565 Tw (islative principles that identify 11 areas a State) Tj 0.244 -12.2018 TD 0.0284 Tc 2.477 Tw (should include when drafting special care unit) Tj ET BT 0.934 0 0 0.9835 61.92 370.8 Tm -0.0225 Tc 1.9962 Tw (legislation or regulations: 1\) statement of mission,) Tj 0.257 -11.9577 TD -0.009 Tc 1.4677 Tw (2\) involvement of family members, 3\) plan of care,) Tj ET BT 0.9835 0 0 0.9835 61.92 346.8 Tm 0.017 Tc 4.5222 Tw (4\) therapeutic programs, 5\) residents\222 rights,) Tj ET BT 0.934 0 0 0.9835 62.16 334.56 Tm -0.0006 Tc 1.7341 Tw (6\) environment, 7\) safety, 8\) staffing patterns and) Tj 0.257 -12.2018 TD -0.0002 Tc 1.0729 Tw (training, 9\) cost of care, 10\) quality assurance, and) Tj 1.0278 -11.9577 TD -0.0222 Tc 1.3212 Tw (11\) enforcement \(4\). As described in chapter 5, the) Tj ET BT 0.9835 0 0 0.9835 62.64 298.56 Tm 0.0413 Tc 0.3896 Tw (special care unit guidelines developed by various) Tj 0 -12.2018 TD 0.026 Tc 1.0966 Tw (organizations identify similar areas that require) Tj 0.244 -12.2018 TD 0.0288 Tc 0.3617 Tw (special consideration in the care of nursing home) Tj ET BT 0.934 0 0 0.9835 62.16 262.8 Tm -0.0302 Tc 1.2152 Tw (residents with dementia. Thus, there appears to be) Tj 0.7709 -12.4458 TD -0.0234 Tc 0.7551 Tw (some agreement about the areas of concern.) Tj ET BT 0.9835 0 0 0.9835 73.68 230.88 Tm 0.0267 Tc 2.4787 Tw (Having agreement about areas of concern is) Tj -11.2256 -12.2018 TD 0.0357 Tc 2.6729 Tw (helpful in \223) Tj ET BT 0.8915 0 0 0.9835 108.24 218.64 Tm 0.0353 Tc 0.6244 Tw (thinking about the particular features that) Tj ET BT 0.934 0 0 0.9835 62.64 207.36 Tm -0.0319 Tc 0.7535 Tw (might be desirable or required in special care units,) Tj ET BT 0.8915 0 0 0.9835 62.64 195.12 Tm 0.0522 Tc 0.5397 Tw (but agreement about areas of concern is not the same) Tj 0.8076 -12.2018 TD 0.0447 Tc 0.7126 Tw (as agreement about particular features. For example,) Tj ET BT 0.934 0 0 0.9835 63.36 171.12 Tm -0.0191 Tc 1.607 Tw (agreement that therapeutic programs and physical) Tj ET BT 0.8915 0 0 0.9835 63.36 158.88 Tm 0.0545 Tc 1.0412 Tw (environment are areas of concern does not constitute) Tj ET BT 0.9835 0 0 0.9835 63.36 146.64 Tm 0.023 Tc 1.0996 Tw (agreement about which therapeutic programs or) Tj -0.244 -11.7137 TD 0.0329 Tc 0.1541 Tw (physical design features should be required. OTA) Tj ET BT 0.934 0 0 0.9835 63.12 122.88 Tm -0.0233 Tc 1.3546 Tw (has observed that in discussions about special care) Tj 0.257 -11.9577 TD -0.0197 Tc 1.3935 Tw (unit regulations, agreement about areas of concern) Tj ET BT 0.8915 0 0 0.9835 63.36 99.36 Tm 0.0371 Tc 1.5377 Tw (often masks considerable disagreement about partic-) Tj 0 -12.2018 TD 0.0473 Tc 0.9339 Tw (ular features and gives an erroneous impression that) Tj 0.2692 -12.2018 TD 0.0397 Tc 1.2116 Tw (there is consensus about the particular features that) Tj 0.2692 -11.7137 TD 0.0563 Tc 2.0007 Tw (should be required.) Tj ET BT 0.9835 0 0 0.9835 74.4 44.4 Tm 0.0285 Tc 0.1179 Tw (As noted earlier, OTA\222s analysis of the existing) Tj -10.9816 -12.4458 TD 0.0299 Tc 0.8893 Tw (State regulations for special care units indicates) Tj 251.8448 619.3625 TD 0.0287 Tc 1.5819 Tw (several problems that are likely to arise in any) Tj ET BT 0.8915 0 0 0.9835 311.52 629.28 Tm 0.0432 Tc 1.0395 Tw (special care unit regulations that could be devised at) Tj -0.5384 -11.9577 TD 0.0446 Tc 0.9909 Tw (present. First, regulatory requirements for particular) Tj ET BT 0.9835 0 0 0.9835 311.28 605.52 Tm 0.0264 Tc 2.4209 Tw (features in special care units imply that those) Tj ET BT 0.934 0 0 0.9835 311.28 593.52 Tm -0.0351 Tc 0.5642 Tw (features are unique to or more important for special) Tj ET BT 0.9835 0 0 0.9835 311.52 581.52 Tm 0.0215 Tc 1.2406 Tw (care unit residents than for other nursing home) Tj ET BT 0.8915 0 0 0.9835 311.28 569.52 Tm 0.02 Tc 0.1907 Tw (residents. Yet many of the features that are important) Tj ET BT 0.934 0 0 0.9835 311.76 557.76 Tm -0.0259 Tc 1.6143 Tw (for special care unit residents are probably just as) Tj ET BT 0.8915 0 0 0.9835 312 546 Tm 0.0344 Tc 1.4869 Tw (important for other residents. This is especially true) Tj 0.5384 -12.4458 TD 0.0403 Tc 0.5188 Tw (since most nursing home residents with dementia are) Tj ET BT 0.934 0 0 0.9835 312 522 Tm -0.0199 Tc 0.6657 Tw (not in special care units now and may never be.) Tj ET BT 0.9835 0 0 0.9835 323.28 498 Tm 0.0221 Tc 0.4905 Tw (Second, regulatory requirements for particular) Tj -11.2256 -12.2018 TD 0.0264 Tc 2.4209 Tw (features in special care units imply that those) Tj 0.244 -11.9577 TD 0.033 Tc -0.0087 Tw (features are more important in the care of special) Tj ET BT 0.934 0 0 0.9835 312.48 462 Tm -0.0262 Tc 0.8758 Tw (care unit residents than other features that are not) Tj -0.257 -11.9577 TD -0.0282 Tc 1.6168 Tw (required by the regulations and that the resources) Tj ET BT 0.9835 0 0 0.9835 312.72 438.24 Tm 0.0505 Tc 0.9497 Tw (available to the unit should be expended for the) Tj -0.244 -12.4458 TD 0.0313 Tc 2.0674 Tw (required features. Most special care units have) Tj ET BT 0.8915 0 0 0.9835 312.72 413.76 Tm 0.0458 Tc 0.5319 Tw (limited resources, so features that are not required in) Tj ET BT 0.9835 0 0 0.9835 313.2 401.76 Tm 0.0324 Tc 1.0901 Tw (special care unit regulations are likely to be ne-) Tj ET BT 0.8915 0 0 0.9835 313.2 390 Tm 0.0374 Tc 1.4835 Tw (glected. Yet experts in dementia care disagree about) Tj ET BT 0.9835 0 0 0.9835 312.96 377.76 Tm 0.0255 Tc 0.792 Tw (which features are most important in the care of) Tj ET BT 0.8915 0 0 0.9835 313.2 366.24 Tm 0.0145 Tc 1.24 Tw (these residents.) Tj ET BT 0.934 0 0 0.9835 324 342 Tm -0.0284 Tc 0.9562 Tw (The problem of special care unit regulations that) Tj ET BT 0.8915 0 0 0.9835 313.44 330.24 Tm 0.0287 Tc 1.0702 Tw (omit features regarded as important by some demen-) Tj ET BT 0.9835 0 0 0.9835 313.44 318 Tm 0.046 Tc 3.4818 Tw (tia experts could be solved by expanding the) Tj ET BT 0.934 0 0 0.9835 313.2 306 Tm -0.0349 Tc 1.2202 Tw (regulations to require those features. The more the) Tj 0 -11.9577 TD -0.0393 Tc 1.286 Tw (regulations are expanded, however, the more likely) Tj 0.5139 -12.4458 TD -0.0339 Tc 0.6236 Tw (it is that the required features will be important for) Tj 0 -12.4458 TD -0.0325 Tc 0.5422 Tw (other nursing home residents as well.) Tj ET BT 0.8915 0 0 0.9835 324.72 246.24 Tm 0.0342 Tc 1.2627 Tw (Given these problems, OTA concludes that OBRA-) Tj ET BT 0.9835 0 0 0.9835 314.16 234.48 Tm 0.0327 Tc 2.8387 Tw (87 provides a better framework for regulating) Tj ET BT 0.934 0 0 0.9835 314.16 222.72 Tm -0.0168 Tc 0.9438 Tw (special care units than any special regulations that) Tj ET BT 0.9835 0 0 0.9835 313.92 210.72 Tm 0.0376 Tc 0.9628 Tw (could be devised at this time. The advantages of) Tj ET BT 0.934 0 0 0.9835 314.16 198.72 Tm -0.0232 Tc 2.3822 Tw (OBRA-87 are its comprehensiveness, its emphasis) Tj ET BT 0.8915 0 0 0.9835 314.4 186.96 Tm 0.0255 Tc 1.4071 Tw (on individualized care, and its mandated assessment) Tj 0.2692 -12.2018 TD 0.0568 Tc 1.6411 Tw (and care planning procedures. The primary problem) Tj ET BT 0.9835 0 0 0.9835 314.4 162.96 Tm 0.0328 Tc 0.8761 Tw (with OBRA-87 for special care units is the same) Tj -0.244 -12.2018 TD 0.0538 Tc 3.3344 Tw (problem faced by anyone who ties to develop) Tj 0 -12.2018 TD 0.0183 Tc 0.7994 Tw (regulations for special care units: i.e., the lack of) Tj ET BT 0.934 0 0 0.9835 314.64 126.96 Tm -0.0173 Tc 1.6479 Tw (agreement among experts about what features are) Tj ET BT 0.8915 0 0 0.9835 314.4 115.68 Tm 0.0256 Tc 1.4968 Tw (most important in the care of residents with demen-) Tj 0.2692 -12.4458 TD 0.0437 Tc 0.28 Tw (tia and thus what should be special about special care) Tj ET BT 0.9835 0 0 0.9835 314.64 91.68 Tm 0.0218 Tc 1.7516 Tw (units. Solving this problem through support for) Tj ET BT 0.934 0 0 0.9835 314.4 80.16 Tm -0.0357 Tc 1.8817 Tw (research to evaluate the effectiveness of particular) Tj ET BT 0.8915 0 0 0.9835 314.64 68.4 Tm 0.034 Tc 1.8911 Tw (features may eventually provide a substantive basis) Tj 0 -12.2018 TD 0.0405 Tc 1.2445 Tw (for special care unit regulations. In the meantime, it) Tj 0 -11.9577 TD 0.03 Tc 0.9149 Tw (is important to consider alternate ways of addressing) Tj ET BT 0.9835 0 0 0.9835 314.64 32.64 Tm 0.0212 Tc 3.5825 Tw (the concerns that have led many Alzheimer\222s) Tj ET endstream endobj 152 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 153 0 obj <>stream 0.72 w 1 j 0 0 0 RG 70.56 681.84 m 548.88 681.84 l S BT 0.9444 0 0 0.9835 70.56 688.32 Tm 0 0 0 rg /F5 10 Tf 0.0803 Tc -0.0449 Tw (40 ) Tj ET BT 0.9207 0 0 0.9598 82.8 688.32 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.9444 0 0 0.9835 88.8 688.32 Tm /F5 10 Tf -0.0146 Tc 0.4369 Tw (Special Care ) Tj ET BT 0.9443 0 0 0.9812 141.6 688.32 Tm /F5 11 Tf -0.0026 Tc 0.8603 Tw (Units for People With Alzheimer\222s ) Tj ET BT 0.9444 0 0 0.9835 292.56 688.32 Tm /F5 10 Tf -0.019 Tc 1.5851 Tw (and Other Dementias) Tj ET BT 0.9835 0 0 0.9835 71.28 647.76 Tm /F4 10 Tf 0.037 Tc 0.5625 Tw (advocates, State officials, and others to favor the) Tj ET BT 0.934 0 0 0.9835 71.28 635.76 Tm -0.0366 Tc 1.1632 Tw (development of special care unit regulations.) Tj ET BT 0.9835 0 0 0.9835 72 618 Tm 0.0351 Tc 0.648 Tw (Alternatives to Special Care Unit Regulations) Tj ET BT 0.934 0 0 0.9835 82.56 600.24 Tm -0.0213 Tc 1.1469 Tw (Alzheimer\222s advocates, State officials, and others) Tj ET BT 0.9835 0 0 0.9835 71.76 588 Tm 0.0423 Tc 1.9516 Tw (who favor the development of special care unit) Tj ET BT 0.8915 0 0 0.9835 71.28 576 Tm 0.0344 Tc 1.4869 Tw (regulations often cite the need to protect individuals) Tj ET BT 0.934 0 0 0.9835 72 564.24 Tm -0.0296 Tc 1.2145 Tw (with dementia from poor-quality care and the need) Tj 0 -12.2018 TD -0.0359 Tc 1.2212 Tw (to protect these individuals and their families from) Tj ET BT 0.8915 0 0 0.9835 72 540.48 Tm 0.0462 Tc 1.1708 Tw (nursing homes that claim to provide special care but) Tj ET BT 0.934 0 0 0.9835 72.24 528.24 Tm -0.042 Tc 0.7322 Tw (actually do not. Some people who favor the develop-) Tj ET BT 0.8915 0 0 0.9835 72 516.48 Tm 0.0511 Tc 1.0194 Tw (ment of special care unit regulations also cite a need) Tj ET BT 0.9835 0 0 0.9835 72.48 504.48 Tm 0.0214 Tc 0.1252 Tw (to assist nursing homes in designing their special) Tj ET BT 0.934 0 0 0.9835 72.48 492.24 Tm -0.025 Tc 1.0673 Tw (care units and to assist surveyors in inspecting the) Tj ET BT 0.9835 0 0 0.9835 72.48 480.48 Tm 0.0335 Tc 2.0651 Tw (units. Each of these objectives can be achieved) Tj ET BT 0.8915 0 0 0.9835 72.72 468.48 Tm 0.0371 Tc 3.099 Tw (without special regulations.) Tj 12.6521 -18.0586 TD 0.0434 Tc 1.387 Tw (In discussions about special care unit regulations,) Tj -12.3829 -11.9577 TD 0.0128 Tc 1.2419 Tw (it is sometimes suggested that there are two types of) Tj ET BT 0.934 0 0 0.9835 73.44 426.72 Tm -0.0277 Tc 2.1301 Tw (special care units\227\222) Tj ET BT 0.9835 0 0 0.9835 164.88 426.48 Tm 0.0198 Tc 1.652 Tw (good\222 units and \221bad\222 units\227) Tj -92.9776 -11.4697 TD 0.0412 Tc 0.5582 Tw (and that regulations are needed to eliminate the) Tj ET BT 0.934 0 0 0.9835 73.92 402.96 Tm -0.0131 Tc 1.258 Tw (\223bad\222 units. In this context, it is probably more ac-) Tj ET BT 0.8915 0 0 0.9835 73.44 391.44 Tm 0.0351 Tc 0.7383 Tw (curate to think about four types of special care units:) Tj ET BT 0.7642 0 0 0.9835 85.68 373.92 Tm 0.0673 Tc 0 Tw (1.) Tj ET BT 0.7718 0 0 0.9795 84.72 337.68 Tm /F7 12 Tf 0.1627 Tc (2.) Tj 0.6219 -48.7613 TD 0.1627 Tc (3.) Tj ET BT 0.8104 0 0 0.9795 84.96 254.4 Tm 0.2359 Tc (4.) Tj ET BT 0.8915 0 0 0.9835 97.92 373.44 Tm /F4 10 Tf 0.0383 Tc 0.6748 Tw (units that provide the features a given observer) Tj 0.5384 -12.2018 TD 0.0266 Tc 2.0878 Tw (considers important for residents with demen-) Tj ET BT 0.8491 0 0 0.9835 98.4 349.44 Tm 0.0392 Tc 0 Tw (tia,) Tj ET BT 0.8915 0 0 0.9835 98.16 337.44 Tm 0.0194 Tc 1.3355 Tw (units that do not provide those features but do) Tj ET BT 0.934 0 0 0.9835 98.16 325.92 Tm -0.0371 Tc 0.7698 Tw (provide other features the unit operator, staff,) Tj ET BT 0.9835 0 0 0.9835 98.64 313.68 Tm 0.0322 Tc 0.1142 Tw (or advisers consider important for residents) Tj ET BT 0.8915 0 0 0.9835 98.64 302.16 Tm 0.016 Tc 2.5843 Tw (with dementia,) Tj ET BT 0.9835 0 0 0.9835 98.4 289.92 Tm 0.0265 Tc 0.9217 Tw (units that claim to provide special care but) Tj 0.7321 -12.2018 TD 0.0316 Tc 3.0432 Tw (actually provide nothing special for their) Tj ET BT 0.8915 0 0 0.9835 98.64 266.16 Tm 0.0133 Tc 2.0489 Tw (residents, and) Tj 0 -12.2018 TD 0.0315 Tc 1.2657 Tw (units that provide poor-quality care that would) Tj ET BT 0.9835 0 0 0.9835 98.64 242.4 Tm 0.0331 Tc 0.2353 Tw (be inappropriate for any nursing home resi-) Tj ET BT 0.8491 0 0 0.9835 98.88 231.36 Tm 0.0417 Tc 0 Tw (dent.) Tj ET BT 0.934 0 0 0.9835 84.96 213.36 Tm -0.0363 Tc 1.7968 Tw (Anecdotal evidence suggests that there are very) Tj ET BT 0.8915 0 0 0.9835 74.16 201.36 Tm 0.0061 Tc 0.8823 Tw (few units of the last type, and the one study that has) Tj ET BT 0.934 0 0 0.9835 74.64 189.12 Tm -0.0234 Tc 0.7551 Tw (addressed this issue supports that conclusion \(154\).) Tj 0 -12.4458 TD -0.022 Tc 2.1668 Tw (OBRA-87 provides a sufficient basis for censuring) Tj ET BT 0.9835 0 0 0.9835 74.16 165.12 Tm 0.0375 Tc 1.8475 Tw (units of that type, without the need for special) Tj ET BT 0.8915 0 0 0.9835 74.16 153.12 Tm 0.0416 Tc 0 Tw (regulations.) Tj 12.3829 -18.3027 TD 0.027 Tc 0.7773 Tw (Most special care units are of the first three types.) Tj -11.5754 -12.4458 TD 0.0403 Tc 1.6148 Tw (Objective classification of particular units into these) Tj ET BT 0.9835 0 0 0.9835 74.64 111.36 Tm 0.0316 Tc 1.8637 Tw (types would be difficult, since the classification) Tj 0 -11.9577 TD 0.0452 Tc 1.0771 Tw (depends on a given observer\222s opinion about the) Tj ET BT 0.8915 0 0 0.9835 74.64 87.6 Tm 0.0419 Tc 0.5512 Tw (features that are important in a special care unit and) Tj ET BT 0.9835 0 0 0.9835 74.64 75.6 Tm 0.0263 Tc 0.4687 Tw (a judgment about the intentions of each facility\222s) Tj 0 -11.9577 TD 0.0181 Tc 0.2749 Tw (administrators. Although some nursing home ad-) Tj -0.4881 -12.4458 TD 0.0217 Tc 2.5652 Tw (ministrators may knowingly provide no special) Tj ET BT 0.8915 0 0 0.9835 74.88 40.08 Tm 0.047 Tc 1.5496 Tw (services in their special care unit, other administra-) Tj ET BT 0.9835 0 0 0.9835 322.32 647.76 Tm 0.0385 Tc 2.06 Tw (tors probably believe erroneously that they are) Tj ET BT 0.8915 0 0 0.9835 321.84 636 Tm 0.0466 Tc 2.0654 Tw (providing appropriate care. One commentator refers) Tj ET BT 0.9835 0 0 0.9835 322.56 624 Tm 0.023 Tc 2.3198 Tw (to the latter units and their administrators as) Tj 0.7321 -11.9577 TD 0.0257 Tc 4.5133 Tw (\223innocent\224 \(21\).) Tj 10.2495 -20.255 TD 0.0341 Tc 0.2168 Tw (An earlier section of this chapter discussed the) Tj -10.9816 -12.2018 TD 0.0364 Tc 1.8181 Tw (need for consumer education about special care) Tj ET BT 0.934 0 0 0.9835 322.8 568.32 Tm -0.0289 Tc 1.6497 Tw (units. As noted there, families and others who are) Tj ET BT 0.9835 0 0 0.9835 322.8 556.56 Tm 0.0324 Tc -0.0996 Tw (trying to evaluate special care units need to know) Tj ET BT 0.8915 0 0 0.9835 323.04 544.32 Tm 0.0322 Tc 1.2201 Tw (that existing units vary greatly. They need compara-) Tj ET BT 0.9835 0 0 0.9835 323.04 532.08 Tm 0.0273 Tc 1.9901 Tw (ble information about the characteristics of the) Tj 0.4881 -11.9577 TD 0.0274 Tc 2.0713 Tw (special care units in their geographic area and) Tj ET BT 0.8915 0 0 0.9835 323.28 508.08 Tm 0.042 Tc 0.9848 Tw (information about characteristics that may be impor-) Tj 0 -11.9577 TD 0.0327 Tc 0.8965 Tw (tant in a special care unit. Lastly, they need to know) Tj 0.2692 -12.2018 TD 0.0295 Tc 1.1847 Tw (that experts disagree about the importance of partic-) Tj ET BT 0.9835 0 0 0.9835 323.28 472.08 Tm 0.0169 Tc 1.2685 Tw (ular unit characteristics and that their personal) Tj 0.244 -12.2018 TD 0.0357 Tc 0.006 Tw (preferences and values are relevant in selecting a) Tj ET BT 0.934 0 0 0.9835 323.76 448.32 Tm -0.0371 Tc 1.1124 Tw (unit. These types of information will not protect all) Tj -0.257 -12.2018 TD -0.0316 Tc 0.8496 Tw (potential special care unit residents and their fami-) Tj ET BT 0.9835 0 0 0.9835 324 424.56 Tm 0.0291 Tc 1.4072 Tw (lies from nursing homes that provide no special) Tj ET BT 0.8915 0 0 0.9835 324.24 412.56 Tm 0.0516 Tc 1.1648 Tw (services in their special care unit. Neither will these) Tj ET BT 0.9835 0 0 0.9835 324 400.8 Tm 0.0335 Tc 0.3081 Tw (individuals be protected, however, by regulations) Tj ET BT 0.8915 0 0 0.9835 324 388.56 Tm 0.0525 Tc 0.5051 Tw (that require special care units to incorporate features) Tj ET BT 0.934 0 0 0.9835 324.24 377.04 Tm -0.0306 Tc 0.9586 Tw (that have not been proven to be effective.) Tj 11.82 -19.7669 TD -0.0406 Tc 1.6729 Tw (For the purpose of consumer protection, nursing) Tj ET BT 0.8915 0 0 0.9835 324.24 345.36 Tm 0.0548 Tc 1.5409 Tw (homes could be required to disclose certain informa-) Tj ET BT 0.9835 0 0 0.9835 324.48 333.12 Tm 0.0346 Tc 2.4126 Tw (tion about their special care units to potential) Tj ET BT 0.8915 0 0 0.9835 324.24 321.6 Tm 0.0346 Tc 0.9483 Tw (residents and their families. In particular, they could) Tj 0.2692 -12.4458 TD 0.0415 Tc 0.5815 Tw (be required to disclose what is special about the unit;) Tj -0.2692 -11.7137 TD 0.0336 Tc 1.3195 Tw (how the unit differs from nonspecialized units in the) Tj ET BT 0.9835 0 0 0.9835 324.96 285.6 Tm 0.021 Tc 2.3625 Tw (same facility; how physical restraints and psy-) Tj ET BT 0.934 0 0 0.9835 324.72 273.36 Tm -0.037 Tc 0.8553 Tw (chotropic medications are used in the unit; whether) Tj ET BT 0.8915 0 0 0.9835 324.96 261.84 Tm 0.0584 Tc 0.3447 Tw (there are behavioral problems that cannot be handled) Tj ET BT 0.934 0 0 0.9835 324.72 249.84 Tm -0.0328 Tc 1.1399 Tw (on the unit; whether it is expected that individuals) Tj ET BT 0.9835 0 0 0.9835 324.96 238.08 Tm 0.0365 Tc 1.208 Tw (who are admitted to the unit will be discharged) Tj -0.244 -12.2018 TD 0.0363 Tc 0.6523 Tw (before their death and, if so, for what reasons. A) Tj 0 -12.2018 TD 0.0341 Tc 0.3969 Tw (disclosure requirement could be mandated at the) Tj ET BT 0.934 0 0 0.9835 324.96 202.08 Tm -0.0381 Tc 1.4805 Tw (Federal level within the framework of OBRA-87 or) Tj ET BT 0.9835 0 0 0.9835 325.2 190.08 Tm 0.036 Tc 0.8729 Tw (at the State level within the framework of State) Tj ET BT 0.8915 0 0 0.9835 325.2 178.08 Tm 0.0568 Tc 1.7309 Tw (licensing regulations. Such a disclosure requirement) Tj ET BT 0.9835 0 0 0.9835 325.2 165.84 Tm 0.0378 Tc 2.7115 Tw (would be quite different from regulations that) Tj ET BT 0.934 0 0 0.9835 324.96 154.08 Tm -0.0257 Tc 1.0359 Tw (require particular features in a special care unit. It) Tj ET BT 0.9835 0 0 0.9835 325.44 141.84 Tm 0.0333 Tc 1.0078 Tw (would make useful information available to con-) Tj ET BT 0.934 0 0 0.9835 325.44 130.08 Tm -0.0169 Tc 1.2449 Tw (sumers without suggesting that particular features) Tj 0 -11.7137 TD -0.0409 Tc 1.0798 Tw (are known to be effective. A disclosure requirement) Tj -0.257 -11.9577 TD -0.047 Tc 1.3229 Tw (would not eliminate the need for the other types of) Tj 0.257 -12.4458 TD -0.0274 Tc 2.0442 Tw (consumer information described above.) Tj 11.563 -19.5229 TD -0.0289 Tc 1.1771 Tw (Guidelines are the best method to assist nursing) Tj -11.82 -11.7137 TD -0.0266 Tc 0.8442 Tw (homes in designing their special care units. Several) Tj ET BT 0.8915 0 0 0.9835 325.44 51.6 Tm 0.0456 Tc 1.3204 Tw (of the guideline documents mentioned earlier in this) Tj 0 -11.7137 TD 0.0387 Tc 1.2464 Tw (chapter and discussed at greater length in chapter 5) Tj ET endstream endobj 154 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 155 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.96 674.88 m 538.56 674.88 l S 66.24 79.44 m 544.8 79.44 l S BT 0.9835 0 0 0.9835 328.32 680.16 Tm 0 0 0 rg /F5 10 Tf 0.0115 Tc 2.8557 Tw (Chapter l-Overview and Policy Implications . 41) Tj -271.1236 -40.5099 TD /F4 10 Tf 0.0317 Tc 0.4075 Tw (are intended primarily for this purpose.) Tj ET BT 1.08 0 0 1.08 245.76 645.12 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (14 ) Tj ET BT 0.9835 0 0 0.9835 251.76 640.32 Tm /F4 10 Tf 0.0654 Tc 0.3244 Tw (More so) Tj -193.2762 -12.2018 TD 0.0269 Tc -0.0839 Tw (than regulations, guidelines can convey the objec-) Tj 0.244 -11.9577 TD 0.0327 Tc 2.8387 Tw (tives of specialized dementia care, the current) Tj 0 -12.2018 TD 0.0347 Tc 1.6165 Tw (uncertainty about the most effective methods of) Tj 0.244 -12.4458 TD 0.0386 Tc 0.7003 Tw (care, and the need for innovation and evaluative) Tj ET BT 0.8915 0 0 0.9835 61.92 580.56 Tm 0.0618 Tc 1.3888 Tw (research in special care units.) Tj ET BT 0.934 0 0 0.9835 73.44 562.8 Tm -0.0387 Tc 1.5253 Tw (Surveyor guidelines developed within the frame-) Tj ET BT 0.9835 0 0 0.9835 62.64 550.56 Tm 0.0442 Tc 1.5356 Tw (work of OBRA-87 are the best method to assist) Tj 0 -11.9577 TD 0.0177 Tc -0.0745 Tw (nursing home surveyors in inspecting special care) Tj ET BT 0.934 0 0 0.9835 62.64 526.8 Tm -0.0124 Tc 0.829 Tw (units. Since 1989, the Joint Commission on Accred-) Tj ET BT 0.9835 0 0 0.9835 62.88 515.04 Tm 0.0332 Tc -0.0821 Tw (itation of Healthcare Organizations \(JCAHO\) has) Tj -0.244 -12.2018 TD 0.0331 Tc 0.8453 Tw (been working on guidelines to help its surveyors) Tj 0.4881 -12.2018 TD 0.03 Tc 1.4412 Tw (evaluate special care units. JCAHO is a private) Tj ET BT 0.934 0 0 0.9835 63.36 478.8 Tm -0.0186 Tc 2.2746 Tw (organization that accredits hospitals, home health) Tj ET BT 0.9835 0 0 0.9835 63.6 466.8 Tm 0.0252 Tc 0.3653 Tw (agencies, mental health organizations, and about) Tj ET BT 0.934 0 0 0.9835 64.56 455.04 Tm 0.006 Tc 0.2312 Tw (1000 nursing homes in the United States \(214\). The) Tj ET BT 0.9835 0 0 0.9835 63.6 442.8 Tm 0.0168 Tc 0.2518 Tw (commission\222s effort ) Tj ET BT 0.9863 0 0 0.9863 155.04 442.8 Tm /F3 9 Tf 0.0085 Tc -0.0784 Tw (to ) Tj ET BT 0.9835 0 0 0.9835 165.84 442.8 Tm /F4 10 Tf 0.0623 Tc 1.0596 Tw (develop guidelines evolved) Tj ET BT 0.934 0 0 0.9835 63.6 431.04 Tm -0.0223 Tc 0.9497 Tw (from its surveyors\222 questions about how to evaluate) Tj ET BT 0.8915 0 0 0.9835 64.08 418.8 Tm 0.058 Tc 0.5181 Tw (the increasing number of special care units they were) Tj ET BT 0.934 0 0 0.9835 64.32 407.04 Tm -0.0249 Tc 1.1727 Tw (seeing in nursing homes accredited by the commis-) Tj 0.257 -11.9577 TD 0.0187 Tc 2.0804 Tw (sion \(434\).) Tj 11.0491 -17.8146 TD -0.0362 Tc 1.6253 Tw (JCAHO\222s draft surveyor guidelines provide what) Tj ET BT 0.8915 0 0 0.9835 64.32 366.24 Tm 0.0223 Tc 1.1714 Tw (is, in effect, a detailed answer to the question, \221What) Tj ET BT 0.934 0 0 0.9835 64.56 354 Tm -0.0374 Tc 1.541 Tw (constitutes appropriate care for nursing home resi-) Tj 0.257 -12.4458 TD -0.0304 Tc 1.509 Tw (dents with dementia?\222 The guidelines are based on) Tj ET BT 0.9835 0 0 0.9835 64.8 330 Tm 0.0153 Tc 0.172 Tw (the commission\222s standards for all nursing homes) Tj 0.244 -12.2018 TD 0.0346 Tc 1.7589 Tw (\(435\). No changes have been made to the basic) Tj ET BT 0.8915 0 0 0.9835 65.28 306 Tm 0.0078 Tc 1.1578 Tw (standards. Instead, statements have been added next) Tj -0.2692 -11.9577 TD 0.024 Tc 1.4312 Tw (to many of the standards to explain the implications) Tj ET BT 0.9835 0 0 0.9835 65.04 282 Tm 0.0408 Tc 2.8203 Tw (of the standard for the care of residents with) Tj ET BT 0.934 0 0 0.9835 65.04 270.48 Tm -0.0423 Tc 1.9989 Tw (dementia and to describe the process the surveyor) Tj ET BT 0.8915 0 0 0.9835 65.52 258.24 Tm 0.0499 Tc 1.1106 Tw (should follow in scoring the special care unit on that) Tj ET BT 0.9835 0 0 0.9835 65.76 246.48 Tm 0.0201 Tc 0.3705 Tw (standard. Although some commentators may dis-) Tj ET BT 0.9863 0 0 0.9863 65.52 234.24 Tm /F3 9 Tf 0.0344 Tc 1.5987 Tw (agree with) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 115.68 234.24 Tm /F4 10 Tf 0.0336 Tc 2.3579 Tw (some of the statements, the JCAHO) Tj ET BT 0.934 0 0 0.9835 65.76 222.24 Tm -0.0355 Tc 1.1107 Tw (guidelines provide a valuable model which could be) Tj 0 -12.2018 TD -0.0358 Tc 0.0832 Tw (adapted ) Tj ET BT 0.9606 0 0 0.9863 104.4 210.24 Tm /F3 9 Tf -0.0029 Tc -0.0019 Tw (to ) Tj ET BT 0.934 0 0 0.9835 114.72 210.24 Tm /F4 10 Tf -0.0249 Tc 2.6411 Tw (OBRA regulations.) Tj ET BT 0.9835 0 0 0.9835 65.76 192.24 Tm 0.0377 Tc 1.3288 Tw (Waivers and Other Methods To Allow) Tj 0.244 -11.9577 TD 0.0361 Tc -0.1339 Tw (Innovation ) Tj ET BT 0.9812 0 0 0.9812 119.76 180.48 Tm /F6 11 Tf 0.0577 Tc -0.1198 Tw (in ) Tj ET BT 0.9835 0 0 0.9835 131.76 180.48 Tm /F4 10 Tf 0.0288 Tc 0.9717 Tw (Special Care Units) Tj ET BT 0.934 0 0 0.9835 77.04 162.48 Tm -0.0422 Tc 1.595 Tw (As noted earlier, special care unit operators and) Tj -11.563 -12.4458 TD -0.0273 Tc 1.5302 Tw (others often complain that the existing regulations) Tj 0 -11.9577 TD -0.0326 Tc 1.1504 Tw (and survey and certification procedures for nursing) Tj ET BT 0.8915 0 0 0.9835 66.24 126.48 Tm 0.0496 Tc 1.6493 Tw (homes discourage innovation by interfering with the) Tj ET BT 0.9835 0 0 0.9835 66.24 114.24 Tm 0.0385 Tc 2.4086 Tw (use of physical design and other features they) Tj ET BT 0.934 0 0 0.9835 66.24 102.48 Tm -0.0486 Tc 0.8677 Tw (believe would be effective for residents with demen-) Tj 0.257 -12.2018 TD -0.0338 Tc 1.7696 Tw (tia. From a societal perspective, one objective, and) Tj ET BT 0.8915 0 0 0.9835 312.72 641.28 Tm 0.0339 Tc 1.2951 Tw (perhaps the most important objective, of special care) Tj ET BT 0.934 0 0 0.9835 312.72 629.04 Tm -0.0323 Tc 0.7361 Tw (units is to develop better ways of caring for nursing) Tj 0 -11.9577 TD -0.0306 Tc 2.0476 Tw (home residents with dementia. To accomplish this) Tj ET BT 0.9835 0 0 0.9835 313.2 604.8 Tm 0.0313 Tc 2.7994 Tw (objective, methods must be found) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 482.16 604.8 Tm /F3 9 Tf 0.0183 Tc 1.3717 Tw (to allow) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 520.8 604.8 Tm /F4 10 Tf 0.5384 Tc 0 Tw (and) Tj ET BT 0.934 0 0 0.9835 313.2 592.8 Tm -0.0246 Tc 0.7906 Tw (encourage innovation in special care units.) Tj ET BT 0.8915 0 0 0.9835 324.72 572.88 Tm 0.0527 Tc 1.1971 Tw (One method to allow greater innovation in special) Tj ET BT 0.9835 0 0 0.9835 313.68 560.88 Tm 0.0188 Tc 0.0232 Tw (care units is to eliminate regulations that restrict) Tj ET BT 0.934 0 0 0.9835 313.68 549.12 Tm -0.0234 Tc 2.2969 Tw (innovative physical design and other features. Al-) Tj 0.257 -12.2018 TD -0.0185 Tc 0.8783 Tw (though this method may eventually be appropriate,) Tj ET BT 0.8915 0 0 0.9835 313.92 525.36 Tm 0.0421 Tc 0.637 Tw (the current lack of agreement about the features that) Tj ET BT 0.934 0 0 0.9835 314.4 513.36 Tm -0.0234 Tc 0.9949 Tw (are important in a special care unit and the lack of) Tj ET BT 0.9835 0 0 0.9835 313.92 501.6 Tm 0.0491 Tc 2.1957 Tw (research-based evidence for the effectiveness of) Tj 0 -12.4458 TD 0.0273 Tc 2.2178 Tw (particular features make decisions to eliminate) Tj ET BT 0.8915 0 0 0.9835 314.64 477.12 Tm 0.0386 Tc 2.1551 Tw (existing regulations premature.) Tj ET BT 0.9835 0 0 0.9835 325.44 457.2 Tm 0.0345 Tc 0.0304 Tw (A better method is to create a process by which) Tj ET BT 0.8915 0 0 0.9835 314.88 445.2 Tm 0.0493 Tc 1.547 Tw (individual special care units could obtain waivers to) Tj ET BT 0.9835 0 0 0.9835 314.88 433.2 Tm 0.0277 Tc 0.7532 Tw (implement physical design features, patient care) Tj 0 -12.2018 TD 0.0315 Tc 0.3995 Tw (practices, and other innovations they believe will) Tj 0.244 -12.4458 TD 0.0335 Tc 2.7484 Tw (benefit residents with dementia. Most existing) Tj ET BT 0.934 0 0 0.9835 314.88 397.2 Tm -0.0356 Tc 1.8817 Tw (regulatory codes have) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 416.4 397.2 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 423.6 397.2 Tm /F4 10 Tf -0.028 Tc 2.1305 Tw (process for granting waiv-) Tj ET BT 0.9835 0 0 0.9835 315.36 385.68 Tm 0.0232 Tc 1.8011 Tw (ers, but in some and perhaps many States, the) Tj 0 -11.9577 TD 0.0282 Tc 0.3622 Tw (waivers that are granted are for relatively trivial) Tj 0.4881 -12.4458 TD 0.0318 Tc 1.6763 Tw (changes \(201\). The purpose of creating) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 504.96 361.68 Tm /F3 9 Tf 0.043 Tc 1.8332 Tw (a waiver) Tj ET BT 0.9835 0 0 0.9835 315.36 349.92 Tm /F4 10 Tf 0.0372 Tc -0.1001 Tw (process for special care units would be ) Tj ET BT 0.9863 0 0 0.9863 492.96 349.92 Tm /F3 9 Tf 0.0249 Tc -0.095 Tw (to allow the) Tj ET BT 0.8915 0 0 0.9835 316.08 337.92 Tm /F4 10 Tf 0.045 Tc 1.8787 Tw (implementation and evaluation of nontrivial) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 511.92 337.92 Tm /F3 9 Tf -0.0058 Tc 0 Tw (innova-) Tj ET BT 0.934 0 0 0.9835 316.08 325.68 Tm /F4 10 Tf -0.0209 Tc 0.471 Tw (tions. Since such innovations would change the care) Tj ET BT 0.8915 0 0 0.9835 316.08 313.92 Tm 0.0257 Tc 1.3428 Tw (of individuals with dementia in significant ways, the) Tj ET BT 0.9835 0 0 0.9835 316.32 302.16 Tm 0.0356 Tc 1.3308 Tw (waivers should only be granted on a facility-by-) Tj 0 -12.2018 TD 0.0291 Tc 0.1522 Tw (facility basis after careful prior review by ) Tj ET BT 0.9863 0 0 0.9863 509.76 290.16 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 517.2 290.16 Tm /F4 10 Tf 0.0587 Tc 0 Tw (panel) Tj -204.2578 -11.9577 TD 0.0237 Tc 0.1228 Tw (that includes health care professionals, consumer) Tj ET BT 0.934 0 0 0.9835 316.56 266.4 Tm -0.032 Tc 2.0705 Tw (advocates, industry representatives, architects, de-) Tj 0.257 -12.4458 TD -0.0181 Tc 2.5824 Tw (signers, surveyors, fire marshals, building inspec-) Tj ET BT 0.8915 0 0 0.9835 316.8 242.4 Tm 0.0373 Tc 1.3489 Tw (tors, and others. The panel would have to determine) Tj ET BT 0.934 0 0 0.9835 316.8 230.16 Tm -0.0311 Tc 1.5342 Tw (whether a proposed innovation was worth evaluat-) Tj ET BT 0.8915 0 0 0.9835 316.8 218.4 Tm 0.0379 Tc 1.0984 Tw (ing and whether sufficient safeguards had been built) Tj ET BT 0.934 0 0 0.9835 316.8 206.4 Tm -0.0491 Tc 0.7077 Tw (into the proposal to protect the residents. The panel) Tj ET BT 0.9835 0 0 0.9835 317.04 194.4 Tm 0.0407 Tc 0.489 Tw (would also have to monitor the waivered innova-) Tj 0.244 -12.2018 TD 0.0353 Tc -0.1059 Tw (tions on an ongoing basis to assure the safety and) Tj 0 -12.2018 TD 0.0411 Tc 1.2643 Tw (well-being of the residents. A panel of this kind) Tj -0.244 -12.2018 TD 0.037 Tc 1.9802 Tw (probably would function most effectively at the) Tj 0.4881 -12.2018 TD 0.0332 Tc 2.4721 Tw (State level, but the Federal Government could) Tj ET BT 0.934 0 0 0.9835 317.52 134.4 Tm -0.0304 Tc 1.6191 Tw (encourage the development of such panels through) Tj ET BT 0.8915 0 0 0.9835 317.52 122.64 Tm 0.0214 Tc 2.309 Tw (demonstration grants.) Tj ET BT 0.9835 0 0 0.9835 328.32 102.96 Tm 0.0399 Tc 0.0714 Tw (At present, State efforts with respect to special) Tj ET BT 0.8915 0 0 0.9835 317.76 90.72 Tm 0.0476 Tc 1.472 Tw (care units are focused primarily on the development) Tj -265.4256 -22.2072 TD 0.0897 Tc -0.1904 Tw (14 ) Tj ET q 28.56 0 0 -7.2 93.6 72.24 cm BI /W 175 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?C?|~??>?>8>?><~y?@??????????>???>x<?x|>|???<>>>??? 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EI Q BT 0.5519 0 0 0.9835 223.2 68.88 Tm 3 Tr 0.1183 Tc 0 Tw (to) Tj 0 Tr ET BT 0.8915 0 0 0.9835 228.24 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 15.36 0 0 -5.76 230.64 74.4 cm BI /W 95 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8?~~?~~ x~|>>?>?|~~~8?~|?~|?~~?>>?<|>@8`<~~<8 EI Q BT 0.5519 0 0 0.9835 230.64 68.88 Tm 3 Tr 0.0758 Tc 0 Tw (assist) Tj 0 Tr ET BT 0.8915 0 0 0.9835 246 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 21.6 0 0 -7.2 248.4 74.4 cm BI /W 133 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x????~?~>~||?|?|~|||||||||||G|??<???x88pp EI Q BT 0.6793 0 0 0.9835 248.4 68.88 Tm 3 Tr -0.0595 Tc 0 Tw (n~sing) Tj 0 Tr ET BT 0.8915 0 0 0.9835 270 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 18.48 0 0 -5.52 272.4 74.16 cm BI /W 114 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ????>>>>>>>>>>>>>>>?>?>?>?>???x???<~?~??????>? EI Q BT 0.5944 0 0 0.9835 272.4 68.88 Tm 3 Tr -0.115 Tc 0 Tw (homes) Tj 0 Tr ET BT 0.8915 0 0 0.9835 290.88 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 5.04 0 0 -5.52 293.28 72.96 cm BI /W 33 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?~?~?~?~?|?~?~?|?|?|?|?|?|??? EI Q BT 0.5094 0 0 0.9835 293.28 68.88 Tm 3 Tr 0.0781 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8915 0 0 0.9835 298.32 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 28.08 0 0 -7.2 300.72 74.4 cm BI /W 171 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? x ?????~?~??|??|???????>>~>~||||?||><~|??>~<??x>?x?=y` EI Q BT 0.8915 0 0 0.9835 300.72 68.88 Tm 3 Tr -0.0417 Tc 0 Tw (&Si@g) Tj 0 Tr 31.4957 0 TD 0 Tc -0.0897 Tw ( ) Tj ET q 2.88 0 0 -4.08 331.2 72.96 cm BI /W 19 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x|>?8?|||>??~ EI Q BT 0.467 0 0 0.9835 331.2 68.88 Tm 3 Tr 0.0897 Tc 0 Tw (a) Tj 0 Tr ET BT 0.8915 0 0 0.9835 334.08 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 19.68 0 0 -7.2 336.48 74.4 cm BI /W 121 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID =~?|<~~p>~x~|`~8~~`~߀~~~|}||||||?~|~|~~||?~||x~||8?|<<|>|?||? ||||||~~<8 EI Q BT 0.5944 0 0 0.9835 336.48 68.88 Tm 3 Tr -0.0276 Tc 0 Tw (special) Tj 0 Tr ET BT 0.8915 0 0 0.9835 356.16 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 11.76 0 0 -4.08 358.56 72.96 cm BI /W 73 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??Ϗ>>ρ>ǁ>>>>>>>>|>?|?>x>>?0 EI Q BT 0.5094 0 0 0.9835 358.56 68.88 Tm 3 Tr -0.0231 Tc 0 Tw (Care) Tj 0 Tr ET BT 0.8915 0 0 0.9835 370.32 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 11.04 0 0 -5.76 372.72 74.64 cm BI /W 69 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~~~|~|~|~>>>?~?~????px0 EI Q BT 0.9835 0 0 0.9835 372.72 68.88 Tm 3 Tr 0.0152 Tc 0 Tw (tit) Tj 0 Tr ET BT 0.8915 0 0 0.9835 383.76 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 8.4 0 0 -4.08 386.16 72.96 cm BI /W 53 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??x|8|<>?8|~ǃ>>??c EI Q BT 0.5094 0 0 0.9835 386.16 68.88 Tm 3 Tr 0.0219 Tc 0 Tw (are) Tj 0 Tr ET BT 0.8915 0 0 0.9835 394.56 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 8.4 0 0 -5.76 396.96 74.64 cm BI /W 52 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x????~>>?>>?>>>p>>>>>~>~|>>~>>?>>?>>?>>>~?~?8>` EI Q BT 0.6793 0 0 0.9835 396.96 68.88 Tm 3 Tr -0.0115 Tc 0 Tw (tie) Tj 0 Tr ET BT 0.8915 0 0 0.9835 405.36 68.88 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 28.8 0 0 -5.76 407.76 74.64 cm BI /W 176 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8???>????x|??8||??8|~#??~??|?|}?|?<??<???>~??>p~?>px~>?x<??|@~xx0 EI Q BT 0.6368 0 0 0.9835 407.76 68.88 Tm 3 Tr 0.0013 Tc 0 Tw (American) Tj 0 Tr ET BT 0.8915 0 0 0.9835 436.56 68.88 Tm 0.0319 Tc 0.0091 Tw ( Association Of Homes ) Tj ET q 8.4 0 0 -5.76 532.8 74.64 cm BI /W 52 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID σ?~~|||~??Àǀ> EI Q BT 0.5094 0 0 0.9835 532.8 68.88 Tm 3 Tr -0.0045 Tc 0 Tw (fOr) Tj 0 Tr ET BT 0.7642 0 0 0.9835 66.72 57.6 Tm -0.0336 Tc 1.8161 Tw (the Aging\222s \223Best Practices\224 document \(10\); the) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 36.96 0 0 -5.52 243.36 63.12 cm BI /W 253 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8x?>`~?ߟ>~??<>8~~>8?p> >0?>0>>>>??>~|>>~>~>>?>>χx>?x>?~x>? ?>|>>p?><>>~~>~>||?>???? ??x?8 EI Q BT 0.5094 0 0 0.9835 243.36 57.6 Tm 3 Tr 0.0167 Tc 0 Tw (Massachusetts) Tj 0 Tr ET BT 0.798 0 0 0.9835 280.32 57.6 Tm /F2 10 Tf 0 Tc -0.0951 Tw ( ) Tj ET q 31.68 0 0 -5.52 282.24 63.12 cm BI /W 217 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  w??>??>~|>||>>||?>||>||>||>||>||?>|x~>?|x|~??~x<~??>x?<~?9???????<>x>x>|>?~?~ EI Q BT 0.6572 0 0 0.9835 282.24 57.6 Tm 3 Tr 0.0227 Tc 0 Tw (Akheimer\222s) Tj 0 Tr ET BT 0.798 0 0 0.9835 313.92 57.6 Tm 0.0303 Tc -0.0202 Tw ( Disease Research Center\222s \223Blueprint\224 document \(287\); the University) Tj -309.777 -9.2734 TD 0.0301 Tc 1.747 Tw (of Wisconsin-Milwaukee\222s Center for Architecture and Urban Planning Research\222s) Tj ET BT 0.8919 0 0 0.9835 350.64 48.96 Tm 0.0569 Tc -0.009 Tw (\223Design Guide\224 ) Tj ET BT 0.8858 0 0 0.99 411.12 48.96 Tm /F5 8 Tf 0.053 Tc -0.1632 Tw (\(95\); ) Tj ET BT 0.8919 0 0 0.9835 427.68 48.96 Tm /F2 10 Tf 0.0836 Tc -0.1734 Tw (and the ) Tj ET q 36.24 0 0 -5.76 456.24 54.48 cm BI /W 219 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??????σ~~~>y~~>y~~~9?~~ >>>>>>>>>>?>>?~>>p?x?>x~????x EI Q BT 0.7041 0 0 0.9835 456.24 48.96 Tm 3 Tr -0.0036 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.8919 0 0 0.9835 492.48 48.96 Tm -0.0091 Tc 1.0068 Tw ( Association\222s) Tj ET BT 0.798 0 0 0.9835 67.2 39.36 Tm 0.0165 Tc 1.9895 Tw (\223Guidelines for Dignity,\222) Tj 108.8731 0.4881 TD 0.0309 Tc -0.0285 Tw (released in July 1992. The forthcoming VA guidelines for special care units in VA medical centers will also be useful for) Tj -109.7754 -9.2734 TD 0.031 Tc -0.0437 Tw (nursing homes that are trying to establish a special care unit.) Tj ET endstream endobj 156 0 obj <>/Rotate 0/Type/Page>> endobj 157 0 obj <>stream 0.48 w 1 j 0 0 0 RG 72.24 683.28 m 550.56 683.28 l S 74.88 88.32 m 553.44 88.32 l S BT 0.9835 0 0 0.9835 72.24 690 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (42 ) Tj ET BT 0.9598 0 0 0.9598 84.72 690 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 90.96 690 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 144.72 690 Tm /F5 11 Tf 0.0681 Tc -0.1305 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 243.12 690 Tm /F5 10 Tf 0.0229 Tc 0.0784 Tw (Alzheimer\222s and Other Dementias) Tj -173.2653 -40.5099 TD /F4 10 Tf 0.0274 Tc 2.356 Tw (of special regulations. To OTA\222s knowledge, no) Tj ET BT 0.934 0 0 0.9835 73.2 637.92 Tm -0.0187 Tc 0.5788 Tw (State has created ) Tj ET BT 0.9606 0 0 0.9863 153.36 637.92 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 160.56 637.92 Tm /F4 10 Tf -0.0352 Tc 1.7956 Tw (process for waiving regulations) Tj ET BT 0.8915 0 0 0.9835 73.2 625.68 Tm 0.0442 Tc 0.601 Tw (that interfere with innovation in special care units. A) Tj ET BT 0.934 0 0 0.9835 73.2 613.92 Tm -0.0231 Tc 1.7215 Tw (few States have provided grants to nursing homes) Tj ET BT 0.8915 0 0 0.9835 73.44 601.68 Tm 0.0453 Tc 0.566 Tw (and other facilities to create model special care units.) Tj ET BT 0.9835 0 0 0.9835 73.44 589.44 Tm 0.0404 Tc 1.7056 Tw (In at least one of these States, the State\222s own) Tj ET BT 0.8915 0 0 0.9835 73.2 577.2 Tm 0.0294 Tc 1.3241 Tw (regulations made it difficult for some of the facilities) Tj ET BT 0.934 0 0 0.9835 73.44 565.2 Tm -0.0319 Tc 1.4372 Tw (that received the grants to implement the features) Tj ET BT 0.9835 0 0 0.9835 73.44 552.96 Tm 0.0414 Tc 1.0322 Tw (they considered appropriate for individuals with) Tj ET BT 0.8915 0 0 0.9835 73.44 540.72 Tm 0.0117 Tc 0.873 Tw (dementia, thus defeating the purpose of the grants. If) Tj ET BT 0.934 0 0 0.9835 73.92 528.72 Tm -0.0379 Tc 0.9848 Tw (special care units are to fulfill the societal objective) Tj ET BT 0.9835 0 0 0.9835 73.92 516.72 Tm 0.0417 Tc 1.0458 Tw (of developing better methods of care for nursing) Tj ET BT 0.934 0 0 0.9835 73.44 504.72 Tm -0.0413 Tc 0.8599 Tw (home residents with dementia, policies to allow and) Tj 0.5139 -12.4458 TD -0.0179 Tc 0.5779 Tw (encourage innovation must receive at least as much) Tj ET BT 0.9835 0 0 0.9835 74.16 480.24 Tm 0.0357 Tc 0.7032 Tw (attention as methods to regulate and control the) Tj ET BT 0.8491 0 0 0.9835 73.92 468 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.9835 0 0 0.9835 85.2 441.12 Tm 0.0379 Tc 1.3982 Tw (In addition to a waiver process, several other) Tj -11.2256 -12.2018 TD 0.0362 Tc 2.7131 Tw (methods to allow and encourage innovation in) Tj ET BT 0.934 0 0 0.9835 74.88 416.88 Tm -0.028 Tc 1.1669 Tw (special care units are discussed in chapter 6. Some) Tj ET BT 0.9835 0 0 0.9835 74.4 404.64 Tm 0.0326 Tc 1.2991 Tw (of the methods pertain primarily to special care) Tj -0.244 -11.9577 TD 0.0143 Tc 0.9052 Tw (units, e.g., providing training materials and pro-) Tj ET BT 0.934 0 0 0.9835 74.64 380.88 Tm -0.0197 Tc 1.8647 Tw (grams to inform surveyors and others about prob-) Tj ET BT 0.9835 0 0 0.9835 74.4 368.88 Tm 0.0226 Tc 1.161 Tw (lems in the care of nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 74.64 356.64 Tm 0.0391 Tc 1.1226 Tw (dementia and the importance of developing alternate) Tj 0.2692 -12.2018 TD 0.0415 Tc 0.3349 Tw (approaches to their care. Other methods pertain to all) Tj ET BT 0.934 0 0 0.9835 74.4 332.4 Tm -0.0458 Tc 1.8925 Tw (residential facilities for older people, e.g., simplify-) Tj ET BT 0.8915 0 0 0.9835 74.64 320.16 Tm 0.0476 Tc 1.2701 Tw (ing the process for obtainin) Tj 133.5204 -0.9761 TD 0.0348 Tc 1.4864 Tw (g approval of new design) Tj -133.2512 -11.7137 TD 0.0418 Tc 1.7926 Tw (or other features, eliminating conflicts and inconsis-) Tj 0 -11.9577 TD 0.0441 Tc 1.2068 Tw (tencies in the requirements of different agencies and) Tj ET BT 0.934 0 0 0.9835 74.64 283.92 Tm -0.0208 Tc 1.3519 Tw (regulatory codes, and including in any new regula-) Tj ET BT 0.9835 0 0 0.9835 74.88 271.92 Tm 0.0407 Tc 0.197 Tw (tions an explicit statement of the purpose of each) Tj ET BT 0.934 0 0 0.9835 74.64 259.92 Tm -0.0285 Tc 2.0025 Tw (requirement; such a statement would provide gov-) Tj 0.257 -12.4458 TD -0.0177 Tc 1.7157 Tw (ernment officials with a basis for allowing innova-) Tj ET BT 0.9835 0 0 0.9835 74.88 235.68 Tm 0.0365 Tc 2.2755 Tw (tions that meet the purpose, if not the precise) Tj ET BT 0.8915 0 0 0.9835 75.36 223.92 Tm 0.0276 Tc 1.9431 Tw (stipulations, of the requirement.) Tj ET BT 0.934 0 0 0.9835 86.16 197.04 Tm -0.0347 Tc 0.7672 Tw (Fire safety regulations and interpretations of fire) Tj ET BT 0.8915 0 0 0.9835 75.6 184.8 Tm 0.0334 Tc 1.387 Tw (safety regulations are often cited as limiting the use) Tj -0.2692 -12.2018 TD 0.0468 Tc 1.2038 Tw (of innovative physical design features in special care) Tj ET BT 0.9835 0 0 0.9835 74.88 160.56 Tm 0.0235 Tc -0.1211 Tw (units. A conference or invitational meeting jointly) Tj 0.7321 -12.4458 TD 0.0329 Tc 3.4811 Tw (sponsored by the Alzheimer\222s Association, the) Tj ET BT 0.934 0 0 0.9835 75.12 136.32 Tm -0.0328 Tc 1.9215 Tw (National Fire Protection Association, and the Fed-) Tj ET BT 0.9835 0 0 0.9835 75.36 124.08 Tm 0.036 Tc -0.0727 Tw (eral Government would be a valuable first step in) Tj 0 -12.2018 TD 0.039 Tc 0.4001 Tw (delineating this problem and identifying possible) Tj ET BT 0.8915 0 0 0.9835 75.6 100.08 Tm 0.0209 Tc 0 Tw (solutions.) Tj ET BT 0.9795 0 0 0.9795 348 653.04 Tm /F7 12 Tf 0.0357 Tc 0.8826 Tw (Implications for Reimbursement for) Tj ET BT 0.9195 0 0 0.9835 390.48 639.6 Tm /F8 10 Tf 0.0005 Tc -0 Tw (Special ) Tj ET BT 0.8875 0 0 0.9795 434.64 639.6 Tm /F7 12 Tf -0.0154 Tc 1.0718 Tw (Care Units) Tj ET BT 0.934 0 0 0.9835 334.8 618.48 Tm /F4 10 Tf -0.0414 Tc 1.4168 Tw (Although most special care unit operators report) Tj ET BT 0.8915 0 0 0.9835 324.24 606.72 Tm 0.0444 Tc 0.5334 Tw (that it costs more to create and operate a special care) Tj ET BT 0.934 0 0 0.9835 324 594.72 Tm -0.0112 Tc 0.4239 Tw (unit than a nonspecialized nursing home unit, some) Tj ET BT 0.8915 0 0 0.9835 324.72 582.48 Tm 0.0493 Tc 0.6241 Tw (special care unit operators disagree. As noted earlier,) Tj ET BT 0.934 0 0 0.9835 324.48 570.48 Tm -0.0509 Tc 0.9024 Tw (the cost of new construction or remodeling to create) Tj 0.257 -11.9577 TD -0.0287 Tc 0.6216 Tw (a special care unit varies greatly for different units.) Tj 0 -12.2018 TD -0.019 Tc 0.5791 Tw (Ongoing operating costs also vary. This variation in) Tj 0 -11.9577 TD -0.0351 Tc 2.1809 Tw (costs provides little justification for an across-the-) Tj ET BT 0.9835 0 0 0.9835 324.72 522.72 Tm 0.0232 Tc 0.5138 Tw (board increase in government reimbursement for) Tj ET BT 0.8915 0 0 0.9835 324.72 511.2 Tm 0.061 Tc 1.1205 Tw (care in special care units.) Tj ET BT 0.9835 0 0 0.9835 335.52 490.56 Tm 0.0286 Tc 1.521 Tw (Ninety percent of government-funded nursing) Tj -10.9816 -11.9577 TD 0.0455 Tc -0.0214 Tw (home care is paid for by Medicaid \(250\). Medicaid) Tj 0 -12.4458 TD 0.0139 Tc 1.963 Tw (reimbursement for nursing home care varies in) Tj ET BT 0.8915 0 0 0.9835 324.96 454.56 Tm 0.0118 Tc 0.3816 Tw (different States. It is low in many States and very low) Tj ET BT 0.934 0 0 0.9835 325.44 442.8 Tm -0.0129 Tc 0.9397 Tw (in some States. High-quality nursing home care for) Tj ET BT 0.8915 0 0 0.9835 325.44 430.56 Tm 0.0368 Tc 1.9328 Tw (individuals with dementia probably costs more than) Tj -0.2692 -11.7137 TD 0.0244 Tc 1.3442 Tw (Medicaid pays in these States, regardless of whether) Tj ET BT 0.9835 0 0 0.9835 325.44 406.56 Tm 0.0345 Tc 1.8444 Tw (the care is provided in a special care unit or a) Tj ET BT 0.8915 0 0 0.9835 325.44 394.8 Tm 0.05 Tc 1.7386 Tw (nonspecialized unit. High-quality nursing home care) Tj ET BT 0.934 0 0 0.9835 325.44 383.04 Tm -0.0369 Tc 2.3969 Tw (for individuals with other diseases and conditions) Tj ET BT 0.9835 0 0 0.9835 325.2 371.04 Tm 0.0358 Tc 1.4701 Tw (probably also costs more than Medicaid pays in) Tj ET BT 0.934 0 0 0.9835 325.68 358.56 Tm -0.0177 Tc 1.263 Tw (these States. To improve quality of care, it may be) Tj -0.257 -11.7137 TD -0.0349 Tc 2.3949 Tw (necessary to increase Medicaid reimbursement for) Tj ET BT 0.8915 0 0 0.9835 325.92 334.56 Tm 0.0383 Tc 1.0937 Tw (all nursing home care in these States. In the context) Tj -0.2692 -12.4458 TD 0.0375 Tc 1.1132 Tw (of this OTA report, however, the question is whether) Tj -0.2692 -11.9577 TD 0.0486 Tc 1.6862 Tw (reimbursement should be increased differentially for) Tj ET BT 0.934 0 0 0.9835 326.16 298.56 Tm -0.0284 Tc 1.617 Tw (special care units.) Tj ET BT 0.9557 0 0 1.08 406.56 303.36 Tm /F4 4 Tf 0.1614 Tc 0 Tw (15) Tj ET BT 0.9835 0 0 0.9835 336.72 278.4 Tm /F4 10 Tf 0.0354 Tc 0.076 Tw (The results of two studies cited earlier indicate) Tj ET BT 0.8915 0 0 0.9835 325.92 266.4 Tm 0.0341 Tc 0.4777 Tw (that average staff time and therefore the average cost) Tj ET BT 0.9835 0 0 0.9835 326.16 254.64 Tm 0.0308 Tc 1.5188 Tw (of care is higher for residents with dementia in) Tj 0 -12.4458 TD 0.0243 Tc 0.4882 Tw (special care units than in nonspecialized nursing) Tj ET BT 0.934 0 0 0.9835 325.92 230.88 Tm -0.0009 Tc 0.8901 Tw (home units \(143,413\). If future studies confirm this) Tj ET BT 0.8915 0 0 0.9835 326.16 218.88 Tm 0.0461 Tc 1.1148 Tw (finding, one could argue that government reimburse-) Tj ET BT 0.934 0 0 0.9835 326.16 207.12 Tm -0.0352 Tc 1.9914 Tw (ment should be increased differentially for care in) Tj 0.5139 -12.2018 TD -0.0289 Tc 0.6753 Tw (special care units. If the higher average cost of care) Tj ET BT 0.9835 0 0 0.9835 326.4 183.36 Tm 0.0298 Tc 0.4216 Tw (in special care units is not associated with better) Tj ET BT 0.934 0 0 0.9835 325.92 171.36 Tm -0.0348 Tc 1.3668 Tw (resident outcomes, however, increasing government) Tj 0 -12.2018 TD -0.0346 Tc 1.6879 Tw (reimbursement will raise government expenditures) Tj ET BT 0.8915 0 0 0.9835 326.64 147.12 Tm 0.0465 Tc 1.3835 Tw (and create financial incentives for the establishment) Tj ET BT 0.9835 0 0 0.9835 326.4 135.12 Tm 0.0263 Tc 3.0486 Tw (of more special care units without necessarily) Tj 0 -11.9577 TD 0.0281 Tc 0.5251 Tw (improving the care available for individuals with) Tj T* 0.0388 Tc 0.7175 Tw (dementia----dearly not a desirable result. On the) Tj 0 -12.4458 TD 0.0297 Tc 1.1471 Tw (other hand, if the higher average cost of care in) Tj ET q 4.08 0 0 -4.32 89.52 81.84 cm BI /W 29 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID }?>>>><<>|> EI Q BT 0.3755 0 0 0.9835 89.52 77.52 Tm 3 Tr /F2 10 Tf 0.1101 Tc 0 Tw (15) Tj 0 Tr ET BT 0.8066 0 0 0.9835 93.6 77.52 Tm /F4 10 Tf 0 Tc -0.1039 Tw ( ) Tj ET q 83.28 0 0 -7.2 95.76 83.04 cm BI /W 543 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0x??|?|??>>???????<???~x~??~~~8~|8?>?>|~~8|0?||?>?>|||||?>??|C||~?>>?|||>??|>>?|||>?>?>?|||>?>?~8||>??>>||x|?|~??>||||?|~? ~?|~|?||>||p?????<~<||<p??x????>~<>>?x~x????~?8~??|~????<??~?>8???  <|<>????x?x8x~88À|珀|???>x 0 EI Q BT 0.6368 0 0 0.9835 95.76 77.52 Tm 3 Tr -0.0501 Tc 0 Tw (Arelat~but~erentquestiOn) Tj 0 Tr ET BT 0.8066 0 0 0.9835 179.04 77.52 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 3.84 0 0 -5.76 181.2 83.04 cm BI /W 26 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |?????????????>>< EI Q BT 0.467 0 0 0.9835 181.2 77.52 Tm 3 Tr -0.038 Tc 0 Tw (is) Tj 0 Tr ET BT 0.8066 0 0 0.9835 185.04 77.52 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 55.2 0 0 -7.2 187.2 83.04 cm BI /W 360 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|@ x9?8?<???x<?????||?|~~??p?>|<|???0>|>>>>|>?>>|ǀ|>?>>|ǀ<>?>>|ǀ>??>|?>|>>p>|>~?8>|?>||>8?x?~?~<?>~`>|>|>| >|> EI Q BT 0.5519 0 0 0.9835 187.2 77.52 Tm 3 Tr 0.0213 Tc 0 Tw (whethergovernment) Tj 0 Tr ET BT 0.8066 0 0 0.9835 242.4 77.52 Tm 0.0653 Tc 0.2614 Tw ( reimbursement ) Tj ET BT 0.798 0 0 0.9835 306.48 77.52 Tm /F2 10 Tf 0.0382 Tc 1.3608 Tw (should be increased differentially for nursing home residents) Tj 0 Tc -0.0951 Tw ( ) Tj ET q 12.24 0 0 -5.76 513.12 84 cm BI /W 80 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<`?p??pxx8<<?>x8? EI Q BT 0.798 0 0 0.9835 513.12 77.52 Tm 3 Tr -0.0571 Tc 0 Tw (witi) Tj 0 Tr 15.3385 0 TD 0 Tc -0.0951 Tw ( ) Tj ET q 24.72 0 0 -5.76 527.28 83.04 cm BI /W 162 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <8????|??~>~?>?>π?|~π??~π??x?`~|?~|?><?~>~???|???>@|< EI Q BT 0.7041 0 0 0.9835 527.28 77.52 Tm 3 Tr 0.0434 Tc 0 Tw (dementk) Tj 0 Tr ET BT 0.798 0 0 0.9835 75.12 67.68 Tm 0.0112 Tc -0.1091 Tw (vs. ) Tj ET q 35.04 0 0 -5.76 86.16 73.2 cm BI /W 239 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |p;@??????~~?~?|?p~|>0~|~0~~?>~><>><>>|?c>>|?>|?>|>|?>?x>?x~x~?|~????|80 ||||0 EI Q BT 0.6102 0 0 0.9835 86.16 67.68 Tm 3 Tr 0.0339 Tc 0 Tw (nondemented) Tj 0 Tr ET BT 0.798 0 0 0.9835 121.2 67.68 Tm 0.0365 Tc 0.0554 Tw ( residents in any nursing home unit. Two studies have found that certain types of residents with dementia \(i.e., those who do not have) Tj ET BT 0.7511 0 0 0.9835 75.36 58.56 Tm 0.0243 Tc 1.3703 Tw (severe impairments in activities of daily living or extensive medical care needs\) use more staff time and therefore more of a nursing home\222s resources) Tj ET BT 0.8449 0 0 0.9835 75.36 49.68 Tm 0.0944 Tc -0.0572 Tw (than ) Tj ET q 37.44 0 0 -5.76 92.16 55.2 cm BI /W 239 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8p8????~~~>|~>|p>?|?0>>|>>>|>>?|>>>|<>>|>>|?>|?>||>~|>~?<~?|~??????py||||xp` EI Q BT 0.6572 0 0 0.9835 92.16 49.68 Tm 3 Tr 0.0446 Tc 0 Tw (nondemented) Tj 0 Tr ET BT 0.8449 0 0 0.9835 129.6 49.68 Tm 0.0749 Tc 0.029 Tw ( residents who have the same impairments and medical care needs \(16,144\). Given these findings, it would be ) Tj ET q 29.52 0 0 -5.76 510.96 55.2 cm BI /W 188 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `!|x;????|???|~?~?~p?|?p߃?|??|>??~>?~>?|? >|?Á>|?~8|?~x8|?~?|?x~?|????|?|?|<|?|? ~?~?~?|? EI Q BT 0.7041 0 0 0.9835 510.96 49.68 Tm 3 Tr 0.0128 Tc 0 Tw (reasomble) Tj 0 Tr ET BT 0.8449 0 0 0.9835 540.48 49.68 Tm 0.087 Tc -0.0485 Tw ( for) Tj ET BT 0.798 0 0 0.9835 75.12 40.8 Tm 0.0297 Tc -0.1322 Tw (government to differentially increase reimbursement for these types of residents with dementia.) Tj ET endstream endobj 158 0 obj <>/Rotate 0/Type/Page>> endobj 159 0 obj <>stream 0.72 w 1 j 0 0 0 RG 58.8 676.8 m 537.12 676.8 l S BT 0.9835 0 0 0.9835 326.16 682.08 Tm 0 0 0 rg /F5 10 Tf 0.0152 Tc 1.8758 Tw (Chapter 1--Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 518.88 682.08 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 525.36 682.08 Tm /F5 10 Tf 0.366 Tc 0 Tw (43) Tj ET BT 0.8915 0 0 0.9835 59.52 643.2 Tm /F4 10 Tf 0.0388 Tc 1.3665 Tw (special care units is associated with better outcomes) Tj ET BT 0.934 0 0 0.9835 59.28 631.2 Tm -0.0325 Tc 1.1503 Tw (for individuals with dementia, policymakers will be) Tj ET BT 0.9835 0 0 0.9835 59.28 619.68 Tm 0.0339 Tc 2.6573 Tw (faced with a difficult question of values, since) Tj ET BT 0.934 0 0 0.9835 59.52 607.44 Tm -0.0261 Tc 1.666 Tw (increasing government reimbursement for the care) Tj 0.257 -12.4458 TD -0.0392 Tc 1.029 Tw (of demented and nondemented residents in nonspe-) Tj ET BT 0.9835 0 0 0.9835 59.76 583.2 Tm 0.0426 Tc 0.2662 Tw (cialized units would probably produce better out-) Tj ET BT 0.934 0 0 0.9835 59.76 571.2 Tm -0.0353 Tc 1.4189 Tw (comes for those individuals as well.) Tj ET BT 0.8915 0 0 0.9835 70.8 553.44 Tm 0.0454 Tc 1.2053 Tw (In the past, reimbursement for nursing home care) Tj -12.1137 -11.9577 TD 0.0225 Tc 1.3992 Tw (inmost State Medicaid programs was based on a flat) Tj -0.2692 -11.9577 TD 0.0233 Tc 0.4824 Tw (rate system that paid nursing homes at the same rate) Tj 0.2692 -12.2018 TD 0.0427 Tc 2.0159 Tw (for each of their Medicaid-eligible residents, regard-) Tj ET BT 0.934 0 0 0.9835 60.24 505.92 Tm -0.0486 Tc 0.7393 Tw (less of differences in the resources required for each) Tj 0.257 -12.2018 TD -0.0065 Tc 0.6942 Tw (individual\222s care. As of 1990, 19 State had switched) Tj ET BT 0.9835 0 0 0.9835 60.48 481.92 Tm 0.036 Tc 3.2478 Tw (to case-mix systems to determine the level of) Tj -0.244 -12.2018 TD 0.0219 Tc 1.8328 Tw (Medicaid reimbursement for nursing home care) Tj 0.7321 -12.4458 TD 0.0297 Tc -0.0227 Tw (\(51\). Case-mix systems are intended to match the) Tj -0.244 -12.2018 TD 0.0353 Tc -0.0924 Tw (level of reimbursement for individual residents to) Tj ET BT 0.8915 0 0 0.9835 60.72 433.44 Tm 0.0509 Tc 0.3318 Tw (the resources used and therefore the cost of their care) Tj ET BT 0.9835 0 0 0.9835 61.2 421.68 Tm 0.0224 Tc 1.751 Tw (\(142\). To implement an increase in government) Tj ET BT 0.934 0 0 0.9835 60.48 410.16 Tm -0.0282 Tc 1.0661 Tw (reimbursement for care in special care units proba-) Tj ET BT 0.9835 0 0 0.9835 60.72 397.92 Tm 0.0214 Tc 1.752 Tw (bly would involve more complex mechanisms in) Tj 0.4881 -11.7137 TD 0.0171 Tc 0.6176 Tw (States with case-mix vs. flat rate reimbursement) Tj ET BT 0.8915 0 0 0.9835 61.44 374.4 Tm 0.0334 Tc 1.3341 Tw (systems. Such an increase is not indicated, however,) Tj ET BT 0.9835 0 0 0.9835 61.2 362.64 Tm 0.0314 Tc 0.9996 Tw (unless and until there is better evidence than is) Tj ET BT 0.934 0 0 0.9835 61.2 350.64 Tm -0.024 Tc 1.6551 Tw (currently available that special care units improve) Tj 0 -11.9577 TD -0.0443 Tc 2.1479 Tw (resident outcomes.) Tj ET BT 0.9939 0 0 0.9939 63.36 312.96 Tm /F6 14 Tf 0.0371 Tc 0.4457 Tw (LEGAL AND ETHICAL ISSUES IN) Tj ET BT 0.9663 0 0 0.9939 100.32 296.4 Tm 0.0382 Tc 1.6745 Tw (SPECIAL CARE UNITS) Tj ET BT 0.934 0 0 0.9835 72.72 278.88 Tm /F4 10 Tf -0.0342 Tc 2.2656 Tw (Because of the cognitive impairments of special) Tj -11.563 -12.2018 TD -0.0297 Tc 0.7007 Tw (care unit residents, difficult legal and ethical issues) Tj 0 -12.4458 TD -0.0287 Tc 0.7501 Tw (arise in connection with many aspects of their care.) Tj ET BT 0.8915 0 0 0.9835 61.92 243.12 Tm 0.0472 Tc 0.7248 Tw (These issues are not unique to special care units, but) Tj ET BT 0.9835 0 0 0.9835 61.92 230.88 Tm 0.0338 Tc 1.9123 Tw (they tend to be magnified in special care units) Tj 0 -12.2018 TD 0.0351 Tc 1.372 Tw (because of the concentration of individuals with) Tj ET BT 0.8915 0 0 0.9835 62.16 207.12 Tm 0.0412 Tc 0.4922 Tw (dementia and the likelihood that they are in the later) Tj ET BT 0.9835 0 0 0.9835 62.64 194.88 Tm 0.0372 Tc 2.5146 Tw (stages of their illness and at least moderately) Tj ET BT 0.934 0 0 0.9835 62.16 182.64 Tm -0.0359 Tc 3.4237 Tw (cognitively impaired.) Tj ET BT 0.8915 0 0 0.9835 73.2 164.88 Tm 0.0334 Tc 0.6205 Tw (Many of the difficult legal and ethical issues in the) Tj ET BT 0.9835 0 0 0.9835 62.4 152.64 Tm 0.0387 Tc 0.1076 Tw (care of individuals with dementia have been ana-) Tj 0.244 -11.9577 TD 0.0352 Tc 2.5514 Tw (lyzed at length in three previous OTA reports) Tj 0.244 -12.2018 TD 0.0368 Tc 0.3535 Tw (\(457,458,459\) and in a supplement to ) Tj 178.6341 0 TD /F5 10 Tf 0.0206 Tc 0.8941 Tw (The Milbank) Tj ET BT 0.9443 0 0 0.9812 62.64 116.64 Tm /F5 11 Tf 0.0059 Tc 0.038 Tw (Quarterly ) Tj ET BT 0.934 0 0 0.9835 107.52 116.64 Tm /F4 10 Tf -0.0121 Tc 1.394 Tw (based on OTA contract documents \(496\).) Tj -48.0507 -11.9577 TD -0.0473 Tc 1.3803 Tw (These issues are: criteria and procedures for deter-) Tj ET BT 0.9835 0 0 0.9835 62.4 92.88 Tm 0.0102 Tc 1.7227 Tw (mining an individual\222s decisionmaking capacity;) Tj 0 -11.9577 TD 0.0195 Tc 2.3844 Tw (methods of enhancing decisionmaking capacity;) Tj ET BT 0.8915 0 0 0.9835 62.64 68.88 Tm 0.0463 Tc 2.7522 Tw (competency determinations; criteria and procedures) Tj ET BT 0.9835 0 0 0.9835 62.4 57.12 Tm 0.0196 Tc 0.1758 Tw (for designating a surrogate decisionmaker; rights) Tj ET BT 0.934 0 0 0.9835 62.64 45.12 Tm -0.022 Tc 0.7536 Tw (and responsibilities of family members as surrogate) Tj ET BT 0.9835 0 0 0.9835 62.64 33.12 Tm 0.0191 Tc 1.8357 Tw (decisionmakers; criteria for surrogate decisions;) Tj ET BT 0.934 0 0 0.9835 310.32 643.2 Tm -0.0211 Tc 2.3158 Tw (guardianship and conservatorship; decisions about) Tj 0 -12.2018 TD -0.0219 Tc 1.2063 Tw (financial matters, use of services, and medical care) Tj ET BT 0.9835 0 0 0.9835 310.32 619.2 Tm 0.0414 Tc 1.2165 Tw (in the end of life; advance directives; the role of) Tj ET BT 0.934 0 0 0.9835 310.56 606.72 Tm -0.0259 Tc 0.9719 Tw (ethics committees; risk taking and professional and) Tj ET BT 0.8915 0 0 0.9835 310.32 594.96 Tm 0.0444 Tc 1.3218 Tw (provider liability; and the ethical aspects of resource) Tj 0.8076 -12.4458 TD 0.0508 Tc 1.7376 Tw (allocation. Other agencies and individuals have also) Tj ET BT 0.934 0 0 0.9835 311.04 570.72 Tm -0.0221 Tc 0.6253 Tw (written extensively about many of these issues.) Tj ET BT 0.9835 0 0 0.9835 321.84 553.2 Tm 0.0261 Tc 0.7304 Tw (This section describes some of the particularly) Tj ET BT 0.934 0 0 0.9835 311.04 541.2 Tm -0.0256 Tc 0.8064 Tw (troublesome legal and ethical issues that arise with) Tj ET BT 0.9835 0 0 0.9835 310.8 529.44 Tm 0.0419 Tc 0.3788 Tw (respect to three aspects of the care of individuals) Tj 0.4881 -12.4458 TD 0.0188 Tc 0.337 Tw (with dementia in special care units: locked units,) Tj ET BT 0.934 0 0 0.9835 311.52 505.2 Tm -0.0232 Tc 1.3973 Tw (admission and discharge, and informed consent for) Tj ET BT 0.8915 0 0 0.9835 311.04 493.44 Tm 0.0401 Tc 1.1727 Tw (research participation. These issues and many of the) Tj ET BT 0.934 0 0 0.9835 311.52 481.44 Tm -0.0301 Tc 1.2334 Tw (issues noted above require further clarification and) Tj 0.257 -12.6899 TD -0.0178 Tc 0.3942 Tw (analysis as they apply to special care units.) Tj ET BT 0.9835 0 0 0.9835 322.56 450.96 Tm 0.0402 Tc 4.0106 Tw (The 1991 report of the Advisory Panel on) Tj -10.9816 -12.2018 TD 0.0311 Tc 0.766 Tw (Alzheimer\222s Disease includes a section on values) Tj 0.4881 -11.9577 TD 0.0371 Tc 0.3532 Tw (\(2\), and the panel is working on a report on legal) Tj ET BT 0.8915 0 0 0.9835 311.76 415.2 Tm 0.0305 Tc 0.9191 Tw (issues in the care of individuals with dementia \(450\).) Tj ET BT 0.934 0 0 0.9835 311.76 403.44 Tm -0.0292 Tc 1.3609 Tw (The panel\222s 1991 report discusses value differences) Tj 0.5139 -12.2018 TD -0.0163 Tc 1.861 Tw (and potential value conflicts among the four main) Tj ET BT 0.9835 0 0 0.9835 312.24 379.68 Tm 0.0324 Tc 0.5207 Tw (constituencies involved in the care of individuals) Tj ET BT 0.8915 0 0 0.9835 312.24 367.92 Tm 0.0265 Tc 1.1368 Tw (with dementia: the individuals, their families, formal) Tj ET BT 0.9835 0 0 0.9835 312.72 355.92 Tm 0.0271 Tc 2.0716 Tw (service providers, and the public. Although not) Tj ET BT 0.934 0 0 0.9835 312.48 343.92 Tm -0.0249 Tc 0.7139 Tw (focused on special care units, the panel\222s analysis of) Tj 0 -12.4458 TD -0.0346 Tc 0.8528 Tw (these value differences and potential value conflicts) Tj ET BT 0.9835 0 0 0.9835 312.72 319.92 Tm 0.0335 Tc 1.8211 Tw (is relevant to some of the most difficult ethical) Tj -0.244 -12.2018 TD 0.0148 Tc 2.5722 Tw (questions that arise in special care units, e.g.,) Tj 0.244 -11.9577 TD 0.038 Tc 1.0031 Tw (questions about whose interests should be given) Tj -0.244 -12.2018 TD 0.0307 Tc 1.057 Tw (precedence in defining the goals of care, making) Tj 0.244 -12.4458 TD 0.038 Tc -0.0951 Tw (day-to-day decisions about care, and selecting the) Tj ET BT 0.8915 0 0 0.9835 312.96 260.16 Tm 0.0484 Tc 1.2356 Tw (outcomes to be studied in special care unit research.) Tj ET BT 0.934 0 0 0.9835 312.96 248.16 Tm -0.0192 Tc 1.2033 Tw (In each of these areas, nondemented nursing home) Tj -0.257 -12.2018 TD -0.028 Tc 1.0513 Tw (residents constitute an important fifth constituency) Tj 0.5139 -11.9577 TD -0.0416 Tc 0.8602 Tw (whose interests must be considered.) Tj ET BT 0.9795 0 0 0.9795 336.24 200.4 Tm /F7 12 Tf 0.046 Tc 0.4311 Tw (Issues With Respect to Locked Units) Tj ET BT 0.9835 0 0 0.9835 324 182.16 Tm /F4 10 Tf 0.0343 Tc 0.6407 Tw (At least three-quarters of existing special care) Tj -10.9816 -11.9577 TD 0.019 Tc 2.0799 Tw (units have an alarm or locking system to keep) Tj ET BT 0.8915 0 0 0.9835 313.2 158.4 Tm 0.0392 Tc 0.6739 Tw (residents from leaving the unit unescorted or without) Tj 0.8076 -12.4458 TD 0.0237 Tc 1.1623 Tw (staff knowledge. Probably at least half of these units) Tj ET BT 0.9835 0 0 0.9835 313.68 134.64 Tm 0.033 Tc 1.473 Tw (are locked, although the exact proportion is not) Tj ET BT 0.934 0 0 0.9835 313.2 122.64 Tm -0.0155 Tc 0.5754 Tw (known and undoubtedly varies from State to State.) Tj 12.3339 -18.0586 TD -0.039 Tc 1.0288 Tw (People\222s attitudes about locked special care units) Tj -11.82 -12.4458 TD -0.0314 Tc 1.8772 Tw (differ \(20,178\). Some people regard locked) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 506.64 92.64 Tm /F3 9 Tf -0.0064 Tc 0.7513 Tw (units as) Tj -200.6186 -11.9231 TD -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 321.12 80.88 Tm /F4 10 Tf -0.0291 Tc 2.1745 Tw (way of providing greater freedom and autonomy) Tj -8.2226 -12.2018 TD -0.0327 Tc 1.2361 Tw (for individuals with dementia who otherwise might) Tj -0.257 -12.4458 TD -0.042 Tc 1.2277 Tw (be physically restrained or medicated to keep them) Tj ET BT 0.9835 0 0 0.9835 313.44 45.12 Tm 0.0237 Tc 0.3363 Tw (from wandering away from the unit. At the other) Tj ET BT 0.934 0 0 0.9835 313.44 32.88 Tm -0.0415 Tc 0.9886 Tw (extreme, some people regard locked units as a form) Tj ET endstream endobj 160 0 obj <>/Rotate 0/Type/Page>> endobj 161 0 obj <>stream 0.48 w 1 j 0 0 0 RG 72 680.88 m 550.32 680.88 l S 74.88 79.44 m 553.44 79.44 l S BT 0.9835 0 0 0.9835 72 686.88 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (44 ) Tj ET BT 0.9598 0 0 0.9598 84.96 686.88 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 91.44 686.88 Tm /F5 10 Tf 0.0125 Tc 1.0922 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -19.0348 -40.2659 TD /F4 10 Tf 0.0254 Tc 0.0723 Tw (of involuntary confinement that restricts freedom) Tj 0 -12.2018 TD 0.0296 Tc 3.3939 Tw (and autonomy and violates the civil rights of) Tj 0 -11.9577 TD 0.0396 Tc 0.4971 Tw (individuals with dementia. Some people consider) Tj ET BT 0.934 0 0 0.9835 72.96 611.28 Tm -0.0346 Tc 0.8956 Tw (locked units a necessary placement option, whereas) Tj ET BT 0.9835 0 0 0.9835 72.96 599.04 Tm 0.0234 Tc 0.1231 Tw (others consider them unnecessary and argue that) Tj ET BT 0.934 0 0 0.9835 73.2 587.28 Tm -0.0249 Tc 1.656 Tw (wandering residents can be managed effectively in) Tj ET BT 0.8915 0 0 0.9835 73.44 575.04 Tm 0.036 Tc 1.3504 Tw (an unlocked unit with an alarm system.) Tj ET BT 0.9835 0 0 0.9835 84.24 552.72 Tm 0.0331 Tc 3.2857 Tw (People distinguish in various ways between) Tj -10.9816 -12.2018 TD 0.0348 Tc -0.0279 Tw (locked units they regard as acceptable and locked) Tj 0 -11.7137 TD 0.0368 Tc 1.4923 Tw (units they regard as unacceptable. Some people) Tj ET BT 0.934 0 0 0.9835 73.2 517.2 Tm -0.0264 Tc 0.9541 Tw (regard locked units that provide adequate staff and) Tj 0.7709 -12.2018 TD -0.0291 Tc 0.6863 Tw (activities as acceptable and locked units that do not) Tj ET BT 0.9835 0 0 0.9835 73.44 493.44 Tm 0.0329 Tc 0.0647 Tw (provide these features as unacceptable. Likewise,) Tj ET BT 0.934 0 0 0.9835 74.16 481.44 Tm -0.0392 Tc 1.4817 Tw (some people regard as acceptable locked units that) Tj ET BT 0.9835 0 0 0.9835 73.92 469.68 Tm 0.0275 Tc 0.4985 Tw (have direct access to an outdoor area, such as an) Tj ET BT 0.934 0 0 0.9835 73.92 457.68 Tm -0.0435 Tc 2.0614 Tw (enclosed courtyard or garden, where residents can) Tj ET BT 0.9835 0 0 0.9835 73.92 445.68 Tm 0.0345 Tc 1.3726 Tw (wander freely \(although they are still confined\),) Tj ET BT 0.934 0 0 0.9835 74.16 433.44 Tm -0.0291 Tc 2.3029 Tw (whereas they regard as unacceptable locked units) Tj 0 -11.7137 TD -0.0175 Tc 0.6546 Tw (that do not have such an outdoor area. It is unclear) Tj ET BT 0.8915 0 0 0.9835 74.16 409.92 Tm 0.0446 Tc 1.1678 Tw (whether these differences are important from a legal) Tj ET BT 0.934 0 0 0.9835 74.16 397.92 Tm -0.0371 Tc 1.1638 Tw (or an ethical point of view.) Tj ET BT 0.9835 0 0 0.9835 85.68 375.12 Tm 0.0482 Tc 2.0501 Tw (Some people also distinguish between locked) Tj -11.7137 -11.4697 TD 0.0269 Tc -0.0974 Tw (units and units that are not locked but have some) Tj ET BT 0.934 0 0 0.9835 74.64 352.08 Tm -0.0399 Tc 1.2256 Tw (other method of keeping residents from leaving the) Tj ET BT 0.8915 0 0 0.9835 74.4 340.08 Tm 0.0283 Tc 0.7758 Tw (unit, e.g., camouflaging the exit doors or using a type) Tj ET BT 0.934 0 0 0.9835 74.88 328.08 Tm -0.0356 Tc 0.964 Tw (of doorknob that most people with dementia cannot) Tj ET BT 0.9835 0 0 0.9835 74.64 316.08 Tm 0.0312 Tc 2.7996 Tw (figure out how to open. Again, although some) Tj -0.244 -12.4458 TD 0.0347 Tc 0.8437 Tw (people regard these as distinct alternatives, it is) Tj ET BT 0.934 0 0 0.9835 74.64 291.84 Tm -0.0296 Tc 0.9208 Tw (unclear whether the distinction is important from a) Tj 0.257 -12.2018 TD -0.0357 Tc 1.1537 Tw (legal or an ethical point of view.) Tj ET BT 0.8915 0 0 0.9835 85.92 257.04 Tm 0.0351 Tc 0.6448 Tw (Units that are not locked but have another method) Tj ET BT 0.934 0 0 0.9835 74.88 244.8 Tm -0.0346 Tc 0.917 Tw (of keeping residents from leaving the unit are often) Tj -0.257 -11.7137 TD -0.062 Tc 1.396 Tw (referred to as) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 138.24 233.28 Tm /F5 11 Tf 0.0128 Tc 1.5556 Tw (secure, secured, protected,) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 257.52 233.28 Tm /F4 10 Tf -0.0976 Tc 0.1494 Tw (or ) Tj ET BT 0.9443 0 0 0.9812 269.28 233.28 Tm /F5 11 Tf 0.2155 Tc 0 Tw (protec-) Tj -205.6106 -12.4742 TD -0.0338 Tc 0.08 Tw (tive ) Tj ET BT 0.934 0 0 0.9835 93.12 221.04 Tm /F4 10 Tf -0.0138 Tc 0.3166 Tw (units. These ) Tj ET BT 0.9606 0 0 0.9863 150 221.04 Tm /F3 9 Tf -0.0074 Tc 0.0029 Tw (terms are also ) Tj ET BT 0.934 0 0 0.9835 211.2 221.04 Tm /F4 10 Tf -0.0222 Tc 3.1521 Tw (used\227sometimes as) Tj ET BT 0.9835 0 0 0.9835 75.12 208.8 Tm 0.0229 Tc 2.442 Tw (euphemisms-for the term) Tj 0 Tc -0.0972 Tw ( ) Tj 127.8747 0 TD /F5 10 Tf -0.0091 Tc -0.0518 Tw (locked. ) Tj 32.9448 0 TD /F4 10 Tf -0.003 Tc 4.0545 Tw (This semantic) Tj -161.0635 -11.9577 TD 0.0339 Tc 0.1124 Tw (problem makes it difficult for people to communi-) Tj ET BT 0.8915 0 0 0.9835 75.12 184.8 Tm 0.0525 Tc 1.2983 Tw (cate clearly about the legal and ethical issues raised) Tj ET BT 0.9835 0 0 0.9835 74.88 172.8 Tm 0.0343 Tc 3.2031 Tw (by various methods of keeping residents from) Tj ET BT 0.934 0 0 0.9835 75.12 161.04 Tm -0.0189 Tc 0.6433 Tw (leaving a special care unit.) Tj 12.0769 -23.1834 TD -0.0225 Tc 1.525 Tw (Some States prohibit locked nursing home units) Tj ET BT 0.9835 0 0 0.9835 75.36 126.24 Tm 0.0267 Tc -0.0197 Tw (or classify them in a different regulatory category) Tj ET BT 0.934 0 0 0.9835 75.6 114.48 Tm -0.0109 Tc 0.9559 Tw (than unlocked units.) Tj ET BT 0.9557 0 0 1.08 166.32 119.28 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (16 ) Tj ET BT 0.934 0 0 0.9835 172.08 114.48 Tm /F4 10 Tf -0.021 Tc 0.7868 Tw (At least one State official has) Tj ET BT 0.9835 0 0 0.9835 75.6 102.72 Tm 0.0256 Tc 1.7477 Tw (argued that locked units constitute physical re-) Tj ET BT 0.8915 0 0 0.9835 75.6 90.72 Tm 0.0283 Tc 0.9217 Tw (straints in the context of OBRA regulations and thus) Tj ET BT 0.9835 0 0 0.9835 324 647.28 Tm 0.041 Tc 0.2272 Tw (require ongoing efforts to move the residents to a) Tj ET BT 0.934 0 0 0.9835 324 635.04 Tm -0.0286 Tc 1.0177 Tw (less restrictive environment \(85\).) Tj 11.563 -20.0109 TD -0.0278 Tc 0.7491 Tw (Families often worry about the safety of a person) Tj ET BT 0.9835 0 0 0.9835 324 603.36 Tm 0.039 Tc 0.6441 Tw (with dementia who wanders. Anecdotal evidence) Tj ET BT 0.8915 0 0 0.9835 324.72 591.12 Tm 0.0359 Tc 0.9804 Tw (suggests that one thing some families are looking for) Tj -0.5384 -12.4458 TD 0.0505 Tc 0.1497 Tw (in a special care unit is assurance that the person will) Tj ET BT 0.9835 0 0 0.9835 324 566.88 Tm 0.0296 Tc 1.8521 Tw (be safe. They may prefer a locked unit for this) Tj 0 -11.9577 TD 0.0248 Tc 0.4572 Tw (reason. On the other hand, some families may be) Tj ET BT 0.8915 0 0 0.9835 324.24 543.12 Tm 0.048 Tc 0.2602 Tw (very reluctant to place their relative with dementia in) Tj ET BT 0.934 0 0 0.9835 324.72 531.36 Tm -0.0303 Tc 0.4627 Tw (a locked unit.) Tj ET BT 0.9835 0 0 0.9835 335.52 511.92 Tm 0.0385 Tc 1.816 Tw (The effect of locked units on the residents is) Tj -10.9816 -12.4458 TD 0.0322 Tc 1.0903 Tw (unclear. One study compared the behavior of 22) Tj ET BT 0.934 0 0 0.9835 325.2 488.16 Tm -0.0383 Tc 1.0036 Tw (special care unit residents after they encountered a) Tj ET BT 0.9835 0 0 0.9835 324.72 476.16 Tm 0.0296 Tc 0.2083 Tw (locked vs. an unlocked exit door. The study found) Tj ET BT 0.8915 0 0 0.9835 325.2 464.16 Tm 0.0252 Tc 0.9251 Tw (that the residents were much less agitated after they) Tj ET BT 0.9835 0 0 0.9835 324.96 452.16 Tm 0.0418 Tc 0.9992 Tw (encountered the unlocked door \(315\). Some resi-) Tj ET BT 0.8915 0 0 0.9835 325.2 440.16 Tm 0.0367 Tc 1.715 Tw (dents who encountered the unlocked door tested the) Tj ET BT 0.9835 0 0 0.9835 325.2 428.16 Tm 0.0401 Tc 1.6401 Tw (door several times-apparently to be sure it was) Tj 0 -11.7137 TD 0.0449 Tc 0.3859 Tw (unlocked-and then decided not to go out.) Tj ET BT 0.9795 0 0 0.9795 355.2 383.04 Tm /F7 12 Tf 0.0445 Tc 0.5674 Tw (Issues With Respect to Admission) Tj 48.2713 -14.7019 TD 0.0388 Tc 1.1245 Tw (and Discharge) Tj -67.3837 -19.6025 TD -0.0034 Tc -0.0576 Tw (Nursing ) Tj ET BT 0.9835 0 0 0.9835 381.36 349.44 Tm /F4 10 Tf 0.0401 Tc 2.1194 Tw (home admission for a nondemented) Tj ET BT 0.8915 0 0 0.9835 325.44 337.68 Tm 0.0344 Tc 0.612 Tw (person raises difficult legal and ethical issues, in part) Tj 0 -12.4458 TD 0.0553 Tc 1.239 Tw (because decisions about nursing home admission are) Tj ET BT 0.9835 0 0 0.9835 326.16 313.44 Tm 0.0314 Tc 1.7418 Tw (seldom autonomous \(8,307\). The admission of a) Tj ET BT 0.8915 0 0 0.9835 325.44 301.68 Tm 0.0462 Tc 0.4866 Tw (person with dementia to a special care unit may raise) Tj ET BT 0.934 0 0 0.9835 325.92 289.44 Tm -0.0352 Tc 1.0782 Tw (even more difficult issues if the person is incapable) Tj ET BT 0.9835 0 0 0.9835 325.92 277.44 Tm 0.0282 Tc 0.8809 Tw (of an autonomous decision, the unit is locked, or) Tj ET BT 0.8915 0 0 0.9835 325.92 265.44 Tm 0.0131 Tc 0 Tw (both.) Tj 12.1137 -20.255 TD 0.0364 Tc 1.5384 Tw (Many commentators have debated the similarities) Tj ET BT 0.934 0 0 0.9835 326.16 233.76 Tm -0.0365 Tc 0.708 Tw (and differences between the admission of an elderly) Tj ET BT 0.9835 0 0 0.9835 325.68 221.76 Tm 0.0333 Tc 0.4927 Tw (person to a nursing home and the admission of ) Tj ET BT 0.9863 0 0 0.9863 547.68 221.76 Tm /F3 9 Tf 0.1038 Tc 0 Tw (a) Tj ET BT 0.9835 0 0 0.9835 325.92 209.76 Tm /F4 10 Tf 0.0208 Tc 0.1258 Tw (psychiatric patient ) Tj ET BT 0.9863 0 0 0.9863 415.68 209.76 Tm /F3 9 Tf 0.0402 Tc -0.1106 Tw (to a ) Tj ET BT 0.9835 0 0 0.9835 434.16 209.76 Tm /F4 10 Tf 0.0211 Tc 0.8575 Tw (mental hospital.) Tj ET BT 1.08 0 0 1.08 509.52 214.56 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (17 ) Tj ET BT 0.9835 0 0 0.9835 515.52 209.76 Tm /F4 10 Tf 0.0307 Tc 0.3598 Tw (The two) Tj ET BT 0.8915 0 0 0.9835 326.4 197.76 Tm 0.0479 Tc 0.4398 Tw (situations are generally perceived as different enough) Tj ET BT 0.9835 0 0 0.9835 326.64 185.76 Tm 0.0359 Tc 0.2629 Tw (so that the legal protections that apply to mental) Tj ET BT 0.934 0 0 0.9835 326.16 174.24 Tm -0.0347 Tc 2.1377 Tw (hospital admissions are considered unnecessary or) Tj 0 -12.4458 TD -0.022 Tc 1.7386 Tw (inappropriate for nursing home admissions. In the) Tj ET BT 0.9835 0 0 0.9835 326.4 149.76 Tm 0.0306 Tc 3.0442 Tw (case of locked units and individuals who lack) Tj 0 -11.9577 TD 0.0301 Tc 2.5567 Tw (decisionmaking capacity, however, some people) Tj -0.244 -12.2018 TD 0.0506 Tc 0.1361 Tw (believe additional legal protection is needed. One) Tj ET BT 0.934 0 0 0.9835 326.16 114 Tm -0.0333 Tc 1.7324 Tw (possibility is a requirement for a legally appointed) Tj 0.5139 -11.7137 TD -0.0268 Tc 1.5189 Tw (guardian to give consent when a person who lacks) Tj ET BT 0.9835 0 0 0.9835 326.64 90.72 Tm 0.028 Tc 1.4606 Tw (decisionmaking capacity is admitted to a locked) Tj ET q 4.56 0 0 -4.32 89.52 72.72 cm BI /W 30 /H 25 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<<<<?~? EI Q BT 0.4225 0 0 0.9835 89.52 68.4 Tm 3 Tr /F2 10 Tf 0.1112 Tc 0 Tw (16) Tj 0 Tr ET BT 0.8719 0 0 1.0281 94.08 68.4 Tm /F2 7 Tf -0.0699 Tc 0.2566 Tw ( AS ) Tj ET q 26.88 0 0 -5.76 105.84 73.92 cm BI /W 169 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0?~?????>>~~~||~x||<|?8||>|||?_|~|?|~|?|~|?||||||||||~||||||>~||>>??|?~????|x EI Q BT 0.8919 0 0 0.9835 105.84 68.4 Tm 3 Tr /F2 10 Tf 0.0032 Tc 0 Tw (descfi~) Tj 0 Tr ET BT 0.8449 0 0 0.9835 132.72 68.4 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 5.52 0 0 -5.28 134.64 72.96 cm BI /W 35 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????px>>> EI Q BT 0.7041 0 0 0.9835 134.64 68.4 Tm 3 Tr 0.0272 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8449 0 0 0.9835 140.16 68.4 Tm 0.0967 Tc 0.2241 Tw ( chapte) Tj ET BT 0.9393 0 0 1.08 165.12 66.48 Tm /F2 4 Tf -0.0545 Tc 0.08 Tw (r ) Tj ET q 4.8 0 0 -6.48 167.28 73.2 cm BI /W 31 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<<~x???? EI Q BT 0.6102 0 0 0.9835 167.28 68.4 Tm 3 Tr /F2 10 Tf -0.0152 Tc 0 Tw (5,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 172.08 68.4 Tm 0.0848 Tc 0.4411 Tw ( Colorado\222s special care unit regulations apply ) Tj ET q 12.24 0 0 -6.96 338.4 73.68 cm BI /W 78 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?pxxx||?~~~~~~||||~~~|~|~|~~~???  EI Q BT 0.9598 0 0 0.9598 338.4 68.4 Tm 3 Tr /F3 6 Tf 0.021 Tc 0 Tw (OI@) Tj 0 Tr ET BT 0.7926 0 0 0.9598 350.64 68.4 Tm 0.0437 Tc 0.2445 Tw ( to ) Tj ET q 18.48 0 0 -5.76 358.56 73.92 cm BI /W 117 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??~~><~>?p?0 >>>?>|?|>>~>??~?x EI Q BT 0.5944 0 0 0.9835 358.56 68.4 Tm 3 Tr /F4 10 Tf -0.0341 Tc 0 Tw (locked) Tj 0 Tr ET BT 0.8491 0 0 0.9835 377.04 68.4 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 15.12 0 0 -5.76 379.2 73.92 cm BI /W 95 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~~~?>?~???|~<?><?>>?>>?>>??>?>??>?|??~|?>~~?>>p?~?~~?????@À?> EI Q BT 0.7642 0 0 0.9835 113.52 57.6 Tm 3 Tr -0.0012 Tc 0 Tw (fore~ple,) Tj 0 Tr 41.4553 0 TD -0.0342 Tc 2.288 Tw ( Cohen,) Tj ET q 65.52 0 0 -7.2 176.16 60.48 cm BI /W 475 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |#?p?8njx?x??|>~????~>>>??~~~>?<~|~>?||~>?||~>?>||~>??||~~?À|<~>?À|>~?>?|>>?>?8|~>>?<~~|>~~>??~| ?~>???>>?>????<8??~|???1 ~?<>>?<>??~|~???|A?8<x?<?~`?? EI Q BT 0.5519 0 0 0.9835 176.16 55.2 Tm 3 Tr 0.0021 Tc 0 Tw (\223CaringfortheMentallyIll) Tj 0 Tr ET BT 0.7217 0 0 0.9835 241.68 55.2 Tm -0.0188 Tc 1.5069 Tw ( Elderly Without DeFacto Commitments to Nursing Homes: The Right to the) Tj 0 Tc -0.1214 Tw ( ) Tj ET q 40.32 0 0 -5.76 512.4 60.72 cm BI /W 292 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx??????>=|?{<=????{~????p9|????0~|??>>~?>>>~???>>>??>????x????x???<~8??<|?<x?|??????~ ~?3 ~?@`?@ EI Q BT 0.5519 0 0 0.9835 512.4 55.2 Tm 3 Tr 0.0135 Tc 0 Tw (LeastR@rictive) Tj 0 Tr ET BT 0.7217 0 0 0.9835 74.88 46.8 Tm -0.0292 Tc 0.8336 Tw (Environment\224 \(90\); Moody, \223Ethical Dilemmas) Tj ET q 4.32 0 0 -5.52 234.24 51.84 cm BI /W 34 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>>>>>>>>>>>>~~?` EI Q BT 0.4245 0 0 0.9835 234.24 46.08 Tm 3 Tr 0.1723 Tc 0 Tw (in) Tj 0 Tr ET BT 0.6793 0 0 0.9835 238.56 46.08 Tm -0.0135 Tc 2.6022 Tw ( Nursing Home Placement\224 \(307\); and Spring, \223Applying Due Process Safeguards\224 \(420\).) Tj ET endstream endobj 162 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 163 0 obj <>stream 0.48 w 1 j 0 0 0 RG 57.6 675.36 m 535.68 675.36 l S BT 0.9835 0 0 0.9835 324.96 680.4 Tm 0 0 0 rg /F5 10 Tf 0.0115 Tc 2.8964 Tw (Chapter l-Overview and Policy Implications . 45) Tj ET BT 0.934 0 0 0.9835 57.84 642.48 Tm /F4 10 Tf -0.0287 Tc 0.8143 Tw (unit. Another possibility is a requirement for a civil) Tj 0.5139 -12.2018 TD -0.0081 Tc 0.9957 Tw (commitment in such cases.) Tj ET BT 0.9835 0 0 0.9835 69.12 612.48 Tm 0.0407 Tc 1.9358 Tw (These requirements would provide additional) Tj ET BT 0.934 0 0 0.9835 58.08 600.96 Tm -0.033 Tc 1.0712 Tw (protection for individuals with dementia and at the) Tj ET BT 0.8915 0 0 0.9835 58.8 588.72 Tm 0.0509 Tc 1.0982 Tw (same time create grave obstacles to special care unit) Tj ET BT 0.9835 0 0 0.9835 58.56 576.72 Tm 0.0269 Tc 1.3397 Tw (admission. Many families would be unwilling to) Tj ET BT 0.934 0 0 0.9835 58.32 564.72 Tm -0.0238 Tc 1.7834 Tw (pursue either guardianship or a civil commitment,) Tj 0.5139 -12.2018 TD -0.0253 Tc 0.8107 Tw (and some individuals with dementia have no one to) Tj 0.257 -12.2018 TD -0.0335 Tc 1.1086 Tw (initiate the necessary legal proceedings for them. If) Tj -0.257 -11.9577 TD -0.0233 Tc 1.2975 Tw (better care is available in a special care unit, legal) Tj -0.257 -11.9577 TD -0.0491 Tc 2.8726 Tw (requirements intended to protect potential special) Tj ET BT 0.8915 0 0 0.9835 59.04 505.2 Tm 0.0436 Tc 1.4429 Tw (care unit residents could be seen instead as denying) Tj ET BT 0.934 0 0 0.9835 59.04 493.2 Tm -0.0294 Tc 1.3097 Tw (them access to better care. In fact, if better care is) Tj 0.257 -12.2018 TD -0.0214 Tc 1.1527 Tw (available in a special care unit, any decision not to) Tj ET BT 0.9835 0 0 0.9835 59.28 469.2 Tm 0.0309 Tc 1.6068 Tw (admit an individual to a special care unit or to) Tj ET BT 0.934 0 0 0.9835 59.28 457.68 Tm -0.0252 Tc 0.8427 Tw (discharge an individual from the unit could be seen) Tj ET BT 0.8915 0 0 0.9835 59.76 445.44 Tm 0.0414 Tc 1.2098 Tw (as denying the individual access to better care. Such) Tj ET BT 0.9835 0 0 0.9835 59.52 433.44 Tm 0.0326 Tc 3.5303 Tw (decisions could be regarded as discrimin) Tj ET BT 0.8915 0 0 0.9835 261.6 432.96 Tm 0.022 Tc 0 Tw (atory,) Tj ET BT 0.934 0 0 0.9835 59.52 421.68 Tm -0.0375 Tc 1.1128 Tw (depending on the basis for the decision.) Tj 12.0769 -18.3027 TD -0.0276 Tc 0.6204 Tw (Some of the difficult legal and ethical issues with) Tj ET BT 0.9835 0 0 0.9835 59.28 391.92 Tm 0.0357 Tc -0.0289 Tw (regard to discharge involve a conflict between the) Tj ET BT 0.8915 0 0 0.9835 59.52 379.92 Tm 0.014 Tc 1.3003 Tw (presumed right of the unit and its staff to determine) Tj ET BT 0.934 0 0 0.9835 60 367.68 Tm -0.036 Tc 1.0598 Tw (who will be cared for in the unit and the presumed) Tj ET BT 0.8915 0 0 0.9835 59.76 355.92 Tm 0.038 Tc 0.3326 Tw (right of residents to remain in the unit if they or their) Tj ET BT 0.934 0 0 0.9835 60 343.92 Tm -0.0244 Tc 1.6127 Tw (families so choose. A recent case in a Washington,) Tj ET BT 0.9835 0 0 0.9835 60.24 332.16 Tm 0.013 Tc -0.0058 Tw (DC, nursing home illustrates one such conflict. In) Tj 0 -12.2018 TD 0.0346 Tc 0.5692 Tw (this case, the family of a 91-year-old special care) Tj -0.244 -12.6899 TD 0.0306 Tc 0.8885 Tw (unit resident challenged the facility\222s decision to) Tj 0.244 -12.2018 TD 0.0268 Tc 1.793 Tw (discharge the resident from the unit \(204\). The) Tj 0 -11.9577 TD 0.0167 Tc 3.8311 Tw (facility, which had a formal discharge policy,) Tj ET BT 0.8915 0 0 0.9835 60.48 271.44 Tm 0.0375 Tc 0.7767 Tw (wanted to move the resident to another unit because,) Tj ET BT 0.934 0 0 0.9835 60.48 259.68 Tm -0.0313 Tc 1.1319 Tw (in the opinion of the unit staff, she could no longer) Tj ET BT 0.8915 0 0 0.9835 60.48 247.44 Tm 0.0444 Tc 1.0382 Tw (benefit from the special care unit. The family argued) Tj 0 -12.2018 TD 0.0396 Tc 0.6735 Tw (that the resident, who had been in the same room for) Tj ET BT 0.934 0 0 0.9835 60.96 223.68 Tm -0.012 Tc 1.4893 Tw (six years, might experience \221\221transfer trauma\224 as a) Tj -0.5139 -11.7137 TD -0.0235 Tc 0.4554 Tw (result of the move. The hearing examiner ruled that) Tj 0.257 -12.4458 TD -0.0351 Tc 0.5642 Tw (the facility could not move the resident even though) Tj ET BT 0.9835 0 0 0.9835 60.96 188.4 Tm 0.0358 Tc 1.8188 Tw (it was clear that the resident did not meet the) Tj ET BT 0.934 0 0 0.9835 60.96 176.16 Tm -0.0301 Tc 0.9765 Tw (facility\222s criteria for placement on the unit.) Tj 11.563 -18.3027 TD -0.0344 Tc 0.692 Tw (A related issue pertains to special care units that) Tj ET BT 0.9835 0 0 0.9835 61.2 146.16 Tm 0.0277 Tc 1.7049 Tw (admit but later discharge individuals who have) Tj -0.4881 -11.9577 TD 0.027 Tc 0.224 Tw (behavioral symptoms which, in the opinion of the) Tj 0.244 -12.4458 TD 0.0245 Tc 0.8846 Tw (unit staff, cannot be managed on the unit. Some) Tj ET BT 0.934 0 0 0.9835 60.72 110.4 Tm -0.0527 Tc 1.1291 Tw (people believe special care units should be expected) Tj ET BT 0.9835 0 0 0.9835 61.2 98.64 Tm 0.0409 Tc 0.268 Tw (to and should be able to care for individuals with) Tj 0.4881 -12.2018 TD 0.0206 Tc 1.8342 Tw (severe behavioral symptoms. They suggest that) Tj 0 -11.9577 TD 0.0201 Tc 0.0044 Tw (special care units that discharge such individuals) Tj ET BT 0.934 0 0 0.9835 61.2 63.12 Tm -0.0162 Tc 0.5761 Tw (may be violating their formal or informal admission) Tj ET BT 0.9835 0 0 0.9835 309.12 642 Tm 0.0311 Tc 1.0914 Tw (agreement with the residents and the residents\222) Tj ET BT 0.934 0 0 0.9835 309.12 630.48 Tm -0.0235 Tc 0.7267 Tw (families. On the other hand, the facility is liable for) Tj 0.257 -12.2018 TD -0.0178 Tc 1.0061 Tw (injuries to other residents that may be caused by a) Tj ET BT 0.8915 0 0 0.9835 308.88 606.48 Tm 0.0387 Tc 1.3923 Tw (physically aggressive resident and responsible to the) Tj ET BT 0.9835 0 0 0.9835 309.6 594.24 Tm 0.036 Tc 0.8424 Tw (other residents and their families for the overall) Tj 0 -12.2018 TD 0.0204 Tc 0.3702 Tw (atmosphere in the unit, which may be negatively) Tj ET BT 0.8915 0 0 0.9835 309.6 570.24 Tm 0.0321 Tc 2.7681 Tw (affected by behaviorally disturbed residents.) Tj ET BT 0.9795 0 0 0.9795 336.24 537.84 Tm /F7 12 Tf 0.0382 Tc 0.7821 Tw (Issues With Respect to Consent for) Tj 30.1389 -13.9668 TD 0.0596 Tc 0.8582 Tw (Research Participation) Tj ET BT 0.8915 0 0 0.9835 321.12 505.68 Tm /F4 10 Tf 0.0646 Tc 0.9818 Tw (Special care unit researchers report) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9126 0 0 0.9863 477.84 505.68 Tm /F3 9 Tf -0.0502 Tc 0.1815 Tw (that ) Tj ET BT 0.8915 0 0 0.9835 495.36 505.68 Tm /F4 10 Tf 0.0545 Tc 0 Tw (obtaining) Tj ET BT 0.9835 0 0 0.9835 310.08 493.68 Tm 0.0302 Tc 2.9958 Tw (informed consent for research participation by) Tj ET BT 0.8491 0 0 0.9835 310.32 481.68 Tm 0.0332 Tc 1.096 Tw (special care unit residents is very difficult \(79,411,436\).) Tj ET BT 0.9835 0 0 0.9835 310.08 469.92 Tm 0.0435 Tc 1.9024 Tw (Most of the residents are not capable of giving) Tj ET BT 0.934 0 0 0.9835 310.32 457.92 Tm -0.0207 Tc 1.2233 Tw (informed consent, and many residents\222 families are) Tj ET BT 0.9835 0 0 0.9835 310.08 446.16 Tm 0.0211 Tc -0.1186 Tw (reluctant to give consent. As a result, studies that) Tj ET BT 0.934 0 0 0.9835 310.08 433.92 Tm -0.0429 Tc 1.6325 Tw (require informed consent are likely to end up with) Tj ET BT 0.8915 0 0 0.9835 311.04 421.68 Tm 0.0272 Tc 1.4276 Tw (small samples that may not be representative of the) Tj ET BT 0.9835 0 0 0.9835 310.56 410.16 Tm 0.0367 Tc 2.5499 Tw (larger population of residents. To address this) Tj ET BT 0.934 0 0 0.9835 310.32 397.92 Tm -0.0297 Tc 1.8753 Tw (problem, some special care unit studies have been) Tj 0.5139 -12.2018 TD -0.0407 Tc 1.0521 Tw (designed to avoid the need for informed consent. In) Tj 0.257 -11.9577 TD -0.0411 Tc 1.6734 Tw (such studies, the researchers review the residents\222) Tj -0.257 -12.2018 TD -0.0401 Tc 1.7397 Tw (medical records, observe the residents, and talk to) Tj 0.257 -12.4458 TD -0.0268 Tc 0.7588 Tw (the unit staff, but they do not interact directly with) Tj ET BT 0.8915 0 0 0.9835 311.04 338.16 Tm 0.0473 Tc 0.9937 Tw (the residents because to do so is perceived to require) Tj ET BT 0.934 0 0 0.9835 311.04 326.16 Tm -0.0395 Tc 1.5432 Tw (informed consent. In contrast, record reviews, resi-) Tj 0 -12.4458 TD -0.03 Tc 1.6921 Tw (dent observation, and staff interviews are not per-) Tj 0 -12.2018 TD -0.0468 Tc 1.5083 Tw (ceived to require informed consent.) Tj ET BT 0.8915 0 0 0.9835 322.32 283.44 Tm 0.0385 Tc 0.8541 Tw (OTA is not aware of any published analyses of the) Tj ET BT 0.934 0 0 0.9835 311.52 271.68 Tm -0.0402 Tc 1.1585 Tw (issue of informed consent for research participation) Tj ET BT 0.8915 0 0 0.9835 311.28 259.44 Tm 0.0459 Tc 0.5655 Tw (by special care unit residents. Much has been written) Tj ET BT 0.934 0 0 0.9835 311.76 247.44 Tm -0.0203 Tc 1.0944 Tw (about this issue, however, as it pertains to nursing) Tj ET BT 0.9835 0 0 0.9835 311.28 235.44 Tm 0.0311 Tc 1.7421 Tw (home residents in general and individuals with) Tj 0.4881 -12.2018 TD 0.0297 Tc 0.9883 Tw (dementia in any setting. In addition, several re-) Tj 0.244 -11.9577 TD 0.0362 Tc 0.7812 Tw (searchers who are part of the Workgroup on Re-) Tj 0 -11.9577 TD 0.0337 Tc 0.7053 Tw (search and Evaluation of Special Care Units are) Tj ET BT 0.934 0 0 0.9835 311.76 188.16 Tm -0.0358 Tc 1.7212 Tw (preparing a paper on ethical issues in special care) Tj 0 -12.2018 TD -0.028 Tc 0.6989 Tw (unit research that includes a discussion of informed) Tj 0.257 -12.2018 TD -0.0254 Tc 1.0356 Tw (consent for research participation \(495\).) Tj ET BT 0.9835 0 0 0.9835 323.04 145.92 Tm 0.0326 Tc -0.0693 Tw (In the late 1970s and early 1980s, the National) Tj ET BT 0.934 0 0 0.9835 312.24 134.16 Tm -0.0207 Tc 1.9942 Tw (Commission for the Protection of Human Subjects) Tj ET BT 0.9835 0 0 0.9835 312 122.4 Tm 0.0394 Tc 1.449 Tw (in Biomedical and Behavioral Research and the) Tj 0.244 -12.2018 TD 0.0267 Tc 1.2179 Tw (Presidents\222 Commission for the Study of Ethical) Tj ET BT 0.934 0 0 0.9835 312.48 98.88 Tm -0.0241 Tc 2.1691 Tw (Problems in Medicine and Biomedical and Behav-) Tj 0 -12.2018 TD -0.031 Tc 1.3629 Tw (ioral Research studied and made recommendations) Tj ET BT 0.8915 0 0 0.9835 312.48 74.88 Tm 0.0502 Tc 1.3794 Tw (about informed consent for research participation by) Tj -0.5384 -11.9577 TD 0.0347 Tc 2.1864 Tw (nursing home residents \(322,350\). Other commenta-) Tj ET endstream endobj 164 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 165 0 obj <>stream 0.48 w 1 j 0 0 0 RG 76.56 688.08 m 554.88 688.08 l S 0.72 w 78.96 75.12 m 557.28 75.12 l S BT 0.9835 0 0 0.9835 76.8 695.28 Tm 0 0 0 rg /F5 10 Tf 0.0149 Tc 1.0774 Tw (46 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0.244 -40.5099 TD /F4 10 Tf 0.0296 Tc 2.9639 Tw (tors have also made recommendations on this) Tj 0 -12.2018 TD 0.0069 Tc 0 Tw (issue.) Tj ET BT 1.08 0 0 1.08 103.92 648.24 Tm /F4 4 Tf -0.0024 Tc (18) Tj ET BT 0.934 0 0 0.9835 88.08 625.44 Tm /F4 10 Tf -0.0384 Tc 1.6705 Tw (All of these recommendations arise from serious) Tj -11.82 -12.4458 TD -0.0315 Tc 0.8922 Tw (concerns about the potential exploitation of nursing) Tj ET BT 0.9835 0 0 0.9835 77.04 601.44 Tm 0.0229 Tc 0.7744 Tw (home residents as research subjects. They would) Tj 0.4881 -12.4458 TD 0.0255 Tc 1.2191 Tw (strictly limit the types of research that could be) Tj ET BT 0.8915 0 0 0.9835 77.28 577.44 Tm 0.0392 Tc 1.6353 Tw (conducted in nursing homes and the participation of) Tj ET BT 0.934 0 0 0.9835 77.04 565.68 Tm -0.0361 Tc 1.4784 Tw (residents who are not capable of informed consent.) Tj ET BT 0.9835 0 0 0.9835 77.52 553.68 Tm 0.0268 Tc 2.438 Tw (The National Commission for the Protection of) Tj 0.244 -11.9577 TD 0.0261 Tc 2.6095 Tw (Human Subjects in Biomedical and Behavioral) Tj ET BT 0.934 0 0 0.9835 77.76 529.68 Tm -0.0325 Tc 1.5186 Tw (Research recommended, for example, that research) Tj ET BT 0.9835 0 0 0.9835 77.76 517.68 Tm 0.0261 Tc 0.8931 Tw (involving nursing home residents should only be) Tj ET BT 0.934 0 0 0.9835 77.76 505.68 Tm -0.0361 Tc 1.6252 Tw (allowed if it is relevant to a condition the subjects) Tj ET BT 0.9835 0 0 0.9835 78 493.44 Tm 0.0174 Tc 0.4778 Tw (suffer from, i.e., therapeutic research, and only if) Tj ET BT 0.8915 0 0 0.9835 78 481.44 Tm 0.0464 Tc 1.1657 Tw (appropriate subjects cannot be obtained in any other) Tj 0 -12.2018 TD 0.0274 Tc 2.0331 Tw (setting. Cassel recommended that surrogates should) Tj ET BT 0.9835 0 0 0.9835 77.76 457.68 Tm 0.0383 Tc 1.7348 Tw (be formally designated to make decisions about) Tj ET BT 0.8915 0 0 0.9835 77.76 445.68 Tm 0.0534 Tc 1.1579 Tw (research participation on behalf of residents who are) Tj ET BT 0.934 0 0 0.9835 78 433.92 Tm -0.0197 Tc 1.6591 Tw (not capable of informed consent \(74\).) Tj 11.82 -18.3027 TD -0.0295 Tc 2.0036 Tw (None of these recommendations has been incor-) Tj ET BT 0.9835 0 0 0.9835 77.76 403.68 Tm 0.0387 Tc 1.8855 Tw (porated into law, and no special regulations on) Tj 0.4881 -11.9577 TD 0.0302 Tc 3.0446 Tw (informed consent for research participation by) Tj ET BT 0.934 0 0 0.9835 78.24 380.16 Tm -0.0254 Tc 0.8429 Tw (nursing home residents are now in effect. OBRA-87) Tj 0.5139 -11.9577 TD -0.0425 Tc 1.5679 Tw (gives residents the right to refuse to participate in) Tj ET BT 0.9835 0 0 0.9835 78.24 356.4 Tm 0.0453 Tc 1.321 Tw (research \(463\) but does not address the issue of) Tj ET BT 0.934 0 0 0.9835 78.48 344.64 Tm -0.0309 Tc 2.3905 Tw (informed consent for research participation. Thus,) Tj ET BT 0.8915 0 0 0.9835 78.24 332.4 Tm 0.0637 Tc 0.5455 Tw (research in nursing homes is governed by the general) Tj ET BT 0.9835 0 0 0.9835 78.48 320.4 Tm 0.0277 Tc 2.7218 Tw (Federal law which allows consent for research) Tj ET BT 0.934 0 0 0.9835 78.24 308.64 Tm -0.0185 Tc 1.3495 Tw (participation by a) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 161.04 308.64 Tm /F5 11 Tf 0.0174 Tc 3.2027 Tw (legally authorized representative) Tj ET BT 0.8915 0 0 0.9835 78.72 296.4 Tm /F4 10 Tf 0.0437 Tc 0.8034 Tw (on behalf of an incompetent person. The term ) Tj ET BT 0.9014 0 0 0.9812 277.2 296.4 Tm /F5 11 Tf 0.1705 Tc 0 Tw (legally) Tj ET BT 0.9812 0 0 0.9812 78.96 284.16 Tm 0.0924 Tc 5.4705 Tw (authorized representative) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 205.44 284.16 Tm /F4 10 Tf 0.0495 Tc 2.1099 Tw (is not defined in the) Tj ET BT 0.8915 0 0 0.9835 78.96 272.4 Tm 0.0537 Tc 2.0036 Tw (Federal law.) Tj ET BT 0.9835 0 0 0.9835 90 254.4 Tm 0.0308 Tc 0.499 Tw (In 1981, the National Institute on Aging spon-) Tj ET BT 0.934 0 0 0.9835 79.2 242.16 Tm -0.0482 Tc 1.863 Tw (sored a conference to explore the legal and ethical) Tj 0 -12.2018 TD -0.0458 Tc 0.7179 Tw (issues with respect to informed consent for research) Tj ET BT 0.9835 0 0 0.9835 78.72 218.64 Tm 0.0281 Tc -0.1257 Tw (participation by individuals with dementia in any) Tj ET BT 0.8915 0 0 0.9835 79.44 206.4 Tm 0.0314 Tc 1.2883 Tw (setting \(301\). After the conference, a task force drew) Tj -0.2692 -12.2018 TD 0.0303 Tc 1.4914 Tw (up guidelines that recommend the use of noninstitu-) Tj 0.2692 -12.4458 TD 0.0428 Tc 2.2851 Tw (tionalized subjects whenever possible \(302\). Federal) Tj ET BT 0.9835 0 0 0.9835 79.2 170.16 Tm 0.0293 Tc 0.5238 Tw (law requires institutions that receive Federal re-) Tj ET BT 0.934 0 0 0.9835 79.92 157.68 Tm -0.0209 Tc 1.4621 Tw (search funds to have an institutional review board) Tj ET BT 0.8915 0 0 0.9835 79.68 146.16 Tm 0.0481 Tc 1.7855 Tw (\(IRB\) to review research proposals involving human) Tj ET BT 0.934 0 0 0.9835 79.68 134.16 Tm -0.0286 Tc 0.8463 Tw (subjects, and the task force\222s guidelines cite several) Tj ET BT 0.9835 0 0 0.9835 79.2 122.4 Tm 0.0382 Tc 0.9448 Tw (criteria IRBs could use to evaluate the informed) Tj ET BT 0.934 0 0 0.9835 79.2 110.64 Tm -0.0339 Tc 0.7378 Tw (consent procedures to be used in a given study. The) Tj ET BT 0.8915 0 0 0.9835 79.44 98.64 Tm 0.0264 Tc 1.5294 Tw (guidelines point out that the greater the risks posed) Tj ET BT 0.934 0 0 0.9835 79.2 86.88 Tm -0.0119 Tc 0.9997 Tw (by a study and the less likely an individual subject) Tj ET BT 0.8915 0 0 0.9835 328.08 654.24 Tm 0.0365 Tc 1.0999 Tw (will benefit directly, the more stringent the informed) Tj ET BT 0.934 0 0 0.9835 328.32 642 Tm -0.0421 Tc 1.2891 Tw (consent procedures should be. These guidelines are) Tj -0.257 -11.7137 TD -0.0271 Tc 1.2302 Tw (not part of any official regulations, however.) Tj ET BT 0.9835 0 0 0.9835 339.12 603.36 Tm 0.0211 Tc 0.8983 Tw (Researchers generally turn to a nursing home) Tj -11.4697 -11.9577 TD 0.0277 Tc 2.1117 Tw (resident\222s family to obtain consent for research) Tj 0.244 -12.4458 TD 0.0239 Tc 0.8954 Tw (participation. It is assumed the family\222s decision) Tj 0.244 -11.9577 TD 0.0375 Tc 1.6035 Tw (will reflect the wishes and best interests of the) Tj ET BT 0.934 0 0 0.9835 328.32 555.6 Tm -0.0332 Tc 1.3973 Tw (resident. The one published study OTA is aware of) Tj ET BT 0.8915 0 0 0.9835 328.56 543.36 Tm 0.0392 Tc 1.1226 Tw (that has addressed families\222 decisions about research) Tj ET BT 0.9835 0 0 0.9835 328.32 531.36 Tm 0.0355 Tc -0.1332 Tw (participation by an elderly relative casts doubt on) Tj ET BT 0.8915 0 0 0.9835 328.8 519.6 Tm 0.0327 Tc 1.4888 Tw (that assumption. The researchers asked the families) Tj ET BT 0.9835 0 0 0.9835 328.8 507.36 Tm 0.0319 Tc 1.0557 Tw (of 168 nursing home residents with dementia to) Tj ET BT 0.934 0 0 0.9835 328.8 495.6 Tm -0.0399 Tc 1.3723 Tw (consent to the residents\222 participation in a low-risk) Tj ET BT 0.9835 0 0 0.9835 329.04 483.36 Tm 0.0299 Tc 1.3366 Tw (study of urinary catheters \(480\). About half the) Tj 0 -11.9577 TD 0.0356 Tc 0.7207 Tw (families consented. Fifty-five of the families said) Tj 0.244 -12.2018 TD 0.0424 Tc 0.6964 Tw (they believed their relative would not consent to) Tj ET BT 0.934 0 0 0.9835 328.8 447.36 Tm -0.0143 Tc 2.5269 Tw (participate in the study, but17ofthe55\(31 percent\)) Tj ET BT 0.8915 0 0 0.9835 329.28 435.36 Tm 0.0252 Tc 1.7663 Tw (consented anyway. Twenty-eight of the families said) Tj ET BT 0.9835 0 0 0.9835 329.28 423.36 Tm 0.0393 Tc 0.3815 Tw (they would not choose to participate in the study) Tj ET BT 0.934 0 0 0.9835 329.28 411.6 Tm -0.0201 Tc 1.6081 Tw (themselves, but 6 of the 28 \(20 percent\) consented) Tj ET BT 0.8915 0 0 0.9835 329.28 399.84 Tm 0.0332 Tc 1.3984 Tw (for their relative with dementia to participate.) Tj ET BT 0.934 0 0 0.9835 340.32 372.72 Tm -0.0158 Tc 0.5757 Tw (The preliminary findings of a similar study being) Tj ET BT 0.9835 0 0 0.9835 329.52 361.2 Tm 0.026 Tc 3.3335 Tw (conducted by researchers at the University of) Tj ET BT 0.8915 0 0 0.9835 329.76 348.96 Tm 0.0411 Tc 0.8512 Tw (Chicago are more positive. As of the spring 1992, the) Tj ET BT 0.934 0 0 0.9835 329.28 337.44 Tm -0.0263 Tc 2.9638 Tw (researchers had interviewed 100 noninstitutional-) Tj ET BT 0.8915 0 0 0.9835 329.76 325.2 Tm 0.0276 Tc 1.0715 Tw (ized individuals with mild to moderate dementia and) Tj ET BT 0.934 0 0 0.9835 329.76 313.2 Tm -0.015 Tc 1.6454 Tw (their family caregivers \(395\). The individuals with) Tj ET BT 0.8915 0 0 0.9835 329.76 301.2 Tm 0.0372 Tc 0.9453 Tw (dementia were asked whether they would participate) Tj ET BT 0.934 0 0 0.9835 329.76 289.2 Tm -0.0265 Tc 1.6578 Tw (in several hypothetical, high- and low-risk medical) Tj ET BT 0.9835 0 0 0.9835 330.48 277.2 Tm 0.0254 Tc 1.2599 Tw (studies. The family caregivers were asked three) Tj -0.4881 -12.2018 TD 0.0303 Tc 1.377 Tw (questions: whether they would consent for their) Tj ET BT 0.934 0 0 0.9835 329.76 253.44 Tm -0.037 Tc 0.7452 Tw (relative with dementia to participate in the studies,) Tj ET BT 0.8915 0 0 0.9835 330 241.2 Tm 0.0419 Tc 1.017 Tw (whether they thought their relative would consent to) Tj ET BT 0.9835 0 0 0.9835 329.76 229.2 Tm 0.0347 Tc 0.1116 Tw (participate, and whether they would be willing to) Tj ET BT 0.934 0 0 0.9835 329.76 217.44 Tm -0.0253 Tc 3.2196 Tw (participate themselves. Preliminary findings from) Tj ET BT 0.8915 0 0 0.9835 330.24 205.44 Tm 0.0329 Tc 1.7578 Tw (the study show discrepancies between the responses) Tj ET BT 0.9835 0 0 0.9835 330.48 193.44 Tm 0.0317 Tc -0.0248 Tw (of the individuals with dementia and their family) Tj ET BT 0.934 0 0 0.9835 330.48 181.44 Tm -0.0196 Tc 0.7083 Tw (caregivers, but the family caregivers generally have) Tj ET BT 0.9835 0 0 0.9835 330.24 169.44 Tm 0.0377 Tc 1.1253 Tw (not volunteered their relative with dementia for) Tj ET BT 0.934 0 0 0.9835 330.24 157.44 Tm -0.0086 Tc 1.0452 Tw (high-risk studies \(395\). In fact, the caregivers have) Tj ET BT 0.8915 0 0 0.9835 330.48 145.68 Tm 0.038 Tc 1.2905 Tw (been less willing than the individuals with dementia) Tj ET BT 0.934 0 0 0.9835 330.48 133.92 Tm -0.0294 Tc 1.251 Tw (to consent to the individuals\222 participation in high-) Tj ET BT 0.8915 0 0 0.9835 330 122.16 Tm 0.0327 Tc 0.5466 Tw (risk studies. On the other hand, the family caregivers) Tj ET BT 0.9835 0 0 0.9835 330 110.4 Tm 0.0281 Tc 0.2229 Tw (have been more willing than the individuals with) Tj ET BT 0.8915 0 0 0.9835 330.48 98.4 Tm 0.032 Tc 1.7587 Tw (dementia to consent to the individuals\222 participation) Tj ET BT 0.934 0 0 0.9835 330.48 86.4 Tm -0.0374 Tc 0.5988 Tw (in the low-risk studies.) Tj ET q 4.56 0 0 -4.32 93.6 68.16 cm BI /W 28 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>>~~ EI Q BT 0.6485 0 0 0.9598 93.6 63.84 Tm 3 Tr /F3 6 Tf -0.0068 Tc 0 Tw (18) Tj 0 Tr ET BT 0.8971 0 0 0.9835 98.16 63.84 Tm /F5 10 Tf 0 Tc -0.0936 Tw ( ) Tj ET q 12 0 0 -6.96 100.32 68.64 cm BI /W 72 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p< x~?~|?gx<~<|<p| p|xx~?><??p|?p>p>?0 EI Q BT 0.7555 0 0 0.9835 100.32 63.84 Tm 3 Tr -0.0073 Tc 0 Tw (see,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 112.32 63.84 Tm /F4 10 Tf 0 Tc -0.0897 Tw ( ) Tj ET q 8.64 0 0 -5.52 114.72 69.36 cm BI /W 52 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~||0>ǀ> EI Q BT 0.6368 0 0 0.9835 114.72 63.84 Tm 3 Tr 0.012 Tc 0 Tw (for) Tj 0 Tr ET BT 0.8919 0 0 0.9835 123.36 63.84 Tm /F2 10 Tf 0.0578 Tc -0.01 Tw ( example, ) Tj ET q 18.72 0 0 -5.76 161.04 69.6 cm BI /W 112 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p`??~~~8|8?~0|||||?|?~??~>x?>x??<~?<>? EI Q BT 0.7041 0 0 0.9835 161.04 63.84 Tm 3 Tr -0.0006 Tc 0 Tw (Annas) Tj 0 Tr ET BT 0.8919 0 0 0.9835 179.76 63.84 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 10.32 0 0 -7.2 181.92 69.6 cm BI /W 63 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p0??||x|>||>>|>|>|>|>|>8?|||~|>>>?~0 EI Q BT 0.7041 0 0 0.9835 181.92 63.84 Tm 3 Tr 0.1035 Tc 0 Tw (Wd) Tj 0 Tr ET BT 0.8971 0 0 0.9835 192.24 63.84 Tm /F5 10 Tf 0 Tc -0.0936 Tw ( ) Tj ET q 18.72 0 0 -6.72 194.4 70.32 cm BI /W 113 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?q '??~~??~?~ ??~|?~|~?~>~~~~?~~~~~~?0>?p??? EI Q BT 0.6138 0 0 0.9835 194.4 63.84 Tm 3 Tr -0.1459 Tc 0 Tw (GkMM,) Tj 0 Tr ET BT 0.798 0 0 0.9835 216.96 62.64 Tm /F2 10 Tf 0.0327 Tc 0.6373 Tw (\223Rules for Research in Nursing Homes\224 \(13\); ) Tj ET q 18.48 0 0 -6.48 370.32 68.16 cm BI /W 124 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p ?<?Gp? ???|?||~~~~?~?~?~>~>~>~~>~>p??>?p>?>>>~? EI Q BT 0.6102 0 0 0.9835 370.32 62.64 Tm 3 Tr -0.0435 Tc 0 Tw (Cassel,) Tj 0 Tr ET BT 0.798 0 0 0.9835 391.92 62.4 Tm 0.0266 Tc 0.0721 Tw (\223Research in Nursing Homes: Ethical Issues\224 \(73\);) Tj ET q 18.96 0 0 -6.48 79.2 59.52 cm BI /W 124 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@1>??<><<>?8>?g??>???????~>?~>?~?~??0???p`?p???>?` EI Q BT 0.6572 0 0 0.9835 79.2 54 Tm 3 Tr 0.031 Tc 0 Tw (Cassel,) Tj 0 Tr ET BT 0.798 0 0 0.9835 98.16 54 Tm 0.0326 Tc 0.8738 Tw ( \223Ethical Issues in the Conduct of Research in Long Term Care\224 \(74\); and ) Tj ET q 19.92 0 0 -6.48 349.44 59.52 cm BI /W 131 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID A???????>?|c?|>|?x>|>|?~?>>>>~?|8|||80 EI Q BT 0.6102 0 0 0.9835 349.44 54 Tm 3 Tr -0.056 Tc 0 Tw (Dubler,) Tj 0 Tr ET q 18.48 0 0 -7.2 373.2 58.8 cm BI /W 123 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 7<|w|?x~8?????>~|?|xx>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 167 0 obj <>stream 0.48 w 1 j 0 0 0 RG 55.44 678.24 m 534.24 678.24 l S BT 0.9835 0 0 0.9835 323.28 683.28 Tm 0 0 0 rg /F5 10 Tf 0.0076 Tc 3.1037 Tw (Chapter l-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516.24 683.28 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.96 683.28 Tm /F5 10 Tf 0.488 Tc 0 Tw (47) Tj -463.6677 -39.5338 TD /F4 10 Tf 0.0273 Tc 0.5584 Tw (Numerous studies that have used hypothetical) Tj ET BT 0.934 0 0 0.9835 56.4 632.4 Tm -0.0419 Tc 0.9034 Tw (scenarios to compare treatment decisions by elderly) Tj ET BT 0.8915 0 0 0.9835 56.16 620.64 Tm 0.0349 Tc 1.7555 Tw (individuals and their families have found discrepan-) Tj ET BT 0.934 0 0 0.9835 56.4 608.4 Tm 0.005 Tc 0.8618 Tw (cies between their responses \(119,340,404,449,45 1,) Tj ET BT 0.9835 0 0 0.9835 56.4 596.4 Tm 0.0264 Tc 0.5732 Tw (523\). It has been suggested that family members) Tj ET BT 0.934 0 0 0.9835 56.4 584.4 Tm -0.0388 Tc 1.4354 Tw (would be more likely to make a treatment decision) Tj 0.5139 -12.2018 TD -0.0401 Tc 1.0014 Tw (the way their elderly relative would make it if they) Tj ET BT 0.9835 0 0 0.9835 56.88 560.64 Tm 0.036 Tc 3.4222 Tw (were specifically instructed to do so, and the) Tj ET BT 0.934 0 0 0.9835 56.88 548.88 Tm -0.0142 Tc 0.7942 Tw (findings of one study support that suggestion \(449\).) Tj 0 -12.2018 TD -0.0285 Tc 1.7272 Tw (Even when families are asked specifically to make) Tj ET BT 0.8915 0 0 0.9835 57.12 524.88 Tm 0.0523 Tc 1.1976 Tw (a decision the way their elderly relative would make) Tj ET BT 0.934 0 0 0.9835 56.88 513.36 Tm -0.0303 Tc 1.619 Tw (it, however, the decisions are not always the same) Tj 0.7709 -12.4458 TD 0.0645 Tc 0 Tw (\(404,449\).) Tj ET BT 0.9835 0 0 0.9835 68.16 477.6 Tm 0.0385 Tc 0.7585 Tw (If the necessary descriptive and evaluative re-) Tj -10.7376 -12.2018 TD 0.0257 Tc 1.951 Tw (search is to be conducted in special care units,) Tj ET BT 0.934 0 0 0.9835 57.36 453.6 Tm -0.0387 Tc 2.1419 Tw (informed consent procedures must be devised that) Tj ET BT 0.8915 0 0 0.9835 57.6 441.84 Tm 0.0279 Tc 0.6192 Tw (will protect the residents from exploitation and at the) Tj ET BT 0.9835 0 0 0.9835 57.84 429.84 Tm 0.031 Tc -0.0372 Tw (same time allow the use of research methods that) Tj ET BT 0.934 0 0 0.9835 57.12 418.08 Tm -0.027 Tc 0.6305 Tw (require informed consent, e.g., methods that involve) Tj ET BT 0.8915 0 0 0.9835 57.6 406.08 Tm 0.0336 Tc 1.6672 Tw (direct interaction with the residents. Some commen-) Tj ET BT 0.934 0 0 0.9835 57.84 394.08 Tm -0.0321 Tc 0.9358 Tw (tators have suggested the use of a durable power of) Tj 0.257 -11.9577 TD -0.0118 Tc 1.8561 Tw (attorney for this purpose \(13,302\). With a durable) Tj ET BT 0.9835 0 0 0.9835 57.6 370.08 Tm 0.0439 Tc 0.1836 Tw (power of attorney, a person who is still capable of) Tj 0.244 -11.7137 TD 0.0277 Tc 0.1884 Tw (making decisions for himself or herself can desig-) Tj ET BT 0.934 0 0 0.9835 57.84 346.56 Tm -0.0318 Tc 1.0104 Tw (nate someone to make decisions in the future when) Tj ET BT 0.8915 0 0 0.9835 57.84 334.8 Tm 0.0561 Tc 0.6818 Tw (he or she is no longer capable. The problem with this) Tj ET BT 0.9835 0 0 0.9835 58.32 322.56 Tm 0.0274 Tc 0.6071 Tw (approach is that most special care unit residents) Tj ET BT 0.8915 0 0 0.9835 57.84 310.56 Tm 0.0591 Tc 0.9207 Tw (probably are not capable of executing a valid durable) Tj ET BT 0.934 0 0 0.9835 57.84 298.56 Tm -0.0307 Tc 0.7844 Tw (power of attorney, and many will not have executed) Tj 0.7709 -12.2018 TD -0.0383 Tc 1.5175 Tw (a durable power of attorney for research participa-) Tj ET BT 0.9835 0 0 0.9835 58.56 274.32 Tm 0.0386 Tc 0.2703 Tw (tion at an earlier time when they were capable of) Tj ET BT 0.8491 0 0 0.9835 58.56 262.56 Tm 0.0178 Tc 1.7198 Tw (doing SO.) Tj ET BT 0.934 0 0 0.9835 69.84 238.32 Tm -0.0306 Tc 1.7906 Tw (Some special care units now require individuals) Tj -12.0769 -11.9577 TD -0.0315 Tc 1.267 Tw (with dementia to have a durable power of attorney) Tj 0 -12.2018 TD -0.0449 Tc 1.1207 Tw (for health care decisions prior to their admission to) Tj 0.257 -12.4458 TD -0.0319 Tc 1.1802 Tw (the unit. Anecdotal evidence indicates that in some) Tj ET BT 0.9835 0 0 0.9835 58.8 190.32 Tm 0.0326 Tc 3.2048 Tw (cases, these documents are being executed by) Tj ET BT 0.8915 0 0 0.9835 59.04 178.32 Tm 0.0472 Tc 1.5878 Tw (individuals who are not capable of making decisions) Tj ET BT 0.934 0 0 0.9835 59.04 166.08 Tm -0.0218 Tc 1.0593 Tw (for themselves \(156\). The same problem could arise) Tj ET BT 0.9835 0 0 0.9835 59.04 154.08 Tm 0.0387 Tc 2.7919 Tw (with a durable power of attorney for research) Tj ET BT 0.8915 0 0 0.9835 58.8 141.84 Tm 0.0253 Tc 0 Tw (participation.) Tj 13.1905 -23.9155 TD 0.0457 Tc 0.9358 Tw (Other approaches that have been proposed are the) Tj ET BT 0.934 0 0 0.9835 59.04 106.56 Tm -0.0154 Tc 1.314 Tw (use of a nursing home council \(13\), a multidiscipli-) Tj ET BT 0.9835 0 0 0.9835 59.04 94.8 Tm 0.0193 Tc 0.0924 Tw (nary nursing home committee \(23,74\), or an inde-) Tj ET BT 0.8915 0 0 0.9835 59.04 82.8 Tm 0.0386 Tc 1.7514 Tw (pendent advocacy group \(29\) to approve and oversee) Tj ET BT 0.9835 0 0 0.9835 59.28 71.28 Tm 0.0175 Tc 0.7636 Tw (nursing home research, including the procedures) Tj 0.244 -12.2018 TD 0.0381 Tc 1.677 Tw (that would be used to obtain informed consent.) Tj 0 -11.9577 TD 0.0462 Tc 2.7494 Tw (Certainly if a panel were established to allow) Tj ET BT 0.934 0 0 0.9835 59.52 35.76 Tm -0.0318 Tc 1.07 Tw (waivers for special care unit research, as suggested) Tj ET BT 0.8915 0 0 0.9835 307.44 644.16 Tm 0.0429 Tc 0.4005 Tw (earlier in this chapter, that panel could perform these) Tj 0 -12.4458 TD 0.0185 Tc 0 Tw (functions.) Tj 12.1137 -18.3027 TD 0.0158 Tc 0.7338 Tw (Lastly, it must be noted that although most special) Tj -11.8446 -12.2018 TD 0.0534 Tc 0.6916 Tw (care unit residents probably are not capable of giving) Tj -0.2692 -12.2018 TD 0.038 Tc 0.9444 Tw (valid informed consent, some are, and they should be) Tj ET BT 0.934 0 0 0.9835 307.92 578.16 Tm -0.0204 Tc 1.3942 Tw (asked. Preliminary findings of the ongoing Univer-) Tj ET BT 0.9835 0 0 0.9835 308.16 565.92 Tm 0.0373 Tc 3.3512 Tw (sity of Chicago study of informed consent for) Tj ET BT 0.934 0 0 0.9835 307.68 554.16 Tm -0.0286 Tc 1.9384 Tw (research participation by noninstitutionalized indi-) Tj ET BT 0.9835 0 0 0.9835 307.92 541.92 Tm 0.0299 Tc 1.4413 Tw (viduals with dementia show that many of these) Tj ET BT 0.934 0 0 0.9835 308.16 530.4 Tm -0.0329 Tc 1.8788 Tw (individuals are able to provide helpful information) Tj ET BT 0.8915 0 0 0.9835 308.4 518.16 Tm 0.0471 Tc 0.8189 Tw (about their values and preferences, even though they) Tj ET BT 0.9835 0 0 0.9835 308.4 506.16 Tm 0.0366 Tc 1.0858 Tw (are not capable of giving valid informed consent) Tj 0.4881 -11.9577 TD 0.0301 Tc 1.0576 Tw (\(395\). Some and perhaps many special care unit) Tj -0.7321 -11.7137 TD 0.0363 Tc 1.3999 Tw (residents may also be capable of providing such) Tj ET BT 0.8915 0 0 0.9835 308.64 470.88 Tm 0.036 Tc 0 Tw (information.) Tj ET BT 0.9663 0 0 0.9939 310.08 443.76 Tm /F6 14 Tf 0.0216 Tc 1.94 Tw (OTHER ISSUES OF IMPORTANCE) Tj ET BT 0.9939 0 0 0.9939 312.48 428.16 Tm 0.0257 Tc 0.3364 Tw (TO NURSING HOME RESIDENTS) Tj 49.9863 -16.1791 TD 0.0531 Tc 0.0674 Tw (WITH DEMENTIA) Tj ET BT 0.9835 0 0 0.9835 319.92 394.32 Tm /F4 10 Tf 0.0328 Tc 2.1065 Tw (Three additional issues are important for all) Tj -11.2256 -12.2018 TD 0.0177 Tc 0.3729 Tw (nursing home residents with dementia, including) Tj ET BT 0.934 0 0 0.9835 309.6 370.32 Tm -0.0387 Tc 2.0318 Tw (special care unit residents. These three issues are) Tj -0.257 -11.9577 TD -0.0398 Tc 2.6571 Tw (discussed briefly below.) Tj ET BT 0.9795 0 0 0.9795 325.44 333.6 Tm /F7 12 Tf 0.0459 Tc 0.3209 Tw (The Availability of Physicians\222 Services) Tj ET BT 0.934 0 0 0.9835 320.4 315.6 Tm /F4 10 Tf -0.0235 Tc 1.7402 Tw (Physicians\222 services are essential for all nursing) Tj -11.82 -12.2018 TD -0.0404 Tc 1.2628 Tw (home residents with dementia. Yet the special care) Tj ET BT 0.8915 0 0 0.9835 309.36 291.6 Tm 0.0405 Tc 1.1435 Tw (unit literature contains little discussion of the role of) Tj ET BT 0.934 0 0 0.9835 309.6 279.6 Tm -0.0303 Tc 1.1051 Tw (physicians in special care units. With the exception) Tj ET BT 0.9835 0 0 0.9835 309.6 267.6 Tm 0.0336 Tc 1.4956 Tw (of the Tennessee regulations, the existing State) Tj -0.244 -12.2018 TD 0.0308 Tc 0.8477 Tw (regulations for special care units do not mention) Tj ET BT 0.8915 0 0 0.9835 309.6 243.84 Tm 0.0415 Tc 0.9021 Tw (physicians except to require that a physician approve) Tj ET BT 0.934 0 0 0.9835 310.08 231.84 Tm -0.0244 Tc 0.4885 Tw (a resident\222s admission to the unit and document the) Tj -0.5139 -12.2018 TD -0.0268 Tc 0.9729 Tw (reason for the admission. Requirements for ongoing) Tj ET BT 0.9835 0 0 0.9835 309.6 207.6 Tm 0.0361 Tc 1.4698 Tw (physician care appear in other sections of these) Tj ET BT 0.8915 0 0 0.9835 310.32 195.6 Tm 0.0447 Tc 1.4753 Tw (States\222 nursing home regulations and in the Federal) Tj ET BT 0.934 0 0 0.9835 309.6 183.6 Tm -0.0384 Tc 1.6277 Tw (regulations for Medicare and Medicaid certification) Tj 0.7709 -12.4458 TD -0.0168 Tc 0.8658 Tw (of nursing homes. The lack of such requirements in) Tj 0 -12.4458 TD -0.0351 Tc 2.0096 Tw (the special care unit regulations implies, however,) Tj 0 -12.2018 TD -0.0325 Tc 1.1503 Tw (that physicians\222 role is limited to admission-related) Tj ET BT 0.9835 0 0 0.9835 310.32 135.36 Tm 0.6624 Tc 0 Tw (fictions.) Tj ET BT 0.934 0 0 0.9835 321.6 118.08 Tm -0.0375 Tc 1.223 Tw (Clearly, the appropriate role of physicians in the) Tj -11.82 -11.9577 TD -0.0328 Tc 1.328 Tw (care of nursing home residents with dementia goes) Tj 0 -11.9577 TD -0.0258 Tc 1.7855 Tw (far beyond admission-related functions. One of the) Tj ET BT 0.9835 0 0 0.9835 310.56 82.8 Tm 0.0338 Tc 0.5657 Tw (most frequent complaints about the care of these) Tj -0.244 -12.2018 TD 0.024 Tc 0.8197 Tw (residents is that acute and chronic illnesses that) Tj ET BT 0.934 0 0 0.9835 310.56 59.04 Tm -0.0318 Tc 1.7748 Tw (exacerbate their cognitive impairments and reduce) Tj ET BT 0.8915 0 0 0.9835 310.56 47.04 Tm 0.0383 Tc 1.6363 Tw (their functioning often are not diagnosed or treated.) Tj ET BT 0.9835 0 0 0.9835 310.56 35.04 Tm 0.0338 Tc 2.1868 Tw (Diagnosis and treatment of these illnesses will) Tj ET endstream endobj 168 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 169 0 obj <>stream 0.72 w 1 j 0 0 0 RG 77.04 683.04 m 555.84 683.04 l S BT 0.9835 0 0 0.9835 77.04 689.52 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (48 ) Tj ET BT 0.9598 0 0 0.9598 90 689.52 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.48 689.52 Tm /F5 10 Tf 0.0125 Tc 1.0922 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 77.04 650.16 Tm /F4 10 Tf -0.0402 Tc 1.6725 Tw (reduce excess disability and improve the residents\222) Tj ET BT 0.8915 0 0 0.9835 77.76 637.92 Tm 0.0361 Tc 1.2457 Tw (quality of life, even if the conditions that cause their) Tj ET BT 0.9835 0 0 0.9835 77.76 626.16 Tm 0.0278 Tc 0.3627 Tw (dementia are incurable and progressive. Ongoing) Tj -0.244 -11.9577 TD 0.0322 Tc 0.1141 Tw (physician involvement is essential to identify and) Tj ET BT 0.934 0 0 0.9835 77.76 602.4 Tm -0.0339 Tc 0.6465 Tw (treat residents\222 acute and chronic illnesses.) Tj 12.3339 -18.3027 TD -0.0363 Tc 0.9831 Tw (One stated objective of some special care units is) Tj ET BT 0.9835 0 0 0.9835 78.24 572.64 Tm 0.0314 Tc 0.3048 Tw (to get away from the \221\221medical model\224 of care and) Tj ET BT 0.934 0 0 0.9835 78.48 560.64 Tm -0.0267 Tc 1.8721 Tw (adopt a) Tj ET BT 0.9835 0 0 0.9835 117.12 560.64 Tm 0.0182 Tc 1.9586 Tw (\221\221social model\222 instead. Semantics aside,) Tj ET BT 0.934 0 0 0.9835 78.48 548.88 Tm -0.0343 Tc 1.2378 Tw (this objective is unrelated to the role of physicians,) Tj 0 -12.2018 TD -0.0243 Tc 1.0987 Tw (who are as essential in a social as a medical model) Tj ET BT 0.9835 0 0 0.9835 78.72 525.12 Tm 0.0197 Tc 0.7776 Tw (of care \(146\). In special care units, as in nursing) Tj -0.244 -12.2018 TD 0.021 Tc 2.3219 Tw (homes generally, the physician may be a team) Tj ET BT 0.8915 0 0 0.9835 78.48 501.12 Tm 0.0434 Tc 0.9721 Tw (member rather than the team leader \(226\), but there) Tj 0.2692 -11.9577 TD 0.049 Tc 1.2312 Tw (is no question about the need for initial and ongoing) Tj ET BT 0.934 0 0 0.9835 78.48 477.12 Tm -0.0317 Tc 1.2167 Tw (physician involvement in the care of residents with) Tj ET BT 0.9835 0 0 0.9835 79.2 465.36 Tm 0.0237 Tc 0.6109 Tw (dementia in special care units and other nursing) Tj ET BT 0.8915 0 0 0.9835 78.96 453.36 Tm 0.0253 Tc 2.5738 Tw (home units.) Tj ET BT 0.9795 0 0 0.9795 88.08 423.12 Tm /F7 12 Tf 0.0576 Tc 0.0762 Tw (The Availability of Mental Health Services) Tj ET BT 0.9835 0 0 0.9835 90.24 405.36 Tm /F4 10 Tf 0.0295 Tc 3.33 Tw (Many commentators have noted the lack of) Tj ET BT 0.934 0 0 0.9835 79.92 393.6 Tm -0.0142 Tc 1.6446 Tw (adequate mental health services in nursing homes) Tj ET BT 0.9835 0 0 0.9835 79.92 381.36 Tm 0.0272 Tc 3.5358 Tw (\(58,175,339,393\). Although Alzheimer\222s disease) Tj ET BT 0.934 0 0 0.9835 79.92 369.36 Tm -0.0252 Tc 0.9712 Tw (and most of the other diseases that cause dementia) Tj 0 -12.2018 TD -0.039 Tc 1.4142 Tw (generally are not considered mental illnesses, their) Tj T* -0.0126 Tc 2.3196 Tw (manifestations include mental, emotional, and be-) Tj ET BT 0.9835 0 0 0.9835 79.92 333.6 Tm 0.0268 Tc 0.4043 Tw (havioral symptoms that may respond to behavior) Tj ET BT 0.934 0 0 0.9835 79.92 321.6 Tm -0.0199 Tc 1.8649 Tw (management techniques, psychotropic medications,) Tj 0.7709 -12.4458 TD -0.013 Tc 1.4977 Tw (and other mental health treatments. Psychiatrists,) Tj -0.7709 -12.2018 TD -0.0292 Tc 2.0675 Tw (psychologists, psychiatric nurses, psychiatric social) Tj ET BT 0.8915 0 0 0.9835 80.4 285.6 Tm 0.0392 Tc 1.661 Tw (workers, and other mental health professionals with) Tj ET BT 0.934 0 0 0.9835 80.4 273.6 Tm -0.0309 Tc 1.7665 Tw (expertise in the evaluation and treatment of these) Tj 0.5139 -12.2018 TD -0.0208 Tc 1.2491 Tw (symptoms seldom work in nursing homes.) Tj ET BT 0.9835 0 0 0.9835 91.44 243.84 Tm 0.0288 Tc 0.4314 Tw (The lack of adequate mental health services in) Tj ET BT 0.8915 0 0 0.9835 80.4 232.08 Tm 0.0342 Tc 0.7564 Tw (most nursing homes is attributable to several factors.) Tj ET BT 0.9835 0 0 0.9835 80.64 219.84 Tm 0.024 Tc 1.1291 Tw (One factor is a lack of reimbursement. A second) Tj ET BT 0.934 0 0 0.9835 80.64 207.84 Tm -0.0355 Tc 0.1686 Tw (factor is the ) Tj ET BT 0.9443 0 0 0.9812 134.88 207.84 Tm /F5 11 Tf -0.0028 Tc 0.0472 Tw (IMD exclusion. ) Tj ET BT 0.934 0 0 0.9835 201.36 207.84 Tm /F4 10 Tf -0.031 Tc 0.7632 Tw (As an optional Medicaid) Tj ET BT 0.9835 0 0 0.9835 80.64 195.84 Tm 0.0456 Tc 2.0935 Tw (benefit, States may choose to provide Medicaid) Tj ET BT 0.8915 0 0 0.9835 80.64 183.84 Tm 0.0515 Tc 1.5831 Tw (reimbursement for the care of individuals under age) Tj ET BT 0.9835 0 0 0.9835 81.12 171.84 Tm 0.0404 Tc 0.8921 Tw (22 or over age 65\227but not individuals age 22 to) Tj 0.244 -12.2018 TD 0.0207 Tc 1.346 Tw (65\227in an) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 131.28 159.84 Tm /F5 11 Tf 0.074 Tc 2.7375 Tw (institution for mental diseases \(IMD\).) Tj ET BT 0.934 0 0 0.9835 81.12 148.08 Tm /F4 10 Tf -0.0151 Tc 1.1622 Tw (Medicaid regulations define an IMD as \221\221an institu-) Tj 0.257 -12.4458 TD -0.0249 Tc 1.3563 Tw (tion that is primarily engaged in providing diagno-) Tj ET BT 0.9835 0 0 0.9835 81.6 124.08 Tm 0.0199 Tc 2.7065 Tw (sis, treatment, or care of persons with mental) Tj ET BT 0.934 0 0 0.9835 81.36 112.08 Tm -0.0212 Tc 1.1468 Tw (diseases, including medical attention, nursing care,) Tj ET BT 0.9835 0 0 0.9835 81.6 100.32 Tm 0.0277 Tc 1.2474 Tw (and related services\222 \(460\). If a nursing home is) Tj ET BT 0.934 0 0 0.9835 81.36 88.32 Tm -0.0247 Tc 1.6451 Tw (classified as an IMD, it loses Medicaid funding for) Tj 0 -12.2018 TD -0.0137 Tc 0.5034 Tw (all its residents age 22 to 65. If the nursing home is) Tj ET BT 0.8915 0 0 0.9835 81.12 64.32 Tm 0.0288 Tc 1.1229 Tw (in a State that does not provide Medicaid reimburse-) Tj ET BT 0.934 0 0 0.9835 80.88 52.56 Tm -0.0296 Tc 0.619 Tw (ment for care in IMDs, it loses Medicaid funding for) Tj ET BT 0.8915 0 0 0.9835 81.36 40.32 Tm 0.0368 Tc 1.2748 Tw (all its residents. Because of a fear of being classified) Tj ET BT 0.9863 0 0 0.9863 329.04 649.92 Tm /F3 9 Tf 0.1017 Tc 1.0438 Tw (as an) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 356.88 649.92 Tm /F4 10 Tf 0.027 Tc 2.8445 Tw (IMD, some nursing homes choose not to) Tj ET BT 0.934 0 0 0.9835 329.04 637.68 Tm -0.0362 Tc 1.7967 Tw (employ mental health professionals, not to provide) Tj 0 -11.7137 TD 0.0003 Tc 1.021 Tw (mental health services, or both \(192,205\).) Tj 11.563 -18.3027 TD -0.0363 Tc 0.5655 Tw (Medicaid regulations cite 10 criteria to be used in) Tj -11.306 -12.4458 TD -0.0207 Tc 0.5809 Tw (determining whether a facility is an IMD. No single) Tj 0 -12.2018 TD -0.0438 Tc 1.6656 Tw (criterion is definitive; rather, the criteria are to be) Tj ET BT 0.9835 0 0 0.9835 329.28 572.16 Tm 0.033 Tc 2.2283 Tw (used together to determine whether a facility\222s) Tj ET BT 0.8915 0 0 0.9835 330 559.92 Tm 0.0468 Tc 0.8336 Tw (\221\221overall character is that of a facility established and) Tj ET BT 0.934 0 0 0.9835 329.52 548.4 Tm -0.0222 Tc 1.2066 Tw (maintained primarily for the care and treatment of) Tj 0.257 -12.2018 TD -0.0183 Tc 1.0923 Tw (individuals with mental diseases\224 \(460\). Two of the) Tj 0 -12.2018 TD -0.0296 Tc 0.8107 Tw (criteria are troublesome to nursing homes that care) Tj 0.257 -12.2018 TD -0.0263 Tc 0.8439 Tw (for individuals with dementia:) Tj ET BT 0.7642 0 0 0.9835 342 494.4 Tm 0.2632 Tc 0 Tw (1\)) Tj ET BT 0.8915 0 0 0.9835 341.76 386.4 Tm 0.2632 Tc (2\)) Tj ET BT 0.9126 0 0 0.9863 355.92 494.16 Tm /F3 9 Tf -0 Tc 0.1265 Tw (\223The ) Tj ET BT 0.8915 0 0 0.9835 376.8 494.16 Tm /F4 10 Tf 0.0383 Tc 0.2038 Tw (facility specializes in providing psychiatric/) Tj -23.4199 -12.4458 TD 0.0464 Tc 1.3836 Tw (psychological care and treatment. This may be) Tj ET BT 0.9835 0 0 0.9835 356.4 470.16 Tm 0.0331 Tc 1.2358 Tw (ascertained through review of patients\222 re-) Tj ET BT 0.8915 0 0 0.9835 356.16 458.16 Tm 0.0217 Tc 1.1421 Tw (cords. It may also be indicated by the fact that) Tj ET BT 0.934 0 0 0.9835 356.4 445.92 Tm -0.0152 Tc 0.7953 Tw (an unusually large proportion of the staff has) Tj 0 -12.2018 TD -0.0312 Tc 3.9325 Tw (specialized psychiatric/psychological training) Tj ET BT 0.9835 0 0 0.9835 356.4 422.16 Tm 0.0397 Tc 0.5132 Tw (or by the fact that a large proportion of the) Tj ET BT 0.934 0 0 0.9835 356.16 410.16 Tm -0.0314 Tc 2.1341 Tw (patients are receiving psychopharmacological) Tj ET BT 0.9835 0 0 0.9835 356.4 398.4 Tm 0.0237 Tc 1.831 Tw (drugs\224 \(460\).) Tj ET BT 0.8915 0 0 0.9835 356.88 386.4 Tm 0.0352 Tc 0.5886 Tw (\223More than 50 percent of all the patients in the) Tj ET BT 0.9835 0 0 0.9835 356.88 374.16 Tm 0.0265 Tc 0.5592 Tw (facility have mental diseases which require) Tj ET BT 0.934 0 0 0.9835 356.88 362.16 Tm -0.0298 Tc 0.8477 Tw (inpatient treatment according to the patients\222) Tj ET BT 0.9835 0 0 0.9835 356.88 351.12 Tm 0.0292 Tc 0.8493 Tw (medical records\224 \(460\).) Tj ET BT 0.934 0 0 0.9835 342 333.12 Tm -0.045 Tc 1.3135 Tw (The second criterion, often referred to as the \22350) Tj ET BT 0.9835 0 0 0.9835 331.2 320.88 Tm 0.0195 Tc 1.3472 Tw (percent rule,\224) Tj 70.2823 0 TD 0.0308 Tc 0.3596 Tw (excludes residents with senility or) Tj ET BT 0.934 0 0 0.9835 331.68 308.88 Tm -0.0161 Tc 1.7323 Tw (organic brain syndrome) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 441.36 308.88 Tm /F5 11 Tf 0.0135 Tc 1.3642 Tw (\223if the facility is appropri-) Tj -116.4026 -11.985 TD 0.0246 Tc 1.3615 Tw (ately treating the patients by providing only general) Tj 0.2542 -12.2296 TD 0.0353 Tc 1.0234 Tw (nursing care. \224) Tj ET BT 0.9835 0 0 0.9835 402.96 285.12 Tm /F4 10 Tf 0.0208 Tc -0.1183 Tw (According ) Tj ET BT 0.9863 0 0 0.9863 451.92 285.12 Tm /F3 9 Tf 0.0275 Tc 0.024 Tw (to the ) Tj ET BT 0.9835 0 0 0.9835 479.04 285.12 Tm /F4 10 Tf 0.021 Tc 1.5897 Tw (regulations, resi-) Tj -149.8379 -11.9577 TD 0.0234 Tc 0.0882 Tw (dents with senility or organic brain syndrome are) Tj ET BT 0.934 0 0 0.9835 331.92 261.36 Tm -0.0394 Tc 2.6566 Tw (excluded because these conditions \223are essentially) Tj ET BT 0.9835 0 0 0.9835 331.68 249.6 Tm 0.0315 Tc 1.335 Tw (untreatable from a mental health point of view\222) Tj 0.4881 -11.9577 TD 0.0278 Tc 2.8437 Tw (\(460\). Residents with senility or organic brain) Tj ET BT 0.934 0 0 0.9835 332.16 225.6 Tm -0.0388 Tc 0.6324 Tw (syndrome are not excluded from the 50 percent rule) Tj ET BT 0.9835 0 0 0.9835 332.64 213.84 Tm 0.033 Tc 1.608 Tw (\223if the facility is treating these patients for the) Tj ET BT 0.934 0 0 0.9835 331.92 201.6 Tm -0.0464 Tc 0.769 Tw (effects of a mental disorder, as opposed to providing) Tj ET BT 0.9835 0 0 0.9835 332.64 189.6 Tm 0.0283 Tc 0.9722 Tw (general nursing and other medical and remedial) Tj -0.244 -12.2018 TD 0.0278 Tc 2.0709 Tw (care\224 \(460\).) Tj ET BT 0.934 0 0 0.9835 343.2 159.84 Tm -0.0281 Tc 1.3597 Tw (A third factor that may discourage the provision) Tj ET BT 0.9835 0 0 0.9835 332.64 148.08 Tm 0.0192 Tc 2.8117 Tw (of mental health services in nursing homes is) Tj ET BT 0.934 0 0 0.9835 332.64 135.84 Tm -0.0215 Tc 2.586 Tw (Preadmission Screening and Annual Resident Re-) Tj 0 -11.7137 TD -0.0027 Tc 1.2041 Tw (view \(PASARR\), a program mandated by OBRA-87) Tj 0 -12.2018 TD -0.0167 Tc 1.4117 Tw (that requires States to: 1\) screen all nursing home) Tj ET BT 0.8915 0 0 0.9835 332.64 100.32 Tm 0.0347 Tc 1.8006 Tw (applicants and nursing home residents to determine) Tj 0 -12.2018 TD 0.0459 Tc 1.2816 Tw (whether they have mental illness or mental retarda-) Tj T* 0.0426 Tc 0.9662 Tw (tion, and 2\) evaluate all those who are found to have) Tj ET BT 0.9835 0 0 0.9835 332.16 64.08 Tm 0.0298 Tc -0.0868 Tw (mental illness or mental retardation to determine) Tj ET BT 0.934 0 0 0.9835 332.64 52.08 Tm -0.0298 Tc 1.1046 Tw (whether they need nursing home care and whether) Tj -0.257 -12.2018 TD -0.0452 Tc 1.8919 Tw (they need) Tj ET BT 0.9835 0 0 0.9835 381.36 40.08 Tm 0.0262 Tc 1.4015 Tw (\221\221specialized services\224 for their mental) Tj ET endstream endobj 170 0 obj <>/Rotate 0/Type/Page>> endobj 171 0 obj <>stream 0.48 w 1 j 0 0 0 RG 54.72 671.76 m 533.28 671.76 l S 58.56 53.76 m 537.36 53.76 l S BT 0.9835 0 0 0.9835 322.32 677.28 Tm 0 0 0 rg /F5 10 Tf 0.0115 Tc 3.0184 Tw (Chapter l-Overview and Policy Implications . 49) Tj -271.8557 -39.7778 TD /F4 10 Tf 0.0274 Tc 2.8441 Tw (illness or mental retardation. Mentally ill and) Tj 0.244 -12.2018 TD 0.0265 Tc 1.6329 Tw (mentally retarded nursing home applicants and) Tj -0.244 -11.9577 TD 0.0425 Tc 0.1734 Tw (residents who are found in a PASARR evaluation) Tj ET BT 0.934 0 0 0.9835 55.2 602.4 Tm -0.0435 Tc 1.6617 Tw (not to need nursing home care or to need \223special-) Tj 0.257 -12.2018 TD -0.0386 Tc 2.3988 Tw (ized services\224 must be placed elsewhere. Mentally) Tj ET BT 0.9835 0 0 0.9835 55.44 578.16 Tm 0.0271 Tc 0.16 Tw (ill and mentally retarded nursing home residents) Tj ET BT 0.934 0 0 0.9835 55.68 566.16 Tm -0.0091 Tc 0.9025 Tw (who have been in a nursing home for 30 months or) Tj ET BT 0.8915 0 0 0.9835 55.44 554.16 Tm 0.0689 Tc 0.9097 Tw (more can choose to remain in the nursing home even) Tj 0.8076 -11.9577 TD 0.0504 Tc 0.7347 Tw (if they are found not to need nursing home care or to) Tj ET BT 0.9835 0 0 0.9835 55.92 530.4 Tm 0.0441 Tc 1.3223 Tw (need \223specialized services\224 \(320\).) Tj 11.2256 -18.3027 TD 0.0377 Tc 1.8168 Tw (The impact of PASARR on the availability of) Tj ET BT 0.934 0 0 0.9835 56.16 500.88 Tm -0.0178 Tc 1.1652 Tw (mental health services in nursing homes is unclear) Tj 0.257 -12.2018 TD -0.0211 Tc 1.1687 Tw (and probably differs from State to State. Anecdotal) Tj ET BT 0.9835 0 0 0.9835 56.16 477.12 Tm 0.0296 Tc 2.0342 Tw (evidence suggests that at least in some States,) Tj 0.244 -11.9577 TD 0.0439 Tc 2.5731 Tw (PASAAR has had the same effect as the IMD) Tj ET BT 0.934 0 0 0.9835 56.64 453.36 Tm -0.0191 Tc 0.4324 Tw (exclusion\227that is, to cause some nursing homes not) Tj ET BT 0.9835 0 0 0.9835 56.64 441.36 Tm 0.0366 Tc 3.4449 Tw (to employ mental health professionals, not to) Tj ET BT 0.934 0 0 0.9835 56.4 429.6 Tm -0.0303 Tc 1.7659 Tw (provide mental health services, or both, because of) Tj ET BT 0.9835 0 0 0.9835 56.88 417.6 Tm 0.03 Tc 1.245 Tw (a fear that if the facility employs mental health) Tj ET BT 0.934 0 0 0.9835 56.64 405.84 Tm -0.0393 Tc 1.8 Tw (professionals or provides mental health services, it) Tj ET BT 0.9835 0 0 0.9835 56.88 393.6 Tm 0.0397 Tc 0.2895 Tw (will be perceived as caring for mentally ill people) Tj ET BT 0.934 0 0 0.9835 57.12 381.6 Tm -0.0362 Tc 1.4968 Tw (and therefore lose Medicaid funding.) Tj 11.563 -18.0586 TD -0.0374 Tc 1.0271 Tw (The Federal regulations for Medicare and Medic-) Tj ET BT 0.8915 0 0 0.9835 57.36 351.84 Tm 0.0482 Tc 1.6509 Tw (aid certification of nursing homes include provisions) Tj ET BT 0.9835 0 0 0.9835 57.36 339.84 Tm 0.0371 Tc 2.3752 Tw (that would seem to require the involvement of) Tj ET BT 0.934 0 0 0.9835 57.12 328.08 Tm -0.0235 Tc 1.8687 Tw (mental health professionals in assessing residents\222) Tj 0.5139 -12.4458 TD -0.0303 Tc 0.8803 Tw (care needs and the provision of some mental health) Tj 0.257 -12.2018 TD -0.0451 Tc 0 Tw (services.) Tj ET BT 0.9557 0 0 1.08 96 308.64 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (19 ) Tj ET BT 0.934 0 0 0.9835 101.76 303.84 Tm /F4 10 Tf -0.0397 Tc 1.2253 Tw (It is unclear how these provisions will be) Tj ET BT 0.8915 0 0 0.9835 57.6 292.08 Tm 0.0215 Tc 2.5781 Tw (interpreted and implemented.) Tj ET BT 0.9835 0 0 0.9835 68.4 274.08 Tm 0.0324 Tc 1.871 Tw (The American Association of Retired Persons) Tj -10.4935 -12.4458 TD 0.0275 Tc -0.0946 Tw (\(AARP\) is currently funding a study of barriers to) Tj -0.4881 -11.9577 TD 0.0166 Tc 1.4199 Tw (mental health care in nursing homes \(260\). The) Tj ET BT 0.934 0 0 0.9835 58.08 238.08 Tm -0.0341 Tc 0.6916 Tw (study, which will be completed in 1993, will provide) Tj 0 -11.9577 TD -0.0107 Tc 1.2769 Tw (information about regulations, reimbursement, and) Tj ET BT 0.9835 0 0 0.9835 58.08 214.08 Tm 0.0266 Tc 0.4685 Tw (other factors that interfere with access to mental) Tj -0.244 -11.9577 TD 0.0195 Tc 2.8521 Tw (health services by all nursing home residents,) Tj ET BT 0.8915 0 0 0.9835 58.08 189.84 Tm 0.0296 Tc 2.5691 Tw (including residents with dementia.) Tj ET BT 0.9795 0 0 0.9795 79.68 165.84 Tm /F7 12 Tf 0.0478 Tc 0.5028 Tw (The Use of Psychotropic Medications) Tj ET BT 0.9835 0 0 0.9835 69.12 147.6 Tm /F4 10 Tf 0.036 Tc 0.8075 Tw (As noted earlier, a large proportion of nursing) Tj -10.9816 -11.9577 TD 0.0291 Tc 0.4224 Tw (home residents receive psychotropic medications,) Tj 0.244 -12.4458 TD 0.0292 Tc -0.0571 Tw (and residents with dementia are more likely than) Tj 0 -11.9577 TD 0.0316 Tc 0.1554 Tw (other residents to receive these medications. Psy-) Tj ET BT 0.934 0 0 0.9835 58.56 99.84 Tm -0.0466 Tc 2.0648 Tw (chotropic medications are frequently referred to in) Tj ET BT 0.9835 0 0 0.9835 58.8 88.32 Tm 0.0336 Tc 0.81 Tw (the special care unit literature and elsewhere as) Tj ET BT 0.9812 0 0 0.9812 58.8 76.32 Tm /F5 11 Tf 0.082 Tc 0.2223 Tw (chemical restraints ) Tj ET BT 0.9835 0 0 0.9835 147.6 76.32 Tm /F4 10 Tf 0.0361 Tc -0.1338 Tw (or ) Tj ET BT 0.9812 0 0 0.9812 159.84 76.32 Tm /F5 11 Tf 0.0918 Tc 2.2914 Tw (pharmacological restraints.) Tj ET BT 0.9443 0 0 0.9812 58.8 64.56 Tm 0.0037 Tc 0.0403 Tw (The ) Tj ET BT 0.934 0 0 0.9835 77.52 64.56 Tm /F4 10 Tf -0.0545 Tc 0.8741 Tw (use of the word ) Tj ET BT 0.9444 0 0 0.9835 149.52 64.56 Tm /F5 10 Tf -0.0071 Tc 0.556 Tw (restraints in this ) Tj ET BT 0.934 0 0 0.9835 216 64.56 Tm /F4 10 Tf -0.0458 Tc 4.4622 Tw (context implies) Tj ET BT 0.9863 0 0 0.9863 306.48 637.92 Tm /F3 9 Tf 0.0106 Tc -0.0805 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 325.44 637.92 Tm /F4 10 Tf 0.0313 Tc 0.9691 Tw (psychotropic medications are an undesirable) Tj ET BT 0.934 0 0 0.9835 306.48 625.92 Tm -0.0382 Tc 1.4134 Tw (treatment option. This implication fits well concep-) Tj 0 -12.2018 TD -0.0296 Tc 1.7284 Tw (tually with the growing concern about the overuse) Tj ET BT 0.9835 0 0 0.9835 306.72 602.16 Tm 0.0358 Tc 0.9646 Tw (and inappropriate use of physical restraints and) Tj ET BT 0.934 0 0 0.9835 306.48 589.92 Tm -0.0278 Tc 1.2737 Tw (psychotropic medications in nursing homes. On the) Tj ET BT 0.9835 0 0 0.9835 306.72 577.92 Tm 0.0217 Tc 0.5315 Tw (other hand, many commentators have noted that) Tj ET BT 0.934 0 0 0.9835 306.72 565.68 Tm -0.0261 Tc 2.077 Tw (psychotropic medications are a valuable treatment) Tj ET BT 0.9835 0 0 0.9835 306.96 553.68 Tm 0.5126 Tc 2.9933 Tw (option for some individuals with dementia) Tj 0.4881 -11.9577 TD 0.0134 Tc 1.1094 Tw (\(19,28,121,180,277,347,353,367,381,402,412\). For) Tj ET BT 0.934 0 0 0.9835 307.2 529.92 Tm -0.0384 Tc 1.936 Tw (individuals with depressive or psychotic symptoms) Tj 0.257 -12.2018 TD -0.0312 Tc 1.0547 Tw (or extreme agitation, psychotropic medications may) Tj -0.5139 -11.9577 TD -0.0294 Tc 0.7003 Tw (be the best treatment option. The important consid-) Tj ET BT 0.8915 0 0 0.9835 307.44 494.4 Tm 0.0415 Tc 0.761 Tw (eration in these instances is the selection of the right) Tj 0 -11.9577 TD 0.0325 Tc 0.7487 Tw (medication, in the right dose, for the right indication.) Tj ET BT 0.934 0 0 0.9835 318.72 464.64 Tm -0.037 Tc 2.4484 Tw (Clearly, psychotropic medications should not be) Tj ET BT 0.8915 0 0 0.9835 307.68 452.64 Tm 0.0489 Tc 1.3168 Tw (used as a substitute for behavioral or environmental) Tj ET BT 0.9835 0 0 0.9835 308.16 440.88 Tm 0.0318 Tc 2.3109 Tw (interventions that may be as effective or more) Tj -0.244 -12.2018 TD 0.0522 Tc -0.0892 Tw (effective and do not have the negative side effects) Tj 0.244 -12.2018 TD 0.0317 Tc 2.372 Tw (often associated with psychotropic medications.) Tj 0 -11.9577 TD 0.0505 Tc 1.0717 Tw (Research is needed to determine) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.934 0 0 0.9835 465.6 405.12 Tm -0.0267 Tc 2.9 Tw (the indications,) Tj ET BT 0.9835 0 0 0.9835 308.16 392.88 Tm 0.0391 Tc 3.1982 Tw (dosages, and long-term effects of various psy-) Tj 0 -11.9577 TD 0.028 Tc 1.6436 Tw (chotropic medications. Referring to psychotropic) Tj ET BT 0.934 0 0 0.9835 308.16 369.36 Tm -0.0204 Tc 0.3237 Tw (medications as ) Tj ET BT 0.9443 0 0 0.9812 375.6 369.36 Tm /F5 11 Tf 0.0247 Tc 0.0181 Tw (restraints ) Tj ET BT 0.934 0 0 0.9835 418.8 369.36 Tm /F4 10 Tf -0.0151 Tc 0.7462 Tw (may create an atmosphere) Tj -118.1996 -12.2018 TD -0.0373 Tc 1.0759 Tw (in which individuals with dementia will not receive) Tj 0 -12.2018 TD -0.0295 Tc 2.646 Tw (medications that could significantly improve their) Tj T* -0.0169 Tc 1.4762 Tw (quality of life.) Tj ET BT 0.9663 0 0 0.9939 324.48 308.4 Tm /F6 14 Tf 0.0487 Tc 1.0427 Tw (ALTERNATIVES TO SPECIAL) Tj 56.8771 -16.4206 TD 0.0519 Tc 1.1635 Tw (CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 319.68 274.32 Tm /F4 10 Tf 0.0655 Tc 2.0325 Tw (As noted) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 366.96 274.32 Tm /F3 9 Tf 0.0551 Tc 2.0644 Tw (at the beg) Tj 47.6925 -0.2433 TD 0.0402 Tc -0.1106 Tw (inning ) Tj ET BT 0.9835 0 0 0.9835 444.72 274.08 Tm /F4 10 Tf 0.026 Tc 1.3406 Tw (of this chapter, the) Tj ET BT 0.934 0 0 0.9835 308.64 262.56 Tm -0.0436 Tc 1.1622 Tw (proliferation of special care units is occurrin) Tj ET BT 0.8491 0 0 0.9835 504.24 262.08 Tm 0.0677 Tc 0.6718 Tw (g at the) Tj ET BT 0.9835 0 0 0.9835 309.36 250.32 Tm 0.0207 Tc 2.3628 Tw (same time as numerous other government and) Tj ET BT 0.8915 0 0 0.9835 308.88 238.8 Tm 0.0437 Tc 1.611 Tw (nongovernment initiatives that are likely to improve) Tj 0.5384 -12.2018 TD 0.0456 Tc 1.2051 Tw (the care of nursing home residents with dementia or) Tj ET BT 0.934 0 0 0.9835 308.88 215.04 Tm -0.0311 Tc 0.8123 Tw (provide alternatives to nursing home care for them.) Tj 0.257 -12.4458 TD -0.0359 Tc 1.7535 Tw (This section briefly describes a few of these initia-) Tj 0.257 -12.4458 TD -0.022 Tc 0.5502 Tw (tives. Each of the initiatives offers an alternate way) Tj 0.257 -12.4458 TD -0.0336 Tc 0.8196 Tw (of accomplishing one or more of the same objectives) Tj ET BT 0.8915 0 0 0.9835 309.6 166.32 Tm 0.0427 Tc 1.1186 Tw (as special care units.) Tj ET BT 0.9795 0 0 0.9795 319.2 143.28 Tm /F7 12 Tf 0.0419 Tc 0.4271 Tw (Initiatives To Reduce The Use of Physical) Tj -3.4304 -13.7218 TD 0.0348 Tc 0.8836 Tw (Restraints for All Nursing Home Residents) Tj ET BT 0.8875 0 0 0.9795 320.64 111.84 Tm 0.0348 Tc -0.0665 Tw (OBRA-87 ) Tj ET BT 0.8915 0 0 0.9835 368.64 111.84 Tm /F4 10 Tf 0.0588 Tc 1.594 Tw (and related legislation require nursing) Tj -66.2218 -11.7137 TD 0.0453 Tc 0.4988 Tw (homes to reduce their use of physical restraints. Prior) Tj ET BT 0.9835 0 0 0.9835 310.08 88.32 Tm 0.0419 Tc 2.6144 Tw (to and since the implementation of the OBRA) Tj ET BT 0.8915 0 0 0.9835 309.6 76.8 Tm 0.0416 Tc 0 Tw (regulations,) Tj ET BT 0.9835 0 0 0.9835 367.92 77.04 Tm 0.0438 Tc 1.8106 Tw (many organizations have developed) Tj -58.8126 -12.2018 TD 0.0167 Tc 0.7807 Tw (training programs and materials to help nursing) Tj ET q 4.56 0 0 -4.32 73.44 45.84 cm BI /W 29 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>>>>>>>>>>>>>>~~ EI Q BT 0.6036 0 0 0.9939 73.44 41.76 Tm 3 Tr /F2 7 Tf 0.0778 Tc 0 Tw (19) Tj 0 Tr ET BT 0.8719 0 0 0.9939 78 41.76 Tm 0 Tc -0.0988 Tw ( ) Tj ET q 10.08 0 0 -5.52 79.44 46.56 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p>~?|?x~<|x~σ<ǃ???`~~>??@ EI Q BT 1.1401 0 0 0.9939 79.44 41.76 Tm 3 Tr 0.0366 Tc 0 Tw (see) Tj 0 Tr ET BT 0.8719 0 0 0.9939 89.52 41.76 Tm 0 Tc -0.0988 Tw ( ) Tj ET q 23.28 0 0 -5.52 90.96 47.28 cm BI /W 141 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?|~>>~?|>π?|>ǀ8?|~ ||?~~p<<|?>x<>??||???p??p EI Q BT 1.1401 0 0 0.9939 90.96 41.76 Tm 3 Tr 0.012 Tc 0 Tw (sectio~) Tj 0 Tr ET BT 0.8719 0 0 0.9939 114.24 41.76 Tm 0 Tc -0.0988 Tw ( ) Tj ET q 53.52 0 0 -6.96 115.68 47.28 cm BI /W 320 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px|>><|xxxp`||<?<><?||<~|>?|?>>>?|q><?x<>|?|>|?|>|?|?>???|?<x?|x?><|x?~|<?|>?<?>>>?>?x>>?<|<?<~><?|>x?>??>x?x|~?<<||<??|??p8?p`` EI Q BT 1.1401 0 0 0.9939 115.68 41.76 Tm 3 Tr 0.0126 Tc 0 Tw (483.20@j\(2\)\(lll\)) Tj 0 Tr ET BT 0.8919 0 0 0.9835 169.2 41.76 Tm /F2 10 Tf 0.117 Tc -0.2109 Tw ( and ) Tj ET BT 0.9021 0 0 0.9598 186.96 41.76 Tm /F6 5 Tf -0.0475 Tc 0.1326 Tw (\(vii\), ) Tj ET BT 0.8919 0 0 0.9835 197.04 41.76 Tm /F2 10 Tf 0.0277 Tc 0.7503 Tw (483.20\(f\), and 483.45\(a\), Federal Register, ) Tj ET q 14.16 0 0 -7.2 357.6 47.28 cm BI /W 86 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?000x??~xxx|<>@>>>>?>~?~?x??>??????`?~~>> EI Q BT 0.6572 0 0 0.9835 357.6 41.76 Tm 3 Tr 0.0309 Tc 0 Tw (Sept.) Tj 0 Tr ET BT 0.8919 0 0 0.9835 371.76 41.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 4.8 0 0 -6.48 373.92 48 cm BI /W 30 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8|||~p??~||~? EI Q BT 0.6102 0 0 0.9835 373.92 41.76 Tm 3 Tr -0.0152 Tc 0 Tw (9,) Tj 0 Tr ET BT 0.8919 0 0 0.9835 378.72 41.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 13.2 0 0 -5.52 380.88 47.04 cm BI /W 79 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???~???~~~~~|~|~||||||~>p EI Q BT 0.6102 0 0 0.9835 380.88 41.76 Tm 3 Tr 0.1108 Tc 0 Tw (1991) Tj 0 Tr ET BT 0.8919 0 0 0.9835 394.08 41.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 17.04 0 0 -6.96 396.24 48.48 cm BI /W 103 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x88?|x?~x?~<xx|<||8||>x>xπ>x>>>>x~xx~xx||x|px?<8x<xx8<?<xp|8|| EI Q BT 0.6572 0 0 0.9835 396.24 41.76 Tm 3 Tr 0.0481 Tc 0 Tw (\(463\).) Tj 0 Tr ET q 5.04 0 0 -4.08 72.72 34.32 cm BI /W 33 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><?<>|xxx<<><? EI Q BT 0.637 0 0 0.99 72.72 30 Tm 3 Tr /F7 8 Tf 0.0221 Tc (zo) Tj 0 Tr ET BT 0.7926 0 0 0.9598 77.76 30 Tm /F3 6 Tf 0 Tc 0.1483 Tw ( ) Tj ET q 11.52 0 0 -6.72 79.2 35.76 cm BI /W 72 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 080|>??~~?~|?8<><||?`?||σ<??`~~~>? EI Q BT 1.2971 0 0 0.9598 79.2 30 Tm 3 Tr 0.0013 Tc 0 Tw (s=,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 90.72 30 Tm /F2 10 Tf 0.0708 Tc 0.3494 Tw ( for example, ) Tj ET q 18.48 0 0 -6.48 139.92 35.52 cm BI /W 115 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??~?>>>|a>|x~x|~xx|`~~|~<|<|???`???0 EI Q BT 0.7027 0 0 0.99 139.92 30 Tm 3 Tr /F3 8 Tf 0.0063 Tc 0 Tw (Rader,) Tj 0 Tr ET BT 0.798 0 0 0.9835 162.24 29.28 Tm /F2 10 Tf 0.038 Tc -0.1426 Tw (\223The ) Tj ET q 16.56 0 0 -7.2 180.96 34.56 cm BI /W 110 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8p||?||>||>||~||||||||||||||>||>>||>~|?~||||<<<?|?? EI Q BT 0.7041 0 0 0.9835 180.96 29.28 Tm 3 Tr 0.0105 Tc 0 Tw (JoyM) Tj 0 Tr ET BT 0.798 0 0 0.9835 197.52 29.28 Tm 0.0161 Tc 0.9876 Tw ( Road to Restraint- Free Care\224 \(360\).) Tj ET endstream endobj 172 0 obj <>/Rotate 0/Type/Page>> endobj 173 0 obj <>stream 0.72 w 1 j 0 0 0 RG 77.76 681.36 m 556.56 681.36 l S 79.92 72.72 m 331.2 72.72 l S 0.48 w 329.76 72.72 m 558.96 72.72 l S BT 0.9835 0 0 0.9835 77.76 688.56 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (50 ) Tj ET BT 0.9598 0 0 0.9598 90.96 688.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.99 0 0 0.99 97.44 688.56 Tm /F7 8 Tf 0.0341 Tc -0.0954 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 124.8 688.56 Tm /F5 10 Tf 0.0128 Tc 1.7562 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj -47.831 -40.0218 TD /F4 10 Tf 0.0256 Tc 0.4869 Tw (homes reduce the use of physical restraints.) Tj ET BT 1.08 0 0 1.08 281.28 654 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (20 ) Tj ET BT 0.9835 0 0 0.9835 287.28 649.2 Tm /F4 10 Tf 0.0082 Tc 0 Tw (The) Tj -212.7991 -12.2018 TD 0.0339 Tc 0.984 Tw (National Institute on Aging has funded a 3-year) Tj 0.244 -12.2018 TD 0.0251 Tc 1.5246 Tw (clinical trial on reducing the use of physical re-) Tj ET BT 0.934 0 0 0.9835 78.48 613.2 Tm -0.0132 Tc 1.408 Tw (straints in nursing homes, and the Food and Drug) Tj ET BT 0.8915 0 0 0.9835 78 601.2 Tm 0.0393 Tc 2.289 Tw (Administration \(FDA\) has increased its surveillance) Tj ET BT 0.9835 0 0 0.9835 78.48 589.2 Tm 0.033 Tc -0.1307 Tw (of restraining devices \(327\).) Tj ET BT 1.08 0 0 1.08 204.96 594 Tm /F4 4 Tf -0.0024 Tc 0 Tw (21) Tj ET BT 0.9835 0 0 0.9835 89.28 570.48 Tm /F4 10 Tf 0.0267 Tc 3.5769 Tw (In 1989, the Kendal Corp. in Pennsylvania) Tj ET BT 0.934 0 0 0.9835 78.48 558.72 Tm -0.0278 Tc 0.4921 Tw (initiated \223Untie the Elderly, \224 a national program to) Tj 0 -12.2018 TD -0.027 Tc 2.1808 Tw (create \221restraint-free\222 nursing homes. In December) Tj 1.2848 -11.9577 TD -0.0159 Tc 1.1998 Tw (1989, the corporation and the Senate Special Com-) Tj ET BT 0.9835 0 0 0.9835 78.48 522.96 Tm 0.0451 Tc 3.4199 Tw (mittee on Aging cosponsored a policy-oriented) Tj 0.7321 -12.4458 TD 0.0265 Tc 2.1768 Tw (symposium on reducing the use of physical re-) Tj 0 -11.9577 TD 0.0154 Tc 1.6361 Tw (straints in nursing homes. The corporation also) Tj ET BT 0.934 0 0 0.9835 79.2 486.96 Tm -0.042 Tc 2.1883 Tw (sponsors workshops to help nursing homes reduce) Tj ET BT 0.9835 0 0 0.9835 78.96 475.2 Tm 0.0288 Tc 1.8259 Tw (their use of physical restraints and publishes a) Tj 0.244 -12.4458 TD 0.0356 Tc 0.3954 Tw (newsletter that describes the successful efforts of) Tj ET BT 0.8915 0 0 0.9835 79.44 450.96 Tm 0.0432 Tc 1.6565 Tw (some nursing homes to decrease restraint use.) Tj ET BT 0.934 0 0 0.9835 90.24 432.24 Tm -0.0201 Tc 0.9015 Tw (In 1991, the Jewish Home and Hospital for Aged) Tj -11.82 -11.9577 TD -0.025 Tc 1.305 Tw (in New York City initiated a three and a half year) Tj ET BT 0.9835 0 0 0.9835 80.16 408.48 Tm 0.0171 Tc 1.7889 Tw (\223Restraint Minimization Project, \224 with funding) Tj -0.7321 -12.2018 TD 0.0191 Tc 3.2185 Tw (from the Commonwealth Fund. The project is) Tj ET BT 0.934 0 0 0.9835 79.68 384.48 Tm -0.0366 Tc 1.1547 Tw (intended to demonstrate ways of reducing restraint) Tj -0.257 -12.4458 TD -0.0122 Tc 0.372 Tw (use in nursing homes. It is being implemented in 14) Tj 0 -12.2018 TD 0.0027 Tc 0.2989 Tw (nursing homes in 4 States.) Tj ET BT 0.9835 0 0 0.9835 90.48 341.28 Tm 0.0176 Tc 2.8134 Tw (Nursing homes often use physical restraints) Tj ET BT 0.8915 0 0 0.9835 79.44 329.76 Tm 0.0454 Tc 1.4745 Tw (because they are afraid of being sued for fall-related) Tj ET BT 0.9835 0 0 0.9835 79.92 317.52 Tm 0.0312 Tc 0.9867 Tw (injuries to residents who are not restrained. Yet) Tj ET BT 0.8915 0 0 0.9835 79.44 305.52 Tm 0.0508 Tc 0.8627 Tw (historically, there has been a greater risk of facilities) Tj ET BT 0.9835 0 0 0.9835 79.68 293.76 Tm 0.0329 Tc 2.6583 Tw (being sued for overuse or misuse of restraints) Tj ET BT 0.934 0 0 0.9835 79.92 281.76 Tm 0.0021 Tc 1.1439 Tw (\(196,224\). By establishing a clear standard of care,) Tj ET BT 0.9835 0 0 0.9835 79.92 269.76 Tm 0.0388 Tc 1.4903 Tw (OBRA requirements for reduced use of physical) Tj ET BT 0.8915 0 0 0.9835 79.44 258.24 Tm 0.0422 Tc 0.4783 Tw (restraints will increase the legal risks associated with) Tj ET BT 0.934 0 0 0.9835 79.92 246 Tm -0.039 Tc 0.8575 Tw (their overuse or misuse.) Tj 11.563 -18.7907 TD -0.0307 Tc 1.2157 Tw (As noted earlier, several studies have found that) Tj ET BT 0.9835 0 0 0.9835 79.92 215.28 Tm 0.0289 Tc -0.0655 Tw (on average physical restraints are used far less in) Tj ET BT 0.934 0 0 0.9835 80.4 203.04 Tm -0.016 Tc 0.3511 Tw (special care units than in other nursing home units.) Tj ET BT 0.8915 0 0 0.9835 79.92 191.28 Tm 0.0422 Tc 0.6705 Tw (It is unclear whether this difference will be sustained) Tj 0.5384 -12.4458 TD 0.0363 Tc 1.9334 Tw (as the implementation of OBRA-87 creates pressure) Tj ET BT 0.934 0 0 0.9835 80.16 167.04 Tm -0.0313 Tc 0.735 Tw (on all nursing homes to reduce their use of physical) Tj ET BT 0.8915 0 0 0.9835 79.92 155.52 Tm 0.0329 Tc 1.3347 Tw (restraints. The 481 nursing homes that responded to) Tj ET BT 0.934 0 0 0.9835 80.4 143.52 Tm -0.0143 Tc 1.088 Tw (a 1991 surwey conducted by the American Associa-) Tj ET BT 0.9835 0 0 0.9835 80.4 131.76 Tm 0.041 Tc 2.4541 Tw (tion of Homes for the Aging reported that the) Tj -0.4881 -12.2018 TD 0.0387 Tc 0.4736 Tw (proportion of their residents who were physically) Tj 0 -11.9577 TD 0.0438 Tc 1.3226 Tw (restrained had decreased from an average of 43) Tj ET BT 0.934 0 0 0.9835 79.92 96 Tm -0.0069 Tc 0.6432 Tw (percent in 1989 to an average of 23 percent in 1991) Tj 0.7709 -12.4458 TD -0.029 Tc 1.3285 Tw (\(9\). Only 13 percent of the nursing homes reported) Tj ET BT 0.9835 0 0 0.9835 329.76 648.48 Tm 0.0197 Tc 1.5911 Tw (having instituted a restraint reduction program) Tj ET BT 0.934 0 0 0.9835 329.76 636.24 Tm -0.0226 Tc 1.9779 Tw (before 1989, the year the pertinent OBRA regula-) Tj 0 -11.9577 TD -0.0415 Tc 1.0314 Tw (tions went into effect.) Tj ET BT 0.9795 0 0 0.9795 338.4 591.84 Tm /F7 12 Tf 0.0188 Tc 1.0225 Tw (Dementia Training Programs for Nursing) Tj 52.4368 -14.4569 TD 0.0263 Tc 0.7698 Tw (Home Staff Members) Tj ET BT 0.934 0 0 0.9835 341.04 558.96 Tm /F4 10 Tf -0.0358 Tc 1.0789 Tw (One of the most frequently cited problems in the) Tj ET BT 0.8915 0 0 0.9835 329.76 547.44 Tm 0.0446 Tc 0.9033 Tw (care of nursing home residents with dementia is lack) Tj ET BT 0.934 0 0 0.9835 330 535.68 Tm -0.0088 Tc 0.9536 Tw (of staff knowledge about dementia. Many organiza-) Tj 0 -12.4458 TD -0.0326 Tc 1.7928 Tw (tions and individuals have developed training pro-) Tj 0.257 -12.2018 TD -0.0201 Tc 1.6081 Tw (grams and materials to address this problem. One) Tj ET BT 0.9835 0 0 0.9835 330 499.68 Tm 0.0166 Tc 2.0823 Tw (video training program, \221\221Managing and Under-) Tj ET BT 0.934 0 0 0.9835 330.48 487.44 Tm -0.023 Tc 0.8403 Tw (standing Behavior Problems in Alzheimer\222s Disease) Tj 0 -11.9577 TD -0.0432 Tc 2.5322 Tw (and Related Disorders,\222) Tj ET BT 0.8915 0 0 0.9835 438.96 475.2 Tm 0.024 Tc 1.0274 Tw (was funded by the National) Tj -121.6758 -11.7137 TD 0.037 Tc 0.7436 Tw (Institute on Aging and has 10 training modules, each) Tj ET BT 0.9835 0 0 0.9835 330.48 451.68 Tm 0.0395 Tc 0.5134 Tw (focused on a different behavioral symptom \(439\).) Tj ET BT 0.8915 0 0 0.9835 330.72 439.2 Tm 0.0426 Tc 1.2533 Tw (Other programs and materials include the following:) Tj ET BT 0.8632 0 0 0.9598 341.76 421.92 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0.278 -25.2542 TD -0.0185 Tc (l) Tj 0.278 -38.5064 TD -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 342.24 336.24 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 342.24 311.76 Tm -0.0185 Tc (l) Tj 0.278 -37.7563 TD -0.0185 Tc (l) Tj ET BT 0.934 0 0 0.9835 352.08 420.96 Tm /F4 10 Tf -0.0115 Tc 1.6724 Tw (a training manual developed by the St. Louis) Tj 0.7709 -11.9577 TD -0.0214 Tc 2.0206 Tw (Chapter of the Alzheimer\222s Association \(39\);) Tj ET BT 0.8915 0 0 0.9835 352.32 396.72 Tm 0.0427 Tc 1.1699 Tw (a training manual and tape series developed by) Tj ET BT 0.9835 0 0 0.9835 352.8 384.48 Tm 0.022 Tc 1.6498 Tw (the Wisconsin Alzheimer\222s Information and) Tj ET BT 0.934 0 0 0.9835 352.56 372.24 Tm 0.0008 Tc 0.9434 Tw (Training Center \(509\);) Tj ET BT 0.9835 0 0 0.9835 352.8 359.28 Tm 0.0446 Tc 0.2236 Tw (a video training program developed by Com-) Tj ET BT 0.934 0 0 0.9835 352.8 347.76 Tm 0.0021 Tc 0.7493 Tw (munity Services Institute, Inc. \(102\);) Tj ET BT 0.8915 0 0 0.9835 352.56 334.8 Tm 0.055 Tc 0.701 Tw (a training guide and resource manual developed) Tj 0.2692 -11.9577 TD 0.028 Tc 0.9557 Tw (for the New Jersey Department of Health \(471\);) Tj ET BT 0.934 0 0 0.9835 352.8 310.32 Tm -0.0309 Tc 1.0201 Tw (a video training program developed by Church) Tj 0.257 -11.9577 TD -0.0283 Tc 0.7176 Tw (Home and distributed by the American Associ-) Tj 0 -12.2018 TD -0.0148 Tc 1.4556 Tw (ation of Homes for the Aging \(86\); and) Tj ET BT 0.8915 0 0 0.9835 352.8 274.32 Tm 0.0444 Tc 0.9372 Tw (a training manual written by Lisa Gwyther and) Tj ET BT 0.934 0 0 0.9835 353.04 262.32 Tm -0.0254 Tc 0.8943 Tw (distributed by the Alzheimer\222s Association and) Tj 0.257 -10.9816 TD -0.0165 Tc 1.2959 Tw (the American Health Care Association \(165\).) Tj -11.82 -18.5467 TD -0.0204 Tc 0.5806 Tw (These training programs and materials are likely) Tj -11.82 -12.4458 TD -0.0374 Tc 1.0806 Tw (to improve the care of nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 331.44 208.8 Tm 0.0476 Tc 3.0873 Tw (dementia generally.) Tj ET BT 0.9835 0 0 0.9835 342.48 190.08 Tm 0.0173 Tc 0.3385 Tw (In 1987, the Alzheimer\222s Family Center, Inc. of) Tj -10.9816 -11.9577 TD 0.04 Tc 0.4548 Tw (San Diego, CA, established a School of Dementia) Tj ET BT 0.934 0 0 0.9835 331.68 166.56 Tm -0.0321 Tc 1.6944 Tw (Care which trains and certifies health care profes-) Tj ET BT 0.9835 0 0 0.9835 331.92 154.8 Tm 0.0277 Tc 1.8676 Tw (sionals to work with individuals with dementia) Tj 0 -11.7137 TD 0.0383 Tc 0.352 Tw (\(422\). In 1991, the Federal Government provided) Tj ET BT 0.934 0 0 0.9835 331.44 131.04 Tm -0.0152 Tc 0.8641 Tw (funding to the center through the Job Training and) Tj ET BT 0.8915 0 0 0.9835 331.68 119.52 Tm 0.0374 Tc 1.3937 Tw (Partnership Act to train) Tj ET BT 0.934 0 0 0.9835 440.4 119.28 Tm -0.0271 Tc 3.4143 Tw (\221\221Certified Nursing Assist-) Tj ET BT 0.9835 0 0 0.9835 331.68 107.28 Tm 0.0268 Tc 3.6988 Tw (ant Alzheimer Care Specialists\222 to work with) Tj ET BT 0.934 0 0 0.9835 331.92 95.76 Tm -0.0153 Tc 1.3889 Tw (individuals with dementia in nursing homes, adult) Tj -0.257 -11.9577 TD -0.0132 Tc 0.4702 Tw (day centers, and other settings \(324\).) Tj ET q 5.52 0 0 -4.32 94.32 65.52 cm BI /W 32 /H 25 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `>x|<>x>>xx|||x>|>q<<? EI Q BT 0.5633 0 0 0.9835 94.32 61.2 Tm 3 Tr /F2 10 Tf -0.0358 Tc 0 Tw (zo) Tj 0 Tr ET BT 0.9388 0 0 0.9835 99.84 61.2 Tm 0 Tc 0.055 Tw ( ) Tj ET q 12.48 0 0 -6.48 102 66.96 cm BI /W 72 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0< =?~?>|?<x~~ |?`||||?>??pp?p>>` EI Q BT 0.7041 0 0 0.9835 102 61.2 Tm 3 Tr -0.0428 Tc 0 Tw (SW,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 114.48 61.2 Tm 0.031 Tc 0.022 Tw ( for ) Tj ET q 27.36 0 0 -7.68 130.32 66.96 cm BI /W 159 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`?p>|><>>?>???????????||?>|x8|>>|8>|@?>|?>|>|>|>|?>| >|>||>|<|>||?| x|`~||||| EI Q BT 0.7511 0 0 0.9835 130.32 61.2 Tm 3 Tr 0.0436 Tc 0 Tw (example,) Tj 0 Tr ET BT 0.934 0 0 0.9835 157.68 61.2 Tm /F4 10 Tf 0 Tc 0.0449 Tw ( ) Tj ET q 19.92 0 0 -6.24 160.08 66.96 cm BI /W 115 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~??>>>~a>|!x>|>>|~x|~p>?><>>||??0?? EI Q BT 0.6368 0 0 0.9835 160.08 61.2 Tm 3 Tr -0.0387 Tc 0 Tw (Rader,) Tj 0 Tr ET BT 0.6793 0 0 0.9835 183.84 60.24 Tm -0.0203 Tc 1.8413 Tw (\223The Joyful Road to Restraint- Free Care\224 \(360\).) Tj ET BT 0.934 0 0 0.9835 94.08 50.4 Tm 0.0897 Tc -0.0512 Tw (21 ) Tj ET q 6.24 0 0 -5.28 107.04 53.76 cm BI /W 38 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?????????>>???? EI Q BT 0.9835 0 0 0.9835 107.04 50.4 Tm 3 Tr 0.0375 Tc 0 Tw (~) Tj 0 Tr ET BT 0.9021 0 0 0.9598 113.28 50.4 Tm /F6 5 Tf 0 Tc 0.0799 Tw ( ) Tj ET q 13.92 0 0 -5.52 114.24 53.76 cm BI /W 82 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @??}x?x??x?<~~>>?>?>?><|||||?>>?? EI Q BT 1.4433 0 0 0.9598 129.12 50.4 Tm 3 Tr 0.011 Tc 0 Tw (1992,) Tj 0 Tr ET BT 0.9021 0 0 0.9598 144.96 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 8.88 0 0 -5.52 145.92 54 cm BI /W 53 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 89??~>~>~x>~8>>?~~?~>>~~>~~>~~~~~~~~~~> EI Q BT 1.8041 0 0 0.9598 145.92 50.4 Tm 3 Tr 0.0268 Tc 0 Tw (he) Tj 0 Tr ET BT 0.9021 0 0 0.9598 154.8 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 15.36 0 0 -5.28 155.76 53.76 cm BI /W 90 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `????~~???x>x<?<???~ EI Q BT 2.6159 0 0 0.9598 155.76 50.4 Tm 3 Tr -0.0319 Tc 0 Tw (~A) Tj 0 Tr ET BT 0.9021 0 0 0.9598 171.12 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 28.08 0 0 -7.2 172.08 55.44 cm BI /W 163 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??`8?????>~|>?~<x<~|8q~>8;~>>~>>~>>~>>~>>~>?>>>~?>?|>?~~|>?|?~?????<`??? EI Q BT 1.3531 0 0 0.9598 172.08 50.4 Tm 3 Tr 0.0454 Tc 0 Tw (propoSed) Tj 0 Tr ET BT 0.9021 0 0 0.9598 200.16 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 3.12 0 0 -3.84 201.12 52.56 cm BI /W 19 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x|>x?|||>> EI Q BT 1.2629 0 0 0.9598 201.12 50.4 Tm 3 Tr -0.0305 Tc 0 Tw (a) Tj 0 Tr ET BT 0.9021 0 0 0.9598 204.24 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 12.48 0 0 -3.84 205.2 52.32 cm BI /W 74 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>??>~~<<>|x<>??? EI Q BT 1.4433 0 0 0.9598 205.2 50.4 Tm 3 Tr 0.0117 Tc 0 Tw (new) Tj 0 Tr ET BT 0.9021 0 0 0.9598 217.68 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 11.52 0 0 -5.52 218.64 55.68 cm BI /W 69 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????>>>x>8?>??~>?~>?>>>?p?>?>?~~|?|?|?? EI Q BT 2.1649 0 0 0.9598 218.64 50.4 Tm 3 Tr 0.0147 Tc 0 Tw (fie) Tj 0 Tr ET BT 0.9021 0 0 0.9598 230.16 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 11.28 0 0 -5.76 231.12 54.24 cm BI /W 67 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >????~@?|?|?|>|>|>|>|>|>|?|?|?|?|???~<  EI Q BT 2.2551 0 0 0.9598 231.12 50.4 Tm 3 Tr 0.0225 Tc 0 Tw (tit) Tj 0 Tr ET BT 0.9021 0 0 0.9598 242.4 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 18.72 0 0 -5.52 243.36 55.92 cm BI /W 110 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `Ap???>~?~??|>|>|>||~|x|p|x|p||>8||>8>|>?<>|?>|~||< EI Q BT 1.8041 0 0 0.9598 243.36 50.4 Tm 3 Tr 0.0398 Tc 0 Tw (~o~d) Tj 0 Tr ET BT 0.9021 0 0 0.9598 262.08 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 21.36 0 0 -7.2 263.04 55.68 cm BI /W 125 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~>>>8>{~????~~>p|>x>8>>>>>π>|π><>?<~~?Ǐ?~  EI Q BT 2.0747 0 0 0.9598 263.04 50.4 Tm 3 Tr -0.0296 Tc 0 Tw (r~fie) Tj 0 Tr ET BT 0.9021 0 0 0.9598 284.4 50.4 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 24.24 0 0 -6.96 285.36 54.24 cm BI /W 142 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?pxp8p1x??<????|?>||>||>||>||>||>||π>|??x??||>?||>?|>?~>?~?????|????>>0~|?|?|?x8 EI Q BT 1.9845 0 0 0.9598 285.36 50.4 Tm 3 Tr 0.0234 Tc 0 Tw (~be~g) Tj 0 Tr ET BT 0.9388 0 0 0.9835 309.6 50.4 Tm /F2 10 Tf 0.0508 Tc 0.0009 Tw ( of ) Tj ET q 25.2 0 0 -7.2 322.08 54.72 cm BI /W 147 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~8?|?Ǐ|?|~|||p?||>8|>8||<x||x|x|x||?~<>~>x| |||` EI Q BT 0.6368 0 0 0.9835 322.08 50.4 Tm 3 Tr /F4 10 Tf -0.0607 Tc 0 Tw (physical) Tj 0 Tr ET BT 0.934 0 0 0.9835 347.28 50.4 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 29.52 0 0 -5.76 349.68 55.92 cm BI /W 172 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0 ? ???~|~?~||>|||>|<>|?>|>|>|>|0>|x?>||>|<|??߀p0 p|p<0  EI Q BT 0.8915 0 0 0.9835 349.68 50.4 Tm 3 Tr 0.0067 Tc 0 Tw (res~ts.) Tj 0 Tr ET BT 0.934 0 0 0.9835 379.2 50.4 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 11.52 0 0 -5.28 381.6 55.68 cm BI /W 69 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p?~?~?~x?~x?~?8?~>?~>?~>?~>?~??~?~?~?~??<`?G???? EI Q BT 0.8066 0 0 0.9835 381.6 50.4 Tm 3 Tr 0.0428 Tc 0 Tw (me) Tj 0 Tr ET BT 0.934 0 0 0.9835 393.12 50.4 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 25.44 0 0 -7.2 395.52 55.68 cm BI /W 148 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~>>>>8~~?????~x~>9|>>>>>>>>~π>|>?σx?<>|?>???_??? EI Q BT 0.7642 0 0 0.9835 395.52 50.4 Tm 3 Tr -0.0165 Tc 0 Tw (req~ed) Tj 0 Tr ET BT 0.9388 0 0 0.9835 420.96 50.4 Tm /F2 10 Tf 0 Tc 0.055 Tw ( ) Tj ET q 14.4 0 0 -5.76 423.12 55.92 cm BI /W 85 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????߀???~~>>~~~~>>~>????|~????~~~~?~??~? EI Q BT 0.7041 0 0 0.9835 423.12 50.4 Tm 3 Tr -0.0049 Tc 0 Tw (label) Tj 0 Tr ET BT 0.9388 0 0 0.9835 437.52 50.4 Tm 0 Tc 0.055 Tw ( ) Tj ET q 18.96 0 0 -5.76 439.68 55.92 cm BI /W 111 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??????~???~>~~~~~~~~~~~~~~~~~~x>~>?x?~>?~~?>?? EI Q BT 0.798 0 0 0.9835 439.68 50.4 Tm 3 Tr 0.0544 Tc 0 Tw (wo~d) Tj 0 Tr ET BT 0.9388 0 0 0.9835 458.64 50.4 Tm 0.0212 Tc 0.0324 Tw ( include directions ) Tj ET q 8.88 0 0 -5.76 530.64 55.92 cm BI /W 52 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????1π EI Q BT 0.5519 0 0 0.9835 530.64 50.4 Tm 3 Tr /F4 10 Tf 0.0318 Tc 0 Tw (fOr) Tj 0 Tr ET BT 0.934 0 0 0.9835 539.52 50.4 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.08 0 0 -4.08 541.92 54.48 cm BI /W 59 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |~x>?>?`~`~||`|?||~?|<>|>?? EI Q BT 0.5944 0 0 0.9835 541.92 50.4 Tm 3 Tr -0.1352 Tc 0 Tw (use) Tj 0 Tr ET BT 0.6368 0 0 0.9835 80.4 39.12 Tm -0.0416 Tc 2.0888 Tw (of the restraints, a warnin) Tj ET BT 0.8066 0 0 0.9835 162.48 38.88 Tm -0.0177 Tc -0.082 Tw (g ) Tj ET BT 0.798 0 0 0.9835 169.2 38.88 Tm /F2 10 Tf 0.0433 Tc 0.8532 Tw (of potential hazards, and the phrase ) Tj ET BT 0.8027 0 0 0.9939 290.64 38.88 Tm /F11 7 Tf -0.0004 Tc 3.4353 Tw (prescription only.) Tj ET endstream endobj 174 0 obj <>/Rotate 0/Type/Page>> endobj 175 0 obj <>stream 0.48 w 1 j 0 0 0 RG 52.8 677.28 m 531.84 677.28 l S 0.72 w 56.16 153.84 m 535.68 153.84 l S BT 0.9835 0 0 0.9835 320.88 682.32 Tm 0 0 0 rg /F5 10 Tf 0.0152 Tc 1.7538 Tw (Chapter 1--Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 513.12 682.32 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 519.6 682.32 Tm /F5 10 Tf 0.366 Tc 0 Tw (51) Tj ET BT 0.9795 0 0 0.9795 65.76 641.28 Tm /F7 12 Tf 0.05 Tc 0.623 Tw (Specialized Programs for Residents With) Tj 9.8013 -13.9668 TD 0.0253 Tc 1.1383 Tw (Dementia in Nonspecialized Nursing) Tj 63.4632 -14.4569 TD 0.0161 Tc 1.1477 Tw (Home Units) Tj ET BT 0.9835 0 0 0.9835 65.04 595.68 Tm /F4 10 Tf 0.0385 Tc 0.5144 Tw (Instead of or in addition to a special care unit,) Tj ET BT 0.934 0 0 0.9835 54.48 583.92 Tm -0.0254 Tc 1.4853 Tw (some nursing homes have specialized programs for) Tj ET BT 0.8915 0 0 0.9835 54 572.16 Tm 0.0258 Tc 1.0735 Tw (residents with dementia in nonspecialized units. It is) Tj ET BT 0.9835 0 0 0.9835 54 559.92 Tm 0.0142 Tc 0.4811 Tw (unclear how many nursing homes have such pro-) Tj 0.7321 -11.7137 TD 0.0201 Tc 1.5364 Tw (grams. In response to a 1991 survey of all U.S.) Tj ET BT 0.934 0 0 0.9835 54.24 536.64 Tm -0.0111 Tc 1.2131 Tw (nursing homes with more than 30 beds, 13 percent) Tj ET BT 0.9835 0 0 0.9835 54.48 524.64 Tm 0.0312 Tc 1.2811 Tw (of the 1463 nursing homes that said they had a) Tj ET BT 0.934 0 0 0.9835 54.72 512.88 Tm -0.0423 Tc 0.5719 Tw (special care unit or program for their residents with) Tj ET BT 0.9835 0 0 0.9835 54.72 500.64 Tm 0.0351 Tc 1.0385 Tw (dementia reported that the program was) Tj 0 Tc -0.0972 Tw ( ) Tj 198.889 0 TD /F5 10 Tf 0.0343 Tc 0.0261 Tw (not in ) Tj 26.3559 0 TD /F4 10 Tf 0.0497 Tc 0 Tw (a) Tj ET BT 0.934 0 0 0.9835 54.48 488.64 Tm -0.011 Tc 1.4516 Tw (physically separate part of the facility \(247\). Thus,) Tj ET BT 0.9835 0 0 0.9835 54.72 476.88 Tm 0.0227 Tc 0.9169 Tw (it is likely that at least several hundred nursing) Tj ET BT 0.934 0 0 0.9835 54.72 464.88 Tm -0.0247 Tc 1.613 Tw (homes have specialized programs.) Tj 12.3339 -18.3027 TD -0.0237 Tc 0.5841 Tw (Some nursing homes have specialized day care or) Tj ET BT 0.8915 0 0 0.9835 55.44 434.88 Tm 0.0226 Tc 2.846 Tw (activity programs.) Tj ET BT 0.9557 0 0 1.08 134.4 443.28 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (22 ) Tj ET BT 0.934 0 0 0.9835 140.16 438.48 Tm /F4 10 Tf -0.0161 Tc 1.7965 Tw (One facility established a\221 wan-) Tj ET BT 0.9835 0 0 0.9835 55.2 423.12 Tm 0.0301 Tc 4.997 Tw (derer\222s lounge\224) Tj 81.7519 0 TD 0.0394 Tc 1.2457 Tw (where specialized activities are) Tj ET BT 0.934 0 0 0.9835 54.96 411.6 Tm -0.032 Tc 0.9928 Tw (provided several hours a day for 15 to 20 demented) Tj 0 -12.4458 TD -0.0229 Tc 0.8831 Tw (residents of the facility\222s nonspecialized units \(299\).) Tj 12.3339 -18.3027 TD -0.0327 Tc 1.8786 Tw (Rovner established an experimental special care) Tj -11.82 -11.9577 TD -0.0446 Tc 3.1247 Tw (program for demented residents of nonspecialized) Tj ET BT 0.9835 0 0 0.9835 55.44 357.6 Tm 0.0209 Tc 1.5899 Tw (units in one Maryland nursing home \(387\). The) Tj 0 -12.2018 TD 0.0395 Tc 1.1235 Tw (program was intended to duplicate the essential) Tj ET BT 0.934 0 0 0.9835 55.68 333.6 Tm -0.0361 Tc 2.182 Tw (components of an apparently effective special care) Tj 0 -12.2018 TD -0.0343 Tc 0.6276 Tw (unit described earlier in this chapter and in chapter) Tj ET BT 0.9835 0 0 0.9835 55.68 309.36 Tm 0.0324 Tc 2.7983 Tw (4 \(392\). The special care program consisted of) Tj ET BT 0.934 0 0 0.9835 56.16 297.36 Tm -0.029 Tc 1.0395 Tw (weekly visits to each resident by a psychiatrist and) Tj ET BT 0.9835 0 0 0.9835 56.16 285.36 Tm 0.0348 Tc 0.1115 Tw (a nurse with the purpose of identifying residents\222) Tj ET BT 0.934 0 0 0.9835 56.16 273.36 Tm -0.0211 Tc 3.1509 Tw (cognitive impairments, treating psychiatric symp-) Tj 0 -11.9577 TD -0.0224 Tc 1.0967 Tw (toms, reducing medication side effects, maintaining) Tj ET BT 0.9835 0 0 0.9835 55.92 249.6 Tm 0.0254 Tc 3.2121 Tw (residents\222 physical health, reducing the use of) Tj 0.244 -12.4458 TD 0.0171 Tc 0.764 Tw (physical restraints, and increasing the residents\222) Tj 0 -11.9577 TD 0.0279 Tc 3.5756 Tw (participation in activities \(387\). Five hours of) Tj 0.7321 -12.4458 TD 0.0408 Tc 3.2291 Tw (specialized activities were provided daily. The) Tj ET BT 0.934 0 0 0.9835 56.88 201.36 Tm -0.0227 Tc 1.207 Tw (special care program is being evaluated. Its impact) Tj 0 -12.2018 TD -0.0407 Tc 0.6024 Tw (will be compared with the impact of the special care) Tj ET BT 0.8915 0 0 0.9835 56.4 177.36 Tm 0.0519 Tc 0.9289 Tw (unit described earlier to determine their relative cost) Tj ET BT 0.934 0 0 0.9835 56.88 165.36 Tm -0.0287 Tc 1.8743 Tw (and effectiveness.) Tj ET BT 0.9795 0 0 0.9795 315.36 641.28 Tm /F7 12 Tf 0.0453 Tc 0.8729 Tw (Specialized Living Arrangements Outside) Tj 64.6884 -14.4569 TD 0.0072 Tc 1.8919 Tw (Nursing Homes) Tj ET BT 0.9835 0 0 0.9835 316.32 607.92 Tm /F4 10 Tf 0.0196 Tc 0.7777 Tw (Outside nursing homes, special care units and) Tj -10.9816 -12.2018 TD 0.0403 Tc 1.2773 Tw (other specialized living arrangements for people) Tj ET BT 0.934 0 0 0.9835 305.52 583.92 Tm -0.0272 Tc 1.3588 Tw (with dementia have been established in residential) Tj ET BT 0.9835 0 0 0.9835 305.52 572.16 Tm 0.0205 Tc 3.2009 Tw (care facilities, assisted living facilities, mental) Tj 0 -11.9577 TD 0.0307 Tc 2.068 Tw (hospitals, and other settings. Three of the best) Tj ET BT 0.934 0 0 0.9835 305.52 548.4 Tm -0.025 Tc 0.4142 Tw (known special care units in the United States are in) Tj -0.257 -11.7137 TD -0.041 Tc 2.6583 Tw (residential care facilities:) Tj ET BT 0.9557 0 0 1.08 418.56 541.68 Tm /F4 4 Tf 0.1614 Tc 0 Tw (23) Tj ET BT 0.9835 0 0 0.9835 317.28 517.2 Tm /F4 10 Tf 0.027 Tc 0.224 Tw (. the Alzheimer\222s Care Center in Gardiner, ME) Tj ET BT 0.934 0 0 0.9835 328.32 505.2 Tm 0.0551 Tc 0 Tw (\(303\);) Tj ET BT 0.8915 0 0 0.9835 317.52 491.76 Tm 0.0579 Tc 0.499 Tw (. the Corinne Dolan Alzheimer\222s Center at Heather) Tj ET BT 0.934 0 0 0.9835 328.08 480 Tm -0.0085 Tc 1.1331 Tw (Hill in Chardon, OH \(317\), and) Tj ET BT 0.9835 0 0 0.9835 317.52 466.32 Tm 0.0348 Tc 0.3555 Tw (. Wesley Hall in the Chelsea United Methodist) Tj ET BT 0.934 0 0 0.9835 328.32 455.52 Tm -0.0143 Tc 1.345 Tw (Retirement Home in Chelsea, MI \(105\).) Tj -11.563 -19.7669 TD -0.0114 Tc 1.2317 Tw (In many discussions about special care units, no) Tj -11.563 -12.2018 TD -0.0331 Tc 1.9891 Tw (distinction is made between these three units and) Tj ET BT 0.9835 0 0 0.9835 306.72 412.32 Tm 0.0195 Tc 0.7197 Tw (other model special care units in nursing homes.) Tj ET BT 0.8915 0 0 0.9835 306.72 400.32 Tm 0.0543 Tc 1.4645 Tw (From a public policy perspective, however, there are) Tj ET BT 0.934 0 0 0.9835 306.96 388.56 Tm -0.0372 Tc 1.4122 Tw (important differences between special care units in) Tj ET BT 0.9835 0 0 0.9835 306.72 376.32 Tm 0.0288 Tc -0.0219 Tw (residential care facilities and special care units in) Tj ET BT 0.934 0 0 0.9835 306.96 364.56 Tm -0.0236 Tc 1.2264 Tw (nursing homes. Residential care facilities are much) Tj ET BT 0.9835 0 0 0.9835 306.96 352.56 Tm 0.0211 Tc 1.3863 Tw (less regulated than nursing homes. The Federal) Tj ET BT 0.8915 0 0 0.9835 306.96 340.32 Tm 0.0503 Tc 1.3344 Tw (Government does not regulate residential care facili-) Tj ET BT 0.934 0 0 0.9835 307.2 328.08 Tm -0.038 Tc 0 Tw (ties.) Tj ET BT 0.9557 0 0 1.08 325.44 332.88 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (24 ) Tj ET BT 0.934 0 0 0.9835 330.96 328.08 Tm /F4 10 Tf -0.0368 Tc 0.7695 Tw (States license various types of residential care) Tj ET BT 0.9835 0 0 0.9835 307.2 316.32 Tm 0.037 Tc 0.3184 Tw (facilities \(251\), but some types of residential care) Tj 0.244 -12.2018 TD 0.0338 Tc 1.2411 Tw (facilities are not licensed in each State, and the) Tj 0 -12.2018 TD 0.0201 Tc 0.1264 Tw (licensing requirements, where they exist, are less) Tj T* 0.0263 Tc 2.7232 Tw (comprehensive and far less stringent than the) Tj ET BT 0.934 0 0 0.9835 307.44 268.32 Tm -0.0221 Tc 1.7387 Tw (licensing requirements for nursing homes.) Tj ET BT 0.9557 0 0 1.08 495.84 273.12 Tm /F4 4 Tf 0.1614 Tc 0 Tw (25) Tj ET BT 0.934 0 0 0.9835 318.72 248.88 Tm /F4 10 Tf -0.0333 Tc 1.2185 Tw (Since special care units in residential care facili-) Tj -11.82 -12.4458 TD -0.0275 Tc 1.045 Tw (ties are not subject to the same kinds of regulatory) Tj ET BT 0.8915 0 0 0.9835 307.44 225.12 Tm 0.0518 Tc 1.0443 Tw (requirements as special care units in nursing homes,) Tj ET BT 0.9835 0 0 0.9835 307.92 212.88 Tm 0.0313 Tc 2.0673 Tw (they are able to implement innovative physical) Tj ET BT 0.934 0 0 0.9835 307.92 200.64 Tm -0.0098 Tc 1.0832 Tw (design features, staffing arrangements, and patient) Tj 0.257 -11.9577 TD -0.0322 Tc 1.0108 Tw (care practices that may be difficult or impossible to) Tj ET BT 0.9835 0 0 0.9835 308.16 176.88 Tm 0.0238 Tc 2.9465 Tw (implement in a nursing home. Because of the) Tj ET BT 0.8915 0 0 0.9835 307.92 165.12 Tm 0.0549 Tc 2.0023 Tw (minimal regulatory requirements, special care units) Tj ET q 5.04 0 0 -4.32 70.56 146.88 cm BI /W 32 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??pxxx<88<|`|p>x~??? EI Q BT 0.4694 0 0 0.9835 70.56 142.56 Tm 3 Tr /F2 10 Tf 0.1081 Tc 0 Tw (22) Tj 0 Tr ET BT 0.8449 0 0 0.9835 75.6 142.56 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 9.6 0 0 -5.76 77.52 148.08 cm BI /W 61 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x>??LJ~8|π8|σx<???~`>~|||<? EI Q BT 0.8449 0 0 0.9835 77.52 142.56 Tm 3 Tr 0.0766 Tc 0 Tw (S=) Tj 0 Tr 11.3616 0 TD 0.087 Tc -0.0485 Tw ( for ) Tj ET q 25.68 0 0 -7.2 101.76 148.08 cm BI /W 160 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8<A?????~?|??x<~?8|>{?????|x???? ?||<???߃????8????? EI Q BT 0.798 0 0 0.9835 101.76 142.56 Tm 3 Tr 0.0324 Tc 0 Tw (exmple,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 127.44 142.56 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 30.72 0 0 -5.76 129.36 148.08 cm BI /W 191 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@~~~??~x~???|8~>a?||~!?|>||?~>~|~>>~|~>>~|~~|?~~|?>x|?>||>>|>~>>p<??p<88|?||||||||~` EI Q BT 0.9835 0 0 0.9835 129.36 142.56 Tm 3 Tr -0.0564 Tc 0 Tw (Clentiel) Tj 0 Tr ET BT 0.8449 0 0 0.9835 160.08 142.56 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 10.08 0 0 -5.76 162 148.32 cm BI /W 63 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?~||x|?x|><|>>|>|>|>|?|x|x||||>>?? EI Q BT 0.6572 0 0 0.9835 162 142.56 Tm 3 Tr 0.052 Tc 0 Tw (and) Tj 0 Tr ET BT 0.8449 0 0 0.9835 172.08 142.56 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 29.04 0 0 -6.24 174 148.08 cm BI /W 181 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????||||||||π||ǀ |ǀ| |ǀ|||<|||~p|~p~??? ?|~p8x0 EI Q BT 0.7511 0 0 0.9835 174 142.56 Tm 3 Tr 0.0417 Tc 0 Tw (Fleishell,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 203.04 142.56 Tm 0.0202 Tc 0.1726 Tw ( \221An ) Tj ET q 29.76 0 0 -5.76 221.28 148.08 cm BI /W 186 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????>|?~c||>|?|||?x???>>>>p~~8|x8???8????? EI Q BT 0.7041 0 0 0.9835 221.28 142.56 Tm 3 Tr 0.0255 Tc 0 Tw (Akheimer) Tj 0 Tr ET BT 0.8449 0 0 0.9835 251.04 142.56 Tm 0.0546 Tc 0.5935 Tw ( Day Care Center for Nursing Home Patients\224 ) Tj ET BT 0.8648 0 0 0.99 415.68 142.56 Tm /F3 8 Tf 0.064 Tc -0.0776 Tw (\(89\); ) Tj ET q 42.24 0 0 -7.2 432.24 148.08 cm BI /W 263 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID > pA~~??~x?߃|?~8σx|?>x|>>x<?|>?|<|??>?|?|??p8?>~|?~q~??>~??x?=@a??80 EI Q BT 0.99 0 0 0.99 432.24 142.56 Tm 3 Tr -0.0452 Tc 0 Tw (lkmczqk~d) Tj 0 Tr ET BT 0.8648 0 0 0.99 474.48 142.56 Tm 0 Tc -0.0036 Tw ( ) Tj ET q 21.12 0 0 -6.24 476.4 148.08 cm BI /W 133 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|D?~?~~|>||?߀|~<x~>~?~8~|~||>?>??? EI Q BT 1.2972 0 0 0.99 476.4 142.56 Tm 3 Tr -0.005 Tc 0 Tw (Ba*,) Tj 0 Tr ET BT 0.8648 0 0 0.99 497.52 142.56 Tm 0 Tc -0.0036 Tw ( ) Tj ET q 33.36 0 0 -5.52 499.44 148.08 cm BI /W 209 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`?~??||~<|>|> |>|>?|>>p|>>8|>|8|>x|<|>x||>xx|>8x~>?|~<~??~~~|{?0px0x?<?p0 EI Q BT 0.8648 0 0 0.99 499.44 142.56 Tm 3 Tr 0.0223 Tc 0 Tw (\223Adven~e) Tj 0 Tr ET BT 0.8919 0 0 0.9835 56.64 132.96 Tm /F2 10 Tf 0.0443 Tc 0.3415 Tw (Program\224 \(173\); Johnson and ) Tj ET q 29.52 0 0 -7.2 167.28 138.48 cm BI /W 179 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>>?0?|??????~>~`>|?><?>>?>>>>>???<?>>~>~?~ ?`|?8p?p EI Q BT 0.7511 0 0 0.9835 167.28 132.96 Tm 3 Tr 0.045 Tc 0 Tw (Chapmaq) Tj 0 Tr ET BT 0.8919 0 0 0.9835 196.8 132.96 Tm 0.0431 Tc 0.1111 Tw ( \223Quest for Life\224 \(21 1\); and Sawyer and ) Tj ET q 38.16 0 0 -6.48 348.24 138.48 cm BI /W 231 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x< ?< ~`?????????~><>|| 8|| ||||||?p|>>0|?x<8|x|8|||<|?<|??<>|~>~x|x~x~|~???>??8~?|?<?? ?? EI Q BT 0.7041 0 0 0.9835 348.24 132.96 Tm 3 Tr 0.0073 Tc 0 Tw (Mendelovitz,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 392.16 132.48 Tm 0.0556 Tc -0.0114 Tw (\223A Management Program for Ambulatory) Tj ET BT 0.798 0 0 0.9835 56.64 124.08 Tm -0.001 Tc 1.4099 Tw (Institutionalized Patients With) Tj 0 Tc -0.0951 Tw ( ) Tj ET q 32.88 0 0 -5.52 159.12 129.36 cm BI /W 218 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0????~~?~~|??~|>~?~|~a ??~~|!?~~|>||x||x|||?<|?~|???||<>x~|>~x~|x~18<<???p EI Q BT 0.6102 0 0 0.9835 159.12 124.08 Tm 3 Tr -0.0698 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.798 0 0 0.9835 192 124.08 Tm 0.0312 Tc 1.0087 Tw ( Disease and Related Disorders\224 \(400\).) Tj ET q 4.8 0 0 -4.08 70.56 117.12 cm BI /W 31 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x8<>>|xx8x<x<x| |0|y??? EI Q BT 0.4694 0 0 0.9835 70.56 112.8 Tm 3 Tr 0.1081 Tc 0 Tw (23) Tj 0 Tr ET BT 0.8858 0 0 0.99 75.36 112.8 Tm /F5 8 Tf 0 Tc -0.1033 Tw ( ) Tj ET q 56.4 0 0 -7.2 77.04 117.36 cm BI /W 353 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `>p | 8 ??p????????~?||x|?~?|gG0|a?|?~|~|??|~|><?||`?>?||>?||??|x|?|||x?||||?|?<|x<>x?|>||><|>x?|x>||~|?<?||???<??<?x<?pc|????xxpp?0 EI Q BT 0.8267 0 0 0.99 77.04 112.8 Tm 3 Tr 0.0388 Tc 0 Tw (Thetermresz2ientia/) Tj 0 Tr ET BT 0.8858 0 0 0.99 133.44 112.8 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 38.16 0 0 -7.2 135.12 118.32 cm BI /W 239 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @~ ?<?>??|>>???p>>1~>|><>|>>xx|>>xx|||x|<x|<>>x<<>>xx|><>|x|>>xx?|||>>||?>|><|<??< x8 8x EI Q BT 0.9448 0 0 0.99 135.12 112.8 Tm 3 Tr 0.0075 Tc 0 Tw (carefacWies) Tj 0 Tr ET BT 0.8449 0 0 0.9835 173.28 112.8 Tm /F2 10 Tf 0.0873 Tc 0.0648 Tw ( refers to a variety ) Tj ET BT 0.8491 0 0 0.9835 239.04 112.8 Tm /F4 10 Tf 0.0947 Tc -0.0667 Tw (Of ) Tj ET q 16.08 0 0 -6.96 251.04 119.04 cm BI /W 102 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?px0x8<x`p~||||||||||||||||||>||>||>?||>?|?p?x||?xx EI Q BT 0.7511 0 0 0.9835 251.04 112.8 Tm 3 Tr /F2 10 Tf 0.1038 Tc 0 Tw (hvtig) Tj 0 Tr 25.2443 -0.9761 TD 0.0393 Tc 0.4385 Tw (arrangements that provide room and board and some degree of protective supervision.) Tj ET BT 0.798 0 0 0.9835 56.88 103.2 Tm 0.0392 Tc -0.1442 Tw (Examples are retirement homes, homes for the aged, group homes, and adult foster homes.) Tj ET BT 0.9835 0 0 0.9835 70.8 93.36 Tm 0.122 Tc -0.1851 Tw (24 ) Tj ET q 12 0 0 -5.28 84.24 96.96 cm BI /W 67 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` ??~|??|??|>?|~`?||?||?|x?||?|?|?|??|>?|>?????  EI Q BT 0.9835 0 0 0.9835 84.24 93.36 Tm 3 Tr -0.0125 Tc 0 Tw (me) Tj 0 Tr 12.2018 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 13.92 0 0 -7.2 98.64 96.96 cm BI /W 78 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?px`8?8<σ<?>~~|||||~p>?<0p EI Q BT 0.8919 0 0 0.9835 98.64 93.36 Tm 3 Tr 0.0625 Tc 0 Tw (o~y) Tj 0 Tr ET BT 0.9835 0 0 0.9835 112.56 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 23.76 0 0 -5.28 114.96 96.96 cm BI /W 133 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<?"<?~?||s>~~>~~?>|~>>||>>|x|>>|>| >>|>>||>||>||~~||~||? ??>>>>~???> EI Q BT 0.9835 0 0 0.9835 114.96 93.36 Tm 3 Tr 0.0146 Tc 0 Tw (F~w~) Tj 0 Tr 24.1595 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 12.48 0 0 -5.28 141.12 98.64 cm BI /W 70 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~>|~|8~|8|<<||||xp|||||>|?||||~| ||| EI Q BT 0.798 0 0 0.9835 141.12 93.36 Tm 3 Tr 0.0206 Tc 0 Tw (role) Tj 0 Tr ET BT 0.9835 0 0 0.9835 153.6 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 6.24 0 0 -4.8 156 96.96 cm BI /W 35 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??  EI Q BT 1.1266 0 0 0.9835 156 93.36 Tm 3 Tr -0.0871 Tc 0 Tw (~) Tj 0 Tr ET BT 0.9835 0 0 0.9835 162.24 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 9.36 0 0 -5.28 164.64 96.96 cm BI /W 52 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |???>>>>>>p>>>0>>>>>>>><>><>>>@>>?>>>>>>?~> EI Q BT 0.7511 0 0 0.9835 164.64 93.36 Tm 3 Tr 0.0786 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9835 0 0 0.9835 174 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -6.96 176.4 98.64 cm BI /W 180 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0???c??~~~>|>>>|>|>~x|xx|x||||x>|?x~>`~>?? EI Q BT 0.9388 0 0 0.9835 176.4 93.36 Tm 3 Tr 0.0044 Tc 0 Tw (re~ation) Tj 0 Tr ET BT 0.9835 0 0 0.9835 208.8 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 6.72 0 0 -5.28 211.2 98.88 cm BI /W 38 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~>||||||||||||||||<|>|@~|||<>< EI Q BT 0.7511 0 0 0.9835 211.2 93.36 Tm 3 Tr -0.0131 Tc 0 Tw (of) Tj 0 Tr ET BT 0.9835 0 0 0.9835 217.92 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 33.12 0 0 -5.28 220.32 98.64 cm BI /W 184 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?LJ??????~>~~|~>|>@|?||||||?<|x<x?xx><>>>>>?>>>x>|>?<8~><??p EI Q BT 0.6572 0 0 0.9835 255.84 93.36 Tm 3 Tr -0.0934 Tc 0 Tw (Cme) Tj 0 Tr ET BT 0.9835 0 0 0.9835 268.8 93.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 27.12 0 0 -5.28 271.2 98.64 cm BI /W 151 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?w||?x<?|>?xp<>|>8`>?p~>`~>|> |>>|><>>|>>>|>>|>?<|>` ><|>p>|>|x>|>x|>>?x???|<|>|>x<@ EI Q BT 0.8449 0 0 0.9835 271.2 93.36 Tm 3 Tr 0.0595 Tc 0 Tw (f~ilities) Tj 0 Tr ET BT 0.9835 0 0 0.9835 298.32 93.36 Tm -0.0424 Tc 0.1041 Tw ( is ) Tj ET q 24.48 0 0 -6.96 310.32 98.64 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>?~>>?>~>>>>|~>>~>>>>|>>>>|>x>>>|><>>>|~<>>>|><>>|>|>>|>>>>>>>>>>>>~>~?|~|??> p>@ EI Q BT 1.4433 0 0 0.9598 310.32 93.36 Tm 3 Tr /F6 5 Tf 0.0093 Tc 0 Tw (through) Tj 0 Tr ET BT 0.9598 0 0 0.9598 334.8 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 9.12 0 0 -5.28 336 98.88 cm BI /W 51 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?>~~~?~`~<< ~|<|||||||||||||?||>||~~p~>  EI Q BT 1.3531 0 0 0.9598 336 93.36 Tm 3 Tr 0.0243 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9598 0 0 0.9598 345.12 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 16.08 0 0 -6.48 346.32 98.64 cm BI /W 90 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????? ~ |`?|>|>px|p|88?<>>߇π??px<?? EI Q BT 1.5335 0 0 0.9598 346.32 93.36 Tm 3 Tr -0.0176 Tc 0 Tw (Keys) Tj 0 Tr ET BT 0.9598 0 0 0.9598 362.4 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 39.36 0 0 -5.28 363.6 98.64 cm BI /W 219 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<??????????x?~|>??8?~>??~> x~<x|<x?|<?x?||?x?||?||?x?||?x?~|~??~|p~?>>~~x~~?~8x=?????=8~C>~>>>~ ~~> EI Q BT 1.5335 0 0 0.9598 363.6 93.36 Tm 3 Tr 0.0242 Tc 0 Tw (Amendment) Tj 0 Tr ET BT 0.9598 0 0 0.9598 402.96 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 5.76 0 0 -4.8 404.16 98.16 cm BI /W 33 /H 26 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x|?>?>???>>>>>?>??>?~? EI Q BT 1.3531 0 0 0.9598 404.16 93.36 Tm 3 Tr -0.0434 Tc 0 Tw (to) Tj 0 Tr ET BT 0.9598 0 0 0.9598 409.92 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 9.36 0 0 -5.28 411.12 98.88 cm BI /W 52 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??>?~>~>p|>0|>?|>>|>>|>>|>>|>?|>|>|>~~<~<  EI Q BT 1.3531 0 0 0.9598 411.12 93.36 Tm 3 Tr 0.0243 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9598 0 0 0.9598 420.48 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 19.44 0 0 -5.52 421.68 98.88 cm BI /W 109 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px ???~>>~|||||~x~||??||||>>|?>|?~???`?~@@||>>?? EI Q BT 1.6237 0 0 0.9598 421.68 93.36 Tm 3 Tr -0.0201 Tc 0 Tw (social) Tj 0 Tr ET BT 0.9598 0 0 0.9598 441.12 93.36 Tm 0 Tc -0.0003 Tw ( ) Tj ET q 26.16 0 0 -7.2 442.32 99.12 cm BI /W 146 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x~ ??|?~>8~>~>~>`~>~>?8~>>|>~|>||>?|>x?|>|?|??????~`?1p~>|~>?@ EI Q BT 1.5335 0 0 0.9598 442.32 93.36 Tm 3 Tr -0.005 Tc 0 Tw (security) Tj 0 Tr ET BT 0.9835 0 0 0.9835 468.48 93.36 Tm /F2 10 Tf 0.0118 Tc 1.3911 Tw ( Act. The Keys) Tj ET BT 0.798 0 0 0.9835 56.88 82.8 Tm 0.0232 Tc 0.327 Tw (Amendment requires States to certify to the U.S. Department of Health and Human) Tj ET q 22.56 0 0 -5.28 330.48 88.08 cm BI /W 146 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??8߀x?π~|??|?~x|????>??`?>???x?x?8????π?~@p|||<>>> EI Q BT 0.6572 0 0 0.9835 330.48 82.8 Tm 3 Tr -0.0177 Tc 0 Tw (Semices) Tj 0 Tr ET BT 0.8449 0 0 0.9835 353.04 82.8 Tm 0.0811 Tc -0.0415 Tw ( that all residential care facilities ) Tj ET q 5.04 0 0 -5.28 465.36 88.32 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>>??>>>?????~` EI Q BT 0.6102 0 0 0.9835 465.36 82.8 Tm 3 Tr 0.0414 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8449 0 0 0.9835 470.4 82.8 Tm 0.0591 Tc -0.0154 Tw ( which a ) Tj ET BT 0.8108 0 0 0.99 501.36 82.8 Tm /F3 8 Tf 0.0769 Tc 0 Tw (significant) Tj ET BT 0.798 0 0 0.9835 56.88 73.92 Tm /F2 10 Tf 0.0306 Tc -0.1334 Tw (number of Supplemental Security ) Tj ET q 19.2 0 0 -5.28 167.04 78.96 cm BI /W 132 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |???????>p?>p|>>>0?|>>>>|>>>>|>><>|>><>>|>>>>|>>?>>>>?>??>>||~?? >@p EI Q BT 0.5633 0 0 0.9835 167.04 73.92 Tm 3 Tr -0.0678 Tc 0 Tw (Lncome) Tj 0 Tr ET BT 0.798 0 0 0.9835 186.24 73.92 Tm 0.0279 Tc -0.0924 Tw ( \(SS1\) recipients reside meet appropriate standards. A 1989 GAO report found that the department does little) Tj -162.1066 -9.2734 TD 0.0269 Tc -0.062 Tw (more than record the receipt of the certifications and that only four States were submitting the required certifications \(453\).) Tj ET BT 0.934 0 0 0.9835 71.04 54.96 Tm /F4 10 Tf 0.0897 Tc -0.0512 Tw (25 ) Tj ET q 28.8 0 0 -5.52 84.24 58.32 cm BI /W 164 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p0?8????<??~?>?>>0>>x>><><<<<~<?>>?>x~|~|?????|?? EI Q BT 0.8066 0 0 0.9835 84.24 54.96 Tm 3 Tr 0.0341 Tc 0 Tw (Reswch) Tj 0 Tr ET BT 0.934 0 0 0.9835 113.04 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 26.16 0 0 -7.2 115.44 58.56 cm BI /W 150 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~8<<< ??|?|||<x|||<|||||0?|x||||||>>~??`@`p???9?? EI Q BT 0.7642 0 0 0.9835 115.44 54.96 Tm 3 Tr -0.0125 Tc 0 Tw (Tfi~gle) Tj 0 Tr ET BT 0.934 0 0 0.9835 141.6 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 25.2 0 0 -5.76 144 58.8 cm BI /W 145 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID π8 ?????~~?>|>>|>|>|>|>|>|>|>|>|>|>?|>|>|>|>|>|>|>|> |>|?p|>|?p|>|x?~>x~???p |><   EI Q BT 0.8491 0 0 0.9835 144 54.96 Tm 3 Tr -0.014 Tc 0 Tw (~ti~te) Tj 0 Tr ET BT 0.934 0 0 0.9835 169.2 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6 0 0 -5.52 171.6 58.8 cm BI /W 35 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~? EI Q BT 0.8915 0 0 0.9835 171.6 54.96 Tm 3 Tr -0.0116 Tc 0 Tw (fi) Tj 0 Tr ET BT 0.934 0 0 0.9835 177.6 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 18.24 0 0 -5.76 180 58.8 cm BI /W 104 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0~?pǀ?~>~>|~>|~||?|||||||||||>~>~>??px8??? EI Q BT 0.7642 0 0 0.9835 180 54.96 Tm 3 Tr 0.0029 Tc 0 Tw (NoM) Tj 0 Tr ET BT 0.934 0 0 0.9835 198.24 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 26.64 0 0 -5.76 200.64 58.8 cm BI /W 152 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~@8?~>||||?||||?|||||||x|||~||||~||||x|||x|||||||||~|?>|~>?|~|~`|?|<?||||` EI Q BT 1.0614 0 0 0.9835 200.64 54.96 Tm 3 Tr 0.0297 Tc 0 Tw (c~ol~) Tj 0 Tr ET BT 0.934 0 0 0.9835 227.28 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 4.32 0 0 -5.52 229.68 60.24 cm BI /W 26 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID π??>>>>>>?y>> EI Q BT 0.5094 0 0 0.9835 229.68 54.96 Tm 3 Tr 0.1119 Tc 0 Tw (is) Tj 0 Tr ET BT 0.934 0 0 0.9835 234 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 34.08 0 0 -7.2 236.4 60.24 cm BI /W 195 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????x???<>>?~<|?p>?|>|8>?x|>??>??>>x>~<>>x>?x>x>|p>>|><?<?><|<<????~x?|??~`> EI Q BT 0.7642 0 0 0.9835 236.4 54.96 Tm 3 Tr -0.0418 Tc 0 Tw (conducfig) Tj 0 Tr ET BT 0.934 0 0 0.9835 270.48 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 3.12 0 0 -3.84 272.88 58.8 cm BI /W 19 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?xx<?8|||>>? EI Q BT 0.5094 0 0 0.9835 272.88 54.96 Tm 3 Tr 0.0897 Tc 0 Tw (a) Tj 0 Tr ET BT 0.934 0 0 0.9835 276 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 16.08 0 0 -7.2 278.4 60.48 cm BI /W 93 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~p>xxxxx?||>|>~>>>>>>>>>>>>À~~À>~>~8>~x>~?x~~?x?`o>>0 EI Q BT 0.5944 0 0 0.9835 278.4 54.96 Tm 3 Tr -0.0174 Tc 0 Tw (Smdy) Tj 0 Tr ET BT 0.934 0 0 0.9835 294.48 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 9.12 0 0 -5.76 296.88 60.48 cm BI /W 52 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||x|||>>Xπ~ EI Q BT 0.6793 0 0 0.9835 296.88 54.96 Tm 3 Tr -0.0194 Tc 0 Tw (for) Tj 0 Tr ET BT 0.934 0 0 0.9835 306 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 9.12 0 0 -5.52 308.4 60.48 cm BI /W 53 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <??~>~>>p>>0>>8>>>>>>>>>>><>>>>>~~|~~> EI Q BT 0.5944 0 0 0.9835 308.4 54.96 Tm 3 Tr -0.0229 Tc 0 Tw (the) Tj 0 Tr ET BT 0.934 0 0 0.9835 317.52 54.96 Tm 0.0302 Tc 0.0125 Tw ( us. ) Tj ET q 36.48 0 0 -7.2 335.52 60.24 cm BI /W 209 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `z@|x????<?>x~><>>8~~>>~|c?~|~|~x||x?||~??|~>?|~?>?>~~<>?>~|~?>~>|߃??`pp00@ EI Q BT 0.8915 0 0 0.9835 335.52 54.96 Tm 3 Tr 0.0338 Tc 0 Tw (Dep~ent) Tj 0 Tr ET BT 0.934 0 0 0.9835 372 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6.72 0 0 -5.52 374.4 60.48 cm BI /W 39 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>|>|>|>>>>>>|>|>|>|>>>>>>> EI Q BT 0.5519 0 0 0.9835 374.4 54.96 Tm 3 Tr 0.0947 Tc 0 Tw (Of) Tj 0 Tr ET BT 0.934 0 0 0.9835 381.12 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 20.88 0 0 -5.52 383.52 60.24 cm BI /W 120 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8?>?????>|c|#||x|?><pp0????? EI Q BT 0.6368 0 0 0.9835 383.52 54.96 Tm 3 Tr -0.067 Tc 0 Tw (Health) Tj 0 Tr ET BT 0.934 0 0 0.9835 404.4 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 10.8 0 0 -5.76 406.8 60.72 cm BI /W 63 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `}~?>>>>x>><>>>>>>>>>>>?>x>x>|~|>|<~? EI Q BT 0.8915 0 0 0.9835 406.8 54.96 Tm 3 Tr 0.0187 Tc 0 Tw (~d) Tj 0 Tr ET BT 0.934 0 0 0.9835 417.6 54.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 23.04 0 0 -5.28 420 60.24 cm BI /W 132 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID h??~~~~>>>>>>>>>>>>>>>>>>~?>>>>?~<?|?0x?? EI Q BT 1.5708 0 0 0.9835 420 54.96 Tm 3 Tr 0.058 Tc 0 Tw (H~) Tj 0 Tr ET BT 0.6793 0 0 0.9835 450.72 53.04 Tm -0.0051 Tc 1.4657 Tw (Services of State licensing) Tj -579.7926 -9.5174 TD -0.0066 Tc 0.408 Tw (requirements and other State regulations for residential care facilities. In addition to a 50- State review of existing regulations, the study will compare) Tj ET BT 0.7217 0 0 0.9835 57.36 35.04 Tm -0.0585 Tc 0.7495 Tw (the quality of care provided in licensed and ) Tj ET q 25.2 0 0 -5.52 206.16 40.8 cm BI /W 188 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |?~??|8p|?|?8x?|~ ?<|aπ ||||?|x|x~|~?<?>><<x>~<<?|>|><?p`y8 EI Q BT 0.467 0 0 0.9835 206.16 35.04 Tm 3 Tr 0.0487 Tc 0 Tw (urdicensed) Tj 0 Tr ET BT 0.7217 0 0 0.9835 231.36 35.04 Tm -0.0533 Tc 0.5067 Tw ( residential care ) Tj ET q 18.24 0 0 -5.52 288.48 40.56 cm BI /W 138 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |?~?|??|>0|>x?<>|><>|>?>|>>|>|>|>p?|>x?|>?x>|>p?|>x~<|>??<> q|>߀|>|>8 EI Q BT 0.467 0 0 0.9835 288.48 35.04 Tm 3 Tr 0.0184 Tc 0 Tw (facilites) Tj 0 Tr ET BT 0.7217 0 0 0.9835 306.72 35.04 Tm 0.0071 Tc 0.2012 Tw ( in 10 States.) Tj ET endstream endobj 176 0 obj <>/Rotate 0/Type/Page>> endobj 177 0 obj <>stream 0.72 w 1 j 0 0 0 RG 76.56 689.04 m 555.6 689.04 l S 81.12 109.92 m 560.16 109.92 l S BT 0.9863 0 0 0.9863 76.56 695.04 Tm 0 0 0 rg /F3 9 Tf 0.1038 Tc -0.175 Tw (52 ) Tj ET BT 0.9598 0 0 0.9598 89.28 695.04 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 95.52 695.04 Tm /F5 11 Tf 0.0882 Tc -0.151 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 131.28 695.04 Tm /F5 10 Tf 0.0128 Tc 0.7496 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj -55.1521 -39.7778 TD /F4 10 Tf 0.0284 Tc 1.9308 Tw (in residential care facilities usually cost less to) Tj 0.244 -12.2018 TD 0.0251 Tc 1.3067 Tw (construct and operate than special care units in) Tj ET BT 0.934 0 0 0.9835 77.04 632.16 Tm -0.0113 Tc 0.346 Tw (nursing homes. As a result, they usually charge less) Tj ET BT 0.8915 0 0 0.9835 77.52 619.92 Tm 0.039 Tc 1.6162 Tw (than nursing homes.) Tj 12.3829 -27.332 TD 0.0301 Tc 1.1327 Tw (Despite these advantages, there are serious poten-) Tj ET BT 0.934 0 0 0.9835 77.76 581.04 Tm -0.0348 Tc 1.734 Tw (tial problems with special care units in residential) Tj ET BT 0.9835 0 0 0.9835 77.76 569.28 Tm 0.0313 Tc 1.7257 Tw (care facilities. Anecdotal evidence suggests that) Tj ET BT 0.8915 0 0 0.9835 77.76 557.52 Tm 0.0299 Tc 1.189 Tw (most of these units are established outside a nursing) Tj ET BT 0.9835 0 0 0.9835 77.76 545.52 Tm 0.0288 Tc 0.5708 Tw (home in order to avoid nursing home regulations) Tj ET BT 0.934 0 0 0.9835 78.48 533.76 Tm -0.0185 Tc 0.5465 Tw (\(273\). This may be entirely appropriate if the intent) Tj -0.257 -12.2018 TD -0.0342 Tc 0.7055 Tw (is to avoid regulatory requirements that restrict the) Tj ET BT 0.9835 0 0 0.9835 78.24 509.52 Tm 0.035 Tc 1.0874 Tw (use of physical design or other features the unit) Tj 0.244 -11.9577 TD 0.0463 Tc -0.1036 Tw (operator believes will benefit individuals with de-) Tj ET BT 0.934 0 0 0.9835 78.24 485.76 Tm -0.0343 Tc 0.9952 Tw (mentia; it is clearly inappropriate if the intent is to) Tj ET BT 0.8915 0 0 0.9835 78.72 473.76 Tm 0.0458 Tc 0.9805 Tw (avoid regulatory requirements that are important for) Tj ET BT 0.934 0 0 0.9835 78.48 461.76 Tm -0.0307 Tc 1.4359 Tw (the safety or well-being of individuals with demen-) Tj ET BT 0.9835 0 0 0.9835 78.72 450 Tm 0.0289 Tc 1.4841 Tw (tia. Many government reports have documented) Tj 0.244 -12.4458 TD 0.0444 Tc 3.2742 Tw (widespread abuse, exploitation, and neglect of) Tj -0.244 -11.9577 TD 0.0356 Tc 1.3716 Tw (elderly and other individuals in residential care) Tj 0.244 -11.9577 TD 0.019 Tc 0 Tw (facilities.) Tj ET BT 1.08 0 0 1.08 122.16 419.04 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (26 ) Tj ET BT 0.9835 0 0 0.9835 128.16 414.24 Tm /F4 10 Tf 0.0308 Tc 1.3967 Tw (Given the vulnerability of individuals) Tj ET BT 0.8915 0 0 0.9835 79.2 402 Tm 0.0392 Tc 1.3277 Tw (with dementia, the proliferation of special care units) Tj ET BT 0.9835 0 0 0.9835 79.2 389.76 Tm 0.024 Tc 1.0986 Tw (in minimally regulated residential care facilities) Tj ET BT 0.934 0 0 0.9835 78.96 378.24 Tm -0.0523 Tc 1.4285 Tw (raises the prospect of severely deficient care.) Tj 12.5908 -27.8201 TD -0.0354 Tc 2.3953 Tw (Specialized living arrangements for people with) Tj -11.82 -12.2018 TD -0.0357 Tc 0.7071 Tw (dementia are also being developed in assisted living) Tj 0.257 -11.9577 TD -0.0315 Tc 0.5925 Tw (facilities. The term ) Tj ET BT 0.9443 0 0 0.9812 166.32 327.12 Tm /F5 11 Tf 0.0108 Tc 0.6257 Tw (assisted living facilities ) Tj ET BT 0.934 0 0 0.9835 269.52 327.12 Tm /F4 10 Tf -0.0685 Tc 1.66 Tw (refers to) Tj ET BT 0.8915 0 0 0.9835 79.92 315.12 Tm 0.0466 Tc 1.2809 Tw (living arrangements in which a variety of supportive) Tj ET BT 0.934 0 0 0.9835 80.16 302.88 Tm -0.0278 Tc 1.1988 Tw (services are available to residents who each have a) Tj ET BT 0.8915 0 0 0.9835 80.4 291.12 Tm 0.0312 Tc 1.5241 Tw (separate apartment that is lockable and has its own) Tj ET BT 0.934 0 0 0.9835 79.92 279.12 Tm -0.0307 Tc 1.7908 Tw (kitchen \(501\). Some people consider assisted living) Tj ET BT 0.8915 0 0 0.9835 80.16 266.88 Tm 0.0383 Tc 1.3816 Tw (facilities a type of residential care facility, and other) Tj ET BT 0.934 0 0 0.9835 79.92 255.12 Tm -0.0423 Tc 2.1457 Tw (people consider them a separate category of living) Tj 0.7709 -11.9577 TD -0.0278 Tc 1.7265 Tw (arrangements. They are less likely to be regulated) Tj 0 -12.2018 TD -0.0393 Tc 2.2711 Tw (than other residential care facilities and therefore) Tj ET BT 0.8915 0 0 0.9835 80.16 219.6 Tm 0.0448 Tc 0.847 Tw (probably present greater potential for deficient care.) Tj ET BT 0.9557 0 0 1.08 302.88 224.4 Tm /F4 4 Tf 0.0359 Tc 0 Tw (27) Tj ET BT 0.8915 0 0 0.9835 91.92 192.48 Tm /F4 10 Tf 0.0469 Tc 1.1138 Tw (Psychogeriatric units in public and private mental) Tj ET BT 0.9835 0 0 0.9835 80.64 180.72 Tm 0.0432 Tc 0.591 Tw (hospitals often serve elderly individuals with de-) Tj ET BT 0.8915 0 0 0.9835 80.88 168.72 Tm 0.0401 Tc 1.4468 Tw (mentia as well as elderly individuals with acute and) Tj ET BT 0.934 0 0 0.9835 81.12 156.96 Tm -0.0212 Tc 0.8384 Tw (chronic mental illnesses, but some mental hospitals) Tj ET BT 0.8915 0 0 0.9835 80.88 144.96 Tm 0.0303 Tc 0.6839 Tw (have units that serve only individuals with dementia.) Tj ET BT 0.934 0 0 0.9835 81.36 132.96 Tm -0.0196 Tc 1.0936 Tw (Such units exist, for example, in two Virginia state) Tj 0 -11.7137 TD 0.0165 Tc 2.5967 Tw (hospitals \(56,252\).) Tj 276.2272 543.2234 TD -0.0304 Tc 0.8911 Tw (Lastly, some organizations have developed or are) Tj ET BT 0.9835 0 0 0.9835 328.56 643.44 Tm 0.0363 Tc 2.7455 Tw (developing campus-like settings that provide a) Tj ET BT 0.8915 0 0 0.9835 328.32 631.68 Tm 0.0471 Tc 1.8764 Tw (variety of living arrangements and other specialized) Tj ET BT 0.934 0 0 0.9835 329.04 619.68 Tm -0.0332 Tc 2.2645 Tw (services for individuals with dementia.) Tj ET BT 0.9557 0 0 1.08 504 624.48 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (28 ) Tj ET BT 0.934 0 0 0.9835 509.76 619.68 Tm /F4 10 Tf -0.0185 Tc 1.8634 Tw (The living) Tj ET BT 0.8915 0 0 0.9835 329.04 607.68 Tm 0.0494 Tc 1.2008 Tw (arrangements available in such settings may include) Tj 0.2692 -12.2018 TD 0.0295 Tc 1.723 Tw (apartments for an individual with dementia and his) Tj ET BT 0.9835 0 0 0.9835 329.04 583.44 Tm 0.0309 Tc 1.1962 Tw (or her spouse, residential care or assisted living) Tj ET BT 0.8915 0 0 0.9835 329.04 571.92 Tm 0.0267 Tc 1.2936 Tw (units, and nursing home units.) Tj ET BT 0.934 0 0 0.9835 340.56 546.96 Tm -0.0399 Tc 1.3724 Tw (In addition to programs intended to improve the) Tj ET BT 0.9835 0 0 0.9835 329.52 534.48 Tm 0.0277 Tc 0.7114 Tw (care of nursing home residents with dementia or) Tj ET BT 0.934 0 0 0.9835 329.28 522.72 Tm -0.0436 Tc 1.5476 Tw (provide alternate residential care options for them,) Tj ET BT 0.8915 0 0 0.9835 329.52 510.72 Tm 0.0329 Tc 1.3731 Tw (many services have been developed to assist individ-) Tj 0.2692 -12.2018 TD 0.0471 Tc 0.994 Tw (uals with dementia who are living at home and their) Tj ET BT 0.9835 0 0 0.9835 329.76 486.72 Tm 0.0205 Tc 0.248 Tw (caregivers. These services include adult day care,) Tj 0 -11.9577 TD 0.0331 Tc 0.7639 Tw (respite care, specialized hospice programs, and a) Tj 0.244 -12.4458 TD 0.0306 Tc 2.6049 Tw (variety of other in-home and community-based) Tj 0.4881 -12.2018 TD 0.0301 Tc 0.279 Tw (services. All these programs and services provide) Tj 0 -12.2018 TD 0.0408 Tc 0.454 Tw (alternatives to special care units for some people) Tj ET BT 0.934 0 0 0.9835 330.24 426.72 Tm -0.0429 Tc 0.9045 Tw (with dementia. Government policies for special care) Tj ET BT 0.9835 0 0 0.9835 330.24 414.72 Tm 0.0378 Tc 0.871 Tw (units should be considered in relation to the full) Tj ET BT 0.934 0 0 0.9835 330 403.2 Tm -0.0351 Tc 1.1531 Tw (range of care options for these individuals.) Tj ET BT 0.9663 0 0 0.9939 397.44 361.2 Tm /F6 14 Tf 0.0433 Tc 0 Tw (CONCLUSION) Tj ET BT 0.934 0 0 0.9835 342 336.24 Tm /F4 10 Tf -0.0217 Tc 0.8711 Tw (A large number of nursing home residents in the) Tj ET BT 0.9835 0 0 0.9835 331.2 324.24 Tm 0.0375 Tc 0.1087 Tw (United States have dementia--637,600 to 922,500) Tj 0.244 -12.2018 TD 0.0338 Tc 0.2752 Tw (according to national surveys-and almost all peo-) Tj ET BT 0.934 0 0 0.9835 331.2 300.48 Tm -0.0357 Tc 0.7576 Tw (ple with dementia will probably spend some time in) Tj 0.5139 -12.2018 TD -0.0285 Tc 0.8748 Tw (a nursing home in the course of their illness. These) Tj ET BT 0.8915 0 0 0.9835 331.68 276.48 Tm 0.0493 Tc 1.8739 Tw (individuals may receive inappropriate care that will) Tj ET BT 0.9835 0 0 0.9835 331.2 264.48 Tm 0.0346 Tc 1.9826 Tw (result in excess disability and severely reduced) Tj ET BT 0.934 0 0 0.9835 331.68 252.96 Tm -0.0169 Tc 1.3477 Tw (quality of life.) Tj ET BT 0.9835 0 0 0.9835 342.72 227.76 Tm 0.0375 Tc 1.5381 Tw (Special care units of various types have been) Tj ET BT 0.934 0 0 0.9835 331.92 215.76 Tm -0.0483 Tc 1.8586 Tw (developed and are proliferating in response to this) Tj ET BT 0.8915 0 0 0.9835 331.68 204 Tm 0.0407 Tc 1.1721 Tw (problem. Special care units promise to provide better) Tj ET BT 0.934 0 0 0.9835 332.16 191.76 Tm -0.0267 Tc 1.2114 Tw (care for individuals with dementia than these indi-) Tj 0 -11.9577 TD -0.0294 Tc 1.3611 Tw (viduals would receive in other nursing home units.) Tj ET BT 0.9835 0 0 0.9835 332.4 168 Tm 0.0185 Tc 2.9171 Tw (It is unlikely all nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 332.64 156.24 Tm 0.0561 Tc 1.1036 Tw (dementia will ever be cared for in special care units,) Tj ET BT 0.934 0 0 0.9835 332.64 144.24 Tm -0.0408 Tc 1.2449 Tw (but methods of care developed in special care units) Tj 0 -11.7137 TD -0.03 Tc 2.261 Tw (could eventually be implemented in other nursing) Tj T* -0.019 Tc 0.5791 Tw (home units as well.) Tj ET q 5.28 0 0 -4.32 95.28 103.92 cm BI /W 32 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?<<xxx|?|~x?x?|?|||? EI Q BT 0.5164 0 0 0.9835 95.28 97.2 Tm 3 Tr /F2 10 Tf 0.1092 Tc 0 Tw (26) Tj 0 Tr ET BT 0.8919 0 0 0.9835 100.56 97.2 Tm 0.0678 Tc -0.1558 Tw ( See, ) Tj ET q 36 0 0 -7.2 120.24 102.72 cm BI /W 217 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~`~rp????????????x?|8>>?>?>~~|~??>~?????=?ǀ? EI Q BT 0.7041 0 0 0.9835 120.24 97.2 Tm 3 Tr 0.0299 Tc 0 Tw (forexample,) Tj 0 Tr ET BT 0.798 0 0 0.9835 158.88 97.2 Tm 0.0361 Tc 0.8049 Tw (\223Board and Care Homes in America: A National Tragedy\224 \(455\), and \221Board and Care: ) Tj ET q 63.12 0 0 -6.24 452.64 102.96 cm BI /W 415 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<C ???????|?|~???|<~|?|~?x|~?~|??~~~?|~?~x~>~~|||?<?~<>~<?~@>~><?~>?~|~??~??>~|~~?>?>~~~?>>~~~? >~~~?>p~?~q8~?~x~x~?p~||?~x~??x?>??~???????0`?????|||q??><|>??? EI Q BT 0.6572 0 0 0.9835 452.64 97.2 Tm 3 Tr 0.0538 Tc 0 Tw (LnsufflcientAssurances) Tj 0 Tr ET BT 0.798 0 0 0.9835 515.76 97.2 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 41.04 0 0 -6.24 517.68 102.96 cm BI /W 271 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @<???????????????~??????????~??~??~~?~>?~~?~>~~?~?~~?|?>???????`??~x??>?8??? EI Q BT 0.6572 0 0 0.9835 517.68 97.2 Tm 3 Tr 0.0538 Tc 0 Tw (ThatResidents\222) Tj 0 Tr ET BT 0.798 0 0 0.9835 81.36 88.32 Tm 0.0404 Tc 0.155 Tw (Needs are Identified and Met\224 \(453\).) Tj ET q 5.04 0 0 -4.32 95.28 81.6 cm BI /W 32 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >pxxxxx<|<||`p?? EI Q BT 0.4694 0 0 0.9835 95.28 77.28 Tm 3 Tr 0.1081 Tc 0 Tw (27) Tj 0 Tr ET BT 0.8118 0 0 0.9598 100.32 77.28 Tm /F6 5 Tf 0 Tc -0.0681 Tw ( ) Tj ET q 21.36 0 0 -7.2 101.28 83.04 cm BI /W 133 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>?<??~?~??~~>~~>|>|>||>||>||>||>>| >x??||~p8~~|>?? EI Q BT 1.5335 0 0 0.9598 101.28 77.28 Tm 3 Tr 0.0074 Tc 0 Tw (Gegon) Tj 0 Tr ET BT 0.8118 0 0 0.9598 122.64 77.28 Tm 0 Tc -0.0681 Tw ( ) Tj ET q 9.12 0 0 -5.28 123.6 82.8 cm BI /W 58 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >ߏ???~~ >?>|~???~>À>>~?? EI Q BT 1.2629 0 0 0.9598 123.6 77.28 Tm 3 Tr -0.0022 Tc 0 Tw (has) Tj 0 Tr ET BT 0.8491 0 0 0.9835 132.72 77.28 Tm /F4 10 Tf 0 Tc 0.0449 Tw ( ) Tj ET q 29.28 0 0 -7.2 134.88 82.56 cm BI /W 182 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |||?>?<??~|~8~~~<~|~|πAπ ππ|x|||>~|~<>~|~?<?>??>?= EI Q BT 0.5944 0 0 0.9835 134.88 77.28 Tm 3 Tr -0.1052 Tc 0 Tw (developed) Tj 0 Tr ET BT 0.8491 0 0 0.9835 164.16 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 19.92 0 0 -7.2 166.32 82.8 cm BI /W 124 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? \~~~???>x?p>|x>?p~π<>?>?|>}~}~?~?~?π~~|x~||~|?~|~????~?߀??<>>>? EI Q BT 0.5944 0 0 0.9835 166.32 77.28 Tm 3 Tr -0.0276 Tc 0 Tw (special) Tj 0 Tr ET BT 0.8449 0 0 0.9835 186.24 77.28 Tm /F2 10 Tf 0 Tc 0.0545 Tw ( ) Tj ET q 31.68 0 0 -6.96 188.4 82.56 cm BI /W 197 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`<~??????????|??~|??~??~???~??~??~??~|???~|`?x~<|??~>>???|?p?~8x?>???? EI Q BT 0.7041 0 0 0.9835 188.4 77.28 Tm 3 Tr 0.011 Tc 0 Tw (regdat.ions) Tj 0 Tr ET BT 0.8449 0 0 0.9835 220.08 77.28 Tm 0.0845 Tc 0.3332 Tw ( for assisted living facilities. In 1987, the State ) Tj ET BT 0.8491 0 0 0.9835 386.4 77.28 Tm /F4 10 Tf -0.0163 Tc 0.064 Tw (Medicaid ) Tj ET q 24.48 0 0 -5.76 426.48 82.08 cm BI /W 152 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??`??????????????|?>?>?>>>?߇χ?|?p? EI Q BT 0.6368 0 0 0.9835 426.48 77.28 Tm 3 Tr -0.0179 Tc 0 Tw (progran) Tj 0 Tr ET BT 0.8491 0 0 0.9835 450.96 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 17.28 0 0 -7.2 453.12 83.76 cm BI /W 108 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??> ????~}>>???x??<?x???? EI Q BT 0.7217 0 0 0.9835 453.12 77.28 Tm 3 Tr -0.0423 Tc 0 Tw (~gan) Tj 0 Tr ET BT 0.8491 0 0 0.9835 470.4 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 19.44 0 0 -7.2 472.56 83.04 cm BI /W 121 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|?<??<<|???????|?~??xxp<?<??|??|??~~?|~ EI Q BT 0.7642 0 0 0.9835 472.56 77.28 Tm 3 Tr -0.0465 Tc 0 Tw (pa@g) Tj 0 Tr ET BT 0.8491 0 0 0.9835 492 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.4 0 0 -5.52 494.16 83.04 cm BI /W 53 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?~~~||~>?߀ EI Q BT 0.6368 0 0 0.9835 494.16 77.28 Tm 3 Tr 0.012 Tc 0 Tw (for) Tj 0 Tr ET BT 0.8491 0 0 0.9835 502.56 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 11.52 0 0 -4.32 504.72 82.56 cm BI /W 73 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?Ϗ>>?????>?x?|?|?>>?| EI Q BT 0.8491 0 0 0.9835 504.72 77.28 Tm 3 Tr -0.0267 Tc 0 Tw (cm) Tj 0 Tr 13.5673 0 TD 0 Tc 0.0449 Tw ( ) Tj ET q 5.28 0 0 -5.52 518.4 84 cm BI /W 34 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>>>>?????????~?>?? EI Q BT 0.5519 0 0 0.9835 518.4 77.28 Tm 3 Tr -0.0669 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8491 0 0 0.9835 523.68 77.28 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 30.24 0 0 -7.2 525.84 83.04 cm BI /W 188 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8p?~?????????>?<?~x~<?~9??~~ ~?~?~^?~|~~|~~||~|>~~|>~~~>??????x>>??? EI Q BT 0.5519 0 0 0.9835 525.84 77.28 Tm 3 Tr 0.0222 Tc 0 Tw (designated) Tj 0 Tr ET BT 0.798 0 0 0.9835 81.36 67.68 Tm /F2 10 Tf 0.0284 Tc -0.0254 Tw (assisted living facilities for individuals who are eligible for Medicaid-funded nursing home care \(501\). One of these facilities serves individuals with) Tj ET BT 0.7511 0 0 0.9835 81.36 58.56 Tm 0.0357 Tc 3.2029 Tw (dementia \(504\).) Tj ET BT 0.8066 0 0 0.9835 95.04 48.72 Tm /F4 10 Tf 0.0897 Tc -0.2151 Tw (28 ) Tj ET q 10.8 0 0 -6.72 106.56 52.32 cm BI /W 72 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|< x?~<~x~<`?|>??? >~>>>p EI Q BT 0.7642 0 0 0.9835 106.56 48.72 Tm 3 Tr 0.0088 Tc 0 Tw (s=,) Tj 0 Tr ET BT 0.8066 0 0 0.9835 117.36 48.72 Tm 0.0054 Tc 0.0382 Tw ( for ) Tj ET q 24.24 0 0 -7.2 132.48 54.48 cm BI /W 160 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??8<`??~?~?||>|>~?||><~||>|?||> |`?||>|||>x||>||>||>||>?||>>?~|>>?>>߃>?>~>x8> >>>~ EI Q BT 0.8491 0 0 0.9835 132.48 48.72 Tm 3 Tr -0.0078 Tc 0 Tw (e~ple,) Tj 0 Tr ET BT 0.8066 0 0 0.9835 156.72 48.72 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 13.44 0 0 -5.76 158.88 54.24 cm BI /W 90 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID q??3>?~>x>><>>>> >>>>>>>?~>>>>>>>>>?~?`~ ~~~>? EI Q BT 0.5094 0 0 0.9835 158.88 48.72 Tm 3 Tr 0.0064 Tc 0 Tw (Stein) Tj 0 Tr ET BT 0.8066 0 0 0.9835 172.32 48.72 Tm 0.054 Tc 0.2754 Tw ( Gerontological ) Tj ET q 18.72 0 0 -6.24 232.8 54.24 cm BI /W 125 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx?<>???|?|?|x?g|<?||~|~|~|||?~`??~?|< ` EI Q BT 0.6368 0 0 0.9835 232.8 48.72 Tm 3 Tr -0.0681 Tc 0 Tw (ceut~,) Tj 0 Tr ET BT 0.6793 0 0 0.9835 255.6 46.08 Tm -0.0062 Tc 2.7921 Tw (\223Pathways: Program Development Plan\224 \(423\).) Tj ET endstream endobj 178 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 179 0 obj <>stream 0.72 w 1 j 0 0 0 RG 54 678.72 m 532.8 678.72 l S BT 0.9835 0 0 0.9835 321.6 683.76 Tm 0 0 0 rg /F5 10 Tf 0.0114 Tc 2.4287 Tw (Chapter L-Overview and Policy Implications) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 514.32 683.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 520.8 683.76 Tm /F5 10 Tf 0.366 Tc 0 Tw (53) Tj ET BT 0.8915 0 0 0.9835 65.52 644.88 Tm /F4 10 Tf 0.0397 Tc 1.0963 Tw (Better methods of care for nursing home residents) Tj ET BT 0.9835 0 0 0.9835 54.48 632.64 Tm 0.0385 Tc 0.1687 Tw (with dementia are likely to benefit not only those) Tj ET BT 0.934 0 0 0.9835 54.24 620.88 Tm -0.0208 Tc 1.0949 Tw (residents, but also their families, the nursing home) Tj ET BT 0.9835 0 0 0.9835 54.96 608.64 Tm 0.0266 Tc 2.5602 Tw (staff members who) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 151.92 608.64 Tm /F3 9 Tf 0.0416 Tc 2.0294 Tw (take care of them, and other) Tj ET BT 0.9835 0 0 0.9835 54.72 596.64 Tm /F4 10 Tf 0.0304 Tc 1.9869 Tw (nursing home residents who are not demented.) Tj 0 -11.9577 TD 0.0319 Tc 1.8227 Tw (Families will benefit because they will be more) Tj 0.4881 -12.4458 TD 0.0401 Tc 0.4896 Tw (satisfied with the care provided for their relative) Tj -0.244 -12.2018 TD 0.0355 Tc 0.7034 Tw (with dementia and therefore may feel less guilty) Tj ET BT 0.8915 0 0 0.9835 55.2 549.12 Tm 0.0503 Tc 0.5605 Tw (about having placed the individual in a nursing home) Tj 0.2692 -12.4458 TD 0.0481 Tc 0.6638 Tw (and less anxious about his or her well-being. Nursing) Tj ET BT 0.9835 0 0 0.9835 55.2 525.12 Tm 0.0348 Tc 0.0767 Tw (home staff members will benefit because the resi-) Tj 0.244 -12.2018 TD 0.0385 Tc 1.45 Tw (dents are likely to be easier to manage. Nonde-) Tj ET BT 0.934 0 0 0.9835 55.44 501.12 Tm -0.03 Tc 0.7194 Tw (mented nursing home residents will benefit because) Tj ET BT 0.8915 0 0 0.9835 55.68 488.88 Tm 0.0306 Tc 1.2988 Tw (the behavioral and other symptoms of residents with) Tj ET BT 0.934 0 0 0.9835 55.68 477.12 Tm -0.0243 Tc 0.5848 Tw (dementia are often disturbing to them; better meth-) Tj ET BT 0.8915 0 0 0.9835 55.92 465.12 Tm 0.0555 Tc 0.8709 Tw (ods of care are likely to reduce the incidence of these) Tj ET BT 0.9835 0 0 0.9835 56.16 453.12 Tm 0.0264 Tc 2.2815 Tw (symptoms and thus improve the quality of the) Tj ET BT 0.934 0 0 0.9835 55.92 441.6 Tm -0.0408 Tc 2.1442 Tw (nondemented residents\222 lives.) Tj 11.82 -18.0586 TD -0.0071 Tc 0.4058 Tw (The number of nursing homes that have a special) Tj -11.563 -11.9577 TD -0.0211 Tc 1.2054 Tw (care unit is increasing rapidly. OTA estimates that) Tj 1.2848 -12.2018 TD -0.0105 Tc 1.2552 Tw (10 percent of all U.S. nursing homes had a special) Tj -1.2848 -12.2018 TD 0.0139 Tc 0.2869 Tw (care unit in 1991.) Tj ET BT 0.8915 0 0 0.9835 67.44 370.32 Tm 0.0464 Tc 0.512 Tw (Existing special care units vary greatly in virtually) Tj ET BT 0.9835 0 0 0.9835 56.88 358.32 Tm 0.0346 Tc 2.7147 Tw (all respects. Although experts agree about the) Tj ET BT 0.934 0 0 0.9835 56.64 346.32 Tm -0.0465 Tc 2.4073 Tw (theoretical principles of specialized dementia care,) Tj ET BT 0.9835 0 0 0.9835 56.88 334.56 Tm 0.0398 Tc 0.1064 Tw (the theoretical principles are implemented differ-) Tj 0 -12.2018 TD 0.0343 Tc 1.4848 Tw (ently in different special care units and are not) Tj ET BT 0.934 0 0 0.9835 56.88 310.8 Tm -0.0252 Tc 1.5494 Tw (implemented at all in some special care units, and) Tj ET BT 0.8915 0 0 0.9835 56.88 298.8 Tm 0.0458 Tc 0.7113 Tw (there is considerable disagreement about the particu-) Tj 0 -11.9577 TD 0.0529 Tc 0.8379 Tw (lar features that are necessary in a special care unit.) Tj ET BT 0.9835 0 0 0.9835 68.16 269.04 Tm 0.0254 Tc 1.8293 Tw (Proponents of special care units make strong) Tj -11.2256 -12.4458 TD 0.0297 Tc -0.0053 Tw (claims about their effectiveness, but the available) Tj ET BT 0.934 0 0 0.9835 56.88 245.28 Tm -0.0434 Tc 0.9723 Tw (research provides little support for the claims. Only) Tj 0.257 -12.4458 TD -0.0313 Tc 1.3888 Tw (two of the six special care unit studies that used a) Tj ET BT 0.9835 0 0 0.9835 57.12 221.04 Tm 0.0369 Tc 3.2004 Tw (control group found any positive outcomes for) Tj 0.4881 -12.2018 TD 0.0325 Tc 1.273 Tw (special care unit residents. Only one of the four) Tj ET BT 0.934 0 0 0.9835 57.6 197.04 Tm -0.0266 Tc 1.5508 Tw (studies that measured the impact of a special care) Tj 0 -12.2018 TD -0.0166 Tc 1.1161 Tw (unit on the unit staff members and only two of the) Tj 0 -11.7137 TD -0.0349 Tc 0.8209 Tw (four studies that evaluated the effect of special care) Tj ET BT 0.9835 0 0 0.9835 57.6 161.28 Tm 0.0328 Tc -0.1305 Tw (units on the residents\222 families found any positive) Tj 0.244 -12.4458 TD 0.0374 Tc 1.4685 Tw (outcomes. None of these studies is definitive by) Tj 0 -11.9577 TD 0.026 Tc 0.4051 Tw (itself, but their combined findings are impressive) Tj 0.244 -12.4458 TD 0.032 Tc -0.1297 Tw (and suggest that we do not yet know exactly what) Tj ET BT 0.8915 0 0 0.9835 57.84 113.28 Tm 0.0374 Tc 1.9321 Tw (constitutes effective nursing home care for individu-) Tj 0.2692 -11.9577 TD 0.02 Tc 1.7722 Tw (als with dementia.) Tj ET BT 0.9835 0 0 0.9835 69.12 83.52 Tm 0.0385 Tc -0.0317 Tw (Because of the diversity of existing special care) Tj ET BT 0.934 0 0 0.9835 57.84 71.28 Tm -0.039 Tc 1.4999 Tw (units, their rapid proliferation, and the widespread) Tj ET BT 0.8915 0 0 0.9835 57.84 59.28 Tm 0.0381 Tc 0.6751 Tw (perception that some special care units use the words) Tj ET BT 0.9014 0 0 0.9812 58.08 47.52 Tm /F5 11 Tf -0.0377 Tc 1.5505 Tw (special care) Tj 0 Tc -0.0889 Tw ( ) Tj ET BT 0.9126 0 0 0.9863 111.12 47.52 Tm /F3 9 Tf -0.01 Tc 0.1374 Tw (as a ) Tj ET BT 0.8915 0 0 0.9835 129.84 47.52 Tm /F4 10 Tf 0.0422 Tc 1.6799 Tw (marketing tool and actually provide) Tj -80.4891 -11.9577 TD 0.0418 Tc 1.0075 Tw (no special services for their residents, there is strong) Tj ET BT 0.934 0 0 0.9835 305.52 644.88 Tm -0.0393 Tc 0.6009 Tw (pressure to regulate special care units. On the other) Tj ET BT 0.9835 0 0 0.9835 305.76 632.64 Tm 0.0263 Tc 0.2247 Tw (hand, given the lack of agreement among experts) Tj ET BT 0.8915 0 0 0.9835 306 620.64 Tm 0.0491 Tc 1.2684 Tw (about the particular features that are necessary in a) Tj ET BT 0.9835 0 0 0.9835 306.48 608.4 Tm 0.0328 Tc 1.4034 Tw (special care unit and the lack of research-based) Tj ET BT 0.934 0 0 0.9835 306 596.4 Tm -0.0431 Tc 1.0224 Tw (evidence of the effectiveness of special care units, it) Tj 0.257 -11.9577 TD -0.0445 Tc 0.7777 Tw (is difficult to determin) Tj ET BT 0.8915 0 0 0.9835 404.4 584.4 Tm 0.0404 Tc 1.2782 Tw (e what regulations should say) Tj ET BT 0.934 0 0 0.9835 306.24 572.4 Tm -0.0183 Tc 1.7346 Tw (beyond general statements about goals and princi-) Tj ET BT 0.9835 0 0 0.9835 306 560.64 Tm 0.0346 Tc 1.881 Tw (ples and a listing of issues that require special) Tj ET BT 0.8915 0 0 0.9835 306.72 548.64 Tm 0.0397 Tc 1.2116 Tw (consideration in the care of residents with dementia,) Tj ET BT 0.934 0 0 0.9835 306.72 536.64 Tm 0.0026 Tc 0.9414 Tw (e.g., staff trainin) Tj 80.1701 -0.244 TD -0.0194 Tc 2.1213 Tw (g, environmental design, security,) Tj -79.9132 -11.9577 TD -0.0182 Tc 0.7324 Tw (activity programs, family involvement, and resident) Tj ET BT 0.8915 0 0 0.9835 306.72 512.88 Tm 0.0044 Tc 0 Tw (rights.) Tj 12.9213 -18.5467 TD 0.0536 Tc 1.1961 Tw (Special care unit regulations are likely to discour-) Tj ET BT 0.934 0 0 0.9835 307.44 482.88 Tm -0.0132 Tc 0.8299 Tw (age innovation by suggesting that we already know) Tj ET BT 0.9835 0 0 0.9835 307.44 470.64 Tm 0.0264 Tc 1.1369 Tw (what constitutes effective care for nursing home) Tj ET BT 0.934 0 0 0.9835 306.96 459.12 Tm -0.0333 Tc 0.7228 Tw (residents with dementia. Regulations are also likely) Tj ET BT 0.9835 0 0 0.9835 307.44 446.88 Tm 0.0312 Tc 0.6033 Tw (to lock in for the future current beliefs about the) Tj ET BT 0.8915 0 0 0.9835 307.44 435.36 Tm 0.0366 Tc 0.946 Tw (features that are important in special care units.) Tj ET BT 0.9835 0 0 0.9835 318.72 417.36 Tm 0.0293 Tc 0.7678 Tw (OTA concludes that the objective of improving) Tj -11.4697 -11.9577 TD 0.024 Tc 0.6513 Tw (nursing home care for individuals with dementia) Tj 0.244 -12.2018 TD 0.0394 Tc 1.1745 Tw (will be better served at present by initiatives to) Tj ET BT 0.8915 0 0 0.9835 307.68 381.36 Tm 0.0472 Tc 1.6519 Tw (develop greater knowledge and agreement about the) Tj ET BT 0.934 0 0 0.9835 307.44 369.84 Tm -0.0246 Tc 0.7136 Tw (particular features that are important in the care of) Tj 0.7709 -11.9577 TD -0.0169 Tc 1.2009 Tw (nursing home residents with dementia than by the) Tj 0 -12.4458 TD -0.0249 Tc 1.6561 Tw (establishment of regulations for special care units.) Tj ET BT 0.9835 0 0 0.9835 308.4 333.84 Tm 0.0432 Tc 1.6587 Tw (Some people argue that we cannot wait for the) Tj ET BT 0.8915 0 0 0.9835 307.92 322.08 Tm 0.0388 Tc 0.9772 Tw (results of such initiatives to develop special care unit) Tj 0 -12.2018 TD 0.0356 Tc 0.2741 Tw (regulations. It is said that regulations are needed now) Tj ET BT 0.9835 0 0 0.9835 308.4 298.08 Tm 0.0379 Tc 1.4912 Tw (to protect individuals with dementia from poor-) Tj ET BT 0.8915 0 0 0.9835 308.4 286.32 Tm 0.0352 Tc 1.2168 Tw (quality care. In contrast, OTA concludes that OBRA-) Tj 0.5384 -12.4458 TD 0.0332 Tc 0.7816 Tw (87 provides a sufficient basis for censuring units that) Tj ET BT 0.934 0 0 0.9835 308.16 262.56 Tm -0.0329 Tc 0.9794 Tw (provide poor-quality care, without any special regu-) Tj ET BT 0.8915 0 0 0.9835 308.64 250.56 Tm 0.0291 Tc 1.2834 Tw (lations. It is also said that regulations are needed to) Tj -0.5384 -12.2018 TD 0.0305 Tc 1.8052 Tw (protect individuals with dementia and their families) Tj ET BT 0.9835 0 0 0.9835 308.64 226.56 Tm 0.0145 Tc 2.3691 Tw (from nursing homes that fraudulently claim to) Tj -0.244 -12.2018 TD 0.0344 Tc 0.6407 Tw (provide special care but actually provide nothing) Tj 0.7321 -12.6899 TD 0.0275 Tc 2.3559 Tw (special for their residents. OTA concludes that) Tj ET BT 0.934 0 0 0.9835 308.88 190.56 Tm -0.0197 Tc 0.6899 Tw (individuals with dementia and their families can be) Tj ET BT 0.9835 0 0 0.9835 308.88 178.56 Tm 0.0312 Tc 3.0842 Tw (better protected from these nursing homes by) Tj ET BT 0.934 0 0 0.9835 309.12 166.8 Tm -0.0157 Tc 1.0038 Tw (initiatives that would: 1\) make available guidelines) Tj ET BT 0.8915 0 0 0.9835 309.12 154.56 Tm 0.0383 Tc 0.9441 Tw (that describe the theoretical concepts and design and) Tj ET BT 0.934 0 0 0.9835 309.36 142.56 Tm -0.033 Tc 1.5256 Tw (other features that are believed to be important in) Tj ET BT 0.9835 0 0 0.9835 309.6 130.08 Tm 0.0236 Tc 0.6516 Tw (special care units, 2\) make available information) Tj ET BT 0.8915 0 0 0.9835 309.6 119.04 Tm 0.0556 Tc 0.7564 Tw (about the characteristics of special care units in local) Tj ET BT 0.934 0 0 0.9835 308.64 107.04 Tm -0.0247 Tc 0 Tw (jurisdictions,) Tj ET BT 0.9835 0 0 0.9835 373.68 107.04 Tm 0.0262 Tc 3.1951 Tw (and 3\) require nursing homes to) Tj ET BT 0.934 0 0 0.9835 309.36 95.04 Tm -0.0316 Tc 0.7211 Tw (disclose to families and others what is special about) Tj ET BT 0.9835 0 0 0.9835 309.6 83.04 Tm 0.0293 Tc 2.6272 Tw (their special care unit. As noted earlier, these) Tj ET BT 0.934 0 0 0.9835 309.6 71.04 Tm -0.0463 Tc 1.3793 Tw (initiatives will not protect all potential special care) Tj ET BT 0.8915 0 0 0.9835 309.36 58.8 Tm 0.0374 Tc 1.022 Tw (unit residents and their families from nursing homes) Tj ET BT 0.934 0 0 0.9835 309.6 47.04 Tm -0.046 Tc 0.8329 Tw (that provide no special services in their special care) Tj -0.257 -12.2018 TD -0.0378 Tc 1.3334 Tw (unit. Neither will these individuals be protected by) Tj ET endstream endobj 180 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 181 0 obj <>stream 0.48 w 1 j 0 0 0 RG 75.6 691.68 m 554.64 691.68 l S BT 0.9835 0 0 0.9835 75.6 697.44 Tm 0 0 0 rg /F4 10 Tf 0.0008 Tc 0.0241 Tw (54 . ) Tj 19.7669 0 TD /F5 10 Tf 0.0144 Tc 1.036 Tw (Special Care Units for People With A[zheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 75.84 658.8 Tm /F4 10 Tf 0.0533 Tc 0.8119 Tw (regulations that require special care units to incorpo-) Tj ET BT 0.9835 0 0 0.9835 75.84 646.56 Tm 0.0422 Tc 2.9104 Tw (rate features that have not been shown to be) Tj ET BT 0.934 0 0 0.9835 76.32 634.56 Tm 0.1854 Tc 0 Tw (effective.) Tj ET BT 0.9835 0 0 0.9835 87.12 616.8 Tm 0.0462 Tc 1.6687 Tw (The potential of special care units to develop) Tj ET BT 0.934 0 0 0.9835 76.32 604.8 Tm -0.0367 Tc 2.0296 Tw (better methods of care for nursing home residents) Tj 0.257 -12.2018 TD -0.0224 Tc 1.1701 Tw (with dementia is exciting. That potential cannot be) Tj ET BT 0.9835 0 0 0.9835 76.32 581.04 Tm 0.0194 Tc 0.5339 Tw (realized without a greater commitment than cur-) Tj 0 -12.2018 TD 0.0318 Tc 0.9992 Tw (rently exists to evaluation of the units and their) Tj 255.7494 90.5372 TD 0.0216 Tc 0.1656 Tw (impact on residents, residents\222 families, unit staff) Tj ET BT 0.8915 0 0 0.9835 327.6 645.12 Tm 0.0349 Tc 1.3786 Tw (members, and nondemented nursing home residents.) Tj ET BT 0.934 0 0 0.9835 328.32 631.92 Tm -0.0182 Tc 0.9821 Tw (Such evaluation must be pursued with the recogni-) Tj ET BT 0.9835 0 0 0.9835 327.84 618.96 Tm 0.0284 Tc 0.8806 Tw (tion that some of the features that are currently) Tj ET BT 0.8915 0 0 0.9835 327.84 606.24 Tm 0.0484 Tc 0.9925 Tw (believed to be essential in special care units may not) Tj ET BT 0.934 0 0 0.9835 328.08 593.04 Tm -0.0386 Tc 1.3389 Tw (be effective and that once effective methods of care) Tj ET BT 0.8915 0 0 0.9835 328.32 580.32 Tm 0.0365 Tc 1.148 Tw (are identified, they may not be unique to individuals) Tj 0 -13.422 TD 0.016 Tc 2.3151 Tw (with dementia.) 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Tj 185.7028 0.7321 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 506.16 645.6 Tm 0.2182 Tc 0 Tw (57) Tj ET BT 0.9835 0 0 0.9835 110.64 632.16 Tm 0.0216 Tc 0.0761 Tw (PREVALENCE OF DEMENTIA IN NURSING HOMES) Tj ET BT 0.8491 0 0 0.9835 372.24 632.88 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 506.16 633.12 Tm 0.0897 Tc 0 Tw (57) Tj -411.6428 -13.422 TD -0.0032 Tc 0.1809 Tw (Dementia-Related Diagnoses of Nursing Home Residents . . . . . . . . . . . . . . . . . . . . . . . . . 58) Tj 0 -12.2018 TD -0.0312 Tc 0.0783 Tw (Factors ) Tj ET BT 0.9606 0 0 0.9863 157.68 607.92 Tm /F3 9 Tf -0.0052 Tc 0.0005 Tw (That ) Tj ET BT 0.934 0 0 0.9835 178.56 607.92 Tm /F4 10 Tf -0.0175 Tc 1.0914 Tw (Could Change the Future Prevalence of Dementia in Nursing Homes . . . 60) Tj ET BT 0.8915 0 0 0.9835 122.16 593.28 Tm 0.2558 Tc 0 Tw (Summary) Tj ET BT 0.8491 0 0 0.9835 171.36 596.16 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 506.64 597.12 Tm 0.0897 Tc 0 Tw (61) Tj ET BT 0.9835 0 0 0.9835 111.12 583.92 Tm 0.0144 Tc 0.1885 Tw (CHARACTERISTICS OF NURSING HOME RESIDENTS WITH DEMENTIA . . . . . . 61) Tj ET BT 0.934 0 0 0.9835 121.92 571.92 Tm 0.0109 Tc 0.0331 Tw (Age, Gender, and Race . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 336.72 572.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 506.88 573.12 Tm 0.0897 Tc 0 Tw (62) Tj -411.6428 -13.422 TD -0.0214 Tc 1.8665 Tw (Impairments in Activities of Daily Living) Tj ET BT 0.8491 0 0 0.9835 312.72 560.16 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 506.88 560.88 Tm 0.0897 Tc 0 Tw (63) Tj -411.1289 -13.1779 TD -0.0037 Tc 0.1152 Tw (Symptoms of Depression and Other Psychiatric Conditions . . . . . . . . . . . . . . . . . . . . . . . . 63) Tj -0.257 -11.9577 TD -0.008 Tc 4.6786 Tw (Behavioral Symptoms) Tj ET BT 0.8491 0 0 0.9835 228.24 536.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 507.12 537.12 Tm 0.2182 Tc 0 Tw (64) Tj -411.6428 -13.1779 TD -0.0405 Tc 2.5935 Tw (Typologies of Nursing Home Residents) Tj ET BT 0.8491 0 0 0.9835 303.12 524.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 507.6 525.36 Tm 0.2182 Tc 0 Tw (64) Tj ET BT 0.8915 0 0 0.9835 122.88 512.16 Tm 0.0322 Tc 1.51 Tw (Factors That Could Change the Types of Individuals With Dementia in Nursing Homes. 68) Tj ET BT 0.934 0 0 0.9835 123.12 500.4 Tm 0.04 Tc 0 Tw (summary) Tj ET BT 0.8491 0 0 0.9835 172.32 500.64 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 507.6 501.12 Tm 0.2182 Tc 0 Tw (69) Tj -423.4628 -13.1779 TD -0.0041 Tc 2.2976 Tw (PROBLEMS IN THE CARE PROVIDED FOR NURSING HOME RESIDENTS) Tj ET BT 0.9835 0 0 0.9835 123.12 475.92 Tm 0.0149 Tc 1.84 Tw (WITH DEMENTIA) Tj ET BT 0.8491 0 0 0.9835 218.16 476.16 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 225.2741 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 507.84 476.88 Tm 0.0497 Tc 0 Tw (70) Tj ET BT 0.934 0 0 0.9835 123.6 463.92 Tm -0.0288 Tc 1.2463 Tw (Complaints and Concerns About the Care Provided for Individuals With) Tj 11.82 -11.9577 TD -0.0072 Tc 1.2731 Tw (Dementia in Many Nursing Homes) Tj ET BT 0.8491 0 0 0.9835 294.72 452.16 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 508.32 452.88 Tm 0.2182 Tc 0 Tw (70) Tj -411.8998 -13.1779 TD -0.0281 Tc 2.045 Tw (Use of Psychotropic Medications and Physical Restraints) Tj ET BT 0.8491 0 0 0.9835 383.52 440.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 508.32 440.88 Tm 0.0897 Tc 0 Tw (72) Tj -411.8998 -12.9339 TD -0.0244 Tc 1.3878 Tw (Negative Consequences for Residents With Dementia, Their Families, Nursing) Tj 12.0769 -12.2018 TD -0.0038 Tc 0.2947 Tw (Home Staff Members, and Nondemented Nursing Home Residents . . . . . . . . . . . . . . . 75) Tj ET BT 0.8915 0 0 0.9835 124.32 401.76 Tm 0.2558 Tc 0 Tw (Summary) Tj ET BT 0.8491 0 0 0.9835 173.52 404.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 264.2802 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 508.8 405.12 Tm 0.0897 Tc 0 Tw (77) Tj ET BT 0.8915 0 0 0.9835 113.28 392.64 Tm -0.0697 Tc 0.3976 Tw (CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 309.84 393.12 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) 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Tj ET BT 0.934 0 0 0.9835 509.76 325.44 Tm 0.2182 Tc 0 Tw (62) Tj -423.4628 -12.4458 TD -0.0183 Tc 1.139 Tw (2-2, Impairments in Activities of Daily Living in Demented and Nondemented Nursing) Tj 21.3273 -12.2018 TD -0.0138 Tc 1.5371 Tw (Home Residents, United States, 1985) Tj ET BT 0.8491 0 0 0.9835 306 301.2 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 163.6558 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 509.76 301.68 Tm 0.2243 Tc 0 Tw (63) Tj ET BT 0.934 0 0 0.9835 114.24 289.2 Tm -0.017 Tc 1.2336 Tw (2-3. Distribution of Psychiatric Symptoms in Demented and Nondemented Nursing) Tj 21.8412 -12.2018 TD -0.0138 Tc 1.6014 Tw (Home Residents, United States, 1987) Tj ET BT 0.8491 0 0 0.9835 306.24 277.2 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) 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It begins with a) Tj -0.244 -11.9577 TD 0.0405 Tc 1.2954 Tw (review of the available data on the number and) Tj 0 -12.2018 TD 0.0359 Tc 1.9406 Tw (proportion of nursing home residents who have) Tj 0.7321 -12.2018 TD 0.042 Tc 0.2436 Tw (dementia, the proportion who have a diagnosis of) Tj 0 -12.2018 TD 0.0284 Tc 1.1987 Tw (dementia, and the factors that could change the) Tj ET BT 0.8915 0 0 0.9835 56.88 427.2 Tm 0.0487 Tc 0.9325 Tw (future prevalence of dementia in nursing homes. The) Tj ET BT 0.934 0 0 0.9835 57.36 415.2 Tm -0.037 Tc 1.6262 Tw (second section of the chapter discusses the charac-) Tj ET BT 0.9835 0 0 0.9835 57.36 402.96 Tm 0.0246 Tc -0.0815 Tw (teristics of nursing home residents with dementia) Tj ET BT 0.934 0 0 0.9835 57.6 391.2 Tm -0.0317 Tc 2.0488 Tw (and compares the characteristics of demented and) Tj ET BT 0.8915 0 0 0.9835 57.36 379.2 Tm 0.0346 Tc 1.5314 Tw (nondemented residents. This comparison is useful in) Tj ET BT 0.9835 0 0 0.9835 66.96 373.44 Tm -0.0972 Tc 7.5667 Tw (. .) Tj ET BT 0.8915 0 0 0.9835 57.6 366.96 Tm 0.0257 Tc 0.9583 Tw (thinking about what is different about residents with) Tj ET BT 0.9835 0 0 0.9835 57.6 355.44 Tm 0.0387 Tc 0.4911 Tw (dementia and what should be special about their) Tj ET BT 0.8915 0 0 0.9835 57.6 343.2 Tm 0.0758 Tc 0 Tw (care.) Tj ET BT 0.9835 0 0 0.9835 68.64 324 Tm 0.0335 Tc -0.0615 Tw (The third section of the chapter discusses prob-) Tj ET BT 0.8915 0 0 0.9835 58.08 312.24 Tm 0.0359 Tc 0.6776 Tw (lems in the care provided for residents with dementia) Tj ET BT 0.9835 0 0 0.9835 58.08 300.48 Tm 0.018 Tc 2.4469 Tw (in many nursing homes and the impact of the) Tj ET BT 0.8915 0 0 0.9835 57.84 288.48 Tm 0.0348 Tc 0.9095 Tw (problems on the residents, their families, the nursing) Tj ET BT 0.9835 0 0 0.9835 58.08 276.24 Tm 0.0251 Tc 1.7808 Tw (home staff members, and nondemented nursing) Tj 0.244 -12.4458 TD 0.025 Tc 0.7722 Tw (home residents. These problems are the primary) Tj -0.244 -12.4458 TD 0.0505 Tc 1.9258 Tw (reason for the development and proliferation of) Tj 0.7321 -12.4458 TD 0.0319 Tc 0.267 Tw (special care units. They explain to a great degree) Tj ET BT 0.8915 0 0 0.9835 58.56 227.76 Tm 0.0507 Tc 0.4186 Tw (why there is a market for special care units. They are) Tj ET BT 0.934 0 0 0.9835 58.8 215.52 Tm -0.0284 Tc 1.5849 Tw (also the rationale for many of the specific physical) Tj ET BT 0.9835 0 0 0.9835 58.8 203.52 Tm 0.0328 Tc 0.2356 Tw (design features and patient care practices recom-) Tj ET BT 0.934 0 0 0.9835 58.56 192 Tm -0.0362 Tc 1.1114 Tw (mended for special care units.) Tj ET BT 0.9835 0 0 0.9835 70.08 172.32 Tm 0.0411 Tc 0.3979 Tw (Overuse and inappropriate use of psychotropic) Tj ET BT 0.8915 0 0 0.9835 58.8 160.56 Tm 0.0415 Tc 1.4789 Tw (medications and physical restraints are problems for) Tj ET BT 0.9835 0 0 0.9835 59.28 148.56 Tm 0.0235 Tc 2.0753 Tw (all nursing home residents, but several studies) Tj ET BT 0.934 0 0 0.9835 59.28 136.32 Tm -0.029 Tc 1.8745 Tw (discussed in this chapter show nursing home resi-) Tj ET BT 0.9835 0 0 0.9835 306.72 587.04 Tm 0.0342 Tc 0.3562 Tw (dents with dementia are more likely than nonde-) Tj 0 -11.7137 TD 0.0322 Tc 2.2291 Tw (mented nursing home residents to receive psy-) Tj 0.244 -12.2018 TD 0.0324 Tc 2.961 Tw (chotropic medications and to be physically re-) Tj 0.4881 -12.2018 TD 0.0395 Tc 0.5948 Tw (strained. 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Tj ET BT 0.9663 0 0 0.9939 313.2 380.4 Tm /F6 14 Tf 0.0487 Tc 1.4152 Tw (PREVALENCE OF DEMENTIA IN) Tj ET BT 0.9939 0 0 0.9939 361.68 364.08 Tm 0.0129 Tc 0.3494 Tw (NURSING HOMES) Tj ET BT 0.9835 0 0 0.9835 319.68 346.32 Tm /F4 10 Tf 0.0157 Tc 0.7817 Tw (The 1985 National Nursing Home Survey con-) Tj ET BT 0.934 0 0 0.9835 308.88 334.32 Tm -0.0271 Tc 0.9549 Tw (ducted by the National Center for Health Statistics) Tj ET BT 0.8915 0 0 0.9835 309.12 322.56 Tm 0.0245 Tc 0.9595 Tw (identified 19,100 nursing homes in the United States) Tj ET BT 0.9835 0 0 0.9835 309.6 310.8 Tm 0.0195 Tc 1.7539 Tw (\(467\). The 19,100 nursing homes had 1,491,400) Tj ET BT 0.934 0 0 0.9835 308.88 298.8 Tm -0.003 Tc 1.0392 Tw (residents and a total bed capacity of 1,624,200.) Tj ET BT 0.9557 0 0 1.08 517.92 303.6 Tm /F4 4 Tf 0.0359 Tc 0 Tw (1) Tj ET BT 0.9835 0 0 0.9835 320.16 280.56 Tm /F4 10 Tf 0.0419 Tc 3.3174 Tw (Estimates of the prevalence of dementia in) Tj ET BT 0.934 0 0 0.9835 309.36 268.56 Tm -0.0125 Tc 1.343 Tw (nursing homes vary, but data from several sources) Tj ET BT 0.8915 0 0 0.9835 309.84 256.08 Tm 0.0322 Tc 1.1304 Tw (show that at least half of all nursing home residents) Tj ET BT 0.934 0 0 0.9835 309.36 244.32 Tm 0.0043 Tc 0.8112 Tw (have dementia. Data from the 1985 National Nurs-) Tj 0.5139 -12.2018 TD -0.0134 Tc 1.2797 Tw (ing Home Survey, a large-scale survey of a nation-) Tj 0.257 -12.4458 TD -0.0304 Tc 1.405 Tw (ally representative, stratified random sample of all) Tj -0.5139 -12.2018 TD 0.0059 Tc 0.5953 Tw (nursing homes, indicate that 696,800 nursing home) Tj ET BT 0.8915 0 0 0.9835 309.6 196.32 Tm 0.0348 Tc 1.262 Tw (residents--47 percent of all nursing home residents\227) Tj ET BT 0.9835 0 0 0.9835 309.84 184.32 Tm 0.0248 Tc 1.551 Tw (had senile dementia or chronic or organic brain) Tj 0.7321 -12.4458 TD 0.0187 Tc 1.8362 Tw (syndrome \(469\). The terms) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 443.28 172.08 Tm /F5 11 Tf 0.0709 Tc 2.0681 Tw (senile dementia) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 518.64 172.08 Tm /F4 10 Tf 0.3757 Tc 0 Tw (and) Tj ET BT 0.9443 0 0 0.9812 310.32 160.32 Tm /F5 11 Tf 0.0375 Tc 0.462 Tw (chronic or organic brain syndrome ) Tj ET BT 0.934 0 0 0.9835 463.68 160.32 Tm /F4 10 Tf -0.0522 Tc 0.8716 Tw (were used in the) Tj ET BT 0.9835 0 0 0.9835 309.84 148.56 Tm 0.0297 Tc 0.7268 Tw (past and are sometimes still used for the clinical) Tj ET BT 0.8915 0 0 0.9835 310.8 136.56 Tm 0.0478 Tc 1.2411 Tw (syndrome referred to in this report and generally) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 527.04 136.56 Tm /F3 9 Tf -0.0097 Tc 0 Tw (as) Tj ET q 0.96 0 0 -4.08 73.44 119.04 cm BI /W 9 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>>>>>>>>>>>>>~> EI Q BT 0.1878 0 0 0.9835 73.44 112.8 Tm 3 Tr /F2 10 Tf 0.1101 Tc (1) Tj 0 Tr ET BT 0.7511 0 0 0.9835 74.4 112.8 Tm -0.0037 Tc 0.4861 Tw ( The term ) Tj ET q 19.44 0 0 -6.96 107.04 117.84 cm BI /W 135 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><|x|<<p`x?p|x~x|c<|<x|>x||>|?|<?||<|>>|>>>>>~??>??>?|~x~>|?~?~?x?x|?|>?|>>>?8< EI Q BT 0.6102 0 0 0.9835 128.4 112.8 Tm 3 Tr 0.0472 Tc 0 Tw (home) Tj 0 Tr ET BT 0.7511 0 0 0.9835 142.08 112.8 Tm 0.0462 Tc 1.0683 Tw ( was defined in the 1985 National Nursing Home Survey as a facility that has three or more beds and provides nursing care,) Tj ET BT 0.798 0 0 0.9835 59.04 103.68 Tm 0.0272 Tc -0.0728 Tw (personal care \(e.g., help with bathing, walking, eating, using the toilet, or dressing\) and/or supervision. Another ) Tj ET q 20.64 0 0 -5.52 419.28 109.2 cm BI /W 142 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~~~~~|?~~|?>>|x?|~>~?~>?~?~>?~?>~?`~~|p??~~>?~~>|?|>||~??~8|~~|8 EI Q BT 0.6572 0 0 0.9835 419.28 103.68 Tm 3 Tr 0.0653 Tc 0 Tw (mtional) Tj 0 Tr ET BT 0.798 0 0 0.9835 439.92 103.68 Tm 0.0576 Tc -0.107 Tw ( survey, the 1986 Inventory of) Tj ET q 44.4 0 0 -7.2 59.04 100.32 cm BI /W 288 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~@~} ?????~??~>??~??~~>?~~??~~?~|?>~|?>|~?|?~?|>?|>??|~~???|~??<|?< p<?~< EI Q BT 0.7041 0 0 0.9835 59.04 94.8 Tm 3 Tr 0.0773 Tc 0 Tw (Imng-RxmCare) Tj 0 Tr ET BT 0.8449 0 0 0.9835 103.44 94.8 Tm 0.0844 Tc -0.0454 Tw ( Places, gathered information about ) Tj ET q 20.4 0 0 -7.2 225.6 99.84 cm BI /W 133 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>xpx?  ??πǀxx||>?>??xxxx>x||>||<||<<|0|<~|x|~<??xp| EI Q BT 0.6572 0 0 0.9835 225.6 94.8 Tm 3 Tr 0.0932 Tc 0 Tw (nursing) Tj 0 Tr ET BT 0.8449 0 0 0.9835 246 94.8 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 17.04 0 0 -5.76 247.92 100.56 cm BI /W 111 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  `<??x?xx?π||>_|>>>>>??|~x <>π? x0@ EI Q BT 0.6102 0 0 0.9835 247.92 94.8 Tm 3 Tr 0.0461 Tc 0 Tw (homes) Tj 0 Tr ET BT 0.8449 0 0 0.9835 264.96 94.8 Tm 0.1064 Tc -0.0715 Tw ( and ) Tj ET BT 0.8108 0 0 0.99 281.28 94.8 Tm /F7 8 Tf 0.1044 Tc -0.0565 Tw (residential ) Tj ET q 38.4 0 0 -7.2 312.48 100.32 cm BI /W 250 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p |?|>?<<||~>x<>?8p<`@>p|x|>`|xx|>||||<>|||>|||<|>||<>|~<<>>>>>>|>>>?<>8|>??x?|?>|?}>?||?xπ??x?<F`<~ <>>>`ǀ? EI Q BT 0.7529 0 0 0.99 312.48 94.8 Tm 3 Tr -0.0019 Tc 0 Tw (carefaciZities,) Tj 0 Tr ET BT 0.8449 0 0 0.9835 350.88 94.8 Tm /F2 10 Tf 0.089 Tc -0.0508 Tw ( such as homes for the aged, tbat provide personal care) Tj ET BT 0.7511 0 0 0.9835 59.04 85.68 Tm 0.0537 Tc 1.0256 Tw (but do not routinely provide nursing care \(466\). By comparing data from the 1985 National Nursing Home Survey and the 1986 Inventory of ) Tj ET q 28.08 0 0 -7.2 509.28 91.2 cm BI /W 196 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @? ????~~~~~?~~~|<~|>~~~~>|?>|??~??x?|>????<00808p8p>??? d EI Q BT 0.7041 0 0 0.9835 509.28 85.68 Tm 3 Tr 0.0627 Tc 0 Tw (Img-lkrm) Tj 0 Tr ET BT 0.7511 0 0 0.9835 59.28 76.8 Tm 0.0529 Tc 0.4431 Tw (Care Places, the National Center for Health Statistics concluded that 2200 of the facilities identified as nursing homes in the 1985 National Nursing Home) Tj 0.3195 -9.0293 TD 0.0563 Tc 1.2743 Tw (Survey were actually residential care facilities \(467\); thus, the 19,100 facilities identified by the 1985 National Nursing Home Survey included 16,900) Tj ET BT 0.798 0 0 0.9835 59.04 59.04 Tm 0.0386 Tc 0.0857 Tw (nursing homes with a bed capacity of 1,558,400 and 2200 residential care facilities with a bed capacity of 71,000. Despite this ) Tj ET q 25.92 0 0 -5.28 469.92 64.56 cm BI /W 177 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?????~>??>|?>x?<??>|?>|?>|?>|>??>x>x>|?>|???>~|<px?>}??0??00 EI Q BT 0.6102 0 0 0.9835 469.92 59.04 Tm 3 Tr -0.0315 Tc 0 Tw (determina) Tj 0 Tr ET q 12 0 0 -6.48 496.08 65.04 cm BI /W 77 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`????|>>|>~|>~|>||>||>||>||>||>||>||>>|>>~?<> EI Q BT 0.7511 0 0 0.9835 496.08 59.52 Tm 3 Tr 0.1023 Tc (tioq) Tj 0 Tr ET BT 0.8449 0 0 0.9835 508.08 59.52 Tm 0.0912 Tc -0.0535 Tw ( the data) Tj ET BT 0.7511 0 0 0.9835 59.52 50.16 Tm 0.0525 Tc 1.3188 Tw (on nursing home residents derived from the 1985 National Nursing Home Survey is based on the 1,491,400 residents of the 19,100 facilities, and this) Tj 0 -9.0293 TD 0.0257 Tc 1.3789 Tw (OTA report uses those figures.) Tj ET q 20.4 0 0 -6.96 288 30.24 cm BI /W 114 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>>>o>&?x|;|<>>??08< EI Q BT 0.8915 0 0 0.9835 288 23.28 Tm 3 Tr /F4 10 Tf 0.0897 Tc 0 Tw (\22657\226) Tj 0 Tr ET endstream endobj 188 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 189 0 obj <>stream 0.48 w 1 j 0 0 0 RG 74.88 690.96 m 553.2 690.96 l S BT 0.99 0 0 0.99 74.88 697.68 Tm 0 0 0 rg /F7 8 Tf 0.1206 Tc -0.1828 Tw (58 ) Tj ET BT 0.9598 0 0 0.9598 85.68 697.68 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.99 0 0 0.99 92.4 697.68 Tm /F7 8 Tf 0.0435 Tc 1.5921 Tw (Special Care) Tj 0 Tc -0.0609 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 139.92 697.68 Tm /F5 11 Tf 0.0681 Tc 1.9078 Tw (Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.99 0 0 0.99 246.24 697.68 Tm /F7 8 Tf 0.0149 Tc 2.1059 Tw (Alzheirner\222s and) Tj 0 Tc -0.0609 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 307.68 697.68 Tm /F5 10 Tf 0.0172 Tc 5.5343 Tw (Other Dementias) Tj ET BT 0.9812 0 0 0.9812 75.36 657.36 Tm /F5 11 Tf 0.049 Tc -0.111 Tw (dementia. These ) Tj ET BT 0.9863 0 0 0.9863 148.8 657.36 Tm /F3 9 Tf 0.0118 Tc -0.0817 Tw (terms ) Tj ET BT 0.9835 0 0 0.9835 175.44 657.36 Tm /F4 10 Tf 0.0345 Tc -0.1322 Tw (include dementia caused by) Tj ET BT 0.934 0 0 0.9835 75.12 645.6 Tm -0.0282 Tc 4.4433 Tw (Alzheimer\222s disease.) Tj ET BT 0.9835 0 0 0.9835 86.4 627.36 Tm 0.0157 Tc 2.49 Tw (The figures from the 1985 National Nursing) Tj -10.9816 -12.2018 TD 0.0356 Tc 2.0282 Tw (Home Survey on the number and proportion of) Tj -0.244 -12.2018 TD 0.0276 Tc 1.461 Tw (nursing home residents with senile dementia or) Tj 0.244 -12.4458 TD 0.0254 Tc 1.5039 Tw (chronic or organic brain syndrome were derived) Tj ET BT 0.934 0 0 0.9835 75.84 579.6 Tm -0.0411 Tc 2.0343 Tw (from the residents\222 diagnoses, as recorded in their) Tj 0 -12.4458 TD -0.0238 Tc 1.8323 Tw (medical records, and the judgments of members of) Tj ET BT 0.9835 0 0 0.9835 76.08 555.36 Tm 0.0173 Tc 0.3733 Tw (the nursing staff at each nursing home surveyed.) Tj 0.244 -11.9577 TD 0.0317 Tc 2.2499 Tw (Staff members were shown a list of 10 mental) Tj ET BT 0.8915 0 0 0.9835 76.32 531.36 Tm 0.0553 Tc 1.7774 Tw (conditions, including senile dementia and chronic or) Tj ET BT 0.9835 0 0 0.9835 76.56 519.36 Tm 0.0234 Tc 1.3839 Tw (organic brain syndrome, and asked whether the) Tj -0.4881 -11.7137 TD 0.0334 Tc 2.3703 Tw (residents in the survey sample had any of the) Tj ET BT 0.8915 0 0 0.9835 76.56 495.36 Tm 0.0252 Tc 1.8112 Tw (conditions \(467\). Staff members based their answers) Tj ET BT 0.934 0 0 0.9835 76.56 483.6 Tm -0.0384 Tc 0.6733 Tw (on their knowledge of the residents and information) Tj 0.257 -12.2018 TD -0.0338 Tc 1.4392 Tw (in the residents\222 medical records, including but not) Tj 0 -12.2018 TD -0.0513 Tc 1.4359 Tw (limited to the residents\222 recorded diagnoses.) Tj ET BT 0.8915 0 0 0.9835 88.08 441.6 Tm 0.0392 Tc 1.1738 Tw (Other data from the 1985 National Nursing Home) Tj ET BT 0.8491 0 0 0.9835 77.04 429.6 Tm 0.0362 Tc 1.6982 Tw (Survey indicate that 922,500 nursing home residents\227) Tj ET BT 0.934 0 0 0.9835 77.04 417.6 Tm -0.0362 Tc 1.9557 Tw (62 percent of all nursing home residents\227were so) Tj ET BT 0.8915 0 0 0.9835 77.28 405.6 Tm 0.0336 Tc 2.5107 Tw (disoriented or memory-impaired that their perform-) Tj ET BT 0.9835 0 0 0.9835 77.76 393.84 Tm 0.0263 Tc 0.1811 Tw (ance of the activities of daily living, mobility, and) Tj -0.4881 -11.9577 TD 0.0302 Tc 0.4648 Tw (other tasks was impaired nearly every day \(467\).) Tj 0.4881 -12.2018 TD 0.036 Tc 1.2491 Tw (These figures were also derived from interviews) Tj ET BT 0.934 0 0 0.9835 77.76 358.08 Tm -0.0063 Tc 1.3685 Tw (with members of the nursing staff at each nursing) Tj ET BT 0.9835 0 0 0.9835 77.76 346.32 Tm 0.0234 Tc 2.0754 Tw (home and reflect the staff members\222 judgments) Tj 0 -12.2018 TD 0.0471 Tc 2.3999 Tw (based on their knowledge of the residents and) Tj ET BT 0.934 0 0 0.9835 78 322.32 Tm -0.0371 Tc 1.318 Tw (information in the residents\222 medical records.) Tj 11.82 -18.0586 TD -0.0101 Tc 1.4946 Tw (The 1987 National Medical Expenditure Survey,) Tj -11.306 -12.4458 TD -0.0274 Tc 0.7594 Tw (another large-scale survey conducted by the Agency) Tj -0.257 -11.9577 TD -0.0354 Tc 1.4409 Tw (for Health Care Policy and Research, also included) Tj ET BT 0.8915 0 0 0.9835 78.48 268.56 Tm 0.0415 Tc 0.8508 Tw (a nationally representative sample of nursing homes.) Tj ET BT 0.8491 0 0 0.9835 78.24 256.56 Tm 0.0462 Tc 1.8748 Tw (The survey found that 637,600 nursing homeresidents-) Tj ET BT 0.8915 0 0 0.9835 78.24 244.8 Tm 0.0477 Tc 1.3181 Tw (42 percent of all nursing home residents\227had senile) Tj ET BT 0.9835 0 0 0.9835 78.48 232.56 Tm 0.0192 Tc 2.1203 Tw (dementia or chronic or organic brain syndrome) Tj 0.7321 -12.2018 TD 0.0349 Tc -0.1327 Tw (\(237\). These figures were derived from interviews) Tj ET BT 0.934 0 0 0.9835 78.72 208.8 Tm -0.0009 Tc 1.5508 Tw (with nursing home staff members. The staff mem-) Tj ET BT 0.9835 0 0 0.9835 78.48 196.56 Tm 0.0374 Tc 1.7125 Tw (bers were instructed to base their responses on) Tj 0.7321 -11.9577 TD 0.0227 Tc 0.6525 Tw (information in the residents\222 medical records, in-) Tj 0 -12.2018 TD 0.0325 Tc 0.4974 Tw (cluding but not limited to the residents\222 recorded) Tj ET BT 0.8915 0 0 0.9835 79.2 160.56 Tm 0.2609 Tc 0 Tw (diagnoses.) Tj ET BT 0.9835 0 0 0.9835 90.24 142.56 Tm 0.0275 Tc 2.0102 Tw (As noted in chapter 1, dementia is a clinical) Tj -10.7376 -12.2018 TD 0.0329 Tc 2.7978 Tw (syndrome characterized by decline of cognitive) Tj ET BT 0.934 0 0 0.9835 79.44 118.8 Tm -0.0133 Tc 0.7014 Tw (functions, including memory, in an alert individual.) Tj -0.257 -12.2018 TD -0.0207 Tc 1.5124 Tw (To be accurate, a diagnosis of dementia and/or the) Tj ET BT 0.9835 0 0 0.9835 79.68 94.8 Tm 0.0326 Tc 0.4275 Tw (disease or condition that is causing the dementia) Tj ET BT 0.934 0 0 0.9835 79.2 82.8 Tm -0.0159 Tc 1.4935 Tw (must be based on a comprehensive patient evalua-) Tj 0.257 -11.9577 TD -0.0332 Tc 1.0226 Tw (tion using accepted diagnostic criteria. Estimates of) Tj ET BT 0.8915 0 0 0.9835 79.68 59.04 Tm 0.0487 Tc 0.9325 Tw (the prevalence of dementia in nursing homes derived) Tj ET BT 0.9835 0 0 0.9835 79.44 47.04 Tm 0.0204 Tc 0.3702 Tw (from the results of interviews with nursing home) Tj 251.6007 620.5826 TD 0.0272 Tc 0.7119 Tw (staff members may not be accurate because staff) Tj ET BT 0.934 0 0 0.9835 326.4 645.36 Tm -0.0057 Tc 0.719 Tw (members\222 judgments about residents\222 mental status) Tj 0.5139 -11.9577 TD -0.0144 Tc 0.4273 Tw (are not necessarily based on such an evaluation.) Tj 11.563 -18.5467 TD -0.035 Tc 1.4099 Tw (Very few studies have used comprehensive diag-) Tj ET BT 0.9835 0 0 0.9835 326.88 603.36 Tm 0.0397 Tc 0.3912 Tw (nostic evaluations to determine the prevalence of) Tj ET BT 0.934 0 0 0.9835 326.88 591.12 Tm -0.0212 Tc 0.6778 Tw (dementia in nursing homes, but the results of three) Tj ET BT 0.8915 0 0 0.9835 327.36 579.6 Tm 0.0287 Tc 0.5318 Tw (studies that have used such evaluations suggest more) Tj ET BT 0.934 0 0 0.9835 327.36 567.36 Tm -0.0145 Tc 1.4736 Tw (than half of all nursing home residents have clini-) Tj 0.257 -12.4458 TD -0.0237 Tc 2.6398 Tw (cally diagnosable dementia. Based on comprehen-) Tj ET BT 0.9835 0 0 0.9835 327.84 543.36 Tm 0.0283 Tc -0.0562 Tw (sive medical and psychiatric evaluations of a ran-) Tj -0.244 -12.2018 TD 0.043 Tc 0.6827 Tw (dom sample of 50 residents of a 180-bed nursing) Tj ET BT 0.934 0 0 0.9835 327.6 519.36 Tm -0.0152 Tc 1.089 Tw (home in Maryland, Rovner et al. concluded that 78) Tj 0 -11.9577 TD -0.0347 Tc 2.1805 Tw (percent of the residents had clinically diagnosable) Tj 0 -12.4458 TD -0.0056 Tc 1.1888 Tw (dementia \(390\). Based on similar evaluations of 65) Tj ET BT 0.9835 0 0 0.9835 327.84 483.36 Tm 0.0341 Tc 1.9561 Tw (of the 68 residents of a nursing home in Iowa,) Tj ET BT 0.8915 0 0 0.9835 328.32 471.6 Tm 0.0495 Tc 1.316 Tw (Chandler and Chandler concluded that 72 percent of) Tj ET BT 0.9835 0 0 0.9835 328.32 459.36 Tm 0.0341 Tc 0.0146 Tw (the residents had clinically diagnosable dementia) Tj 0 -12.2018 TD 0.0287 Tc 1.0938 Tw (\(82\). Lastly, based on similar evaluations of 454) Tj ET BT 0.934 0 0 0.9835 328.32 435.6 Tm -0.0132 Tc 1.7476 Tw (individuals admitted to 8 nursing homes in Mary-) Tj ET BT 0.9835 0 0 0.9835 328.32 423.36 Tm 0.0304 Tc 2.5564 Tw (land between February 1987 and March 1988,) Tj 0.244 -12.2018 TD 0.0394 Tc 2.3336 Tw (Rovner et al. concluded that 67 percent of the) Tj 0 -12.2018 TD 0.032 Tc 2.3107 Tw (individuals had clinically diagnosable dementia) Tj ET BT 0.934 0 0 0.9835 329.04 387.36 Tm -0.023 Tc 1.7075 Tw (\(389\). The results of these three studies cannot be) Tj ET BT 0.9835 0 0 0.9835 329.04 375.36 Tm 0.0321 Tc 1.8631 Tw (generalized with certainty because of the small) Tj ET BT 0.8915 0 0 0.9835 329.04 363.6 Tm 0.0352 Tc 1.4859 Tw (number of nursing homes involved, but they suggest) Tj ET BT 0.9835 0 0 0.9835 329.04 351.6 Tm 0.0248 Tc 0.8538 Tw (the findings of the 1985 National Nursing Home) Tj ET BT 0.934 0 0 0.9835 329.28 339.84 Tm -0.0105 Tc 0.6985 Tw (Survey and the 1987 National Medical Expenditure) Tj ET BT 0.8915 0 0 0.9835 329.52 328.08 Tm 0.04 Tc 1.346 Tw (Survey underestimate the true prevalence of demen-) Tj 0 -12.2018 TD 0.0413 Tc 1.2099 Tw (tia in nursing homes.) Tj ET BT 0.9795 0 0 0.9795 364.08 288.24 Tm /F7 12 Tf 0.0441 Tc 1.9768 Tw (Dementia-Related Diagnoses of) Tj 16.6622 -14.2118 TD 0.026 Tc 1.2601 Tw (Nursing Home Residents) Tj ET BT 0.9835 0 0 0.9835 340.56 256.32 Tm /F4 10 Tf 0.0305 Tc 3.0443 Tw (Although large proportions of nursing home) Tj -11.2256 -12.2018 TD 0.0436 Tc 2.1246 Tw (residents were said to have senile dementia or) Tj 0.244 -12.2018 TD 0.0112 Tc 0.2052 Tw (chronic or organic brain syndrome by the nursing) Tj 0 -12.2018 TD 0.0366 Tc 3.1601 Tw (home staff members interviewed for the 1985) Tj 0 -11.9577 TD 0.0191 Tc 3.3406 Tw (National Nursing Home Survey and the 1987) Tj 0.4881 -12.2018 TD 0.0386 Tc 1.7671 Tw (National Medical Expenditure Survey and even) Tj 0.244 -11.9577 TD 0.0345 Tc 1.6167 Tw (larger proportions were found to have clinically) Tj ET BT 0.8915 0 0 0.9835 330.48 172.8 Tm 0.0266 Tc 1.4956 Tw (diagnosable dementia in the three studies just cited,) Tj -0.2692 -12.4458 TD 0.0454 Tc 0.9361 Tw (relatively few nursing home residents have a diagno-) Tj ET BT 0.934 0 0 0.9835 331.2 148.56 Tm -0.0328 Tc 0.5082 Tw (sis of dementia in their medical records. In fact, one) Tj ET BT 0.8915 0 0 0.9835 330.72 136.56 Tm 0.0438 Tc 1.4426 Tw (of the frequent complaints about the care of nursing) Tj -0.2692 -11.9577 TD 0.0281 Tc 1.2247 Tw (home residents with dementia is that their dementia) Tj ET BT 0.934 0 0 0.9835 330.72 113.04 Tm -0.0285 Tc 1.8741 Tw (is not carefully or accurately diagnosed and some-) Tj ET BT 0.8915 0 0 0.9835 330.96 100.8 Tm 0.0257 Tc 1.2274 Tw (times is not diagnosed at all \(17,82,370,389,390,433\).) Tj ET BT 0.9835 0 0 0.9835 341.76 83.04 Tm 0.0179 Tc 2.4471 Tw (Data from the 1985 National Nursing Home) Tj -10.7376 -12.2018 TD 0.0246 Tc 1.6404 Tw (Survey show that at the time of the survey, 16) Tj -0.7321 -12.2018 TD 0.0377 Tc 1.6425 Tw (percent of all residents had a recorded primary) Tj 0.244 -11.9577 TD 0.048 Tc 0.2201 Tw (diagnosis of dementia or of a disease or condition) Tj ET endstream endobj 190 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 191 0 obj <>stream 0.72 w 1 j 0 0 0 RG 53.28 678.96 m 532.56 678.96 l S 57.6 48.24 m 536.88 48.24 l S BT 0.9835 0 0 0.9835 168.72 684.48 Tm 0 0 0 rg /F5 10 Tf 0.0187 Tc 1.7502 Tw (Chapter 2-Nursing Home Residents With Dementia: Characteristics and Problems) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 514.56 684.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 521.04 684.48 Tm /F5 10 Tf 0.366 Tc 0 Tw (59) Tj -474.8934 -39.7778 TD /F4 10 Tf 0.0287 Tc 0.7103 Tw (that causes dementia. The 16 percent included 3) Tj ET BT 0.934 0 0 0.9835 53.76 633.36 Tm -0.0262 Tc 0.6603 Tw (percent who had a primary diagnosis of Alzheimer\222s) Tj 0.257 -12.2018 TD -0.0538 Tc 1.3016 Tw (disease or another specified or unspecified degener-) Tj ET BT 0.9835 0 0 0.9835 54.48 609.36 Tm 0.0383 Tc 0.8052 Tw (ation of the brain \(ICD-9-CM codes 331.0, 331.2,) Tj ET BT 0.934 0 0 0.9835 54.72 597.6 Tm -0.0017 Tc 0.4321 Tw (and 331.9\)2; 3 percent who had a primary diagnosis) Tj ET BT 0.9835 0 0 0.9835 54.48 585.6 Tm 0.0326 Tc 1.8626 Tw (of senile dementia or another organic psychotic) Tj 0.244 -12.2018 TD 0.0499 Tc 2.5365 Tw (condition \(ICD-9-CM codes 290-294\), 9 percent) Tj 0 -12.2018 TD 0.0261 Tc 2.9094 Tw (who had a primary diagnosis of organic brain) Tj ET BT 0.934 0 0 0.9835 55.2 549.84 Tm -0.0177 Tc 1.1651 Tw (syndrome \(ICD-9-CM code 310\); and 1 percent who) Tj -0.5139 -12.2018 TD -0.0228 Tc 1.0604 Tw (had a primary diagnosis of senility without psycho-) Tj ET BT 0.9835 0 0 0.9835 55.44 526.08 Tm 0.0563 Tc 0.5167 Tw (sis \(ICD-9-CM code 797\) \(467\).) Tj ET BT 0.934 0 0 0.9835 66.24 505.92 Tm -0.0317 Tc 1.203 Tw (Of the nursing home residents who were said by) Tj -12.0769 -11.7137 TD -0.0107 Tc 0.3419 Tw (members of the nursing staff at each facility to have) Tj ET BT 0.9835 0 0 0.9835 55.44 482.4 Tm 0.0246 Tc 0.087 Tw (either senile dementia or chronic or organic brain) Tj ET BT 0.934 0 0 0.9835 55.68 470.4 Tm -0.0295 Tc 1.661 Tw (syndrome, about one-third had a recorded primary) Tj ET BT 0.9835 0 0 0.9835 55.44 458.64 Tm 0.0275 Tc 3.5761 Tw (diagnosis of any mental disorder, including 7) Tj -0.244 -12.4458 TD 0.0359 Tc 2.4461 Tw (percent who had a primary diagnosis of senile) Tj 0.244 -11.9577 TD 0.0284 Tc 1.5335 Tw (dementia or another organic psychotic condition) Tj ET BT 0.934 0 0 0.9835 56.16 422.64 Tm -0.0026 Tc 1.0754 Tw (\(ICD-9-CM codes 290-294\) and 19 percent who had) Tj ET BT 0.9835 0 0 0.9835 55.92 410.88 Tm 0.0222 Tc 2.3207 Tw (a primary diagnosis of organic brain syndrome) Tj 0.244 -12.2018 TD 0.0534 Tc 0.4412 Tw (\(ICD-9-CM code 310\) \(467\). Of the residents who) Tj 0 -12.2018 TD 0.0338 Tc 1.1158 Tw (were said by members of the nursing staff to be) Tj T* 0.0344 Tc 0.5187 Tw (disoriented or memory-impaired, 4 percent had a) Tj -0.4881 -12.2018 TD 0.034 Tc 1.2511 Tw (primary diagnosis of senile dementia or another) Tj 0.4881 -12.2018 TD 0.0281 Tc 0.2577 Tw (organic psychotic condition, and 12 percent had a) Tj ET BT 0.934 0 0 0.9835 55.92 339.12 Tm -0.0175 Tc 1.297 Tw (primary diagnosis of organic brain syndrome.) Tj ET BT 0.9835 0 0 0.9835 66.96 318.96 Tm 0.0247 Tc 0.2682 Tw (Nursing home residents generally have several) Tj ET BT 0.934 0 0 0.9835 56.64 307.2 Tm -0.0392 Tc 1.7998 Tw (diagnoses in their medical records. Considering all) Tj ET BT 0.9835 0 0 0.9835 56.64 295.2 Tm 0.0305 Tc 0.0345 Tw (the diagnoses listed in residents\222 medical records,) Tj ET BT 0.934 0 0 0.9835 56.64 282.96 Tm 0.004 Tc 1.3988 Tw (the 1985 National Nursing Home Survey found 23) Tj ET BT 0.9835 0 0 0.9835 56.16 270.72 Tm 0.0429 Tc 3.3803 Tw (percent of the residents had any diagnosis of) Tj 0.4881 -12.2018 TD 0.0408 Tc 0.563 Tw (dementia or of a disease or condition that causes) Tj 0.244 -12.2018 TD 0.036 Tc 0.1103 Tw (dementia \(189\). As noted earlier, the 1985 survey) Tj ET BT 0.8915 0 0 0.9835 56.88 234.72 Tm 0.0327 Tc 1.0514 Tw (found 47 percent of all residents had dementia. Thus) Tj 0 -12.4458 TD 0.0295 Tc 1.1035 Tw (fewer than half of the residents with dementia had a) Tj ET BT 0.9835 0 0 0.9835 56.64 210.96 Tm 0.0472 Tc -0.0232 Tw (recorded diagnosis of dementia or a diagnosis of a) Tj 0.4881 -12.4458 TD 0.038 Tc 0.5149 Tw (disease or condition that causes dementia. More-) Tj 0.244 -12.2018 TD 0.041 Tc 1.4169 Tw (over, most of those with a recorded diagnosis of) Tj ET BT 0.8915 0 0 0.9835 57.36 174.96 Tm 0.0553 Tc 0.9586 Tw (dementia had a general diagnosis, such as chronic or) Tj ET BT 0.9835 0 0 0.9835 57.6 162.72 Tm 0.0248 Tc 0.2681 Tw (organic brain syndrome. These general diagnoses) Tj ET BT 0.934 0 0 0.9835 57.6 150.96 Tm -0.031 Tc 1.1059 Tw (were widely used in the past but have been largely) Tj -0.7709 -11.7137 TD -0.0375 Tc 0.7091 Tw (replaced in most settings by more specific diagnoses) Tj 0.7709 -12.6899 TD -0.0167 Tc 1.1639 Tw (that identify the cause of an individual\222s dementia,) Tj 0 -11.9577 TD -0.0215 Tc 1.404 Tw (e.g., Alzheimer\222s disease or multi-infarct dementia.) Tj 11.563 -20.255 TD -0.0147 Tc 1.6023 Tw (There are many possible reasons why a nursing) Tj ET BT 0.9835 0 0 0.9835 57.6 83.52 Tm 0.0309 Tc 3.0091 Tw (home resident with dementia may not have a) Tj -0.244 -11.7137 TD 0.0472 Tc 0.0073 Tw (recorded diagnosis of dementia or a diagnosis of a) Tj 0.4881 -12.4458 TD 0.0345 Tc 1.9827 Tw (disease or condition that causes dementia. One) Tj ET BT 0.8915 0 0 0.9835 305.04 645.12 Tm 0.0377 Tc 1.1755 Tw (possible reason is that the physician who determines) Tj ET BT 0.934 0 0 0.9835 305.28 632.88 Tm -0.0361 Tc 1.561 Tw (the person\222s diagnoses is not aware of the person\222s) Tj 0.257 -11.7137 TD -0.0246 Tc 0.6585 Tw (dementia. A second possible reason is that although) Tj 0.5139 -12.4458 TD -0.0271 Tc 0.5557 Tw (the physician is aware of the person\222s dementia, the) Tj ET BT 0.8915 0 0 0.9835 305.28 597.36 Tm 0.0255 Tc 0.4537 Tw (physician does not think the dementia is as important) Tj ET BT 0.934 0 0 0.9835 306 585.12 Tm -0.0371 Tc 1.3694 Tw (as the person\222s other medical conditions and there-) Tj ET BT 0.9835 0 0 0.9835 306 573.12 Tm 0.0364 Tc 0.4759 Tw (fore does not document it in the person\222s medical) Tj ET BT 0.934 0 0 0.9835 305.76 561.36 Tm -0.0342 Tc 0.8202 Tw (record. A third possible reason is that the physician) Tj 0.257 -11.9577 TD -0.0439 Tc 0.7021 Tw (does not feel competent to diagnose the dementia. A) Tj ET BT 0.9835 0 0 0.9835 306.24 537.6 Tm 0.0313 Tc 2.3114 Tw (fourth reason is that in some States, Medicaid) Tj ET BT 0.8915 0 0 0.9835 306 525.6 Tm 0.0349 Tc 2.2938 Tw (policies restrict eligibility for Medicaid-funded nurs-) Tj ET BT 0.934 0 0 0.9835 306.24 513.84 Tm -0.0207 Tc 1.0949 Tw (ing home care for persons with dementia \(83\). As a) Tj ET BT 0.9835 0 0 0.9835 306 501.84 Tm 0.0264 Tc -0.0194 Tw (result, physicians who want to help their patients) Tj ET BT 0.934 0 0 0.9835 306.72 489.6 Tm -0.0187 Tc 1.1355 Tw (with dementia obtain Medicaid funding for nursing) Tj ET BT 0.8915 0 0 0.9835 306.48 478.08 Tm 0.0484 Tc 1.101 Tw (home care may choose not to document the dementia) Tj ET BT 0.9835 0 0 0.9835 306.72 465.84 Tm 0.026 Tc 2.0728 Tw (in the patients\222) Tj 82.7281 0.244 TD 0.0041 Tc 3.0711 Tw (medical records. Lastly, many) Tj ET BT 0.8915 0 0 0.9835 306.72 454.08 Tm 0.0354 Tc 1.7549 Tw (nursing home administrators and staff are reluctant) Tj ET BT 0.9835 0 0 0.9835 306.72 442.08 Tm 0.044 Tc 0.6207 Tw (to admit someone they believe will be difficult to) Tj 0.244 -12.2018 TD 0.041 Tc 3.1382 Tw (manage, and they tend to regard people with) Tj ET BT 0.934 0 0 0.9835 307.2 418.08 Tm 0.0089 Tc 1.5771 Tw (dementia as difficult to manage \(170,454,520\). For) Tj ET BT 0.9835 0 0 0.9835 307.2 406.32 Tm 0.025 Tc 2.3177 Tw (this reason, physicians who want to help their) Tj ET BT 0.934 0 0 0.9835 306.96 394.08 Tm -0.0246 Tc 1.0347 Tw (patients with dementia to be admitted to a nursing) Tj ET BT 0.9835 0 0 0.9835 307.2 382.08 Tm 0.0275 Tc 3.2565 Tw (home may not document the dementia in the) Tj ET BT 0.934 0 0 0.9835 307.2 370.08 Tm -0.0399 Tc 1.8863 Tw (patients\222 medical records.) Tj ET BT 0.9835 0 0 0.9835 318.48 346.32 Tm 0.0303 Tc 0.4008 Tw (The proportion of nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 307.68 334.32 Tm 0.0438 Tc 1.2071 Tw (dementia who have a recorded diagnosis of dementia) Tj ET BT 0.934 0 0 0.9835 307.68 322.32 Tm -0.0307 Tc 1.2769 Tw (or a diagnosis of a disease or condition that causes) Tj 0.257 -12.2018 TD -0.0246 Tc 0.4994 Tw (dementia is likely to increase in the future and may) Tj ET BT 0.9835 0 0 0.9835 307.68 298.32 Tm 0.0336 Tc 1.7396 Tw (have already increased since the 1985 National) Tj 0 -12.2018 TD 0.0095 Tc 2.1302 Tw (Nursing Home Survey. Findings from the 1987) Tj ET BT 0.934 0 0 0.9835 307.92 274.32 Tm -0.022 Tc 2.5866 Tw (National Medical Expenditure Survey suggest the) Tj -0.257 -12.4458 TD -0.0347 Tc 1.1098 Tw (proportion of nursing home residents who had such) Tj ET BT 0.9835 0 0 0.9835 308.4 249.84 Tm 0.0235 Tc 0.9597 Tw (a diagnosis in their medical records was slightly) Tj ET BT 0.934 0 0 0.9835 308.16 237.84 Tm 0.0285 Tc 0.6246 Tw (higher in 1987 than it was in 1985 \(236\).) Tj ET BT 0.9835 0 0 0.9835 319.44 213.84 Tm 0.0427 Tc 2.5438 Tw (One reason for the expected increase in the) Tj -11.4697 -11.9577 TD 0.0363 Tc 0.4586 Tw (proportion of nursing home residents who have a) Tj 0 -12.2018 TD 0.0392 Tc 2.9541 Tw (recorded diagnosis of dementia is the growing) Tj 0.7321 -12.2018 TD 0.0338 Tc 1.7394 Tw (awareness among physicians and others of Alz-) Tj -0.4881 -11.9577 TD 0.0351 Tc 2.4295 Tw (heimer\222s disease and other diseases that cause) Tj ET BT 0.8915 0 0 0.9835 308.88 154.32 Tm 0.0166 Tc 1.6863 Tw (dementia. In addition, the resident assessment proc-) Tj 0 -11.9577 TD 0.0391 Tc 0.9432 Tw (ess mandated by the nursing home reform provisions) Tj ET BT 0.934 0 0 0.9835 308.88 130.32 Tm -0.0202 Tc 1.9753 Tw (of the Omnibus Budget Reconciliation Act of 1987) Tj ET BT 0.9835 0 0 0.9835 309.6 118.8 Tm 0.0437 Tc 3.519 Tw (\(OBRA-87\) requires evaluation of a resident\222s) Tj ET BT 0.934 0 0 0.9835 308.88 106.8 Tm -0.0101 Tc 1.5607 Tw (cognitive status. The Minimum Data Set, the resi-) Tj ET BT 0.8915 0 0 0.9835 308.88 95.04 Tm 0.0174 Tc 1.2816 Tw (dent assessment instrument developed for the imple-) Tj ET BT 0.9835 0 0 0.9835 309.12 83.52 Tm 0.0346 Tc 3.3329 Tw (mentation of OBRA-87, includes six questions) Tj ET BT 0.934 0 0 0.9835 309.6 71.28 Tm -0.0171 Tc 1.1481 Tw (about cognitive status on its first page \(see fig. 5-1) Tj -0.257 -11.9577 TD -0.0257 Tc 0.8432 Tw (in ch. 5\). By calling attention to residents\222 cognitive) Tj ET BT 0.9389 0 0 0.9939 71.76 37.92 Tm /F2 7 Tf 0.0761 Tc -0.043 Tw (2 ) Tj ET q 35.04 0 0 -5.76 76.8 41.52 cm BI /W 199 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>x?`?|?|>~??~????~??~>?~|~~>`??p<?<?|???>?|  EI Q BT 1.1401 0 0 0.9939 76.8 37.92 Tm 3 Tr -0.008 Tc 0 Tw (ICD.9.CM) Tj 0 Tr ET BT 0.9389 0 0 0.9939 111.84 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 17.52 0 0 -5.52 113.28 41.52 cm BI /W 100 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?ǃ<?>?|>G||x?xxxxxx|~<?<>>~< EI Q BT 0.7377 0 0 0.9939 113.28 37.92 Tm 3 Tr 0.0824 Tc 0 Tw (~O&=~) Tj 0 Tr ET BT 0.9389 0 0 0.9939 130.8 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 9.12 0 0 -3.84 132.24 39.84 cm BI /W 53 /H 21 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??p?x8x|< p?x?|?|>>~?< EI Q BT 0.9939 0 0 0.9939 132.24 37.92 Tm 3 Tr 0.0215 Tc 0 Tw (we) Tj 0 Tr ET BT 0.9389 0 0 0.9939 141.36 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 31.68 0 0 -7.2 142.8 41.52 cm BI /W 180 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?σ??~~~x>>~x>x~p??p>~? >>>>>>>|>~><>~<>>~<|>>?>x|>>>?||>>>~ |>>>| |>~<?|<><?|?x~xpxx EI Q BT 1.2072 0 0 0.9939 142.8 37.92 Tm 3 Tr 0.0076 Tc 0 Tw (&PO~tic) Tj 0 Tr ET BT 0.9389 0 0 0.9939 174.48 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 17.28 0 0 -5.52 175.92 41.52 cm BI /W 99 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|?>?~>>|?>v>|>|>|?>|>|?x?x?>|><~ǁ> 8 EI Q BT 0.9389 0 0 0.9939 175.92 37.92 Tm 3 Tr 0.0355 Tc 0 Tw (~~d~-) Tj 0 Tr 18.4038 0 TD -0.0176 Tc 0.1845 Tw ( from ) Tj ET q 9.12 0 0 -5.28 210 41.76 cm BI /W 53 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?>?>?p>8>>>>>>>>>>>~>~><~>p EI Q BT 1.2743 0 0 0.9939 210 37.92 Tm 3 Tr -0.0117 Tc 0 Tw (tie) Tj 0 Tr ET BT 0.9389 0 0 0.9939 219.12 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 41.76 0 0 -5.28 220.56 43.2 cm BI /W 237 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `<>`` ?>?x?|<?<?<?~?<0x>?x>x|>x<xx>|<x|<>|||x<>x<<||x<|><<~|<|<|>x|>~||>~?x|||??????`0x@`0x||8x EI Q BT 1.1401 0 0 0.9939 220.56 37.92 Tm 3 Tr 0.0095 Tc 0 Tw (Intermtional) Tj 0 Tr ET BT 0.9389 0 0 0.9939 262.32 37.92 Tm 0 Tc 0.038 Tw ( ) Tj ET q 43.2 0 0 -6.96 263.76 43.2 cm BI /W 244 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>?|<>?x>?>?<8>>><x?<0>>><x><><|~<|><|>>|>xxxxxxx||x|x|<||||<>||>|Ã|~|><Ã|~x><<x??p><?`p`p8|<||~?|>?8| EI Q BT 0.9939 0 0 0.9939 263.76 37.92 Tm 3 Tr 0.0359 Tc 0 Tw (cla~~ifi\224cation) Tj 0 Tr ET BT 0.9448 0 0 0.99 306.96 37.92 Tm /F5 8 Tf 0.0153 Tc 0.2699 Tw ( of Diseases, ) Tj ET q 9.6 0 0 -5.04 348.72 43.2 cm BI /W 55 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `~xxxxxxx<|<<><>>?>>>>?|>|8>x<x<x<p>>> EI Q BT 0.7677 0 0 0.99 348.72 37.92 Tm 3 Tr 0.0143 Tc 0 Tw ($lth) Tj 0 Tr ET BT 0.9448 0 0 0.99 358.32 37.92 Tm 0 Tc 0.0321 Tw ( ) Tj ET q 28.8 0 0 -6.24 360 43.2 cm BI /W 164 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?>????>~x|???<>>?? <>>8>>~>|>||x|x||||x<~|p|>>p|p~?ǀ~?~?|>|0~||>~|||| EI Q BT 0.9448 0 0 0.99 360 37.92 Tm 3 Tr 0.0186 Tc 0 Tw (Revision,) Tj 0 Tr 30.4813 0 TD 0 Tc 0.0321 Tw ( ) Tj ET q 25.2 0 0 -5.28 390.48 43.2 cm BI /W 143 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x?????~?<??|>A>|~|||||||||||><|>>|~>>|||<?~<?x~<?|?~>????~``p0|||??p~ EI Q BT 0.99 0 0 0.99 390.48 37.92 Tm 3 Tr 0.0299 Tc 0 Tw (clinical) Tj 0 Tr ET BT 0.8647 0 0 0.9598 415.68 37.92 Tm /F3 6 Tf 0 Tc -0.003 Tw ( ) Tj ET q 42.24 0 0 -7.2 417.12 43.2 cm BI /W 239 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px<<>0~|?>x??x??|>|?|x<>?>|0~><>|>>ǀ~?~x||>xx||>x||<x||<>||>>|>>|>|>|~>|>σ|<~~8~??pp0|>~|>|>x> ` EI Q BT 0.9598 0 0 0.9598 417.12 37.92 Tm 3 Tr 0.019 Tc 0 Tw (Mod@\224cation,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 459.36 37.92 Tm /F2 10 Tf 0.0508 Tc 0.2565 Tw ( published ) Tj ET q 5.76 0 0 -5.28 502.08 43.2 cm BI /W 34 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>>?????>`@ EI Q BT 1.1266 0 0 0.9835 502.08 37.92 Tm 3 Tr -0.103 Tc 0 Tw (b) Tj 0 Tr ET BT 0.9388 0 0 0.9835 507.84 37.92 Tm 0.0991 Tc 0.4608 Tw ( 1980.) Tj ET q 0 0 614.88 739.92 re W n BT 0.9835 0 0 0.9835 71.28 8.16 Tm 0.1126 Tc 1.5937 Tw (328-405 - 92 - 3) Tj 0 Tc -0.061 Tw ( ) Tj ET Q q 8.4 0 0 -5.76 147.6 13.2 cm BI /W 47 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?|><><>xxppxx<<>| EI Q BT 0.6102 0 0 0.9835 147.6 8.16 Tm 3 Tr 0.0183 Tc 0 Tw (QL) Tj 0 Tr ET q 0 0 614.88 739.92 re W n BT 0.9835 0 0 0.9835 156 8.16 Tm 0.122 Tc 0.7911 Tw ( 3) Tj ET Q endstream endobj 192 0 obj <>/Rotate 0/Type/Page>> endobj 193 0 obj <>stream 0.72 w 1 j 0 0 0 RG 77.76 681.84 m 556.56 681.84 l S 84.24 60 m 563.04 60 l S BT 0.9835 0 0 0.9835 78.24 688.08 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (60 ) Tj ET BT 0.9598 0 0 0.9598 90.72 688.08 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.96 688.08 Tm /F5 10 Tf 0.0065 Tc -0.0677 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 150.72 688.08 Tm /F5 11 Tf 0.0681 Tc -0.1305 Tw (Units for People With ) Tj ET BT 0.9835 0 0 0.9835 249.12 688.08 Tm /F5 10 Tf 0.0229 Tc 0.0784 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 78.72 648 Tm /F3 9 Tf 0.0257 Tc -0.0959 Tw (status, ) Tj ET BT 0.9835 0 0 0.9835 110.64 648 Tm /F4 10 Tf 0.0148 Tc 1.291 Tw (this assessment instrument increases the) Tj ET BT 0.934 0 0 0.9835 78.72 636 Tm -0.0439 Tc 2.0191 Tw (likelihood dementia will be diagnosed.) Tj ET BT 0.9835 0 0 0.9835 90 614.88 Tm 0.0299 Tc 1.4586 Tw (Preadmission Screening and Annual Resident) Tj -10.9816 -12.2018 TD 0.043 Tc 0.0421 Tw (Review \(PASARR\), another mandated component) Tj 0 -12.4458 TD 0.0419 Tc 2.7074 Tw (of OBRA-87, also increases the likelihood that) Tj 0.244 -11.9577 TD 0.044 Tc 2.3473 Tw (dementia will be diagnosed. OBRA-87 requires) Tj ET BT 0.8915 0 0 0.9835 79.68 566.64 Tm 0.03 Tc 0.6842 Tw (States to have a PASARR program that 1\) screens all) Tj -0.5384 -11.7137 TD 0.0415 Tc 0.9853 Tw (nursing home applicants and nursing home residents) Tj ET BT 0.934 0 0 0.9835 79.92 543.12 Tm -0.052 Tc 2.6701 Tw (to determin) Tj ET BT 0.9835 0 0 0.9835 132.24 542.88 Tm 0.0302 Tc 0.3602 Tw (e whether they have mental illness or) Tj ET BT 0.8915 0 0 0.9835 79.68 531.36 Tm 0.0337 Tc 1.7183 Tw (mental retardation, and 2\) evaluates all those found) Tj ET BT 0.9835 0 0 0.9835 80.16 519.12 Tm 0.0308 Tc 1.789 Tw (to have mental illness or mental retardation to) Tj ET BT 0.8915 0 0 0.9835 79.92 507.12 Tm 0.0555 Tc 0.9248 Tw (determine whether they need nursing home care and) Tj ET BT 0.9835 0 0 0.9835 80.16 495.36 Tm 0.0313 Tc 2.474 Tw (whether they need \223active treatment\224 for their) Tj ET BT 0.8915 0 0 0.9835 80.16 483.36 Tm 0.0428 Tc 0.6314 Tw (mental illness or mental retardation. Mentally ill and) Tj ET BT 0.9835 0 0 0.9835 80.16 471.6 Tm 0.0265 Tc 1.7793 Tw (mentally retarded nursing home applicants and) Tj 0.4881 -12.4458 TD 0.0425 Tc 0.1734 Tw (residents who are found in a PASARR evaluation) Tj 0.244 -12.2018 TD 0.037 Tc 0.6516 Tw (not to need nursing home care or to need \223active) Tj 0.244 -12.2018 TD 0.0244 Tc 0.5288 Tw (treatment\224 must be discharged. \(Mentally ill and) Tj ET BT 0.8915 0 0 0.9835 81.12 423.36 Tm 0.0456 Tc 1.6537 Tw (mentally retarded nursing home residents who have) Tj ET BT 0.934 0 0 0.9835 81.12 411.12 Tm -0.0104 Tc 1.0838 Tw (been in a nursing home for 30 months or more can) Tj ET BT 0.8915 0 0 0.9835 81.6 399.6 Tm 0.0597 Tc 0.1932 Tw (choose to remain in the nursing home even if they are) Tj ET BT 0.9835 0 0 0.9835 81.6 387.36 Tm 0.0426 Tc 1.2153 Tw (found not to need nursing home care or to need) Tj ET BT 0.934 0 0 0.9835 82.32 375.12 Tm -0.0127 Tc 0.5724 Tw (\221\221active treatment. \222 \221\)) Tj ET BT 0.9557 0 0 1.08 174.24 379.92 Tm /F4 4 Tf 0.0359 Tc 0 Tw (3) Tj ET BT 0.9835 0 0 0.9835 92.88 354.72 Tm /F4 10 Tf 0.0256 Tc 1.6257 Tw (In the original OBRA-87 language, a nursing) Tj -10.9816 -12.2018 TD 0.0266 Tc 2.9089 Tw (home applicant or resident with a primary or) Tj ET BT 0.934 0 0 0.9835 82.8 330.48 Tm -0.0346 Tc 0.8528 Tw (secondary diagnosis of a mental disorder as defined) Tj -0.5139 -11.9577 TD -0.0234 Tc 1.2262 Tw (in the American Psychiatric Association\222s) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 268.8 318.72 Tm /F5 11 Tf 0.0261 Tc 0 Tw (Diagnos-) Tj ET BT 0.9812 0 0 0.9812 82.8 306.48 Tm 0.088 Tc -0.1507 Tw (tic and Statistical Manual of Mental Disorders, ) Tj ET BT 0.9835 0 0 0.9835 293.76 306.48 Tm /F4 10 Tf 0.0379 Tc 0 Tw (3rd) Tj -214.7514 -12.2018 TD 0.0624 Tc 0.2461 Tw (edition \(DSM III\) ) Tj ET BT 0.9863 0 0 0.9863 166.56 294.48 Tm /F3 9 Tf 0.0864 Tc -0.1574 Tw (was ) Tj ET BT 0.9835 0 0 0.9835 186.48 294.48 Tm /F4 10 Tf 0.0399 Tc 0.8384 Tw (considered to have mental) Tj -105.4234 -12.2018 TD 0.0444 Tc 1.0779 Tw (illness and therefore to be subject to a PASARR) Tj 0.244 -11.9577 TD 0.0314 Tc 1.0911 Tw (evaluation. According to DSM III, dementia is a) Tj ET BT 0.934 0 0 0.9835 82.8 258.72 Tm -0.0194 Tc 1.2036 Tw (mental disorder, but an amendment to the original) Tj ET BT 0.9835 0 0 0.9835 83.28 246.96 Tm 0.0418 Tc 1.0805 Tw (OBRA-87 language exempted individuals with a) Tj -0.4881 -12.2018 TD 0.0268 Tc 3.585 Tw (primary diagnosis of dementia, including Alz-) Tj 0.244 -11.9577 TD 0.0348 Tc 1.5758 Tw (heimer\222s disease or a related disorder, from the) Tj 0.4881 -12.2018 TD 0.0505 Tc 1.0106 Tw (PASARR evaluation process. OBRA-90 extended) Tj ET BT 0.8915 0 0 0.9835 83.52 199.2 Tm 0.0319 Tc 1.7588 Tw (that exemption to individuals who have any diagno-) Tj 0.8076 -12.2018 TD 0.0345 Tc 0.4833 Tw (sis of dementia as long as they do not have a primary) Tj ET BT 0.934 0 0 0.9835 84 175.2 Tm -0.0134 Tc 1.087 Tw (diagnosis of a serious mental illness \(320\).) Tj ET BT 0.9835 0 0 0.9835 95.28 154.08 Tm 0.0302 Tc 2.7657 Tw (Since a PASARR evaluation can result in a) Tj ET BT 0.8915 0 0 0.9835 84 142.08 Tm 0.0359 Tc 0 Tw (determin) Tj 43.8787 -0.244 TD 0.0427 Tc 0.247 Tw (ation that an applicant or resident cannot be) Tj ET BT 0.9835 0 0 0.9835 84.24 130.32 Tm 0.0176 Tc 0.495 Tw (admitted to or cannot remain in a nursing home,) Tj 0 -12.2018 TD 0.0309 Tc 0.5222 Tw (PASARR creates an incentive for physicians who) Tj ET BT 0.8915 0 0 0.9835 84.24 106.32 Tm 0.0301 Tc 1.1328 Tw (want to have their patients admitted to or remain in) Tj ET BT 0.9835 0 0 0.9835 84.72 94.56 Tm 0.034 Tc 0.0039 Tw (a nursing home to give the patients a diagnosis of) Tj ET BT 0.934 0 0 0.9835 84.48 82.8 Tm -0.0299 Tc 0.912 Tw (dementia in order to exempt them from the evalua-) Tj ET BT 0.8915 0 0 0.9835 84.48 70.8 Tm 0.0485 Tc 0.899 Tw (tion. The current lack of a definitive physical marker) Tj ET BT 0.934 0 0 0.9835 329.76 648.72 Tm -0.027 Tc 1.6889 Tw (for Alzheimer\222s disease, the most common cause of) Tj 0.257 -12.4458 TD -0.0114 Tc 1.9842 Tw (dementia, means that disproving such a diagnosis) Tj ET BT 0.8915 0 0 0.9835 330.24 624.24 Tm 0.0249 Tc 0.9053 Tw (would be difficult. OTA is not aware of any data that) Tj ET BT 0.934 0 0 0.9835 330.48 612.24 Tm -0.0326 Tc 0.7863 Tw (show an increase in the proportion of nursing home) Tj ET BT 0.8915 0 0 0.9835 330 600.24 Tm 0.0383 Tc 1.0114 Tw (residents who have a diagnosis of dementia since the) Tj ET BT 0.9835 0 0 0.9835 330.48 588.24 Tm 0.0296 Tc 0.0355 Tw (implementation of PASARR in January 1989, but) Tj 0.244 -12.4458 TD 0.0286 Tc 0.1178 Tw (anecdotal evidence suggests such an increase has) Tj ET BT 0.934 0 0 0.9835 330.48 564 Tm -0.0255 Tc 0.3805 Tw (occurred, at least in some States.) Tj ET BT 0.9795 0 0 0.9795 345.6 539.28 Tm /F7 12 Tf 0.0464 Tc 0.8718 Tw (Factors That Could Change the Future) Tj -8.3311 -13.9668 TD 0.0257 Tc 0.7949 Tw (Prevalence of Dementia in Nursing Homes) Tj ET BT 0.8915 0 0 0.9835 342 507.6 Tm /F4 10 Tf 0.0503 Tc 1.3151 Tw (At least three factors could change the prevalence) Tj ET BT 0.9835 0 0 0.9835 331.2 495.36 Tm 0.0232 Tc 0.7334 Tw (of dementia in nursing homes in the future. One) Tj ET BT 0.8915 0 0 0.9835 331.68 483.6 Tm 0.0488 Tc 1.3553 Tw (factor is the availability of alternate residential care) Tj ET BT 0.934 0 0 0.9835 331.92 471.6 Tm -0.0378 Tc 1.7371 Tw (settings for people with dementia, e.g. adult foster) Tj ET BT 0.9835 0 0 0.9835 331.92 459.36 Tm 0.0354 Tc 2.621 Tw (homes and board and care and assisted living) Tj ET BT 0.8915 0 0 0.9835 331.92 447.6 Tm 0.0293 Tc 1.6079 Tw (facilities. These types of settings are proliferating in) Tj ET BT 0.9835 0 0 0.9835 332.4 435.12 Tm 0.0265 Tc 0.425 Tw (some parts of the country and may substitute for) Tj ET BT 0.934 0 0 0.9835 332.16 423.36 Tm -0.0216 Tc 0.9673 Tw (nursing homes for some individuals with dementia.) Tj 11.82 -18.3027 TD -0.0346 Tc 0.9996 Tw (A second factor that could change the prevalence) Tj -11.306 -12.4458 TD -0.0153 Tc 1.4745 Tw (of dementia in nursing homes is the availability of) Tj ET BT 0.9835 0 0 0.9835 332.88 381.12 Tm 0.0333 Tc 0.113 Tw (supportive services for individuals with dementia) Tj 0.244 -11.9577 TD 0.0229 Tc 2.564 Tw (who live at home, e.g., adult day services and) Tj ET BT 0.934 0 0 0.9835 333.12 357.36 Tm -0.0286 Tc 1.7886 Tw (in-home and overnight respite services. Such serv-) Tj 0 -11.9577 TD -0.0359 Tc 1.9554 Tw (ices may prevent or postpone nursing home place-) Tj 0 -12.2018 TD -0.0236 Tc 1.098 Tw (ment for some individuals.) Tj 11.82 -18.3027 TD -0.0287 Tc 1.2961 Tw (A third factor that could affect the future preva-) Tj ET BT 0.9835 0 0 0.9835 333.6 303.36 Tm 0.0231 Tc 0.3369 Tw (lence of dementia in nursing homes is changes in) Tj ET BT 0.934 0 0 0.9835 333.36 291.36 Tm -0.0441 Tc 1.6338 Tw (Medicare or Medicaid eligibility, coverage, or reim-) Tj ET BT 0.8915 0 0 0.9835 333.6 279.36 Tm 0.0555 Tc 1.7772 Tw (bursement policies that either encourage or discour-) Tj 0.5384 -12.2018 TD 0.0451 Tc 0.7009 Tw (age nursing home care for persons with dementia. As) Tj ET BT 0.9835 0 0 0.9835 333.84 255.6 Tm 0.042 Tc 2.3412 Tw (noted earlier, Medicaid policies in some States) Tj ET BT 0.8915 0 0 0.9835 334.08 243.84 Tm 0.0387 Tc 1.9127 Tw (restrict eligibility for Medicaid-funded nursing home) Tj ET BT 0.9835 0 0 0.9835 334.32 231.84 Tm 0.0341 Tc 2.1691 Tw (care for people with dementia. Any changes in) Tj -0.244 -11.9577 TD 0.0416 Tc 2.4055 Tw (Medicaid policies in those or other States that) Tj ET BT 0.8915 0 0 0.9835 334.08 208.32 Tm 0.0514 Tc 1.1986 Tw (resulted in more or less restrictive eligibility policies) Tj ET BT 0.934 0 0 0.9835 334.56 196.08 Tm -0.0313 Tc 1.1062 Tw (for persons with dementia would affect the number) Tj 0.257 -11.9577 TD -0.025 Tc 0.5855 Tw (of residents with dementia in nursing homes.) Tj 11.563 -18.3027 TD -0.0407 Tc 1.416 Tw (With respect to reimbursement policies, flat rate) Tj ET BT 0.8915 0 0 0.9835 335.52 154.08 Tm 0.0368 Tc 0.5612 Tw (systems, which reimburse nursing homes at the same) Tj ET BT 0.9835 0 0 0.9835 334.8 142.56 Tm 0.0292 Tc 0.5007 Tw (rate for all residents, generally create a financial) Tj 0.4881 -12.4458 TD 0.0236 Tc 0.6516 Tw (incentive for nursing homes to admit individuals) Tj ET BT 0.934 0 0 0.9835 335.52 118.56 Tm -0.0232 Tc 0.8405 Tw (they regard as relatively easy and thus inexpensive) Tj ET BT 0.8915 0 0 0.9835 335.52 106.56 Tm 0.0316 Tc 1.131 Tw (to care for and to deny admission to individuals they) Tj ET BT 0.934 0 0 0.9835 335.52 95.04 Tm -0.0291 Tc 1.6911 Tw (regard as relatively difficult and thus more expen-) Tj 0.5139 -12.4458 TD -0.0007 Tc 1.1698 Tw (sive to care for \(51,416\). Since many nursing home) Tj ET BT 0.8915 0 0 0.9835 335.76 70.8 Tm 0.0261 Tc 1.2808 Tw (administrators and staff members regard individuals) Tj ET BT 0.8647 0 0 0.9598 98.4 48.96 Tm /F3 6 Tf -0.006 Tc 0.0039 Tw (3 ) Tj ET q 11.52 0 0 -5.52 102.96 52.56 cm BI /W 69 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~>x>8>8>>>>>>>>~~`C `p?p??; EI Q BT 1.2971 0 0 0.9598 102.96 48.96 Tm 3 Tr 0.0135 Tc 0 Tw (me) Tj 0 Tr ET BT 0.8647 0 0 0.9598 114.48 48.96 Tm 0 Tc -0.003 Tw ( ) Tj ET q 27.36 0 0 -5.52 115.92 52.56 cm BI /W 160 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p9??~>??<>?8>>8?>>0??>>~>>~>>~>>~?>?>?>??>>?>>>>~?>~?~??~??p EI Q BT 1.4412 0 0 0.9598 115.92 48.96 Tm 3 Tr -0.0037 Tc 0 Tw (ofibu~) Tj 0 Tr ET BT 0.8647 0 0 0.9598 143.28 48.96 Tm 0 Tc -0.003 Tw ( ) Tj ET q 21.84 0 0 -7.2 144.72 52.56 cm BI /W 129 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??<??~8?߀???~?>~>?q|>?s|>>3|>>|>>|>>|>?|>?|>?|>~~??~0~>?>p~0?} EI Q BT 1.3691 0 0 0.9598 144.72 48.96 Tm 3 Tr -0.0221 Tc 0 Tw (B@~t) Tj 0 Tr ET BT 0.8647 0 0 0.9598 166.56 48.96 Tm 0 Tc -0.003 Tw ( ) Tj ET q 44.64 0 0 -5.52 168 52.56 cm BI /W 260 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <`8~|? ???????~?x??~~?9x??~~?8??~|߀??~??~??|??~??~??|߀??||yp??~||???~||??~>>x??>???0 ~|>? >>>?>?>>`@ EI Q BT 1.153 0 0 0.9598 168 48.96 Tm 3 Tr 0.0342 Tc 0 Tw (Re~~~fiatio~) Tj 0 Tr ET BT 0.8647 0 0 0.9598 212.64 48.96 Tm 0 Tc -0.003 Tw ( ) Tj ET q 10.32 0 0 -5.52 214.08 52.56 cm BI /W 62 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????p~x~|?8????? EI Q BT 1.5853 0 0 0.9598 214.08 48.96 Tm 3 Tr 0.0134 Tc 0 Tw (At) Tj 0 Tr ET BT 0.9388 0 0 0.9835 224.4 48.96 Tm /F2 10 Tf 0 Tc 0.055 Tw ( ) Tj ET q 6.48 0 0 -5.52 226.56 52.56 cm BI /W 39 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?~>~~~~>|>>>>>|<~~>~?~?~~>>> EI Q BT 0.7511 0 0 0.9835 226.56 48.96 Tm 3 Tr -0.0131 Tc 0 Tw (of) Tj 0 Tr ET BT 0.9388 0 0 0.9835 233.04 48.96 Tm 0 Tc 0.055 Tw ( ) Tj ET q 14.4 0 0 -5.76 235.2 52.8 cm BI /W 84 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x???߀~??<|x?|?~~?~~?~~?|~?|~?|~O>|>|>?? EI Q BT 0.7041 0 0 0.9835 235.2 48.96 Tm 3 Tr 0.1094 Tc 0 Tw (1990) Tj 0 Tr ET BT 0.9388 0 0 0.9835 249.6 48.96 Tm 0 Tc 0.055 Tw ( ) Tj ET q 35.52 0 0 -6.96 251.76 54.48 cm BI /W 208 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0>qx??|>~?|<|<|??>>|~~>x~>x~~?}~?~?~??~>x~>|?>|y<<}|>?x>?x~?~||~????p EI Q BT 0.7511 0 0 0.9835 251.76 48.96 Tm 3 Tr 0.0364 Tc 0 Tw (\(OBRA.90\)) Tj 0 Tr ET BT 0.9195 0 0 0.9835 287.28 48.96 Tm /F8 10 Tf 0 Tc 0.0005 Tw ( ) Tj ET q 24.96 0 0 -7.2 292.8 54.72 cm BI /W 147 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID v08y??????~??~?q?>3?>?>?>?>x?x?x?x?|?>?>~??|??|8<0???? EI Q BT 0.7996 0 0 0.9835 292.8 48.96 Tm 3 Tr -0.0013 Tc 0 Tw (c~ged) Tj 0 Tr ET BT 0.9195 0 0 0.9835 317.76 48.96 Tm 0 Tc 0.0005 Tw ( ) Tj ET q 8.88 0 0 -5.52 323.28 54.72 cm BI /W 53 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x???3?>?~?~?x~??8~??8~?>~?>~??~??~?>?~?~>~?~>p EI Q BT 0.7196 0 0 0.9835 323.28 48.96 Tm 3 Tr 0.0002 Tc 0 Tw (me) Tj 0 Tr ET BT 0.9195 0 0 0.9835 332.16 48.96 Tm 0 Tc 0.0005 Tw ( ) Tj ET q 13.68 0 0 -4.8 337.68 53.76 cm BI /W 81 /H 26 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID aa|>~>||>>||>>||>>|>>||>>||>>||?>||?>||?>||>?~|>??<<? EI Q BT 0.7196 0 0 0.9835 337.68 48.96 Tm 3 Tr 0.0002 Tc 0 Tw (te~) Tj 0 Tr ET BT 0.9195 0 0 0.9835 351.36 48.96 Tm 0 Tc 0.0005 Tw ( ) Tj ET q 18.24 0 0 -5.52 356.88 54.48 cm BI /W 107 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?80?|x?x~|?|~~||||||||>}||>>~>p>>x??<|?||<< EI Q BT 0.4797 0 0 0.9835 356.88 48.96 Tm 3 Tr -0.0013 Tc 0 Tw (active) Tj 0 Tr ET BT 0.9195 0 0 0.9835 375.12 48.96 Tm 0 Tc 0.0005 Tw ( ) Tj ET q 29.52 0 0 -4.32 380.64 53.28 cm BI /W 172 /H 25 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x ~?<|?|?~<~?x>~|>|||| >|||||<|~>|>>>>|>>>>>?>>>>>~><?>>????????????|8x>p EI Q BT 0.5197 0 0 0.9835 380.64 48.96 Tm 3 Tr -0.0002 Tc 0 Tw (t~eatme~t) Tj 0 Tr ET BT 0.9195 0 0 0.9835 410.16 48.96 Tm 0 Tc 0.0005 Tw ( ) Tj ET q 5.28 0 0 -4.8 415.68 53.76 cm BI /W 32 /H 26 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|~|>>~>>?>?>?>?>?>?~~~>~~?>> EI Q BT 0.3998 0 0 0.9835 415.68 48.96 Tm 3 Tr 0.0015 Tc 0 Tw (to) Tj 0 Tr ET BT 0.9444 0 0 0.9835 420.96 48.96 Tm /F5 10 Tf 0 Tc 0.0402 Tw ( ) Tj ET q 34.08 0 0 -7.2 423.12 54.72 cm BI /W 199 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||||>`?@ <?????x~??|~?||q| Ï1?`~|p|?|~x~?~|~<|~?>>|~~>>|?~??~|>??~|>?x?~~|~~?`~?|||~~| EI Q BT 0.7555 0 0 0.9835 423.12 48.96 Tm 3 Tr 0.03 Tc 0 Tw (specialized) Tj 0 Tr ET BT 0.9444 0 0 0.9835 457.2 48.96 Tm 0 Tc 0.0402 Tw ( ) Tj ET q 24.48 0 0 -5.28 459.36 54.48 cm BI /W 143 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????||??|???Ã???????<??~>>>><>>|߀?|8 @ EI Q BT 0.8027 0 0 0.9835 459.36 48.96 Tm 3 Tr 0.0063 Tc 0 Tw (se~-ces) Tj 0 Tr ET BT 0.9388 0 0 0.9835 483.84 48.96 Tm /F2 10 Tf 0.031 Tc 0.022 Tw ( for ) Tj ET q 28.8 0 0 -5.52 499.44 54 cm BI /W 169 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?????x?~x?~x~x?~x<~?????????~??~??~~???|><?8? EI Q BT 0.7041 0 0 0.9835 499.44 48.96 Tm 3 Tr -0.0115 Tc 0 Tw (PASARR) Tj 0 Tr ET BT 0.9021 0 0 0.9598 528.24 48.96 Tm /F6 5 Tf 0 Tc 0.0799 Tw ( ) Tj ET q 28.56 0 0 -5.76 529.2 52.8 cm BI /W 167 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~1??8?|>~|??|<?>8|??8????0???~s?~|~0?|~?>|~???~????????>???>>>??> ?| EI Q BT 1.9845 0 0 0.9598 529.2 48.96 Tm 3 Tr -0.0035 Tc 0 Tw (p~SeS.) Tj 0 Tr ET q 29.76 0 0 -5.76 84.48 43.68 cm BI /W 183 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????~?>?~>?~>|~|?||~?||?|<||~|~>|~~~?||?~?|~>~?~>~?>>|>?|???x0? EI Q BT 0.7511 0 0 0.9835 84.48 37.92 Tm 3 Tr /F2 10 Tf 0.0562 Tc (OBR4-90) Tj 0 Tr ET BT 0.8919 0 0 0.9835 114.24 37.92 Tm 0.0537 Tc -0.1399 Tw ( also changed the term ) Tj ET BT 0.8687 0 0 0.99 196.56 37.92 Tm /F7 8 Tf -0.0154 Tc 0.3657 Tw (mental illness ) Tj ET BT 0.8648 0 0 0.99 239.04 37.92 Tm /F3 8 Tf 0.1097 Tc -0.1304 Tw (to ) Tj ET BT 0.8687 0 0 0.99 247.68 37.92 Tm /F7 8 Tf -0.0509 Tc -0.0078 Tw (serious ) Tj ET q 19.44 0 0 -5.52 270.72 43.44 cm BI /W 120 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` <>?~>???~?||>~>>?~???x?|x?|||x|<||>???x?|x8|x|0|~>~ EI Q BT 0.8108 0 0 0.99 270.72 37.92 Tm 3 Tr 0.0699 Tc 0 Tw (mental) Tj 0 Tr ET BT 0.8687 0 0 0.99 290.16 37.92 Tm 0 Tc -0.0664 Tw ( ) Tj ET q 18.24 0 0 -5.52 291.84 43.2 cm BI /W 112 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x~|?Cx~|?|>|?|>|<<>>>>>>> > ><?>|>??xx>x|<<>> EI Q BT 0.7529 0 0 0.99 291.84 37.92 Tm 3 Tr 0.0036 Tc 0 Tw (iZlness) Tj 0 Tr ET BT 0.8919 0 0 0.9835 310.08 37.92 Tm /F2 10 Tf -0.0322 Tc -0.0437 Tw ( for ) Tj ET q 27.36 0 0 -5.76 324.96 43.68 cm BI /W 169 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?????????x??x~x~?><~?????????~??>~>?><??<? EI Q BT 0.6572 0 0 0.9835 324.96 37.92 Tm 3 Tr -0.0368 Tc 0 Tw (PASARR) Tj 0 Tr ET BT 0.8919 0 0 0.9835 352.32 37.92 Tm 0.0185 Tc 0.1685 Tw ( purposes \(320\).) Tj ET endstream endobj 194 0 obj <>/Rotate 0/Type/Page>> endobj 195 0 obj <>stream 0.72 w 1 j 0 0 0 RG 52.8 684.96 m 531.36 684.96 l S 56.88 71.52 m 535.44 71.52 l S BT 0.9835 0 0 0.9835 168.48 690.48 Tm 0 0 0 rg /F5 10 Tf 0.0197 Tc 1.2611 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 513.36 690.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 519.6 690.48 Tm /F5 10 Tf 0.244 Tc 0 Tw (61) Tj ET BT 0.8915 0 0 0.9835 53.52 651.84 Tm /F4 10 Tf 0.0248 Tc 1.4976 Tw (with dementia) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 119.04 651.84 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (as ) Tj ET BT 0.8915 0 0 0.9835 130.8 651.84 Tm /F4 10 Tf 0.0362 Tc 1.4309 Tw (relatively difficult to care for, they) Tj ET BT 0.934 0 0 0.9835 53.28 639.84 Tm -0.0205 Tc 0.4201 Tw (may be reluctant to admit these individuals under ) Tj ET BT 0.9606 0 0 0.9863 275.76 639.84 Tm /F3 9 Tf -0.0097 Tc 0 Tw (a) Tj -231.0987 -11.9231 TD -0.0039 Tc -0.0008 Tw (flat ) Tj ET BT 0.934 0 0 0.9835 68.64 628.08 Tm /F4 10 Tf -0.016 Tc 0.8329 Tw (rate reimbursement system.) Tj ET BT 0.9835 0 0 0.9835 64.8 608.64 Tm 0.0319 Tc 3.6356 Tw (As of 1990, 19 States were using case-mix) Tj ET BT 0.934 0 0 0.9835 53.52 596.4 Tm -0.0229 Tc 2.4462 Tw (reimbursement systems for Medicaid-funded nurs-) Tj ET BT 0.9835 0 0 0.9835 54 584.4 Tm 0.0311 Tc 1.0565 Tw (ing home care \(51\), and Congress has mandated) Tj ET BT 0.934 0 0 0.9835 54 572.4 Tm -0.0233 Tc 2.6394 Tw (development of a case-mix reimbursement system) Tj ET BT 0.9835 0 0 0.9835 54 560.4 Tm 0.0303 Tc 0.1568 Tw (for Medicare-funded nursing home care. The pur-) Tj 0 -12.2018 TD 0.026 Tc 3.2116 Tw (pose of case-mix reimbursement systems is to) Tj ET BT 0.8915 0 0 0.9835 54 536.64 Tm 0.0553 Tc 2.0557 Tw (recognize explicitly differences among nursing home) Tj 0 -12.2018 TD 0.0536 Tc 1.1577 Tw (residents in the resources required and therefore the) Tj ET BT 0.9835 0 0 0.9835 54.72 512.88 Tm 0.2786 Tc 2.792 Tw (cost of their care and to adjust the level of) Tj ET BT 0.8915 0 0 0.9835 54.24 500.88 Tm 0.0362 Tc 1.754 Tw (reimbursement to reflect those differences \(142,416\).) Tj ET BT 0.9835 0 0 0.9835 54.72 488.88 Tm 0.0329 Tc 0.327 Tw (To the extent that the level of reimbursement for) Tj ET BT 0.934 0 0 0.9835 54.48 476.88 Tm -0.0214 Tc 0.802 Tw (residents with dementia in a given case-mix system) Tj ET BT 0.9835 0 0 0.9835 54.96 464.88 Tm 0.0232 Tc 0.1233 Tw (corresponds to nursing home administrators\222 per-) Tj 0 -12.2018 TD 0.0365 Tc -0.0427 Tw (ception of the relative difficulty and cost of caring) Tj ET BT 0.934 0 0 0.9835 55.2 441.12 Tm -0.0448 Tc 1.5382 Tw (for these residents vs. other types of residents, the) Tj ET BT 0.9835 0 0 0.9835 55.44 429.12 Tm 0.0252 Tc 1.7947 Tw (administrators are likely to be willing to admit) Tj 0 -12.2018 TD 0.0251 Tc 0.9755 Tw (individuals with dementia.) Tj ET BT 1.08 0 0 1.08 180.72 421.44 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (4 ) Tj ET BT 0.9835 0 0 0.9835 184.56 416.64 Tm /F4 10 Tf 0.2832 Tc 5.2278 Tw (Anecdotal evidence) Tj ET BT 0.934 0 0 0.9835 55.44 405.12 Tm -0.0293 Tc 1.1469 Tw (suggests the level of reimbursement for individuals) Tj ET BT 0.9835 0 0 0.9835 55.44 393.36 Tm 0.0235 Tc 2.238 Tw (with dementia vs. other individuals in existing) Tj 0 -11.9577 TD 0.0327 Tc -0.0898 Tw (case-mix systems does not correspond to adminis-) Tj ET BT 0.8915 0 0 0.9835 55.68 369.6 Tm 0.029 Tc 1.4544 Tw (trators\222 perceptions of the relative difficulty and cost) Tj ET BT 0.934 0 0 0.9835 55.68 357.6 Tm -0.0335 Tc 1.494 Tw (of their care and in effect discourages admission of) Tj ET BT 0.8915 0 0 0.9835 55.68 345.84 Tm 0.0225 Tc 2.8462 Tw (individuals with dementia.) Tj ET BT 0.9795 0 0 0.9795 145.68 312.48 Tm /F7 12 Tf -0.0011 Tc 0 Tw (Summary) Tj ET BT 0.9835 0 0 0.9835 66.96 294 Tm /F4 10 Tf 0.0233 Tc -0.0162 Tw (A very large number of nursing home residents) Tj -11.2256 -12.4458 TD 0.0357 Tc 4.0151 Tw (have dementia-637,000 to 922,500 individuals) Tj 0.244 -12.2018 TD 0.0266 Tc 2.5602 Tw (according to national surveys. Not all of these) Tj 0 -11.9577 TD 0.0353 Tc 0.4596 Tw (individuals have a diagnosis of dementia in their) Tj ET BT 0.934 0 0 0.9835 56.16 246 Tm -0.0186 Tc 1.0559 Tw (medical records, however. In 1985, at least one-half) Tj 0.257 -12.4458 TD -0.0319 Tc 0.593 Tw (of all nursing home residents with dementia did not) Tj ET BT 0.9835 0 0 0.9835 56.16 222 Tm 0.0346 Tc 2.7961 Tw (have a diagnosis of dementia in their medical) Tj ET BT 0.934 0 0 0.9835 56.16 210.24 Tm -0.0424 Tc 1.3108 Tw (records. Moreover, most of the residents who had a) Tj 0.5139 -12.4458 TD -0.0162 Tc 0.5761 Tw (diagnosis of dementia had a general diagnosis, such) Tj ET BT 0.9835 0 0 0.9835 56.88 186.24 Tm 0.0167 Tc 0.3739 Tw (as organic brain syndrome, rather than a specific) Tj ET BT 0.934 0 0 0.9835 56.64 174.24 Tm -0.0191 Tc 1.607 Tw (diagnosis, such as Alzheimer\222s disease. These find-) Tj ET BT 0.8915 0 0 0.9835 56.88 162.24 Tm 0.0359 Tc 1.2496 Tw (ings support the complaint of many special care unit) Tj 0.2692 -12.4458 TD 0.0376 Tc 1.1756 Tw (advocates and others that dementia in nursing home) Tj ET BT 0.9835 0 0 0.9835 56.64 138.24 Tm 0.0257 Tc 0.2834 Tw (residents frequently is not carefully or accurately) Tj ET BT 0.934 0 0 0.9835 57.12 126 Tm -0.0252 Tc 0.8427 Tw (diagnosed and sometimes is not diagnosed at all.) Tj ET BT 0.9835 0 0 0.9835 67.92 107.04 Tm 0.0303 Tc 0.4008 Tw (The proportion of nursing home residents with) Tj ET BT 0.934 0 0 0.9835 57.12 95.04 Tm -0.0161 Tc 1.2505 Tw (dementia that has a diagnosis of dementia in their) Tj 0 -11.9577 TD -0.0275 Tc 1.0379 Tw (medical records is probably higher now than it was) Tj 265.1781 577.8764 TD -0.0287 Tc 1.1034 Tw (in 1985. For reasons discussed earlier, that propor-) Tj 0 -12.2018 TD -0.038 Tc 0.7423 Tw (tion is likely to continue to increase in the future.) Tj ET BT 0.9835 0 0 0.9835 315.6 621.6 Tm 0.031 Tc 0.6034 Tw (The true proportion of nursing home residents) Tj ET BT 0.8915 0 0 0.9835 305.28 609.36 Tm 0.0486 Tc 1.2466 Tw (with dementia could increase or decrease, depending) Tj ET BT 0.934 0 0 0.9835 305.04 597.12 Tm -0.0247 Tc 1.2093 Tw (on several factors, e.g., the availability of appropri-) Tj ET BT 0.9835 0 0 0.9835 305.28 584.88 Tm 0.0363 Tc 1.3301 Tw (ate care in alternate settings and Medicare and) Tj -0.244 -11.9577 TD 0.0384 Tc 2.6946 Tw (Medicaid policies that encourage or discourage) Tj ET BT 0.934 0 0 0.9835 305.28 561.12 Tm -0.0283 Tc 0.7603 Tw (nursing home care for persons with dementia.) Tj ET BT 0.9663 0 0 0.9939 339.84 538.8 Tm /F6 14 Tf 0.0339 Tc 3.6658 Tw (CHARACTERISTICS OF) Tj ET BT 0.9939 0 0 0.9939 321.12 522.96 Tm 0.026 Tc 0.4569 Tw (NURSING HOME RESIDENTS) Tj ET BT 0.9663 0 0 0.9939 359.04 507.12 Tm 0.0412 Tc 3.4099 Tw (WITH DEMENTIA) Tj ET BT 0.9835 0 0 0.9835 316.8 489.12 Tm /F4 10 Tf 0.0123 Tc 1.0291 Tw (The 1985 National Nursing Home Survey, the) Tj -9.7614 -12.2018 TD 0.0345 Tc 0.7951 Tw (1987 National Medical Expenditure Survey, and) Tj ET BT 0.934 0 0 0.9835 306.72 465.12 Tm -0.0311 Tc 2.6477 Tw (several smaller studies provide information about) Tj -0.7709 -11.9577 TD -0.0265 Tc 2.6428 Tw (various characteristics of nursing home residents.) Tj ET BT 0.9835 0 0 0.9835 306.48 440.88 Tm 0.0279 Tc 2.1405 Tw (OTA has used this information to compare the) Tj ET BT 0.934 0 0 0.9835 306.24 429.36 Tm -0.0333 Tc 2.179 Tw (characteristics of nursing home residents with de-) Tj ET BT 0.8915 0 0 0.9835 306.48 417.36 Tm 0.0347 Tc 1.1276 Tw (mentia and nondemented nursing home residents. In) Tj 0 -12.2018 TD 0.0331 Tc 0.8489 Tw (this section the two groups of residents are compared) Tj ET BT 0.9835 0 0 0.9835 306.72 393.84 Tm 0.0182 Tc 0.4422 Tw (with respect to age, gender, race, impairments in) Tj ET BT 0.934 0 0 0.9835 306.96 381.84 Tm -0.0158 Tc 0.5757 Tw (activities of daily living, and psychiatric and behav-) Tj ET BT 0.9835 0 0 0.9835 306.72 369.84 Tm 0.0269 Tc 1.1363 Tw (ioral symptoms. Two topologies of nursing home) Tj ET BT 0.8915 0 0 0.9835 306.72 358.08 Tm 0.0219 Tc 2.1738 Tw (residents are discussed.) Tj 12.6521 -18.3027 TD 0.0377 Tc 1.6446 Tw (Information about the characteristics of demented) Tj ET BT 0.934 0 0 0.9835 307.44 328.08 Tm -0.0258 Tc 1.2287 Tw (and nondemented nursing home residents is useful) Tj ET BT 0.9835 0 0 0.9835 307.44 316.08 Tm 5.861 Tc 0 Tw (in) Tj 0.0124 Tc (\224) Tj 14.6421 -0.244 TD 0.0308 Tc 1.4984 Tw (thinking about what should be special about) Tj -14.8862 -11.9577 TD 0.0211 Tc 0.0441 Tw (nursing home care for individuals with dementia.) Tj ET BT 0.8915 0 0 0.9835 307.44 292.08 Tm 0.0244 Tc 0.2194 Tw (The data presented in this section show that residents) Tj 0 -12.2018 TD 0.0492 Tc 0.8421 Tw (with dementia generally are older than nondemented) Tj ET BT 0.934 0 0 0.9835 307.2 268.32 Tm -0.0328 Tc 0.7545 Tw (residents. They are also more likely to have impair-) Tj ET BT 0.8915 0 0 0.9835 307.44 256.32 Tm 0.0332 Tc 0.8825 Tw (ments in activities of daily living and psychiatric and) Tj ET BT 0.9835 0 0 0.9835 307.44 244.08 Tm 0.0282 Tc 0.1182 Tw (behavioral symptoms. There is considerable over-) Tj ET BT 0.934 0 0 0.9835 307.68 232.32 Tm -0.0383 Tc 1.6276 Tw (lap, however, between demented and nondemented) Tj ET BT 0.8915 0 0 0.9835 307.44 220.32 Tm 0.0329 Tc 1.6679 Tw (residents in the distribution of these characteristics.) Tj ET BT 0.934 0 0 0.9835 318.72 202.56 Tm -0.0158 Tc 1.8605 Tw (Information about the characteristics of nursing) Tj ET BT 0.9835 0 0 0.9835 307.92 190.56 Tm 0.0323 Tc 2.0315 Tw (home residents with dementia is also useful in) Tj 0 -12.2018 TD 0.0292 Tc 0.1172 Tw (thinking about whether there are certain types of) Tj 0.244 -12.2018 TD 0.0269 Tc 2.7226 Tw (individuals with dementia who might be more) Tj ET BT 0.934 0 0 0.9835 308.16 154.32 Tm -0.0363 Tc 1.2584 Tw (appropriate than other types for special care units.) Tj ET BT 0.9835 0 0 0.9835 308.16 142.56 Tm 0.0212 Tc 0.288 Tw (Probably the most important information for this) Tj ET BT 0.934 0 0 0.9835 307.92 130.56 Tm -0.0325 Tc 1.2788 Tw (purpose is information about their coexisting medi-) Tj 0.257 -12.2018 TD -0.0213 Tc 1.4809 Tw (cal conditions and physical impairments. To OTA\222s) Tj ET BT 0.9835 0 0 0.9835 308.16 106.8 Tm 0.0283 Tc 0.1181 Tw (knowledge, that information is not available from) Tj ET BT 0.8915 0 0 0.9835 308.16 94.8 Tm 0.0527 Tc 0.8382 Tw (research based on a nationally representative sample) Tj ET BT 0.9835 0 0 0.9835 308.64 82.56 Tm 0.0233 Tc 2.9296 Tw (of nursing home residents. The 1985 National) Tj ET q 27.6 0 0 -8.16 70.56 66.72 cm BI /W 174 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pxxx<w??|>?~x~?x~x~<p?~p0~0~~~?~?8~?|?~>|??~>|??>>|x~~>||~?>??~???~xx|?8|<||||<>?~?~?<|< EI Q BT 0.7511 0 0 0.9835 70.56 60.24 Tm 3 Tr /F2 10 Tf 0.0515 Tc 0 Tw (AExis~g) Tj 0 Tr ET BT 0.8449 0 0 0.9835 98.16 60.24 Tm 0.0643 Tc 0.1204 Tw ( case-mix ) Tj ET q 42.48 0 0 -5.76 133.92 66 cm BI /W 266 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >L???~?~?~~|?<>?~~>~> >>~>>>~>π>~~??π>~~??π>~~??π>?~~????~~??>>>~?!?|>>~?q??x~??|?~?x??????8 <`~x8?? EI Q BT 0.7041 0 0 0.9835 133.92 60.24 Tm 3 Tr 0.0141 Tc 0 Tw (reimbmsement) Tj 0 Tr ET BT 0.8449 0 0 0.9835 176.4 60.24 Tm 0.0576 Tc 0.1284 Tw ( systems ) Tj ET q 26.16 0 0 -7.2 208.32 66 cm BI /W 165 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?8|8|8<8x8ρ???~??~q~|9||?|?|>|>~>?~?~?~~?|~?>?8`?? EI Q BT 0.6572 0 0 0.9835 208.32 60.24 Tm 3 Tr 0.0218 Tc 0 Tw (generaUy) Tj 0 Tr ET BT 0.8449 0 0 0.9835 234.48 60.24 Tm 0.0855 Tc 0.2374 Tw ( do not use dementia or a resident\222s cognitive status ) Tj ET q 5.76 0 0 -4.08 418.08 64.8 cm BI /W 36 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |||>?8<~>??<@ EI Q BT 0.6572 0 0 0.9835 418.08 60.24 Tm 3 Tr 0.0314 Tc 0 Tw (as) Tj 0 Tr ET BT 0.8449 0 0 0.9835 423.84 60.24 Tm 0.0887 Tc -0.0505 Tw ( variables ) Tj ET q 5.04 0 0 -4.56 459.6 65.04 cm BI /W 33 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??#|?>?>??????????????~??? EI Q BT 0.6102 0 0 0.9835 459.6 60.24 Tm 3 Tr 0.0414 Tc 0 Tw (to) Tj 0 Tr ET BT 0.8449 0 0 0.9835 464.64 60.24 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 17.52 0 0 -5.76 466.56 66 cm BI /W 110 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???~?x~<||~>?????  EI Q BT 0.7511 0 0 0.9835 466.56 60.24 Tm 3 Tr 0.0293 Tc 0 Tw (defhe) Tj 0 Tr ET BT 0.8449 0 0 0.9835 484.08 60.24 Tm 0.0969 Tc -0.0602 Tw ( case ) Tj ET q 12.24 0 0 -5.76 503.28 66.96 cm BI /W 78 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >@p????~?> ???????>?? EI Q BT 0.6572 0 0 0.9835 503.28 60.24 Tm 3 Tr 0.0463 Tc 0 Tw (mix.) Tj 0 Tr ET BT 0.8449 0 0 0.9835 515.52 60.24 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 15.84 0 0 -5.76 517.44 65.76 cm BI /W 101 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<??????x?8??????|~?|?|?|?|?~??x~~??? ??x EI Q BT 0.7511 0 0 0.9835 517.44 60.24 Tm 3 Tr 0.0419 Tc 0 Tw (Otier) Tj 0 Tr ET BT 0.798 0 0 0.9835 56.88 50.64 Tm 0.0361 Tc 0.361 Tw (variables, such as ) Tj ET q 38.16 0 0 -6.72 117.12 56.16 cm BI /W 252 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >%????????|?~?~?~>||~||>|||?|||||||||||~||~?||||?|||?||<|~|||>?~~~?>???>px| ~>>> 8||||@8` EI Q BT 0.6572 0 0 0.9835 117.12 50.64 Tm 3 Tr 0.0822 Tc 0 Tw (disorientatio~) Tj 0 Tr ET BT 0.798 0 0 0.9835 155.28 50.64 Tm 0.0572 Tc 0.4949 Tw ( need for supervision and ) Tj ET q 20.4 0 0 -7.2 241.92 56.16 cm BI /W 135 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|?x>xp>?~

~p~p~ ~0~~?~~~?>~>~~~||<|??~||<~|>~>~??}??>/Rotate 0/Type/Page>> endobj 197 0 obj <>stream 0.48 w 1 j 0 0 0 RG 77.76 683.04 m 556.08 683.04 l S 0.72 w 330.72 366 m 558 366 l S 330.96 334.08 m 558.48 334.08 l S 331.92 213.12 m 558.96 213.12 l S 80.64 167.76 m 559.44 167.76 l S BT 0.9835 0 0 0.9835 77.76 689.76 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (62 ) Tj ET BT 0.9598 0 0 0.9598 91.68 689.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 97.92 689.76 Tm /F5 10 Tf 0.0125 Tc 0.9566 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 77.76 650.16 Tm /F4 10 Tf -0.0207 Tc 2.5338 Tw (Nursing Home Survey provides information about) Tj ET BT 0.8915 0 0 0.9835 78 637.92 Tm 0.047 Tc 1.1026 Tw (the primary and other diagnoses of all nursing home) Tj ET BT 0.9835 0 0 0.9835 77.76 626.4 Tm 0.0284 Tc -0.126 Tw (residents. For residents with dementia, diagnoses) Tj ET BT 0.934 0 0 0.9835 77.76 614.16 Tm -0.0294 Tc 1.8383 Tw (related to their mental status have been extracted) Tj ET BT 0.8915 0 0 0.9835 78.24 601.92 Tm 0.0354 Tc 1.1828 Tw (from the survey data, but their other diagnoses have) Tj ET BT 0.9835 0 0 0.9835 78.24 589.92 Tm 0.039 Tc 0.3513 Tw (not been extracted. According to an official of the) Tj ET BT 0.934 0 0 0.9835 78.48 577.68 Tm -0.0159 Tc 0.7043 Tw (National Center for Health Statistics, that informa-) Tj ET BT 0.8915 0 0 0.9835 78.48 565.92 Tm 0.0457 Tc 1.3732 Tw (tion would be of questionable validity because of the) Tj ET BT 0.9835 0 0 0.9835 78.48 554.16 Tm 0.0316 Tc 3.0839 Tw (large number of diagnostic categories and the) Tj 0 -12.2018 TD 0.0229 Tc 0.2282 Tw (relatively small number of individuals in many of) Tj 0.244 -12.2018 TD 0.0517 Tc 3.6154 Tw (the categories \(189\). One of the topologies of) Tj ET BT 0.8915 0 0 0.9835 78.48 518.64 Tm 0.0358 Tc 0.5624 Tw (nursing home residents discussed later in this section) Tj 0.5384 -11.9577 TD 0.046 Tc 2.9544 Tw (incorporates information about residents\222 coexisting) Tj ET BT 0.934 0 0 0.9835 78.72 494.64 Tm -0.0202 Tc 2.5333 Tw (medical conditions and physical impairments that) Tj ET BT 0.9835 0 0 0.9835 79.2 482.88 Tm 0.0399 Tc 0.8079 Tw (was derived from data on residents of New York) Tj ET BT 0.934 0 0 0.9835 78.96 470.88 Tm -0.0016 Tc 2.6161 Tw (nursing homes.) Tj ET BT 0.9557 0 0 1.08 147.84 475.68 Tm /F4 4 Tf -0.0943 Tc 0 Tw (s) Tj ET BT 0.9795 0 0 0.9795 134.64 436.08 Tm /F7 12 Tf 0.0403 Tc 0.8779 Tw (Age, Gender, and Race) Tj ET BT 0.934 0 0 0.9835 90.24 416.16 Tm /F4 10 Tf -0 Tc 1.6967 Tw (Table 2-1 presents data from the 1985 National) Tj -11.82 -12.2018 TD -0.0184 Tc 0.996 Tw (Nursing Home Survey on the age, gender, and race) Tj 0.5139 -11.9577 TD -0.0314 Tc 2.0484 Tw (of demented and nondemented nursing home resi-) Tj ET BT 0.9835 0 0 0.9835 79.68 380.4 Tm 0.0303 Tc 0.3601 Tw (dents. For the purpose of the comparisons in this) Tj ET BT 0.934 0 0 0.9835 79.92 368.16 Tm -0.0378 Tc 1.3701 Tw (section, demented nursing home residents are resi-) Tj ET BT 0.9835 0 0 0.9835 79.92 356.4 Tm 0.04 Tc 1.601 Tw (dents who had a diagnosis of dementia in their) Tj 0 -12.2018 TD 0.0332 Tc 1.2418 Tw (medical records or were said by members of the) Tj 0 -11.9577 TD 0.0328 Tc 2.519 Tw (nursing home staff to have senile dementia or) Tj 0 -12.4458 TD 0.0184 Tc 0.3234 Tw (chronic or organic brain syndrome. Nondemented) Tj 0 -11.9577 TD 0.033 Tc 0.0087 Tw (nursing home residents are residents who did not) Tj 0 -12.4458 TD 0.0346 Tc 2.7961 Tw (have a diagnosis of dementia in their medical) Tj ET BT 0.8915 0 0 0.9835 79.92 284.4 Tm 0.0467 Tc 0.8449 Tw (records and were not said by members of the nursing) Tj ET BT 0.9835 0 0 0.9835 80.16 272.16 Tm 0.0339 Tc 0.9361 Tw (home staff to have senile dementia or chronic or) Tj ET BT 0.934 0 0 0.9835 80.4 259.92 Tm -0.0132 Tc 1.2153 Tw (organic brain syndrome.) Tj 11.82 -20.499 TD -0.0281 Tc 1.6595 Tw (According to the survey data, demented nursing) Tj -11.563 -12.2018 TD -0.0363 Tc 0.8545 Tw (home residents were, on average, older than nonde-) Tj 0 -12.2018 TD -0.022 Tc 1.4266 Tw (mented nursing home residents. As shown in table) Tj T* -0.0375 Tc 0.7458 Tw (2-1,48 percent of residents with dementia were over) Tj ET BT 0.9835 0 0 0.9835 81.12 191.52 Tm 0.0429 Tc 1.2624 Tw (age 85, compared with 33 percent of the nonde-) Tj ET BT 0.8915 0 0 0.9835 80.64 179.76 Tm 0.0107 Tc 2.8594 Tw (mented residents.) Tj ET BT 0.9835 0 0 0.9835 340.08 649.44 Tm 0.0395 Tc 1.0829 Tw (The proportion of residents with dementia in-) Tj ET BT 0.8915 0 0 0.9835 329.28 637.2 Tm 0.0405 Tc 1.2108 Tw (creased with age, from 20 percent of residents under) Tj 0.2692 -11.9577 TD 0.0455 Tc 0.7157 Tw (age 65, to 38 percent of those age 65 to 74,49 percent) Tj ET BT 0.9835 0 0 0.9835 329.52 613.2 Tm 0.0503 Tc -0.1261 Tw (of those age 75 to 84, and 56 percent of those over) Tj 0.244 -12.2018 TD 0.0403 Tc 2.1279 Tw (age 85 \(data not shown\) \(469\). Conversely, the) Tj ET BT 0.8915 0 0 0.9835 329.28 589.2 Tm 0.0338 Tc 2.0259 Tw (proportion of nondemented residents decreased with) Tj ET BT 0.8491 0 0 0.9835 329.76 576.96 Tm 0.2661 Tc 0 Tw (age.) Tj ET BT 0.9835 0 0 0.9835 340.56 556.08 Tm 0.0238 Tc 0.3179 Tw (Three-quarters of nursing home residents with) Tj ET BT 0.934 0 0 0.9835 330 544.32 Tm -0.0386 Tc 1.6279 Tw (dementia were female \(see table 2-l\). A preponder-) Tj ET BT 0.9835 0 0 0.9835 330.24 532.32 Tm 0.0348 Tc -0.0279 Tw (ance of female residents among all residents with) Tj -0.244 -11.9577 TD 0.0377 Tc 1.1893 Tw (dementia is to be expected since female nursing) Tj ET BT 0.934 0 0 0.9835 329.76 508.8 Tm -0.0272 Tc 2.1296 Tw (home residents greatly outnumber male residents.) Tj ET BT 0.9835 0 0 0.9835 330 496.8 Tm 0.0266 Tc 1.8688 Tw (The survey data indicate, however, that female) Tj ET BT 0.934 0 0 0.9835 330.24 484.8 Tm -0.0312 Tc 0.8125 Tw (nursing home residents were more likely than male) Tj ET BT 0.9835 0 0 0.9835 330 472.8 Tm 0.0365 Tc 2.8638 Tw (residents to have dementia \(48 percent vs. 40) Tj ET BT 0.934 0 0 0.9835 330.24 460.56 Tm -0.0233 Tc 1.5601 Tw (percent, respectively\) \(data not shown\) \(469\).) Tj ET BT 0.9835 0 0 0.9835 341.28 439.92 Tm 0.0303 Tc 0.4008 Tw (The proportion of nursing home residents with) Tj ET BT 0.934 0 0 0.9835 330.72 427.68 Tm -0.0271 Tc 1.5299 Tw (dementia did not differ by race. As shown in table) Tj ET BT 0.9835 0 0 0.9835 330.72 415.92 Tm 0.0386 Tc 2.792 Tw (2-1, the proportion of demented nursing home) Tj ET BT 0.9863 0 0 0.9863 356.88 395.28 Tm /F3 9 Tf 0.0354 Tc 0.9285 Tw (Table 2-l\227Distribution of Demented and) Tj -3.6499 -10.2198 TD 0.0641 Tc -0.0131 Tw (Nondemented Nursing Home Residents by) Tj -2.6766 -10.2198 TD 0.0522 Tc 0.2828 Tw (Age, Gender, and Race, United States, 1985) Tj ET BT 0.7567 0 0 0.99 413.28 356.88 Tm /F3 8 Tf 0.1866 Tc 0 Tw (All) Tj ET BT 0.9189 0 0 0.99 459.36 356.88 Tm -0.0012 Tc (Demented) Tj 54.3265 -0.2424 TD 0.0196 Tc (Nondemented) Tj ET BT 0.8648 0 0 0.99 401.76 347.76 Tm 0.0262 Tc (residents) Tj 69.1002 0 TD 0.0262 Tc (residents) Tj 65.7701 0 TD 0.0262 Tc (residents) Tj ET BT 0.99 0 0 0.99 391.2 339.12 Tm 0.1827 Tc 2.9851 Tw (\(N=1,491,400\) \(N =696,800\) \(N= 794,600\)) Tj ET BT 0.8648 0 0 0.99 331.2 325.2 Tm 0.236 Tc 0 Tw (Age) Tj ET BT 0.99 0 0 0.99 340.56 316.08 Tm -0.0386 Tc 0.9663 Tw (Under 65.. . .) Tj ET BT 0.8108 0 0 0.99 410.4 316.08 Tm 0.2146 Tc 0 Tw (1270) Tj ET BT 0.9835 0 0 0.9835 340.32 306.96 Tm /F4 10 Tf -0.0212 Tc 0.199 Tw (65-74 . . . . . . . 14) Tj 0.244 -9.0293 TD -0.0212 Tc 0.1685 Tw (75-84 . . . . . . . 34) Tj -0.244 -9.5174 TD -0.0456 Tc 0.2474 Tw (85+. . . . . . . . . 40) Tj ET BT 0.8648 0 0 0.99 331.92 275.76 Tm /F3 8 Tf 0.2353 Tc 0 Tw (Gender) Tj ET BT 0.99 0 0 0.99 340.8 267.12 Tm -0.0601 Tc 2.2304 Tw (Male. . . . . . . . 28) Tj 0.2424 -9.2124 TD -0.0604 Tc 2.7256 Tw (Female. . . . . . 72) Tj ET BT 0.8648 0 0 0.99 332.16 244.8 Tm 0.2158 Tc 0 Tw (Race) Tj ET BT 0.99 0 0 0.99 340.56 235.92 Tm -0.0479 Tc 2.638 Tw (White. . . . . . . 92) Tj 0.4849 -9.2124 TD -0.0461 Tc 0.0041 Tw (Black. . . . . . .) Tj ET BT 0.8648 0 0 0.99 415.44 226.8 Tm -0.0072 Tc 0 Tw (7) Tj ET BT 0.99 0 0 0.99 340.8 217.44 Tm -0.0299 Tc 3.0354 Tw (Other. . . . . . . 1) Tj 134.792 99.397 TD 0.0373 Tc 0 Tw (5%) Tj ET BT 0.8648 0 0 0.99 470.4 306.96 Tm 0.1315 Tc (12) Tj ET BT 0.99 0 0 0.99 469.92 297.84 Tm -0.085 Tc (36) Tj 0 -8.97 TD -0.085 Tc (48) Tj ET BT 0.9189 0 0 0.99 470.16 266.88 Tm 0.1235 Tc (25) Tj 0 -8.97 TD 0.1235 Tc (75) Tj ET BT 0.8027 0 0 0.9835 470.4 235.44 Tm /F5 10 Tf 0.2298 Tc (92) Tj ET BT 0.7555 0 0 0.9835 475.2 226.8 Tm 0.0803 Tc (7) Tj ET BT 0.4865 0 0 0.99 475.44 217.68 Tm /F3 8 Tf -0.0091 Tc (1) Tj ET BT 0.9189 0 0 0.99 527.04 315.84 Tm 0.1498 Tc (18%) Tj ET BT 0.8648 0 0 0.99 527.28 306.96 Tm 0.1315 Tc (16) Tj ET BT 0.99 0 0 0.99 526.8 297.6 Tm -0.085 Tc (33) Tj 0 -8.97 TD -0.085 Tc (33) Tj ET BT 0.9189 0 0 0.99 527.04 266.64 Tm 0.1235 Tc (32) Tj 0 -8.97 TD 0.1235 Tc (68) Tj ET BT 0.8027 0 0 0.9835 527.28 235.44 Tm /F5 10 Tf 0.2298 Tc (92) Tj 5.9798 -9.0293 TD 0.0804 Tc (7) Tj ET BT 0.4865 0 0 0.99 532.32 217.44 Tm /F3 8 Tf -0.0091 Tc (1) Tj ET BT 0.9262 0 0 0.9939 332.4 204.72 Tm /F3 7 Tf 0.0613 Tc 0.2329 Tw (SOURCE: Adapted from ) Tj ET q 11.76 0 0 -5.28 410.16 210 cm BI /W 70 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|||?|??~?|||||||||||>>>`>>>>>>>?>> EI Q BT 0.8645 0 0 0.9939 410.16 204.72 Tm 3 Tr -0.004 Tc 0 Tw (U.S,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 421.92 204.72 Tm 0.0611 Tc 0.1467 Tw ( Department of Health and Human ) Tj ET q 26.88 0 0 -6.48 531.12 210.24 cm BI /W 158 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxp|?~??p>?>????>p~?}>?|>>?>|{|?~?>~>~<|π<<~<?<>~|< EI Q BT 0.8645 0 0 0.9939 531.12 204.72 Tm 3 Tr 0.0068 Tc 0 Tw (Serviees,) Tj 0 Tr -190.9981 -7.9688 TD -0.035 Tc 2.1539 Tw (\223Mental Illness in Nursing Homes: United States, 1985,\224 Public) Tj ET BT 0.9939 0 0 0.9939 366.24 188.88 Tm 0.0143 Tc -0.0298 Tw (Health ) Tj ET q 24.96 0 0 -6.24 389.52 194.16 cm BI /W 139 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<<<?<>??<>>>?<<>}<|~|<|~x<||<|?|<>?>|<>><<>><><|?<<~<|<<|||0~|~?<>>> EI Q BT 0.9262 0 0 0.9939 389.52 188.88 Tm 3 Tr 0.0434 Tc 0 Tw (Serviee,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 414.48 188.88 Tm 0.0075 Tc -0.023 Tw ( National Center for Health Statistics, DHHS) Tj -48.5374 -7.9688 TD 0.0142 Tc -0.0297 Tw (Pub. No. ) Tj ET q 18.24 0 0 -7.2 396.48 186.48 cm BI /W 102 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >><x?|?|?x?x>>>>x>x>x>|>|~?x|~|>|>>>>>>>?>>>>>?a EI Q BT 0.9262 0 0 0.9939 396.48 180.96 Tm 3 Tr 0.0229 Tc 0 Tw (\(PHS\)) Tj 0 Tr ET BT 0.9939 0 0 0.9939 414.72 180.96 Tm -0.0148 Tc -0.0005 Tw ( 89-1758, ) Tj ET q 33.84 0 0 -7.2 445.92 186.48 cm BI /W 188 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|l||||?|??|??|?|?|??|?π>?>>~?|?|σ|?>?σ?>?>?<?|||???|?| EI Q BT 0.8645 0 0 0.9939 445.92 180.96 Tm 3 Tr -0.0272 Tc 0 Tw (Hyattsville,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 479.76 180.96 Tm -0.0137 Tc -0.0017 Tw ( MD, ) Tj ET q 27.84 0 0 -7.2 496.32 186.48 cm BI /W 155 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~ <><>?<||?<|<?|<<<><><>><??~>>~>>|?~?~?|?????0 @ EI Q BT 0.9262 0 0 0.9939 496.32 180.96 Tm 3 Tr 0.0609 Tc 0 Tw (Februafy) Tj 0 Tr ET BT 0.9939 0 0 0.9939 524.16 180.96 Tm -0.0278 Tc 0.0125 Tw ( 1991.) Tj ET q 2.16 0 0 -4.32 94.8 162 cm BI /W 15 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>>>>|???? EI Q BT 0.4225 0 0 0.9835 94.8 156.24 Tm 3 Tr /F2 10 Tf 0.1112 Tc 0 Tw (5) Tj 0 Tr ET BT 0.8449 0 0 0.9835 96.96 156.24 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 10.56 0 0 -5.76 98.88 162 cm BI /W 69 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??~?~?~x?~8?~~~>?~>?~>?~?~?||?|?|???~@?G?????8 EI Q BT 0.8449 0 0 0.9835 98.88 156.24 Tm 3 Tr -0.0077 Tc 0 Tw (me) Tj 0 Tr 12.4978 0 TD 0 Tc 0.0545 Tw ( ) Tj ET q 12.24 0 0 -5.76 111.36 162 cm BI /W 81 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<??<>~||~~!>?~~~?~?>>?~?|>||><O|<?<>? EI Q BT 0.5633 0 0 0.9835 111.36 156.24 Tm 3 Tr 0.1101 Tc 0 Tw (1985) Tj 0 Tr ET BT 0.8449 0 0 0.9835 123.6 156.24 Tm 0.0453 Tc 0.0009 Tw ( National Nursing Home ) Tj ET q 19.2 0 0 -7.2 209.76 162 cm BI /W 124 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~??p?x>8>>?@>>p>>p>|x>|8><?><~>~>~??????~~`~|~>> EI Q BT 0.7511 0 0 0.9835 209.76 156.24 Tm 3 Tr 0.038 Tc 0 Tw (SWey) Tj 0 Tr ET BT 0.8449 0 0 0.9835 228.96 156.24 Tm 0.0801 Tc -0.0403 Tw ( provides information about the primary reason for residents\222 admission ) Tj ET q 4.8 0 0 -5.04 476.64 161.28 cm BI /W 33 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|?>>>>>>~~>>>>>?>?~~~> EI Q BT 0.6102 0 0 0.9835 476.64 156.24 Tm 3 Tr 0.0414 Tc 0 Tw (to) Tj 0 Tr ET BT 0.8449 0 0 0.9835 481.44 156.24 Tm 0.1013 Tc -0.0654 Tw ( a ) Tj ET q 20.64 0 0 -7.2 489.12 162 cm BI /W 134 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ppsN|?????????~?~?~~~?~|?|?|~~~~~~>~>???x<xx EI Q BT 0.9598 0 0 0.9598 489.12 156.24 Tm 3 Tr /F3 6 Tf 0.0166 Tc 0 Tw (nWS@) Tj 0 Tr ET BT 0.7926 0 0 0.9598 509.76 156.24 Tm 0 Tc 0.1483 Tw ( ) Tj ET q 15.12 0 0 -5.76 511.2 162 cm BI /W 98 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~?π?~~|~?>??? EI Q BT 0.8647 0 0 0.9598 511.2 156.24 Tm 3 Tr -0.0461 Tc 0 Tw (home) Tj 0 Tr ET BT 0.7926 0 0 0.9598 526.32 156.24 Tm 0 Tc 0.1483 Tw ( ) Tj ET q 5.28 0 0 -4.08 527.76 160.32 cm BI /W 35 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|>8?x?|?|?>?? EI Q BT 0.7926 0 0 0.9598 527.76 156.24 Tm 3 Tr -0.0062 Tc 0 Tw (as) Tj 0 Tr 6.6611 0 TD 0 Tc 0.1483 Tw ( ) Tj ET q 22.8 0 0 -7.2 534.48 162 cm BI /W 148 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??????|~C?>?~|>?|=~?|||?|c~?|~?|~?||?|~?|~?|??|~??|>|||??`s0 ~>??? EI Q BT 0.9598 0 0 0.9598 534.48 156.24 Tm 3 Tr -0.0128 Tc 0 Tw (report~) Tj 0 Tr ET BT 0.7511 0 0 0.9835 81.12 146.88 Tm /F2 10 Tf 0.0339 Tc 0.8844 Tw (by their next of kin. According to these next-of-kin reports, the primary reasons for admission for 32 percent of ) Tj ET q 6 0 0 -5.28 434.16 151.92 cm BI /W 43 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???||>??8||>>~??p EI Q BT 0.6102 0 0 0.9835 434.16 146.88 Tm 3 Tr -0.0572 Tc 0 Tw (all) Tj 0 Tr ET BT 0.7511 0 0 0.9835 440.16 146.88 Tm 0.0524 Tc 0.8374 Tw ( residents overage 65 who had mental) Tj ET BT 0.8449 0 0 0.9835 81.12 137.76 Tm 0.0739 Tc -0.0329 Tw (disorders were ) Tj ET q 33.6 0 0 -5.76 132.96 143.28 cm BI /W 218 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0 <}????|||||p ~||>0~||>?||>||>||<||>?||??||????||p~??|px~<x~?@߀<`??x|8<`<>~??| EI Q BT 0.6572 0 0 0.9835 132.96 137.76 Tm 3 Tr 0.0314 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.8449 0 0 0.9835 166.56 137.76 Tm 0.0866 Tc -0.048 Tw ( disease, ) Tj ET q 28.08 0 0 -6.24 197.04 143.28 cm BI /W 183 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x|<<?>@p~????|???σ>~?Á|?>~Á||x~>|||||>||>|?|>||>||>||>||~?|@|||?|||>|?>~|???8  ||||88 EI Q BT 0.6572 0 0 0.9835 197.04 137.76 Tm 3 Tr 0.0727 Tc 0 Tw (confusio~) Tj 0 Tr ET BT 0.8449 0 0 0.9835 225.12 137.76 Tm 0.0812 Tc -0.0416 Tw ( forgetfulness, senility, or other emotional, mental, or nervous conditions. The primary reasons for) Tj ET BT 0.798 0 0 0.9835 81.36 128.88 Tm 0.0318 Tc -0.1349 Tw (admission for the re) Tj ET q 21.36 0 0 -7.2 145.2 134.16 cm BI /W 145 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>|>|>|>|>|>||>|?>|x>|x>|>|>|??>|??~<|?<>>>>  EI Q BT 0.6102 0 0 0.9835 145.2 128.64 Tm 3 Tr 0.0348 Tc 0 Tw (maining) Tj 0 Tr ET BT 0.798 0 0 0.9835 166.56 128.64 Tm 0.0412 Tc 0.2209 Tw ( residents over age 65 who had mental disorders were stroke \(10 percent\), atherosclerosis and other heart and circulatory) Tj -106.7678 -8.7853 TD 0.0309 Tc 0.0576 Tw (conditions \(10 percent\), hip or other fractures \(7 percent\), arthritis or another bone, muscle, or joint condition \(4 percent\), cancer \(1 percent\), central) Tj ET BT 0.7511 0 0 0.9835 81.36 111.12 Tm 0.019 Tc 0.5268 Tw (nervous system diseases or injuries \(2 percent\), diseases of ) Tj ET q 7.2 0 0 -5.28 264.96 115.92 cm BI /W 53 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?>?>p>8>>>>>>>>>>?>> EI Q BT 0.5633 0 0 0.9835 264.96 111.12 Tm 3 Tr 0.0431 Tc 0 Tw (the) Tj 0 Tr ET BT 0.7511 0 0 0.9835 272.16 111.12 Tm 0.0315 Tc 0.4239 Tw ( digestive or endocrine systems \(3 percent\), ) Tj ET BT 0.7642 0 0 0.9835 408.72 111.12 Tm /F4 10 Tf 0.0897 Tc 0 Tw (1) Tj ET BT 0.7885 0 0 1.0281 413.04 111.12 Tm /F4 7 Tf -0.0798 Tc -0.0196 Tw (0SS ) Tj ET BT 0.7511 0 0 0.9835 424.8 111.12 Tm /F2 10 Tf 0.0267 Tc 0.7119 Tw (of vision or hearing \(2 percent\), respiratory) Tj ET BT 0.798 0 0 0.9835 81.36 102.24 Tm 0.0249 Tc 0.6141 Tw (conditions \(2 percent\), Parkinson\222s disease \(2 percent\), dizziness, fainting, or falls \(1 percent\), ) Tj ET q 35.76 0 0 -7.2 393.36 107.76 cm BI /W 239 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??p?0x8xx8x<p0<?χ <??<??<??>???>|>>?~|~>~||>?~||>?~ρ||>x~|>?<~|>??||>?C>||>?>|~>?~>?|>>?~?>~?~x|~~?|??x|????p` EI Q BT 0.6572 0 0 0.9835 393.36 102.24 Tm 3 Tr 0.0705 Tc 0 Tw (genitourinmy) Tj 0 Tr ET BT 0.798 0 0 0.9835 429.12 102.24 Tm 0.0416 Tc 0.4113 Tw ( diseases \(1 percent\), old age or general) Tj -435.7931 -8.7853 TD 0.0302 Tc -0.0827 Tw (debilitation \(3 percent\), or other or no) Tj 155.49 -0.4881 TD 0.0227 Tc 0.0833 Tw (main reason \(21 percent\) \(469\). Although interesting in itself, this information is of little value in determining) Tj ET BT 0.8449 0 0 0.9835 81.36 84.48 Tm 0.0749 Tc -0.0341 Tw (the coexisting medical conditions and physical impairments of residents with dementia for two reasons. ) Tj ET q 13.92 0 0 -6.48 434.88 90 cm BI /W 91 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>???||| ||||||<|||@|||?? <|< ? EI Q BT 0.6572 0 0 0.9835 434.88 84.48 Tm 3 Tr 0.0389 Tc 0 Tw (Firs~) Tj 0 Tr ET BT 0.8449 0 0 0.9835 448.8 84.48 Tm 0.0938 Tc -0.0565 Tw ( the category of ) Tj ET q 21.6 0 0 -5.76 503.76 88.32 cm BI /W 141 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>?>?|?>?χ??|>>|>>>?>>?>?||?||>|>~~~>|0? |pπ|p>|?0 |?@ EI Q BT 0.6572 0 0 0.9835 503.76 84.48 Tm 3 Tr 0.0667 Tc 0 Tw (persons) Tj 0 Tr ET BT 0.8449 0 0 0.9835 525.36 84.48 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 11.28 0 0 -5.76 527.28 90 cm BI /W 74 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????>?~À~?????ǀ?>~?~p0 EI Q BT 0.6102 0 0 0.9835 527.28 84.48 Tm 3 Tr -0.0222 Tc 0 Tw (with) Tj 0 Tr ET BT 0.8108 0 0 0.99 538.56 84.48 Tm /F7 8 Tf 0 Tc 0.0723 Tw ( ) Tj ET q 18.48 0 0 -5.76 540 90.24 cm BI /W 121 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `xp ??||||>>x??x?|x||||??>|?>|>>>>>?>||??~||>0<|><>>? EI Q BT 0.6949 0 0 0.99 540 84.48 Tm 3 Tr -0.0205 Tc 0 Tw (mentaZ) Tj 0 Tr ET BT 0.7529 0 0 0.99 81.36 75.6 Tm 0.0768 Tc -0.1898 Tw (disorders ) Tj ET BT 0.798 0 0 0.9835 107.76 75.6 Tm /F2 10 Tf 0.0406 Tc 0.031 Tw (includes residents with schizophrenia, other psychoses, depressive and anxiety disorders, mental retardation, and alcohol and drug abuse, ss) Tj -33.3837 -9.0293 TD -0.0211 Tc -0.0686 Tw (well ) Tj ET q 5.04 0 0 -4.08 96.96 70.56 cm BI /W 35 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??|<?>?8||>>? EI Q BT 0.5633 0 0 0.9835 96.96 66.72 Tm 3 Tr -0.1196 Tc 0 Tw (as) Tj 0 Tr ET BT 0.798 0 0 0.9835 102 66.72 Tm 0.0421 Tc 0.5826 Tw ( persons with dementia. In addition, since the residents\222 next of kin were asked about only one condition-the condition they considered the) Tj ET BT 0.8919 0 0 0.9835 80.88 56.16 Tm 0.0129 Tc 0.3094 Tw (P-reason for ) Tj ET q 8.64 0 0 -5.28 128.4 61.68 cm BI /W 53 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??3?>?>8>8>>>>>>>>>>?~?>00 EI Q BT 0.7041 0 0 0.9835 128.4 56.16 Tm 3 Tr 0.0142 Tc 0 Tw (the) Tj 0 Tr ET BT 0.8919 0 0 0.9835 137.04 56.16 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 27.84 0 0 -5.76 139.2 61.68 cm BI /W 169 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID !??????߇?|~>~||~||G|||?|||||<|<|?|px>xpx>x|?p>?p>x?~?|?>>???x?~x?| |>|x?|><<|~~~?><>?p?| EI Q BT 0.9388 0 0 0.9835 169.2 56.16 Tm 3 Tr -0.0008 Tc 0 Tw (a~ssion) Tj 0 Tr ET BT 0.8919 0 0 0.9835 198.96 56.16 Tm 0.0094 Tc -0.0903 Tw ( to ) Tj ET q 8.64 0 0 -5.52 210.48 61.92 cm BI /W 52 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8p???>?~?p>>0>>>>>>>>><>><>>>>>>>>>>>>~~|~>` EI Q BT 0.7041 0 0 0.9835 210.48 56.16 Tm 3 Tr 0.0142 Tc 0 Tw (the) Tj 0 Tr ET BT 0.8919 0 0 0.9835 219.12 56.16 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 21.84 0 0 -7.2 221.28 61.44 cm BI /W 133 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p o~??????|>|||??|>|>|||||||x|||<?|?pp@ EI Q BT 0.8449 0 0 0.9835 270 56.16 Tm 3 Tr 0.0862 Tc 0 Tw (heir) Tj 0 Tr ET BT 0.8919 0 0 0.9835 283.2 56.16 Tm 0.0406 Tc 0.3591 Tw ( responses provide no information about the medical conditions and ) Tj ET q 24 0 0 -7.68 533.76 61.68 cm BI /W 146 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID o????>??? ??~?~~>~o>?|>?x|>~xx>|8x><|><|>|>?>>?>>>>>?>8?> >>~~~< EI Q BT 0.6102 0 0 0.9835 533.76 56.16 Tm 3 Tr 0.0094 Tc 0 Tw (physiea.1) Tj 0 Tr ET BT 0.798 0 0 0.9835 81.36 48.96 Tm 0.0409 Tc -0.1463 Tw (impairments of residents admitted because of mental conditions and no information about secondary medical conditions and physical impairments of) Tj -0.6015 -8.7853 TD 0.037 Tc -0.1414 Tw (residents admitted because of physical conditions.) Tj ET endstream endobj 198 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 199 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.44 675.84 m 540.72 675.84 l S 61.92 614.16 m 289.92 614.16 l S 0.48 w 313.44 613.92 m 541.2 613.92 l S 0.72 w 62.16 582.24 m 290.16 582.24 l S 313.68 581.76 m 541.44 581.76 l S 0.48 w 62.64 514.56 m 290.64 514.56 l S 0.72 w 314.4 488.64 m 541.92 488.64 l S 65.28 90.24 m 544.32 90.24 l S BT 0.9835 0 0 0.9835 177.12 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0214 Tc 1.4058 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems . 63) Tj ET BT 0.9863 0 0 0.9863 65.04 642.96 Tm /F3 9 Tf 0.0276 Tc 0.5511 Tw (Table 2-2\227lmpairments in Activities of Daily Living) Tj 11.4365 -9.7332 TD 0.0637 Tc 0.0603 Tw (in Demented and Nondemented Nursing Home) Tj 34.3094 -10.4631 TD 0.0463 Tc 0.3699 Tw (Residents, United States, 1985) Tj 214.8594 19.953 TD 0.0332 Tc 0.5658 Tw (Table 2-3\227Distribution of Psychiatric Symptoms) Tj 5.5966 -10.2198 TD 0.0637 Tc 0.0603 Tw (in Demented and Nondemented Nursing Home) Tj 34.3094 -10.2198 TD 0.0463 Tc 0.3699 Tw (Residents, United States, 1987) Tj ET BT 0.7567 0 0 0.99 144.96 605.04 Tm /F3 8 Tf 0.1866 Tc 0 Tw (All) Tj ET BT 0.9189 0 0 0.99 191.52 605.04 Tm -0.0012 Tc (Demented) Tj 54.0654 -0.2424 TD 0.0196 Tc (Nondemented) Tj ET BT 0.8648 0 0 0.99 133.2 595.92 Tm 0.0262 Tc (residents) Tj 69.3777 0 TD 0.0262 Tc (residents) Tj 65.4926 -0.2424 TD 0.0262 Tc (residents) Tj ET BT 0.99 0 0 0.99 122.88 587.04 Tm -0.0528 Tc 3.7927 Tw (\(N= 1,491,400\) \(N =696,800\) \(N= 794,600\)) Tj ET BT 0.7567 0 0 0.99 404.88 604.56 Tm 0.1866 Tc 0 Tw (All) Tj ET BT 0.99 0 0 0.99 448.08 604.56 Tm -0.0458 Tc 4.3675 Tw (Demented Nondemented) Tj ET BT 0.8648 0 0 0.99 393.12 595.68 Tm 0.0262 Tc 0 Tw (residents) Tj 65.7701 0 TD 0.0262 Tc (residents) Tj 62.44 0 TD 0.0262 Tc (residents) Tj ET BT 0.99 0 0 0.99 383.04 586.8 Tm -0.0528 Tc 3.8291 Tw (\(N=1,518,400\) \(N =643,600\) \(N =856,200\)) Tj ET BT 0.9189 0 0 0.99 62.88 573.36 Tm 0.0315 Tc 0.0928 Tw (Needs help with:) Tj ET BT 0.99 0 0 0.99 71.76 564.48 Tm -0.0442 Tc 0.2984 Tw (Bathing. . . . . . . . . 89%) Tj 132.1252 -0.4849 TD -0.0842 Tc 0 Tw (96%) Tj 57.2139 -0.2424 TD -0.0842 Tc (82%) Tj -189.0967 -8.2427 TD -0.045 Tc 0.9727 Tw (Dressing. . . . . . . 75) Tj 132.3677 -0.7273 TD -0.085 Tc 0 Tw (87) Tj ET BT 0.9189 0 0 0.99 259.92 554.88 Tm 0.1235 Tc (65) Tj ET BT 0.99 0 0 0.99 72 546.24 Tm -0.0417 Tc 1.0905 Tw (Using the toilet. . 61) Tj ET BT 0.8648 0 0 0.99 203.28 546.24 Tm 0.2703 Tc 0 Tw (74) Tj 65.4926 -0.2424 TD 0.2703 Tc (49) Tj ET BT 0.99 0 0 0.99 71.52 537.6 Tm -0.0324 Tc 0.1842 Tw (Transferring. . . . . ) Tj ET BT 0.9835 0 0 0.9835 140.88 537.6 Tm /F2 10 Tf 0.244 Tc 0 Tw (60) Tj ET BT 0.8648 0 0 0.99 203.28 537.36 Tm /F3 8 Tf 0.2703 Tc (70) Tj ET BT 0.7567 0 0 0.99 259.92 536.88 Tm 0.151 Tc (51) Tj ET BT 0.99 0 0 0.99 72 528.48 Tm -0.0469 Tc 1.411 Tw (Continence. . . . . 52) Tj ET BT 0.9189 0 0 0.99 203.28 528.24 Tm 0.1235 Tc 0 Tw (69) Tj 61.6397 -0.2424 TD 0.1235 Tc (37) Tj ET BT 0.99 0 0 0.99 72.24 519.6 Tm -0.0447 Tc 0.3663 Tw (Eating. . . . . . . . . . 39) Tj ET BT 0.9189 0 0 0.99 203.28 519.12 Tm 0.1235 Tc 0 Tw (54) Tj 61.6397 0 TD 0.1235 Tc (27) Tj ET BT 0.9262 0 0 0.9939 63.12 506.88 Tm /F3 7 Tf 0.0598 Tc 0.0618 Tw (SOURCE: Adapted from U.S. Department of Health and Human Services,) Tj ET BT 0.8645 0 0 0.9939 97.2 498.72 Tm -0.035 Tc 2.1886 Tw (\223Mental Illness in Nursing Homes: United States, 1985,\224 Public) Tj ET BT 0.9262 0 0 0.9939 97.2 490.8 Tm 0.0585 Tc 1.3587 Tw (Health Service, National Center for Health Statistics, DHHS) Tj 0.2591 -7.7273 TD 0.0478 Tc 0.7225 Tw (Pub. No. \(PHS\) 89-1758, ) Tj ET q 33.12 0 0 -6.96 177.12 488.64 cm BI /W 187 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????px|~>?>>>?>~>>>>>>|><>>>>>>>|>||>>>>><?>|>|~>>>>>>>>p EI Q BT 0.8645 0 0 0.9939 177.12 483.12 Tm 3 Tr -0.0272 Tc 0 Tw (Hyattsville,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 210.24 483.12 Tm 0.0684 Tc 0.8298 Tw ( MD, February 1991.) Tj ET BT 0.9835 0 0 0.9835 62.88 464.16 Tm /F4 10 Tf 0.0213 Tc 0.3344 Tw (residents who were white, black, or \221\221other\224 corre-) Tj 0.9761 -12.4458 TD 0.05 Tc 0.5841 Tw (sponds exactly to the proportion of nondemented) Tj ET BT 0.934 0 0 0.9835 63.36 440.16 Tm -0.0242 Tc 0.7903 Tw (nursing home residents in each category.) Tj ET BT 0.9795 0 0 0.9795 75.6 409.68 Tm /F7 12 Tf 0.041 Tc 0.5832 Tw (Impairments in Activities of Daily Living) Tj ET BT 0.9835 0 0 0.9835 74.64 391.92 Tm /F4 10 Tf 0.0362 Tc -0.134 Tw (Table 2-2 presents data from the 1985 National) Tj ET BT 0.934 0 0 0.9835 63.6 379.68 Tm -0.0183 Tc 1.2207 Tw (Nursing Home Survey on impairments in activities) Tj 0.5139 -12.2018 TD -0.0253 Tc 2.256 Tw (of daily living among demented and nondemented) Tj ET BT 0.9835 0 0 0.9835 64.08 355.68 Tm 0.0158 Tc 1.5137 Tw (nursing home residents. The data show nursing) Tj 0 -11.9577 TD 0.0348 Tc 0.5996 Tw (home residents with dementia were considerably) Tj ET BT 0.934 0 0 0.9835 64.08 331.92 Tm -0.0281 Tc 2.0449 Tw (more likely than nondemented nursing home resi-) Tj ET BT 0.8915 0 0 0.9835 64.08 319.68 Tm 0.0269 Tc 1.0167 Tw (dents to need assistance with each of the activities of) Tj ET BT 0.9835 0 0 0.9835 64.32 307.68 Tm 0.0291 Tc 0.466 Tw (daily living. For example, 96 percent of residents) Tj 0.244 -12.2018 TD 0.03 Tc 2.2639 Tw (with dementia needed assistance with bathing,) Tj 0 -12.4458 TD 0.0432 Tc 1.4859 Tw (compared with 82 percent of nondemented resi-) Tj ET BT 0.8915 0 0 0.9835 64.56 271.68 Tm 0.0171 Tc 1.9549 Tw (dents. Sixty-nine percent of residents with dementia) Tj ET BT 0.9835 0 0 0.9835 64.56 259.68 Tm 0.0323 Tc 0.3581 Tw (needed assistance to remain continent, compared) Tj ET BT 0.934 0 0 0.9835 64.8 247.68 Tm -0.0389 Tc 1.0116 Tw (with 37 percent of nondemented residents.) Tj ET BT 0.9795 0 0 0.9795 90.24 217.44 Tm /F7 12 Tf 0.0268 Tc 1.1367 Tw (Symptoms of Depression and Other) Tj 32.3442 -14.4569 TD 0.0525 Tc 1.6006 Tw (Psychiatric Conditions) Tj ET BT 0.8915 0 0 0.9835 76.32 185.76 Tm /F4 10 Tf 0.0409 Tc 1.1207 Tw (Data from the 1987 National Medical Expenditure) Tj ET BT 0.9835 0 0 0.9835 65.52 173.28 Tm 0.0337 Tc 0.1533 Tw (Survey indicate that symptoms of depression and) Tj -0.244 -11.7137 TD 0.018 Tc 1.8368 Tw (other psychiatric conditions are common among) Tj ET BT 0.934 0 0 0.9835 65.28 149.52 Tm -0.0233 Tc 1.3546 Tw (nursing home residents with dementia. The survey) Tj ET BT 0.8915 0 0 0.9835 65.52 137.52 Tm 0.0339 Tc 1.1172 Tw (data show that 70 percent of nursing home residents) Tj ET BT 0.934 0 0 0.9835 65.52 125.76 Tm -0.0265 Tc 1.3066 Tw (with dementia had depressive symptoms, including) Tj ET BT 0.8915 0 0 0.9835 65.52 113.52 Tm 0.0283 Tc 2.5032 Tw (worry, apprehension, drowsiness, withdrawal, impa-) Tj ET BT 0.934 0 0 0.9835 65.76 102 Tm -0.0183 Tc 1.0066 Tw (tience, and suspiciousness \(see table 2-3\). Sixty-one) Tj ET BT 0.8648 0 0 0.99 314.64 572.88 Tm /F3 8 Tf 0.2552 Tc 0 Tw (Depressive) Tj ET BT 0.9189 0 0 0.99 323.04 563.76 Tm 0.0516 Tc 0.2798 Tw (symptoms. . . . . .) Tj ET BT 0.99 0 0 0.99 401.52 563.52 Tm -0.0842 Tc 0 Tw (64%) Tj ET BT 0.7642 0 0 0.9835 458.64 563.76 Tm /F4 10 Tf 0.3174 Tc (70%) Tj 70.3484 -0.244 TD 0.3174 Tc (61%) Tj ET BT 0.8648 0 0 0.99 314.64 551.04 Tm /F3 8 Tf 0.0258 Tc (Psychotic) Tj ET BT 0.99 0 0 0.99 323.28 541.92 Tm -0.0577 Tc 2.4401 Tw (symptoms. . . . . . 30) Tj ET BT 0.9189 0 0 0.99 460.08 541.92 Tm 0.1235 Tc 0 Tw (36) Tj 58.7667 0 TD 0.1235 Tc (26) Tj ET BT 0.8648 0 0 0.99 314.64 529.2 Tm 0.0291 Tc 2.1828 Tw (Behavioral problems) Tj ET BT 0.99 0 0 0.99 323.28 520.08 Tm -0.0528 Tc 2.7988 Tw (0 problems. . . . . 53) Tj ET BT 0.7567 0 0 0.99 460.08 520.08 Tm 0.3096 Tc 0 Tw (41) Tj ET BT 0.9189 0 0 0.99 514.08 519.6 Tm 0.1235 Tc (63) Tj ET BT 0.99 0 0 0.99 323.76 511.2 Tm -0.0514 Tc 1.1284 Tw (1+. . . . . . . . . . . . . 47) Tj ET BT 0.9189 0 0 0.99 460.08 510.96 Tm 0.1235 Tc 0 Tw (59) Tj ET BT 0.99 0 0 0.99 514.08 510.96 Tm -0.085 Tc (40) Tj -192.2483 -8.7275 TD -0.0499 Tc 1.3412 Tw (1-4. . . . . . . . . . . . 43) Tj ET BT 0.9189 0 0 0.99 460.08 502.08 Tm 0.1235 Tc 0 Tw (53) Tj ET BT 0.99 0 0 0.99 514.08 501.84 Tm -0.085 Tc (37) Tj -192.7332 -8.7275 TD -0.0503 Tc 1.9478 Tw (5-10. . . . . . . . . . . 4) Tj 142.7922 -0.2424 TD -0.085 Tc 0 Tw (6) Tj ET BT 0.8648 0 0 0.99 518.64 492.96 Tm -0.0072 Tc (2) Tj ET BT 0.9262 0 0 0.9939 314.88 480.48 Tm /F3 7 Tf 0.0598 Tc 0.0618 Tw (SOURCE: Adapted from U.S. Department of Health and Human Services,) Tj 36.2752 -8.2103 TD 0.0802 Tc 0.0397 Tw (published and unpublished datafromthe ) Tj ET q 39.36 0 0 -5.28 475.92 477.36 cm BI /W 234 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <8ǀ>|??|?|??|???|?~??||~??|||??||?>||~?>||~?>|??>|>???|?~?~~???~|??|<?~|>>???|>?!|~? x>????`????? EI Q BT 0.8645 0 0 0.9939 475.92 472.32 Tm 3 Tr -0.037 Tc 0 Tw (1987National) Tj 0 Tr ET BT 0.9262 0 0 0.9939 515.28 472.32 Tm 0.0695 Tc 0.0513 Tw ( Medical) Tj ET BT 0.8645 0 0 0.9939 348.72 464.16 Tm -0.0561 Tc 3.9482 Tw (Expenditure Survey, Institutional Population Component, Cur-) Tj ET BT 0.9262 0 0 0.9939 348.48 456.24 Tm 0.0629 Tc 0.3607 Tw (rent Residents, Agency for Health Care ) Tj ET q 17.52 0 0 -7.2 475.44 461.52 cm BI /W 102 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |~|x~|x~|x|x|x|x|x|y|y||{|yyxxxρ~x~ρ|x||?x?|~x|>x|>0x|~|||p7xx EI Q BT 0.741 0 0 0.9939 475.44 456.24 Tm 3 Tr -0.0269 Tc 0 Tw (Pol\224ky) Tj 0 Tr ET BT 0.9262 0 0 0.9939 492.96 456.24 Tm 0.06 Tc 0.4502 Tw ( and Research,) Tj ET q 29.04 0 0 -6.48 348.96 453.6 cm BI /W 162 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~|>??>>>><><|<?>>|?<>|?>>|>|>|<>|<>x>|<>|<>><<>>|?>>|?<<<?<~>||O>>>< EI Q BT 0.8645 0 0 0.9939 348.96 448.32 Tm 3 Tr -0.0212 Tc 0 Tw (Rockville,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 378 448.32 Tm -0.0225 Tc 0.1279 Tw ( MD, 1991.) Tj ET BT 0.8915 0 0 0.9835 314.88 427.44 Tm /F4 10 Tf 0.0293 Tc 1.1336 Tw (percent of the nondemented residents had depressive) Tj ET BT 0.9835 0 0 0.9835 315.36 415.2 Tm 0.0181 Tc 0.1284 Tw (symptoms \(464\).) Tj ET BT 1.08 0 0 1.08 390.48 420 Tm /F4 4 Tf -0.0024 Tc 0 Tw (6) Tj ET BT 0.934 0 0 0.9835 326.16 394.56 Tm /F4 10 Tf -0.0115 Tc 2.0614 Tw (The 1987 National Medical Expenditure Survey) Tj ET BT 0.9835 0 0 0.9835 315.36 382.56 Tm 0.0324 Tc 0.6717 Tw (found 36 percent of nursing home residents with) Tj 0 -12.2018 TD 0.0218 Tc 0.7755 Tw (dementia had psychotic symptoms, such as delu-) Tj ET BT 0.934 0 0 0.9835 315.84 358.32 Tm -0.0101 Tc 1.0835 Tw (sions and hallucinations \(see table 2-3\). Twenty-six) Tj -0.5139 -11.9577 TD -0.0338 Tc 2.1367 Tw (percent of nondemented residents had such symp-) Tj ET BT 0.8915 0 0 0.9835 315.6 334.56 Tm -0.034 Tc 0 Tw (toms.) Tj ET BT 0.934 0 0 0.9835 326.4 313.44 Tm -0.0072 Tc 1.7228 Tw (Although these figures show that many nursing) Tj -11.306 -12.2018 TD -0.035 Tc 1.2815 Tw (home residents with dementia have depressive and) Tj -0.257 -12.4458 TD -0.026 Tc 1.1648 Tw (psychotic symptoms, it should be noted that not all) Tj 0.257 -11.9577 TD -0.0256 Tc 2.1707 Tw (nursing home residents with dementia have these) Tj ET BT 0.9835 0 0 0.9835 316.32 265.2 Tm 0.0288 Tc 0.6463 Tw (symptoms. Seventy percent of the residents with) Tj ET BT 0.8915 0 0 0.9835 316.08 253.2 Tm 0.0253 Tc 1.9457 Tw (dementia had depressive symptoms according to the) Tj ET BT 0.9835 0 0 0.9835 316.56 241.44 Tm 0.0317 Tc 0.5112 Tw (survey data, but 30 percent of the residents with) Tj ET BT 0.8915 0 0 0.9835 316.32 229.44 Tm 0.0212 Tc 1.7708 Tw (dementia did not have such symptoms. Likewise, 36) Tj -0.2692 -12.2018 TD 0.0281 Tc 1.2247 Tw (percent of the residents with dementia had psychotic) Tj ET BT 0.934 0 0 0.9835 316.8 205.68 Tm -0.0194 Tc 0.7337 Tw (symptoms, and 64 percent did not.) Tj ET BT 0.8915 0 0 0.9835 327.6 184.8 Tm 0.0288 Tc 0.2368 Tw (It is also clear from the survey data that depressive) Tj -12.1137 -12.2018 TD 0.0282 Tc 1.763 Tw (and psychotic symptoms are not unique to residents) Tj ET BT 0.9835 0 0 0.9835 316.8 161.04 Tm 0.0413 Tc 1.9758 Tw (with dementia. Sixty-one percent of the nonde-) Tj ET BT 0.934 0 0 0.9835 316.56 149.04 Tm -0.0259 Tc 0.8863 Tw (mented residents had depressive symptoms, and 26) Tj ET BT 0.9835 0 0 0.9835 316.56 136.8 Tm 0.0203 Tc 3.0547 Tw (percent had psychotic symptoms. In fact, data) Tj 0.4881 -11.9577 TD 0.0374 Tc 0.1394 Tw (tabulated for OTA by the Agency for Health Care) Tj 0 -11.9577 TD 0.0337 Tc 1.2718 Tw (Policy and Research show that 53 percent of all) Tj ET BT 0.934 0 0 0.9835 316.8 101.28 Tm -0.031 Tc 1.7911 Tw (nursing home residents who had depressive symp-) Tj ET BT 0.798 0 0 0.9835 79.44 79.2 Tm /F2 10 Tf -0.1488 Tc 0.0915 Tw (S ) Tj ET q 10.32 0 0 -5.52 85.92 84.72 cm BI /W 68 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??~||?|p?|>0?|>?|>?|<?|<?|>?|??|?|?|?|????x???? EI Q BT 0.6572 0 0 0.9835 85.92 79.2 Tm 3 Tr 0.0469 Tc 0 Tw (The) Tj 0 Tr ET BT 0.798 0 0 0.9835 96.24 79.2 Tm 0.0438 Tc 0.3013 Tw ( reported ) Tj ET q 29.28 0 0 -6.96 128.4 84.48 cm BI /W 192 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@? x0???8?|~~|??~~|?>s||||?7|x||?~||>~>|>~|>~߃<<~x~<~>|>~0|~x||~~>|||~~|<|~?>}>?????7~?  EI Q BT 0.7041 0 0 0.9835 128.4 79.2 Tm 3 Tr 0.0393 Tc 0 Tw (prevalen~) Tj 0 Tr ET BT 0.798 0 0 0.9835 157.68 79.2 Tm 0.0486 Tc 1.1017 Tw ( of depression and depressive symptoms among nursing home residents varies greatly) Tj 0 Tc -0.0951 Tw ( ) Tj ET q 28.08 0 0 -7.2 447.6 84.72 cm BI /W 185 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??p|??????>x??||~>>||>?>|>>>>>?>>??>>?>|>>|~>||>>|?>><>>><>>x????߀`?>0 EI Q BT 0.5519 0 0 0.9835 447.6 79.2 Tm 3 Tr /F4 10 Tf -0.0173 Tc 0 Tw (depending) Tj 0 Tr ET BT 0.8066 0 0 0.9835 475.68 79.2 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 6.48 0 0 -4.08 477.84 83.28 cm BI /W 44 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~|||~>>|0 EI Q BT 0.5519 0 0 0.9835 477.84 79.2 Tm 3 Tr 0.0947 Tc 0 Tw (on) Tj 0 Tr ET BT 0.8066 0 0 0.9835 484.32 79.2 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 7.92 0 0 -5.52 486.48 84.72 cm BI /W 52 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????>p?>?0>>?>>>>>>>>>?>?@>>?>>>>>>>~?| EI Q BT 0.5094 0 0 0.9835 486.48 79.2 Tm 3 Tr 0.0219 Tc 0 Tw (the) Tj 0 Tr ET BT 0.8066 0 0 0.9835 494.4 79.2 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 14.16 0 0 -6.96 496.56 84.72 cm BI /W 94 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?xx@8?<8<<|~|?~|?>|>>@>>>>>>>>?>>>>>>>>8>>8>>x>~?x??8 EI Q BT 0.6793 0 0 0.9835 496.56 79.2 Tm 3 Tr 0.0146 Tc 0 Tw (S~@) Tj 0 Tr ET BT 0.798 0 0 0.9835 510.72 79.2 Tm /F2 10 Tf 0 Tc -0.0951 Tw ( ) Tj ET q 18.72 0 0 -7.2 512.64 84.72 cm BI /W 123 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?>|?|?>?~>~>||>|<>|?>x?>x>|>0?>x>|8x~<x|?>x|>>>??  EI Q BT 0.8449 0 0 0.9835 512.64 79.2 Tm 3 Tr 0.0685 Tc 0 Tw (s~Ple) Tj 0 Tr ET BT 0.798 0 0 0.9835 531.36 79.2 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 9.36 0 0 -5.28 533.28 84.72 cm BI /W 63 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>|>|>><>>>>>>>>>??>8>|>|>>>>??p EI Q BT 0.8919 0 0 0.9835 533.28 79.2 Tm 3 Tr 0.039 Tc 0 Tw (~d) Tj 0 Tr ET BT 0.7511 0 0 0.9835 66 69.6 Tm 0.0517 Tc 1.298 Tw (the procedures by which the condition and its symptoms are identified. Moreover, clinicians disagree about what constitutes depression and depressive) Tj 0 -9.0293 TD 0.0507 Tc 1.1991 Tw (symptoms in persons with dementia. A study of 227 residents of one Pennsylvania nursing home found that 87 of the 166 residents with dementia \(52) Tj ET BT 0.798 0 0 0.9835 65.76 51.84 Tm 0.0457 Tc -0.0608 Tw (percent\) and 69 of the 111 cognitively normal residents \(62 percent\) had major or minor depression based on self reports and observer ratings \(342\).) Tj ET BT 0.7511 0 0 0.9835 65.76 42.96 Tm 0.0556 Tc 0.6324 Tw (Another study of 454 residents of 8 Maryland nursing homes found that 29 of the 306 residents with dementia \(9 percent\) and 110 of the 148 cognitively) Tj 0 -8.7853 TD 0.0261 Tc 2.0334 Tw (normal residents \(74 percent\) had major depression or depressive symptoms \(388,389\).) Tj ET endstream endobj 200 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 201 0 obj <>stream 0.72 w 1 j 0 0 0 RG 69.6 683.04 m 548.4 683.04 l S BT 0.9835 0 0 0.9835 69.84 689.28 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (64 ) Tj ET BT 0.9598 0 0 0.9598 82.56 689.28 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 88.8 689.28 Tm /F5 10 Tf 0.0125 Tc 1.0922 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -19.0348 -40.2659 TD /F4 10 Tf 0.0405 Tc 2.7596 Tw (toms and 49 percent of all residents who had) Tj ET BT 0.934 0 0 0.9835 69.84 637.68 Tm -0.0274 Tc 1.9242 Tw (psychotic symptoms were not demented \(464\).) Tj ET BT 0.9795 0 0 0.9795 129.6 613.92 Tm /F7 12 Tf 0.0526 Tc 1.3555 Tw (Behavioral Symptoms) Tj ET BT 0.9835 0 0 0.9835 81.36 595.92 Tm /F4 10 Tf 0.0204 Tc 0.6549 Tw (Both the 1985 National Nursing Home Survey) Tj ET BT 0.934 0 0 0.9835 70.56 583.68 Tm -0.0105 Tc 0.7413 Tw (and the 1987 National Medical Expenditure Survey) Tj 0 -11.7137 TD -0.0241 Tc 1.9978 Tw (found behavioral symptoms were more common in) Tj ET BT 0.8915 0 0 0.9835 70.56 560.16 Tm 0.041 Tc 1.3641 Tw (nursing home residents with dementia than in other) Tj ET BT 0.934 0 0 0.9835 70.8 548.16 Tm -0.0249 Tc 1.7417 Tw (nursing home residents. The 1985 survey collected) Tj ET BT 0.8491 0 0 0.9835 71.04 536.16 Tm 0.0211 Tc 2.6205 Tw (information about six behavioral symptoms \(disrobing/) Tj ET BT 0.934 0 0 0.9835 71.04 523.92 Tm -0.0144 Tc 2.2701 Tw (exposing oneself, screaming, being physically abu-) Tj ET BT 0.9835 0 0 0.9835 71.28 511.92 Tm 0.0287 Tc 2.9852 Tw (sive to self or others, stealing, getting lost or) Tj ET BT 0.8915 0 0 0.9835 71.28 500.16 Tm 0.0464 Tc 1.7426 Tw (wandering into unacceptable places, and inability to) Tj ET BT 0.934 0 0 0.9835 71.52 487.92 Tm -0.0223 Tc 2.2956 Tw (avoid simple dangers\) \(468\). Fifty-eight percent of) Tj ET BT 0.9835 0 0 0.9835 71.04 476.16 Tm 0.0424 Tc 0.4524 Tw (residents with dementia exhibited one or more of) Tj ET BT 0.934 0 0 0.9835 71.76 464.16 Tm -0.029 Tc 0.9202 Tw (these symptoms, whereas only 24 percent of nonde-) Tj ET BT 0.9835 0 0 0.9835 71.52 452.4 Tm 0.0459 Tc 2.3662 Tw (mented residents exhibited one or more of the) Tj ET BT 0.8915 0 0 0.9835 72 440.16 Tm 0.2039 Tc 0 Tw (symptoms.) Tj ET BT 0.934 0 0 0.9835 82.8 422.16 Tm -0.0115 Tc 2.0614 Tw (The 1987 National Medical Expenditure Survey) Tj ET BT 0.9835 0 0 0.9835 72 410.16 Tm 0.0347 Tc 1.2829 Tw (collected information about 10 behavioral symp-) Tj ET BT 0.934 0 0 0.9835 72 398.16 Tm -0.0168 Tc 1.913 Tw (toms \(wandering, physically hurting others, physi-) Tj 0.257 -12.4458 TD -0.0301 Tc 1.3618 Tw (cally hurting oneself, dressing inappropriately, cry-) Tj ET BT 0.9835 0 0 0.9835 72.48 374.4 Tm 0.0274 Tc 0.8512 Tw (ing for long periods, hoarding, getting upset, not) Tj ET BT 0.8915 0 0 0.9835 72.72 362.4 Tm 0.0296 Tc 1.8152 Tw (avoiding dangerous things, stealing, and inappropri-) Tj ET BT 0.9835 0 0 0.9835 72.72 350.4 Tm 0.0387 Tc 1.6124 Tw (ate sexual behavior\) \(237\). Fifty-nine percent of) Tj ET BT 0.8915 0 0 0.9835 72.48 338.64 Tm 0.0413 Tc 1.3894 Tw (nursing home residents with dementia exhibited one) Tj ET BT 0.9835 0 0 0.9835 72.72 326.64 Tm 0.0279 Tc 2.4543 Tw (or more of these symptoms, compared with 40) Tj ET BT 0.934 0 0 0.9835 72.24 314.4 Tm -0.0359 Tc 1.2396 Tw (percent of nondemented residents \(see table 2-3\).) Tj 12.0769 -18.3027 TD -0.0265 Tc 1.4008 Tw (Wandering is probably the most frequently cited) Tj ET BT 0.9835 0 0 0.9835 72.72 284.88 Tm 0.0224 Tc 1.8811 Tw (behavioral symptom of nursing home residents.) Tj ET BT 0.934 0 0 0.9835 72.96 272.88 Tm -0.0132 Tc 1.6435 Tw (Data from the 1987 National Medical Expenditure) Tj ET BT 0.9835 0 0 0.9835 73.2 260.4 Tm 0.0192 Tc 1.9983 Tw (Survey and a previous National Nursing Home) Tj 0 -11.7137 TD 0.0372 Tc 0.8106 Tw (Survey conducted in 1977 show 11 percent of all) Tj ET BT 0.934 0 0 0.9835 73.2 237.12 Tm -0.0074 Tc 1.5945 Tw (nursing home residents wander \(237,465\). At least) Tj ET BT 0.9835 0 0 0.9835 73.44 225.12 Tm 0.0219 Tc 1.2635 Tw (three smaller studies have shown nursing home) Tj ET BT 0.934 0 0 0.9835 72.96 213.36 Tm -0.0371 Tc 1.2225 Tw (residents with dementia are more likely than other) Tj ET BT 0.8915 0 0 0.9835 73.2 201.36 Tm 0.0378 Tc 1.06 Tw (nursing home residents to wander \(98,1 16,417\). One) Tj ET BT 0.934 0 0 0.9835 73.92 189.12 Tm -0.0076 Tc 0.4526 Tw (study of 402 residents of a 520-bed nursing home in) Tj -0.5139 -11.9577 TD -0.0251 Tc 1.5033 Tw (Rockville, MD, found, for example, that 47 percent) Tj 0.257 -12.4458 TD -0.0386 Tc 1.1568 Tw (of the 216 demented residents wandered, compared) Tj 0 -12.2018 TD -0.0313 Tc 1.8403 Tw (with 31 percent of the 186 nondemented residents) Tj 0.5139 -12.4458 TD 0.0482 Tc 0 Tw (\(98\).) Tj ET BT 0.9812 0 0 0.9812 84.96 122.88 Tm /F5 11 Tf 0.1097 Tc -0.1728 Tw (Sundowning ) Tj ET BT 0.9835 0 0 0.9835 143.04 122.88 Tm /F4 10 Tf 0.0366 Tc 0.6588 Tw (is another frequently cited behav-) Tj ET BT 0.934 0 0 0.9835 73.92 111.12 Tm -0.0256 Tc 0.8431 Tw (ioral symptom of nursing home residents. The term) Tj ET BT 0.9812 0 0 0.9812 74.16 99.12 Tm /F5 11 Tf 0.1095 Tc -0.1727 Tw (sundowning ) Tj ET BT 0.9835 0 0 0.9835 130.8 99.12 Tm /F4 10 Tf 0.039 Tc 0.2292 Tw (refers to an observed increase in agi-) Tj -57.5924 -12.2018 TD 0.0319 Tc 0.2191 Tw (tated and confused behaviors that occurs in some) Tj 0 -11.9577 TD 0.0382 Tc 1.6333 Tw (individuals in the late afternoon. A study of 89) Tj ET BT 0.934 0 0 0.9835 73.92 63.36 Tm -0.03 Tc 1.2761 Tw (randomly selected residents of one 180-bed nursing) Tj ET BT 0.8915 0 0 0.9835 74.16 51.6 Tm 0.0345 Tc 1.1577 Tw (home in Washington, DC, found 15 percent of the 59) Tj ET BT 0.9835 0 0 0.9835 73.92 39.84 Tm 0.0262 Tc 0.6083 Tw (residents with dementia exhibited this symptom,) Tj 251.6007 619.6065 TD 0.044 Tc 0.9039 Tw (compared with 7 percent of the 30 nondemented) Tj ET BT 0.8915 0 0 0.9835 321.12 637.44 Tm 0.0108 Tc 4.2052 Tw (residents \(132\).) Tj ET BT 0.9835 0 0 0.9835 332.64 617.76 Tm 0.0199 Tc 0.2487 Tw (Excessive or disruptive noisemaking, including) Tj ET BT 0.934 0 0 0.9835 321.84 605.76 Tm -0.0138 Tc 2.1153 Tw (screaming, moaning, and repetitive verbalizations,) Tj ET BT 0.9835 0 0 0.9835 321.84 593.76 Tm 0.0313 Tc 0.5683 Tw (is a third frequently cited behavioral symptom of) Tj ET BT 0.934 0 0 0.9835 321.6 582 Tm -0.0278 Tc 1.9468 Tw (nursing home residents. At least two studies have) Tj ET BT 0.9835 0 0 0.9835 322.32 569.76 Tm 0.0332 Tc 1.496 Tw (shown demented residents are more likely than) Tj -0.4881 -11.9577 TD 0.0328 Tc 1.7729 Tw (nondemented residents to exhibit this symptom) Tj ET BT 0.934 0 0 0.9835 322.56 545.76 Tm 0.0582 Tc 0 Tw (\(72,97\).) Tj ET BT 0.9835 0 0 0.9835 333.12 525.84 Tm 0.0245 Tc 1.3422 Tw (Although these figures indicate nursing home) Tj ET BT 0.934 0 0 0.9835 321.84 514.08 Tm -0.0371 Tc 1.2225 Tw (residents with dementia are more likely than other) Tj 0.5139 -12.2018 TD -0.0204 Tc 0.8804 Tw (nursing home residents to exhibit behavioral symp-) Tj 0.257 -12.2018 TD -0.0288 Tc 0.5896 Tw (toms, it is clear not all nursing home residents with) Tj 0 -12.2018 TD -0.0119 Tc 0.4247 Tw (dementia exhibit such symptoms. As shown in table) Tj 0.257 -11.9577 TD -0.006 Tc 0.7365 Tw (2-3, the 1987 National Medical Expenditure Survey) Tj ET BT 0.9835 0 0 0.9835 322.8 454.08 Tm 0.0324 Tc 0.6717 Tw (found 41 percent of nursing home residents with) Tj 0 -11.9577 TD 0.0405 Tc 2.6507 Tw (dementia did not exhibit any of the measured) Tj ET BT 0.934 0 0 0.9835 323.28 430.08 Tm 0.0037 Tc 0.5977 Tw (symptoms \(464\). Likewise, the 1985 National Nurs-) Tj 0 -12.2018 TD -0.0194 Tc 0.708 Tw (ing Home Survey found 42 percent of nursing home) Tj -0.5139 -12.2018 TD -0.0318 Tc 1.6849 Tw (residents with dementia did not exhibit any of the) Tj 0.5139 -12.2018 TD 0.0051 Tc 1.4526 Tw (measured symptoms \(468\).) Tj ET BT 0.8915 0 0 0.9835 334.56 374.4 Tm 0.0426 Tc 0.1615 Tw (It is also clear from the survey data that behavioral) Tj -11.8446 -12.2018 TD 0.0243 Tc 0.6906 Tw (symptoms are not unique to residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 323.52 350.4 Tm 0.0346 Tc 1.5271 Tw (The 1987 National Medical Expenditure Survey) Tj 0.244 -11.9577 TD 0.0393 Tc 1.3677 Tw (found 40 percent of nondemented nursing home) Tj -0.244 -12.2018 TD 0.0387 Tc 0.1075 Tw (residents exhibited one or more behavioral symp-) Tj 0.4881 -12.2018 TD 0.0415 Tc 0.1962 Tw (toms \(see table 2-3\). Moreover, data from the two) Tj 0 -11.7137 TD 0.0288 Tc -0.0959 Tw (national surveys show 35 to 47 percent of nursing) Tj -0.244 -12.2018 TD 0.0429 Tc -0.0361 Tw (home residents who exhibited one or more behav-) Tj ET BT 0.934 0 0 0.9835 324 279.12 Tm -0.015 Tc 1.5512 Tw (ioral symptoms were not demented \(464,468\).) Tj ET BT 0.8915 0 0 0.9835 335.04 259.2 Tm 0.0315 Tc 1.0325 Tw (The results of a study of a random sample of 1139) Tj ET BT 0.934 0 0 0.9835 324 247.44 Tm -0.0296 Tc 1.2008 Tw (residents of 42 New York nursing homes also show) Tj ET BT 0.9835 0 0 0.9835 324.24 235.44 Tm 0.031 Tc 0.4814 Tw (behavioral symptoms are not unique to residents) Tj 0.244 -11.9577 TD 0.0346 Tc 0.1117 Tw (with dementia. The study found 23 percent of the) Tj -0.244 -11.9577 TD 0.0294 Tc 0.239 Tw (residents exhibited serious behavioral symptoms,) Tj 0.4881 -11.9577 TD 0.0184 Tc 2.3855 Tw (including dangerous, physically aggressive, and) Tj 0 -12.4458 TD 0.0319 Tc 1.9854 Tw (verbally noisy or abusive behaviors \(520\). Two-) Tj ET BT 0.934 0 0 0.9835 324.72 175.92 Tm -0.0357 Tc 0.7438 Tw (thirds of the residents who exhibited serious behav-) Tj 0 -12.2018 TD -0.0206 Tc 1.4251 Tw (ioral symptoms had dementia. By implication, it is) Tj 0.257 -12.2018 TD -0.0399 Tc 1.8496 Tw (clear that one-third of the residents who exhibited) Tj ET BT 0.8915 0 0 0.9835 325.44 139.92 Tm 0.0329 Tc 1.3987 Tw (serious behavioral symptoms did not have dementia.) Tj ET BT 0.9795 0 0 0.9795 342.24 106.8 Tm /F7 12 Tf 0.0446 Tc 0.3222 Tw (Topologies of Nursing Home Residents) Tj ET BT 0.9835 0 0 0.9835 336.24 86.88 Tm /F4 10 Tf 0.066 Tc 1.788 Tw (Several topologies have been proposed to de-) Tj ET BT 0.8915 0 0 0.9835 325.68 75.12 Tm 0.0314 Tc 1.0672 Tw (scribe different types of nursing home residents. One) Tj ET BT 0.934 0 0 0.9835 325.44 63.36 Tm -0.0458 Tc 2.5349 Tw (typology delineates five general types of residents) Tj 0.5139 -11.9577 TD -0.0241 Tc 0.7274 Tw (\(339\). The five types are based on differences in the) Tj ET BT 0.9835 0 0 0.9835 325.2 40.08 Tm 0.0262 Tc -0.1238 Tw (primary reason for the individuals\222 admission to a) Tj ET endstream endobj 202 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 203 0 obj <>stream q 60.48 0 0 -2.88 125.28 36.48 cm BI /W 336 /H 16 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ???~?~??~ >?~?~>p>px EI Q 0.72 w 1 j 0 0 0 RG 62.64 680.64 m 541.2 680.64 l S BT 0.9835 0 0 0.9835 178.08 685.92 Tm 0 0 0 rg /F5 10 Tf 0.0197 Tc 1.3526 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 523.68 685.92 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 530.16 685.92 Tm /F5 10 Tf 0.244 Tc 0 Tw (65) Tj ET BT 0.8915 0 0 0.9835 63.12 646.56 Tm /F4 10 Tf 0.0336 Tc 0.882 Tw (nursing home and their expected lengths of stay. The) Tj ET BT 0.934 0 0 0.9835 63.36 634.56 Tm -0.0348 Tc 0.9815 Tw (five types are:) Tj ET BT 0.7642 0 0 0.9835 75.6 615.36 Tm 0.0673 Tc 0 Tw (1.) Tj ET BT 0.8607 0 0 0.9812 74.88 590.4 Tm /F6 11 Tf 0.0549 Tc (2.) Tj ET BT 0.8197 0 0 0.9812 75.6 553.2 Tm 0.1174 Tc (3.) Tj ET BT 0.8607 0 0 0.9812 75.6 516.48 Tm 0.1944 Tc (4.) Tj 0.5577 -38.1564 TD 0.0549 Tc (5.) Tj ET BT 0.9835 0 0 0.9835 88.32 615.36 Tm /F4 10 Tf 0.026 Tc 1.5033 Tw (individuals who are terminally ill and will) Tj ET BT 0.934 0 0 0.9835 88.32 603.36 Tm -0.0209 Tc 0.8381 Tw (remain in the facility for 6 months or less;) Tj ET BT 0.8915 0 0 0.9835 88.56 590.4 Tm 0.0484 Tc 2.5479 Tw (individuals who require short-term rehabilita-) Tj ET BT 0.934 0 0 0.9835 89.04 578.16 Tm -0.0304 Tc 0.7381 Tw (tion or treatment for subacute illness and will) Tj -0.257 -12.2018 TD -0.0209 Tc 0.8381 Tw (remain in the facility for 6 months or less;) Tj 0.257 -12.9339 TD -0.0225 Tc 2.3815 Tw (individuals who are primarily physically im-) Tj ET BT 0.8915 0 0 0.9835 89.04 541.2 Tm 0.0532 Tc 0.8265 Tw (paired and will remain in the facility for longer) Tj 0.5384 -12.2018 TD 0.0164 Tc 1.507 Tw (than 6 months;) Tj ET BT 0.934 0 0 0.9835 89.28 516.24 Tm -0.0281 Tc 1.6681 Tw (individuals who are primarily cognitively im-) Tj ET BT 0.8915 0 0 0.9835 89.28 504 Tm 0.0532 Tc 0.7928 Tw (paired and will remain in the facility for longer) Tj ET BT 0.934 0 0 0.9835 90 492.24 Tm 0.0256 Tc 0.0175 Tw (than 6 months; and) Tj ET BT 0.8915 0 0 0.9835 89.76 479.04 Tm 0.0425 Tc 2.0161 Tw (individuals who have significant cognitive and) Tj ET BT 0.934 0 0 0.9835 89.52 467.04 Tm -0.0174 Tc 1.905 Tw (physical impairments and will remain in the) Tj 0.5139 -11.9577 TD -0.0022 Tc 1.075 Tw (facility for longer than 6 months \(339\).) Tj ET BT 0.8915 0 0 0.9835 87.12 436.56 Tm 0.0247 Tc 1.9015 Tw (In this typology, individuals with dementia are) Tj ET BT 0.9835 0 0 0.9835 65.52 424.56 Tm 0.039 Tc 0.5953 Tw (included in two of the groups-long-stay residents) Tj 0 -11.7137 TD 0.0275 Tc 0.4036 Tw (who are primarily cognitively impaired and long-) Tj ET BT 0.934 0 0 0.9835 66 400.8 Tm -0.0265 Tc 1.7251 Tw (stay residents who are both cognitively and physi-) Tj 0 -12.2018 TD -0.0271 Tc 1.6156 Tw (cally impaired.) Tj 11.563 -19.0348 TD -0.0476 Tc 1.5518 Tw (A more complicated typology that was developed) Tj ET BT 0.8915 0 0 0.9835 66.24 358.32 Tm 0.0396 Tc 0.6061 Tw (with the use of a statistical grouping technique called) Tj ET BT 0.9812 0 0 0.9812 66 346.56 Tm /F5 11 Tf 0.0404 Tc 4.0559 Tw (grade of membership \(GOM\)) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 212.16 346.56 Tm /F4 10 Tf 0.0507 Tc 2.9425 Tw (and data on the) Tj -148.3737 -12.9339 TD 0.0271 Tc 3.4545 Tw (characteristics of 3427 residents of New York) Tj ET BT 0.934 0 0 0.9835 66.24 322.32 Tm -0.0213 Tc 1.7562 Tw (nursing homes delineates 6 types of nursing home) Tj -0.257 -12.4458 TD -0.0184 Tc 0.9896 Tw (residents \(283\). The six types are:) Tj ET BT 0.7217 0 0 0.9835 78.72 291.36 Tm 0.1504 Tc 0 Tw (1.) Tj ET BT 0.8491 0 0 0.9835 78.24 206.4 Tm 0.0673 Tc (2.) Tj ET BT 0.8066 0 0 0.9835 79.2 120.48 Tm 0.1417 Tc (3.) Tj ET BT 0.8915 0 0 0.9835 79.2 48.72 Tm 0.1346 Tc (4.) Tj ET BT 0.9443 0 0 0.9812 91.44 290.88 Tm /F5 11 Tf 0.0101 Tc 1.3042 Tw (limited impaired residents) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 207.36 290.88 Tm /F4 10 Tf 0.0044 Tc 1.068 Tw (who usually have a) Tj -124.3665 -11.9577 TD -0.025 Tc 2.3328 Tw (primary diagnosis of heart disease, diabetes,) Tj 0.5139 -12.4458 TD -0.0342 Tc 0.5954 Tw (arthritis, or a cognitive or mental disorder but) Tj ET BT 0.8915 0 0 0.9835 91.92 255.12 Tm 0.0463 Tc 0.5761 Tw (are relatively healthy, have few impairments in) Tj ET BT 0.9835 0 0 0.9835 91.92 243.12 Tm 0.0268 Tc 1.3805 Tw (activities of daily living or sensory impair-) Tj -0.244 -11.9577 TD 0.0186 Tc 1.2506 Tw (ments, and require relatively little nursing) Tj ET BT 0.8915 0 0 0.9835 92.16 219.36 Tm 0.0758 Tc 0 Tw (care;) Tj ET BT 0.9812 0 0 0.9812 91.92 206.16 Tm /F5 11 Tf 0.0946 Tc 3.3891 Tw (oldest-old, deteriorating residents) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 255.36 206.16 Tm /F4 10 Tf 0.0427 Tc 2.2998 Tw (who are) Tj ET BT 0.934 0 0 0.9835 92.16 194.16 Tm -0.0216 Tc 1.3955 Tw (over age 85, have multiple medical problems,) Tj ET BT 0.9835 0 0 0.9835 92.16 182.16 Tm -0.0002 Tc 5.2718 Tw (including cancer,) Tj 92.2455 0 TD 0.0162 Tc 1.8387 Tw (heart disease, arthritis,) Tj ET BT 0.934 0 0 0.9835 92.64 169.68 Tm -0.033 Tc 3.0994 Tw (stroke, diabetes, and digestive, neurological,) Tj ET BT 0.8915 0 0 0.9835 92.64 157.44 Tm 0.0341 Tc 0.8591 Tw (and pulmonary problems, but no dementia, and) Tj -0.5384 -11.9577 TD 0.0676 Tc 0.3392 Tw (require more nursing care than any of the other) Tj ET BT 0.934 0 0 0.9835 92.64 133.44 Tm -0.044 Tc 1.3767 Tw (types except type 6;) Tj ET BT 0.9812 0 0 0.9812 92.64 120.24 Tm /F5 11 Tf 0.0951 Tc 3.0217 Tw (acute and rehabilitative residents) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 255.6 120.24 Tm /F4 10 Tf 0.0427 Tc 2.7879 Tw (who are) Tj ET BT 0.934 0 0 0.9835 92.88 108.48 Tm -0.0136 Tc 0.6835 Tw (acutely ill, usually have been admitted from a) Tj -0.257 -11.7137 TD -0.0313 Tc 2.3909 Tw (hospital for rehabilitation following hip frac-) Tj ET BT 0.8915 0 0 0.9835 92.88 84.72 Tm 0.0476 Tc 1.5169 Tw (ture, stroke, or another condition, generally do) Tj 0 -11.7137 TD 0.043 Tc 1.3875 Tw (not have dementia, and are usually discharged) Tj ET BT 0.934 0 0 0.9835 92.88 61.2 Tm -0.0106 Tc 0.3773 Tw (home after a short stay;) Tj ET BT 0.9812 0 0 0.9812 93.36 48.48 Tm /F5 11 Tf 0.0899 Tc 3.5162 Tw (behavioral problem residents) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 236.16 48.48 Tm /F4 10 Tf 0.02 Tc 4.2751 Tw (who usually) Tj -145.2012 -11.9577 TD 0.0274 Tc -0.0204 Tw (have a primarv diagnosis of a mental illness) Tj ET BT 0.934 0 0 0.9835 339.36 646.8 Tm -0.011 Tc 1.4956 Tw (and exhibit psychiatric and behavioral symp-) Tj ET BT 0.8915 0 0 0.9835 339.6 634.8 Tm 0.1813 Tc 0 Tw (toms;) Tj ET BT 0.9835 0 0 0.9835 325.92 621.12 Tm -0.0237 Tc -0.073 Tw (5. ) Tj ET BT 0.9812 0 0 0.9812 336.72 621.12 Tm /F5 11 Tf 0.0798 Tc -0.1424 Tw (dementia residents ) Tj ET BT 0.9835 0 0 0.9835 422.16 621.12 Tm /F4 10 Tf 0.0442 Tc -0.0811 Tw (who are relatively old and) Tj ET BT 0.934 0 0 0.9835 339.6 609.6 Tm -0.0157 Tc 1.295 Tw (usually have stroke, dementia, and/or psychi-) Tj ET BT 0.9835 0 0 0.9835 340.08 597.6 Tm 0.0081 Tc 1.3995 Tw (atric symptoms, as well as impairments in) Tj ET BT 0.934 0 0 0.9835 340.08 585.36 Tm -0.0225 Tc 1.3537 Tw (activities of daily living; and) Tj -14.9034 -13.422 TD 0.0673 Tc -0.0272 Tw (6. ) Tj ET BT 0.9443 0 0 0.9812 336.72 572.16 Tm /F5 11 Tf 0.004 Tc 1.9462 Tw (severely impaired residents) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 459.36 572.16 Tm /F4 10 Tf -0.0421 Tc 2.531 Tw (who are relatively) Tj -127.7069 -12.4458 TD -0.0157 Tc 1.6462 Tw (young, often terminally ill, and have medical) Tj ET BT 0.9835 0 0 0.9835 340.08 548.4 Tm 0.0162 Tc 0.7812 Tw (problems, such as stroke, renal failure, and) Tj 0 -12.2018 TD 0.0338 Tc 2.3088 Tw (respiratory and neurological diseases, and) Tj 0.9761 -12.4458 TD 0.0281 Tc -0.0037 Tw (severe impairments in activities of daily liv-) Tj -0.4881 -12.2018 TD 0.0229 Tc 0.1236 Tw (ing; they have the longest stays and usually) Tj ET BT 0.934 0 0 0.9835 340.56 500.4 Tm -0.023 Tc 1.2258 Tw (require nursing services, such as wound care,) Tj 0.7709 -12.4458 TD -0.0268 Tc 1.1528 Tw (sterile dressings, and turning and positioning) Tj 0 -11.9577 TD 0.0551 Tc 0 Tw (\(283\).) Tj ET BT 0.8915 0 0 0.9835 327.36 457.2 Tm 0.0407 Tc 1.2105 Tw (Table 2-4 presents data on the resident character-) Tj ET BT 0.9835 0 0 0.9835 316.56 445.44 Tm 0.0278 Tc 1.4608 Tw (istics associated with each of the six types. The) Tj ET BT 0.8915 0 0 0.9835 316.56 433.44 Tm 0.0401 Tc 1.2786 Tw (figures in table 2-4 represent the probability that an) Tj ET BT 0.9835 0 0 0.9835 316.8 421.68 Tm 0.0298 Tc 1.5198 Tw (individual who is exactly like that type has the) Tj ET BT 0.934 0 0 0.9835 316.8 409.68 Tm -0.0202 Tc 0.786 Tw (particular characteristic. Individuals with a diagno-) Tj ET BT 0.9835 0 0 0.9835 317.52 397.44 Tm 0.0394 Tc 0.6995 Tw (sis of Alzheimer\222s disease or senile dementia are) Tj ET BT 0.934 0 0 0.9835 317.28 385.68 Tm -0.0387 Tc 2.1419 Tw (included in four types\227) Tj ET BT 0.9835 0 0 0.9835 426.96 385.68 Tm 0.0205 Tc 0.5653 Tw (1,4, 5, and 6 \(283\). These) Tj -111.5243 -11.9577 TD 0.0348 Tc 0.4601 Tw (four types differ greatly in their other diagnoses,) Tj ET BT 0.8915 0 0 0.9835 317.04 361.92 Tm 0.0338 Tc 2.1604 Tw (physical impairments, and care needs.) Tj ET BT 0.9835 0 0 0.9835 328.32 343.2 Tm 0.0404 Tc 1.326 Tw (The GOM technique is intended to model the) Tj -10.9816 -12.4458 TD 0.0323 Tc 0.7648 Tw (complex clinical reality of disease and functional) Tj 0.7321 -12.4458 TD 0.0446 Tc 0.1712 Tw (status in elderly people \(283\). Although the typo-) Tj -0.4881 -11.9577 TD 0.0389 Tc 1.9376 Tw (logy just described is derived from data on the) Tj 0.244 -12.2018 TD 0.0188 Tc 1.0225 Tw (characteristics of residents of New York nursing) Tj ET BT 0.8915 0 0 0.9835 317.76 282.96 Tm 0.0489 Tc 1.3552 Tw (homes, experience in using the GOM technique with) Tj ET BT 0.934 0 0 0.9835 318 270.96 Tm -0.0294 Tc 0.8839 Tw (data on other nursing home residents indicates ) Tj ET BT 0.9261 0 0 0.9795 529.92 270.96 Tm /F7 12 Tf 0.0687 Tc 0 Tw (the) Tj ET BT 0.9835 0 0 0.9835 318.48 258.96 Tm /F4 10 Tf 0.0236 Tc 0.7024 Tw (same six types emerge \(282\). Thus, the six types) Tj -0.4881 -12.2018 TD 0.0352 Tc 3.6903 Tw (probably describe real types of nursing home) Tj ET BT 0.8915 0 0 0.9835 318 235.2 Tm 0.022 Tc 1.0393 Tw (residents, and the four types that include individuals) Tj ET BT 0.934 0 0 0.9835 318.48 223.2 Tm -0.0324 Tc 1.9297 Tw (with dementia probably represent more accurately) Tj ET BT 0.9835 0 0 0.9835 318.48 211.2 Tm 0.0357 Tc 1.9816 Tw (than the simpler typology described earlier the) Tj ET BT 0.934 0 0 0.9835 318.48 199.2 Tm -0.0221 Tc 0.8822 Tw (clinical reality of dementia in nursing homes.) Tj ET BT 0.9835 0 0 0.9835 329.52 179.76 Tm 0.0249 Tc 0.8537 Tw (The GOM typology is useful in thinking about) Tj ET BT 0.8915 0 0 0.9835 318.96 167.52 Tm 0.0324 Tc 1.7583 Tw (which individuals with dementia might be appropri-) Tj ET BT 0.934 0 0 0.9835 319.2 155.52 Tm -0.0311 Tc 1.4272 Tw (ately cared for in special care units vs. nonspecial-) Tj ET BT 0.9835 0 0 0.9835 319.2 143.52 Tm 0.0267 Tc 0.4858 Tw (ized units or other settings. For example, in type) Tj ET BT 0.9443 0 0 0.9812 319.2 131.28 Tm /F5 11 Tf 0.0006 Tc 1.3143 Tw (6--severely impaired residents,) Tj 0 Tc 0.0442 Tw ( ) Tj ET BT 0.934 0 0 0.9835 454.56 131.28 Tm /F4 10 Tf -0.0337 Tc 0.9161 Tw (there is a 20 percent) Tj ET BT 0.9835 0 0 0.9835 318.96 120 Tm 0.0342 Tc 1.2713 Tw (probability that an individual of this type has a) Tj ET BT 0.934 0 0 0.9835 318.96 108 Tm -0.0344 Tc 2.3087 Tw (primary diagnosis of Alzheimer\222s disease or senile) Tj ET BT 0.9835 0 0 0.9835 319.68 96 Tm 0.0419 Tc 0.8364 Tw (dementia and therefore might be an appropriate) Tj ET BT 0.8915 0 0 0.9835 319.68 84.24 Tm 0.0454 Tc 0.4277 Tw (candidate for placement in a special care unit. On the) Tj ET BT 0.934 0 0 0.9835 319.68 72.48 Tm -0.02 Tc 0.5159 Tw (other hand, all individuals of this type have impair-) Tj ET BT 0.9835 0 0 0.9835 319.68 60.96 Tm 0.0286 Tc 3.3309 Tw (ments in activities of daily living-100 percent) Tj ET BT 0.934 0 0 0.9835 319.68 49.44 Tm -0.0182 Tc 1.2463 Tw (require assistance in transferring, eating, dressing,) Tj 0.257 -12.2018 TD -0.0103 Tc 0.5331 Tw (bathing, toileting, and hygiene, and 100 percent are) Tj ET endstream endobj 204 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 205 0 obj <>stream 0.48 w 1 j 0 0 0 RG 66.96 679.92 m 545.76 679.92 l S 0.72 w 67.2 637.68 m 546 637.68 l S 220.32 619.44 m 546.24 619.44 l S 67.68 587.76 m 546.48 587.76 l S 71.28 35.52 m 549.6 35.52 l S BT 0.9835 0 0 0.9835 67.2 686.64 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (66 ) Tj ET BT 0.9598 0 0 0.9598 79.92 686.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 86.16 686.64 Tm /F5 10 Tf 0.0125 Tc 1.0922 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 126.48 646.56 Tm /F3 9 Tf 0.0447 Tc 0.1725 Tw (Table 2-4\227Characteristics of Six Types of Nursing Home Residents, New York State) Tj ET BT 0.8648 0 0 0.99 322.32 628.08 Tm /F3 8 Tf 0.0512 Tc 1.6023 Tw (Type of nursing home residents) Tj -112.1144 -17.9399 TD 0.0596 Tc 0 Tw (Limited) Tj 62.995 -0.2424 TD 0.0407 Tc (Oldest-old) Tj ET BT 0.9189 0 0 0.99 333.36 610.08 Tm 0.0155 Tc 0.3713 Tw (Acute and) Tj ET BT 0.8648 0 0 0.99 386.88 610.08 Tm 0.0173 Tc 0 Tw (Behavioral) Tj ET BT 0.9189 0 0 0.99 498 609.84 Tm 0.0004 Tc (Severely) Tj ET BT 0.8648 0 0 0.99 223.2 601.2 Tm 0.0299 Tc (impaired) Tj ET BT 0.99 0 0 0.99 275.52 601.2 Tm -0.0389 Tc 1.4514 Tw (deteriorating rehabilitative) Tj ET BT 0.8648 0 0 0.99 391.2 600.96 Tm 0.0511 Tc 0 Tw (problem) Tj ET BT 0.9189 0 0 0.99 442.8 600.96 Tm 0.0052 Tc (Dementia) Tj ET BT 0.8648 0 0 0.99 498 601.2 Tm 0.2727 Tc (impaired) Tj ET BT 0.9189 0 0 0.99 67.68 592.8 Tm 0.0274 Tc (Variable) Tj ET BT 0.8648 0 0 0.99 172.08 592.32 Tm 0.0382 Tc (Frequency) Tj 71.5978 -0.2424 TD 0.0719 Tc (\(1\)) Tj 69.1002 0 TD 0.0719 Tc (\(2\)) Tj 61.8849 -0.2424 TD 0.0719 Tc (\(3\)) Tj 62.1625 0.2424 TD 0.0719 Tc (\(4\)) Tj 62.44 -0.2424 TD 0.0719 Tc (\(5\)) Tj 62.1625 0 TD 0.0719 Tc (\(6\)) Tj ET BT 0.9189 0 0 0.99 68.4 578.88 Tm 0.0357 Tc 0.0882 Tw (1. Primary diagnosis) Tj ET BT 0.99 0 0 0.99 77.04 569.76 Tm -0.0405 Tc 0.017 Tw (Cancer. . . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 77.04 560.88 Tm 0.059 Tc 0.237 Tw (Heart disease. . . . . . . . .) Tj 0.2612 -9.4548 TD 0.087 Tc 0.0324 Tw (Stroke. . . . . . . . . . . . . . .) Tj 0.2612 -8.97 TD 0.0831 Tc 0.1019 Tw (Diabetes. . . . . . . . . . . . .) Tj -0.5224 -9.2124 TD 0.0876 Tc 0.0317 Tw (Arthritis. . . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 77.76 524.64 Tm -0.0443 Tc 0.1639 Tw (Renal problems.. . . . . .) Tj ET BT 0.8648 0 0 0.99 77.76 515.76 Tm 0.0258 Tc 0.8546 Tw (Digestive problems. . . . .) Tj ET BT 0.9189 0 0 0.99 77.76 506.64 Tm 0.0712 Tc 0.0495 Tw (Hip fracture. . . . . . . . . . .) Tj 0 -8.97 TD 0.0547 Tc 0.0676 Tw (Liver and gall bladder) Tj 9.4027 -8.97 TD 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj -9.6639 -8.97 TD 0.0285 Tc 0.6184 Tw (Alzheimer\222s disease and) Tj 9.6639 -9.2124 TD 0.0573 Tc 0.587 Tw (senile dementia. . . . .) Tj ET BT 0.8648 0 0 0.99 77.76 462 Tm 0.0284 Tc 4.1262 Tw (Other neurological) Tj ET BT 0.9189 0 0 0.99 86.64 453.12 Tm 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 77.76 444.24 Tm 0.0236 Tc 3.5768 Tw (Chronic respiratory) Tj ET BT 0.9189 0 0 0.99 86.64 435.36 Tm 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj -9.6639 -9.2124 TD 0.0219 Tc 0.6256 Tw (Other respiratory) Tj 9.925 -8.7275 TD 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj -9.1415 -9.2124 TD 0.0526 Tc 0.5399 Tw (Infectious disease. . . . .) Tj -0.2612 -8.97 TD 0.0368 Tc 0.087 Tw (Other endocrine) Tj 9.6639 -9.4548 TD 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj -9.4027 -8.7275 TD 0.0672 Tc 0.2106 Tw (Metabolic disorder. . . . .) Tj 0 -8.7275 TD 0.0821 Tc 0.1356 Tw (Blood disorder. . . . . . . .) Tj 0.2612 -9.4548 TD 0.0732 Tc 0.4205 Tw (Mental disorder. . . . . . .) Tj ET BT 0.8648 0 0 0.99 78.24 354.96 Tm 0.0126 Tc 0.8143 Tw (Atherosclerosis. . . . . . . .) Tj 0.2775 -9.4548 TD 0.013 Tc 3.8665 Tw (Other circulatory) Tj ET BT 0.9189 0 0 0.99 87.6 336.72 Tm 0.0895 Tc 0.0297 Tw (problems. . . . . . . . . . .) Tj -9.925 -8.97 TD 0.1008 Tc 0.0347 Tw (Other. . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 69.6 313.2 Tm 0.0484 Tc 4.3805 Tw (Associated conditions) Tj ET BT 0.9189 0 0 0.99 184.8 569.52 Tm 0.0264 Tc 0 Tw (1.43) Tj -4.9625 -9.4548 TD 0.0197 Tc (17.79) Tj 0.5224 -8.97 TD 0.0197 Tc (10.78) Tj ET BT 0.99 0 0 0.99 184.32 542.16 Tm -0.0744 Tc (4.05) Tj ET BT 0.9189 0 0 0.99 184.56 533.04 Tm 0.0264 Tc (5.94) Tj ET BT 0.99 0 0 0.99 184.56 524.16 Tm -0.0744 Tc (0.64) Tj ET BT 0.9189 0 0 0.99 184.8 515.52 Tm 0.0264 Tc (0.70) Tj 0.5224 -9.2124 TD 0.0264 Tc (1.92) Tj -0.2612 -18.1824 TD 0.0264 Tc (0.12) Tj -4.4402 -17.9399 TD 0.0197 Tc (15.29) Tj 0.2612 -17.9399 TD 0.0197 Tc (10.30) Tj 4.9625 -17.9399 TD 0.0264 Tc (1.64) Tj ET BT 0.8648 0 0 0.99 185.28 416.88 Tm -0.0063 Tc (0.61) Tj ET BT 0.99 0 0 0.99 185.28 408 Tm -0.0744 Tc (0.34) Tj 0.2424 -18.1824 TD -0.0744 Tc (0.18) Tj ET BT 0.9189 0 0 0.99 185.76 381.12 Tm 0.0264 Tc (0.34) Tj ET BT 0.99 0 0 0.99 185.52 372.24 Tm -0.0744 Tc (0.49) Tj ET BT 0.9189 0 0 0.99 181.92 363.36 Tm 0.0197 Tc (18.40) Tj 4.179 -8.97 TD 0.0264 Tc (2.56) Tj 0.7836 -18.1824 TD 0.0264 Tc (1.22) Tj ET BT 0.99 0 0 0.99 186 327.6 Tm -0.0744 Tc (5.27) Tj ET BT 0.9189 0 0 0.99 186.24 303.84 Tm 0.0264 Tc (3.33) Tj ET BT 0.99 0 0 0.99 181.68 294.48 Tm -0.0765 Tc (50.60) Tj ET BT 0.9189 0 0 0.99 182.16 285.84 Tm 0.0197 Tc (16.37) Tj 0 -9.2124 TD 0.0197 Tc (12.26) Tj ET BT 0.99 0 0 0.99 181.92 267.84 Tm -0.0765 Tc (22.03) Tj ET BT 0.9189 0 0 0.99 186.48 258.48 Tm 0.0264 Tc (6.39) Tj ET BT 0.99 0 0 0.99 186.48 249.84 Tm -0.0744 Tc (7.56) Tj ET BT 0.8648 0 0 0.99 186.48 240.72 Tm -0.0063 Tc (4.61) Tj ET BT 0.9189 0 0 0.99 186.96 222.48 Tm 0.0264 Tc (1.02) Tj ET BT 0.99 0 0 0.99 186.48 204.48 Tm -0.0744 Tc (8.17) Tj ET BT 0.9189 0 0 0.99 182.88 186.48 Tm 0.0197 Tc (16.49) Tj 4.179 -18.6672 TD 0.0264 Tc (5.16) Tj 0.7836 -17.9399 TD 0.0264 Tc (1.93) Tj ET BT 0.99 0 0 0.99 186.96 141.12 Tm -0.0744 Tc (6.39) Tj ET BT 0.9189 0 0 0.99 182.64 132.24 Tm 0.0197 Tc (75.72) Tj 4.9625 -17.9399 TD 0.0264 Tc (2.66) Tj ET BT 0.8648 0 0 0.99 187.2 105.36 Tm -0.0063 Tc (2.31) Tj ET BT 0.99 0 0 0.99 187.2 96.24 Tm -0.0744 Tc (6.24) Tj ET BT 0.9189 0 0 0.99 183.36 87.36 Tm 0.0197 Tc (17.54) Tj 0 -9.2124 TD 0.0197 Tc (12.28) Tj 4.179 -8.7275 TD 0.0264 Tc (2.83) Tj 0.2612 -9.2124 TD 0.0264 Tc (5.46) Tj ET BT 0.99 0 0 0.99 187.44 42.48 Tm -0.0744 Tc (5.25) Tj 44.8499 531.895 TD -0.0744 Tc (0.66) Tj -4.3638 -8.97 TD -0.0765 Tc (35.56) Tj 4.6062 -9.4548 TD -0.0744 Tc (0.00) Tj 0.2424 -8.7275 TD -0.0744 Tc (7.77) Tj -0.2424 -9.4548 TD -0.0744 Tc (8.56) Tj 0.4849 -8.7275 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 292.32 569.28 Tm 0.0264 Tc (1.79) Tj ET BT 0.99 0 0 0.99 287.28 559.92 Tm -0.0765 Tc (62.83) Tj ET BT 0.9189 0 0 0.99 291.84 550.8 Tm 0.0264 Tc (0.00) Tj 0.2612 -8.97 TD 0.0264 Tc (8.57) Tj -4.4402 -8.97 TD 0.0197 Tc (14.39) Tj ET BT 0.99 0 0 0.99 292.08 523.92 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 292.8 515.04 Tm 0.0264 Tc (1.52) Tj -0.5224 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 345.36 569.04 Tm -0.0063 Tc (3.01) Tj ET BT 0.9189 0 0 0.99 345.6 559.92 Tm 0.0264 Tc (9.48) Tj -4.179 -8.97 TD 0.0197 Tc (18.56) Tj ET BT 0.8648 0 0 0.99 346.32 541.92 Tm 0.2018 Tc (1.10) Tj ET BT 0.9189 0 0 0.99 341.76 532.8 Tm 0.0197 Tc (11.10) Tj 4.9625 -8.7275 TD 0.0264 Tc (1.74) Tj ET BT 0.99 0 0 0.99 345.84 515.04 Tm -0.0744 Tc (2.27) Tj ET BT 0.9189 0 0 0.99 345.84 505.92 Tm 0.0264 Tc (9.52) Tj 0.2612 -18.1824 TD 0.0264 Tc (0.00) Tj 0 -17.9399 TD 0.0264 Tc (0.00) Tj -4.4402 -17.6975 TD 0.0197 Tc (24.64) Tj ET BT 0.99 0 0 0.99 346.32 434.64 Tm -0.0744 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 346.32 416.4 Tm -0.0063 Tc (0.81) Tj ET BT 0.9189 0 0 0.99 346.32 407.52 Tm 0.0264 Tc (0.00) Tj 0.5224 -18.1824 TD 0.0264 Tc (0.00) Tj 0 -8.7275 TD 0.0264 Tc (0.00) Tj 0.2612 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj T* 0.0264 Tc (0.00) Tj 0 -18.4248 TD 0.0264 Tc (6.05) Tj -4.179 -8.7275 TD 0.0197 Tc (11.72) Tj 4.4402 -24.0007 TD 0.0264 Tc (2.36) Tj ET BT 0.99 0 0 0.99 342.72 294.48 Tm -0.0765 Tc (49.95) Tj ET BT 0.9189 0 0 0.99 343.44 285.36 Tm 0.0197 Tc (17.67) Tj 0 -8.97 TD 0.0197 Tc (17.43) Tj 0 -9.2124 TD 0.0197 Tc (12.28) Tj 4.4402 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -9.4548 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (6.28) Tj 0 -18.1824 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 347.76 204 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 347.76 186 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 347.76 167.76 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 348.48 150 Tm 0.0264 Tc (1.38) Tj ET BT 0.99 0 0 0.99 348 141.12 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 339.6 132.48 Tm 0.0153 Tc (100.00) Tj 9.4027 -18.1824 TD 0.0264 Tc (2.20) Tj ET BT 0.8648 0 0 0.99 348.24 105.6 Tm -0.0063 Tc (2.11) Tj ET BT 0.9189 0 0 0.99 348.48 96.48 Tm 0.0264 Tc (0.00) Tj 0 -8.7275 TD 0.0264 Tc (0.00) Tj 0 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 348.48 69.84 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj 0 -18.1824 TD -0.0744 Tc (8.49) Tj ET BT 0.9189 0 0 0.99 399.6 569.28 Tm 0.0264 Tc (1.39) Tj -0.5224 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 399.36 550.8 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (9.47) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 399.6 523.92 Tm 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -17.9399 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 395.28 470.16 Tm -0.0765 Tc (22.68) Tj ET BT 0.9189 0 0 0.99 400.08 452.4 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 400.08 434.4 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 400.32 416.4 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 400.32 407.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 401.04 389.52 Tm 0.0264 Tc (1.46) Tj ET BT 0.99 0 0 0.99 400.32 380.64 Tm -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj -4.3638 -8.97 TD -0.0765 Tc (44.54) Tj 0 -9.2124 TD -0.0765 Tc (20.46) Tj 4.6062 -17.9399 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 52.6077 244.3711 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 453.12 559.68 Tm 0.0264 Tc (0.00) Tj -4.179 -8.97 TD 0.0197 Tc (19.46) Tj 4.4402 -9.4548 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 453.6 523.44 Tm -0.0744 Tc (0.06) Tj 0 -8.7275 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0 -18.1824 TD -0.0744 Tc (0.34) Tj -4.3638 -17.6975 TD -0.0765 Tc (42.50) Tj 4.6062 -18.1824 TD -0.0744 Tc (0.00) Tj 0 -18.1824 TD -0.0744 Tc (0.00) Tj 0.2424 -18.1824 TD -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.70) Tj ET BT 0.9189 0 0 0.99 454.32 389.28 Tm 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 454.56 371.52 Tm -0.0744 Tc (0.00) Tj -4.6062 -8.97 TD -0.0765 Tc (36.94) Tj 4.6062 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 454.8 335.52 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 454.8 326.88 Tm -0.0744 Tc (0.00) Tj 0.2424 -24.0007 TD -0.0744 Tc (0.00) Tj -4.6062 -9.2124 TD -0.0765 Tc (62.03) Tj ET BT 0.9189 0 0 0.99 450.96 285.12 Tm 0.0197 Tc (13.43) Tj ET BT 0.99 0 0 0.99 455.04 276.24 Tm -0.0744 Tc (5.20) Tj ET BT 0.8648 0 0 0.99 451.2 267.12 Tm -0.0065 Tc (19.11) Tj ET BT 0.99 0 0 0.99 455.04 258.24 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 455.28 249.12 Tm 0.0264 Tc (0,00) Tj ET BT 0.8648 0 0 0.99 455.52 240.24 Tm -0.0063 Tc (7.21) Tj ET BT 0.9189 0 0 0.99 455.28 222 Tm 0.0264 Tc (0,00) Tj 0.2612 -18.4248 TD 0.0264 Tc (0.00) Tj 0.2612 -17.9399 TD 0.0264 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 455.76 167.76 Tm -0.0063 Tc (2,61) Tj ET BT 0.9189 0 0 0.99 455.76 150 Tm 0.0264 Tc (3,33) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj -8.6191 -8.7275 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 455.76 114.72 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 456.24 87.84 Tm 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0.2612 -8.7275 TD 0.0264 Tc (7.83) Tj 0 -18.1824 TD 0.0264 Tc (0.00) Tj 55.6325 531.1677 TD 0.0264 Tc (1.32) Tj -0.7836 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 502.56 550.8 Tm -0.0765 Tc (20.72) Tj ET BT 0.9189 0 0 0.99 507.12 541.44 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 507.12 532.56 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 508.08 523.68 Tm 0.0264 Tc (1.44) Tj -0.5224 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -18.1824 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 503.28 470.16 Tm -0.0765 Tc (20.07) Tj 0 -18.1824 TD -0.0765 Tc (27.32) Tj 4.6062 -18.1824 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 508.56 416.16 Tm 0.0264 Tc (1.17) Tj ET BT 0.99 0 0 0.99 508.08 407.04 Tm -0.0744 Tc (0.00) Tj 0.2424 -17.9399 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 509.04 380.64 Tm 0.0264 Tc (1.55) Tj ET BT 0.99 0 0 0.99 508.32 371.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 504.72 362.88 Tm 0.0197 Tc (17.83) Tj ET BT 0.99 0 0 0.99 508.32 353.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 508.8 335.76 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 508.56 326.88 Tm -0.0744 Tc (8.59) Tj 0.2424 -24.0007 TD -0.0744 Tc (0.00) Tj -4.3638 -8.97 TD -0.0765 Tc (21.23) Tj 0 -8.97 TD -0.0765 Tc (22.95) Tj ET BT 0.9189 0 0 0.99 509.04 276.24 Tm 0.0264 Tc (7.46) Tj ET BT 0.99 0 0 0.99 509.04 267.12 Tm -0.0744 Tc (0.00) Tj -4.3638 -8.97 TD -0.0765 Tc (29.95) Tj ET BT 0.9189 0 0 0.99 509.28 249.12 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 509.04 240.24 Tm -0.0744 Tc (6.73) Tj 0 -18.4248 TD -0.0744 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 505.44 204.24 Tm -0.0065 Tc (10.01) Tj ET BT 0.99 0 0 0.99 509.52 186 Tm -0.0744 Tc (0.00) Tj 0 -18.4248 TD -0.0744 Tc (0.00) Tj 0.2424 -17.9399 TD -0.0744 Tc (3.10) Tj -4.3638 -8.7275 TD -0.0765 Tc (29.95) Tj ET BT 0.9189 0 0 0.99 501.12 132.48 Tm 0.0153 Tc (100.00) Tj 9.4027 -17.9399 TD 0.0264 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 509.76 105.84 Tm -0.0063 Tc (0.71) Tj ET BT 0.99 0 0 0.99 510 96.96 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj T* -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 510.48 61.2 Tm 0.0264 Tc (3.82) Tj ET BT 0.99 0 0 0.99 510.24 43.44 Tm -0.0744 Tc (0.00) Tj -280.4934 449.2258 TD -0.0744 Tc (0.42) Tj ET BT 0.9189 0 0 0.99 292.32 488.16 Tm 0.0264 Tc (0.00) Tj -69.2141 -17.9399 TD 0.0197 Tc (12.07) Tj 69.2141 -0.2424 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 232.8 452.64 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 292.56 452.4 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 232.8 434.88 Tm -0.0744 Tc (6.79) Tj ET BT 0.9189 0 0 0.99 292.8 434.64 Tm 0.0264 Tc (3.30) Tj ET BT 0.99 0 0 0.99 233.04 416.88 Tm -0.0744 Tc (0.00) Tj 0 -9.4548 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 293.28 416.64 Tm 0.0264 Tc (1.37) Tj 0 -9.2124 TD 0.0264 Tc (1.43) Tj ET BT 0.99 0 0 0.99 233.28 389.76 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.20) Tj T* -0.0744 Tc (0.00) Tj -4.3638 -8.97 TD -0.0765 Tc (22.20) Tj 4.6062 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 293.04 389.52 Tm 0.0264 Tc (0.00) Tj 0 -8.7275 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (3.05) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 233.52 336.24 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 233.76 327.36 Tm 0.0264 Tc (5.78) Tj 64.774 8.7275 TD 0.0264 Tc (0.00) Tj 0.5224 -8.7275 TD 0.0264 Tc (1.75) Tj ET BT 0.8648 0 0 0.99 74.4 304.32 Tm -0.0054 Tc (2.) Tj -0.2775 -9.2124 TD -0.0054 Tc (3.) Tj 0 -8.97 TD -0.0054 Tc (4.) Tj 0.555 -9.2124 TD -0.0054 Tc (5.) Tj -0.2775 -9.2124 TD -0.0054 Tc (6.) Tj 0.2775 -8.97 TD -0.0054 Tc (7.) Tj -0.2775 -9.2124 TD 0.1333 Tc (8.) Tj 0.2775 -9.2124 TD -0.0054 Tc (9.) Tj -4.7177 -8.97 TD -0.006 Tc (10.) Tj 0.2775 -18.4248 TD -0.006 Tc (11.) Tj 0 -18.1824 TD -0.006 Tc (12.) Tj 0.2775 -18.1824 TD -0.006 Tc (13.) Tj ET BT 0.8108 0 0 0.99 71.04 159.6 Tm 0.0432 Tc (14,) Tj 0.296 -18.1824 TD 0.0432 Tc (15,) Tj 0 -9.2124 TD 0.0432 Tc (16,) Tj 0 -8.97 TD 0.0432 Tc (17,) Tj 0 -18.1824 TD 0.0432 Tc (18,) Tj ET BT 0.8648 0 0 0.99 71.28 96.48 Tm 0.179 Tc (19.) Tj ET BT 0.9189 0 0 0.99 71.04 87.36 Tm 0.0376 Tc (20.) Tj ET BT 0.8648 0 0 0.99 71.28 78.48 Tm 0.179 Tc (21.) Tj 0 -9.2124 TD 0.179 Tc (22.) Tj ET BT 0.9189 0 0 0.99 71.28 60.48 Tm 0.0376 Tc (23.) Tj 0 -8.97 TD 0.0376 Tc (24.) Tj ET BT 0.99 0 0 0.99 233.76 303.6 Tm -0.0744 Tc (4.37) Tj -4.3638 -9.2124 TD -0.0765 Tc (47.13) Tj 4.3638 -9.2124 TD -0.0744 Tc (6.07) Tj ET BT 0.9189 0 0 0.99 234 276.48 Tm 0.0264 Tc (5.96) Tj -4.179 -8.97 TD 0.0197 Tc (19.36) Tj ET BT 0.99 0 0 0.99 234 258.48 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (4.55) Tj ET BT 0.9189 0 0 0.99 234.24 240.48 Tm 0.0264 Tc (2.54) Tj 60.3338 63.7595 TD 0.0197 Tc (14.32) Tj -4.9625 -9.2124 TD 0.0153 Tc (100.00) Tj 4.4402 -8.97 TD 0.0197 Tc (28.96) Tj ET BT 0.99 0 0 0.99 289.2 276.48 Tm -0.0765 Tc (25.80) Tj ET BT 0.9189 0 0 0.99 285.36 267.6 Tm 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj -4.7013 -9.4548 TD 0.0197 Tc (55.16) Tj 4.7013 -8.97 TD 0.0264 Tc (0.00) Tj 116.7498 63.7595 TD 0.0264 Tc (4.93) Tj ET BT 0.99 0 0 0.99 396.72 294 Tm -0.0765 Tc (32.83) Tj ET BT 0.9189 0 0 0.99 396.96 285.12 Tm 0.0197 Tc (13.49) Tj ET BT 0.8648 0 0 0.99 396.72 276.24 Tm -0.0065 Tc (27.91) Tj ET BT 0.99 0 0 0.99 401.04 267.36 Tm -0.0744 Tc (4.25) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 401.52 249.12 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 401.28 240.24 Tm -0.0744 Tc (0.00) Tj 0 -18.4248 TD -0.0744 Tc (0.00) Tj -4.3638 -18.4248 TD -0.0765 Tc (61.62) Tj 4.8486 -17.9399 TD -0.0744 Tc (0.00) Tj 0 -18.4248 TD -0.0744 Tc (6.82) Tj 0 -17.9399 TD -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 393.36 132.24 Tm 0.0153 Tc (100.00) Tj 9.4027 -17.9399 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (6.36) Tj ET BT 0.99 0 0 0.99 402.24 96.72 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 393.84 87.84 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 402.24 78.72 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj 0.2424 -8.7275 TD -0.0744 Tc (0.00) Tj 0 -18.1824 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 85.68 304.08 Tm 0.0894 Tc 0.0732 Tw (Cancer. . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 85.68 295.2 Tm -0.047 Tc 0.005 Tw (Heart disease. . . . . . .) Tj ET BT 0.9189 0 0 0.99 85.68 286.08 Tm 0.085 Tc 0.0346 Tw (Stroke. . . . . . . . . . . . . .) Tj 0.2612 -8.97 TD 0.0809 Tc 0.039 Tw (Diabetes. . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 85.44 268.08 Tm 0.0093 Tc 0.3326 Tw (Arthritis. . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 86.16 259.2 Tm 0.0644 Tc 0.0569 Tw (Renal problems. . . . . .) Tj 0 -9.2124 TD 0.0452 Tc 0.0778 Tw (Digestive problems. . .) Tj T* 0.0657 Tc 0.1427 Tw (Hip fracture. . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.16 231.84 Tm 0.0277 Tc 1.3519 Tw (Liver and gall) Tj ET BT 0.9189 0 0 0.99 92.4 222.72 Tm 0.0576 Tc 0.5214 Tw (bladder disease. . . .) Tj -7.052 -8.97 TD 0.0253 Tc 0.3607 Tw (Alzheimer\222s disease) Tj 7.052 -9.2124 TD 0.0403 Tc 0.0832 Tw (and senile dementia.) Tj ET BT 0.8648 0 0 0.99 85.92 195.6 Tm 0.0284 Tc 4.1262 Tw (Other neurological) Tj ET BT 0.9189 0 0 0.99 92.88 186.72 Tm 0.0874 Tc 0.0319 Tw (problems. . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.4 177.36 Tm 0.0236 Tc 3.5768 Tw (Chronic respiratory) Tj ET BT 0.99 0 0 0.99 92.88 168.48 Tm -0.0445 Tc 0.0025 Tw (problems... . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.4 159.12 Tm 0.0096 Tc 4.703 Tw (Other respiratory) Tj ET BT 0.99 0 0 0.99 92.88 150.48 Tm -0.0445 Tc 0.0025 Tw (problems... . . . . . . .) Tj ET BT 0.9189 0 0 0.99 86.64 141.12 Tm 0.0572 Tc 0.4566 Tw (Urological problems. .) Tj 0.2612 -8.7275 TD 0.0491 Tc 0.0736 Tw (Infectious disease. . . .) Tj -0.5224 -9.4548 TD 0.0368 Tc 0.087 Tw (Other endocrine) Tj 7.3132 -8.7275 TD 0.0874 Tc 0.0319 Tw (problems. . . . . . . . . .) Tj -6.7908 -9.2124 TD 0.0613 Tc 0.8439 Tw (Metabolic disorder. . .) Tj ET BT 0.8648 0 0 0.99 86.88 96.48 Tm 0.0267 Tc 0.6791 Tw (Blood disorder. . . . . . .) Tj ET BT 0.9189 0 0 0.99 87.12 87.36 Tm 0.0706 Tc 0.0503 Tw (Mental disorder. . . . . .) Tj ET BT 0.99 0 0 0.99 87.12 78.24 Tm -0.0471 Tc 0.2879 Tw (Eye problems.. . . . . .) Tj ET BT 0.9189 0 0 0.99 87.12 69.36 Tm 0.0644 Tc 0.057 Tw (Ear problems. . . . . . . .) Tj 0 -8.97 TD 0.0555 Tc 0.0667 Tw (Atherosclerosis. . . . . .) Tj ET BT 0.8648 0 0 0.99 86.88 51.12 Tm 0.013 Tc 3.8665 Tw (Other circulatory) Tj ET BT 0.9189 0 0 0.99 234.72 222.48 Tm 0.0264 Tc 0 Tw (1.34) Tj 64.5128 -0.2424 TD 0.0264 Tc (7.00) Tj ET BT 0.99 0 0 0.99 234.24 204.24 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 294 204 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 234.48 186.24 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 285.84 186.24 Tm 0.0153 Tc (100.00) Tj -55.6325 -18.4248 TD 0.0264 Tc (7.59) Tj 60.0726 0 TD 0.0197 Tc (23.40) Tj -59.5502 -18.1824 TD 0.0264 Tc (1.57) Tj ET BT 0.99 0 0 0.99 234.72 141.12 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 226.32 132.48 Tm 0.0153 Tc (100.00) Tj 74.1766 17.4551 TD 0.0264 Tc (0.00) Tj 0 -8.7275 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 234.72 114.48 Tm -0.0744 Tc (2.63) Tj 0 -9.4548 TD -0.0744 Tc (3.42) Tj 0 -8.7275 TD -0.0744 Tc (0.00) Tj 0.2424 -9.2124 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 290.4 114.48 Tm 0.0197 Tc (15.70) Tj 4.4402 -9.2124 TD 0.0264 Tc (5.00) Tj ET BT 0.99 0 0 0.99 290.16 96.48 Tm -0.0765 Tc (51.34) Tj ET BT 0.9189 0 0 0.99 294.72 87.6 Tm 0.0264 Tc (0.00) Tj -9.1415 -9.2124 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 290.16 69.6 Tm -0.0765 Tc (31.94) Tj ET BT 0.9189 0 0 0.99 290.64 60.96 Tm 0.0197 Tc (27.35) Tj -59.8114 -18.4248 TD 0.0264 Tc (1.55) Tj ET BT 0.99 0 0 0.99 290.4 42.96 Tm -0.0765 Tc (29.66) Tj ET BT 0.9189 0 0 0.99 93.6 42.48 Tm 0.0874 Tc 0.0319 Tw (problems. . . . . . . . . .) Tj ET endstream endobj 206 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 207 0 obj <>stream 0.48 w 1 j 0 0 0 RG 63.36 679.44 m 542.16 679.44 l S 0.72 w 63.84 636.96 m 542.4 636.96 l S 216.96 618.96 m 542.88 618.96 l S 64.08 587.52 m 543.12 587.52 l S 68.4 32.64 m 547.2 32.64 l S BT 0.9835 0 0 0.9835 179.04 684.72 Tm 0 0 0 rg /F5 10 Tf 0.0214 Tc 1.4546 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems . 67) Tj ET BT 0.9863 0 0 0.9863 95.76 646.08 Tm /F3 9 Tf 0.0429 Tc 0.5062 Tw (Table 2-4\227Characteristics of Six Types of Nursing Home Residents, New York State--Continued) Tj ET BT 0.8648 0 0 0.99 318.96 627.6 Tm /F3 8 Tf 0.0512 Tc 1.6717 Tw (Type of nursing home residents) Tj -112.1144 -17.9399 TD 0.0596 Tc 0 Tw (Limited) Tj 62.995 0 TD 0.0407 Tc (Oldest-old) Tj ET BT 0.9189 0 0 0.99 330.24 609.84 Tm 0.0155 Tc 0.3713 Tw (Acute and) Tj ET BT 0.8648 0 0 0.99 383.52 609.84 Tm 0.0173 Tc 0 Tw (Behavioral) Tj ET BT 0.9189 0 0 0.99 494.64 609.6 Tm 0.0004 Tc (Severely) Tj ET BT 0.8648 0 0 0.99 219.84 600.96 Tm 0.0299 Tc (impaired) Tj ET BT 0.99 0 0 0.99 272.16 600.96 Tm -0.0389 Tc 1.4514 Tw (deteriorating rehabilitative) Tj ET BT 0.8648 0 0 0.99 388.08 600.96 Tm 0.0511 Tc 0 Tw (problem) Tj ET BT 0.9189 0 0 0.99 439.44 601.2 Tm 0.0052 Tc (Dementia) Tj ET BT 0.8648 0 0 0.99 494.64 600.96 Tm 0.2727 Tc (impaired) Tj ET BT 0.9189 0 0 0.99 64.56 592.32 Tm 0.0274 Tc (Variable) Tj ET BT 0.8648 0 0 0.99 168.96 592.32 Tm 0.0382 Tc (Frequency) Tj 71.3203 -0.2424 TD 0.0719 Tc (\(1\)) Tj 69.1002 0 TD 0.0719 Tc (\(2\)) Tj 62.1625 -0.2424 TD 0.0719 Tc (\(3\)) Tj 62.1625 0 TD 0.0719 Tc (\(4\)) Tj 62.44 0 TD 0.0719 Tc (\(5\)) Tj 62.1625 0 TD 0.0719 Tc (\(6\)) Tj ET BT 0.99 0 0 0.99 64.8 578.4 Tm -0.0481 Tc 0.0364 Tw (25. Skin problems. . . . . . .) Tj 0 -9.2124 TD -0.0458 Tc 0.125 Tw (26. Fractured extremities.) Tj 0 -8.97 TD -0.0482 Tc 0.2728 Tw (27. Comatose. . . . . . . . . .) Tj T* -0.0494 Tc 0.2768 Tw (28. Terminally ill. . . . . . . .) Tj 0.2424 -8.97 TD -0.0498 Tc 0.0987 Tw (29. Alcohol abuse. . . . . . .) Tj 0 -8.97 TD -0.0443 Tc 0.2447 Tw (30. Drug abuse. . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 65.52 518.88 Tm 0.0392 Tc 0 Tw (Limitations) Tj ET BT 0.99 0 0 0.99 65.28 509.76 Tm -0.0464 Tc 0.0044 Tw (31. Vision:) Tj ET BT 0.8648 0 0 0.99 83.28 500.88 Tm 0.0802 Tc -0.0963 Tw (No ) Tj ET BT 0.9018 0 0 0.9835 95.04 500.88 Tm /F6 10 Tf -0.0714 Tc 0.1181 Tw (loss. . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 83.52 492 Tm /F3 8 Tf -0.0512 Tc 0.1708 Tw (Moderate loss. . . . . .) Tj -0.2424 -9.2124 TD -0.0498 Tc 0.22 Tw (Severe loss. . . . . . . .) Tj -17.9399 -15.0308 TD -0.0384 Tc 1.2085 Tw (32. Hearing:) Tj ET BT 0.8648 0 0 0.99 81.36 459.36 Tm 0.0802 Tc -0.0963 Tw (No ) Tj ET BT 0.8567 0 0 0.9835 92.64 459.36 Tm /F6 10 Tf 0.0218 Tc -0.0059 Tw (loss. . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 81.36 450.48 Tm /F3 8 Tf 0.0687 Tc 0.3134 Tw (Moderate loss. . . . . . .) Tj 0 -9.4548 TD 0.0639 Tc 0.2316 Tw (Severe loss. . . . . . . . .) Tj -16.7159 -15.2732 TD 0.0251 Tc 1.5363 Tw (33. Verbal expression:) Tj 17.2382 -8.7275 TD 0.0739 Tc 0.0466 Tw (No difficulty. . . . . . . . .) Tj -0.5224 -8.97 TD 0.0706 Tc 0.0502 Tw (With difficulty. . . . . . . .) Tj 0 -8.97 TD 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj ET BT 0.99 0 0 0.99 66.24 384.24 Tm -0.045 Tc 0.4878 Tw (34. Reception:) Tj ET BT 0.8648 0 0 0.99 82.08 375.6 Tm 0.0311 Tc 0.4045 Tw (No difficulty . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 81.84 366.72 Tm 0.0706 Tc 0.0502 Tw (With difficulty. . . . . . . .) Tj 0 -9.2124 TD 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj ET BT 0.99 0 0 0.99 66.72 342.48 Tm -0.0368 Tc 1.2068 Tw (35. Diet:) Tj 16.2429 -8.97 TD -0.038 Tc 0.04 Tw (Regular. . . . . . . . . . . .) Tj -0.4849 -9.2124 TD -0.0316 Tc 0.0454 Tw (Other. . . . . . . . . . . . . .) Tj -15.5156 -15.5156 TD -0.0418 Tc 0.7271 Tw (36. Decubiti:) Tj ET BT 0.9189 0 0 0.99 82.8 300.24 Tm 0.1063 Tc 0.0113 Tw (None. . . . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 82.8 291.12 Tm -0.0424 Tc 0.1216 Tw (Single. . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 82.8 282.24 Tm 0.1073 Tc 0.0103 Tw (Multiple. . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 67.2 267.36 Tm -0.0422 Tc 0.0304 Tw (37. Discoloration. . . . . . . .) Tj 0 -9.2124 TD -0.0505 Tc 0.1391 Tw (38. Edema. . . . . . . . . . . . .) Tj 0.2424 -9.2124 TD -0.0496 Tc 0.1531 Tw (39. Weight loss. . . . . . . . .) Tj 0 -8.97 TD -0.0503 Tc 0.1538 Tw (40. Severe pain. . . . . . . . .) Tj T* -0.0387 Tc 0.2087 Tw (41. Contractures. . . . . . . .) Tj T* -0.0501 Tc 0.0081 Tw (42. Dyspnea. . . . . . . . . . . .) Tj 0.2424 -15.2732 TD -0.0517 Tc 0.737 Tw (43. Mobility:) Tj ET BT 0.9189 0 0 0.99 83.52 198.48 Tm 0.0621 Tc 0.0595 Tw (No impairment. . . . . . .) Tj -0.2612 -9.4548 TD 0.097 Tc 0.0927 Tw (With help. . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 83.28 180.24 Tm -0.0462 Tc 0.2466 Tw (Wheelchairfast. . . . . .) Tj 0.2424 -9.2124 TD -0.036 Tc 0.0181 Tw (Chairfast. . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 83.76 162.48 Tm 0.0787 Tc 0.0414 Tw (Bedfast. . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 68.16 147.36 Tm -0.0388 Tc 0.4815 Tw (44. Transfer:) Tj ET BT 0.9189 0 0 0.99 86.16 138.72 Tm 0.0585 Tc 0.3246 Tw (No impairment. . . . . .) Tj -0.5224 -9.2124 TD 0.097 Tc 0.0215 Tw (With help. . . . . . . . . . .) Tj 0.7836 -8.7275 TD 0.0761 Tc 0.1392 Tw (Bedfast. . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 68.4 106.32 Tm -0.0419 Tc 1.4544 Tw (45. Eating:) Tj ET BT 0.8648 0 0 0.99 84.24 97.44 Tm 0.0802 Tc -0.0963 Tw (No ) Tj ET BT 0.8567 0 0 0.9835 95.52 97.44 Tm /F6 10 Tf 0.0218 Tc -0.0059 Tw (loss. . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 84 88.56 Tm /F3 8 Tf -0.044 Tc 0.2443 Tw (With supervision. . . .) Tj ET BT 0.9189 0 0 0.99 83.76 79.68 Tm 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj -16.4547 -15.2732 TD 0.026 Tc 2.7107 Tw (46. Dressing:) Tj 17.4994 -8.97 TD 0.0621 Tc 0.0595 Tw (No impairment. . . . . . .) Tj ET BT 0.99 0 0 0.99 84.24 46.56 Tm -0.044 Tc 0.2443 Tw (With supervision. . . .) Tj ET BT 0.9189 0 0 0.99 84.24 37.68 Tm 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj 105.2577 545.9561 TD 0.0264 Tc 0 Tw (2.60) Tj ET BT 0.8108 0 0 0.99 181.44 569.28 Tm 0.0305 Tc (1.81) Tj ET BT 0.9189 0 0 0.99 181.44 560.16 Tm 0.0264 Tc (1.20) Tj 0.2612 -8.97 TD 0.0264 Tc (1.32) Tj ET BT 0.99 0 0 0.99 181.44 542.4 Tm -0.0744 Tc (3.17) Tj ET BT 0.9189 0 0 0.99 181.44 533.52 Tm 0.0264 Tc (0.26) Tj -4.4402 -32.9707 TD 0.0197 Tc (74.53) Tj 0.5224 -9.2124 TD 0.0197 Tc (19.03) Tj ET BT 0.99 0 0 0.99 181.68 482.64 Tm -0.0744 Tc (6.44) Tj -4.1213 -24.0007 TD -0.0765 Tc (80.22) Tj ET BT 0.9189 0 0 0.99 178.08 450 Tm 0.0197 Tc (15.26) Tj ET BT 0.99 0 0 0.99 182.16 441.12 Tm -0.0744 Tc (4.52) Tj -4.3638 -24.4856 TD -0.0765 Tc (66.43) Tj 0 -8.97 TD -0.0765 Tc (23.72) Tj ET BT 0.9189 0 0 0.99 182.4 399.12 Tm 0.0264 Tc (9.85) Tj ET BT 0.99 0 0 0.99 178.08 375.12 Tm -0.0765 Tc (57.50) Tj 0.2424 -8.97 TD -0.0765 Tc (34.36) Tj 4.6062 -9.2124 TD -0.0744 Tc (8.14) Tj ET BT 0.9189 0 0 0.99 179.28 333.12 Tm 0.0197 Tc (19.56) Tj ET BT 0.99 0 0 0.99 178.56 323.76 Tm -0.0765 Tc (80.44) Tj 0.2424 -24.4856 TD -0.0765 Tc (88.79) Tj 4.6062 -8.97 TD -0.0744 Tc (9.57) Tj ET BT 0.9189 0 0 0.99 183.84 282 Tm 0.0264 Tc (1.64) Tj -0.2612 -15.2732 TD 0.0264 Tc (6.02) Tj -4.4402 -8.97 TD 0.0197 Tc (15.16) Tj ET BT 0.8648 0 0 0.99 179.52 248.88 Tm -0.0065 Tc (13.61) Tj ET BT 0.9189 0 0 0.99 183.6 240 Tm 0.0264 Tc (8.03) Tj ET BT 0.99 0 0 0.99 179.28 231.12 Tm -0.0765 Tc (22.49) Tj ET BT 0.8648 0 0 0.99 183.6 222.24 Tm -0.0063 Tc (4.71) Tj ET BT 0.9189 0 0 0.99 179.52 198 Tm 0.0197 Tc (21.65) Tj ET BT 0.99 0 0 0.99 179.76 188.88 Tm -0.0765 Tc (24.37) Tj ET BT 0.8648 0 0 0.99 179.76 179.76 Tm 0.2155 Tc (38.11) Tj ET BT 0.9189 0 0 0.99 180.24 170.88 Tm 0.0197 Tc (14.74) Tj 5.2237 -8.97 TD 0.0264 Tc (1.14) Tj ET BT 0.8648 0 0 0.99 180 138.24 Tm -0.0065 Tc (29.51) Tj 0 -8.97 TD -0.0065 Tc (40.11) Tj ET BT 0.99 0 0 0.99 180 120.48 Tm -0.0765 Tc (30.39) Tj ET BT 0.9189 0 0 0.99 180.48 97.2 Tm 0.0197 Tc (22.12) Tj ET BT 0.99 0 0 0.99 180.48 88.32 Tm -0.0765 Tc (55.85) Tj 0 -8.97 TD -0.0765 Tc (22.03) Tj ET BT 0.9189 0 0 0.99 180.96 55.44 Tm 0.0197 Tc (13.22) Tj ET BT 0.99 0 0 0.99 180.72 46.32 Tm -0.0765 Tc (36.68) Tj 0 -9.2124 TD -0.0765 Tc (50.10) Tj 48.4863 546.1985 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 228.96 559.92 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 228.96 551.28 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (4.77) Tj 0.2424 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 221.04 500.64 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 229.44 491.52 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 221.28 458.88 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 229.68 449.76 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 221.76 416.88 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 229.92 408 Tm -0.0744 Tc (0.00) Tj 0.2424 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 222 375.12 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 230.4 366 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.8499 0 0 0.9835 226.32 332.88 Tm /F5 10 Tf 0.0723 Tc (34.80) Tj 0 -9.2734 TD 0.0723 Tc (65.20) Tj ET BT 0.9189 0 0 0.99 222.72 299.52 Tm /F3 8 Tf 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 231.12 290.64 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0 -14.7883 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj T* -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 231.36 240 Tm 0.0264 Tc (4.19) Tj ET BT 0.99 0 0 0.99 231.36 230.88 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 223.2 197.76 Tm 0.0153 Tc (100.00) Tj 9.4027 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 231.84 179.52 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 232.08 161.76 Tm 0.0264 Tc (0.00) Tj -8.8803 -23.7583 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 232.32 129.12 Tm -0.0744 Tc (0.00) Tj 0 -8.7275 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 224.16 97.2 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 232.56 88.08 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 232.56 79.2 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 228.24 55.2 Tm -0.0765 Tc (62.72) Tj 0 -8.97 TD -0.0765 Tc (37.28) Tj 4.6062 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 284.4 577.92 Tm 0.0197 Tc (14.27) Tj 4.4402 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 288.72 551.28 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 288.72 542.4 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 288.72 533.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 289.2 500.64 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 284.64 491.52 Tm -0.0765 Tc (63.05) Tj 0.2424 -8.97 TD -0.0765 Tc (36.95) Tj ET BT 0.9189 0 0 0.99 289.44 458.88 Tm 0.0264 Tc (0.00) Tj -4.7013 -9.2124 TD 0.0197 Tc (77.15) Tj 0 -8.97 TD 0.0197 Tc (22.85) Tj -4.179 -24.2432 TD 0.0153 Tc (100.00) Tj 9.1415 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 285.6 375.12 Tm -0.0765 Tc (47.26) Tj 0.2424 -9.2124 TD -0.0765 Tc (52.74) Tj ET BT 0.9189 0 0 0.99 290.16 356.88 Tm 0.0264 Tc (0.00) Tj 0.2612 -24.2432 TD 0.0264 Tc (0.00) Tj -8.8803 -9.2124 TD 0.0153 Tc (100.00) Tj 0 -24.4856 TD 0.0153 Tc (100.00) Tj 9.4027 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 286.56 266.88 Tm -0.0765 Tc (59.66) Tj 0 -9.4548 TD -0.0765 Tc (93.48) Tj ET BT 0.9189 0 0 0.99 286.56 248.64 Tm 0.0197 Tc (53.30) Tj ET BT 0.8648 0 0 0.99 286.56 240 Tm -0.0065 Tc (25.41) Tj ET BT 0.9189 0 0 0.99 291.12 230.88 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 286.56 222 Tm -0.0765 Tc (46.50) Tj ET BT 0.9189 0 0 0.99 291.36 197.76 Tm 0.0264 Tc (0.00) Tj 0.2612 -9.4548 TD 0.0264 Tc (0.00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -24.0007 TD 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -23.7583 TD 0.0264 Tc (0.00) Tj -9.4027 -8.7275 TD 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -24.2432 TD 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -9.4548 TD 0.0264 Tc (0.00) Tj 53.8042 546.1985 TD 0.0264 Tc (0.00) Tj 0.2612 -9.2124 TD 0.0264 Tc (3.62) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0.5224 -8.7275 TD 0.0264 Tc (1.79) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj -8.8803 -32.9707 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj -8.8803 -23.7583 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 339.12 416.64 Tm -0.0065 Tc (91.11) Tj ET BT 0.9189 0 0 0.99 343.44 407.76 Tm 0.0264 Tc (8.89) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj -8.8803 -24.0007 TD 0.0153 Tc (100.00) Tj 9.4027 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.8499 0 0 0.9835 339.84 332.64 Tm /F5 10 Tf 0.0723 Tc (28.35) Tj ET BT 0.8027 0 0 0.9835 339.84 323.76 Tm 0.2816 Tc (71.65) Tj ET BT 0.8499 0 0 0.9835 339.84 299.28 Tm 0.0723 Tc (93.73) Tj 5.3651 -9.0293 TD 0.0703 Tc (6.27) Tj ET BT 0.9189 0 0 0.99 344.64 281.28 Tm /F3 8 Tf 0.0264 Tc (0.00) Tj 0 -14.7883 TD 0.0264 Tc (0.00) Tj ET BT 0.8027 0 0 0.9835 340.56 257.52 Tm /F5 10 Tf 0.0424 Tc (13.38) Tj 5.0828 -9.2734 TD 0.2572 Tc (9.86) Tj ET BT 0.8499 0 0 0.9835 340.32 239.76 Tm 0.0723 Tc (20.44) Tj ET BT 0.9189 0 0 0.99 344.88 230.64 Tm /F3 8 Tf 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0 -24.4856 TD 0.0264 Tc (0.00) Tj ET BT 0.8027 0 0 0.9835 340.8 188.4 Tm /F5 10 Tf 0.2816 Tc (62.36) Tj ET BT 0.8499 0 0 0.9835 340.8 179.52 Tm 0.0723 Tc (37.64) Tj ET BT 0.9189 0 0 0.99 345.6 170.4 Tm /F3 8 Tf 0.0264 Tc (0.00) Tj 0 -8.7275 TD 0.0264 Tc (0.00) Tj 0 -24.0007 TD 0.0264 Tc (0.00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -23.7583 TD 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj 0.2612 -24.2432 TD 0.0264 Tc (0.00) Tj -9.4027 -8.7275 TD 0.0153 Tc (100.00) Tj 9.4027 -9.4548 TD 0.0264 Tc (0.00) Tj 54.0654 546.1985 TD 0.0264 Tc (2.14) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 396 559.92 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 391.92 542.16 Tm 0.0197 Tc (26.64) Tj 4.9625 -8.97 TD 0.0264 Tc (3.14) Tj -9.1415 -32.9707 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 396.72 491.52 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 388.32 458.88 Tm 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 392.64 416.64 Tm -0.0765 Tc (83.53) Tj ET BT 0.9189 0 0 0.99 393.12 407.76 Tm 0.0197 Tc (16.65) Tj ET BT 0.99 0 0 0.99 397.2 398.64 Tm -0.0744 Tc (0.00) Tj 0.2424 -24.0007 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 389.28 366 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 397.68 356.88 Tm -0.0744 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 393.84 332.64 Tm -0.0065 Tc (18.81) Tj ET BT 0.99 0 0 0.99 393.6 323.28 Tm -0.0765 Tc (81.19) Tj ET BT 0.9189 0 0 0.99 389.52 299.28 Tm 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 398.16 266.64 Tm -0.0744 Tc (0.00) Tj -4.3638 -9.2124 TD -0.0765 Tc (21.33) Tj 0 -8.97 TD -0.0765 Tc (42.09) Tj 4.6062 -9.2124 TD -0.0744 Tc (9.77) Tj ET BT 0.9189 0 0 0.99 398.64 230.64 Tm 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj -9.1415 -24.2432 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 398.88 188.4 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 399.12 170.4 Tm 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj -8.8803 -23.7583 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 399.36 129.12 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 399.6 120.24 Tm 0.0264 Tc (0.00) Tj 0 -23.5159 TD 0.0264 Tc (0.00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 399.6 79.2 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 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(26.83) Tj 0.2424 -9.2124 TD -0.0765 Tc (73.17) Tj ET BT 0.9189 0 0 0.99 443.52 299.28 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 452.16 290.4 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 452.16 266.64 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 452.16 257.52 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (4.39) Tj ET BT 0.9189 0 0 0.99 452.4 239.52 Tm 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 452.4 221.52 Tm -0.0744 Tc (0.00) Tj 0.2424 -24.2432 TD -0.0744 Tc (0.00) Tj -4.1213 -9.2124 TD -0.0765 Tc (38.43) Tj 0 -9.2124 TD -0.0765 Tc (61.57) Tj 4.3638 -8.7275 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 453.12 161.76 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 453.12 138 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 444.72 129.36 Tm 0.0153 Tc (100.00) Tj 9.4027 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -23.5159 TD 0.0264 Tc (0.00) Tj -9.4027 -8.97 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 453.6 79.44 Tm -0.0744 Tc (0.00) Tj ET 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501.12 356.64 Tm 0.2155 Tc (61.11) Tj ET BT 0.9189 0 0 0.99 505.68 332.4 Tm 0.0264 Tc (0.19) Tj ET BT 0.8648 0 0 0.99 501.12 323.04 Tm 0.2155 Tc (99.81) Tj ET BT 0.99 0 0 0.99 501.6 299.04 Tm -0.0765 Tc (52.33) Tj 0 -8.97 TD -0.0765 Tc (39,88) Tj ET BT 0.9189 0 0 0.99 506.16 281.28 Tm 0.0264 Tc (7.79) Tj ET BT 0.99 0 0 0.99 506.16 266.4 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (4.90) Tj ET BT 0.9189 0 0 0.99 502.32 248.4 Tm 0.0197 Tc (10.14) Tj ET BT 0.99 0 0 0.99 506.16 239.52 Tm -0.0744 Tc (0.00) Tj -4.3638 -9.2124 TD -0.0765 Tc (97.90) Tj ET BT 0.9189 0 0 0.99 506.4 221.52 Tm 0.0264 Tc (0.00) Tj 0.2612 -24.4856 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 506.88 188.4 Tm -0.0744 Tc (0.00) Tj -4.6062 -9.2124 TD -0.0765 Tc (36.15) Tj 0.2424 -8.97 TD -0.0765 Tc (59.27) Tj ET BT 0.9189 0 0 0.99 506.88 161.76 Tm 0.0264 Tc (4.58) Tj 0.2612 -24.0007 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 507.12 129.12 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 498.72 120.48 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 507.36 97.2 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 507.6 88.32 Tm 0.0264 Tc (0.00) Tj -9.4027 -8.97 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 507.6 55.44 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 507.6 46.32 Tm 0.0264 Tc (0.00) Tj -9.1415 -9.2124 TD 0.0153 Tc (100.00) Tj ET endstream endobj 208 0 obj <>/Rotate 0/Type/Page>> endobj 209 0 obj <>stream 0.72 w 1 j 0 0 0 RG 68.4 688.32 m 546.72 688.32 l S 68.64 646.08 m 547.2 646.08 l S 221.76 628.08 m 547.2 628.08 l S 69.12 596.16 m 547.68 596.16 l S 0.48 w 71.76 223.2 m 550.08 223.2 l S BT 0.9835 0 0 0.9835 68.64 694.8 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (68 ) Tj ET BT 0.9598 0 0 0.9598 82.56 694.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 88.8 694.8 Tm /F5 10 Tf 0.0125 Tc 0.9566 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 100.8 655.2 Tm /F3 9 Tf 0.0429 Tc 0.4619 Tw (Table 2-4\227Characteristics of Six Types of Nursing Home Residents, New York State--Continued) Tj ET BT 0.8648 0 0 0.99 323.52 636.48 Tm /F3 8 Tf 0.0512 Tc 1.6717 Tw (Type of nursing home residents) Tj -111.8369 -17.9399 TD 0.0596 Tc 0 Tw (Limited) Tj 62.7175 -0.2424 TD 0.0407 Tc (Oldest-old) Tj ET BT 0.9189 0 0 0.99 334.8 618.48 Tm 0.0155 Tc 0.3713 Tw (Acute and) Tj ET BT 0.8648 0 0 0.99 388.08 618.48 Tm 0.0173 Tc 0 Tw (Behavioral) Tj ET BT 0.9189 0 0 0.99 499.2 618.48 Tm 0.0004 Tc (Severely) Tj ET BT 0.8648 0 0 0.99 224.4 609.84 Tm 0.0299 Tc (impaired) Tj ET BT 0.99 0 0 0.99 276.96 609.36 Tm -0.0389 Tc 1.2089 Tw (deteriorating rehabilitative) Tj ET BT 0.8648 0 0 0.99 392.4 609.6 Tm 0.0511 Tc 0 Tw (problem) Tj ET BT 0.9189 0 0 0.99 444 609.6 Tm 0.0052 Tc (Dementia) Tj ET BT 0.8648 0 0 0.99 499.2 609.6 Tm 0.2727 Tc (impaired) Tj ET BT 0.9189 0 0 0.99 69.12 601.2 Tm 0.0274 Tc (Variable) Tj ET BT 0.8648 0 0 0.99 173.52 600.48 Tm 0.2848 Tc (Frequency) Tj 71.5978 0.2424 TD 0.0719 Tc (\(1\)) Tj 69.1002 -0.2424 TD 0.0719 Tc (\(2\)) Tj 61.8849 0 TD 0.0719 Tc (\(3\)) Tj 62.1625 0 TD 0.0719 Tc (\(4\)) Tj 62.44 0 TD 0.0719 Tc (\(5\)) Tj 62.1625 0 TD 0.0719 Tc (\(6\)) Tj ET BT 0.99 0 0 0.99 69.12 587.04 Tm -0.0377 Tc 0.4804 Tw (47. Bathing:) Tj ET BT 0.9189 0 0 0.99 85.2 578.16 Tm 0.0621 Tc 0.0595 Tw (No impairment. . . . . . .) Tj -0.5224 -9.2124 TD 0.0519 Tc 0.1141 Tw (With assistance. . . . . .) Tj 0.2612 -8.97 TD 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj -16.4547 -14.7883 TD 0.0527 Tc 1.3756 Tw (48. Toileting:) Tj 19.3277 -9.2124 TD 0.0585 Tc 0.3681 Tw (No impairment. . . . . .) Tj -0.5224 -8.97 TD 0.097 Tc 0.0215 Tw (With help. . . . . . . . . . .) Tj 0.2612 -8.97 TD 0.0664 Tc 0.2637 Tw (Totally impaired. . . . .) Tj -19.0665 -14.7883 TD 0.0353 Tc 1.0028 Tw (49. Bladder control:) Tj 17.2382 -9.4548 TD 0.0843 Tc 0.0353 Tw (Continent . . . . . . . . . . .) Tj -16.7159 -42.1831 TD 0.0376 Tc 0 Tw (50.) Tj ET BT 0.8648 0 0 0.99 70.8 411.12 Tm 0.179 Tc (51.) Tj ET BT 0.9189 0 0 0.99 71.04 369.36 Tm 0.0376 Tc (52.) Tj 0.2612 -42.4255 TD 0.0376 Tc (53.) Tj 0 -8.97 TD 0.0376 Tc (54.) Tj 0.2612 -18.1824 TD 0.0376 Tc (55.) Tj ET BT 0.8648 0 0 0.99 71.76 282.48 Tm 0.179 Tc (56.) Tj ET BT 0.9189 0 0 0.99 71.76 273.36 Tm 0.0376 Tc (57.) Tj 0 -9.2124 TD 0.0376 Tc (58.) Tj 0.2612 -8.97 TD 0.0376 Tc (59.) Tj ET BT 0.8648 0 0 0.99 72 246.24 Tm 0.179 Tc (60.) Tj ET BT 0.9189 0 0 0.99 72 237.12 Tm 0.0376 Tc (61.) Tj ET BT 0.99 0 0 0.99 72 228 Tm -0.0708 Tc (62.) Tj ET BT 0.8648 0 0 0.99 86.4 486 Tm 0.0335 Tc 0.451 Tw (Incontinent. . . . . . . . . .) Tj 0 -8.97 TD 0.012 Tc 0.482 Tw (Indwelling. . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 86.4 468 Tm 0.0783 Tc 0.0419 Tw (External. . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.4 453.12 Tm 0.0238 Tc 0 Tw (Bowel:) Tj ET BT 0.9189 0 0 0.99 86.4 444.24 Tm 0.0843 Tc 0.0353 Tw (Continent. . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.4 435.12 Tm 0.0335 Tc 0.451 Tw (Incontinent. . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 86.4 426 Tm 0.0774 Tc 0.1009 Tw (Colostomy. . . . . . . . . .) Tj 0.2612 -15.0308 TD 0.028 Tc 0.0966 Tw (Personal hygiene:) Tj -0.2612 -9.2124 TD 0.0621 Tc 0.0595 Tw (No impairment. . . . . . .) Tj ET BT 0.99 0 0 0.99 86.4 393.12 Tm -0.044 Tc 0.1837 Tw (With supervision. . . .) Tj ET BT 0.9189 0 0 0.99 86.4 384.48 Tm 0.0519 Tc 0.1141 Tw (With assistance. . . . . .) Tj ET BT 0.8648 0 0 0.99 87.12 369.36 Tm 0.0518 Tc 0 Tw (Learning:) Tj ET BT 0.9189 0 0 0.99 86.88 360.48 Tm 0.0621 Tc 0.0595 Tw (No impairment. . . . . . .) Tj -0.5224 -9.2124 TD 0.0706 Tc 0.0502 Tw (With difficulty. . . . . . . .) Tj 0 -8.7275 TD 0.0693 Tc 0.0516 Tw (Totally impaired. . . . . .) Tj 1.5671 -15.2732 TD 0.0424 Tc 0.6032 Tw (Patient wanders. . . . .) Tj ET BT 0.8648 0 0 0.99 87.84 318.48 Tm 0.0175 Tc 3.5838 Tw (Patient verbally) Tj ET BT 0.9189 0 0 0.99 93.6 309.36 Tm 0.0915 Tc 0.0275 Tw (abusive. . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 87.84 300.72 Tm 0.0246 Tc 3.5755 Tw (Patient physically) Tj ET BT 0.9189 0 0 0.99 93.6 291.6 Tm 0.0708 Tc 0.3112 Tw (aggressive. . . . . . . .) Tj -6.2684 -9.4548 TD 0.0362 Tc 0.8713 Tw (Severe depression. . .) Tj 0 -8.97 TD 0.0757 Tc 0.0882 Tw (Hallucinations. . . . . . .) Tj ET BT 0.99 0 0 0.99 88.08 264.48 Tm -0.0426 Tc 0.0248 Tw (Paranoia. . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 87.84 255.36 Tm 0.0445 Tc 0.2092 Tw (Patient withdrawn. . . .) Tj ET BT 0.8648 0 0 0.99 88.08 246.24 Tm 0.0155 Tc 0.4325 Tw (Delusion. . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 88.32 237.12 Tm 0.0954 Tc 0.1538 Tw (Hoarding. . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 88.08 228.24 Tm -0.0523 Tc 0.0796 Tw (Manipulative. . . . . . . .) Tj ET BT 0.9189 0 0 0.99 185.76 577.68 Tm 0.0264 Tc 0 Tw (2.25) Tj ET BT 0.99 0 0 0.99 181.44 568.8 Tm -0.0765 Tc (42.88) Tj 0 -8.97 TD -0.0765 Tc (54.87) Tj 0 -23.7583 TD -0.0765 Tc (27.37) Tj 0 -9.2124 TD -0.0765 Tc (24.25) Tj 0 -8.97 TD -0.0765 Tc (48.38) Tj ET BT 0.8648 0 0 0.99 181.68 494.64 Tm 0.2155 Tc (39.31) Tj ET BT 0.99 0 0 0.99 181.92 485.52 Tm -0.0765 Tc (51.59) Tj ET BT 0.9189 0 0 0.99 186.48 476.64 Tm 0.0264 Tc (7.27) Tj 0.5224 -8.97 TD 0.0264 Tc (1.84) Tj ET BT 0.99 0 0 0.99 182.16 443.76 Tm -0.0765 Tc (46.57) Tj 0 -8.97 TD -0.0765 Tc (53.38) Tj ET BT 0.9189 0 0 0.99 187.44 425.76 Tm 0.0264 Tc (1.05) Tj -4.9625 -24.2432 TD 0.0197 Tc (12.32) Tj ET BT 0.99 0 0 0.99 182.64 392.88 Tm -0.0765 Tc (25.84) Tj 0 -9.2124 TD -0.0765 Tc (61.84) Tj 0.2424 -24.0007 TD -0.0765 Tc (32.80) Tj 0 -8.7275 TD -0.0765 Tc (49.09) Tj ET BT 0.8648 0 0 0.99 183.6 342 Tm -0.0065 Tc (18.11) Tj ET BT 0.9189 0 0 0.99 187.44 326.88 Tm 0.0264 Tc (9.48) Tj ET BT 0.99 0 0 0.99 183.12 308.88 Tm -0.0765 Tc (34.90) Tj ET BT 0.9189 0 0 0.99 183.6 291.36 Tm 0.0197 Tc (16.95) Tj 4.7013 -9.2124 TD 0.0264 Tc (7.36) Tj ET BT 0.99 0 0 0.99 187.92 272.88 Tm -0.0744 Tc (6.13) Tj ET BT 0.9189 0 0 0.99 188.16 264 Tm 0.0264 Tc (7.65) Tj ET BT 0.8648 0 0 0.99 183.6 254.88 Tm 0.2155 Tc (32.11) Tj 4.9952 -8.97 TD -0.0063 Tc (4.41) Tj ET BT 0.9189 0 0 0.99 188.16 236.64 Tm 0.0264 Tc (5.66) Tj -4.179 -8.97 TD 0.0197 Tc (11.97) Tj 49.1028 353.4653 TD 0.0197 Tc (10.12) Tj ET BT 0.99 0 0 0.99 228.96 568.56 Tm -0.0765 Tc (89.88) Tj 4.3638 -8.7275 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 225.36 536.4 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 233.52 527.04 Tm -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 225.6 494.64 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 234 485.28 Tm -0.0744 Tc (0.00) Tj 0 -8.7275 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 229.92 443.52 Tm 0.2155 Tc (99.11) Tj ET BT 0.9189 0 0 0.99 234.48 434.64 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 234.48 425.52 Tm -0.0744 Tc (0.89) Tj -4.3638 -24.2432 TD -0.0765 Tc (54.55) Tj 0 -8.7275 TD -0.0765 Tc (45.56) Tj 4.6062 -8.97 TD -0.0744 Tc (0.00) Tj -4.3638 -24.2432 TD -0.0765 Tc (91.94) Tj 4.6062 -8.97 TD -0.0744 Tc (8.06) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj 0.2424 -15.2732 TD -0.0744 Tc (0.00) Tj 0 -17.9399 TD -0.0744 Tc (0.00) Tj 0.2424 -18.1824 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj T* -0.0744 Tc (0.00) Tj T* -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 236.16 236.88 Tm 0.0264 Tc (7.25) Tj ET BT 0.99 0 0 0.99 235.68 227.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 293.04 577.44 Tm 0.0264 Tc (0.00) Tj -8.6191 -8.7275 TD 0.0153 Tc (100.00) Tj 8.6191 -9.2124 TD 0.0264 Tc (0.00) Tj 0.2612 -24.0007 TD 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 293.52 494.4 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 285.12 485.76 Tm 0.0153 Tc (100.00) Tj 9.4027 -9.4548 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -24.2432 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj 9.1415 -24.4856 TD 0.0264 Tc (0.00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -24.0007 TD 0.0264 Tc (0.00) Tj -8.8803 -8.97 TD 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj 0.2612 -15.2732 TD 0.0264 Tc (0.00) Tj 0 -18.1824 TD 0.0264 Tc (0.00) Tj 0.2612 -18.1824 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 290.88 254.64 Tm -0.0765 Tc (86.14) Tj 4.3638 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 295.44 236.64 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 295.44 227.52 Tm -0.0744 Tc (0.00) Tj 51.6379 353.4653 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 338.4 568.8 Tm 0.0153 Tc (100.00) Tj 9.1415 -8.97 TD 0.0264 Tc (0.00) Tj 0.2612 -24.2432 TD 0.0264 Tc (0.00) Tj -9.4027 -8.97 TD 0.0153 Tc (100.00) Tj 9.4027 -8.97 TD 0.0264 Tc (0.00) Tj -8.8803 -24.0007 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 347.28 485.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 347.52 476.64 Tm 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 343.44 443.52 Tm -0.0765 Tc (99.17) Tj ET BT 0.9189 0 0 0.99 347.76 434.64 Tm 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.83) Tj ET BT 0.99 0 0 0.99 347.76 401.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 339.84 392.64 Tm 0.0153 Tc (100.00) Tj 9.1415 -8.97 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 343.92 360 Tm -0.0765 Tc (84.46) Tj ET BT 0.9189 0 0 0.99 344.64 351.12 Tm 0.0197 Tc (15.54) Tj 4.179 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -15.2732 TD 0.0264 Tc (0.00) Tj 0 -18.1824 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 348.72 290.88 Tm -0.0744 Tc (0.00) Tj 0 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 348.96 272.88 Tm 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj 0.2612 -8.97 TD 0.0264 Tc (0.00) Tj 0 -9.4548 TD 0.0264 Tc (0.00) Tj ET BT 0.8648 0 0 0.99 349.2 236.64 Tm -0.0063 Tc (7.81) Tj ET BT 0.9189 0 0 0.99 344.88 227.52 Tm 0.0197 Tc (36.44) Tj 51.1923 353.4653 TD 0.0153 Tc (100.00) Tj 9.4027 -8.97 TD 0.0264 Tc (0.00) Tj 0 -8.97 TD 0.0264 Tc (0.00) Tj -8.8803 -23.7583 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 400.8 527.04 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 401.04 494.4 Tm 0.0264 Tc (0.00) Tj -9.1415 -8.97 TD 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj 0 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 401.52 443.52 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 401.52 434.4 Tm 0.0264 Tc (0.00) Tj -9.1415 -8.97 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 401.76 401.28 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 401.76 392.4 Tm 0.0264 Tc (0.00) Tj -8.8803 -8.7275 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 402 359.76 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 393.84 350.88 Tm 0.0153 Tc (100.00) Tj 9.1415 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 397.68 326.64 Tm -0.0765 Tc (94.33) Tj ET BT 0.9189 0 0 0.99 393.84 308.88 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 393.84 291.12 Tm -0.0779 Tc (100.00) Tj ET BT 0.9189 0 0 0.99 394.08 282 Tm 0.0153 Tc (100.00) Tj 0.2612 -9.2124 TD 0.0153 Tc (100,00) Tj 0 -9.2124 TD 0.0153 Tc (100.00) Tj 0.2612 -8.97 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 398.4 245.52 Tm -0.0765 Tc (82.83) Tj 0 -9.2124 TD -0.0765 Tc (39.77) Tj 0.2424 -8.97 TD -0.0765 Tc (78.97) Tj 56.2441 353.4653 TD -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 445.92 559.92 Tm 0.0153 Tc (100.00) Tj 9.6639 -24.2432 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 446.16 527.04 Tm -0.0779 Tc (100.00) Tj ET BT 0.9189 0 0 0.99 454.8 518.4 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 455.04 494.4 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 446.4 485.52 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 455.04 476.4 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj 0.2424 -24.2432 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 447.12 434.64 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 455.52 425.52 Tm -0.0744 Tc (0.00) Tj 0.2424 -24.2432 TD -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 447.36 383.76 Tm 0.0153 Tc (100.00) Tj 9.4027 -24.0007 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 451.68 350.64 Tm -0.0765 Tc (93.40) Tj 4.3638 -8.97 TD -0.0744 Tc (6.60) Tj ET BT 0.9189 0 0 0.99 452.16 326.64 Tm 0.0197 Tc (17.90) Tj ET BT 0.99 0 0 0.99 456.24 308.88 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 456.48 290.88 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 456.48 281.76 Tm -0.0744 Tc (0.00) Tj 0 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 456.48 263.52 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 456.72 254.88 Tm -0.0744 Tc (0.00) Tj -0.2424 -9.4548 TD -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj 0.2424 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 508.32 577.44 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 508.32 568.56 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 499.92 559.68 Tm 0.0153 Tc (100.00) Tj 9.4027 -24.0007 TD 0.0264 Tc (0.00) Tj 0.2612 -8.97 TD 0.0264 Tc (0.00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj 9.4027 -24.2432 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 504.48 485.28 Tm -0.0765 Tc (58.92) Tj 0.2424 -8.97 TD -0.0765 Tc (32.78) Tj 4.3638 -9.2124 TD -0.0744 Tc (8.29) Tj 0.2424 -24.0007 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 500.88 434.64 Tm 0.0153 Tc (100.00) Tj 9.4027 -9.2124 TD 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 509.76 401.28 Tm -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 509.76 392.4 Tm 0.0264 Tc (0,00) Tj -9.1415 -8.7275 TD 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 509.76 359.76 Tm -0.0744 Tc (0.00) Tj 0.2424 -9.2124 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 501.6 342 Tm 0.0153 Tc (100.00) Tj ET BT 0.99 0 0 0.99 510 326.64 Tm -0.0744 Tc (0.00) Tj 0.2424 -17.9399 TD -0.0744 Tc (0.00) Tj 0.2424 -18.1824 TD -0.0744 Tc (0.00) Tj 0 -9.4548 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 510.48 272.64 Tm 0.0264 Tc (0.00) Tj ET BT 0.99 0 0 0.99 510.48 263.52 Tm -0.0744 Tc (0.00) Tj -4.3638 -8.7275 TD -0.0765 Tc (47.16) Tj 4.3638 -9.4548 TD -0.0744 Tc (0.00) Tj 0.2424 -8.97 TD -0.0744 Tc (0.00) Tj ET BT 0.9189 0 0 0.99 510.96 227.52 Tm 0.0264 Tc (0.00) Tj ET BT 0.9262 0 0 0.9939 72.24 215.28 Tm /F3 7 Tf 0.0517 Tc 0.0706 Tw (SOURCE: ) Tj ET q 12.72 0 0 -5.28 105.12 220.32 cm BI /W 74 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|?>~???????||??|>~??x  EI Q BT 0.8645 0 0 0.9939 105.12 215.28 Tm 3 Tr 0.0099 Tc 0 Tw (K.G.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 117.84 215.28 Tm 0.0896 Tc 0.0296 Tw ( Manton, ) Tj ET q 11.76 0 0 -5.28 147.36 220.32 cm BI /W 68 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~??|?~~?|||~??? EI Q BT 0.8645 0 0 0.9939 147.36 215.28 Tm 3 Tr -0.0179 Tc 0 Tw (J.C.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 159.12 215.28 Tm 0 Tc 0.1263 Tw ( ) Tj ET q 26.88 0 0 -6.48 160.8 220.56 cm BI /W 156 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<??<??<<<<~<><~<>>>?>~>>?<?||~?>???|??|?~?~?>~>~~x EI Q BT 0.8645 0 0 0.9939 160.8 215.28 Tm 3 Tr 0.0014 Tc 0 Tw (Vertrees,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 187.68 215.28 Tm 0.0823 Tc 0.0375 Tw ( and ) Tj ET q 12.96 0 0 -5.28 203.28 220.32 cm BI /W 75 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|||~|~?|>?|????????~ EI Q BT 0.8645 0 0 0.9939 203.28 215.28 Tm 3 Tr -0.017 Tc 0 Tw (M.A.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 216.24 215.28 Tm 0.0867 Tc 0.4096 Tw ( Woodbury, \223Functionally and Medically Defined Subgroups of Nursing Home Populations,\224 ) Tj ET q 19.68 0 0 -5.52 512.64 220.56 cm BI /W 114 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>??|??|?~?~>|>>>??||?|?|?|?<~~>>|>|>|?~~>>> EI Q BT 0.8645 0 0 0.9939 512.64 215.28 Tm 3 Tr -0.05 Tc 0 Tw (Hea/th) Tj 0 Tr ET BT 0.9266 0 0 0.99 532.32 215.28 Tm /F7 8 Tf 0.0151 Tc 0.574 Tw ( Care) Tj ET BT 0.9262 0 0 0.9939 106.56 206.88 Tm /F11 7 Tf 0.097 Tc 0.0216 Tw (Financing ) Tj ET q 22.56 0 0 -5.76 140.88 212.4 cm BI /W 128 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?|?~?~??~|??|?|?|~?~?~?????>?>>|~>??>??||8` EI Q BT 0.9262 0 0 0.9939 140.88 206.88 Tm 3 Tr 0.0379 Tc 0 Tw (Review) Tj 0 Tr 24.3562 0 TD 0 Tc 0.1263 Tw ( ) Tj ET q 36 0 0 -7.2 165.12 212.4 cm BI /W 205 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >8><?<??||~|?||>|~|||?|}~x}~x}|?||||?|>|>|>p<><||||~???? EI Q BT 0.9262 0 0 0.9939 165.12 206.88 Tm 3 Tr 0.0069 Tc 0 Tw (12\(1\):50-52,) Tj 0 Tr 38.8663 0 TD 0.0201 Tc 0.6228 Tw ( 1990.) Tj ET BT 0.9835 0 0 0.9835 72.24 188.16 Tm /F4 10 Tf 0.022 Tc 1.5887 Tw (incontinent; they also require extensive nursing) Tj ET BT 0.934 0 0 0.9835 323.28 187.68 Tm -0.0154 Tc 0.9607 Tw (needed by individuals in type 6, and exhibit behav-) Tj -268.2616 -11.7137 TD -0.0293 Tc 1.0673 Tw (services, such as wound care, sterile dressings, and) Tj ET BT 0.9835 0 0 0.9835 323.52 175.68 Tm 0.0202 Tc 0.8991 Tw (ioral symptoms. Thus they might be appropriate) Tj -255.2613 -11.7137 TD 0.0214 Tc 1.142 Tw (turning and positioning. For these reasons, they) Tj ET BT 0.934 0 0 0.9835 323.76 163.68 Tm -0.0272 Tc 0.5879 Tw (candidates for placement in a special care unit.) Tj -269.0325 -11.7137 TD -0.0339 Tc 1.1732 Tw (might be more appropriately cared for in a nonspe-) Tj ET BT 0.9835 0 0 0.9835 72.72 140.16 Tm 0.0156 Tc 1.6998 Tw (cialized nursing home unit. In contrast, in type) Tj ET BT 0.9795 0 0 0.9795 335.04 137.76 Tm /F7 12 Tf 0.0509 Tc 0.9897 Tw (Factors That Could Change the Types of) Tj ET BT 0.9812 0 0 0.9812 72.72 128.88 Tm /F5 11 Tf 0.3248 Tc 2.7876 Tw (4--behavioral problem residents,) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 236.4 128.88 Tm /F4 10 Tf 0.0368 Tc 1.9804 Tw (there is a 23) Tj ET BT 0.9795 0 0 0.9795 369.84 124.56 Tm /F7 12 Tf 0.0347 Tc 1.1287 Tw (Individuals With Dementia) Tj ET BT 0.8915 0 0 0.9835 72.48 116.64 Tm /F4 10 Tf 0.0294 Tc 0.5839 Tw (percent probability that an individual of this type has) Tj ET BT 0.9795 0 0 0.9795 391.68 110.64 Tm /F7 12 Tf 0.0086 Tc 0.9103 Tw (in Nursing Homes) Tj ET BT 0.934 0 0 0.9835 73.2 104.64 Tm /F4 10 Tf -0.0317 Tc 0.7028 Tw (a primary diagnosis of Alzheimer\222s disease or senile) Tj 0 -11.9577 TD -0.0082 Tc 0.7281 Tw (dementia and a 62 percent probability that such an) Tj ET BT 0.8915 0 0 0.9835 335.04 92.88 Tm 0.0507 Tc 0.7763 Tw (The same factors that could change the prevalence) Tj ET BT 0.934 0 0 0.9835 73.44 81.12 Tm -0.0183 Tc 1.0923 Tw (individual has any diagnosis of Alzheimer\222s disease) Tj 268.7755 -0.244 TD -0.0209 Tc 0.5812 Tw (of dementia in nursing homes could also change the) Tj ET BT 0.8915 0 0 0.9835 73.44 69.12 Tm 0.031 Tc 1.0532 Tw (or senile dementia. Individuals in this type have less) Tj ET BT 0.9835 0 0 0.9835 324.72 68.88 Tm 0.0281 Tc 3.0468 Tw (types of individuals with dementia in nursing) Tj -255.2613 -11.7137 TD 0.022 Tc 1.8734 Tw (severe impairments in activities of daily living,) Tj 255.0173 0 TD 0.0291 Tc 0.158 Tw (homes. These factors include availability of alter-) Tj ET BT 0.8915 0 0 0.9835 73.68 45.84 Tm 0.0536 Tc 0.5904 Tw (generally do not require the kinds of nursing services) Tj ET BT 0.9835 0 0 0.9835 324.48 45.36 Tm 0.0325 Tc 2.7982 Tw (nate residential care settings for persons with) Tj ET endstream endobj 210 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 211 0 obj <>stream 0.48 w 1 j 0 0 0 RG 63.6 677.04 m 542.16 677.04 l S BT 0.9835 0 0 0.9835 179.04 682.32 Tm 0 0 0 rg /F5 10 Tf 0.0214 Tc 1.4058 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems . 69) Tj -116.8931 -39.5338 TD /F4 10 Tf 0.0341 Tc 1.9668 Tw (dementia, availability of supportive services for) Tj 0 -12.4458 TD 0.0333 Tc 2.902 Tw (persons with dementia who live at home, and) Tj 0 -11.7137 TD 0.0367 Tc 1.1345 Tw (Medicare and Medicaid eligibility, coverage, and) Tj ET BT 0.934 0 0 0.9835 64.08 607.44 Tm -0.0374 Tc 2.5517 Tw (reimbursement policies that encourage or discour-) Tj 0.7709 -12.2018 TD -0.0286 Tc 0.6858 Tw (age nursing home care for certain types of individu-) Tj 0.257 -11.9577 TD -0.0279 Tc 1.1025 Tw (als with dementia. Greater availability of appropri-) Tj ET BT 0.8491 0 0 0.9835 65.04 571.68 Tm 0.0362 Tc 1.8193 Tw (ate services for persons with dementia in non-nursing-) Tj ET BT 0.9835 0 0 0.9835 64.8 559.92 Tm 0.0262 Tc 0.5473 Tw (home settings is likely to reduce the number and) Tj ET BT 0.8915 0 0 0.9835 64.8 548.16 Tm 0.0372 Tc 2.0221 Tw (proportion of nursing home residents with dementia) Tj ET BT 0.934 0 0 0.9835 65.28 535.92 Tm -0.0342 Tc 0.4926 Tw (who are in the middle stages of their illness and are) Tj ET BT 0.8915 0 0 0.9835 64.8 524.16 Tm 0.0422 Tc 1.7921 Tw (relatively physically healthy except for their demen-) Tj 0.8076 -12.2018 TD 0.0483 Tc 1.0482 Tw (tia and, conversely, increase the number and propor-) Tj 0.2692 -12.2018 TD 0.0396 Tc 1.0234 Tw (tion who are in the late stages of dementia and have) Tj ET BT 0.934 0 0 0.9835 65.52 487.92 Tm -0.0228 Tc 2.1249 Tw (numerous medical conditions and physical impair-) Tj ET BT 0.9835 0 0 0.9835 65.52 476.4 Tm 0.0358 Tc 1.0866 Tw (ments in addition to dementia. The wider use of) Tj ET BT 0.8915 0 0 0.9835 65.76 464.16 Tm 0.0334 Tc 1.7187 Tw (case-mix systems to determine the level of Medicare) Tj 0.5384 -11.9577 TD 0.0568 Tc 1.7757 Tw (and Medicaid reimbursement for nursing home care) Tj 0 -12.2018 TD 0.0451 Tc 1.321 Tw (is also likely to differentially increase the proportion) Tj ET BT 0.934 0 0 0.9835 66.24 428.16 Tm -0.0261 Tc 1.1006 Tw (of nursing home residents with dementia who have) Tj 0 -11.7137 TD -0.0228 Tc 2.1249 Tw (numerous medical conditions and physical impair-) Tj ET BT 0.8915 0 0 0.9835 66.24 404.64 Tm 0.0164 Tc 1.9108 Tw (ments in addition to dementia.) Tj ET BT 0.9835 0 0 0.9835 77.52 386.64 Tm 0.0361 Tc 1.4349 Tw (Another factor that could change the types of) Tj -10.9816 -12.2018 TD 0.0203 Tc 2.3633 Tw (individuals with dementia in nursing homes is) Tj ET BT 0.934 0 0 0.9835 66.96 362.4 Tm -0.0305 Tc 2.5443 Tw (changes in hospital discharge practices. Following) Tj ET BT 0.9835 0 0 0.9835 66.96 350.4 Tm 0.0427 Tc 1.5677 Tw (the implementation of the Medicare prospective) Tj -0.244 -12.4458 TD 0.0276 Tc 2.0711 Tw (payment system in 1983, the average length of) Tj ET BT 0.934 0 0 0.9835 66.96 326.64 Tm -0.0388 Tc 1.5253 Tw (hospital stays for Medicare beneficiaries decreased,) Tj 0.5139 -12.4458 TD -0.0272 Tc 0.8449 Tw (and the average severity of illness increased among) Tj ET BT 0.9835 0 0 0.9835 67.44 302.4 Tm 0.0304 Tc 0.5227 Tw (individuals who were admitted to nursing homes) Tj 0 -11.9577 TD 0.0187 Tc 1.7873 Tw (from hospitals \(262,396,430\). Future changes in) Tj ET BT 0.934 0 0 0.9835 67.2 278.64 Tm -0.0378 Tc 0.899 Tw (hospital discharge practices that resulted in shorter) Tj ET BT 0.9835 0 0 0.9835 67.92 266.64 Tm 0.032 Tc 1.8226 Tw (average length of hospital stays could result in) Tj ET BT 0.934 0 0 0.9835 67.68 254.64 Tm -0.0272 Tc 1.8359 Tw (further increases in severity of illness among both) Tj ET BT 0.8915 0 0 0.9835 67.68 242.88 Tm 0.0307 Tc 1.4371 Tw (demented and nondemented nursing home residents.) Tj ET BT 0.9795 0 0 0.9795 157.92 218.64 Tm /F7 12 Tf -0.0011 Tc 0 Tw (Summary) Tj ET BT 0.934 0 0 0.9835 79.2 200.88 Tm /F4 10 Tf -0.0279 Tc 0.9558 Tw (Findings of two national surveys based on repre-) Tj -11.306 -12.4458 TD -0.0269 Tc 1.9152 Tw (sentative samples of nursing home residents show) Tj ET BT 0.8915 0 0 0.9835 68.16 176.88 Tm 0.0413 Tc 1.2868 Tw (residents with dementia are more likely than nonde-) Tj 0.2692 -12.2018 TD 0.0273 Tc 0.9564 Tw (mented residents to have impairments in activities of) Tj ET BT 0.9835 0 0 0.9835 68.64 153.12 Tm 0.031 Tc 0.034 Tw (daily living and depressive, psychotic, and behav-) Tj ET BT 0.8915 0 0 0.9835 68.88 141.12 Tm 0.0158 Tc 1.3731 Tw (ioral symptoms. At the same time, survey data show) Tj 0.2692 -11.9577 TD 0.0368 Tc 1.0227 Tw (that some nursing home residents with dementia are) Tj ET BT 0.934 0 0 0.9835 68.88 117.6 Tm -0.0316 Tc 1.0208 Tw (not impaired in each of the activities of daily living) Tj 0.257 -12.2018 TD -0.0096 Tc 0.9545 Tw (about which information was obtained, that signifi-) Tj ET BT 0.9835 0 0 0.9835 69.12 93.84 Tm 0.0283 Tc 1.1349 Tw (cant proportions of nursing home residents with) Tj 0.244 -11.9577 TD 0.0428 Tc 3.2758 Tw (dementia do not have depressive or psychotic) Tj ET BT 0.8915 0 0 0.9835 69.84 70.08 Tm 0.0232 Tc 2.0827 Tw (symptoms \(30 percent and 64 percent, respectively\),) Tj ET BT 0.9835 0 0 0.9835 69.84 58.08 Tm 0.0258 Tc 1.2798 Tw (and that more than 40 percent of nursing home) Tj -0.4881 -11.9577 TD 0.0395 Tc 1.4896 Tw (residents with dementia do not have behavioral) Tj ET BT 0.8915 0 0 0.9835 70.08 34.32 Tm 0.0189 Tc 1.1154 Tw (symptoms \(464\). It is also clear from the survey data) Tj ET BT 0.9606 0 0 0.9863 315.6 643.44 Tm /F3 9 Tf -0.004 Tc -0.0007 Tw (that ) Tj ET BT 0.934 0 0 0.9835 333.6 643.44 Tm /F4 10 Tf -0.0368 Tc 1.1635 Tw (although nondemented residents are less likely) Tj ET BT 0.9835 0 0 0.9835 315.84 631.44 Tm 0.0304 Tc 0.5227 Tw (than demented residents to have impairments in) Tj ET BT 0.934 0 0 0.9835 316.08 619.68 Tm -0.0349 Tc 2.1378 Tw (activities of daily living and depressive, psychotic,) Tj 0 -12.4458 TD -0.0221 Tc 0.788 Tw (and behavioral symptoms, significant proportions of) Tj ET BT 0.8915 0 0 0.9835 315.84 595.92 Tm 0.0458 Tc 1.1151 Tw (nondemented residents have each of these character-) Tj 0.2692 -12.2018 TD -0.0051 Tc 0 Tw (istics.) Tj ET BT 0.934 0 0 0.9835 326.88 565.92 Tm -0.0345 Tc 1.5134 Tw (The literature on nursing home care for persons) Tj ET BT 0.8915 0 0 0.9835 316.32 553.92 Tm 0.0332 Tc 0.5652 Tw (with dementia often implies that virtually all nursing) Tj ET BT 0.9835 0 0 0.9835 316.32 541.92 Tm 0.0345 Tc 2.4546 Tw (home residents with dementia have behavioral) Tj ET BT 0.8915 0 0 0.9835 316.8 530.16 Tm 0.023 Tc 1.8137 Tw (symptoms and that behavioral symptoms in nursing) Tj ET BT 0.9835 0 0 0.9835 316.56 518.16 Tm 0.032 Tc 0.6431 Tw (homes are almost always symptoms of demented) Tj ET BT 0.934 0 0 0.9835 316.32 505.92 Tm -0.0193 Tc 1.0077 Tw (residents. The survey data contradict both assump-) Tj ET BT 0.8915 0 0 0.9835 317.04 493.92 Tm -0.0003 Tc 0 Tw (tions.) Tj ET BT 0.9835 0 0 0.9835 328.08 476.4 Tm 0.0208 Tc 2.2407 Tw (Parenthetically, it is interesting to note that) Tj ET BT 0.934 0 0 0.9835 317.52 464.16 Tm -0.0235 Tc 1.783 Tw (sundowning behavior, which is mentioned often in) Tj ET BT 0.8915 0 0 0.9835 317.52 452.16 Tm 0.0548 Tc 1.0939 Tw (the literature on nursing home care for persons with) Tj ET BT 0.934 0 0 0.9835 317.52 440.16 Tm -0.0256 Tc 1.0633 Tw (dementia, was exhibited by only a small proportion) Tj 0 -12.2018 TD -0.0355 Tc 1.7531 Tw (of residents with dementia \(15 percent\) in the one) Tj 0.5139 -12.2018 TD -0.0283 Tc 0.8139 Tw (study OTA is aware of that measured the incidence) Tj -0.257 -12.2018 TD -0.0112 Tc 1.8556 Tw (of this behavior \(132\). Similar findings for several) Tj 0.257 -12.2018 TD -0.0241 Tc 0.5478 Tw (other behavioral symptoms are noted in chapter 4.) Tj 11.82 -18.3027 TD -0.0253 Tc 0.8856 Tw (Behavioral symptoms are often difficult for nurs-) Tj -11.563 -12.4458 TD -0.0099 Tc 0.6015 Tw (ing home staff members to manage. As discussed in) Tj ET BT 0.8915 0 0 0.9835 318.24 349.92 Tm 0.0309 Tc 1.3711 Tw (the following section of this chapter, one of the most) Tj ET BT 0.9835 0 0 0.9835 318.24 338.16 Tm 0.0393 Tc 1.3678 Tw (frequent complaints about the care provided for) Tj 0 -12.2018 TD 0.0214 Tc 1.142 Tw (residents with dementia by most nursing homes) Tj ET BT 0.934 0 0 0.9835 318.72 313.92 Tm -0.0431 Tc 1.3243 Tw (concerns inappropriate staff responses to residents\222) Tj ET BT 0.9835 0 0 0.9835 318.48 302.16 Tm 0.0292 Tc -0.1268 Tw (behavioral symptoms. As a result, one objective of) Tj 0 -12.4458 TD 0.0192 Tc 2.7768 Tw (many special care units is to implement more) Tj ET BT 0.934 0 0 0.9835 318.96 278.16 Tm -0.0381 Tc 1.0279 Tw (effective methods of responding to these symptoms.) Tj ET BT 0.9835 0 0 0.9835 318.96 266.16 Tm 0.0282 Tc -0.0212 Tw (Even if all nursing home residents with dementia) Tj ET BT 0.934 0 0 0.9835 318.96 254.4 Tm -0.0433 Tc 1.0869 Tw (were in special care units, however, a large propor-) Tj 0.257 -12.2018 TD -0.0256 Tc 1.8343 Tw (tion of all nursing home residents with behavioral) Tj ET BT 0.9835 0 0 0.9835 319.68 230.64 Tm 0.0301 Tc 0.1163 Tw (symptoms \(35 to 47 percent according to national) Tj ET BT 0.934 0 0 0.9835 319.68 218.64 Tm -0.026 Tc 1.2107 Tw (survey data\) would still be in nonspecialized units.) Tj ET BT 0.9835 0 0 0.9835 319.44 206.64 Tm 0.0331 Tc 0.3224 Tw (Likewise, if special care units were designated to) Tj ET BT 0.934 0 0 0.9835 319.68 194.16 Tm -0.0237 Tc 2.1773 Tw (serve only residents with behavioral symptoms-an) Tj ET BT 0.8915 0 0 0.9835 319.68 182.16 Tm 0.0214 Tc 1.386 Tw (option that has been suggested\227the units would not) Tj ET BT 0.9835 0 0 0.9835 320.16 170.4 Tm 0.0385 Tc 3.0768 Tw (serve all individuals with dementia who need) Tj ET BT 0.934 0 0 0.9835 319.68 158.88 Tm -0.0177 Tc 0.4492 Tw (nursing home care, because more than 40 percent of) Tj ET BT 0.8915 0 0 0.9835 319.68 146.64 Tm 0.036 Tc 1.0236 Tw (nursing home residents with dementia do not exhibit) Tj ET BT 0.934 0 0 0.9835 319.92 135.12 Tm -0.0057 Tc 1.5927 Tw (behavioral symptoms.) Tj 11.82 -17.8146 TD -0.0301 Tc 1.2517 Tw (These findings point out the diversity of nursing) Tj ET BT 0.9835 0 0 0.9835 320.16 105.6 Tm 0.0342 Tc 2.2271 Tw (home residents with dementia. The typology of) Tj 0.244 -11.7137 TD 0.0326 Tc 0.7412 Tw (nursing home residents based on the GOM tech-) Tj ET BT 0.934 0 0 0.9835 320.4 82.32 Tm -0.0307 Tc 1.1056 Tw (nique identifies four distinct types of nursing home) Tj ET BT 0.9835 0 0 0.9835 320.4 70.32 Tm 0.0345 Tc 3.0403 Tw (residents with dementia-limited impaired resi-) Tj ET BT 0.934 0 0 0.9835 320.64 58.08 Tm -0.0314 Tc 1.1577 Tw (dents, behavioral problem residents, dementia resi-) Tj ET BT 0.8915 0 0 0.9835 320.88 46.32 Tm 0.0341 Tc 1.9358 Tw (dents, and severely impaired residents. Special care) Tj ET BT 0.9835 0 0 0.9835 320.88 34.32 Tm 0.0403 Tc 0.655 Tw (units may be more appropriate for some of these) Tj ET endstream endobj 212 0 obj <>/Rotate 0/Type/Page>> endobj 213 0 obj <>stream 0.72 w 1 j 0 0 0 RG 69.12 684 m 547.92 684 l S BT 0.9863 0 0 0.9863 69.84 690.24 Tm 0 0 0 rg /F3 9 Tf 0.0459 Tc 0.0053 Tw (70 . ) Tj ET BT 0.9835 0 0 0.9835 87.6 690.24 Tm /F5 10 Tf 0.0125 Tc 1.2007 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 69.6 650.16 Tm /F4 10 Tf 0.0269 Tc 1.2597 Tw (types than others. As discussed in chapter 3, current) Tj ET BT 0.9835 0 0 0.9835 69.36 638.4 Tm 0.0332 Tc 0.6012 Tw (residents of special care units are somewhat less) Tj ET BT 0.8915 0 0 0.9835 69.36 626.16 Tm 0.0327 Tc 1.7579 Tw (physically impaired than residents with dementia in) Tj ET BT 0.9835 0 0 0.9835 69.84 614.4 Tm 0.0253 Tc 1.5854 Tw (nonspecialized nursing home units. Special care) Tj 0 -12.4458 TD 0.0389 Tc 0.1345 Tw (units may be shown to be more effective for these) Tj ET BT 0.8915 0 0 0.9835 69.84 590.4 Tm 0.0289 Tc 1.8968 Tw (less physically impaired residents than for individu-) Tj ET BT 0.9835 0 0 0.9835 70.32 578.4 Tm 0.0281 Tc 0.188 Tw (als with dementia who have many medical condi-) Tj -0.244 -12.2018 TD 0.0278 Tc 3.047 Tw (tions and physical impairments in addition to) Tj ET BT 0.8915 0 0 0.9835 70.32 554.4 Tm 0.0171 Tc 0 Tw (dementia.) Tj ET BT 0.9939 0 0 0.9939 96.48 532.56 Tm /F6 14 Tf 0.0323 Tc 0.4908 Tw (PROBLEMS IN THE CARE) Tj -25.1139 -15.6962 TD 0.0126 Tc 0.5911 Tw (PROVIDED FOR NURSING HOME) Tj 11.1081 -16.1791 TD 0.0449 Tc 0.0757 Tw (RESIDENTS WITH DEMENTIA) Tj ET BT 0.8915 0 0 0.9835 81.84 483.12 Tm /F4 10 Tf 0.0444 Tc 1.0526 Tw (Problems in the care provided for individuals with) Tj ET BT 0.934 0 0 0.9835 70.8 471.12 Tm -0.0083 Tc 1.7055 Tw (dementia in many nursing homes are the primary) Tj ET BT 0.9835 0 0 0.9835 70.8 459.12 Tm 0.0505 Tc 1.9258 Tw (reason for the development and proliferation of) Tj 0.4881 -11.9577 TD 0.0158 Tc 1.5951 Tw (special care units.) Tj 94.4418 -0.244 TD 0.0242 Tc 2.2373 Tw (This section discusses these) Tj ET BT 0.8915 0 0 0.9835 71.04 435.36 Tm 0.0308 Tc 1.4909 Tw (problems and their impact on residents with demen-) Tj ET BT 0.934 0 0 0.9835 71.28 423.36 Tm -0.0111 Tc 0.4239 Tw (tia, their families, nursing home staff members who) Tj 0 -11.9577 TD -0.0199 Tc 1.2041 Tw (take care of them, and nondemented nursing home) Tj ET BT 0.8915 0 0 0.9835 71.04 399.84 Tm 0.0096 Tc 0 Tw (residents.) Tj ET BT 0.9795 0 0 0.9795 80.4 379.68 Tm /F7 12 Tf 0.051 Tc 0.818 Tw (Complaints and Concerns About the Care) Tj -1.9603 -14.2118 TD 0.047 Tc 0.6261 Tw (Provided for Individuals With Dementia in) Tj 52.1918 -14.7019 TD 0.02 Tc 1.5113 Tw (Many Nursing Homes) Tj ET BT 0.8875 0 0 0.9795 82.8 333.84 Tm 0.0421 Tc -0.0746 Tw (The ) Tj ET BT 0.8915 0 0 0.9835 103.44 333.84 Tm /F4 10 Tf 0.0558 Tc 1.4628 Tw (literature on nursing home care for individu-) Tj ET BT 0.9835 0 0 0.9835 72 321.84 Tm 0.0194 Tc 0.3712 Tw (als with dementia contains numerous complaints) Tj 0 -12.2018 TD 0.0409 Tc 1.9181 Tw (and concerns about the care provided for these) Tj ET BT 0.934 0 0 0.9835 72 297.84 Tm -0.0005 Tc 1.1466 Tw (individuals in many nursing homes. Table 2-5 lists) Tj 0 -11.9577 TD -0.0285 Tc 1.4887 Tw (the most frequently cited complaints and concerns.) Tj 0.7709 -12.4458 TD -0.0107 Tc 0.4674 Tw (\(An identical list appears in table 1-1 in ch. 1.\) This) Tj ET BT 0.9835 0 0 0.9835 72.48 261.84 Tm 0.0273 Tc 0.3021 Tw (list was derived from OTA\222s review of 30 articles,) Tj ET BT 0.8915 0 0 0.9835 72 250.08 Tm 0.0506 Tc 1.3005 Tw (reports, and books on nursing home care for persons) Tj ET BT 0.9835 0 0 0.9835 72.48 237.84 Tm 0.016 Tc 0.2934 Tw (with dementia \(48,55,59,67,107,1 15,125,162,163,) Tj ET BT 0.934 0 0 0.9835 73.68 225.6 Tm 0.0785 Tc 0 Tw (165,170,171,182,191,241,243,263,274,339,346,352,) Tj ET BT 0.9835 0 0 0.9835 72.96 213.6 Tm 0.0137 Tc 0.6211 Tw (354,359,364,370,385,386,393,414,446\). The inclu-) Tj 0 -12.4458 TD 0.0402 Tc -0.0649 Tw (sion of items in table 2-5 does not imply that data) Tj -0.244 -12.2018 TD 0.0301 Tc 1.0924 Tw (necessarily exist to prove the items are true but) Tj ET BT 0.8915 0 0 0.9835 72.72 177.6 Tm 0.0307 Tc 1.3116 Tw (rather that the items are aspects of what is believed) Tj ET BT 0.934 0 0 0.9835 73.2 165.36 Tm -0.0576 Tc 1.4769 Tw (to be wrong with the care provided for people with) Tj ET BT 0.8915 0 0 0.9835 73.2 153.36 Tm 0.0395 Tc 1.3273 Tw (dementia in most nursing homes and therefore what) Tj ET BT 0.934 0 0 0.9835 73.44 141.6 Tm -0.0352 Tc 0.9635 Tw (should be done differently in special care units.) Tj ET BT 0.9835 0 0 0.9835 84.48 123.84 Tm 0.0316 Tc 0.9514 Tw (Some of the complaints and concerns listed in) Tj ET BT 0.934 0 0 0.9835 73.44 112.08 Tm -0.0209 Tc 0.6913 Tw (table 2-5 apply primarily to nursing home residents) Tj ET BT 0.9835 0 0 0.9835 73.44 100.08 Tm 0.0052 Tc 0.7517 Tw (with dementia, e.g.,) Tj ET BT 0.934 0 0 0.9835 171.12 99.84 Tm -0.019 Tc 2.3778 Tw (the complaint that dementia) Tj ET BT 0.9835 0 0 0.9835 73.44 88.32 Tm 0.0348 Tc 0.2161 Tw (often is not carefully or accurately diagnosed and) Tj ET BT 0.934 0 0 0.9835 73.92 76.08 Tm -0.0281 Tc 0.5521 Tw (sometimes is not diagnosed at all. Other complaints) Tj -0.257 -11.9577 TD -0.0232 Tc 0.5194 Tw (and concerns listed in table 2-5 would apply equally) Tj ET BT 0.8915 0 0 0.9835 73.68 52.56 Tm 0.0343 Tc 1.0255 Tw (to nondemented residents if the explicit references to) Tj ET BT 0.934 0 0 0.9835 73.44 40.56 Tm -0.0451 Tc 1.6349 Tw (dementia were omitted. To determine which of the) Tj ET BT 0.9835 0 0 0.9835 320.64 650.16 Tm 0.0285 Tc 2.3142 Tw (frequently cited complaints and concerns about) Tj ET BT 0.8915 0 0 0.9835 321.12 638.16 Tm 0.0515 Tc 1.0831 Tw (nursing home care for individuals with dementia are) Tj 0 -12.2018 TD 0.0551 Tc 0.2792 Tw (the same as the problems in nursing home care for all) Tj ET BT 0.934 0 0 0.9835 320.88 613.92 Tm -0.0323 Tc 2.3064 Tw (residents, OTA compared the complaints and con-) Tj ET BT 0.8915 0 0 0.9835 321.36 601.92 Tm 0.0325 Tc 1.3207 Tw (cerns listed in table 2-5 with the problems identified) Tj ET BT 0.934 0 0 0.9835 321.12 589.92 Tm -0.025 Tc 1.7235 Tw (by the Institute of Medicine\222s Committee on Nurs-) Tj ET BT 0.9835 0 0 0.9835 321.36 578.16 Tm 0.0254 Tc 0.0165 Tw (ing Home Regulation in its landmark 1986 report) Tj ET BT 0.9812 0 0 0.9812 320.88 566.16 Tm /F5 11 Tf 0.0725 Tc 1.6821 Tw (Improving the Quality of Care in Nursing Homes) Tj ET BT 0.9443 0 0 0.9812 321.84 554.16 Tm 0.0119 Tc 0.4129 Tw (\(318\). The ) Tj ET BT 0.934 0 0 0.9835 369.36 554.16 Tm /F4 10 Tf -0.0492 Tc 2.9883 Tw (Institute of Medicine\222s report identified) Tj ET BT 0.9835 0 0 0.9835 321.6 542.4 Tm 0.0316 Tc 1.6486 Tw (many problems with the care provided by some) Tj ET BT 0.8915 0 0 0.9835 321.6 530.4 Tm 0.0417 Tc 3.0938 Tw (nursing homes:) Tj ET BT 0.8632 0 0 0.9598 333.36 513.12 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0 -12.7521 TD -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 333.36 488.64 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 333.6 452.4 Tm -0.0185 Tc (l) Tj 0.278 -25.2542 TD -0.0185 Tc (l) Tj 0 -25.2542 TD -0.0185 Tc (l) Tj 0.278 -37.7563 TD -0.0185 Tc (l) Tj 0.5561 -50.2583 TD -0.0185 Tc (l) Tj 0.278 -38.0063 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 334.8 258.72 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 334.8 246 Tm -0.0185 Tc (l) Tj 0.278 -13.0022 TD -0.0185 Tc (l) Tj 0 -13.2522 TD -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 335.52 196.56 Tm 0.0203 Tc (l) Tj ET BT 0.9863 0 0 0.9863 324.24 165.36 Tm /F3 9 Tf 0.2603 Tc (The) Tj ET BT 0.8915 0 0 0.9835 343.44 512.16 Tm /F4 10 Tf 0.0206 Tc 2.4445 Tw (insufficient attention to residents\222 rights;) Tj ET BT 0.934 0 0 0.9835 343.2 499.92 Tm -0.012 Tc 0.8286 Tw (physical abuse and neglect;) Tj ET BT 0.8915 0 0 0.9835 343.44 487.44 Tm 0.0556 Tc 1.4092 Tw (inadequate medical and nursing care, including) Tj ET BT 0.934 0 0 0.9835 343.92 475.68 Tm -0.0278 Tc 1.3594 Tw (failure to identify and treat acute and chronic) Tj 0.257 -12.4458 TD -0.0326 Tc 1.2361 Tw (diseases and conditions;) Tj ET BT 0.8915 0 0 0.9835 343.92 451.2 Tm 0.0277 Tc 2.0866 Tw (lack of well-trained, motivated, and adequately) Tj 0.8076 -12.2018 TD -0.0096 Tc 3.6897 Tw (supervised staff;) Tj ET BT 0.9835 0 0 0.9835 343.92 427.2 Tm 0.0318 Tc 0.8467 Tw (insufficient attention to residents\222 quality of) Tj ET BT 0.934 0 0 0.9835 344.4 415.2 Tm -0.0409 Tc 0 Tw (life;) Tj -0.257 -12.6899 TD -0.0354 Tc 0.927 Tw (lack of choices for residents, e.g., choices about) Tj ET BT 0.8915 0 0 0.9835 344.88 390.72 Tm 0.03 Tc 0.886 Tw (when and what they eat, whom they room with,) Tj ET BT 0.934 0 0 0.9835 344.88 378.72 Tm -0.0213 Tc 0.71 Tw (and when they go to bed and get up;) Tj ET BT 0.9835 0 0 0.9835 344.88 366.48 Tm 0.0402 Tc 0.6348 Tw (failure to notify residents about and involve) Tj 0 -12.4458 TD 0.0304 Tc 0.116 Tw (them in decisions about their care and about) Tj 0.244 -11.9577 TD 0.0429 Tc 1.5675 Tw (aspects of the operation of the facility that) Tj ET BT 0.934 0 0 0.9835 345.36 330.24 Tm -0.0265 Tc 0.555 Tw (affect their care and the quality of their lives;) Tj -0.5139 -12.4458 TD -0.0232 Tc 2.0397 Tw (failure to notify residents\222 families about and) Tj 0.257 -12.2018 TD -0.0325 Tc 1.5357 Tw (involve them in decisions about the residents\222) Tj ET BT 0.8915 0 0 0.9835 345.12 294.24 Tm 0.0758 Tc 0 Tw (care;) Tj ET BT 0.934 0 0 0.9835 345.12 282 Tm -0.0369 Tc 0.8981 Tw (lack of psychiatric treatment for residents who) Tj ET BT 0.8915 0 0 0.9835 345.36 269.76 Tm 0.0108 Tc 1.2441 Tw (need it;) Tj ET BT 0.934 0 0 0.9835 345.12 257.52 Tm -0.0338 Tc 1.5713 Tw (overuse and misuse of psychotropic drugs;) Tj 0 -12.9339 TD -0.0234 Tc 0.5838 Tw (overuse and misuse of physical restraints;) Tj 0 -12.4458 TD -0.0316 Tc 0.9009 Tw (failure to create a home-like environment;) Tj ET BT 0.9835 0 0 0.9835 345.12 219.84 Tm 0.0304 Tc 2.5563 Tw (lack of adequate and comfortable lighting,) Tj ET BT 0.934 0 0 0.9835 346.08 207.84 Tm -0.0275 Tc 0.6396 Tw (sound levels, and room temperature; and) Tj -0.7709 -12.4458 TD -0.0288 Tc 2.0028 Tw (lack of interaction between the nursing home) Tj 1.0278 -12.4458 TD 0.0144 Tc 0.8003 Tw (and the community \(318\).) Tj -1.5417 -18.3027 TD -0.0327 Tc 1.6215 Tw (Institute of Medicine\222s report emphasized that) Tj ET BT 0.9835 0 0 0.9835 324.24 153.6 Tm 0.0255 Tc 0.8531 Tw (these problems exist in some but not all nursing) Tj ET BT 0.934 0 0 0.9835 324.24 141.6 Tm -0.0167 Tc 1.3475 Tw (homes and that some nursing homes provide high-) Tj 0 -11.9577 TD 0.0136 Tc 0.9296 Tw (quality care \(318\).) Tj 12.0769 -18.5467 TD -0.0401 Tc 2.0578 Tw (Clearly there are similarities between the prob-) Tj -11.563 -11.7137 TD -0.0404 Tc 1.3407 Tw (lems cited in the Institute of Medicine\222s report and) Tj ET BT 0.9835 0 0 0.9835 324.72 88.08 Tm 0.0283 Tc 1.4777 Tw (the concerns and complaints listed in table 2-5.) Tj 0 -11.9577 TD 0.5164 Tc 3.5264 Tw (There are also some notable differences\227) Tj ET BT 0.934 0 0 0.9835 324.24 64.08 Tm -0.0303 Tc 0.5912 Tw (particularly in the emphasis placed on certain types) Tj 0.5139 -11.9577 TD -0.0445 Tc 1.3451 Tw (of problems. One of these differences is the greater) Tj 0 -11.9577 TD -0.0262 Tc 0.6189 Tw (emphasis in the literature on nursing home care for) Tj ET endstream endobj 214 0 obj <>/Rotate 0/Type/Page>> endobj 215 0 obj <>stream 0.72 w 1 j 0 0 0 RG 56.16 676.32 m 533.76 676.32 l S 0.96 w 64.8 654.96 m 532.8 654.96 l S 0.72 w 537.12 655.92 m 537.12 139.44 l S 59.76 654.72 m 59.76 138.96 l S 66 139.44 m 534 139.44 l S BT 0.9835 0 0 0.9835 171.36 681.36 Tm 0 0 0 rg /F5 10 Tf 0.0205 Tc 1.6507 Tw (Chapter 2-Nursing Home Residents With Dementia: Characteristics and Problems . 71) Tj ET BT 0.8875 0 0 0.9795 103.68 630.72 Tm /F7 12 Tf -0.0055 Tc 1.6013 Tw (Table 2-5\227Frequently Cited Complaints and Concerns About the Care Provided for) Tj 111.1371 -12.0066 TD -0.0014 Tc 1.7996 Tw (Nursing Home Residents With Dementia) Tj -127.6319 -19.1125 TD 0.02 Tc 0.3107 Tw (\215 Dementia in ) Tj ET BT 0.9018 0 0 0.9835 153.84 600.24 Tm /F6 10 Tf 0.0419 Tc 0.0753 Tw (nursing home residents often is not carefully ) Tj ET BT 0.8915 0 0 0.9835 329.76 600.24 Tm /F4 10 Tf 0.0405 Tc 0.7172 Tw (or accurately diagnosed and sometimes is not) Tj ET BT 0.8066 0 0 0.9835 98.88 587.52 Tm 0.0451 Tc 1.9228 Tw (diagnosed at all.) Tj ET BT 0.8491 0 0 0.9835 89.28 574.08 Tm 0.0222 Tc 0.4555 Tw (\215 Acute and chronic illesses, depression, and sensory impairments that can ) Tj ET BT 0.8646 0 0 0.9863 393.12 574.08 Tm /F3 9 Tf 0.0139 Tc -0.0212 Tw (exacerbate ) Tj ET BT 0.8491 0 0 0.9835 436.56 574.08 Tm /F4 10 Tf 0.0163 Tc 1.7216 Tw (cognitive impairment) Tj ET BT 0.8066 0 0 0.9835 99.12 562.32 Tm 0.0484 Tc 1.5618 Tw (in an individual with dementia frequently are not diagnosed or treated.) Tj -11.9011 -15.6183 TD 0.0607 Tc 1.2258 Tw (. There is a pervasive sense of nihilism about nursing home residents with dementia; that is, a general feeling) Tj 12.1987 -10.9816 TD 0.0562 Tc 1.5201 Tw (among nursing home administrators and staff that nothing can be done for these residents.) Tj ET BT 0.8915 0 0 0.9835 89.76 522.24 Tm 0.0305 Tc 1.0201 Tw (\215 Nursing home staff members) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9018 0 0 0.9835 225.6 522.24 Tm /F6 10 Tf 0.039 Tc 0.9683 Tw (frequently are not knowledgeable about dementia) Tj 0 Tc -0.1063 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 426.24 522.24 Tm /F4 10 Tf 0.0252 Tc 1.4971 Tw (or effective methods of) Tj ET BT 0.8491 0 0 0.9835 99.6 510 Tm 0.0429 Tc 1.4453 Tw (caring for residents with dementia. They generally are not aware of effective methods of responding to) Tj ET BT 0.8066 0 0 0.9835 99.6 499.44 Tm 0.053 Tc 2.2106 Tw (behavioral symptoms in residents with dementia.) Tj ET BT 0.8915 0 0 0.9835 90 484.56 Tm 0.0415 Tc 0.0656 Tw (\215 Psychotropic medications are used inappropriately for residents with dementia, particularly to control) Tj ET BT 0.8491 0 0 0.9835 99.6 473.52 Tm 0.0078 Tc 1.7315 Tw (behavioral symptoms.) Tj -11.0235 -15.3742 TD 0.0342 Tc 0.5264 Tw (. Physical restraints are used inappropriately for residents with dementia, particularly to control behavioral) Tj ET BT 0.8066 0 0 0.9835 100.8 447.6 Tm 0.2795 Tc 0 Tw (symptoms.) Tj ET BT 0.8491 0 0 0.9835 90.48 432.96 Tm 0.0305 Tc 1.3224 Tw (\215 The basic needs of residents with dementia, e.g., hunger, thirst, and pain relief, sometimes are not met) Tj 11.3061 -10.9816 TD 0.0306 Tc 0.1703 Tw (because the individuals cannot identify or communicate their needs, and nursing home staff members may) Tj ET BT 0.8066 0 0 0.9835 100.08 411.12 Tm 0.0454 Tc 1.3274 Tw (not anticipate the needs.) Tj ET BT 0.8491 0 0 0.9835 90.48 396.72 Tm 0.0254 Tc 0.6509 Tw (\215 The level of stimulation and noise in many nursing homes is confusing for residents with dementia.) Tj ET BT 0.8632 0 0 0.9598 90.72 380.88 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 96 380.88 Tm /F4 10 Tf 0.0296 Tc 0.6622 Tw (Nursing homes generally do not provide activities that are appropriate for residents with dementia) Tj ET BT 0.8915 0 0 0.9835 90.72 367.2 Tm 0.0451 Tc 0.314 Tw (\215 Nursing homes generally do not provide enough exercise and physical movement to meet the needs of) Tj ET BT 0.8066 0 0 0.9835 100.8 354.72 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj ET BT 0.8632 0 0 0.9598 90.96 341.04 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 96.48 341.04 Tm /F4 10 Tf 0.0267 Tc 1.2382 Tw (Nursing homes do not) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9018 0 0 0.9835 190.08 341.04 Tm /F6 10 Tf 0.0391 Tc -0.1497 Tw (provide enough continuity in staff and ) Tj ET BT 0.8491 0 0 0.9835 339.6 341.04 Tm /F4 10 Tf 0.0281 Tc 1.5461 Tw (daily routines to meet the needs of residents) Tj ET BT 0.8066 0 0 0.9835 101.28 328.8 Tm 0.0345 Tc 2.531 Tw (with dementia.) Tj ET BT 0.9207 0 0 0.9598 91.2 315.36 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.9018 0 0 0.9835 96.96 315.36 Tm /F6 10 Tf 0.0332 Tc 0.744 Tw (Nursing home staff members do not have enough time or flexibility to ) Tj ET BT 0.8915 0 0 0.9835 377.76 315.36 Tm /F4 10 Tf 0.0277 Tc 1.5482 Tw (respond to the individual needs of) Tj ET BT 0.8066 0 0 0.9835 101.04 303.36 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj ET BT 0.8056 0 0 0.9598 91.44 288 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8066 0 0 0.9835 96.72 288 Tm /F4 10 Tf 0.0477 Tc 1.8968 Tw (Nursing home staff members encourage dependency in residents with dementia by performing personal care) Tj 5.9506 -11.2256 TD 0.0554 Tc 1.408 Tw (functions, such as bathing and dressing, for them instead of allowing and assisting the residents to perform) Tj 0 -10.9816 TD 0.0621 Tc 3.092 Tw (these functions themselves.) Tj ET BT 0.8915 0 0 0.9835 91.68 251.04 Tm 0.0379 Tc 0.3882 Tw (\215 The physical environment of most nursing homes is too \223institutional\222 and not \223home-like\224 enough for) Tj ET BT 0.8066 0 0 0.9835 101.52 240 Tm 0.0443 Tc 2.0726 Tw (residents with dementia.) Tj ET BT 0.8491 0 0 0.9835 91.92 225.12 Tm 0.0249 Tc 0.9504 Tw (. Most nursing homes do not provide cues to help residents find their way.) Tj 0.2827 -15.3742 TD 0.0258 Tc 0.8625 Tw (. Most nursing homes do not provide appropriate space for residents to wander.) Tj ET BT 0.8915 0 0 0.9835 92.16 195.12 Tm 0.0267 Tc 1.4954 Tw (\215 Most nursing homes do not make use of design features that could support residents\222 independent) Tj ET BT 0.8066 0 0 0.9835 102.24 184.08 Tm 0.0541 Tc 0 Tw (functioning.) Tj ET BT 0.8632 0 0 0.9598 92.4 169.44 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 97.92 169.44 Tm /F4 10 Tf 0.0285 Tc 0.6775 Tw (The needs of families of residents with dementia are not met in many nursing homes.) Tj ET BT 0.8915 0 0 0.9835 72.48 151.68 Tm -0.0063 Tc -0.0827 Tw (SOURCE ) Tj ET q 18.72 0 0 -5.76 114.96 157.44 cm BI /W 114 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID D@ ???~q~{??>;? _? ??~~_?~???@~?>~@~?_Bc~~?~"~???~????F??/0~@~~F  EI Q BT 0.5519 0 0 0.9835 114.96 151.68 Tm 3 Tr 0.047 Tc 0 Tw (OKleG) Tj 0 Tr ET BT 0.8915 0 0 0.9835 133.68 151.68 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 6.24 0 0 -5.76 136.08 157.44 cm BI /W 39 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0 @??~~~~~~~~~~~~~~~~?~?~?~~>> EI Q BT 0.5094 0 0 0.9835 136.08 151.68 Tm 3 Tr 0.0947 Tc 0 Tw (Of) Tj 0 Tr ET BT 0.8919 0 0 0.9835 142.32 151.68 Tm /F2 10 Tf 0 Tc -0.0798 Tw ( ) Tj ET q 33.84 0 0 -7.2 144.48 157.44 cm BI /W 205 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?|8"@ |x0~?<#1db??x??????????~??????>?~??>>?G?/~~?>??||>?>π?~?~??~?~??/~~?~???~?>??~?~G??|>??>?~??~???~??????'~?~????~3`N EI Q BT 0.6572 0 0 0.9835 144.48 151.68 Tm 3 Tr 0.0782 Tc 0 Tw (\221Jk@nology) Tj 0 Tr ET BT 0.8919 0 0 0.9835 178.32 151.68 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 36.24 0 0 -7.2 180.48 157.44 cm BI /W 219 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  D@" ;?1@~`p|?????>???>|>?<?|<|~<|8<~88?>0? A2 >>?  >~ ?~?~?~???~?&|>.~x>|>zσx?>~???~0x8 EI Q BT 0.7511 0 0 0.9835 180.48 151.68 Tm 3 Tr 0.0048 Tc 0 Tw (Assessment) Tj 0 Tr ET BT 0.8648 0 0 0.99 216.72 151.68 Tm /F3 8 Tf -0.0065 Tc 0.8364 Tw ( 1992.) Tj ET BT 0.8915 0 0 0.9835 60.72 110.64 Tm /F4 10 Tf 0.0272 Tc 1.4949 Tw (individuals with dementia on aspects of the physical) Tj ET BT 0.9835 0 0 0.9835 311.52 111.36 Tm 0.0324 Tc 1.6392 Tw (independent functioning in cognitively impaired) Tj -254.7732 -13.91 TD 0.0237 Tc 0.1228 Tw (environment of most nursing homes that are per-) Tj ET BT 0.8915 0 0 0.9835 311.76 99.36 Tm 0.0202 Tc 0 Tw (individuals.) Tj ET BT 0.9835 0 0 0.9835 60.96 84.72 Tm 0.0442 Tc 1.2001 Tw (ceived to be inappropriate for these individuals.) Tj ET BT 0.934 0 0 0.9835 322.56 81.12 Tm -0.0529 Tc 2.5426 Tw (A second difference between the problems cited) Tj ET BT 0.9835 0 0 0.9835 60.72 72 Tm 0.0348 Tc 2.5213 Tw (These aspects include the lack of cues to help) Tj ET BT 0.934 0 0 0.9835 311.76 69.36 Tm -0.0336 Tc 0.815 Tw (in the Institute of Medicine\222s report and complaints) Tj ET BT 0.9835 0 0 0.9835 60.48 59.04 Tm 0.0357 Tc 1.0867 Tw (residents find their way, the lack of appropriate) Tj 255.7494 -1.7082 TD 0.0337 Tc 2.4615 Tw (and concerns listed in table 2-5 is the greater) Tj -255.0173 -11.7137 TD 0.0405 Tc 0.8073 Tw (space for residents to wander, and the failure to) Tj ET BT 0.934 0 0 0.9835 311.76 45.36 Tm -0.0262 Tc 0.6189 Tw (emphasis in the literature on nursing home care for) Tj ET BT 0.8915 0 0 0.9835 61.2 33.12 Tm 0.0358 Tc 1.7993 Tw (incorporate other design features that could support) Tj 280.7697 0.4881 TD 0.0342 Tc 1.9357 Tw (persons with dementia on behavioral symptoms and) Tj ET endstream endobj 216 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 217 0 obj <>stream 0.48 w 1 j 0 0 0 RG 77.76 687.12 m 556.32 687.12 l S BT 0.9863 0 0 0.9863 78.24 693.36 Tm 0 0 0 rg /F3 9 Tf 0.1038 Tc -0.175 Tw (72 ) Tj ET BT 0.9598 0 0 0.9598 90.96 693.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 97.2 693.36 Tm /F5 11 Tf 0.0882 Tc -0.151 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 132.96 693.36 Tm /F5 10 Tf 0.0128 Tc 0.6886 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 78.48 653.76 Tm /F4 10 Tf 0.0142 Tc 1.3172 Tw (staff responses to these symptoms that are perceived) Tj 0 -12.2018 TD 0.0261 Tc 1.1597 Tw (to be inappropriate for the residents. As discussed in) Tj ET BT 0.9835 0 0 0.9835 78.24 629.76 Tm 0.0232 Tc -0.1207 Tw (the previous section, nursing home residents with) Tj 0.244 -12.2018 TD 0.0324 Tc 0.602 Tw (dementia are more likely than other residents to) Tj 0 -12.2018 TD 0.0231 Tc 1.3843 Tw (exhibit behavioral symptoms. Critics of the care) Tj T* 0.037 Tc 1.7361 Tw (provided for individuals with dementia by most) Tj T* 0.0181 Tc 1.8367 Tw (nursing homes contend that nursing home staff) Tj T* 0.2747 Tc 3.7111 Tw (members often use inappropriate methods\227) Tj ET BT 0.934 0 0 0.9835 78.48 558 Tm -0.0309 Tc 2.4548 Tw (particularly psychotropic medications and physical) Tj ET BT 0.9835 0 0 0.9835 78.72 546 Tm 0.0257 Tc 0.6088 Tw (restraints-to manage residents\222 behavioral symp-) Tj ET BT 0.8915 0 0 0.9835 79.2 533.76 Tm 0.0254 Tc 1.2875 Tw (toms and that staff members are not aware of other,) Tj ET BT 0.9835 0 0 0.9835 79.2 522 Tm 0.0476 Tc 2.9456 Tw (more effective methods of responding to these) Tj ET BT 0.934 0 0 0.9835 79.92 510 Tm 0.0514 Tc 5.6429 Tw (symptoms \(109,171,191,277,359\).) Tj 11.563 -18.3027 TD -0.0255 Tc 1.357 Tw (Both the Institute of Medicine\222s 1986 report and) Tj ET BT 0.8915 0 0 0.9835 79.68 479.76 Tm 0.0548 Tc 1.1275 Tw (the literature on nursing home care for persons with) Tj ET BT 0.934 0 0 0.9835 79.68 467.76 Tm -0.0242 Tc 0.6168 Tw (dementia cite the lack of adequately trained staff in) Tj ET BT 0.9835 0 0 0.9835 79.68 456 Tm 0.0165 Tc 0.5368 Tw (many nursing homes. The Institute of Medicine\222s) Tj ET BT 0.8915 0 0 0.9835 79.44 444 Tm 0.0561 Tc 0.7896 Tw (report focuses on lack of training in general, whereas) Tj 0.5384 -12.2018 TD 0.0548 Tc 1.0939 Tw (the literature on nursing home care for persons with) Tj ET BT 0.9835 0 0 0.9835 80.16 420 Tm 0.0286 Tc 1.3786 Tw (dementia focuses specifically on lack of training) Tj ET BT 0.934 0 0 0.9835 80.4 408.24 Tm -0.0242 Tc 0.7315 Tw (about the care of residents with dementia. Training) Tj ET BT 0.9835 0 0 0.9835 80.4 396.24 Tm 0.0279 Tc 2.3149 Tw (about the care of nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 80.4 384.24 Tm 0.0488 Tc 0.3042 Tw (dementia is clearly a subset of training about the care) Tj ET BT 0.9835 0 0 0.9835 80.64 372.48 Tm 0.029 Tc 1.8562 Tw (of all kinds of nursing home residents, but one) Tj ET BT 0.8915 0 0 0.9835 80.4 360.48 Tm 0.0419 Tc 1.2429 Tw (rationale for establishing special care units is that it) Tj ET BT 0.9835 0 0 0.9835 80.88 348.48 Tm 0.0442 Tc 0.9735 Tw (is easier to develop and maintain an adequately) Tj ET BT 0.934 0 0 0.9835 80.88 336.48 Tm -0.0214 Tc 0.8386 Tw (trained staff when the focus of training is dementia) Tj 0.5139 -11.9577 TD -0.0263 Tc 0.9723 Tw (and the care of residents with dementia than when) Tj -0.257 -12.2018 TD 0.0072 Tc 0.5144 Tw (the focus of training is much broader \(263,270,354\).) Tj ET BT 0.9835 0 0 0.9835 92.16 294.72 Tm 0.0413 Tc 0.3141 Tw (Both the Institute of Medicine\222s report and the) Tj -10.9816 -12.4458 TD 0.0241 Tc 0.6801 Tw (literature on nursing home care for persons with) Tj ET BT 0.8915 0 0 0.9835 81.36 270.48 Tm 0.038 Tc 1.9314 Tw (dementia also cite inappropriate use of psychotropic) Tj 0 -11.9577 TD 0.0254 Tc 1.9456 Tw (medications and physical restraints. As discussed in) Tj ET BT 0.934 0 0 0.9835 81.36 246.48 Tm -0.0403 Tc 1.7398 Tw (the following section, these two problems affect all) Tj ET BT 0.8915 0 0 0.9835 81.36 234.72 Tm 0.0461 Tc 0.7814 Tw (nursing home residents to some degree, but available) Tj 0 -12.2018 TD 0.0337 Tc 2.3491 Tw (data indicate psychotropic medications and physical) Tj 0 -12.4458 TD 0.0456 Tc 1.4743 Tw (restraints are used more for nursing home residents) Tj 0.5384 -12.2018 TD 0.0285 Tc 1.3857 Tw (with dementia than for other residents.) Tj ET BT 0.9795 0 0 0.9795 114.96 170.4 Tm /F7 12 Tf 0.0523 Tc 0.294 Tw (Use of Psychotropic Medications) Tj 22.5429 -14.7019 TD 0.0474 Tc 0.8707 Tw (and Physical Restraints) Tj ET BT 0.934 0 0 0.9835 93.36 138.48 Tm /F4 10 Tf -0.0298 Tc 1.2973 Tw (Psychotropic medications and physical restraints) Tj ET BT 0.8915 0 0 0.9835 82.56 126.72 Tm 0.0558 Tc 1.2273 Tw (are used extensively in nursing homes and are more) Tj ET BT 0.9835 0 0 0.9835 82.08 114.72 Tm 0.03 Tc 0.3909 Tw (likely to be used for nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 82.32 102.48 Tm 0.0242 Tc 2.1712 Tw (dementia than for nondemented residents. As noted) Tj ET BT 0.9835 0 0 0.9835 82.56 90.72 Tm 0.0439 Tc 3.0306 Tw (at the beg) Tj 52.9557 0 TD 0.0258 Tc 3.0979 Tw (inning of this chapter, overuse and) Tj ET BT 0.934 0 0 0.9835 82.08 78.96 Tm -0.0402 Tc 2.4005 Tw (inappropriate use of psychotropic medications and) Tj ET BT 0.9835 0 0 0.9835 81.84 66.96 Tm 0.0179 Tc 1.3895 Tw (physical restraints are major problems in them-) Tj ET BT 0.934 0 0 0.9835 82.56 54.96 Tm -0.0376 Tc 1.2735 Tw (selves. They are also perceived by special care unit) Tj ET BT 0.8915 0 0 0.9835 82.32 42.96 Tm 0.031 Tc 1.183 Tw (advocates and others as manifestations of the failure) Tj ET BT 0.9835 0 0 0.9835 329.28 653.28 Tm 0.03 Tc 1.0925 Tw (of many nursing homes to use more appropriate) Tj 0 -12.4458 TD 0.0397 Tc 2.7421 Tw (methods of responding to residents\222 behavioral) Tj ET BT 0.8915 0 0 0.9835 329.76 629.04 Tm 0.2039 Tc 0 Tw (symptoms.) Tj ET BT 0.9835 0 0 0.9835 329.76 605.04 Tm 0.0304 Tc 1.5802 Tw (Use of Psychotropic Medications) Tj ET BT 0.934 0 0 0.9835 340.8 587.04 Tm -0.0172 Tc 0.4487 Tw (Various studies have shown that 35 to 65 percent) Tj -11.563 -11.9577 TD -0.0347 Tc 1.22 Tw (of all nursing home residents are prescribed and/or) Tj ET BT 0.8915 0 0 0.9835 329.76 563.52 Tm 0.0448 Tc 1.9238 Tw (receive at least one psychotropic medication, includ-) Tj ET BT 0.934 0 0 0.9835 330.48 551.28 Tm -0.0115 Tc 1.92 Tw (ing antipsychotic, antidepressant, antianxiety, and) Tj ET BT 0.9835 0 0 0.9835 330.48 539.28 Tm 0.0222 Tc 1.4665 Tw (sedative/hypnotic medications \(18,19,52,366,414,) Tj ET BT 0.934 0 0 0.9835 330.24 527.28 Tm 0.0025 Tc 1.694 Tw (425, 429,433,461\). According to these studies, 9 to) Tj ET BT 0.8915 0 0 0.9835 330.48 515.28 Tm 0.0553 Tc 1.4249 Tw (26 percent of residents are prescribed and/or receive) Tj ET BT 0.934 0 0 0.9835 330.48 503.28 Tm -0.0199 Tc 0.9013 Tw (more than one such medication.) Tj 11.82 -18.3027 TD -0.0299 Tc 1.276 Tw (Nursing home residents with dementia are more) Tj -11.306 -12.4458 TD -0.039 Tc 1.2246 Tw (likely than other nursing home residents to receive) Tj ET BT 0.9835 0 0 0.9835 330.72 461.04 Tm 0.0296 Tc 1.3369 Tw (psychotropic medications. A study of medication) Tj ET BT 0.934 0 0 0.9835 330.72 449.04 Tm -0.0045 Tc 0.9169 Tw (use by residents of 12 nursing homes in Massachu-) Tj ET BT 0.9835 0 0 0.9835 331.44 437.28 Tm 0.0353 Tc 1.7146 Tw (setts found that during a one-month period, 72) Tj ET BT 0.934 0 0 0.9835 330.96 425.52 Tm -0.0368 Tc 0.9653 Tw (percent of residents with a diagnosis of Alzheimer\222s) Tj ET BT 0.9835 0 0 0.9835 331.2 413.52 Tm 0.0418 Tc -0.0176 Tw (disease used at least one psychotropic medication) Tj ET BT 0.934 0 0 0.9835 331.44 401.52 Tm -0.0344 Tc 0.981 Tw (for 5 or more days, compared with 53 percent of all) Tj ET BT 0.8915 0 0 0.9835 331.2 389.52 Tm 0.0052 Tc 3.6732 Tw (residents \(19\).) Tj ET BT 0.9835 0 0 0.9835 342.72 371.76 Tm 0.0474 Tc 2.8877 Tw (A study of a representative sample of 3352) Tj -11.4697 -12.2018 TD 0.0375 Tc 0.9803 Tw (residents of nursing homes in Rhode Island also) Tj 0.4881 -12.2018 TD 0.0372 Tc 2.5494 Tw (found the use of psychotropic medications was) Tj ET BT 0.934 0 0 0.9835 332.4 335.76 Tm -0.0203 Tc 1.5569 Tw (significantly correlated with cognitive status \(425\).) Tj ET BT 0.9835 0 0 0.9835 331.92 324.24 Tm 0.023 Tc 0.0015 Tw (Among residents with no cognitive impairment or) Tj ET BT 0.934 0 0 0.9835 332.4 312 Tm -0.0365 Tc 0.7263 Tw (only mild cognitive impairment, 49 percent received) Tj ET BT 0.8915 0 0 0.9835 332.4 300 Tm 0.0357 Tc 1.7546 Tw (at least one psychotropic medication, compared with) Tj ET BT 0.934 0 0 0.9835 332.4 287.76 Tm -0.0372 Tc 0.8555 Tw (50 percent of those with moderate cognitive impair-) Tj 0 -11.9577 TD -0.0364 Tc 1.3044 Tw (ment and 57 percent of those with severe cognitive) Tj ET BT 0.8915 0 0 0.9835 332.64 263.76 Tm 0.0334 Tc 1.8917 Tw (impairment. Cognitive impairment was not the only) Tj ET BT 0.934 0 0 0.9835 332.16 252.24 Tm -0.039 Tc 2.0138 Tw (resident characteristic significantly correlated with) Tj ET BT 0.9835 0 0 0.9835 332.4 240 Tm 0.0321 Tc -0.1298 Tw (receipt of psychotropic medications. Sixty-six per-) Tj 0.244 -12.2018 TD 0.0393 Tc 0.3916 Tw (cent of residents who exhibited behavioral symp-) Tj ET BT 0.934 0 0 0.9835 332.64 216.24 Tm -0.0125 Tc 2.3709 Tw (toms \(e.g., noisiness, abusiveness, wandering, dis-) Tj -0.257 -12.2018 TD -0.0507 Tc 2.4545 Tw (robing\) received one or more psychotropic medica-) Tj ET BT 0.8915 0 0 0.9835 333.12 192 Tm 0.0297 Tc 1.0135 Tw (tions, compared with 48 percent of those who did not) Tj ET BT 0.934 0 0 0.9835 333.12 180.24 Tm -0.0053 Tc 1.0783 Tw (exhibit such symptoms.) Tj ET BT 0.9835 0 0 0.9835 344.16 162.24 Tm 0.0249 Tc 1.6468 Tw (Considering only antipsychotic medications, a) Tj -10.7376 -12.4458 TD 0.0412 Tc 2.0224 Tw (study of 484 residents admitted to 8 Maryland) Tj ET BT 0.934 0 0 0.9835 333.36 138.24 Tm 0.0016 Tc 1.4993 Tw (nursing homes between February 1987 and March) Tj ET BT 0.9835 0 0 0.9835 334.56 126.72 Tm 0.0432 Tc 3.1359 Tw (1988 found the use of these medications was) Tj ET BT 0.8915 0 0 0.9835 333.6 114.72 Tm 0.0366 Tc 1.6638 Tw (significantly higher in residents with dementia than) Tj ET BT 0.934 0 0 0.9835 333.36 102.72 Tm -0.0332 Tc 1.8791 Tw (nondemented residents \(389\). Forty-four percent of) Tj ET BT 0.9835 0 0 0.9835 333.36 90.72 Tm 0.0346 Tc 1.2506 Tw (the 123 residents with dementia complicated by) Tj ET BT 0.934 0 0 0.9835 333.12 78.72 Tm -0.0404 Tc 1.0058 Tw (depression, delusions, or delirium and 34 percent of) Tj 0.257 -12.4458 TD -0.0232 Tc 1.74 Tw (the 183 residents with dementia uncomplicated by) Tj 0.257 -11.7137 TD -0.0347 Tc 1.6666 Tw (any of these factors received antipsychotic medica-) Tj ET BT 0.8915 0 0 0.9835 333.36 42.72 Tm 0.0266 Tc 0.8376 Tw (tions. In contrast, 24 percent of the 58 residents with) Tj ET endstream endobj 218 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 219 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.4 682.8 m 535.2 682.8 l S BT 0.9835 0 0 0.9835 172.08 688.08 Tm 0 0 0 rg /F5 10 Tf 0.0197 Tc 1.2916 Tw (Chapter 2--Nursing Home Residents With Dementia: Characteristics and Problems) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 517.2 688.08 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 523.44 688.08 Tm /F5 10 Tf 0.244 Tc 0 Tw (73) Tj ET BT 0.9863 0 0 0.9863 57.36 648.24 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 65.52 648.24 Tm /F4 10 Tf 0.0364 Tc 3.0383 Tw (mental illness and only 7 percent of the 90) Tj ET BT 0.8915 0 0 0.9835 57.36 636.24 Tm 0.0422 Tc 1.2089 Tw (residents with neither dementia nor a mental illness) Tj ET BT 0.934 0 0 0.9835 57.36 624.48 Tm -0.0397 Tc 3.0424 Tw (received antipsychotic medications.) Tj 12.5908 -21.4751 TD -0.0217 Tc 1.6099 Tw (Considering antipsychotic and antianxiety medi-) Tj ET BT 0.9835 0 0 0.9835 58.08 591.12 Tm 0.0301 Tc 1.428 Tw (cations, a study of 760 residents of 7 Wisconsin) Tj ET BT 0.934 0 0 0.9835 57.84 579.36 Tm -0.0253 Tc 1.8706 Tw (nursing homes found the use of these medications) Tj 0.5139 -12.4458 TD -0.0242 Tc 1.0129 Tw (was significantly higher in residents with dementia) Tj 0 -12.2018 TD -0.019 Tc 2.0694 Tw (than in nondemented residents \(429\). Thirty-three) Tj 0 -11.9577 TD -0.0285 Tc 1.3602 Tw (percent of the 274 residents with dementia uncom-) Tj ET BT 0.9835 0 0 0.9835 58.32 531.6 Tm 0.0247 Tc 1.586 Tw (plicated by psychotic symptoms or other mental) Tj 0.4881 -12.2018 TD 0.0516 Tc 3.3584 Tw (illness received one or both of these types of) Tj 0.244 -12.2018 TD 0.0376 Tc 1.5728 Tw (medications over a one-month period, compared) Tj ET BT 0.934 0 0 0.9835 59.04 495.6 Tm -0.0382 Tc 1.444 Tw (with 15 percent of residents with neither dementia) Tj ET BT 0.8915 0 0 0.9835 59.04 483.6 Tm 0.0451 Tc 1.744 Tw (nor mental illness.) Tj ET BT 0.9835 0 0 0.9835 70.32 463.44 Tm 0.0357 Tc 3.283 Tw (Interestingly, a study of 408 residents of a) Tj ET BT 0.934 0 0 0.9835 59.76 451.2 Tm -0.01 Tc 0.8999 Tw (508-bed nursing home in Rockville, MD, found that) Tj ET BT 0.9835 0 0 0.9835 59.52 439.44 Tm 0.0492 Tc 0.8696 Tw (residents who were agitated and demented were) Tj 0.7321 -12.2018 TD 0.0248 Tc 0.0403 Tw (significantly more likely than residents who were) Tj ET BT 0.934 0 0 0.9835 60.24 415.44 Tm -0.0377 Tc 1.7983 Tw (agitated but not demented to receive antipsychotic) Tj ET BT 0.9835 0 0 0.9835 59.76 403.68 Tm 0.0281 Tc 0.281 Tw (medications \(28\). In contrast, residents who were) Tj 0.7321 -12.4458 TD 0.0414 Tc 2.0571 Tw (agitated but not demented were more likely to) Tj ET BT 0.934 0 0 0.9835 60 379.44 Tm -0.0287 Tc 1.6173 Tw (receive antianxiety medications.) Tj 12.3339 -20.9871 TD -0.0418 Tc 2.3166 Tw (Psychotropic medications are often used to con-) Tj ET BT 0.8915 0 0 0.9835 60.96 346.8 Tm 0.0426 Tc 1.6571 Tw (trol behavioral symptoms in nursing home residents) Tj ET BT 0.9835 0 0 0.9835 60.96 334.8 Tm 0.0289 Tc 1.1982 Tw (with dementia, but many of the frequently used) Tj -0.244 -11.9577 TD 0.0436 Tc 2.3395 Tw (medications have not been demonstrated to be) Tj 0.4881 -12.4458 TD 0.2705 Tc 2.8613 Tw (effective for this purpose \(18,19,180,208,277,) Tj ET BT 0.934 0 0 0.9835 61.2 299.04 Tm 0.0406 Tc 3.0849 Tw (285,339,381,389,397,406,414,425\). Moreover, some) Tj 0 -12.2018 TD -0.0235 Tc 1.7218 Tw (of the most frequently used medications can cause) Tj 0.257 -12.4458 TD -0.0344 Tc 2.6513 Tw (confusion, disorientation, and oversedation in eld-) Tj ET BT 0.9835 0 0 0.9835 61.44 262.56 Tm 0.0377 Tc 0.8813 Tw (erly people, thus tending to exacerbate cognitive) Tj ET BT 0.8915 0 0 0.9835 61.68 250.32 Tm 0.0294 Tc 2.0757 Tw (deficits in elderly individuals with dementia. Propo-) Tj ET BT 0.934 0 0 0.9835 61.44 238.56 Tm -0.0352 Tc 1.7344 Tw (nents of specialized nursing home care for persons) Tj ET BT 0.8915 0 0 0.9835 61.68 226.32 Tm 0.0386 Tc 1.7513 Tw (with dementia advocate the use of other approaches) Tj ET BT 0.9835 0 0 0.9835 61.92 214.32 Tm 0.0272 Tc 2.0715 Tw (to manage behavioral symptoms and argue the) Tj ET BT 0.934 0 0 0.9835 62.16 202.08 Tm -0.0301 Tc 1.5821 Tw (staff\222s first response to these symptoms should not) Tj ET BT 0.8915 0 0 0.9835 61.92 190.32 Tm 0.0324 Tc 1.1189 Tw (be psychotropic medications. On the other hand, it is) Tj ET BT 0.9835 0 0 0.9835 62.4 178.32 Tm 0.0327 Tc 3.2373 Tw (clear psychotropic medications are effective in) Tj 0 -11.9577 TD 0.0193 Tc 1.1441 Tw (treating certain symptoms in some persons with) Tj ET BT 0.934 0 0 0.9835 62.64 154.56 Tm 0.0414 Tc 3.8549 Tw (dementia \(121,180,277,347\).) Tj ET BT 0.8915 0 0 0.9835 73.68 133.44 Tm 0.0451 Tc 1.4748 Tw (One intent of the nursing home reform provisions) Tj ET BT 0.9835 0 0 0.9835 62.88 121.68 Tm 0.0428 Tc 0.988 Tw (of OBRA-87 was to limit the use of psychotropic) Tj ET BT 0.934 0 0 0.9835 62.64 109.92 Tm -0.007 Tc 1.3885 Tw (medications in nursing homes. OBRA-87 mandates) Tj ET BT 0.9835 0 0 0.9835 63.36 98.16 Tm 0.0181 Tc 0.525 Tw (a bill of rights for nursing home residents, which) Tj 0 -11.9577 TD 0.0232 Tc 0.042 Tw (includes the right \221\221to be free from any physical or) Tj 0 -12.4458 TD 0.034 Tc 1.8206 Tw (chemical restraints imposed for the purposes of) Tj ET BT 0.934 0 0 0.9835 63.12 62.4 Tm -0.046 Tc 1.489 Tw (discipline or convenience, and not required to treat) Tj ET BT 0.9835 0 0 0.9835 63.36 50.64 Tm 0.0193 Tc 2.2422 Tw (the resident\222s medical symptoms.\224 In 1991, the) Tj ET BT 0.934 0 0 0.9835 63.12 38.88 Tm -0.0209 Tc 1.1464 Tw (Health Care Financing Administration issued draft) Tj ET BT 0.9835 0 0 0.9835 308.4 648.96 Tm 0.0253 Tc 0.5483 Tw (interpretative guidelines for surveyors, including) Tj 0.7321 -12.6899 TD 0.0389 Tc 3.6865 Tw (specific guidelines on the use of psychotropic) Tj -0.244 -11.7137 TD 0.0266 Tc 1.34 Tw (medications. The guidelines list specific medica-) Tj ET BT 0.934 0 0 0.9835 308.88 612.96 Tm -0.0216 Tc 1.128 Tw (tions and conditions for which they can and cannot) Tj ET BT 0.9835 0 0 0.9835 308.88 600.72 Tm 0.0407 Tc 0.1752 Tw (be used. A recent retrospective review of antipsy-) Tj 0.244 -12.2018 TD 0.0317 Tc 0.2367 Tw (chotic medication use from 1976 to 1985 for more) Tj ET BT 0.8915 0 0 0.9835 309.36 576.72 Tm 0.0362 Tc 1.2755 Tw (than 8000 residents of 60 nursing homes in 8 States) Tj 0.2692 -11.9577 TD 0.0284 Tc 1.4038 Tw (found half of the use of these medications would not) Tj ET BT 0.934 0 0 0.9835 309.36 552.96 Tm -0.0243 Tc 1.2088 Tw (have been allowed under the new guidelines \(150\).) Tj ET BT 0.9812 0 0 0.9812 310.08 522.96 Tm /F6 11 Tf 0.0023 Tc -0.0634 Tw (Use ) Tj ET BT 0.9835 0 0 0.9835 329.76 522.96 Tm /F4 10 Tf 0.0205 Tc 0.7361 Tw (of Physical Restraints) Tj ET BT 0.8915 0 0 0.9835 321.12 504.96 Tm 0.0339 Tc 1.9585 Tw (Like psychotropic medications, physical restraints) Tj -12.1137 -12.2018 TD 0.0486 Tc 1.2017 Tw (are also used extensively in nursing homes. Physical) Tj ET BT 0.9835 0 0 0.9835 310.08 481.44 Tm 0.035 Tc 1.8196 Tw (restraints include any externally applied device) Tj ET BT 0.934 0 0 0.9835 310.56 469.44 Tm -0.0363 Tc 2.1822 Tw (intended to restrict an individual\222s free movement) Tj ET BT 0.8915 0 0 0.9835 311.04 457.2 Tm 0.0325 Tc 1.6684 Tw (\(383,446\). Examples of physical restraints are Posey) Tj ET BT 0.934 0 0 0.9835 310.8 445.68 Tm -0.0267 Tc 0.4075 Tw (vests that are put on the individual and then tied to) Tj ET BT 0.9835 0 0 0.9835 311.04 433.92 Tm 0.0152 Tc 0.2709 Tw (the individual\222s bed or chair; geriatric chairs that) Tj -0.244 -12.4458 TD 0.0263 Tc 2.6999 Tw (have a tray table which the individual cannot) Tj 0.244 -11.9577 TD 0.0186 Tc 0.4025 Tw (remove; bed rails; lap belts; chest, waist, leg, and) Tj 0.244 -12.4458 TD 0.0173 Tc 0.9834 Tw (wrist restraints; and mittens that the individual) Tj ET BT 0.8915 0 0 0.9835 311.28 385.44 Tm 0.0446 Tc 1.6549 Tw (cannot remove. Since physical restraints are defined) Tj 0.2692 -11.9577 TD 0.0408 Tc 0.4298 Tw (in large part by the purposes for which they are used,) Tj ET BT 0.934 0 0 0.9835 311.76 361.68 Tm -0.0191 Tc 1.497 Tw (devices such as wheelchair brakes and sheets may) Tj ET BT 0.9835 0 0 0.9835 312.24 349.68 Tm 0.0368 Tc 0.201 Tw (also be physical restraints if they are intended to) Tj ET BT 0.934 0 0 0.9835 312 337.92 Tm -0.0027 Tc 1.5381 Tw (inhibit a person\222s free movement \(182,300\).) Tj ET BT 0.9835 0 0 0.9835 322.8 319.92 Tm 0.043 Tc -0.1002 Tw (A 1989 literature review identified four studies) Tj ET BT 0.934 0 0 0.9835 312.24 307.92 Tm -0.0424 Tc 1.6962 Tw (that reported on the prevalence of restraint use in) Tj 0 -12.2018 TD 0.0071 Tc 0.3263 Tw (U.S. nursing homes \(133\). The studies show that 25) Tj ET BT 0.8915 0 0 0.9835 312.48 283.92 Tm 0.0366 Tc 0.6767 Tw (to 41 percent of residents were restrained at the time) Tj ET BT 0.9835 0 0 0.9835 312.48 271.68 Tm 0.0368 Tc 0.3942 Tw (the studies were conducted. A recently published) Tj 0.4881 -12.4458 TD 0.0194 Tc 2.6285 Tw (study of restraint use in 12 nursing homes in) Tj ET BT 0.8915 0 0 0.9835 312.96 247.44 Tm 0.036 Tc 1.3841 Tw (Connecticut found that 1042 of the 1756 residents of) Tj ET BT 0.934 0 0 0.9835 312.72 235.2 Tm -0.0404 Tc 1.9969 Tw (these facilities \(59 percent\) were restrained at the) Tj ET BT 0.9835 0 0 0.9835 312.48 223.2 Tm 0.0401 Tc 2.516 Tw (beginning of the study \(446\). A sample of 397) Tj ET BT 0.934 0 0 0.9835 312.72 211.44 Tm -0.03 Tc 0.6872 Tw (residents who had not been restrained at the begin-) Tj ET BT 0.9835 0 0 0.9835 312.96 199.44 Tm 0.0356 Tc 0.6258 Tw (ning of the study was followed for a year, during) Tj ET BT 0.8915 0 0 0.9835 313.44 187.68 Tm 0.0454 Tc 1.037 Tw (which time 122 of the 397 residents were restrained.) Tj ET BT 0.934 0 0 0.9835 313.2 175.68 Tm -0.0072 Tc 1.3944 Tw (Thus a total of 1164 of the original 1756 residents) Tj ET BT 0.8915 0 0 0.9835 313.92 163.68 Tm 0.0387 Tc 0.9099 Tw (\(66 percent\) were restrained at some time during the) Tj -0.2692 -12.2018 TD 0.0512 Tc 0 Tw (year.) Tj ET BT 0.9835 0 0 0.9835 324.72 133.68 Tm 0.0258 Tc 0.4693 Tw (Restraint use varies from one nursing home to) Tj ET BT 0.934 0 0 0.9835 314.16 122.16 Tm -0.0119 Tc 1.4709 Tw (another. The study of 454 residents of 8 Maryland) Tj -0.257 -11.7137 TD 0.0016 Tc 1.5849 Tw (nursing homes between February 1987 and March) Tj 1.5417 -12.2018 TD -0.0106 Tc 1.0841 Tw (1988 found that in the 3 facilities with the highest) Tj ET BT 0.9835 0 0 0.9835 314.16 86.64 Tm 0.0378 Tc 0.6507 Tw (use of restraints, an average of 73 percent of the) Tj ET BT 0.934 0 0 0.9835 313.92 74.64 Tm -0.0418 Tc 1.8883 Tw (residents were restrained at some time during the) Tj 0.257 -12.4458 TD -0.0265 Tc 0.5872 Tw (year, compared with an average of 55 percent of the) Tj ET BT 0.9835 0 0 0.9835 313.92 50.64 Tm 0.0376 Tc 0.3798 Tw (residents in the 3 facilities with the lowest use of) Tj ET BT 0.8915 0 0 0.9835 313.92 38.88 Tm 0.0101 Tc 1.7833 Tw (restraints \(61\).) Tj ET endstream endobj 220 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 221 0 obj <>stream 0.72 w 1 j 0 0 0 RG 74.88 684.48 m 553.68 684.48 l S BT 0.9835 0 0 0.9835 75.6 690.48 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (74 ) Tj ET BT 0.9598 0 0 0.9598 88.32 690.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 94.56 690.48 Tm /F5 10 Tf 0.0125 Tc 1.0651 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 86.4 651.12 Tm /F4 10 Tf -0.0268 Tc 1.05 Tw (Some commentators contend that once restraints) Tj ET BT 0.8915 0 0 0.9835 75.84 639.12 Tm 0.0507 Tc 1.1657 Tw (are used for a nursing home resident, they generally) Tj ET BT 0.934 0 0 0.9835 75.84 627.12 Tm 0.0017 Tc 0.377 Tw (are used on a regular basis \(300\), but the study just) Tj ET BT 0.9835 0 0 0.9835 76.08 615.12 Tm 0.0229 Tc 1.553 Tw (cited of restraint use in 12 Connecticut nursing) Tj -0.244 -12.2018 TD 0.0352 Tc 2.3684 Tw (homes found use was more varied. Of the 122) Tj -0.244 -11.9577 TD 0.0346 Tc 1.4365 Tw (residents who were restrained for the first time) Tj ET BT 0.8915 0 0 0.9835 76.32 579.12 Tm 0.0433 Tc 0.7702 Tw (during the study year, 34 percent were restrained for) Tj 0 -12.2018 TD 0.02 Tc 1.1799 Tw (a single period of time that lasted less than 30 days;) Tj ET BT 0.9835 0 0 0.9835 76.8 555.6 Tm 0.0329 Tc 0.218 Tw (34 percent were restrained during more than one) Tj ET BT 0.934 0 0 0.9835 76.32 543.36 Tm -0.0463 Tc 0.9224 Tw (period of time but had long periods when they were) Tj 0.257 -12.2018 TD -0.0365 Tc 0.8869 Tw (not restrained; and 32 percent were restrained on a) Tj ET BT 0.8915 0 0 0.9835 76.32 519.84 Tm 0.0355 Tc 0.8574 Tw (regular basis, defined as at least 20 days each month) Tj ET BT 0.934 0 0 0.9835 77.04 507.84 Tm 0.0551 Tc 0 Tw (\(446\).) Tj 11.563 -20.255 TD -0.0299 Tc 1.276 Tw (Nursing home residents with dementia are more) Tj -11.82 -12.2018 TD -0.0303 Tc 0.891 Tw (likely than nondemented nursing home residents to) Tj ET BT 0.9835 0 0 0.9835 77.04 463.92 Tm 0.0256 Tc 0.3649 Tw (be physically restrained \(133,389,446\). The study) Tj ET BT 0.934 0 0 0.9835 76.32 451.68 Tm -0.0208 Tc 0.7416 Tw (just cited of restraint use in 12 Connecticut nursing) Tj 1.0278 -11.9577 TD -0.0171 Tc 0.7377 Tw (homes found that during the study year, 51 percent) Tj ET BT 0.9835 0 0 0.9835 77.52 428.16 Tm 0.0508 Tc 2.1172 Tw (of the residents who were disoriented were re-) Tj 0.244 -12.2018 TD 0.0356 Tc 0.5639 Tw (strained, compared with only 17 percent of those) Tj ET BT 0.934 0 0 0.9835 77.76 403.92 Tm -0.0391 Tc 1.6927 Tw (who were not disoriented \(446\).) Tj ET BT 0.9835 0 0 0.9835 88.56 384.24 Tm 0.0239 Tc 1.6914 Tw (The study of 8 Maryland nursing homes con-) Tj ET BT 0.8915 0 0 0.9835 78.24 372 Tm 0.0622 Tc 1.3018 Tw (ducted between February 1987 and March 1988 also) Tj 0 -11.9577 TD 0.0219 Tc 1.6162 Tw (found that the residents with dementia were signifi-) Tj 0.2692 -12.4458 TD 0.0413 Tc 1.2099 Tw (cantly more likely than nondemented residents to be) Tj ET BT 0.9835 0 0 0.9835 78 336.24 Tm 0.0303 Tc 0.0672 Tw (physically restrained \(389\). Forty-eight percent of) Tj 0.4881 -12.4458 TD 0.0346 Tc 1.2506 Tw (the 123 residents with dementia complicated by) Tj ET BT 0.934 0 0 0.9835 78.48 311.76 Tm -0.0404 Tc 0.969 Tw (depression, delusions, or delirium and 41 percent of) Tj 0 -12.2018 TD -0.0232 Tc 1.74 Tw (the 183 residents with dementia uncomplicated by) Tj 0.5139 -11.9577 TD -0.0294 Tc 1.9484 Tw (any of these factors were physically restrained. In) Tj ET BT 0.8915 0 0 0.9835 78.96 275.76 Tm 0.0332 Tc 0.561 Tw (contrast, 27 percent of the 58 residents with a mental) Tj 0.2692 -12.2018 TD 0.041 Tc 0.283 Tw (illness and 13 percent of the 90 residents with neither) Tj ET BT 0.9835 0 0 0.9835 79.2 251.52 Tm 0.0274 Tc 2.8034 Tw (dementia nor a mental illness were physically) Tj ET BT 0.934 0 0 0.9835 78.96 239.76 Tm -0.0324 Tc 2.178 Tw (restrained. Residents with dementia who also had) Tj 0.7709 -12.4458 TD -0.0361 Tc 0.6709 Tw (severe impairments in activities of daily living were) Tj ET BT 0.9835 0 0 0.9835 79.2 216 Tm 0.02 Tc -0.0129 Tw (much more likely to be physically restrained than) Tj 0 -12.2018 TD 0.0339 Tc 1.5766 Tw (residents with dementia who did not have such) Tj ET BT 0.934 0 0 0.9835 79.68 192 Tm 0.007 Tc 1.0652 Tw (impairments \(61\).) Tj ET BT 0.9835 0 0 0.9835 90.72 172.32 Tm 0.0426 Tc 1.9745 Tw (A variety of reasons are given for the use of) Tj ET BT 0.934 0 0 0.9835 79.44 160.32 Tm -0.0253 Tc 0.5859 Tw (physical restraints for nursing home residents: 1\) to) Tj ET BT 0.9835 0 0 0.9835 79.68 148.32 Tm 0.0296 Tc 2.9058 Tw (protect residents from injury due to falling or) Tj 0.244 -12.2018 TD 0.0245 Tc 0.8948 Tw (wandering; 2\) to prevent residents from injuring) Tj 0.244 -11.9577 TD 0.0336 Tc 1.9605 Tw (other residents or staff members; 3\) to prevent) Tj ET BT 0.8915 0 0 0.9835 79.92 112.8 Tm 0.0326 Tc 1.6683 Tw (residents from interfering with their own treatment,) Tj ET BT 0.934 0 0 0.9835 80.4 101.04 Tm -0.0289 Tc 1.6175 Tw (for example, by removing feeding tubes or opening) Tj ET BT 0.9835 0 0 0.9835 80.64 89.28 Tm 0.0372 Tc 0.8411 Tw (wounds; 4\) to prevent behavioral problems; 5\) to) Tj 0 -12.2018 TD 0.0283 Tc 0.6469 Tw (satisfy some residents\222 families who request that) Tj ET BT 0.8915 0 0 0.9835 79.92 65.52 Tm 0.0381 Tc 1.3289 Tw (restraints be used, primarily to protect their relative) Tj 0.5384 -11.9577 TD 0.0326 Tc 1.1598 Tw (from falling; 6\) to protect the nursing home from the) Tj ET BT 0.934 0 0 0.9835 79.92 41.76 Tm -0.0259 Tc 0.9291 Tw (risk of being sued for fall-related injuries; and 7\) to) Tj ET BT 0.9835 0 0 0.9835 326.88 651.12 Tm 0.0362 Tc 4.2587 Tw (provide \223postural support\224 or maintain \223body) Tj ET BT 0.934 0 0 0.9835 327.12 639.12 Tm -0.0216 Tc 0.8022 Tw (alignment,\222 for example, by keeping a resident from) Tj 0.257 -12.2018 TD 0.006 Tc 1.0663 Tw (slipping down in his or her chair \(133,182,212,300,) Tj 0.257 -12.4458 TD -0.0052 Tc 1.0782 Tw (311,446\). In addition, physical restraints are some-) Tj ET BT 0.9835 0 0 0.9835 327.36 603.12 Tm 0.0207 Tc 0.3699 Tw (times used when a nursing home has insufficient) Tj ET BT 0.8915 0 0 0.9835 327.6 591.12 Tm 0.0154 Tc 2.1138 Tw (staff to adequately supervise residents.) Tj ET BT 0.9835 0 0 0.9835 338.4 573.12 Tm 0.029 Tc 0.4834 Tw (Sometimes physical restraints are also used to) Tj ET BT 0.934 0 0 0.9835 327.36 561.12 Tm -0.0129 Tc 0.6368 Tw (punish residents \(133,31 1\). A telephone survey of a) Tj 0.257 -11.9577 TD -0.0105 Tc 0.9233 Tw (random sample of 577 nurses and nurse aides from) Tj 0.5139 -11.9577 TD -0.0167 Tc 1.4943 Tw (31 nursing homes in New Hampshire found exces-) Tj ET BT 0.9835 0 0 0.9835 328.32 525.6 Tm 0.0292 Tc 2.5576 Tw (sive use of restraints was the most frequently) Tj ET BT 0.934 0 0 0.9835 327.84 513.6 Tm -0.0224 Tc 0.9498 Tw (mentioned type of resident abuse \(348\). One-fifth of) Tj 0.5139 -11.9577 TD -0.0239 Tc 1.291 Tw (the nurses and nurse aides said they had observed) Tj ET BT 0.8915 0 0 0.9835 328.08 489.6 Tm 0.0209 Tc 1.2327 Tw (this type of abuse, and of those who had observed it,) Tj ET BT 0.934 0 0 0.9835 328.08 477.6 Tm -0.0258 Tc 0.9535 Tw (two-thirds said they had observed it frequently. Six) Tj 0 -11.9577 TD -0.0428 Tc 0.8616 Tw (percent of the nurses and nurse aides reported they) Tj ET BT 0.8915 0 0 0.9835 328.32 453.6 Tm 0.0181 Tc 1.1283 Tw (had used restraints to punish residents.) Tj ET BT 0.934 0 0 0.9835 339.36 435.6 Tm -0.018 Tc 0.8778 Tw (Many negative effects of physical restraints have) Tj ET BT 0.9835 0 0 0.9835 328.56 423.6 Tm 0.0438 Tc 3.1772 Tw (been identified. These negative effects include) Tj ET BT 0.934 0 0 0.9835 328.56 411.84 Tm -0.0252 Tc 1.6564 Tw (physiological effects of immobility, such as inconti-) Tj ET BT 0.9835 0 0 0.9835 328.8 399.84 Tm 0.0241 Tc 0.7499 Tw (nence, contractures, and loss of bone and muscle) Tj ET BT 0.934 0 0 0.9835 329.04 387.84 Tm -0.0046 Tc 2.1054 Tw (mass; increased anxiety and agitation; aggravated) Tj ET BT 0.9835 0 0 0.9835 329.04 375.6 Tm 0.0023 Tc 0.2909 Tw (behavioral symptoms, such as screaming, hitting,) Tj ET BT 0.934 0 0 0.9835 329.52 363.6 Tm -0.0324 Tc 0.8932 Tw (and biting; decreased social behavior and decreased) Tj ET BT 0.9835 0 0 0.9835 329.76 351.36 Tm 0.035 Tc 1.4779 Tw (social relationships; demoralization, loss of self-) Tj ET BT 0.8915 0 0 0.9835 329.52 339.84 Tm 0.0332 Tc 1.2638 Tw (-esteem, and emotional withdrawal; and injuries and) Tj ET BT 0.9835 0 0 0.9835 329.76 327.6 Tm 0.0408 Tc -0.0573 Tw (death due to improper use of the restraints or the) Tj -0.4881 -12.2018 TD 0.0289 Tc 0.7682 Tw (residents\222 attempts to escape from the restraints) Tj ET BT 0.8915 0 0 0.9835 330 303.36 Tm 0.029 Tc 0 Tw (\(3O,l33,l39,l82,2O8,3OO,3O5,383,427,446,49O,498\).) Tj ET BT 0.9835 0 0 0.9835 340.56 285.6 Tm 0.0338 Tc 0.6006 Tw (A study of 24 agitated nursing home residents) Tj -10.7376 -12.4458 TD 0.0386 Tc 0.1991 Tw (with dementia found the use of restraints did not) Tj ET BT 0.8915 0 0 0.9835 330 261.36 Tm 0.0459 Tc 1.0509 Tw (reduce and may have increased their agitation \(490\).) Tj 0.5384 -12.4458 TD 0.0336 Tc 0.4446 Tw (Over the 3-month period of the study, the researchers) Tj 0 -11.9577 TD 0.0351 Tc 2.3475 Tw (observed that residents exhibited significantly more) Tj ET BT 0.934 0 0 0.9835 330.48 225.36 Tm -0.0267 Tc 1.1441 Tw (agitated behaviors when they were restrained than) Tj 0 -11.7137 TD -0.0384 Tc 0.7998 Tw (when they were not. Seven of the 24 residents were) Tj ET BT 0.8915 0 0 0.9835 330.48 201.84 Tm 0.0377 Tc 0.4063 Tw (restrained more than 50 percent of the day and night.) Tj ET BT 0.9835 0 0 0.9835 330.72 189.84 Tm 0.0382 Tc 0.0267 Tw (Five of these seven residents exhibited physically) Tj 0.4881 -12.2018 TD 0.0145 Tc 1.0269 Tw (aggressive behaviors, such as biting and hitting,) Tj -0.244 -11.9577 TD 0.0379 Tc 3.2808 Tw (while they were restrained. Fifteen of the 24) Tj ET BT 0.934 0 0 0.9835 330.96 154.08 Tm -0.0415 Tc 1.2135 Tw (residents fell at least once during the study period,) Tj ET BT 0.9835 0 0 0.9835 331.44 142.32 Tm 0.0293 Tc 1.5813 Tw (sometimes while they were restrained. It is not) Tj ET BT 0.934 0 0 0.9835 330.96 130.32 Tm -0.0659 Tc 2.685 Tw (possible to dete) Tj 75.5449 0.4881 TD -0.0228 Tc 1.0971 Tw (rmine from the study data whether) Tj ET BT 0.9835 0 0 0.9835 331.44 118.8 Tm 0.0434 Tc 0.1028 Tw (they would have fallen more often if they had not) Tj ET BT 0.8915 0 0 0.9835 331.2 107.04 Tm 0.0511 Tc 1.1989 Tw (been restrained.) Tj ET BT 0.934 0 0 0.9835 342.48 89.28 Tm -0.04 Tc 1.3082 Tw (As noted earlier, one of the primary objectives of) Tj ET BT 0.9835 0 0 0.9835 331.44 77.52 Tm 0.0299 Tc 1.9874 Tw (many special care units is to reduce the use of) Tj -0.244 -12.6899 TD 0.021 Tc 0.1865 Tw (psychotropic medications and physical restraints.) Tj 0.244 -11.9577 TD 0.0406 Tc 1.6744 Tw (Results of studies reviewed in the next chapter) Tj ET BT 0.934 0 0 0.9835 331.68 41.04 Tm -0.0185 Tc 0.652 Tw (suggest that special care units have been successful) Tj ET endstream endobj 222 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 223 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.2 678.48 m 540 678.48 l S BT 0.9835 0 0 0.9835 176.88 683.76 Tm 0 0 0 rg /F5 10 Tf 0.0187 Tc 1.6587 Tw (Chapter 2-Nursing Home Residents With Dementia: Characteristics and Problems) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 522 683.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 528.48 683.76 Tm /F5 10 Tf 0.366 Tc 0 Tw (75) Tj ET BT 0.934 0 0 0.9835 61.92 644.88 Tm /F4 10 Tf -0.0254 Tc 0.8715 Tw (in reducing the use of physical restraints but use of) Tj -0.257 -12.2018 TD -0.0273 Tc 1.8728 Tw (psychotropic medications remains high.) Tj ET BT 0.9795 0 0 0.9795 69.12 607.92 Tm /F7 12 Tf 0.0435 Tc 0.7522 Tw (Negative Consequences for Residents With) Tj 2.2053 -14.2118 TD 0.0241 Tc 1.017 Tw (Dementia, Their Families, Nursing Home) Tj -2.4503 -14.9469 TD 0.0163 Tc 1.0862 Tw (Staff Members, and Nondemented Nursing) Tj 68.1188 -14.2118 TD 0.0419 Tc 1.3664 Tw (Home Residents) Tj ET BT 0.934 0 0 0.9835 73.68 547.92 Tm /F4 10 Tf -0.0353 Tc 1.7345 Tw (Problems in the care provided for nursing home) Tj -12.0769 -12.2018 TD -0.0212 Tc 0.7528 Tw (residents with dementia have many negative conse-) Tj 0.5139 -12.2018 TD -0.0254 Tc 1.5281 Tw (quences for residents, their families, nursing home) Tj ET BT 0.9835 0 0 0.9835 63.36 511.68 Tm 0.0325 Tc 0.0833 Tw (staff members who take care of them, and nonde-) Tj ET BT 0.934 0 0 0.9835 62.64 499.68 Tm -0.0314 Tc 1.1063 Tw (mented residents. Inappropriate nursing home care) Tj ET BT 0.9835 0 0 0.9835 63.12 487.92 Tm 0.0416 Tc 0.9064 Tw (tends to exacerbate the effects of an individual\222s) Tj ET BT 0.934 0 0 0.9835 63.12 475.92 Tm -0.02 Tc 1.1369 Tw (dementing disease or condition. In many instances,) Tj ET BT 0.9835 0 0 0.9835 62.88 464.16 Tm 0.0332 Tc 0.5097 Tw (however, it is difficult to distinguish effects of an) Tj 0.4881 -12.4458 TD 0.0356 Tc 1.7702 Tw (individual\222s dementing disease or condition and) Tj ET BT 0.934 0 0 0.9835 63.36 439.68 Tm -0.0443 Tc 1.3771 Tw (effects of inappropriate care.) Tj ET BT 0.9835 0 0 0.9835 63.6 416.64 Tm 0.0383 Tc 1.0231 Tw (Negative Consequences for Residents With) Tj ET BT 0.934 0 0 0.9835 63.84 404.88 Tm 0.202 Tc 0 Tw (Dementia) Tj 11.82 -18.0586 TD -0.0353 Tc 1.7345 Tw (Problems in the care provided for nursing home) Tj -12.0769 -12.4458 TD -0.0212 Tc 0.7528 Tw (residents with dementia have many negative conse-) Tj 0.5139 -12.2018 TD -0.0318 Tc 2.0061 Tw (quences for the residents. These consequences can) Tj 0 -11.9577 TD -0.0395 Tc 0.9681 Tw (be categorized in terms of excess disability, reduced) Tj T* -0.0296 Tc 1.0677 Tw (quality of life, reduced physical safety, and reduced) Tj 0.257 -12.2018 TD -0.0247 Tc 0.8421 Tw (access to nursing home care. As noted in chapter 1,) Tj ET BT 0.8915 0 0 0.9835 64.32 315.6 Tm 0.0278 Tc 1.7634 Tw (excess disability is the discrepancy that exists when) Tj ET BT 0.934 0 0 0.9835 64.56 303.6 Tm -0.0186 Tc 0.8357 Tw (a person\222s fictional impairment is greater than that) Tj ET BT 0.9835 0 0 0.9835 64.32 291.6 Tm 0.0372 Tc 2.4274 Tw (warranted by the person\222s disease or condition) Tj ET BT 0.934 0 0 0.9835 64.8 279.84 Tm -0.017 Tc 0.7972 Tw (\(47,219\). The concept of excess disability implies an) Tj ET BT 0.8915 0 0 0.9835 64.8 267.6 Tm 0.0384 Tc 1.1234 Tw (individual with dementia has certain impairments in) Tj ET BT 0.934 0 0 0.9835 64.8 255.36 Tm -0.0283 Tc 0.846 Tw (functioning caused directly by his or her dementing) Tj ET BT 0.9835 0 0 0.9835 64.8 243.6 Tm 0.0323 Tc 2.7171 Tw (disease or condition and other impairments in) Tj ET BT 0.934 0 0 0.9835 64.8 231.6 Tm -0.0246 Tc 0.8053 Tw (functioning caused by other factors. One example of) Tj ET BT 0.8915 0 0 0.9835 64.8 219.6 Tm 0.0446 Tc 1.2062 Tw (excess disability is the increased confusion caused in) Tj ET BT 0.934 0 0 0.9835 65.28 207.84 Tm -0.0378 Tc 1.4986 Tw (some persons with dementia by psychotropic medi-) Tj -0.257 -12.4458 TD -0.0401 Tc 1.0128 Tw (cations intended to control their behavior.) Tj ET BT 0.8915 0 0 0.9835 76.32 178.08 Tm 0.0587 Tc 1.0558 Tw (Inappropriate nursing home care can cause excess) Tj ET BT 0.9835 0 0 0.9835 65.28 165.84 Tm 0.0241 Tc 2.9695 Tw (disability in terms of an individual\222s cognitive) Tj ET BT 0.934 0 0 0.9835 65.28 153.84 Tm -0.0183 Tc 1.4006 Tw (functioning, mood, self-care abilities, and behavior.) Tj ET BT 0.9835 0 0 0.9835 65.52 142.08 Tm 0.0228 Tc 0.6524 Tw (Excess disability in cognitive functioning may be) Tj ET BT 0.934 0 0 0.9835 65.52 130.08 Tm -0.0279 Tc 1.6165 Tw (caused, for example, by untreated acute or chronic) Tj ET BT 0.8915 0 0 0.9835 65.52 118.08 Tm 0.0282 Tc 1.8079 Tw (illness, depression, sensory impairments, or pain, as) Tj ET BT 0.9835 0 0 0.9835 65.52 106.08 Tm 0.0342 Tc 3.4473 Tw (well as by excessive environmental noise and) Tj ET BT 0.934 0 0 0.9835 66.24 94.08 Tm -0.0288 Tc 3.4161 Tw (stimulation and psychotropic medications. Excess) Tj -0.5139 -11.9577 TD -0.0167 Tc 1.476 Tw (disability in behavior maybe caused by inappropri-) Tj ET BT 0.9835 0 0 0.9835 66 70.32 Tm 0.0373 Tc 1.8172 Tw (ate staff responses to the resident\222s physical or) Tj ET BT 0.934 0 0 0.9835 65.76 58.32 Tm -0.0309 Tc 1.4141 Tw (emotional needs or behavioral symptoms, excessive) Tj ET BT 0.9835 0 0 0.9835 65.76 46.56 Tm 0.0207 Tc 2.1391 Tw (environmental noise or stimulation, insufficient) Tj ET BT 0.8915 0 0 0.9835 65.76 34.56 Tm 0.033 Tc 0.7578 Tw (activities and exercise, use of physical restraints, and) Tj ET BT 0.9835 0 0 0.9835 313.2 644.88 Tm 0.0306 Tc 1.3847 Tw (other factors. Extreme behavioral responses, re-) Tj 0 -12.2018 TD 0.0531 Tc 1.0691 Tw (ferred to as) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 371.76 632.88 Tm /F5 11 Tf 0.0944 Tc 2.5332 Tw (catastrophic reactions, in) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 495.36 632.88 Tm /F4 10 Tf 0.0011 Tc 2.8301 Tw (which an) Tj ET BT 0.934 0 0 0.9835 313.2 621.12 Tm -0.0236 Tc 1.098 Tw (individual with dementia becomes acutely agitated,) Tj ET BT 0.9835 0 0 0.9835 313.44 608.88 Tm 0.0287 Tc 0.2223 Tw (angry, or combative, are often attributed to these) Tj 0 -12.4458 TD 0.0227 Tc 1.1 Tw (factors rather than to an individual\222s dementing) Tj ET BT 0.934 0 0 0.9835 313.44 584.4 Tm 0.0091 Tc 0.9987 Tw (disease or condition \(47,274,353,371,385\). Although) Tj 0.257 -12.2018 TD -0.0383 Tc 2.1415 Tw (it is difficult in practice to differentiate functional) Tj ET BT 0.9835 0 0 0.9835 313.68 560.4 Tm 0.0232 Tc 0.3368 Tw (impairments that are or are not warranted by an) Tj 0.244 -11.9577 TD 0.0365 Tc 3.811 Tw (individual\222s disease or condition, some of the) Tj ET BT 0.934 0 0 0.9835 313.92 536.64 Tm -0.0333 Tc 2.1361 Tw (characteristics of nursing home residents with de-) Tj ET BT 0.9835 0 0 0.9835 313.92 524.64 Tm 0.0292 Tc 0.8144 Tw (mentia cited earlier \(e.g., the high proportions of) Tj 0 -12.2018 TD 0.0248 Tc 1.1384 Tw (residents with impairments in activities of daily) Tj 0.244 -12.4458 TD 0.0279 Tc 1.3038 Tw (living and behavioral symptoms\) may be due as) Tj 0 -12.2018 TD 0.0245 Tc 0.7456 Tw (much to problems in the care they receive in the) Tj T* 0.0289 Tc 2.1396 Tw (nursing home as to their dementing disease or) Tj ET BT 0.934 0 0 0.9835 314.4 464.4 Tm 0.0504 Tc 3.4598 Tw (condition \(107,1 15,125,165,171,263,353,385,386\).) Tj ET BT 0.9835 0 0 0.9835 325.68 446.16 Tm 0.0381 Tc 0.0777 Tw (Quality of life is difficult to evaluate in general) Tj ET BT 0.934 0 0 0.9835 314.88 433.92 Tm -0.0233 Tc 1.3974 Tw (and particularly difficult to evaluate in individuals) Tj 0 -11.9577 TD -0.0305 Tc 1.7477 Tw (with dementia. Poor quality of life is attributed to) Tj ET BT 0.8915 0 0 0.9835 314.64 410.16 Tm 0.0436 Tc 0.6305 Tw (nursing home residents with dementia when they are) Tj ET BT 0.934 0 0 0.9835 314.88 397.92 Tm -0.0398 Tc 1.3723 Tw (observed to be agitated, restless, depressed, crying,) Tj ET BT 0.8915 0 0 0.9835 315.36 384.72 Tm 0.0428 Tc 1.9082 Tw (screaming, calling out repetitively, and/or extremely) Tj ET BT 0.934 0 0 0.9835 315.12 374.16 Tm -0.0237 Tc 2.0402 Tw (withdrawn. In some instances, these reactions are) Tj ET BT 0.9835 0 0 0.9835 315.36 362.4 Tm 0.0329 Tc 1.9844 Tw (caused by an individual\222s dementing disease or) Tj ET BT 0.934 0 0 0.9835 315.36 350.4 Tm -0.0236 Tc 0.4556 Tw (condition, and in other instances they are caused by) Tj ET BT 0.8915 0 0 0.9835 315.36 338.88 Tm 0.0416 Tc 3.0939 Tw (inappropriate care \(38,107,1 15,125,263\).) Tj ET BT 0.9835 0 0 0.9835 326.4 320.88 Tm 0.0436 Tc 2.8277 Tw (In addition to excess disability and reduced) Tj -11.2256 -12.4458 TD 0.0399 Tc 1.0824 Tw (quality of life, problems in the care provided for) Tj ET BT 0.934 0 0 0.9835 315.36 297.12 Tm -0.0274 Tc 1.359 Tw (nursing home residents with dementia occasionally) Tj 0 -12.4458 TD -0.0323 Tc 0.5933 Tw (have drastic consequences in terms of the residents\222) Tj ET BT 0.9835 0 0 0.9835 315.6 272.88 Tm 0.03 Tc 0.5068 Tw (physical safety. Individuals with dementia some-) Tj ET BT 0.934 0 0 0.9835 316.08 261.12 Tm -0.0158 Tc 0.929 Tw (times wander away from nursing homes if they are) Tj -0.257 -12.4458 TD -0.047 Tc 1.1801 Tw (not well supervised and the facility is not locked or) Tj ET BT 0.9835 0 0 0.9835 316.08 236.64 Tm 0.0414 Tc 0.7555 Tw (otherwise secured. Some of these individuals die) Tj ET BT 0.934 0 0 0.9835 315.84 225.12 Tm -0.0122 Tc 1.3427 Tw (before they are found \(188\).) Tj ET BT 0.9835 0 0 0.9835 326.88 207.12 Tm 0.0374 Tc 2.5492 Tw (A final consequence of problems in the care) Tj ET BT 0.934 0 0 0.9835 315.84 195.12 Tm -0.039 Tc 1.3714 Tw (provided for nursing home residents with dementia) Tj ET BT 0.9835 0 0 0.9835 316.32 183.36 Tm 0.0118 Tc 1.0761 Tw (is reduced access to nursing home care. Nursing) Tj ET BT 0.934 0 0 0.9835 316.08 171.6 Tm -0.0305 Tc 2.0047 Tw (home administrators and staff often regard people) Tj ET BT 0.8915 0 0 0.9835 316.56 159.36 Tm 0.0347 Tc 0.8472 Tw (with dementia as difficult to manage because of their) Tj -0.2692 -12.2018 TD 0.0332 Tc 1.5651 Tw (behavioral symptoms and may be reluctant to admit) Tj ET BT 0.934 0 0 0.9835 316.8 135.84 Tm -0.0219 Tc 1.2889 Tw (them for this reason. As a result, some individuals) Tj ET BT 0.8915 0 0 0.9835 316.56 123.6 Tm 0.0508 Tc 1.1656 Tw (with dementia who need nursing home care may not) Tj ET BT 0.934 0 0 0.9835 316.56 111.6 Tm 0.0114 Tc 0.5466 Tw (be able to obtain it \(109,170,454,520\). To the extent) Tj 0.257 -11.9577 TD -0.0232 Tc 1.9112 Tw (that residents\222 behavioral symptoms are caused or) Tj 0 -12.4458 TD -0.0308 Tc 0.763 Tw (exacerbated by inappropriate care, this access prob-) Tj ET BT 0.8915 0 0 0.9835 316.8 76.08 Tm 0.0431 Tc 1.3873 Tw (lem is also attributable to inappropriate care.) Tj 12.1137 -18.5467 TD 0.0457 Tc 1.205 Tw (The reluctance of nursing homes to admit persons) Tj -12.1137 -12.2018 TD 0.0426 Tc 1.2084 Tw (with dementia, especially those who are perceived to) Tj ET BT 0.9835 0 0 0.9835 316.56 33.84 Tm 0.0261 Tc 0.6491 Tw (have behavioral symptoms, was documented in a) Tj ET endstream endobj 224 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 225 0 obj <>stream 0.48 w 1 j 0 0 0 RG 69.84 686.64 m 547.92 686.64 l S BT 0.9835 0 0 0.9835 70.56 692.88 Tm 0 0 0 rg /F4 10 Tf 0.0008 Tc 0.0241 Tw (76 . ) Tj 19.7669 0 TD /F5 10 Tf 0.0125 Tc 1.038 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -19.0348 -40.0218 TD /F4 10 Tf 0.0387 Tc 3.4426 Tw (1990 report of the General Accounting Office) Tj -0.4881 -12.4458 TD 0.0365 Tc -0.1342 Tw (\(GAO\), ) Tj ET BT 0.9812 0 0 0.9812 107.04 641.28 Tm /F5 11 Tf 0.0632 Tc 2.3816 Tw (Nursing Homes: Admission Problems for) Tj -37.9118 -12.2296 TD 0.0588 Tc 1.6319 Tw (Medicaid Recipients and Attempts To Solve Them) Tj ET BT 0.9014 0 0 0.9812 70.8 617.28 Tm 0.0334 Tc 0.2734 Tw (\(454\). The ) Tj ET BT 0.8915 0 0 0.9835 116.16 617.28 Tm /F4 10 Tf 0.0379 Tc 1.3932 Tw (GAO report was based on interviews with) Tj -51.1469 -12.2018 TD 0.0276 Tc 2.3021 Tw (Medicaid and health department officials, long-term) Tj 0 -12.2018 TD 0.0458 Tc 1.0971 Tw (care ombudsmen, representatives from nursing home) Tj ET BT 0.934 0 0 0.9835 70.8 581.28 Tm -0.0183 Tc 4.4327 Tw (industry associations,) Tj ET BT 0.9835 0 0 0.9835 176.4 581.04 Tm 0.0411 Tc 1.976 Tw (advocates for the elderly,) Tj -107.6197 -12.2018 TD 0.0217 Tc 2.3699 Tw (hospital discharge planners, and nursing home) Tj ET BT 0.8915 0 0 0.9835 71.04 557.28 Tm 0.0372 Tc 1.6375 Tw (officials in nine States. The report focuses primarily) Tj ET BT 0.9835 0 0 0.9835 71.04 545.28 Tm 0.041 Tc 2.0575 Tw (on the problems Medicaid recipients face when) Tj ET BT 0.934 0 0 0.9835 71.28 533.28 Tm -0.0117 Tc 1.021 Tw (trying to gain admission to nursing homes but also) Tj -0.257 -11.7137 TD -0.0356 Tc 1.2392 Tw (notes the access problems encountered by individu-) Tj 0.5139 -12.2018 TD -0.0411 Tc 1.1901 Tw (als with dementia. According to the GAO report:) Tj ET BT 0.9835 0 0 0.9835 91.92 492.96 Tm /F5 10 Tf 0.0213 Tc 1.4222 Tw (Elderly with behavioral problems thought to be) Tj -10.4935 -11.4697 TD 0.0228 Tc 1.2986 Tw (caused by Alzheimer\222s disease or other conditions) Tj ET BT 0.9444 0 0 0.9835 81.36 470.88 Tm 0 Tc 0.8026 Tw (may have trouble getting into nursing homes whether) Tj ET BT 0.9835 0 0 0.9835 81.6 460.08 Tm -0.0058 Tc 0.799 Tw (they are Medicaid recipients or not. Officials in all) Tj ET BT 0.8491 0 0 0.9835 81.36 449.28 Tm /F4 10 Tf 0.027 Tc 0.3428 Tw (nine States indicated that access problems probably) Tj 0.2827 -11.2256 TD 0.0384 Tc 1.3068 Tw (exist for these people, but none could estimate the) Tj 0.2827 -11.2256 TD 0.0285 Tc 1.0477 Tw (extent of the problems. Residents with Alzheimer\222s) Tj 0 -11.2256 TD 0.025 Tc 0.6278 Tw (disease often disrupt other nursing home residents.) Tj ET BT 0.934 0 0 0.9835 82.08 405.36 Tm -0.0236 Tc 1.0979 Tw (In addition, some Alzheimer\222s residents have a) Tj ET BT 0.8491 0 0 0.9835 82.08 394.56 Tm 0.0377 Tc 0.8484 Tw (tendency to wander, making them difficult to man-) Tj ET BT 0.8915 0 0 0.9835 82.32 383.28 Tm 0.0417 Tc 0.5172 Tw (age in nursing homes not specifically designed to) Tj ET BT 0.8491 0 0 0.9835 82.32 372.24 Tm 0.0452 Tc 0.18 Tw (allow wandering in a controlled environment. Nurs-) Tj 0 -10.9816 TD 0.0265 Tc 0.9087 Tw (ing homes specifically consider behavior during the) Tj ET BT 0.8915 0 0 0.9835 82.32 350.64 Tm 0.0404 Tc 2.18 Tw (admissions process, one California advocate ex-) Tj ET BT 0.934 0 0 0.9835 82.32 339.84 Tm -0.0375 Tc 0.7273 Tw (plained, and determine how well the individual) Tj ET BT 0.8915 0 0 0.9835 82.32 328.56 Tm 0.0419 Tc 1.3102 Tw (would fit in with the overall environment of the) Tj ET BT 0.934 0 0 0.9835 82.32 317.76 Tm -0.0226 Tc 1.2682 Tw (home. Discharge planners from the Ohio State) Tj ET BT 0.8491 0 0 0.9835 82.32 306.48 Tm 0.0306 Tc 1.5432 Tw (University Hospital told us that they have trouble) Tj 0.2827 -10.9816 TD 0.0324 Tc 1.6084 Tw (placing Alzheimer\222s patients who are combative or) Tj ET BT 0.8915 0 0 0.9835 82.8 284.16 Tm 0.0301 Tc 0.4149 Tw (wander. In Mississippi, Alzheimer\222s residents are) Tj ET BT 0.8491 0 0 0.9835 82.8 273.12 Tm 0.033 Tc 1.0962 Tw (considered heavy care residents in a nursing home) Tj 0 -10.9816 TD 0.0261 Tc 0.2026 Tw (market oriented toward light care \(emphasis added\)) Tj 0.2827 -11.2256 TD 0.0723 Tc 0 Tw (\(454\).) Tj ET BT 0.9835 0 0 0.9835 93.84 233.04 Tm 0.0369 Tc 0.4231 Tw (It is possible that if residents with dementia) Tj ET BT 0.934 0 0 0.9835 72.72 221.04 Tm -0.0402 Tc 1.5012 Tw (received more appropriate nursing home care, they) Tj ET BT 0.9835 0 0 0.9835 73.2 208.8 Tm 0.031 Tc 0.1153 Tw (would, in general, be less difficult to care for, and) Tj 0 -11.9577 TD 0.0267 Tc 1.0145 Tw (nursing home administrators and staff would be) Tj ET BT 0.934 0 0 0.9835 73.2 184.8 Tm -0.027 Tc 1.0374 Tw (more willing to admit them.) Tj ET BT 0.9835 0 0 0.9835 73.44 155.76 Tm 0.0362 Tc 0.891 Tw (Negative Consequences for the Families of) Tj 0.244 -11.9577 TD 0.0324 Tc 0.7241 Tw (Residents With Dementia) Tj ET BT 0.934 0 0 0.9835 84.72 126 Tm -0.0353 Tc 1.7345 Tw (Problems in the nursing home care provided for) Tj ET BT 0.8915 0 0 0.9835 73.44 113.76 Tm 0.0397 Tc 1.795 Tw (individuals with dementia also have negative conse-) Tj ET BT 0.934 0 0 0.9835 73.68 101.76 Tm -0.0216 Tc 0.6553 Tw (quences for the residents\222 families. Many families of) Tj 0 -11.7137 TD -0.0264 Tc 1.2723 Tw (individuals with dementia feel intensely guilty and) Tj ET BT 0.8915 0 0 0.9835 73.92 78.48 Tm 0.0409 Tc 1.3787 Tw (sad about having to place the individuals in nursing) Tj ET BT 0.9835 0 0 0.9835 73.44 66.48 Tm 0.015 Tc -0.0514 Tw (homes \(45,84,107,128,263,349\). Although it might) Tj 0 -11.9577 TD 0.0288 Tc 0.6754 Tw (be assumed that family members who have been) Tj ET BT 0.8915 0 0 0.9835 73.44 42.96 Tm 0.0464 Tc 0.576 Tw (caring for a person with dementia at home would feel) Tj ET BT 0.9835 0 0 0.9835 321.12 653.04 Tm 0.0423 Tc 0.592 Tw (relieved when the person is finally admitted to a) Tj ET BT 0.934 0 0 0.9835 321.12 640.8 Tm -0.0123 Tc 0.5719 Tw (nursing home, at least five studies have shown that) Tj ET BT 0.9835 0 0 0.9835 321.6 629.04 Tm 0.0186 Tc 0.1977 Tw (family members\222 continue to feel guilty, sad, anx-) Tj 0 -12.4458 TD 0.0256 Tc 2.3782 Tw (ious, and stressed \(152,341,349,424,516\). These) Tj ET BT 0.934 0 0 0.9835 321.6 604.8 Tm -0.0296 Tc 1.2145 Tw (feelings are probably due primarily to the patient\222s) Tj 0 -12.4458 TD -0.019 Tc 0.8361 Tw (condition and other factors that have made nursing) Tj ET BT 0.9835 0 0 0.9835 321.6 580.56 Tm 0.0282 Tc 1.7451 Tw (home placement necessary, but the feelings are) Tj ET BT 0.934 0 0 0.9835 321.84 568.32 Tm -0.0303 Tc 1.2336 Tw (undoubtedly intensified if the family perceives that) Tj ET BT 0.9835 0 0 0.9835 321.84 556.56 Tm 0.0394 Tc 0.4729 Tw (the individual is receiving inappropriate or poor-) Tj 0.244 -11.9577 TD 0.018 Tc -0.0457 Tw (quality care. Families are particularly likely to be) Tj 0.244 -12.4458 TD 0.0322 Tc 2.6242 Tw (anxious if they believe the nursing home staff) Tj -0.244 -11.7137 TD 0.0381 Tc 0.9867 Tw (members are not knowledgeable about dementia) Tj ET BT 0.934 0 0 0.9835 322.56 509.04 Tm 0.0669 Tc 0 Tw (\(84,162,263\).) Tj ET BT 0.9835 0 0 0.9835 333.6 491.04 Tm 0.0324 Tc 0.4068 Tw (Other negative consequences for families arise) Tj -11.4697 -12.4458 TD 0.0301 Tc 0.9704 Tw (because of the failure of many nursing homes to) Tj 0 -11.7137 TD 0.0292 Tc -0.0049 Tw (recognize and respond to families\222 needs. Nursing) Tj ET BT 0.934 0 0 0.9835 322.56 455.52 Tm -0.0387 Tc 1.1142 Tw (homes generally focus their efforts on the residents) Tj ET BT 0.9835 0 0 0.9835 323.04 443.28 Tm 0.0309 Tc 0.573 Tw (and may ignore families and fail to involve them) Tj ET BT 0.934 0 0 0.9835 323.28 431.28 Tm -0.0209 Tc 1.4254 Tw (sufficiently in the residents\222 care \(349\). Families of) Tj ET BT 0.9835 0 0 0.9835 322.8 419.52 Tm 0.0249 Tc 0.8537 Tw (nursing home residents with dementia generally) Tj ET BT 0.8066 0 0 0.9835 323.28 407.52 Tm 0.0478 Tc 1.4897 Tw (want to be involved in the individuals\222 care \(46,166,418\).) Tj ET BT 0.8915 0 0 0.9835 323.28 395.52 Tm 0.0494 Tc 1.047 Tw (Since many of the primary caregiving functions have) Tj 0 -12.2018 TD 0.0422 Tc 1.2089 Tw (been assumed by the nursing home, family members) Tj -0.2692 -12.2018 TD 0.0501 Tc 0.628 Tw (may be uncertain about their role. In some instances,) Tj ET BT 0.934 0 0 0.9835 323.52 359.76 Tm -0.0443 Tc 2.6619 Tw (a competitive or adversarial relationship develops) Tj ET BT 0.9835 0 0 0.9835 323.28 347.76 Tm 0.0347 Tc 1.4364 Tw (between the family and the staff, with negative) Tj 0.244 -12.2018 TD 0.0298 Tc -0.1275 Tw (consequences for the family, the resident, and the) Tj ET BT 0.934 0 0 0.9835 324 324 Tm 0.0469 Tc 1.5364 Tw (staff \(45,50,55\).) Tj ET BT 0.9835 0 0 0.9835 334.56 306 Tm 0.0288 Tc -0.1264 Tw (Visiting is frequently more difficult for families) Tj -10.9816 -12.4458 TD 0.0282 Tc -0.1258 Tw (of nursing home residents with dementia than for) Tj ET BT 0.934 0 0 0.9835 324 281.76 Tm -0.012 Tc 2.1133 Tw (families of other nursing home residents \(45,125\).) Tj ET BT 0.8915 0 0 0.9835 323.76 270 Tm 0.0324 Tc 1.8929 Tw (Although families of residents with dementia gener-) Tj ET BT 0.934 0 0 0.9835 324.24 257.52 Tm -0.0226 Tc 1.0647 Tw (ally visit regularly, at least two studies have found) Tj -0.257 -12.2018 TD -0.024 Tc 1.259 Tw (their visits are shorter and less enjoyable than the) Tj ET BT 0.9835 0 0 0.9835 324 233.52 Tm 0.033 Tc 1.7402 Tw (nursing home visits of families of nondemented) Tj -0.244 -12.2018 TD 0.0301 Tc 1.3365 Tw (residents \(310,515\). If the nursing home fails to) Tj ET BT 0.8915 0 0 0.9835 324 209.52 Tm 0.0393 Tc 1.5967 Tw (recognize and respond to this problem, families may) Tj ET BT 0.9835 0 0 0.9835 324 197.76 Tm 0.0295 Tc 0.0355 Tw (visit less often, again with negative consequences) Tj ET BT 0.934 0 0 0.9835 324.48 185.76 Tm -0.0485 Tc 2.7948 Tw (for everyone involved.) Tj ET BT 0.9835 0 0 0.9835 324.72 155.52 Tm 0.0256 Tc 0.975 Tw (Negative Consequences for Nursing Home) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 525.6 155.52 Tm /F6 11 Tf 0.0259 Tc 0 Tw (Staff) Tj ET BT 0.9835 0 0 0.9835 324.72 143.76 Tm /F4 10 Tf 0.0301 Tc (Members) Tj ET BT 0.934 0 0 0.9835 335.52 126 Tm -0.0347 Tc 2.3089 Tw (As noted earlier, individuals with dementia are) Tj ET BT 0.9835 0 0 0.9835 324.72 113.76 Tm 0.0294 Tc 0.5702 Tw (often difficult for nursing home staff members to) Tj 0 -11.7137 TD 0.0284 Tc 3.0464 Tw (manage because of their behavioral symptoms) Tj ET BT 0.934 0 0 0.9835 324.96 90.48 Tm 0.0663 Tc 1.3871 Tw (\(107,167,170,181,191,263,352,359,385\). Staff mem-) Tj ET BT 0.9835 0 0 0.9835 324.48 78.24 Tm 0.0329 Tc -0.0764 Tw (bers are most likely to be disturbed by verbally or) Tj -0.244 -11.9577 TD 0.0281 Tc 2.2536 Tw (physically aggressive and demanding behaviors) Tj 0.4881 -11.9577 TD 0.0288 Tc 1.0449 Tw (\(134,191,506\). Other resident behaviors that are) Tj -0.244 -12.4458 TD 0.0189 Tc 2.8121 Tw (disturbing to nursing home staff members are) Tj ET endstream endobj 226 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 227 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.92 676.32 m 540.24 676.32 l S BT 0.9835 0 0 0.9835 177.12 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0205 Tc 1.7728 Tw (Chapter 2-Nursing Home Residents With Dementia: Characteristics and Problems . 77) Tj ET BT 0.934 0 0 0.9835 61.92 642.72 Tm /F4 10 Tf -0.0355 Tc 1.8815 Tw (resistance to care, wandering, repetitive questions,) Tj ET BT 0.8915 0 0 0.9835 62.64 630.48 Tm 0.0296 Tc 2.2998 Tw (agitation, crying, and withdrawal.) Tj ET BT 0.934 0 0 0.9835 73.44 611.76 Tm -0.0349 Tc 0.8531 Tw (The difficulty of caring for residents with demen-) Tj -11.306 -12.6899 TD -0.0287 Tc 1.9477 Tw (tia causes stress, lowered morale, and burnout for) Tj 0.5139 -12.2018 TD 0.0025 Tc 0.7029 Tw (some, and perhaps many, nursing home staff mem-) Tj ET BT 0.9835 0 0 0.9835 62.88 575.52 Tm 0.0305 Tc 0.2379 Tw (bers \(191,263,346,352,398\). These staff responses) Tj ET BT 0.934 0 0 0.9835 63.12 563.52 Tm -0.0142 Tc 0.574 Tw (may in turn lead to increased absenteeism and staff) Tj ET BT 0.9835 0 0 0.9835 63.36 551.76 Tm 0.0254 Tc 0.121 Tw (turnover. To the extent that residents\222 behavioral) Tj ET BT 0.934 0 0 0.9835 63.84 539.76 Tm -0.0292 Tc 0.847 Tw (symptoms are caused or exacerbated by inappropri-) Tj 0 -12.4458 TD -0.0108 Tc 1.3697 Tw (ate nursing home care, the job of staff members is) Tj -0.5139 -11.9577 TD -0.0199 Tc 3.0854 Tw (unnecessarily difficult. Any resulting absenteeism) Tj 0.5139 -12.2018 TD -0.02 Tc 0.3875 Tw (or staff turnover is unnecessary in the same sense.) Tj ET BT 0.9835 0 0 0.9835 64.08 472.8 Tm 0.0418 Tc 1.3246 Tw (Negative Consequences for Nondemented) Tj 0 -12.4458 TD 0.0212 Tc 0.9794 Tw (Nursing Home Residents) Tj ET BT 0.934 0 0 0.9835 75.12 441.6 Tm -0.0226 Tc 2.3816 Tw (Nondemented nursing home residents may also) Tj -11.563 -12.4458 TD -0.0378 Tc 2.1923 Tw (experience negative consequences because of prob-) Tj 0.5139 -11.9577 TD -0.0464 Tc 0.8333 Tw (lems in the care provided for residents with demen-) Tj ET BT 0.9835 0 0 0.9835 64.8 405.36 Tm 0.0239 Tc 0.2853 Tw (tia. Behavioral and psychiatric symptoms of resi-) Tj 0 -11.9577 TD 0.0167 Tc 0.3252 Tw (dents with dementia, e.g., agitation, restlessness,) Tj ET BT 0.8066 0 0 0.9835 65.04 381.6 Tm 0.0646 Tc 0 Tw (screaming) Tj ET BT 0.934 0 0 0.9835 104.64 379.44 Tm -0.0233 Tc 2.3182 Tw ( repetitive verbalizations, and combative-) Tj ET BT 0.9835 0 0 0.9835 64.8 369.84 Tm 0.0368 Tc 2.9891 Tw (ness, are upsetting for nondemented residents) Tj 0.7321 -12.2018 TD 0.0206 Tc 0.0039 Tw (\(46,220,263,268,352,373\). The cognitive and func-) Tj ET BT 0.934 0 0 0.9835 65.28 345.84 Tm -0.0229 Tc 0.9687 Tw (tional impairments of residents with dementia may) Tj ET BT 0.9835 0 0 0.9835 65.52 333.84 Tm 0.0425 Tc 0.1037 Tw (also be bothersome to nondemented residents. To) Tj ET BT 0.8915 0 0 0.9835 65.52 321.6 Tm 0.0426 Tc 1.2085 Tw (the extent that these problems are caused or exacer-) Tj ET BT 0.9835 0 0 0.9835 65.28 309.84 Tm 0.0313 Tc 1.7745 Tw (bated by inappropriate care, they unnecessarily) Tj ET BT 0.934 0 0 0.9835 65.28 297.84 Tm -0.04 Tc 1.0788 Tw (reduce the quality of life of nondemented residents.) Tj ET BT 0.8915 0 0 0.9835 76.56 278.4 Tm 0.0511 Tc 0.9297 Tw (There is disagreement about the overall impact on) Tj ET BT 0.9835 0 0 0.9835 65.52 266.64 Tm 0.03 Tc 0.4011 Tw (nondemented nursing home residents of living in) Tj ET BT 0.934 0 0 0.9835 65.76 254.64 Tm -0.0244 Tc 1.6127 Tw (close proximity with demented residents \(270,398\).) Tj 0.5139 -11.9577 TD -0.0299 Tc 2.518 Tw (Some commentators argue nondemented residents) Tj ET BT 0.9835 0 0 0.9835 65.76 230.88 Tm 0.0264 Tc 0.12 Tw (benefit overall from living in close proximity with) Tj ET BT 0.934 0 0 0.9835 66.24 218.88 Tm -0.0298 Tc 2.1324 Tw (demented residents, primarily because of bonding,) Tj ET BT 0.8915 0 0 0.9835 66.24 206.88 Tm 0.0208 Tc 0.9253 Tw (the potential for mutual assistance, and reduced staff) Tj ET BT 0.8066 0 0 0.9835 66.24 195.12 Tm 0.0381 Tc 2.8241 Tw (expectations for the nondemented residents \(69,486,503\).) Tj ET BT 0.934 0 0 0.9835 66.72 182.88 Tm -0.0292 Tc 2.0803 Tw (other commentators argue that nondemented resi-) Tj ET BT 0.8915 0 0 0.9835 66.48 171.12 Tm 0.0521 Tc 0.9622 Tw (dents are harmed overall by living in close proximity) Tj ET BT 0.934 0 0 0.9835 66.48 159.12 Tm -0.0281 Tc 0.8137 Tw (with nondemented residents and that it is unfair to) Tj ET BT 0.9835 0 0 0.9835 66.48 146.88 Tm 0.0471 Tc 0.5522 Tw (nondemented residents to be placed in a 24-hour) Tj 0.244 -11.9577 TD 0.0273 Tc 4.6582 Tw (living situation with someone with dementia) Tj ET BT 0.934 0 0 0.9835 67.2 122.88 Tm 0.0717 Tc 0 Tw (\(1,148,220,354,373,510\).) Tj ET BT 0.8915 0 0 0.9835 77.76 104.16 Tm 0.0183 Tc 1.0263 Tw (The two studies OTA is aware of that address this) Tj -12.1137 -12.4458 TD 0.0397 Tc 2.2884 Tw (issue indicate nondemented nursing home residents) Tj ET BT 0.9835 0 0 0.9835 67.2 79.92 Tm 0.0305 Tc 3.6021 Tw (who live in close proximity to residents with) Tj -0.244 -11.9577 TD 0.0297 Tc 1.2393 Tw (dementia have significantly reduced mental and) Tj 0.4881 -12.2018 TD 0.0281 Tc 0.3623 Tw (emotional status and reduced social interactions.) Tj ET BT 0.934 0 0 0.9835 67.2 44.4 Tm -0.0236 Tc 1.4283 Tw (Wiltzius et al. compared the mental and emotional) Tj 0.5139 -12.2018 TD -0.0209 Tc 1.9944 Tw (status of 20 nondemented nursing home residents) Tj ET BT 0.9835 0 0 0.9835 313.44 642.72 Tm 0.0484 Tc 0.5857 Tw (before and 2 weeks after they were moved into a) Tj ET BT 0.934 0 0 0.9835 313.2 630.96 Tm -0.0256 Tc 0.6433 Tw (room with a demented resident \(507\). Two of the 20) Tj ET BT 0.9835 0 0 0.9835 313.68 618.96 Tm 0.0414 Tc 0.3001 Tw (nondemented residents showed signs of cognitive) Tj 0.244 -12.4458 TD 0.0414 Tc 2.6061 Tw (decline after the move; 17 of the 20 residents) Tj ET BT 0.934 0 0 0.9835 313.92 594.48 Tm -0.0416 Tc 1.9309 Tw (expressed feelings of depression and loneliness; 12) Tj ET BT 0.9835 0 0 0.9835 314.16 582.72 Tm 0.0392 Tc 0.7171 Tw (expressed feelings of anxiety and insecurity over) Tj ET BT 0.934 0 0 0.9835 313.92 570.72 Tm -0.0149 Tc 1.5062 Tw (having a roommate who was confused; and 5 were) Tj ET BT 0.8915 0 0 0.9835 313.44 558.48 Tm 0.0274 Tc 1.1059 Tw (judged by staff members to be less friendly and more) Tj ET BT 0.9835 0 0 0.9835 314.64 546.72 Tm 0.0269 Tc 1.1499 Tw (irritable after the move. In contrast, 2 of the 20) Tj ET BT 0.934 0 0 0.9835 314.4 534.72 Tm -0.0409 Tc 1.5447 Tw (residents became more friendly and expressed con-) Tj ET BT 0.9835 0 0 0.9835 314.64 522.48 Tm 0.0255 Tc 2.1139 Tw (cern for their demented roommate. The control) Tj ET BT 0.934 0 0 0.9835 314.88 510.96 Tm -0.0343 Tc 0.5955 Tw (group did not show similar changes over the 2-week) Tj ET BT 0.9835 0 0 0.9835 314.64 498.72 Tm 0.0305 Tc 1.4987 Tw (period, but it is not clear from the study report) Tj ET BT 0.934 0 0 0.9835 315.12 486.96 Tm -0.0418 Tc 1.2642 Tw (whether the control group members were moved at) Tj 0.257 -12.2018 TD -0.0131 Tc 0.5085 Tw (the beginning of the study.) Tj 11.563 -20.9871 TD -0.0299 Tc 1.1781 Tw (Teresi et al. compared the mental and emotional) Tj -11.0491 -12.4458 TD -0.0241 Tc 1.0128 Tw (status and other characteristics of 72 nondemented) Tj ET BT 0.8915 0 0 0.9835 315.36 430.32 Tm 0.0378 Tc 1.5984 Tw (nursing home residents, one-third of whom shared a) Tj ET BT 0.9835 0 0 0.9835 315.36 418.32 Tm 0.0403 Tc 1.2447 Tw (room or lived in a room adjacent to a demented) Tj 0 -12.2018 TD 0.0361 Tc 0.5983 Tw (resident \(438\). After 6 months, the nondemented) Tj T* 0.0357 Tc 1.3579 Tw (residents who shared a room or lived in a room) Tj ET BT 0.934 0 0 0.9835 316.08 382.32 Tm -0.0334 Tc 1.6652 Tw (adjacent to a demented resident were significantly) Tj ET BT 0.8915 0 0 0.9835 315.84 370.56 Tm 0.0393 Tc 1.2122 Tw (more likely than the other nondemented residents to) Tj 0.2692 -12.4458 TD 0.0267 Tc 1.6493 Tw (express dissatisfaction with life in general, the unit,) Tj 0.2692 -12.2018 TD 0.0425 Tc 1.0739 Tw (their room, their roommate, and the amount of noise) Tj ET BT 0.934 0 0 0.9835 316.32 334.32 Tm -0.0365 Tc 1.3687 Tw (in the room. They were significantly more likely to) Tj ET BT 0.9835 0 0 0.9835 316.08 322.32 Tm 0.0477 Tc 0.935 Tw (be perceived as depressed by staff members and) Tj 0.7321 -11.9577 TD 0.0285 Tc 0.7105 Tw (significantly less likely to receive visits or phone) Tj ET BT 0.934 0 0 0.9835 316.8 298.32 Tm -0.0234 Tc 1.2262 Tw (calls from family or friends.) Tj ET BT 0.9835 0 0 0.9835 327.6 277.68 Tm 0.0296 Tc -0.1272 Tw (It is unclear whether the negative outcomes for) Tj -10.9816 -11.7137 TD 0.043 Tc 1.3234 Tw (nondemented residents in these two studies are) Tj ET BT 0.934 0 0 0.9835 317.04 254.16 Tm -0.0339 Tc 0.8948 Tw (attributable to characteristics of the demented resi-) Tj ET BT 0.8915 0 0 0.9835 317.04 242.16 Tm 0.0357 Tc 0.4984 Tw (dents that are caused by their dementing illness or to) Tj ET BT 0.934 0 0 0.9835 317.28 230.4 Tm -0.0228 Tc 1.8312 Tw (characteristics that are caused by problems in the) Tj ET BT 0.9835 0 0 0.9835 317.28 218.64 Tm 0.0184 Tc 1.941 Tw (nursing home care they receive. In either case,) Tj ET BT 0.8915 0 0 0.9835 317.04 206.4 Tm 0.0308 Tc 1.6704 Tw (placing the demented and nondemented residents in) Tj ET BT 0.9835 0 0 0.9835 317.76 194.64 Tm 0.0379 Tc 1.3286 Tw (separate units would eliminate the cause of the) Tj ET BT 0.934 0 0 0.9835 317.28 182.64 Tm -0.0249 Tc 0.7322 Tw (problems. As discussed in chapter 1, some commen-) Tj 0.257 -12.2018 TD -0.0288 Tc 1.4033 Tw (tators believe placing individuals with dementia in) Tj ET BT 0.9835 0 0 0.9835 318 158.64 Tm 0.0309 Tc 0.2375 Tw (special care units may be justifiable solely on the) Tj 0 -12.4458 TD 0.0352 Tc 1.0872 Tw (grounds that it benefits nondemented residents,) Tj ET BT 0.8915 0 0 0.9835 318 134.4 Tm 0.0276 Tc 1.456 Tw (assuming the placements do not harm the demented) Tj -0.5384 -11.7137 TD 0.0096 Tc 0 Tw (residents.) Tj ET BT 0.9795 0 0 0.9795 407.28 88.56 Tm /F7 12 Tf -0.0011 Tc (Summary) Tj ET BT 0.934 0 0 0.9835 329.28 68.16 Tm /F4 10 Tf -0.0101 Tc 2.0256 Tw (Complaints and concerns about the quality and) Tj ET BT 0.9835 0 0 0.9835 318.48 56.4 Tm 0.0423 Tc 0.8359 Tw (appropriateness of the care provided for nursing) Tj -0.244 -11.7137 TD 0.0218 Tc 1.9549 Tw (home residents with dementia by most nursing) Tj ET BT 0.934 0 0 0.9835 318.24 32.88 Tm -0.0274 Tc 1.359 Tw (homes are pervasive. In comparison with the prob-) Tj ET endstream endobj 228 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 229 0 obj <>stream 0.72 w 1 j 0 0 0 RG 70.56 682.32 m 548.88 682.32 l S BT 0.9835 0 0 0.9835 71.04 688.56 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (78 ) Tj ET BT 0.9598 0 0 0.9598 83.76 688.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 90 688.56 Tm /F5 10 Tf 0.0125 Tc 1.0651 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -19.2788 -40.2659 TD /F4 10 Tf 0.04 Tc 0.2893 Tw (lems identified by the Institute of Medicine in its) Tj 0.9761 -12.2018 TD 0.0352 Tc 0.4093 Tw (1986 report on nursing home care for all types of) Tj ET BT 0.934 0 0 0.9835 70.8 624.96 Tm -0.0275 Tc 2.2584 Tw (residents, complaints and concerns about the care) Tj 0 -12.2018 TD -0.0476 Tc 1.1971 Tw (provided for residents with dementia focus more on) Tj ET BT 0.9835 0 0 0.9835 71.28 600.72 Tm 0.0476 Tc 1.1662 Tw (lack of staff knowledge about how to respond to) Tj -0.244 -12.2018 TD 0.0257 Tc 1.0969 Tw (residents\222 behavioral symptoms and physical as-) Tj 0.244 -12.2018 TD 0.0376 Tc 1.4203 Tw (pects of nursing homes that are perceived to be) Tj 0.244 -12.2018 TD 0.0309 Tc 0.0666 Tw (inappropriate for individuals with dementia \(e.g.,) Tj ET BT 0.8915 0 0 0.9835 71.76 552.96 Tm 0.0375 Tc 0.9719 Tw (lack of cues to help residents find their way and lack) Tj ET BT 0.934 0 0 0.9835 72 540.72 Tm -0.046 Tc 1.489 Tw (of appropriate space for residents to wander\). Both) Tj 0 -12.4458 TD -0.0399 Tc 0.9686 Tw (the Institute of Medicine\222s report and the literature) Tj ET BT 0.8915 0 0 0.9835 72 516.72 Tm 0.0516 Tc 1.0974 Tw (on nursing home care for persons with dementia cite) Tj 0 -12.2018 TD 0.0366 Tc 1.7985 Tw (overuse and inappropriate use of psychotropic medi-) Tj ET BT 0.9835 0 0 0.9835 72.24 492.48 Tm 0.0218 Tc 2.2235 Tw (cations and physical restraints. Although these) Tj ET BT 0.934 0 0 0.9835 72 480.72 Tm -0.0305 Tc 1.3623 Tw (problems affect all nursing home residents to some) Tj 0.5139 -12.2018 TD -0.0463 Tc 0.8974 Tw (degree, they are more likely to affect residents with) Tj ET BT 0.8915 0 0 0.9835 72.48 456.72 Tm 0.0171 Tc 0 Tw (dementia.) Tj ET BT 0.9835 0 0 0.9835 83.52 439.2 Tm 0.0224 Tc -0.0502 Tw (Problems in the care of nursing home residents) Tj ET BT 0.934 0 0 0.9835 72.72 427.44 Tm -0.0269 Tc 1.9152 Tw (with dementia have negative consequences for the) Tj -0.257 -12.2018 TD -0.0155 Tc 1.903 Tw (residents, their families, nursing home staff mem-) Tj ET BT 0.9835 0 0 0.9835 72.72 403.2 Tm 0.0264 Tc 1.2914 Tw (bers, and nondemented nursing home residents.) Tj ET BT 0.8915 0 0 0.9835 72.72 391.68 Tm 0.0493 Tc 0.9766 Tw (Inappropriate nursing home care tends to exacerbate) Tj ET BT 0.934 0 0 0.9835 73.2 379.44 Tm -0.0314 Tc 1.9872 Tw (the effects of an individual\222s dementing disease or) Tj 0.257 -12.2018 TD -0.0213 Tc 1.6522 Tw (condition. In particular instances, however, it may) Tj -0.257 -11.9577 TD -0.0337 Tc 1.1822 Tw (be difficult to differentiate effects of an individual\222s) Tj ET BT 0.9835 0 0 0.9835 73.44 343.68 Tm 0.047 Tc 3.6782 Tw (dementing disease or condition and effects of) Tj ET BT 0.8915 0 0 0.9835 73.44 331.68 Tm 0.0494 Tc 2.0084 Tw (inappropriate care.) Tj 12.3829 -18.0586 TD 0.0587 Tc 1.1006 Tw (Inappropriate nursing home care can cause excess) Tj -12.1137 -12.2018 TD 0.0325 Tc 1.6428 Tw (disability in terms of a resident\222s cognitive function-) Tj ET BT 0.9835 0 0 0.9835 73.68 289.92 Tm 0.0262 Tc -0.1238 Tw (ing, mood, self-care abilities, and behavior. To the) Tj ET BT 0.8915 0 0 0.9835 73.92 277.44 Tm 0.0358 Tc 1.6647 Tw (extent that inappropriate care causes excess disabil-) Tj ET BT 0.934 0 0 0.9835 73.92 265.68 Tm -0.0064 Tc 0.5086 Tw (ity, it makes the job of nursing home staff members) Tj ET BT 0.9835 0 0 0.9835 73.92 253.68 Tm 0.0326 Tc 3.0421 Tw (more difficult and may therefore be indirectly) Tj ET BT 0.934 0 0 0.9835 73.68 241.68 Tm -0.0245 Tc 1.1503 Tw (responsible for increasing staff stress, absenteeism,) Tj ET BT 0.8915 0 0 0.9835 74.4 229.68 Tm 0.0253 Tc 0.4203 Tw (and turnover. Likewise, to the extent that inappropri-) Tj ET BT 0.934 0 0 0.9835 74.4 217.44 Tm -0.0377 Tc 0.9662 Tw (ate care causes or exacerbates the cognitive deficits) Tj ET BT 0.9835 0 0 0.9835 74.64 205.44 Tm 0.0383 Tc 0.8807 Tw (and mood and behavioral symptoms of residents) Tj ET BT 0.934 0 0 0.9835 74.4 193.68 Tm -0.0331 Tc 1.5854 Tw (with dementia, it may be indirectly responsible for) Tj ET BT 0.8915 0 0 0.9835 74.16 181.92 Tm 0.0356 Tc 1.2163 Tw (reducing the quality of life of nondemented residents) Tj ET BT 0.934 0 0 0.9835 74.88 169.92 Tm -0.0461 Tc 0.7795 Tw (who live with or near demented residents.) Tj ET BT 0.9663 0 0 0.9939 141.84 139.68 Tm /F6 14 Tf 0.0433 Tc 0 Tw (CONCLUSION) Tj ET BT 0.9835 0 0 0.9835 85.92 121.68 Tm /F4 10 Tf 0.0287 Tc 0.2223 Tw (A very large number and proportion of nursing) Tj -11.2256 -12.2018 TD 0.0282 Tc 0.3623 Tw (home residents have dementia, although many of) Tj 0.4881 -12.2018 TD 0.038 Tc -0.0815 Tw (them do not have a diagnosis of dementia in their) Tj ET BT 0.8915 0 0 0.9835 75.12 85.92 Tm 0.0378 Tc 2.0215 Tw (medical records. Compared with nondemented nurs-) Tj ET BT 0.934 0 0 0.9835 75.36 74.16 Tm -0.0328 Tc 0.5938 Tw (ing home residents, residents with dementia are, on) Tj ET BT 0.9835 0 0 0.9835 75.36 61.92 Tm 0.0257 Tc 1.8778 Tw (average, older, more functionally impaired, and) Tj -0.4881 -11.7137 TD 0.029 Tc 3.0865 Tw (more likely to have depressive, psychotic, and) Tj ET BT 0.934 0 0 0.9835 75.12 38.16 Tm -0.0086 Tc 2.0241 Tw (behavioral symptoms. On the other hand, nursing) Tj ET BT 0.9835 0 0 0.9835 321.84 648.72 Tm 0.0343 Tc 1.7389 Tw (home residents with dementia are also diverse.) Tj ET BT 0.934 0 0 0.9835 322.08 636.96 Tm -0.0261 Tc 1.2107 Tw (According to national surveys, 5 percent of nursing) Tj ET BT 0.8915 0 0 0.9835 322.08 624.96 Tm 0.0428 Tc 0.939 Tw (home residents with dementia are under age 65; 4 to) Tj ET BT 0.934 0 0 0.9835 322.08 612.96 Tm -0.0276 Tc 1.2307 Tw (46 percent do not have impairments in activities of) Tj ET BT 0.9835 0 0 0.9835 322.56 600.48 Tm 0.0284 Tc 0.118 Tw (daily living, depending on the specific activity; 30) Tj -0.4881 -12.4458 TD 0.0371 Tc 3.3223 Tw (percent do not have depressive symptoms; 64) Tj 0.244 -11.9577 TD 0.0285 Tc 0.9197 Tw (percent do not have psychotic symptoms; and 40) Tj ET BT 0.8915 0 0 0.9835 322.32 564.48 Tm 0.0409 Tc 1.5949 Tw (percent do not have behavioral symptoms. Some are) Tj ET BT 0.9835 0 0 0.9835 322.56 552.72 Tm 0.0296 Tc 0.4015 Tw (physically healthy except for their dementia, and) Tj ET BT 0.8915 0 0 0.9835 323.04 540.72 Tm 0.0344 Tc 0.8138 Tw (others have many diseases and physical impairments) Tj 0.2692 -12.4458 TD 0.0272 Tc 1.4276 Tw (in addition to their dementia.) Tj 12.1137 -20.499 TD 0.0215 Tc 0.4246 Tw (For policy purposes, it is important to note that the) Tj ET BT 0.934 0 0 0.9835 323.28 496.56 Tm -0.0324 Tc 1.7926 Tw (diversity of nursing home residents with dementia) Tj 0 -12.2018 TD -0.0234 Tc 0.4982 Tw (makes it unlikely any particular type of unit will be) Tj ET BT 0.8915 0 0 0.9835 323.76 472.32 Tm 0.026 Tc 1.3424 Tw (appropriate for all these individuals. With respect to) Tj ET BT 0.9835 0 0 0.9835 323.52 460.56 Tm 0.0332 Tc 0.7639 Tw (the long-range possibilities for special care units) Tj ET BT 0.934 0 0 0.9835 323.76 448.8 Tm -0.0329 Tc 1.5361 Tw (discussed in chapter 1, it is also important to note) Tj ET BT 0.8915 0 0 0.9835 324 437.04 Tm 0.0357 Tc 1.2931 Tw (that placing all nursing home residents with demen-) Tj 0 -11.9577 TD 0.0428 Tc 0.367 Tw (tia in special care units would not eliminate residents) Tj ET BT 0.9835 0 0 0.9835 324 413.28 Tm 0.0299 Tc 2.9229 Tw (with behavioral symptoms from nonspecialized) Tj -0.244 -12.4458 TD 0.022 Tc 0.8217 Tw (units since more than one-third of nursing home) Tj 0.244 -11.7137 TD 0.0337 Tc 1.3735 Tw (residents with behavioral symptoms are not de-) Tj ET BT 0.8915 0 0 0.9835 324 377.28 Tm -0.0021 Tc 0 Tw (mented.) Tj ET BT 0.934 0 0 0.9835 335.52 357.12 Tm -0.0354 Tc 0.8965 Tw (Special care units have been developed primarily) Tj ET BT 0.9835 0 0 0.9835 324.72 345.6 Tm 0.0409 Tc 2.8943 Tw (in response to perceived problems in the care) Tj -0.244 -12.4458 TD 0.0353 Tc 2.8361 Tw (provided for residents with dementia in many) Tj 0 -11.7137 TD 0.0307 Tc 0.4643 Tw (nursing homes. Some of these problems affect all) Tj ET BT 0.934 0 0 0.9835 324.72 309.6 Tm -0.0261 Tc 1.2719 Tw (nursing home residents and others affect primarily) Tj -0.257 -12.2018 TD -0.0285 Tc 1.2133 Tw (residents with dementia. Even if the problems that) Tj 0.7709 -12.4458 TD -0.0361 Tc 0.8544 Tw (affect all nursing home residents were solved, some) Tj ET BT 0.8915 0 0 0.9835 324.72 273.36 Tm 0.0246 Tc 1.2286 Tw (problems that affect primarily residents with demen-) Tj ET BT 0.9835 0 0 0.9835 325.2 261.12 Tm 0.0256 Tc 0.4346 Tw (tia would remain. These problems include lack of) Tj 0 -12.2018 TD 0.0316 Tc 3.2262 Tw (cues to help residents find their way, lack of) Tj ET BT 0.934 0 0 0.9835 325.44 237.36 Tm -0.0411 Tc 1.08 Tw (appropriate space for residents to wander, and lack) Tj 0 -12.2018 TD -0.0235 Tc 0.6803 Tw (of specific staff training about methods of caring for) Tj ET BT 0.9835 0 0 0.9835 325.44 213.36 Tm 0.0296 Tc 0.2998 Tw (individuals with dementia, including appropriate) Tj 0 -11.9577 TD 0.0397 Tc 2.6933 Tw (methods of responding to residents\222 behavioral) Tj ET BT 0.8915 0 0 0.9835 326.16 189.36 Tm 0.2039 Tc 0 Tw (symptoms.) Tj ET BT 0.9835 0 0 0.9835 336.96 169.68 Tm 0.0386 Tc 2.7107 Tw (Special care units promise to provide better) Tj -11.4697 -11.9577 TD 0.0167 Tc 0.3739 Tw (nursing home care than is currently available for) Tj ET BT 0.8915 0 0 0.9835 326.16 145.68 Tm 0.0325 Tc 1.6236 Tw (individuals with dementia. By providing better care,) Tj ET BT 0.934 0 0 0.9835 326.16 133.44 Tm -0.0384 Tc 1.2422 Tw (they expect to benefit residents, residents\222 families,) Tj ET BT 0.9835 0 0 0.9835 326.16 121.92 Tm 0.0284 Tc 0.9965 Tw (nursing home staff, and nondemented residents.) Tj 0 -11.9577 TD 0.0275 Tc 2.2339 Tw (Better care can only alleviate impairments not) Tj 0.244 -12.4458 TD 0.0259 Tc 2.1948 Tw (directly or inevitably caused by an individual\222s) Tj 0 -11.9577 TD 0.0308 Tc 1.0917 Tw (dementing disease or condition. Likewise, better) Tj 0 -12.2018 TD 0.0366 Tc 0.8723 Tw (care for residents can only lessen that portion of) Tj T* 0.0001 Tc 1.611 Tw (family members\222) Tj 85.6565 -0.244 TD 0.0312 Tc 1.8844 Tw (feelings of guilt, sadness, and) Tj ET BT 0.8915 0 0 0.9835 326.88 50.4 Tm 0.0371 Tc 1.5511 Tw (anxiety due to inappropriate care, not the portion of) Tj -0.5384 -12.4458 TD 0.0379 Tc 1.4829 Tw (those feelings caused by a resident\222s impairments or) Tj ET endstream endobj 230 0 obj <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>> endobj 231 0 obj <>stream q 610.2001038 0 0 737.2801056 -0.1000061 -0.1400146 cm /Im0 Do Q q 1 0 0 1 52.5599976 676.5599976 cm 0 0 m 479.04 0 l n Q BT 0 0 0 rg /T1_0 10 Tf 0.0187 Tc 1.7197 Tw 0.9835 0 0 0.9835 168.24 682.32 Tm (Chapter 2-Nursing Home Residents With Dementia: Characteristics and Prob\ lems)Tj 0 Tc -0.061 Tw ( )Tj /T1_1 6 Tf 0.0036 Tc 0.0781 Tw 0.9598 0 0 0.9598 513.84 682.32 Tm (l )Tj /T1_0 10 Tf 0.366 Tc 0 Tw 0.9835 0 0 0.9835 520.32 682.32 Tm (79)Tj /T1_2 10 Tf 0.0403 Tc 2.0186 Tw 0.8915 0 0 0.9835 53.28 643.44 Tm (deteriorating condition. 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endstream endobj 236 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 237 0 obj <>stream BT 0.9663 0 0 0.9939 289.68 658.8 Tm 0 0 0 rg /F6 14 Tf -0.0052 Tc 0 Tw (Contents) Tj ET BT 0.8971 0 0 0.9835 500.88 642 Tm /F5 10 Tf 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 113.04 629.76 Tm /F4 10 Tf 0.0236 Tc 0.237 Tw (INTRODUCTION . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 266.16 629.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 219.6211 0.244 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . .) Tj 66.706 -0.244 TD 0.231 Tc 0 Tw (83) Tj ET BT 0.934 0 0 0.9835 113.04 618 Tm 0.0183 Tc 0.5392 Tw (TYPES OF DESCRIPTIVE STUDIES OF SPECIAL CARE UNITS . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 113.04 605.76 Tm 0.0022 Tc 0.1446 Tw (NUMBER OF NURSING HOMES THAT HAVE A SPECIAL CARE UNIT . . . . . . . .) Tj 0.244 -12.2018 TD 0.0295 Tc 0.0356 Tw (CHARACTERISTICS OF NURSING HOMES THAT HAVE A) Tj 11.4697 -11.9577 TD 0.0278 Tc 1.4608 Tw (SPECIAL CARE UNIT) Tj 114.9408 -0.244 TD -0.0666 Tc 2.7595 Tw (... ... ... ... ... ... ..*. .*. ... ... **. .. *.. ... *) Tj ET BT 1.08 0 0 1.08 440.88 579.84 Tm /F4 4 Tf 0.0012 Tc 0 Tw (c) Tj ET BT 0.9835 0 0 0.9835 443.04 581.76 Tm /F4 10 Tf 0.2578 Tc 3.7893 Tw (*. .* *a**,) Tj ET BT 0.8915 0 0 0.9835 124.56 570 Tm 0.2811 Tc 0 Tw (Ownership) Tj ET BT 0.8491 0 0 0.9835 177.6 570 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 182.0283 -0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 458.64 570 Tm -0.1039 Tc 0.3596 Tw (. . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 124.56 558 Tm -0.0639 Tc 0.0393 Tw (Certification Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 124.56 546.24 Tm 0.0129 Tc 0.7439 Tw (Nursing Home Size) Tj ET BT 0.8491 0 0 0.9835 220.32 546 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 124.56 534 Tm -0.0454 Tc 0.212 Tw (Nursing Home Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 114 522.24 Tm 0.0365 Tc 0.4149 Tw (CHARACTERISTICS OF SPECIAL CARE UNITS) Tj ET BT 0.8491 0 0 0.9835 439.2 534 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . .) Tj -103.4508 -12.2018 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 124.8 510.24 Tm -0.0252 Tc 2.6414 Tw (Number of Residents) Tj ET BT 0.8491 0 0 0.9835 225.36 509.52 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 225.5568 0.244 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 125.28 498 Tm 0.0359 Tc 0.5985 Tw (Age of the Units) Tj ET BT 0.8491 0 0 0.9835 206.64 498 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 148.6752 -0.244 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 459.36 497.76 Tm -0.1039 Tc 0.3596 Tw (. . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 125.28 486.48 Tm -0.0303 Tc 1.0409 Tw (Patient Care Philosophies and Goals) Tj ET BT 0.8491 0 0 0.9835 290.88 485.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 125.28 474 Tm 0.0504 Tc 2.1688 Tw (Physical Design and Other Environmental Features) Tj ET BT 0.8491 0 0 0.9835 356.4 473.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 125.76 462 Tm 0.0115 Tc 0.0326 Tw (Staff Composition and Training . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 353.52 461.52 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 126 450 Tm -0.0608 Tc 0.2611 Tw (Staff-to-Resident Ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 425.52 449.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 126 438.24 Tm 0.0412 Tc 0.105 Tw (staff support Groups) Tj ET BT 0.8491 0 0 0.9835 226.08 437.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 125.76 426 Tm -0.0633 Tc 0.1533 Tw (Activity Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 0.2692 -11.9577 TD -0.0245 Tc 0.2285 Tw (Programs for Families . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 339.84 413.52 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 126 402.24 Tm -0.0348 Tc 2.1806 Tw (Use of Psychotropic Drugs and Other Medications) Tj ET BT 0.8491 0 0 0.9835 357.12 402 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 126.24 390.48 Tm -0.02 Tc 1.7793 Tw (Use of Physical Restraints) Tj ET BT 0.8491 0 0 0.9835 249.6 390 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 148.6752 0 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 126 378.72 Tm -0.0311 Tc 1.8768 Tw (Admission and Discharge Policies and Practices) Tj ET BT 0.8491 0 0 0.9835 344.64 377.76 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 126.72 366.48 Tm -0.009 Tc 1.0823 Tw (Costs, Charges, and Payment Methods) Tj ET BT 0.8491 0 0 0.9835 301.68 366 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.934 0 0 0.9835 115.44 354.72 Tm 0.0167 Tc 0.2197 Tw (DESCRIPTIVE TYPOLOGIES OF SPECIAL CARE UNITS . . . . . . . . . . . . . . . . . . . . . . .) Tj 0.5139 -12.4458 TD 0.0184 Tc 0.5177 Tw (CHARACTERISTICS OF SPECIAL CARE UNIT RESIDENTS . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 115.92 330.48 Tm -0.0738 Tc 0.2702 Tw (CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 354.72 330.48 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9835 0 0 0.9835 115.92 318.96 Tm 0.0225 Tc -0.12 Tw (FORTHCOMING DESCRIPTIVE INFORMATION ABOUT SPECIAL) Tj ET BT 0.934 0 0 0.9835 483.84 330.48 Tm 0.0595 Tc -0.0188 Tw (+.. .) Tj -381.836 -23.6715 TD 0.0256 Tc 0.1503 Tw (CARE UNITS AND SPECIAL CARE UNIT RESIDENTS . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.7718 0 0 0.9795 509.28 617.76 Tm /F7 12 Tf 0.5279 Tc 0 Tw (83) Tj 0.311 -12.0066 TD 0.3724 Tc (85) Tj 0.311 -24.7482 TD 0.5279 Tc (88) Tj 0 -12.0066 TD 0.5279 Tc (88) Tj ET BT 0.8104 0 0 0.9795 509.76 557.76 Tm 0.3639 Tc (89) Tj ET BT 0.7718 0 0 0.9795 510 546 Tm 0.5279 Tc (89) Tj ET BT 0.934 0 0 0.9835 509.76 533.76 Tm /F4 10 Tf 0.2182 Tc (90) Tj 0 -12.2018 TD 0.2182 Tc (90) Tj ET BT 0.9835 0 0 0.9835 509.76 509.52 Tm 0.0497 Tc (90) Tj ET BT 0.934 0 0 0.9835 510.24 497.28 Tm 0.2182 Tc (90) Tj ET BT 0.8915 0 0 0.9835 510 485.52 Tm 0.0897 Tc (91) Tj ET BT 0.934 0 0 0.9835 510.24 473.52 Tm 0.2182 Tc (92) Tj ET BT 0.849 0 0 0.9795 510.24 461.52 Tm /F7 12 Tf 0.3583 Tc (94) Tj ET BT 0.8104 0 0 0.9795 510.48 449.52 Tm 0.3639 Tc (95) Tj 0 -12.2516 TD 0.3639 Tc (95) Tj ET BT 0.7718 0 0 0.9795 510.48 425.52 Tm 0.5279 Tc (95) Tj ET BT 0.849 0 0 0.9795 510.72 413.76 Tm 0.3583 Tc (96) Tj ET BT 0.8104 0 0 0.9795 510.96 401.52 Tm 0.512 Tc (96) Tj ET BT 0.849 0 0 0.9795 510.96 390 Tm 0.3583 Tc (96) Tj ET BT 0.8104 0 0 0.9795 511.2 378 Tm 0.3639 Tc (97) Tj 0 -12.2516 TD 0.3639 Tc (98) Tj ET BT 0.849 0 0 0.9795 511.2 354 Tm 0.3583 Tc (99) Tj ET BT 0.8066 0 0 0.9835 507.12 342.48 Tm /F4 10 Tf 0.2881 Tc (101) Tj ET BT 0.8491 0 0 0.9835 507.12 330.72 Tm 0.0897 Tc (103) Tj ET BT 0.8915 0 0 0.9835 507.36 307.2 Tm 0.0897 Tc (106) Tj ET BT 0.8875 0 0 0.9795 309.6 275.04 Tm /F7 12 Tf 0.1863 Tc (Tables) Tj ET BT 0.8499 0 0 0.9835 116.16 263.28 Tm /F5 10 Tf 0.0728 Tc (Table) Tj ET BT 0.8971 0 0 0.9835 504 263.04 Tm 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 116.64 251.04 Tm /F4 10 Tf 0.0095 Tc 0.2603 Tw (3-1. Descriptive Studies of Special Care Units... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84) Tj 0 -12.4458 TD -0.0138 Tc 0.7137 Tw (3-2. Characteristics of Nursing Homes That Had a Special Care Unit in) Tj ET BT 0.9835 0 0 0.9835 137.52 226.8 Tm 0.0212 Tc 1.084 Tw (1987 or Planned To Have a Special Care Unit by 1991, United States, 1987..... 88) Tj ET BT 0.934 0 0 0.9835 116.64 214.8 Tm -0.029 Tc 1.3607 Tw (3-3. Proportion of Special Care Units That Encouraged or Discouraged) Tj 21.0704 -11.9577 TD -0.0327 Tc 2.1355 Tw (Admission of Residents With Certain Problems) Tj ET BT 0.8491 0 0 0.9835 354 203.04 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 512.4 203.28 Tm 0.2243 Tc 0 Tw (98) Tj ET BT 0.934 0 0 0.9835 116.88 191.04 Tm 0.0016 Tc 0.4429 Tw (3-4. Ratings on Some Variables for Eight Types of Special Care Units . . . . . . . . . . . . . . . 100) Tj 0.257 -12.2018 TD -0.0176 Tc 1.3018 Tw (3-5. Impairments in Activities of Daily Living Among Special Care Unit Residents,) Tj 21.0704 -11.9577 TD -0.0243 Tc 1.1309 Tw (Residents With Dementia in Nonspecialized Nursing Home Units, and) Tj 0 -12.4458 TD -0.035 Tc 2.0523 Tw (All Nursing Home Residents) Tj ET BT 0.8491 0 0 0.9835 269.76 154.8 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 508.32 155.52 Tm 0.0897 Tc 0 Tw (102) Tj ET BT 0.934 0 0 0.9835 117.12 143.04 Tm -0.0051 Tc 0.4633 Tw (3-6. Conclusions From Descriptive Studies of Special Care Units . . . . . . . . . . . . . . . . . . . 104) Tj ET endstream endobj 238 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 239 0 obj <>stream 1.44 w 1 j 0 0 0 RG 49.68 624.24 m 528.96 624.24 l S BT 0.9663 0 0 0.9939 468.24 681.12 Tm 0 0 0 rg /F6 14 Tf -0.0214 Tc 1.2393 Tw (Chapter 3) Tj ET BT 0.9857 0 0 0.9857 168.48 655.92 Tm /F6 18 Tf 0.0205 Tc 0.5876 Tw (Special Care Units For People With Dementia:) Tj 94.2221 -18.9905 TD 0.0226 Tc 1.0724 Tw (Findings From Descriptive Studies) Tj ET BT 0.9663 0 0 0.9939 108.24 579.12 Tm /F6 14 Tf 0.2862 Tc 0 Tw (INTRODUCTION) Tj ET BT 0.9835 0 0 0.9835 61.68 561.6 Tm /F4 10 Tf 0.0299 Tc 0.8486 Tw (Much of the existing literature on special care) Tj -11.2256 -12.2018 TD 0.025 Tc 0.1215 Tw (units consists of reports about an individual unit.) Tj ET BT 0.934 0 0 0.9835 50.88 537.6 Tm -0.0356 Tc 2.1386 Tw (These reports usually describe the physical design) Tj ET BT 0.8915 0 0 0.9835 51.12 525.6 Tm 0.0259 Tc 2.1962 Tw (features, patient care philosophy, activity programs,) Tj ET BT 0.9835 0 0 0.9835 51.36 513.36 Tm 0.019 Tc 0.4631 Tw (and other characteristics of the unit that make it) Tj ET BT 0.8915 0 0 0.9835 51.84 501.36 Tm 0.0406 Tc 0.8817 Tw (special in the view of the report authors. The reports) Tj ET BT 0.9835 0 0 0.9835 51.6 489.36 Tm 0.0534 Tc 1.6788 Tw (often present anecdotal evidence of the positive) Tj ET BT 0.934 0 0 0.9835 51.84 477.6 Tm -0.0343 Tc 1.1094 Tw (outcomes of the unit and advocate the development) Tj ET BT 0.9835 0 0 0.9835 51.84 465.6 Tm 0.0344 Tc 3.3454 Tw (of more special care units like the one being) Tj ET BT 0.934 0 0 0.9835 51.84 453.6 Tm -0.0513 Tc 0 Tw (described.) Tj ET BT 0.9835 0 0 0.9835 62.88 434.64 Tm 0.0343 Tc 1.7715 Tw (Descriptive reports on individual special care) Tj ET BT 0.8915 0 0 0.9835 51.84 422.64 Tm 0.0405 Tc 0.8407 Tw (units are interesting in that they convey the authors\222) Tj ET BT 0.934 0 0 0.9835 52.32 410.88 Tm -0.0355 Tc 0.7681 Tw (commitment to providing better care for individuals) Tj 0 -12.2018 TD -0.0259 Tc 2.2995 Tw (with dementia and the authors\222 perceptions about) Tj 0.257 -11.7137 TD -0.0316 Tc 1.1065 Tw (what constitutes appropriate nursing home care for) Tj 0 -12.4458 TD -0.0249 Tc 0.9525 Tw (these individuals. On the other hand, the anecdotal) Tj 0 -12.2018 TD -0.0503 Tc 1.4937 Tw (evidence presented in these reports about the posi-) Tj 0 -11.9577 TD -0.0354 Tc 1.1748 Tw (tive outcomes of individual special care units is not) Tj 0.257 -12.4458 TD -0.0346 Tc 1.7778 Tw (adequate to evaluate their effectiveness. Moreover,) Tj ET BT 0.8915 0 0 0.9835 52.8 327.36 Tm 0.0366 Tc 1.4844 Tw (many of the descriptive reports on individual special) Tj ET BT 0.934 0 0 0.9835 53.04 315.36 Tm -0.0376 Tc 1.5168 Tw (care units do not provide enough detailed informa-) Tj 0 -12.2018 TD -0.0274 Tc 0.7308 Tw (tion about the characteristics of the units to allow a) Tj 0 -11.9577 TD -0.0192 Tc 1.4787 Tw (meaningful comparison of different units.) Tj ET BT 0.8915 0 0 0.9835 64.32 272.16 Tm 0.0561 Tc 0.6848 Tw (Research on special care units is in an early stage,) Tj ET BT 0.9835 0 0 0.9835 53.04 260.16 Tm 0.0341 Tc 0.7467 Tw (but in the past few years, a number of studies of) Tj ET BT 0.934 0 0 0.9835 53.76 248.16 Tm -0.0298 Tc 0.7191 Tw (special care units have been conducted. Some of the) Tj 0.257 -12.2018 TD -0.0339 Tc 2.1796 Tw (studies are descriptive, and others are evaluative.) Tj -0.5139 -11.9577 TD -0.0393 Tc 2.9134 Tw (The descriptive studies provide information about) Tj 0 -12.4458 TD -0.024 Tc 0.6946 Tw (the number and characteristics of special care units) Tj ET BT 0.8915 0 0 0.9835 53.52 200.16 Tm 0.0591 Tc 1.0361 Tw (nationally and in certain geographic areas and about) Tj ET BT 0.934 0 0 0.9835 54 187.92 Tm -0.032 Tc 1.6637 Tw (the similarities and differences among special care) Tj ET BT 0.8915 0 0 0.9835 53.76 175.68 Tm 0.0441 Tc 1.2067 Tw (units and between special care units and nonspecial-) Tj ET BT 0.9835 0 0 0.9835 54 163.68 Tm 0.0234 Tc 1.2212 Tw (ized nursing home units. The evaluative studies) Tj ET BT 0.934 0 0 0.9835 54.24 151.44 Tm -0.0415 Tc 0.7638 Tw (attempt to measure the effectiveness of one or more) Tj 0.257 -11.9577 TD -0.0269 Tc 1.2728 Tw (special care units in terms of changes in aspects of) Tj -0.257 -12.2018 TD -0.0348 Tc 0.7245 Tw (their residents\222 condition and functioning over time.) Tj ET BT 0.9835 0 0 0.9835 65.04 108.72 Tm 0.0192 Tc 2.6084 Tw (This chapter discusses what is known about) Tj -10.4935 -12.4458 TD 0.0311 Tc 1.3354 Tw (special care units from the available descriptive) Tj 0 -11.7137 TD 0.0348 Tc 1.5758 Tw (studies. Chapter 4 discusses the findings of the) Tj ET BT 0.934 0 0 0.9835 54.72 72.72 Tm -0.0182 Tc 2.12 Tw (available evaluative studies. The findings of these) Tj ET BT 0.9835 0 0 0.9835 54.72 60.72 Tm 0.038 Tc 0.1083 Tw (studies are discussed in some detail because they) Tj ET BT 0.934 0 0 0.9835 54.48 49.2 Tm -0.0384 Tc 1.8846 Tw (provide a basis for informed policy decisions about) Tj ET BT 0.9835 0 0 0.9835 54.96 36.96 Tm 0.041 Tc 0.5119 Tw (the development of special regulations and reim-) Tj ET BT 0.934 0 0 0.9835 302.4 583.2 Tm -0.028 Tc 0.7494 Tw (bursement for special care units, about the need for) Tj ET BT 0.9835 0 0 0.9835 302.4 571.2 Tm 0.029 Tc 1.2562 Tw (and content of consumer education materials on) Tj ET BT 0.8915 0 0 0.9835 302.64 559.44 Tm 0.0419 Tc 0.7717 Tw (special care units, and about the future direction and) Tj ET BT 0.934 0 0 0.9835 302.4 547.44 Tm -0.0451 Tc 1.3779 Tw (level of government support for research on special) Tj ET BT 0.8915 0 0 0.9835 302.4 535.44 Tm 0.0433 Tc 0.6693 Tw (care units.) Tj ET BT 0.9835 0 0 0.9835 313.44 517.2 Tm 0.0303 Tc 0.2517 Tw (Table 3-6 at the end of this chapter lists OTA\222s) Tj ET BT 0.934 0 0 0.9835 302.88 505.2 Tm -0.0445 Tc 2.8162 Tw (conclusions from the descriptive studies discussed) Tj ET BT 0.8915 0 0 0.9835 302.88 493.2 Tm 0.034 Tc 1.1284 Tw (in the chapter. \(An identical list appears in table 1-2) Tj ET BT 0.934 0 0 0.9835 303.12 481.2 Tm -0.0164 Tc 0.5396 Tw (inch. 1\). Probably the most important conclusion for) Tj -0.257 -12.2018 TD -0.0378 Tc 1.4986 Tw (policy purposes is the diversity of existing units. It) Tj ET BT 0.9835 0 0 0.9835 303.12 457.44 Tm 0.0286 Tc 0.4664 Tw (is also clear from available studies that although) Tj ET BT 0.934 0 0 0.9835 303.12 445.68 Tm -0.0302 Tc 1.0193 Tw (most special care units have a method of locking or) Tj ET BT 0.9835 0 0 0.9835 303.36 433.44 Tm 0.0182 Tc 1.9412 Tw (otherwise securing the unit, many units do not) Tj ET BT 0.934 0 0 0.9835 303.6 421.68 Tm -0.0416 Tc 2.0594 Tw (incorporate the other physical design features rec-) Tj 0.257 -12.2018 TD -0.0363 Tc 0.7444 Tw (ommended in the special care unit literature. More-) Tj ET BT 0.8915 0 0 0.9835 303.84 397.92 Tm 0.0346 Tc 0.4435 Tw (over, at least one-quarter of existing units report they) Tj ET BT 0.9835 0 0 0.9835 303.84 385.92 Tm 0.0397 Tc 3.4185 Tw (do not provide special training for their staff) Tj ET BT 0.934 0 0 0.9835 303.84 374.16 Tm -0.0292 Tc 2.0461 Tw (members. On the positive side, physical restraints) Tj 0.5139 -12.2018 TD -0.0268 Tc 0.9215 Tw (are used far less in special care units than in other) Tj -0.5139 -12.2018 TD -0.0143 Tc 1.1981 Tw (nursing home units. On average, special care units) Tj 0.7709 -12.2018 TD -0.0259 Tc 1.6143 Tw (also have fewer residents and more staff members) Tj ET BT 0.9835 0 0 0.9835 304.08 326.16 Tm 0.0218 Tc 0.8569 Tw (per resident than other nursing home units, and) Tj ET BT 0.934 0 0 0.9835 304.8 314.16 Tm -0.0379 Tc 1.0766 Tw (special care unit residents are probably more likely) Tj ET BT 0.9835 0 0 0.9835 304.56 302.4 Tm 0.0336 Tc 0.1127 Tw (than individuals with dementia in nonspecialized) Tj ET BT 0.8915 0 0 0.9835 304.32 290.4 Tm 0.0235 Tc 1.7683 Tw (units to participate in activity programs.) Tj ET BT 0.9663 0 0 0.9939 305.04 262.8 Tm /F6 14 Tf 0.0215 Tc 0.8638 Tw (TYPES OF DESCRIPTIVE STUDIES) Tj 27.8176 -16.1791 TD 0.0293 Tc 1.6009 Tw (OF SPECIAL CARE UNITS) Tj ET BT 0.934 0 0 0.9835 315.84 228.72 Tm /F4 10 Tf -0.0454 Tc 2.3204 Tw (Descriptive studies of special care units include) Tj ET BT 0.8915 0 0 0.9835 305.28 216.48 Tm 0.0012 Tc 1.5241 Tw (studies of three types:) Tj ET BT 0.934 0 0 0.9835 316.56 198.48 Tm -0.0197 Tc 0.69 Tw (. studies of nursing homes that include questions) Tj ET BT 0.8915 0 0 0.9835 327.36 186.48 Tm 0.0465 Tc 1.4733 Tw (about special care units,) Tj -11.8446 -12.4458 TD 0.0296 Tc 1.6076 Tw (. studies that compare selected special care units,) Tj ET BT 0.8491 0 0 0.9835 327.6 162.24 Tm 0.0347 Tc 0 Tw (and) Tj ET BT 0.934 0 0 0.9835 316.8 150 Tm -0.0379 Tc 0.9664 Tw (. studies that compare selected special care units) Tj ET BT 0.8915 0 0 0.9835 327.6 138.48 Tm 0.0417 Tc 0.7249 Tw (and selected nonspecialized nursing home units.) Tj ET BT 0.9835 0 0 0.9835 316.56 120.96 Tm 0.0302 Tc 1.8941 Tw (Tables 3-la, 3-lb, and 3-lc list the descriptive) Tj -10.7376 -12.4458 TD 0.0315 Tc 2.6598 Tw (studies of each type for which conclusions are) Tj ET BT 0.934 0 0 0.9835 305.76 96.72 Tm -0.0165 Tc 0.994 Tw (currently available at least in draft form. To OTA\222s) Tj ET BT 0.8915 0 0 0.9835 305.52 85.44 Tm 0.0378 Tc 1.483 Tw (knowledge, these tables include all such studies. For) Tj ET BT 0.934 0 0 0.9835 306 73.2 Tm -0.0227 Tc 0.6794 Tw (each study, the tables identify the citation, the year) Tj 0 -12.2018 TD -0.0318 Tc 1.5563 Tw (the study was conducted, the source of funding for) Tj ET BT 0.8915 0 0 0.9835 306 49.68 Tm 0.0252 Tc 0.4473 Tw (the study if given in the study report, and the general) Tj ET BT 0.934 0 0 0.9835 306 37.68 Tm -0.0412 Tc 1.6307 Tw (method of the study. The following sections review) Tj ET BT 0.9835 0 0 0.9835 283.68 19.68 Tm 0.0585 Tc 0 Tw (\22683-) Tj ET endstream endobj 240 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 241 0 obj <>stream 0.72 w 1 j 0 0 0 RG 80.16 685.2 m 558.72 685.2 l S 80.4 631.92 m 559.44 631.92 l S 80.64 609.84 m 559.2 609.84 l S 81.6 483.6 m 560.4 483.6 l S 83.28 287.28 m 562.32 287.28 l S 192.24 93.36 m 564 93.36 l S 84.96 92.88 m 193.68 92.88 l S BT 0.9835 0 0 0.9835 80.16 691.92 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (84 ) Tj ET BT 0.9598 0 0 0.9598 92.64 691.92 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 98.88 691.92 Tm /F5 10 Tf 0.0065 Tc 0.0544 Tw (Special Care ) Tj ET BT 0.9812 0 0 0.9812 152.88 691.92 Tm /F5 11 Tf 0.0745 Tc 0.0465 Tw (Units for People with ) Tj ET BT 0.9835 0 0 0.9835 250.32 691.92 Tm /F5 10 Tf 0.0229 Tc 0.4038 Tw (Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 207.12 650.88 Tm /F3 9 Tf 0.0365 Tc 0.7854 Tw (Table 3-l\227Descriptive Studies of Special Care Units) Tj -82.4885 -15.0864 TD 0.0458 Tc 0.3097 Tw (a. Descriptive Studies of Nursing Homes That Include Questions About Special Care Units) Tj ET BT 0.9189 0 0 0.99 141.12 622.08 Tm /F3 8 Tf -0.0132 Tc 0.4026 Tw (Year of) Tj -65.2963 -8.97 TD 0.0332 Tc 0 Tw (Citation) Tj 65.0351 -0.2424 TD 0.0127 Tc 0.3744 Tw (the study) Tj ET BT 0.8648 0 0 0.99 189.36 612.96 Tm 0.0599 Tc 1.8697 Tw (Funding source) Tj ET BT 0.9189 0 0 0.99 392.16 613.2 Tm 0.0263 Tc 0.2726 Tw (Method of the study) Tj ET BT 0.8108 0 0 0.99 81.36 600.24 Tm 0.1017 Tc 0.907 Tw (Hepburn et. al.,) Tj ET BT 0.9189 0 0 0.99 81.36 591.12 Tm -0.0071 Tc 0 Tw (1988) Tj 0 -14.061 TD 0.0346 Tc 0.2199 Tw (Holmes et al.,) Tj 0.2612 -8.97 TD 0.1888 Tc 0 Tw (1992) Tj ET BT 0.8648 0 0 0.99 82.08 545.76 Tm 0.0363 Tc 1.0645 Tw (Leon et. al.,) Tj ET BT 0.9189 0 0 0.99 82.08 537.12 Tm -0.0071 Tc 0 Tw (1990) Tj 0 -23.2734 TD 0.0295 Tc 1.4008 Tw (Mayers and) Tj 0 -8.97 TD 0.0258 Tc 0.6213 Tw (Block, 1990) Tj 65.0351 95.7605 TD -0.0071 Tc 0 Tw (1986) Tj ET BT 0.8648 0 0 0.99 189.36 599.76 Tm 0.0541 Tc 0.7663 Tw (No funding source reported) Tj 124.3249 0.2424 TD 0.0291 Tc 0.5178 Tw (Mail survey of all 438 licensed nursing homes in Minnesota, with a 76 percent) Tj ET BT 0.9189 0 0 0.99 296.64 590.88 Tm 0.0234 Tc 0.3628 Tw (response rate.) Tj -168.4645 -13.8186 TD -0.0071 Tc 0 Tw (1990) Tj 51.7147 -0.4849 TD 0.0235 Tc 0.4932 Tw (See note below) Tj 117.2722 0.2424 TD 0.0318 Tc 0.2823 Tw (Mail and telephone survey of all nursing homes in 5 northeastern States) Tj 0.2612 -8.97 TD 0.0223 Tc 0.6252 Tw (\(Connecticut, Massachusetts, New Jersey, New York, and Pennsylvania\),) Tj -0.7836 -8.7275 TD 0.0234 Tc 0.5195 Tw (with an 81 percent response rate.) Tj -168.2033 -13.8186 TD 0.1888 Tc 0 Tw (1987) Tj 51.7147 -0.2424 TD 0.0123 Tc 0.636 Tw (Agency for Health Care) Tj ET BT 0.8648 0 0 0.99 297.36 545.52 Tm 0.0335 Tc 1.484 Tw (On-site survey of a nationally representative sample of 759 nursing homes,) Tj ET BT 0.9189 0 0 0.99 190.08 536.64 Tm 0.0224 Tc 0.2332 Tw (Policy and Research) Tj ET BT 0.8648 0 0 0.99 297.36 536.4 Tm 0.0355 Tc 1.6204 Tw (using questionnaires and face-to-face interviews with facility administrators) Tj ET BT 0.9189 0 0 0.99 297.36 527.52 Tm 0.0113 Tc 0.1148 Tw (and staff.) Tj -168.7257 -13.8186 TD -0.0071 Tc 0 Tw (1989) Tj ET BT 0.8648 0 0 0.99 190.08 513.6 Tm 0.0541 Tc 1.0438 Tw (No funding source reported) Tj 124.3249 0.2424 TD 0.0322 Tc 0.9625 Tw (Mail survey of all 305 nursing homes in Washington State, with a 50 percent) Tj ET BT 0.9189 0 0 0.99 297.6 504.72 Tm 0.0234 Tc 0.1016 Tw (response rate.) Tj ET BT 0.9863 0 0 0.9863 180.72 487.92 Tm /F3 9 Tf 0.044 Tc 0.5548 Tw (b. Descriptive Studies That Compare Selected Special Care Units) Tj ET BT 0.9189 0 0 0.99 82.08 474.24 Tm /F3 8 Tf 0.0569 Tc 0.0651 Tw (Cairl et. al.,) Tj 65.8187 -0.2424 TD -0.0071 Tc 0 Tw (1990) Tj ET BT 0.8648 0 0 0.99 190.08 473.76 Tm 0.0626 Tc 1.7278 Tw (Administration on Aging) Tj 124.88 0 TD 0.0371 Tc 1.2022 Tw (Study comparing 13 nursing home special care units in 10 counties in west) Tj -248.9273 -8.4851 TD -0.0072 Tc 0 Tw (1991) Tj 248.6498 -0.4849 TD 0.0292 Tc 1.6585 Tw (central Florida, using an interview schedule for face-to-face interviews with) Tj -0.2775 -8.97 TD 0.0362 Tc 2.4521 Tw (facility staff.) Tj ET BT 0.9189 0 0 0.99 82.8 442.32 Tm 0.0145 Tc 1.9395 Tw (Hyde, 1989) Tj ET BT 0.8108 0 0 0.99 142.56 442.08 Tm 0.2939 Tc 0 Tw (not) Tj 59.4984 -0.2424 TD 0.0523 Tc 2.448 Tw (University of Massachusetts,) Tj ET BT 0.8648 0 0 0.99 298.08 442.08 Tm 0.0377 Tc 1.0629 Tw (Study of 7 nursing home special care units in eastern Massachusetts, using) Tj -179.8271 -8.97 TD 0.2806 Tc 0 Tw (reported) Tj 55.7797 -0.4849 TD 0.0492 Tc 3.8246 Tw (Gerontology Institute) Tj ET BT 0.9189 0 0 0.99 298.08 432.96 Tm 0.027 Tc 0.0976 Tw (a semi-structured interview schedule.) Tj ET BT 0.8648 0 0 0.99 82.8 419.76 Tm 0.0447 Tc 0 Tw (Knoefel,) Tj ET BT 0.9189 0 0 0.99 143.04 419.52 Tm -0.0071 Tc (1989) Tj 52.2371 -0.2424 TD -0.0054 Tc 1.1777 Tw (Department of Veterans) Tj ET BT 0.8648 0 0 0.99 298.32 419.28 Tm 0.0284 Tc 0.9669 Tw (Study of 5 special care units in VA and nonVA facilities, using chart reviews) Tj -249.2049 -8.7275 TD 0.0667 Tc 0 Tw (unpublished) Tj 124.6024 -0.2424 TD 0.0283 Tc (Affairs) Tj ET BT 0.9189 0 0 0.99 298.08 410.16 Tm 0.043 Tc 0.0803 Tw (and an interview schedule.) Tj ET BT 0.8648 0 0 0.99 82.8 401.76 Tm 0.0455 Tc 0 Tw (manuscript) Tj ET BT 0.9189 0 0 0.99 83.04 387.84 Tm 0.0228 Tc 1.147 Tw (Mace, 1991) Tj 65.5575 -0.2424 TD 0.0234 Tc 2.1258 Tw (1988-1989 No funding source reported) Tj 169.2481 -0.2424 TD 0.0388 Tc 0.0848 Tw (Mail survey of 12 nursing home special care units.) Tj -234.8056 -13.8186 TD 0.0294 Tc 1.1398 Tw (Ohta and) Tj ET BT 0.8108 0 0 0.99 143.28 373.44 Tm 0.2939 Tc 0 Tw (not) Tj ET BT 0.8648 0 0 0.99 191.52 373.44 Tm 0.0541 Tc 0.9513 Tw (No funding source reported) Tj ET BT 0.9189 0 0 0.99 298.8 373.44 Tm 0.0421 Tc 0.0812 Tw (Study of 16 nursing home special care units, using published and) Tj ET BT 0.99 0 0 0.99 83.04 364.8 Tm -0.0475 Tc 0.0055 Tw (Ohta, 1988) Tj ET BT 0.8648 0 0 0.99 143.28 364.56 Tm 0.2806 Tc 0 Tw (reported) Tj ET BT 0.9189 0 0 0.99 298.8 364.32 Tm 0.0432 Tc 0.08 Tw (unpublished reports, facility manuals, and site visits.) Tj -234.8056 -13.8186 TD 0.042 Tc 0.3425 Tw (Weiner and) Tj ET BT 0.99 0 0 0.99 143.76 350.64 Tm -0.0447 Tc 0.9724 Tw (1985-1986 Partial funding from the) Tj ET BT 0.9189 0 0 0.99 299.04 350.4 Tm 0.0351 Tc 0.1838 Tw (Mail survey of 22 nursing home special care units and several specialized) Tj ET BT 0.8648 0 0 0.99 83.76 342 Tm 0.0336 Tc 0.7901 Tw (Reingoid, 1989) Tj 124.6024 -0.7273 TD 0.0604 Tc 4.0892 Tw (Brookdale Foundation) Tj 124.0474 0 TD 0.0446 Tc 1.6099 Tw (programs in other settings.) Tj ET BT 0.9189 0 0 0.99 83.28 318.72 Tm 0.0389 Tc 1.3907 Tw (White and) Tj 66.0799 0 TD 0.1888 Tc 0 Tw (1987) Tj 51.7147 -0.4849 TD 0.0144 Tc 1.4174 Tw (Oregon State University) Tj 117.5334 0 TD 0.0305 Tc 0.2839 Tw (Mail survey of 99 nursing home special care units in 34 States.) Tj ET BT 0.8648 0 0 0.99 83.76 309.84 Tm 0.0131 Tc 2.7564 Tw (Kwon, 1991) Tj ET BT 0.9606 0 0 0.9863 83.76 291.6 Tm /F3 9 Tf -0.0067 Tc 0.3769 Tw (c. Descriptive Studies That Compare Selected Special Care Units and Selected Nonspecialized Nursing Home Units) Tj ET BT 0.99 0 0 0.99 84.24 277.92 Tm /F3 8 Tf -0.0592 Tc 0.987 Tw (Lindman et al., 1990) Tj ET BT 0.8648 0 0 0.99 84.24 268.8 Tm -0.0072 Tc 0 Tw (1991) Tj ET BT 0.99 0 0 0.99 84.24 236.88 Tm -0.0365 Tc 1.2065 Tw (Mathew et. al., Not) Tj ET BT 0.9189 0 0 0.99 84.48 227.76 Tm -0.0071 Tc 0 Tw (1988) Tj 64.774 -0.2424 TD 0.0257 Tc (reported) Tj ET BT 0.99 0 0 0.99 84.96 195.36 Tm -0.0315 Tc 1.6864 Tw (Rovner et. al., Not) Tj ET BT 0.9189 0 0 0.99 84.72 186.48 Tm 0.0267 Tc 0.6204 Tw (no date) Tj ET BT 0.8648 0 0 0.99 144.72 186.48 Tm 0.2806 Tc 0 Tw (reported) Tj ET BT 0.99 0 0 0.99 84.96 154.32 Tm -0.0596 Tc 1.9572 Tw (Sloane et. al., 1987-1989) Tj ET BT 0.9189 0 0 0.99 85.44 145.44 Tm -0.0071 Tc 0 Tw (1990) Tj ET BT 0.99 0 0 0.99 85.68 123.12 Tm -0.0448 Tc 0.0028 Tw (Riter and Fries, 1990) Tj ET BT 0.9189 0 0 0.99 85.44 114.48 Tm 0.1888 Tc 0 Tw (1992) Tj 115.9663 164.6111 TD 0.0202 Tc 0.758 Tw (California Department of) Tj 0.2612 -9.2124 TD 0.0079 Tc 1.4244 Tw (Health Services) Tj ET BT 0.8648 0 0 0.99 192.24 236.16 Tm 0.0541 Tc 0.9513 Tw (No funding source reported) Tj 0.8325 -41.4558 TD 0.0541 Tc 0.9513 Tw (No funding source reported) Tj -0.2775 -41.4558 TD 0.0232 Tc 4.4098 Tw (Alzheimer\222s Association) Tj ET BT 0.9189 0 0 0.99 193.44 123.12 Tm 0.0318 Tc 0.789 Tw (Health Care Financing Ad-) Tj ET BT 0.8648 0 0 0.99 193.44 114.48 Tm 0.0472 Tc 0 Tw (ministration) Tj ET BT 0.9189 0 0 0.99 299.52 277.2 Tm 0.0417 Tc 0.0817 Tw (Study comparing 11 individuals with dementia in 2 nursing home special) Tj ET BT 0.8648 0 0 0.99 299.28 268.32 Tm 0.036 Tc 1.1153 Tw (care units, 11 individuals with dementia in nonspecialized units in 2 nursing) Tj 0.2775 -8.97 TD 0.0319 Tc 1.1453 Tw (homes, and 8 individuals with dementia in 2 residential care facilities, using) Tj ET BT 0.9189 0 0 0.99 299.52 250.56 Tm 0.0364 Tc 0.3486 Tw (chart reviews, questionnaires, and patient observation.) Tj ET BT 0.8648 0 0 0.99 299.76 236.16 Tm 0.0429 Tc 1.3621 Tw (Study comparing 13 individuals with dementia in one nursing home special) Tj ET BT 0.9189 0 0 0.99 299.76 227.04 Tm 0.0457 Tc 0.0773 Tw (care unit and 34 individuals with dementia in nonspecialized units in 2) Tj 0.2612 -8.97 TD 0.0335 Tc 0.2937 Tw (nursing homes, using chart reviews and patient observation and examina-) Tj ET BT 0.8648 0 0 0.99 299.52 209.04 Tm 0.064 Tc 0 Tw (tion.) Tj 0.8325 -14.061 TD 0.0429 Tc 1.3621 Tw (Study comparing 19 individuals with dementia in one nursing home special) Tj ET BT 0.9189 0 0 0.99 300.24 186 Tm 0.0418 Tc 0.0816 Tw (care unit and 20 individuals with dementia in nonspecialized units of the) Tj 0 -8.97 TD 0.034 Tc 0.2932 Tw (same nursing home, using chart reviews and patient observation and) Tj T* 0.039 Tc 0 Tw (examination.) Tj 0.2612 -14.3035 TD 0.0378 Tc 0.1334 Tw (Study comparing 10 individuals with dementia in each of 31 nursing home) Tj 0.2612 -8.7275 TD 0.0349 Tc 0.2553 Tw (special care units and 32 nonspecialized nursing home units in 5 States,) Tj 0 -9.2124 TD 0.0394 Tc 0.1277 Tw (using chart reviews, questionnaires, and patient observation.) Tj ET BT 0.8648 0 0 0.99 300.96 123.12 Tm 0.0392 Tc 1.4774 Tw (Study comparing 127 individuals with dementia in 10 nursing home special) Tj ET BT 0.9189 0 0 0.99 300.48 114.48 Tm 0.043 Tc 0.1277 Tw (care units and 103 individuals with dementia in nonspecialized units in the) Tj 0.5224 -8.97 TD 0.0373 Tc 0.217 Tw (same nursing homes, using chart reviews, questionnaires, and patient) Tj ET BT 0.8648 0 0 0.99 300.72 96.72 Tm 0.0373 Tc 0 Tw (observation.) Tj ET BT 0.8027 0 0 0.9939 85.44 84.96 Tm /F3 7 Tf -0.0276 Tc 3.6685 Tw (NOTE: Thisstudywasoonducted by researchers) Tj 0 Tc 0.1461 Tw ( ) Tj ET BT 0.8449 0 0 0.9835 224.4 84.96 Tm /F2 10 Tf 0.0529 Tc 0.1339 Tw (atthe Hebrew Home forthe Aged to ) Tj ET BT 0.8027 0 0 0.9939 348.48 84.96 Tm /F3 7 Tf 0.0067 Tc 1.7447 Tw (obtain information about special care units in five States) Tj 0 Tc 0.1461 Tw ( ) Tj ET BT 0.8108 0 0 0.99 514.32 84.96 Tm /F3 8 Tf 0.0345 Tc 0.1018 Tw (that ) Tj ET BT 0.8027 0 0 0.9939 528.72 84.96 Tm /F3 7 Tf -0.0073 Tc 3.7429 Tw (would allow) Tj ET BT 0.8645 0 0 0.9939 108 76.8 Tm -0.0634 Tc 1.2283 Tw (them to identify a sample of units for their study of the impact of special care units; the latter study is funded by the National Institute on Aging, but no) Tj ET BT 0.9262 0 0 0.9939 108.24 69.12 Tm 0.0609 Tc 0.0606 Tw (findings are yet available from it.) Tj -24.3562 -10.8666 TD 0.0463 Tc 0.0763 Tw (SOURCE: Office of Technology Assessment, 1992.) Tj ET endstream endobj 242 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 243 0 obj <>stream 0.48 w 1 j 0 0 0 RG 51.12 674.16 m 529.92 674.16 l S BT 0.9835 0 0 0.9835 314.88 679.44 Tm 0 0 0 rg /F5 10 Tf 0.0193 Tc 2.5427 Tw (Chapter 3-Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 511.68 679.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 518.16 679.44 Tm /F5 10 Tf 0.366 Tc 0 Tw (85) Tj -474.1613 -39.0457 TD /F4 10 Tf 0.0398 Tc 1.2046 Tw (the findings of these studies with respect to the) Tj ET BT 0.934 0 0 0.9835 51.84 629.04 Tm -0.0145 Tc 1.4415 Tw (number of nursing homes with a special care unit,) Tj ET BT 0.9835 0 0 0.9835 52.08 617.04 Tm 0.0169 Tc 2.326 Tw (the characteristics of these nursing homes, the) Tj 0 -12.2018 TD 0.021 Tc 1.2062 Tw (characteristics of the special care units, and the) Tj ET BT 0.8915 0 0 0.9835 52.08 593.04 Tm 0.038 Tc 2.0211 Tw (characteristics of their residents.) Tj ET BT 0.934 0 0 0.9835 63.36 574.8 Tm -0.0107 Tc 1.2126 Tw (In 1991, researchers at George Washington Uni-) Tj -11.82 -12.2018 TD -0.0153 Tc 1.4745 Tw (versity in Washington, DC, mailed a questionnaire) Tj ET BT 0.8915 0 0 0.9835 52.56 551.04 Tm 0.0528 Tc 0.9614 Tw (about special care units to more than 17,000 nursing) Tj ET BT 0.934 0 0 0.9835 52.56 539.04 Tm -0.0177 Tc 0.6511 Tw (homes nationwide \(246\). Results of this survey with) Tj 0 -11.9577 TD -0.0163 Tc 0.5762 Tw (respect to the number of nursing homes that have a) Tj 0.7709 -12.2018 TD -0.0407 Tc 1.1805 Tw (special care unit are noted in the following section.) Tj ET BT 0.9835 0 0 0.9835 52.8 503.04 Tm 0.037 Tc 0.7601 Tw (As of May 1992, the other findings of the survey) Tj 0.4881 -11.9577 TD 0.0333 Tc 1.6179 Tw (were still being analyzed. Once available, these) Tj 0 -12.2018 TD 0.0281 Tc 0.5576 Tw (findings will greatly expand existing information) Tj ET BT 0.934 0 0 0.9835 53.52 467.52 Tm -0.0315 Tc 0.9065 Tw (about special care units. OTA is aware of two other) Tj ET BT 0.8915 0 0 0.9835 54 455.52 Tm 0.0431 Tc 1.6386 Tw (sources of forthcoming descriptive information about) Tj ET BT 0.9835 0 0 0.9835 54 443.28 Tm 0.0267 Tc 0.5163 Tw (special care units which are described in the last) Tj ET BT 0.934 0 0 0.9835 54 431.28 Tm -0.0402 Tc 1.0301 Tw (section of the chapter.) Tj ET BT 0.9939 0 0 0.9939 62.64 409.44 Tm /F6 14 Tf 0.0161 Tc 0.2656 Tw (NUMBER OF NURSING HOMES) Tj ET BT 0.9663 0 0 0.9939 88.56 393.36 Tm 0.0482 Tc 0.1739 Tw (THAT HAVE A SPECIAL) Tj 42.2232 -16.6621 TD 0.0695 Tc 1.1454 Tw (CARE UNIT) Tj ET BT 0.9835 0 0 0.9835 65.28 359.04 Tm /F4 10 Tf 0.0439 Tc 0.021 Tw (Five studies conducted between 1987 and 1991) Tj ET BT 0.934 0 0 0.9835 54 347.04 Tm -0.0279 Tc 1.6593 Tw (provide information about the number and propor-) Tj 0.5139 -12.2018 TD -0.0145 Tc 0.6314 Tw (tion of nursing homes that have a special care unit.) Tj ET BT 0.9835 0 0 0.9835 54.48 323.04 Tm 0.0277 Tc 2.9425 Tw (The five studies are discussed in this section.) Tj 0.244 -11.9577 TD 0.0443 Tc 3.1523 Tw (Because of differences among the studies and) Tj 0 -12.2018 TD 0.0266 Tc 1.1367 Tw (definitional questions, no firm conclusion can be) Tj ET BT 0.8915 0 0 0.9835 54.72 287.04 Tm 0.0402 Tc 0.7326 Tw (drawn at this time about the number or proportion of) Tj 0.2692 -11.7137 TD 0.0467 Tc 0.1869 Tw (nursing homes that have a special care unit. Based on) Tj ET BT 0.9835 0 0 0.9835 55.2 263.52 Tm 0.0279 Tc 1.3997 Tw (the results of the two most recent studies, OTA) Tj 0 -12.2018 TD 0.0243 Tc 0.8542 Tw (estimates that in 1991, 10 percent of all nursing) Tj ET BT 0.934 0 0 0.9835 54.96 239.52 Tm -0.0177 Tc 0.7775 Tw (homes in the United States had a special care unit.) Tj 0.5139 -11.9577 TD -0.0178 Tc 0.3851 Tw (This proportion varies among States, and at least in) Tj 0.5139 -12.6899 TD -0.0176 Tc 1.6054 Tw (some States, it includes nursing homes that group) Tj 0.257 -11.9577 TD -0.0391 Tc 0.7841 Tw (some of their residents with dementia in ) Tj ET BT 0.9443 0 0 0.9812 238.32 203.52 Tm /F5 11 Tf 0.015 Tc 1.045 Tw (clusters in) Tj ET BT 0.9606 0 0 0.9863 55.44 191.28 Tm /F3 9 Tf -0.0064 Tc 0.3141 Tw (units that also serve ) Tj ET BT 0.934 0 0 0.9835 143.04 191.28 Tm /F4 10 Tf -0.0385 Tc 3.6834 Tw (nondemented residents, rather) Tj ET BT 0.9835 0 0 0.9835 56.16 179.28 Tm 0.031 Tc -0.059 Tw (than placing the residents in an entirely separate) Tj ET BT 0.934 0 0 0.9835 56.16 167.52 Tm -0.0297 Tc 0.5906 Tw (special care unit.) Tj 11.563 -18.3027 TD -0.0115 Tc 2.0614 Tw (The 1987 National Medical Expenditure Survey) Tj ET BT 0.8915 0 0 0.9835 56.16 138 Tm 0.0526 Tc 1.3992 Tw (conducted by the Agency for Health Care Policy and) Tj ET BT 0.934 0 0 0.9835 56.16 125.76 Tm -0.0123 Tc 0.7718 Tw (Research is, thus far, the only study of a nationally) Tj ET BT 0.9835 0 0 0.9835 56.16 114 Tm 0.0282 Tc 0.403 Tw (representative sample of nursing homes that has) Tj 0.4881 -11.9577 TD 0.0271 Tc 1.2174 Tw (included questions about special care units. The) Tj 0.4881 -12.4458 TD 0.0184 Tc 0.2328 Tw (sampling frame for the study was 22,064 nursing) Tj -0.244 -11.7137 TD 0.0243 Tc 3.1726 Tw (homes and personal care homes, including all) Tj ET BT 0.8915 0 0 0.9835 56.88 66.48 Tm 0.042 Tc 2.2859 Tw (Medicare and Medicaid-certified nursing homes and) Tj ET BT 0.9835 0 0 0.9835 57.12 54.24 Tm 0.0415 Tc 1.5201 Tw (all State-licensed and otherwise officially recog-) Tj ET BT 0.8915 0 0 0.9835 57.12 42.48 Tm 0.0454 Tc 1.2053 Tw (nized nursing and personal care homes that: 1\) have) Tj ET BT 0.934 0 0 0.9835 57.6 30.48 Tm -0.0364 Tc 0.6834 Tw (three or more beds, 2\) provide personal care, and 3\)) Tj ET BT 0.9835 0 0 0.9835 303.12 640.8 Tm 0.0244 Tc 0.7627 Tw (are not primarily facilities for the mentally ill or) Tj ET BT 0.8915 0 0 0.9835 303.12 629.04 Tm 0.0351 Tc 1.3322 Tw (mentally retarded. Eight percent of the 759 facilities) Tj ET BT 0.934 0 0 0.9835 303.12 617.04 Tm -0.0305 Tc 0.7841 Tw (in the survey sample reported having a special care) Tj ET BT 0.8915 0 0 0.9835 303.12 604.8 Tm 0.0277 Tc 0.8214 Tw (unit \(249\). Extrapolated to the 22,064 facilities in the) Tj ET BT 0.9835 0 0 0.9835 303.84 592.56 Tm 0.0205 Tc 0.8989 Tw (sampling frame, this finding indicates that 1668) Tj ET BT 0.934 0 0 0.9835 303.36 580.8 Tm -0.0058 Tc 1.0218 Tw (nursing and personal care homes in the U.S. had a) Tj ET BT 0.8915 0 0 0.9835 303.84 568.56 Tm 0.0459 Tc 0.7 Tw (special care unit in 1987. These units were estimated) Tj ET BT 0.934 0 0 0.9835 303.84 556.56 Tm 0.0031 Tc 0.7611 Tw (to contain more than 53,000 beds.) Tj 11.563 -17.8146 TD -0.0115 Tc 2.1128 Tw (The 1987 National Medical Expenditure Survey) Tj ET BT 0.9835 0 0 0.9835 304.08 526.8 Tm 0.0257 Tc 1.062 Tw (also found that many nursing and personal care) Tj ET BT 0.8915 0 0 0.9835 303.84 515.04 Tm 0.0422 Tc 0.85 Tw (homes had plans to establish a special care unit. The) Tj 0.8076 -12.6899 TD 0.034 Tc 0.8143 Tw (survey data indicate that in 1987, 1444 facilities that) Tj -0.2692 -11.9577 TD 0.0377 Tc 0.8849 Tw (did not have a special care unit intended to establish) Tj ET BT 0.9835 0 0 0.9835 304.32 478.8 Tm 0.0386 Tc 1.1448 Tw (one by 1991. Moreover, 535 of the facilities that) Tj ET BT 0.934 0 0 0.9835 304.56 466.8 Tm -0.0243 Tc 1.709 Tw (already had a special care unit planned to expand) Tj ET BT 0.8915 0 0 0.9835 304.56 454.8 Tm 0.0352 Tc 0.1699 Tw (their unit by 1991. If all these plans had materialized,) Tj 0 -12.2018 TD 0.0604 Tc 0.6837 Tw (more than 3100 nursing and personal care homes \(14) Tj ET BT 0.9835 0 0 0.9835 304.56 430.56 Tm 0.0283 Tc 2.0704 Tw (percent of the facilities in the survey sampling) Tj ET BT 0.934 0 0 0.9835 304.8 418.8 Tm -0.0027 Tc 0.8757 Tw (frame\) would have had a special care unit by 1991,) Tj ET BT 0.8915 0 0 0.9835 305.28 406.8 Tm 0.0396 Tc 0.6734 Tw (and these units would have contained almost 100,000) Tj -0.5384 -12.4458 TD 0.2083 Tc 0 Tw (beds.) Tj ET BT 0.9835 0 0 0.9835 315.84 376.32 Tm 0.0278 Tc 1.2342 Tw (When published in 1990, the figures from the) Tj -9.5174 -12.2018 TD 0.0386 Tc 0.3029 Tw (1987 National Medical Expenditure Survey were) Tj ET BT 0.934 0 0 0.9835 305.28 352.32 Tm -0.0055 Tc 0.895 Tw (much higher than any previous estimates, but they) Tj ET BT 0.9835 0 0 0.9835 305.52 340.32 Tm 0.0337 Tc 0.008 Tw (were generally accepted as accurate. A few public) Tj 0 -12.4458 TD 0.0385 Tc -0.0317 Tw (officials and other individuals in some States told) Tj ET BT 0.8915 0 0 0.9835 306 316.08 Tm 0.0346 Tc 1.0081 Tw (OTA informally that they did not believe as many as) Tj ET BT 0.934 0 0 0.9835 306.24 304.08 Tm -0.0187 Tc 0.733 Tw (8 percent of the nursing homes in their State had a) Tj ET BT 0.8915 0 0 0.9835 306 292.32 Tm 0.058 Tc 0.9489 Tw (special care unit in 1987 or that 14 percent would in) Tj ET BT 0.934 0 0 0.9835 306.96 280.56 Tm 0.0052 Tc 0.7735 Tw (1991. Data from the 1987 National Medical Expen-) Tj ET BT 0.8915 0 0 0.9835 306 268.32 Tm 0.0358 Tc 1.1488 Tw (diture Survey cannot be broken down by State \(246\),) Tj ET BT 0.934 0 0 0.9835 306.48 256.56 Tm -0.0309 Tc 0.9344 Tw (so the survey data cannot be used to determine the) Tj ET BT 0.8915 0 0 0.9835 306 244.56 Tm 0.0586 Tc 1.1905 Tw (number or proportion of nursing homes in particular) Tj 0.8076 -12.4458 TD 0.0297 Tc 0.2269 Tw (States that have a special care unit. The data do show) Tj ET BT 0.934 0 0 0.9835 306.72 220.56 Tm -0.0312 Tc 0.9133 Tw (that the proportion of nursing homes with a special) Tj 0 -12.2018 TD -0.0325 Tc 1.3644 Tw (care unit varies in different regions of the country,) Tj ET BT 0.9835 0 0 0.9835 306.72 196.32 Tm 0.0429 Tc 1.9742 Tw (and findings of several studies discussed below) Tj ET BT 0.8915 0 0 0.9835 306.96 184.8 Tm 0.0313 Tc 1.7595 Tw (indicate the proportion varies by State.) Tj ET BT 0.9835 0 0 0.9835 317.76 166.8 Tm 0.0296 Tc 3.818 Tw (To OTA\222s knowledge, four studies have at-) Tj -10.7376 -11.9577 TD 0.0239 Tc 1.4953 Tw (tempted to survey all nursing homes in a given) Tj 0.244 -12.2018 TD 0.0359 Tc 1.1563 Tw (geographic area and thus to determine the total) Tj -0.244 -11.7137 TD 0.0218 Tc -0.0583 Tw (number of nursing homes that have a special care) Tj 0 -12.4458 TD 0.024 Tc 0.7326 Tw (unit in that area. One of the four studies, a mail) Tj 0.4881 -11.9577 TD 0.0389 Tc 2.0901 Tw (survey conducted from 1989 to 1990 of all 305) Tj ET BT 0.934 0 0 0.9835 307.68 96 Tm -0.0053 Tc 0.4176 Tw (nursing homes in Washington State found that only) Tj 0.5139 -12.2018 TD -0.0364 Tc 1.026 Tw (3 percent of the 154 facilities that responded to the) Tj 0 -12.4458 TD -0.0162 Tc 0.5761 Tw (survey \(or about 1.5 percent of all nursing homes in) Tj -0.257 -11.9577 TD -0.0164 Tc 0.5764 Tw (the State\) reported having a special care unit \(294\).) Tj ET BT 0.9835 0 0 0.9835 318.96 42.24 Tm 0.0229 Tc 0.0694 Tw (A 1986 mail survey of all 438 nursing homes in) Tj ET BT 0.934 0 0 0.9835 308.16 30.24 Tm -0.0197 Tc 0.9011 Tw (Minnesota found that 7 percent of the 332 facilities) Tj ET endstream endobj 244 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 245 0 obj <>stream 0.48 w 1 j 0 0 0 RG 79.92 684.24 m 558.96 684.24 l S BT 0.9835 0 0 0.9835 79.92 690.48 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (86 ) Tj ET BT 0.9598 0 0 0.9598 92.88 690.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 99.36 690.48 Tm /F5 10 Tf 0.0125 Tc 1.1464 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -19.2788 -40.2659 TD /F4 10 Tf 0.0414 Tc 1.6736 Tw (that responded to the survey reported having a) Tj ET BT 0.8915 0 0 0.9835 80.88 638.64 Tm 0.04 Tc 0.3499 Tw (special care unit \(18 1\). An additional 7 percent of the) Tj -0.8076 -12.2018 TD 0.0289 Tc 1.9417 Tw (responding facilities reported they planned to estab-) Tj ET BT 0.8491 0 0 0.9835 80.64 614.64 Tm 0.0389 Tc 0.8688 Tw (lish a special care unit in the next 2 to 3 years. If these) Tj ET BT 0.8915 0 0 0.9835 80.4 602.4 Tm 0.0364 Tc 1.3308 Tw (plans had materialized, 14 percent of the responding) Tj ET BT 0.9835 0 0 0.9835 80.88 590.64 Tm 0.0289 Tc 1.7647 Tw (facilities \(or 11 percent of all nursing homes in) Tj -0.244 -12.4458 TD 0.0373 Tc 0.0784 Tw (Minnesota\) would have had a special care unit by) Tj ET BT 0.934 0 0 0.9835 82.08 566.16 Tm 0.0516 Tc 0.7605 Tw (1988 or 1989.) Tj 10.7921 -18.3027 TD -0.027 Tc 0.7161 Tw (In 1990, researchers at the Hebrew Home for the) Tj ET BT 0.9835 0 0 0.9835 81.36 536.64 Tm 0.0325 Tc 2.3508 Tw (Aged in Riverdale, NY, mailed a questionnaire) Tj ET BT 0.934 0 0 0.9835 81.6 524.4 Tm -0.0204 Tc 0.5806 Tw (about special care units to all nursing homes in five) Tj ET BT 0.8915 0 0 0.9835 81.6 512.64 Tm 0.0305 Tc 1.3759 Tw (northeastern States \(194\). Seven percent of the 2370) Tj 0 -11.9577 TD 0.0319 Tc 0.0539 Tw (nursing homes in the 5 States reported having at least) Tj ET BT 0.934 0 0 0.9835 81.84 488.64 Tm -0.0351 Tc 0.682 Tw (one special care unit. An additional 5 percent of the) Tj 0 -12.2018 TD -0.0267 Tc 1.3215 Tw (nursing homes reported that although they did not) Tj ET BT 0.8915 0 0 0.9835 81.84 464.64 Tm 0.0444 Tc 1.018 Tw (have a special care unit, they did place some of their) Tj 0 -12.2018 TD 0.0281 Tc 0.9219 Tw (residents with dementia in clusters in units that also) Tj ET BT 0.934 0 0 0.9835 82.8 440.4 Tm -0.027 Tc 1.8724 Tw (served nondemented residents. Thus, a total of 12) Tj -0.7709 -11.9577 TD -0.0477 Tc 0.8668 Tw (percent of the facilities reported using some method) Tj 0.5139 -12.2018 TD -0.0382 Tc 2.1414 Tw (to physically group residents with dementia-either) Tj ET BT 0.8915 0 0 0.9835 82.56 404.88 Tm 0.0527 Tc 0.4569 Tw (in a special care unit or in a cluster in units that also) Tj ET BT 0.934 0 0 0.9835 83.04 393.12 Tm -0.0514 Tc 1.3846 Tw (serve nondemented residents. A telephone followup) Tj ET BT 0.9835 0 0 0.9835 82.8 381.12 Tm 0.0336 Tc 0.7635 Tw (to a random sample of 150 of the nursing homes) Tj 0 -11.7137 TD 0.0384 Tc 0.4875 Tw (found that in 15 of the facilities \(10 percent\), the) Tj 0 -12.4458 TD 0.024 Tc 1.8714 Tw (nursing home administrator and the director of) Tj ET BT 0.8915 0 0 0.9835 83.04 345.84 Tm 0.0454 Tc 1.4745 Tw (nursing disagreed about whether their facility had a) Tj ET BT 0.9835 0 0 0.9835 83.52 333.6 Tm 0.0227 Tc 1.466 Tw (special care unit. The researchers reduced their) Tj -0.7321 -11.9577 TD 0.0392 Tc -0.137 Tw (previous estimate to eliminate these questionable) Tj ET BT 0.934 0 0 0.9835 83.28 309.6 Tm -0.013 Tc 0.5727 Tw (units. Their conservative conclusion is that in 1990,) Tj 1.2848 -12.2018 TD -0.0118 Tc 0.6485 Tw (11 percent of all nursing homes in the 5 States had) Tj ET BT 0.8915 0 0 0.9835 84 285.84 Tm 0.049 Tc 1.033 Tw (at least one special care unit or cluster unit.) Tj ET BT 0.934 0 0 0.9835 94.56 267.84 Tm -0.0324 Tc 1.7314 Tw (As noted earlier, in 1991, researchers at George) Tj ET BT 0.8915 0 0 0.9835 83.76 255.84 Tm 0.0424 Tc 1.2086 Tw (Washington University mailed a questionnaire about) Tj ET BT 0.9835 0 0 0.9835 84.24 243.84 Tm 0.0227 Tc 0.4375 Tw (special care units to about 17,000 nursing homes) Tj ET BT 0.934 0 0 0.9835 84 232.08 Tm -0.0185 Tc 1.0925 Tw (nationwide, including all nursing homes thought to) Tj 0 -12.2018 TD -0.0352 Tc 0.6536 Tw (have 30 or more beds and to serve primarily elderly) Tj ET BT 0.9835 0 0 0.9835 84 207.6 Tm 0.0419 Tc -0.0351 Tw (people. After the elimination of facilities that had) Tj 0.4881 -11.9577 TD 0.0381 Tc 1.0538 Tw (closed or did not meet these criteria, there were) Tj ET BT 0.934 0 0 0.9835 85.44 183.84 Tm -0.0065 Tc 1.5935 Tw (15,490 potential respondents \(246\). Four thousand) Tj -1.0278 -12.4458 TD -0.04 Tc 2.9142 Tw (questionnaires were completed and returned. The) Tj -0.257 -11.7137 TD -0.0368 Tc 2.0115 Tw (researchers telephoned most of the nursing homes) Tj ET BT 0.9835 0 0 0.9835 84.96 147.84 Tm 0.0332 Tc 0.6927 Tw (that did not return the questionnaire. As of May) Tj 0.7321 -11.9577 TD 0.0273 Tc 2.6001 Tw (1992, information was available on more than) Tj 0 -12.2018 TD 0.0221 Tc 1.1006 Tw (14,000 nursing homes \(90 percent of all nursing) Tj -0.9761 -12.2018 TD 0.0262 Tc 3.2927 Tw (homes in the sampling frame\). Based on this) Tj ET BT 0.8915 0 0 0.9835 84.96 100.32 Tm 0.0502 Tc 1.5139 Tw (information, the researchers concluded that in 1991,) Tj ET BT 0.9835 0 0 0.9835 86.16 88.8 Tm 0.0248 Tc 0.8538 Tw (1463 nursing homes had a special care unit or a) Tj ET BT 0.8915 0 0 0.9835 85.68 76.56 Tm 0.0297 Tc 1.7613 Tw (special program for residents with dementia. Ninety) Tj ET BT 0.9835 0 0 0.9835 84.96 64.56 Tm 0.0305 Tc 0.4514 Tw (percent of the 1463 nursing homes with a special) Tj 0.4881 -12.2018 TD 0.0296 Tc 0.6354 Tw (care unit or special program reported the unit or) Tj -0.4881 -12.2018 TD 0.0236 Tc 1.3736 Tw (program was in a physically distinct part of the) Tj ET BT 0.934 0 0 0.9835 331.68 650.64 Tm -0.02 Tc 0.9977 Tw (facility. If only these nursing homes are counted as) Tj ET BT 0.9835 0 0 0.9835 331.68 638.64 Tm 0.0181 Tc 0.0979 Tw (having a special care unit, 1318 nursing homes \(9) Tj ET BT 0.934 0 0 0.9835 331.68 626.4 Tm -0.018 Tc 0.4816 Tw (percent of all nursing homes in the sampling frame\)) Tj 0.257 -12.2018 TD 0.0004 Tc 0.4727 Tw (had a special care unit in 1991.) Tj 11.563 -18.3027 TD -0.0244 Tc 1.3043 Tw (The George Washington University survey found) Tj -11.0491 -12.6899 TD -0.0354 Tc 1.4777 Tw (great differences among States in the proportion of) Tj -0.257 -11.9577 TD -0.0118 Tc 1.2281 Tw (nursing homes in the State that had a special care) Tj 0.257 -12.6899 TD -0.038 Tc 0.9298 Tw (unit or special program for residents with dementia) Tj ET BT 0.8915 0 0 0.9835 332.64 547.92 Tm 0.0298 Tc 1.1892 Tw (\(247\). Preliminary analysis of the data shows that in) Tj ET BT 0.9835 0 0 0.9835 332.88 535.92 Tm 0.0306 Tc 3.4509 Tw (some States a surprisingly high proportion of) Tj ET BT 0.8915 0 0 0.9835 332.64 524.4 Tm 0.0576 Tc 0.9561 Tw (nursing homes reported having a special care unit or) Tj ET BT 0.9835 0 0 0.9835 333.36 512.16 Tm 0.0296 Tc 1.2556 Tw (special program for residents with dementia: 36) Tj -0.7321 -12.2018 TD 0.0316 Tc 1.1824 Tw (percent of the nursing homes in Arizona and 27) Tj 0 -12.2018 TD 0.0292 Tc 2.0695 Tw (percent of the nursing homes in Utah reported) Tj ET BT 0.934 0 0 0.9835 332.88 476.16 Tm -0.0005 Tc 0.3023 Tw (having such a unit or program.) Tj ET BT 0.9835 0 0 0.9835 344.16 458.16 Tm 0.0188 Tc 0.0301 Tw (The George Washington University survey also) Tj ET BT 0.934 0 0 0.9835 333.36 446.16 Tm -0.0084 Tc 0.996 Tw (found that many of the nursing homes that did not) Tj ET BT 0.8915 0 0 0.9835 333.36 434.16 Tm 0.0534 Tc 1.0169 Tw (have a special care unit in 1991 planned to establish) Tj ET BT 0.934 0 0 0.9835 333.6 422.16 Tm -0.0143 Tc 0.5998 Tw (one, and some of the nursing homes that did have a) Tj ET BT 0.8915 0 0 0.9835 334.08 410.4 Tm 0.0344 Tc 1.4868 Tw (special care unit planned to expand it \(247\). Prelim-) Tj -0.2692 -11.9577 TD 0.0325 Tc 1.2198 Tw (inary analysis of the survey data shows that 1000 to) Tj ET BT 0.9835 0 0 0.9835 334.8 386.88 Tm 0.0387 Tc 0.498 Tw (1600 of the nursing homes \(6 to 10 percent of all) Tj -0.9761 -12.2018 TD 0.0246 Tc 0.1219 Tw (nursing homes in the sampling frame\) planned to) Tj 0.244 -12.4458 TD 0.0333 Tc 0.6316 Tw (establish a new special care unit or expand their) Tj ET BT 0.8915 0 0 0.9835 334.08 350.88 Tm 0.016 Tc 2.0459 Tw (existing unit.) Tj 12.6521 -18.3027 TD 0.0329 Tc 1.2866 Tw (For several reasons, the results of the five studies) Tj ET BT 0.934 0 0 0.9835 334.56 320.64 Tm -0.0422 Tc 1.2279 Tw (described in this section are not precisely compara-) Tj ET BT 0.9835 0 0 0.9835 334.32 308.88 Tm 0.0361 Tc 1.1909 Tw (ble. First, the studies sampled different types of) Tj 0.4881 -12.2018 TD 0.0151 Tc 1.8398 Tw (facilities \(i.e.,) Tj 71.0144 0 TD 0.0241 Tc 1.4645 Tw (nursing homes and personal care) Tj -71.2584 -11.9577 TD 0.0065 Tc 0.3843 Tw (homes, all nursing homes, or nursing homes with) Tj ET BT 0.934 0 0 0.9835 334.8 273.12 Tm -0.0263 Tc 1.9819 Tw (more than 30 beds\). Second, the studies identified) Tj 0 -12.4458 TD -0.0286 Tc 1.6494 Tw (different types of units \(i.e., special care units and) Tj 0.257 -11.9577 TD -0.031 Tc 0.6883 Tw (cluster units\), and some of the studies also included) Tj 0.5139 -12.2018 TD -0.0407 Tc 1.5017 Tw (special programs. Third, the studies covered differ-) Tj ET BT 0.9835 0 0 0.9835 335.28 225.12 Tm 0.0253 Tc 2.8462 Tw (ent geographic areas. Lastly, the studies were) Tj 0 -11.9577 TD 0.036 Tc 0.8075 Tw (conducted over a 4-year period during which the) Tj 0 -12.4458 TD 0.0267 Tc 1.1656 Tw (number and proportion of nursing homes with a) Tj ET BT 0.8915 0 0 0.9835 335.76 189.12 Tm 0.0487 Tc 2.211 Tw (special care unit undoubtedly increased.) Tj ET BT 0.934 0 0 0.9835 346.56 171.36 Tm -0.0229 Tc 1.8681 Tw (The preliminary estimate from the 1991 George) Tj -11.82 -12.2018 TD -0.0197 Tc 0.4942 Tw (Washington University survey and the conclusion of) Tj ET BT 0.8915 0 0 0.9835 336 147.36 Tm 0.0475 Tc 1.1132 Tw (the 1990 survey of all nursing homes in 5 northeast-) Tj ET BT 0.934 0 0 0.9835 336 135.12 Tm -0.0186 Tc 0.8613 Tw (ern States show that 9 to 11 percent of the nursing) Tj ET BT 0.9835 0 0 0.9835 336 123.6 Tm 0.0176 Tc 0.251 Tw (homes had a special care unit, a cluster unit, or a) Tj ET BT 0.8915 0 0 0.9835 336.48 111.84 Tm 0.0289 Tc 1.6276 Tw (special program for residents with dementia. Almost) Tj ET BT 0.9835 0 0 0.9835 336.24 100.32 Tm 0.0375 Tc 0.5968 Tw (half the units identified in the 1990 survey of all) Tj 0 -11.9577 TD 0.0265 Tc 1.6248 Tw (nursing homes in five northeastern States were) Tj 0.244 -12.2018 TD 0.023 Tc -0.1205 Tw (cluster units \(194\). It is unclear whether the 1463) Tj ET BT 0.8915 0 0 0.9835 336.96 64.32 Tm 0.0412 Tc 1.5561 Tw (special care units and special programs identified in) Tj ET BT 0.934 0 0 0.9835 336.72 52.56 Tm -0.0295 Tc 2.646 Tw (the George Washington University survey include) Tj 0 -12.2018 TD -0.0075 Tc 0.6096 Tw (cluster units, and if so, how many.) Tj ET endstream endobj 246 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 247 0 obj <>stream 0.72 w 1 j 0 0 0 RG 59.04 680.16 m 536.88 680.16 l S 62.64 67.44 m 540.24 67.44 l S BT 0.9835 0 0 0.9835 322.56 685.2 Tm 0 0 0 rg /F5 10 Tf 0.0237 Tc 1.9891 Tw (Chapter 3--Findings From Descriptive Studies . 87) Tj ET BT 0.8915 0 0 0.9835 70.56 646.32 Tm /F4 10 Tf 0.0318 Tc 1.2878 Tw (The biggest discrepancy in the findings of the five) Tj ET BT 0.934 0 0 0.9835 60.24 634.32 Tm -0.035 Tc 1.2707 Tw (studies is between the total number of special care) Tj ET BT 0.9835 0 0 0.9835 59.76 622.56 Tm 0.0358 Tc -0.1336 Tw (units and special programs identified by the 1987) Tj ET BT 0.934 0 0 0.9835 59.76 610.8 Tm -0.0092 Tc 2.3673 Tw (National Medical Expenditure Survey \(1668 units) Tj ET BT 0.8915 0 0 0.9835 60.24 598.56 Tm 0.0296 Tc 0.7856 Tw (and programs\) and the total number identified in the) Tj ET BT 0.934 0 0 0.9835 61.2 586.8 Tm -0.0023 Tc 2.1029 Tw (1991 George Washington University survey \(1463) Tj ET BT 0.8915 0 0 0.9835 60 574.32 Tm 0.0256 Tc 0.6506 Tw (units and programs\). These figures suggest there was) Tj ET BT 0.934 0 0 0.9835 60.48 562.56 Tm -0.0253 Tc 1.3567 Tw (a decrease in the number of special care units and) Tj -0.5139 -11.9577 TD 0.005 Tc 0.4066 Tw (programs between 1987 and 1991, a highly unlikely) Tj ET BT 0.8915 0 0 0.9835 60.48 538.56 Tm 0.0439 Tc 1.4378 Tw (conclusion. The figures lend themselves to two other) Tj 0 -11.9577 TD 0.0281 Tc 0 Tw (explanations:) Tj ET BT 0.934 0 0 0.9835 72.72 508.08 Tm -0.007 Tc 2.0224 Tw (1. the 1987 National Medical Expenditure Sur-) Tj 13.6186 -12.4458 TD -0.0343 Tc 1.4092 Tw (vey overestimated the number of special care) Tj ET BT 0.8915 0 0 0.9835 85.44 484.08 Tm 0.0046 Tc 1.5203 Tw (units, and) Tj ET BT 0.934 0 0 0.9835 72 471.36 Tm -0.0097 Tc 0.8689 Tw (2. the 1991 George Washington University study) Tj ET BT 0.9835 0 0 0.9835 85.68 459.12 Tm 0.0327 Tc 1.285 Tw (underestimated the number of special care) Tj ET BT 0.8491 0 0 0.9835 85.68 447.36 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.934 0 0 0.9835 61.2 428.4 Tm -0.0412 Tc 1.181 Tw (One or both of these explanations could be correct.) Tj ET BT 0.9557 0 0 1.08 285.6 433.2 Tm /F4 4 Tf -0.0045 Tc 0 Tw (l) Tj ET BT 0.934 0 0 0.9835 72 409.2 Tm /F4 10 Tf -0.0115 Tc 2.01 Tw (The 1987 National Medical Expenditure Survey) Tj -11.306 -11.9577 TD -0.0122 Tc 0.4862 Tw (and the 1991 George Washington University survey) Tj ET BT 0.8915 0 0 0.9835 61.68 385.44 Tm 0.0444 Tc 0.7218 Tw (asked about special care units ) Tj ET BT 0.9014 0 0 0.9812 193.68 385.44 Tm /F5 11 Tf 0.0884 Tc -0.187 Tw (and ) Tj ET BT 0.8915 0 0 0.9835 211.68 385.44 Tm /F4 10 Tf 0.036 Tc 2.8311 Tw (special programs.) Tj -168.7849 -12.2018 TD 0.066 Tc 1.014 Tw (The researchers who worked on the special care unit) Tj ET BT 0.934 0 0 0.9835 61.2 361.2 Tm -0.0259 Tc 2.2567 Tw (portion of the 1987 National Medical Expenditure) Tj ET BT 0.8915 0 0 0.9835 61.92 349.44 Tm 0.0367 Tc 1.2151 Tw (Survey concluded on the basis of the survey findings) Tj 0 -12.2018 TD 0.0269 Tc 1.1663 Tw (and the results of other studies that virtually all the) Tj ET BT 0.934 0 0 0.9835 61.92 325.92 Tm -0.0333 Tc 0.8514 Tw (facilities that reported having a special care unit or) Tj 0 -12.4458 TD -0.0153 Tc 1.4316 Tw (a special program in 1987 had at least one special) Tj 0 -12.2018 TD -0.0256 Tc 1.5283 Tw (care unit \(246\). As noted earlier, 90 percent of the) Tj 1.2848 -11.9577 TD -0.0137 Tc 1.6013 Tw (1463 nursing homes identified in the 1991 George) Tj -1.2848 -12.2018 TD -0.0077 Tc 1.8946 Tw (Washington University survey as having a special) Tj 0 -12.4458 TD -0.043 Tc 0.6369 Tw (care unit or program reported their unit or program) Tj ET BT 0.9835 0 0 0.9835 62.16 253.92 Tm 0.0248 Tc 0.5284 Tw (was in a physically distinct part of the facility. If) Tj ET BT 0.934 0 0 0.9835 62.16 241.68 Tm -0.0128 Tc 1.5681 Tw (only these nursing homes are counted as having a) Tj ET BT 0.9835 0 0 0.9835 62.64 229.44 Tm 0.0301 Tc 2.5973 Tw (special care unit, the discrepancy between the) Tj ET BT 0.934 0 0 0.9835 62.4 217.44 Tm 0.0046 Tc 0.4968 Tw (findings of the 1987 and 1991 surveys is bigger and) Tj -0.257 -12.2018 TD -0.037 Tc 1.6262 Tw (more difficult to explain.) Tj ET BT 0.9835 0 0 0.9835 73.44 186 Tm 0.0415 Tc 4.0092 Tw (An obvious obstacle to developing accurate) Tj -10.9816 -11.9577 TD 0.0201 Tc 1.5906 Tw (figures on the number of nursing homes with a) Tj ET BT 0.934 0 0 0.9835 62.88 162.24 Tm -0.0295 Tc 0.676 Tw (special care unit is the lack of a standard definition) Tj -0.257 -12.2018 TD -0.0392 Tc 0.3438 Tw (of the term ) Tj ET BT 0.9443 0 0 0.9812 114 150.24 Tm /F5 11 Tf 0.0184 Tc 0.2789 Tw (special care unit. ) Tj ET BT 0.934 0 0 0.9835 190.08 150.24 Tm /F4 10 Tf -0.0433 Tc 0.8621 Tw (All the figures cited in) Tj ET BT 0.8915 0 0 0.9835 62.64 138.72 Tm 0.0305 Tc 0.9528 Tw (this section are based on self-report, and most reflect) Tj 0 -12.2018 TD 0.037 Tc 1.0994 Tw (the opinions of the nursing home administrators and) Tj ET BT 0.934 0 0 0.9835 62.88 114.72 Tm -0.0301 Tc 0.9214 Tw (other survey respondents about what a special care) Tj ET BT 0.9835 0 0 0.9835 62.64 102.96 Tm 0.0157 Tc -0.0399 Tw (unit is. The 1990 survey of all nursing homes in 5) Tj ET BT 0.8915 0 0 0.9835 62.64 91.2 Tm 0.0287 Tc 0.7866 Tw (northeastern States found that only 49 percent of the) Tj ET BT 0.9835 0 0 0.9835 62.64 79.2 Tm 0.0241 Tc 1.9526 Tw (nursing homes that placed their residents with) Tj ET BT 0.8915 0 0 0.9835 310.32 646.32 Tm 0.0416 Tc 0.0251 Tw (dementia in a separate unit and only 12 percent of the) Tj ET BT 0.9835 0 0 0.9835 310.32 634.32 Tm 0.0241 Tc 1.9933 Tw (nursing homes that placed their residents with) Tj ET BT 0.8915 0 0 0.9835 310.56 622.56 Tm 0.0383 Tc 0.9057 Tw (dementia in clusters in nonspecialized units used the) Tj ET BT 0.9835 0 0 0.9835 310.8 610.32 Tm 0.0208 Tc 2.0781 Tw (term \223special care\224) Tj ET BT 0.934 0 0 0.9835 405.36 610.32 Tm -0.0046 Tc 1.3345 Tw (for these arrangements \(194\).) Tj -101.4975 -12.2018 TD -0.0321 Tc 0.9072 Tw (Moreover, as noted earlier, in 10 percent of the 150) Tj 0.5139 -11.9577 TD -0.0313 Tc 1.5345 Tw (facilities contacted by telephone, the nursing home) Tj 0 -12.6899 TD -0.0334 Tc 0.8943 Tw (administrator and the director of nursing disagreed) Tj ET BT 0.8915 0 0 0.9835 311.04 562.08 Tm 0.0484 Tc 1.2692 Tw (about whether their facility had a special care unit.) Tj ET BT 0.934 0 0 0.9835 322.08 541.44 Tm -0.023 Tc 1.1402 Tw (Having a standard definition of the term) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 507.12 541.44 Tm /F5 11 Tf 0.0116 Tc 0 Tw (special) Tj ET BT 0.9812 0 0 0.9812 311.28 529.2 Tm 0.0924 Tc 2.2908 Tw (care unit) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 358.32 529.2 Tm /F4 10 Tf 0.0504 Tc 4.7323 Tw (would facilitate the development of) Tj -47.587 -11.9577 TD 0.018 Tc 0.2331 Tw (accurate figures on the number of nursing homes) Tj 0 -11.9577 TD 0.0238 Tc 0.1227 Tw (with a unit that met that definition. On the other) Tj ET BT 0.8915 0 0 0.9835 311.28 493.68 Tm 0.016 Tc 0.4606 Tw (hand, units that did not meet the definition would not) Tj 0.2692 -12.2018 TD 0.0593 Tc 0.9504 Tw (be counted. Since research on special care units is in) Tj 0.5384 -11.9577 TD 0.035 Tc 0.3556 Tw (an early stage, it is important not to define away care) Tj ET BT 0.9835 0 0 0.9835 312 457.92 Tm 0.019 Tc 0.158 Tw (arrangements that may turn out to be variants of) Tj ET BT 0.8915 0 0 0.9835 312.24 446.16 Tm 0.0293 Tc 1.1636 Tw (special care units. In this context, it should be noted) Tj ET BT 0.934 0 0 0.9835 312 434.16 Tm -0.0137 Tc 0.5092 Tw (that the first information about the large number of) Tj ET BT 0.8915 0 0 0.9835 312 422.4 Tm 0.0196 Tc 0.5163 Tw (cluster units in some States was derived from a study) Tj 0.2692 -12.4458 TD 0.0265 Tc 0.8035 Tw (that deliberately did not define the term ) Tj ET BT 0.9014 0 0 0.9812 488.16 410.16 Tm /F5 11 Tf -0.0377 Tc 2.6155 Tw (special care) Tj ET BT 0.9443 0 0 0.9812 312.48 398.16 Tm 0.0393 Tc 0.0026 Tw (unit ) Tj ET BT 0.934 0 0 0.9835 331.68 398.16 Tm /F4 10 Tf -0.014 Tc 0.9409 Tw (and instead asked a very broad question about) Tj ET BT 0.9835 0 0 0.9835 312.24 386.16 Tm 0.0314 Tc 2.352 Tw (the \223types of living arrangements available for) Tj 0.244 -12.2018 TD 0.0353 Tc 0.355 Tw (cognitively impaired \(demented\) residents\222 in the) Tj 0 -11.9577 TD 0.0267 Tc 0.6078 Tw (facility \(177\). Although cluster units do not meet) Tj 0.244 -12.4458 TD 0.0391 Tc 2.3035 Tw (some definitions of the term) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 455.52 350.16 Tm /F5 11 Tf 0.0809 Tc 3.5254 Tw (special care unit,) Tj ET BT 0.934 0 0 0.9835 312.48 338.16 Tm /F4 10 Tf -0.0331 Tc 1.2183 Tw (information on cluster units presented later in this) Tj 0 -11.9577 TD -0.0343 Tc 1.6661 Tw (chapter shows that significant proportions of these) Tj ET BT 0.9835 0 0 0.9835 312.48 314.4 Tm 0.0327 Tc 0.009 Tw (units incorporate features said to be important in) Tj 0.4881 -12.2018 TD 0.02 Tc 1.0214 Tw (special care units \(e.g., physical design features,) Tj ET BT 0.934 0 0 0.9835 313.2 290.64 Tm -0.0144 Tc 2.1587 Tw (special staff training, staff support groups, family) Tj ET BT 0.8915 0 0 0.9835 313.2 278.64 Tm 0.0278 Tc 1.5391 Tw (support groups, and formal admission and discharge) Tj -0.2692 -12.2018 TD 0.0444 Tc 0 Tw (criteria\).) Tj ET BT 0.9835 0 0 0.9835 323.76 245.52 Tm 2.7163 Tc (In) Tj 0.0041 Tc (s) Tj 20.9871 -0.244 TD 0.0178 Tc 3.5453 Tw (ummary, findings of the 1987 National) Tj ET BT 0.8915 0 0 0.9835 312.72 233.52 Tm 0.0351 Tc 1.0823 Tw (Medical Expenditure Survey indicated that 8 percent) Tj ET BT 0.934 0 0 0.9835 313.2 221.28 Tm -0.0062 Tc 0.3855 Tw (of all nursing homes had a special care unit in 1987) Tj 0 -12.2018 TD -0.01 Tc 1.1155 Tw (and that if plans reported in 1987 materialized, 14) Tj ET BT 0.9835 0 0 0.9835 312.96 197.28 Tm 0.0334 Tc -0.1006 Tw (percent of all nursing homes would have a special) Tj 0.244 -12.4458 TD 0.0314 Tc 0.603 Tw (care unit in 1991. Results of several studies con-) Tj ET BT 0.934 0 0 0.9835 313.2 173.28 Tm -0.0098 Tc 0.3766 Tw (ducted since 1987 suggest the figures from the 1987) Tj 0 -11.7137 TD -0.0283 Tc 1.4242 Tw (National Medical Expenditure Survey overestimate) Tj ET BT 0.8915 0 0 0.9835 313.44 149.52 Tm 0.0399 Tc 0.2357 Tw (the number and proportion of nursing homes that had) Tj ET BT 0.9835 0 0 0.9835 313.68 138 Tm 0.0278 Tc 1.149 Tw (a special care unit in 1987 and the number and) Tj -0.4881 -11.7137 TD 0.0355 Tc 0.2328 Tw (proportion that would have a special care unit by) Tj ET BT 0.934 0 0 0.9835 314.64 114.24 Tm 0.002 Tc 0.8136 Tw (1991. Based on available data, OTA estimates that) Tj -1.0278 -11.7137 TD -0.0096 Tc 0.8545 Tw (in 1991, 10 percent of nursing homes in the United) Tj ET BT 0.8915 0 0 0.9835 313.92 90.72 Tm 0.0383 Tc 0.8094 Tw (States had a special care unit. This proportion varies) Tj ET BT 0.9835 0 0 0.9835 313.68 78.96 Tm 0.0325 Tc 0.141 Tw (in different States, and in at least some States, it) Tj ET q 0.96 0 0 -4.32 77.28 61.68 cm BI /W 9 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>>>>>~~ EI Q BT 0.1878 0 0 0.9835 77.28 55.44 Tm 3 Tr /F2 10 Tf 0.1101 Tc 0 Tw (1) Tj 0 Tr ET BT 0.7511 0 0 0.9835 78.24 55.44 Tm 0.0566 Tc 0.5921 Tw ( Another theoretically possible but unlikely explanation is that many of the special care units included in the 1987 figure are in personal care homes) Tj -20.1315 -9.2734 TD 0.0455 Tc 0.5537 Tw (or nursing homes with ) Tj ET q 26.16 0 0 -5.76 135.6 51.84 cm BI /W 184 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p >??~??x~?~8|>>8|>>|>>|>x>|><>|>?>|>~|>~|>`~||>>x?|~>>xx?>??|????C<??@?>>>`~π~ EI Q BT 0.6102 0 0 0.9835 135.6 46.32 Tm 3 Tr -0.0741 Tc 0 Tw (fewerthau) Tj 0 Tr ET BT 0.7511 0 0 0.9835 161.76 46.32 Tm 0.0737 Tc 0.6465 Tw ( 30 beds which were included in the 1987 National Medical Expenditure Survey but not in the 1991 George Washington) Tj -131.6539 -9.0293 TD 0.047 Tc 3.1879 Tw (University survey.) Tj ET endstream endobj 248 0 obj <>/Rotate 0/Type/Page>> endobj 249 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.48 687.12 m 550.8 687.12 l S 75.36 335.04 m 553.68 335.04 l S 201.12 321.84 m 367.2 321.84 l S 386.88 321.6 m 553.68 321.6 l S 75.6 291.12 m 554.16 291.12 l S 75.6 278.4 m 553.68 278.4 l S 0.48 w 75.6 265.2 m 554.16 265.2 l S 0.72 w 77.04 82.8 m 555.12 82.8 l S BT 0.9835 0 0 0.9835 72.72 693.12 Tm 0 0 0 rg /F5 10 Tf 0.0149 Tc 1.0774 Tw (88 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0.4881 -39.2897 TD /F4 10 Tf 0.0234 Tc 0.7507 Tw (includes nursing homes that group some of their) Tj ET BT 0.8915 0 0 0.9835 72.72 642.24 Tm 0.0281 Tc 0.9219 Tw (residents with dementia in clusters in units that also) Tj 0.8076 -12.2018 TD 0.0296 Tc 2.8381 Tw (serve nondemented residents.) Tj ET BT 0.9835 0 0 0.9835 324.24 654 Tm 0.028 Tc 0.8506 Tw (States \(194\), and a University of North Carolina) Tj ET BT 0.934 0 0 0.9835 324.48 641.76 Tm -0.0102 Tc 1.7076 Tw (study conducted from 1987 to 1989 that compared) Tj ET BT 0.9835 0 0 0.9835 324.72 629.76 Tm 0.0336 Tc 1.8209 Tw (31 randomly selected special care units and 32) Tj ET BT 0.934 0 0 0.9835 324.24 618 Tm -0.0059 Tc 0.7364 Tw (matched nonspecialized units in 5 States \(413\).) Tj ET BT 0.9663 0 0 0.9939 108 596.16 Tm /F6 14 Tf 0.0339 Tc 3.6658 Tw (CHARACTERISTICS OF) Tj -24.092 -16.1791 TD 0.0402 Tc 0.9273 Tw (NURSING HOMES THAT HAVE) Tj ET BT 0.9939 0 0 0.9939 108.96 564 Tm 0.037 Tc 0.0836 Tw (A SPECIAL CARE UNIT) Tj ET BT 0.8915 0 0 0.9835 84.72 546.24 Tm /F4 10 Tf 0.0412 Tc 0.9745 Tw (Nursing homes that have a special care unit differ) Tj ET BT 0.9835 0 0 0.9835 74.16 534.48 Tm 0.0168 Tc 3.0989 Tw (from other nursing homes in their ownership,) Tj 0 -12.2018 TD 0.0221 Tc 0.1244 Tw (certification status, size, and geographic location.) Tj 0 -11.9577 TD 0.0335 Tc 3.1633 Tw (Table 3-2 presents information from the 1987) Tj 0 -12.2018 TD 0.0388 Tc 0.7582 Tw (National Medical Expenditure Survey on each of) Tj 0.244 -11.9577 TD 0.0181 Tc 2.1215 Tw (these characteristics for all nursing homes and) Tj -0.244 -11.9577 TD 0.0277 Tc -0.0338 Tw (personal care homes in the survey sample, for the) Tj 0.244 -12.2018 TD 0.0313 Tc 1.9453 Tw (nursing and personal care homes that reported) Tj 0.244 -12.4458 TD 0.026 Tc 1.8829 Tw (having a special care unit in 1987, and for the) Tj ET BT 0.8915 0 0 0.9835 74.64 438.96 Tm 0.0448 Tc 1.5905 Tw (nursing and personal care homes that reported they) Tj ET BT 0.934 0 0 0.9835 74.88 426.96 Tm -0.0034 Tc 0.6195 Tw (would have a special care unit by 1991 \(248\). Other) Tj 0.257 -12.2018 TD -0.0285 Tc 2.1739 Tw (sources of information about the characteristics of) Tj -0.257 -11.9577 TD -0.0114 Tc 0.3711 Tw (nursing homes with a special care unit are the 1986) Tj ET BT 0.9835 0 0 0.9835 75.6 390.96 Tm 0.0263 Tc 0.7477 Tw (survey of nursing homes in Minnesota \(181\), the) Tj ET BT 0.934 0 0 0.9835 76.32 379.2 Tm -0.0057 Tc 0.7576 Tw (1990 survey of all nursing homes in 5 northeastern) Tj ET BT 0.9795 0 0 0.9795 411.12 580.8 Tm /F7 12 Tf -0.0145 Tc 0 Tw (Ownership) Tj ET BT 0.9835 0 0 0.9835 335.52 557.76 Tm /F4 10 Tf 0.0336 Tc 2.1696 Tw (As shown in table 3-2, the National Medical) Tj -10.7376 -12.2018 TD 0.0415 Tc 0.5579 Tw (Expenditure Survey found that 60 percent of the) Tj -0.244 -12.2018 TD 0.0313 Tc 1.986 Tw (nursing and personal care homes that reported) Tj 0 -11.9577 TD 0.0282 Tc 0.4843 Tw (having a special care unit in 1987 were privately) Tj 0.4881 -12.2018 TD 0.0403 Tc 1.7328 Tw (owned, for-profit facilities; 21 percent were pri-) Tj -0.244 -11.7137 TD 0.0361 Tc 0.639 Tw (vately owned, nonprofit facilities, and 19 percent) Tj 0.4881 -12.2018 TD 0.0451 Tc 3.8835 Tw (were publicly owned \(249\). The proportion of) Tj 0 -12.2018 TD 0.0388 Tc 0.5141 Tw (for-profit facilities that reported having a special) Tj ET BT 0.8915 0 0 0.9835 325.44 462.48 Tm 0.0467 Tc 0.2168 Tw (care unit in 1987 \(60 percent\) was smaller than might) Tj ET BT 0.934 0 0 0.9835 325.44 450.24 Tm -0.033 Tc 0.7654 Tw (be expected, given that 73 percent of all facilities in) Tj ET BT 0.9835 0 0 0.9835 325.68 438.48 Tm 0.0337 Tc 2.8377 Tw (the survey sample were for-profit facilities. In) Tj ET BT 0.934 0 0 0.9835 325.92 426.48 Tm -0.0376 Tc 2.1408 Tw (contrast, the proportion of publicly owned nursing) Tj -0.257 -12.2018 TD -0.0198 Tc 1.3829 Tw (homes that reported having a special care unit \(19) Tj 0 -12.2018 TD -0.0291 Tc 1.1038 Tw (percent\) was greater than might be expected, given) Tj ET BT 0.9835 0 0 0.9835 326.16 390.48 Tm 0.0306 Tc 1.0377 Tw (that only 5 percent of all facilities in the survey) Tj ET BT 0.934 0 0 0.9835 326.4 378.48 Tm -0.0419 Tc 1.8884 Tw (sample were publicly owned.) Tj ET BT 0.9863 0 0 0.9863 90.96 355.2 Tm /F3 9 Tf 0.051 Tc 0.4653 Tw (Table 3-2-Characteristics of Nursing Homes That Had a Special Care Unit in 1987 or Planned To Have a) Tj 125.5577 -10.7065 TD 0.0482 Tc 0.3333 Tw (Special Care Unit by 1991, United States, 1987) Tj ET BT 0.8648 0 0 0.99 239.04 325.68 Tm /F3 8 Tf 0.0596 Tc 1.5925 Tw (Number of nursing homes) Tj 204.8031 -0.2424 TD 0.0609 Tc 1.591 Tw (Number of nursing home beds) Tj ET BT 0.9189 0 0 0.99 268.32 312.72 Tm 0.0378 Tc 0.3471 Tw (with a) Tj 64.774 0 TD 0.0378 Tc 0.3471 Tw (with a) Tj ET BT 0.8648 0 0 0.99 453.6 312.24 Tm 0.0195 Tc 1.0838 Tw (In special) Tj 69.1002 0 TD 0.0195 Tc 1.0838 Tw (In special) Tj ET BT 0.9189 0 0 0.99 257.76 303.36 Tm 0.0275 Tc 0.0971 Tw (special care) Tj 64.774 0 TD 0.0275 Tc 0.0971 Tw (special care) Tj 147.0473 -0.2424 TD 0.0245 Tc 0.1004 Tw (care units) Tj 65.0351 0 TD 0.0245 Tc 0.1004 Tw (care units) Tj -474.5737 -8.2427 TD 0.0231 Tc 0.1019 Tw (Characteristic of facilities) Tj ET BT 0.8648 0 0 0.99 210.48 294.72 Tm 0.0633 Tc 0 Tw (Total) Tj ET BT 0.9189 0 0 0.99 258.48 294.48 Tm 0.04 Tc 0.0835 Tw (unit in 1987) Tj ET BT 0.8648 0 0 0.99 316.8 294.48 Tm 0.0395 Tc 1.0607 Tw (unit by 1991) Tj 97.9614 -0.2424 TD 0.0633 Tc 0 Tw (Total) Tj ET BT 0.9189 0 0 0.99 457.2 294.48 Tm 0.029 Tc 0.879 Tw (in 1987) Tj ET BT 0.8648 0 0 0.99 515.76 294.24 Tm 0.0119 Tc 1.3701 Tw (by 1991) Tj -508.9552 -11.8792 TD 0.0515 Tc 0 Tw (Totals) Tj ET BT 0.99 0 0 0.99 207.36 282 Tm -0.0779 Tc (22,064) Tj ET BT 0.9189 0 0 0.99 269.76 281.76 Tm 0.0197 Tc (1,668) Tj ET BT 0.99 0 0 0.99 328.8 281.52 Tm -0.0765 Tc (3,112) Tj ET BT 0.9189 0 0 0.99 393.12 281.76 Tm 0.0227 Tc (1,645,861) Tj ET BT 0.99 0 0 0.99 457.92 281.28 Tm -0.0779 Tc (53,798) Tj 60.6079 0 TD -0.0779 Tc (99,698) Tj ET BT 0.8648 0 0 0.99 252.72 269.04 Tm 0.0439 Tc 1.0556 Tw (Percent of total) Tj 220.8987 -0.2424 TD 0.0439 Tc 1.3331 Tw (Percent of total) Tj -425.1468 -12.8489 TD 0.2479 Tc 0 Tw (Ownership) Tj ET BT 0.8108 0 0 0.99 85.68 247.44 Tm 0.1337 Tc 0.0287 Tw (For profit, . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 94.32 238.56 Tm 0.03 Tc 0.0773 Tw (Independent . . . . . . . . . . . .) Tj 0 -9.2124 TD 0.018 Tc 0.1837 Tw (Multi-facility . . . . . . . . . . . .) Tj -9.9904 -8.7275 TD 0.0224 Tc 0.0194 Tw (Nonprofit . . . . . . . . . . . . . . . . .) Tj 0 -8.97 TD 0.0025 Tc 0.0073 Tw (Public . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 215.76 247.2 Tm 0.1498 Tc 0 Tw (73%) Tj ET BT 0.8648 0 0 0.99 215.52 237.84 Tm 0.2703 Tc (35) Tj 0.2775 -8.97 TD 0.2703 Tc (38) Tj 0 -8.7275 TD 0.2703 Tc (23) Tj 5.2727 -9.2124 TD -0.0072 Tc (5) Tj ET BT 0.99 0 0 0.99 275.04 246.72 Tm -0.0842 Tc (60%) Tj 0 -8.97 TD -0.085 Tc (27) Tj ET BT 0.9189 0 0 0.99 275.28 228.96 Tm 0.1235 Tc (33) Tj ET BT 0.9598 0 0 0.9598 275.28 222.72 Tm /F3 6 Tf 3.1642 Tc (2) Tj -0.0863 Tc (1) Tj ET BT 1.2 0 0 1.2 284.64 225.6 Tm /F3 2 Tf -0.0213 Tc (b) Tj ET BT 0.8108 0 0 0.99 275.76 211.44 Tm /F3 8 Tf 0.0433 Tc (19b) Tj ET BT 0.99 0 0 0.99 334.8 246.72 Tm 0.239 Tc (57%) Tj ET BT 1.1198 0 0 1.1198 351.36 250.56 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 334.56 237.84 Tm /F3 8 Tf -0.085 Tc (28) Tj 0.2424 -8.7275 TD -0.085 Tc (29) Tj ET BT 0.8648 0 0 0.99 334.8 220.32 Tm 0.2703 Tc (28) Tj 0.8325 -9.2124 TD 0.1315 Tc (15) Tj ET BT 0.99 0 0 0.99 406.08 246.48 Tm -0.0842 Tc (67%) Tj 0 -8.7275 TD -0.085 Tc (24) Tj 0.2424 -8.7275 TD -0.085 Tc (44) Tj ET BT 0.9189 0 0 0.99 406.32 220.08 Tm 0.1235 Tc (24) Tj ET BT 0.8648 0 0 0.99 411.12 211.2 Tm -0.0072 Tc (9) Tj ET BT 0.99 0 0 0.99 466.08 246.48 Tm -0.0842 Tc (69%) Tj ET BT 0.7567 0 0 0.99 466.08 237.6 Tm 0.3096 Tc (31) Tj ET BT 0.9189 0 0 0.99 466.32 228.72 Tm 0.1235 Tc (38) Tj ET BT 0.8648 0 0 0.99 466.8 220.08 Tm 0.1315 Tc (18) Tj ET BT 0.99 0 0 0.99 467.04 211.2 Tm 0.0362 Tc (13) Tj ET BT 1.1198 0 0 1.1198 475.92 215.04 Tm /F3 3 Tf 0.0946 Tc (b) Tj ET BT 0.99 0 0 0.99 526.08 246.48 Tm /F3 8 Tf -0.0842 Tc (51%) Tj ET BT 0.7567 0 0 0.99 526.32 237.84 Tm 0.3096 Tc (21) Tj ET BT 0.9189 0 0 0.99 526.32 228.96 Tm 0.1235 Tc (29) Tj ET BT 0.99 0 0 0.99 526.08 219.84 Tm -0.085 Tc (38) Tj ET BT 0.9598 0 0 0.9598 526.8 213.84 Tm /F3 6 Tf 2.9142 Tc (1) Tj -0.0863 Tc (2) Tj ET BT 1.2 0 0 1.2 535.92 216.72 Tm /F3 2 Tf -0.0213 Tc (b) Tj ET BT 0.9189 0 0 0.99 76.8 196.8 Tm /F3 8 Tf 0.0178 Tc 1.6748 Tw (SNF Certification) Tj ET BT 0.8648 0 0 0.99 85.68 187.92 Tm -0.0063 Tc 0.0667 Tw (Yes . . . . . . . . . . . . . . . . . . . . . .) Tj 0 -9.2124 TD 0.0031 Tc -0.0072 Tw (No . . . . . . . . . . . . . . . . . . . . . . .) Tj 150.6885 8.7275 TD 0.2703 Tc 0 Tw (40) Tj 0 -9.2124 TD 0.2703 Tc (60) Tj ET BT 0.99 0 0 0.99 275.76 187.44 Tm 0.2786 Tc (75) Tj ET BT 1.1198 0 0 1.1198 285.12 191.28 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 275.52 178.32 Tm /F3 8 Tf 0.2786 Tc (25) Tj ET BT 1.1198 0 0 1.1198 284.88 182.16 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 335.28 187.44 Tm /F3 8 Tf 0.2786 Tc (70) Tj ET BT 1.1198 0 0 1.1198 344.64 191.28 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 335.04 180.72 Tm /F3 8 Tf 0.3999 Tc (30) Tj ET BT 1.1198 0 0 1.1198 344.64 184.56 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 406.56 186.96 Tm /F3 8 Tf -0.085 Tc (64) Tj ET BT 0.9189 0 0 0.99 406.8 178.08 Tm 0.1235 Tc (36) Tj ET BT 0.7555 0 0 0.9835 466.8 187.2 Tm /F5 10 Tf 0.2392 Tc (76) Tj ET BT 0.8027 0 0 0.9835 466.56 178.32 Tm 0.0804 Tc (24) Tj ET BT 0.7567 0 0 0.99 526.32 186.96 Tm /F3 8 Tf 0.3096 Tc (81) Tj ET BT 0.99 0 0 0.99 527.04 178.32 Tm -0.0708 Tc (19\222) Tj ET BT 0.9189 0 0 0.99 77.28 163.92 Tm 0.0252 Tc 0.0996 Tw (Facility size \(number of beds\)) Tj ET BT 0.8648 0 0 0.99 85.68 155.04 Tm 0.0072 Tc 0.0278 Tw (<1oo . . . . . . . . . . . . . . . . . . . . .) Tj 0.8325 -8.7275 TD 0.0001 Tc 0.1967 Tw (100-149 . . . . . . . . . . . . . . . . . .) Tj 0 -8.97 TD -0.0021 Tc 0.078 Tw (150+ . . . . . . . . . . . . . . . . . . . . .) Tj 149.8559 17.2126 TD 0.2703 Tc 0 Tw (69) Tj 0.2775 -8.7275 TD 0.2703 Tc (20) Tj ET BT 0.7027 0 0 0.99 216.72 137.04 Tm 0.163 Tc (11) Tj ET BT 0.9189 0 0 0.99 275.76 154.8 Tm 0.1235 Tc (45) Tj 0 -9.2124 TD 0.1235 Tc (28) Tj ET BT 0.99 0 0 0.99 275.76 137.04 Tm 0.2786 Tc (26) Tj ET BT 1.1198 0 0 1.1198 285.12 140.88 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.8648 0 0 0.99 335.04 156.96 Tm /F3 8 Tf -0.0072 Tc (47a) Tj ET BT 0.9189 0 0 0.99 335.52 145.68 Tm 0.1235 Tc (26) Tj ET BT 0.8648 0 0 0.99 335.52 139.2 Tm -0.0072 Tc (27a) Tj ET BT 0.99 0 0 0.99 406.8 154.32 Tm -0.085 Tc (36) Tj 0 -8.7275 TD -0.085 Tc (32) Tj 0 -9.2124 TD -0.085 Tc (32) Tj ET BT 0.8165 0 0 0.9863 466.8 154.32 Tm /F3 9 Tf 0.139 Tc (34) Tj ET BT 0.9189 0 0 0.99 466.8 145.68 Tm /F3 8 Tf 0.1235 Tc (32) Tj 0 -9.2124 TD 0.1235 Tc (34) Tj ET BT 0.7567 0 0 0.99 526.8 154.56 Tm 0.3096 Tc (41) Tj ET BT 0.9189 0 0 0.99 526.8 145.68 Tm 0.1235 Tc (24) Tj 0 -9.2124 TD 0.1235 Tc (36) Tj ET BT 0.8648 0 0 0.99 77.76 121.92 Tm 0.0609 Tc (Region) Tj 9.9904 -8.7275 TD 0.0134 Tc -0.0191 Tw (Northeast . . . . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 86.4 104.16 Tm 0.1213 Tc 0.0259 Tw (Mideast . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 86.16 95.28 Tm 0.012 Tc 0.0658 Tw (South . . . . . . . . . . . . . . . . . . . .) Tj -0.2775 -8.7275 TD -0.0015 Tc 0.0642 Tw (West . . . . . . . . . . . . . . . . . . . . .) Tj 151.2435 26.6675 TD 0.1315 Tc 0 Tw (19) Tj ET BT 0.9189 0 0 0.99 216.48 103.92 Tm 0.1235 Tc (29) Tj ET BT 0.8648 0 0 0.99 216.48 95.04 Tm 0.2703 Tc (30) Tj 0.2775 -8.97 TD 0.2703 Tc (22) Tj ET BT 0.99 0 0 0.99 276 112.8 Tm -0.085 Tc (27) Tj 0.4849 -8.97 TD 0.0362 Tc (16) Tj ET BT 1.1198 0 0 1.1198 285.36 107.76 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.99 0 0 0.99 275.76 95.28 Tm /F3 8 Tf -0.085 Tc (22) Tj 0.2424 -9.4548 TD -0.085 Tc (37) Tj ET BT 0.8648 0 0 0.99 335.52 112.56 Tm 0.2703 Tc (30) Tj ET BT 0.9189 0 0 0.99 335.52 103.92 Tm 0.1235 Tc (22) Tj 0 -8.7275 TD 0.1235 Tc (23) Tj 0 -9.2124 TD 0.1235 Tc (26) Tj 78.0944 26.9099 TD 0.1235 Tc (22) Tj ET BT 0.7567 0 0 0.99 407.04 103.92 Tm 0.3096 Tc (31) Tj ET BT 0.99 0 0 0.99 407.04 94.8 Tm -0.085 Tc (30) Tj ET BT 0.8648 0 0 0.99 407.52 86.4 Tm 0.2703 Tc (17) Tj ET BT 0.8027 0 0 0.9835 467.28 112.8 Tm /F5 10 Tf 0.0804 Tc (22) Tj ET BT 0.99 0 0 0.99 467.52 106.56 Tm /F3 8 Tf 0.1574 Tc (18) Tj ET BT 1.1198 0 0 1.1198 476.64 110.4 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.8027 0 0 0.9835 467.28 95.04 Tm /F5 10 Tf 0.0804 Tc (23) Tj ET BT 0.8648 0 0 0.99 467.04 88.8 Tm /F3 8 Tf -0.0072 Tc (37a) Tj ET BT 0.99 0 0 0.99 527.04 113.04 Tm -0.085 Tc (20) Tj 0 -8.97 TD 0.2786 Tc (29) Tj ET BT 1.1198 0 0 1.1198 536.4 108 Tm /F3 3 Tf 0.0454 Tc (a) Tj ET BT 0.7567 0 0 0.99 527.04 95.28 Tm /F3 8 Tf 0.3096 Tc (21) Tj ET BT 0.9189 0 0 0.99 527.04 86.16 Tm 0.1235 Tc (29) Tj ET q 37.44 0 0 -7.68 77.28 81.36 cm BI /W 223 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |xx|>p??????ߟ???~>|> ?~||>|~~~? ????|?~?x߀>?x0xx8|~?x|xx?<  EI Q BT 0.9262 0 0 0.9939 77.28 75.84 Tm 3 Tr /F3 7 Tf 0.0263 Tc (astatistial[y) Tj 0 Tr ET BT 0.8645 0 0 0.9939 114.72 75.84 Tm 0 Tc -0.0033 Tw ( ) Tj ET q 29.52 0 0 -6.72 116.4 80.88 cm BI /W 177 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~ @x>??>?>>σ>~χ>|χ~>|χ>>|Ϗ>>|>>|?>>|>>|>?|~?|?|?~?????????@~ |x||<x EI Q BT 0.9262 0 0 0.9939 116.4 75.84 Tm 3 Tr 0.081 Tc 0 Tw (signifi~nt) Tj 0 Tr ET BT 0.8645 0 0 0.9939 145.92 75.84 Tm -0.0666 Tc 1.5173 Tw ( in comparison to the total) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8648 0 0 0.99 229.68 75.84 Tm /F3 8 Tf 0.059 Tc 0 Tw (column.) Tj ET q 26.88 0 0 -7.2 77.28 74.64 cm BI /W 164 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??????~??~~~?||?|~|?||||?|?|?|~?<|~?||~>~~?~??>?~|~~|~||~|~|~A||<x? |xx EI Q BT 0.7027 0 0 0.99 77.28 67.68 Tm 3 Tr 0.0328 Tc (bRelative) Tj 0 Tr ET BT 0.8648 0 0 0.99 104.16 67.68 Tm 0.0126 Tc 0.4675 Tw ( standard error X30 ) Tj ET q 22.56 0 0 -6.72 172.08 72.48 cm BI /W 138 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x||xx|| ?????|~|~?||?|||||||||||>|~>|?~|?x?|||| EI Q BT 0.8648 0 0 0.99 172.08 67.68 Tm 3 Tr 0.0228 Tc 0 Tw (w~ent.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 77.52 55.68 Tm /F3 7 Tf 0.0535 Tc 0.1981 Tw (SOURCE: J. ) Tj ET q 15.6 0 0 -6.24 117.84 60.96 cm BI /W 91 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<????????????? EI Q BT 0.8027 0 0 0.9939 117.84 55.68 Tm 3 Tr 0.0319 Tc 0 Tw (Imon,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 133.44 55.68 Tm 0.0845 Tc 0.2078 Tw ( D. Potter, and P. Cunningham, ) Tj ET q 35.28 0 0 -6.48 234.24 60.96 cm BI /W 205 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @8|?|^~ߏ|~|||~??|~~>|?~?>||??>~|?~|~|~|?~|x~~|x??>|>?>|>?~||>~||>||~|?<?~x`?8>~|x<<|><<>|x<~8 |~8 EI Q BT 0.8645 0 0 0.9939 234.24 55.68 Tm 3 Tr -0.0168 Tc 0 Tw (\223Avaiiabiiity) Tj 0 Tr ET BT 0.9262 0 0 0.9939 269.52 55.68 Tm 0.0712 Tc 0.2715 Tw ( of Special Nursing Home Programs for ) Tj ET q 34.32 0 0 -5.28 396.96 60.72 cm BI /W 198 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  `x??>x?>|?>|>|~?>|~?>||?~~>?||>?x>?>?~>?|>>?|?>||>~|<?x?|>>>>>>x?>>>?> EI Q BT 0.8645 0 0 0.9939 396.96 55.68 Tm 3 Tr -0.0145 Tc 0 Tw (Aizheimer\222s) Tj 0 Tr ET BT 0.9262 0 0 0.9939 431.28 55.68 Tm 0.0413 Tc 0.3409 Tw ( Disease Patients,\224 ) Tj ET q 28.56 0 0 -5.52 493.68 60.96 cm BI /W 166 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|?>>>~~߀>?~~>>??>?|???|~?~~߀|>߀|>||?||??~~|?>~|?~>??|~???????x EI Q BT 0.9262 0 0 0.9939 493.68 55.68 Tm 3 Tr 0.0326 Tc 0 Tw (Ametkan) Tj 0 Tr 30.834 0 TD /F11 7 Tf 0 Tc 0.1263 Tw ( ) Tj ET q 22.8 0 0 -5.28 523.92 60.96 cm BI /W 132 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <p>>?>?~??~??~???>??>~?>π?|?|π?||~|>|?|?~?~?~~?~>>> | EI Q BT 0.8645 0 0 0.9939 523.92 55.68 Tm 3 Tr -0.0438 Tc 0 Tw (Journa/) Tj 0 Tr ET BT 0.9262 0 0 0.9939 546.72 55.68 Tm 0 Tc 0.1263 Tw ( ) Tj ET q 6.48 0 0 -5.28 548.4 60.96 cm BI /W 38 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x~|||~|~|~~>>>?>???p EI Q BT 0.9262 0 0 0.9939 548.4 55.68 Tm 3 Tr 0.0635 Tc 0 Tw (of) Tj 0 Tr ET q 35.28 0 0 -5.52 111.12 53.04 cm BI /W 202 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>ߏ>?~Ϗ>π>???>|?||?|||?x||?>~>~߀>>߀?>_?>???~?~?~??????x~||8x EI Q BT 0.9262 0 0 0.9939 111.12 47.76 Tm 3 Tr 0.06 Tc (Akheimer\222s) Tj 0 Tr 38.089 0 TD 0.0517 Tc 0.5239 Tw ( Care and Related Disorders and Research 6\(1\):2-11, ) Tj 183.9673 0 TD /F3 7 Tf 0.0201 Tc 0 Tw (1991.) Tj ET endstream endobj 250 0 obj <>/Rotate 0/Type/Page>> endobj 251 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.24 677.28 m 537.84 677.28 l S 61.92 64.32 m 539.76 64.32 l S BT 0.9835 0 0 0.9835 323.76 682.56 Tm 0 0 0 rg /F5 10 Tf 0.0193 Tc 2.4207 Tw (Chapter 3-Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 520.08 682.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 526.56 682.56 Tm /F5 10 Tf 0.366 Tc 0 Tw (89) Tj ET BT 0.934 0 0 0.9835 71.52 644.64 Tm /F4 10 Tf 0.0461 Tc -0.0045 Tw (In ) Tj ET BT 0.9606 0 0 0.9863 83.76 644.64 Tm /F3 9 Tf -0.007 Tc 0.0024 Tw (terms ) Tj ET BT 0.934 0 0 0.9835 109.44 644.64 Tm /F4 10 Tf -0.0336 Tc 0.8517 Tw (of bed capacity, 69 percent of the special) Tj ET BT 0.8915 0 0 0.9835 60.72 632.64 Tm 0.0466 Tc 0.875 Tw (care unit beds were in for-profit facilities in 1987; 18) Tj ET BT 0.934 0 0 0.9835 60.48 620.64 Tm -0.0417 Tc 1.5945 Tw (percent were in nonprofit facilities, and 13 percent) Tj ET BT 0.9835 0 0 0.9835 60.72 608.4 Tm 0.0423 Tc 1.324 Tw (were in publicly owned facilities \(see table 3-2\).) Tj ET BT 0.8915 0 0 0.9835 60.72 596.4 Tm 0.0424 Tc 0.8049 Tw (Thus, the proportion of special care unit bed capacity) Tj ET BT 0.9835 0 0 0.9835 60.96 584.64 Tm 0.042 Tc 1.0803 Tw (in for-profit facilities \(69 percent\)) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 222 584.64 Tm /F3 9 Tf 0.0864 Tc -0.1574 Tw (was ) Tj ET BT 0.9835 0 0 0.9835 242.16 584.64 Tm /F4 10 Tf 0.0429 Tc 1.5675 Tw (about the) Tj ET BT 0.934 0 0 0.9835 61.2 572.4 Tm -0.0286 Tc 0.5323 Tw (same as would be expected, given that 67 percent of) Tj 0 -11.9577 TD -0.0312 Tc 1.9871 Tw (all bed capacity was in for-profit facilities. Special) Tj ET BT 0.9835 0 0 0.9835 61.2 548.4 Tm 0.0307 Tc 0.0808 Tw (care unit bed capacity in publicly owned facilities) Tj 0.4881 -12.2018 TD 0.0336 Tc 1.4027 Tw (\(13 percent\) was slightly greater than would be) Tj -0.4881 -11.9577 TD 0.2852 Tc 2.7853 Tw (expected, given) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 143.28 524.64 Tm /F3 9 Tf 0.0106 Tc -0.0805 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 164.4 524.64 Tm /F4 10 Tf 0.0508 Tc 2.7308 Tw (only 9 percent of all bed) Tj ET BT 0.934 0 0 0.9835 61.2 512.64 Tm -0.0179 Tc 0.064 Tw (capacity ) Tj ET BT 0.9606 0 0 0.9863 101.28 512.64 Tm /F3 9 Tf -0.0079 Tc 0.1283 Tw (was in ) Tj ET BT 0.934 0 0 0.9835 130.8 512.64 Tm /F4 10 Tf -0.0388 Tc 3.5553 Tw (publicly owned facilities.) Tj ET BT 0.9835 0 0 0.9835 72.24 493.2 Tm 0.024 Tc 1.2381 Tw (The greatest growth in special care units and) Tj ET BT 0.8915 0 0 0.9835 61.92 481.2 Tm 0.0543 Tc 1.0158 Tw (special care unit bed capacity from 1987) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9189 0 0 0.99 238.32 481.2 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.8915 0 0 0.9835 247.44 481.2 Tm /F4 10 Tf 0.0591 Tc 1.7283 Tw (1991 was) Tj ET BT 0.934 0 0 0.9835 61.2 469.44 Tm -0.0676 Tc 0.1172 Tw (projected ) Tj ET BT 0.9189 0 0 0.99 105.36 469.44 Tm /F3 8 Tf 0.0428 Tc 0.4287 Tw (to occur in ) Tj ET BT 0.934 0 0 0.9835 147.12 469.44 Tm /F4 10 Tf -0.0351 Tc 2.6519 Tw (nonprofit facilities. Whereas in) Tj ET BT 0.8915 0 0 0.9835 62.64 457.44 Tm 0.0521 Tc 1.2988 Tw (1987,21 percent of special care units and 18 percent) Tj ET BT 0.934 0 0 0.9835 61.68 445.68 Tm -0.0412 Tc 0.7314 Tw (of special care unit beds were in nonprofit facilities,) Tj ET BT 0.9835 0 0 0.9835 61.44 433.92 Tm 0.0367 Tc 1.5738 Tw (by 1991, 28 percent of special care) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.99 0 0 0.99 231.6 433.92 Tm /F3 8 Tf -0.0411 Tc -0.001 Tw (units ) Tj ET BT 0.9835 0 0 0.9835 253.92 433.92 Tm /F4 10 Tf 0.0501 Tc 2.0483 Tw (and 38) Tj ET BT 0.8915 0 0 0.9835 61.2 421.44 Tm 0.0492 Tc 1.1626 Tw (percent of special care unit beds were projected) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9189 0 0 0.99 268.8 421.44 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.8915 0 0 0.9835 277.92 421.44 Tm /F4 10 Tf 0.2353 Tc 0 Tw (be) Tj ET BT 0.934 0 0 0.9835 61.68 409.68 Tm -0.025 Tc 1.3051 Tw (in nonprofit facilities \(see table 3-2\).) Tj 11.82 -19.5229 TD -0.0123 Tc 1.1822 Tw (In 1987, about one-third of all special care units) Tj -11.563 -12.2018 TD -0.0345 Tc 1.0068 Tw (and 38 percent of all special care unit beds were in) Tj 0 -12.2018 TD -0.0259 Tc 1.1518 Tw (nursing homes owned by multi-facility corporations) Tj 0.5139 -12.2018 TD -0.0463 Tc 1.422 Tw (\(see table 3-2\). These proportions were projected) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 281.04 354.48 Tm /F3 8 Tf 0.1424 Tc 0 Tw (to) Tj ET BT 0.9835 0 0 0.9835 61.92 342.96 Tm /F4 10 Tf 0.0291 Tc 0.3613 Tw (decrease slightly by 1991. The Hillhaven Corp. of) Tj 0 -11.7137 TD 0.01 Tc 1.2756 Tw (Takoma, WA, the Nation\222s second largest multi-) Tj ET BT 0.934 0 0 0.9835 62.16 319.44 Tm -0.0274 Tc 0.6523 Tw (facility nursing home corporation, ) Tj ET BT 0.9606 0 0 0.9863 213.84 319.44 Tm /F3 9 Tf -0.0098 Tc 0.0054 Tw (was ) Tj ET BT 0.934 0 0 0.9835 232.56 319.44 Tm /F4 10 Tf -0.0152 Tc 1.3459 Tw (probably the) Tj ET BT 0.9606 0 0 0.9863 62.16 307.68 Tm /F3 9 Tf -0.0041 Tc -0.0006 Tw (first ) Tj ET BT 0.934 0 0 0.9835 80.64 307.68 Tm /F4 10 Tf -0.041 Tc 1.3735 Tw (such corporation) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 157.2 307.68 Tm /F3 9 Tf -0.0029 Tc -0.0019 Tw (to ) Tj ET BT 0.934 0 0 0.9835 167.52 307.68 Tm /F4 10 Tf -0.0242 Tc 1.3556 Tw (establish special care units) Tj ET BT 0.9835 0 0 0.9835 62.16 295.68 Tm 0.0379 Tc 2.0911 Tw (for persons with dementia. As of late 1990, 56) Tj ET BT 0.934 0 0 0.9835 62.16 283.44 Tm -0.0193 Tc 1.6072 Tw (Hillhaven-owned nursing homes had) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 229.2 283.44 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 236.4 283.44 Tm /F4 10 Tf -0.0473 Tc 2.4081 Tw (special care) Tj ET BT 0.9835 0 0 0.9835 61.92 271.44 Tm 0.0295 Tc 0.3609 Tw (unit, and these special care units contained 1283) Tj ET BT 0.934 0 0 0.9835 61.92 259.2 Tm 0.0202 Tc 2.3359 Tw (beds \(337\).) Tj 12.3339 -19.7669 TD -0.0427 Tc 0.6045 Tw (OTA contacted ) Tj ET BT 0.9606 0 0 0.9863 141.84 239.76 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 149.04 239.76 Tm /F4 10 Tf -0.023 Tc 1.5256 Tw (few other multi-facility nursing) Tj ET BT 0.9835 0 0 0.9835 61.92 227.76 Tm 0.0372 Tc 1.6953 Tw (home corporations to find out how many of the) Tj 0 -12.2018 TD 0.0203 Tc 0.0775 Tw (nursing homes they own have ) Tj ET BT 0.9863 0 0 0.9863 201.84 215.76 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 209.28 215.76 Tm /F4 10 Tf 0.0165 Tc 0.2521 Tw (special care unit.) Tj -149.8379 -11.9577 TD 0.0365 Tc 0.3538 Tw (Manor Care Corp. of Silver Spring, MD, reported) Tj ET BT 0.9863 0 0 0.9863 62.16 192 Tm /F3 9 Tf 0.0417 Tc 0.0097 Tw (that as ) Tj ET BT 0.9835 0 0 0.9835 93.84 192 Tm /F4 10 Tf 0.0323 Tc 0.2225 Tw (of late 1990, 51 of its nursing homes had ) Tj ET BT 0.99 0 0 0.99 284.64 192 Tm /F3 8 Tf -0.085 Tc 0 Tw (a) Tj ET BT 0.9835 0 0 0.9835 62.64 180.24 Tm /F4 10 Tf 0.0336 Tc 2.4136 Tw (special care unit \(157\). ARA Living Centers of) Tj ET BT 0.934 0 0 0.9835 62.4 168.24 Tm -0.0266 Tc 1.2618 Tw (Houston, TX, reported 35 of its nursing homes had) Tj ET BT 0.9606 0 0 0.9863 62.64 156 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 69.84 156 Tm /F4 10 Tf -0.0278 Tc 1.6163 Tw (special care unit \(3\). Unicare Health Facilities of) Tj ET BT 0.9835 0 0 0.9835 62.4 144.24 Tm 0.027 Tc 0.3635 Tw (Milwaukee, WI, reported 15 of its nursing homes) Tj ET BT 0.934 0 0 0.9835 62.4 132.24 Tm 0.0175 Tc 0.0261 Tw (had ) Tj ET BT 0.9606 0 0 0.9863 81.6 132.24 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 88.8 132.24 Tm /F4 10 Tf -0.009 Tc 0.9967 Tw (special care unit \(374\).) Tj ET BT 0.8915 0 0 0.9835 73.44 112.8 Tm 0.0409 Tc 1.0758 Tw (Data from the 1987 National Medical Expenditure) Tj ET BT 0.934 0 0 0.9835 62.64 100.56 Tm -0.021 Tc 1.609 Tw (Survey indicate) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 135.84 100.56 Tm /F3 8 Tf -0.0088 Tc 0.1366 Tw (that ) Tj ET BT 0.934 0 0 0.9835 152.16 100.56 Tm /F4 10 Tf 0.012 Tc 1.5737 Tw (by 1991, multi-facility nursing) Tj -96.3583 -11.9577 TD -0.0204 Tc 1.6818 Tw (home corporations planned to have more than 900) Tj ET BT 0.8915 0 0 0.9835 62.4 76.8 Tm 0.0376 Tc 0.4363 Tw (nursing homes with a special care unit. If these plans) Tj ET BT 0.9835 0 0 0.9835 311.04 643.92 Tm 0.0284 Tc 0.1587 Tw (had materialized, the four corporations just men-) Tj ET BT 0.934 0 0 0.9835 311.52 631.68 Tm -0.0308 Tc 0.6489 Tw (tioned would account for only 17 percent \(157 out of) Tj ET BT 0.9835 0 0 0.9835 311.52 619.68 Tm 0.0194 Tc 2.8812 Tw (900\) of all such nursing homes. These figures) Tj 0 -12.2018 TD 0.0346 Tc -0.1323 Tw (indicate ) Tj ET BT 0.99 0 0 0.99 351.12 607.68 Tm /F3 8 Tf -0.0302 Tc -0.012 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 367.68 607.68 Tm /F4 10 Tf 0.0328 Tc 0.1135 Tw (ownership of special care units is not) Tj -57.1043 -12.4458 TD 0.0225 Tc 2.727 Tw (dominated by a small number of multi-facility) Tj ET BT 0.934 0 0 0.9835 311.52 583.68 Tm -0.0275 Tc 1.1021 Tw (nursing home corporations.) Tj ET BT 0.9835 0 0 0.9835 322.56 565.68 Tm 0.0236 Tc 4.0971 Tw (A 1989 survey by the U.S. Department of) Tj ET BT 0.934 0 0 0.9835 311.76 553.44 Tm -0.0055 Tc 1.2785 Tw (Veterans Affairs \(VA\) found that 31 of the 172 VA) Tj 0 -11.9577 TD -0.044 Tc 0.9363 Tw (medical centers nationwide had one or more special) Tj ET BT 0.9835 0 0 0.9835 312 529.68 Tm 0.0282 Tc 2.2535 Tw (care units \(159\). The VA has issued no formal) Tj 0 -12.4458 TD 0.0355 Tc 2.3071 Tw (department-wide policies on special care units.) Tj ET BT 0.934 0 0 0.9835 311.76 505.68 Tm -0.0286 Tc 1.4704 Tw (Thus, the special care units identified in&e survey) Tj ET BT 0.9835 0 0 0.9835 312.24 493.68 Tm 0.0414 Tc 0.8369 Tw (were established entirely on the initiative of the) Tj ET BT 0.934 0 0 0.9835 312.24 481.44 Tm -0.0245 Tc 0.9521 Tw (individual VA medical centers. The 31 units identi-) Tj 0 -11.9577 TD -0.0223 Tc 1.0109 Tw (fied by the 1989 survey were in acute care hospital) Tj T* -0.0221 Tc 1.9956 Tw (units, intermediate care units, and long-term care) Tj 0 -12.2018 TD 0.0294 Tc 0.2703 Tw (units \(103\).) Tj ET BT 0.9795 0 0 0.9795 377.28 421.68 Tm /F7 12 Tf 0.0492 Tc 0.6239 Tw (Certification Status) Tj ET BT 0.934 0 0 0.9835 323.28 403.92 Tm /F4 10 Tf -0.0507 Tc 0.0991 Tw (According ) Tj ET BT 0.9189 0 0 0.99 370.32 403.92 Tm /F3 8 Tf 0.008 Tc 0.2489 Tw (to the ) Tj ET BT 0.934 0 0 0.9835 393.36 403.92 Tm /F4 10 Tf -0.0082 Tc 2.0237 Tw (1987 National Medical Expendi-) Tj -86.594 -12.4458 TD -0.0247 Tc 1.7598 Tw (ture Survey, nursing homes that were certified by) Tj ET BT 0.9835 0 0 0.9835 312.48 379.92 Tm 0.033 Tc 0.154 Tw (Medicare or Medicaid as skilled nursing facilities) Tj 0.7321 -11.9577 TD 0.0176 Tc 1.4538 Tw (\(SNFs\) were far more likely than other nursing) Tj ET BT 0.934 0 0 0.9835 312.48 356.4 Tm -0.0196 Tc 0.0658 Tw (homes ) Tj ET BT 0.9189 0 0 0.99 342.96 356.4 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.934 0 0 0.9835 352.08 356.4 Tm /F4 10 Tf -0.0058 Tc 0.3723 Tw (have a special care unit \(248\). As shown in) Tj -42.1407 -12.2018 TD -0.0047 Tc 0.8208 Tw (table 3-2, this pattern ) Tj ET BT 0.9606 0 0 0.9863 414 344.4 Tm /F3 9 Tf -0.0098 Tc 0.0054 Tw (was ) Tj ET BT 0.934 0 0 0.9835 433.2 344.4 Tm /F4 10 Tf -0.0566 Tc 2.0754 Tw (projected to continue to) Tj ET BT 0.9835 0 0 0.9835 313.92 333.12 Tm 0.0307 Tc 0.2682 Tw (1991. A telephone survey of all nursing homes in) Tj ET BT 0.934 0 0 0.9835 312.72 320.88 Tm -0.0025 Tc 1.4929 Tw (five States conducted in 1987 and 1988 also found) Tj 0.257 -11.9577 TD -0.0272 Tc 0.4273 Tw (SNFs were more likely than other nursing homes to) Tj -0.5139 -12.2018 TD -0.0021 Tc 1.0235 Tw (have a special care unit \(413\).) Tj ET BT 0.9557 0 0 1.08 446.16 301.92 Tm /F4 4 Tf 0.0359 Tc 0 Tw (2) Tj ET BT 0.9795 0 0 0.9795 377.04 272.64 Tm /F7 12 Tf 0.012 Tc 1.1519 Tw (Nursing Home Size) Tj ET BT 0.8915 0 0 0.9835 323.52 254.88 Tm /F4 10 Tf 0.05 Tc 0.6281 Tw (As shown in table 3-2, larger nursing and personal) Tj -11.8446 -11.9577 TD 0.06 Tc 0.6842 Tw (care homes are far more likely than smaller facilities) Tj ET BT 0.9835 0 0 0.9835 312.96 230.88 Tm 0.0222 Tc 0.4226 Tw (to have a special care unit. This finding from the) Tj ET BT 0.934 0 0 0.9835 313.92 219.12 Tm -0.0142 Tc 1.6018 Tw (1987 National Medical Expenditure Survey agrees) Tj ET BT 0.8915 0 0 0.9835 312.96 207.12 Tm 0.0384 Tc 0.8842 Tw (with the results of the 1986 survey of nursing homes) Tj ET BT 0.934 0 0 0.9835 312.96 195.6 Tm -0.0153 Tc 0.4467 Tw (in Minnesota which found ) Tj ET BT 0.9189 0 0 0.99 429.84 195.6 Tm /F3 8 Tf -0.0088 Tc 0.1366 Tw (that ) Tj ET BT 0.934 0 0 0.9835 445.68 195.6 Tm /F4 10 Tf -0.0203 Tc 0.5805 Tw (18 percent of nursing) Tj -142.0964 -12.2018 TD -0.0134 Tc 1.1727 Tw (homes with more than 100 beds had a special care) Tj ET BT 0.8915 0 0 0.9835 312.96 171.6 Tm 0.0425 Tc 0.973 Tw (unit, compared with only 2 percent of nursing homes) Tj ET BT 0.9835 0 0 0.9835 313.2 159.6 Tm 0.0283 Tc 1.0332 Tw (with less than 100 beds \(181\). The University of) Tj 0 -12.4458 TD 0.0338 Tc 2.9596 Tw (North Carolina study of 31 randomly selected) Tj 0.244 -12.2018 TD 0.0254 Tc 1.2497 Tw (special care units in 5 States found the nursing) Tj ET BT 0.8915 0 0 0.9835 312.96 123.84 Tm 0.0567 Tc 0.6004 Tw (homes with a special care unit had an average of 192) Tj ET BT 0.9835 0 0 0.9835 312.96 111.36 Tm 0.0429 Tc 0.1033 Tw (beds, compared with an average of 92 beds for all) Tj 0.244 -11.9577 TD 0.017 Tc 1.1973 Tw (U.S. nursing homes \(413\). The 1990 study of all) Tj ET BT 0.934 0 0 0.9835 312.96 87.6 Tm -0.0086 Tc 1.1553 Tw (nursing homes in 5 northeastern States found that) Tj ET BT 0.9835 0 0 0.9835 312.96 75.6 Tm 0.019 Tc 1.9578 Tw (nursing homes with a special care unit had an) Tj ET q 2.4 0 0 -4.32 75.84 58.08 cm BI /W 16 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?xx8<>>~x|? EI Q BT 0.5164 0 0 0.9835 75.84 53.76 Tm 3 Tr /F2 10 Tf 0.2048 Tc 0 Tw (z) Tj 0 Tr ET BT 0.8449 0 0 0.9835 78.24 53.76 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 10.8 0 0 -5.52 80.16 59.52 cm BI /W 68 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|?|?p?|>0?|>?|>?|>?|>?|??|??|?|?|????~????? EI Q BT 0.8449 0 0 0.9835 80.16 53.76 Tm 3 Tr -0.0077 Tc 0 Tw (me) Tj 0 Tr 12.7818 0 TD 0 Tc 0.0545 Tw ( ) Tj ET q 12.72 0 0 -5.52 92.88 58.56 cm BI /W 80 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ``a??>???88x?x?|||>>??? EI Q BT 0.6572 0 0 0.9835 92.88 53.76 Tm 3 Tr -0.0317 Tc 0 Tw (SNF) Tj 0 Tr ET BT 0.8449 0 0 0.9835 105.6 53.76 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 24.48 0 0 -6.72 107.52 58.8 cm BI /W 153 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?p>8x8|`8>~????#~??>>?~>?|>?|>~|>xx>x?>xx>?<|>><|>>>>?>?~????? ? EI Q BT 0.7041 0 0 0.9835 107.52 53.76 Tm 3 Tr 0.0087 Tc 0 Tw (categow) Tj 0 Tr ET BT 0.8449 0 0 0.9835 132 53.76 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 8.4 0 0 -5.52 133.92 59.28 cm BI /W 53 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?| ~~??  EI Q BT 0.7041 0 0 0.9835 133.92 53.76 Tm 3 Tr 0.0873 Tc 0 Tw (for) Tj 0 Tr ET BT 0.8449 0 0 0.9835 142.32 53.76 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 27.6 0 0 -5.52 144.24 59.52 cm BI /W 171 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0< ?~?>>?p~?0?~>~?~>>?>>?||x~||>||~~|>|>~|~>?<~>χ>>>>σπ~?>~>?~?????~~??` EI Q BT 0.7041 0 0 0.9835 144.24 53.76 Tm 3 Tr 0.0049 Tc 0 Tw (Medicaid) Tj 0 Tr ET BT 0.8449 0 0 0.9835 171.84 53.76 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 34.32 0 0 -5.76 173.76 59.28 cm BI /W 214 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <pv???????>~|>?LJ|?|>|?>|?>~?|>|>c?|>| >|>|>?|>|?|>|>>|>?|>|<x>~>>|>|<?>|>>|>|<>|>>|>|<>>|>|<>x?|>|>?|?|>|~?~>????|?8x|P|><>> |>||x80 EI Q BT 0.798 0 0 0.9835 173.76 53.76 Tm 3 Tr 0.0115 Tc 0 Tw (cetiication) Tj 0 Tr ET BT 0.8449 0 0 0.9835 208.08 53.76 Tm 0.0724 Tc 0.6079 Tw ( of nursing homes was eliminated in 1990 due to the implementation ) Tj ET BT 0.8491 0 0 0.9835 453.6 53.76 Tm /F4 10 Tf 0.0947 Tc -0.0667 Tw (Of ) Tj ET q 19.2 0 0 -5.76 465.84 59.52 cm BI /W 121 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?~~?~<~~~~~>|>>|>>|>~|~~|>~|>~|>~~~|~>?~?{  x8<~~>< EI Q BT 0.9835 0 0 0.9835 465.84 53.76 Tm 3 Tr 0.0688 Tc 0 Tw (Ceh) Tj 0 Tr ET BT 0.8491 0 0 0.9835 485.04 53.76 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 29.52 0 0 -7.2 487.2 59.52 cm BI /W 183 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????w???|?>|>???>>???>~????`?>@?>?>??>?>??>???>??x >?~?xp??|?|x~|<?|?|~????~???`<>>> EI Q BT 0.467 0 0 0.9835 487.2 53.76 Tm 3 Tr -0.0447 Tc 0 Tw (prOViSiOnS) Tj 0 Tr ET BT 0.8491 0 0 0.9835 516.72 53.76 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 6.24 0 0 -5.76 518.88 59.52 cm BI /W 39 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?~~~~~~~~~~|~|~|~>~>~?~~~~> >> EI Q BT 0.5094 0 0 0.9835 518.88 53.76 Tm 3 Tr 0.0947 Tc 0 Tw (Of) Tj 0 Tr ET BT 0.8491 0 0 0.9835 525.12 53.76 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 8.4 0 0 -5.76 527.28 59.52 cm BI /W 52 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xG??????????p?????>??>??>????>??>??>?~?~? EI Q BT 0.6793 0 0 0.9835 527.28 53.76 Tm 3 Tr -0.0115 Tc 0 Tw (tie) Tj 0 Tr ET BT 0.798 0 0 0.9835 62.16 43.68 Tm /F2 10 Tf 0.0386 Tc 0.6085 Tw (Omnibus Budget Reconciliation Act of 1987 ) Tj ET q 32.88 0 0 -6.96 212.4 49.2 cm BI /W 219 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxx?><~<?|>>??|>?~<~~<~|~?|~|~||~>~x?x|?<|~<|p|><x?><8??<<~=~<>~|x|x|~~~~??|~ǀ?pa  EI Q BT 0.6102 0 0 0.9835 212.4 43.68 Tm 3 Tr -0.0748 Tc 0 Tw (\(OBIG4-87\).) Tj 0 Tr ET BT 0.798 0 0 0.9835 245.28 43.68 Tm 0.0275 Tc -0.0292 Tw ( As a ) Tj ET q 16.08 0 0 -6.48 264 48.96 cm BI /W 107 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~x?????o?>~~||~~~~|~|~~|~|~|||~|?|~~?|~~?<~|~< EI Q BT 0.7041 0 0 0.9835 264 43.68 Tm 3 Tr -0.0133 Tc 0 Tw (result) Tj 0 Tr ET BT 0.798 0 0 0.9835 280.08 43.68 Tm 0.0292 Tc 0.3195 Tw ( the distinction between ) Tj ET q 14.16 0 0 -5.52 360.48 48.96 cm BI /W 95 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x@w~x>~?p>|<?p><?p~8??`~8??8?@<?<?0<?p??<?<?<?~<?|???? EI Q BT 0.5633 0 0 0.9835 360.48 43.68 Tm 3 Tr -0.0133 Tc 0 Tw (SNFS) Tj 0 Tr ET BT 0.798 0 0 0.9835 374.64 43.68 Tm 0.038 Tc 0.5591 Tw ( and other nursing homes will not be important in) Tj -391.883 -8.7853 TD 0.0293 Tc -0.1318 Tw (future special care unit research.) Tj ET endstream endobj 252 0 obj <>/Rotate 0/Type/Page>> endobj 253 0 obj <>stream 0.72 w 1 j 0 0 0 RG 74.4 687.12 m 552.48 687.12 l S BT 0.9835 0 0 0.9835 74.4 693.12 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (90 ) Tj ET BT 0.9598 0 0 0.9598 88.32 693.12 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9812 0 0 0.9812 94.56 693.12 Tm /F5 11 Tf 0.0882 Tc -0.151 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 130.32 693.12 Tm /F5 10 Tf 0.0128 Tc 0.5665 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj -56.3722 -40.5099 TD /F4 10 Tf 0.043 Tc -0.0493 Tw (average of 251 beds, compared with an average of) Tj ET BT 0.934 0 0 0.9835 76.08 641.28 Tm -0.0091 Tc 0.3687 Tw (166 beds for nursing homes with a cluster unit, and) Tj 0 -11.9577 TD -0.0225 Tc 0.5186 Tw (130 beds for nursing homes without either a special) Tj -1.0278 -12.6899 TD -0.0102 Tc 0.3555 Tw (care unit or a cluster unit \(194\).) Tj ET BT 0.9795 0 0 0.9795 128.16 595.92 Tm /F7 12 Tf 0.0354 Tc 0.6379 Tw (Nursing Home Location) Tj ET BT 0.934 0 0 0.9835 86.4 577.92 Tm /F4 10 Tf -0.023 Tc 0.7119 Tw (According to the 1987 National Medical Expendi-) Tj ET BT 0.8915 0 0 0.9835 75.6 566.16 Tm 0.0511 Tc 1.0307 Tw (ture Survey, nursing and personal care homes in the) Tj ET BT 0.9835 0 0 0.9835 75.6 554.16 Tm 0.0246 Tc 0.1219 Tw (West were more likely than nursing and personal) Tj ET BT 0.934 0 0 0.9835 75.84 541.92 Tm -0.0317 Tc 0.5413 Tw (care homes in other regions of the country to have a) Tj ET BT 0.9835 0 0 0.9835 76.32 530.4 Tm 0.0307 Tc 0.5224 Tw (special care unit \(248\). As shown in table 3-2, 22) Tj -0.7321 -12.4458 TD 0.0433 Tc 0.8892 Tw (percent of all the facilities and 37 percent of the) Tj ET BT 0.934 0 0 0.9835 76.08 506.64 Tm -0.0378 Tc 1.1416 Tw (facilities with a special care unit were in the West.) Tj ET BT 0.8915 0 0 0.9835 76.32 494.64 Tm 0.0409 Tc 0.6182 Tw (In contrast, 29 percent of all the facilities but only 16) Tj -0.2692 -12.2018 TD 0.0488 Tc 1.1118 Tw (percent of the facilities with a special care unit were) Tj ET BT 0.9835 0 0 0.9835 76.32 471.12 Tm 0.0322 Tc 2.2291 Tw (in the Midwest. Projections for 1991 suggested) Tj ET BT 0.934 0 0 0.9835 76.8 459.36 Tm -0.0396 Tc 0.9683 Tw (special care units would be more evenly distributed) Tj 0 -12.2018 TD -0.0336 Tc 0.7232 Tw (across the regions.) Tj ET BT 0.9663 0 0 0.9939 78.96 424.32 Tm /F6 14 Tf 0.03 Tc 3.049 Tw (CHARACTERISTICS OF SPECIAL) Tj 71.531 -16.4206 TD 0.0519 Tc 0.9151 Tw (CARE UNITS) Tj ET BT 0.934 0 0 0.9835 88.08 390.72 Tm /F4 10 Tf -0.0355 Tc 0.7252 Tw (Existing special care units are extremely diverse.) Tj -11.82 -12.2018 TD -0.0432 Tc 1.4787 Tw (Descriptive studies show that special care) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 267.36 378.72 Tm /F3 8 Tf 0.0245 Tc 1.4063 Tw (units vary) Tj -206.8588 -12.1216 TD 0.0438 Tc 0.21 Tw (in the ) Tj ET BT 0.934 0 0 0.9835 100.08 366.72 Tm /F4 10 Tf -0.033 Tc 2.0502 Tw (number of residents they serve, their patient) Tj ET BT 0.9835 0 0 0.9835 77.52 354.48 Tm 0.0356 Tc 0.9648 Tw (care philosophies and goals, physical design and) Tj ET BT 0.8915 0 0 0.9835 77.52 342.72 Tm 0.0324 Tc 2.512 Tw (other environmental features, staff composition and) Tj ET BT 0.9835 0 0 0.9835 77.76 330.72 Tm 0.0335 Tc -0.1312 Tw (training, staff-to-resident ratios, provision of staff) Tj 0.244 -12.2018 TD 0.0155 Tc 1.4978 Tw (support groups, activity programs, programs for) Tj ET BT 0.934 0 0 0.9835 77.76 307.2 Tm -0.0329 Tc 0.9794 Tw (families, use of psychotropic and other medications,) Tj 0 -12.6899 TD -0.0203 Tc 1.2657 Tw (use of physical restraints, admission and discharge) Tj 0 -12.4458 TD -0.0311 Tc 1.2024 Tw (policies and practices, and cost. Findings in each of) Tj 0.257 -11.9577 TD -0.0372 Tc 0.9657 Tw (these areas are discussed in the following sections.) Tj ET BT 0.9835 0 0 0.9835 89.04 252.48 Tm 0.0406 Tc 0.6983 Tw (Each of the descriptive studies listed in tables) Tj -10.7376 -12.4458 TD 0.0325 Tc 3.4083 Tw (3-la, 3-lb, and 3-lc provides some information) Tj 0 -12.2018 TD 0.0249 Tc 1.2197 Tw (about the characteristics of existing special care) Tj -0.244 -11.9577 TD 0.0107 Tc 1.3214 Tw (units. The four nursing home surveys that have) Tj ET BT 0.8915 0 0 0.9835 78.48 204.48 Tm 0.0449 Tc 1.0136 Tw (included questions about special care units \(see table) Tj ET BT 0.934 0 0 0.9835 79.2 192.48 Tm -0.0224 Tc 1.0967 Tw (3-la\) provide information about certain characteris-) Tj ET BT 0.9835 0 0 0.9835 78.96 180.48 Tm 0.0323 Tc 1.1444 Tw (tics of the units. With the exception of the 1990) Tj 0.244 -12.4458 TD 0.0232 Tc 0.96 Tw (survey of all nursing homes in five northeastern) Tj ET BT 0.934 0 0 0.9835 79.2 156 Tm -0.0107 Tc 1.341 Tw (States \(194\), however, these nursing home surveys) Tj -0.5139 -11.7137 TD -0.0298 Tc 0.8477 Tw (have included very few questions about special care) Tj 0.257 -12.2018 TD -0.01 Tc 0.3767 Tw (units, beyond asking whether the facility has such a) Tj ET BT 0.8491 0 0 0.9835 79.2 120.72 Tm 0.0553 Tc 0 Tw (unit.) Tj ET BT 0.934 0 0 0.9835 90.24 102.96 Tm -0.042 Tc 2.0598 Tw (The seven studies that compare selected special) Tj ET BT 0.9835 0 0 0.9835 79.44 90.96 Tm 0.0342 Tc 2.936 Tw (care units \(see table 3-lb\) provide much more) Tj 0 -11.9577 TD 0.0224 Tc 1.2955 Tw (comprehensive information about the units. The) Tj ET BT 0.934 0 0 0.9835 79.44 67.44 Tm -0.0272 Tc 1.8727 Tw (findings of these studies are particularly useful in) Tj -0.257 -11.9577 TD -0.0295 Tc 1.5218 Tw (pointing out the diversity of existing units. On the) Tj ET BT 0.9835 0 0 0.9835 79.2 43.92 Tm 0.0389 Tc 1.7851 Tw (other hand, none of the studies used a random) Tj ET BT 0.934 0 0 0.9835 326.16 653.28 Tm -0.0295 Tc 1.4897 Tw (sample of special care units, so their findings with) Tj ET BT 0.9835 0 0 0.9835 325.44 641.28 Tm 0.035 Tc 2.6213 Tw (respect to the proportion of units with certain) Tj ET BT 0.934 0 0 0.9835 326.16 629.28 Tm -0.0266 Tc 1.3581 Tw (characteristics are less useful. Even the findings of) Tj ET BT 0.9835 0 0 0.9835 326.4 617.04 Tm 0.0204 Tc 1.4509 Tw (studies with large sample sizes, e.g., White and) Tj -0.244 -11.9577 TD 0.0404 Tc 1.021 Tw (Kwon\222s findings based on a sample of 99 special) Tj ET BT 0.934 0 0 0.9835 326.16 593.04 Tm -0.0196 Tc 0.5797 Tw (care units \(492\), cannot be generalized to all special) Tj ET BT 0.9835 0 0 0.9835 326.4 581.04 Tm 0.0288 Tc 2.4185 Tw (care units since they are based on nonrandom) Tj ET BT 0.8915 0 0 0.9835 326.64 569.04 Tm -0.0032 Tc 0 Tw (samples.) Tj ET BT 0.9835 0 0 0.9835 337.68 551.04 Tm 0.038 Tc 1.003 Tw (The five studies that compare selected special) Tj ET BT 0.8915 0 0 0.9835 326.88 539.04 Tm 0.0513 Tc 1.4679 Tw (care units and selected nonspecialized nursing home) Tj ET BT 0.9835 0 0 0.9835 326.88 527.04 Tm 0.0363 Tc 3.0384 Tw (units \(see table 3-lc\) are useful in identifying) Tj 0 -11.9577 TD 0.0229 Tc 1.5878 Tw (characteristics that distinguish the two types of) Tj ET BT 0.8915 0 0 0.9835 326.88 503.52 Tm 0.0294 Tc 0.6512 Tw (units. Three of these studies have very small samples) Tj ET BT 0.934 0 0 0.9835 327.6 491.52 Tm -0.0236 Tc 1.2521 Tw (\(1 to 2 special care units and 1 to 4 nonspecialized) Tj ET BT 0.9835 0 0 0.9835 327.12 479.76 Tm 0.029 Tc 1.0122 Tw (units\) \(256,292,391\). The other two studies have) Tj ET BT 0.934 0 0 0.9835 327.36 468.24 Tm 0.0038 Tc 1.4357 Tw (much larger samples \(382,413\). The study done by) Tj -0.257 -12.2018 TD -0.0285 Tc 1.8741 Tw (researchers at the University of North Carolina is) Tj ET BT 0.9835 0 0 0.9835 327.6 444.24 Tm 0.0338 Tc 0.0312 Tw (especially valuable because the special care units) Tj ET BT 0.8915 0 0 0.9835 327.84 432.48 Tm 0.0546 Tc 0.9595 Tw (were randomly selected from all special care units in) Tj ET BT 0.934 0 0 0.9835 327.84 420.24 Tm -0.0111 Tc 0.6349 Tw (the five States studied \(413\).) Tj ET BT 0.9795 0 0 0.9795 388.8 396.24 Tm /F7 12 Tf 0.0267 Tc 1.0144 Tw (Number of Residents) Tj ET BT 0.934 0 0 0.9835 339.12 378.48 Tm /F4 10 Tf -0.0235 Tc 1.0015 Tw (It is often said that nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 328.32 366.24 Tm 0.0533 Tc 0.5683 Tw (dementia can be better cared for in small rather than) Tj ET BT 0.9835 0 0 0.9835 328.32 354.48 Tm 0.0216 Tc 1.101 Tw (large groups, and some commentators have sug-) Tj 0.4881 -12.2018 TD 0.0393 Tc 0.1069 Tw (gested 8 to 20 residents may be ideal \(63,93,109\).) Tj ET BT 0.934 0 0 0.9835 328.8 330.48 Tm -0.0249 Tc 0.9892 Tw (Studies of nonrandom samples of special care units) Tj ET BT 0.9835 0 0 0.9835 329.04 318.72 Tm 0.0279 Tc 0.4672 Tw (show the number of residents in individual units) Tj ET BT 0.934 0 0 0.9835 328.56 306.72 Tm -0.0213 Tc 1.0955 Tw (varies greatly. The 16 special care units studied by) Tj ET BT 0.9835 0 0 0.9835 329.04 294.48 Tm 0.0356 Tc 0.0022 Tw (Ohta and Ohta had from 10 to 49 residents \(332\).) Tj ET BT 0.8915 0 0 0.9835 328.8 282.48 Tm 0.039 Tc 0.6202 Tw (The 7 special care units studied by Hyde had from 12) Tj ET BT 0.934 0 0 0.9835 329.04 270.48 Tm -0.0122 Tc 1.1428 Tw (to 41 residents \(199\), and the 12 special care units) Tj ET BT 0.9835 0 0 0.9835 329.28 258.24 Tm 0.0478 Tc 2.5657 Tw (studied by Mace and Coons had from 8 to 47) Tj -0.4881 -11.9577 TD 0.0341 Tc 0.885 Tw (residents \(275\). Although these ranges are wide,) Tj ET BT 0.8915 0 0 0.9835 329.76 234.48 Tm 0.0481 Tc 0.9331 Tw (some of the units clearly had a very small number of) Tj ET BT 0.934 0 0 0.9835 329.04 222.48 Tm -0.0108 Tc 1.6624 Tw (residents \(8 to 12 individuals\). The 1990 survey of) Tj ET BT 0.8915 0 0 0.9835 329.52 210.48 Tm 0.0339 Tc 0.3433 Tw (all nursing homes in 5 northeastern States found that) Tj ET BT 0.934 0 0 0.9835 329.76 198.48 Tm -0.0037 Tc 0.734 Tw (special care units had an average of 37 beds \(194\).) Tj ET BT 0.8915 0 0 0.9835 340.8 180.48 Tm 0.0285 Tc 1.455 Tw (Data from the University of North Carolina study) Tj ET BT 0.9835 0 0 0.9835 329.76 168.24 Tm 0.037 Tc 0.2923 Tw (of 31 randomly selected special care units and 32) Tj 0 -12.2018 TD 0.0252 Tc -0.074 Tw (matched nonspecialized nursing home units show) Tj 0.4881 -11.9577 TD 0.035 Tc 0.8434 Tw (that on average the special care units had fewer) Tj -0.4881 -11.7137 TD 0.0325 Tc 0.0093 Tw (residents than the nonspecialized units \(36 vs. 59) Tj ET BT 0.934 0 0 0.9835 329.76 120.72 Tm -0.0295 Tc 0.7617 Tw (residents, respectively\) \(413\). The special care units) Tj ET BT 0.9835 0 0 0.9835 330.48 109.2 Tm 0.0449 Tc 1.1994 Tw (also had fewer rooms and a larger proportion of) Tj ET BT 0.934 0 0 0.9835 330 97.2 Tm -0.0421 Tc 1.3747 Tw (private rooms) Tj 64.7528 0 TD -0.0421 Tc 1.8886 Tw (\227i.e. rooms for only one resident.) Tj ET BT 0.9795 0 0 0.9795 402.48 73.68 Tm /F7 12 Tf 0.0324 Tc 0.641 Tw (Age of the Units) Tj ET BT 0.9835 0 0 0.9835 341.28 55.92 Tm /F4 10 Tf 0.0323 Tc 0.2768 Tw (Available data indicate most special care units) Tj -11.4697 -12.2018 TD 0.0384 Tc 0.2124 Tw (have been established since 1983, although a few) Tj ET endstream endobj 254 0 obj <>/Rotate 0/Type/Page>> endobj 255 0 obj <>stream 0.48 w 1 j 0 0 0 RG 52.8 681.84 m 530.88 681.84 l S 0.72 w 57.6 61.44 m 82.08 61.44 l S 80.64 61.44 m 303.84 61.44 l S 303.84 61.2 m 535.68 61.2 l S BT 0.9835 0 0 0.9835 316.32 687.36 Tm 0 0 0 rg /F5 10 Tf 0.0209 Tc 1.6259 Tw (Chapter 3--Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 512.16 687.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 518.64 687.36 Tm /F5 10 Tf 0.244 Tc 0 Tw (91) Tj -473.1851 -39.5338 TD /F4 10 Tf 0.0236 Tc 2.0403 Tw (units have been in operation much longer. The) Tj ET BT 0.8915 0 0 0.9835 53.28 636.72 Tm 0.0511 Tc 1.0979 Tw (Minnesota nursing homes with a special care unit in) Tj 1.6152 -11.7137 TD 0.0437 Tc 0.0408 Tw (1986 reported that the units had been in operation for) Tj ET BT 0.934 0 0 0.9835 54 612.96 Tm -0.0098 Tc 0.3408 Tw (an average of 2 years \(181\). Likewise, the 31 special) Tj ET BT 0.9835 0 0 0.9835 53.76 600.72 Tm 0.0183 Tc 2.5686 Tw (care units included in the University of North) Tj 0.244 -11.7137 TD 0.0385 Tc 0.5958 Tw (Carolina study conducted from 1987 to 1989 had) Tj ET BT 0.8915 0 0 0.9835 54 576.96 Tm 0.0552 Tc 0.7158 Tw (been in operation an average of 4.6 years: the special) Tj ET BT 0.934 0 0 0.9835 54 564.72 Tm -0.0308 Tc 1.202 Tw (care units in nonprofit facilities had been in opera-) Tj ET BT 0.9835 0 0 0.9835 54.48 552.96 Tm 0.0264 Tc 2.4791 Tw (tion twice as long as the special care units in) Tj ET BT 0.934 0 0 0.9835 54.48 540.96 Tm -0.0319 Tc 0.7031 Tw (for-profit facilities \(6 years vs. 3 years, respectively\)) Tj 0.257 -11.9577 TD -0.0165 Tc 0.782 Tw (\(413\). On the other hand, one of the 31 special care) Tj -0.257 -12.2018 TD -0.0163 Tc 0.5762 Tw (units in the University of North Carolina study had) Tj ET BT 0.8915 0 0 0.9835 54.48 505.2 Tm 0.0444 Tc 0.8026 Tw (been in operation for 25 years. Likewise, the samples) Tj 0.2692 -11.9577 TD 0.0403 Tc 1.1774 Tw (of special care units studied by Weiner and Reingold) Tj 0.5384 -11.9577 TD 0.0391 Tc 0.4646 Tw (and White and Kwon each included one unit that had) Tj ET BT 0.934 0 0 0.9835 54.72 469.68 Tm -0.0016 Tc 1.2457 Tw (been in operation for 20 years \(485,494\).) Tj ET BT 0.9795 0 0 0.9795 76.8 437.28 Tm /F7 12 Tf 0.0536 Tc 0.7419 Tw (Patient Care Philosophies and Goals) Tj ET BT 0.934 0 0 0.9835 66.24 418.32 Tm /F4 10 Tf -0.0328 Tc 1.3648 Tw (None of the descriptive studies that have used a) Tj ET BT 0.8915 0 0 0.9835 55.2 406.56 Tm 0.03 Tc 1.559 Tw (random sample of special care units or attempted to) Tj 0.8076 -12.2018 TD 0.065 Tc 1.1834 Tw (survey all nursing homes in a given geographic area) Tj -0.5384 -12.2018 TD 0.0297 Tc 1.3912 Tw (has addressed the question of the units\222 patient care) Tj ET BT 0.9835 0 0 0.9835 55.44 370.56 Tm 0.0403 Tc 5.2307 Tw (philosophies or goals.) Tj ET BT 1.08 0 0 1.08 163.92 375.36 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (3 ) Tj ET BT 0.9835 0 0 0.9835 167.76 370.56 Tm /F4 10 Tf 0.0278 Tc 3.5351 Tw (Four studies that used) Tj ET BT 0.934 0 0 0.9835 55.68 358.8 Tm -0.0208 Tc 2.6367 Tw (nonrandom samples have addressed this question) Tj 0.5139 -12.4458 TD 0.0185 Tc 1.2242 Tw (\(64,199,332,485\). Based on a nonrandom sample of) Tj 0 -11.7137 TD -0.0321 Tc 1.8779 Tw (22 special care units, Weiner and Reingold identi-) Tj ET BT 0.8915 0 0 0.9835 56.16 323.04 Tm 0.039 Tc 0.8895 Tw (fied nine goals of the units \(485\). The nine goals are:) Tj ET BT 0.7642 0 0 0.9835 68.4 304.32 Tm 0.0673 Tc 0 Tw (1.) Tj ET BT 0.8607 0 0 0.9812 67.44 279.6 Tm /F6 11 Tf 0.0549 Tc (2.) Tj ET BT 0.8197 0 0 0.9812 67.92 242.4 Tm 0.1174 Tc (3.) Tj ET BT 0.8607 0 0 0.9812 67.68 217.92 Tm 0.1944 Tc (4.) Tj 0.2788 -12.7188 TD 0.0549 Tc (5.) Tj 0.2788 -24.7038 TD 0.0549 Tc (6.) Tj 0.2788 -37.178 TD 0.1944 Tc (7.) Tj 0.8365 -49.163 TD 0.0549 Tc (8.) Tj ET BT 0.9835 0 0 0.9835 80.88 304.32 Tm /F4 10 Tf 0.0405 Tc 3.0341 Tw (to provide a safe, secure, and supportive) Tj ET BT 0.8915 0 0 0.9835 81.12 292.32 Tm 0.0331 Tc 2.2958 Tw (environment for residents with dementia;) Tj ET BT 0.9835 0 0 0.9835 81.12 279.36 Tm 0.0418 Tc 1.2433 Tw (to reduce feelings of anxiety and confusion) Tj 0.244 -12.4458 TD 0.0126 Tc 1.1102 Tw (through environmental and communication) Tj ET BT 0.8915 0 0 0.9835 81.84 255.12 Tm -0.016 Tc 0 Tw (support;) Tj ET BT 0.9835 0 0 0.9835 81.36 242.64 Tm 0.0296 Tc 0.5235 Tw (to help residents reach or maintain optimal) Tj ET BT 0.934 0 0 0.9835 81.36 230.64 Tm -0.026 Tc 1.8713 Tw (levels of physical and cognitive functioning;) Tj 0.257 -12.9339 TD -0.0497 Tc 1.0617 Tw (to provide holistic patient care;) Tj ET BT 0.8915 0 0 0.9835 81.6 205.44 Tm 0.0198 Tc 1.2879 Tw (to offer staff members understanding, training,) Tj ET BT 0.934 0 0 0.9835 82.08 193.68 Tm -0.0354 Tc 1.2647 Tw (education, and freedom from excessive stress;) Tj ET BT 0.8915 0 0 0.9835 81.84 181.2 Tm 0.0408 Tc 0.8515 Tw (to recognize that individuals with dementia are) Tj ET BT 0.934 0 0 0.9835 82.08 169.44 Tm -0.0454 Tc 1.0356 Tw (entitled to experiences and activities that will) Tj 0 -11.9577 TD -0.0216 Tc 0.5819 Tw (enhance the quality of their lives;) Tj ET BT 0.8915 0 0 0.9835 82.08 144.96 Tm 0.0408 Tc 0.8515 Tw (to recognize that individuals with dementia are) Tj ET BT 0.934 0 0 0.9835 82.32 132.72 Tm -0.0232 Tc 1.226 Tw (autonomous and can expect that their special) Tj ET BT 0.9835 0 0 0.9835 82.32 121.2 Tm 0.0417 Tc -0.0786 Tw (needs and those of their families will be met) Tj ET BT 0.8915 0 0 0.9835 82.56 108.96 Tm 0.0164 Tc 2.3146 Tw (with sensitivity and appropriateness;) Tj ET BT 0.934 0 0 0.9835 82.32 96.48 Tm -0.049 Tc 1.6819 Tw (to provide patients with opportunities to suc-) Tj ET BT 0.9835 0 0 0.9835 82.8 84.48 Tm 0.0365 Tc 2.3758 Tw (ceed, which will build their sense of self-) Tj ET BT 0.8915 0 0 0.9835 82.8 72.96 Tm 0.0066 Tc 1.518 Tw (-esteem, dignity, and hope, and) Tj ET BT 0.9261 0 0 0.9795 315.36 648.24 Tm /F7 12 Tf 0.0331 Tc 0.0727 Tw (9. ) Tj ET BT 0.934 0 0 0.9835 326.64 648.24 Tm /F4 10 Tf -0.0248 Tc 0.8851 Tw (to improve the environment and community of) Tj 2.3126 -11.7137 TD -0.0257 Tc 1.3571 Tw (nondemented residents of the facility \(485\).) Tj -14.3895 -19.0348 TD -0.0259 Tc 0.8756 Tw (The number of units that professed each of these) Tj -11.306 -12.4458 TD -0.0168 Tc 1.1477 Tw (goals and the mix of goals for individual units was) Tj ET BT 0.8915 0 0 0.9835 304.56 594.24 Tm 0.0152 Tc 1.2392 Tw (not noted in the study report.) Tj ET BT 0.934 0 0 0.9835 316.08 575.04 Tm -0.0367 Tc 0.7449 Tw (Several topologies of special care units have been) Tj -12.0769 -11.9577 TD -0.0313 Tc 1.51 Tw (proposed based on the units\222 philosophy and goals.) Tj 0.5139 -12.2018 TD -0.0501 Tc 1.0621 Tw (These topologies point out one facet of the diversity) Tj 0 -12.4458 TD -0.0181 Tc 1.1884 Tw (of existing units. From their study of a nonrandom) Tj ET BT 0.9835 0 0 0.9835 305.76 527.28 Tm 0.0283 Tc 1.5823 Tw (sample of 16 special care units, Ohta and Ohta) Tj ET BT 0.934 0 0 0.9835 305.52 515.76 Tm -0.0419 Tc 1.0533 Tw (identified three types of special care units based on) Tj 0 -12.4458 TD -0.0045 Tc 0.6207 Tw (the units\222 goals: 1\) units that have as their primary) Tj 0.257 -12.2018 TD -0.03 Tc 0.8157 Tw (goal to meet residents\222 physical care needs; 2\) units) Tj ET BT 0.9835 0 0 0.9835 306 479.76 Tm 0.0205 Tc -0.0875 Tw (that have as their primary goals to maintain resi-) Tj ET BT 0.934 0 0 0.9835 306 467.76 Tm -0.0346 Tc 1.3024 Tw (dents\222 ability to perform activities of daily living to) Tj ET BT 0.8915 0 0 0.9835 306 455.76 Tm 0.0316 Tc 0.9515 Tw (the greatest extent possible and to minimize memory) Tj 0 -11.9577 TD 0.0238 Tc 1.6782 Tw (impairments and behavioral symptoms; and 3\) units) Tj 0.2692 -12.4458 TD 0.0391 Tc 0.2366 Tw (that have as their primary goal to maintain residents\222) Tj 0 -12.2018 TD 0.0431 Tc 1.1069 Tw (quality of life, while also maintaining their ability to) Tj ET BT 0.9835 0 0 0.9835 306 407.76 Tm 0.0219 Tc 1.0194 Tw (perform activities of daily living and minimizing) Tj 0.4881 -12.4458 TD 0.0183 Tc 0.3235 Tw (their memory impairments and behavioral symp-) Tj ET BT 0.934 0 0 0.9835 306.72 383.52 Tm 0.0263 Tc 1.5585 Tw (toms \(332\).) Tj ET BT 0.9835 0 0 0.9835 317.52 365.04 Tm 0.0491 Tc 0.6257 Tw (Another typology based on the philosophy and) Tj ET BT 0.934 0 0 0.9835 306.96 353.04 Tm -0.0261 Tc 1.5182 Tw (goals of a nonrandom sample of seven special care) Tj -0.257 -12.2018 TD -0.0268 Tc 0.873 Tw (units posited two types of units: 1\) units that adopt) Tj ET BT 0.9835 0 0 0.9835 307.2 329.28 Tm 0.0312 Tc 1.7014 Tw (a medical model of care and focus primarily on) Tj -0.4881 -11.9577 TD 0.03 Tc 0.0554 Tw (hygiene and physical aspects of care; and 2\) units) Tj 0.4881 -12.2018 TD 0.0288 Tc 1.4423 Tw (that focus more on psychosocial aspects of care,) Tj 0 -12.2018 TD 0.0171 Tc 0.7396 Tw (including continuity with a resident\222s family and) Tj -0.244 -12.4458 TD 0.0348 Tc 0.9046 Tw (previous life \(199\). The author of this study also) Tj ET BT 0.8915 0 0 0.9835 307.44 269.04 Tm 0.0366 Tc 0.6383 Tw (distinguished between special care units that have as) Tj 0.2692 -11.9577 TD 0.0403 Tc 1.1774 Tw (a goal to maintain their residents\222 functioning to the) Tj ET BT 0.934 0 0 0.9835 307.68 245.04 Tm -0.0345 Tc 2.0518 Tw (greatest extent possible, with the expectation that) Tj 0.5139 -12.2018 TD -0.0219 Tc 1.9098 Tw (some residents\222 functioning might improve and, in) Tj ET BT 0.9835 0 0 0.9835 307.68 221.28 Tm 0.0224 Tc 2.2391 Tw (contrast, special care units that emphasize the) Tj -0.244 -11.9577 TD 0.034 Tc 2.3493 Tw (progressive nature of most diseases that cause) Tj ET BT 0.8915 0 0 0.9835 308.16 197.76 Tm 0.0379 Tc 0.6214 Tw (dementia and have as a goal to allow the residents to) Tj ET BT 0.934 0 0 0.9835 308.16 186 Tm -0.0301 Tc 0.8158 Tw (decline over time with as much comfort and dignity) Tj ET BT 0.8915 0 0 0.9835 308.16 174.24 Tm 0.0191 Tc 2.85 Tw (as possible.) Tj 12.3829 -18.7907 TD 0.0244 Tc 1.1279 Tw (Lastly, from their study of a nonrandom sample of) Tj -11.037 -12.2018 TD 0.0456 Tc 0.5769 Tw (13 special care units in Florida, Cairl et al. identified) Tj -1.0768 -12.2018 TD 0.0255 Tc 0.7161 Tw (two types of units: 1\) units in which the primary goal) Tj ET BT 0.9835 0 0 0.9835 308.64 120 Tm 0.0266 Tc -0.0022 Tw (was behavior management-that is, to reduce resi-) Tj ET BT 0.8915 0 0 0.9835 308.64 108.24 Tm 0.0271 Tc 2.4641 Tw (dent anxiety, wandering, and behavioral symptoms,) Tj ET BT 0.9835 0 0 0.9835 308.88 96.48 Tm 0.0214 Tc 2.0232 Tw (and 2\) units in which the primary goal was to) Tj -0.244 -11.9577 TD 0.0204 Tc 0.4311 Tw (maximize residents\222 functioning while preserving) Tj ET BT 0.934 0 0 0.9835 308.88 72.72 Tm -0.0151 Tc 0.8319 Tw (their individual dignity \(64\).) Tj ET q 2.16 0 0 -4.32 71.76 55.44 cm BI /W 15 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?ppx<<>px`xp||?? EI Q BT 0.6496 0 0 0.99 71.76 49.92 Tm 3 Tr /F5 8 Tf -0.1562 Tc 0 Tw (s) Tj 0 Tr ET BT 0.8858 0 0 0.99 73.92 49.92 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 10.8 0 0 -5.52 75.6 55.68 cm BI /W 69 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??~?~?~x?~?8?|??|??|>?~>?~??~?~?~?~?|????8@?g??? EI Q BT 1.122 0 0 0.99 75.6 49.92 Tm 3 Tr 0.042 Tc 0 Tw (me) Tj 0 Tr ET BT 0.8858 0 0 0.99 86.4 49.92 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 12.48 0 0 -5.76 88.08 55.44 cm BI /W 79 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x~????~?q??~~?~?|?|?|?|?||~?>??? @ EI Q BT 0.8267 0 0 0.99 88.08 49.92 Tm 3 Tr 0.0354 Tc 0 Tw (19gI) Tj 0 Tr ET BT 0.8858 0 0 0.99 100.56 49.92 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 20.4 0 0 -7.2 102.24 55.68 cm BI /W 129 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|8|8<x?>???Ϗx|?||>>>ǁ>>>?~>π~>|π|>?|?~<?<~~~?8`p EI Q BT 1.122 0 0 0.99 102.24 49.92 Tm 3 Tr 0.0395 Tc 0 Tw (@rge) Tj 0 Tr ET BT 0.8858 0 0 0.99 122.64 49.92 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 34.08 0 0 -7.2 124.32 55.44 cm BI /W 212 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?xp<?>?>??~~>>|>~?|>|?>>?>>|><>>>>|>>|<~~~?>~~>?>??????x??<?0?<?<?p?? 8 EI Q BT 0.8267 0 0 0.99 124.32 49.92 Tm 3 Tr 0.0593 Tc 0 Tw (Wmhi.ugton) Tj 0 Tr ET BT 0.8858 0 0 0.99 158.4 49.92 Tm 0 Tc -0.1033 Tw ( ) Tj ET q 29.76 0 0 -7.2 160.08 55.44 cm BI /W 186 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?>>?>>?>?~>|p>|p>|8p>x?p>x>p>x~p>|p>p>|p?>p<p~x>px?p?p~??p?p10?pppx>>>z `> EI Q BT 0.8858 0 0 0.99 160.08 49.92 Tm 3 Tr -0.0403 Tc 0 Tw (un.iversi~) Tj 0 Tr ET BT 0.8645 0 0 0.9939 189.84 49.92 Tm /F3 7 Tf -0.0163 Tc 0.2932 Tw ( surve) Tj ET BT 0.8647 0 0 1.0398 207.84 48.72 Tm /F3 3 Tf -0.0042 Tc 0.0028 Tw (y ) Tj ET BT 0.8449 0 0 0.9835 210 49.92 Tm /F2 10 Tf 0.0836 Tc 0.4053 Tw (asked whether the special care units or special programs it identified operated ) Tj ET q 16.08 0 0 -5.76 485.28 55.68 cm BI /W 102 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?~?<~??~??~|?~|~|~|~|~|~~?~?x???|?<~p????? EI Q BT 0.8919 0 0 0.9835 485.28 49.92 Tm 3 Tr 0.062 Tc 0 Tw (uder) Tj 0 Tr ET BT 0.8449 0 0 0.9835 501.36 49.92 Tm 0.1013 Tc -0.0654 Tw ( a ) Tj ET q 24.24 0 0 -5.76 509.28 55.68 cm BI /W 152 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??????y~?y>~9>~g??|??|??|?>||>|?~??>?>>??>x c`>??>?@ EI Q BT 0.6572 0 0 0.9835 509.28 49.92 Tm 3 Tr 0.0262 Tc 0 Tw (different) Tj 0 Tr ET BT 0.798 0 0 0.9835 57.84 40.56 Tm 0.0394 Tc -0.1307 Tw (philosophy of care from the rest of the facility. The survey responses with respect to this question have not yet been analyzed \(246\).) Tj ET BT 0.9835 0 0 0.9835 70.8 12 Tm 0.1126 Tc 1.5937 Tw (328-405 - 92 - 4) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9939 0 0 0.9939 147.12 12 Tm /F2 7 Tf 0.0403 Tc -0.1013 Tw (QL ) Tj ET BT 0.99 0 0 0.99 159.6 12 Tm /F5 8 Tf 0.1206 Tc 0 Tw (3) Tj ET endstream endobj 256 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 257 0 obj <>stream 0.72 w 1 j 0 0 0 RG 78.72 683.52 m 557.28 683.52 l S BT 0.9835 0 0 0.9835 78.96 689.04 Tm 0 0 0 rg /F5 10 Tf 0.0149 Tc 1.0996 Tw (92 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 90.24 649.92 Tm /F4 10 Tf -0.0279 Tc 0.8456 Tw (These topologies are useful in thinking about the) Tj -11.306 -11.9577 TD -0.0249 Tc 1.7233 Tw (differences among special care units. It is unclear,) Tj ET BT 0.8915 0 0 0.9835 79.44 626.4 Tm 0.0386 Tc 1.5975 Tw (however, which of the topologies best represents the) Tj 0.2692 -12.2018 TD 0.0463 Tc 1.089 Tw (differences among existing special care units in their) Tj -0.2692 -12.4458 TD 0.0411 Tc 0.9073 Tw (patient care philosophies and goals. It is also unclear) Tj ET BT 0.934 0 0 0.9835 79.92 590.16 Tm -0.0364 Tc 0.8975 Tw (whether the topologies encompass the full variation) Tj ET BT 0.9835 0 0 0.9835 79.92 578.16 Tm 0.0351 Tc 0.8839 Tw (in philosophies and goals among existing special) Tj ET BT 0.8915 0 0 0.9835 79.92 566.16 Tm 0.058 Tc 0.6527 Tw (care units) Tj 0.5384 -12.4458 TD 0.0599 Tc 1.9966 Tw (are based) Tj ET BT 0.8491 0 0 0.9835 80.16 542.16 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.934 0 0 0.9835 126 566.16 Tm -0.0463 Tc 1.2507 Tw (since the studies on which the topologies) Tj 0.7709 -12.4458 TD -0.0292 Tc 1.772 Tw (used nonrandom samples of special care) Tj ET BT 0.9795 0 0 0.9795 126.72 514.32 Tm /F7 12 Tf 0.0298 Tc 1.1337 Tw (Physical Design and Other) Tj 6.1258 -14.4569 TD 0.0394 Tc 1.859 Tw (Environmental Features) Tj ET BT 0.9835 0 0 0.9835 91.44 482.16 Tm /F4 10 Tf 0.0283 Tc 2.7676 Tw (As discussed in chapter 1, the literature on) Tj ET BT 0.934 0 0 0.9835 81.36 470.16 Tm -0.0306 Tc 1.7907 Tw (specialized nursing home care for individuals with) Tj ET BT 0.9835 0 0 0.9835 80.88 458.16 Tm 0.0339 Tc 0.8933 Tw (dementia emphasizes the importance of physical) Tj ET BT 0.8915 0 0 0.9835 81.12 446.4 Tm 0.0436 Tc 1.438 Tw (environment in the care of these individuals. Design) Tj ET BT 0.9835 0 0 0.9835 81.12 434.4 Tm 0.0264 Tc 2.235 Tw (features and other physical characteristics of a) Tj 0 -12.2018 TD 0.0355 Tc 0.2633 Tw (nursing home are believed to be important for all) Tj ET BT 0.8915 0 0 0.9835 80.88 410.4 Tm 0.0252 Tc 1.2728 Tw (residents, but especially important for residents with) Tj 0.5384 -12.2018 TD 0.0227 Tc 1.3803 Tw (dementia. It is said that the more severe an individ-) Tj ET BT 0.934 0 0 0.9835 81.36 386.4 Tm -0.0247 Tc 0.6954 Tw (ual\222s impairment, the greater the negative effects of) Tj 0.5139 -11.9577 TD -0.0267 Tc 1.8207 Tw (an inappropriate environment and, conversely, the) Tj 0 -11.9577 TD -0.0427 Tc 1.9626 Tw (greater the positive effects of an appropriate envi-) Tj -0.5139 -12.2018 TD 0.014 Tc 1.8286 Tw (ronment \(241\).) Tj ET BT 0.9835 0 0 0.9835 92.88 332.88 Tm 0.0363 Tc 0.1797 Tw (A variety of physical design and other environ-) Tj ET BT 0.934 0 0 0.9835 81.84 321.36 Tm -0.038 Tc 0.8197 Tw (mental features have been proposed for special care) Tj ET BT 0.8915 0 0 0.9835 82.08 309.6 Tm 0.0211 Tc 0.896 Tw (units. Most of these features are intended to compen-) Tj ET BT 0.9835 0 0 0.9835 82.32 297.36 Tm 0.0211 Tc -0.0698 Tw (sate directly for residents\222 cognitive impairments,) Tj -0.244 -12.2018 TD 0.0389 Tc 0.0724 Tw (but some are intended to compensate for physical) Tj 0 -12.2018 TD 0.0182 Tc 0.3236 Tw (impairments that may exacerbate an individual\222s) Tj 0.244 -12.4458 TD 0.0183 Tc 1.2671 Tw (fictional deficits, e.g., reduced visual acuity that) Tj ET BT 0.8915 0 0 0.9835 82.56 249.36 Tm 0.0398 Tc 1.3654 Tw (can interfere with the individual\222s perceptions of the) Tj ET BT 0.934 0 0 0.9835 82.56 237.12 Tm -0.0229 Tc 0.6154 Tw (environment and thus add to his or her confusion.) Tj ET BT 0.9835 0 0 0.9835 93.6 219.12 Tm 0.0378 Tc 2.1827 Tw (Some of the design and other environmental) Tj -10.9816 -11.9577 TD 0.0477 Tc 0.3425 Tw (features that have been proposed for special care) Tj -0.244 -11.9577 TD 0.0105 Tc 0.206 Tw (units are structural, such as arrangement of resi-) Tj ET BT 0.8915 0 0 0.9835 82.8 183.6 Tm 0.0534 Tc 1.4655 Tw (dents\222 bedrooms around a common, central area and) Tj ET BT 0.934 0 0 0.9835 82.8 171.36 Tm -0.0362 Tc 1.7721 Tw (location of the nurses\222 station to facilitate resident) Tj 0.7709 -12.2018 TD -0.0233 Tc 1.3545 Tw (supervision and staff/resident interaction. Unless a) Tj ET BT 0.9835 0 0 0.9835 83.04 147.36 Tm 0.0213 Tc 0.1659 Tw (unit is originally constructed with these features,) Tj 0 -12.2018 TD 0.0382 Tc 2.0604 Tw (extensive remodeling is required to incorporate) Tj 0.244 -12.2018 TD 0.0179 Tc 0.6167 Tw (them. Other physical design features, e.g., a safe) Tj 0.244 -12.2018 TD 0.0414 Tc 0.2878 Tw (space for wandering, are more easily added to an) Tj ET BT 0.934 0 0 0.9835 83.52 99.6 Tm -0.0301 Tc 1.6616 Tw (existing facility, but still require some remodeling.) Tj ET BT 0.9835 0 0 0.9835 83.28 87.84 Tm 0.0387 Tc 1.8463 Tw (A third type of physical design features can be) Tj 0.244 -12.4458 TD 0.0256 Tc 1.8698 Tw (incorporated in an existing facility without any) Tj -0.244 -12.2018 TD 0.0221 Tc 1.3446 Tw (remodeling. These features include: an alarm or) Tj 0.244 -11.7137 TD 0.0078 Tc 0.139 Tw (locking system; environmental cues, such as color) Tj ET BT 0.934 0 0 0.9835 83.52 39.84 Tm -0.0506 Tc 1.0626 Tw (coding of rooms and corridors to help residents find) Tj ET BT 0.9835 0 0 0.9835 330.48 649.92 Tm 0.0176 Tc -0.0453 Tw (their way around the unit; and personal markers,) Tj ET BT 0.8915 0 0 0.9835 331.2 638.16 Tm 0.0448 Tc 0.6137 Tw (such as a picture of the resident placed near the door) Tj ET BT 0.934 0 0 0.9835 330.72 626.4 Tm -0.0461 Tc 0.7366 Tw (to his or her room.) Tj 11.563 -18.5467 TD -0.0199 Tc 0.6229 Tw (Available data indicate that most existing special) Tj -11.0491 -12.4458 TD -0.0382 Tc 0.5996 Tw (care units were not originally constructed as special) Tj -0.257 -12.2018 TD -0.0242 Tc 1.0129 Tw (care units and that at least one-fifth were not even) Tj ET BT 0.9835 0 0 0.9835 330.72 571.92 Tm 0.0393 Tc 1.3968 Tw (remodeled for this purpose. Of the 31 randomly) Tj ET BT 0.8915 0 0 0.9835 331.44 559.92 Tm 0.0378 Tc 1.0456 Tw (selected special care units in the University of North) Tj ET BT 0.9835 0 0 0.9835 331.44 547.92 Tm 0.0297 Tc 1.9469 Tw (Carolina study, 21 percent were originally con-) Tj 0.4881 -12.2018 TD 0.0263 Tc 2.177 Tw (structed as special care units; 59 percent were) Tj -0.7321 -11.9577 TD 0.045 Tc 0.7983 Tw (remodeled for this purpose; and 21 percent were) Tj ET BT 0.934 0 0 0.9835 331.68 511.92 Tm -0.0468 Tc 2.4504 Tw (created without either original construction or re-) Tj ET BT 0.9835 0 0 0.9835 331.44 499.92 Tm 0.038 Tc 0.881 Tw (modeling \(415\). One-fifth of the 99 nonrandomly) Tj 0.7321 -12.4458 TD 0.0364 Tc 0.9117 Tw (selected special care units studied by White and) Tj ET BT 0.8915 0 0 0.9835 331.68 475.92 Tm 0.0563 Tc 1.6417 Tw (Kwon were created without either original construc-) Tj ET BT 0.9835 0 0 0.9835 331.92 463.92 Tm 0.032 Tc -0.0687 Tw (tion or remodeling \(494\). Of the special care units) Tj ET BT 0.934 0 0 0.9835 332.16 452.16 Tm -0.0203 Tc 1.6512 Tw (identified by the 1991 George Washington Univer-) Tj ET BT 0.9835 0 0 0.9835 332.4 440.16 Tm 0.0235 Tc 0.5065 Tw (sity survey, more than half were created without) Tj -0.244 -12.2018 TD 0.0256 Tc 1.2922 Tw (either original construction or remodeling \(247\).) Tj 0.244 -12.4458 TD 0.0329 Tc 1.6996 Tw (Clearly, these types of units cannot incorporate) Tj ET BT 0.934 0 0 0.9835 332.16 403.92 Tm -0.0301 Tc 0.7623 Tw (physical design features that require either original) Tj 0.5139 -12.2018 TD -0.0439 Tc 1.8905 Tw (construction or remodeling.) Tj ET BT 0.8915 0 0 0.9835 343.44 374.16 Tm 0.0318 Tc 1.2654 Tw (The most frequently used physical design features) Tj ET BT 0.934 0 0 0.9835 332.64 362.4 Tm -0.0196 Tc 0.4085 Tw (in special care units are alarm systems to alert staff) Tj ET BT 0.9835 0 0 0.9835 332.88 350.4 Tm 0.0287 Tc 2.131 Tw (when residents try to leave a unit and locking) Tj ET BT 0.934 0 0 0.9835 333.36 338.64 Tm -0.0279 Tc 0.4602 Tw (systems to stop residents from leaving the unit. The) Tj 0.7709 -11.9577 TD -0.0057 Tc 0.6934 Tw (1990 survey of all nursing homes in 5 northeastern) Tj -0.7709 -12.2018 TD -0.0182 Tc 0.4926 Tw (States found 86 percent of special care units and 78) Tj ET BT 0.9835 0 0 0.9835 332.88 303.12 Tm 0.0198 Tc 1.2859 Tw (percent of cluster units had an alarm system or) Tj ET BT 0.934 0 0 0.9835 333.36 290.88 Tm -0.0249 Tc 1.913 Tw (another method for securing exits \(194\). Likewise,) Tj 0 -12.2018 TD -0.0037 Tc 0.5627 Tw (among Minnesota nursing homes that had a special) Tj ET BT 0.8915 0 0 0.9835 333.36 266.88 Tm 0.0513 Tc 0.5706 Tw (care unit in 1986,73 percent reported the unit had an) Tj ET BT 0.934 0 0 0.9835 333.84 255.12 Tm -0.0223 Tc 0.422 Tw (alarm system, and 41 percent reported the unit was) Tj ET BT 0.9835 0 0 0.9835 333.6 243.12 Tm 0.0394 Tc -0.1373 Tw (locked \(181\).) Tj 11.2256 -18.5467 TD 0.0241 Tc 1.6476 Tw (The 1990 survey of all nursing homes in five) Tj ET BT 0.934 0 0 0.9835 333.6 213.12 Tm -0.025 Tc 2.8467 Tw (northeastern States included questions about two) Tj 0.5139 -12.2018 TD -0.0253 Tc 1.0484 Tw (other physical design features: environmental cues,) Tj ET BT 0.9835 0 0 0.9835 334.32 188.88 Tm 0.0255 Tc 1.0056 Tw (such as color coding of rooms and corridors, and) Tj -0.4881 -11.7137 TD 0.0194 Tc 1.7134 Tw (modifications to the nurses\222 station. The survey) Tj ET BT 0.934 0 0 0.9835 334.08 165.36 Tm -0.0295 Tc 0.7617 Tw (found that 44 percent of the facilities with a special) Tj ET BT 0.9835 0 0 0.9835 334.08 153.12 Tm 0.0195 Tc 0.5105 Tw (care unit were using environmental cues, and 35) Tj ET BT 0.934 0 0 0.9835 333.84 141.36 Tm -0.0238 Tc 1.1715 Tw (percent had modified their nurses\222 station \(194\). Of) Tj ET BT 0.9835 0 0 0.9835 334.32 129.6 Tm 0.0246 Tc 0.5489 Tw (the facilities with a cluster unit, 34 percent were) Tj -0.244 -12.2018 TD 0.0234 Tc 2.6855 Tw (using environmental cues, and 13 percent had) Tj ET BT 0.8915 0 0 0.9835 334.08 106.08 Tm 0.0281 Tc 1.6285 Tw (modified their nurses\222 stations. Thus, although some) Tj ET BT 0.9835 0 0 0.9835 334.32 93.84 Tm 0.0381 Tc 0.7589 Tw (facilities had incorporated each of these physical) Tj ET BT 0.8915 0 0 0.9835 334.56 81.84 Tm 0.0209 Tc 1.6635 Tw (design features, the majority had not.) Tj ET BT 0.934 0 0 0.9835 345.6 63.84 Tm -0.0301 Tc 1.3619 Tw (Findings of descriptive studies based on nonran-) Tj ET BT 0.9835 0 0 0.9835 334.56 52.08 Tm 0.0299 Tc 1.5807 Tw (dom samples of special care units illustrate the) Tj ET BT 0.8915 0 0 0.9835 334.56 40.08 Tm 0.0294 Tc 0.4493 Tw (diversity of the units in their physical design features) Tj ET endstream endobj 258 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 259 0 obj <>stream 0.72 w 1 j 0 0 0 RG 54.72 685.92 m 532.32 685.92 l S BT 0.9443 0 0 0.9812 318 691.2 Tm 0 0 0 rg /F5 11 Tf 0.0175 Tc 0.5763 Tw (Chapter 3-Findings From Descriptive Studies . 93) Tj ET BT 0.934 0 0 0.9835 55.44 651.12 Tm /F4 10 Tf 0.0441 Tc 1.0768 Tw (\(64,199,332,275,485,494\). In their 1985-86 study of) Tj ET BT 0.8915 0 0 0.9835 55.92 639.12 Tm 0.0498 Tc 0.8302 Tw (a nonrandom sample of 22 special care units, Weiner) Tj ET BT 0.934 0 0 0.9835 55.92 627.36 Tm -0.0252 Tc 0.8748 Tw (and Reingold found, for example, that 40 percent of) Tj 0 -12.2018 TD -0.0223 Tc 0.8396 Tw (the units were using orientation aids, such as large) Tj ET BT 0.9835 0 0 0.9835 56.16 603.12 Tm 0.0249 Tc 0.4063 Tw (calendars and daily schedules; by implication, 60) Tj ET BT 0.934 0 0 0.9835 55.68 591.12 Tm -0.0371 Tc 0.7086 Tw (percent were not \(485\). Twenty-seven percent of the) Tj ET BT 0.8915 0 0 0.9835 55.92 579.12 Tm 0.0417 Tc 0.9066 Tw (units had increased the communal space on the unit;) Tj ET BT 0.934 0 0 0.9835 56.4 567.12 Tm -0.0444 Tc 1.5056 Tw (23 percent had color-coded corridors and furniture;) Tj ET BT 0.8915 0 0 0.9835 57.6 555.36 Tm 0.045 Tc 0.9366 Tw (15 percent had an outside garden or walkway; and 4) Tj ET BT 0.9835 0 0 0.9835 56.4 543.36 Tm 0.0268 Tc 1.4444 Tw (percent had small areas for group activities. By) Tj 0.4881 -12.4458 TD 0.0285 Tc 0.4839 Tw (implication, the other units had not incorporated) Tj 0 -11.9577 TD 0.0352 Tc 0.9042 Tw (these design features. Only two of the units had) Tj ET BT 0.934 0 0 0.9835 57.12 507.36 Tm -0.0191 Tc 0.8362 Tw (eliminated their public address system \(485\).) Tj 11.563 -19.0348 TD -0.0318 Tc 1.327 Tw (White and Kwon found similar diversity in their) Tj ET BT 0.9835 0 0 0.9835 57.6 476.88 Tm 0.0354 Tc 0.5684 Tw (survey of a nonrandom sample of 99 special care) Tj -0.244 -12.2018 TD 0.0283 Tc 0.2401 Tw (units in 34 States \(494\). Installation of a security) Tj ET BT 0.934 0 0 0.9835 58.08 453.12 Tm -0.0341 Tc 0.6524 Tw (system and creation of a safe outdoor area were the) Tj -0.5139 -11.9577 TD -0.0398 Tc 1.1581 Tw (physical changes reported by the largest proportion) Tj 0.5139 -12.2018 TD -0.0391 Tc 1.1145 Tw (of the survey respondents. These two changes were) Tj ET BT 0.9835 0 0 0.9835 58.32 417.36 Tm 0.0422 Tc 2.6969 Tw (also reported to be the most successful of the) Tj ET BT 0.934 0 0 0.9835 58.32 405.6 Tm -0.0126 Tc 1.129 Tw (environmental changes made in creating the units.) Tj 0 -12.4458 TD -0.0155 Tc 0.347 Tw (Still, these changes were made by less than half the) Tj ET BT 0.8915 0 0 0.9835 58.32 381.36 Tm 0.0296 Tc 1.3384 Tw (units \(44 percent and 32 percent, respectively\) \(493\).) Tj ET BT 0.934 0 0 0.9835 58.8 369.84 Tm -0.037 Tc 1.0022 Tw (Likewise, although 70 percent of the units reported) Tj -0.257 -12.2018 TD -0.0229 Tc 0.4365 Tw (using personal markers, such as a resident\222s picture) Tj 0.257 -11.9577 TD -0.0425 Tc 1.0081 Tw (near the resident\222s room, smaller proportions of the) Tj 0 -12.2018 TD -0.0257 Tc 1.7105 Tw (units \(12 to 41 percent, depending on the method\)) Tj ET BT 0.9835 0 0 0.9835 58.8 322.32 Tm 0.0299 Tc 1.5807 Tw (reported using any of the environmental cueing) Tj ET BT 0.934 0 0 0.9835 59.04 310.32 Tm -0.0184 Tc 0.7498 Tw (methods listed in the survey questionnaire \(492\).) Tj ET BT 0.9835 0 0 0.9835 70.08 291.36 Tm 0.0294 Tc -0.0574 Tw (White and Kwon included in their survey ques-) Tj ET BT 0.8915 0 0 0.9835 59.76 279.12 Tm 0.0459 Tc 1.5893 Tw (tionnaire a list of 13 environmental features consid-) Tj 0 -12.4458 TD 0.0406 Tc 0.5527 Tw (ered by the researchers to be important for the safety) Tj ET BT 0.934 0 0 0.9835 59.76 255.12 Tm -0.0243 Tc 1.0472 Tw (of special care unit residents \(494\):) Tj ET BT 0.7642 0 0 0.9835 77.28 235.92 Tm 0.0673 Tc 0 Tw (1.) Tj ET BT 0.8104 0 0 0.9795 76.32 222.72 Tm /F7 12 Tf 0.2359 Tc (2.) Tj ET BT 0.7718 0 0 0.9795 76.8 209.28 Tm 0.1627 Tc (3.) Tj ET BT 0.849 0 0 0.9795 76.32 196.32 Tm 0.1627 Tc (4.) Tj ET BT 0.8104 0 0 0.9795 77.04 183.12 Tm 0.2359 Tc (5.) Tj 0 -13.4767 TD 0.2359 Tc (6.) Tj ET BT 0.849 0 0 0.9795 77.04 156.72 Tm 0.1627 Tc (7.) Tj ET BT 0.7718 0 0 0.9795 77.76 143.76 Tm 0.1627 Tc (8.) Tj ET BT 0.8104 0 0 0.9795 77.28 130.08 Tm 0.2359 Tc (9.) Tj ET BT 0.8491 0 0 0.9835 73.44 105.6 Tm /F4 10 Tf 0.0748 Tc (10.) Tj ET BT 0.8066 0 0 0.9835 73.68 80.4 Tm 0.2235 Tc (11.) Tj ET BT 0.8491 0 0 0.9835 73.68 67.44 Tm 0.0748 Tc (12.) Tj ET BT 0.8066 0 0 0.9835 73.92 42.48 Tm 0.2235 Tc (13.) Tj ET BT 0.934 0 0 0.9835 90.24 235.92 Tm -0.0362 Tc 1.3684 Tw (housekeeping chemicals are secured,) Tj ET BT 0.8915 0 0 0.9835 90.24 222.48 Tm 0.0351 Tc 1.486 Tw (breakable items are kept from residents,) Tj ET BT 0.934 0 0 0.9835 90.48 209.04 Tm -0.0258 Tc 0.7148 Tw (clutter is minimized,) Tj ET BT 0.8915 0 0 0.9835 90.24 196.08 Tm 0.0519 Tc 2.185 Tw (housekeeping carts are secured,) Tj ET BT 0.934 0 0 0.9835 90.48 182.88 Tm -0.0309 Tc 1.1058 Tw (patients smoke only with supervision,) Tj ET BT 0.8915 0 0 0.9835 90.96 169.68 Tm 0.0447 Tc 1.283 Tw (outdoor exits can be opened but have alarms,) Tj -0.2692 -13.1779 TD 0.0268 Tc 1.926 Tw (patients smoke only in designated areas,) Tj ET BT 0.934 0 0 0.9835 91.2 143.52 Tm -0.0191 Tc 0.8362 Tw (exits have automatic fire unlocks,) Tj ET BT 0.8915 0 0 0.9835 91.44 130.32 Tm 0.0516 Tc 0.7753 Tw (stairs and elevators have alarms or are other-) Tj ET BT 0.934 0 0 0.9835 90.96 118.56 Tm -0.0553 Tc 2.1597 Tw (wise secured,) Tj ET BT 0.8915 0 0 0.9835 91.44 105.36 Tm 0.0591 Tc 1.1002 Tw (wide-angle mirrors or video cameras are used) Tj 0 -11.9577 TD 0.0243 Tc 2.4403 Tw (to monitor residents,) Tj 0.5384 -13.422 TD 0.0358 Tc 1.7545 Tw (interior exits are disguised,) Tj -0.5384 -13.1779 TD 0.0315 Tc 1.4003 Tw (patients wear sensors that activate an alarm,) Tj ET BT 0.8491 0 0 0.9835 91.92 55.44 Tm 0.2231 Tc 0 Tw (and) Tj ET BT 0.934 0 0 0.9835 91.92 42.72 Tm -0.0294 Tc 0.8105 Tw (half doors or clutch doors are used \(493\).) Tj 240.7674 619.6065 TD -0.049 Tc 0.8315 Tw (The proportion of special care units that reported) Tj ET BT 0.9835 0 0 0.9835 306 640.08 Tm 0.0341 Tc 0.426 Tw (having these features ranged from 96 percent for) Tj ET BT 0.9812 0 0 0.9812 306.48 628.32 Tm /F5 11 Tf 0.0726 Tc 0.293 Tw (housekeeping chemicals are secured ) Tj ET BT 0.9835 0 0 0.9835 471.6 628.32 Tm /F4 10 Tf 0.0672 Tc -0.1655 Tw (to ) Tj ET BT 0.9795 0 0 0.9795 483.12 628.32 Tm /F7 12 Tf 0.123 Tc -0.1866 Tw (18 ) Tj ET BT 0.9835 0 0 0.9835 498 628.32 Tm /F4 10 Tf 0.0368 Tc 0 Tw (percent) Tj ET BT 0.934 0 0 0.9835 306.48 616.08 Tm -0.0623 Tc 0.1115 Tw (for ) Tj ET BT 0.9443 0 0 0.9812 321.6 616.08 Tm /F5 11 Tf 0.0428 Tc 0.8702 Tw (half doors or clutch doors are used ) Tj ET BT 0.934 0 0 0.9835 479.04 616.08 Tm /F4 10 Tf 0.0551 Tc 0 Tw (\(493\).) Tj ET BT 0.9835 0 0 0.9835 317.52 597.84 Tm 0.0344 Tc 0.2164 Tw (For their study of 31 randomly selected special) Tj -10.9816 -12.4458 TD 0.0263 Tc 1.0149 Tw (care units and 32 matched nonspecialized units,) Tj ET BT 0.8915 0 0 0.9835 307.2 573.6 Tm 0.0397 Tc 0.8527 Tw (Sloane et al. used a list of 12 environmental features) Tj ET BT 0.9835 0 0 0.9835 307.2 561.84 Tm 0.0274 Tc 0.7117 Tw (they considered important in the care of nursing) Tj ET BT 0.8915 0 0 0.9835 307.2 549.84 Tm 0.0263 Tc 2.0343 Tw (home residents with dementia:) Tj ET BT 0.7642 0 0 0.9835 324.96 531.84 Tm 0.0673 Tc 0 Tw (1.) Tj ET BT 0.8607 0 0 0.9812 324 520.08 Tm /F6 11 Tf 0.1944 Tc (2.) Tj 0.5577 -12.2296 TD 0.0549 Tc (3.) Tj ET BT 0.9017 0 0 0.9812 324 484.8 Tm 0.1313 Tc (4.) Tj ET BT 0.8607 0 0 0.9812 324.72 460.56 Tm 0.1944 Tc (5.) Tj ET BT 0.9017 0 0 0.9812 324.72 449.04 Tm 0.1313 Tc (6.) Tj ET BT 0.8607 0 0 0.9812 324.96 425.04 Tm 0.1944 Tc (7.) Tj ET BT 0.8197 0 0 0.9812 325.68 400.8 Tm 0.1174 Tc (8.) Tj ET BT 0.9427 0 0 0.9812 325.44 377.04 Tm 0.0737 Tc (9.) Tj ET BT 0.8491 0 0 0.9835 321.36 353.28 Tm /F4 10 Tf 0.0748 Tc (10.) Tj ET BT 0.8066 0 0 0.9835 321.6 341.52 Tm 0.2235 Tc (11.) Tj 0.2975 -24.4036 TD 0.0252 Tc (12.) Tj ET BT 0.934 0 0 0.9835 337.68 531.84 Tm -0.0381 Tc 1.6274 Tw (absence of shiny or slippery floors,) Tj 0 -11.9577 TD -0.029 Tc 1.4249 Tw (absence of loud, distracting noise,) Tj ET BT 0.9835 0 0 0.9835 337.92 508.08 Tm 0.0297 Tc 4.3141 Tw (absence of odors coming from cleaning) Tj ET BT 0.8915 0 0 0.9835 337.92 496.32 Tm 0.0209 Tc 0 Tw (solutions,) Tj ET BT 0.9835 0 0 0.9835 338.16 484.56 Tm 0.0379 Tc 0.2304 Tw (absence of odors coming from bodily excre-) Tj ET BT 0.8915 0 0 0.9835 337.68 472.56 Tm -0.0003 Tc 0 Tw (tions,) Tj ET BT 0.934 0 0 0.9835 338.64 460.56 Tm -0.0317 Tc 1.3636 Tw (absence of glare from the floors,) Tj ET BT 0.9835 0 0 0.9835 338.16 448.8 Tm 0.0358 Tc 3.2341 Tw (presence of personal items in residents\222) Tj ET BT 0.934 0 0 0.9835 337.92 437.04 Tm 0.184 Tc 0 Tw (rooms,) Tj ET BT 0.9835 0 0 0.9835 338.4 425.04 Tm 0.0277 Tc -0.0765 Tw (presence of home-like furnishings in public) Tj ET BT 0.8491 0 0 0.9835 338.88 413.04 Tm 0.0464 Tc 0 Tw (areas,) Tj ET BT 0.9835 0 0 0.9835 338.64 401.04 Tm 0.0418 Tc 1.8533 Tw (presence of an outdoor area or courtyard) Tj ET BT 0.934 0 0 0.9835 338.88 389.04 Tm -0.0433 Tc 1.2475 Tw (accessible to residents,) Tj 0.5139 -12.2018 TD -0.032 Tc 1.7921 Tw (availability of separate rooms or alcoves for) Tj 0 -11.9577 TD -0.0125 Tc 0.6364 Tw (small group and family interactions,) Tj 0.5139 -12.2018 TD -0.0243 Tc 0.7133 Tw (availability of a kitchen for resident use,) Tj 0 -12.2018 TD -0.0284 Tc 0.8094 Tw (absence of routine television use in the main) Tj -0.7709 -11.9577 TD -0.0055 Tc 0.4362 Tw (public area, and) Tj 0.7709 -12.2018 TD -0.0157 Tc 1.475 Tw (overall adequacy of the lighting level \(413\).) Tj ET BT 0.8915 0 0 0.9835 320.64 299.76 Tm 0.0361 Tc 1.3311 Tw (The study findings show there were no significant) Tj ET BT 0.934 0 0 0.9835 310.08 287.76 Tm -0.0373 Tc 1.7978 Tw (differences between special care units and nonspe-) Tj ET BT 0.9835 0 0 0.9835 310.32 275.52 Tm 0.0327 Tc 2.5191 Tw (cialized nursing home units for seven of these) Tj ET BT 0.8915 0 0 0.9835 310.32 263.76 Tm 0.0395 Tc 1.1735 Tw (environmental features, but five of the features were) Tj ET BT 0.934 0 0 0.9835 311.04 251.76 Tm -0.0365 Tc 1.5293 Tw (statistically more likely to be found in special care) Tj -0.7709 -12.4458 TD -0.0101 Tc 0.9733 Tw (units than in nonspecialized units \(413\). These five) Tj ET BT 0.9835 0 0 0.9835 310.56 227.52 Tm 0.0365 Tc -0.0732 Tw (features are the amount of personal items seen in) Tj ET BT 0.934 0 0 0.9835 310.56 215.52 Tm -0.0241 Tc 1.6552 Tw (residents\222 rooms, the amount of home-like furnish-) Tj 0.5139 -12.4458 TD -0.0209 Tc 1.095 Tw (ings in public areas, the existence of areas suitable) Tj ET BT 0.9835 0 0 0.9835 311.04 191.52 Tm 0.0264 Tc 1.4448 Tw (for small group interaction, the availability of a) Tj 0 -11.9577 TD 0.0305 Tc 1.1966 Tw (kitchen for residents\222 use, and the probability of) Tj ET BT 0.934 0 0 0.9835 311.04 167.76 Tm -0.0227 Tc 1.3218 Tw (having a television off in public areas. New special) Tj ET BT 0.8915 0 0 0.9835 311.76 155.76 Tm 0.0461 Tc 1.0507 Tw (care units and units originally constructed as special) Tj ET BT 0.934 0 0 0.9835 311.76 143.76 Tm -0.0416 Tc 1.2778 Tw (care units were more likely than other special care) Tj ET BT 0.8915 0 0 0.9835 311.52 132 Tm 0.0377 Tc 1.3754 Tw (units to incorporate the 12 features.) Tj ET BT 0.9835 0 0 0.9835 322.8 114.24 Tm 0.0558 Tc 0.2529 Tw (Some people who are knowledgeable about the) Tj ET BT 0.8915 0 0 0.9835 311.76 102.48 Tm 0.0391 Tc 1.3662 Tw (care of nursing home residents with dementia might) Tj ET BT 0.9835 0 0 0.9835 312.24 90.48 Tm 0.035 Tc 1.4779 Tw (question the specific environmental features se-) Tj ET BT 0.8915 0 0 0.9835 312.48 78.96 Tm 0.0288 Tc 0.207 Tw (lected for analysis in these two studies and argue that) Tj 0 -12.4458 TD 0.052 Tc 1.1081 Tw (other environmental features are more important for) Tj -0.2692 -11.9577 TD 0.0354 Tc 1.4473 Tw (residents\222 safety and care. Other people might argue) Tj ET BT 0.934 0 0 0.9835 312.48 42.96 Tm -0.0233 Tc 0.4874 Tw (many of the environmental features on the two lists) Tj ET endstream endobj 260 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 261 0 obj <>stream 0.72 w 1 j 0 0 0 RG 76.32 688.08 m 554.4 688.08 l S BT 0.9835 0 0 0.9835 76.32 694.56 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (94 ) Tj ET BT 0.9598 0 0 0.9598 90 694.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.24 694.56 Tm /F4 10 Tf 0.0455 Tc -0.1434 Tw (Special ) Tj 36.3613 0 TD /F5 10 Tf 0.0088 Tc -0.0394 Tw (Care Units fire- People With Alzheimer\222s and Other Dementias) Tj -56.1282 -40.0218 TD /F4 10 Tf 0.0386 Tc 2.9445 Tw (are important for the safety and care of both) Tj ET BT 0.8915 0 0 0.9835 76.8 643.2 Tm 0.0336 Tc 1.9184 Tw (demented and nondemented nursing home residents) Tj ET BT 0.9835 0 0 0.9835 76.8 631.68 Tm 0.0265 Tc 0.147 Tw (and thus are not specific for special care units. In) Tj 0 -12.2018 TD 0.0299 Tc 0.751 Tw (fact, researchers who have conducted descriptive) Tj ET BT 0.934 0 0 0.9835 77.04 607.68 Tm -0.0317 Tc 0.5606 Tw (studies of special care units have commented on the) Tj ET BT 0.9835 0 0 0.9835 77.04 595.92 Tm 0.0387 Tc 2.9546 Tw (differences of opinion among special care unit) Tj ET BT 0.934 0 0 0.9835 77.04 583.68 Tm -0.0268 Tc 2.3861 Tw (operators about which environmental features are) Tj ET BT 0.8915 0 0 0.9835 77.04 572.16 Tm 0.0272 Tc 1.293 Tw (important for the safety and care of individuals with) Tj ET BT 0.934 0 0 0.9835 77.04 560.4 Tm 0.0346 Tc 3.0913 Tw (dementia \(199,275,332\).) Tj 12.3339 -18.5467 TD -0.034 Tc 0.9806 Tw (It is clear from the preceding discussion that use) Tj -11.82 -12.2018 TD -0.0323 Tc 1.3642 Tw (of specific physical design and other environmental) Tj ET BT 0.8915 0 0 0.9835 77.76 518.16 Tm 0.0371 Tc 0.3173 Tw (features varies in existing special care units. It is also) Tj ET BT 0.9835 0 0 0.9835 77.76 506.64 Tm 0.0323 Tc -0.0893 Tw (clear that despite the emphasis on environmental) Tj ET BT 0.934 0 0 0.9835 77.76 494.64 Tm -0.0334 Tc 0.723 Tw (features in the special care unit literature, even the) Tj 0 -12.2018 TD -0.0267 Tc 1.1012 Tw (most widely used of the features-alarm and locking) Tj 0.7709 -12.2018 TD -0.0282 Tc 2.302 Tw (systems\227are present in only three-quarters of all) Tj -0.7709 -12.2018 TD -0.0091 Tc 0.8255 Tw (units, and many of the environmental features said) Tj ET BT 0.8915 0 0 0.9835 78.24 446.88 Tm 0.0517 Tc 0.6598 Tw (to be important in the special care unit literature are) Tj ET BT 0.9835 0 0 0.9835 78 434.88 Tm 0.0354 Tc 0.843 Tw (being used in only a small proportion of existing) Tj ET BT 0.934 0 0 0.9835 78.72 423.12 Tm -0.0418 Tc 0.6769 Tw (special care units. According to the researchers who) Tj ET BT 0.8915 0 0 0.9835 78.48 411.12 Tm 0.0418 Tc 0.9017 Tw (studied Minnesota nursing homes with a special care) Tj 0 -12.2018 TD 0.0399 Tc 0.8526 Tw (unit in 1986, the nursing homes seemed to have paid) Tj ET BT 0.9835 0 0 0.9835 78.48 387.12 Tm 0.0314 Tc 1.8639 Tw (very little attention to environmental or design) Tj ET BT 0.934 0 0 0.9835 78.72 375.12 Tm -0.0182 Tc 1.0922 Tw (considerations for the units \(181\).) Tj ET BT 0.9795 0 0 0.9795 113.04 344.64 Tm /F7 12 Tf 0.0372 Tc 0.8811 Tw (Staff Composition and Training) Tj ET BT 0.9261 0 0 0.9795 90 327.12 Tm 0.0319 Tc 0.074 Tw (The ) Tj ET BT 0.934 0 0 0.9835 111.36 327.12 Tm /F4 10 Tf -0.0346 Tc 1.8292 Tw (literature on specialized nursing home care) Tj -34.1751 -12.2018 TD -0.0439 Tc 2.2209 Tw (for people with dementia emphasizes the need for) Tj ET BT 0.8915 0 0 0.9835 79.68 303.12 Tm 0.0417 Tc 1.5235 Tw (staff members who are knowledgeable about demen-) Tj -0.2692 -11.9577 TD 0.0359 Tc 1.3842 Tw (tia and skilled in caring for individuals with demen-) Tj ET BT 0.934 0 0 0.9835 79.68 279.36 Tm -0.0174 Tc 0.4631 Tw (tia. In fact, one of the frequently cited arguments in) Tj 0 -11.9577 TD -0.0159 Tc 1.3467 Tw (favor of establishing special care units is that staff) Tj -0.257 -12.2018 TD -0.0304 Tc 2.1331 Tw (members with the necessary knowledge and skills) Tj ET BT 0.9835 0 0 0.9835 79.92 243.36 Tm 0.0378 Tc 1.7557 Tw (can be more easily assembled and trained on a) Tj ET BT 0.934 0 0 0.9835 80.16 231.36 Tm -0.0203 Tc 1.6083 Tw (special care unit than on a nonspecialized nursing) Tj ET BT 0.9835 0 0 0.9835 79.92 219.36 Tm 0.026 Tc 0.8525 Tw (home unit \(263,270,354\). In theory at least, staff) Tj 0 -12.2018 TD 0.0313 Tc 1.5487 Tw (members for a special care unit can be selected) Tj 0.7321 -12.2018 TD 0.0413 Tc 1.8131 Tw (specifically to meet the needs of residents with) Tj -0.244 -11.7137 TD 0.0195 Tc 1.8353 Tw (dementia; formal and informal trainin) Tj 185.7111 -0.7321 TD 0.0258 Tc 3.5371 Tw (g can be) Tj -185.4671 -11.2256 TD 0.0342 Tc -0.132 Tw (focused on these residents\222 needs, rather than the) Tj -0.244 -12.2018 TD 0.0539 Tc -0.1112 Tw (more heterogeneous needs of residents of nonspe-) Tj 0.244 -11.9577 TD 0.0276 Tc 3.5353 Tw (cialized units; and training about the care of) Tj -0.244 -11.9577 TD 0.0383 Tc 1.8859 Tw (residents with dementia can be targeted to the) Tj ET BT 0.934 0 0 0.9835 81.36 124.56 Tm -0.0161 Tc 0.5118 Tw (special care unit staff members.) Tj 11.306 -17.8146 TD -0.0212 Tc 1.2422 Tw (Little information is available about the types of) Tj ET BT 0.9835 0 0 0.9835 81.36 95.04 Tm 0.0205 Tc 0.2655 Tw (staff on existing special care units. Some nursing) Tj ET BT 0.934 0 0 0.9835 80.88 83.28 Tm -0.0311 Tc 0.9775 Tw (homes with a special care unit report having added) Tj ET BT 0.9835 0 0 0.9835 81.6 71.28 Tm 0.0324 Tc 0.114 Tw (staff, changed the composition of the staff, and/or) Tj ET BT 0.8915 0 0 0.9835 81.36 59.52 Tm 0.0244 Tc 0.8058 Tw (changed staffing patterns when the unit was created.) Tj 0 -11.9577 TD 0.0517 Tc 0.7197 Tw (The 1990 survey of all nursing homes in 5 northeast-) Tj ET BT 0.934 0 0 0.9835 327.6 654.72 Tm -0.0277 Tc 1.445 Tw (ern States found 69 percent of the facilities with a) Tj 0.5139 -12.2018 TD -0.0398 Tc 2.2716 Tw (special care unit reported providing extra nursing) Tj 0 -11.7137 TD -0.0347 Tc 0.596 Tw (staff for the unit, and 45 percent reported providing) Tj 0 -12.2018 TD -0.0237 Tc 1.0981 Tw (additional staff of other, unspecified types \(194\). Of) Tj ET BT 0.8915 0 0 0.9835 328.08 607.2 Tm 0.038 Tc 1.281 Tw (the facilities with a cluster unit, 40 percent reported) Tj ET BT 0.9835 0 0 0.9835 327.6 595.68 Tm 0.0252 Tc 0.5178 Tw (providing extra nursing staff for the unit, and 30) Tj ET BT 0.934 0 0 0.9835 327.84 583.44 Tm -0.0474 Tc 1.1663 Tw (percent reported providing additional staff of other,) Tj ET BT 0.9835 0 0 0.9835 328.32 571.44 Tm 0.0294 Tc 0.5563 Tw (unspecified types. Among the Minnesota nursing) Tj ET BT 0.934 0 0 0.9835 328.08 559.92 Tm -0.0135 Tc 1.3441 Tw (homes with a special care unit in 1986, 59 percent) Tj ET BT 0.8915 0 0 0.9835 328.32 547.68 Tm 0.0176 Tc 0.4625 Tw (reported the staffing pattern on the unit was different) Tj ET BT 0.9835 0 0 0.9835 328.8 535.44 Tm 0.0353 Tc -0.1331 Tw (than the staffing patterns on their nonspecialized) Tj ET BT 0.8915 0 0 0.9835 328.56 523.92 Tm 0.0341 Tc 0.7095 Tw (units \(18 1\), but the differences were not described in) Tj 0.2692 -12.4458 TD 0.0047 Tc 1.1164 Tw (the study report.) Tj 12.3829 -18.5467 TD 0.0305 Tc 1.7604 Tw (Several descriptive studies of nonrandom samples) Tj ET BT 0.9835 0 0 0.9835 329.04 481.44 Tm 0.0412 Tc 2.9289 Tw (of special care units have noted the following) Tj ET BT 0.8915 0 0 0.9835 329.28 469.2 Tm 0.0376 Tc 1.4832 Tw (staffing changes that have been implemented in one) Tj ET BT 0.934 0 0 0.9835 329.28 457.68 Tm -0.0398 Tc 0.6014 Tw (or more of the units studied:) Tj ET BT 0.8632 0 0 0.9598 340.56 440.4 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0 -13.2522 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 340.8 391.2 Tm -0.0556 Tc (l) Tj 0.2607 -13.2522 TD -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 341.28 353.76 Tm -0.0185 Tc (l) Tj 0.278 -25.5042 TD -0.0185 Tc (l) Tj ET BT 0.8915 0 0 0.9835 350.64 438.96 Tm /F4 10 Tf 0.0318 Tc 0.9851 Tw (nurses and aides are not rotated to other units;) Tj ET BT 0.9835 0 0 0.9835 351.12 426.48 Tm 0.0433 Tc 1.567 Tw (aides are assigned fewer patients but have) Tj -0.244 -11.9577 TD 0.0392 Tc 1.856 Tw (responsibility for more aspects of their pa-) Tj ET BT 0.8915 0 0 0.9835 351.36 402.24 Tm 0.0379 Tc 2.2905 Tw (tients\222 care;) Tj ET BT 0.934 0 0 0.9835 351.36 389.76 Tm -0.026 Tc 1.1005 Tw (aides conduct activity programs;) Tj 0 -12.9339 TD -0.0497 Tc 1.8968 Tw (social workers\222 and recreation workers\222 offices) Tj ET BT 0.8915 0 0 0.9835 352.08 365.04 Tm 0.0461 Tc 1.1372 Tw (are located on the unit;) Tj ET BT 0.934 0 0 0.9835 351.36 352.56 Tm -0.0258 Tc 1.657 Tw (part-time assistants are hired for the evening) Tj ET BT 0.8915 0 0 0.9835 352.32 340.32 Tm 0.0056 Tc 1.4855 Tw (shift to feed patients and help out at bedtime;) Tj ET BT 0.9835 0 0 0.9835 351.84 327.84 Tm 0.0306 Tc 1.8647 Tw (a \221\221clinical coordinator\222 is designated to de-) Tj ET BT 0.8915 0 0 0.9835 352.08 316.08 Tm 0.0219 Tc 1.9046 Tw (velop new programs, educate staff, and market) Tj ET BT 0.934 0 0 0.9835 352.32 304.08 Tm 0.0428 Tc 1.0268 Tw (the units \(64,275,332,485\).) Tj ET BT 0.9835 0 0 0.9835 330.72 285.6 Tm 0.0327 Tc 1.5778 Tw (OTA is not aware of any information about the) Tj -0.4881 -11.9577 TD 0.0332 Tc -0.0612 Tw (proportion of existing special care units that have) Tj ET BT 0.934 0 0 0.9835 330.72 261.84 Tm -0.014 Tc 0.8307 Tw (implemented any of these staffing changes.) Tj 11.82 -19.0348 TD -0.0147 Tc 2.0306 Tw (Most\227but not all-nursing homes with a special) Tj -11.563 -11.9577 TD -0.0407 Tc 1.7036 Tw (care unit provide some type of specialized training) Tj 0.257 -12.2018 TD -0.0261 Tc 0.5224 Tw (for the unit staff. According to the National Medical) Tj ET BT 0.9835 0 0 0.9835 331.2 207.12 Tm 0.0278 Tc -0.1255 Tw (Expenditure Survey, 74 percent of nursing homes) Tj ET BT 0.8915 0 0 0.9835 331.2 195.36 Tm 0.0526 Tc 1.1075 Tw (that reported having a special care unit in 1987 also) Tj ET BT 0.934 0 0 0.9835 331.2 183.84 Tm -0.0371 Tc 0.7453 Tw (reported providing special training for the unit staff) Tj ET BT 0.9835 0 0 0.9835 331.92 171.84 Tm 0.0266 Tc 2.1128 Tw (\(248\). Nonprofit and public nursing homes and) Tj -0.244 -11.7137 TD 0.0208 Tc 0.9624 Tw (larger nursing homes were more likely than for-) Tj ET BT 0.934 0 0 0.9835 331.44 148.08 Tm -0.0184 Tc 0.9088 Tw (profit nursing homes and smaller nursing homes to) Tj 0 -11.7137 TD -0.037 Tc 1.0266 Tw (report providing such trainin) Tj ET BT 0.9835 0 0 0.9835 459.84 136.32 Tm 0.0226 Tc 0.49 Tw (g. The 1990 survey of) Tj ET BT 0.8915 0 0 0.9835 331.92 124.8 Tm 0.0415 Tc 1.3106 Tw (all nursing homes in 5 northeastern States found 70) Tj ET BT 0.934 0 0 0.9835 331.68 112.8 Tm -0.0357 Tc 0.911 Tw (percent of the facilities with a special care unit and) Tj ET BT 0.9835 0 0 0.9835 332.16 101.04 Tm 0.0286 Tc 2.5887 Tw (53 percent of the facilities with a cluster unit) Tj ET BT 0.934 0 0 0.9835 331.92 89.28 Tm -0.0371 Tc 0.7453 Tw (reported providing special training for the unit staff) Tj 0.7709 -11.9577 TD 0.0551 Tc 0 Tw (\(194\).) Tj ET BT 0.8915 0 0 0.9835 343.44 58.8 Tm 0.0298 Tc 0.9537 Tw (Given the emphasis on the need for staff members) Tj ET BT 0.934 0 0 0.9835 332.4 46.8 Tm -0.0315 Tc 1.2348 Tw (who are knowledgeable about dementia and skilled) Tj ET endstream endobj 262 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 263 0 obj <>stream 0.72 w 1 j 0 0 0 RG 63.84 686.4 m 542.16 686.4 l S BT 0.9835 0 0 0.9835 327.6 691.68 Tm 0 0 0 rg /F5 10 Tf 0.0217 Tc 2.2759 Tw (Chapter 3-Findings From Descriptive Studies \215 95) Tj ET BT 0.934 0 0 0.9835 64.56 653.04 Tm /F4 10 Tf -0.0321 Tc 0.8134 Tw (in caring for individuals with dementia, the propor-) Tj ET BT 0.9835 0 0 0.9835 64.32 640.8 Tm 0.0289 Tc 0.8802 Tw (tions of nursing homes in these two studies that) Tj ET BT 0.8915 0 0 0.9835 64.08 629.04 Tm 0.0403 Tc 1.3792 Tw (reported they do not provide any special training for) Tj ET BT 0.9835 0 0 0.9835 64.56 616.56 Tm 0.024 Tc -0.0911 Tw (the staff of their special care units are surprising.) Tj ET BT 0.8491 0 0 0.9835 64.8 604.56 Tm 0.0354 Tc 1.9818 Tw (Data from the National Medical Expenditure Survey\227) Tj ET BT 0.9835 0 0 0.9835 64.8 592.32 Tm 0.0386 Tc 0.5609 Tw (a survey of a nationally representative sample of) Tj ET BT 0.934 0 0 0.9835 64.8 580.32 Tm -0.02 Tc 1.5223 Tw (nursing homes\227indicate 26 percent of the nursing) Tj ET BT 0.9835 0 0 0.9835 64.8 568.32 Tm 0.0281 Tc 0.2404 Tw (homes that reported having a special care unit in) Tj ET BT 0.8915 0 0 0.9835 66.24 556.56 Tm 0.0448 Tc 0.8471 Tw (1987 did not provide any special trainin) Tj 191.9356 -0.244 TD 0.03 Tc 0.056 Tw (g for the unit) Tj ET BT 0.934 0 0 0.9835 65.52 544.32 Tm -0.0004 Tc 0.5913 Tw (staff \(248\). Likewise, the 1990 survey of all nursing) Tj ET BT 0.8915 0 0 0.9835 65.04 532.56 Tm 0.0321 Tc 0.6818 Tw (homes in 5 northeastern States found that 30 percent) Tj 0.5384 -12.2018 TD 0.0484 Tc 0.8789 Tw (of the nursing homes with a special care unit and 47) Tj ET BT 0.9835 0 0 0.9835 65.28 508.32 Tm 0.0199 Tc 0.8893 Tw (percent of the nursing homes with a cluster unit) Tj ET BT 0.8915 0 0 0.9835 65.28 496.8 Tm 0.0349 Tc 1.262 Tw (reported they did not provide special trainin) Tj 214.5479 -0.244 TD 0.0314 Tc 0.6826 Tw (g for the) Tj ET BT 0.9835 0 0 0.9835 65.76 484.8 Tm 0.0244 Tc 2.8472 Tw (unit staff \(194\). These figures are particularly) Tj ET BT 0.8915 0 0 0.9835 66.24 472.8 Tm 0.0353 Tc 1.3175 Tw (surprising since they are based on self-report, and it) Tj ET BT 0.9835 0 0 0.9835 66.24 461.04 Tm 0.024 Tc 0.4072 Tw (is unlikely nursing homes would underreport the) Tj ET BT 0.934 0 0 0.9835 66 449.28 Tm -0.0287 Tc 1.0006 Tw (provision of training for their staff.) Tj ET BT 0.9795 0 0 0.9795 120.96 428.16 Tm /F7 12 Tf 0.0432 Tc 1.1201 Tw (Staff-to-Resident Ratios) Tj ET BT 0.9835 0 0 0.9835 77.52 410.4 Tm /F4 10 Tf 0.0301 Tc 0.0553 Tw (As noted earlier, the 1990 survey of all nursing) Tj ET BT 0.8915 0 0 0.9835 66.72 398.64 Tm 0.0321 Tc 0.6145 Tw (homes in 5 northeastern States found that 69 percent) Tj ET BT 0.9835 0 0 0.9835 66.96 386.64 Tm 0.0335 Tc 1.7397 Tw (of the facilities with a special care unit and 40) Tj ET BT 0.934 0 0 0.9835 66.72 374.64 Tm -0.0478 Tc 1.1881 Tw (percent of the facilities with a cluster unit reported) Tj ET BT 0.9835 0 0 0.9835 66.96 362.88 Tm 0.0268 Tc 1.5838 Tw (providing extra nursing staff for the unit \(194\).) Tj ET BT 0.934 0 0 0.9835 67.44 351.12 Tm -0.0385 Tc 1.4672 Tw (Likewise, 45 percent of the facilities with a special) Tj ET BT 0.9835 0 0 0.9835 67.44 339.12 Tm 0.033 Tc 1.4149 Tw (care unit and 30 percent of the facilities with a) Tj 0.244 -12.2018 TD 0.0408 Tc 0.3495 Tw (cluster unit reported providing additional staff of) Tj 0 -11.9577 TD 0.0368 Tc 2.8427 Tw (other, unspecified types. Descriptive studies of) Tj ET BT 0.934 0 0 0.9835 67.68 303.12 Tm -0.0207 Tc 1.4252 Tw (nonrandom samples of special care units have also) Tj 0 -12.2018 TD -0 Tc 1.137 Tw (found that some of the units added staff \(275,332\);) Tj 0 -11.9577 TD -0.0343 Tc 2.3299 Tw (nevertheless, staff-to-resident ratios varied greatly) Tj 0.257 -12.4458 TD -0.0261 Tc 0.651 Tw (from one unit to another.) Tj ET BT 0.9835 0 0 0.9835 79.2 249.36 Tm 0.0251 Tc 1.3416 Tw (The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 67.92 237.12 Tm 0.0451 Tc 1.2056 Tw (randomly selected special care units and 32 matched) Tj ET BT 0.9835 0 0 0.9835 68.4 225.36 Tm 0.0348 Tc 0.7216 Tw (nonspecialized units found the special care units) Tj ET BT 0.8915 0 0 0.9835 68.64 213.12 Tm 0.0429 Tc 0.5688 Tw (were staffed at a higher level than the nonspecialized) Tj ET BT 0.934 0 0 0.9835 68.4 201.12 Tm -0.0139 Tc 1.0019 Tw (units \(291\). This difference was statistically signifi-) Tj 0.5139 -11.9577 TD -0.0256 Tc 1.7608 Tw (cant for nurses, social workers, and activities staff) Tj ET BT 0.9835 0 0 0.9835 69.12 177.12 Tm 0.0291 Tc 0.8982 Tw (and approached statistical significance for nurse) Tj 0 -12.4458 TD 0.0368 Tc 0.9462 Tw (aides. After adjusting for the relative severity of) Tj 0 -11.7137 TD 0.0405 Tc 0.892 Tw (illness of residents of the two types of units, the) Tj -0.244 -12.4458 TD 0.0262 Tc 0.6083 Tw (researchers concluded that the special care units) Tj ET BT 0.8915 0 0 0.9835 69.12 129.36 Tm 0.0514 Tc 1.3524 Tw (provided about one-third more hours of nursing care) Tj 0.2692 -12.2018 TD 0.0316 Tc 1.8938 Tw (per resident than the nonspecialized units \(415\).) Tj ET BT 0.9795 0 0 0.9795 130.08 96.72 Tm /F7 12 Tf 0.022 Tc 0.8966 Tw (Staff Support Groups) Tj ET BT 0.9835 0 0 0.9835 80.64 79.2 Tm /F4 10 Tf 0.0197 Tc 0.4116 Tw (Working with nursing home residents with de-) Tj ET BT 0.934 0 0 0.9835 69.84 66.96 Tm -0.0264 Tc 0.6128 Tw (mentia is often said to be very stressful for the staff) Tj 0.5139 -11.7137 TD 0.0295 Tc 2.7756 Tw (\(48,107,167,191,263,346,352\). To address the per-) Tj ET BT 0.9835 0 0 0.9835 70.08 43.2 Tm 0.0363 Tc 1.2255 Tw (ceived problem of staff stress, some special care) Tj 249.4044 619.8505 TD 0.0374 Tc 1.6646 Tw (units provide a support group for the unit staff) Tj ET BT 0.934 0 0 0.9835 315.36 640.8 Tm -0.001 Tc 1.1701 Tw (members. The 1990 survey of all nursing homes in) Tj 0 -12.2018 TD -0.0186 Tc 1.446 Tw (5 northeastern States found that 44 percent of the) Tj ET BT 0.9835 0 0 0.9835 315.36 616.8 Tm 0.0207 Tc 2.0171 Tw (nursing homes with a special care unit and 18) Tj 0 -12.6899 TD 0.0199 Tc 0.8588 Tw (percent of the nursing homes with a cluster unit) Tj 0 -11.9577 TD 0.0328 Tc 1.9264 Tw (reported having such a support group \(194\). In) Tj ET BT 0.934 0 0 0.9835 316.08 580.08 Tm -0.0202 Tc 1.3512 Tw (contrast, only one of the Minnesota nursing homes) Tj ET BT 0.9835 0 0 0.9835 316.08 568.08 Tm 0.0306 Tc -0.1012 Tw (with a special care unit in 1986 reported having a) Tj 0.4881 -12.2018 TD 0.0382 Tc 1.7814 Tw (support group for the unit staff; two additional) Tj ET BT 0.934 0 0 0.9835 316.32 544.32 Tm -0.0397 Tc 0.9096 Tw (facilities reported having stress reduction programs) Tj 0.257 -12.2018 TD -0.0131 Tc 0.7441 Tw (for the special care unit staff \(181\).) Tj ET BT 0.9795 0 0 0.9795 385.2 508.8 Tm /F7 12 Tf 0.0589 Tc 0.3689 Tw (Activity Programs) Tj ET BT 0.9261 0 0 0.9795 327.84 490.56 Tm 0.0196 Tc 0.0873 Tw (One ) Tj ET BT 0.934 0 0 0.9835 349.92 490.56 Tm /F4 10 Tf -0.028 Tc 1.017 Tw (of the frequently cited complaints about the) Tj -35.2029 -12.2018 TD -0.0375 Tc 0.7091 Tw (care provided for individuals with dementia in most) Tj -0.257 -11.9577 TD -0.03 Tc 1.3618 Tw (nursing homes is the lack of appropriate activities,) Tj ET BT 0.9835 0 0 0.9835 317.28 455.04 Tm 0.028 Tc 0.3625 Tw (including adequate physical exercise. Descriptive) Tj ET BT 0.934 0 0 0.9835 317.52 443.28 Tm -0.0278 Tc 1.2126 Tw (studies of nonrandom samples of special care units) Tj 0 -12.2018 TD -0.0312 Tc 0.7206 Tw (indicate the units provide a great variety of activity) Tj -0.257 -12.4458 TD -0.0354 Tc 2.2926 Tw (programs intended to increase stimulation, reduce) Tj ET BT 0.9835 0 0 0.9835 317.76 407.52 Tm 0.0345 Tc 0.2164 Tw (idleness and stress, and respond to and maintain) Tj ET BT 0.8915 0 0 0.9835 317.52 395.76 Tm 0.0341 Tc 1.7025 Tw (residents\222 interests. These programs include singing,) Tj ET BT 0.934 0 0 0.9835 318 383.52 Tm -0.0143 Tc 1.3963 Tw (dancing, exercises, painting, crafts, games, parties,) Tj 0 -12.2018 TD -0.0387 Tc 1.628 Tw (pet therapy, field trips, reality orientation, sensory) Tj ET BT 0.9835 0 0 0.9835 318.48 360 Tm 0.0152 Tc 0.8635 Tw (and cognitive stimulation, reminiscence therapy,) Tj -0.4881 -12.2018 TD 0.0229 Tc -0.1205 Tw (religious services, housekeeping, cooking, garden-) Tj ET BT 0.934 0 0 0.9835 318.24 336.24 Tm -0.0099 Tc 1.5971 Tw (ing, and sheltered workshop activities \(64,275,485,) Tj 0 -11.9577 TD -0.0287 Tc 1.9171 Tw (494\). Weiner and Reingold found physical exercise) Tj ET BT 0.9835 0 0 0.9835 318.96 312.24 Tm 0.0208 Tc 0.7602 Tw (\(including walks, dance exercise, and wheelchair) Tj 0 -12.4458 TD 0.0258 Tc 3.1711 Tw (exercise\) and music therapy were the activity) Tj ET BT 0.934 0 0 0.9835 318.48 288 Tm -0.0443 Tc 0.9733 Tw (programs provided by the largest proportions of the) Tj 0.7709 -11.9577 TD -0.0242 Tc 1.7089 Tw (special care units they studied \(84 percent and 58) Tj -0.5139 -12.2018 TD -0.0378 Tc 1.884 Tw (percent, respectively\); 42 percent of the units they) Tj 1.0278 -12.2018 TD -0.0376 Tc 1.9266 Tw (studied provided reality orientation, and the same) Tj -0.7709 -12.2018 TD -0.0414 Tc 2.1448 Tw (proportion said they provided sensory stimulation.) Tj 0.7709 -12.4458 TD -0.0434 Tc 1.7432 Tw (Other types of activity programs were provided by) Tj 0 -12.2018 TD -0.0293 Tc 0.9572 Tw (smaller proportions of the special care units \(485\).) Tj ET BT 0.9835 0 0 0.9835 330.48 198.48 Tm 0.0251 Tc 1.3416 Tw (The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 319.44 186.48 Tm 0.0451 Tc 1.2056 Tw (randomly selected special care units and 32 matched) Tj 0.2692 -12.4458 TD 0.0451 Tc 1.8787 Tw (nonspecialized units found virtually no difference in) Tj ET BT 0.9835 0 0 0.9835 320.16 162.24 Tm 0.0425 Tc 2.0966 Tw (the proportion of units that reported providing) Tj ET BT 0.934 0 0 0.9835 320.4 150.48 Tm -0.0349 Tc 1.6974 Tw (activity programs for their residents: 90 percent of) Tj 0 -12.4458 TD -0.0304 Tc 0.677 Tw (the special care units and 91 percent of the nonspe-) Tj ET BT 0.9835 0 0 0.9835 320.4 126.72 Tm 0.0288 Tc 1.3866 Tw (cialized units reported providing such programs) Tj 0.4881 -11.7137 TD 0.034 Tc 1.6986 Tw (\(290\). Information about the particular types of) Tj ET BT 0.934 0 0 0.9835 320.88 102.96 Tm -0.0422 Tc 2.06 Tw (activity programs they provided was not collected,) Tj ET BT 0.8915 0 0 0.9835 320.64 91.2 Tm 0.0419 Tc 1.2092 Tw (except for reality orientation, which was provided by) Tj ET BT 0.9835 0 0 0.9835 320.88 79.2 Tm 0.0363 Tc 1.7098 Tw (all the special care units and 97 percent of the) Tj ET BT 0.934 0 0 0.9835 320.64 67.2 Tm -0.0264 Tc 5.7261 Tw (nonspecialized units,) Tj ET BT 0.9835 0 0 0.9835 424.32 66.96 Tm 0.0179 Tc 0.9828 Tw (and reminiscence therapy,) Tj ET BT 0.8915 0 0 0.9835 320.88 55.44 Tm 0.0498 Tc 1.0807 Tw (which was provided by 90 percent of the special care) Tj -0.2692 -12.2018 TD 0.0376 Tc 0.9448 Tw (units and 87 percent of the nonspecialized units. The) Tj ET endstream endobj 264 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 265 0 obj <>stream 0.72 w 1 j 0 0 0 RG 68.88 693.6 m 547.44 693.6 l S BT 0.9835 0 0 0.9835 69.12 699.84 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (96 ) Tj ET BT 0.9598 0 0 0.9598 81.84 699.84 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 88.08 699.84 Tm /F5 10 Tf 0.0125 Tc 1.0922 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 70.32 660.48 Tm /F4 10 Tf -0.0057 Tc 0.7576 Tw (1990 survey of all nursing homes in 5 northeastern) Tj ET BT 0.8915 0 0 0.9835 69.84 648.24 Tm 0.0321 Tc 1.1304 Tw (States found 79 percent of the special care units and) Tj ET BT 0.9835 0 0 0.9835 69.6 636 Tm 0.0365 Tc 0.1795 Tw (74 percent of the cluster units reported providing) Tj -0.244 -11.9577 TD 0.0267 Tc 0.559 Tw (reality orientation or cognitive stimulation \(194\).) Tj 0.4881 -12.2018 TD 0.0425 Tc 0.9984 Tw (OTA is not aware of other available data on the) Tj ET BT 0.8915 0 0 0.9835 69.6 600.48 Tm 0.0365 Tc 1.4845 Tw (proportion of special care units that provide particu-) Tj ET BT 0.9835 0 0 0.9835 70.08 588.48 Tm 0.0268 Tc 1.3398 Tw (lar types of activity programs. The 1991 George) Tj ET BT 0.934 0 0 0.9835 70.08 576.48 Tm -0.021 Tc 3.2792 Tw (Washington University survey included questions) Tj 0.5139 -11.7137 TD -0.0266 Tc 1.9234 Tw (about reality orientation and recreational therapy,) Tj ET BT 0.8915 0 0 0.9835 70.08 552.96 Tm 0.0359 Tc 0.6776 Tw (but the survey responses for these questions have not) Tj ET BT 0.934 0 0 0.9835 70.32 540.96 Tm 0.0067 Tc 1.3224 Tw (yet been analyzed \(246\).) Tj ET BT 0.9795 0 0 0.9795 127.44 518.4 Tm /F7 12 Tf 0.0442 Tc 0.9965 Tw (Programs for Families) Tj ET BT 0.8915 0 0 0.9835 81.84 500.16 Tm /F4 10 Tf 0.0496 Tc 1.3801 Tw (Another frequently cited complaint about the care) Tj ET BT 0.9835 0 0 0.9835 70.56 488.16 Tm 0.0361 Tc 1.9811 Tw (provided for individuals with dementia in most) Tj 0.4881 -12.2018 TD 0.0291 Tc 0.4833 Tw (nursing homes is that the needs of the residents\222) Tj ET BT 0.934 0 0 0.9835 71.28 464.4 Tm -0.0313 Tc 0.9594 Tw (families are not met. Descriptive studies of nonran-) Tj ET BT 0.9835 0 0 0.9835 71.28 452.16 Tm 0.0276 Tc 0.851 Tw (dom samples of special care units indicate many) Tj ET BT 0.934 0 0 0.9835 71.28 440.16 Tm -0.0195 Tc 0.9467 Tw (units have special programs to involve, inform, and) Tj 0.7709 -11.9577 TD -0.0487 Tc 4.4653 Tw (support residents\222) Tj ET BT 0.9835 0 0 0.9835 160.56 428.16 Tm 0.0236 Tc 2.1972 Tw (families \(64,485,494\). Weiner) Tj ET BT 0.934 0 0 0.9835 72 416.4 Tm -0.0252 Tc 0.9391 Tw (and Reingold found, for example, that 82 percent of) Tj -0.257 -12.2018 TD -0.016 Tc 1.147 Tw (the 22 special care units they studied had a family) Tj ET BT 0.9835 0 0 0.9835 72.24 392.4 Tm 0.0305 Tc 1.4581 Tw (support group \(485\). Figures from these studies) Tj -0.244 -12.2018 TD 0.0361 Tc 2.6551 Tw (cannot be generalized to all special care units) Tj ET BT 0.934 0 0 0.9835 72 368.16 Tm -0.0115 Tc 0.8708 Tw (because they are based on nonmndom samples.) Tj ET BT 0.9835 0 0 0.9835 83.28 350.16 Tm 0.0251 Tc 1.4113 Tw (The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 72 338.4 Tm 0.0451 Tc 1.2825 Tw (randomly selected special care units and 32 matched) Tj ET BT 0.9835 0 0 0.9835 72.48 326.4 Tm 0.0348 Tc 0.7216 Tw (nonspecialized units found the special care units) Tj ET BT 0.934 0 0 0.9835 72.72 314.16 Tm -0.0365 Tc 0.8976 Tw (were somewhat more likely than the nonspecialized) Tj ET BT 0.9835 0 0 0.9835 72.72 302.4 Tm 0.0287 Tc -0.1264 Tw (units to provide special programs for families, but) Tj ET BT 0.8915 0 0 0.9835 72.96 290.4 Tm 0.0207 Tc 1.6817 Tw (this difference was not statistically significant \(413\).) Tj 0 -12.2018 TD 0.0517 Tc 0.7496 Tw (The 1990 survey of all nursing homes in 5 northeast-) Tj ET BT 0.934 0 0 0.9835 73.2 266.4 Tm -0.0277 Tc 1.5306 Tw (ern States found 59 percent of the facilities with a) Tj ET BT 0.8915 0 0 0.9835 73.44 254.4 Tm 0.0442 Tc 1.0272 Tw (special care unit and 35 percent of the facilities with) Tj ET BT 0.9835 0 0 0.9835 73.44 242.64 Tm 0.0288 Tc 0.8802 Tw (a cluster unit had a support group for residents\222) Tj ET BT 0.934 0 0 0.9835 73.44 231.12 Tm 0.0138 Tc 3.1135 Tw (families \(194\).) Tj ET BT 0.9835 0 0 0.9835 110.4 207.84 Tm 0.0082 Tc -0.1055 Tw (Use ) Tj ET BT 0.9795 0 0 0.9795 131.04 207.84 Tm /F7 12 Tf 0.0269 Tc 1.1366 Tw (of Psychotropic Drugs and) Tj 10.5364 -14.2118 TD 0.0494 Tc 0.8687 Tw (Other Medications) Tj ET BT 0.8915 0 0 0.9835 84.96 176.16 Tm /F4 10 Tf 0.0334 Tc 1.2188 Tw (As discussed in chapter 2, nursing home residents) Tj ET BT 0.9835 0 0 0.9835 74.16 164.4 Tm 0.0334 Tc 3.39 Tw (with dementia are very likely to receive psy-) Tj ET BT 0.934 0 0 0.9835 74.16 152.4 Tm -0.0368 Tc 1.8316 Tw (chotropic medications, sometimes to control behav-) Tj 0 -12.2018 TD -0.0289 Tc 1.2321 Tw (ioral symptoms which might be more appropriately) Tj ET BT 0.9835 0 0 0.9835 74.16 128.4 Tm 0.0308 Tc 2.556 Tw (managed in other ways. One frequently stated) Tj 0.244 -11.9577 TD 0.0395 Tc 1.0015 Tw (objective of special care units is to reduce use of) Tj ET BT 0.8915 0 0 0.9835 74.16 104.64 Tm 0.0244 Tc 1.9827 Tw (psychotropic medications and substitute other meth-) Tj ET BT 0.934 0 0 0.9835 74.64 92.88 Tm -0.0142 Tc 1.3963 Tw (ods for managing residents\222 behavioral symptoms.) Tj ET BT 0.9835 0 0 0.9835 85.68 75.12 Tm 0.0302 Tc 2.2149 Tw (Descriptive studies indicate special care unit) Tj ET BT 0.8915 0 0 0.9835 74.4 63.36 Tm 0.0487 Tc 0.4949 Tw (residents are as likely or more likely than individuals) Tj 0.5384 -12.4458 TD 0.0441 Tc 1.5208 Tw (with dementia in nonspecialized nursing home units) Tj ET BT 0.9835 0 0 0.9835 320.64 660 Tm 0.0245 Tc 2.5624 Tw (to receive psychotropic medications. Two small) Tj ET BT 0.934 0 0 0.9835 321.12 647.76 Tm -0.0425 Tc 1.3109 Tw (studies that each compared one or two special care) Tj ET BT 0.9835 0 0 0.9835 320.88 636 Tm 0.0266 Tc 0.3638 Tw (units and two nonspecialized nursing home units) Tj ET BT 0.8915 0 0 0.9835 320.88 624 Tm 0.0456 Tc 0.6069 Tw (found that a larger proportion of the special care unit) Tj -0.2692 -11.9577 TD 0.0287 Tc 1.2688 Tw (residents than the demented residents in nonspecial-) Tj ET BT 0.934 0 0 0.9835 321.12 600.48 Tm -0.035 Tc 2.6518 Tw (ized units received psychotropic medications \(256,) Tj 0 -12.2018 TD -0.007 Tc 1.1123 Tw (298\). The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 321.12 576.72 Tm 0.0451 Tc 1.2056 Tw (randomly selected special care units and 32 matched) Tj ET BT 0.934 0 0 0.9835 321.36 564.96 Tm -0.0203 Tc 0.8375 Tw (nonspecialized nursing home units found no signifi-) Tj 0.257 -12.4458 TD -0.0349 Tc 0.7389 Tw (cant difference between the 2 types of units in their) Tj 0 -11.9577 TD -0.0261 Tc 2.3854 Tw (use of psychotropic medications \(413\).) Tj ET BT 0.8915 0 0 0.9835 332.64 522.96 Tm 0.0278 Tc 1.2251 Tw (In contrast to the use of psychotropic medications,) Tj ET BT 0.9835 0 0 0.9835 322.08 510.72 Tm 0.0498 Tc 0.8284 Tw (the use of medications of all types appears to be) Tj 0 -11.9577 TD 0.0317 Tc 0.1844 Tw (lower in special care units than in nonspecialized) Tj ET BT 0.934 0 0 0.9835 322.08 486.96 Tm -0.0153 Tc 1.0891 Tw (nursing home units. The University of North Caro-) Tj ET BT 0.8915 0 0 0.9835 322.32 474.96 Tm 0.0417 Tc 1.3104 Tw (lina study of 31 randomly selected special care units) Tj ET BT 0.934 0 0 0.9835 322.56 462.96 Tm -0.0101 Tc 0.484 Tw (and 32 matched, nonspecialized nursing home units) Tj ET BT 0.8915 0 0 0.9835 322.56 450.96 Tm 0.0391 Tc 1.597 Tw (found the special care unit residents received signif-) Tj 0 -12.2018 TD 0.0312 Tc 1.6058 Tw (icantly fewer medications of all types than residents) Tj ET BT 0.9835 0 0 0.9835 322.56 426.96 Tm 0.034 Tc 0.9664 Tw (with dementia in the nonspecialized units \(413\).) Tj ET BT 0.934 0 0 0.9835 322.8 414.96 Tm -0.0326 Tc 1.4746 Tw (Likewise, a pilot study that compared 19 residents) Tj ET BT 0.9835 0 0 0.9835 323.04 403.2 Tm 0.0328 Tc 2.2793 Tw (with dementia in one special care unit and 20) Tj ET BT 0.934 0 0 0.9835 322.8 390.96 Tm -0.0341 Tc 2.1798 Tw (residents with dementia in nonspecialized units of) Tj 0.5139 -12.4458 TD -0.0201 Tc 1.2227 Tw (the same nursing home found the special care unit) Tj ET BT 0.9835 0 0 0.9835 323.04 366.96 Tm 0.0376 Tc 0.7188 Tw (residents were receiving fewer medications of all) Tj ET BT 0.934 0 0 0.9835 323.28 354.96 Tm 0.0088 Tc 1.8341 Tw (types \(391\).) Tj ET BT 0.9835 0 0 0.9835 334.56 336.96 Tm 0.0426 Tc 2.0864 Tw (The lower use of medications of all types on) Tj -10.7376 -12.2018 TD 0.0299 Tc 1.5459 Tw (special care units may reflect differences in the) Tj ET BT 0.8915 0 0 0.9835 324 312.96 Tm 0.031 Tc 1.3368 Tw (characteristics of the residents. As discussed later in) Tj ET BT 0.9835 0 0 0.9835 324 300.96 Tm 0.0313 Tc 1.986 Tw (this chapter, the findings of several descriptive) Tj ET BT 0.934 0 0 0.9835 324.48 288.96 Tm -0.0311 Tc 1.5098 Tw (studies suggest that residents of special care units) Tj ET BT 0.9835 0 0 0.9835 324 277.2 Tm 0.0298 Tc 2.7196 Tw (may have fewer medical conditions than other) Tj ET BT 0.8915 0 0 0.9835 324 265.2 Tm 0.0328 Tc 1.1656 Tw (nursing home residents with dementia \(292,382,413\);) Tj 0.8076 -12.4458 TD 0.0358 Tc 1.246 Tw (as a result, they may have less need for medications) Tj ET BT 0.934 0 0 0.9835 324.48 241.44 Tm -0.0381 Tc 1.1134 Tw (of all types. In addition or instead, the lower use of) Tj ET BT 0.9835 0 0 0.9835 324.48 229.68 Tm 0.0298 Tc 0.0861 Tw (medications of all types on special care units may) Tj 0 -12.2018 TD 0.0383 Tc 0.8807 Tw (reflect deliberate efforts by physicians who treat) Tj ET BT 0.8915 0 0 0.9835 325.2 205.92 Tm 0.0451 Tc 1.3595 Tw (special care unit residents to reduce medication use,) Tj ET BT 0.934 0 0 0.9835 324.72 193.92 Tm -0.0493 Tc 1.8964 Tw (perhaps in recognition of the deleterious effects on) Tj 0.257 -11.9577 TD -0.0197 Tc 1.7545 Tw (cognition of many types of medications. The avail-) Tj 0.257 -12.2018 TD -0.0445 Tc 1.2631 Tw (able data do not allow one to choose between these) Tj 0.257 -11.9577 TD -0.0347 Tc 1.1612 Tw (two explanations or other possible explanations.) Tj ET BT 0.9795 0 0 0.9795 374.4 128.64 Tm /F7 12 Tf 0.0351 Tc 0.5565 Tw (Use of Physical Restraints) Tj ET BT 0.8915 0 0 0.9835 336.48 111.12 Tm /F4 10 Tf 0.0334 Tc 1.2188 Tw (As discussed in chapter 2, nursing home residents) Tj ET BT 0.934 0 0 0.9835 325.68 99.12 Tm -0.0271 Tc 1.6584 Tw (with dementia are often physically restrained, and) Tj ET BT 0.9835 0 0 0.9835 325.44 87.36 Tm 0.0312 Tc 0.6032 Tw (reduced use of physical restraints is a frequently) Tj 0.7321 -12.2018 TD 0.033 Tc 0.7234 Tw (stated objective of special care units. Descriptive) Tj ET BT 0.8915 0 0 0.9835 326.16 63.36 Tm 0.0351 Tc 0.8467 Tw (studies show use of physical restraints is much lower) Tj ET BT 0.934 0 0 0.9835 326.16 51.6 Tm -0.0207 Tc 0.8012 Tw (in special care units than in nonspecialized nursing) Tj ET endstream endobj 266 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 267 0 obj <>stream 0.72 w 1 j 0 0 0 RG 64.08 681.6 m 542.16 681.6 l S BT 0.9835 0 0 0.9835 327.84 686.88 Tm 0 0 0 rg /F5 10 Tf 0.0209 Tc 1.87 Tw (Chapter 3--Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 524.88 686.88 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 531.36 686.88 Tm /F5 10 Tf 0.366 Tc 0 Tw (97) Tj -474.6493 -40.0218 TD /F4 10 Tf 0.0179 Tc 1.5441 Tw (home units \(256,292,391,413\). The University of) Tj ET BT 0.934 0 0 0.9835 64.8 635.28 Tm -0.02 Tc 1.1584 Tw (North Carolina study found that only 16 percent of) Tj ET BT 0.9835 0 0 0.9835 64.8 623.28 Tm 0.0303 Tc 1.8243 Tw (the special care unit residents were restrained,) Tj 0.244 -12.2018 TD 0.0365 Tc 1.5739 Tw (compared with 36 percent of the residents with) Tj ET BT 0.934 0 0 0.9835 65.04 599.04 Tm -0.0161 Tc 0.8843 Tw (dementia on the nonspecialized units \(413\).) Tj ET BT 0.9835 0 0 0.9835 76.32 581.28 Tm 0.0251 Tc 1.8993 Tw (In theory, lower use of physical restraints in) Tj -10.9816 -12.2018 TD 0.0344 Tc 0.8092 Tw (special care units could reflect differences in the) Tj ET BT 0.8915 0 0 0.9835 65.52 557.28 Tm 0.033 Tc 0.7482 Tw (characteristics of the residents; that is, if special care) Tj ET BT 0.9835 0 0 0.9835 65.52 545.28 Tm 0.0293 Tc -0.1269 Tw (unit residents exhibit fewer behavioral symptoms) Tj ET BT 0.934 0 0 0.9835 65.76 533.52 Tm -0.0228 Tc 1.611 Tw (than other nursing home residents with dementia,) Tj 0.257 -12.2018 TD -0.0357 Tc 1.425 Tw (special care unit residents may be less likely to be) Tj -0.5139 -11.9577 TD -0.0206 Tc 1.8142 Tw (physically restrained. This explanation is probably) Tj ET BT 0.9835 0 0 0.9835 65.76 498 Tm 0.0167 Tc 0.3434 Tw (not true, since, as discussed later in this chapter,) Tj ET BT 0.8915 0 0 0.9835 66.24 485.76 Tm 0.0508 Tc 0.9301 Tw (special care unit residents generally exhibit as many) Tj ET BT 0.9835 0 0 0.9835 66 474 Tm 0.018 Tc 0.3726 Tw (or more behavioral symptoms than other nursing) Tj 0 -12.2018 TD 0.0273 Tc 3.5763 Tw (home residents with dementia. A more likely) Tj ET BT 0.934 0 0 0.9835 66.24 450 Tm -0.0348 Tc 1.2568 Tw (explanation for the lower use of physical restraints) Tj ET BT 0.9835 0 0 0.9835 66.48 438 Tm 0.034 Tc 0.492 Tw (in special care units is a deliberate effort by unit) Tj 0 -12.2018 TD 0.0342 Tc 1.2509 Tw (operators and staff members to substitute other) Tj 0 -11.9577 TD 0.0271 Tc -0.0759 Tw (methods of managing residents\222 behavioral symp-) Tj ET BT 0.934 0 0 0.9835 66.72 402 Tm -0.0282 Tc 2.302 Tw (toms. Another possible explanation is that special) Tj ET BT 0.8915 0 0 0.9835 66.96 390.48 Tm 0.0404 Tc 0.6053 Tw (care unit residents are perceived by staff members as) Tj ET BT 0.934 0 0 0.9835 66.96 378.96 Tm -0.0381 Tc 1.4989 Tw (less physically frail and therefore less likely to fall) Tj 0 -12.4458 TD -0.0228 Tc 1.6538 Tw (than other nursing home residents with dementia,) Tj 0.257 -11.7137 TD -0.0293 Tc 1.1041 Tw (and as a result, special care unit residents are less) Tj 0 -12.2018 TD -0.034 Tc 1.3982 Tw (likely to be restrained. Available data do not allow) Tj ET BT 0.8915 0 0 0.9835 67.2 330.96 Tm 0.0482 Tc 1.2021 Tw (one to choose between the latter two explanations or) Tj 0.2692 -11.9577 TD 0.0363 Tc 3.3691 Tw (other possible explanations.) Tj ET BT 0.9795 0 0 0.9795 95.76 291.12 Tm /F7 12 Tf 0.0476 Tc 0.8705 Tw (Admission and Discharge Policies) Tj 52.6818 -14.4569 TD 0.0552 Tc 1.1078 Tw (and Practices) Tj ET BT 0.9835 0 0 0.9835 78.96 259.2 Tm /F4 10 Tf 0.0256 Tc 1.9918 Tw (Some existing special care units have formal) Tj ET BT 0.8915 0 0 0.9835 68.16 247.2 Tm 0.0327 Tc 1.6041 Tw (admission and discharge policies, and others do not.) Tj -0.5384 -12.2018 TD 0.0517 Tc 0.7197 Tw (The 1990 survey of all nursing homes in 5 northeast-) Tj 0.5384 -12.2018 TD 0.0247 Tc 0.8696 Tw (ern States found that 43 percent of the facilities with) Tj ET BT 0.9835 0 0 0.9835 68.4 211.44 Tm 0.0361 Tc 0.1101 Tw (a special care unit and 19 percent of the facilities) Tj ET BT 0.934 0 0 0.9835 68.16 199.44 Tm -0.0298 Tc 1.2514 Tw (with a cluster unit reported having formal, written) Tj 0.257 -12.2018 TD -0.0179 Tc 1.7771 Tw (admission criteria for the unit \(194\). Twenty-eight) Tj -0.5139 -12.2018 TD -0.0357 Tc 0.911 Tw (percent of the facilities with a special care unit and) Tj ET BT 0.9835 0 0 0.9835 68.4 163.2 Tm 0.0286 Tc 2.6192 Tw (20 percent of the facilities with a cluster unit) Tj -0.244 -12.4458 TD 0.0214 Tc -0.1189 Tw (reported having formal, written discharge criteria) Tj 0.9761 -11.9577 TD 0.0323 Tc 1.985 Tw (\(194\). Eight of the 13 special care units in the) Tj -0.7321 -12.4458 TD 0.0316 Tc -0.1293 Tw (nonrandom sample of units studied by Cairl et al.) Tj ET BT 0.934 0 0 0.9835 68.4 115.2 Tm -0.0293 Tc 1.2509 Tw (reported having formal admission policies, and 3 of) Tj ET BT 0.9835 0 0 0.9835 68.64 103.2 Tm 0.0279 Tc 2.8029 Tw (the 13 units reported having formal discharge) Tj -0.244 -11.9577 TD 0.042 Tc 0.3482 Tw (policies \(64\).) Tj ET BT 0.934 0 0 0.9835 79.92 73.68 Tm -0.0235 Tc 2.1685 Tw (Regardless of whether they have formal admis-) Tj -11.306 -12.4458 TD -0.0311 Tc 1.4731 Tw (sion and discharge policies, special care units vary) Tj 0 -11.7137 TD -0.0263 Tc 1.5291 Tw (greatly in their admission and discharge practices.) Tj ET BT 0.9835 0 0 0.9835 69.12 37.92 Tm 0.0251 Tc 2.9452 Tw (The University of North Carolina study of 31) Tj 250.3806 620.0945 TD 0.0348 Tc 3.0806 Tw (randomly selected special care units found 40) Tj ET BT 0.934 0 0 0.9835 315.36 635.76 Tm -0.0317 Tc 1.3635 Tw (percent of the units primarily admitted individuals) Tj ET BT 0.9835 0 0 0.9835 315.84 623.52 Tm 0.03 Tc 0.1977 Tw (who had been living in other parts of the nursing) Tj ET BT 0.934 0 0 0.9835 315.6 611.52 Tm -0.0219 Tc 0.8392 Tw (home; the remaining 60 percent primarily admitted) Tj 0.5139 -12.4458 TD -0.0274 Tc 1.0653 Tw (individuals who had been living outside the facility) Tj 0.257 -11.9577 TD -0.0231 Tc 0.6936 Tw (\(413\). Weiner and Reingold found that two-thirds of) Tj ET BT 0.8915 0 0 0.9835 316.08 575.28 Tm 0.0499 Tc 1.3541 Tw (the 22 nonrandomly selected special care\222 units they) Tj 0.8076 -12.2018 TD 0.028 Tc 0.9557 Tw (studied admitted primarily individuals who had been) Tj ET BT 0.934 0 0 0.9835 316.32 551.52 Tm -0.0169 Tc 0.944 Tw (living in other parts of the facility \(485\).) Tj ET BT 0.8915 0 0 0.9835 327.6 531.6 Tm 0.0367 Tc 0.6767 Tw (In response to the 1990 study of all nursing homes) Tj ET BT 0.934 0 0 0.9835 316.8 519.6 Tm -0.0269 Tc 1.2116 Tw (in five northeastern States, facilities with a special) Tj ET BT 0.8915 0 0 0.9835 316.8 507.6 Tm 0.0528 Tc 0.5241 Tw (care unit reported using several criteria to select unit) Tj -0.2692 -11.9577 TD 0.0398 Tc 0.9424 Tw (residents. The criteria and the proportion of facilities) Tj 0.5384 -12.4458 TD 0.0317 Tc 0.9515 Tw (that reported using them areas follows: 1\) the degree) Tj ET BT 0.9835 0 0 0.9835 317.04 471.84 Tm 0.0364 Tc 1.8181 Tw (of an individual\222s dementia \(85 percent\); 2\) the) Tj ET BT 0.8915 0 0 0.9835 317.04 460.08 Tm 0.0334 Tc 1.6418 Tw (individual\222s need for supervision \(73 percent\); 3\) the) Tj ET BT 0.9835 0 0 0.9835 317.04 447.84 Tm 0.0275 Tc 0.1677 Tw (individual\222s behavioral symptoms \(79 percent\); 4\)) Tj 0.4881 -12.2018 TD 0.0256 Tc 1.6257 Tw (the individual\222s limitations in activities of daily) Tj ET BT 0.934 0 0 0.9835 317.52 424.08 Tm -0.0152 Tc 0.7035 Tw (living \(51 percent\); and 5\) the individual\222s ability to) Tj ET BT 0.9835 0 0 0.9835 317.76 412.08 Tm 0.0399 Tc 1.961 Tw (ambulate independently \(38 percent\) \(194\). For) Tj ET BT 0.8915 0 0 0.9835 317.52 400.08 Tm 0.0436 Tc 0.9382 Tw (nursing homes with a cluster unit, the corresponding) Tj 0.2692 -11.9577 TD 0.0393 Tc 1.0439 Tw (figures are: 1\) the degree of an individual\222s dementia) Tj 0.5384 -11.9577 TD 0.0334 Tc 1.6418 Tw (\(81 percent\); 2\) the individual\222s need for supervision) Tj ET BT 0.9835 0 0 0.9835 318.24 364.8 Tm 0.0315 Tc 0.2775 Tw (\(78 percent\); 3\) the individual\222s behavioral symp-) Tj ET BT 0.934 0 0 0.9835 318 353.04 Tm -0.017 Tc 1.2377 Tw (toms \(64 percent\); 4\) the individual\222s limitations in) Tj ET BT 0.9835 0 0 0.9835 318.24 340.8 Tm 0.0347 Tc 1.2402 Tw (activities of daily living \(57 percent\); and 5\) the) Tj ET BT 0.934 0 0 0.9835 318.24 329.04 Tm -0.0149 Tc 2.4248 Tw (individual\222s ability to ambulate independently \(44) Tj -0.257 -12.2018 TD -0.0384 Tc 1.8479 Tw (percent\). Most of the nursing homes reported they) Tj 0.5139 -12.4458 TD -0.0253 Tc 2.1704 Tw (generally seek individuals with more, rather than) Tj ET BT 0.9835 0 0 0.9835 318.48 293.04 Tm 0.0354 Tc 1.2265 Tw (less, severe dementia \(194\). Only 12 percent re-) Tj -0.244 -12.2018 TD 0.0362 Tc 1.2489 Tw (ported they generally seek individuals with less) Tj ET BT 0.934 0 0 0.9835 318.96 269.04 Tm -0.0334 Tc 1.3287 Tw (severe dementia. Likewise, about 40 percent of the) Tj ET BT 0.8915 0 0 0.9835 318.48 257.28 Tm 0.0423 Tc 1.7471 Tw (nursing homes reported they generally seek individ-) Tj ET BT 0.9835 0 0 0.9835 318.72 245.28 Tm 0.0241 Tc 0.5291 Tw (uals with more severe behavioral symptoms, and) Tj ET BT 0.934 0 0 0.9835 318.96 233.28 Tm -0.0411 Tc 1.727 Tw (only 15 to 18 percent reported they generally seek) Tj 0 -12.2018 TD -0.0251 Tc 1.0482 Tw (individuals with less severe behavioral symptoms.) Tj ET BT 0.9835 0 0 0.9835 329.76 201.6 Tm 0.0325 Tc 0.6019 Tw (Table 3-3 presents data from the University of) Tj ET BT 0.934 0 0 0.9835 318.96 189.6 Tm -0.0447 Tc 0.7534 Tw (North Carolina study with respect to the proportion) Tj ET BT 0.9835 0 0 0.9835 319.2 177.36 Tm 0.0304 Tc 0.1159 Tw (of special care units that encourage or discourage) Tj ET BT 0.934 0 0 0.9835 319.44 165.36 Tm -0.0249 Tc 1.6133 Tw (admission of individuals with eight types of symp-) Tj ET BT 0.8915 0 0 0.9835 319.2 153.12 Tm 0.0232 Tc 1.1629 Tw (toms. Most of the units reported that they encourage) Tj 0.5384 -11.9577 TD 0.0317 Tc 2.2436 Tw (admission of individuals with confusion, wandering,) Tj 0 -12.2018 TD 0.0181 Tc 1.236 Tw (and agitation \(413\). Most reported that they discour-) Tj ET BT 0.9835 0 0 0.9835 319.68 117.6 Tm 0.0326 Tc 1.3746 Tw (age admission of individuals who are physically) Tj ET BT 0.934 0 0 0.9835 319.92 105.6 Tm -0.0245 Tc 0.6364 Tw (abusive or unable to walk independently.) Tj ET BT 0.9835 0 0 0.9835 330.72 86.16 Tm 0.0299 Tc 1.1333 Tw (Reported admission practices may or may not) Tj -11.2256 -12.2018 TD 0.0245 Tc 1.0167 Tw (reflect actual admission practices in special care) Tj ET BT 0.8915 0 0 0.9835 319.68 62.16 Tm 0.0167 Tc 0.9298 Tw (units. Data from the Multi-State Nursing Home Case) Tj ET BT 0.934 0 0 0.9835 319.92 50.64 Tm -0.0131 Tc 1.7291 Tw (Mix and Quality Demonstration, a 5-year congres-) Tj 0.5139 -12.4458 TD -0.0109 Tc 1.898 Tw (sionally mandated study, suggest the major factor) Tj ET endstream endobj 268 0 obj <>/Rotate 0/Type/Page>> endobj 269 0 obj <>stream 0.48 w 1 j 0 0 0 RG 68.88 682.8 m 547.44 682.8 l S 69.12 619.92 m 296.88 619.92 l S 69.36 606.96 m 296.88 606.96 l S 0.72 w 71.76 366.72 m 299.28 366.72 l S BT 0.9835 0 0 0.9835 68.88 689.28 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (98 ) Tj ET BT 0.9598 0 0 0.9598 82.08 689.28 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.99 0 0 0.99 88.56 689.28 Tm /F7 8 Tf 0.0341 Tc -0.0954 Tw (Special ) Tj ET BT 0.9835 0 0 0.9835 115.92 689.28 Tm /F5 10 Tf 0.0128 Tc 1.7562 Tw (Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 78 649.44 Tm /F3 9 Tf 0.0378 Tc 0.4191 Tw (Table 3-3\227Proportion of Special Care Units That) Tj -7.5432 -9.9765 TD 0.0572 Tc -0.1278 Tw (Encouraged or Discouraged Admission of Residents) Tj 64.9688 -10.2198 TD 0.0225 Tc 0.7591 Tw (With Certain Problems) Tj ET BT 0.9939 0 0 0.9939 70.08 610.8 Tm /F3 7 Tf -0.002 Tc 0 Tw (Problem) Tj ET BT 0.8648 0 0 0.99 70.08 597.6 Tm /F3 8 Tf 0.0769 Tc (Confusion) Tj -0.2775 -30.304 TD 0.2796 Tc (Wandering) Tj ET BT 0.9189 0 0 0.99 70.08 538.32 Tm 0.0379 Tc (Agitation) Tj 0.5224 -30.0615 TD 0.0237 Tc 0.6236 Tw (Verbal abusiveness) Tj ET BT 0.8648 0 0 0.99 71.28 478.56 Tm 0.0147 Tc 4.6971 Tw (Physical abusiveness) Tj 0.2775 -30.304 TD 0.0336 Tc 4.3977 Tw (Urinary incontinence) Tj ET BT 0.9189 0 0 0.99 72 418.56 Tm 0.0347 Tc 0.2199 Tw (Unable to walk) Tj ET BT 0.8648 0 0 0.99 72.24 388.8 Tm 0.0509 Tc 3.8226 Tw (Feeding problems) Tj 108.2293 210.9155 TD 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 166.08 588.48 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 165.84 579.6 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 215.28 579.6 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.08 567.6 Tm 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 166.32 558.96 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.32 549.84 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 215.76 550.08 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.32 538.08 Tm 0.0167 Tc 0.096 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 166.56 529.44 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.32 520.32 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 215.76 520.56 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.56 508.56 Tm 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 166.8 499.44 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.8 490.56 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 216.24 490.56 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 166.8 478.32 Tm 0.0167 Tc 0.096 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 167.04 469.44 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.04 460.32 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 216.48 460.32 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.04 448.32 Tm 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj 0.2775 -8.97 TD 0.0357 Tc 0 Tw (neither) Tj ET BT 0.8108 0 0 0.99 194.64 439.44 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.28 430.32 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 216.72 430.56 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.52 418.32 Tm 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 167.76 409.44 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.52 400.56 Tm 0.0407 Tc 0 Tw (discouraged) Tj ET BT 0.8108 0 0 0.99 216.96 400.56 Tm 0.1443 Tc -0.0337 Tw (. . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 167.76 388.32 Tm 0.0167 Tc 0.0762 Tw (encouraged . . . . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 167.76 379.68 Tm 0.1271 Tc -0.0125 Tw (neither . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8648 0 0 0.99 168 370.56 Tm 0.0167 Tc 0.2546 Tw (discouraged . . . . . . . . . . . . .) Tj ET BT 0.99 0 0 0.99 274.56 597.36 Tm -0.0842 Tc 0 Tw (93%) Tj ET BT 0.8648 0 0 0.99 279.36 588.48 Tm -0.0072 Tc (7) Tj ET BT 0.7433 0 0 0.9812 279.36 579.36 Tm /F12 11 Tf 0.1477 Tc (0) Tj ET BT 0.9189 0 0 0.99 275.04 567.6 Tm /F3 8 Tf 0.1235 Tc (87) Tj ET BT 0.8648 0 0 0.99 275.28 558.96 Tm 0.2703 Tc (13) Tj 4.9952 -9.2124 TD -0.0072 Tc (0) Tj ET BT 0.9189 0 0 0.99 275.28 538.08 Tm 0.1235 Tc (53) Tj 0 -8.7275 TD 0.1235 Tc (40) Tj ET BT 0.8648 0 0 0.99 279.84 520.56 Tm -0.0072 Tc (7) Tj ET BT 0.99 0 0 0.99 275.52 508.56 Tm -0.085 Tc (27) Tj 0 -9.4548 TD -0.085 Tc (57) Tj ET BT 0.8648 0 0 0.99 276.24 490.56 Tm 0.1315 Tc (17) Tj 4.4402 -12.364 TD -0.0072 Tc (7) Tj ET BT 0.99 0 0 0.99 275.76 469.2 Tm -0.085 Tc (35) Tj ET BT 0.8648 0 0 0.99 276 460.32 Tm 0.2703 Tc (59) Tj ET BT 0.9189 0 0 0.99 276 448.32 Tm 0.1235 Tc (30) Tj 0 -8.97 TD 0.1235 Tc (63) Tj ET BT 0.8648 0 0 0.99 280.8 430.32 Tm -0.0072 Tc (7) Tj -4.4402 -12.1216 TD 0.1315 Tc (10) Tj ET BT 0.99 0 0 0.99 276.48 409.44 Tm -0.085 Tc (27) Tj ET BT 0.9189 0 0 0.99 276.48 400.32 Tm 0.1235 Tc (63) Tj ET BT 0.8648 0 0 0.99 277.2 388.56 Tm 0.1315 Tc (17) Tj ET BT 0.99 0 0 0.99 276.48 379.44 Tm -0.085 Tc (67) Tj ET BT 0.8648 0 0 0.99 277.44 370.56 Tm 0.1315 Tc (17) Tj ET BT 0.9939 0 0 0.9939 72.24 359.04 Tm /F3 7 Tf 0.2501 Tc -0.267 Tw (SOURCE: ) Tj ET q 12.72 0 0 -5.28 110.88 364.08 cm BI /W 71 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>~>|?|?|><w||||| EI Q BT 0.9262 0 0 0.9939 110.88 359.04 Tm 3 Tr 0.0933 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9939 0 0 0.9939 123.6 359.04 Tm -0.0061 Tc 1.9226 Tw ( Sloane,) Tj 0 Tc -0.0154 Tw ( ) Tj ET q 10.32 0 0 -5.28 156 364.08 cm BI /W 58 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~>>>>>>>>>>>>>>>>>>??? EI Q BT 0.8027 0 0 0.9939 156 359.04 Tm 3 Tr 0.0481 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9939 0 0 0.9939 166.32 359.04 Tm 0.0196 Tc 1.8967 Tw ( Mathew,) Tj 0 Tc -0.0154 Tw ( ) Tj ET q 12.24 0 0 -5.28 201.84 364.08 cm BI /W 68 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||~?||~?|||||x>>>?~~>~>~~~~~_~? EI Q BT 0.9262 0 0 0.9939 201.84 359.04 Tm 3 Tr 0.0932 Tc 0 Tw (J.R.) Tj 0 Tr ET BT 0.9939 0 0 0.9939 214.08 359.04 Tm 0 Tc -0.0154 Tw ( ) Tj ET q 18.72 0 0 -5.76 216.24 364.32 cm BI /W 105 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~|||||||?|>?|>?|>??|?|?||||<|>?|>|><<>|<|||< EI Q BT 0.8645 0 0 0.9939 216.24 359.04 Tm 3 Tr -0.0142 Tc 0 Tw (Desai,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 234.96 359.04 Tm -0.0043 Tc 0.6328 Tw ( et al., ) Tj ET q 38.64 0 0 -5.52 259.44 364.32 cm BI /W 215 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<8<8xx>~?>x?>x?>?|??>>x????>>|x~~>?>>>|x~~?>>~x>|?||>|0?<||~<>|><>|>><~>|>>>>|~>>|~?>>xxh?>x??>x??>|>|>>>|x|@>>|?~|xx|xx>x|<>|>x8 EI Q BT 0.8645 0 0 0.9939 259.44 359.04 Tm 3 Tr 0 Tc 0 Tw (\223Specialized) Tj 0 Tr ET BT 0.9262 0 0 0.9939 106.32 350.88 Tm 0.0684 Tc 0.0525 Tw (Dementia Units in Nursing Homes: A Study of ) Tj ET q 23.76 0 0 -9.36 252.24 358.56 cm BI /W 140 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<<@| >~??|>|~>|>?>>>|~~??~w|8`tx|x|`~?p0p8 EI Q BT 0.8027 0 0 0.9939 252.24 350.88 Tm 3 Tr 0.0428 Tc 0 Tw (Settirigs) Tj 0 Tr ET BT 0.9262 0 0 0.9939 276 350.88 Tm 0.0822 Tc 0.0376 Tw ( in Five) Tj -183.4491 -7.9688 TD 0.0795 Tc 0.3968 Tw (States,\224 University of North Carolina, Chapel Hill, NC, March) Tj 0.5182 -8.2103 TD 0.0201 Tc 0 Tw (1990.) Tj ET BT 0.934 0 0 0.9835 72.72 308.64 Tm /F4 10 Tf -0.0296 Tc 1.6183 Tw (distinguishing special care unit residents and resi-) Tj ET BT 0.8915 0 0 0.9835 72.48 296.64 Tm 0.041 Tc 1.3448 Tw (dents with dementia in nonspecialized nursing home) Tj ET BT 0.934 0 0 0.9835 72.48 284.64 Tm -0.0274 Tc 1.7628 Tw (units is the severity of their physical impairments) Tj ET BT 0.9835 0 0 0.9835 73.2 272.64 Tm 0.0411 Tc 0.7151 Tw (\(382\). Among a subsample of 127 residents of 10) Tj ET BT 0.8915 0 0 0.9835 73.2 260.64 Tm 0.0412 Tc 0.5707 Tw (special care units and 103 residents with dementia in) Tj ET BT 0.934 0 0 0.9835 73.92 248.88 Tm -0.011 Tc 0.5339 Tw (10 nonspecialized units in the same nursing homes,) Tj ET BT 0.8915 0 0 0.9835 73.2 236.88 Tm 0.043 Tc 1.0157 Tw (the special care unit residents were significantly less) Tj 0.2692 -12.2018 TD 0.0403 Tc 1.2783 Tw (likely to have severe limitations in activities of daily) Tj ET BT 0.9835 0 0 0.9835 73.2 213.36 Tm 0.019 Tc -0.0757 Tw (living or severe physical impairments. Once other) Tj ET BT 0.934 0 0 0.9835 73.68 201.12 Tm -0.0451 Tc 1.2311 Tw (study variables were controlled, the two groups did) Tj ET BT 0.9835 0 0 0.9835 73.44 189.36 Tm 0.0327 Tc 0.5204 Tw (not differ significantly with respect to behavioral) Tj 0.4881 -12.2018 TD 0.0195 Tc 1.8353 Tw (symptoms, including wandering and verbal and) Tj ET BT 0.934 0 0 0.9835 73.44 165.6 Tm -0.0061 Tc 1.5931 Tw (physical abusiveness.) Tj ET BT 0.8915 0 0 0.9835 85.2 147.84 Tm 0.0316 Tc 0.7593 Tw (Some special care units admit individuals with the) Tj ET BT 0.934 0 0 0.9835 74.16 135.6 Tm -0.0287 Tc 1.2136 Tw (expectation that the individuals will remain on the) Tj ET BT 0.9835 0 0 0.9835 74.16 124.08 Tm 0.0222 Tc 2.46 Tw (unit until they die, whereas other units admit) Tj 0 -12.2018 TD 0.0337 Tc 0.1126 Tw (individuals with the expectation that they will be) Tj ET BT 0.8915 0 0 0.9835 74.4 100.32 Tm 0.0275 Tc 0.7169 Tw (discharged from the unit at some time prior to death.) Tj ET BT 0.934 0 0 0.9835 74.4 88.56 Tm -0.0094 Tc 0.5117 Tw (All but one of the 22 Minnesota nursing homes that) Tj ET BT 0.9835 0 0 0.9835 74.16 76.8 Tm 0.0376 Tc 2.7625 Tw (had a special care unit in 1986 reported they) Tj ET BT 0.934 0 0 0.9835 74.64 64.56 Tm -0.0291 Tc 1.6606 Tw (admitted individuals with the expectation that the) Tj ET BT 0.8915 0 0 0.9835 74.4 52.8 Tm 0.0375 Tc 1.1805 Tw (individuals would remain on the unit until they died) Tj ET BT 0.9835 0 0 0.9835 74.88 40.8 Tm 0.0295 Tc 0.788 Tw (\(181\). According to the 1990 study of all nursing) Tj 249.6485 618.6304 TD 0.0288 Tc 2.0351 Tw (homes in 5 northeastern States, about half the) Tj 0 -11.9577 TD 0.0207 Tc 2.1086 Tw (nursing homes with a special care unit and 60) Tj 0 -12.2018 TD 0.0199 Tc 0.8893 Tw (percent of the nursing homes with a cluster unit) Tj ET BT 0.8915 0 0 0.9835 320.4 613.44 Tm 0.0306 Tc 1.7218 Tw (reported they seldom discharge residents of the unit) Tj ET BT 0.934 0 0 0.9835 320.64 601.44 Tm -0.0355 Tc 0.6396 Tw (or cluster prior to their death \(194\).) Tj ET BT 0.9835 0 0 0.9835 331.92 583.44 Tm 0.0264 Tc 3.2112 Tw (Among special care units that do discharge) Tj -11.2256 -11.9577 TD 0.0357 Tc 2.9345 Tw (residents prior to their death, the reasons for) Tj 0.244 -12.2018 TD 0.0217 Tc 0.3688 Tw (discharge vary. In their study of 99 nonrandomly) Tj ET BT 0.934 0 0 0.9835 321.84 547.92 Tm -0.0384 Tc 1.7011 Tw (selected special care units, White and Kwon found) Tj -0.5139 -11.9577 TD -0.0343 Tc 1.3664 Tw (the two most frequently cited reasons for discharg-) Tj ET BT 0.9835 0 0 0.9835 321.6 524.4 Tm 0.0253 Tc 2.6225 Tw (ing residents from the units were: 1\) that the) Tj -0.244 -12.2018 TD 0.0422 Tc 0.7547 Tw (residents had become nonresponsive \(cited by 70) Tj ET BT 0.934 0 0 0.9835 321.6 500.4 Tm -0.0276 Tc 1.2628 Tw (percent of the survey respondents\), and 2\) that the) Tj 0 -12.2018 TD -0.0527 Tc 0.1013 Tw (residents ) Tj ET BT 0.9606 0 0 0.9863 365.52 488.4 Tm /F3 9 Tf -0.0086 Tc 0.0041 Tw (were ) Tj ET BT 0.934 0 0 0.9835 387.84 488.4 Tm /F4 10 Tf -0.0207 Tc 1.6087 Tw (combative, violent,) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 474.48 488.4 Tm /F3 8 Tf 0.0491 Tc 0.0737 Tw (or ) Tj ET BT 0.934 0 0 0.9835 484.32 488.4 Tm /F4 10 Tf 0.0229 Tc 0.0204 Tw (harmful ) Tj ET BT 0.9606 0 0 0.9863 523.2 488.4 Tm /F3 9 Tf -0.0051 Tc 0.2503 Tw (to self) Tj -209.3629 -12.4098 TD -0.0057 Tc 0.2509 Tw (or others ) Tj ET BT 0.934 0 0 0.9835 362.88 476.16 Tm /F4 10 Tf -0.0639 Tc 0.1133 Tw (\(cited ) Tj ET BT 0.9606 0 0 0.9863 390.72 476.16 Tm /F3 9 Tf -0.0075 Tc 0.003 Tw (by ) Tj ET BT 0.934 0 0 0.9835 403.44 476.16 Tm /F4 10 Tf -0.036 Tc 1.1969 Tw (63 percent of the) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 482.4 476.16 Tm /F3 8 Tf 0.042 Tc 0.0813 Tw (units\). ) Tj ET BT 0.9606 0 0 0.9863 507.84 476.16 Tm /F3 9 Tf -0.0052 Tc 0 Tw (One-third) Tj ET BT 0.9863 0 0 0.9863 322.08 464.16 Tm 0.0284 Tc 1.1181 Tw (of the units) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 376.08 464.16 Tm /F4 10 Tf 0.0328 Tc 3.408 Tw (reported discharging residents) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 529.2 464.16 Tm /F3 9 Tf 0.4051 Tc 0 Tw (who) Tj ET BT 0.9606 0 0 0.9863 322.32 452.16 Tm -0.0091 Tc 0.0046 Tw (became ) Tj ET BT 0.8915 0 0 0.9835 356.64 452.16 Tm /F4 10 Tf 0.0875 Tc -0.1879 Tw (unable ) Tj ET BT 0.9189 0 0 0.99 388.8 452.16 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.8915 0 0 0.9835 397.92 452.16 Tm /F4 10 Tf 0.0421 Tc 1.9493 Tw (ambulate, and 14 percent reported) Tj ET BT 0.9863 0 0 0.9863 322.32 440.16 Tm /F3 9 Tf 0.0502 Tc -0.1207 Tw (discharging ) Tj ET BT 0.9835 0 0 0.9835 376.56 440.16 Tm /F4 10 Tf 0.0331 Tc 0.6623 Tw (residents when the residents\222 private) Tj ET BT 0.9863 0 0 0.9863 322.56 428.16 Tm /F3 9 Tf 0.0622 Tc -0.1329 Tw (funds ) Tj ET BT 0.99 0 0 0.99 349.92 428.16 Tm /F3 8 Tf -0.0132 Tc -0.0292 Tw (were ) Tj ET BT 0.9835 0 0 0.9835 370.56 428.16 Tm /F4 10 Tf 0.0436 Tc 0.9567 Tw (exhausted \(492\). Weiner and Reingold) Tj ET BT 0.99 0 0 0.99 322.56 416.4 Tm /F3 8 Tf -0.0501 Tc 0.3718 Tw (cite similar ) Tj ET BT 0.9835 0 0 0.9835 366.96 416.4 Tm /F4 10 Tf 0.0325 Tc 1.3341 Tw (reasons for discharge \(485\).) Tj -33.921 -18.3027 TD 0.0319 Tc 3.5309 Tw (The 1990) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 385.92 398.4 Tm /F3 9 Tf 0.3073 Tc -0.3813 Tw (study ) Tj ET BT 0.9835 0 0 0.9835 416.64 398.4 Tm /F4 10 Tf 0.0207 Tc 3.7863 Tw (of all nursing homes in 5) Tj ET BT 0.934 0 0 0.9835 322.8 386.4 Tm -0.0251 Tc 0.5856 Tw (northeastern States indicate 45 percent of the nurs-) Tj 0.257 -11.9577 TD -0.0258 Tc 0.9205 Tw (ing homes with a special care unit or a cluster unit) Tj -0.257 -12.2018 TD -0.0487 Tc 2.1954 Tw (reported they discharge residents who need inten-) Tj ET BT 0.9835 0 0 0.9835 323.76 350.16 Tm 0.0339 Tc 1.6986 Tw (sive medical care \(194\). Twenty-one percent re-) Tj -0.7321 -11.9577 TD 0.0444 Tc 2.3387 Tw (ported they discharge residents who need tube) Tj ET BT 0.934 0 0 0.9835 323.52 326.4 Tm -0.0209 Tc 0.6097 Tw (feeding, and a few of the nursing homes \(10 percent) Tj 0.257 -12.4458 TD -0.0465 Tc 1.1225 Tw (or less\) reported they discharge residents who have) Tj 0.257 -12.2018 TD -0.0393 Tc 2.3995 Tw (severe decubitus ulcers, contractures, or recurring) Tj ET BT 0.8915 0 0 0.9835 323.76 290.4 Tm 0.0439 Tc 1.4762 Tw (urinary tract infections.) Tj ET BT 0.9795 0 0 0.9795 341.76 266.4 Tm /F7 12 Tf 0.0427 Tc 0.753 Tw (Costs, Charges, and Payment Methods) Tj ET BT 0.934 0 0 0.9835 335.04 248.64 Tm /F4 10 Tf -0.0246 Tc 0.732 Tw (Very little information is available about the cost) Tj ET BT 0.9835 0 0 0.9835 324.48 236.64 Tm 0.0256 Tc 2.3172 Tw (of special care units. The cost obviously varies) Tj 0.244 -11.9577 TD 0.0333 Tc 1.5773 Tw (among units, depending on the cost of any new) Tj ET BT 0.934 0 0 0.9835 324.48 212.88 Tm -0.0286 Tc 1.6686 Tw (construction, renovation, or other physical changes) Tj 0 -11.9577 TD -0.0289 Tc 1.2138 Tw (to a unit and ongoing operating costs. Respondents) Tj 0.257 -12.4458 TD -0.0226 Tc 1.2968 Tw (to one survey of a nonrandom sample of 12 special) Tj ET BT 0.8915 0 0 0.9835 324.72 177.12 Tm 0.0538 Tc 1.51 Tw (care units reported new construction and renovation) Tj 0.2692 -12.2018 TD 0.0483 Tc 0.7406 Tw (costs ranging from $4100 to $150,000 \(275\). Cameron) Tj ET BT 0.9835 0 0 0.9835 324.72 153.36 Tm 0.0308 Tc 1.3357 Tw (et al. reported initial costs of only $1300, which) Tj 0.4881 -11.9577 TD 0.0233 Tc 0.1842 Tw (covered the cost of an alarm system, color coding,) Tj ET BT 0.934 0 0 0.9835 325.44 129.84 Tm -0.0267 Tc 0.6194 Tw (and other physical changes made to create a special) Tj 0 -12.2018 TD 0.0047 Tc 0.2968 Tw (care unit \(70\).) Tj 12.0769 -17.8146 TD -0.0313 Tc 1.6201 Tw (Some special care unit operators and others say) Tj -11.82 -11.9577 TD -0.0386 Tc 1.8849 Tw (ongoing operating costs are higher for special care) Tj -0.257 -12.2018 TD -0.0144 Tc 2.1588 Tw (units than for nonspecialized nursing home units.) Tj 0.257 -12.4458 TD -0.0399 Tc 2.1065 Tw (One-third of the respondents in Weiner and Rein-) Tj ET BT 0.9835 0 0 0.9835 325.68 52.56 Tm 0.0384 Tc 0.4739 Tw (gold\222s study of a nonrandom sample of 22 special) Tj ET BT 0.934 0 0 0.9835 325.44 40.56 Tm -0.0388 Tc 1.2611 Tw (care units cited higher costs associated with opera-) Tj ET endstream endobj 270 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 271 0 obj <>stream 0.72 w 1 j 0 0 0 RG 65.28 677.04 m 542.88 677.04 l S BT 0.9835 0 0 0.9835 329.04 682.32 Tm 0 0 0 rg /F5 10 Tf 0.0223 Tc 2.4787 Tw (Chapter 3-Findings From Descriptive Studies . 99) Tj ET BT 0.8915 0 0 0.9835 66 643.44 Tm /F4 10 Tf 0.0222 Tc 0.9921 Tw (tion of the unit, whereas the other two-thirds did not) Tj 0.2692 -12.4458 TD 0.034 Tc 1.248 Tw (\(485\). Of the 13 special care units in Florida studied) Tj ET BT 0.934 0 0 0.9835 66 618.96 Tm -0.0365 Tc 0.7977 Tw (by Cairl et al., 7 reported higher operating costs for) Tj ET BT 0.8915 0 0 0.9835 66.24 606.96 Tm 0.048 Tc 1.1014 Tw (the special care unit than for nonspecialized units in) Tj ET BT 0.9835 0 0 0.9835 66.48 594.96 Tm 0.0379 Tc 3.49 Tw (the same facility; 5 reported no difference in) Tj ET BT 0.8915 0 0 0.9835 66.48 582.96 Tm 0.0358 Tc 1.1776 Tw (operating costs, and 1 reported lower operating costs) Tj ET BT 0.9835 0 0 0.9835 66.96 570.72 Tm 0.0326 Tc 0.7064 Tw (\(64\). Two studies of individual special care units) Tj ET BT 0.934 0 0 0.9835 66.72 559.2 Tm -0.0422 Tc 1.7786 Tw (found no difference in operating costs between the) Tj 0.5139 -12.4458 TD -0.0337 Tc 2.051 Tw (special care units they studied and nonspecialized) Tj -0.257 -11.9577 TD 0.0021 Tc 0.762 Tw (units in the same facilities \(70,265\).) Tj ET BT 0.9835 0 0 0.9835 77.76 517.44 Tm 0.0261 Tc 1.2185 Tw (The Multi-State Nursing Home Case Mix and) Tj -10.4935 -12.2018 TD 0.0227 Tc 1.1 Tw (Quality Demonstration, a 5-year congressionally) Tj ET BT 0.934 0 0 0.9835 66.96 493.68 Tm -0.0162 Tc 0.5761 Tw (mandated study that included 20 special care units,) Tj ET BT 0.8915 0 0 0.9835 67.68 481.68 Tm 0.0167 Tc 0.9982 Tw (found that on average the amount of staff time spent) Tj 0 -12.6899 TD 0.0421 Tc 0.6033 Tw (caring for residents with dementia was greater in the) Tj 0.2692 -11.9577 TD 0.0471 Tc 0.9006 Tw (special care units than in the nonspecialized units in) Tj ET BT 0.9835 0 0 0.9835 67.68 445.44 Tm 0.0362 Tc 3.2825 Tw (the study sample \(143\). As noted earlier, the) Tj ET BT 0.934 0 0 0.9835 67.68 433.2 Tm -0.0154 Tc 1.3094 Tw (University of North Carolina study of 31 randomly) Tj ET BT 0.9835 0 0 0.9835 68.4 421.44 Tm 0.0415 Tc 0.5114 Tw (selected special care units and 32 nonspecialized) Tj ET BT 0.934 0 0 0.9835 67.92 409.44 Tm -0.003 Tc 0.4335 Tw (nursing home units in 5 States had similar findings) Tj ET BT 0.8915 0 0 0.9835 68.4 397.44 Tm 0.0255 Tc 1.5304 Tw (\(413\). The greater amount of staff time spent caring) Tj 0 -11.9577 TD 0.0448 Tc 1.5905 Tw (for special care unit residents translates into higher) Tj ET BT 0.934 0 0 0.9835 68.4 373.92 Tm -0.03 Tc 0.5909 Tw (average operating costs in the special care units.) Tj ET BT 0.8915 0 0 0.9835 79.92 356.16 Tm 0.0409 Tc 0.8065 Tw (Citing higher operating costs, some nursing homes) Tj -12.6521 -11.9577 TD 0.07 Tc 0.2625 Tw (charge more for care in their special care unit than in) Tj ET BT 0.934 0 0 0.9835 68.88 332.64 Tm -0.0352 Tc 1.2388 Tw (their nonspecialized units. To OTA\222s knowledge, no) Tj ET BT 0.9835 0 0 0.9835 68.4 320.4 Tm 0.0222 Tc -0.0282 Tw (public program currently pays more for care of an) Tj ET BT 0.8915 0 0 0.9835 68.88 308.64 Tm 0.053 Tc 0.5388 Tw (individual in a special care unit than in a nonspecial-) Tj ET BT 0.934 0 0 0.9835 69.12 296.64 Tm -0.014 Tc 0.638 Tw (ized nursing home unit. Thus, it is only private-pay) Tj ET BT 0.9835 0 0 0.9835 68.88 284.64 Tm 0.0294 Tc 0.605 Tw (residents who may be charged more for care in a) Tj 0.7321 -12.4458 TD 0.0296 Tc 0.171 Tw (special care unit than they would be charged in a) Tj ET BT 0.934 0 0 0.9835 69.12 260.64 Tm -0.0216 Tc 0.8388 Tw (nonspecialized unit in the same facility.) Tj ET BT 0.8915 0 0 0.9835 80.64 242.64 Tm 0.0436 Tc 2.2841 Tw (Compared with nonspecialized units, special care) Tj ET BT 0.934 0 0 0.9835 69.36 230.64 Tm -0.0311 Tc 0.9224 Tw (units generally have a higher proportion of private-) Tj ET BT 0.9835 0 0 0.9835 69.12 218.64 Tm 0.0259 Tc 3.293 Tw (pay residents \(292,413,477\). The University of) Tj 0.244 -11.9577 TD 0.0338 Tc 3.0409 Tw (North Carolina study of 31 randomly selected) Tj 0.7321 -12.2018 TD 0.0344 Tc 0.1526 Tw (special care units and 32 matched nonspecialized) Tj -0.244 -12.4458 TD 0.0333 Tc 1.3637 Tw (units found, for example, that 60 percent of the) Tj ET BT 0.934 0 0 0.9835 70.32 170.88 Tm -0.0382 Tc 2.3983 Tw (special care unit residents were private-pay, com-) Tj ET BT 0.9835 0 0 0.9835 69.84 158.64 Tm 0.0472 Tc 2.9663 Tw (pared with 30 percent of the residents of the) Tj ET BT 0.8915 0 0 0.9835 69.84 146.64 Tm 0.0396 Tc 1.4811 Tw (nonspecialized units \(413\). Six of the 31 special care) Tj ET BT 0.934 0 0 0.9835 70.08 134.88 Tm -0.0255 Tc 0.6961 Tw (units did not accept Medicaid payment at all.) Tj ET BT 0.8915 0 0 0.9835 81.36 117.12 Tm 0.027 Tc 0.9568 Tw (The University of North Carolina study found that) Tj ET BT 0.9835 0 0 0.9835 70.56 104.88 Tm 0.0324 Tc 1.0359 Tw (79 percent of the special care units in the study) Tj ET BT 0.934 0 0 0.9835 70.8 93.12 Tm -0.0364 Tc 1.026 Tw (sample charged private-pay residents more for care) Tj ET BT 0.8915 0 0 0.9835 70.56 81.36 Tm 0.0446 Tc 0.3089 Tw (in the special care unit than the residents would have) Tj ET BT 0.934 0 0 0.9835 70.32 69.36 Tm -0.0206 Tc 1.6407 Tw (been charged in a nonspecialized unit in the same) Tj ET BT 0.9835 0 0 0.9835 70.56 57.36 Tm 0.0282 Tc 0.9549 Tw (facility \(415\). The excess charge varied from one) Tj ET BT 0.934 0 0 0.9835 70.32 45.6 Tm -0.0095 Tc 1.14 Tw (unit to another and from State to State. The mean) Tj ET BT 0.8915 0 0 0.9835 70.32 33.6 Tm 0.048 Tc 1.2697 Tw (excess charge ranged from $3.17 a day in intermedi-) Tj ET BT 0.934 0 0 0.9835 317.04 643.44 Tm -0.0101 Tc 0.9807 Tw (ate care facilities \(ICFs\) in Ohio to $19.75 a day in) Tj 0.257 -12.4458 TD -0.0183 Tc 0.9895 Tw (skilled nursing facilities \(SNFs\) in California.) Tj ET BT 0.8915 0 0 0.9835 327.84 613.2 Tm 0.0477 Tc 1.7411 Tw (Preliminary data from the 1991 George Washing-) Tj ET BT 0.9835 0 0 0.9835 317.28 600.96 Tm 0.0212 Tc 2.6703 Tw (ton University survey of all special care units) Tj ET BT 0.934 0 0 0.9835 317.28 589.44 Tm -0.022 Tc 1.0962 Tw (nationwide indicate about half of the units charged) Tj 0 -12.4458 TD -0.036 Tc 1.6251 Tw (private-pay residents more in the special care unit) Tj ET BT 0.9835 0 0 0.9835 317.52 564.96 Tm 0.0366 Tc 0.5367 Tw (than the residents would have been charged in a) Tj ET BT 0.934 0 0 0.9835 317.52 553.2 Tm -0.0126 Tc 1.8203 Tw (nonspecialized unit in the same facility \(246\). The) Tj ET BT 0.8915 0 0 0.9835 317.76 540.96 Tm 0.0521 Tc 1.0632 Tw (excess charge averaged $9.24 a day and ranged from) Tj ET BT 0.934 0 0 0.9835 318 528.72 Tm 0.0372 Tc 0.5189 Tw ($1 to $83 a day.) Tj ET BT 0.8915 0 0 0.9835 329.04 511.44 Tm 0.0151 Tc 1.2393 Tw (Lastly, a small pilot study that compared monthly) Tj ET BT 0.9835 0 0 0.9835 318.24 499.44 Tm 0.0211 Tc 0.1255 Tw (charges for care in two nursing home special care) Tj ET BT 0.934 0 0 0.9835 318.24 487.2 Tm -0.0194 Tc 0.653 Tw (units and two nonspecialized nursing home units in) Tj ET BT 0.8915 0 0 0.9835 318.48 475.2 Tm 0.0529 Tc 1.3123 Tw (California found the special care units charged their) Tj ET BT 0.934 0 0 0.9835 318.24 463.44 Tm -0.0131 Tc 1.4538 Tw (residents an average of $3196 per month, whereas) Tj 0.257 -12.4458 TD -0.0323 Tc 1.2785 Tw (the nonspecialized units charged their residents an) Tj 0.5139 -12.2018 TD 0.012 Tc 1.0598 Tw (average of $2803 per month \(256\).) Tj ET BT 0.9663 0 0 0.9939 325.44 407.28 Tm /F6 14 Tf 0.0231 Tc 2.4351 Tw (DESCRIPTIVE TOPOLOGIES OF) Tj 33.0334 -16.1791 TD 0.0382 Tc 1.7987 Tw (SPECIAL CARE UNITS) Tj ET BT 0.934 0 0 0.9835 330.48 373.44 Tm /F4 10 Tf -0.0367 Tc 0.7449 Tw (Several topologies of special care units have been) Tj ET BT 0.9835 0 0 0.9835 319.44 361.92 Tm 0.048 Tc 0.8302 Tw (developed based on information from descriptive) Tj 0.244 -11.9577 TD 0.0394 Tc 2.5472 Tw (studies. Three topologies based on information) Tj 0 -12.2018 TD 0.0307 Tc 2.2074 Tw (about unit goals were discussed earlier in this) Tj 0 -12.4458 TD 0.0333 Tc 0.8451 Tw (chapter. OTA is aware of three other descriptive) Tj ET BT 0.934 0 0 0.9835 319.68 314.16 Tm -0.0266 Tc 2.0188 Tw (topologies based on information about a variety of) Tj 0 -12.2018 TD -0.0367 Tc 1.8462 Tw (unit characteristics. One of the topologies is based) Tj ET BT 0.9835 0 0 0.9835 319.92 289.92 Tm 0.0413 Tc 0.0235 Tw (on information about 13 of the 31 VA special care) Tj 0 -11.9577 TD 0.0382 Tc 0.4567 Tw (units identified by the 1989 VA survey discussed) Tj ET BT 0.934 0 0 0.9835 320.16 266.16 Tm -0.0403 Tc 1.0791 Tw (earlier in this chapter. This typology reflects differ-) Tj 0 -12.2018 TD -0.0202 Tc 0.4947 Tw (ences among the units in their goals and the typical) Tj ET BT 0.8915 0 0 0.9835 320.4 242.4 Tm 0.0207 Tc 0.8904 Tw (length of stay in the unit \(103\). On the basis of these) Tj 0 -12.4458 TD 0.025 Tc 1.5743 Tw (differences, three types of units were identified. One) Tj 0 -11.9577 TD 0.0271 Tc 1.2259 Tw (type of unit has a relatively short length of stay and) Tj ET BT 0.9835 0 0 0.9835 320.4 206.88 Tm 0.0237 Tc 0.0252 Tw (focuses primarily on diagnosis, short-term behav-) Tj 0.244 -12.2018 TD 0.0266 Tc 2.7554 Tw (ioral stabilization, and discharge placement. A) Tj ET BT 0.8915 0 0 0.9835 321.12 182.64 Tm 0.0267 Tc 0.329 Tw (second type of unit has an intermediate length of stay) Tj ET BT 0.9835 0 0 0.9835 321.12 170.64 Tm 0.0355 Tc 1.0056 Tw (and focuses on behavioral management and dis-) Tj ET BT 0.8915 0 0 0.9835 321.12 158.64 Tm 0.0414 Tc 1.2397 Tw (charge placement. The third type of unit has a more) Tj ET BT 0.9835 0 0 0.9835 321.12 146.64 Tm 0.0373 Tc 0.597 Tw (extended length of stay and focuses primarily on) Tj ET BT 0.8915 0 0 0.9835 321.12 134.88 Tm 0.0345 Tc 3.1019 Tw (long-term supportive care.) Tj ET BT 0.934 0 0 0.9835 332.16 117.12 Tm -0.0264 Tc 1.3579 Tw (A second typology is based on information about) Tj ET BT 0.9835 0 0 0.9835 321.6 104.88 Tm 0.0305 Tc 0.3599 Tw (a nonrandom sample of 13 special care units in a) Tj 0.9761 -11.7137 TD 0.0277 Tc 0.7113 Tw (10-county area of west central Florida \(64\). This) Tj ET BT 0.934 0 0 0.9835 321.36 81.12 Tm -0.0291 Tc 1.5076 Tw (typology reflects differences among the units in 13) Tj ET BT 0.8915 0 0 0.9835 321.12 69.12 Tm 0.0402 Tc 2.2879 Tw (characteristics: their origin and philosophy, motives) Tj ET BT 0.934 0 0 0.9835 321.36 57.12 Tm -0.038 Tc 1.2847 Tw (for development, level of commitment, target popu-) Tj ET BT 0.9835 0 0 0.9835 321.12 45.12 Tm 0.0328 Tc 3.2372 Tw (lation, policies and procedures, admission and) Tj ET BT 0.934 0 0 0.9835 321.12 32.88 Tm -0.0259 Tc 1.5115 Tw (discharge criteria, assessment and followup, physi-) Tj ET endstream endobj 272 0 obj <>/Rotate 0/Type/Page>> endobj 273 0 obj <>stream 0.72 w 1 j 0 0 0 RG 67.68 686.88 m 546 686.88 l S 68.16 643.68 m 546.48 643.68 l S 68.4 608.64 m 546.96 608.64 l S 69.12 541.92 m 547.2 541.92 l S BT 0.9835 0 0 0.9835 68.4 692.64 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (100 ) Tj ET BT 0.9598 0 0 0.9598 86.4 692.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 92.64 692.64 Tm /F5 10 Tf 0.0125 Tc 1.038 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 144.48 653.28 Tm /F3 9 Tf 0.0443 Tc 0.7037 Tw (Table 3-4-Ratings on Some Variables for Eight Types of Special Care Units) Tj ET BT 0.798 0 0 0.9835 244.8 635.04 Tm /F2 10 Tf -0.04 Tc -0.0449 Tw (Staff ) Tj ET BT 0.8027 0 0 0.9939 262.32 635.04 Tm /F3 7 Tf 0.0116 Tc 0 Tw (with) Tj ET BT 0.8645 0 0 0.9939 242.4 627.12 Tm 0.2375 Tc (specialized) Tj ET BT 0.9262 0 0 0.9939 412.08 627.12 Tm -0.0024 Tc (Staff) Tj ET BT 0.8645 0 0 0.9939 498.48 627.12 Tm 0.2142 Tc (Administrative) Tj -405.0381 -8.2103 TD -0.0427 Tc 4.2103 Tw (Cleanliness of) Tj 115.4872 0 TD -0.0518 Tc 0 Tw (training) Tj ET BT 0.9262 0 0 0.9939 294.48 618.96 Tm 0.0371 Tc (Staff/patient) Tj 60.8906 0.2415 TD 0.0249 Tc 0.6176 Tw (Staff attitudes) Tj ET BT 0.8645 0 0 0.9939 409.92 618.96 Tm -0.0142 Tc 0 Tw (stress) Tj 38.3107 0.2415 TD 0.2142 Tc (Administrative) Tj ET BT 0.9262 0 0 0.9939 507.12 619.2 Tm 0.0401 Tc (attitudes) Tj ET BT 0.8645 0 0 0.9939 68.4 611.52 Tm 0.1478 Tc (Type) Tj 96.3319 -0.2415 TD -0.03 Tc 3.0851 Tw (public areas) Tj 66.072 -0.2415 TD 0.2065 Tc 0 Tw (Odors) Tj 38.3107 0.2415 TD -0.0597 Tc 3.3971 Tw (in dementia) Tj 64.1287 -0.2415 TD -0.0489 Tc 0 Tw (interaction) Tj 59.6869 0.2415 TD -0.0473 Tc 4.7708 Tw (toward patients) Tj 73.5676 -0.2415 TD -0.0053 Tc 0 Tw (level) Tj 42.4749 0 TD -0.0705 Tc (philosophy) Tj 55.2451 0.2415 TD -0.0473 Tc 4.7708 Tw (toward patients) Tj ET BT 0.7567 0 0 0.99 69.12 600.48 Tm /F3 8 Tf -0.0102 Tc 0.2872 Tw (Ideal . . . . . . . . . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 163.92 600.24 Tm /F3 7 Tf 0.2209 Tc 0 Tw (High) Tj ET BT 0.8645 0 0 0.9939 214.08 600 Tm 0.1913 Tc (No) Tj 46.6391 0 TD 0.0119 Tc (Yes) Tj ET BT 0.8027 0 0 0.9939 306.96 600 Tm 0.2209 Tc (High) Tj ET BT 0.8645 0 0 0.9939 362.88 600 Tm 0.1906 Tc (Caring) Tj ET BT 0.8027 0 0 0.9939 413.52 599.76 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 447.12 600 Tm 0.0667 Tc (Therapeutic) Tj ET BT 0.8645 0 0 0.9939 510.96 600 Tm 0.1906 Tc (Caring) Tj -511.0865 -7.4859 TD -0.0326 Tc 0.6514 Tw (Uncultivated . . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 163.92 592.08 Tm 0.2209 Tc 0 Tw (High) Tj ET BT 0.8645 0 0 0.9939 214.08 591.84 Tm 0.1913 Tc (No) Tj 46.6391 0 TD 0.0119 Tc (Yes) Tj 60.7974 0 TD -0.0725 Tc (High) Tj 64.684 0 TD 0.1906 Tc (Caring) Tj 57.7436 0 TD -0.0725 Tc (High) Tj ET BT 0.9262 0 0 0.9939 445.68 591.84 Tm 0.0546 Tc (Maintenance) Tj 65.5546 0 TD 0.0542 Tc (Apathetic) Tj ET BT 0.8645 0 0 0.9939 69.36 584.64 Tm -0.0365 Tc 0.4175 Tw (Heart of gold . . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 164.64 584.16 Tm 0.3145 Tc 0 Tw (Low) Tj ET BT 0.8645 0 0 0.9939 214.32 583.92 Tm 0.1913 Tc (No) Tj 46.6391 0 TD 0.0119 Tc (Yes) Tj ET BT 0.8027 0 0 0.9939 307.2 583.92 Tm 0.2209 Tc (High) Tj ET BT 0.8645 0 0 0.9939 363.12 583.92 Tm 0.1906 Tc (Caring) Tj ET BT 0.8027 0 0 0.9939 413.04 583.68 Tm 0.2209 Tc (High) Tj ET BT 0.9262 0 0 0.9939 447.12 583.92 Tm 0.0667 Tc (Therapeutic) Tj ET BT 0.8645 0 0 0.9939 511.2 583.92 Tm 0.1906 Tc (Caring) Tj ET BT 0.9262 0 0 0.9939 69.36 576.72 Tm 0.0649 Tc 0.0562 Tw (Rotten at the core . . . .) Tj ET BT 0.8645 0 0 0.9939 163.92 576 Tm -0.0725 Tc 0 Tw (High) Tj 58.2988 0 TD 0.1913 Tc (No) Tj ET BT 0.8027 0 0 0.9939 256.08 576 Tm 0.4153 Tc (No) Tj 64.5777 0 TD 0.1152 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 358.32 576 Tm 0.0542 Tc (Apathetic) Tj ET BT 0.8027 0 0 0.9939 413.76 575.76 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 445.92 576 Tm 0.0546 Tc (Maintenance) Tj 65.2954 0 TD 0.0542 Tc (Apathetic) Tj ET BT 0.8645 0 0 0.9939 69.36 568.8 Tm -0.0369 Tc 0.4835 Tw (Institutional . . . . . . . . . .) Tj 109.6573 -0.483 TD -0.0725 Tc 0 Tw (High) Tj 56.6332 -0.2415 TD 0.0119 Tc (Yes) Tj 49.6928 0 TD 0.1913 Tc (No) Tj 59.1317 0 TD -0.0725 Tc (High) Tj 64.684 0 TD 0.1906 Tc (Caring) Tj ET BT 0.8027 0 0 0.9939 413.76 568.08 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 445.92 568.08 Tm 0.0546 Tc (Maintenance) Tj ET BT 0.8645 0 0 0.9939 511.2 568.08 Tm 0.1906 Tc (Caring) Tj -511.0865 -7.4859 TD -0.0246 Tc 0.2829 Tw (Limited . . . . . . . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 164.88 560.16 Tm 0.3145 Tc 0 Tw (Low) Tj ET BT 0.8645 0 0 0.9939 213.12 560.16 Tm 0.0119 Tc (Yes) Tj ET BT 0.8027 0 0 0.9939 256.32 560.16 Tm 0.4153 Tc (No) Tj 64.2787 0 TD 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 358.56 559.92 Tm 0.0542 Tc (Apathetic) Tj ET BT 0.8027 0 0 0.9939 414 559.92 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 447.36 559.92 Tm 0.0667 Tc (Therapeutic) Tj ET BT 0.8645 0 0 0.9939 511.2 559.92 Tm 0.1906 Tc (Caring) Tj ET BT 0.9262 0 0 0.9939 69.12 552.72 Tm 0.1002 Tc 0.0181 Tw (Conventional . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 164.88 552.24 Tm 0.3145 Tc 0 Tw (Low) Tj ET BT 0.8645 0 0 0.9939 213.12 552.24 Tm 0.0119 Tc (Yes) Tj ET BT 0.8027 0 0 0.9939 256.32 552.24 Tm 0.4153 Tc (No) Tj 64.5777 0 TD 0.3145 Tc (Low) Tj ET BT 0.8645 0 0 0.9939 363.36 552.24 Tm 0.1906 Tc (Caring) Tj ET BT 0.8027 0 0 0.9939 413.28 552 Tm 0.2209 Tc (High) Tj ET BT 0.9262 0 0 0.9939 446.16 552.24 Tm 0.0546 Tc (Maintenanca) Tj 65.2954 0 TD 0.0542 Tc (Apathetic) Tj -471.8373 -7.4859 TD 0.0865 Tc 0.0329 Tw (Execrable . . . . . . . . . . .) Tj ET BT 0.8027 0 0 0.9939 164.88 544.32 Tm 0.3145 Tc 0 Tw (Low) Tj ET BT 0.8645 0 0 0.9939 213.12 544.32 Tm 0.0119 Tc (Yes) Tj 49.9704 0 TD 0.1913 Tc (No) Tj ET BT 0.8027 0 0 0.9939 308.16 544.32 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 358.56 544.08 Tm 0.0542 Tc (Apathetic) Tj ET BT 0.8027 0 0 0.9939 414 544.08 Tm 0.3145 Tc (Low) Tj ET BT 0.9262 0 0 0.9939 446.4 544.08 Tm 0.0546 Tc (Maintenance) Tj 65.2954 0.2415 TD 0.0542 Tc (Apathetic) Tj -472.0964 -10.6251 TD 0.0517 Tc 0.0706 Tw (SOURCE: ) Tj ET q 11.04 0 0 -5.52 102.24 539.28 cm BI /W 64 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ????>~>>???>~~ EI Q BT 0.8027 0 0 0.9939 102.24 533.76 Tm 3 Tr 0.0565 Tc 0 Tw (D.T.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 113.28 533.76 Tm 0.0999 Tc 0.0184 Tw ( Gold, ) Tj ET q 12 0 0 -5.52 134.16 539.04 cm BI /W 71 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x>|>~?~?|>x||||?~ EI Q BT 0.8645 0 0 0.9939 134.16 533.76 Tm 3 Tr -0.004 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 146.16 533.76 Tm 0.0695 Tc 0.0513 Tw ( Sloane, ) Tj ET q 10.08 0 0 -5.28 173.52 538.8 cm BI /W 59 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?~?|?||||||||||||||x EI Q BT 0.8027 0 0 0.9939 173.52 533.76 Tm 3 Tr 0.0481 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 183.6 533.76 Tm 0.0609 Tc 0.1254 Tw ( Mathew, et al., \223Special Care Units: A ) Tj ET q 26.64 0 0 -6.48 305.28 539.28 cm BI /W 155 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?||<<|~~?>?~?~|~~~||~>π|~?π<>??<>>|?<>>~?<~|>?<>|>>|>|~|>~~>>>?>>?>>|>>|>@>>? EI Q BT 0.8027 0 0 0.9939 305.28 533.76 Tm 3 Tr -0.0416 Tc 0 Tw (Typology) Tj 0 Tr ET BT 0.9262 0 0 0.9939 331.92 533.76 Tm 0.0683 Tc 0.2469 Tw ( of Care Settings for Memory-lmpaired Older Adults,\224 ) Tj 184.4855 0 TD /F11 7 Tf 0.0764 Tc 0 Tw (Gerontologist) Tj ET q 4.8 0 0 -0.48 330.72 532.08 cm BI /W 27 /H 3 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  EI Q BT 0.7608 0 0 0.9835 330.72 531.6 Tm 3 Tr /F1 10 Tf 0.0974 Tc (-.) Tj 0 Tr ET q 31.44 0 0 -6.96 103.2 531.36 cm BI /W 175 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >0<8|x<||xx<|<~<<~>>|~?>>|~>>|?||><>?>>>>p|`|~x~>x?<x><x>~<x>><|>?<|>|x~||||~|||>||`>?~??~???x~<>  EI Q BT 0.9262 0 0 0.9939 103.2 525.84 Tm 3 Tr /F3 7 Tf 0.0088 Tc (31\(4\):470,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 134.64 525.84 Tm -0.0278 Tc 0.254 Tw ( 1991,) Tj ET BT 0.9835 0 0 0.9835 69.84 498 Tm /F4 10 Tf 0.015 Tc 0.9126 Tw (cal environment, activity programs, staffing pat-) Tj ET BT 0.8915 0 0 0.9835 69.84 486 Tm 0.0152 Tc 1.957 Tw (terns, staff training, family involvement, and efforts) Tj ET BT 0.9835 0 0 0.9835 69.84 474.24 Tm 0.0386 Tc 3.3411 Tw (to evaluate the impact of the unit. Based on) Tj ET BT 0.934 0 0 0.9835 69.84 462.24 Tm -0.02 Tc 1.6815 Tw (differences among the units in these 13 character-) Tj ET BT 0.8915 0 0 0.9835 69.84 450.72 Tm 0.0273 Tc 1.7255 Tw (istics, the researchers identified three types of units) Tj ET BT 0.9835 0 0 0.9835 70.08 438.48 Tm 0.0231 Tc 0.1234 Tw (that, in their view, reflect the extent to which the) Tj ET BT 0.934 0 0 0.9835 70.08 426.48 Tm -0.0364 Tc 2.1823 Tw (units were tailored for individuals with dementia:) Tj ET BT 0.9835 0 0 0.9835 70.8 414.96 Tm 0.2597 Tc 3.6653 Tw (\223highly specific\224 units, \223moderately specific\224) Tj -0.7321 -11.9577 TD -0.0035 Tc 0.7605 Tw (units, and \221\221minimally specific\222 units.) Tj 11.4697 -24.1595 TD 0.0427 Tc 2.5438 Tw (A third descriptive typology is based on the) Tj ET BT 0.8915 0 0 0.9835 70.56 367.2 Tm 0.0234 Tc 1.3982 Tw (findings of the University of North Carolina study of) Tj ET BT 0.9835 0 0 0.9835 70.8 354.96 Tm 0.0336 Tc 1.8906 Tw (31 randomly selected special care units and 32) Tj -0.244 -11.7137 TD 0.0238 Tc 0.8954 Tw (matched nonspecialized nursing home units in 5) Tj ET BT 0.934 0 0 0.9835 70.8 331.2 Tm -0.0166 Tc 1.1639 Tw (States. This typology was derived from an analysis) Tj ET BT 0.8915 0 0 0.9835 71.04 318.96 Tm 0.0417 Tc 0.7864 Tw (of narrative accounts dictated by an investigator who) Tj ET BT 0.9835 0 0 0.9835 70.56 307.44 Tm 0.0305 Tc 1.9287 Tw (visited each of the units \(154\). These narrative) Tj ET BT 0.934 0 0 0.9835 71.28 295.2 Tm -0.0232 Tc 0.498 Tw (accounts were available for 28 of the 31 special care) Tj ET BT 0.8915 0 0 0.9835 70.8 282.96 Tm 0.037 Tc 1.0053 Tw (units and 27 of the 32 nonspecialized units. The unit) Tj ET BT 0.9835 0 0 0.9835 71.28 271.44 Tm 0.0336 Tc 2.7158 Tw (characteristics used in the development of the) Tj 0 -12.4458 TD 0.0322 Tc 1.0089 Tw (typology include: appearance of the units\222 public) Tj ET BT 0.934 0 0 0.9835 71.28 247.44 Tm -0.0094 Tc 0.6202 Tw (area, general maintenance, cleanliness, unit layout,) Tj ET BT 0.9835 0 0 0.9835 71.04 235.68 Tm 0.036 Tc 2.3763 Tw (presence of an activity room, decoration of the) Tj ET BT 0.8915 0 0 0.9835 71.04 223.2 Tm 0.0424 Tc 1.8817 Tw (public areas \(institutional or home-like\), noise level,) Tj ET BT 0.934 0 0 0.9835 71.52 210.96 Tm -0.034 Tc 1.4762 Tw (odor, ambiance \(depressing or cheerful\), size of the) Tj 0 -11.9577 TD -0.0491 Tc 1.939 Tw (facility for the population \(crowded or uncrowded\),) Tj ET BT 0.9835 0 0 0.9835 71.28 186.96 Tm 0.0257 Tc 0.5112 Tw (resident living arrangements \(shared or private\),) Tj ET BT 0.934 0 0 0.9835 71.28 174.96 Tm -0.0475 Tc 2.4725 Tw (resident appearance \(ill-groomed or well-groomed\),) Tj ET BT 0.8915 0 0 0.9835 71.52 162.96 Tm 0.0486 Tc 0.8727 Tw (resident location during the day \(in their rooms or in) Tj ET BT 0.9835 0 0 0.9835 72 150.72 Tm 0.029 Tc 0.4834 Tw (the public areas\), resident activity level, resident) Tj 0 -11.9577 TD 0.0268 Tc 0.4683 Tw (wandering, use of physical restraints, use of psy-) Tj ET BT 0.934 0 0 0.9835 72 126.72 Tm -0.0427 Tc 1.0328 Tw (chotropic medications, presence of an activity direc-) Tj ET BT 0.9835 0 0 0.9835 72.24 114.96 Tm 0.0235 Tc 1.0991 Tw (tor, staff relations with the administration, staff) Tj ET BT 0.8915 0 0 0.9835 72.72 102.96 Tm 0.006 Tc 1.4802 Tw (stress level, staff training in dementia, staff attitude) Tj -0.5384 -11.7137 TD 0.0185 Tc 2.3122 Tw (toward residents \(apathetic or caring\), staff/resident) Tj ET BT 0.934 0 0 0.9835 72.48 79.44 Tm -0.0298 Tc 1.0532 Tw (interaction \(high or low\), administrative philosophy) Tj ET BT 0.8915 0 0 0.9835 72.72 67.68 Tm 0.0432 Tc 1.477 Tw (\(maintenance or therapeutic\), admission criteria \(lax) Tj ET BT 0.934 0 0 0.9835 72.48 55.68 Tm -0.0304 Tc 2.0045 Tw (or strict\), the administration\222s attitude toward the) Tj -0.5139 -11.9577 TD -0.0267 Tc 1.915 Tw (residents \(apathetic or caring\), and involvement of) Tj ET BT 0.8915 0 0 0.9835 320.64 497.28 Tm 0.0319 Tc 1.605 Tw (the administration in resident care. Based on differ-) Tj ET BT 0.934 0 0 0.9835 320.64 485.28 Tm -0.0236 Tc 1.4283 Tw (ences among the units in these characteristics, the) Tj ET BT 0.9835 0 0 0.9835 320.4 473.76 Tm 0.0344 Tc 0.2746 Tw (researchers identified eight types of units: \223ideal,) Tj 0.244 -12.4458 TD 0.0264 Tc 2.6649 Tw (uncultivated, heart of gold, rotten at the core,) Tj ET BT 0.934 0 0 0.9835 321.12 449.76 Tm -0.0223 Tc 1.0452 Tw (institutional, limited, conventional, and execrable. \222) Tj -0.257 -12.2018 TD -0.0215 Tc 0.9159 Tw (Table 3-4 shows the ratings of each of the types for) Tj ET BT 0.8915 0 0 0.9835 321.12 425.52 Tm 0.0375 Tc 1.7526 Tw (eight of the characteristics.) Tj ET BT 0.9835 0 0 0.9835 332.16 408.24 Tm 0.0352 Tc 2.5921 Tw (The typology based on information from the) Tj -10.9816 -11.9577 TD 0.024 Tc 2.1154 Tw (University of North Carolina study reflects the) Tj 0 -12.2018 TD 0.0238 Tc 1.5869 Tw (characteristics of the special care units and the) Tj ET BT 0.934 0 0 0.9835 321.12 372.48 Tm -0.0132 Tc 0.8299 Tw (nonspecialized units in the study sample \(154\). The) Tj 0 -11.9577 TD -0.0459 Tc 1.232 Tw (researchers found a larger proportion of the special) Tj 0.7709 -12.6899 TD -0.035 Tc 1.1673 Tw (care units in the study sample were in the positive) Tj ET BT 0.8915 0 0 0.9835 321.84 336.24 Tm 0.0409 Tc 0.5643 Tw (types: 43 percent of the special care units were in the) Tj ET BT 0.934 0 0 0.9835 322.56 324.72 Tm -0.0333 Tc 1.8792 Tw (\221\221ideal\224 type; 11 percent were in the \221uncultivated\224) Tj -0.7709 -12.4458 TD -0.0403 Tc 0.6276 Tw (type, and 4 percent were in the \223heart of gold\224 type.) Tj ET BT 0.8915 0 0 0.9835 321.84 300.24 Tm 0.0441 Tc 1.2741 Tw (In contrast, none of the nonspecialized units were in) Tj ET BT 0.9835 0 0 0.9835 321.84 288.48 Tm 0.0246 Tc 0.8191 Tw (the \221ideal\222 or \221uncultivated\222 types, and 15 percent) Tj ET BT 0.934 0 0 0.9835 322.08 276.48 Tm -0.0419 Tc 1.1947 Tw (were in the \221heart of gold\222 type. None of the special) Tj ET BT 0.9835 0 0 0.9835 322.08 264.24 Tm 0.0339 Tc 3.1018 Tw (care units were in two of the negative types,) Tj 0.7321 -11.7137 TD 0.0298 Tc 4.8753 Tw (\223conventional\224 and \223execrable,\224) Tj 159.3553 0 TD 0.0498 Tc 0.0149 Tw (and only 7 per-) Tj ET BT 0.934 0 0 0.9835 322.32 240.72 Tm -0.0386 Tc 1.0626 Tw (cent of the special care units were in the \221\221rotten at) Tj ET BT 0.9835 0 0 0.9835 322.56 228.48 Tm 0.0339 Tc 3.1802 Tw (the core\224 type. Of the nonspecialized units, 7) Tj ET BT 0.934 0 0 0.9835 322.08 216.72 Tm -0.0423 Tc 1.3382 Tw (percent were in the \223conventional\224 type; 11 percent) Tj ET BT 0.9835 0 0 0.9835 322.56 204.24 Tm 0.0398 Tc 0.0455 Tw (were in the \223execrable\224 type, and 15 percent were) Tj ET BT 0.934 0 0 0.9835 322.56 192.24 Tm -0.035 Tc 0.4164 Tw (in the \221rotten at the core\222 type. Thus the special care) Tj ET BT 0.9835 0 0 0.9835 322.56 180.24 Tm 0.0274 Tc -0.0945 Tw (units seem, in general, to be providing better care) Tj ET BT 0.8915 0 0 0.9835 322.8 168.24 Tm 0.0351 Tc 0.7939 Tw (than the nonspecialized units for their residents with) Tj 0 -12.2018 TD 0.0171 Tc 0 Tw (dementia.) Tj 12.1137 -18.3027 TD 0.0457 Tc 1.5511 Tw (As noted earlier, topologies are useful in thinking) Tj -11.5754 -11.9577 TD 0.0458 Tc 1.474 Tw (about differences among special care units, although) Tj -0.2692 -11.9577 TD 0.0533 Tc 1.0426 Tw (it is unclear whether topologies based on nonrandom) Tj ET BT 0.934 0 0 0.9835 323.52 102.96 Tm -0.0169 Tc 0.8338 Tw (samples, such as the typology based on information) Tj ET BT 0.8915 0 0 0.9835 323.28 91.2 Tm 0.0487 Tc 0.7305 Tw (about the 13 special care units in Florida, encompass) Tj ET BT 0.934 0 0 0.9835 323.28 79.2 Tm -0.0182 Tc 0.6884 Tw (the full variation among existing special care units.) Tj ET BT 0.8915 0 0 0.9835 323.28 67.44 Tm 0.0383 Tc 1.6362 Tw (The typology based on information from the Univer-) Tj 0.5384 -12.2018 TD 0.0194 Tc 0.7559 Tw (sity of North Carolina study does not suffer from this) Tj ET BT 0.9835 0 0 0.9835 323.04 43.44 Tm 0.0333 Tc -0.009 Tw (potential drawback because that study included a) Tj ET endstream endobj 274 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 275 0 obj <>stream 0.72 w 1 j 0 0 0 RG 64.08 672.24 m 542.4 672.24 l S BT 0.9835 0 0 0.9835 322.8 677.76 Tm 0 0 0 rg /F5 10 Tf 0.0193 Tc 2.2377 Tw (Chapter 3-Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 518.16 677.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 524.64 677.76 Tm /F5 10 Tf 0.2847 Tc 0 Tw (101) Tj -468.0604 -40.0218 TD /F4 10 Tf 0.0272 Tc -0.0943 Tw (random sample of special care units. On the other) Tj ET BT 0.934 0 0 0.9835 64.8 626.4 Tm -0.0145 Tc 1.0311 Tw (hand, the latter typology is based on an analysis of) Tj 0 -11.9577 TD -0.0147 Tc 2.3732 Tw (nonquantitative observations by three individuals,) Tj ET BT 0.9835 0 0 0.9835 65.28 602.64 Tm 0.0345 Tc 1.2506 Tw (one of whom visited each of the units once. The) Tj ET BT 0.934 0 0 0.9835 65.04 590.64 Tm -0.0243 Tc 0.8418 Tw (validity of these individuals\222 observations cannot be) Tj ET BT 0.8915 0 0 0.9835 65.28 578.64 Tm 0.0466 Tc 1.2488 Tw (determined. The process by which their observations) Tj ET BT 0.9835 0 0 0.9835 65.52 567.12 Tm 0.0406 Tc 0.8029 Tw (were combined to create the typology also raises) Tj ET BT 0.934 0 0 0.9835 65.28 555.12 Tm -0.0312 Tc 4.9604 Tw (methodological questions.) Tj ET BT 0.8915 0 0 0.9835 76.8 537.36 Tm 0.026 Tc 1.3808 Tw (Both topologies imply that certain types of special) Tj ET BT 0.934 0 0 0.9835 66 525.36 Tm -0.0369 Tc 1.0159 Tw (care units are more appropriate than other types of) Tj 0.257 -12.2018 TD -0.032 Tc 1.731 Tw (special care units for nursing home residents with) Tj -0.257 -11.9577 TD -0.0241 Tc 0.5846 Tw (dementia. Some of the unit characteristics on which) Tj 0.257 -11.9577 TD -0.0474 Tc 0.9949 Tw (the topologies are based are not specific for individ-) Tj ET BT 0.9835 0 0 0.9835 66.24 477.84 Tm 0.0257 Tc 0.2254 Tw (uals with dementia, however. With respect to the) Tj ET BT 0.934 0 0 0.9835 66.96 465.6 Tm -0.0237 Tc 1.2694 Tw (\221\221execrable\222 units, for example, the researchers say:) Tj ET BT 0.8915 0 0 0.9835 87.12 448.8 Tm 0.0458 Tc 0.4421 Tw (The administrators of execrable units are apa-) Tj ET BT 0.934 0 0 0.9835 76.32 437.52 Tm -0.0172 Tc 1.1645 Tw (thetic, have weak authority over staff, and are) Tj ET BT 0.8915 0 0 0.9835 76.56 426.72 Tm 0.0278 Tc 0.4623 Tw (unresponsive either to patient complaints or staff) Tj ET BT 0.8066 0 0 0.9835 76.8 415.92 Tm 0.06 Tc 0.7143 Tw (difficulties. Their lax admissions criteria result in the) Tj 0 -11.2256 TD 0.0517 Tc 0.7246 Tw (units being filled with patients who are inappropriate) Tj 0.2975 -10.9816 TD 0.0472 Tc 1.7502 Tw (for an intermediate care facility. Rather than screen) Tj ET BT 0.8491 0 0 0.9835 77.04 383.04 Tm 0.0257 Tc 0.203 Tw (out behavior problems or serious physical comorbid-) Tj 0 -10.9816 TD 0.0506 Tc 1.7283 Tw (ity, directors of execrable units encourage recruit-) Tj ET BT 0.8915 0 0 0.9835 77.52 361.2 Tm 0.0318 Tc 0.6822 Tw (ment of any potential patient. Each bed occupied) Tj ET BT 0.8491 0 0 0.9835 77.52 350.16 Tm 0.0345 Tc 0.1456 Tw (means reimbursement \(154\).) Tj ET BT 0.9835 0 0 0.9835 67.68 331.68 Tm 0.0392 Tc 2.1 Tw (Clearly, the care provided by these \223execrable\224) Tj 0 -12.2018 TD 0.0456 Tc 0.0192 Tw (units would be inappropriate for nondemented as) Tj ET BT 0.934 0 0 0.9835 67.92 307.92 Tm -0.0334 Tc 0.6459 Tw (well as demented nursing home residents.) Tj ET BT 0.9835 0 0 0.9835 78.96 290.16 Tm 0.033 Tc 1.0547 Tw (Although it is obvious poor-quality care is not) Tj ET BT 0.934 0 0 0.9835 68.4 277.68 Tm -0.0333 Tc 0.8514 Tw (appropriate for any nursing home resident, there is) Tj ET BT 0.8915 0 0 0.9835 68.16 265.68 Tm 0.0448 Tc 1.2829 Tw (very little evidence that any specific characteristic of) Tj 0 -11.9577 TD 0.0337 Tc 0.9493 Tw (nursing home units is associated with better resident) Tj ET BT 0.934 0 0 0.9835 68.64 241.68 Tm -0.0321 Tc 0.6666 Tw (outcomes. The available studies with respect to this) Tj ET BT 0.9835 0 0 0.9835 68.64 230.16 Tm 0.0244 Tc 1.8303 Tw (issue are discussed in chapter 4. Without some) Tj 0 -12.2018 TD 0.0386 Tc 0.5957 Tw (evidence of improved outcomes, it cannot be said) Tj 0.244 -12.2018 TD 0.017 Tc -0.0098 Tw (with certainty that any particular type of nursing) Tj ET BT 0.934 0 0 0.9835 68.64 194.4 Tm -0.0356 Tc 1.4412 Tw (home unit is more appropriate for individuals with) Tj ET BT 0.8915 0 0 0.9835 69.12 182.4 Tm 0.0195 Tc 0.9988 Tw (dementia, except in the sense that units that provide) Tj ET BT 0.934 0 0 0.9835 68.88 170.4 Tm -0.0394 Tc 1.6716 Tw (poor-quality care which would be inappropriate for) Tj ET BT 0.8915 0 0 0.9835 69.6 158.4 Tm 0.0339 Tc 1.2182 Tw (any resident are, by definition, providing inappropri-) Tj 0 -11.9577 TD 0.0339 Tc 1.3798 Tw (ate care for residents with dementia.) Tj ET BT 0.9663 0 0 0.9939 71.76 122.64 Tm /F6 14 Tf 0.03 Tc 3.049 Tw (CHARACTERISTICS OF SPECIAL) Tj 32.2883 -15.9376 TD 0.0523 Tc 1.9082 Tw (CARE UNIT RESIDENTS) Tj ET BT 0.9835 0 0 0.9835 80.64 89.28 Tm /F4 10 Tf 0.0304 Tc 1.2548 Tw (Many reports on individual special care units) Tj -10.9816 -11.9577 TD 0.0273 Tc 1.2347 Tw (describe residents of a particular unit, but little) Tj ET BT 0.934 0 0 0.9835 69.84 65.52 Tm -0.0107 Tc 1.0841 Tw (research-based information is available about char-) Tj ET BT 0.8915 0 0 0.9835 70.32 53.52 Tm 0.0441 Tc 1.274 Tw (acteristics of special care unit residents or about the) Tj ET BT 0.9835 0 0 0.9835 70.08 41.52 Tm 0.0239 Tc 0.4581 Tw (ways, if any, in which these residents differ from) Tj 0 -11.9577 TD 0.0303 Tc 1.2142 Tw (other nursing home residents. A few descriptive) Tj ET BT 0.934 0 0 0.9835 316.08 638.4 Tm -0.037 Tc 2.1401 Tw (studies provide information about residents of the) Tj ET BT 0.9835 0 0 0.9835 316.08 626.64 Tm 0.0333 Tc 1.2286 Tw (special care units they studied, and five studies) Tj -0.244 -12.2018 TD 0.022 Tc 1.9955 Tw (compare the characteristics of special care unit) Tj ET BT 0.8915 0 0 0.9835 315.84 603.12 Tm 0.0307 Tc 1.2218 Tw (residents and residents with dementia in nonspecial-) Tj ET BT 0.9835 0 0 0.9835 316.08 590.88 Tm 0.0289 Tc 3.4992 Tw (ized nursing home units \(see table 3-lc\). The) Tj ET BT 0.934 0 0 0.9835 316.32 579.12 Tm -0.0154 Tc 1.1993 Tw (University of North Carolina study of 31 randomly) Tj 0.5139 -12.2018 TD -0.0289 Tc 1.1036 Tw (selected special care units and 32 matched nonspe-) Tj ET BT 0.9835 0 0 0.9835 316.32 555.12 Tm 0.0255 Tc 2.5614 Tw (cialized units compared some characteristics of) Tj ET BT 0.8915 0 0 0.9835 317.04 543.36 Tm 0.0432 Tc 1.0539 Tw (special care unit residents with the characteristics of) Tj ET BT 0.934 0 0 0.9835 316.56 531.6 Tm -0.0159 Tc 1.1631 Tw (nursing home residents in general \(413\). Several of) Tj ET BT 0.9835 0 0 0.9835 316.8 519.6 Tm 0.0354 Tc -0.0286 Tw (the evaluative studies discussed in chapter 4 also) Tj ET BT 0.934 0 0 0.9835 316.56 507.84 Tm -0.0267 Tc 0.8957 Tw (provide comparative information about the baseline) Tj ET BT 0.9835 0 0 0.9835 316.8 495.84 Tm 0.0191 Tc 0.5342 Tw (characteristics of their subjects \(special care unit) Tj ET BT 0.8915 0 0 0.9835 316.8 483.84 Tm 0.0244 Tc 0.8443 Tw (residents and residents with dementia in the nonspe-) Tj ET BT 0.934 0 0 0.9835 317.28 471.6 Tm -0.0092 Tc 1.6393 Tw (cialized nursing home units\). This section summa-) Tj -0.257 -11.9577 TD -0.0318 Tc 0.8498 Tw (rizes the findings of all of these studies.) Tj 12.0769 -20.499 TD -0.0376 Tc 1.4127 Tw (Descriptive studies show that on average special) Tj ET BT 0.8915 0 0 0.9835 317.76 427.44 Tm 0.0492 Tc 0.9319 Tw (care unit residents are younger than other demented) Tj 0.2692 -11.7137 TD 0.0366 Tc 2.3458 Tw (and nondemented nursing home residents \(256,292,) Tj ET BT 0.934 0 0 0.9835 318.24 403.68 Tm -0.0149 Tc 0.6848 Tw (391,413\). Special care units residents are also more) Tj -0.257 -12.2018 TD -0.0299 Tc 0.8478 Tw (likely than other demented and nondemented nurs-) Tj 0.257 -11.9577 TD -0.0075 Tc 1.2735 Tw (ing home residents to be white and male \(256,292,) Tj 0 -12.2018 TD 0.0707 Tc 0 Tw (413,492\).) Tj ET BT 0.8915 0 0 0.9835 329.52 347.76 Tm 0.035 Tc 0.6786 Tw (Special care units admit individuals with a variety) Tj ET BT 0.9835 0 0 0.9835 318.48 335.76 Tm 0.035 Tc 0.6482 Tw (of dementia-related diagnoses, the most common) Tj ET BT 0.934 0 0 0.9835 318.48 323.76 Tm 0.0098 Tc 2.4112 Tw (being Alzheimer\222s disease \(275,292,391,413\). Resi-) Tj ET BT 0.8915 0 0 0.9835 318.72 312 Tm 0.0505 Tc 0.721 Tw (dents of special care units are much more likely than) Tj ET BT 0.934 0 0 0.9835 318.48 300 Tm -0.0352 Tc 1.8812 Tw (residents with dementia in nonspecialized units to) Tj ET BT 0.9835 0 0 0.9835 318.96 287.76 Tm 0.0217 Tc 3.0939 Tw (have a specific diagnosis, such as Alzheimer\222s) Tj ET BT 0.934 0 0 0.9835 318.96 275.52 Tm -0.0173 Tc 0.7241 Tw (disease, rather than a more general diagnosis, such) Tj 0.257 -12.2018 TD 0.003 Tc 1.7547 Tw (as senility or organic brain syndrome \(99,292,391,) Tj ET BT 0.9835 0 0 0.9835 318.96 251.76 Tm 0.0291 Tc 1.8866 Tw (413\). Not all special care unit residents have a) Tj 0.4881 -12.2018 TD 0.0316 Tc 1.4814 Tw (dementia diagnosis, however. Some special care) Tj ET BT 0.934 0 0 0.9835 319.44 228 Tm -0.0101 Tc 0.8693 Tw (units admit individuals who have behavioral symp-) Tj 0.257 -11.9577 TD -0.0121 Tc 1.0214 Tw (toms but no diagnosis of a dementing illness \(64\).) Tj ET BT 0.9835 0 0 0.9835 330.48 196.32 Tm 0.0251 Tc 1.4113 Tw (The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 319.68 184.8 Tm 0.0451 Tc 1.1671 Tw (randomly selected special care units and 32 matched) Tj ET BT 0.9835 0 0 0.9835 319.68 172.56 Tm 0.0302 Tc 0.5229 Tw (nonspecialized nursing home units found that on) Tj 0.7321 -12.2018 TD 0.0335 Tc -0.1312 Tw (average the special care unit residents were more) Tj ET BT 0.934 0 0 0.9835 320.4 148.8 Tm -0.0392 Tc 1.6714 Tw (severely cognitively impaired than residents of the) Tj ET BT 0.8915 0 0 0.9835 320.16 136.8 Tm 0.0404 Tc 1.3456 Tw (nonspecialized units, even though all the individuals) Tj 0.2692 -12.2018 TD 0.0184 Tc 1.4375 Tw (in the study sample had a dementia diagnosis \(413\).) Tj ET BT 0.934 0 0 0.9835 320.4 113.52 Tm -0.0388 Tc 1.1142 Tw (This difference in the average severity of residents\222) Tj ET BT 0.8915 0 0 0.9835 320.64 101.28 Tm 0.0423 Tc 1.0069 Tw (cognitive impairment was due to the presence on the) Tj ET BT 0.934 0 0 0.9835 320.4 89.76 Tm -0.0443 Tc 0.9732 Tw (nonspecialized units of some residents with little or) Tj ET BT 0.9835 0 0 0.9835 320.4 78 Tm 0.032 Tc 1.8226 Tw (no cognitive impairment despite their dementia) Tj ET BT 0.8915 0 0 0.9835 320.88 66 Tm 0.0153 Tc 0 Tw (diagnosis.) Tj ET BT 0.9835 0 0 0.9835 372.24 66 Tm 0.0333 Tc 2.9195 Tw (Two evaluative studies discussed in) Tj ET BT 0.8915 0 0 0.9835 320.88 53.76 Tm 0.0446 Tc 0.4285 Tw (chapter 4 also found the special care unit residents in) Tj ET BT 0.934 0 0 0.9835 320.88 41.76 Tm -0.0306 Tc 1.7478 Tw (their study samples were significantly more cogni-) Tj ET BT 0.8915 0 0 0.9835 320.88 30 Tm 0.0294 Tc 1.7617 Tw (tively impaired than residents with dementia in the) Tj ET endstream endobj 276 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 277 0 obj <>stream 0.72 w 1 j 0 0 0 RG 69.84 678.72 m 548.64 678.72 l S 0.24 w 130.32 615.36 m 489.36 615.36 l S 0.72 w 130.8 584.4 m 489.6 584.4 l S 131.04 545.04 m 489.6 545.04 l S BT 0.9835 0 0 0.9835 70.56 684.24 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (102 ) Tj ET BT 0.9598 0 0 0.9598 88.56 684.24 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 94.8 684.24 Tm /F5 10 Tf 0.0125 Tc 1.0651 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 143.76 644.88 Tm /F3 9 Tf 0.0333 Tc 0.4561 Tw (Table 3-5\227lmpairments in Activities of Daily Living Among Special Care Unit) Tj 2.6766 -10.2198 TD 0.0444 Tc 0.2197 Tw (Residents, Residents With Dementia in Nonspecialized Nursing Home Units,) Tj 94.6549 -10.2198 TD 0.0514 Tc -0.0002 Tw (and All Nursing Home Residents) Tj ET BT 0.8648 0 0 0.99 348.48 605.76 Tm /F3 8 Tf 0.0342 Tc 2.4544 Tw (Residents with) Tj ET BT 0.9189 0 0 0.99 270 596.64 Tm 0.018 Tc 0.891 Tw (Special care) Tj 60.595 0.2424 TD 0.0459 Tc 0.495 Tw (dementia in nonspecialized All nursing home) Tj ET BT 0.8648 0 0 0.99 131.52 588 Tm 0.0542 Tc 4.6514 Tw (Functional impairment) Tj 158.4588 -0.4849 TD 0.043 Tc 1.6117 Tw (unit residents) Tj 82.9758 0.2424 TD 0.0619 Tc 1.4511 Tw (nursing home units) Tj 117.3871 0.2424 TD 0.0262 Tc 0 Tw (residents) Tj -359.0992 -12.8489 TD 0.02 Tc 0.2904 Tw (Needs help with dressing . . . . . . . . . . .) Tj ET BT 0.8108 0 0 0.99 288 574.8 Tm 0.0306 Tc 0 Tw (81%.) Tj ET BT 0.99 0 0 0.99 369.84 574.8 Tm -0.0842 Tc (93%) Tj 84.6086 0 TD -0.0842 Tc (89%) Tj ET BT 0.9189 0 0 0.99 131.28 566.16 Tm 0.0418 Tc 0.0815 Tw (Needs help with getting out of bed . .) Tj 170.554 -0.2424 TD 0.1235 Tc 0 Tw (45) Tj ET BT 0.8648 0 0 0.99 370.08 565.92 Tm 0.2703 Tc (78) Tj ET BT 0.7567 0 0 0.99 453.6 566.16 Tm 0.3096 Tc (71) Tj ET BT 0.8648 0 0 0.99 131.52 557.28 Tm 0.0335 Tc 0.7145 Tw (Needs help with ambulating . . . . . . . .) Tj ET BT 0.99 0 0 0.99 288 557.04 Tm -0.085 Tc 0 Tw (30) Tj 82.9116 0 TD -0.085 Tc (60) Tj 84.6086 0 TD -0.085 Tc (54) Tj ET BT 0.8648 0 0 0.99 131.76 548.64 Tm 0.0187 Tc -0.0136 Tw (Incontinent . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.9189 0 0 0.99 288 548.16 Tm 0.1235 Tc 0 Tw (69) Tj ET BT 0.99 0 0 0.99 370.08 548.16 Tm -0.085 Tc (84) Tj ET BT 0.7567 0 0 0.99 454.08 548.4 Tm 0.3096 Tc (71) Tj ET BT 0.9262 0 0 0.9939 131.52 536.88 Tm /F3 7 Tf 0.0517 Tc 0.0706 Tw (SOURCE: ) Tj ET q 12.24 0 0 -5.04 164.16 541.68 cm BI /W 72 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~?~~>>>|||||~|||||~|~|~|||~ EI Q BT 0.8645 0 0 0.9939 164.16 536.88 Tm 3 Tr -0.004 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 176.4 536.88 Tm 0.0695 Tc 0.0513 Tw ( Sloane, ) Tj ET q 9.84 0 0 -5.04 203.76 541.92 cm BI /W 58 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0`?~~|>||||>>>>>>>>>>>>>>>>> EI Q BT 0.8027 0 0 0.9939 203.76 536.88 Tm 3 Tr 0.0481 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9262 0 0 0.9939 213.6 536.88 Tm 0 Tc 0.1263 Tw ( ) Tj ET q 25.44 0 0 -6.48 215.28 542.16 cm BI /W 149 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px ><>>~>~~~>>~?>~>~?><>?|<}{ ||>x|??x??????? >>>>~8 EI Q BT 0.8645 0 0 0.9939 215.28 536.88 Tm 3 Tr -0.02 Tc 0 Tw (Mathew,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 240.72 536.88 Tm 0.087 Tc 0.0324 Tw ( M. Scarborough, et al.,) Tj ET BT 0.8645 0 0 0.9939 316.8 536.4 Tm -0.0421 Tc 2.1737 Tw (\223Physical and Pharmacologic Restraint of Nursing Home) Tj ET BT 0.9262 0 0 0.9939 165.6 528.72 Tm 0.057 Tc 1.3604 Tw (Patients With Dementia: Impact of Specialized Units,\224) Tj 0 Tc 0.1263 Tw ( ) Tj ET q 23.28 0 0 -5.04 344.4 534 cm BI /W 131 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~p0p?x??x??x|>>|~||><>||>>>>> >>>>>π?|>~|~|||8< EI Q BT 0.8645 0 0 0.9939 344.4 528.72 Tm 3 Tr /F11 7 Tf -0.0438 Tc 0 Tw (Journa/) Tj 0 Tr ET BT 0.9262 0 0 0.9939 367.68 528.72 Tm 0 Tc 0.1263 Tw ( ) Tj ET q 6 0 0 -5.04 369.36 534 cm BI /W 35 /H 29 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||x|x>x>|? EI Q BT 0.8645 0 0 0.9939 369.36 528.72 Tm 3 Tr -0.1125 Tc 0 Tw (of) Tj 0 Tr ET BT 0.9262 0 0 0.9939 375.36 528.72 Tm 0 Tc 0.1263 Tw ( ) Tj ET q 9.36 0 0 -5.28 377.04 534.24 cm BI /W 54 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID | xxx>x>x|?Gx<><x>>xx8 EI Q BT 0.8645 0 0 0.9939 377.04 528.72 Tm 3 Tr -0.0772 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9262 0 0 0.9939 386.4 528.72 Tm 0.0654 Tc 1.6103 Tw ( American Medical Association) Tj ET q 42.72 0 0 -6.96 165.36 526.08 cm BI /W 238 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0px<@<>px8"|>|<?||<?|<|<|<~>x~?|<<>>><>>>|<>>|<?>>|<?>>>|<x>><<x~><<x?><<~x<<?x<<x<|<~x||<>|||>|<?||><||8~>>x?>?|?<<xp>x0 EI Q BT 0.9262 0 0 0.9939 165.36 521.04 Tm 3 Tr /F3 7 Tf 0.0053 Tc 0 Tw (265\(10\):1260,) Tj 0 Tr ET BT 0.9939 0 0 0.9939 208.08 521.04 Tm -0.0278 Tc 0.254 Tw ( 1991.) Tj ET BT 0.934 0 0 0.9835 71.52 501.84 Tm /F4 10 Tf -0.018 Tc 1.3917 Tw (nonspecialized units studied \(99,195\). On the other) Tj ET BT 0.9835 0 0 0.9835 71.52 490.08 Tm 0.0268 Tc 0.2823 Tw (hand, two descriptive studies with small samples) Tj 0.244 -12.2018 TD 0.0385 Tc 1.2233 Tw (found no significant difference in the severity of) Tj 0 -11.9577 TD 0.027 Tc 2.7429 Tw (cognitive impairment between individuals with) Tj ET BT 0.8915 0 0 0.9835 72 454.08 Tm 0.0514 Tc 0.9294 Tw (dementia on special care units and on nonspecialized) Tj ET BT 0.934 0 0 0.9835 72 442.08 Tm 0.0425 Tc 1.5411 Tw (units \(256,292\).) Tj 11.82 -18.0586 TD -0.0447 Tc 0.7779 Tw (With respect to coexisting medical conditions, the) Tj ET BT 0.8915 0 0 0.9835 72.24 412.56 Tm 0.0306 Tc 1.3372 Tw (University of North Carolina study found the special) Tj 0.2692 -12.2018 TD 0.041 Tc 1.4122 Tw (care unit residents were less likely than residents of) Tj ET BT 0.9835 0 0 0.9835 72.48 388.8 Tm 0.0308 Tc 0.8477 Tw (the nonspecialized nursing home units to have a) Tj -0.244 -11.9577 TD 0.0192 Tc 0.964 Tw (history of stroke, hip fracture, or other fractures) Tj ET BT 0.934 0 0 0.9835 72.96 365.04 Tm -0.0275 Tc 1.7628 Tw (\(413\). The special care unit residents were signifi-) Tj ET BT 0.8915 0 0 0.9835 72.72 353.04 Tm 0.0484 Tc 0.9926 Tw (cantly more likely to be ambulatory and to be taking) Tj ET BT 0.934 0 0 0.9835 72.72 341.28 Tm -0.026 Tc 0.6967 Tw (fewer medications of all types, thus suggesting they) Tj ET BT 0.9835 0 0 0.9835 72.72 329.04 Tm 0.0303 Tc 0.2206 Tw (may have fewer medical conditions than the resi-) Tj ET BT 0.8915 0 0 0.9835 72.96 317.28 Tm 0.0296 Tc 1.3769 Tw (dents with dementia on the nonspecialized units. An) Tj ET BT 0.9835 0 0 0.9835 72.96 305.04 Tm 0.0313 Tc 0.3242 Tw (earlier study that compared one special care unit) Tj ET BT 0.934 0 0 0.9835 72.96 293.04 Tm -0.026 Tc 1.7857 Tw (with two nonspecialized nursing home units found) Tj ET BT 0.9835 0 0 0.9835 73.2 281.04 Tm 0.0261 Tc 1.6253 Tw (the special care unit residents had significantly) Tj 0 -11.9577 TD 0.0408 Tc -0.0341 Tw (fewer medical diagnoses than the residents of the) Tj 0 -12.4458 TD 0.0343 Tc 1.0068 Tw (nonspecialized units \(292\). Data from the Multi-) Tj ET BT 0.934 0 0 0.9835 73.44 245.04 Tm -0.0112 Tc 0.6809 Tw (State Nursing Home Case Mix and Quality Demon-) Tj 0.257 -12.4458 TD -0.0307 Tc 1.7801 Tw (stration show that the residents of 10 special care) Tj ET BT 0.9835 0 0 0.9835 73.44 221.04 Tm 0.0233 Tc 0.8553 Tw (units in the study sample were significantly less) Tj ET BT 0.934 0 0 0.9835 73.44 209.04 Tm -0.0306 Tc 1.3624 Tw (likely than the residents with dementia in nonspe-) Tj 0 -12.4458 TD -0.0119 Tc 1.0855 Tw (cialized units in the same nursing homes to have a) Tj ET BT 0.9835 0 0 0.9835 73.68 184.56 Tm 0.0408 Tc 0.6981 Tw (diagnosis of stroke or diabetes \(382\). The special) Tj ET BT 0.8915 0 0 0.9835 73.92 172.56 Tm 0.0459 Tc 0.5991 Tw (care unit residents were somewhat less likely to have) Tj ET BT 0.9835 0 0 0.9835 73.92 160.56 Tm 0.0303 Tc 0.7087 Tw (a diagnosis of congestive heart failure or chronic) Tj ET BT 0.8915 0 0 0.9835 73.92 148.32 Tm 0.0339 Tc 1.972 Tw (obstructive pulmonary disease, but these differences) Tj ET BT 0.934 0 0 0.9835 74.16 136.8 Tm -0.0308 Tc 1.02 Tw (were not statistically significant, and the difference) Tj ET BT 0.9835 0 0 0.9835 74.16 124.8 Tm 0.0342 Tc 0.1121 Tw (with respect to diabetes was no longer significant) Tj 0 -12.2018 TD 0.0316 Tc 0.6435 Tw (when other study variables were controlled. Two) Tj ET BT 0.934 0 0 0.9835 74.16 101.04 Tm -0.0485 Tc 1.2852 Tw (other studies found no difference in the presence of) Tj 0.257 -11.9577 TD -0.0313 Tc 2.0484 Tw (specific medical conditions, the average number of) Tj ET BT 0.9835 0 0 0.9835 73.92 77.76 Tm 0.0344 Tc 2.1049 Tw (medical conditions per resident, or the average) Tj ET BT 0.934 0 0 0.9835 73.92 66 Tm -0.0143 Tc 1.345 Tw (number of medications per resident \(99,391\).) Tj ET BT 0.8915 0 0 0.9835 85.68 48.24 Tm 0.0398 Tc 0.7181 Tw (Several studies indicate special care unit residents) Tj ET BT 0.9835 0 0 0.9835 74.4 36 Tm 0.0238 Tc 0.2273 Tw (are less likely than other nursing home residents) Tj ET BT 0.934 0 0 0.9835 323.04 501.84 Tm -0.0248 Tc 1.503 Tw (with dementia to have impairments in activities of) Tj ET BT 0.9835 0 0 0.9835 322.8 489.6 Tm 0.0281 Tc 3.3315 Tw (daily living \(99,256,413\). Table 3-5 shows the) Tj ET BT 0.934 0 0 0.9835 323.04 478.08 Tm -0.0218 Tc 1.7201 Tw (findings of the University of North Carolina study) Tj ET BT 0.9835 0 0 0.9835 323.04 465.84 Tm 0.0386 Tc 0.1687 Tw (with respect to the proportion of special care unit) Tj ET BT 0.934 0 0 0.9835 323.04 454.08 Tm -0.028 Tc 1.017 Tw (residents and individuals with dementia in nonspe-) Tj ET BT 0.8915 0 0 0.9835 323.28 442.08 Tm 0.0385 Tc 1.0207 Tw (cialized units who were impaired in dressing, getting) Tj ET BT 0.934 0 0 0.9835 323.28 429.84 Tm -0.0429 Tc 1.9629 Tw (out of bed, and continence. These differences were) Tj ET BT 0.8915 0 0 0.9835 323.76 417.84 Tm 0.0122 Tc 1.4221 Tw (statistically significant. In contrast, two studies with) Tj ET BT 0.9835 0 0 0.9835 324 406.08 Tm 0.0308 Tc 1.3357 Tw (small samples found no significant difference in) Tj -0.4881 -11.7137 TD 0.0272 Tc 0.8921 Tw (impairments in activities of daily living between) Tj ET BT 0.8915 0 0 0.9835 324 382.32 Tm 0.0331 Tc 0.6807 Tw (special care unit residents and residents with demen-) Tj ET BT 0.934 0 0 0.9835 324 370.8 Tm -0.0004 Tc 0.8589 Tw (tia in nonspecialized nursing home units \(292,391\).) Tj -0.257 -12.4458 TD -0.0107 Tc 0.7171 Tw (Data from the Multi-State Nursing Home Case Mix) Tj ET BT 0.8915 0 0 0.9835 324 346.32 Tm 0.0327 Tc 1.4888 Tw (and Quality Demonstration show the residents of 10) Tj ET BT 0.934 0 0 0.9835 324 334.8 Tm -0.03 Tc 1.169 Tw (special care units in the study sample were signifi-) Tj 0 -12.4458 TD -0.0297 Tc 0.5906 Tw (cantly more likely than the residents with dementia) Tj ET BT 0.8915 0 0 0.9835 324 310.56 Tm 0.0438 Tc 0.7696 Tw (in nonspecialized units in the same nursing homes to) Tj ET BT 0.9835 0 0 0.9835 324 298.8 Tm 0.0338 Tc 0.2956 Tw (have impairments on an index of two activities of) Tj 0 -12.4458 TD 0.0289 Tc -0.1265 Tw (daily living described by the researchers as \223early) Tj ET BT 0.934 0 0 0.9835 324.24 274.56 Tm -0.0208 Tc 0.838 Tw (loss\222 activities \(grooming and dressing\). In contrast,) Tj ET BT 0.8915 0 0 0.9835 324.48 262.8 Tm 0.043 Tc 0.9388 Tw (the special care unit residents were significantly less) Tj 0 -12.2018 TD 0.0462 Tc 1.2044 Tw (likely to have impairments on an index of four other) Tj 0 -12.4458 TD 0.0479 Tc 1.2025 Tw (activities of daily living described by the researchers) Tj ET BT 0.9835 0 0 0.9835 324.72 226.8 Tm 0.0362 Tc 3.5266 Tw (as \223late loss\224) Tj 72.9667 0 TD 0.0217 Tc 0.1249 Tw (activities \(eating, using the toilet,) Tj ET BT 0.934 0 0 0.9835 324.72 214.56 Tm -0.002 Tc 0.9464 Tw (transferring, and bed mobility\) \(382\).) Tj 11.82 -24.1595 TD -0.0339 Tc 0.8842 Tw (Special care unit residents may be more likely to) Tj -11.82 -12.4458 TD -0.0113 Tc 1.3417 Tw (exhibit behavioral symptoms than individuals with) Tj ET BT 0.9835 0 0 0.9835 324.72 166.32 Tm 0.0274 Tc 2.0225 Tw (dementia in nonspecialized nursing home units) Tj ET BT 0.934 0 0 0.9835 325.44 154.8 Tm -0.0009 Tc 1.8874 Tw (\(256,413\). The University of North Carolina study) Tj -0.257 -12.2018 TD -0.0321 Tc 0.7538 Tw (found a trend for a greater prevalence of behavioral) Tj ET BT 0.8915 0 0 0.9835 325.44 130.8 Tm 0.0268 Tc 1.3031 Tw (symptoms among special care unit residents, but the) Tj ET BT 0.934 0 0 0.9835 324.96 119.04 Tm -0.0239 Tc 2.5372 Tw (differences were not statistically significant \(413\).) Tj ET BT 0.9835 0 0 0.9835 324.96 107.28 Tm 0.0439 Tc -0.0502 Tw (An earlier study found no difference in the preva-) Tj ET BT 0.934 0 0 0.9835 325.2 95.52 Tm -0.0246 Tc 1.7842 Tw (lence of behavioral symptoms among the residents) Tj ET BT 0.9835 0 0 0.9835 325.2 83.76 Tm 0.0453 Tc 1.7742 Tw (of one special care unit and two nonspecialized) Tj ET BT 0.8915 0 0 0.9835 325.2 72 Tm 0.0186 Tc 1.3507 Tw (nursing home units \(292\). Data from the Multi-State) Tj ET BT 0.9835 0 0 0.9835 324.96 60 Tm 0.0214 Tc 0.0438 Tw (Nursing Home Case Mix and Quality Demonstra-) Tj ET BT 0.934 0 0 0.9835 325.44 48.24 Tm -0.0295 Tc 0.6475 Tw (tion show that the residents of 10 special care units) Tj 0 -11.7137 TD -0.0316 Tc 1.8774 Tw (in the study sample were significantly more likely) Tj ET endstream endobj 278 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 279 0 obj <>stream 0.72 w 1 j 0 0 0 RG 59.28 672.96 m 537.12 672.96 l S BT 0.9835 0 0 0.9835 317.52 678.48 Tm 0 0 0 rg /F5 10 Tf 0.026 Tc 1.9055 Tw (Chapter 3--Findings From Descriptive Studies . 103) Tj ET BT 0.8915 0 0 0.9835 59.76 639.12 Tm /F4 10 Tf 0.0334 Tc 0.3102 Tw (than the residents of nonspecialized units in the same) Tj ET BT 0.9835 0 0 0.9835 59.52 627.6 Tm 0.033 Tc 0.7234 Tw (nursing homes to wander and to be verbally and) Tj ET BT 0.934 0 0 0.9835 59.28 615.84 Tm -0.0235 Tc 1.3976 Tw (physically abusive \(382\). These differences were no) Tj ET BT 0.8915 0 0 0.9835 60 603.6 Tm 0.0431 Tc 1.6565 Tw (longer significant, however, when other study varia-) Tj ET BT 0.934 0 0 0.9835 59.76 591.36 Tm -0.0354 Tc 2.4382 Tw (bles were controlled. Interestingly, the study data) Tj ET BT 0.8915 0 0 0.9835 60.48 579.36 Tm 0.0457 Tc 1.0368 Tw (show that the greater likelihood of wandering on the) Tj 0 -11.7137 TD 0.0458 Tc 0.7562 Tw (special care unit was due to the greater proportion of) Tj ET BT 0.934 0 0 0.9835 59.76 556.08 Tm -0.0405 Tc 1.4051 Tw (residents in the special care units who were physi-) Tj 0.7709 -11.9577 TD -0.0192 Tc 1.5215 Tw (cally capable of wandering.) Tj ET BT 0.8915 0 0 0.9835 71.28 526.56 Tm 0.0312 Tc 1.5673 Tw (The University of North Carolina study found the) Tj -11.5754 -12.6899 TD 0.0526 Tc 0.9617 Tw (special care unit residents were more likely than the) Tj -0.2692 -11.9577 TD 0.042 Tc 1.7476 Tw (individuals with dementia in nonspecialized nursing) Tj ET BT 0.9835 0 0 0.9835 60.48 490.56 Tm 0.0402 Tc 2.1803 Tw (home units to be out of their rooms and to be) Tj 0.244 -12.4458 TD 0.018 Tc 2.8129 Tw (participating in activity programs \(413\). Three) Tj ET BT 0.934 0 0 0.9835 61.44 466.32 Tm -0.0266 Tc 1.8353 Tw (studies with small sample sizes also found special) Tj ET BT 0.8915 0 0 0.9835 61.2 454.32 Tm 0.0468 Tc 0.5981 Tw (care unit residents were more likely than residents of) Tj ET BT 0.934 0 0 0.9835 61.2 442.32 Tm -0.0361 Tc 2.3104 Tw (nonspecialized units to participate in activity pro-) Tj 0.257 -12.2018 TD 0.0572 Tc 2.5531 Tw (grams \(256,292,391\).) Tj 12.0769 -17.8146 TD -0.023 Tc 1.8315 Tw (Lastly, one study that compared 13 residents of) Tj ET BT 0.9835 0 0 0.9835 61.68 400.8 Tm 0.0322 Tc 3.1123 Tw (one special care unit and 34 individuals with) Tj 0 -12.4458 TD 0.0279 Tc 0.2405 Tw (dementia in 2 nonspecialized nursing home units) Tj 0.244 -11.7137 TD 0.0355 Tc 1.331 Tw (found the special care unit residents were more) Tj ET BT 0.934 0 0 0.9835 61.92 364.8 Tm -0.0229 Tc 1.2578 Tw (likely to fall \(292\). This difference was not statisti-) Tj 0 -12.2018 TD -0.0218 Tc 1.1388 Tw (cally significant. Several studies discussed in chap-) Tj ET BT 0.9835 0 0 0.9835 62.16 340.8 Tm 0.0353 Tc 0.1653 Tw (ter 4 also found a higher incidence of falls among) Tj ET BT 0.934 0 0 0.9835 62.64 328.8 Tm -0.0272 Tc 0.5511 Tw (special care unit residents than other nursing home) Tj ET BT 0.9835 0 0 0.9835 61.92 316.56 Tm 0.0353 Tc 1.624 Tw (residents \(99,265,497,521\). One of these studies) Tj ET BT 0.934 0 0 0.9835 62.64 304.8 Tm -0.0462 Tc 1.3791 Tw (found special care units residents were more likely) Tj ET BT 0.9835 0 0 0.9835 62.64 292.8 Tm 0.042 Tc 1.4289 Tw (than the residents of nonspecialized units to be) Tj ET BT 0.934 0 0 0.9835 62.4 281.04 Tm -0.0204 Tc 0.889 Tw (hospitalized for a hip fracture \(99\).) Tj ET BT 0.9835 0 0 0.9835 73.68 263.28 Tm 0.0292 Tc 0.5007 Tw (Since the studies discussed in this chapter are) Tj -11.2256 -12.2018 TD 0.0257 Tc 0.6785 Tw (cross-sectional, it is unclear whether some of the) Tj 0.244 -11.9577 TD 0.027 Tc 0.3635 Tw (findings reflect pre-existing characteristics of the) Tj ET BT 0.8915 0 0 0.9835 62.64 227.52 Tm 0.0383 Tc 1.0595 Tw (residents and the admission and discharge criteria of) Tj 0.5384 -12.6899 TD 0.027 Tc 1.0057 Tw (the units, or on the other hand, the effect of the unit) Tj ET BT 0.934 0 0 0.9835 63.12 203.04 Tm -0.0411 Tc 0.7495 Tw (on residents. With respect to participation in activi-) Tj 0 -12.2018 TD -0.0394 Tc 1.5645 Tw (ties, for example it is unclear whether special care) Tj ET BT 0.9835 0 0 0.9835 63.36 179.04 Tm 0.026 Tc 2.0728 Tw (units admit individuals who are more likely to) Tj ET BT 0.934 0 0 0.9835 63.12 167.28 Tm -0.0464 Tc 1.1223 Tw (participate in activities or whether one effect of the) Tj ET BT 0.9835 0 0 0.9835 63.36 155.28 Tm 0.0284 Tc 0.362 Tw (units is to cause greater resident participation in) Tj ET BT 0.8915 0 0 0.9835 63.84 143.28 Tm 0.017 Tc 0 Tw (activities.) Tj ET BT 0.9663 0 0 0.9939 130.32 119.52 Tm /F6 14 Tf 0.0433 Tc (CONCLUSION) Tj ET BT 0.934 0 0 0.9835 74.64 102.24 Tm /F4 10 Tf -0.0339 Tc 1.4761 Tw (The preceding review of findings from the avail-) Tj -11.306 -12.2018 TD -0.0416 Tc 1.264 Tw (able descriptive studies of special care units allows) Tj ET BT 0.8915 0 0 0.9835 64.08 78.24 Tm 0.0539 Tc 1.0948 Tw (some conclusions to be drawn about the number and) Tj ET BT 0.934 0 0 0.9835 64.08 66.24 Tm -0.0272 Tc 0.698 Tw (characteristics of nursing homes with a special care) Tj ET BT 0.8915 0 0 0.9835 64.08 54.24 Tm 0.0385 Tc 0.8092 Tw (unit, the characteristics of the special care units, and) Tj ET BT 0.934 0 0 0.9835 64.08 42.48 Tm -0.0289 Tc 0.6999 Tw (the characteristics of their residents. Table 3-6 lists) Tj 0.257 -13.1779 TD -0.0215 Tc 0.7286 Tw (OTA\222s conclusions in these four areas. Each ) Tj ET BT 0.9468 0 0 0.9835 260.4 29.52 Tm /F6 10 Tf 0.0433 Tc 0 Tw (conclu-) Tj ET BT 0.8915 0 0 0.9835 310.8 639.12 Tm /F4 10 Tf 0.0145 Tc 0.6478 Tw (sion is supported by the findings of at least one study) Tj -0.2692 -11.9577 TD 0.0324 Tc 1.643 Tw (that used a representative sample of nursing homes) Tj 0 -11.9577 TD 0.0613 Tc 1.2884 Tw (or surveyed all nursing homes in a given geographic) Tj ET BT 0.934 0 0 0.9835 311.04 603.6 Tm -0.032 Tc 0.85 Tw (area. None of the conclusions is contradicted by the) Tj -0.257 -12.2018 TD -0.0278 Tc 1.6806 Tw (findings of any descriptive study OTA is aware of,) Tj 0.257 -12.2018 TD -0.0146 Tc 0.7286 Tw (including studies with small, nonrandom samples.) Tj ET BT 0.9835 0 0 0.9835 321.84 559.44 Tm 0.026 Tc 0.578 Tw (The diversity of existing special care units is a) Tj -10.7376 -11.9577 TD 0.016 Tc 0.6187 Tw (common finding in all special care unit research.) Tj 0 -12.2018 TD 0.033 Tc 2.5943 Tw (Because of this diversity, no single descriptive) Tj 0.4881 -12.2018 TD 0.029 Tc 3.0764 Tw (statement is true of all special care units for) Tj ET BT 0.934 0 0 0.9835 311.52 511.68 Tm -0.0209 Tc 1.095 Tw (individuals with dementia, including the statement) Tj ET BT 0.8915 0 0 0.9835 311.52 499.68 Tm 0.023 Tc 1.0766 Tw (that they only serve individuals with dementia. With) Tj ET BT 0.9835 0 0 0.9835 311.52 487.92 Tm 0.0313 Tc 1.0099 Tw (respect to existing units\222 philosophies and goals,) Tj 0.7321 -12.4458 TD 0.0271 Tc 2.218 Tw (staffing patterns, physical design features, and) Tj ET BT 0.934 0 0 0.9835 312 463.68 Tm -0.0223 Tc 0.5827 Tw (activity programs, diversity is probably the primary) Tj 0 -11.9577 TD -0.0149 Tc 0.639 Tw (finding from the available studies.) Tj 11.563 -21.2311 TD -0.0464 Tc 1.3472 Tw (As noted earlier, one of the difficulties in special) Tj ET BT 0.9835 0 0 0.9835 312.48 419.04 Tm 0.0266 Tc 3.3533 Tw (care unit research is the lack of an accepted) Tj 0 -11.9577 TD 0.0419 Tc 0.3484 Tw (definition of the term ) Tj ET BT 0.9812 0 0 0.9812 415.2 407.28 Tm /F5 11 Tf 0.0809 Tc 0.3457 Tw (special care unit. ) Tj ET BT 0.9835 0 0 0.9835 495.84 407.28 Tm /F4 10 Tf -0.0148 Tc 0.894 Tw (Thus far,) Tj ET BT 0.934 0 0 0.9835 312.24 395.52 Tm -0.038 Tc 1.9577 Tw (most descriptive studies of special care units have) Tj ET BT 0.8915 0 0 0.9835 312.48 383.52 Tm 0.0166 Tc 3.3911 Tw (used self-report) Tj 75.6436 0 TD 0.0252 Tc 1.228 Tw (\227i.e., the statement of a special care) Tj ET BT 0.8491 0 0 0.9835 312.48 371.52 Tm 0.0452 Tc 1.7683 Tw (unit operator or another nursing home staff member\227) Tj ET BT 0.934 0 0 0.9835 312.72 359.52 Tm -0.0301 Tc 1.3619 Tw (to determine which nursing home units are special) Tj 0.257 -12.2018 TD -0.0192 Tc 1.2034 Tw (care units. The University of North Carolina study) Tj 0.257 -12.4458 TD -0.0319 Tc 0.7642 Tw (added several additional conditions. For that study,) Tj 0 -12.2018 TD -0.0328 Tc 0.9976 Tw (a special care unit was defined as follows:) Tj ET BT 0.8491 0 0 0.9835 323.28 303.84 Tm 0.0499 Tc 0.6142 Tw (a distinct functional area of a nursing home, or the) Tj ET BT 0.8915 0 0 0.9835 323.28 292.8 Tm 0.034 Tc 0.1413 Tw (entire home, which identified itself as a dementia) Tj ET BT 0.8066 0 0 0.9835 323.04 282 Tm 0.0454 Tc 1.6249 Tw (unit, served primarily dementia residents, and satis-) Tj ET BT 0.8915 0 0 0.9835 323.28 271.2 Tm 0.0282 Tc 1.2918 Tw (fied at least three of the following conditions: 1\)) Tj 0.2692 -10.9816 TD 0.0408 Tc 1.3643 Tw (separation from the remainder of the facility by) Tj ET BT 0.8491 0 0 0.9835 323.28 249.6 Tm 0.0441 Tc 1.1235 Tw (closed doors; 2\) over 50 percent of the staff having) Tj 0.5653 -10.9816 TD 0.0347 Tc 0.2462 Tw (at least a year\222s experience with geriatric residents;) Tj ET BT 0.8066 0 0 0.9835 323.76 227.76 Tm 0.0476 Tc 0.7297 Tw (3\) specific staff training in dementia care; and 4\) unit) Tj 0 -11.4697 TD 0.0518 Tc 1.8154 Tw (activities being designed with the dementia resident) Tj ET BT 0.8491 0 0 0.9835 323.76 205.68 Tm 0.0278 Tc 0.86 Tw (in mind \(413\).) Tj ET BT 0.9835 0 0 0.9835 324.96 185.28 Tm 0.0307 Tc 3.2068 Tw (By defining the term) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 435.6 185.28 Tm /F5 11 Tf 0.094 Tc 2.7783 Tw (special care unit in) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 534.48 185.28 Tm /F4 10 Tf 0.0497 Tc 0 Tw (a) Tj -224.2688 -12.2018 TD 0.0187 Tc 0.0465 Tw (particular way, researchers necessarily focus on a) Tj 0.7321 -12.2018 TD 0.0341 Tc 0.0512 Tw (subset of all facilities that might be considered or) Tj ET BT 0.8915 0 0 0.9835 314.16 149.52 Tm 0.0217 Tc 1.1982 Tw (might self-identify as special care units. By doing so,) Tj ET BT 0.934 0 0 0.9835 314.4 137.52 Tm -0.0281 Tc 0.8458 Tw (they eliminate some of the diversity that character-) Tj 0.257 -11.9577 TD -0.0298 Tc 1.2973 Tw (izes the full universe of existing special care units.) Tj 0 -11.7137 TD -0.0229 Tc 0.4805 Tw (If, for example, the term ) Tj ET BT 0.9443 0 0 0.9812 424.8 114.24 Tm /F5 11 Tf 0.0167 Tc 0.2807 Tw (special care unit ) Tj ET BT 0.934 0 0 0.9835 498.24 114.24 Tm /F4 10 Tf -0.0561 Tc 1.9036 Tw (is defined) Tj ET BT 0.8915 0 0 0.9835 314.64 102.48 Tm 0.032 Tc 0.7717 Tw (for a particular study as a physically separate part of) Tj ET BT 0.934 0 0 0.9835 314.64 90.48 Tm -0.0131 Tc 1.6006 Tw (the nursing home that has certain physical design) Tj 0 -12.2018 TD -0.0106 Tc 0.3703 Tw (features, such as a safe area for wandering, then all) Tj ET BT 0.9835 0 0 0.9835 315.12 66.48 Tm 0.0217 Tc 2.1992 Tw (special care units in the study sample will, by) Tj -0.244 -12.2018 TD 0.037 Tc 2.6193 Tw (definition, have a safe area for wandering. As) Tj ET BT 0.934 0 0 0.9835 314.88 42.96 Tm -0.0244 Tc 0.6813 Tw (discussed in chapter 4, it is unclear what particular) Tj ET BT 0.9835 0 0 0.9835 314.64 30.72 Tm 0.0319 Tc 2.5199 Tw (physical design features, if any, are related to) Tj ET endstream endobj 280 0 obj <>/Rotate 0/Type/Page>> endobj 281 0 obj <>stream 0.72 w 1 j 0 0 0 RG 74.4 681.36 m 552.96 681.36 l S 0.96 w 83.52 658.8 m 550.08 658.8 l S 0.72 w 554.64 659.52 m 554.64 199.68 l S 77.52 658.56 m 77.52 176.88 l S 557.04 199.68 m 557.04 175.92 l S 84.24 176.4 m 557.28 176.4 l S BT 0.9835 0 0 0.9835 74.88 686.4 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (104 ) Tj ET BT 0.9598 0 0 0.9598 92.88 686.4 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 99.12 686.4 Tm /F5 10 Tf 0.0125 Tc 1.038 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8875 0 0 0.9795 150.48 635.28 Tm /F7 12 Tf -0.0086 Tc 2.5175 Tw (Table 3-6-Conclusions From Descriptive Studies of Special Care Units) Tj ET BT 0.9017 0 0 0.9812 87.12 612.72 Tm /F6 11 Tf -0.0118 Tc 0.4555 Tw (Number of Nursing Homes That Have a Special Care Unit) Tj ET BT 0.8607 0 0 0.9812 107.28 596.16 Tm 0.0394 Tc -0.0091 Tw (\215 OTA estimates that in 1991, 10 percent ) Tj ET BT 0.8491 0 0 0.9835 273.6 596.16 Tm /F4 10 Tf 0.0723 Tc -0.0403 Tw (of ) Tj ET BT 0.8607 0 0 0.9812 283.2 596.16 Tm /F6 11 Tf 0.0293 Tc 0.0026 Tw (all ) Tj ET BT 0.8491 0 0 0.9835 295.68 596.16 Tm /F4 10 Tf 0.0325 Tc 0.1761 Tw (nursing homes in the United ) Tj ET BT 0.8646 0 0 0.9863 412.8 596.16 Tm /F3 9 Tf 0.0158 Tc 0.0321 Tw (States had a special care ) Tj ET BT 0.8607 0 0 0.9812 508.32 596.16 Tm /F6 11 Tf -0.0074 Tc 0.0453 Tw (unit. In) Tj ET BT 0.8646 0 0 0.9863 117.84 583.44 Tm /F3 9 Tf 0.0231 Tc 0.0608 Tw (at least some States, this figure ) Tj ET BT 0.8491 0 0 0.9835 238.08 583.44 Tm /F4 10 Tf 0.0271 Tc 0.6296 Tw (includes nursing homes that place some of their residents with dementia in) Tj -141.3263 -10.9816 TD 0.0286 Tc 0.6976 Tw (\223clusters\224 in units that also serve nondemented residents.) Tj -11.8714 -13.422 TD 0.0442 Tc 0.1483 Tw (. The proportion of nursing homes that have a special care unit varies in different parts of the country and in) Tj ET BT 0.8066 0 0 0.9835 118.08 546.72 Tm 0.0135 Tc 2.8546 Tw (different States.) Tj ET BT 0.8491 0 0 0.9835 108.48 531.84 Tm 0.0372 Tc 0.6704 Tw (. Many nursing homes that do not have a special care unit are planning to establish one, and some nursing) Tj 11.5888 -11.2256 TD 0.0404 Tc -0.0028 Tw (homes that have a special care unit are pl) Tj ET BT 0.8066 0 0 0.9835 284.4 520.8 Tm 0.0515 Tc 1.0223 Tw (anning to expand the unit.) Tj ET BT 0.8915 0 0 0.9835 89.04 504 Tm 0.0414 Tc 0.821 Tw (Characteristics of Nursing Homes That Have a Special Care Unit) Tj ET BT 0.8632 0 0 0.9598 108.72 487.2 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 114.24 487.2 Tm /F4 10 Tf 0.0394 Tc 0.7522 Tw (Larger nursing homes ) Tj ET BT 0.8632 0 0 0.9598 207.6 487.2 Tm /F9 6 Tf -0.0386 Tc 0.0452 Tw (are ) Tj ET BT 0.8491 0 0 0.9835 220.8 487.2 Tm /F4 10 Tf 0.029 Tc 0.0107 Tw (more ) Tj ET BT 0.8567 0 0 0.9835 243.84 487.2 Tm /F6 10 Tf 0.0345 Tc 0.4462 Tw (likely than Smaller ) Tj ET BT 0.8491 0 0 0.9835 318 487.2 Tm /F4 10 Tf 0.0389 Tc 1.0892 Tw (nursing homes to have a special care unit.) Tj ET BT 0.8632 0 0 0.9598 108.72 472.56 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 115.68 472.56 Tm /F4 10 Tf 0.0405 Tc 0.6409 Tw (As of late 1987, most nursing homes that had a special care unit were private, for-profit facilities. At that) Tj 3.6745 -12.9339 TD 0.0347 Tc 0.2489 Tw (time, multi-facility nursing home corporations owned about one-third of all the facilities that had a special) Tj ET BT 0.8066 0 0 0.9835 119.04 448.8 Tm 0.0532 Tc 0.6566 Tw (care unit. There is no evidence, however, that ownership of special care units is dominated by a small number) Tj ET BT 0.8491 0 0 0.9835 119.28 438.24 Tm 0.0313 Tc 0.9973 Tw (of multi-facility nursing home corporations.) Tj ET BT 0.8915 0 0 0.9835 89.76 421.68 Tm 0.04 Tc 1.0768 Tw (Characteristics of Special Care Units) Tj ET BT 0.8491 0 0 0.9835 109.44 403.92 Tm 0.0274 Tc 1.1432 Tw (. Special care units are extremely diverse.) Tj 0.2827 -15.1302 TD 0.0464 Tc 0.6001 Tw (\215 Most special care units have been established since 1983, although a few have been in operation for 20 to) Tj 11.8714 -11.4697 TD 0.0457 Tc -0.0089 Tw (25 years.) Tj ET BT 0.8632 0 0 0.9598 109.92 364.56 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 116.88 364.56 Tm /F4 10 Tf 0.0254 Tc 0.3784 Tw (The goals of special care units differ. For some units, the primary goal is to maintain residents\222 ability to) Tj 3.6745 -12.4458 TD 0.0247 Tc 1.2877 Tw (perform activities of daily living. Other units focus on maintaining residents\222 quality of life, eliminating) Tj 0 -11.4697 TD 0.0111 Tc 1.021 Tw (behavioral symptoms, or meeting residents\222 physical needs.) Tj -11.3061 -14.8862 TD 0.0316 Tc 0.39 Tw (\216 Most existing special care units were not originally constructed as special care units, and at least one-fifth) Tj 11.8714 -11.4697 TD 0.0384 Tc 0.2822 Tw (were neither originally constructed nor remodeled for this purpose.) Tj -11.8714 -14.8862 TD 0.0278 Tc 0.8071 Tw (\215 The use of specific physical design and other environmental features varies in existing special care units.) Tj 11.5888 -10.9816 TD 0.0353 Tc 0.7275 Tw (Many of the physical design and other environmental features cited as important in the special care unit) Tj 0.2827 -10.9816 TD 0.0317 Tc 0.1874 Tw (literature are used in only a small proportion of special care units.) Tj -11.5888 -14.6421 TD 0.0166 Tc 0.4964 Tw (\215 The most extensivel) Tj ET BT 0.8495 0 0 1.08 198.24 262.56 Tm /F4 4 Tf 0.1119 Tc -0.1138 Tw (y ) Tj ET BT 0.8491 0 0 0.9835 201.36 264.48 Tm /F4 10 Tf 0.0305 Tc 0.2916 Tw (used environmental feature in special care units is an alarm or locking system, found) Tj ET BT 0.8066 0 0 0.9835 120.96 252.72 Tm 0.0565 Tc 1.512 Tw (in more than three-fourths of existing units.) Tj ET BT 0.8056 0 0 0.9598 110.88 237.84 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 117.6 237.84 Tm /F4 10 Tf 0.0381 Tc 0.4348 Tw (On average, special care units probably have fewer residents than nonspecialized nursing home units.) Tj ET BT 0.8066 0 0 0.9835 110.88 222.72 Tm 0.0527 Tc 1.0022 Tw (\215 On average, special care units probably have more staff per resident than nonspecialized nursing home units.) Tj ET BT 0.8915 0 0 0.9835 111.12 207.6 Tm 0.0322 Tc 0.3491 Tw (\215 Although the majority of existing special care units provide special training for the unit staff, at least) Tj ET BT 0.8491 0 0 0.9835 120.96 196.56 Tm 0.0466 Tc 0.7249 Tw (one-fourth of existing units do not.) Tj ET BT 0.8027 0 0 0.9835 459.36 181.68 Tm /F5 10 Tf 0.0287 Tc 1.5492 Tw (\(Continued on next page\)) Tj ET BT 0.934 0 0 0.9835 79.44 158.4 Tm /F4 10 Tf -0.0389 Tc 2.0136 Tw (positive outcomes for nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 330.48 157.92 Tm 0.0281 Tc 0.8882 Tw (residents with dementia in clusters in units that also) Tj ET BT 0.9835 0 0 0.9835 79.92 146.16 Tm 0.0196 Tc 1.2658 Tw (dementia. Given that uncertainty, it is probably) Tj 255.5053 -1.7082 TD 0.0396 Tc 1.8149 Tw (served nondemented residents \(194\). The study) Tj ET BT 0.934 0 0 0.9835 79.68 134.16 Tm -0.0489 Tc 1.8102 Tw (premature to exclude for research purposes special) Tj 268.7755 -2.6844 TD -0.0324 Tc 1.6213 Tw (found that a significant proportion of these cluster) Tj ET BT 0.9835 0 0 0.9835 79.92 122.16 Tm 0.0233 Tc 0.7943 Tw (care units that do not have a particular physical) Tj ET BT 0.8915 0 0 0.9835 79.92 110.4 Tm 0.0427 Tc 1.7467 Tw (design or other feature.) Tj ET BT 0.934 0 0 0.9835 330.72 119.04 Tm -0.0322 Tc 1.4376 Tw (units incorporated features said to be important in) Tj 0.7709 -12.9339 TD -0.0289 Tc 1.7277 Tw (special care units, although the cluster units were) Tj -257.2125 -19.7669 TD -0.0342 Tc 1.0579 Tw (In this context, it is important to note one of the) Tj ET BT 0.9835 0 0 0.9835 331.2 93.84 Tm 0.0238 Tc -0.0942 Tw (less likely than the special care units in the study) Tj -255.0173 -19.2788 TD 0.0298 Tc 0.0081 Tw (findings of the 1990 study of all nursing homes in) Tj ET BT 0.934 0 0 0.9835 331.44 80.64 Tm -0.0361 Tc 1.0792 Tw (States to incorporate the features. It will be impor-) Tj -268.5186 -18.0586 TD -0.023 Tc 1.6112 Tw (five northeastern States, i.e., that 5 percent of the) Tj 268.2616 5.1247 TD -0.0335 Tc 0.5946 Tw (tant to determine in future special care unit studies) Tj -268.5186 -17.3265 TD -0.0267 Tc 1.2481 Tw (nursing homes reported that although they did not) Tj ET BT 0.8915 0 0 0.9835 331.68 54.96 Tm 0.057 Tc 0.4856 Tw (whether cluster units are more like special care units) Tj ET BT 0.9835 0 0 0.9835 80.64 39.12 Tm 0.0332 Tc 2.95 Tw (have a special care unit, they did place some) Tj ET BT 0.8915 0 0 0.9835 331.68 42.24 Tm 0.0506 Tc 0.738 Tw (than they are like nonspecialized nursing home units) Tj ET endstream endobj 282 0 obj <>/Rotate 0/Type/Page>> endobj 283 0 obj <>stream 0.48 w 1 j 0 0 0 RG 59.04 683.52 m 536.64 683.52 l S 0.72 w 69.12 661.92 m 534.24 661.92 l S 538.8 662.64 m 538.8 187.44 l S 61.92 660.96 m 61.92 187.92 l S 67.68 187.68 m 535.68 187.68 l S BT 0.9835 0 0 0.9835 317.52 688.8 Tm 0 0 0 rg /F5 10 Tf 0.0193 Tc 2.2987 Tw (Chapter 3-Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 513.12 688.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 519.6 688.8 Tm /F5 10 Tf 0.4474 Tc 0 Tw (105) Tj ET BT 0.9261 0 0 0.9795 102 637.68 Tm /F7 12 Tf 0.0103 Tc 1.1987 Tw (Table 3-6-Conclusions From Descriptive Studies of Special Care Units-\(Continued\)) Tj ET BT 0.8104 0 0 0.9795 92.16 617.76 Tm 0.0293 Tc 0.7381 Tw (\215 Less than half ) Tj ET BT 0.8491 0 0 0.9835 161.52 617.76 Tm /F4 10 Tf 0.0239 Tc 0.2993 Tw (of existing special care units provide a support group for unit staff members.) Tj ET BT 0.8632 0 0 0.9598 92.16 602.4 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 97.68 602.4 Tm /F4 10 Tf 0.0248 Tc 0.8636 Tw (The types of activity programs provided by special care units vary greatly, but existing special care) Tj 5.0877 -12.2018 TD 0.03 Tc 0.4335 Tw (units are probably no more likely than nonspecialized units to provide activity programs for their) Tj ET BT 0.8066 0 0 0.9835 102.24 579.36 Tm 0.0422 Tc 0 Tw (residents.) Tj ET BT 0.8491 0 0 0.9835 92.4 563.76 Tm 0.021 Tc 0.8681 Tw (\215 About half of existing special care units provide a support group for residents\222 families.) Tj ET BT 0.8056 0 0 0.9598 92.4 546.96 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8066 0 0 0.9835 98.88 546.96 Tm /F4 10 Tf 0.061 Tc 0.151 Tw (Special care unit residents are as likely ) Tj ET BT 0.8116 0 0 0.9835 256.56 546.96 Tm /F6 10 Tf -0.0033 Tc 0.0168 Tw (or more ) Tj ET BT 0.8066 0 0 0.9835 286.8 546.96 Tm /F4 10 Tf 0.0638 Tc 0.497 Tw (likely than other nursing home residents with dementia) Tj ET BT 0.8491 0 0 0.9835 102.24 534.72 Tm 0.0271 Tc 1.7089 Tw (to receive psychotropic medications.) Tj -11.0235 -17.3265 TD 0.0284 Tc 0.1999 Tw (\215 Special care unit residents are probably less likely than other nursing home residents with dementia) Tj 11.8714 -10.9816 TD 0.024 Tc 0.3506 Tw (in nonspecialized nursing home units to receive medications of all types.) Tj -11.8714 -17.3265 TD 0.0326 Tc 0.2361 Tw (* Special care unit residents are less likely than other nursing home residents with dementia to be) Tj ET BT 0.8066 0 0 0.9835 102.96 479.04 Tm 0.0483 Tc 4.0017 Tw (physically restrained.) Tj ET BT 0.8632 0 0 0.9598 93.6 464.16 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 99.12 464.16 Tm /F4 10 Tf 0.0297 Tc 0.4338 Tw (Special care ) Tj ET BT 0.8646 0 0 0.9863 150.48 464.16 Tm /F3 9 Tf 0.0238 Tc 0.1062 Tw (units vary ) Tj ET BT 0.8491 0 0 0.9835 190.32 464.16 Tm /F4 10 Tf 0.0268 Tc 1.0668 Tw (greatly in their admission and discharge policies and practices. About half of) Tj ET BT 0.8066 0 0 0.9835 103.2 453.36 Tm 0.0674 Tc 0.6001 Tw (all special care units admit residents with the intention that the residents will remain on the unit until) Tj 0 -10.9816 TD 0.0161 Tc 2.2564 Tw (they die.) Tj ET BT 0.8491 0 0 0.9835 93.6 428.88 Tm 0.0412 Tc 0.4517 Tw (* The cost of special care units varies depending on the cost of new construction or remodeling, if any,) Tj ET BT 0.8066 0 0 0.9835 103.68 416.64 Tm 0.0482 Tc 0.8876 Tw (and ongoing operating costs. On average, existing special care units probably cost more to operate than) Tj ET BT 0.8491 0 0 0.9835 103.2 405.84 Tm 0.0292 Tc 0.1627 Tw (onnspecialized nursing home units, primarily because of the higher average staffing levels on special) Tj ET BT 0.8066 0 0 0.9835 103.68 394.8 Tm 0.0574 Tc 0.7175 Tw (care units.) Tj ET BT 0.8491 0 0 0.9835 93.84 381.12 Tm 0.0313 Tc 0.6439 Tw (* Special care units ) Tj ET BT 0.8567 0 0 0.9835 176.16 381.12 Tm /F6 10 Tf 0.0362 Tc 0.6497 Tw (generally have a higher proportion ) Tj ET BT 0.8491 0 0 0.9835 310.8 381.12 Tm /F4 10 Tf 0.0255 Tc 2.3467 Tw (of private-pay residents than nonspecialized) Tj ET BT 0.8066 0 0 0.9835 103.68 369.12 Tm 0.0499 Tc 1.3033 Tw (nursing home units, and the private-pay residents are often charged more for their care in the special) Tj ET BT 0.8491 0 0 0.9835 104.16 358.08 Tm 0.0483 Tc 0.0193 Tw (care unit than they would be in a nonspecialized unit.) Tj ET BT 0.9017 0 0 0.9812 74.4 340.56 Tm /F6 11 Tf -0.0302 Tc -0.0564 Tw (Characteristics ) Tj ET BT 0.8915 0 0 0.9835 142.08 340.56 Tm /F4 10 Tf 0.005 Tc -0.0953 Tw (of ) Tj ET BT 0.9017 0 0 0.9812 152.16 340.56 Tm /F6 11 Tf -0.0303 Tc 0.476 Tw (Special Care Unit Residents) Tj ET BT 0.8197 0 0 0.9812 94.56 322.56 Tm 0.0432 Tc 0.9649 Tw (* Special care unit residents are younger than other nursing home residents, and they are more likely) Tj 11.7111 -11.0067 TD 0.0398 Tc 0.7779 Tw (than other nursing home residents to be male and white.) Tj -11.4184 -15.1647 TD 0.0412 Tc 1.2235 Tw (\215 Special care unit residents are more likely than other nursing home residents to have a specific) Tj ET BT 0.8491 0 0 0.9835 104.64 285.84 Tm /F4 10 Tf 0.0134 Tc 0.3824 Tw (diagnosis for their dementing illness.) Tj -11.5888 -15.3742 TD 0.0252 Tc 0.7327 Tw (* Special care unit residents are probably somewhat more cognitively impaired and somewhat less) Tj 11.5888 -10.9816 TD 0.0285 Tc 0.3223 Tw (physically and functionally impaired than other nursing home residents with dementia) Tj ET BT 0.8066 0 0 0.9835 95.04 244.8 Tm 0.057 Tc 1.1148 Tw (\215 Special care unit residents are probably somewhat more likely than other nursing home residents with) Tj 12.4962 -10.9816 TD 0.0336 Tc 1.9372 Tw (dementia to participate in activity programs.) Tj ET BT 0.8491 0 0 0.9835 95.04 220.08 Tm 0.0286 Tc 0.2232 Tw (\215 Special care unit residents are mom likely than other nursing home residents with dementia to fall.) Tj ET BT 0.8066 0 0 0.9835 75.36 198.72 Tm -0.083 Tc -0.001 Tw (SOURCE: ) Tj ET q 17.28 0 0 -6.48 116.88 204.96 cm BI /W 114 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 13?o??/??~y??y????9?G????????~???~?DC?~?~~???"#_?? ??#>@O@@>>D EI Q BT 0.7217 0 0 0.9835 116.88 198.72 Tm 3 Tr 0.0189 Tc 0 Tw (\(X&e) Tj 0 Tr ET BT 0.8066 0 0 0.9835 134.16 198.72 Tm 0 Tc -0.1039 Tw ( ) Tj ET q 6 0 0 -6.24 136.32 204.72 cm BI /W 40 /H 35 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID E??????? ??????????_???? EI Q BT 0.6793 0 0 0.9835 136.32 198.72 Tm 3 Tr -0.1044 Tc 0 Tw (of) Tj 0 Tr ET BT 0.8116 0 0 0.9835 142.32 198.72 Tm /F6 10 Tf 0 Tc -0.1352 Tw ( ) Tj ET q 31.44 0 0 -7.44 144.24 204.96 cm BI /W 206 /H 43 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID D<? ~|#~< ~<Fg30??xO|?||~??~~~~ ~_~ ????~O@??~?~??~?>???????? ?~?>?ǀ??~?~???_????????~'?/????~/'?????#???????'???0`| ????F EI Q BT 0.5862 0 0 0.9835 144.24 198.72 Tm 3 Tr 0.0329 Tc 0 Tw (TkdInology) Tj 0 Tr ET BT 0.8116 0 0 0.9835 175.68 198.72 Tm -0.0487 Tc 0.5163 Tw ( Assessment, ) Tj ET BT 0.8108 0 0 0.99 222.96 198.72 Tm /F3 8 Tf 0.023 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 63.6 172.08 Tm /F4 10 Tf 0.0347 Tc 1.3317 Tw (and to compare the outcomes for residents with) Tj ET BT 0.934 0 0 0.9835 324.96 172.08 Tm -0.0203 Tc 0.5805 Tw (2. special care units probably have more staff per) Tj -279.8246 -11.9577 TD -0.0331 Tc 0.5085 Tw (dementia of the three types of units.) Tj 12.0769 -24.1595 TD -0.0319 Tc 1.428 Tw (Four of the conclusions listed in table 3-6 would) Tj ET BT 0.9835 0 0 0.9835 63.6 124.8 Tm 0.0382 Tc 0.3826 Tw (be regarded by many people as indicators that in) Tj ET BT 0.8915 0 0 0.9835 64.08 113.28 Tm 0.0563 Tc 1.3084 Tw (general special care units are providing more appro-) Tj -0.5384 -12.2018 TD 0.0439 Tc 1.6556 Tw (priate care than nonspecialized units for individuals) Tj ET BT 0.9835 0 0 0.9835 64.08 89.52 Tm 0.021 Tc 3.0539 Tw (with dementia. These conclusions are that) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 278.16 89.52 Tm /F5 11 Tf 1.1009 Tc 0 Tw (o) Tj -0.1221 Tc (n) Tj ET BT 0.9443 0 0 0.9812 64.08 77.04 Tm 0.003 Tc (average:) Tj ET BT 0.9835 0 0 0.9835 76.32 53.52 Tm /F4 10 Tf 0.0327 Tc 0.6714 Tw (1. special care units probably have fewer resi-) Tj ET BT 0.8915 0 0 0.9835 89.04 41.52 Tm 0.0359 Tc 1.4851 Tw (dents than nonspecialized nursing home units;) Tj ET BT 0.9835 0 0 0.9835 338.64 159.6 Tm 0.0305 Tc 1.2751 Tw (resident than nonspecialized nursing home) Tj ET BT 0.8491 0 0 0.9835 338.88 147.12 Tm 0.0277 Tc 0 Tw (units;) Tj ET BT 0.934 0 0 0.9835 325.68 126 Tm -0.0311 Tc 1.0739 Tw (3. special care unit residents are less likely than) Tj ET BT 0.9835 0 0 0.9835 339.12 113.52 Tm 0.0361 Tc -0.1339 Tw (individuals with dementia in nonspecialized) Tj ET BT 0.8915 0 0 0.9835 339.12 101.04 Tm 0.0419 Tc 0.8503 Tw (nursing home units to be physically restrained;) Tj ET BT 0.8491 0 0 0.9835 339.6 88.32 Tm 0.0347 Tc 0 Tw (and) Tj ET BT 0.9427 0 0 0.9812 325.44 66.72 Tm /F6 11 Tf 0.0737 Tc -0.029 Tw (4. ) Tj ET BT 0.934 0 0 0.9835 336 66.72 Tm /F4 10 Tf -0.0354 Tc 2.0527 Tw (special care unit residents are probably more) Tj 3.5974 -12.9339 TD -0.029 Tc 0.7183 Tw (likely than other nursing home residents with) Tj ET BT 0.8915 0 0 0.9835 339.36 41.52 Tm 0.0265 Tc 1.9803 Tw (dementia to participate in activity programs.) Tj ET endstream endobj 284 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 285 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.24 676.56 m 550.8 676.56 l S BT 0.9835 0 0 0.9835 72.72 682.32 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (106 ) Tj ET BT 0.9598 0 0 0.9598 90.72 682.32 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.96 682.32 Tm /F5 10 Tf 0.0125 Tc 1.038 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -13.1779 -39.5338 TD /F4 10 Tf 0.0203 Tc 1.451 Tw (In contrast, the finding that special care unit) Tj -11.4697 -12.2018 TD 0.027 Tc 1.1871 Tw (residents are as likely or more likely than other) Tj 0.244 -11.9577 TD 0.0286 Tc 0.5245 Tw (nursing home residents with dementia to receive) Tj 0 -12.2018 TD 0.0385 Tc 2.2065 Tw (psychotropic medications would be regarded by) Tj ET BT 0.934 0 0 0.9835 73.2 595.92 Tm -0.0227 Tc 1.0327 Tw (many people as an indicator that special care units) Tj ET BT 0.8915 0 0 0.9835 73.44 583.92 Tm 0.0468 Tc 0.8961 Tw (are not providing more appropriate care for individu-) Tj ET BT 0.934 0 0 0.9835 73.44 572.16 Tm -0.026 Tc 0.8436 Tw (als with dementia. The issue of criteria for evaluat-) Tj 0 -11.9577 TD -0.0264 Tc 1.3579 Tw (ing the quality of special care units is discussed in) Tj ET BT 0.8915 0 0 0.9835 73.44 548.4 Tm 0.0289 Tc 1.3136 Tw (chapter 1. One question with respect to that issue is) Tj 0.2692 -12.2018 TD 0.0289 Tc 0.4162 Tw (whether criteria such as number of residents, staff-to-) Tj ET BT 0.9835 0 0 0.9835 73.44 524.4 Tm 0.0289 Tc -0.022 Tw (resident ratios, and use of physical restraints and) Tj ET BT 0.934 0 0 0.9835 73.44 512.16 Tm -0.0412 Tc 1.2881 Tw (psychotropic medications are valid criteria for eval-) Tj ET BT 0.8915 0 0 0.9835 73.68 500.16 Tm 0.0423 Tc 0.4012 Tw (uating quality in themselves or whether their validity) Tj ET BT 0.9835 0 0 0.9835 73.92 488.16 Tm 0.0302 Tc 3.1492 Tw (remains to be demonstrated in terms of their) Tj ET BT 0.934 0 0 0.9835 73.92 476.4 Tm -0.0465 Tc 1.0582 Tw (relationship to other resident outcomes.) Tj ET BT 0.9835 0 0 0.9835 85.2 458.4 Tm 0.0309 Tc 0.4083 Tw (Lastly, despite these tentative conclusions and) Tj ET BT 0.934 0 0 0.9835 74.4 446.64 Tm -0.0343 Tc 1.1094 Tw (observations, the overriding conclusion to be drawn) Tj ET BT 0.9835 0 0 0.9835 74.4 434.64 Tm 0.0319 Tc 2.0667 Tw (from this review of findings from the available) Tj ET BT 0.8915 0 0 0.9835 74.64 423.12 Tm 0.0365 Tc 0.8788 Tw (descriptive studies is the need for more research that) Tj ET BT 0.9835 0 0 0.9835 74.64 410.88 Tm 0.0261 Tc 2.9675 Tw (builds on, clarifies, and expands upon current) Tj ET BT 0.934 0 0 0.9835 74.88 398.64 Tm -0.0315 Tc 0.8923 Tw (findings. As noted throughout the preceding discus-) Tj 0.257 -12.2018 TD -0.013 Tc 1.3436 Tw (sion, many of the available studies have used very) Tj 0.257 -12.4458 TD -0.0155 Tc 1.7573 Tw (small samples and nonrandom samples. Moreover,) Tj 0.257 -12.2018 TD -0.0399 Tc 0.6336 Tw (since the studies did not use common definitions for) Tj -0.5139 -11.9577 TD -0.0319 Tc 1.0212 Tw (the unit and resident characteristics they observed,) Tj ET BT 0.8915 0 0 0.9835 75.12 338.4 Tm 0.0524 Tc 1.6012 Tw (their findings are not necessarily comparable. These) Tj ET BT 0.9835 0 0 0.9835 74.88 326.64 Tm 0.0302 Tc 3.6954 Tw (problems are minimized in several sources of) Tj 0.4881 -12.2018 TD 0.0289 Tc -0.1265 Tw (forthcoming descriptive information about special) Tj ET BT 0.934 0 0 0.9835 75.6 302.64 Tm -0.0306 Tc 0.72 Tw (care units and special care unit residents which are) Tj 0 -12.2018 TD -0.042 Tc 0.9892 Tw (described in the next section.) Tj ET BT 0.9663 0 0 0.9939 84.72 266.88 Tm /F6 14 Tf 0.0302 Tc 5.1599 Tw (FORTHCOMING DESCRIPTIVE) Tj -6.2093 -15.6962 TD 0.0347 Tc 2.6715 Tw (INFORMATION ABOUT SPECIAL) Tj 19.373 -16.1791 TD 0.0432 Tc 1.6693 Tw (CARE UNITS AND SPECIAL) Tj 11.9218 -16.4206 TD 0.0523 Tc 2.0324 Tw (CARE UNIT RESIDENTS) Tj ET BT 0.9835 0 0 0.9835 87.12 201.36 Tm /F4 10 Tf 0.0385 Tc 0.805 Tw (OTA is aware of several sources of descriptive) Tj ET BT 0.8915 0 0 0.9835 76.08 189.6 Tm 0.0549 Tc 1.0408 Tw (information about special care units and special care) Tj ET BT 0.8491 0 0 0.9835 76.08 177.6 Tm 0.0485 Tc 1.1812 Tw (unit residents that will be available in the near future.) Tj ET BT 0.8915 0 0 0.9835 76.08 165.36 Tm 0.0448 Tc 0.4993 Tw (As noted in the beginning of this chapter, researchers) Tj ET BT 0.9835 0 0 0.9835 76.32 153.36 Tm 0.0155 Tc 2.0835 Tw (at George Washington University are currently) Tj 0 -11.9577 TD 0.0414 Tc 0.8776 Tw (analyzing responses to a questionnaire and tele-) Tj -0.4881 -12.2018 TD 0.0211 Tc 0.7355 Tw (phone interviews with more than 14,000 nursing) Tj 0.4881 -11.9577 TD 0.0351 Tc 3.7717 Tw (homes \(247\). The questionnaire asked for re-) Tj ET BT 0.8915 0 0 0.9835 76.8 105.84 Tm 0.0389 Tc 1.751 Tw (spondents\222 opinions about the minimum characteris-) Tj ET BT 0.9835 0 0 0.9835 76.32 94.08 Tm 0.0284 Tc 0.2806 Tw (tics a nursing home unit should have to be desig-) Tj ET BT 0.934 0 0 0.9835 76.32 82.32 Tm -0.0195 Tc 0.8045 Tw (nated as a special care unit. The questionnaire also) Tj ET BT 0.9835 0 0 0.9835 76.56 70.08 Tm 0.0396 Tc 1.7233 Tw (asked about each of the topics discussed in the) Tj ET BT 0.8915 0 0 0.9835 76.32 58.32 Tm 0.0426 Tc 1.6122 Tw (preceding sections, including the size and ownership) Tj 0.2692 -11.9577 TD 0.0404 Tc 0.7533 Tw (of the nursing home, the size of the special care unit,) Tj ET BT 0.9835 0 0 0.9835 76.56 34.56 Tm 0.0179 Tc 2.8619 Tw (its physical characteristics, philosophy of care,) Tj 251.8448 618.6304 TD 0.0258 Tc 1.6337 Tw (admission and discharge criteria, staff selection) Tj ET BT 0.934 0 0 0.9835 324 630.96 Tm -0.0189 Tc 2.5318 Tw (criteria, staff training, staff-to-resident ratio, staff) Tj ET BT 0.9835 0 0 0.9835 324.48 618.96 Tm 0.0155 Tc 1.5466 Tw (support groups, activity programs, programs for) Tj ET BT 0.934 0 0 0.9835 324 607.44 Tm -0.0204 Tc 1.7798 Tw (residents\222 families, use of physical and pharmacol-) Tj ET BT 0.9835 0 0 0.9835 324.48 595.2 Tm 0.0141 Tc 1.0598 Tw (ogical restraints, and reimbursement. Once ana-) Tj ET BT 0.934 0 0 0.9835 324.48 583.68 Tm -0.0322 Tc 0.6896 Tw (lyzed, the results of this study will provide valuable) Tj 0.257 -12.2018 TD -0.0118 Tc 0.5714 Tw (information that is not currently available about all) Tj 0 -12.2018 TD -0.0501 Tc 1.3832 Tw (of these topics.) Tj 11.563 -18.0586 TD -0.0264 Tc 1.2551 Tw (Another source of forthcoming information about) Tj -10.7921 -12.4458 TD -0.0343 Tc 1.0452 Tw (special care units and special care unit residents is) Tj -0.5139 -12.2018 TD -0.0243 Tc 0.9886 Tw (data currently being collected by all nursing homes) Tj ET BT 0.9835 0 0 0.9835 325.2 505.2 Tm 0.0365 Tc 3.4652 Tw (as a result of the implementation in 1990 of) Tj ET BT 0.8915 0 0 0.9835 324.96 493.68 Tm 0.0316 Tc 1.9387 Tw (mandatory assessment of nursing home residents in) Tj 0.5384 -12.4458 TD 0.057 Tc 1.3269 Tw (accordance with the nursing home reform provisions) Tj ET BT 0.934 0 0 0.9835 325.44 469.68 Tm -0.0202 Tc 1.9386 Tw (of the Omnibus Budget Reconciliation Act of 1987) Tj ET BT 0.9835 0 0 0.9835 325.68 457.68 Tm 0.0277 Tc -0.1253 Tw (\(OBRA-87\). As discussed in chapter 1, all nursing) Tj -0.244 -11.7137 TD 0.0376 Tc 1.6949 Tw (homes are now required to assess each of their) Tj ET BT 0.934 0 0 0.9835 325.2 433.92 Tm -0.0367 Tc 1.369 Tw (residents at the time of the resident\222s admission to) Tj ET BT 0.8915 0 0 0.9835 325.68 422.16 Tm 0.0485 Tc 1.5479 Tw (the nursing home and annually thereafter using the) Tj 0 -12.2018 TD 0.0103 Tc 1.155 Tw (Minimum Data Set or a State-designated assessment) Tj ET BT 0.934 0 0 0.9835 325.92 397.92 Tm -0.0222 Tc 1.4269 Tw (instrument that includes the same core items. The) Tj ET BT 0.8915 0 0 0.9835 325.68 385.68 Tm 0.0377 Tc 1.5985 Tw (Minimum Data Set contains questions about each of) Tj 0.2692 -12.2018 TD 0.032 Tc 0.8614 Tw (the resident characteristics discussed in this chapter.) Tj ET BT 0.934 0 0 0.9835 326.16 361.68 Tm -0.0268 Tc 0.6976 Tw (Although there will undoubtedly be variation in the) Tj ET BT 0.9835 0 0 0.9835 326.16 349.68 Tm 0.0428 Tc 2.3404 Tw (way these questions are answered by different) Tj ET BT 0.934 0 0 0.9835 326.16 337.68 Tm -0.0178 Tc 1.3915 Tw (nursing home staff members, in different facilities,) Tj ET BT 0.9835 0 0 0.9835 326.4 325.68 Tm 0.0319 Tc -0.0753 Tw (and in different States, use of the same or similar) Tj ET BT 0.934 0 0 0.9835 326.4 313.68 Tm -0.0136 Tc 0.7275 Tw (assessment instruments should increase the availa-) Tj 0 -12.2018 TD -0.0126 Tc 2.0283 Tw (bility of comparable information about all nursing) Tj 0 -11.9577 TD -0.0403 Tc 2.058 Tw (home residents, including residents of special care) Tj ET BT 0.9835 0 0 0.9835 326.4 278.16 Tm 0.0146 Tc 1.3173 Tw (units. Since all nursing home residents must be) Tj ET BT 0.934 0 0 0.9835 326.16 266.16 Tm 0.0001 Tc 1.458 Tw (reassessed annually using the Minimum Data Set,) Tj ET BT 0.9835 0 0 0.9835 326.88 254.4 Tm 0.0318 Tc 1.0907 Tw (longitudinal data on individual special care unit) Tj -0.244 -11.9577 TD 0.0336 Tc 0.3568 Tw (residents will also become available. Variation in) Tj ET BT 0.934 0 0 0.9835 326.88 230.64 Tm -0.0333 Tc 1.6865 Tw (the way the information is collected from one staff) Tj ET BT 0.8915 0 0 0.9835 326.88 218.64 Tm 0.0591 Tc 0.8535 Tw (member to another and one nursing home to another) Tj ET BT 0.9835 0 0 0.9835 326.88 207.12 Tm 0.0185 Tc 0.7382 Tw (may, however, compromise its value for research) Tj ET BT 0.934 0 0 0.9835 326.88 194.64 Tm -0.0091 Tc 2.6242 Tw (purposes \(437\).) Tj ET BT 0.9835 0 0 0.9835 337.92 176.88 Tm 0.0271 Tc 0.2413 Tw (An early version of the Minimum Data Set has) Tj -10.4935 -12.2018 TD 0.041 Tc 0.1052 Tw (already been used to collect information on about) Tj ET BT 0.8915 0 0 0.9835 327.6 153.12 Tm 0.0338 Tc 0.8146 Tw (300 residents of 20 special care units in six States as) Tj -0.8076 -12.4458 TD 0.0172 Tc 1.4724 Tw (part of the Multi-State Nursing Home Case Mix and) Tj ET BT 0.9835 0 0 0.9835 327.6 129.12 Tm 0.0306 Tc 0.7868 Tw (Quality Demonstration-a 5-year study mandated) Tj -0.244 -11.9577 TD 0.0374 Tc -0.0742 Tw (by Congress as part of OBRA-87. The special care) Tj ET BT 0.8915 0 0 0.9835 327.36 105.6 Tm 0.0341 Tc 1.3974 Tw (units included in the demonstration were designated) Tj 0 -12.2018 TD 0.046 Tc 1.7879 Tw (by the Health Care Financing Administration based) Tj ET BT 0.934 0 0 0.9835 327.6 81.84 Tm -0.0272 Tc 1.5643 Tw (on recommendations from the Alzheimer\222s Associa-) Tj ET BT 0.8915 0 0 0.9835 327.6 69.84 Tm 0.0264 Tc 0.446 Tw (tion and State officials in the four States in which the) Tj ET BT 0.934 0 0 0.9835 327.6 58.08 Tm -0.017 Tc 2.0159 Tw (demonstration is being conducted \(Kansas, Maine,) Tj ET BT 0.9835 0 0 0.9835 327.6 46.32 Tm 0.0393 Tc 0.7345 Tw (Mississippi, and South Dakota\) and in two addi-) Tj ET BT 0.8915 0 0 0.9835 327.6 34.32 Tm 0.0218 Tc 0.7271 Tw (tional States that are participating in some aspects of) Tj ET endstream endobj 286 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 287 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.48 675.84 m 538.32 675.84 l S BT 0.9835 0 0 0.9835 318.96 681.36 Tm 0 0 0 rg /F5 10 Tf 0.0209 Tc 1.87 Tw (Chapter 3--Findings From Descriptive Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 515.76 681.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.24 681.36 Tm /F5 10 Tf 0.2847 Tc 0 Tw (107) Tj -469.0365 -39.7778 TD /F4 10 Tf 0.0298 Tc 1.9712 Tw (the demonstration \(Nebraska and Texas\) \(137\).) Tj ET BT 0.934 0 0 0.9835 61.2 630.48 Tm -0.0333 Tc 0.9982 Tw (Information on residents of these special care units) Tj ET BT 0.8915 0 0 0.9835 61.2 618.48 Tm 0.0475 Tc 1.2029 Tw (was collected in 1990. Data comparing 127 residents) Tj 0 -11.9577 TD 0.0391 Tc 0.8355 Tw (of 10 of the special care units and 103 residents with) Tj 0 -12.4458 TD 0.0434 Tc 0.5154 Tw (dementia in nonspecialized units in the same nursing) Tj ET BT 0.934 0 0 0.9835 61.2 582.72 Tm -0.0385 Tc 1.9949 Tw (homes were reported earlier in this chapter \(382\).) Tj 0.5139 -12.4458 TD -0.0262 Tc 0.5869 Tw (Other findings from the demonstration have not yet) Tj -0.257 -12.2018 TD -0.0175 Tc 1.2628 Tw (been published. Individuals familiar with the dem-) Tj ET BT 0.9835 0 0 0.9835 61.92 546.48 Tm 0.0308 Tc 1.3009 Tw (onstration\222s findings say they show lower use of) Tj -0.4881 -12.2018 TD 0.0206 Tc 3.0544 Tw (physical restraints, the same or higher use of) Tj ET BT 0.934 0 0 0.9835 61.68 522 Tm -0.0356 Tc 1.2821 Tw (psychotropic medications, and a higher incidence of) Tj ET BT 0.8915 0 0 0.9835 61.92 510.48 Tm 0.0442 Tc 0.9973 Tw (falls in the special care units than in the nonspecial-) Tj ET BT 0.934 0 0 0.9835 62.4 498.48 Tm -0.0234 Tc 0.5471 Tw (ized nursing home units included in the demonstra-) Tj ET BT 0.9835 0 0 0.9835 62.4 486.48 Tm 0.0278 Tc 3.8838 Tw (tion \(15,521\). As discussed in chapter 1, the) Tj ET BT 0.934 0 0 0.9835 62.4 474.96 Tm -0.0354 Tc 1.4104 Tw (demonstration data also show greater resource use) Tj 0 -11.9577 TD -0.0326 Tc 0.7405 Tw (for equally impaired residents with dementia in the) Tj 267.2338 181.8066 TD -0.0241 Tc 1.6124 Tw (special care units than in the nonspecialized units) Tj 0.257 -11.7137 TD 0.0551 Tc 0 Tw (\(143\).) Tj ET BT 0.8915 0 0 0.9835 322.8 606.72 Tm 0.0607 Tc 0.6497 Tw (Because of the current lack of agreed upon criteria) Tj ET BT 0.934 0 0 0.9835 311.76 594.48 Tm -0.0273 Tc 0.902 Tw (for evaluating special care units, there is no way to) Tj ET BT 0.9835 0 0 0.9835 312.24 582.48 Tm 0.0419 Tc 0.2263 Tw (determine the quality of the care provided by the) Tj ET BT 0.934 0 0 0.9835 312.48 570.48 Tm -0.0232 Tc 0.5836 Tw (special care units included in the Multi-State Nurs-) Tj ET BT 0.9835 0 0 0.9835 312.48 558.48 Tm 0.0246 Tc 0.854 Tw (ing Home Case Mix and Quality Demonstration.) Tj ET BT 0.934 0 0 0.9835 312.48 546.48 Tm -0.0441 Tc 0.5489 Tw (Nor is it possible to determine at this point whether) Tj ET BT 0.8915 0 0 0.9835 312.72 534.24 Tm 0.0444 Tc 0.4325 Tw (these units are typical of special care units nationally) Tj ET BT 0.934 0 0 0.9835 312.96 522 Tm -0.0346 Tc 0.5101 Tw (and whether the residents of the units are typical of) Tj ET BT 0.8915 0 0 0.9835 313.2 510.24 Tm 0.0402 Tc 2.2879 Tw (special care unit residents nationally. Nevertheless,) Tj ET BT 0.9835 0 0 0.9835 313.2 498.24 Tm 0.037 Tc -0.1347 Tw (the findings provide valuable information about a) Tj ET BT 0.8915 0 0 0.9835 312.72 486.48 Tm 0.0554 Tc 0.9249 Tw (relatively large number of special care unit residents) Tj ET BT 0.9835 0 0 0.9835 313.2 474.96 Tm 0.0314 Tc -0.1291 Tw (and comparable information about residents with) Tj ET BT 0.934 0 0 0.9835 313.2 462.96 Tm -0.0194 Tc 0.631 Tw (dementia in nonspecialized nursing home units.) Tj ET endstream endobj 288 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 289 0 obj <>stream BT 0.9857 0 0 0.9857 438.72 613.92 Tm 0 0 0 rg /F6 18 Tf -0.0028 Tc 0.3677 Tw (Chapter 4) Tj ET BT 0.9597 0 0 0.998 223.92 559.68 Tm /F6 31 Tf -0.0179 Tc 0.5154 Tw (Special Care Units For) Tj -5.5014 -35.5921 TD -0.0321 Tc 0.0301 Tw (People With Dementia:) Tj -144.5367 -35.3516 TD -0.0299 Tc 1.5281 Tw (Findings From Evaluative Studies) Tj ET endstream endobj 290 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 291 0 obj <>stream BT 0.9663 0 0 0.9939 282 655.68 Tm 0 0 0 rg /F6 14 Tf -0.0052 Tc 0 Tw (Contents) Tj ET BT 0.8971 0 0 0.9835 492.48 638.64 Tm /F5 10 Tf 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 105.6 626.88 Tm /F4 10 Tf 0.0207 Tc 0.4338 Tw (INTRODUCTION . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 244.08 626.16 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 151.5018 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . .) Tj 84.2305 0 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 496.08 626.88 Tm 0.2881 Tc 0 Tw (111) Tj ET BT 0.9835 0 0 0.9835 105.36 614.88 Tm -0.0095 Tc -0.0163 Tw (TYPES OF EVALUATIVE STUDIES OF SPECIAL CARE UNITS . . . . . . . . . . . . . . . . 112) Tj 0.4881 -11.9577 TD 0.0041 Tc 0.1427 Tw (EVALUATIVE STUDIES WITHOUT A CONTROL GROUP:) Tj ET BT 0.934 0 0 0.9835 116.88 591.36 Tm 0.0129 Tc 2.4721 Tw (EFFECTS ON RESIDENTS) Tj ET BT 0.8491 0 0 0.9835 248.88 590.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 180.0497 0 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 496.56 590.88 Tm 0.0897 Tc 0 Tw (112) Tj ET BT 0.9835 0 0 0.9835 105.84 579.36 Tm 0.009 Tc 0.0401 Tw (EVALUATIVE STUDIES WITH A CONTROL GROUP:) Tj ET BT 0.8915 0 0 0.9835 116.88 567.36 Tm -0.0598 Tc 0.3064 Tw (EFFECTS ON RESIDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117) Tj ET BT 0.934 0 0 0.9835 106.08 555.6 Tm 0.0118 Tc 2.5161 Tw (STUDIES OF PARTICULAR FEATURES AND INTERVENTIONS IN) Tj 12.0769 -12.2018 TD 0.0156 Tc 2.3408 Tw (SPECIAL CARE UNITS: EFFECTS ON RESIDENTS) Tj ET BT 0.8491 0 0 0.9835 366.48 542.88 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 496.8 542.88 Tm 0.2881 Tc 0 Tw (121) Tj ET BT 0.934 0 0 0.9835 106.56 531.6 Tm 0.0036 Tc 1.6791 Tw (STUDIES THAT EVALUATE THE EFFECTS OF SPECIAL CARE UNITS) Tj ET BT 0.8915 0 0 0.9835 117.36 519.36 Tm -0.0601 Tc 0.3485 Tw (ON UNIT STAFF MEMBERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123) Tj ET BT 0.934 0 0 0.9835 106.32 507.36 Tm 0.0036 Tc 1.7112 Tw (STUDIES THAT EVALUATE THE EFFECTS OF SPECIAL CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 117.36 495.12 Tm 0.0207 Tc 0.4919 Tw (ON RESIDENTS\222 FAMILIES) Tj ET BT 0.8491 0 0 0.9835 259.2 494.4 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 176.0926 0 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 497.04 494.4 Tm 0.2881 Tc 0 Tw (125) Tj ET BT 0.8915 0 0 0.9835 106.56 483.36 Tm -0.0739 Tc 0.197 Tw (CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127) Tj ET BT 0.8875 0 0 0.9795 299.52 450.96 Tm /F7 12 Tf 0.1863 Tc 0 Tw (Tables) Tj ET BT 0.99 0 0 0.99 106.56 440.16 Tm /F7 8 Tf 0.2424 Tc (Table) Tj ET BT 0.8971 0 0 0.9835 493.68 438.96 Tm /F5 10 Tf 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 106.32 428.4 Tm /F4 10 Tf -0.0193 Tc 1.3932 Tw (4-1. Evaluative Studies Without a Control Group) Tj ET BT 0.8491 0 0 0.9835 329.52 427.2 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 497.52 427.2 Tm 0.2881 Tc 0 Tw (113) Tj ET BT 0.934 0 0 0.9835 106.56 416.88 Tm -0.0083 Tc 0.5281 Tw (4-2. Evaluative Studies With a Control Group . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 350.16 415.44 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 497.52 415.44 Tm 0.2881 Tc 0 Tw (118) Tj ET BT 0.934 0 0 0.9835 106.56 405.12 Tm -0.0026 Tc 0.635 Tw (4-3. OTA\222S Conclusions From the Evaluative Studies of Special Care Units . . . . . . . . . . 128) Tj ET endstream endobj 292 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 293 0 obj <>stream 1.44 w 1 j 0 0 0 RG 54.48 625.92 m 533.52 625.92 l S BT 0.9663 0 0 0.9939 473.04 682.08 Tm 0 0 0 rg /F6 14 Tf -0.0214 Tc 1.4877 Tw (Chapter 4) Tj ET BT 0.9857 0 0 0.9857 173.52 657.12 Tm /F6 18 Tf 0.0205 Tc 0.5064 Tw (Special Care Units For People With Dementia:) Tj 98.848 -18.5036 TD 0.0185 Tc 0.9953 Tw (Findings From Evaluative Studies) Tj ET BT 0.9663 0 0 0.9939 112.8 580.56 Tm /F6 14 Tf 0.2862 Tc 0 Tw (INTRODUCTION) Tj ET BT 0.934 0 0 0.9835 66.24 562.56 Tm /F4 10 Tf -0.0283 Tc 1.4171 Tw (As noted in chapter 3, much of the literature on) Tj ET BT 0.9835 0 0 0.9835 55.92 550.8 Tm 0.0313 Tc 1.3759 Tw (special care units consists of descriptive reports) Tj ET BT 0.934 0 0 0.9835 55.92 538.8 Tm -0.0315 Tc 1.5347 Tw (about an individual unit. These descriptive reports) Tj ET BT 0.9835 0 0 0.9835 55.68 526.56 Tm 0.0438 Tc 3.3154 Tw (often present anecdotal evidence of the unit\222s) Tj ET BT 0.934 0 0 0.9835 55.44 515.04 Tm -0.0417 Tc 2.8132 Tw (positive outcomes. Frequently, the reports include) Tj 0.5139 -11.7137 TD -0.0295 Tc 0.5582 Tw (case examples that show how the unit benefited one) Tj ET BT 0.9835 0 0 0.9835 56.16 491.52 Tm 0.0377 Tc 0.4882 Tw (or more of its residents. Many of the reports also) Tj ET BT 0.934 0 0 0.9835 56.16 479.76 Tm -0.0468 Tc 1.1962 Tw (describe positive outcomes of the unit for residents\222) Tj 0 -12.2018 TD -0.0006 Tc 0.4951 Tw (families and unit staff members.) Tj ET BT 0.9835 0 0 0.9835 66.96 448.08 Tm 0.0516 Tc 0.8671 Tw (Anecdotal evidence of the positive outcomes of) Tj ET BT 0.934 0 0 0.9835 56.4 436.32 Tm -0.0305 Tc 0.7016 Tw (individual special care units is compelling. The case) Tj ET BT 0.8915 0 0 0.9835 56.4 424.56 Tm 0.047 Tc 2.011 Tw (examples are particularly compelling: the individual) Tj -0.2692 -12.2018 TD 0.0401 Tc 1.2113 Tw (residents they describe seem typical of nursing home) Tj ET BT 0.9835 0 0 0.9835 56.16 400.32 Tm 0.0439 Tc 2.085 Tw (residents with dementia who do not do well in) Tj 0.4881 -11.9577 TD 0.0375 Tc 1.2313 Tw (nonspecialized units; these individuals often are) Tj ET BT 0.8915 0 0 0.9835 56.88 376.56 Tm 0.0359 Tc 0.6237 Tw (admitted to the special care unit in a very agitated or) Tj ET BT 0.9835 0 0 0.9835 57.12 364.56 Tm 0.0316 Tc 1.5301 Tw (withdrawn condition; they frequently have been) Tj ET BT 0.8915 0 0 0.9835 57.12 352.8 Tm 0.0451 Tc 2.8881 Tw (overmedicated and physically restrained; character-) Tj ET BT 0.9835 0 0 0.9835 57.36 340.8 Tm 0.0181 Tc 2.5689 Tw (istics of the unit, including its physical design) Tj ET BT 0.934 0 0 0.9835 57.36 328.8 Tm -0.0288 Tc 1.7459 Tw (features, patient care philosophy, and activity pro-) Tj 0.257 -12.4458 TD -0.0165 Tc 0.737 Tw (grams, seem to match their needs exactly; and they) Tj ET BT 0.9835 0 0 0.9835 57.12 304.8 Tm 0.0337 Tc 2.0649 Tw (respond positively and dramatically to the unit) Tj ET BT 0.8915 0 0 0.9835 57.6 292.56 Tm 0.0471 Tc 0 Tw (environment.) Tj ET BT 0.9835 0 0 0.9835 68.88 273.12 Tm 0.0514 Tc 0.1353 Tw (Case examples and other anecdotal evidence of) Tj -11.2256 -11.7137 TD 0.0366 Tc 0.9115 Tw (the positive outcomes of individual units are not) Tj ET BT 0.934 0 0 0.9835 58.32 249.6 Tm -0.0322 Tc 1.7924 Tw (adequate, however, to evaluate the effectiveness of) Tj ET BT 0.8915 0 0 0.9835 58.32 237.6 Tm 0.0344 Tc 0.8407 Tw (special care units. In the past few years, a number of) Tj ET BT 0.9835 0 0 0.9835 58.08 225.6 Tm 0.0383 Tc 0.1776 Tw (evaluative studies of special care units have been) Tj ET BT 0.934 0 0 0.9835 58.32 213.36 Tm -0.0318 Tc 1.0211 Tw (conducted. These studies attempt to measure objec-) Tj 0 -12.2018 TD -0.0494 Tc 1.9286 Tw (tively the effectiveness of one or more special care) Tj ET BT 0.9835 0 0 0.9835 58.32 189.6 Tm 0.0234 Tc 3.5091 Tw (units in terms of changes in aspects of their) Tj 0 -12.2018 TD 0.0245 Tc 2.9528 Tw (residents\222 condition and functioning over time.) Tj ET BT 0.934 0 0 0.9835 59.04 165.36 Tm -0.0252 Tc 1.7236 Tw (Several of the evaluative studies also measure the) Tj ET BT 0.9835 0 0 0.9835 58.56 153.6 Tm 0.0338 Tc 0.6006 Tw (effects of special care units on residents\222 families) Tj ET BT 0.8915 0 0 0.9835 59.04 141.6 Tm 0.0085 Tc 1.6954 Tw (and unit staff members.) Tj 12.1137 -19.2788 TD 0.0452 Tc 1.3593 Tw (This chapter reviews what is known about special) Tj ET BT 0.934 0 0 0.9835 59.04 110.88 Tm -0.0155 Tc 1.4563 Tw (care units from the available evaluative studies. It) Tj ET BT 0.9835 0 0 0.9835 59.04 98.88 Tm 0.0363 Tc 0.5167 Tw (does not include information from descriptive re-) Tj ET BT 0.8915 0 0 0.9835 58.8 87.36 Tm 0.0349 Tc 0.847 Tw (ports on individual special care units. Findings of the) Tj ET BT 0.934 0 0 0.9835 59.52 75.36 Tm -0.0238 Tc 1.9975 Tw (available evaluative studies are discussed in some) Tj ET BT 0.8915 0 0 0.9835 59.28 63.36 Tm 0.0255 Tc 1.8109 Tw (detail because, like the descriptive studies discussed) Tj 0 -11.7137 TD 0.0409 Tc 1.001 Tw (in chapter 3, they provide a basis for informed policy) Tj ET BT 0.934 0 0 0.9835 59.04 39.6 Tm -0.0381 Tc 2.1841 Tw (decisions about the development of special regula-) Tj ET BT 0.8915 0 0 0.9835 306.72 584.64 Tm 0.0446 Tc 0.6293 Tw (tions and reimbursement for special care units, about) Tj ET BT 0.9835 0 0 0.9835 306.72 572.64 Tm 0.0399 Tc 1.4311 Tw (the need for and content of consumer education) Tj 0.244 -12.2018 TD 0.0289 Tc 2.6624 Tw (about special care units, and about the future) Tj 0 -11.9577 TD 0.0406 Tc 3.4001 Tw (direction and level of government support for) Tj ET BT 0.8915 0 0 0.9835 306.96 536.88 Tm 0.063 Tc 1.4547 Tw (research on special care units.) Tj ET BT 0.9835 0 0 0.9835 318.48 517.2 Tm 0.023 Tc 1.0509 Tw (OTA\222s conclusions from the evaluative studies) Tj ET BT 0.8066 0 0 0.9835 307.44 505.44 Tm 0.0566 Tc 1.611 Tw (discussed in this chapter are summarized) Tj ET BT 0.9835 0 0 0.9835 472.08 505.68 Tm 0.2643 Tc 3.6607 Tw (in table 4-3) Tj -167.1644 -12.4458 TD 0.0344 Tc 2.5828 Tw (at the end of the chapter. The findings differ,) Tj -0.244 -11.9577 TD 0.0413 Tc 1.7085 Tw (depending on whether the study used a control) Tj ET BT 0.8915 0 0 0.9835 307.92 469.68 Tm 0.0301 Tc 0.9532 Tw (group. The nine evaluative studies that did not use a) Tj ET BT 0.9835 0 0 0.9835 307.68 457.44 Tm 0.0393 Tc 0.6357 Tw (control group found positive outcomes for special) Tj ET BT 0.8915 0 0 0.9835 307.92 445.68 Tm 0.0408 Tc 0.8815 Tw (care unit residents in a variety of areas. If contradic-) Tj ET BT 0.9835 0 0 0.9835 307.92 433.68 Tm 0.0375 Tc 0.806 Tw (tory findings are excluded, the only positive out-) Tj ET BT 0.8915 0 0 0.9835 308.16 421.68 Tm 0.0472 Tc 0.7456 Tw (comes found in more than one of the nine studies are) Tj ET BT 0.9835 0 0 0.9835 308.16 409.44 Tm 0.0299 Tc 2.1908 Tw (decreased nighttime wakefulness, improved hy-) Tj ET BT 0.934 0 0 0.9835 308.4 397.68 Tm -0.0252 Tc 1.5279 Tw (giene, and weight gain. A few of the studies found) Tj ET BT 0.9835 0 0 0.9835 308.16 385.44 Tm 0.0277 Tc -0.1254 Tw (improvements over time in the important areas of) Tj ET BT 0.934 0 0 0.9835 308.16 373.92 Tm -0.0355 Tc 0.8537 Tw (residents\222 ability to perform activities of daily living) Tj ET BT 0.9835 0 0 0.9835 308.88 361.68 Tm 0.0243 Tc -0.1218 Tw (and residents\222 behavioral symptoms, but an equal) Tj ET BT 0.934 0 0 0.9835 308.4 349.92 Tm -0.0249 Tc 0.9892 Tw (number of studies did not find such improvements.) 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The second) Tj ET BT 0.8915 0 0 0.9835 309.6 234.24 Tm 0.0314 Tc 0.8322 Tw (study found that 13 residents of one special care unit) Tj ET BT 0.934 0 0 0.9835 309.6 222 Tm -0.033 Tc 2.0716 Tw (exhibited significantly fewer catastrophic reactions) Tj ET BT 0.9835 0 0 0.9835 309.6 210 Tm 0.0357 Tc 0.2326 Tw (than 9 residents with dementia in nonspecialized) Tj ET BT 0.934 0 0 0.9835 309.6 198 Tm -0.0098 Tc 0.9976 Tw (units of the same facility \(265\). The 13 special care) Tj ET BT 0.9835 0 0 0.9835 309.84 186 Tm 0.0254 Tc 1.4877 Tw (unit residents also interacted significantly more) Tj ET BT 0.934 0 0 0.9835 310.08 174.24 Tm -0.0127 Tc 0.7436 Tw (often with staff members.) Tj ET BT 0.9835 0 0 0.9835 321.12 154.32 Tm 0.0388 Tc 2.4432 Tw (Only one of the four evaluative studies that) Tj ET BT 0.934 0 0 0.9835 310.08 142.56 Tm -0.0237 Tc 1.4121 Tw (measured the impact of a special care unit on unit) Tj ET BT 0.9835 0 0 0.9835 310.56 130.56 Tm 0.0285 Tc 1.094 Tw (staff members found any positive outcomes. The) Tj -0.244 -11.7137 TD 0.0306 Tc 1.7427 Tw (findings with respect to outcomes for residents\222) Tj ET BT 0.934 0 0 0.9835 310.32 107.28 Tm -0.0351 Tc 1.2571 Tw (families are contradictory, as described later in the) Tj ET BT 0.8491 0 0 0.9835 310.56 95.28 Tm 0.0572 Tc 0 Tw (chapter.) Tj ET BT 0.9835 0 0 0.9835 321.6 75.6 Tm 0.0317 Tc 0.8467 Tw (The limited positive findings in many of these) Tj ET BT 0.934 0 0 0.9835 310.56 63.36 Tm -0.0375 Tc 0.966 Tw (evaluative studies and the complete lack of positive) Tj ET BT 0.9835 0 0 0.9835 310.8 51.6 Tm 0.03 Tc -0.0362 Tw (findings in some of the studies are surprising and) Tj 0 -12.4458 TD 0.0353 Tc 0.0761 Tw (appear to contradict the conviction of special care) Tj ET BT 0.8915 0 0 0.9835 285.84 21.12 Tm 0.0897 Tc 0 Tw (\226111\226) Tj ET endstream endobj 294 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 295 0 obj <>stream 0.72 w 1 j 0 0 0 RG 79.68 675.84 m 557.76 675.84 l S BT 0.9835 0 0 0.9835 79.92 681.12 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0534 Tw (112 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0 -39.5338 TD /F4 10 Tf 0.0341 Tc 1.4021 Tw (unit operators and others that the units benefit) Tj 0 -11.9577 TD 0.0219 Tc -0.0787 Tw (residents, residents\222 families, and unit staff mem-) Tj ET BT 0.934 0 0 0.9835 80.16 618.48 Tm -0.0202 Tc 0.9979 Tw (bers. Each of the available studies suffers from one) Tj 0.5139 -11.9577 TD -0.0364 Tc 1.497 Tw (or more methodological problems that could invali-) Tj 0 -12.2018 TD -0.0137 Tc 0.659 Tw (date its findings, e.g., small sample sizes and use of) Tj ET BT 0.9835 0 0 0.9835 80.64 583.2 Tm 0.0247 Tc -0.1223 Tw (nonrandom samples. Citing these problems, some) Tj 0.4881 -12.4458 TD 0.0305 Tc 1.8241 Tw (special care unit advocates discount the lack of) Tj -0.4881 -11.9577 TD 0.0214 Tc 0.0438 Tw (positive findings. In contrast, OTA concludes that) Tj ET BT 0.934 0 0 0.9835 81.36 547.2 Tm -0.0285 Tc 0.6994 Tw (some of the studies-particularly the six studies that) Tj ET BT 0.9835 0 0 0.9835 81.12 534.96 Tm 0.0321 Tc 0.7488 Tw (used a control group-constitute credible research) Tj 0.244 -11.9577 TD 0.0285 Tc 1.2839 Tw (in an area in which good research is difficult to) Tj 0 -12.2018 TD 0.0398 Tc -0.1376 Tw (design and conduct. Despite methodological prob-) Tj T* 0.0218 Tc 2.5651 Tw (lems, the studies\222 findings are meaningful and) Tj ET BT 0.934 0 0 0.9835 81.6 486.96 Tm -0.0386 Tc 1.371 Tw (deserve careful consideration by policymakers, spe-) Tj 0 -11.9577 TD -0.0224 Tc 0.48 Tw (cial care unit advocates, and others.) Tj ET BT 0.9663 0 0 0.9939 82.32 439.92 Tm /F6 14 Tf 0.0371 Tc 1.3444 Tw (TYPES OF EVALUATIVE STUDIES) Tj 27.5692 -16.6621 TD 0.0293 Tc 1.4353 Tw (OF SPECIAL CARE UNITS) Tj ET BT 0.934 0 0 0.9835 92.88 403.92 Tm /F4 10 Tf -0.0393 Tc 1.7388 Tw (Three types of evaluative studies of special care) Tj ET BT 0.9835 0 0 0.9835 82.08 391.68 Tm 0.0395 Tc 0.9086 Tw (units have been conducted. In one type, selected) Tj ET BT 0.934 0 0 0.9835 82.08 380.16 Tm -0.0298 Tc 2.5436 Tw (characteristics of individuals with dementia, their) Tj ET BT 0.8915 0 0 0.9835 82.56 368.16 Tm 0.0286 Tc 1.6472 Tw (families, and/or unit staff members are measured at) Tj 0 -11.9577 TD 0.0348 Tc 0.9928 Tw (designated intervals before and after the individuals\222) Tj ET BT 0.934 0 0 0.9835 82.8 344.16 Tm -0.023 Tc 0.8975 Tw (admission to a special care unit. Changes or lack of) Tj -0.257 -11.7137 TD -0.0276 Tc 2.0016 Tw (changes in the measured characteristics over time) Tj 0.257 -12.4458 TD -0.0336 Tc 0.6518 Tw (are then attributed to the impact of the special care) Tj ET BT 0.9835 0 0 0.9835 82.56 308.88 Tm 0.0378 Tc 1.1388 Tw (unit. This type of study does not use a separate) Tj ET BT 0.934 0 0 0.9835 82.8 296.88 Tm -0.0468 Tc 2.4075 Tw (control group.) Tj ET BT 0.9835 0 0 0.9835 93.6 277.2 Tm 0.0471 Tc 0.343 Tw (The second type of evaluative study does use a) Tj ET BT 0.8915 0 0 0.9835 83.04 265.2 Tm 0.0188 Tc 0.9659 Tw (separate control group. In this type of study, selected) Tj -0.2692 -12.2018 TD 0.0441 Tc 0.3991 Tw (characteristics of the special care unit residents, their) Tj ET BT 0.9835 0 0 0.9835 82.8 241.2 Tm 0.0269 Tc 1.0956 Tw (families, and/or unit staff members and selected) Tj ET BT 0.934 0 0 0.9835 83.04 229.2 Tm -0.031 Tc 2.0823 Tw (characteristics of other individuals with dementia,) Tj 0 -12.2018 TD -0.0173 Tc 1.6479 Tw (their families, and/or staff members in nonspecial-) Tj ET BT 0.9835 0 0 0.9835 83.28 205.2 Tm 0.0247 Tc 2.9107 Tw (ized nursing home units or other settings are) Tj ET BT 0.8915 0 0 0.9835 83.04 193.44 Tm 0.0369 Tc 1.0994 Tw (measured at designated intervals. Changes or lack of) Tj ET BT 0.934 0 0 0.9835 83.52 181.2 Tm -0.0283 Tc 1.36 Tw (changes in the measured characteristics of the two) Tj ET BT 0.8915 0 0 0.9835 83.76 169.2 Tm 0.0371 Tc 1.1762 Tw (groups of subjects are compared, and any differences) Tj -0.2692 -12.4458 TD 0.029 Tc 1.4256 Tw (between the two groups are attributed to the impact) Tj ET BT 0.934 0 0 0.9835 83.52 144.96 Tm -0.033 Tc 0.6583 Tw (of the special care unit.) Tj ET BT 0.9835 0 0 0.9835 94.56 125.28 Tm 0.0361 Tc 0.8422 Tw (A third type of evaluative study measures the) Tj ET BT 0.8915 0 0 0.9835 83.52 113.28 Tm 0.0368 Tc 1.4303 Tw (effectiveness of particular features and interventions) Tj 0 -11.9577 TD 0.0558 Tc 0.8646 Tw (in special care units. One example is research on the) Tj ET BT 0.9835 0 0 0.9835 83.52 89.28 Tm 0.0513 Tc 1.0709 Tw (effectiveness of various types of devices to deter) Tj ET BT 0.934 0 0 0.9835 83.28 77.28 Tm -0.0285 Tc 0.7178 Tw (residents who wander from leaving the unit.) Tj ET BT 0.9835 0 0 0.9835 94.32 57.36 Tm 0.043 Tc 0.5913 Tw (The findings of these three types of evaluative) Tj -10.9816 -12.2018 TD 0.0324 Tc 2.2289 Tw (studies are discussed in the following sections.) Tj ET BT 0.934 0 0 0.9835 83.52 33.36 Tm -0.0454 Tc 1.86 Tw (Findings with respect to the effects of special care) Tj ET BT 0.8915 0 0 0.9835 331.2 642.48 Tm 0.0148 Tc 1.7781 Tw (units on residents, residents\222 families, and unit staff) Tj 0 -11.9577 TD 0.0339 Tc 2.2052 Tw (members are discussed separately.) Tj ET BT 0.9663 0 0 0.9939 368.64 603.12 Tm /F6 14 Tf 0.0538 Tc -0.0803 Tw (EVALUATIVE STUDIES) Tj -33.5302 -16.4206 TD 0.0435 Tc 1.8346 Tw (WITHOUT A CONTROL GROUP:) Tj ET BT 0.9939 0 0 0.9939 359.28 570.96 Tm 0.0163 Tc 0.4667 Tw (EFFECTS ON RESIDENTS) Tj ET BT 0.8915 0 0 0.9835 342.72 552.96 Tm /F4 10 Tf 0.0423 Tc 1.2424 Tw (OTA is aware of nine evaluative studies of special) Tj -12.1137 -12.4458 TD 0.0501 Tc 0.6617 Tw (care units in which a control group was not used \(see) Tj ET BT 0.934 0 0 0.9835 332.4 528.96 Tm -0.0337 Tc 0.9161 Tw (table 4-l\). Seven of the nine studies were conducted) Tj 0 -12.2018 TD -0.0341 Tc 1.2805 Tw (in a single special care unit. The other two studies) Tj 0 -12.4458 TD -0.0436 Tc 0.9909 Tw (were conducted in two and three special care units,) Tj ET BT 0.8915 0 0 0.9835 331.92 493.2 Tm 0.0329 Tc 1.2791 Tw (respectively. The samples for 6 of the 9 studies were) Tj ET BT 0.934 0 0 0.9835 332.64 480.96 Tm -0.0142 Tc 0.3741 Tw (very small \(under 12 individuals each\). One of the 3) Tj -0.257 -12.4458 TD -0.0017 Tc 0.8496 Tw (remaining studies had a sample of 32 subjects, and) Tj ET BT 0.9835 0 0 0.9835 332.64 456.96 Tm 0.0347 Tc 2.5215 Tw (one had a sample of 53 subjects \(24,245\). The) Tj ET BT 0.8915 0 0 0.9835 333.12 444.96 Tm 0.0219 Tc 0.774 Tw (sample size for the ninth study is not specified in the) Tj 0.2692 -11.9577 TD -0.0012 Tc 2.0652 Tw (study report \(22\).) Tj ET BT 0.9835 0 0 0.9835 343.68 415.2 Tm 0.0331 Tc 1.9261 Tw (Table 4-1 lists the physical design and other) Tj -10.7376 -12.2018 TD 0.0258 Tc 0.4867 Tw (changes made to create the special care units, as) Tj 0 -12.2018 TD 0.0286 Tc 2.9649 Tw (described in the study reports. These changes) Tj ET BT 0.934 0 0 0.9835 333.12 379.44 Tm -0.0373 Tc 0.695 Tw (differed from one special care unit to another. Some) Tj ET BT 0.8915 0 0 0.9835 333.36 367.68 Tm 0.055 Tc 1.0061 Tw (changes that were made to create one or more of the) Tj ET BT 0.9835 0 0 0.9835 333.36 355.68 Tm 0.0297 Tc 0.6658 Tw (units may not have been mentioned in the study) Tj ET BT 0.8491 0 0 0.9835 333.12 343.68 Tm 0.2771 Tc 0 Tw (reports.) Tj ET BT 0.9835 0 0 0.9835 344.64 325.68 Tm 0.0443 Tc 1.6706 Tw (Each of the nine studies found some positive) Tj -10.9816 -11.9577 TD 0.0181 Tc -0.1155 Tw (outcomes of the special care units, as summariz) Tj ET BT 0.8915 0 0 0.9835 550.08 313.92 Tm 0.4144 Tc 0 Tw (ed) Tj ET BT 0.934 0 0 0.9835 333.6 301.92 Tm -0.04 Tc 2.0577 Tw (below. The study reports emphasize these positive) Tj 0.5139 -11.9577 TD -0.0353 Tc 1.0249 Tw (outcomes. Negative outcomes are also reported, but) Tj -0.257 -11.9577 TD -0.0368 Tc 0.5982 Tw (they receive less emphasis in the study reports. The) Tj 0.257 -12.2018 TD -0.0225 Tc 1.9961 Tw (statistical significance of the studies\222 findings was) Tj ET BT 0.9835 0 0 0.9835 333.84 254.64 Tm 0.0347 Tc 0.681 Tw (computed in only four of the nine studies. In the) Tj 0.244 -12.2018 TD 0.0221 Tc 0.2058 Tw (following discussion, OTA uses the terms ) Tj ET BT 0.9812 0 0 0.9812 526.56 242.64 Tm /F5 11 Tf 0.1076 Tc 0 Tw (statisti-) Tj ET BT 0.9014 0 0 0.9812 334.08 230.4 Tm -0.0486 Tc 2.6275 Tw (cally significant) Tj 0 Tc -0.0889 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 404.16 230.4 Tm /F4 10 Tf 0.0257 Tc -0.1186 Tw (and ) Tj ET BT 0.9014 0 0 0.9812 423.12 230.4 Tm /F5 11 Tf -0.0378 Tc -0.047 Tw (significant ) Tj ET BT 0.8915 0 0 0.9835 470.16 230.4 Tm /F4 10 Tf 0.0502 Tc 2.1421 Tw (for research findings) Tj ET BT 0.934 0 0 0.9835 334.08 218.4 Tm -0.0087 Tc 0.7149 Tw (with a P value of 0.05 or less.) Tj ET BT 0.9835 0 0 0.9835 345.12 200.64 Tm 0.0236 Tc 2.0752 Tw (Bell and Smith found statistically significant) Tj -10.7376 -12.2018 TD 0.0301 Tc 1.6211 Tw (improvements in behavior among residents of a) Tj ET BT 0.934 0 0 0.9835 334.32 176.64 Tm -0.023 Tc 1.3543 Tw (newly created 24-bed special care unit \(22\). Over a) Tj 0.5139 -12.4458 TD -0.0253 Tc 1.8192 Tw (3-month period, the residents became significantly) Tj ET BT 0.9835 0 0 0.9835 334.32 152.64 Tm 0.0392 Tc 0.7346 Tw (more likely to exhibit three behaviors defined as) Tj 0.9761 -12.2018 TD 0.0256 Tc 0.6496 Tw (\223positive\222 by the researchers-having a clean face,) Tj ET BT 0.934 0 0 0.9835 334.56 128.88 Tm -0.0174 Tc 0.6738 Tw (having clean clothes, and walking alone. At the end) Tj ET BT 0.9835 0 0 0.9835 334.8 117.12 Tm 0.043 Tc 3.1013 Tw (of the 3-month period, the frequency of these) Tj ET BT 0.8915 0 0 0.9835 334.56 105.12 Tm 0.0446 Tc 1.4369 Tw (behaviors among residents of the newly created unit) Tj ET BT 0.934 0 0 0.9835 334.8 92.88 Tm -0.0237 Tc 0.8089 Tw (was similar to their frequency among residents of a) Tj 0 -11.9577 TD -0.022 Tc 0.6144 Tw (26-bed special care unit that had been operating for) Tj ET BT 0.9835 0 0 0.9835 334.8 68.88 Tm 0.0194 Tc 2.9161 Tw (over a year. This outcome fit the researchers\222) Tj ET BT 0.934 0 0 0.9835 334.32 56.64 Tm -0.0299 Tc 2.1753 Tw (hypothesis that behaviors they defined as positive) Tj ET BT 0.9835 0 0 0.9835 334.8 44.64 Tm 0.0315 Tc 2.4942 Tw (would increase over time in the new unit and) Tj ET BT 0.934 0 0 0.9835 334.32 32.64 Tm -0.036 Tc 1.7964 Tw (behaviors they defined as negative would decrease) Tj ET endstream endobj 296 0 obj <>/ProcSet 565 0 R/XObject<>>>/Rotate 0/Type/Page>> endobj 297 0 obj [298 0 R 299 0 R] endobj 298 0 obj <>stream q 10.08 0 0 -217.44 681.12 297.12 cm /im113 Do endstream endobj 299 0 obj <>stream Q 0.72 w 1 j 0 0 0 RG 678.24 558 m 678.24 79.92 l S 54.72 538.32 m 653.28 538.32 l S 54.48 519.6 m 653.28 519.6 l S 51.84 98.88 m 650.88 98.88 l S BT 0.9863 0 0 0.9863 234.96 547.92 Tm 0 0 0 rg /F3 9 Tf 0.0352 Tc 0.8679 Tw (Table 4-l\227Evaluative Studies Without a Control Group) Tj ET BT 0.9262 0 0 0.9939 126 529.92 Tm /F3 7 Tf 0.039 Tc 0.0842 Tw (Year of) Tj ET BT 0.8645 0 0 0.9939 174.48 530.16 Tm 0.1397 Tc 0 Tw (Funding) Tj 179.616 0.2415 TD -0.0694 Tc 2.5755 Tw (Duration of) Tj -318.1451 -8.6933 TD 0.1777 Tc 0 Tw (Citation) Tj ET BT 0.9262 0 0 0.9939 126 522 Tm 0.0452 Tc 0.3367 Tw (the Study) Tj ET BT 0.8645 0 0 0.9939 174.24 522.24 Tm -0.0234 Tc 0 Tw (Source) Tj 82.4512 0 TD -0.0392 Tc (Subjects) Tj 97.1647 0.2415 TD 0.1516 Tc (study) Tj ET BT 0.9262 0 0 0.9939 412.32 522.48 Tm 0.059 Tc 0.5438 Tw (Changes Made to Create the Special Care Unit) Tj -386.0722 -11.8325 TD 0.0759 Tc 0.0444 Tw (Bell and Smith,) Tj ET BT 0.8645 0 0 0.9939 54.48 503.04 Tm -0.0744 Tc 0 Tw (unpublished) Tj 0 -7.9688 TD -0.0542 Tc (manuscript) Tj ET BT 0.9262 0 0 0.9939 126.48 510.96 Tm -0.0065 Tc (1986) Tj ET BT 0.8645 0 0 0.9939 174.24 511.2 Tm -0.0739 Tc 1.8867 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj 82.4512 7.7273 TD -0.0568 Tc 1.728 Tw (residents of one 24-bed) Tj ET BT 0.9262 0 0 0.9939 245.04 503.28 Tm 0.0604 Tc 0.0611 Tw (special care unit and) Tj ET BT 0.8645 0 0 0.9939 245.28 495.36 Tm -0.0354 Tc 1.4257 Tw (one 28-bed special care) Tj ET BT 0.8027 0 0 0.9939 245.28 487.2 Tm 0.2292 Tc 0 Tw (unit) Tj ET BT 0.8645 0 0 0.9939 245.04 473.28 Tm -0.0427 Tc 0.7864 Tw (32 residents of ) Tj ET BT 0.9018 0 0 0.9835 292.08 473.28 Tm /F6 10 Tf 0.0535 Tc -0.1657 Tw (a ) Tj ET BT 0.8645 0 0 0.9939 298.8 473.28 Tm /F3 7 Tf 0.1437 Tc 0 Tw (46-) Tj -61.9078 -8.2103 TD -0.0385 Tc 1.9845 Tw (bed special care unit) Tj 97.4423 46.6055 TD -0.0066 Tc 0.0044 Tw (6 ) Tj 6.1075 0 TD /F11 7 Tf -0.0829 Tc 0.0926 Tw (months, ) Tj 31.0927 0 TD /F3 7 Tf -0.0593 Tc 1.4534 Tw (from 3) Tj -37.4778 -7.9688 TD -0.0739 Tc 1.6553 Tw (months before to 3) Tj -0.2776 -8.2103 TD -0.0656 Tc 2.2935 Tw (months after the 24-) Tj 0 -7.9688 TD -0.0805 Tc 2.3108 Tw (bed unit opened) Tj ET BT 0.9262 0 0 0.9939 412.56 511.2 Tm 0.0625 Tc 0.0588 Tw (locked access doors; secure outdoor area; separate lounge, dining area and) Tj -0.2591 -7.7273 TD 0.0574 Tc 0.0644 Tw (nurses\222 station; increased staff-to-resident ratio compared to nonspecialized) Tj ET BT 0.8645 0 0 0.9939 412.32 495.6 Tm -0.0435 Tc 2.0155 Tw (units in the same two facilities; staff training by the Denver Alzheimer\222s) Tj -0.5552 -8.2103 TD -0.0492 Tc 2.8297 Tw (Association Chapter; efforts to involve families.) Tj 0.2776 -14.0058 TD -0.06 Tc 0.066 Tw (unlocked ) Tj ET BT 0.9018 0 0 0.9835 442.08 473.52 Tm /F6 10 Tf 0.083 Tc -0.1983 Tw (access ) Tj ET BT 0.8645 0 0 0.9939 468 473.52 Tm /F3 7 Tf -0.0483 Tc 2.2338 Tw (doors with alarms and double doorknobs; special activity) Tj -64.684 -7.9688 TD -0.0434 Tc 2.9618 Tw (programs; sensory stimulation; reality orientation; personal markers on resi-) Tj -0.2776 -8.2103 TD -0.0643 Tc 2.1069 Tw (dents\222 doors; orientation boards; ongoing staff training; family support groups.) Tj -413.6442 15.4547 TD -0.0665 Tc 0.3512 Tw (Benson et ) Tj ET BT 0.8449 0 0 0.9835 85.68 472.8 Tm /F2 10 Tf 0.0672 Tc 0 Tw (al.,) Tj ET BT 0.9262 0 0 0.9939 54.48 464.88 Tm /F3 7 Tf 0.0316 Tc 0.8696 Tw (1987 and) Tj -0.5182 -8.2103 TD 0.0657 Tc 0.0554 Tw (Cameron et al.,) Tj 0.5182 -7.9688 TD -0.0065 Tc 0 Tw (1987) Tj 77.4736 24.3894 TD -0.0057 Tc (1984-1985) Tj ET BT 0.8645 0 0 0.9939 173.76 473.28 Tm -0.0739 Tc 2.0255 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.8027 0 0 0.9939 329.28 473.52 Tm -0.0643 Tc 0.2261 Tw (one ) Tj ET BT 0.8499 0 0 0.9835 341.76 473.52 Tm /F5 10 Tf 0.0667 Tc -0.0383 Tw (year, ) Tj ET BT 0.8027 0 0 0.9939 361.2 473.52 Tm /F3 7 Tf 0.0048 Tc 1.7844 Tw (from just be-) Tj ET BT 0.8645 0 0 0.9939 328.8 465.36 Tm -0.0438 Tc 1.5743 Tw (fore to one year after) Tj -0.2776 -8.2103 TD -0.0803 Tc 2.4493 Tw (the unit opened) Tj ET BT 0.9262 0 0 0.9939 245.28 436.32 Tm 0.0359 Tc 0.541 Tw (11 residents of a 20) Tj ET BT 0.8645 0 0 0.9939 244.8 428.16 Tm -0.0385 Tc 1.9845 Tw (bed special care unit) Tj 97.4423 8.4518 TD -0.068 Tc 1.4634 Tw (8 months, from 4) Tj -0.2776 -8.4518 TD -0.0739 Tc 1.6553 Tw (months before to 4) Tj 0 -7.7273 TD -0.0741 Tc 1.9332 Tw (months after the unit) Tj -0.5552 -8.2103 TD 0.153 Tc 0 Tw (opened) Tj 0.5552 -12.7984 TD -0.0066 Tc 0.0044 Tw (6 ) Tj 5.8299 0 TD /F11 7 Tf -0.0829 Tc 0.0926 Tw (months, ) Tj 30.8151 0 TD /F3 7 Tf -0.0593 Tc 1.4534 Tw (from 3) Tj -37.2002 -8.2103 TD -0.0739 Tc 1.6553 Tw (months before to 3) Tj 0 -7.9688 TD -0.0741 Tc 2.0257 Tw (months after the unit) Tj T* 0.153 Tc 0 Tw (opened) Tj 96.6095 61.3358 TD -0.0484 Tc 2.8288 Tw (\223quiet, predictable environment;\224 increased staff-to-resident ratio compared to) Tj -0.2776 -8.2103 TD -0.0483 Tc 1.7183 Tw (the rest of the facility.) Tj -413.6442 7.7273 TD -0.0339 Tc 1.1464 Tw (Bullock et al.,) Tj -0.2776 -8.4518 TD -0.0744 Tc 0 Tw (unpublished) Tj -0.2776 -7.9688 TD -0.0495 Tc (manuscript,) Tj ET BT 0.9262 0 0 0.9939 54 411.6 Tm -0.0065 Tc (1988) Tj 77.7327 24.6309 TD -0.0065 Tc (1987) Tj ET BT 0.8645 0 0 0.9939 173.52 436.32 Tm -0.0739 Tc 2.0255 Tw (no funding source) Tj 0 -8.2103 TD 0.1977 Tc 0 Tw (reported) Tj -0.2776 -28.9775 TD -0.0739 Tc 1.8867 Tw (no funding source) Tj -0.2776 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj 83.2841 7.9688 TD -0.0403 Tc 1.5008 Tw (11 residents of a 16-) Tj -0.5552 -7.9688 TD -0.0385 Tc 1.9845 Tw (bed special care unit) Tj ET BT 0.9262 0 0 0.9939 411.36 399.6 Tm 0.0485 Tc 0.0739 Tw (closed access doors; separate dining and activity areas; efforts to reduce) Tj ET BT 0.8645 0 0 0.9939 411.36 391.68 Tm -0.056 Tc 1.7523 Tw (stimulation; consistent dally routine; neutral colors and design; no TV or radio;) Tj 0 -8.2103 TD -0.0641 Tc 1.9909 Tw (only one phone; visitor and staff traffic through the unit limited to reduce) Tj -0.2776 -7.9688 TD -0.0544 Tc 2.6044 Tw (stimulation; training programs for staff and families.) Tj ET BT 0.9262 0 0 0.9939 53.28 398.88 Tm 0.0605 Tc 0.061 Tw (Cleary et al.,) Tj 0.5182 -7.9688 TD -0.0065 Tc 0 Tw (1988) Tj ET BT 0.8027 0 0 0.9939 125.28 399.12 Tm 0.1573 Tc (not) Tj ET BT 0.8645 0 0 0.9939 125.04 391.2 Tm 0.1977 Tc (reported) Tj 55.2451 -29.702 TD -0.0739 Tc 2.0255 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.9262 0 0 0.9939 244.08 361.68 Tm 0.0436 Tc 0.0792 Tw (6 residents of a 26-bed) Tj -0.2591 -7.9688 TD 0.056 Tc 0.0658 Tw (special care unit) Tj ET BT 0.8645 0 0 0.9939 328.56 361.92 Tm -0.0066 Tc 0.0044 Tw (4 ) Tj 5.8299 0 TD /F11 7 Tf -0.0829 Tc 0.0926 Tw (months, ) Tj 30.8151 0 TD /F3 7 Tf -0.059 Tc 2.8411 Tw (from before) Tj -37.2002 -7.9688 TD -0.072 Tc 2.0232 Tw (admission to 4 months) Tj -0.2776 -7.9688 TD -0.0471 Tc 1.7169 Tw (after admission for 5) Tj ET BT 0.8027 0 0 0.9939 327.84 336.72 Tm -0.0127 Tc 1.2581 Tw (subjects, and one month,) Tj ET BT 0.8645 0 0 0.9939 327.6 330.24 Tm -0.0567 Tc 2.6996 Tw (from before admission) Tj 0 -7.9688 TD -0.0809 Tc 0.5761 Tw (to one month after ) Tj ET BT 0.8567 0 0 0.9835 383.76 322.32 Tm /F6 10 Tf 0.0358 Tc 0 Tw (ad-) Tj ET BT 0.8645 0 0 0.9939 327.84 314.4 Tm /F3 7 Tf -0.0568 Tc 1.728 Tw (mission for one subject) Tj 0.2776 -12.7984 TD /F11 7 Tf -0.0734 Tc 0.3592 Tw (3 months, ) Tj 35.8121 0 TD /F3 7 Tf -0.0691 Tc 1.0482 Tw (from the time) Tj -36.3674 -7.7273 TD -0.0797 Tc 1.6158 Tw (the unit opened to 3) Tj 0.2776 -7.9688 TD -0.0707 Tc 2.0218 Tw (months after it opened) Tj ET BT 0.9262 0 0 0.9939 411.36 361.92 Tm 0.0625 Tc 0.0588 Tw (locked access doors; separate dining room and day room; calm, reassuring) Tj ET BT 0.8567 0 0 0.9835 411.12 354 Tm /F6 10 Tf 0.038 Tc -0.0248 Tw (approach; ) Tj ET BT 0.8645 0 0 0.9939 452.4 354 Tm /F3 7 Tf -0.0468 Tc 1.5181 Tw (flexible daily routine; familiar background music; residents encour-) Tj -47.7495 -7.9688 TD -0.0582 Tc 1.8151 Tw (aged to bring in personal Items; 40 hours of staff training; efforts to Involve) Tj ET BT 0.9262 0 0 0.9939 410.88 338.16 Tm 0.0533 Tc 0 Tw (families.) Tj -386.3314 23.182 TD 0.0495 Tc 0.2025 Tw (Greene et al.,) Tj 0.2591 -7.9688 TD -0.0065 Tc 0 Tw (1985) Tj ET BT 0.8027 0 0 0.9939 124.8 361.2 Tm 0.1573 Tc (not) Tj ET BT 0.8645 0 0 0.9939 124.56 353.52 Tm 0.1977 Tc (reported) Tj -83.2841 -52.6425 TD -0.0206 Tc 1.2698 Tw (Hall et al.,) Tj ET BT 0.9262 0 0 0.9939 52.8 293.28 Tm -0.0065 Tc 0 Tw (1966) Tj ET BT 0.8645 0 0 0.9939 172.32 301.44 Tm -0.0739 Tc 2.0255 Tw (no funding source) Tj 0 -7.7273 TD 0.1977 Tc 0 Tw (reported) Tj 83.2841 7.7273 TD -0.0427 Tc 0.6938 Tw (12 residents of ) Tj ET BT 0.9018 0 0 0.9835 290.88 301.44 Tm /F6 10 Tf 0.0535 Tc -0.1657 Tw (a ) Tj ET BT 0.8645 0 0 0.9939 297.6 301.44 Tm /F3 7 Tf 0.1437 Tc 0 Tw (24-) Tj -62.1854 -7.7273 TD -0.07 Tc 1.7434 Tw (bed unit that also) Tj 0 -7.9688 TD 0.1788 Tc 2.0108 Tw (housed nondemented) Tj -0.5552 -7.7273 TD -0.035 Tc 3.9238 Tw (chairfast residents) Tj 193.7742 23.665 TD -0.06 Tc 0.066 Tw (unlocked ) Tj ET BT 0.9018 0 0 0.9835 440.64 301.68 Tm /F6 10 Tf 0.083 Tc -0.1983 Tw (access ) Tj ET BT 0.8645 0 0 0.9939 466.32 301.68 Tm /F3 7 Tf -0.0633 Tc 2.2511 Tw (door; minimal remodeling; efforts to reduce stimulation; no) Tj -63.8511 -7.7273 TD -0.048 Tc 1.7457 Tw (mirrors; no TV; no public address system; home-like atmosphere; textured wall) Tj -0.2776 -7.9688 TD -0.046 Tc 2.132 Tw (hangings; chairs placed in the corridor to encourage resting; flexible dally) Tj 0 -7.7273 TD -0.0588 Tc 1.9386 Tw (routine; residents fed In small groups; visitor and staff traffic through the unit) Tj 0 -7.9688 TD -0.0611 Tc 1.6321 Tw (limited to reduce stimulation; no Increase in staff; ongoing staff training; efforts) Tj -0.5552 -7.9688 TD -0.0535 Tc 2.2795 Tw (to involve families; family support groups.) Tj ET BT 0.8027 0 0 0.9939 124.08 301.2 Tm 0.1573 Tc 0 Tw (not) Tj ET BT 0.8645 0 0 0.9939 124.08 293.52 Tm 0.1977 Tc (reported) Tj 331.4706 -45.1567 TD -0.048 Tc 2.088 Tw (locked access doors; resident bedrooms situated on three skies of) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.9018 0 0 0.9835 620.16 248.64 Tm /F6 10 Tf 0.0535 Tc -0.1657 Tw (a ) Tj ET BT 0.8645 0 0 0.9939 627.12 248.64 Tm /F3 7 Tf 0.2064 Tc 0 Tw (large) Tj ET BT 0.9262 0 0 0.9939 410.4 240.72 Tm 0.0559 Tc 0.0948 Tw (central space; designated dining and activity areas; open, centrally located) Tj ET BT 0.8645 0 0 0.9939 410.64 232.32 Tm -0.0506 Tc 1.2697 Tw (nurses\222 station; therapeutic kitchen for residents; lounge for residents) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8567 0 0 0.9835 621.6 232.32 Tm /F6 10 Tf 0.039 Tc -0.026 Tw (and ) Tj ET BT 0.8645 0 0 0.9939 637.92 232.32 Tm /F3 7 Tf -0.0365 Tc 0 Tw (their) Tj -263.1776 -7.7273 TD -0.0552 Tc 2.332 Tw (families; staff offices located just outside the unit; movable furniture in central) Tj 0 -8.2103 TD -0.0316 Tc 2.0598 Tw (area; washable, vinyl wall coverings in neutral colors; fabric wall hangings;) Tj 0.2776 -7.9688 TD -0.0337 Tc 1.9096 Tw (mirrors in residents\222 rooms; large) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8806 0 0 0.99 516.48 208.56 Tm /F2 8 Tf 0.0418 Tc -0.14 Tw (dock; ) Tj ET BT 0.8645 0 0 0.9939 534.96 208.56 Tm /F3 7 Tf -0.0624 Tc 3.9554 Tw (orientation board; color-coded door) Tj -144.6367 -7.7273 TD -0.0605 Tc 1.7323 Tw (jams and bedrooms; residents\222 name on bedroom door; toilet In each bedroom.) Tj ET BT 0.9262 0 0 0.9939 124.32 247.92 Tm 0.2246 Tc 0 Tw (1973-1974) Tj ET BT 0.8645 0 0 0.9939 172.08 248.16 Tm -0.0739 Tc 2.0255 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.9262 0 0 0.9939 243.36 248.16 Tm 0.0506 Tc 0.0717 Tw (53 residents of 3 iden-) Tj ET BT 0.8645 0 0 0.9939 243.36 240.24 Tm -0.0275 Tc 0.8613 Tw (tical 40-bed special care) Tj 0 -7.9688 TD -0.0566 Tc 1.3808 Tw (units in a 120-bed nurs-) Tj T* -0.0687 Tc 2.0194 Tw (ing home designed for) Tj 0 -8.2103 TD -0.0481 Tc 3.6613 Tw (persons with dementia) Tj 98.8304 32.5997 TD -0.0066 Tc 0.0044 Tw (19 ) Tj 9.9941 0 TD /F11 7 Tf -0.0829 Tc 0.0926 Tw (months, ) Tj 30.5375 0 TD /F3 7 Tf -0.075 Tc 2.0267 Tw (from one) Tj -42.1973 -7.9688 TD -0.0567 Tc 1.0339 Tw (year before to 7 months) Tj 0 -8.4518 TD -0.0649 Tc 2.2001 Tw (after the units opened) Tj -318.4227 15.4547 TD -0.0408 Tc 1.7095 Tw (Lawton et al.,) Tj ET BT 0.9262 0 0 0.9939 52.56 239.76 Tm 0.0316 Tc 0.6105 Tw (1984 and) Tj ET BT 0.8645 0 0 0.9939 51.84 231.6 Tm -0.0259 Tc 1.9699 Tw (Liebowitz et al.,) Tj ET BT 0.9262 0 0 0.9939 52.32 223.68 Tm -0.0065 Tc 0 Tw (1979) Tj ET BT 0.8645 0 0 0.9939 327.36 178.32 Tm -0.051 Tc 0.6804 Tw (one year, from before to) Tj ET BT 0.9262 0 0 0.9939 326.88 170.4 Tm 0.051 Tc 0.0713 Tw (one year after the unit) Tj ET BT 0.8645 0 0 0.9939 326.88 162.24 Tm 0.153 Tc 0 Tw (opened) Tj ET BT 0.9262 0 0 0.9939 409.92 178.32 Tm 0.0654 Tc 0.0558 Tw (closed unit; no other features of the unit are described in the study report.) Tj -386.5905 -0.7244 TD 0.0601 Tc 0.3206 Tw (McCracken and) Tj 0 -7.9688 TD 0.042 Tc 1.1174 Tw (Fitzwater, 1988) Tj ET BT 0.8027 0 0 0.9939 123.6 177.6 Tm 0.3566 Tc 0 Tw (not) Tj ET BT 0.8645 0 0 0.9939 123.6 169.68 Tm 0.1977 Tc (reported) Tj 55.2451 8.4518 TD -0.0739 Tc 2.1643 Tw (no funding source) Tj 0 -8.2103 TD 0.1977 Tc 0 Tw (reported) Tj 83.2841 8.2103 TD -0.0427 Tc 0.6938 Tw (11 residents of ) Tj ET BT 0.9018 0 0 0.9835 289.92 178.08 Tm /F6 10 Tf 0.0535 Tc -0.1657 Tw (a ) Tj ET BT 0.8645 0 0 0.9939 296.64 178.08 Tm /F3 7 Tf 0.1487 Tc 0 Tw (spe-) Tj -62.463 -7.9688 TD -0.0329 Tc 1.5617 Tw (cial care unit; unit size) Tj 0.2776 -8.4518 TD -0.0637 Tc 3.4018 Tw (not reported) Tj 192.9414 -12.5569 TD -0.0553 Tc 1.9114 Tw (doorways painted in contrasting colors; enclosed outdoor area with nonpoison-) Tj ET BT 0.9262 0 0 0.9939 409.92 141.36 Tm 0.0669 Tc 0.0541 Tw (ous plants; furniture with rounded edges; medication carts and housekeeping) Tj ET BT 0.8645 0 0 0.9939 51.84 148.32 Tm 0.2044 Tc 0 Tw (Mummah-Castillo,) Tj ET BT 0.9262 0 0 0.9939 52.08 140.4 Tm -0.0065 Tc (1987) Tj 77.4736 8.2103 TD 0.2246 Tc (1983-1984) Tj ET BT 0.8645 0 0 0.9939 171.36 148.8 Tm -0.0739 Tc 2.1643 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.9262 0 0 0.9939 243.36 148.8 Tm 0.0338 Tc 0.0898 Tw (10 residents of a 22-) Tj ET BT 0.8645 0 0 0.9939 242.88 140.88 Tm -0.0385 Tc 1.9845 Tw (bed special care unit) Tj ET BT 0.9262 0 0 0.9939 327.12 149.04 Tm /F11 7 Tf 0.06 Tc 0.0615 Tw (one year, ) Tj 32.6477 0 TD /F3 7 Tf 0.0482 Tc 0.0743 Tw (from 6) Tj ET BT 0.8645 0 0 0.9939 326.88 141.12 Tm -0.0739 Tc 1.6553 Tw (months before to 6) Tj 95.7767 -7.9688 TD -0.049 Tc 2.4594 Tw (carts locked; residents encouraged to bring in personal items; home-like) Tj ET BT 0.9262 0 0 0.9939 409.92 125.28 Tm 0.0577 Tc 0.064 Tw (atmosphere; visual cues; clocks, calendars, and orientation boards; remi-) Tj ET BT 0.8645 0 0 0.9939 409.92 117.12 Tm -0.0512 Tc 2.9708 Tw (niscence therapy; pet therapy; cooking; encourage resident participation In) Tj 0 -7.7273 TD -0.0503 Tc 2.2001 Tw (activities; staff training; staff selected specifically for the unit; efforts to involve) Tj ET BT 0.9262 0 0 0.9939 409.68 101.52 Tm 0.0533 Tc 0 Tw (families.) Tj ET BT 0.8645 0 0 0.9939 326.88 132.96 Tm -0.0623 Tc 2.0121 Tw (months after admission) Tj ET BT 0.9262 0 0 0.9939 52.08 90 Tm 0.0463 Tc 0.0763 Tw (SOURCE: Office of Technology Assessment, 1992.) Tj ET endstream endobj 300 0 obj <>/Filter/CCITTFaxDecode/Height 1208/Length 1805/Name/im113/Subtype/Image/Type/XObject/Width 56>>stream &Qa# pO|>}/G~'_zҥ{cXAP|.AHǝA_ka|&@jf`م_ < ծDpKR_{$c5Πה ~==?? a)C7 A~^KhZk;,ry ]R~/kK} ֶ\W.,|eRA|$ ם8}r!>j%>0AiH #HH9rL^3A^It֐^.+[CC"=JipN [ ZD FEסY *lY R.f/[8j#\LA/Kᯠ __-5_% 0װ]kwAO]U:X< O Z5?@KK ap\ Υ5W8 ?z3 O}%K K/[i|'便ց<.p\E:^PpCBzCL^^{|/ 8]0&'F^u4m[C2zCLM ]c i5 ,r #?eO @T״fxm a.xѢV (a Ԑ .Ox @gC*V.)iip5?$ ,rq LHkSV]ZK/KL%-B]yO $|:tx]p\O~ |5,|w{]B~N$<#P 恩a=?7|Q^}|\.O1<r02]8~h %_X%Kku]r/Aq 뭬Ta?' pK tk>N tGW%K_0\:خ[ 0Y!]A/ iBpMl@A=tN} kAz _] ~EPqe6D0N@'`PTAN.)\z:?Ok%V_ xKLalX}Hq"H3^"% tCX\">&@.`Ӆad |/["z^%v%dzq[]ma,  endstream endobj 301 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 302 0 obj <>stream 0.72 w 1 j 0 0 0 RG 79.2 675.84 m 556.8 675.84 l S 81.36 72.48 m 560.16 72.48 l S BT 0.9835 0 0 0.9835 79.2 681.36 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0534 Tw (114 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 79.44 642.72 Tm /F4 10 Tf 0.0533 Tc 0.1795 Tw (and eventually reach the same frequency as in the old) Tj ET BT 0.8491 0 0 0.9835 79.2 630.72 Tm 0.0553 Tc 0 Tw (unit.) Tj ET BT 0.934 0 0 0.9835 90.72 608.16 Tm -0.0236 Tc 1.2906 Tw (Other findings of Bell and Smith\222s study did not) Tj ET BT 0.8915 0 0 0.9835 79.68 596.88 Tm 0.022 Tc 1.0778 Tw (fit their hypothesis. Use of physical restraints, which) Tj 0.2692 -12.2018 TD 0.0411 Tc 0.941 Tw (was significantly higher in the new unit than the old) Tj 0 -12.2018 TD 0.0295 Tc 0.6847 Tw (unit at the beg) Tj ET BT 0.934 0 0 0.9835 143.28 572.4 Tm -0.0197 Tc 0.4942 Tw (inning of the study, increased in both) Tj -67.8363 -11.4697 TD -0.0224 Tc 1.011 Tw (units over the course of the study \(22\). In addition,) Tj ET BT 0.8915 0 0 0.9835 80.4 549.12 Tm 0.0166 Tc 0.4569 Tw (at all times during the study, residents of the old unit) Tj ET BT 0.934 0 0 0.9835 80.4 537.12 Tm -0.0359 Tc 1.2212 Tw (were significantly more likely than residents of the) Tj ET BT 0.9835 0 0 0.9835 80.16 525.36 Tm 0.0423 Tc 3.3809 Tw (new unit to exhibit two behaviors defined as) Tj 0 -12.4458 TD 0.0315 Tc 2.8602 Tw (negative by the researchers-being incompletely) Tj 0.4881 -12.4458 TD 0.0415 Tc 3.0737 Tw (dressed and talking to oneself. One \223positive\224) Tj 0 -12.2018 TD 0.0201 Tc 2.9735 Tw (behavior\227talking with others-was significantly) Tj ET BT 0.934 0 0 0.9835 80.64 477.12 Tm -0.0156 Tc 0.3442 Tw (more common in the new unit than the old unit, but) Tj ET BT 0.9835 0 0 0.9835 80.88 465.12 Tm 0.0233 Tc 1.8619 Tw (increased over time in the old unit. Thus some) Tj -0.244 -11.7137 TD 0.0323 Tc 0.4627 Tw (negative behaviors were more common in the old) Tj 0.244 -12.4458 TD 0.035 Tc 3.1443 Tw (than the new unit, and one positive behavior) Tj 0.244 -11.9577 TD 0.0284 Tc 1.1348 Tw (increased in the old unit over time.) Tj 176.6818 -0.9761 TD 0.4392 Tc 0 Tw (\221\221Negative\222) Tj ET BT 0.934 0 0 0.9835 80.88 417.6 Tm -0.0025 Tc 1.1182 Tw (behaviors, such as shouting, swearing, and hitting,) Tj 0.5139 -11.9577 TD -0.031 Tc 0.4206 Tw (were rare on both units, and their frequency did not) Tj 0 -12.4458 TD -0.0236 Tc 1.0979 Tw (change over time.) Tj ET BT 0.9835 0 0 0.9835 92.4 370.8 Tm 0.0239 Tc 0.2446 Tw (Benson et al. found statistically significant im-) Tj ET BT 0.8915 0 0 0.9835 81.36 359.04 Tm 0.0302 Tc 1.0877 Tw (provements in mental and emotional status, hygiene,) Tj ET BT 0.934 0 0 0.9835 81.84 347.04 Tm -0.0185 Tc 1.2393 Tw (and other physical functions among 32 residents of) Tj ET BT 0.9835 0 0 0.9835 81.6 335.28 Tm 0.0424 Tc 0.3478 Tw (one 46-bed special care unit \(24\). Compared with) Tj ET BT 0.934 0 0 0.9835 81.36 323.04 Tm -0.0231 Tc 1.1295 Tw (baseline values at the time of the residents\222 admis-) Tj ET BT 0.9835 0 0 0.9835 82.08 311.28 Tm 0.0216 Tc 1.7112 Tw (sion to the unit, significant improvements were) Tj ET BT 0.934 0 0 0.9835 81.6 299.52 Tm -0.0108 Tc 0.9044 Tw (found at both 4 months and 1 year in the following) Tj ET BT 0.9835 0 0 0.9835 81.84 287.52 Tm 0.0353 Tc 2.4293 Tw (aspects of the residents\222 mental and emotional) Tj ET BT 0.934 0 0 0.9835 82.08 275.76 Tm -0.0354 Tc 1.2819 Tw (status: the residents made more decisions, compre-) Tj ET BT 0.9835 0 0 0.9835 81.36 264 Tm 0.0391 Tc 2.9867 Tw (hended more, were more responsive, exhibited) Tj ET BT 0.934 0 0 0.9835 81.84 251.76 Tm -0.0365 Tc 0.7447 Tw (greater interest in themselves and others, and were) Tj -1.0278 -12.2018 TD -0.027 Tc 0.7482 Tw (judged by the researchers to be less lonely, anxious,) Tj ET BT 0.9835 0 0 0.9835 81.84 227.76 Tm 0.0421 Tc 0.2871 Tw (apathetic, depressed, and self-centered. Improve-) Tj -0.244 -12.2018 TD 0.0231 Tc 2.6858 Tw (ments in hygiene and other physical functions) Tj ET BT 0.934 0 0 0.9835 81.84 204 Tm -0.0318 Tc 1.3637 Tw (included increased cleanliness and neatness, better) Tj ET BT 0.9835 0 0 0.9835 81.84 191.76 Tm 0.0193 Tc 1.7541 Tw (eating habits, normal bowel habits, and normal) Tj ET BT 0.934 0 0 0.9835 81.84 179.76 Tm -0.0237 Tc 1.7833 Tw (urinary function. Residents also had less difficulty) Tj ET BT 0.8915 0 0 0.9835 82.32 168 Tm 0.0287 Tc 0.801 Tw (sleeping, took fewer sedatives, had less diarrhea, and) Tj ET BT 0.9835 0 0 0.9835 82.08 156 Tm 0.0218 Tc 0.6127 Tw (were less malodorous. No statistically significant) Tj 0 -11.9577 TD 0.0418 Tc 0.8365 Tw (changes were noted over the l-year course of the) Tj 0.244 -12.2018 TD 0.0435 Tc 2.6476 Tw (study in the proportion of residents who were) Tj ET BT 0.934 0 0 0.9835 82.08 120 Tm -0.0226 Tc 1.207 Tw (dependent in activities of daily living \(i.e., bathing,) Tj 0 -11.7137 TD -0.0222 Tc 1.0965 Tw (dressing, eating, transferring, or walking\) or in the) Tj ET BT 0.9835 0 0 0.9835 81.6 96.48 Tm 0.05 Tc 0.3808 Tw (proportion of residents who exhibited five behav-) Tj 0.4881 -12.2018 TD 0.0211 Tc -0.1187 Tw (ioral symptoms \(i.e., regressive behavior, wander-) Tj ET BT 0.8915 0 0 0.9835 330.48 642.72 Tm 0.0228 Tc 0.9615 Tw (ing, nighttime agitation, assaultiveness, and abusive-) Tj ET BT 0.934 0 0 0.9835 330.48 630.48 Tm 0.0167 Tc 1.3118 Tw (ness\) \(70\).) Tj ET BT 0.9835 0 0 0.9835 341.52 611.76 Tm 0.0272 Tc 0.648 Tw (Bullock et al. found improvements in behavior) Tj ET BT 0.934 0 0 0.9835 330.72 599.52 Tm -0.0177 Tc 1.2201 Tw (among 13 female residents of a 20-bed special care) Tj -0.257 -11.9577 TD 0.0268 Tc 1.044 Tw (unit \(56\).) Tj ET BT 0.9557 0 0 1.08 371.52 592.56 Tm /F4 4 Tf 0.0359 Tc -0.1452 Tw (1 ) Tj ET BT 0.934 0 0 0.9835 374.88 587.76 Tm /F4 10 Tf -0.0366 Tc 2.0755 Tw (The researchers compared the frequency) Tj -47.0229 -12.2018 TD -0.016 Tc 1.3101 Tw (of 11 behavioral symptoms over an 8-month period) Tj 0 -11.9577 TD -0.0117 Tc 0.9996 Tw (from 4 months before until 4 months after the unit) Tj ET BT 0.9835 0 0 0.9835 330.96 551.76 Tm 0.036 Tc 0.4763 Tw (opened. The 11 behavioral symptoms were agita-) Tj 0.244 -11.9577 TD 0.0149 Tc 0.4977 Tw (tion, anxiety, combativeness, insomnia, resistive-) Tj ET BT 0.934 0 0 0.9835 331.2 528 Tm -0.0294 Tc 3.1598 Tw (ness, uncooperativeness, restlessness, withdrawal,) Tj ET BT 0.9835 0 0 0.9835 331.2 515.76 Tm 0.0252 Tc 1.3821 Tw (verbal abusiveness, yelling, and taking off one\222s) Tj ET BT 0.934 0 0 0.9835 331.44 503.76 Tm -0.0227 Tc 1.1827 Tw (clothes. In the 4 months after the special care unit) Tj ET BT 0.9835 0 0 0.9835 331.68 491.52 Tm 0.0489 Tc 1.5919 Tw (opened, the frequency of 9 of the 11 behavioral) Tj 0.244 -12.2018 TD 0.0301 Tc 2.6613 Tw (symptoms was greatly reduced \(from 12 to 84) Tj ET BT 0.934 0 0 0.9835 331.44 467.76 Tm -0.0306 Tc 1.1054 Tw (percent, depending on the behavior\). The frequency) Tj 0.5139 -12.2018 TD -0.0263 Tc 2.0773 Tw (of the other 2 behavioral symptoms\227resistiveness) Tj ET BT 0.9835 0 0 0.9835 331.92 444 Tm 0.0409 Tc 3.6844 Tw (and verbal abuse-increased 5 percent and 20) Tj -0.244 -12.2018 TD 0.0278 Tc -0.1254 Tw (percent, respectively. No other negative outcomes) Tj ET BT 0.8915 0 0 0.9835 332.16 420 Tm 0.0207 Tc 0.1562 Tw (are noted in the study report. On the positive side, the) Tj ET BT 0.9835 0 0 0.9835 331.68 408.24 Tm 0.0385 Tc 1.9206 Tw (report notes slight reductions in the dosages of) Tj 0.244 -12.2018 TD 0.0368 Tc 0.3942 Tw (psychotropic medications received by some of the) Tj ET BT 0.934 0 0 0.9835 331.92 384 Tm -0.0259 Tc 1.2718 Tw (residents. The statistical significance of the study\222s) Tj 0.257 -12.4458 TD -0.0233 Tc 1.2689 Tw (findings was not computed.) Tj ET BT 0.9835 0 0 0.9835 343.2 353.04 Tm 0.0298 Tc 2.5027 Tw (As part of the study by Bullock et al., brief) Tj ET BT 0.934 0 0 0.9835 332.64 341.04 Tm -0.0489 Tc 2.1528 Tw (interviews were conducted with the unit residents) Tj 0.257 -12.2018 TD -0.0385 Tc 1.848 Tw (\(56\). The residents were asked whether they liked) Tj ET BT 0.9835 0 0 0.9835 332.64 317.04 Tm 0.0249 Tc -0.0179 Tw (the unit; whether they were \223very happy,\224 \223pretty) Tj -0.244 -12.2018 TD 0.0275 Tc 4.2675 Tw (happy,\224 or) Tj 58.3245 0 TD 0.2369 Tc 3.6885 Tw (\221\221not so happy;\222) Tj 85.4125 0 TD 0.0362 Tc -0.134 Tw (whether they were) Tj -143.493 -11.9577 TD 0.0396 Tc 1.4663 Tw (treated well; and whether they were worried or) Tj ET BT 0.8915 0 0 0.9835 332.4 281.76 Tm 0.0315 Tc 2.0285 Tw (relaxed. In general, the residents expressed positive) Tj ET BT 0.934 0 0 0.9835 332.88 269.76 Tm -0.0243 Tc 0.9702 Tw (attitudes toward the unit. No attempt was made to) Tj ET BT 0.8915 0 0 0.9835 332.64 258 Tm 0.0424 Tc 1.0933 Tw (evaluate the reliability or validity of their responses.) Tj ET BT 0.934 0 0 0.9835 332.64 245.76 Tm -0.053 Tc 1.1722 Tw (Moreover, since the interviews were conducted only) Tj 0.257 -12.4458 TD -0.041 Tc 1.5448 Tw (once, after the unit opened, it is not clear whether) Tj 0 -11.9577 TD -0.0329 Tc 1.5117 Tw (there were changes in the residents\222 attitudes that) Tj T* -0.0376 Tc 0.7988 Tw (could be attributed to the impact of the special care) Tj ET BT 0.8491 0 0 0.9835 332.88 197.76 Tm 0.0553 Tc 0 Tw (unit.) Tj ET BT 0.9835 0 0 0.9835 344.16 179.04 Tm 0.0219 Tc 0.7754 Tw (Cleary et al. found statistically significant im-) Tj ET BT 0.8915 0 0 0.9835 332.88 167.28 Tm 0.0349 Tc 1.3325 Tw (provements in several aspects of the functioning and) Tj ET BT 0.934 0 0 0.9835 332.88 155.28 Tm -0.0314 Tc 1.1384 Tw (physical condition of 9 residents of a 16-bed special) Tj 0.5139 -12.4458 TD -0.0338 Tc 0.4922 Tw (care unit which is described in the study report as a) Tj ET BT 0.9835 0 0 0.9835 334.08 131.52 Tm 0.0236 Tc 1.221 Tw (\223reduced stimulation unit\224 \(88\). Over a 6-month) Tj ET BT 0.934 0 0 0.9835 332.88 119.28 Tm -0.0304 Tc 0.7341 Tw (period from 3 months before to 3 months after their) Tj 0.5139 -11.7137 TD -0.0312 Tc 1.1061 Tw (admission to the unit, the residents\222 average scores) Tj ET BT 0.9835 0 0 0.9835 333.36 95.76 Tm 0.0254 Tc 1.8781 Tw (improved significantly on the Haycox Dementia) Tj ET BT 0.8915 0 0 0.9835 333.36 83.76 Tm 0.0287 Tc 1.224 Tw (Behavior Scale \(176\), an assessment instrument that) Tj ET q 0.96 0 0 -4.08 96.24 66.72 cm BI /W 9 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>>>>>>>>>>>>>>> EI Q BT 0.1878 0 0 0.9835 96.24 60.24 Tm 3 Tr /F2 10 Tf 0.1101 Tc 0 Tw (1) Tj 0 Tr ET BT 0.7511 0 0 0.9835 97.2 60.24 Tm 0.0525 Tc 0.4112 Tw ( This study ) Tj ET q 16.56 0 0 -5.76 134.64 66 cm BI /W 115 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~??~?~~~|~|c~|~|~|~|~|><>>>|>~>ǃ~~``w~~~>?? EI Q BT 0.6572 0 0 0.9835 134.64 60.24 Tm 3 Tr 0.0776 Tc 0 Tw (diilers) Tj 0 Tr ET BT 0.7511 0 0 0.9835 151.2 60.24 Tm 0.0441 Tc 0.907 Tw ( from the other studies discussed in this section because the special care unit was in a mental hospital rather ) Tj ET q 11.04 0 0 -5.76 494.88 66 cm BI /W 77 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @>0???????????>??|??|????????????????}?8 EI Q BT 0.6102 0 0 0.9835 494.88 60.24 Tm 3 Tr 0.0195 Tc 0 Tw (than) Tj 0 Tr ET BT 0.7511 0 0 0.9835 505.92 60.24 Tm 0.0434 Tc 1.169 Tw ( a nursing home.) Tj -564.6419 -9.0293 TD 0.0536 Tc 0.6644 Tw (OTA has included the study in this analysis of evaluative research on special care units because, like the other special care units included ) Tj ET q 4.8 0 0 -5.52 514.08 56.88 cm BI /W 35 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????px EI Q BT 0.6102 0 0 0.9835 514.08 51.36 Tm 3 Tr 0.0414 Tc 0 Tw (in) Tj 0 Tr ET BT 0.7511 0 0 0.9835 518.88 51.36 Tm 0.0539 Tc 0.6223 Tw ( the analysis,) Tj ET BT 0.8449 0 0 0.9835 82.08 42.48 Tm 0.0881 Tc -0.0498 Tw (this special care unit is intended to serve ) Tj ET BT 0.8118 0 0 0.9598 224.16 42.48 Tm /F6 5 Tf -0.0392 Tc 0.5714 Tw (only individuals ) Tj ET q 12.48 0 0 -5.28 254.4 47.28 cm BI /W 79 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `o?px8><~>0rp0?? EI Q BT 1.3531 0 0 0.9598 254.4 42.48 Tm 3 Tr -0.0118 Tc 0 Tw (with) Tj 0 Tr ET BT 0.8449 0 0 0.9835 266.88 42.48 Tm /F2 10 Tf 0 Tc 0.0545 Tw ( ) Tj ET q 34.08 0 0 -5.52 268.8 48 cm BI /W 217 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~a~|?>|?||?~?????>p??>p~~8|}ߏ<?????8x3????? EI Q BT 0.6572 0 0 0.9835 268.8 42.48 Tm 3 Tr 0.0179 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.8449 0 0 0.9835 302.88 42.48 Tm 0.092 Tc -0.0544 Tw ( disease and related ) Tj ET q 29.52 0 0 -5.52 372.24 48 cm BI /W 187 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?7~?ߏ?~~|>|>~~~~~?~~~|~>?>>x>`|>~|~~~>~|??|?x8 EI Q BT 0.6572 0 0 0.9835 372.24 42.48 Tm 3 Tr 0.0373 Tc 0 Tw (dementias.) Tj 0 Tr ET BT 0.8449 0 0 0.9835 401.76 42.48 Tm 0.0851 Tc 0.0011 Tw ( Other studies that have evaluated specialized) Tj ET BT 0.798 0 0 0.9835 81.84 33.6 Tm 0.0436 Tc 0.0222 Tw (units in mental hospitals have focused on ) Tj ET q 12.24 0 0 -5.52 217.44 38.64 cm BI /W 85 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID À||||||||||||||?||||||||||p~??|?x|||x0 EI Q BT 0.6102 0 0 0.9835 217.44 33.6 Tm 3 Tr 0.0414 Tc 0 Tw (units) Tj 0 Tr ET BT 0.798 0 0 0.9835 229.68 33.6 Tm 0.0296 Tc 0.1256 Tw ( that serve elderly persons with a variety of psychiatric conditions as well as dementia.) Tj ET endstream endobj 303 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 304 0 obj <>stream 0.72 w 1 j 0 0 0 RG 51.84 682.08 m 530.64 682.08 l S BT 0.9835 0 0 0.9835 314.64 687.36 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.7432 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 507.84 687.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 514.32 687.36 Tm /F5 10 Tf 0.2847 Tc 0 Tw (115) Tj ET BT 0.8915 0 0 0.9835 52.56 648.48 Tm /F4 10 Tf 0.0513 Tc 1.7909 Tw (includes measurements in 8 areas \(language/conver-) Tj ET BT 0.934 0 0 0.9835 53.04 636.24 Tm -0.0198 Tc 1.4151 Tw (sation, social interaction, attention/awareness, spa-) Tj ET BT 0.9835 0 0 0.9835 52.8 623.76 Tm 0.0324 Tc 2.7983 Tw (tial orientation, motor coordination, bowel and) Tj ET BT 0.934 0 0 0.9835 52.56 611.76 Tm -0.0248 Tc 1.656 Tw (bladder control, eating and nutrition, and dressing) Tj 0.7709 -12.4458 TD -0.0283 Tc 1.2131 Tw (and grooming\). The special care unit residents also) Tj ET BT 0.9835 0 0 0.9835 52.8 587.04 Tm 0.0273 Tc 0.1192 Tw (became significantly less agitated; use of physical) Tj 0 -11.9577 TD 0.0235 Tc -0.0804 Tw (restraints was significantly reduced; and the resi-) Tj ET BT 0.934 0 0 0.9835 53.28 563.04 Tm -0.0368 Tc 1.7361 Tw (dents\222 weight increased. No changes were noted in) Tj ET BT 0.9835 0 0 0.9835 53.04 551.04 Tm 0.0385 Tc 2.2227 Tw (residents\222 sleep patterns or use of psychotropic) Tj ET BT 0.8915 0 0 0.9835 53.28 539.04 Tm 0.0575 Tc 1.4609 Tw (medications. The researchers observed more interac-) Tj ET BT 0.9835 0 0 0.9835 53.52 526.8 Tm 0.0392 Tc 0.0257 Tw (tions among residents and between residents and) Tj ET BT 0.934 0 0 0.9835 54 514.56 Tm -0.0203 Tc 0.709 Tw (staff members, but the study design did not include) Tj ET BT 0.8915 0 0 0.9835 54 502.32 Tm 0.042 Tc 1.5456 Tw (a measure of these interactions.) Tj ET BT 0.9835 0 0 0.9835 64.8 474.96 Tm 0.0338 Tc 0.1668 Tw (As part of the study by Cleary et al. interviews) Tj ET BT 0.8915 0 0 0.9835 54 462.96 Tm 0.03 Tc 0.4487 Tw (were conducted with the unit residents to assess their) Tj ET BT 0.9835 0 0 0.9835 54 451.44 Tm 0.036 Tc 0.5983 Tw (feelings of security and well-being \(88\). The resi-) Tj ET BT 0.8915 0 0 0.9835 54 439.2 Tm 0.0243 Tc 0.3317 Tw (dents were asked the same six questions at four times) Tj ET BT 0.9835 0 0 0.9835 54 426.96 Tm 0.0402 Tc 0.1975 Tw (before and four times after the unit opened. They) Tj ET BT 0.934 0 0 0.9835 54.24 415.44 Tm -0.0395 Tc 0.6653 Tw (were asked whether they felt safe; whether they got) Tj ET BT 0.9835 0 0 0.9835 54.72 403.44 Tm 0.0439 Tc -0.0198 Tw (the help they needed; whether they got enough to) Tj -0.244 -11.9577 TD 0.0291 Tc 0.2393 Tw (eat; whether the unit was \223a good place;\222 whether) Tj 0.244 -12.4458 TD 0.0433 Tc 0.2927 Tw (they had a place to sleep; and whether they were) Tj ET BT 0.934 0 0 0.9835 54.96 367.2 Tm -0.02 Tc 0.6373 Tw (afraid. Nine of the 11 residents in the study sample) Tj ET BT 0.9835 0 0 0.9835 54.96 355.2 Tm 0.0309 Tc 0.1852 Tw (completed all the interviews. In general, the resi-) Tj 0 -12.2018 TD 0.0314 Tc 2.4507 Tw (dents expressed a high level of security. Their) Tj ET BT 0.934 0 0 0.9835 54.72 331.2 Tm -0.0321 Tc 1.1499 Tw (responses were also highly consistent, suggesting it) Tj 0.5139 -11.9577 TD -0.0384 Tc 0.71 Tw (is possible to obtain consistent responses from some) Tj ET BT 0.8915 0 0 0.9835 54.96 307.44 Tm 0.0328 Tc 1.8026 Tw (nursing home residents with dementia. Whether the) Tj ET BT 0.934 0 0 0.9835 54.96 295.2 Tm -0.0491 Tc 0.9784 Tw (residents\222 responses reflect their true feelings is not) Tj 0 -12.4458 TD -0.0115 Tc 0 Tw (known.) Tj ET BT 0.8915 0 0 0.9835 66.48 255.6 Tm 0.0485 Tc 1.048 Tw (Greene et al. found improvements in behavior and) Tj ET BT 0.934 0 0 0.9835 55.68 243.36 Tm -0.0245 Tc 1.2595 Tw (other aspects of functioning among 6 residents of a) Tj ET BT 0.9835 0 0 0.9835 55.68 231.36 Tm 0.0314 Tc 2.2299 Tw (26-bed special care unit \(160\). The researchers) Tj 0.244 -12.4458 TD 0.0363 Tc 0.2726 Tw (compared the frequency of 10 negative indicators) Tj ET BT 0.8915 0 0 0.9835 55.92 207.36 Tm 0.0412 Tc 0.9678 Tw (over a 4-month period for 5 of the residents and over) Tj ET BT 0.934 0 0 0.9835 56.16 195.12 Tm -0.0316 Tc 1.6204 Tw (a l-month period for one resident. The 10 negative) Tj 0 -11.9577 TD -0.0401 Tc 1.167 Tw (indicators were hostility, agitation, decreased appe-) Tj ET BT 0.8915 0 0 0.9835 56.16 170.64 Tm 0.0309 Tc 1.5676 Tw (tite, failure to feed oneself, combativeness, failure to) Tj ET BT 0.9835 0 0 0.9835 56.16 158.4 Tm 0.0246 Tc 0.0243 Tw (ambulate, incontinence, inability to dress oneself,) Tj 0.244 -12.4458 TD 0.0212 Tc 0.5646 Tw (withdrawal, and hallucinations. The frequency of) Tj ET BT 0.934 0 0 0.9835 56.16 134.16 Tm -0.0525 Tc 1.5786 Tw (eight of these indicators decreased to zero over the) Tj 0.257 -12.2018 TD -0.0312 Tc 1.4202 Tw (course of the study, and the frequency of the other) Tj ET BT 0.9835 0 0 0.9835 56.4 109.92 Tm 0.0312 Tc 0.1151 Tw (two indicators-hostility and failure to ambulate\227) Tj ET BT 0.934 0 0 0.9835 56.64 97.92 Tm -0.0328 Tc 2.0071 Tw (was greatly reduced. An improvement in cognitive) Tj ET BT 0.9835 0 0 0.9835 56.88 85.68 Tm 0.0351 Tc 1.006 Tw (skills was found in two of the three residents in) Tj ET BT 0.934 0 0 0.9835 56.88 73.92 Tm -0.0363 Tc 1.5397 Tw (whom cognitive skills were measured. An improve-) Tj ET BT 0.9835 0 0 0.9835 56.4 61.92 Tm 0.0336 Tc 0.1669 Tw (ment in mood was found in the three residents in) Tj ET BT 0.934 0 0 0.9835 56.88 49.68 Tm -0.0193 Tc 2.0355 Tw (whom mood was measured. The statistical signifi-) Tj -0.257 -12.2018 TD -0.0233 Tc 1.428 Tw (cance of the study\222s findings was not computed.) Tj ET BT 0.9835 0 0 0.9835 314.64 648 Tm 0.0389 Tc 1.8156 Tw (Hall et al. found reduced use of psychotropic) Tj ET BT 0.934 0 0 0.9835 303.84 636 Tm -0.0292 Tc 1.4894 Tw (medications and desirable weight gain in residents) Tj 0.257 -12.4458 TD -0.0282 Tc 1.16 Tw (of a 24-bed special care unit described in the study) Tj ET BT 0.9835 0 0 0.9835 303.84 612 Tm 0.0416 Tc 2.0569 Tw (report as a) Tj 61.9851 0 TD 0.0075 Tc 4.6539 Tw (\223low stimulus unit\224) Tj 106.6436 0 TD 0.037 Tc 2.6716 Tw (\(171\). In the) Tj -167.8965 -12.4458 TD 0.0302 Tc 0.4648 Tw (3-month period after their admission to the unit,) Tj ET BT 0.934 0 0 0.9835 303.84 587.76 Tm -0.0471 Tc 2.2794 Tw (psychotropic medication use was reduced or elimi-) Tj ET BT 0.8915 0 0 0.9835 304.32 576 Tm 0.0225 Tc 1.1771 Tw (nated in 5 of the 12 individuals in the study sample.) Tj ET BT 0.934 0 0 0.9835 304.56 564 Tm -0.0366 Tc 1.0262 Tw (Prior to their admission to the special care unit, all) Tj ET BT 0.9835 0 0 0.9835 305.76 552.24 Tm 0.0338 Tc 1.3632 Tw (12 individuals had been losing weight. In the 3) Tj -1.2202 -12.2018 TD 0.0262 Tc 0.4185 Tw (months after their admission to the unit, 6 of the) Tj 0 -12.2018 TD 0.0363 Tc 0.2727 Tw (residents gained weight; 5 stopped losing weight,) Tj 0.4881 -12.2018 TD 0.0316 Tc 0.7074 Tw (and one continued to lose. The statistical signifi-) Tj ET BT 0.934 0 0 0.9835 305.04 504 Tm -0.0233 Tc 1.428 Tw (cance of the study\222s findings was not computed.) Tj 11.82 -18.3027 TD -0.0232 Tc 0.5836 Tw (The study by Hall et al. was intended to evaluate) Tj -11.563 -12.4458 TD -0.0379 Tc 0.6636 Tw (the effectiveness of the special care unit in reducing) Tj ET BT 0.8915 0 0 0.9835 305.28 462.24 Tm 0.0446 Tc 1.7895 Tw (catastrophic reactions, defined by the researchers to) Tj ET BT 0.934 0 0 0.9835 305.52 450.48 Tm -0.0191 Tc 0.7333 Tw (include outbursts of noisiness, agitation, combative-) Tj -0.257 -12.2018 TD -0.0242 Tc 2.5375 Tw (ness, sudden withdrawal, increased confusion and) Tj 0.5139 -11.9577 TD -0.0177 Tc 1.1431 Tw (fear, intensified pacing, and nighttime wakefulness) Tj 0.257 -12.2018 TD -0.0083 Tc 0.7879 Tw (\(171\). The study did not include quantitative meas-) Tj ET BT 0.8915 0 0 0.9835 305.76 402.96 Tm 0.047 Tc 1.1138 Tw (urements of these indicators, however. The research-) Tj ET BT 0.9835 0 0 0.9835 306 390.96 Tm 0.053 Tc 1.0691 Tw (ers observed a decreased incidence of two of the) Tj 0 -11.9577 TD 0.0232 Tc 2.0756 Tw (indicators-agitation and nighttime wakefulness.) Tj ET BT 0.934 0 0 0.9835 306.24 366.96 Tm -0.0476 Tc 0.9951 Tw (Other positive outcomes were also observed, includ-) Tj ET BT 0.8915 0 0 0.9835 306.24 354.96 Tm 0.0484 Tc 1.3814 Tw (ing increased social interaction among the residents,) Tj ET BT 0.9835 0 0 0.9835 306.24 343.2 Tm 0.0423 Tc 2.5442 Tw (decreased wandering, and reduced incidence of) Tj ET BT 0.934 0 0 0.9835 306.48 331.2 Tm -0.035 Tc 1.2815 Tw (delusions. The researchers point out, however, that) Tj ET BT 0.9835 0 0 0.9835 306.48 319.68 Tm 0.0409 Tc 2.5457 Tw (these positive findings are based on subjective) Tj 0.244 -12.4458 TD 0.0316 Tc 1.7254 Tw (evaluations and that objective measurements of) Tj ET BT 0.934 0 0 0.9835 306.72 295.2 Tm -0.0406 Tc 1.2446 Tw (various outcome indicators are needed.) Tj ET BT 0.9835 0 0 0.9835 317.76 277.44 Tm 0.0213 Tc 0.654 Tw (Lawton et al. found statistically significant in-) Tj ET BT 0.934 0 0 0.9835 306.72 265.44 Tm -0.026 Tc 1.5777 Tw (creases in friendliness and interest among 53 resi-) Tj ET BT 0.9835 0 0 0.9835 306.96 253.44 Tm 0.0385 Tc 1.9206 Tw (dents who were moved from a 350-bed nursing) Tj -0.244 -12.4458 TD 0.0379 Tc 0.6778 Tw (home to three 40-bed special care units in a new) Tj ET BT 0.934 0 0 0.9835 308.16 229.68 Tm -0.006 Tc 1.4645 Tw (120-bed nursing home \(245\). The researchers com-) Tj ET BT 0.8915 0 0 0.9835 306.72 217.44 Tm 0.0371 Tc 2.0222 Tw (pared the residents\222 cognitive and self-care abilities,) Tj ET BT 0.934 0 0 0.9835 306.96 205.44 Tm -0.0266 Tc 1.5294 Tw (behavior, and mood at 4 times in the l-year period) Tj ET BT 0.9835 0 0 0.9835 307.2 193.68 Tm 0.0368 Tc 1.7635 Tw (before the move and 2 times, one month and 7) Tj ET BT 0.8915 0 0 0.9835 307.44 181.68 Tm 0.0258 Tc 1.3619 Tw (months, after the move. Over the 19-month period of) Tj 0 -12.6899 TD 0.0258 Tc 1.3426 Tw (the study, the subjects showed a significant decrease) Tj ET BT 0.9835 0 0 0.9835 307.44 157.68 Tm 0.03 Tc 0.8892 Tw (in cognitive and self-care abilities. Following the) Tj ET BT 0.8915 0 0 0.9835 307.44 145.44 Tm 0.0286 Tc 1.4934 Tw (move, the subjects spent less time in their bedrooms) Tj ET BT 0.934 0 0 0.9835 307.92 133.2 Tm -0.0278 Tc 0.3315 Tw (and more time in the social spaces, but there ) Tj ET BT 0.9189 0 0 0.99 505.92 133.2 Tm /F3 8 Tf 0.0341 Tc 0.6123 Tw (were no) Tj ET BT 0.934 0 0 0.9835 308.16 121.44 Tm /F4 10 Tf -0.0156 Tc 1.6033 Tw (significant changes in social behavior, involvement) Tj ET BT 0.8915 0 0 0.9835 307.68 109.44 Tm 0.0234 Tc 1.7146 Tw (in planned or staff-supervised activities, ambulation,) Tj 0 -12.4458 TD 0.0237 Tc 1.0374 Tw (behavioral symptoms, use of restraints, or time spent) Tj ET BT 0.934 0 0 0.9835 308.16 85.68 Tm -0.0289 Tc 0.7503 Tw (sleeping or doing nothing. There was an increase in) Tj ET BT 0.8915 0 0 0.9835 308.16 73.44 Tm 0.044 Tc 1.1172 Tw (solitary activities and a decrease in self-maintenance) Tj 0 -12.2018 TD 0.0295 Tc 1.2231 Tw (activities. Although the residents were judged by the) Tj T* 0.0272 Tc 1.7256 Tw (staff to be significantly more friendly and interested) Tj ET BT 0.9835 0 0 0.9835 308.16 37.44 Tm 0.0432 Tc 3.8855 Tw (after the move, they were also judged to be) Tj ET endstream endobj 305 0 obj <>/Rotate 0/Type/Page>> endobj 306 0 obj <>stream 0.72 w 1 j 0 0 0 RG 79.44 673.68 m 557.76 673.68 l S 81.36 71.04 m 560.16 71.04 l S BT 0.9835 0 0 0.9835 79.92 679.2 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (116 ) Tj ET BT 0.9598 0 0 0.9598 99.6 679.2 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 105.84 679.2 Tm /F5 10 Tf 0.0125 Tc 0.8211 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 80.4 640.08 Tm /F4 10 Tf 0.0317 Tc 1.4898 Tw (significantly more depressed. There were no statisti-) Tj ET BT 0.9835 0 0 0.9835 79.92 627.84 Tm 0.0257 Tc 0.0597 Tw (cally significant changes in any of the other mood) Tj ET BT 0.8915 0 0 0.9835 80.4 615.84 Tm 0.0046 Tc 0.8921 Tw (states studied \(i.e., anxiety, anger, happiness, amuse-) Tj -0.2692 -12.2018 TD 0.0166 Tc 1.7759 Tw (ment, agitation, and tranquility\).) Tj ET BT 0.9835 0 0 0.9835 91.44 576.72 Tm 0.0382 Tc 0.291 Tw (Lawton et al. also compared the behavior of 80) Tj ET BT 0.8915 0 0 0.9835 79.92 564.96 Tm 0.0369 Tc 1.0354 Tw (residents of the 3 special care units and 40 residents) Tj ET BT 0.9835 0 0 0.9835 80.4 552.72 Tm 0.2795 Tc 2.9538 Tw (of the old 350-bed nursing home \(245\).) Tj ET BT 1.08 0 0 1.08 282.96 557.52 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (2 ) Tj ET BT 0.9835 0 0 0.9835 287.04 552.72 Tm /F4 10 Tf 1.1716 Tc 0 Tw (Th) Tj 0.122 Tc (e) Tj ET BT 0.934 0 0 0.9835 80.64 540.48 Tm -0.0413 Tc 2.0591 Tw (comparison showed the special care unit residents) Tj 0 -12.4458 TD -0.0359 Tc 1.368 Tw (were significantly more likely than the residents of) Tj 0 -12.2018 TD -0.0278 Tc 0.7598 Tw (the old nursing home to be involved in planned and) Tj ET BT 0.9835 0 0 0.9835 80.88 503.76 Tm 0.0308 Tc 2.1899 Tw (staff-supervised activities and significantly less) Tj -0.244 -12.2018 TD 0.0227 Tc 3.0523 Tw (likely to exhibit behavioral symptoms. On the) Tj ET BT 0.934 0 0 0.9835 80.64 479.76 Tm -0.043 Tc 2.0365 Tw (negative side, the special care unit residents were) Tj ET BT 0.9835 0 0 0.9835 81.12 467.04 Tm 0.0337 Tc 3.0411 Tw (significantly less likely to be involved in self-) Tj -0.4881 -12.4458 TD 0.0193 Tc 0.3713 Tw (maintenance activities. There were no significant) Tj ET BT 0.934 0 0 0.9835 80.64 443.04 Tm -0.0445 Tc 1.1632 Tw (differences between the special care units residents) Tj 0.257 -12.2018 TD -0.0321 Tc 1.1927 Tw (and the residents of the old nursing home in social) Tj -0.257 -12.4458 TD -0.0104 Tc 0.6213 Tw (behavior, ambulation, involvement in solitary activ-) Tj 0.5139 -12.2018 TD -0.0396 Tc 0.9683 Tw (ities, or time spent sleeping or doing nothing.) Tj ET BT 0.8915 0 0 0.9835 91.92 379.44 Tm 0.0404 Tc 1.9109 Tw (McCracken and Fitzwater found improvements in) Tj ET BT 0.9835 0 0 0.9835 81.36 366.96 Tm 0.0255 Tc 0.8531 Tw (special care unit residents\222 scores on the Haycox) Tj ET BT 0.8915 0 0 0.9835 81.36 354.96 Tm 0.0347 Tc 1.2509 Tw (Dementia Behavior Scale \(297\), \(as did Cleary et al.,) Tj ET BT 0.9835 0 0 0.9835 81.36 342.48 Tm 0.0417 Tc 1.5687 Tw (discussed earlier\). Over the l-year period of the) Tj -0.244 -12.2018 TD 0.0264 Tc 3.6412 Tw (McCracken and Fitzwater study, 8 of the 11) Tj 0.244 -12.6899 TD 0.0354 Tc 0.3549 Tw (individuals in the study sample showed improve-) Tj ET BT 0.934 0 0 0.9835 81.36 305.76 Tm -0.0357 Tc 1.0788 Tw (ments in their overall scores on the scale. Improve-) Tj ET BT 0.9835 0 0 0.9835 81.12 293.76 Tm 0.0387 Tc 0.5956 Tw (ments were noted in all but two of the measured) Tj 0.244 -12.6899 TD 0.0233 Tc 2.8076 Tw (characteristics-motor coordination and dressing) Tj 0 -12.4458 TD 0.0249 Tc 1.5858 Tw (and grooming. The three subjects whose overall) Tj 0.244 -12.6899 TD 0.0424 Tc 1.568 Tw (scores on the scale did not improve showed the) Tj ET BT 0.9606 0 0 0.9863 81.6 243.84 Tm /F3 9 Tf -0.0063 Tc 0.0017 Tw (greatest ) Tj ET BT 0.934 0 0 0.9835 117.6 243.84 Tm /F4 10 Tf -0.0394 Tc 0.7937 Tw (decline in these two areas, as well as bowel) Tj ET BT 0.8915 0 0 0.9835 81.6 231.84 Tm 0.0339 Tc 0.7567 Tw (and bladder control, eating and nutrition, and spatial) Tj ET BT 0.9835 0 0 0.9835 81.6 219.36 Tm 0.0253 Tc 2.0246 Tw (orientation. The statistical significance of these) Tj ET BT 0.934 0 0 0.9835 81.36 207.12 Tm -0.0233 Tc 1.3545 Tw (findings was not computed.) Tj ET BT 0.9835 0 0 0.9835 92.64 180 Tm 0.0722 Tc 0 Tw (M) Tj 9.7614 -0.244 TD 0.0331 Tc 0.3085 Tw (ummah-Castillo found reductions in the dos-) Tj -20.499 -12.4458 TD 0.0395 Tc 2.5471 Tw (ages of psychotropic medications and desirable) Tj ET BT 0.934 0 0 0.9835 81.84 155.28 Tm -0.0267 Tc 0.7159 Tw (weight changes in residents of a 22-bed special care) Tj ET BT 0.9835 0 0 0.9835 81.6 143.04 Tm 0.0299 Tc 1.9162 Tw (unit \(312\). Over a l-year period from 6 months) Tj ET BT 0.934 0 0 0.9835 81.6 130.8 Tm -0.0249 Tc 0.4141 Tw (before to 6 months after their admission to the unit,) Tj 0.257 -12.2018 TD -0.0203 Tc 1.0373 Tw (9 of the 10 individuals in the study sample showed) Tj ET BT 0.9835 0 0 0.9835 82.08 107.04 Tm 0.036 Tc 2.0626 Tw (a weight gain, and the dosages of psychotropic) Tj ET BT 0.934 0 0 0.9835 81.36 94.8 Tm -0.0324 Tc 0.7219 Tw (medications were decreased for 7 of the 10 subjects.) Tj ET BT 0.8915 0 0 0.9835 81.6 82.56 Tm 0.0287 Tc 1.724 Tw (The statistical significance of these findings was not) Tj 279.6929 566.6508 TD 0.0441 Tc 2.0144 Tw (computed. The researchers observed that aggressive) Tj -0.2692 -12.9339 TD 0.0525 Tc 0.2551 Tw (behaviors and catastrophic reactions ) Tj ET BT 0.9017 0 0 0.9812 487.68 627.12 Tm /F6 11 Tf -0.0303 Tc 0.2098 Tw (were rare on the) Tj ET BT 0.9812 0 0 0.9812 330.96 614.64 Tm 0.0331 Tc -0.0947 Tw (unit, but the incidence of these behaviors was ) Tj ET BT 0.9835 0 0 0.9835 542.88 614.64 Tm /F4 10 Tf 0.0406 Tc 0 Tw (not) Tj ET BT 0.8915 0 0 0.9835 331.2 602.4 Tm 0.0306 Tc (measured.) Tj ET BT 0.9606 0 0 0.9863 342.24 575.04 Tm /F3 9 Tf -0.0051 Tc 0.0004 Tw (In ) Tj ET BT 0.934 0 0 0.9835 352.08 575.04 Tm /F4 10 Tf 0.0924 Tc 0 Tw (Summ) Tj 31.0916 -1.4642 TD -0.0212 Tc 0.7956 Tw (ary, all nine studies found some ) Tj ET BT 0.9468 0 0 0.9835 526.08 573.6 Tm /F6 10 Tf 0.0191 Tc 0 Tw (positive) Tj ET BT 0.9835 0 0 0.9835 331.2 562.8 Tm /F4 10 Tf 0.0325 Tc -0.1302 Tw (outcomes of the special care units they evaluated.) Tj 0 -12.4458 TD 0.0315 Tc 2.7993 Tw (The positive outcomes vary from one study to) Tj ET BT 0.934 0 0 0.9835 331.92 537.84 Tm -0.0266 Tc 0.5505 Tw (another, and some of the findings are contradictory.) Tj ET BT 0.9835 0 0 0.9835 331.44 525.36 Tm 0.0318 Tc 0.3586 Tw (As noted earlier, if the contradictory findings are) Tj ET BT 0.934 0 0 0.9835 331.68 512.64 Tm -0.0422 Tc 1.3748 Tw (excluded, the only positive outcomes found in more) Tj ET BT 0.8915 0 0 0.9835 331.68 500.16 Tm 0.0398 Tc 1.1107 Tw (than one of the nine studies are decreased nighttime) Tj ET BT 0.934 0 0 0.9835 331.92 487.68 Tm -0.0182 Tc 1.1435 Tw (wakefulness, improved hygiene, and weight gain.) Tj ET BT 0.8915 0 0 0.9835 342.72 459.84 Tm 0.0375 Tc 0.7911 Tw (These studies are frequently cited as evidence that) Tj ET BT 0.934 0 0 0.9835 332.16 447.6 Tm -0.0368 Tc 1.2589 Tw (special care units are effective. Often the research-) Tj ET BT 0.9835 0 0 0.9835 331.92 435.36 Tm 0.0182 Tc 1.9586 Tw (ers\222 general observations, rather than a study\222s) Tj 0.4881 -12.6899 TD 0.0156 Tc 2.612 Tw (specific findings, are cited. In many instances,) Tj -0.4881 -12.6899 TD 0.0307 Tc 0.1157 Tw (findings that are cited from one study are contra-) Tj ET BT 0.934 0 0 0.9835 331.92 397.92 Tm -0.0243 Tc 0.9959 Tw (dicted by findings of another study.) Tj 11.82 -28.3081 TD -0.0417 Tc 1.1495 Tw (All the studies suffer from one or more problems) Tj ET BT 0.9835 0 0 0.9835 332.4 357.6 Tm 0.0339 Tc 2.2041 Tw (that raise questions about the validity of their) Tj 0 -12.6899 TD 0.0426 Tc 0.4696 Tw (findings-both positive and negative. One of these) Tj ET BT 0.934 0 0 0.9835 331.92 332.4 Tm -0.0285 Tc 0.6994 Tw (problems is small sample sizes. The second problem) Tj ET BT 0.9835 0 0 0.9835 332.4 320.16 Tm 0.0293 Tc 0.2391 Tw (is the lack of rigorous research design and imple-) Tj ET BT 0.934 0 0 0.9835 332.4 307.2 Tm -0.0176 Tc 1.0915 Tw (mentation. In many of the studies, the outcomes to) Tj ET BT 0.9835 0 0 0.9835 332.4 294.72 Tm 0.0406 Tc 3.278 Tw (be measured are not clearly defined, and the) Tj ET BT 0.934 0 0 0.9835 332.4 282.24 Tm -0.0322 Tc 2.0322 Tw (measurement process is more impressionistic than) Tj ET BT 0.9835 0 0 0.9835 332.64 269.52 Tm 0.0395 Tc 2.0996 Tw (objective or standardized. As noted earlier, the) Tj ET BT 0.8915 0 0 0.9835 332.64 256.8 Tm 0.0234 Tc 2.0376 Tw (statistical significance of the findings was computed) Tj 0 -12.6899 TD 0.0341 Tc 0.5719 Tw (in only four of the nine studies. Failure of the studies) Tj ET BT 0.934 0 0 0.9835 332.64 231.6 Tm -0.0413 Tc 1.3096 Tw (to include a control group is another problem since) Tj ET BT 0.9835 0 0 0.9835 332.64 218.88 Tm 0.0291 Tc 0.2698 Tw (without a control group, the impact of the special) Tj 0 -12.6899 TD 0.0328 Tc 0.6016 Tw (care unit cannot be separated from the impact of) Tj 0 -12.9339 TD 0.0265 Tc 1.2587 Tw (other factors that may affect resident outcomes.) Tj ET BT 0.934 0 0 0.9835 332.88 181.44 Tm -0.0233 Tc 0.5516 Tw (Finally, many of the studies were conducted by unit) Tj ET BT 0.9835 0 0 0.9835 333.12 168.96 Tm 0.0328 Tc 0.8457 Tw (staff members or other individuals who were in-) Tj -0.4881 -12.9339 TD 0.0364 Tc 1.3301 Tw (volved in plannin) Tj 84.4363 -0.244 TD 0.025 Tc 1.5857 Tw (g or operating the unit. These) Tj -84.4363 -12.2018 TD 0.0312 Tc 2.2301 Tw (individuals have an obvious interest in finding) Tj -0.244 -12.6899 TD 0.0406 Tc 0.0568 Tw (positive outcomes. The potentially powerful effect) Tj 0.4881 -12.4458 TD 0.0359 Tc 1.4525 Tw (of their expectations coupled with small sample) Tj ET BT 0.934 0 0 0.9835 333.36 107.04 Tm -0.0269 Tc 0.6732 Tw (sizes, lack of a rigorous research design, and lack of) Tj ET BT 0.8915 0 0 0.9835 332.88 94.8 Tm 0.0239 Tc 1.2967 Tw (control groups means the results of the studies must) Tj -0.2692 -12.6899 TD 0.0108 Tc 2.5901 Tw (be suspect.) Tj ET q 2.64 0 0 -4.08 95.52 63.84 cm BI /W 16 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<<<<|y? EI Q BT 0.4225 0 0 0.9835 95.52 59.52 Tm 3 Tr /F2 10 Tf 0.137 Tc 0 Tw (Z) Tj 0 Tr ET BT 0.8919 0 0 0.9835 98.16 59.52 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 12.72 0 0 -5.76 100.32 65.28 cm BI /W 78 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~?~?~?|?|?|?|??|?|?|?|?|p?|???????@???? EI Q BT 0.5633 0 0 0.9835 100.32 59.52 Tm 3 Tr 0.077 Tc 0 Tw (\221rh.is) Tj 0 Tr ET BT 0.8915 0 0 0.9835 113.04 59.52 Tm /F4 10 Tf 0 Tc -0.0897 Tw ( ) Tj ET q 32.4 0 0 -6.48 115.44 64.32 cm BI /W 197 /H 36 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?? ????|?~?|>~>>|~>~|>|O>|>|>|>|>~>|??~|?>~?||>~?|<~?|??>?????8 EI Q BT 0.6368 0 0 0.9835 115.44 59.52 Tm 3 Tr -0.0515 Tc 0 Tw (component) Tj 0 Tr ET BT 0.8919 0 0 0.9835 147.84 59.52 Tm /F2 10 Tf 0.0033 Tc -0.0834 Tw ( of ) Tj ET q 8.4 0 0 -5.76 159.84 65.28 cm BI /W 53 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????>x>>8>>>>>>>>>>>>p>>>>>>>>>>??` EI Q BT 0.6572 0 0 0.9835 159.84 59.52 Tm 3 Tr 0.0622 Tc 0 Tw (the) Tj 0 Tr ET BT 0.8919 0 0 0.9835 168.24 59.52 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 15.6 0 0 -7.2 170.4 65.28 cm BI /W 95 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???x<<w<0~<<>||>x>?>p>>|p~>| >|>|>|>|?>|?>|>|~>||>|x|>x|>>~<~???? ?|||< EI Q BT 0.7041 0 0 0.9835 170.4 59.52 Tm 3 Tr 0.026 Tc 0 Tw (study) Tj 0 Tr ET BT 0.8919 0 0 0.9835 186 59.52 Tm 0.1207 Tc -0.215 Tw ( had a ) Tj ET q 23.76 0 0 -6.72 209.76 64.56 cm BI /W 144 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|?|?|?|?x?????ρ?>?~?|?|?|?|>|>|?|?|?|?|?|?|?|???~xp0 EI Q BT 0.7041 0 0 0.9835 209.76 59.52 Tm 3 Tr 0.0338 Tc 0 Tw (pre-post) Tj 0 Tr ET BT 0.8919 0 0 0.9835 233.52 59.52 Tm 0.0193 Tc 0.2061 Tw ( design like the other studies discussed ) Tj ET q 5.52 0 0 -5.76 376.56 65.52 cm BI /W 34 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~>>>>>>>>>>>~~? EI Q BT 0.7041 0 0 0.9835 376.56 59.52 Tm 3 Tr 0.0272 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8919 0 0 0.9835 382.08 59.52 Tm -0.0493 Tc -0.0245 Tw ( this ) Tj ET q 20.4 0 0 -5.76 399.36 65.28 cm BI /W 124 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|???|?~~~8~~~~||` |||||?||π||π8||8||||<<~>x|>??|??8~>` EI Q BT 0.6572 0 0 0.9835 399.36 59.52 Tm 3 Tr 0.0574 Tc 0 Tw (SWiOn) Tj 0 Tr ET BT 0.8919 0 0 0.9835 419.76 59.52 Tm 0.117 Tc -0.2109 Tw ( and ) Tj ET q 6.96 0 0 -4.32 437.28 64.32 cm BI /W 43 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????|?<?>??????<?>?>?>?` EI Q BT 0.7041 0 0 0.9835 437.28 59.52 Tm 3 Tr 0.0488 Tc 0 Tw (an) Tj 0 Tr ET BT 0.8919 0 0 0.9835 444.24 59.52 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 25.44 0 0 -6.24 446.4 64.56 cm BI /W 154 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? |??<?>~x~~8~||>~||>~>||>||~߃~~~~~~?~8?~|?>~~?>σ~~~?>??w><>x8 EI Q BT 0.6572 0 0 0.9835 446.4 59.52 Tm 3 Tr 0.07 Tc 0 Tw (apptUent) Tj 0 Tr ET BT 0.8806 0 0 0.99 471.84 59.52 Tm /F2 8 Tf 0 Tc -0.0925 Tw ( ) Tj ET q 20.4 0 0 -5.76 473.52 65.28 cm BI /W 124 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?ç????|?>?|??|?>?>>?>>?>?>>>?>~x??~|??||~?>?????c EI Q BT 0.8806 0 0 0.99 473.52 59.52 Tm 3 Tr 0.0323 Tc 0 Tw (control) Tj 0 Tr 23.1657 0 TD 0 Tc -0.0925 Tw ( ) Tj ET q 17.04 0 0 -5.76 495.6 64.56 cm BI /W 103 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 6???x8|8|0??|||||||<||>||>||>||>||~?||~?||~?||~?~~?~???  EI Q BT 0.8806 0 0 0.99 495.6 59.52 Tm 3 Tr 0.0822 Tc 0 Tw (group) Tj 0 Tr 19.3502 0 TD 0 Tc -0.0925 Tw ( ) Tj ET q 10.56 0 0 -5.76 514.32 65.52 cm BI /W 65 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~??~??~??????????|?>?x>>?>>>>>?>~?> EI Q BT 0.99 0 0 0.99 514.32 59.52 Tm 3 Tr 0.081 Tc 0 Tw (me) Tj 0 Tr ET BT 0.8806 0 0 0.99 524.88 59.52 Tm 0 Tc -0.0925 Tw ( ) Tj ET q 8.4 0 0 -5.76 526.56 65.52 cm BI /W 53 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |????~?~?x>x>?8>??>??>?>>??~??~?~?~?~??`> EI Q BT 0.8219 0 0 0.99 526.56 59.52 Tm 3 Tr 0.0516 Tc 0 Tw (the) Tj 0 Tr ET BT 0.8806 0 0 0.99 534.96 59.52 Tm 0 Tc -0.0925 Tw ( ) Tj ET q 19.92 0 0 -5.76 536.64 65.52 cm BI /W 120 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID o|?||?x~?~x?~?~p?@?~ ?|>~?>~??~?~?~??~?|~>|>~?????8 EI Q BT 0.8806 0 0 0.99 536.64 59.52 Tm 3 Tr -0.0217 Tc 0 Tw (studies) Tj 0 Tr ET BT 0.7632 0 0 0.99 81.6 50.16 Tm 0.008 Tc 0.1911 Tw (in the ) Tj ET BT 0.798 0 0 0.9835 97.68 50.16 Tm /F2 10 Tf 0.0311 Tc -0.0646 Tw (following section of the chapter. The study is included in this section because the status of the control group is unclear. Some, but not all, of the) Tj ET BT 0.7511 0 0 0.9835 81.84 41.04 Tm 0.0501 Tc 1.1467 Tw (80 special care unit residents were among the 40 residents of the old nursing home who constituted the control group \(245\). The study report provides) Tj ET BT 0.798 0 0 0.9835 81.36 32.16 Tm 0.041 Tc -0.1089 Tw (no information about the special care unit residents who were not among the 40 residents of the old nursing home that constituted the control group,) Tj ET endstream endobj 307 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 308 0 obj <>stream 0.48 w 1 j 0 0 0 RG 49.92 680.4 m 528.96 680.4 l S BT 0.9835 0 0 0.9835 312.24 685.68 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.9263 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 506.4 685.68 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 512.88 685.68 Tm /F5 10 Tf 0.2847 Tc 0 Tw (117) Tj ET BT 0.9663 0 0 0.9939 58.8 642.72 Tm /F6 14 Tf 0.0467 Tc 0.9205 Tw (EVALUATIVE STUDIES WITH A) Tj 8.1963 -15.9376 TD 0.0322 Tc 2.4258 Tw (CONTROL GROUP: EFFECTS) Tj 47.439 -16.4206 TD 0.0395 Tc 2.6666 Tw (ON RESIDENTS) Tj ET BT 0.934 0 0 0.9835 62.16 590.88 Tm /F4 10 Tf -0.0318 Tc 1.2352 Tw (OTA is aware of six evaluative studies of special) Tj ET BT 0.9835 0 0 0.9835 51.12 579.12 Tm 0.0271 Tc 0.282 Tw (care units in which a control group was used \(see) Tj ET BT 0.934 0 0 0.9835 51.12 567.36 Tm -0.0194 Tc 0.7794 Tw (table 4-2\). The samples for these six studies are, on) Tj ET BT 0.9835 0 0 0.9835 51.36 555.6 Tm 0.0289 Tc 1.0588 Tw (average, larger than the samples for the studies) Tj 0 -12.2018 TD 0.0279 Tc 0.3626 Tw (discussed in the previous section. The six studies) Tj ET BT 0.8915 0 0 0.9835 51.36 531.84 Tm 0.0316 Tc 0.615 Tw (vary in the outcomes they studied and their duration.) Tj ET BT 0.934 0 0 0.9835 51.36 519.6 Tm -0.0315 Tc 1.4204 Tw (The control groups they used also vary: four of the) Tj 0.5139 -12.2018 TD -0.0361 Tc 1.3683 Tw (studies used a control group consisting of individu-) Tj 0 -11.9577 TD -0.0226 Tc 1.9106 Tw (als with dementia in nonspecialized nursing home) Tj ET BT 0.9835 0 0 0.9835 51.84 483.84 Tm 0.0361 Tc 0.3949 Tw (units that also serve nondemented residents; one) Tj ET BT 0.934 0 0 0.9835 52.32 471.6 Tm -0.0311 Tc 0.849 Tw (study used a control group consisting of individuals) Tj ET BT 0.9835 0 0 0.9835 51.84 459.84 Tm 0.0396 Tc 0.0253 Tw (with dementia in a segregated but nonspecialized) Tj ET BT 0.934 0 0 0.9835 51.84 447.84 Tm -0.0264 Tc 1.1009 Tw (unit; and one study used a control group consisting) Tj 0.5139 -12.2018 TD -0.0267 Tc 1.0156 Tw (of individuals on the waiting list for admission to a) Tj ET BT 0.9835 0 0 0.9835 52.56 423.84 Tm 0.0368 Tc 0.567 Tw (special care unit. As described below, only two of) Tj 0 -11.9577 TD 0.0232 Tc 0.7741 Tw (the six studies found any statistically significant) Tj ET BT 0.8915 0 0 0.9835 52.32 400.08 Tm 0.0363 Tc 1.4848 Tw (positive outcomes for the special care unit residents.) Tj ET BT 0.9835 0 0 0.9835 63.84 379.92 Tm 0.0378 Tc 0.1492 Tw (Chafetz compared changes in cognitive and be-) Tj ET BT 0.8915 0 0 0.9835 52.56 368.4 Tm 0.06 Tc 0.9197 Tw (havioral characteristics over a 15-month period in 12) Tj ET BT 0.9835 0 0 0.9835 52.56 356.16 Tm 0.0441 Tc 2.5424 Tw (residents of a 30-bed special care unit and 18) Tj ET BT 0.934 0 0 0.9835 52.56 344.16 Tm -0.0189 Tc 0.6432 Tw (residents of a 60-bed nursing home unit that served) Tj ET BT 0.9835 0 0 0.9835 53.28 331.92 Tm 0.0384 Tc 1.6127 Tw (only individuals with dementia but provided no) Tj ET BT 0.934 0 0 0.9835 53.76 320.16 Tm -0.0324 Tc 0.8504 Tw (specialized services \(80\). The study was designed to) Tj ET BT 0.9835 0 0 0.9835 53.28 307.92 Tm 0.0346 Tc 0.7218 Tw (test the hypothesis that cognitive abilities would) Tj 0 -11.9577 TD 0.0403 Tc 0.9296 Tw (decline equally over time in residents of the two) Tj 0 -12.2018 TD 0.0317 Tc 3.4498 Tw (units, whereas behavior would decline less in) Tj ET BT 0.934 0 0 0.9835 53.28 272.4 Tm -0.031 Tc 0.7633 Tw (residents of the special care unit. As shown in table) Tj 0.257 -12.2018 TD -0.0272 Tc 1.7626 Tw (4-2, the staff-to-resident ratios were similar in the) Tj ET BT 0.9835 0 0 0.9835 53.76 248.64 Tm 0.0207 Tc -0.0267 Tw (two units, but the special care unit staff members) Tj ET BT 0.8915 0 0 0.9835 53.76 236.64 Tm 0.0456 Tc 1.3397 Tw (were specifically selected and trained to work on the) Tj 0.2692 -12.4458 TD 0.0379 Tc 1.5598 Tw (unit. The special care unit provided family meetings) Tj ET BT 0.9835 0 0 0.9835 54.24 212.4 Tm 0.0245 Tc 1.3073 Tw (and a more extensive activity program than the) Tj -0.244 -11.9577 TD 0.0358 Tc 2.6729 Tw (nonspecialized unit, and a few physical design) Tj ET BT 0.8915 0 0 0.9835 54 188.4 Tm 0.0348 Tc 1.5633 Tw (features distinguished the special care unit from the) Tj ET BT 0.9835 0 0 0.9835 54 176.64 Tm 0.032 Tc 2.2293 Tw (nonspecialized unit. The study found that both) Tj ET BT 0.934 0 0 0.9835 54.48 164.64 Tm -0.038 Tc 1.2418 Tw (cognitive abilities and behavior worsened over time) Tj 0 -11.9577 TD -0.0346 Tc 1.4523 Tw (in residents of the two units. The special care unit) Tj ET BT 0.9835 0 0 0.9835 54.48 141.12 Tm 0.0277 Tc -0.0846 Tw (had no statistically significant effect on residents\222) Tj ET BT 0.934 0 0 0.9835 54.72 129.12 Tm -0.0396 Tc 1.0783 Tw (cognitive abilities or their behavior, and there were) Tj -0.257 -12.2018 TD -0.0376 Tc 0.8881 Tw (no positive outcomes that could be attributed to the) Tj 0.257 -12.2018 TD -0.0297 Tc 0.5906 Tw (special care unit.) Tj 12.0769 -20.255 TD -0.0265 Tc 1.4681 Tw (Coleman et al. compared the rate of hospitaliza-) Tj -12.0769 -12.2018 TD -0.0429 Tc 0.6047 Tw (tion over a l-year period for 47 residents of 2 special) Tj ET BT 0.8915 0 0 0.9835 54.72 61.2 Tm 0.0414 Tc 1.2771 Tw (care units and 58 residents of 2 nonspecialized units) Tj ET BT 0.934 0 0 0.9835 54.72 49.68 Tm -0.0084 Tc 1.0817 Tw (in the same nursing home \(99\). The 58 residents of) Tj ET BT 0.9835 0 0 0.9835 54.72 37.44 Tm 0.0369 Tc 1.1343 Tw (the nonspecialized units included 36 individuals) Tj ET BT 0.934 0 0 0.9835 301.68 646.32 Tm -0.0124 Tc 0.4756 Tw (who had a diagnosis of dementia and 22 individuals) Tj ET BT 0.8915 0 0 0.9835 302.16 634.56 Tm 0.0244 Tc 1.1392 Tw (who did not have a diagnosis of dementia. The study) Tj 0 -12.6899 TD 0.0438 Tc 1.3224 Tw (was designed to determine whether special care unit) Tj -0.5384 -11.9577 TD 0.0369 Tc 1.061 Tw (residents are less likely than residents of nonspecial-) Tj ET BT 0.9835 0 0 0.9835 302.16 598.08 Tm 0.0456 Tc -0.1028 Tw (ized units to be hospitalized. The staff-to-resident) Tj ET BT 0.8915 0 0 0.9835 301.92 586.32 Tm 0.0451 Tc 0.1558 Tw (ratios were the same for the special care units and the) Tj ET BT 0.9835 0 0 0.9835 302.4 574.08 Tm 0.0368 Tc 1.8584 Tw (nonspecialized units. The study report does not) Tj ET BT 0.934 0 0 0.9835 302.4 562.08 Tm -0.0455 Tc 1.6353 Tw (describe the differences in physical design or other) Tj ET BT 0.8915 0 0 0.9835 302.4 550.08 Tm 0.0162 Tc 1.0025 Tw (features of the units. The study found no statistically) Tj ET BT 0.934 0 0 0.9835 303.12 537.6 Tm -0.03 Tc 2.1326 Tw (significant difference in the rate of hospitalization) Tj ET BT 0.8915 0 0 0.9835 302.88 525.36 Tm 0.0353 Tc 0.4689 Tw (for the special care unit residents and the residents of) Tj ET BT 0.9835 0 0 0.9835 302.88 513.12 Tm 0.0267 Tc 1.5026 Tw (the nonspecialized units. There was, however, a) Tj 0 -11.9577 TD 0.0353 Tc 0.0064 Tw (nonsignificant trend for a larger proportion of the) Tj ET BT 0.8915 0 0 0.9835 303.6 488.88 Tm 0.0432 Tc 0.7703 Tw (special care unit residents to be hospitalized over the) Tj ET BT 0.9835 0 0 0.9835 303.12 476.64 Tm 0.0303 Tc 2.2209 Tw (course of the study \(21 percent vs. 14 percent,) Tj ET BT 0.934 0 0 0.9835 302.88 464.64 Tm -0.0352 Tc 1.7528 Tw (respectively\). The higher rate of hospitalization for) Tj 0.7709 -12.4458 TD -0.0374 Tc 0.8557 Tw (the special care unit residents was due primarily to) Tj 0.257 -12.4458 TD -0.0355 Tc 1.025 Tw (a higher incidence of hip fractures: 9 percent of the) Tj ET BT 0.9835 0 0 0.9835 303.84 427.92 Tm 0.027 Tc 0.3286 Tw (special care unit residents, compared with only 3) Tj ET BT 0.934 0 0 0.9835 303.36 415.92 Tm -0.0414 Tc 1.117 Tw (percent of the residents of the nonspecialized units,) Tj 0.5139 -12.4458 TD -0.0418 Tc 0.989 Tw (were hospitalized for hip fractures.) Tj ET BT 0.9835 0 0 0.9835 315.12 376.56 Tm 0.0204 Tc 1.8344 Tw (Holmes et al. compared changes in cognitive,) Tj -10.9816 -12.4458 TD 0.0209 Tc 1.3458 Tw (functional, and behavioral characteristics over a) Tj ET BT 0.8915 0 0 0.9835 304.32 352.08 Tm 0.0414 Tc 0.7611 Tw (6-month period in 49 residents of 4 special care units) Tj ET BT 0.934 0 0 0.9835 304.56 339.6 Tm -0.0208 Tc 0.8809 Tw (and 44 individuals with dementia in nonspecialized) Tj -0.257 -12.4458 TD 0.0041 Tc 0.4973 Tw (units in the same 4 nursing homes \(195\). The study) Tj ET BT 0.8915 0 0 0.9835 304.56 315.36 Tm 0.0397 Tc 0.9425 Tw (was designed to measure the impact of a special care) Tj ET BT 0.9835 0 0 0.9835 304.56 303.36 Tm 0.0214 Tc 1.9728 Tw (unit vs. a nonspecialized nursing home unit on) Tj ET BT 0.934 0 0 0.9835 304.8 291.36 Tm -0.0084 Tc 0.5678 Tw (individuals with dementia. Table 4-2 lists the many) Tj -0.257 -12.4458 TD -0.0378 Tc 2.141 Tw (differences between the special care units and the) Tj ET BT 0.9835 0 0 0.9835 304.8 267.12 Tm 0.0267 Tc 1.8687 Tw (nonspecialized nursing homes in terms of staff,) Tj 0.4881 -12.2018 TD 0.0188 Tc 1.3967 Tw (activity programs, and physical design features.) Tj ET BT 0.8915 0 0 0.9835 305.04 243.12 Tm 0.0341 Tc 0.9488 Tw (Baseline measurements indicated there were statisti-) Tj 0.2692 -12.4458 TD 0.0505 Tc 1.6483 Tw (cally significant differences between the special care) Tj 0 -12.6899 TD 0.0308 Tc 0.7987 Tw (unit residents and the residents of the nonspecialized) Tj ET BT 0.934 0 0 0.9835 305.28 206.16 Tm -0.0214 Tc 0.5817 Tw (units at the start of the study. The special care unit) Tj ET BT 0.9835 0 0 0.9835 305.28 194.16 Tm 0.0271 Tc 3.4545 Tw (residents were, for example, more likely than) Tj 0 -12.2018 TD 0.0455 Tc 0.3447 Tw (residents of the nonspecialized units to be disori-) Tj 0.4881 -12.4458 TD 0.0303 Tc 1.9871 Tw (ented and to exhibit behavioral symptoms. The) Tj ET BT 0.934 0 0 0.9835 306 157.92 Tm -0.0499 Tc 1.4473 Tw (special care unit residents were also more likely to) Tj -0.5139 -12.2018 TD -0.0155 Tc 0.9058 Tw (be able to ambulate independently. After 6 months,) Tj ET BT 0.8915 0 0 0.9835 306 133.68 Tm 0.031 Tc 1.2214 Tw (the study found little change in any of the measured) Tj ET BT 0.9835 0 0 0.9835 305.52 122.16 Tm 0.0172 Tc 0.4344 Tw (resident characteristics, including cognitive abili-) Tj 0.4881 -12.4458 TD 0.0318 Tc 1.9274 Tw (ties, mood, ability to perform activities of daily) Tj 0 -12.2018 TD 0.0259 Tc 2.0729 Tw (living, frequency of behavioral symptoms, sleep) Tj -0.244 -12.2018 TD 0.0334 Tc 0.1618 Tw (problems, and ability to ambulate independently.) Tj ET BT 0.934 0 0 0.9835 306 73.92 Tm -0.0354 Tc 1.1105 Tw (Taking into account differences between the special) Tj 0 -12.4458 TD -0.0365 Tc 1.2218 Tw (care unit residents and residents of the nonspecial-) Tj ET BT 0.9835 0 0 0.9835 306 49.68 Tm 0.0405 Tc 3.3392 Tw (ized units at the beg) Tj 108.8399 -0.244 TD 0.0233 Tc 3.4177 Tw (inning of the study, the) Tj ET BT 0.8915 0 0 0.9835 305.76 37.68 Tm 0.0361 Tc 1.7541 Tw (researchers found no statistically significant positive) Tj ET endstream endobj 309 0 obj <>/ProcSet 565 0 R/XObject<>>>/Rotate 0/Type/Page>> endobj 310 0 obj [311 0 R 312 0 R] endobj 311 0 obj <>stream q 10.08 0 0 -311.04 684 531.12 cm /im114 Do endstream endobj 312 0 obj <>stream Q q 83.52 0 0 -8.16 237.6 331.2 cm BI /W 465 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >x0pxxx8xxxxp<<< ÿ| x|x|>?>?<|?x||??|><?|?x|?|?|>|?|x|Ϗx>|>||x<~x||>?||?|x<x|||x<x||>~|yx=||>|>|>|xx?||>|>??>|>|xx||?|>>|>|xx|||<>>?|>|x|||||><|>|x||||~>`<|>~x||||<~?x|>~x~~|>??>}??????>??????????>x<> | ~ |~|~>||?>|<?>|?>|p| EI Q 0.72 w 1 j 0 0 0 RG 680.4 531.84 m 680.4 53.76 l S 60.96 509.52 m 656.88 509.52 l S 60.72 490.8 m 656.4 490.8 l S 57.12 61.2 m 654.72 61.2 l S BT 0.9863 0 0 0.9863 247.2 519.36 Tm 0 0 0 rg /F3 9 Tf 0.049 Tc 0.0022 Tw (Table 4-2\227Evaluative ) Tj ET BT 0.9835 0 0 0.9835 342.24 519.36 Tm /F4 10 Tf 0.0431 Tc -0.141 Tw (Studies ) Tj ET BT 0.9863 0 0 0.9863 379.44 519.36 Tm /F3 9 Tf 0.0247 Tc 0.0674 Tw (With a Control Group) Tj ET BT 0.8645 0 0 0.9939 120.24 500.88 Tm /F3 7 Tf -0.0228 Tc 1.4112 Tw (Year of) Tj 54.9675 0 TD -0.0983 Tc 0 Tw (Funding) Tj 193.7742 0.7244 TD -0.0694 Tc 3.4084 Tw (Duration of) Tj -317.3123 -8.9347 TD 0.1777 Tc 0 Tw (Citation) Tj 68.0153 0.2415 TD -0.066 Tc 2.8492 Tw (the Study) Tj 54.9675 0.2415 TD 0.208 Tc 0 Tw (Source) Tj ET BT 0.8108 0 0 0.99 239.04 493.44 Tm /F3 8 Tf 0.0506 Tc (subjects) Tj 118.4048 0.2424 TD 0.055 Tc (study) Tj ET BT 0.9262 0 0 0.9939 406.8 493.68 Tm /F3 7 Tf 0.059 Tc 0.3958 Tw (Changes Made to Create the Special Care Unit) Tj ET q 5.76 0 0 -0.72 93.12 487.2 cm BI /W 32 /H 3 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?` EI Q BT 0.6265 0 0 0.9835 93.12 486.48 Tm 3 Tr /F1 10 Tf 0.1487 Tc 0 Tw (_-) Tj 0 Tr ET q 2.16 0 0 -0.72 121.44 487.2 cm BI /W 12 /H 3 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  EI Q BT 0.6265 0 0 0.9835 121.44 486.48 Tm 3 Tr 0.1153 Tc (-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 123.6 486.48 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 6 0 0 -0.72 128.16 487.2 cm BI /W 34 /H 4 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? EI Q BT 0.8503 0 0 0.9835 128.16 486.48 Tm 3 Tr 0.0554 Tc 0 Tw (--) Tj 0 Tr ET BT 0.9835 0 0 0.9835 134.16 486.48 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 13.68 0 0 -0.72 138.72 487.2 cm BI /W 76 /H 4 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |8?? EI Q BT 0.9835 0 0 0.9835 138.72 486.48 Tm 3 Tr 0.0846 Tc 0 Tw (----) Tj 0 Tr ET BT 0.8645 0 0 0.9939 60.96 481.68 Tm /F3 7 Tf -0.0275 Tc 3.6374 Tw (Chafetz, 1981) Tj -0.8328 -64.2335 TD -0.0427 Tc 2.267 Tw (Coleman et al.,) Tj ET BT 0.9262 0 0 0.9939 60.48 409.44 Tm -0.0065 Tc 0 Tw (1990) Tj ET BT 0.8645 0 0 0.9939 59.76 348.96 Tm -0.0367 Tc 1.566 Tw (Holmes et al.,) Tj ET BT 0.9262 0 0 0.9939 59.76 341.04 Tm -0.0065 Tc 0 Tw (1990) Tj -0.7773 -47.33 TD 0.0506 Tc 0.3308 Tw (Maas and) Tj ET BT 0.8645 0 0 0.9939 58.8 286.08 Tm -0.0145 Tc 0 Tw (Buckwalter,) Tj ET BT 0.9262 0 0 0.9939 59.04 278.4 Tm -0.0065 Tc (1990) Tj ET BT 0.8645 0 0 0.9939 57.84 182.88 Tm -0.0318 Tc 1.5604 Tw (Rovner et al.,) Tj ET BT 0.9262 0 0 0.9939 58.08 174.72 Tm -0.0065 Tc 0 Tw (1990) Tj ET BT 0.8645 0 0 0.9939 57.36 102.72 Tm -0.0301 Tc 0.4479 Tw (Wells and Jorm,) Tj ET BT 0.9262 0 0 0.9939 57.84 94.8 Tm -0.0065 Tc 0 Tw (1987) Tj ET BT 0.9598 0 0 0.9598 120.48 481.92 Tm /F3 6 Tf 0.368 Tc (1988-1987) Tj ET BT 0.9262 0 0 0.9939 119.76 418.08 Tm /F3 7 Tf -0.0057 Tc (1987-1988) Tj ET BT 0.8027 0 0 0.9939 118.8 349.44 Tm -0.0387 Tc 2.885 Tw (not reported) Tj ET BT 0.9262 0 0 0.9939 118.8 294.24 Tm -0.0057 Tc 0 Tw (1986-1988) Tj -1.2955 -111.805 TD -0.0057 Tc (1885-1886) Tj -0.5182 -80.6542 TD -0.0065 Tc (1986) Tj ET BT 0.8645 0 0 0.9939 167.52 482.16 Tm -0.0371 Tc 1.9828 Tw (University of Texas) Tj -0.5552 -7.9688 TD -0.0489 Tc 6.1607 Tw (southwestern Med-) Tj 0 -7.9688 TD -0.0387 Tc 1.7072 Tw (ical Center and Its) Tj ET BT 0.8027 0 0 0.9939 167.04 458.4 Tm 0.0505 Tc 0 Tw (affiliated) Tj 32.5878 0 TD 0.0416 Tc (Alzheimer\222s) Tj ET BT 0.9262 0 0 0.9939 167.04 450.24 Tm 0.0379 Tc 0.0854 Tw (Disease Research) Tj -0.2591 -7.9688 TD 0.0612 Tc 0 Tw (Center) Tj ET BT 0.8645 0 0 0.9939 167.04 418.32 Tm -0.0418 Tc 2.4047 Tw (University of Cal-) Tj ET BT 0.9262 0 0 0.9939 166.56 410.16 Tm 0.0775 Tc 0.0427 Tw (ifornia, San Fran-) Tj ET BT 0.8027 0 0 0.9939 166.32 402.24 Tm 0.0241 Tc 0.1161 Tw (cisco, School of Meal-) Tj ET BT 0.9262 0 0 0.9939 166.32 394.32 Tm 0.0856 Tc 0.0339 Tw (icine, and U.S.) Tj 0.2591 -8.2103 TD 0.0561 Tc 0.0658 Tw (Health Resources) Tj ET BT 0.8027 0 0 0.9939 166.32 378.48 Tm 0.0058 Tc 2.3811 Tw (and Services Admin-) Tj ET BT 0.8645 0 0 0.9939 166.32 370.32 Tm -0.0464 Tc 0 Tw (istration) Tj -0.2776 -20.7672 TD -0.0739 Tc 2.0255 Tw (no funding source) Tj -0.2776 -8.2103 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.9262 0 0 0.9939 165.6 294.24 Tm 0.073 Tc 0.0475 Tw (National Center for) Tj ET BT 0.8645 0 0 0.9939 165.6 286.56 Tm -0.0341 Tc 4.7556 Tw (Nursing Research) Tj -1.6657 -103.8362 TD -0.0662 Tc 2.433 Tw (Johns Hopkins Uni-) Tj ET BT 0.9262 0 0 0.9939 164.16 175.44 Tm 0.0439 Tc 0.0789 Tw (versity\222s affiliated) Tj ET BT 0.8645 0 0 0.9939 164.16 167.28 Tm -0.014 Tc 0 Tw (Alzheimer'sDisease) Tj ET BT 0.9262 0 0 0.9939 164.64 159.36 Tm 0.051 Tc 0.8485 Tw (Research Center) Tj ET BT 0.8645 0 0 0.9939 164.16 103.2 Tm -0.0739 Tc 2.1643 Tw (no funding source) Tj 0 -7.9688 TD 0.1977 Tc 0 Tw (reported) Tj ET BT 0.9262 0 0 0.9939 239.28 482.16 Tm 0.0411 Tc 0.0819 Tw (12 residents of a 30-bed) Tj ET BT 0.8645 0 0 0.9939 238.56 474.48 Tm -0.0322 Tc 1.1444 Tw (special care unit and 8 resi-) Tj 0 -7.9688 TD -0.0701 Tc 1.6324 Tw (dents of a 60-bed unit In) Tj -0.2776 -8.2103 TD -0.0425 Tc 2.4519 Tw (which individuals with de-) Tj 0.2776 -7.9688 TD -0.043 Tc 1.7121 Tw (mentia were segregated but) Tj 0 -7.9688 TD -0.0106 Tc 1.9522 Tw (no special services were) Tj T* -0.0526 Tc 0 Tw (provided) Tj ET BT 0.9262 0 0 0.9939 238.32 418.56 Tm 0.0432 Tc 0.0797 Tw (46 residents of two 28-bed) Tj -0.2591 -8.2103 TD 0.0508 Tc 0.1362 Tw (special care units and 58) Tj ET BT 0.8645 0 0 0.9939 238.32 402.24 Tm -0.0614 Tc 0.8312 Tw (residents of two 28-bed non-) Tj ET BT 0.8027 0 0 0.9939 238.08 394.56 Tm 0.0145 Tc 1.7723 Tw (specialized units in the same) Tj ET BT 0.8645 0 0 0.9939 237.84 386.4 Tm -0.0459 Tc 2.1319 Tw (facility \(of the 58 residents) Tj 0 -7.9688 TD -0.0526 Tc 2.0008 Tw (of the nonspecialized units,) Tj ET BT 0.9262 0 0 0.9939 237.84 370.56 Tm 0.0499 Tc 0.5259 Tw (36 had dementia, and 22) Tj ET BT 0.8645 0 0 0.9939 237.6 362.64 Tm -0.0974 Tc 2.0526 Tw (did not\)) Tj 0 -12.7984 TD -0.0279 Tc 1.4864 Tw (49 residents of special care) Tj 0.2776 -8.2103 TD -0.0623 Tc 1.5956 Tw (units in 4 nursing homes) Tj ET BT 0.9262 0 0 0.9939 237.6 334.08 Tm 0.0515 Tc 0.1355 Tw (and 44 residents with de-) Tj 0.2591 -39.6026 TD 0.0411 Tc 0.0819 Tw (13 residents of a 20-bed) Tj ET BT 0.8645 0 0 0.9939 237.12 287.04 Tm -0.0366 Tc 1.5936 Tw (special care unit in a State-) Tj ET BT 0.9262 0 0 0.9939 237.12 279.12 Tm 0.0538 Tc 0.241 Tw (owned veterans home and) Tj ET BT 0.8645 0 0 0.9939 237.12 271.2 Tm -0.0435 Tc 1.0186 Tw (9 residents with dementia in) Tj 0 -7.9688 TD -0.0546 Tc 2.5584 Tw (nonspecialized units of the) Tj ET BT 0.9262 0 0 0.9939 236.88 255.36 Tm 0.0279 Tc 0.0962 Tw (same facility) Tj 0.2591 -72.2024 TD 0.0411 Tc 0.0819 Tw (14 residents of a 22-bed) Tj ET BT 0.8645 0 0 0.9939 236.4 175.68 Tm -0.0283 Tc 1.6257 Tw (special care unit which i) Tj ET BT 0.9511 0 0 1.0078 311.04 175.68 Tm /F3 5 Tf -0.0557 Tc 0 Tw (S) Tj ET BT 0.8645 0 0 0.9939 236.64 167.52 Tm /F3 7 Tf -0.0618 Tc 1.2249 Tw (part of a 31-bed unit and 14) Tj -0.2776 -7.9688 TD -0.0451 Tc 2.4548 Tw (residents with dementia in) Tj 0 -8.2103 TD -0.0546 Tc 2.5584 Tw (nonspecialized units of the) Tj ET BT 0.9262 0 0 0.9939 236.16 143.52 Tm 0.0279 Tc 0.0962 Tw (same facility) Tj ET BT 0.8645 0 0 0.9939 236.4 103.44 Tm -0.0337 Tc 1.632 Tw (12 residents of a special) Tj -0.8328 -7.9688 TD -0.0389 Tc 0.93 Tw (care unit in Australia and 10) Tj 0.5552 -7.9688 TD -0.0475 Tc 3.7994 Tw (individuals with dementia) Tj -0.8328 -7.9688 TD -0.0353 Tc 1.0924 Tw (who were on the waiting list) Tj 0.2776 -7.9688 TD -0.064 Tc 1.6253 Tw (for the unit and living at) Tj 0.2776 -7.7273 TD 0.1201 Tc 0 Tw (home) Tj 115.2096 421.1402 TD -0.0691 Tc 1.7423 Tw (13 to 15 months) Tj ET BT 0.9262 0 0 0.9939 334.32 418.8 Tm 0.0505 Tc 0.59 Tw (one year) Tj ET BT 0.8645 0 0 0.9939 334.08 349.92 Tm -0.0834 Tc 2.8693 Tw (6 months) Tj ET BT 0.9262 0 0 0.9939 333.6 294.96 Tm 0.0157 Tc 0.6276 Tw (2 years) Tj -0.7773 -111.805 TD 0.0505 Tc 0.59 Tw (one year) Tj ET BT 0.8645 0 0 0.9939 332.64 103.68 Tm -0.0695 Tc 1.9279 Tw (3 months, from just) Tj 0 -7.9688 TD -0.0595 Tc 1.87 Tw (before admission to) Tj T* -0.0864 Tc 0.9295 Tw (the unit to 3 months) Tj 0 -8.2103 TD -0.0478 Tc 3.9385 Tw (after admission) Tj 85.7826 405.4441 TD -0.0395 Tc 1.6849 Tw (in the special care unit: access door secured with special locks; secure outdoor) Tj 0 -7.7273 TD -0.0328 Tc 1.9779 Tw (area; 34 hours per week of specialized activities; staff selected specifically for the) Tj 0 -7.9688 TD -0.0559 Tc 1.7733 Tw (unit; staff training over a 10-week period and ongoing training; efforts to involve) Tj ET BT 0.9262 0 0 0.9939 406.56 458.88 Tm 0.0329 Tc 0.0908 Tw (families; family meetings every 6 to 8 weeks.) Tj ET BT 0.8645 0 0 0.9939 406.56 447.6 Tm -0.0489 Tc 1.7189 Tw (in the comparison unit: no special physical design features; 5 hours per week of) Tj 0 -7.9688 TD -0.0432 Tc 1.9345 Tw (nonspecialized activities; no special staff training or special efforts to involve) Tj -0.2776 -7.9688 TD 0.2177 Tc 0 Tw (families.) Tj 0 -13.0399 TD -0.0403 Tc 1.2605 Tw (no physical design or other special features of the special care units are described) Tj 0 -8.2103 TD -0.056 Tc 1.7912 Tw (in the study report; the report says that the distinguishing features of the special) Tj ET BT 0.9262 0 0 0.9939 406.08 402.72 Tm 0.0562 Tc 0.0657 Tw (care units \223are similar to those found in the literature;\224 the staff-t-resident ratios) Tj 0 -7.7273 TD 0.0583 Tc 0.0633 Tw (were the same on the special care units and the nonspecialized units.) Tj ET BT 0.8645 0 0 0.9939 406.08 350.16 Tm -0.0474 Tc 1.3285 Tw (in the special care units: dosed) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8919 0 0 0.9835 503.52 350.16 Tm /F2 10 Tf 0.0461 Tc -0.1314 Tw (access ) Tj ET BT 0.8645 0 0 0.9939 528.72 350.16 Tm /F3 7 Tf -0.0483 Tc 2.2734 Tw (doors with alarms; furniture with rounded) Tj -141.8605 -7.9688 TD -0.0449 Tc 2.1686 Tw (edges; special activity rooms; nurses\222 station located near the exits to facilitate) Tj 0 -7.9688 TD -0.0472 Tc 1.3005 Tw (monitoring residents; special activity programs; reality orientation; music programs;) Tj -0.2776 -7.9688 TD -0.0463 Tc 2.9453 Tw (Increased staff-to-resident ratios; staff training; multidisciplinary team care.) Tj 0 -10.8666 TD -0.0465 Tc 2.0443 Tw (in the comparison units: no special physical design features, activity programs, or) Tj -0.2776 -7.7273 TD -0.0545 Tc 3.1135 Tw (staff training.) Tj 0.2776 -13.0399 TD -0.0429 Tc 1.8887 Tw (in the special care unit: locked access doors; access doors camouflaged with) Tj 0 -7.9688 TD -0.0461 Tc 2.1599 Tw (murals; secure outdoor area; separate day room/dining room; dividers in resident) Tj -0.2776 -7.9688 TD -0.0477 Tc 1.6481 Tw (rooms to provide privacy; residents\222 beds dose to the floor; curtains and wall) Tj 0 -7.9688 TD -0.0516 Tc 1.5832 Tw (hangings with velcro fasteners to prevent damage if residents pull on them; safety) Tj 0 -7.7273 TD -0.0455 Tc 1.2239 Tw (mirrors; safety glass; supplies stored out of view; no highly waxed floors; no stairs) Tj -0.2776 -7.9688 TD -0.0428 Tc 1.5411 Tw (In the unit; residents\222 lockers and all but one drawer are locked to prevent) Tj 0 -7.9688 TD -0.0591 Tc 2.1934 Tw (rummaging; flexible daily routine; efforts to reduce stimulation; subdivided dining) Tj T* -0.0461 Tc 1.5235 Tw (room to allow residents to eat In small groups; fabric wall decorations; colors that) Tj 0 -7.7273 TD -0.0519 Tc 1.5373 Tw (are \223functionally stimulating and reassuring;\224 orientation signs; piped-in music; pet) Tj 0 -8.2103 TD -0.0343 Tc 1.2301 Tw (therapy; specialized activity programs; activity barrel filled with pliable plastic items) Tj -0.2776 -7.9688 TD -0.0504 Tc 2.2142 Tw (for residents; multidisciplinary team; consistent staff; efforts to involve families.) Tj 0.2776 -11.1081 TD -0.0465 Tc 2.0443 Tw (in the comparison units: no special physical design features, activity programs, or) Tj -0.2776 -7.9688 TD -0.0545 Tc 3.1135 Tw (staff training.) Tj 0.2776 -13.2814 TD -0.0453 Tc 1.672 Tw (in the special care unit: an activity room; staff training; weekly rounds with a) Tj 0 -7.7273 TD -0.0501 Tc 2.0596 Tw (psychiatrist and internist; staff efforts to identify residents\222 specific cognitive) Tj -0.2776 -8.4518 TD -0.0474 Tc 2.6542 Tw (Impairments, to treat depression, delusions, and hallucinations, to recognize) Tj 0 -7.9688 TD -0.0501 Tc 2.0736 Tw (medication side effects, to maintain residents\222 physical health, to reduce use of) Tj 0 -8.2103 TD -0.0373 Tc 1.9138 Tw (physical restraints, and to increase participation in activities; 40 hours a week of) Tj -0.2776 -7.9688 TD -0.0196 Tc 5.8493 Tw (specialized activities.) Tj 0 -11.1081 TD -0.047 Tc 2.0196 Tw (in the comparison units: no special physical design features, activities, or staff) Tj -0.2776 -8.2103 TD -0.0438 Tc 0.9496 Tw (training; less hours of nursing care per resident \(2.1 hours/day in the nonspecialized) Tj 0 -7.9688 TD -0.0412 Tc 1.71 Tw (units vs. 2.9 hours/day In the special care unit\).) Tj 0 -13.0399 TD -0.0434 Tc 1.9145 Tw (In the special care unit: corridors designed for wandering; secure outdoor area;) Tj 0 -7.9688 TD -0.0446 Tc 1.6446 Tw (private rooms; several activity rooms; home-like atmosphere; residents encouraged) Tj T* -0.0528 Tc 1.897 Tw (to bring their own furniture; unit philosophy of \223normalization.\224) Tj ET BT 0.9262 0 0 0.9939 404.4 77.04 Tm 0.0597 Tc 0.0619 Tw (for the comparison group: respite care, adult day care, and in-home services as) Tj ET BT 0.8645 0 0 0.9939 404.64 69.12 Tm 0.1857 Tc 0 Tw (needed.) Tj -401.4291 -16.6621 TD -0.0396 Tc 2.8742 Tw (SOURCE: Office of Technology Assessment, 1992.) Tj ET endstream endobj 313 0 obj <>/Filter/CCITTFaxDecode/Height 1728/Length 2654/Name/im114/Subtype/Image/Type/XObject/Width 56>>stream &Q!A>ރ}?KH1]] A HC߂ / ZKIj%g[ Cl| = G#$,r OXHi:a ]< GQ^O_ Ү/^B^in%%.+ -<  l!!tt@zDR5N/B]./ vk`!#F'Ǯ|:ـZXDޞ ,OC̓m ‚ I>k~ %_^].i/-NV[C3  ~~ 5? v} x]=.bZ k b. _ _4 [ 4F`pM>QJZKu/hWu]l. , Cޑ=z}\?X\ xO UK` p"^ |,roC"0PPykkGna=r ꖒ=*ҥWЭ+ ?x!RA ǯ): s@0UD4II^.p@D, 7( ,X]~Nl!my d?z@o=yug, pK 8A`a-,  O WC05i.O Ma!!39CB#.7/! 'u=/Tq/]u/״+  ` Az,$D "AȀ]pC; јE_^pR}.8 *ȀO((" 3ODM']zK^{ m\W[[ aa=5zIU ]i/U%mu[ jGjv =?}/ y Hǂ*) _< X.p5XO^](pCl9<'}/K^^/$p`|R^B@>* m= F@ ;F :@* 5K Q̞6~ < Q|y2} בQ6 01' ѭAGבGgZ>C!H~^[\@`ZE> X\Fb!\\r z K}_V!Z֗jI~/`C> ^'/d@~x` 5Gf.?]}Q/ZK]t_BX0D+KKtk:îv>AOR4h KO^%KT u[ aa!>Co_v~Kҽ///_^]KKb[[Xal,̏A.Aq1V3R(M ]JJ4!|Z#.r҃6A/ R~=FO%Iu%% hVk . Cn N'k 64F  izI/0KmaXt]Wz^~_^_X0X`] =tѠ Үz'@3 VT l3C| B5CD5>~Nߜ^_ ~׵l.4 Lm!xA< ^kkk ,0 hAA͍o͒oPAk67H00}oA^2T54# y {82QpO\ 8\ju^6# 3צA/.^ d@'\85V므 endstream endobj 314 0 obj <>/Rotate 0/Type/Page>> endobj 315 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.88 686.16 m 535.2 686.16 l S 0.72 w 62.64 83.28 m 540.96 83.28 l S BT 0.9835 0 0 0.9835 319.2 691.44 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.6822 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 512.16 691.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 518.64 691.44 Tm /F5 10 Tf 0.2847 Tc 0 Tw (119) Tj ET BT 0.8915 0 0 0.9835 57.6 652.56 Tm /F4 10 Tf 0.0394 Tc 1.2793 Tw (outcomes that could be attributed to the special care) Tj ET BT 0.8491 0 0 0.9835 57.6 640.8 Tm 0.0553 Tc 0 Tw (unit.) Tj ET BT 0.934 0 0 0.9835 68.4 622.08 Tm -0.0164 Tc 1.5185 Tw (Maas and Buckwalter compared changes in cog-) Tj -11.306 -12.2018 TD -0.0212 Tc 2.1746 Tw (nitive, fictional, behavioral, and other characteris-) Tj 0.257 -12.2018 TD -0.021 Tc 0.4527 Tw (tics in 13 residents of a 20-bed special care unit and) Tj 0 -12.2018 TD -0.0237 Tc 0.7554 Tw (9 individuals with dementia in nonspecialized units) Tj ET BT 0.8915 0 0 0.9835 58.08 574.32 Tm 0.0189 Tc 1.1452 Tw (in the same facility \(265\). The study was designed to) Tj ET BT 0.9835 0 0 0.9835 58.32 562.32 Tm 0.0241 Tc 0.0308 Tw (measure the effect of a \221\221low stimulus\222 special care) Tj 0 -12.4458 TD 0.0203 Tc 2.9327 Tw (unit vs. nonspecialized nursing home units on) Tj ET BT 0.8915 0 0 0.9835 58.32 538.56 Tm 0.0239 Tc 1.4601 Tw (residents with dementia, their families, and the unit) Tj ET BT 0.934 0 0 0.9835 59.28 526.32 Tm 0.0001 Tc 0.3338 Tw (staff members. As noted in table 4-2, many physical) Tj -0.257 -11.7137 TD -0.0365 Tc 1.6578 Tw (design and other changes were made to create the) Tj ET BT 0.9835 0 0 0.9835 59.28 502.56 Tm 0.0352 Tc 1.9414 Tw (special care unit. Extensive baseline data were) Tj 0 -12.2018 TD 0.048 Tc -0.085 Tw (collected in the year before the unit opened \(264\).) Tj -0.244 -11.9577 TD 0.0511 Tc 0.0644 Tw (After the unit opened, data were collected for one) Tj ET BT 0.934 0 0 0.9835 59.28 466.56 Tm -0.0131 Tc 1.1968 Tw (year at 2-month intervals. Due to subject attrition,) Tj 0.257 -12.2018 TD -0.019 Tc 1.7033 Tw (complete data for the 22 subjects are available for) Tj 0.257 -11.9577 TD -0.017 Tc 1.3478 Tw (only a 10-month period, from 4 months before to 6) Tj ET BT 0.8915 0 0 0.9835 59.52 431.04 Tm 0.023 Tc 1.1631 Tw (months after the unit opened \(265\). These data show) Tj ET BT 0.934 0 0 0.9835 59.76 419.04 Tm -0.0316 Tc 2.1771 Tw (no statistically significant differences over time in) Tj ET BT 0.9835 0 0 0.9835 60 407.04 Tm 0.035 Tc 0.5994 Tw (the cognitive or functional abilities of the special) Tj ET BT 0.8915 0 0 0.9835 60 395.04 Tm 0.0334 Tc 0.4881 Tw (care unit residents and the individuals with dementia) Tj ET BT 0.9835 0 0 0.9835 60.24 383.04 Tm 0.027 Tc 0.8922 Tw (in the nonspecialized units. The most frequently) Tj ET BT 0.8915 0 0 0.9835 60 371.28 Tm 0.0446 Tc 1.5524 Tw (reported behaviors for both groups of residents were) Tj ET BT 0.9835 0 0 0.9835 61.2 359.04 Tm 0.2403 Tc 3.7258 Tw (\221\221sleeping/resting, \222 \221 \221quiet, \222 and \221\221pleasant/) Tj ET BT 0.934 0 0 0.9835 60.48 346.8 Tm -0.0301 Tc 2.5952 Tw (happy.\224 Catastrophic reactions occurred, but their) Tj ET BT 0.9835 0 0 0.9835 60.72 335.28 Tm 0.0319 Tc 2.4328 Tw (frequency decreased significantly from baseline) Tj 0.244 -12.2018 TD 0.0398 Tc 0.3505 Tw (levels for both groups of residents.) Tj ET BT 1.08 0 0 1.08 220.32 328.08 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (3 ) Tj ET BT 0.9835 0 0 0.9835 223.92 323.28 Tm /F4 10 Tf 0.0203 Tc 0 Tw (Nevertheless,) Tj -165.7002 -12.4458 TD 0.0262 Tc 0.5595 Tw (catastrophic reactions were significantly less fre-) Tj ET BT 0.934 0 0 0.9835 61.2 298.8 Tm -0.0242 Tc 0.9844 Tw (quent in the special care unit residents than in the) Tj ET BT 0.9835 0 0 0.9835 61.2 287.04 Tm 0.0365 Tc 1.33 Tw (individuals with dementia in the nonspecialized) Tj 0 -12.2018 TD 0.0257 Tc 1.6896 Tw (units. The special care unit residents were also) Tj ET BT 0.934 0 0 0.9835 61.68 262.8 Tm -0.0224 Tc 1.7818 Tw (significantly more likely than the individuals with) Tj ET BT 0.8915 0 0 0.9835 61.44 251.04 Tm 0.0366 Tc 1.0614 Tw (dementia in the nonspecialized units to interact with) Tj ET BT 0.934 0 0 0.9835 61.92 238.8 Tm -0.0358 Tc 0.9826 Tw (staff. There were no significant differences between) Tj ET BT 0.8915 0 0 0.9835 61.68 226.8 Tm 0.0446 Tc 1.3408 Tw (the two groups in the frequency of their interactions) Tj ET BT 0.9835 0 0 0.9835 61.92 214.8 Tm 0.0206 Tc 0.9626 Tw (with other residents or family members. The re-) Tj ET BT 0.934 0 0 0.9835 62.4 203.04 Tm -0.0346 Tc 1.5273 Tw (searchers noted a general trend for the subjects to) Tj ET BT 0.9835 0 0 0.9835 61.92 191.28 Tm 0.0379 Tc 1.6423 Tw (become more active after being admitted to the) Tj 0.7321 -12.2018 TD 0.0197 Tc 0.0455 Tw (special care unit. This increased activity included) Tj ET BT 0.934 0 0 0.9835 61.92 167.28 Tm -0.0242 Tc 0.8844 Tw (both positive and negative behaviors. The research-) Tj ET BT 0.8915 0 0 0.9835 62.64 155.52 Tm 0.0087 Tc 0.9773 Tw (ers point out that:) Tj 11.037 -17.8146 TD 0.0322 Tc 1.8258 Tw (Behaviors such as \223screaming/yelling,\224 \223pacing,\224) Tj ET BT 0.9835 0 0 0.9835 72.96 126.72 Tm 0.191 Tc 0 Tw (\221\221noisy,\222) Tj ET BT 0.8915 0 0 0.9835 114.24 126.96 Tm -0.0084 Tc 3.4192 Tw (and \223restless,\224) Tj 75.3744 0 TD 0.0604 Tc 0.1117 Tw (as well as a decrease in) Tj ET BT 0.9835 0 0 0.9835 73.2 115.92 Tm 0.0224 Tc 0 Tw (\221\221cooperative\222) Tj 67.1098 0 TD 0.0381 Tc 1.0843 Tw (behavior may be seen as non-) Tj ET BT 0.8491 0 0 0.9835 72.72 104.64 Tm 0.0352 Tc 1.9255 Tw (constructive. Positive behaviors such as \223pleasant/) Tj ET BT 0.8066 0 0 0.9835 72.48 93.84 Tm 0.2349 Tc 0 Tw (happy,) Tj ET BT 0.8915 0 0 0.9835 100.56 93.84 Tm -0.0058 Tc 1.3973 Tw (\223 \223talking/visiting,\224 \223a wake,\224 and \223up and) Tj ET BT 0.8066 0 0 0.9835 318.72 653.76 Tm 0.0414 Tc 1.8 Tw (about,\222 were all reported more frequently among the) Tj ET BT 0.8491 0 0 0.9835 318.48 642.96 Tm 0.0296 Tc 0.4811 Tw (experimental group. . .) Tj ET BT 0.934 0 0 0.9835 414 642.96 Tm -0.0374 Tc 0.7915 Tw (Viewed singly, no one be-) Tj -102.5253 -10.9816 TD -0.0218 Tc 1.9954 Tw (havior \(changed\) significantly. However, when) Tj ET BT 0.8066 0 0 0.9835 318.48 621.12 Tm 0.0409 Tc 0.9079 Tw (viewed \(together\), it seems that important changes in) Tj ET BT 0.8491 0 0 0.9835 318.96 610.32 Tm 0.0513 Tc 1.5188 Tw (overall level of activity were occurring after intro-) Tj 0 -11.2256 TD 0.0507 Tc 0.5505 Tw (duction of the special care unit \(265\).) Tj -11.3061 -19.7669 TD 0.0495 Tc 1.1171 Tw (Other results of the study show that for their first four) Tj ET BT 0.934 0 0 0.9835 309.12 568.08 Tm -0.0265 Tc 1.6149 Tw (months in the unit, the special care unit residents) Tj ET BT 0.9835 0 0 0.9835 309.6 555.84 Tm 0.0266 Tc 3.9431 Tw (were significantly less likely to be physically) Tj ET BT 0.8915 0 0 0.9835 309.36 544.32 Tm 0.0342 Tc 0.8333 Tw (restrained than the individuals with dementia on the) Tj ET BT 0.934 0 0 0.9835 309.6 532.32 Tm -0.0166 Tc 0.6729 Tw (nonspecialized units, but for the next 2 months, the) Tj 0.7709 -11.9577 TD -0.0388 Tc 1.9279 Tw (special care unit residents were significantly more) Tj ET BT 0.9835 0 0 0.9835 310.08 508.56 Tm 0.0296 Tc 0.3608 Tw (likely to be physically restrained. Use of antipsy-) Tj ET BT 0.934 0 0 0.9835 310.08 496.32 Tm -0.0274 Tc 1.9157 Tw (chotic medications was significantly higher for the) Tj ET BT 0.9835 0 0 0.9835 310.56 484.32 Tm 0.0356 Tc 1.4703 Tw (special care unit residents both at baseline and) Tj -0.244 -12.2018 TD 0.0278 Tc 0.014 Tw (following their admission to the special care unit.) Tj ET BT 0.8915 0 0 0.9835 310.32 460.32 Tm 0.0459 Tc 1.6278 Tw (There was no significant difference between the two) Tj ET BT 0.9835 0 0 0.9835 310.8 448.32 Tm 0.0326 Tc 1.1814 Tw (groups in the total number of medications of all) Tj ET BT 0.934 0 0 0.9835 310.32 436.56 Tm -0.0231 Tc 0.3908 Tw (kinds that they were taking. Lastly, the special care) Tj 0.257 -11.9577 TD -0.0381 Tc 1.4805 Tw (unit residents were significantly more likely to fall) Tj 0.257 -12.4458 TD -0.0218 Tc 1.3162 Tw (than the individuals with dementia on the nonspe-) Tj ET BT 0.9835 0 0 0.9835 311.04 400.8 Tm 0.0318 Tc 0.1842 Tw (cialized units, but the increased incidence of falls) Tj ET BT 0.934 0 0 0.9835 311.04 388.8 Tm -0.0181 Tc 0.7709 Tw (was not accompanied by an increase in injuries due) Tj 0 -12.4458 TD -0.02 Tc 0.5802 Tw (to falls.) Tj ET BT 0.9835 0 0 0.9835 322.56 357.12 Tm 0.0288 Tc 3.0866 Tw (Rovner et al. compared changes in fictional) Tj -10.9816 -12.2018 TD 0.0444 Tc 1.7015 Tw (ability over a l-year period in 14 residents of a) Tj 0 -11.9577 TD 0.0356 Tc 0.9473 Tw (22-bed special care unit and 14 individuals with) Tj ET BT 0.8915 0 0 0.9835 311.76 321.12 Tm 0.0434 Tc 0.5538 Tw (dementia in nonspecialized units in the same nursing) Tj ET BT 0.934 0 0 0.9835 311.76 309.12 Tm -0.0083 Tc 1.0816 Tw (home \(392\). As shown in table 4-2, the special care) Tj 0 -12.2018 TD -0.0335 Tc 1.0764 Tw (unit provided more hours of nursing care and more) Tj ET BT 0.9835 0 0 0.9835 312.48 285.12 Tm 0.0212 Tc 1.0039 Tw (activity programs than the nonspecialized units.) Tj ET BT 0.8915 0 0 0.9835 312.48 273.12 Tm 0.0486 Tc 1.168 Tw (Only one physical design change was made to create) Tj ET BT 0.934 0 0 0.9835 312.48 261.36 Tm -0.0304 Tc 1.1623 Tw (the unit. In the view of the researchers, the distin-) Tj 0.257 -12.2018 TD -0.0322 Tc 1.6211 Tw (guishing features of the special care unit were the) Tj ET BT 0.9835 0 0 0.9835 312.48 237.12 Tm 0.0279 Tc 0.3626 Tw (efforts of its multidisciplinary staff to accomplish) Tj 0.7321 -11.9577 TD 0.0207 Tc 2.0782 Tw (six objectives:) Tj 74.6749 0 TD 0.038 Tc 2.6706 Tw (1\) to identify residents\222 specific) Tj ET BT 0.934 0 0 0.9835 312.72 213.12 Tm -0.0261 Tc 3.2847 Tw (cognitive impairments and associated disabilities,) Tj ET BT 0.8915 0 0 0.9835 312.96 201.6 Tm 0.0292 Tc 1.7618 Tw (2\) to treat depression, delusions, and hallucinations,) Tj ET BT 0.934 0 0 0.9835 313.44 189.6 Tm -0.0248 Tc 0.7459 Tw (3\) to identify medication side effects; 4\) to maintain) Tj ET BT 0.9835 0 0 0.9835 312.96 177.84 Tm 0.0327 Tc 3.1815 Tw (residents\222 physical health; 5\) to reduce use of) Tj ET BT 0.934 0 0 0.9835 313.2 166.08 Tm -0.0202 Tc 1.8652 Tw (physical restraints,) Tj ET BT 0.9835 0 0 0.9835 404.88 166.08 Tm 0.035 Tc 1.6366 Tw (and 6\) to increase residents\222) Tj ET BT 0.934 0 0 0.9835 313.2 154.08 Tm -0.0263 Tc 2.7068 Tw (participation in activities. Baseline measurements) Tj 0.5139 -11.9577 TD -0.0417 Tc 1.8514 Tw (indicated that the special care unit residents were) Tj ET BT 0.8915 0 0 0.9835 313.92 130.32 Tm 0.0406 Tc 1.2556 Tw (significantly younger, on average, than the residents) Tj 0 -12.2018 TD 0.0389 Tc 1.5154 Tw (of the nonspecialized units and that the special care) Tj ET BT 0.934 0 0 0.9835 313.68 106.32 Tm -0.0388 Tc 1.2106 Tw (unit residents were less likely to be taking medica-) Tj 0.257 -12.2018 TD -0.0233 Tc 0.4039 Tw (tions of all types. The study found that over a l-year) Tj ET BT 0.8647 0 0 0.9598 76.8 71.76 Tm /F3 6 Tf -0.006 Tc 0.0039 Tw (3 ) Tj ET q 38.64 0 0 -7.2 81.12 77.52 cm BI /W 232 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x?8><~>~>?~π|8??>>?|||~~~~|~>>>~~?>>>>>|~>|>|||x~>>|>>?|>???????x|8x` >ppp@|~|?| EI Q BT 0.9598 0 0 0.9598 81.12 71.76 Tm 3 Tr -0.0012 Tc 0 Tw (c~taS&ophic) Tj 0 Tr ET BT 0.8647 0 0 0.9598 119.76 71.76 Tm 0 Tc -0.003 Tw ( ) Tj ET q 24.24 0 0 -5.52 121.2 77.04 cm BI /W 147 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||x~?>?>?x<|>< |>|<|~~<x~~~><|>?~>>~>???>>?????x||||>>????π EI Q BT 0.9598 0 0 0.9598 121.2 71.76 Tm 3 Tr -0.0015 Tc 0 Tw (~eaction) Tj 0 Tr ET BT 0.8647 0 0 0.9598 145.44 71.76 Tm 0 Tc -0.003 Tw ( ) Tj ET q 11.28 0 0 -4.08 146.88 75.84 cm BI /W 68 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0xx?x?~Á~>>πpx8<<`<>?>?? >x EI Q BT 0.9598 0 0 0.9598 146.88 71.76 Tm 3 Tr -0.0303 Tc 0 Tw (was) Tj 0 Tr ET BT 0.8806 0 0 0.99 158.16 71.76 Tm /F2 8 Tf 0 Tc -0.0925 Tw ( ) Tj ET q 21.84 0 0 -5.76 159.84 77.52 cm BI /W 132 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID #s??????><~|x||<?>x??|><>>?~?>?>>>>?~| ?? EI Q BT 0.8806 0 0 0.99 183.36 71.76 Tm 3 Tr 0.0217 Tc 0 Tw (in) Tj 0 Tr ET BT 0.9021 0 0 0.9598 188.88 71.76 Tm /F6 5 Tf 0 Tc 0.0799 Tw ( ) Tj ET q 9.84 0 0 -5.76 189.84 77.52 cm BI /W 61 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~?~?x~?~>|>|>|>>?>><>|>0~>p~~x~H> EI Q BT 1.8943 0 0 0.9598 189.84 71.76 Tm 3 Tr -0.02 Tc 0 Tw (tis) Tj 0 Tr ET BT 0.9021 0 0 0.9598 199.68 71.76 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 15.12 0 0 -7.2 200.64 77.28 cm BI /W 93 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~px>xx8|||||~|~>>>>>?>À>~>>8>8>?xx~}??x EI Q BT 1.2629 0 0 0.9598 200.64 71.76 Tm 3 Tr 0.0215 Tc 0 Tw (study) Tj 0 Tr ET BT 0.9021 0 0 0.9598 215.76 71.76 Tm 0 Tc 0.0799 Tw ( ) Tj ET q 5.76 0 0 -3.84 216.72 74.88 cm BI /W 35 /H 22 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??||||<?<|~>~ EI Q BT 1.2629 0 0 0.9598 216.72 71.76 Tm 3 Tr -0.038 Tc 0 Tw (as) Tj 0 Tr ET BT 0.9021 0 0 0.9598 222.48 71.76 Tm -0.0692 Tc 0.1566 Tw ( \221 ) Tj ET q 4.8 0 0 -5.76 226.08 77.52 cm BI /W 30 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|<x< EI Q BT 0.9598 0 0 0.9598 226.08 71.76 Tm 3 Tr 0.0421 Tc 0 Tw (\221a) Tj 0 Tr ET BT 0.8919 0 0 0.9835 230.88 71.76 Tm /F2 10 Tf 0.0432 Tc 0.1794 Tw ( reaction \(mood change\) of the resident ) Tj ET q 5.76 0 0 -5.52 376.56 78 cm BI /W 35 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 3?????~ EI Q BT 0.7041 0 0 0.9835 376.56 71.76 Tm 3 Tr 0.0272 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8915 0 0 0.9835 382.32 71.76 Tm /F4 10 Tf 0 Tc -0.0897 Tw ( ) Tj ET q 25.44 0 0 -5.76 384.72 75.6 cm BI /W 154 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @???|?|?>?|~>>|~>|>|>@??|>~>~>?~>~>>??~?x??8|?|?x|?8 EI Q BT 0.5944 0 0 0.9835 384.72 71.76 Tm 3 Tr -0.1254 Tc 0 Tw (response) Tj 0 Tr ET BT 0.8915 0 0 0.9835 410.16 71.76 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 5.28 0 0 -4.56 412.56 76.56 cm BI /W 32 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|>|>~>>>>>?>>>>>>?>?>~>> EI Q BT 0.5519 0 0 0.9835 412.56 71.76 Tm 3 Tr 0.1183 Tc 0 Tw (to) Tj 0 Tr ET BT 0.8915 0 0 0.9835 417.84 71.76 Tm 0 Tc -0.0897 Tw ( ) Tj ET q 14.16 0 0 -5.76 420.24 77.52 cm BI /W 86 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p??~?~??~??~?~?x~?~~?px~8~?<~>|~?~?? EI Q BT 0.6368 0 0 0.9835 420.24 71.76 Tm 3 Tr -0.1004 Tc 0 Tw (Wtit) Tj 0 Tr ET BT 0.8919 0 0 0.9835 434.4 71.76 Tm /F2 10 Tf 0 Tc -0.0798 Tw ( ) Tj ET q 12.48 0 0 -5.76 436.56 77.04 cm BI /W 77 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `????????????????????????>>??> EI Q BT 0.7041 0 0 0.9835 436.56 71.76 Tm 3 Tr 0.0153 Tc 0 Tw (WY) Tj 0 Tr ET BT 0.8919 0 0 0.9835 449.04 71.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 19.68 0 0 -5.76 451.2 75.84 cm BI /W 119 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? 8??>??>?~>||>||><|??~?~>~>~>?~>8?Á>|?|?~<?>?????#`?0 EI Q BT 0.7511 0 0 0.9835 451.2 71.76 Tm 3 Tr -0.0359 Tc 0 Tw (aPPe~) Tj 0 Tr ET BT 0.8919 0 0 0.9835 470.88 71.76 Tm 0.0094 Tc -0.0903 Tw ( to ) Tj ET q 19.68 0 0 -5.76 482.4 79.2 cm BI /W 119 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p????|??~>?~~>?~||>>||>>|~>>|>>>|>>>|>?>>|>?>|>>>|>>>~~>>|~8>>|~|?>~??>???|?<? ? EI Q BT 1.1266 0 0 0.9835 482.4 71.76 Tm 3 Tr -0.0649 Tc 0 Tw (s~to) Tj 0 Tr ET BT 0.8919 0 0 0.9835 502.08 71.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 6.48 0 0 -5.76 504.24 79.44 cm BI /W 41 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8y?x??? EI Q BT 1.1735 0 0 0.9835 504.24 71.76 Tm 3 Tr -0.0952 Tc 0 Tw (~) Tj 0 Tr ET BT 0.8919 0 0 0.9835 510.72 71.76 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 24 0 0 -5.76 512.88 79.68 cm BI /W 146 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `yo>p?y??~??~~?~>?~>??~>??~>?~~~~>>>?>?~>~>~>??>~?>>?>??x>>>>>~x0~ EI Q BT 4.4594 0 0 0.9835 512.88 71.76 Tm 3 Tr 0.0227 Tc 0 Tw (~) Tj 0 Tr ET BT 0.798 0 0 0.9835 62.88 60.96 Tm 0.0299 Tc 0.657 Tw (stimuli \(bathing, dressing, having to go to the ) Tj ET q 26.64 0 0 -6.96 216.48 66.72 cm BI /W 177 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?~??~~?~|?~x~|||||||>|~~>>~~~>>|~|~|>~|~|?>>|~|>>~|~>~~~~?>~|~|||?||??|1?~ ?? EI Q BT 0.7041 0 0 0.9835 216.48 60.96 Tm 3 Tr 0.0508 Tc 0 Tw (bathmo~) Tj 0 Tr ET BT 0.798 0 0 0.9835 243.12 60.96 Tm 0.0491 Tc 0.7886 Tw ( a question asked of the person\) which can be characterized by weeping, blushing, anger,) Tj ET q 24.24 0 0 -7.2 62.64 57.6 cm BI /W 164 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~G??|?|||>?|?|8|||~|>~>>??~@||(<<   EI Q BT 0.6572 0 0 0.9835 62.64 51.84 Tm 3 Tr 0.0795 Tc 0 Tw (agitatio~) Tj 0 Tr ET BT 0.798 0 0 0.9835 86.88 51.84 Tm 0.036 Tc 0.1333 Tw ( or stubbornness. The reaction is not necessarily very dramatic or ) Tj ET q 19.44 0 0 -6.96 300.48 57.6 cm BI /W 132 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?p????~?~>?|>|?<>|<>><>><>>>>>>>>~>~>>~>>|~|>|~?|?~~?~p~?~>>>> EI Q BT 0.6102 0 0 0.9835 300.48 51.84 Tm 3 Tr 0.0364 Tc 0 Tw (violen~) Tj 0 Tr ET BT 0.798 0 0 0.9835 319.92 51.84 Tm 0.0387 Tc 0.1873 Tw ( but may appear over-emotional or not appropriate for the stimulus\222) Tj ET BT 0.7511 0 0 0.9835 63.12 42.96 Tm 0.0188 Tc 0 Tw (\(265\).) Tj ET endstream endobj 316 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 317 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.72 681.12 m 550.32 681.12 l S 76.56 68.88 m 325.2 68.88 l S 323.76 68.88 m 554.4 68.88 l S BT 0.9835 0 0 0.9835 72.96 686.4 Tm 0 0 0 rg /F4 10 Tf 0.013 Tc 0.0116 Tw (120 . ) Tj 25.6237 0 TD /F5 10 Tf 0.0125 Tc 0.9566 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 72.72 647.52 Tm /F4 10 Tf -0.0406 Tc 1.341 Tw (period, there was much less decline in the fictional) Tj 1.0278 -12.2018 TD -0.0316 Tc 1.3955 Tw (abilities of the special care unit residents than the) Tj -0.5139 -11.7137 TD -0.036 Tc 1.6251 Tw (residents of the nonspecialized units: 14 percent of) Tj 0.257 -12.4458 TD -0.0353 Tc 0.5109 Tw (the special care unit residents and 64 percent of the) Tj ET BT 0.9835 0 0 0.9835 73.44 600 Tm 0.0428 Tc 1.1202 Tw (residents of the nonspecialized units declined in) Tj ET BT 0.934 0 0 0.9835 73.92 588 Tm -0.0378 Tc 1.4986 Tw (their \223level of care\224 as determinedly the number of) Tj ET BT 0.9835 0 0 0.9835 74.16 576 Tm 0.0327 Tc 1.055 Tw (activities of daily living with which they needed) Tj 0 -12.2018 TD 0.016 Tc 1.8998 Tw (assistance. This statistically significant positive) Tj 0 -11.9577 TD 0.0299 Tc 1.8247 Tw (outcome is attributed by the researchers to the) Tj ET BT 0.934 0 0 0.9835 74.16 540.48 Tm -0.0288 Tc 0.6409 Tw (impact of the special care unit.) Tj 11.82 -21.4751 TD -0.0257 Tc 2.0423 Tw (Wells and Jorm compared changes in cognitive,) Tj ET BT 0.9835 0 0 0.9835 74.4 507.36 Tm 0.0209 Tc 1.297 Tw (functional, and behavioral characteristics over a) Tj 0.4881 -12.2018 TD 0.0361 Tc 1.0863 Tw (3-month period in 12 residents of an Australian) Tj ET BT 0.8915 0 0 0.9835 74.88 483.36 Tm 0.0548 Tc 0.8358 Tw (special care unit and 10 individuals who were on the) Tj 0 -12.2018 TD 0.0342 Tc 1.1281 Tw (waiting list for the unit and living in the community) Tj ET BT 0.934 0 0 0.9835 75.12 459.84 Tm -0.0256 Tc 0.6183 Tw (\(489\). The study was designed to compare the effect) Tj -0.257 -12.4458 TD -0.0252 Tc 1.7604 Tw (on individuals with dementia and their families of) Tj 0 -11.9577 TD -0.028 Tc 1.1598 Tw (being in a special care unit vs. being deferred from) Tj ET BT 0.9835 0 0 0.9835 75.12 423.84 Tm 0.0249 Tc 0.1216 Tw (admission. The study findings with respect to the) Tj ET BT 0.934 0 0 0.9835 75.36 411.84 Tm -0.0243 Tc 1.319 Tw (impact on the subjects\222 families are discussed later) Tj ET BT 0.8915 0 0 0.9835 75.36 400.08 Tm 0.0439 Tc 1.1061 Tw (in this chapter. The physical changes made to create) Tj ET BT 0.9835 0 0 0.9835 75.36 387.84 Tm 0.0269 Tc 1.3803 Tw (the special care unit included an environmental) Tj 0 -11.9577 TD 0.0348 Tc -0.0279 Tw (design to allow wandering, a secure outdoor area,) Tj ET BT 0.934 0 0 0.9835 75.6 364.08 Tm -0.0338 Tc 1.3291 Tw (and efforts to create a home-like atmosphere. Most) Tj ET BT 0.8915 0 0 0.9835 75.6 352.32 Tm 0.0349 Tc 1.0489 Tw (of the individuals on the waiting list received respite) Tj ET BT 0.934 0 0 0.9835 75.6 340.32 Tm -0.0338 Tc 1.5906 Tw (care, and some received adult day care or in-home) Tj ET BT 0.9835 0 0 0.9835 76.08 328.56 Tm 0.0248 Tc 2.318 Tw (services. The study found that over a 3-month) Tj -0.4881 -12.2018 TD 0.035 Tc 0.8434 Tw (period, the cognitive and functional abilities and) Tj 0 -11.9577 TD 0.0387 Tc 0.321 Tw (behavior of all the subjects declined. Except for a) Tj ET BT 0.8915 0 0 0.9835 75.84 292.8 Tm 0.0433 Tc 1.3692 Tw (temporary worsening of behavioral symptoms among) Tj ET BT 0.934 0 0 0.9835 75.84 281.28 Tm -0.0333 Tc 1.1369 Tw (the special care unit residents in the first month of) Tj ET BT 0.9835 0 0 0.9835 76.32 269.04 Tm 0.0375 Tc -0.1352 Tw (the study, there was little difference in the rate of) Tj ET BT 0.934 0 0 0.9835 76.32 257.52 Tm -0.0436 Tc 1.4191 Tw (decline in these characteristics between the special) Tj ET BT 0.8915 0 0 0.9835 76.32 245.28 Tm 0.0376 Tc 0.3729 Tw (care unit residents and the individuals on the waiting) Tj ET BT 0.8491 0 0 0.9835 76.32 233.28 Tm -0.0172 Tc 0 Tw (list.) Tj ET BT 0.8915 0 0 0.9835 87.36 209.28 Tm 0.0185 Tc 1.2355 Tw (In summary,) Tj 64.3374 2.9284 TD 0.022 Tc 0.6034 Tw (four of the six evaluative studies that) Tj ET BT 0.9835 0 0 0.9835 76.32 200.16 Tm 0.0313 Tc -0.129 Tw (used a control group found no statistically signifi-) Tj 0 -12.2018 TD 0.0354 Tc 3.446 Tw (cant positive resident outcomes that could be) Tj ET BT 0.8915 0 0 0.9835 77.04 176.16 Tm 0.0269 Tc 0.7775 Tw (attributed to the special care unit. One of the studies) Tj ET BT 0.934 0 0 0.9835 76.8 164.16 Tm -0.037 Tc 1.562 Tw (with a positive resident outcome found that over a) Tj 1.0278 -11.9577 TD -0.0482 Tc 0.8674 Tw (l-year period the special care unit residents showed) Tj ET BT 0.9835 0 0 0.9835 77.04 140.4 Tm 0.0245 Tc 2.5623 Tw (significantly less decline than individuals with) Tj ET BT 0.8915 0 0 0.9835 77.04 128.4 Tm 0.0435 Tc 1.592 Tw (dementia in the nonspecialized units in their ability) Tj ET BT 0.934 0 0 0.9835 77.04 116.4 Tm -0.0276 Tc 0.9737 Tw (to perform activities of daily living \(392\). The three) Tj ET BT 0.8915 0 0 0.9835 77.04 104.64 Tm 0.0344 Tc 0.5783 Tw (other studies that used a control group and measured) Tj ET BT 0.934 0 0 0.9835 76.8 92.64 Tm -0.0355 Tc 0.7069 Tw (residents\222 ability to perform activities of daily living) Tj 0.257 -12.2018 TD -0.0299 Tc 1.4901 Tw (found no significant effect of the special care units) Tj 264.4073 576.6562 TD -0.0126 Tc 0.0584 Tw (in this ) Tj ET BT 0.9606 0 0 0.9863 354.72 647.76 Tm /F3 9 Tf -0.0074 Tc 0.0029 Tw (area. The ) Tj ET BT 0.934 0 0 0.9835 395.04 647.76 Tm /F4 10 Tf -0.0487 Tc 1.3817 Tw (second study with positive resident) Tj ET BT 0.9835 0 0 0.9835 324 635.52 Tm 0.0309 Tc 1.6204 Tw (outcomes found that special care unit residents) Tj ET BT 0.934 0 0 0.9835 324.24 623.76 Tm -0.033 Tc 1.8788 Tw (exhibited significantly fewer catastrophic reactions) Tj 0 -12.2018 TD -0.0302 Tc 1.1478 Tw (than residents with dementia in the nonspecialized) Tj ET BT 0.9835 0 0 0.9835 324.24 599.52 Tm 0.0274 Tc 1.4786 Tw (units \(265\). The special care unit residents also) Tj ET BT 0.934 0 0 0.9835 324.72 588 Tm -0.0205 Tc 0.7349 Tw (interacted significantly more with staff members.) Tj 11.563 -20.0109 TD -0.0302 Tc 0.6339 Tw (The research design and implementation of these) Tj ET BT 0.8915 0 0 0.9835 324.96 556.32 Tm 0.0403 Tc 0.7026 Tw (six studies are far more rigorous than the design and) Tj 0 -11.9577 TD 0.0349 Tc 1.6658 Tw (implementation of the nine studies discussed earlier) Tj ET BT 0.934 0 0 0.9835 324.96 532.56 Tm -0.0336 Tc 1.28 Tw (that did not use a control group. The outcomes are) Tj ET BT 0.9835 0 0 0.9835 324.96 520.8 Tm 0.0394 Tc 0.1068 Tw (more precisely defined and measured in these six) Tj ET BT 0.8915 0 0 0.9835 325.44 508.56 Tm 0.0412 Tc 0.4623 Tw (studies, and their use of a control group increases the) Tj ET BT 0.934 0 0 0.9835 324.96 496.56 Tm -0.0301 Tc 1.0407 Tw (presumed validity of their findings.) Tj ET BT 0.8915 0 0 0.9835 336.48 476.88 Tm 0.0611 Tc 0.2903 Tw (On the other hand, there are one or more problems) Tj -12.3829 -12.2018 TD 0.02 Tc 1.0244 Tw (with each of the studies that could affect the validity) Tj ET BT 0.9835 0 0 0.9835 325.68 453.12 Tm 0.039 Tc 0.758 Tw (of their findings-both positive and negative. One) Tj ET BT 0.8915 0 0 0.9835 325.44 441.12 Tm 0.0351 Tc 0.8467 Tw (problem is that several of the studies were conducted) Tj ET BT 0.9835 0 0 0.9835 325.44 429.12 Tm 0.0339 Tc 0.9491 Tw (by individuals who were involved in planning or) Tj ET BT 0.934 0 0 0.9835 325.68 417.36 Tm -0.0275 Tc 0.9022 Tw (working on the special care unit that was the focus) Tj 0.5139 -12.4458 TD -0.0244 Tc 0.982 Tw (of the study. In one of the two studies that found a) Tj ET BT 0.9835 0 0 0.9835 325.68 393.12 Tm 0.0362 Tc 1.4523 Tw (positive resident outcome \(392\), the nurses who) Tj ET BT 0.8915 0 0 0.9835 326.16 381.36 Tm 0.0328 Tc 2.0271 Tw (evaluated the residents\222 ability to perform activities) Tj ET BT 0.9835 0 0 0.9835 326.16 369.36 Tm 0.0316 Tc 2.6597 Tw (of daily living were unit staff members whose) Tj -0.7321 -11.9577 TD 0.0356 Tc 1.9816 Tw (judgments about the residents could have been) Tj ET BT 0.934 0 0 0.9835 326.16 345.6 Tm -0.0299 Tc 1.019 Tw (biased by their expectations about the effectiveness) Tj 0.257 -11.9577 TD -0.033 Tc 1.1722 Tw (of the special care unit.) Tj ET BT 0.9557 0 0 1.08 430.56 338.64 Tm /F4 4 Tf 0.0359 Tc 0 Tw (4) Tj ET BT 0.934 0 0 0.9835 337.44 314.4 Tm /F4 10 Tf -0.0346 Tc 0.8849 Tw (A second problem that could affect the validity of) Tj -11.563 -12.2018 TD -0.033 Tc 0.7654 Tw (the findings of some of the studies discussed in this) Tj ET BT 0.9835 0 0 0.9835 326.88 290.64 Tm 0.0297 Tc 1.3979 Tw (section is selection bias. If the special care unit) Tj ET BT 0.934 0 0 0.9835 326.4 279.12 Tm -0.0384 Tc 1.3707 Tw (residents and the control group subjects differed in) Tj ET BT 0.9835 0 0 0.9835 327.12 267.12 Tm 0.0271 Tc 0.3939 Tw (significant ways at the start of the studies, these) Tj ET BT 0.8915 0 0 0.9835 326.88 255.12 Tm 0.0403 Tc 0.5381 Tw (differences, rather than the impact of the special care) Tj ET BT 0.934 0 0 0.9835 326.88 243.12 Tm -0.0326 Tc 1.8417 Tw (unit, could account for any observed differences in) Tj ET BT 0.9835 0 0 0.9835 327.12 231.12 Tm 0.0251 Tc -0.053 Tw (outcomes. To address this problem, all six studies) Tj ET BT 0.934 0 0 0.9835 327.12 218.88 Tm -0.0366 Tc 1.5401 Tw (discussed in this section compared the characteris-) Tj ET BT 0.9835 0 0 0.9835 327.36 207.12 Tm 0.0309 Tc 0.573 Tw (tics of the special care unit residents and control) Tj 0 -12.4458 TD 0.0271 Tc 0.4243 Tw (group subjects at the beginning of the study, and) Tj 0.244 -11.9577 TD 0.0379 Tc 0.457 Tw (several of the studies used statistical methods to) Tj 0 -12.2018 TD 0.0394 Tc 2.1637 Tw (correct for any observed differences in the two) Tj ET BT 0.8915 0 0 0.9835 327.6 159.36 Tm 0.0139 Tc 0 Tw (groups.) Tj ET BT 0.9835 0 0 0.9835 338.4 140.16 Tm 0.0316 Tc 2.9212 Tw (As discussed in chapter 1, randomization of) Tj ET BT 0.934 0 0 0.9835 327.84 127.92 Tm -0.0383 Tc 0.4855 Tw (subjects to the special care unit or the control group) Tj ET BT 0.9835 0 0 0.9835 327.6 116.4 Tm 0.0525 Tc 0.3375 Tw (would be the ideal way to address the problem of) Tj ET BT 0.934 0 0 0.9835 327.6 104.4 Tm -0.0287 Tc 1.7274 Tw (entry point differences among subjects. Two of the) Tj ET BT 0.8915 0 0 0.9835 328.08 92.16 Tm 0.0239 Tc 1.9472 Tw (studies discussed in this section \(265,489\) randomly) Tj ET BT 0.9835 0 0 0.9835 327.84 80.16 Tm 0.0294 Tc 1.2456 Tw (assigned subjects to the special care unit or the) Tj ET BT 0.8647 0 0 0.9598 90.24 57.36 Tm /F3 6 Tf -0.006 Tc 0.0039 Tw (4111 ) Tj ET q 24.48 0 0 -5.76 103.44 63.12 cm BI /W 147 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0`????????~?~~??~~??>~???~???~??~??~?<~?>~??~???????@`p@~x~8~x EI Q BT 0.9598 0 0 0.9598 103.44 57.36 Tm 3 Tr 0.0518 Tc 0 Tw (addition) Tj 0 Tr ET BT 0.8647 0 0 0.9598 127.92 57.36 Tm -0.057 Tc 0.2017 Tw ( to ) Tj ET q 11.52 0 0 -5.76 136.08 63.12 cm BI /W 70 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID π?~??~??~??~??~?~?~??~~?~??~?~0?~x?????~??|????<~~~>< EI Q BT 0.9598 0 0 0.9598 136.08 57.36 Tm 3 Tr -0.0018 Tc 0 Tw (bias) Tj 0 Tr ET BT 0.8647 0 0 0.9598 147.6 57.36 Tm 0 Tc -0.003 Tw ( ) Tj ET q 31.44 0 0 -6.24 149.04 63.6 cm BI /W 189 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@????~<~?~?~~?~~?~|?~|?~|?~x?~|?~||?~||?~~~|?=?>??p`~`~ EI Q BT 0.9598 0 0 0.9598 149.04 57.36 Tm 3 Tr -0.0011 Tc 0 Tw (iIIrm&KXXI) Tj 0 Tr ET BT 0.8647 0 0 0.9598 180.48 57.36 Tm 0 Tc -0.003 Tw ( ) Tj ET q 7.2 0 0 -7.2 181.92 63.12 cm BI /W 44 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????????~??????????? EI Q BT 0.9598 0 0 0.9598 181.92 57.36 Tm 3 Tr -0.0013 Tc 0 Tw (by) Tj 0 Tr ET BT 0.8647 0 0 0.9598 189.12 57.36 Tm 0 Tc -0.003 Tw ( ) Tj ET q 43.92 0 0 -5.76 190.56 63.12 cm BI /W 262 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8???????|???~|?~~??~??|~>?~?>|?~?>?~?>?>~?>>~?>?>~?>?~?>?~>>?~>>?~?>|?8??>?~|??|???`??0@x??|>???p EI Q BT 1.153 0 0 0.9598 190.56 57.36 Tm 3 Tr 0.0151 Tc 0 Tw (StimemberS\222) Tj 0 Tr ET BT 0.8647 0 0 0.9598 234.48 57.36 Tm 0 Tc -0.003 Tw ( ) Tj ET q 38.16 0 0 -7.2 235.92 63.12 cm BI /W 229 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>8?????????~?~~x~?~<~?~<~?|~?}~??~?~?~?~?߀~?π0~?|π~?||~?>|>>  EI Q BT 0.9598 0 0 0.9598 235.92 57.36 Tm 3 Tr -0.0076 Tc 0 Tw (expectations,) Tj 0 Tr ET BT 0.8919 0 0 0.9835 274.08 57.36 Tm /F2 10 Tf 0.0194 Tc 0.3769 Tw ( a more subtle form of bias could arise ) Tj ET q 5.52 0 0 -5.76 418.08 63.36 cm BI /W 34 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID py?>>>>>>>>~~~>~~? EI Q BT 0.7041 0 0 0.9835 418.08 57.36 Tm 3 Tr 0.0272 Tc 0 Tw (in) Tj 0 Tr ET BT 0.8919 0 0 0.9835 423.6 57.36 Tm 0.0219 Tc 0.075 Tw ( this and ) Tj ET BT 0.9018 0 0 0.9835 456.96 57.36 Tm /F6 10 Tf 0.074 Tc -0.1884 Tw (other ) Tj ET q 20.16 0 0 -5.76 480.24 63.12 cm BI /W 121 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0~x??~?|?|~?<~?~8??~8A?~?~?~??~?~?~??~??~?|??>|??????< EI Q BT 0.496 0 0 0.9835 480.24 57.36 Tm 3 Tr -0.0673 Tc 0 Tw (St\222UdieS) Tj 0 Tr ET BT 0.9018 0 0 0.9835 500.4 57.36 Tm 0 Tc -0.1063 Tw ( ) Tj ET q 10.8 0 0 -5.76 502.56 63.84 cm BI /W 66 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @<??????~~>>>?>?>>>~?>~>~>~?~~?|<` EI Q BT 0.5411 0 0 0.9835 502.56 57.36 Tm 3 Tr 0.2148 Tc 0 Tw (thttt) Tj 0 Tr ET BT 0.9018 0 0 0.9835 513.36 57.36 Tm 0 Tc -0.1063 Tw ( ) Tj ET q 11.52 0 0 -7.2 515.52 63.12 cm BI /W 70 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |xx|???~a~?>?>?p0 EI Q BT 0.6763 0 0 0.9835 515.52 57.36 Tm 3 Tr 0.0906 Tc 0 Tw (rely) Tj 0 Tr ET BT 0.9018 0 0 0.9835 527.04 57.36 Tm 0 Tc -0.1063 Tw ( ) Tj ET q 7.2 0 0 -4.32 529.2 61.68 cm BI /W 44 /H 24 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~~~~>??x< EI Q BT 0.5411 0 0 0.9835 529.2 57.36 Tm 3 Tr 0.2029 Tc 0 Tw (On) Tj 0 Tr ET BT 0.9018 0 0 0.9835 536.4 57.36 Tm 0 Tc -0.1063 Tw ( ) Tj ET q 13.44 0 0 -5.76 538.56 64.32 cm BI /W 80 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID w |x~x???p??p??`???????????????~ ???|>??|>?~??????ßϟ EI Q BT 1.3526 0 0 0.9835 538.56 57.36 Tm 3 Tr 0.0357 Tc 0 Tw (sti) Tj 0 Tr ET BT 0.7511 0 0 0.9835 76.8 47.52 Tm /F2 10 Tf 0.0342 Tc 0.4972 Tw (members\222 evaluations of residents\222 ability to perform activities of daily living as a result of differences in the way imp) Tj ET q 23.04 0 0 -5.76 443.28 53.04 cm BI /W 152 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID c???~~??x>?~??x???~~x>?~~p~|?~~~q!>?~|~??~~~?~~|?~~~??~~??~~<?~~ ~?~~?~~?~?|>~~>?????0>x EI Q BT 0.6572 0 0 0.9835 443.28 47.28 Tm 3 Tr 0.0282 Tc 0 Tw (airments) Tj 0 Tr ET BT 0.798 0 0 0.9835 466.32 47.28 Tm 0 Tc -0.0951 Tw ( ) Tj ET q 5.04 0 0 -5.52 468.24 53.04 cm BI /W 35 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????`p EI Q BT 0.6102 0 0 0.9835 468.24 47.28 Tm 3 Tr 0.0414 Tc 0 Tw (in) Tj 0 Tr ET BT 0.798 0 0 0.9835 473.28 47.28 Tm 0.0132 Tc 0.7155 Tw ( activities of daily living) Tj -496.5455 -8.7853 TD 0.0385 Tc -0.1433 Tw (are ) Tj ET q 25.68 0 0 -7.2 89.04 44.16 cm BI /W 173 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>?????????>|?=~ ~?|?p|~x|~8|<|>|>??|?|?~????????>?? EI Q BT 0.6572 0 0 0.9835 89.04 38.64 Tm 3 Tr 0.0194 Tc 0 Tw (pereeived) Tj 0 Tr ET BT 0.798 0 0 0.9835 114.72 38.64 Tm 0.0423 Tc 0.3714 Tw ( on a special care unit vs. a nonspecialized nursing home unit.) Tj ET endstream endobj 318 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 319 0 obj <>stream 0.72 w 1 j 0 0 0 RG 58.08 677.52 m 535.92 677.52 l S BT 0.9835 0 0 0.9835 320.16 682.56 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.5602 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 512.4 682.56 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 518.88 682.56 Tm /F5 10 Tf 0.2847 Tc 0 Tw (121) Tj ET BT 0.8915 0 0 0.9835 58.32 644.16 Tm /F4 10 Tf 0.0373 Tc 2.0758 Tw (control group. Randomization of subjects apparently) Tj 0.2692 -12.4458 TD 0.0321 Tc 0.8613 Tw (worked well in the 3-month study by Wells and Jorm) Tj ET BT 0.934 0 0 0.9835 59.04 620.4 Tm -0.0211 Tc 2.1659 Tw (\(489\). Randomization also worked well initially in) Tj ET BT 0.9835 0 0 0.9835 58.8 608.16 Tm 0.0276 Tc 2.4546 Tw (the longer study by Maas and Buckwalter but) Tj ET BT 0.934 0 0 0.9835 58.8 595.92 Tm -0.0202 Tc 1.2411 Tw (eventually broke down, in part because some fami-) Tj 0 -11.9577 TD -0.0457 Tc 1.6997 Tw (lies were reluctant to move their relative who was) Tj ET BT 0.9835 0 0 0.9835 58.8 571.92 Tm 0.0413 Tc 0.5625 Tw (doing well in a nonspecialized unit to the special) Tj 0.244 -12.2018 TD 0.0293 Tc 1.2457 Tw (care unit to meet the requirements of the study) Tj ET BT 0.934 0 0 0.9835 59.04 547.68 Tm 0.01 Tc 2.6037 Tw (design \(265\).) Tj ET BT 0.9835 0 0 0.9835 70.08 529.92 Tm 0.038 Tc 0.5963 Tw (A third methodological problem\227and one that) Tj ET BT 0.934 0 0 0.9835 59.28 518.16 Tm -0.0353 Tc 0.882 Tw (could affect the validity of the findings of Rovner et) Tj ET BT 0.9835 0 0 0.9835 59.52 505.92 Tm 0.035 Tc 0.4251 Tw (al. \(392\)\227is failure to measure differences in the) Tj ET BT 0.934 0 0 0.9835 59.28 494.16 Tm -0.0397 Tc 1.4455 Tw (cognitive abilities of the special care unit residents) Tj 0.5139 -12.2018 TD -0.0207 Tc 0.658 Tw (and control group subjects at the end of a study. As) Tj ET BT 0.8915 0 0 0.9835 59.28 470.64 Tm 0.0377 Tc 0.8101 Tw (noted earlier, the outcomes measured in the study by) Tj ET BT 0.934 0 0 0.9835 59.52 458.88 Tm -0.0228 Tc 0.3833 Tw (Rovner et al. were changes in the subjects\222 ability to) Tj 0 -12.2018 TD -0.0192 Tc 1.3502 Tw (perform activities of daily living \(392\). In individu-) Tj ET BT 0.9835 0 0 0.9835 60 435.12 Tm 0.0294 Tc 0.5005 Tw (als with dementia, ability to perform activities of) Tj 0 -12.2018 TD 0.0399 Tc 0.3503 Tw (daily living is related to some degree to cognitive) Tj ET BT 0.8915 0 0 0.9835 60.24 411.12 Tm 0.0402 Tc 1.2881 Tw (ability \(369,508\). The special care unit residents and) Tj ET BT 0.9835 0 0 0.9835 60 399.12 Tm 0.0308 Tc 0.4206 Tw (control group subjects in this study did not differ) Tj ET BT 0.8915 0 0 0.9835 60.48 387.36 Tm 0.0424 Tc 1.5548 Tw (significantly in their cognitive abilities at the begin-) Tj ET BT 0.934 0 0 0.9835 60 375.36 Tm -0.0302 Tc 1.2977 Tw (ning of the study, but their cognitive abilities were) Tj ET BT 0.8915 0 0 0.9835 60.24 363.36 Tm 0.0179 Tc 0.967 Tw (not measured at the end of the study, and significant) Tj ET BT 0.9835 0 0 0.9835 60.48 351.6 Tm 0.0514 Tc 1.4775 Tw (differences could have developed. If such differ-) Tj ET BT 0.8915 0 0 0.9835 60.48 339.6 Tm 0.0262 Tc 0.6287 Tw (ences did develop, they, rather than the impact of the) Tj ET BT 0.9835 0 0 0.9835 60.96 327.36 Tm 0.0304 Tc 1.0573 Tw (special care unit, could account for the observed) Tj -0.4881 -11.7137 TD 0.0413 Tc 1.0462 Tw (differences in the proportion of special care unit) Tj ET BT 0.934 0 0 0.9835 60.24 303.84 Tm -0.0343 Tc 0.9993 Tw (residents vs. control group subjects that declined in) Tj 0.5139 -12.2018 TD -0.0329 Tc 1.1079 Tw (their ability to perform activities of daily living.) Tj ET BT 0.9835 0 0 0.9835 72 274.08 Tm 0.0403 Tc 1.3261 Tw (In addition to these methodological problems,) Tj ET BT 0.934 0 0 0.9835 60.96 262.08 Tm -0.039 Tc 1.5917 Tw (there are difficulties in interpreting the findings of) Tj ET BT 0.9835 0 0 0.9835 61.2 249.84 Tm 0.0268 Tc 1.0348 Tw (the six evaluative studies. In all six studies, the) Tj 0.244 -12.4458 TD 0.0235 Tc 1.4042 Tw (special care units differ in many ways from the) Tj ET BT 0.8915 0 0 0.9835 61.2 225.84 Tm 0.0376 Tc 1.214 Tw (control group settings. It is unclear whether particu-) Tj ET BT 0.934 0 0 0.9835 61.2 213.6 Tm -0.039 Tc 0.7432 Tw (lar features of the special care units or their overall) Tj ET BT 0.9835 0 0 0.9835 60.96 201.36 Tm 0.0208 Tc 1.5899 Tw (milieu account for the studies\222 findings. A third) Tj ET BT 0.934 0 0 0.9835 60.96 189.36 Tm -0.0268 Tc 0.9087 Tw (possibility proposed by Rovner et al. as an explana-) Tj 0.5139 -12.2018 TD -0.0313 Tc 0.8777 Tw (tion for the findings of their study is that increased) Tj ET BT 0.8915 0 0 0.9835 61.92 165.36 Tm 0.0253 Tc 1.0596 Tw (staff attention to the unit residents could account for) Tj ET BT 0.9835 0 0 0.9835 61.44 153.36 Tm 0.036 Tc 1.4525 Tw (the positive outcome, irrespective of any special) Tj ET BT 0.934 0 0 0.9835 61.44 141.36 Tm -0.0156 Tc 1.1151 Tw (features of the unit \(392\). In all these studies, it is) Tj 0.5139 -12.2018 TD -0.036 Tc 0.8221 Tw (also possible that certain aspects of the special care) Tj -0.7709 -12.4458 TD -0.0157 Tc 0.4287 Tw (units \(i.e., particular features, milieu, or staff atten-) Tj 0.5139 -12.2018 TD -0.0246 Tc 0.9063 Tw (tion\) have a positive impact and other aspects have) Tj ET BT 0.8915 0 0 0.9835 61.92 93.36 Tm 0.0092 Tc 1.1861 Tw (a negative impact, and that the two types of impacts) Tj 0 -11.9577 TD 0.0405 Tc 0.908 Tw (cancel each other out. Still another possibility is that) Tj ET BT 0.9835 0 0 0.9835 61.92 69.36 Tm 0.0312 Tc 1.8539 Tw (certain aspects of the special care units have a) Tj ET BT 0.934 0 0 0.9835 61.44 57.36 Tm -0.034 Tc 1.3981 Tw (positive impact on some residents and a neutral or) Tj 0.257 -11.7137 TD -0.0269 Tc 1.5786 Tw (negative impact on other residents, and that these) Tj 0.257 -12.2018 TD -0.0167 Tc 1.4576 Tw (impacts cancel each other out. Small sample sizes,) Tj 264.9212 620.3386 TD -0.0173 Tc 1.4583 Tw (lack of a common taxonomy for classifying individ-) Tj ET BT 0.9835 0 0 0.9835 309.36 631.68 Tm 0.0256 Tc 1.097 Tw (uals with dementia across studies, and lack of a) Tj 0 -11.9577 TD 0.0477 Tc 1.0135 Tw (precise description of the features of each of the) Tj ET BT 0.934 0 0 0.9835 310.08 607.68 Tm -0.034 Tc 1.4945 Tw (special care units make it impossible at present to) Tj ET BT 0.8915 0 0 0.9835 309.6 595.68 Tm 0.034 Tc 2.5641 Tw (differentiate among these various explanations.) Tj ET BT 0.9835 0 0 0.9835 320.64 577.68 Tm 0.0331 Tc 0.3573 Tw (The one study that found a significant positive) Tj ET BT 0.934 0 0 0.9835 309.84 565.44 Tm -0.0338 Tc 1.0517 Tw (effect of a special care unit on the residents\222 ability) Tj ET BT 0.8915 0 0 0.9835 310.08 553.44 Tm 0.0356 Tc 1.2761 Tw (to perform activities of daily living focused on a unit) Tj 0.2692 -12.4458 TD 0.0282 Tc 0.417 Tw (that was created with the addition of an activity room) Tj ET BT 0.934 0 0 0.9835 310.08 529.44 Tm -0.0067 Tc 0.4191 Tw (but no other physical design changes \(392\). Instead,) Tj 0.257 -12.2018 TD -0.0338 Tc 1.006 Tw (the \223special\224 features of the unit, in the view of the) Tj -0.257 -11.9577 TD -0.0434 Tc 1.5474 Tw (researchers, were staff efforts to identify residents\222) Tj 0.7709 -12.2018 TD -0.0407 Tc 1.6816 Tw (specific cognitive impairments, to treat depression,) Tj ET BT 0.9835 0 0 0.9835 310.32 481.92 Tm 0.0311 Tc 0.164 Tw (delusions, hallucinations, and medication side ef-) Tj ET BT 0.934 0 0 0.9835 310.56 469.92 Tm -0.0181 Tc 0.9452 Tw (fects, to maintain residents\222 physical health, and to) Tj ET BT 0.9835 0 0 0.9835 310.8 458.4 Tm 0.0189 Tc 0.8598 Tw (increase their involvement in activities. Ongoing) Tj ET BT 0.8915 0 0 0.9835 310.8 446.64 Tm 0.023 Tc 0.8416 Tw (involvement of a psychiatrist on the staff seems to be) Tj ET BT 0.934 0 0 0.9835 310.8 434.4 Tm -0.0201 Tc 0.7087 Tw (unique to this study. Whether any of these features) Tj ET BT 0.8915 0 0 0.9835 311.04 422.4 Tm 0.0391 Tc 1.4479 Tw (are different enough from the features of the special) Tj ET BT 0.9835 0 0 0.9835 311.04 410.64 Tm 0.0303 Tc 2.0074 Tw (care units in the other studies to explain their) Tj 0 -12.2018 TD 0.0287 Tc -0.0775 Tw (contradictory findings cannot be determined from) Tj ET BT 0.8915 0 0 0.9835 311.04 386.88 Tm 0.0387 Tc 0.809 Tw (the available data.) Tj ET BT 0.9663 0 0 0.9939 335.76 356.64 Tm /F6 14 Tf 0.0314 Tc 1.8056 Tw (STUDIES OF PARTICULAR) Tj -25.0855 -15.6962 TD 0.0503 Tc 1.5377 Tw (FEATURES AND INTERVENTIONS) Tj 27.0725 -16.1791 TD 0.0395 Tc 1.5903 Tw (IN SPECIAL CARE UNITS:) Tj ET BT 0.9939 0 0 0.9939 339.36 308.88 Tm 0.0163 Tc 0.3459 Tw (EFFECTS ON RESIDENTS) Tj ET BT 0.8915 0 0 0.9835 322.56 291.12 Tm /F4 10 Tf 0.0309 Tc 1.6061 Tw (Unlike studies that evaluate the overall impact of) Tj ET BT 0.934 0 0 0.9835 311.76 279.36 Tm -0.03 Tc 0.88 Tw (a special care unit, some studies evaluate the effect) Tj 0 -12.2018 TD -0.0275 Tc 0.8452 Tw (of particular features and interventions in a special) Tj ET BT 0.8915 0 0 0.9835 312 255.36 Tm 0.0363 Tc 1.1818 Tw (care unit. Such studies do not constitute special care) Tj ET BT 0.9835 0 0 0.9835 311.76 243.36 Tm 0.0268 Tc 1.9804 Tw (unit research in the same sense as the studies) Tj ET BT 0.8915 0 0 0.9835 312 231.12 Tm 0.0451 Tc 0.8211 Tw (discussed earlier in this chapter because the features) Tj ET BT 0.934 0 0 0.9835 312.24 219.12 Tm -0.0245 Tc 1.1723 Tw (and interventions generally can be used in nonspe-) Tj ET BT 0.8915 0 0 0.9835 312.24 207.12 Tm 0.048 Tc 0.4717 Tw (cialized nursing home units and other residential and) Tj -0.2692 -12.2018 TD 0.0525 Tc 0.7935 Tw (nonresidential care settings as well as in special care) Tj ET BT 0.934 0 0 0.9835 312.24 182.88 Tm -0.0231 Tc 1.6848 Tw (units. The research to evaluate these features and) Tj ET BT 0.8915 0 0 0.9835 312.48 171.12 Tm 0.041 Tc 0.7487 Tw (interventions can also be conducted in other settings.) Tj 0 -12.2018 TD 0.0351 Tc 1.486 Tw (For these reasons, studies of particular features and) Tj ET BT 0.934 0 0 0.9835 312.48 147.12 Tm -0.0357 Tc 0.7071 Tw (interventions in special care units are not discussed) Tj ET BT 0.9835 0 0 0.9835 312.48 135.12 Tm 0.0305 Tc 1.1734 Tw (in the same detail in this report as studies that) Tj ET BT 0.934 0 0 0.9835 312.48 122.88 Tm -0.0229 Tc 0.4548 Tw (evaluate the overall impact of the units.) Tj ET BT 0.8915 0 0 0.9835 323.28 105.36 Tm 0.0431 Tc 0.0413 Tw (The particular features and interventions that have) Tj ET BT 0.934 0 0 0.9835 312.48 93.36 Tm -0.0298 Tc 1.2331 Tw (been studied most in special care units are various) Tj 0.5139 -11.9577 TD -0.0314 Tc 1.1063 Tw (devices and visual barriers to stop individuals with) Tj ET BT 0.8915 0 0 0.9835 312.96 69.6 Tm 0.0451 Tc 1.0902 Tw (dementia from escaping or wandering away from the) Tj ET BT 0.9835 0 0 0.9835 312.72 57.6 Tm 0.0194 Tc 1.3125 Tw (unit. To OTA\222s knowledge, the frost research on) Tj ET BT 0.934 0 0 0.9835 312.72 45.84 Tm -0.0293 Tc 1.0076 Tw (interventions of this kind was a study conducted in) Tj ET BT 0.9835 0 0 0.9835 312.96 33.6 Tm 0.0272 Tc 0.3633 Tw (the geriatric ward of a psychiatric hospital \(198\).) Tj ET endstream endobj 320 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 321 0 obj <>stream 0.48 w 1 j 0 0 0 RG 72 678 m 549.6 678 l S BT 0.9835 0 0 0.9835 72.48 684 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (122 ) Tj ET BT 0.9598 0 0 0.9598 92.16 684 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 98.4 684 Tm /F5 10 Tf 0.0125 Tc 0.7939 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -26.5999 -39.7778 TD /F4 10 Tf 0.0365 Tc 1.2995 Tw (That study found that when strips of tape were) Tj ET BT 0.934 0 0 0.9835 72.48 632.64 Tm -0.0349 Tc 1.367 Tw (placed in any of four different grid patterns on the) Tj ET BT 0.9835 0 0 0.9835 72.72 620.4 Tm 0.0366 Tc 0.0283 Tw (floor in front of the exit doors, the frequency with) Tj ET BT 0.934 0 0 0.9835 72.72 608.16 Tm -0.036 Tc 2.396 Tw (which demented patients approached and touched) Tj ET BT 0.8915 0 0 0.9835 72.72 595.92 Tm 0.0329 Tc 2.0718 Tw (the doors decreased significantly. Two other studies) Tj ET BT 0.9835 0 0 0.9835 72.72 584.16 Tm 0.0338 Tc 0.7958 Tw (have attempted unsuccessfully to replicate these) Tj ET BT 0.8915 0 0 0.9835 72.72 572.16 Tm 0.029 Tc 1.0314 Tw (results in special care units \(75,77,316\). Both studies) Tj ET BT 0.9835 0 0 0.9835 72.96 560.16 Tm 0.046 Tc -0.0774 Tw (found that use of strips of tape in front of the exit) Tj 0.244 -12.4458 TD 0.0335 Tc 2.5531 Tw (doors resulted in a temporary increase but no) Tj ET BT 0.8915 0 0 0.9835 73.44 535.44 Tm 0.0418 Tc 1.5555 Tw (significant long-term change in the number of times) Tj -0.2692 -12.2018 TD 0.0373 Tc 0.2274 Tw (per day the special care unit residents opened the exit) Tj 0.2692 -12.4458 TD 0.2444 Tc 0 Tw (doors.) Tj ET BT 0.934 0 0 0.9835 84.72 484.32 Tm -0.041 Tc 1.8874 Tw (Other interventions to stop individuals with de-) Tj -12.0769 -11.9577 TD -0.0149 Tc 0.8317 Tw (mentia from escaping or wandering away have also) Tj ET BT 0.8915 0 0 0.9835 73.44 460.32 Tm 0.0284 Tc 1.5272 Tw (been tested in special care units. Chafetz found that) Tj 0.2692 -12.2018 TD 0.0359 Tc 1.2757 Tw (use of a second spring-loaded latch on the exit doors) Tj ET BT 0.9835 0 0 0.9835 74.16 436.32 Tm 0.0446 Tc 1.9144 Tw (stopped residents of one special care unit from) Tj ET BT 0.934 0 0 0.9835 74.16 424.56 Tm -0.0023 Tc 0.9467 Tw (opening the doors \(75,77\). Namazi et al. found that) Tj ET BT 0.8915 0 0 0.9835 74.16 412.32 Tm 0.0603 Tc 1.0988 Tw (concealing the exit doors with either a beige cloth or) Tj 0.2692 -11.9577 TD 0.0301 Tc 1.4532 Tw (a green patterned cloth stopped residents of another) Tj ET BT 0.934 0 0 0.9835 74.4 388.32 Tm -0.0289 Tc 1.1036 Tw (special care unit from opening the exit doors \(316\).) Tj ET BT 0.9835 0 0 0.9835 74.16 376.32 Tm 0.0338 Tc 1.8208 Tw (Two other interventions-painting the door knob) Tj 0.244 -12.4458 TD 0.0375 Tc 0.2552 Tw (the same color as the door and using a door knob) Tj 0.244 -12.2018 TD 0.0269 Tc 2.7429 Tw (cover that allows the knob to turn only when) Tj -0.4881 -12.2018 TD 0.0473 Tc 0.8797 Tw (pressure is applied-also decreased the frequency) Tj 0.4881 -12.2018 TD 0.0337 Tc -0.0269 Tw (with which special care unit residents opened the) Tj ET BT 0.8915 0 0 0.9835 74.64 315.84 Tm 0.0381 Tc 0.8097 Tw (exit door \(316\). The latter two interventions were not) Tj ET BT 0.934 0 0 0.9835 74.88 303.84 Tm -0.0381 Tc 1.3704 Tw (as effective as concealing the doorknob with apiece) Tj 0 -12.2018 TD -0.0442 Tc 2.5333 Tw (of cloth, however.) Tj ET BT 0.9835 0 0 0.9835 85.92 264.72 Tm 0.0315 Tc 0.6517 Tw (Researchers at the Corinne Dolan Alzheimer\222s) Tj ET BT 0.934 0 0 0.9835 75.12 252.48 Tm -0.0334 Tc 1.2185 Tw (Center in Chardon, OH, have conducted studies on) Tj ET BT 0.8915 0 0 0.9835 74.88 240.48 Tm 0.0507 Tc 0.5072 Tw (many other features and interventions in special care) Tj 0 -12.6899 TD 0.0412 Tc 1.4792 Tw (units. The center was designed to facilitate research) Tj 0.2692 -12.2018 TD 0.0237 Tc 0.3323 Tw (of this kind. It has 2 separate but essentially identical) Tj ET BT 0.9835 0 0 0.9835 75.36 204.24 Tm 0.0235 Tc 2.6853 Tw (wings, each housing 12 residents, so alternate) Tj ET BT 0.934 0 0 0.9835 75.36 192 Tm -0.035 Tc 1.7953 Tw (interventions that require physical design or other) Tj ET BT 0.8915 0 0 0.9835 75.36 180.24 Tm 0.0299 Tc 0.7112 Tw (modifications to the unit can be tested in the 2 wings) Tj 0.5384 -12.6899 TD 0.0372 Tc 2.0759 Tw (simultaneously and their outcomes compared. Eight) Tj -0.2692 -12.2018 TD 0.0402 Tc 1.1214 Tw (interventions studied recently at the center are:) Tj ET BT 0.7217 0 0 0.9835 87.84 128.88 Tm 0.1504 Tc 0 Tw (1.) Tj ET BT 0.8491 0 0 0.9835 87.12 72.48 Tm 0.0673 Tc (2.) Tj ET BT 0.9835 0 0 0.9835 100.56 128.64 Tm 0.2593 Tc 3.2998 Tw (use of) Tj 39.2897 -0.244 TD 0.2463 Tc 3.679 Tw (\223significant\224 vs. \223nonsignificant\224) Tj -39.5338 -11.7137 TD 0.0344 Tc 2.8451 Tw (personal belongings in showcases next to) Tj 0 -11.9577 TD 0.031 Tc 0.6441 Tw (residents\222 rooms to help them identify their) Tj ET BT 0.934 0 0 0.9835 100.56 93.36 Tm 0.184 Tc 0 Tw (rooms;) Tj ET BT 0.8915 0 0 0.9835 100.56 72.48 Tm 0.0463 Tc 1.2043 Tw (use of clearly visible toilets in residents\222 rooms) Tj ET BT 0.934 0 0 0.9835 100.8 60.24 Tm -0.0255 Tc 0.843 Tw (vs. toilets that are concealed behind a curtain) Tj 0 -12.2018 TD -0.0229 Tc 1.0605 Tw (to help them locate the bathroom and remain) Tj ET BT 0.8915 0 0 0.9835 100.8 36.48 Tm 0.0332 Tc 0 Tw (continent;) Tj ET BT 0.8197 0 0 0.9812 334.32 644.16 Tm /F6 11 Tf 0.1174 Tc (3.) Tj ET BT 0.8607 0 0 0.9812 334.08 608.16 Tm 0.1944 Tc (4.) Tj 0.8365 -36.1997 TD 0.0549 Tc (5.) Tj 0 -36.4443 TD 0.0549 Tc (6.) Tj 0.5577 -48.9185 TD 0.0549 Tc (7.) Tj ET BT 0.7787 0 0 0.9812 336 441.6 Tm 0.1864 Tc (8.) Tj ET BT 0.934 0 0 0.9835 347.52 644.16 Tm /F4 10 Tf -0.0343 Tc 1.1093 Tw (use of certain types, colors, and placements of) Tj ET BT 0.9835 0 0 0.9835 348.48 631.92 Tm 0.0346 Tc -0.0916 Tw (signs to help residents locate the bathrooms) Tj ET BT 0.8915 0 0 0.9835 348.48 620.16 Tm 0.0467 Tc 1.3384 Tw (and remain continent;) Tj ET BT 0.9835 0 0 0.9835 347.76 608.16 Tm 0.0336 Tc 1.9604 Tw (use of partitions of various heights in the) Tj ET BT 0.934 0 0 0.9835 348.24 596.4 Tm -0.036 Tc 1.4416 Tw (dining room and the activity rooms to reduce) Tj ET BT 0.8915 0 0 0.9835 348.24 584.64 Tm 0.0197 Tc 2.3109 Tw (distractions for residents;) Tj ET BT 0.9835 0 0 0.9835 348 572.64 Tm 0.0406 Tc 1.7224 Tw (use of unlocked vs. locked doors to an en-) Tj ET BT 0.8915 0 0 0.9835 348.48 560.64 Tm 0.0471 Tc 1.6072 Tw (closed courtyard to enhance residents\222 sense of) Tj 0.2692 -11.7137 TD 0.2675 Tc 0 Tw (autonomy;) Tj ET BT 0.934 0 0 0.9835 348.48 536.88 Tm -0.0493 Tc 0.7584 Tw (use of special closet doors that allow residents) Tj ET BT 0.9835 0 0 0.9835 348.96 524.64 Tm 0.0355 Tc 0.7941 Tw (to see only one set of clothing at a time vs.) Tj 0 -11.7137 TD 0.0421 Tc -0.0993 Tw (ordinary closet doors to help residents dress) Tj ET BT 0.8915 0 0 0.9835 349.2 500.88 Tm 0.021 Tc 5.809 Tw (themselves independently;) Tj ET BT 0.934 0 0 0.9835 348.72 489.12 Tm -0.041 Tc 1.7406 Tw (use of refrigerators with glass doors vs. ordi-) Tj 0.257 -11.7137 TD -0.0412 Tc 1.4166 Tw (nary refrigerators with opaque doors to allow) Tj ET BT 0.9835 0 0 0.9835 348.72 465.6 Tm 0.0497 Tc 0.2591 Tw (residents to see food and thereby encourage) Tj ET BT 0.8915 0 0 0.9835 349.2 453.36 Tm 0.0399 Tc 1.1731 Tw (them to eat when they are hungry; and) Tj ET BT 0.934 0 0 0.9835 349.2 441.84 Tm -0.0061 Tc 0.5286 Tw (use of familiar tasks \(e.g., washing dishes and) Tj 0.257 -12.2018 TD 0.0081 Tc 0.6015 Tw (dusting\) vs. unfamiliar tasks \(e.g., untangling) Tj ET BT 0.8915 0 0 0.9835 349.68 417.84 Tm 0.0373 Tc 0.7914 Tw (a box of hangers\) to engage residents\222 attention) Tj 0 -12.2018 TD 0.0216 Tc 1.1647 Tw (and sustain their interest \(314\).) Tj ET BT 0.934 0 0 0.9835 324.96 387.84 Tm -0.042 Tc 1.5994 Tw (Results of some of these studies were published in) Tj 0 -12.2018 TD -0.0164 Tc 0.5763 Tw (late 1991 \(317\), and results of the other studies will) Tj 0 -12.4458 TD 0.006 Tc 0.8093 Tw (be published in 1992.) Tj ET BT 0.9835 0 0 0.9835 336 345.84 Tm 0.0232 Tc 0.7159 Tw (The Dementia Study Unit in the Geriatric Re-) Tj ET BT 0.934 0 0 0.9835 325.44 333.84 Tm -0.0248 Tc 1.3562 Tw (search, Education, Clinical Center \(GRECC\) at the) Tj ET BT 0.9835 0 0 0.9835 325.44 322.08 Tm 0.265 Tc 3.5379 Tw (E.N. Rogers Memorial Veterans Hospital in) Tj ET BT 0.934 0 0 0.9835 325.44 310.08 Tm -0.0238 Tc 1.9425 Tw (Bedford, MA, has also conducted studies on many) Tj ET BT 0.9835 0 0 0.9835 325.2 297.84 Tm 0.0167 Tc -0.0734 Tw (particular interventions in special care units. The) Tj 0.244 -12.2018 TD 0.0257 Tc 0.7309 Tw (Dementia Study Unit includes three special care) Tj ET BT 0.8915 0 0 0.9835 325.44 273.6 Tm 0.0339 Tc 1.1028 Tw (units that serve elderly veterans with dementia. The) Tj 0.2692 -11.9577 TD 0.0276 Tc 1.7637 Tw (interventions evaluated in the Dementia Study Unit) Tj 0.2692 -12.2018 TD 0.0472 Tc 0 Tw (include:) Tj ET BT 0.8632 0 0 0.9598 336.96 233.04 Tm /F9 6 Tf -0.0185 Tc (l) Tj 0.278 -37.5062 TD -0.0185 Tc (l) Tj 0.5561 -37.5062 TD -0.0185 Tc (l) Tj 0 -49.0081 TD -0.0185 Tc (l) Tj 0.278 -24.7541 TD -0.0185 Tc (l) Tj ET BT 0.934 0 0 0.9835 347.04 231.84 Tm /F4 10 Tf -0.0321 Tc 0.6502 Tw (use of a hospice-like approach in the care of 40) Tj 1.0278 -12.2018 TD -0.0473 Tc 2.0483 Tw (severely demented special care unit residents) Tj 0 -11.9577 TD 0.0551 Tc 0 Tw (\(474\);) Tj 0 -12.4458 TD -0.027 Tc 0.8446 Tw (substitution of normal feeding for tube feeding) Tj ET BT 0.9835 0 0 0.9835 348.24 184.08 Tm 0.03 Tc 1.476 Tw (in six special care unit residents who were) Tj ET BT 0.934 0 0 0.9835 348.24 171.84 Tm -0.0096 Tc 0.8581 Tw (being tube fed on admission to the unit \(475\);) Tj ET BT 0.8915 0 0 0.9835 348.24 160.08 Tm 0.0449 Tc 0.3493 Tw (use of a few beds on one of the special care units) Tj ET BT 0.9835 0 0 0.9835 348.24 147.84 Tm 0.0415 Tc 1.046 Tw (to provide respite care for 22 veterans with) Tj ET BT 0.934 0 0 0.9835 348.24 136.32 Tm -0.031 Tc 1.5831 Tw (dementia who were still living in the commu-) Tj 0 -11.9577 TD 0.0439 Tc 1.7965 Tw (nity \(238,405\);) Tj ET BT 0.8915 0 0 0.9835 347.76 112.8 Tm 0.0299 Tc 0.5304 Tw (use of antibiotics vs. palliative measures to treat) Tj ET BT 0.934 0 0 0.9835 348.48 101.28 Tm -0.0224 Tc 0.803 Tw (fevers in special care unit residents \(135\); and) Tj ET BT 0.8915 0 0 0.9835 348 89.04 Tm 0.0396 Tc 0.7887 Tw (use of dietary changes and enforced rest periods) Tj ET BT 0.934 0 0 0.9835 348.48 77.04 Tm -0.0186 Tc 1.2394 Tw (to maintain normal body weight in six special) Tj ET BT 0.8915 0 0 0.9835 348.48 65.28 Tm 0.0337 Tc 1.5325 Tw (care unit residents who paced constantly \(376\).) Tj -24.2275 -18.0586 TD 0.025 Tc 1.531 Tw (Studies to evaluate the impact of other features and) Tj ET BT 0.934 0 0 0.9835 326.88 35.76 Tm -0.0343 Tc 0.7668 Tw (interventions have been conducted or are underway) Tj ET endstream endobj 322 0 obj <>/Rotate 0/Type/Page>> endobj 323 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.4 685.44 m 534.72 685.44 l S BT 0.9835 0 0 0.9835 318.48 690.72 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.6212 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 511.2 690.72 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 517.68 690.72 Tm /F5 10 Tf 0.2847 Tc 0 Tw (123) Tj -468.3044 -39.7778 TD /F4 10 Tf 0.0306 Tc 0.6343 Tw (in special care units at several other VA medical) Tj ET BT 0.934 0 0 0.9835 57.12 639.6 Tm -0.004 Tc 1.5909 Tw (centers \(159\).) Tj 11.82 -18.5467 TD -0.0259 Tc 0.9077 Tw (An analysis of the results of studies of particular) Tj -11.306 -12.2018 TD -0.0313 Tc 1.5834 Tw (features or interventions in VA and nonVA special) Tj ET BT 0.8915 0 0 0.9835 57.6 597.12 Tm 0.0382 Tc 0.7647 Tw (care units and a comparison of these results with the) Tj ET BT 0.934 0 0 0.9835 57.6 585.12 Tm -0.036 Tc 2.2675 Tw (results of similar studies conducted in nonspecial-) Tj 0.5139 -11.9577 TD -0.0235 Tc 1.6117 Tw (ized nursing home units and other residential and) Tj -0.257 -12.2018 TD -0.0406 Tc 1.9971 Tw (nonresidential care settings is beyond the scope of) Tj ET BT 0.8915 0 0 0.9835 58.32 549.12 Tm 0.0232 Tc 1.0283 Tw (this report. The important point is that the existence) Tj 0 -11.9577 TD 0.0634 Tc 1.0313 Tw (of special care units probably encourages research to) Tj ET BT 0.934 0 0 0.9835 58.32 525.12 Tm -0.0215 Tc 0.7531 Tw (evaluate particular features and interventions. It is) Tj ET BT 0.9835 0 0 0.9835 58.56 513.12 Tm 0.04 Tc 1.2958 Tw (easier and more efficient to conduct this type of) Tj ET BT 0.8915 0 0 0.9835 58.32 501.36 Tm 0.062 Tc 0.3253 Tw (research in a special care unit, in part because all the) Tj 0.2692 -11.9577 TD 0.0208 Tc 1.1945 Tw (residents have dementia. In addition, as discussed in) Tj ET BT 0.934 0 0 0.9835 59.04 477.36 Tm -0.035 Tc 0.5641 Tw (chapter 1, the existence of special care units focuses) Tj ET BT 0.9835 0 0 0.9835 59.04 465.36 Tm 0.0372 Tc 1.8871 Tw (attention on the special needs of nursing home) Tj -0.244 -11.9577 TD 0.0337 Tc 0.7471 Tw (residents with dementia and thereby encourages) Tj ET BT 0.8915 0 0 0.9835 58.8 441.6 Tm 0.0514 Tc 0.4359 Tw (research to evaluate particular features and interven-) Tj 0.8076 -12.4458 TD 0.0121 Tc 1.9157 Tw (tions to address those needs.) Tj 12.3829 -18.0586 TD 0.0527 Tc 1.5201 Tw (Research on particular features and interventions) Tj ET BT 0.9835 0 0 0.9835 59.52 399.84 Tm 0.0373 Tc 1.2986 Tw (may help to explain the findings of studies that) Tj ET BT 0.934 0 0 0.9835 59.76 387.6 Tm -0.026 Tc 1.3896 Tw (evaluate the overall impact of special care units. If) Tj 0 -11.7137 TD -0.034 Tc 0.742 Tw (particular features or interventions are shown to be) Tj ET BT 0.8915 0 0 0.9835 60.24 364.08 Tm 0.0495 Tc 1.2344 Tw (effective or ineffective in general or for certain types) Tj ET BT 0.934 0 0 0.9835 60.24 352.08 Tm -0.0246 Tc 0.9522 Tw (of residents, those findings may explain the contra-) Tj 0 -12.2018 TD -0.0349 Tc 1.991 Tw (dictory results of studies that evaluate the overall) Tj ET BT 0.8915 0 0 0.9835 60.48 328.56 Tm 0.0234 Tc 1.4607 Tw (impact of the units. More importantly, however, this) Tj -0.5384 -12.2018 TD 0.0355 Tc 0.7229 Tw (research may identify features and interventions that) Tj 0.8076 -12.2018 TD 0.0543 Tc 0.9506 Tw (can be used not only in special care units but also in) Tj ET BT 0.934 0 0 0.9835 60.72 292.56 Tm -0.0265 Tc 2.0433 Tw (nonspecialized nursing home units and other resi-) Tj 0.257 -12.4458 TD -0.0359 Tc 1.3681 Tw (dential and nonresidential care settings to improve) Tj 0.257 -12.2018 TD -0.0279 Tc 0.6401 Tw (the care of individuals with dementia.) Tj ET BT 0.9663 0 0 0.9939 68.4 246.24 Tm /F6 14 Tf 0.061 Tc 0.1606 Tw (STUDIES THAT EVALUATE THE) Tj ET BT 0.9341 0 0 0.9939 61.2 230.64 Tm -0.0846 Tc 1.2786 Tw (EFFECTS OF SPECIAL CARE UNITS) Tj ET BT 0.9663 0 0 0.9939 84.24 214.56 Tm 0.0194 Tc 1.1144 Tw (ON UNIT STAFF MEMBERS) Tj ET BT 0.9835 0 0 0.9835 72.72 196.56 Tm /F4 10 Tf 0.0373 Tc 0.3835 Tw (OTA is aware of four studies that evaluate the) Tj -10.9816 -12.2018 TD 0.0317 Tc 0.6028 Tw (effect of special care units on unit staff members) Tj 0 -12.4458 TD 0.0342 Tc -0.0273 Tw (over time. Two frequently cited reasons for estab-) Tj ET BT 0.8915 0 0 0.9835 61.92 160.56 Tm 0.0468 Tc 0.5756 Tw (lishing special care units are: 1\) a belief that training) Tj ET BT 0.934 0 0 0.9835 62.4 148.32 Tm -0.0227 Tc 1.8678 Tw (about dementia can be more easily and effectively) Tj -0.5139 -11.7137 TD -0.0326 Tc 1.0048 Tw (provided for the staff of a special care unit than for) Tj 0.7709 -12.2018 TD -0.0171 Tc 1.458 Tw (the staff of nonspecialized nursing home units and) Tj ET BT 0.9835 0 0 0.9835 62.4 112.56 Tm 0.0298 Tc -0.1275 Tw (therefore that special care unit staff members are) Tj 0 -11.9577 TD 0.0393 Tc 0.3916 Tw (likely to be more knowledgeable about dementia,) Tj 0.244 -12.2018 TD 0.0392 Tc 1.8885 Tw (and 2\) a belief that it is less stressful for staff) Tj ET BT 0.934 0 0 0.9835 62.16 76.8 Tm -0.0341 Tc 0.4989 Tw (members to work with residents with dementia on a) Tj ET BT 0.8915 0 0 0.9835 62.88 64.8 Tm 0.0529 Tc 1.0046 Tw (special care unit than on nonspecialized units. Three) Tj ET BT 0.9835 0 0 0.9835 62.64 53.28 Tm 0.0479 Tc 1.0438 Tw (of the available studies measured the effect of a) Tj ET BT 0.8915 0 0 0.9835 62.64 41.04 Tm 0.0447 Tc 1.4753 Tw (special care unit on staff members\222 knowledge about) Tj ET BT 0.9835 0 0 0.9835 308.16 651.84 Tm 0.042 Tc 1.9519 Tw (dementia; two studies measured the effect of a) Tj ET BT 0.8915 0 0 0.9835 308.4 639.84 Tm 0.0351 Tc 0.7382 Tw (special care unit on staff stress and burnout, and one) Tj 0.2692 -12.2018 TD 0.0367 Tc 0.9459 Tw (study measured the extent to which special care unit) Tj ET BT 0.9835 0 0 0.9835 308.64 615.84 Tm 0.036 Tc 1.679 Tw (and other staff members were disturbed by the) Tj ET BT 0.934 0 0 0.9835 308.4 603.36 Tm -0.0243 Tc 0.8931 Tw (behavioral symptoms of residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 319.68 583.44 Tm 0.045 Tc 1.3213 Tw (Chafetz and West compared knowledge about) Tj ET BT 0.934 0 0 0.9835 308.88 571.68 Tm -0.0096 Tc 0.9224 Tw (dementia among 1\) 11 staff members of one special) Tj ET BT 0.9835 0 0 0.9835 308.88 559.68 Tm 0.0339 Tc 1.2977 Tw (care unit, 2\) 13 staff members of nonspecialized) Tj 0.244 -12.4458 TD 0.0207 Tc 1.2375 Tw (units in the same nursing home, and 3\) 30 staff) Tj ET BT 0.934 0 0 0.9835 309.36 535.68 Tm -0.0196 Tc 0.5798 Tw (members of nonspecialized units in another nursing) Tj 0 -12.2018 TD -0.0159 Tc 1.1469 Tw (home \(81\). During the 9- to 12-month period of the) Tj 0.5139 -12.4458 TD -0.0212 Tc 1.8295 Tw (study, the special care unit staff members partici-) Tj ET BT 0.8915 0 0 0.9835 309.36 499.68 Tm 0.034 Tc 0.9489 Tw (pated in 10 weekly training sessions about dementia.) Tj ET BT 0.934 0 0 0.9835 309.84 487.68 Tm -0.0378 Tc 0.8883 Tw (The staff of the nonspecialized units did not receive) Tj ET BT 0.9835 0 0 0.9835 310.08 475.44 Tm 0.0214 Tc 0.0438 Tw (this training. All staff members\222 knowledge about) Tj ET BT 0.8915 0 0 0.9835 310.08 463.92 Tm 0.0336 Tc 1.1647 Tw (dementia was measured at the beg) Tj ET BT 0.934 0 0 0.9835 460.08 464.16 Tm -0.0123 Tc 0.7432 Tw (inning and end of) Tj -160.3403 -12.6899 TD -0.0038 Tc 0.3701 Tw (the study using a 20-item true-false quiz. The study) Tj ET BT 0.9835 0 0 0.9835 310.32 439.92 Tm 0.0394 Tc 1.9197 Tw (found that despite the training received by the) Tj 0.4881 -12.2018 TD 0.0269 Tc 2.1764 Tw (special care unit staff members, there were no) Tj 0.244 -12.4458 TD 0.0334 Tc 0.5196 Tw (significant differences among the three groups of) Tj ET BT 0.8915 0 0 0.9835 311.04 403.68 Tm 0.0267 Tc 0.5982 Tw (staff members in the extent to which their test scores) Tj ET BT 0.934 0 0 0.9835 311.04 391.92 Tm -0.0349 Tc 1.5383 Tw (changed over time. The researchers concluded that) Tj ET BT 0.8915 0 0 0.9835 311.04 379.92 Tm 0.0478 Tc 0.1259 Tw (the trainin) Tj ET BT 0.9835 0 0 0.9835 356.4 380.16 Tm 0.0407 Tc -0.0688 Tw (g provided for the special care unit staff) Tj ET BT 0.934 0 0 0.9835 311.04 368.16 Tm -0.0205 Tc 0.8377 Tw (members did not have a significant or lasting effect) Tj 0.257 -12.2018 TD -0.0313 Tc 0.9135 Tw (on their knowledge about dementia.) Tj ET BT 0.8915 0 0 0.9835 322.08 336.48 Tm 0.0458 Tc 2.0124 Tw (Maas and Buckwalter compared knowledge about) Tj ET BT 0.934 0 0 0.9835 311.52 324.48 Tm -0.0088 Tc 0.6416 Tw (dementia among 21 special care unit staff members) Tj 0.5139 -11.9577 TD -0.0128 Tc 0.6046 Tw (and 55 staff members of nonspecialized units in the) Tj 0 -12.4458 TD -0.0055 Tc 0.8537 Tw (same facility \(265\). During the frost 3 months after) Tj 0 -11.9577 TD -0.0258 Tc 1.1003 Tw (the special care unit opened, its staff members and) Tj ET BT 0.9835 0 0 0.9835 312 276.72 Tm 0.0366 Tc 3.1601 Tw (the staff members of the nonspecialized units) Tj ET BT 0.934 0 0 0.9835 311.76 264.48 Tm -0.0201 Tc 1.8284 Tw (received 80 hours of training about dementia. The) Tj 0.7709 -12.2018 TD -0.0315 Tc 1.6938 Tw (study found that during the baseline period before) Tj ET BT 0.9835 0 0 0.9835 312.48 240.48 Tm 0.0403 Tc 0.2584 Tw (the unit opened and throughout the course of the) Tj 0.4881 -12.2018 TD 0.0244 Tc 0.4707 Tw (study, the special care unit staff members scored) Tj -0.244 -12.2018 TD 0.0204 Tc 2.7059 Tw (slightly higher than the staff members on the) Tj ET BT 0.934 0 0 0.9835 312.48 204.72 Tm -0.0307 Tc 0.922 Tw (nonspecialized units on a 33-item test of knowledge) Tj ET BT 0.8915 0 0 0.9835 312.72 192.72 Tm 0.0196 Tc 1.8495 Tw (of dementia, but this difference was not statistically) Tj ET BT 0.934 0 0 0.9835 313.2 180.96 Tm -0.0185 Tc 2.1632 Tw (significant. There was also no statistically signifi-) Tj ET BT 0.8915 0 0 0.9835 313.2 168.96 Tm 0.0431 Tc 0.5349 Tw (cant change in the scores of the special care unit staff) Tj ET BT 0.9835 0 0 0.9835 312.96 156.96 Tm 0.0337 Tc 0.1824 Tw (members over the course of the study. Registered) Tj 0.244 -11.9577 TD 0.0201 Tc 1.1433 Tw (nurses \(RNs\) scored significantly higher than li-) Tj 0 -11.9577 TD 0.0165 Tc 0.7809 Tw (censed practical nurses \(LPNs\), nurse aides, and) Tj ET BT 0.934 0 0 0.9835 313.2 121.2 Tm -0.0184 Tc 2.5828 Tw (non-nursing staff members, regardless of whether) Tj 0.257 -11.9577 TD -0.043 Tc 0.9474 Tw (they worked on the special care unit or the nonspe-) Tj ET BT 0.8915 0 0 0.9835 313.44 97.2 Tm 0.034 Tc 2.2948 Tw (cialized units.) Tj ET BT 0.9835 0 0 0.9835 324.72 77.28 Tm 0.0424 Tc 0.7138 Tw (Cleary et al. compared knowledge of dementia) Tj ET BT 0.934 0 0 0.9835 313.92 65.04 Tm -0.0122 Tc 0.7774 Tw (among the staff of a 16-bed special care unit at one) Tj -0.7709 -11.9577 TD -0.0185 Tc 1.1496 Tw (point 3 months before the unit opened and again 3) Tj 0 -12.2018 TD -0.019 Tc 0.6433 Tw (months after it opened \(88\). Despite a staff training) Tj ET BT 0.99 0 0 0.99 74.88 16.08 Tm /F7 8 Tf 0.3335 Tc 2.4508 Tw (328-405 - 92 - 5) Tj 0 Tc -0.0609 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 145.92 16.08 Tm /F6 10 Tf 0.4519 Tc -0.5205 Tw (Ql ) Tj ET BT 0.99 0 0 0.99 162.48 16.08 Tm /F3 8 Tf -0.085 Tc 0 Tw (3) Tj ET endstream endobj 324 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 325 0 obj <>stream 0.72 w 1 j 0 0 0 RG 74.88 678.24 m 551.52 678.24 l S BT 0.9835 0 0 0.9835 74.64 683.76 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 0.9869 Tw (124 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0 -39.5338 TD /F4 10 Tf 0.0256 Tc 1.7071 Tw (program conducted during this time period, the) Tj 0.7321 -12.4458 TD 0.0285 Tc 2.872 Tw (study found no significant change in the staff) Tj -0.4881 -11.9577 TD 0.0272 Tc 0.5259 Tw (members\222 knowledge of dementia. This study did) Tj ET BT 0.934 0 0 0.9835 74.88 608.88 Tm -0.0276 Tc 0.9095 Tw (not have a control group.) Tj ET BT 0.9835 0 0 0.9835 85.92 589.2 Tm 0.027 Tc 1.7231 Tw (With respect to job satisfaction, Cleary et al.) Tj ET BT 0.934 0 0 0.9835 75.36 577.2 Tm -0.0304 Tc 0.6647 Tw (compared special care unit staff members\222 scores on) Tj ET BT 0.8915 0 0 0.9835 75.6 565.68 Tm 0.0405 Tc 1.6338 Tw (a questionnaire administered at one point 3 months) Tj ET BT 0.934 0 0 0.9835 75.36 553.44 Tm -0.0125 Tc 1.3751 Tw (before the 16-bed unit opened and again 3 months) Tj ET BT 0.9835 0 0 0.9835 75.6 541.68 Tm 0.0413 Tc 1.9758 Tw (after it opened \(88\). The 83-item questionnaire) Tj 0.244 -11.9577 TD 0.0398 Tc 1.4893 Tw (addressed 6 aspects of job satisfaction \(working) Tj ET BT 0.8915 0 0 0.9835 75.6 518.16 Tm 0.0374 Tc 4.1754 Tw (conditions, professional considerations, professional) Tj ET BT 0.9835 0 0 0.9835 75.6 505.92 Tm 0.0248 Tc 1.1588 Tw (preparation, emotional climate, supervision, and) Tj ET BT 0.934 0 0 0.9835 76.32 493.92 Tm -0.0181 Tc 1.6488 Tw (social significance\). The study found no significant) Tj ET BT 0.8915 0 0 0.9835 75.84 482.16 Tm 0.0438 Tc 1.409 Tw (change in the staff members\222 scores before and after) Tj 0.2692 -12.4458 TD 0.0336 Tc 0.6128 Tw (the unit opened. On the positive side, the researchers) Tj -0.2692 -11.9577 TD 0.0143 Tc 0.3788 Tw (point out that the staff members did not seem to react) Tj 0.2692 -11.9577 TD 0.0404 Tc 0.852 Tw (negatively to the isolation of the special care unit, as) Tj ET BT 0.934 0 0 0.9835 76.08 434.64 Tm -0.0403 Tc 0.9016 Tw (might have been expected. Moreover, in open-ended) Tj 0.257 -11.9577 TD -0.0415 Tc 1.2884 Tw (interviews, some staff members reported they were) Tj ET BT 0.9835 0 0 0.9835 76.56 410.88 Tm 0.0242 Tc 0.529 Tw (spending much less time retrieving patients who) Tj ET BT 0.8915 0 0 0.9835 76.56 399.12 Tm 0.0521 Tc 1.044 Tw (wandered away from the unit and were experiencing) Tj ET BT 0.9835 0 0 0.9835 76.32 387.12 Tm 0.0255 Tc 0.6497 Tw (fewer interruptions when caring for patients. No) Tj ET BT 0.8915 0 0 0.9835 76.32 375.12 Tm 0.0337 Tc 0.6801 Tw (measurements were made of the latter two outcomes.) Tj ET BT 0.934 0 0 0.9835 87.84 354.96 Tm 0.0033 Tc 0.4268 Tw (Using the same 83-item questionnaire, Maas and) Tj ET BT 0.9835 0 0 0.9835 76.8 343.2 Tm 0.0263 Tc 1.3403 Tw (Buckwalter compared job satisfaction among 21) Tj ET BT 0.8915 0 0 0.9835 77.04 330.96 Tm 0.0301 Tc 0.5158 Tw (special care unit staff members and 55 staff members) Tj ET BT 0.9835 0 0 0.9835 76.8 319.2 Tm 0.0317 Tc -0.0597 Tw (on nonspecialized units in the same facility \(265\).) Tj 0 -12.2018 TD 0.0329 Tc 0.1541 Tw (The study found job satisfaction was \223moderately) Tj T* 0.0281 Tc -0.0037 Tw (high\224 for both groups of staff members during the) Tj ET BT 0.934 0 0 0.9835 76.8 283.2 Tm -0.0494 Tc 1.7496 Tw (baseline period before the special care unit opened) Tj 0.257 -12.2018 TD -0.0253 Tc 1.2282 Tw (and throughout the course of the study. There was) Tj ET BT 0.8915 0 0 0.9835 77.04 259.44 Tm 0.0365 Tc 1.0807 Tw (little difference between the scores of the two groups) Tj ET BT 0.934 0 0 0.9835 77.04 247.2 Tm -0.0214 Tc 0.5246 Tw (of staff members on the questionnaire as a whole or) Tj ET BT 0.9835 0 0 0.9835 77.28 235.2 Tm 0.0187 Tc 0.86 Tw (any of its six subscales. RNs scored significantly) Tj ET BT 0.8915 0 0 0.9835 77.04 222.96 Tm 0.0274 Tc 0.764 Tw (higher than LPNs, nurse aides, and non-nursing staff) Tj ET BT 0.934 0 0 0.9835 77.04 211.2 Tm -0.0202 Tc 2.1221 Tw (members on one of the subscales-satisfaction with) Tj ET BT 0.8915 0 0 0.9835 77.04 199.2 Tm 0.0398 Tc 3.0959 Tw (professional preparation-regardless of whether they) Tj 0.5384 -12.4458 TD 0.0558 Tc 0.7562 Tw (worked on the special care unit or the nonspecialized) Tj ET BT 0.9835 0 0 0.9835 77.28 175.2 Tm 0.0191 Tc 1.3476 Tw (units. After the special care unit opened, LPNs,) Tj ET BT 0.934 0 0 0.9835 77.52 163.2 Tm -0.0106 Tc 1.8549 Tw (nurse aides, and other non-nursing staff members) Tj 0.257 -12.4458 TD -0.0454 Tc 1.4103 Tw (who worked on the special care unit scored signifi-) Tj ET BT 0.8915 0 0 0.9835 77.52 139.44 Tm 0.0574 Tc 1.1918 Tw (cantly higher on the same subscale than comparable) Tj ET BT 0.9835 0 0 0.9835 77.76 127.2 Tm 0.0288 Tc 0.1583 Tw (staff members on the nonspecialized units. There) Tj ET BT 0.8915 0 0 0.9835 77.76 115.44 Tm 0.0348 Tc 1.2172 Tw (were no significant differences for the staff members) Tj ET BT 0.934 0 0 0.9835 77.76 103.68 Tm -0.0172 Tc 0.7313 Tw (on any of the other subscales.) Tj ET BT 0.8915 0 0 0.9835 88.56 84 Tm 0.0099 Tc 1.399 Tw (With respect to staff stress, Maas and Buckwalter) Tj ET BT 0.9835 0 0 0.9835 77.76 72 Tm 0.0396 Tc 1.9368 Tw (found a generally low level of stress among 15) Tj ET BT 0.8915 0 0 0.9835 77.76 59.76 Tm 0.0301 Tc 0.5158 Tw (special care unit staff members and 49 staff members) Tj ET BT 0.9835 0 0 0.9835 77.52 48 Tm 0.0321 Tc 0.7418 Tw (on nonspecialized units in the same facility both) Tj ET BT 0.934 0 0 0.9835 77.28 36 Tm -0.0274 Tc 1.1341 Tw (before and after the special care unit opened \(265\).) Tj ET BT 0.9835 0 0 0.9835 325.44 644.88 Tm 0.0212 Tc 0.8981 Tw (The special care unit staff members consistently) Tj ET BT 0.934 0 0 0.9835 325.44 632.64 Tm -0.0306 Tc 1.4909 Tw (reported less stress than the staff members on the) Tj 0 -12.2018 TD -0.0278 Tc 1.1025 Tw (nonspecialized units. Nevertheless, the study found) Tj ET BT 0.9835 0 0 0.9835 325.92 608.4 Tm 0.0362 Tc 1.4523 Tw (that after the special care unit opened, its staff) Tj ET BT 0.934 0 0 0.9835 325.68 596.88 Tm -0.0285 Tc 2.0796 Tw (members experienced a statistically significant re-) Tj 0.257 -12.2018 TD -0.0238 Tc 0.5842 Tw (duction in stress, whereas the staff members on the) Tj ET BT 0.9835 0 0 0.9835 325.92 573.12 Tm 0.0378 Tc 1.7679 Tw (nonspecialized units experienced an increase in) Tj ET BT 0.934 0 0 0.9835 326.4 561.12 Tm -0.0187 Tc 0.4503 Tw (stress. The special care unit staff members also had) Tj ET BT 0.8915 0 0 0.9835 326.4 549.12 Tm 0.0378 Tc 1.0215 Tw (somewhat lower scores than the other staff members) Tj ET BT 0.9835 0 0 0.9835 326.16 537.36 Tm 0.039 Tc 0.1769 Tw (on a test of three indicators of burnout-emotional) Tj ET BT 0.934 0 0 0.9835 326.16 525.36 Tm -0.021 Tc 1.0952 Tw (exhaustion, depersonalization, and lack of a feeling) Tj ET BT 0.9835 0 0 0.9835 326.4 513.36 Tm 0.029 Tc 3.2898 Tw (of personal accomplishment; this difference in) Tj 0.4881 -12.2018 TD 0.0302 Tc 2.5566 Tw (scores was statistically significant for deperso-) Tj ET BT 0.934 0 0 0.9835 326.4 489.36 Tm -0.0285 Tc 1.1031 Tw (nalization but not for the other two indicators. The) Tj ET BT 0.9835 0 0 0.9835 326.88 477.36 Tm 0.0263 Tc 0.4862 Tw (study\222s findings with respect to use of sick leave,) Tj 0 -11.9577 TD 0.0326 Tc 1.822 Tw (leave without pay, and overtime are still being) Tj ET BT 0.934 0 0 0.9835 326.88 453.36 Tm 0.022 Tc 0.7921 Tw (analyzed \(54\).) Tj ET BT 0.9835 0 0 0.9835 337.92 430.08 Tm 0.0207 Tc 0.1563 Tw (Finally, in their study of special care units and) Tj ET BT 0.8915 0 0 0.9835 326.88 418.08 Tm 0.0426 Tc 0.6701 Tw (nonspecialized units in the same four nursing homes,) Tj ET BT 0.9835 0 0 0.9835 327.12 406.08 Tm 0.0256 Tc 0.7716 Tw (Holmes et al. compared staff members\222 attitudes) Tj ET BT 0.8915 0 0 0.9835 327.12 394.08 Tm 0.0232 Tc 1.7685 Tw (toward residents\222 behavioral symptoms \(195\). At the) Tj 0 -12.2018 TD 0.0393 Tc 0.6402 Tw (beginning of the study, although the special care unit) Tj ET BT 0.934 0 0 0.9835 326.88 370.32 Tm -0.0195 Tc 2.327 Tw (residents had significantly more behavioral symp-) Tj ET BT 0.8915 0 0 0.9835 327.36 358.32 Tm 0.0222 Tc 1.4621 Tw (toms than the demented residents of the nonspecial-) Tj ET BT 0.9835 0 0 0.9835 327.6 346.08 Tm 0.032 Tc 3.0427 Tw (ized units, there was no significant difference) Tj ET BT 0.934 0 0 0.9835 327.36 334.08 Tm -0.0268 Tc 0.4161 Tw (between the staff members in the two types of units) Tj ET BT 0.8915 0 0 0.9835 327.6 322.32 Tm 0.0349 Tc 1.2844 Tw (in the extent to which they reported being disturbed) Tj ET BT 0.9835 0 0 0.9835 327.36 310.08 Tm 0.0259 Tc 2.2355 Tw (by the residents\222 behavioral symptoms. After 6) Tj 0.244 -11.9577 TD 0.0246 Tc 1.5047 Tw (months, there was still no significant difference) Tj ET BT 0.934 0 0 0.9835 327.6 286.32 Tm -0.0268 Tc 0.4161 Tw (between the staff members in the two types of units) Tj ET BT 0.8915 0 0 0.9835 327.6 274.56 Tm 0.0332 Tc 0.546 Tw (in this regard.) Tj 12.6521 -24.6476 TD 0.0207 Tc 1.5022 Tw (In addition to these four longitudinal studies, two) Tj ET BT 0.934 0 0 0.9835 327.84 238.08 Tm -0.0388 Tc 0.8206 Tw (descriptive studies have addressed the issue of staff) Tj ET BT 0.8915 0 0 0.9835 328.32 226.08 Tm 0.0272 Tc 0.822 Tw (stress in special care units. One study that compared) Tj 0 -11.9577 TD 0.0143 Tc 0.3429 Tw (staff stress on two special care units found that stress) Tj ET BT 0.934 0 0 0.9835 328.32 202.32 Tm -0.0411 Tc 0.9882 Tw (was related to the severity of the residents\222 impair-) Tj ET BT 0.9835 0 0 0.9835 328.08 190.56 Tm 0.0232 Tc 0.3063 Tw (ment \(506\). Staff members on the unit with more) Tj ET BT 0.8915 0 0 0.9835 328.32 178.56 Tm 0.0475 Tc 1.0491 Tw (impaired residents were more likely to report feeling) Tj ET BT 0.934 0 0 0.9835 328.08 166.56 Tm -0.0133 Tc 0.3482 Tw (highly stressed than staff members on the unit with) Tj 0.257 -12.2018 TD -0.027 Tc 1.6583 Tw (less impaired residents. Interestingly, many of the) Tj 0.257 -12.2018 TD -0.0366 Tc 1.9929 Tw (specific types of stressors identified by staff mem-) Tj ET BT 0.9835 0 0 0.9835 328.32 130.56 Tm 0.0387 Tc 2.7919 Tw (bers on both units were unrelated to resident) Tj ET BT 0.934 0 0 0.9835 328.32 119.04 Tm -0.0409 Tc 2.1443 Tw (characteristics and therefore might be expected to) Tj ET BT 0.9835 0 0 0.9835 328.32 107.04 Tm 0.0263 Tc 2.2351 Tw (occur as frequently in work with nondemented) Tj ET BT 0.8915 0 0 0.9835 328.32 95.52 Tm 0.0441 Tc 1.8798 Tw (residents and on nonspecialized nursing home units) Tj ET BT 0.9835 0 0 0.9835 328.56 83.28 Tm 0.0289 Tc 2.1241 Tw (as on special care units. In another study of a) Tj -0.244 -12.2018 TD 0.0291 Tc 1.3375 Tw (nonrandom sample of special care units, the re-) Tj 0.244 -12.4458 TD 0.0352 Tc 2.3074 Tw (searchers concluded staff stress was related to) Tj 0 -12.2018 TD 0.0347 Tc 1.5758 Tw (staff-to-resident ratios: units with less staff per) Tj ET BT 0.8915 0 0 0.9835 328.08 35.04 Tm 0.0503 Tc 0.5604 Tw (resident were much more likely than units with more) Tj ET endstream endobj 326 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 327 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.16 684 m 534.48 684 l S BT 0.9835 0 0 0.9835 318.48 689.04 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.6212 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 511.2 689.04 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 517.68 689.04 Tm /F5 10 Tf 0.2847 Tc 0 Tw (125) Tj ET BT 0.8915 0 0 0.9835 57.12 650.64 Tm /F4 10 Tf 0.0095 Tc 1.01 Tw (staff per resident to report problems with staff stress) Tj ET BT 0.934 0 0 0.9835 57.36 638.4 Tm 0.0551 Tc 0 Tw (\(332\).) Tj ET BT 0.9835 0 0 0.9835 67.68 620.64 Tm 0.0251 Tc 1.4113 Tw (The University of North Carolina study of 31) Tj ET BT 0.8915 0 0 0.9835 56.88 608.64 Tm 0.0451 Tc 1.2056 Tw (randomly selected special care units and 32 matched) Tj 0.2692 -12.2018 TD 0.0249 Tc 1.4975 Tw (nonspecialized units in 5 States found staff turnover) Tj ET BT 0.9835 0 0 0.9835 57.36 584.4 Tm 0.019 Tc 0.5241 Tw (was significantly lower for RNs and LPNs on the) Tj ET BT 0.8915 0 0 0.9835 57.84 572.4 Tm 0.0541 Tc 1.2292 Tw (special care units \(291\). Turnover was also lower for) Tj ET BT 0.9835 0 0 0.9835 57.36 560.88 Tm 0.024 Tc 2.4103 Tw (nurse aides on the special care units, but this) Tj ET BT 0.934 0 0 0.9835 57.6 548.64 Tm -0.0264 Tc 0.844 Tw (difference was not statistically significant. Accurate) Tj 0 -11.9577 TD -0.0341 Tc 1.8801 Tw (interpretation of these findings is difficult because) Tj ET BT 0.8915 0 0 0.9835 57.6 524.88 Tm 0.0386 Tc 0.7553 Tw (they are based on data collected at one point in time.) Tj ET BT 0.934 0 0 0.9835 57.84 513.12 Tm -0.0397 Tc 2.0573 Tw (It is possible that pre-existing differences between) Tj 0 -12.2018 TD -0.0246 Tc 1.2703 Tw (the staff members on the two types of units rather) Tj 0.5139 -12.4458 TD -0.0284 Tc 0.9746 Tw (than differential effects of the units account for the) Tj 0 -12.2018 TD -0.0302 Tc 0.8481 Tw (differences in staff turnover.) Tj ET BT 0.9835 0 0 0.9835 69.12 459.12 Tm 1.4961 Tc 0 Tw (In) Tj 0.0041 Tc (s) Tj ET BT 0.934 0 0 0.9835 87.36 458.64 Tm -0.0141 Tc 1.5503 Tw (ummary, the three longitudinal studies that) Tj ET BT 0.9835 0 0 0.9835 58.32 447.12 Tm 0.0471 Tc 1.2378 Tw (measured staff knowledge of dementia found no) Tj 0.244 -12.2018 TD 0.0297 Tc 1.5809 Tw (statistically significant effect of the special care) Tj 0 -11.9577 TD 0.0318 Tc 1.1822 Tw (units. One of the two studies that measured job) Tj ET BT 0.8915 0 0 0.9835 59.04 411.12 Tm 0.022 Tc 1.7699 Tw (satisfaction found a statistically significant improve-) Tj ET BT 0.934 0 0 0.9835 58.56 399.6 Tm -0.025 Tc 1.1565 Tw (ment in the scores of LPNs, nurse aides, and other) Tj 0.257 -12.4458 TD -0.0237 Tc 1.4406 Tw (non-nursing staff of the special care unit on one of) Tj 0.257 -12.2018 TD -0.0336 Tc 1.4941 Tw (six aspects of job satisfaction. There were no other) Tj ET BT 0.9835 0 0 0.9835 59.28 363.36 Tm 0.0331 Tc 0.5708 Tw (significant effects of the special care units on job) Tj ET BT 0.934 0 0 0.9835 59.28 351.36 Tm -0.0125 Tc 1.1289 Tw (satisfaction. The one longitudinal study that meas-) Tj ET BT 0.9835 0 0 0.9835 59.04 339.84 Tm 0.0289 Tc -0.1265 Tw (ured staff stress and burnout found a statistically) Tj ET BT 0.8915 0 0 0.9835 59.52 327.6 Tm 0.0451 Tc 0.7826 Tw (significant reduction in stress among the special care) Tj ET BT 0.9835 0 0 0.9835 59.04 315.6 Tm 0.0177 Tc 0.7389 Tw (unit staff members and a statistically significant) Tj ET BT 0.934 0 0 0.9835 59.28 303.84 Tm -0.0321 Tc 1.2172 Tw (difference between the special care unit staff mem-) Tj ET BT 0.9835 0 0 0.9835 59.28 291.6 Tm 0.041 Tc 2.7286 Tw (bers and other staff members on one of three) Tj ET BT 0.934 0 0 0.9835 59.52 279.84 Tm -0.0361 Tc 1.8821 Tw (indicators of burnout. There were no other signifi-) Tj 0.257 -12.2018 TD -0.0328 Tc 0.4911 Tw (cant effects of the special care unit on staff stress or) Tj ET BT 0.8915 0 0 0.9835 59.52 255.84 Tm 0.0141 Tc 1.7404 Tw (burnout. Lastly, the study that measured the extent) Tj 0.2692 -11.9577 TD 0.0309 Tc 1.4908 Tw (to which staff members were disturbed by residents\222) Tj ET BT 0.9835 0 0 0.9835 59.76 232.32 Tm 0.0326 Tc 0.8459 Tw (behavioral symptoms found no significant differ-) Tj 0 -12.4458 TD 0.0332 Tc 2.828 Tw (ences over time for the special care unit staff) Tj ET BT 0.934 0 0 0.9835 59.76 208.08 Tm -0.0276 Tc 1.4021 Tw (members and no significant difference between the) Tj ET BT 0.9835 0 0 0.9835 60.24 196.08 Tm 0.0301 Tc 1.9639 Tw (special care unit staff members and other staff) Tj ET BT 0.8915 0 0 0.9835 60 184.32 Tm 0.0299 Tc 1.6713 Tw (members in this respect.) Tj ET BT 0.9663 0 0 0.9939 67.2 162 Tm /F6 14 Tf 0.061 Tc 0.1606 Tw (STUDIES THAT EVALUATE THE) Tj ET BT 0.9341 0 0 0.9939 60.48 146.16 Tm -0.0846 Tc 1.2143 Tw (EFFECTS OF SPECIAL CARE UNITS) Tj ET BT 0.9663 0 0 0.9939 83.52 129.84 Tm 0.0259 Tc 1.9355 Tw (ON RESIDENTS\222 FAMILIES) Tj ET BT 0.9835 0 0 0.9835 71.28 112.08 Tm /F4 10 Tf 0.0373 Tc 0.353 Tw (OTA is aware of four studies that evaluate the) Tj -11.2256 -12.2018 TD 0.0355 Tc 0.5073 Tw (effect of a special care unit on residents\222 families) Tj 0.244 -12.2018 TD 0.0242 Tc -0.0172 Tw (over time. One study conducted in Australia com-) Tj ET BT 0.8915 0 0 0.9835 59.76 76.32 Tm 0.0339 Tc 1.4873 Tw (pared the psychological status of 12 family members) Tj ET BT 0.934 0 0 0.9835 60.48 64.32 Tm -0.0389 Tc 1.2245 Tw (of individuals with dementia who were admitted to) Tj ET BT 0.9835 0 0 0.9835 60.48 52.56 Tm 0.0266 Tc 2.8652 Tw (a special care unit and 10 family members of) Tj ET BT 0.934 0 0 0.9835 60.48 40.32 Tm -0.0398 Tc 1.6292 Tw (individuals with dementia who were placed on the) Tj 264.9212 620.0945 TD -0.023 Tc 1.9782 Tw (waiting list and offered in-home services \(489\). At) Tj ET BT 0.8915 0 0 0.9835 308.16 638.16 Tm 0.0607 Tc 2.2649 Tw (the beginnin) Tj ET BT 0.9835 0 0 0.9835 363.36 637.92 Tm 0.0187 Tc 0.093 Tw (g of the study, the family members in) Tj -56.3722 -11.9577 TD 0.0354 Tc 1.4008 Tw (both groups showed high levels of symptoms on) Tj ET BT 0.934 0 0 0.9835 307.92 614.16 Tm -0.0297 Tc 0.8476 Tw (psychological tests of anxiety, depression, guilt, and) Tj 0.5139 -12.4458 TD -0.0178 Tc 0.4172 Tw (grief. After 3 months, family members of the special) Tj ET BT 0.8915 0 0 0.9835 308.16 590.4 Tm 0.0318 Tc 1.8935 Tw (care unit residents showed a statistically significant) Tj ET BT 0.934 0 0 0.9835 308.16 578.4 Tm -0.0228 Tc 0.9686 Tw (reduction in symptoms on all the tests. In contrast,) Tj ET BT 0.9835 0 0 0.9835 308.4 566.4 Tm 0.0339 Tc 0.6005 Tw (family members of the individuals who had been) Tj ET BT 0.8915 0 0 0.9835 308.4 554.4 Tm 0.0402 Tc 0.6728 Tw (placed on the waiting list showed little change in any) Tj ET BT 0.9835 0 0 0.9835 308.64 542.4 Tm 0.0149 Tc 0.3757 Tw (of the symptoms, except guilt, which was slightly) Tj ET BT 0.8915 0 0 0.9835 308.4 530.64 Tm 0.0372 Tc 0 Tw (reduced.) Tj 12.9213 -18.7907 TD 0.0371 Tc 1.753 Tw (Chafetz measured knowledge about dementia and) Tj ET BT 0.9835 0 0 0.9835 309.12 500.4 Tm 0.045 Tc 2.094 Tw (attitudes toward older people among 12 family) Tj ET BT 0.934 0 0 0.9835 308.88 488.64 Tm -0.0262 Tc 1.6789 Tw (members of residents of a 30-bed special care unit) Tj 0.7709 -12.4458 TD -0.0222 Tc 0.711 Tw (\(76\). Anxiety and depression were measured among) Tj ET BT 0.9835 0 0 0.9835 309.12 464.4 Tm 0.0274 Tc 0.9325 Tw (9 of the 12 family members. The study found no) Tj ET BT 0.934 0 0 0.9835 309.6 452.64 Tm -0.0264 Tc 0.844 Tw (statistically significant changes over a l-year period) Tj ET BT 0.9835 0 0 0.9835 309.6 440.64 Tm 0.033 Tc 0.9674 Tw (in any of these areas, although there were some) Tj 0 -11.9577 TD 0.0258 Tc 0.1613 Tw (nonsignificant improvements in each of the areas) Tj ET BT 0.934 0 0 0.9835 309.6 416.88 Tm -0.0272 Tc 1.0651 Tw (except anxiety. This study had no control group.) Tj ET BT 0.9835 0 0 0.9835 320.88 398.4 Tm 0.0246 Tc 0.1626 Tw (Cleary et al. measured family satisfaction with) Tj ET BT 0.934 0 0 0.9835 309.84 386.64 Tm -0.0072 Tc 1.3007 Tw (care among 11 family members of individuals with) Tj ET BT 0.9835 0 0 0.9835 309.84 374.88 Tm 0.044 Tc 0.3869 Tw (dementia who were moved from a nonspecialized) Tj ET BT 0.934 0 0 0.9835 309.84 362.88 Tm -0.0186 Tc 0.8613 Tw (unit to a new special care unit in the same nursing) Tj ET BT 0.9835 0 0 0.9835 309.84 351.12 Tm 0.0241 Tc 0.5755 Tw (home \(88\). Family satisfaction with the care pro-) Tj ET BT 0.934 0 0 0.9835 310.32 339.12 Tm -0.0185 Tc 0.964 Tw (vided by the nonspecialized unit was quite high, as) Tj 0 -12.2018 TD -0.0075 Tc 2.2627 Tw (measured by a 38-item satisfaction questionnaire;) Tj -0.257 -11.9577 TD -0.0237 Tc 3.0895 Tw (nevertheless, family satisfaction increased signifi-) Tj ET BT 0.8915 0 0 0.9835 310.32 303.36 Tm 0.0373 Tc 0.2184 Tw (cantly in the frost 3 months after the special care unit) Tj ET BT 0.934 0 0 0.9835 310.32 291.12 Tm -0.0336 Tc 1.1515 Tw (opened. This study had no control group.) Tj ET BT 0.9835 0 0 0.9835 321.6 273.36 Tm 0.0361 Tc 1.0864 Tw (In addition to the questionnaire, Cleary et al.) Tj -11.2256 -12.2018 TD 0.0515 Tc 0.8266 Tw (conducted open-ended telephone interviews with) Tj 0 -11.7137 TD 0.0235 Tc 0.9597 Tw (the family members \(88\). According to the study) Tj ET BT 0.8915 0 0 0.9835 310.56 237.84 Tm 0.0365 Tc 1.2452 Tw (report, only 7 of the 11 family members visited their) Tj ET BT 0.9835 0 0 0.9835 310.56 226.08 Tm 0.0322 Tc 1.0902 Tw (relative with dementia frequently enough in the) Tj ET BT 0.934 0 0 0.9835 311.28 213.84 Tm -0.0343 Tc 0.8781 Tw (special care unit to be able to respond in any detail) Tj ET BT 0.9835 0 0 0.9835 311.04 201.84 Tm 0.0439 Tc 0.8343 Tw (to the open-ended questions. These seven family) Tj ET BT 0.934 0 0 0.9835 311.04 190.08 Tm -0.0399 Tc 0.9869 Tw (members reported their relative with dementia was) Tj 0.257 -12.2018 TD -0.0274 Tc 0.7423 Tw (less agitated in the special care unit than he or she) Tj ET BT 0.9835 0 0 0.9835 311.04 166.08 Tm 0.0389 Tc 1.2359 Tw (had been in the nonspecialized unit. Five of the) Tj ET BT 0.8915 0 0 0.9835 311.76 153.84 Tm 0.0441 Tc 0.8991 Tw (seven family members also reported they were better) Tj -0.2692 -11.9577 TD 0.0525 Tc 0.558 Tw (able to communicate with their relative in the special) Tj ET BT 0.9835 0 0 0.9835 311.04 130.08 Tm 0.0212 Tc 3.2629 Tw (care unit. None of the seven family members) Tj 0.244 -12.2018 TD 0.0303 Tc 0.7088 Tw (expressed concern that the special care unit was) Tj ET BT 0.934 0 0 0.9835 311.52 106.56 Tm -0.0349 Tc 1.2814 Tw (isolated, and none described difficulties in visiting.) Tj ET BT 0.9835 0 0 0.9835 322.32 88.32 Tm 0.0195 Tc 0.3711 Tw (Lastly, Maas and Buckwalter compared family) Tj -10.9816 -12.4458 TD 0.0241 Tc 0.1224 Tw (satisfaction with care at 2-month intervals over a) Tj ET BT 0.934 0 0 0.9835 312.48 64.32 Tm -0.0268 Tc 0.6976 Tw (l-year period among family members of special care) Tj -1.5417 -11.9577 TD -0.0289 Tc 1.2138 Tw (unit residents and residents with dementia in non-) Tj 0.5139 -12.4458 TD -0.0201 Tc 1.6402 Tw (specialized units of the same facility \(265\). Due to) Tj ET endstream endobj 328 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 329 0 obj <>stream 0.72 w 1 j 0 0 0 RG 74.4 677.04 m 552.24 677.04 l S BT 0.9835 0 0 0.9835 74.88 682.32 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0313 Tw (126 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0.4881 -40.2659 TD /F4 10 Tf 0.0236 Tc 0.7737 Tw (subject attrition and replacement, the number of) Tj ET BT 0.934 0 0 0.9835 75.36 630.96 Tm -0.0273 Tc 0.4916 Tw (family members varied over the course of the study,) Tj ET BT 0.9835 0 0 0.9835 75.6 618.96 Tm 0.026 Tc 0.0391 Tw (from 17 to 22 family members of special care unit) Tj -0.4881 -12.2018 TD 0.0315 Tc 1.8536 Tw (residents and from 12 to 21 family members of) Tj ET BT 0.934 0 0 0.9835 75.6 594.96 Tm -0.0247 Tc 1.87 Tw (individuals with dementia in nonspecialized units.) Tj 0.257 -11.9577 TD -0.0274 Tc 0.8084 Tw (Both groups of family members reported fairly high) Tj ET BT 0.8915 0 0 0.9835 75.84 571.44 Tm 0.0416 Tc 1.2096 Tw (levels of satisfaction with the care their relative was) Tj -0.2692 -12.2018 TD 0.0278 Tc 0.8212 Tw (receiving. They tended to be most satisfied with their) Tj ET BT 0.9835 0 0 0.9835 75.84 547.68 Tm 0.0338 Tc 0.1822 Tw (relative\222s overall care and least satisfied with the) Tj 0.4881 -12.4458 TD 0.0092 Tc 3.31 Tw (nursing care he or she was receiving. Family) Tj 0 -11.9577 TD 0.0309 Tc 1.9283 Tw (members of the special care unit residents had) Tj 0.4881 -12.2018 TD 0.0201 Tc 1.0537 Tw (somewhat higher satisfaction scores than family) Tj -0.4881 -12.2018 TD 0.0296 Tc 0.4654 Tw (members of the individuals with dementia in the) Tj ET BT 0.934 0 0 0.9835 76.32 487.68 Tm -0.0383 Tc 1.028 Tw (nonspecialized units, but these differences were not) Tj ET BT 0.8915 0 0 0.9835 77.04 475.44 Tm 0.0163 Tc 3.9299 Tw (statistically significant.) Tj ET BT 0.9835 0 0 0.9835 87.84 455.52 Tm 0.0378 Tc -0.1356 Tw (In addition to these four longitudinal studies, a) Tj -10.9816 -11.7137 TD 0.0317 Tc 0.6028 Tw (number of cross-sectional studies have compared) Tj 0 -12.4458 TD 0.0254 Tc 0.9752 Tw (various characteristics of families of special care) Tj 0 -11.7137 TD 0.0316 Tc 2.4738 Tw (unit residents and families of individuals with) Tj 0.244 -11.9577 TD 0.0244 Tc 1.3423 Tw (dementia in nonspecialized nursing home units.) Tj ET BT 0.8915 0 0 0.9835 77.52 396.48 Tm 0.0258 Tc 1.1675 Tw (Since the findings of these studies are based on data) Tj ET BT 0.934 0 0 0.9835 77.52 384.96 Tm -0.0437 Tc 1.0338 Tw (collected at one point in time, it is unclear whether) Tj 0 -12.2018 TD -0.0339 Tc 0.538 Tw (they are attributable to the effect of the special care) Tj T* -0.0326 Tc 1.6215 Tw (units vs. the nonspecialized units or to preexisting) Tj 0.257 -11.9577 TD -0.0415 Tc 1.5454 Tw (differences between the two groups of families.) Tj ET BT 0.9835 0 0 0.9835 88.56 329.04 Tm 0.0419 Tc 2.0566 Tw (The study by Chafetz discussed above had a) Tj -10.7376 -11.9577 TD 0.0297 Tc 1.0318 Tw (cross-sectional component that compared knowl-) Tj 0 -12.4458 TD 0.0532 Tc 0.8656 Tw (edge of dementia, attitudes toward older people,) Tj ET BT 0.8915 0 0 0.9835 78.24 293.04 Tm 0.0309 Tc 1.4523 Tw (anxiety, depression, and guilt among three groups of) Tj ET BT 0.9835 0 0 0.9835 78 281.28 Tm 0.0201 Tc 0.5099 Tw (family members: 1\) 18 family members of special) Tj ET BT 0.8915 0 0 0.9835 78.48 269.04 Tm 0.0324 Tc 1.6044 Tw (care unit residents, 2\)7 family members of residents) Tj ET BT 0.934 0 0 0.9835 78.48 257.28 Tm -0.0231 Tc 1.8683 Tw (of a nonspecialized nursing home unit that served) Tj ET BT 0.8915 0 0 0.9835 78.24 245.28 Tm 0.0225 Tc 1.4618 Tw (both demented and nondemented residents, and 3\) 8) Tj ET BT 0.9835 0 0 0.9835 78.48 233.76 Tm 0.0309 Tc 0.1459 Tw (family members of residents of a unit that served) Tj 0 -12.4458 TD 0.0384 Tc 1.4907 Tw (only individuals with dementia but provided no) Tj ET BT 0.934 0 0 0.9835 78.96 209.28 Tm -0.0203 Tc 0.6906 Tw (special services \(76\). The study found no significant) Tj -0.5139 -12.2018 TD -0.0338 Tc 2.0511 Tw (differences between family members of the special) Tj ET BT 0.8915 0 0 0.9835 78.96 185.28 Tm 0.0352 Tc 1.6013 Tw (care unit residents and family members of residents) Tj ET BT 0.9835 0 0 0.9835 78.96 173.28 Tm 0.0425 Tc 3.1541 Tw (of the two nonspecialized units in any of the) Tj 0 -12.2018 TD 0.0146 Tc 0.8641 Tw (measured characteristics. Interestingly, all three) Tj ET BT 0.934 0 0 0.9835 79.2 148.8 Tm -0.0225 Tc 0.5186 Tw (groups of family members had low levels of anxiety,) Tj 0 -11.7137 TD -0.0378 Tc 0.7705 Tw (depression, and grief. Moreover, in comparison with) Tj ET BT 0.8915 0 0 0.9835 79.2 125.28 Tm 0.0329 Tc 1.6039 Tw (family members of the individuals in the segregated) Tj ET BT 0.9835 0 0 0.9835 78.96 113.04 Tm 0.0271 Tc 1.9903 Tw (but nonspecialized unit, family members of the) Tj ET BT 0.934 0 0 0.9835 79.44 101.28 Tm -0.0388 Tc 1.9279 Tw (special care unit residents were significantly more) Tj ET BT 0.8915 0 0 0.9835 79.2 89.52 Tm 0.0231 Tc 2.7109 Tw (depressed and anxious.) Tj ET BT 0.9835 0 0 0.9835 90.24 69.6 Tm 0.0335 Tc 0.6619 Tw (A small pilot study done by researchers at the) Tj ET BT 0.934 0 0 0.9835 79.44 57.36 Tm -0.0192 Tc 1.2033 Tw (University of North Carolina found that families of) Tj -0.257 -11.9577 TD -0.0301 Tc 1.839 Tw (individuals with dementia in one special care unit) Tj ET BT 0.9835 0 0 0.9835 79.44 33.6 Tm 0.0273 Tc 2.699 Tw (were, on average, more likely than families of) Tj 250.3806 619.8505 TD 0.0373 Tc 1.0362 Tw (individuals with dementia in two nonspecialized) Tj ET BT 0.934 0 0 0.9835 325.92 630.96 Tm -0.0299 Tc 0.5908 Tw (units to be satisfied with the physical aspects of the) Tj 0.257 -12.2018 TD -0.0435 Tc 1.0622 Tw (unit and the care their relative received and to feel) Tj ET BT 0.8915 0 0 0.9835 326.4 606.72 Tm 0.0339 Tc 0.4106 Tw (their relative with dementia was better off in the unit) Tj 0 -12.2018 TD 0.0214 Tc 1.0527 Tw (than at home \(292\). The findings differed for the two) Tj ET BT 0.934 0 0 0.9835 326.4 582.96 Tm -0.0269 Tc 0.8445 Tw (nonspecialized units, however. Compared with fam-) Tj ET BT 0.9835 0 0 0.9835 326.64 571.2 Tm 0.0517 Tc 1.8026 Tw (ilies of the) Tj 0 Tc -0.0972 Tw ( ) Tj 56.8603 0 TD /F2 10 Tf -0.009 Tc 3.0393 Tw (special care unit residents,) Tj 0 Tc -0.061 Tw ( ) Tj 120.0655 0 TD /F4 10 Tf 0.2616 Tc 3.0534 Tw (families of) Tj ET BT 0.934 0 0 0.9835 326.88 559.2 Tm -0.0304 Tc 0.9584 Tw (individuals with dementia in one of the nonspecial-) Tj ET BT 0.9835 0 0 0.9835 327.12 547.44 Tm 0.0343 Tc 1.7897 Tw (ized units were as satisfied with the care their) Tj -0.244 -12.2018 TD 0.0349 Tc 1.5756 Tw (relative received,) Tj 0 Tc -0.0972 Tw ( ) Tj 85.9005 0 TD /F2 10 Tf 0.0017 Tc 1.1574 Tw (more satisfied) Tj 0 Tc -0.061 Tw ( ) Tj 61.2529 0 TD /F4 10 Tf 0.0206 Tc 1.5901 Tw (with the physical) Tj ET BT 0.934 0 0 0.9835 327.36 523.2 Tm -0.0352 Tc 0.9498 Tw (aspects of the care environment, and more likely to) Tj -0.257 -12.2018 TD -0.0306 Tc 0.6771 Tw (believe their relative was better off in the unit than) Tj ET BT 0.8915 0 0 0.9835 327.6 499.44 Tm 0.0247 Tc 1.3182 Tw (at home. In contrast, families of the residents in the) Tj ET BT 0.9835 0 0 0.9835 327.6 487.2 Tm 0.0345 Tc 2.2268 Tw (other nonspecialized unit were less likely than) Tj 0 -11.9577 TD 0.0377 Tc 1.6948 Tw (families of the special care unit residents to be) Tj ET BT 0.8915 0 0 0.9835 327.84 463.44 Tm 0.0153 Tc 0.3417 Tw (satisfied with the physical aspects of the unit and less) Tj ET BT 0.934 0 0 0.9835 327.84 451.44 Tm -0.0449 Tc 1.4348 Tw (likely to believe their relative was better off in the) Tj ET BT 0.8915 0 0 0.9835 327.6 439.44 Tm 0.0265 Tc 0.5984 Tw (unit than at home.) Tj 12.6521 -19.7669 TD 0.0319 Tc 0.9513 Tw (Another small pilot study of two special care units) Tj ET BT 0.9835 0 0 0.9835 328.32 408 Tm 0.0286 Tc 2.7208 Tw (and two nonspecialized nursing home units in) Tj ET BT 0.8915 0 0 0.9835 328.32 396 Tm 0.0413 Tc 0.8061 Tw (California found that families of the special care unit) Tj ET BT 0.934 0 0 0.9835 327.84 384.48 Tm -0.0427 Tc 1.1184 Tw (residents were less likely than families of residents) Tj 0.5139 -11.9577 TD -0.0345 Tc 1.5914 Tw (of the nonspecialized units to be satisfied with the) Tj ET BT 0.8915 0 0 0.9835 328.32 360.48 Tm 0.0347 Tc 1.2173 Tw (physical aspects of the unit and less likely to believe) Tj 0.2692 -11.9577 TD 0.0373 Tc 0.8914 Tw (their relative was better off in the unit than at home) Tj ET BT 0.9835 0 0 0.9835 329.04 336.72 Tm 0.03 Tc 0.8485 Tw (\(256\). Families of the special care unit residents) Tj ET BT 0.934 0 0 0.9835 328.8 324.72 Tm -0.0377 Tc 0.542 Tw (were also less likely to be satisfied with the number) Tj 0 -12.2018 TD -0.0264 Tc 1.0046 Tw (of staff members, the adequacy of the care received) Tj ET BT 0.9835 0 0 0.9835 328.56 300.72 Tm 0.0209 Tc 2.444 Tw (by their relative,) Tj 91.2693 0 TD 0.0385 Tc 3.5243 Tw (and the willingness of staff) Tj ET BT 0.934 0 0 0.9835 328.8 288.72 Tm -0.0182 Tc 1.4776 Tw (members to discuss the family members\222 concerns.) Tj ET BT 0.8915 0 0 0.9835 340.08 268.8 Tm 0.0314 Tc 1.5672 Tw (Finally, the University of North Carolina study of) Tj ET BT 0.9835 0 0 0.9835 329.52 256.8 Tm 0.0336 Tc 1.8209 Tw (31 randomly selected special care units and 32) Tj ET BT 0.8915 0 0 0.9835 329.04 245.04 Tm 0.0362 Tc 1.4464 Tw (nonspecialized nursing home units in 5 States found) Tj ET BT 0.934 0 0 0.9835 329.28 233.04 Tm -0.0372 Tc 0.9198 Tw (that families of the special care unit residents were) Tj ET BT 0.8915 0 0 0.9835 329.76 220.8 Tm 0.0386 Tc 1.527 Tw (significantly more likely than families of individuals) Tj ET BT 0.9835 0 0 0.9835 329.52 209.04 Tm 0.0325 Tc -0.0256 Tw (with dementia in the nonspecialized units to visit) Tj ET BT 0.8915 0 0 0.9835 329.76 196.8 Tm 0.0525 Tc 1.7358 Tw (their relative regularly \(413\).) Tj ET BT 0.9835 0 0 0.9835 340.56 176.88 Tm 0.0381 Tc 0.0268 Tw (Accurate interpretation of the findings of these) Tj ET BT 0.934 0 0 0.9835 329.76 164.64 Tm -0.0335 Tc 1.5368 Tw (cross-sectional studies is difficult because the find-) Tj ET BT 0.8915 0 0 0.9835 329.76 153.12 Tm 0.0423 Tc 1.1549 Tw (ings are based on data collected at one point in time) Tj 0.2692 -12.4458 TD 0.0391 Tc 1.7122 Tw (and therefore cannot be attributed with certainty to) Tj ET BT 0.934 0 0 0.9835 330 128.64 Tm -0.0303 Tc 1.4584 Tw (the differential impact of the special care units vs.) Tj 0 -11.7137 TD -0.0296 Tc 0.7005 Tw (the nonspecialized units. It is possible, for example,) Tj 0 -12.2018 TD -0.0207 Tc 0.6773 Tw (that the finding of the University of North Carolina) Tj ET BT 0.9835 0 0 0.9835 330.48 93.12 Tm 0.0252 Tc 0.6093 Tw (study--i.e., that families of special care unit resi-) Tj ET BT 0.934 0 0 0.9835 330.24 81.36 Tm -0.0299 Tc 0.5908 Tw (dents were significantly more likely than families of) Tj 0 -12.2018 TD -0.032 Tc 0.7398 Tw (individuals in the nonspecialized units to visit their) Tj -0.5139 -12.2018 TD -0.0416 Tc 1.5669 Tw (relative with dementia\227reflects pre-existing differ-) Tj ET BT 0.8915 0 0 0.9835 330.24 45.12 Tm 0.0423 Tc 0.8386 Tw (ences between the two groups of families rather than) Tj 0 -12.2018 TD 0.0217 Tc 1.3217 Tw (the impact of programs and policies of the two types) Tj ET endstream endobj 330 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 331 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.48 682.32 m 538.56 682.32 l S BT 0.9835 0 0 0.9835 322.56 688.08 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.8043 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516 688.08 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.48 688.08 Tm /F5 10 Tf 0.2847 Tc 0 Tw (127) Tj ET BT 0.934 0 0 0.9835 60.72 648.48 Tm /F4 10 Tf -0.0182 Tc 1.3491 Tw (of units that might encourage or discourage family) Tj ET BT 0.8915 0 0 0.9835 60.96 636.48 Tm 0.0072 Tc 0 Tw (visiting.) Tj ET BT 0.9835 0 0 0.9835 72 618.48 Tm 0.5107 Tc (Ins) Tj ET BT 0.934 0 0 0.9835 88.56 618.24 Tm -0.0206 Tc 1.1376 Tw (ummary, two of the four longitudinal studies) Tj ET BT 0.9835 0 0 0.9835 61.2 606.48 Tm 0.0308 Tc 0.8172 Tw (that evaluate the impact of special care units on) Tj ET BT 0.934 0 0 0.9835 60.96 594.48 Tm -0.0239 Tc 1.2525 Tw (residents\222 families had statistically significant posi-) Tj 0.257 -12.2018 TD -0.0223 Tc 0.968 Tw (tive findings. One of the studies found a significant) Tj 0.257 -11.7137 TD -0.0161 Tc 1.4754 Tw (increase in family members\222 satisfaction with care,) Tj 0.257 -11.9577 TD -0.023 Tc 0.6477 Tw (and the other study found a significant reduction in) Tj ET BT 0.9835 0 0 0.9835 61.44 547.44 Tm 0.0259 Tc 1.5847 Tw (family members\222 feelings of anxiety, depression,) Tj ET BT 0.934 0 0 0.9835 61.92 535.68 Tm -0.0292 Tc 1.4343 Tw (guilt, and grief. The other two longitudinal studies) Tj 0 -11.9577 TD -0.0257 Tc 1.2103 Tw (found no significant differences in these areas. The) Tj ET BT 0.8915 0 0 0.9835 61.92 511.92 Tm 0.0115 Tc 1.8266 Tw (two studies that had statistically significant positive) Tj 0 -11.9577 TD 0.0267 Tc 0.7215 Tw (findings were much shorter than the two studies that) Tj ET BT 0.934 0 0 0.9835 61.92 487.92 Tm -0.0191 Tc 0.9463 Tw (did not have significant positive findings \(3 months) Tj 0 -12.4458 TD -0.0249 Tc 1.5276 Tw (vs. 1 year, respectively\).) Tj ET BT 0.9835 0 0 0.9835 73.44 457.68 Tm 0.0389 Tc 1.9202 Tw (One of the four cross-sectional studies had a) Tj ET BT 0.8915 0 0 0.9835 62.64 445.92 Tm 0.0204 Tc 2.5793 Tw (statistically significant positive finding with respect) Tj ET BT 0.934 0 0 0.9835 62.4 433.92 Tm -0.0277 Tc 0.4742 Tw (to the frequency of visiting by families of the special) Tj ET BT 0.9835 0 0 0.9835 62.4 422.16 Tm 0.0169 Tc 0.2517 Tw (care unit residents, but it is unclear whether this) Tj 0.244 -12.2018 TD 0.0335 Tc -0.0397 Tw (finding is attributable to the impact of the special) Tj 0 -11.9577 TD 0.0186 Tc 2.3243 Tw (care units. The findings with respect to family) Tj 0.244 -12.2018 TD 0.0236 Tc 1.0502 Tw (satisfaction with care are contradictory, perhaps) Tj ET BT 0.934 0 0 0.9835 62.64 374.88 Tm -0.0289 Tc 1.4034 Tw (reflecting differences among the particular units in) Tj ET BT 0.8915 0 0 0.9835 62.88 362.64 Tm -0.0089 Tc 2.0737 Tw (the study samples.) Tj ET BT 0.9663 0 0 0.9939 130.08 332.4 Tm /F6 14 Tf 0.0433 Tc 0 Tw (CONCLUSION) Tj ET BT 0.9835 0 0 0.9835 74.4 314.64 Tm /F4 10 Tf 0.0435 Tc 0.0678 Tw (Based on the preceding review of findings from) Tj ET BT 0.934 0 0 0.9835 63.36 302.4 Tm -0.0212 Tc 2.4316 Tw (the available evaluative studies, some conclusions) Tj 0 -12.2018 TD -0.0298 Tc 0.8155 Tw (can be drawn about the effectiveness of special care) Tj ET BT 0.9835 0 0 0.9835 63.36 278.4 Tm 0.0142 Tc 0.8646 Tw (units. Table 4-3 lists OTA\222s conclusions from the) Tj ET BT 0.8915 0 0 0.9835 64.08 266.16 Tm 0.0185 Tc 1.8507 Tw (studies\222 findings. In general, these studies show few) Tj ET BT 0.934 0 0 0.9835 63.36 254.4 Tm -0.0445 Tc 0.7166 Tw (positive outcomes of special care units. With respect) Tj ET BT 0.9835 0 0 0.9835 63.84 242.16 Tm 0.0341 Tc 0.9489 Tw (to residents\222 ability to perform activities of daily) Tj 0 -12.2018 TD 0.0329 Tc 1.2252 Tw (living, the findings of studies that did not use a) Tj ET BT 0.8915 0 0 0.9835 64.08 217.92 Tm 0.0477 Tc 1.4719 Tw (control group are contradictory. Three of the studies) Tj ET BT 0.934 0 0 0.9835 64.08 205.92 Tm -0.0296 Tc 1.6183 Tw (that used a control group and measured residents\222) Tj 0.257 -11.9577 TD -0.0314 Tc 1.1705 Tw (ability to perform activities of daily living found no) Tj ET BT 0.9835 0 0 0.9835 64.8 182.16 Tm 0.0285 Tc 3.4298 Tw (significant effect of the special care units. In) Tj ET BT 0.8915 0 0 0.9835 64.32 170.16 Tm 0.0308 Tc 1.1207 Tw (contrast, one study \(392\) found less decline in ability) Tj ET BT 0.9835 0 0 0.9835 64.32 158.16 Tm 0.0346 Tc 1.1184 Tw (to perform activities of daily living over a l-year) Tj -0.244 -11.9577 TD 0.032 Tc 0.0795 Tw (period among the special care unit residents than) Tj ET BT 0.934 0 0 0.9835 64.8 134.4 Tm -0.029 Tc 2.003 Tw (among residents of the nonspecialized units. Like-) Tj 0 -11.7137 TD -0.0392 Tc 1.1432 Tw (wise, three of the studies that used a control group) Tj ET BT 0.8915 0 0 0.9835 64.8 110.88 Tm 0.0331 Tc 1.7574 Tw (and measured residents\222 behavioral symptoms found) Tj ET BT 0.9835 0 0 0.9835 64.56 99.12 Tm 0.0298 Tc 1.3673 Tw (no significant effect of the special care units. In) Tj ET BT 0.934 0 0 0.9835 64.8 87.36 Tm -0.0218 Tc 2.0382 Tw (contrast, one study \(265\) found fewer catastrophic) Tj ET BT 0.8915 0 0 0.9835 64.56 75.36 Tm 0.0474 Tc 1.4723 Tw (reactions among the special care unit residents than) Tj ET BT 0.934 0 0 0.9835 65.04 63.12 Tm -0.0266 Tc 2.3003 Tw (among residents of the nonspecialized units. Only) Tj 0 -12.2018 TD -0.0323 Tc 0.6705 Tw (one of the four studies that measured the effect of a) Tj ET BT 0.8915 0 0 0.9835 65.04 39.12 Tm 0.0367 Tc 0.557 Tw (special care unit on the unit staff members found any) Tj ET BT 0.9835 0 0 0.9835 312.48 648 Tm 0.0219 Tc 1.5888 Tw (significant positive outcomes. The findings with) Tj 0 -11.9577 TD 0.0327 Tc -0.1304 Tw (respect to family members\222 feelings of depression,) Tj ET BT 0.8915 0 0 0.9835 312.48 624.24 Tm 0.0377 Tc 0.5746 Tw (anxiety, and guilt and their satisfaction with care are) Tj 0 -12.2018 TD 0.0419 Tc 0 Tw (contradictory.) Tj 12.1137 -18.0586 TD 0.0241 Tc 1.289 Tw (As noted at the beginning of this chapter, the fact) Tj -12.1137 -12.4458 TD 0.0328 Tc 1.556 Tw (that many of the available evaluative studies do not) Tj ET BT 0.9835 0 0 0.9835 312.96 570.72 Tm 0.033 Tc 0.154 Tw (show significant positive outcomes of special care) Tj ET BT 0.8915 0 0 0.9835 312.48 558.72 Tm 0.0224 Tc 1.0516 Tw (units is surprising. The failure of most of the studies) Tj 0.2692 -11.9577 TD 0.0222 Tc 1.7697 Tw (to show the expected positive outcomes is attributed) Tj ET BT 0.934 0 0 0.9835 312.72 535.2 Tm -0.0309 Tc 1.26 Tw (by some commentators to methodological problems.) Tj 0.257 -11.9577 TD -0.0288 Tc 0.9751 Tw (The preceding discussion has noted many methodo-) Tj ET BT 0.9835 0 0 0.9835 313.2 511.68 Tm 0.0309 Tc 2.3524 Tw (logical problems with the available studies. As) Tj 0 -12.4458 TD 0.0257 Tc 1.2014 Tw (discussed in chapter 1, there are also numerous) Tj 0 -12.2018 TD 0.0344 Tc 0.1607 Tw (difficult conceptual and methodological issues in-) Tj ET BT 0.8915 0 0 0.9835 313.2 475.2 Tm 0.0556 Tc 1.1554 Tw (volved in designing special care unit research. These) Tj ET BT 0.9835 0 0 0.9835 313.44 463.44 Tm 0.033 Tc 0.1621 Tw (conceptual and methodological issues include un-) Tj 0 -12.4458 TD 0.0265 Tc 0.852 Tw (certainty about which outcomes should be meas-) Tj ET BT 0.8915 0 0 0.9835 313.44 439.44 Tm 0.0387 Tc 1.3666 Tw (ured; the difficulty of measuring certain outcomes in) Tj ET BT 0.9835 0 0 0.9835 313.92 427.68 Tm 0.0327 Tc 1.2525 Tw (individuals with dementia; the lack of validated) Tj 0 -12.2018 TD 0.0157 Tc 2.3273 Tw (instruments for measuring these outcomes; the) Tj T* 0.0367 Tc 1.0044 Tw (difficulty of identifying and correcting for differ-) Tj 0 -11.7137 TD 0.0378 Tc 3.0369 Tw (ences between special care unit residents and) Tj 0 -12.2018 TD 0.0404 Tc 0.0245 Tw (residents of nonspecialized units that could affect) Tj 0.244 -12.2018 TD 0.0266 Tc 0.2245 Tw (the study outcomes; and attrition in sample sizes) Tj ET BT 0.8915 0 0 0.9835 314.16 356.16 Tm 0.027 Tc 0.4856 Tw (over time which means even studies that started with) Tj ET BT 0.9835 0 0 0.9835 314.64 343.92 Tm 0.0417 Tc 1.2704 Tw (a sample of a respectable size may end up with) Tj -0.244 -12.2018 TD 0.0381 Tc -0.0817 Tw (usable data on so few individuals that only a very) Tj 0.4881 -12.2018 TD 0.0385 Tc 2.8531 Tw (strong effect of the special care unit could be) Tj ET BT 0.8915 0 0 0.9835 314.64 307.92 Tm -0.0055 Tc 0 Tw (detected.) Tj ET BT 0.9835 0 0 0.9835 325.44 289.92 Tm 0.0419 Tc 0.7388 Tw (Methodological problems and the difficult con-) Tj -10.7376 -12.4458 TD 0.0371 Tc 3.5256 Tw (ceptual and methodological issues involved in) Tj 0 -11.9577 TD 0.0302 Tc 0.5229 Tw (designing special care unit research probably ex-) Tj -0.244 -12.2018 TD 0.0419 Tc 0.7279 Tw (plain part of the failure of many of the available) Tj ET BT 0.934 0 0 0.9835 315.36 241.68 Tm -0.0404 Tc 0.8222 Tw (studies to find positive outcomes. Moreover, it must) Tj -0.5139 -12.2018 TD -0.0338 Tc 1.141 Tw (be noted that very few evaluative studies of special) Tj ET BT 0.9835 0 0 0.9835 315.36 217.68 Tm 0.0239 Tc 3.1208 Tw (care units have been conducted thus far. The) Tj ET BT 0.934 0 0 0.9835 315.12 205.68 Tm -0.0347 Tc 0.9814 Tw (preceding sections discuss a total of only 15 studies) Tj 0.257 -12.2018 TD -0.018 Tc 0.6423 Tw (that have measured impacts on residents and a few) Tj 0.5139 -11.9577 TD -0.0193 Tc 2.0355 Tw (additional studies that have measured impacts on) Tj ET BT 0.8915 0 0 0.9835 315.36 170.16 Tm 0.023 Tc 1.2305 Tw (residents\222 families and/or unit staff members. On the) Tj ET BT 0.934 0 0 0.9835 315.84 158.16 Tm -0.0203 Tc 1.6817 Tw (other hand, some of the available studies, particu-) Tj 0 -12.2018 TD -0.035 Tc 0.8532 Tw (larly the studies that used a control group, are well) Tj T* -0.0428 Tc 1.3241 Tw (designed and carefully conducted, despite methodo-) Tj ET BT 0.9835 0 0 0.9835 316.08 122.88 Tm 0.024 Tc 2.9289 Tw (logical difficulties. The special care units they) Tj ET BT 0.934 0 0 0.9835 316.32 110.88 Tm -0.0479 Tc 1.8948 Tw (studied incorporated the patient care philosophies,) Tj ET BT 0.8915 0 0 0.9835 316.32 99.12 Tm 0.0228 Tc 2.442 Tw (staff training, programming) Tj ET BT 0.9835 0 0 0.9835 437.52 97.68 Tm 0.0229 Tc 1.3437 Tw (g, and physical design) Tj -123.482 -10.4935 TD 0.0363 Tc 0.5167 Tw (features recommended by special care unit advo-) Tj ET BT 0.934 0 0 0.9835 316.08 75.36 Tm -0.0349 Tc 1.367 Tw (cates, and the researchers used accepted statistical) Tj ET BT 0.9835 0 0 0.9835 316.08 63.12 Tm 0.0368 Tc 0.0281 Tw (methods to correct for baseline differences among) Tj 0.244 -12.4458 TD 0.0262 Tc 0.1202 Tw (the subjects that could affect the study outcomes.) Tj ET BT 0.8915 0 0 0.9835 316.08 39.36 Tm 0.0225 Tc 0.5849 Tw (Thus, it is unlikely that the failure of these studies to) Tj ET endstream endobj 332 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 333 0 obj <>stream 0.72 w 1 j 0 0 0 RG 69.84 676.32 m 548.4 676.32 l S 72.24 654.96 m 72.24 165.84 l S 71.04 654.96 m 548.64 654.96 l S 550.08 655.68 m 550.08 165.36 l S 73.44 166.08 m 552 166.08 l S BT 0.9835 0 0 0.9835 70.56 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0534 Tw (128 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8875 0 0 0.9795 122.4 630.24 Tm /F7 12 Tf -0.0005 Tc 1.8932 Tw (Table 4-3-OTA\222S Conclusions From the Evaluative Studies of Special Care Units) Tj ET BT 0.8632 0 0 0.9598 102.96 603.36 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 108.48 603.36 Tm /F4 10 Tf 0.035 Tc 1.2913 Tw (Evaluative studies of special care units that did not use a control group have found a variety of positive) Tj 5.3704 -11.2256 TD 0.0289 Tc 0.2935 Tw (outcomes in special care unit residents. If contradictory findings are excluded, the positive outcomes found) Tj ET BT 0.8066 0 0 0.9835 113.04 581.52 Tm 0.0488 Tc 1.4025 Tw (in more than one of these studies are decreased nighttime wakefulness, improved hygiene, and weight gain.) Tj ET BT 0.8056 0 0 0.9598 103.44 566.4 Tm /F9 6 Tf 0.0203 Tc 0.0942 Tw (l ) Tj ET BT 0.8066 0 0 0.9835 108.72 566.4 Tm /F4 10 Tf 0.0473 Tc 1.3582 Tw (A few evaluative studies of special care units that did not use a control group have found improvements over) Tj 5.3555 -10.9816 TD 0.0531 Tc 1.1691 Tw (time in the important areas of residents\222 ability to perform activities of daily living and residents\222 behavioral) Tj ET BT 0.8491 0 0 0.9835 113.76 544.56 Tm 0.0273 Tc 0.477 Tw (symptoms, but an equal number of studies of this type have not found such improvements.) Tj ET BT 0.8632 0 0 0.9598 103.68 531.12 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 109.2 531.12 Tm /F4 10 Tf 0.0355 Tc 0.5683 Tw (For of the six evaluative studies of special care units that used a control group have found no statistically) Tj ET BT 0.8066 0 0 0.9835 114 518.88 Tm 0.056 Tc 1.0763 Tw (significant differences between the special care unit residents and the control group subjects in the following) Tj ET BT 0.8491 0 0 0.9835 113.76 507.84 Tm 0.0198 Tc 0.5666 Tw (areas: cognitive abilities, ability to perform activities of daily living, behavioral symptoms, mood, and rate) Tj 0 -10.9816 TD 0.024 Tc 0.2428 Tw (of hospitalization. Two of the six studies of this type found certain statistically significant positive resident) Tj ET BT 0.8066 0 0 0.9835 113.76 486 Tm 0.0504 Tc 1.5444 Tw (outcomes: one study found that over a l-year period, 14 special care unit residents showed significantly less) Tj ET BT 0.8491 0 0 0.9835 113.76 474.96 Tm 0.0309 Tc 0.8564 Tw (decline than 14 residents with dementia in nonspecialized nursing home units in their ability to perform) Tj 0.2827 -10.9816 TD 0.032 Tc 0.8374 Tw (activities of daily living; the other study found that 13 special care unit residents had significantly fewer) Tj -0.2827 -11.7137 TD 0.0335 Tc 0.1064 Tw (catastrophic reactions than 9 residents with dementia in nonspecialized nursing home units; the 13 special) Tj ET BT 0.8066 0 0 0.9835 114 441.6 Tm 0.0538 Tc 1.2799 Tw (care unit residents also interacted significantly more with the unit staff members. These two studies had no) Tj ET BT 0.8491 0 0 0.9835 114.24 430.8 Tm 0.0216 Tc 0.3021 Tw (other statistically significant positive resident outcomes.) Tj ET BT 0.8632 0 0 0.9598 104.4 415.92 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 109.92 415.92 Tm /F4 10 Tf 0.0336 Tc 0.7321 Tw (Evaluative studies of particular features and interventions in special care units have focused primarily on) Tj 5.3704 -10.9816 TD 0.0312 Tc 1.4967 Tw (methods to deter individuals with dementia from escaping or wandering away from the unit. The most) Tj ET BT 0.8066 0 0 0.9835 114.72 394.32 Tm 0.0575 Tc 1.5505 Tw (successful methods identified thus far are latches and locks the residents cannot open and various methods) Tj ET BT 0.8491 0 0 0.9835 114.48 383.52 Tm 0.0454 Tc 1.122 Tw (of concealing the exit doors.) Tj -11.8714 -14.6421 TD 0.0432 Tc 0.2342 Tw (. Three of the four studies that evaluated the impact of special care units on the unit staff members found no) Tj ET BT 0.8066 0 0 0.9835 115.2 357.6 Tm 0.0536 Tc 1.4475 Tw (statistically significant effects. One of the 4 studies of this type found a statistically significant reduction in) Tj ET BT 0.8491 0 0 0.9835 114.96 347.04 Tm 0.0318 Tc 0.3277 Tw (staff stress among 15 special care unit staff members and a statistically significant difference between the) Tj 0.5653 -10.9816 TD 0.0309 Tc 0.8731 Tw (15 special care unit staff members and 49 staff members on nonspecialized nursing home units in one of) Tj -1.1306 -11.2256 TD 0.0351 Tc 0.1271 Tw (three indicators of burnout. The study also found a statistically significant improvement in the scores of 16) Tj ET BT 0.8066 0 0 0.9835 115.2 314.16 Tm 0.0573 Tc 1.0577 Tw (special care unit staff mernbers \(licensed practical nurses, nurse aides and other non-nursing staff members\)) Tj 0 -11.2256 TD 0.0446 Tc 1.3615 Tw (on 1 of 6 indicators of job satisfaction. None of the three studies that measured staff knowledge of dementia) Tj ET BT 0.8491 0 0 0.9835 115.2 292.32 Tm 0.0463 Tc 0.485 Tw (found any significant effect of the special care unit.) Tj ET BT 0.8915 0 0 0.9835 105.12 276.96 Tm 0.0294 Tc 0.8942 Tw (. Two of the four studies that evaluated the impact of special care units on the residents\222 families had) Tj 11.5754 -10.9816 TD 0.0259 Tc 0.4196 Tw (statistically significant positive findings. One of the studies found a significant increase in the family) Tj ET BT 0.8491 0 0 0.9835 115.2 255.12 Tm 0.0378 Tc 0.3537 Tw (members\222 satisfaction with the care provided for their relative with dementia, and the other study found a) Tj 0.5653 -11.2256 TD 0.0318 Tc 0.2901 Tw (significant reduction in the family members\222 feelings of anxiety, depression, guilt, and grief. The other two) Tj 0.2827 -10.9816 TD 0.0354 Tc 0.7452 Tw (studies of this type found no significant changes in either of these areas. One cross-sectional study found) Tj -0.848 -10.9816 TD 0.0216 Tc 1.1854 Tw (that families of special care unit residents are more likely than families of individuals with dementia in) Tj ET BT 0.8066 0 0 0.9835 115.2 211.44 Tm 0.0598 Tc 1.0471 Tw (nonspecialized units to visit their relative regularly, but it is not clear whether this finding is attributable to) Tj ET BT 0.8491 0 0 0.9835 115.2 200.4 Tm 0.0441 Tc 0.6465 Tw (the effect of the special care unit or to preexisting differences between the two groups of families.) Tj ET BT 0.8449 0 0 0.9835 85.68 180.72 Tm /F2 10 Tf -0.0319 Tc 0.0923 Tw (SOURCE: ) Tj ET q 18 0 0 -6.24 125.28 186.72 cm BI /W 113 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @"?~/??~??~??~?{?~?3??~?????~>?~>~?~>~>?~?~??~???~~?~~??????<~ߏ|8 EI Q BT 0.7511 0 0 0.9835 125.28 180.72 Tm 3 Tr -0.0011 Tc 0 Tw (Offke) Tj 0 Tr ET BT 0.8449 0 0 0.9835 143.28 180.72 Tm 0 Tc 0.0545 Tw ( ) Tj ET q 6.48 0 0 -5.76 145.44 186.48 cm BI /W 40 /H 34 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?????~?~~?~?~?~?????`?x ?? 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EI Q BT 0.5633 0 0 0.9835 235.44 180.72 Tm 3 Tr 0.1101 Tc 0 Tw (19924) Tj 0 Tr ET BT 0.934 0 0 0.9835 74.16 146.64 Tm /F4 10 Tf -0.0491 Tc 1.4556 Tw (show positive outcomes is due entirely to methodo-) Tj 268.5186 -0.7321 TD -0.0343 Tc 0.7953 Tw (effect of special care units is on residents\222 quality of) Tj ET BT 0.8915 0 0 0.9835 73.92 134.16 Tm 0.0478 Tc 2.1718 Tw (logical problems. Alternate explanations include the) Tj ET BT 0.9835 0 0 0.9835 73.68 120.96 Tm 0.0327 Tc 3.1815 Tw (possibility that some or many of the features) Tj ET BT 0.934 0 0 0.9835 73.44 108.48 Tm -0.0443 Tc 0.753 Tw (recommended for special care units are not effective) Tj 0.7709 -12.9339 TD -0.0328 Tc 2.0255 Tw (and the possibility that some of the recommended) Tj ET BT 0.9835 0 0 0.9835 73.92 83.52 Tm 0.0457 Tc 2.9984 Tw (features have a positive effect on some or all) Tj -0.4881 -12.9339 TD 0.0211 Tc 0.1661 Tw (residents, families, and staff members, that other) Tj 0.7321 -12.4458 TD 0.0396 Tc 2.1287 Tw (features have a negative effect, and that these) Tj ET BT 0.934 0 0 0.9835 73.92 45.84 Tm -0.0345 Tc 1.4767 Tw (positive and negative effects cancel each other out.) Tj 0.5139 -12.6899 TD -0.03 Tc 0.7377 Tw (Still another possibility is that the primary positive) Tj ET BT 0.9835 0 0 0.9835 324.96 134.4 Tm 0.0462 Tc 1.5642 Tw (life-an outcome that is difficult to define opera-) Tj ET BT 0.8915 0 0 0.9835 325.2 122.16 Tm 0.0447 Tc 0.9706 Tw (tionally and one that has not been measured directly) Tj ET BT 0.9835 0 0 0.9835 325.2 110.16 Tm 0.0219 Tc 0.5517 Tw (in any of the studies conducted thus far. Further) Tj ET BT 0.934 0 0 0.9835 324.72 98.4 Tm -0.038 Tc 0.8564 Tw (research is needed to differentiate among these and) Tj ET BT 0.8915 0 0 0.9835 325.2 86.4 Tm 0.0363 Tc 3.2345 Tw (other possible explanations.) Tj ET BT 0.934 0 0 0.9835 336.24 68.88 Tm -0.0422 Tc 1.1607 Tw (Research on specific interventions in special care) Tj ET BT 0.8915 0 0 0.9835 325.2 57.12 Tm 0.015 Tc 0.9104 Tw (units may help to explain the findings of studies that) Tj ET BT 0.934 0 0 0.9835 325.44 45.12 Tm -0.0263 Tc 1.7754 Tw (evaluate the overall effect of the units by showing) Tj ET BT 0.9835 0 0 0.9835 325.44 33.36 Tm 0.029 Tc 0.0198 Tw (that certain interventions have positive outcomes) Tj ET endstream endobj 334 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 335 0 obj <>stream q 7.2 0 0 -41.76 72.24 483.36 cm BI /W 40 /H 232 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?? EI Q 0.72 w 1 j 0 0 0 RG 61.92 676.32 m 539.28 676.32 l S BT 0.9835 0 0 0.9835 323.52 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0256 Tc 1.6212 Tw (Chapter 4--Findings From Evaluative Studies) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516.24 681.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.72 681.6 Tm /F5 10 Tf 0.2847 Tc 0 Tw (129) Tj -468.3044 -39.0457 TD /F4 10 Tf 0.0345 Tc 1.4947 Tw (and others do not. This type of research is also) Tj ET BT 0.8915 0 0 0.9835 62.16 631.2 Tm 0.0383 Tc 0.8543 Tw (important because some and perhaps many interven-) Tj ET BT 0.934 0 0 0.9835 62.16 618.96 Tm -0.036 Tc 1.5394 Tw (tions that are shown to be effective in special care) Tj ET BT 0.9835 0 0 0.9835 61.92 606.72 Tm 0.0302 Tc 0.918 Tw (units can also be used in nonspecialized nursing) Tj 0 -12.2018 TD 0.0247 Tc 1.2606 Tw (home units, residential care facilities, and other) Tj 0.7321 -11.9577 TD 0.0314 Tc 1.4397 Tw (settings to improve the care of individuals with) Tj ET BT 0.8915 0 0 0.9835 62.4 570.96 Tm 0.0145 Tc 1.5091 Tw (dementia in these settings.) Tj ET BT 0.934 0 0 0.9835 73.44 553.44 Tm -0.027 Tc 0.7482 Tw (Finally, it is important to note certain findings of) Tj -11.0491 -12.2018 TD -0.0323 Tc 0.7861 Tw (several of the studies discussed in this chapter that) Tj ET BT 0.9835 0 0 0.9835 62.64 529.68 Tm 0.04 Tc 0.8688 Tw (do not fit with widely held beliefs about nursing) Tj ET BT 0.934 0 0 0.9835 62.64 518.16 Tm -0.0264 Tc 2.1716 Tw (home residents with dementia, their families, and) Tj ET BT 0.9835 0 0 0.9835 62.64 505.92 Tm 0.018 Tc 0.2681 Tw (nursing home staff members who work with resi-) Tj ET BT 0.8915 0 0 0.9835 62.88 494.16 Tm 0.007 Tc 1.9213 Tw (dents with dementia:) Tj 24.4967 -18.3027 TD 0.032 Tc 1.0665 Tw (three studies found that the incidence of behav-) Tj ET BT 0.934 0 0 0.9835 84.96 464.4 Tm -0.0293 Tc 0.7615 Tw (ioral symptoms was much lower than expected) Tj 0.257 -12.2018 TD 0.0054 Tc 1.0669 Tw (among residents with dementia \(22,265,312\);) Tj ET BT 0.9835 0 0 0.9835 84.72 440.64 Tm 0.0372 Tc 0.8412 Tw (one study found that three groups of family) Tj ET BT 0.934 0 0 0.9835 84.96 428.88 Tm -0.0161 Tc 0.6273 Tw (members\227family members of special care unit) Tj ET BT 0.9835 0 0 0.9835 84.72 416.88 Tm 0.0305 Tc 1.458 Tw (residents, family members of residents of a) Tj ET BT 0.934 0 0 0.9835 84.96 405.12 Tm -0.0114 Tc 1.5987 Tw (nonspecialized nursing home unit, and family) Tj ET BT 0.9835 0 0 0.9835 84.96 393.12 Tm 0.0255 Tc 3.5026 Tw (members of residents of a unit in which) Tj ET BT 0.8632 0 0 0.9598 324.24 593.52 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.8056 0 0 0.9598 324.72 544.08 Tm 0.0203 Tc (l) Tj ET BT 0.8915 0 0 0.9835 334.8 642.72 Tm /F4 10 Tf 0.034 Tc 1.9718 Tw (individuals with dementia were segregated but) Tj ET BT 0.934 0 0 0.9835 334.56 630.48 Tm -0.0456 Tc 2.4576 Tw (no special services were provided\227had much) Tj ET BT 0.9835 0 0 0.9835 334.8 618.48 Tm 0.0367 Tc 0.1502 Tw (lower levels of anxiety, depression, and guilt) Tj ET BT 0.934 0 0 0.9835 334.8 606.24 Tm -0.0137 Tc 1.0874 Tw (than expected \(76\);) Tj ET BT 0.9835 0 0 0.9835 334.56 592.32 Tm 0.0335 Tc 2.9437 Tw (two studies found moderately high family) Tj ET BT 0.8915 0 0 0.9835 335.28 580.56 Tm 0.0284 Tc 1.1346 Tw (satisfaction with the care provided for individu-) Tj ET BT 0.9835 0 0 0.9835 335.04 568.56 Tm 0.0285 Tc 0.4108 Tw (als with dementia in nonspecialized nursing) Tj ET BT 0.934 0 0 0.9835 334.8 556.8 Tm 0.033 Tc 1.4656 Tw (home units \(88,265,266\); and) Tj ET BT 0.9835 0 0 0.9835 334.8 542.88 Tm 0.032 Tc 1.23 Tw (one study found that staff members in four) Tj 0.7321 -11.9577 TD 0.0368 Tc 2.6962 Tw (special care units and four nonspecialized) Tj ET BT 0.934 0 0 0.9835 335.28 519.6 Tm -0.0262 Tc 1.529 Tw (nursing home units were not particularly dis-) Tj 0.257 -12.4458 TD -0.0202 Tc 1.6596 Tw (turbed by the residents\222 behavioral symptoms) Tj 0.5139 -11.9577 TD 0.0551 Tc 0 Tw (\(195\).) Tj -23.6399 -20.255 TD -0.0295 Tc 1.7283 Tw (It is unclear whether these findings reflect unique) Tj ET BT 0.9835 0 0 0.9835 313.92 463.44 Tm 0.0195 Tc 0.2897 Tw (characteristics of particular study samples or are) Tj 0 -11.7137 TD 0.0284 Tc 2.0703 Tw (more generally representative. Certainly, if the) Tj 0 -11.9577 TD 0.0337 Tc 3.041 Tw (baseline levels of behavioral symptoms among) Tj ET BT 0.934 0 0 0.9835 313.68 428.16 Tm -0.0146 Tc 0.6258 Tw (residents, negative feelings among family members,) Tj ET BT 0.8915 0 0 0.9835 314.16 415.92 Tm 0.0392 Tc 0.9095 Tw (and distress among staff members are low in general) Tj ET BT 0.9835 0 0 0.9835 314.16 404.4 Tm 0.0165 Tc 0.2827 Tw (or in particular study samples, it is unrealistic to) Tj ET BT 0.934 0 0 0.9835 314.16 392.16 Tm -0.0322 Tc 0.8181 Tw (expect large positive changes in a special care unit.) Tj ET endstream endobj 336 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 337 0 obj <>stream BT 0.9857 0 0 0.9857 444 622.08 Tm 0 0 0 rg /F6 18 Tf -0.0028 Tc -0.1192 Tw (Chapter 5) Tj ET BT 0.9597 0 0 0.998 108.24 566.88 Tm /F6 31 Tf -0.0181 Tc 1.2658 Tw (Regulations And Guidelines For) Tj 183.5466 -36.554 TD -0.0228 Tc 0.6455 Tw (Special Care Units) Tj ET endstream endobj 338 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 339 0 obj <>stream BT 0.9663 0 0 0.9939 279.36 662.64 Tm 0 0 0 rg /F6 14 Tf -0.0052 Tc 0 Tw (Contents) Tj ET BT 0.8971 0 0 0.9835 490.32 646.8 Tm /F5 10 Tf 0.0765 Tc (Page) Tj ET BT 0.8915 0 0 0.9835 102.96 633.36 Tm /F4 10 Tf -0.0672 Tc 0.3736 Tw (INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 355.92 634.08 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 162.5252 0.4881 TD 0.0897 Tc 0 Tw (133) Tj ET BT 0.9835 0 0 0.9835 103.2 621.6 Tm -0.0028 Tc 0.3022 Tw (THE EXISTING REGULATORY STRUCTURE FOR NURSING HOMES . . . . . . . . . 134) Tj ET BT 0.934 0 0 0.9835 114.48 609.6 Tm -0.0271 Tc 1.6156 Tw (Federal Regulations for Medicare and Medicaid Certification of Nursing Homes . . . 134) Tj ET BT 0.8915 0 0 0.9835 114.48 597.12 Tm -0.0045 Tc 0.4537 Tw (State Licensing Regulations . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 299.04 597.6 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 494.4 598.56 Tm 0.2881 Tc 0 Tw (138) Tj ET BT 0.934 0 0 0.9835 114.72 585.36 Tm -0.0343 Tc 1.6233 Tw (State Certificate of Need Regulations) Tj ET BT 0.8491 0 0 0.9835 284.88 585.6 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 247.0384 0.7321 TD 0.0897 Tc 0 Tw (138) Tj ET BT 0.934 0 0 0.9835 114.72 573.36 Tm -0.0134 Tc 0.8301 Tw (Other State and Local Government Regulations That Apply to Nursing Homes . . . . . 138) Tj ET BT 0.8915 0 0 0.9835 114.96 561.6 Tm -0.0269 Tc 0.1711 Tw (Survey and Certification Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139) Tj 0.2692 -12.2018 TD -0.0213 Tc 0.4322 Tw (State Long-Term Care Ombudsman Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139) Tj ET BT 0.7642 0 0 0.9835 115.2 537.36 Tm -0.0226 Tc 0 Tw (S) Tj ET BT 0.934 0 0 0.9835 121.2 537.36 Tm 0.0091 Tc 0.9601 Tw (ummary and Implications . . .) Tj ET BT 0.8491 0 0 0.9835 257.04 537.6 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 495.36 538.32 Tm 0.0897 Tc 0 Tw (140) Tj ET BT 0.934 0 0 0.9835 104.4 525.12 Tm -0.0021 Tc 1.8886 Tw (STATE REGULATIONS AND OTHER STATE POLICIES FOR) Tj 12.0769 -11.4697 TD 0.0312 Tc 0.0114 Tw (SPECIAL CARE UNITS . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 313.2 514.08 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 495.36 514.56 Tm 0.0897 Tc 0 Tw (140) Tj ET BT 0.934 0 0 0.9835 115.44 501.84 Tm -0.0167 Tc 1.7329 Tw (Six States\222 Regulations for Special Care Units) Tj ET BT 0.8491 0 0 0.9835 327.36 502.08 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 495.36 502.56 Tm 0.2881 Tc 0 Tw (141) Tj ET BT 0.934 0 0 0.9835 115.68 490.08 Tm -0.0385 Tc 1.7884 Tw (States That Are Developing or Considering Developing Regulations for) Tj 11.82 -12.2018 TD -0.0055 Tc 0.1976 Tw (Special Care Units . . . . .) Tj ET BT 0.8491 0 0 0.9835 239.04 478.32 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 148.3926 0.4881 TD 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 154.0457 0.244 TD 0.2781 Tc 0 Tw (146) Tj ET BT 0.934 0 0 0.9835 115.92 466.08 Tm -0.0455 Tc 1.584 Tw (States That Have Developed or Are Developing Guidelines for Special Care) Tj 11.82 -11.9577 TD -0.0171 Tc 0.545 Tw (Units or for the Care of People With Dementia in All Nursing Homes . . . . . . . . . . . 147) Tj -11.306 -11.9577 TD -0.0156 Tc 0.5988 Tw (States That Have Certificate of Need Exceptions for Special Care Units . . . . . . . . . . . 148) Tj 0 -12.2018 TD -0.0349 Tc 0.8959 Tw (Other State Policies for Special Care Units) Tj ET BT 0.8491 0 0 0.9835 309.6 430.56 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 219.6211 0.4881 TD 0.2781 Tc 0 Tw (149) Tj ET BT 0.9835 0 0 0.9835 116.4 418.56 Tm 0.0041 Tc (s) Tj ET BT 0.8915 0 0 0.9835 122.16 418.56 Tm -0.0487 Tc 0.2488 Tw (ummary and Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149) Tj ET BT 0.934 0 0 0.9835 105.6 406.56 Tm -0.0079 Tc 2.476 Tw (SPECIAL CARE UNIT GUIDELINES DEVELOPED BY OTHER PUBLIC) Tj 11.563 -12.2018 TD 0.0315 Tc 0.0112 Tw (AND PRIVATE ORGANIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151) Tj ET BT 0.9835 0 0 0.9835 116.4 382.56 Tm 0.0266 Tc 0.3638 Tw (The American Association of Homes for the Aging-\222 \221Best Practices for Special) Tj 11.7137 -12.2018 TD 0.0247 Tc -0.0874 Tw (Care Programs for Persons With Alzheimer\222s Disease or a Related Disorder\224 . . . 151) Tj ET BT 0.934 0 0 0.9835 116.64 358.56 Tm -0.0233 Tc 2.588 Tw (The Massachusetts Alzheimer\222s Disease Research Center\227\222) Tj ET BT 0.8915 0 0 0.9835 387.6 358.8 Tm 0.0478 Tc 1.6065 Tw (Blueprint for a) Tj ET BT 0.934 0 0 0.9835 127.92 346.56 Tm 0.0051 Tc 0.0394 Tw (Specialized Alzheimer\222s Disease Nursing Home\224 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152) Tj -11.82 -11.7137 TD -0.026 Tc 1.3253 Tw (The Alzheimer\222s Disease Education and Referral Center\227\222 \221Standards for) Tj 12.0769 -12.4458 TD 0.0069 Tc 0.0375 Tw (Care for Dementia Patients in Special Care Units\224 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152) Tj -12.0769 -12.2018 TD -0.0304 Tc 2.39 Tw (The University of South Florida\222s Suncoast Gerontology Center\227"Draft Guidelines) Tj 12.0769 -11.9577 TD -0.0242 Tc 1.9123 Tw (for Dementia Specific Care Units \(DSCUs\) for Memory Impaired Older Adults\224 . 152) Tj -11.82 -12.4458 TD -0.0274 Tc 1.7122 Tw (The University of Wisconsin-Milwaukee\222s Center for Architecture and Urban) Tj ET BT 0.9835 0 0 0.9835 128.4 274.56 Tm 0.244 Tc 3.5593 Tw (Planning Research-\222) Tj 102.495 0 TD 0.0267 Tc -0.0023 Tw (Environments for People With Dementia: Design Guide\224 . 153) Tj ET BT 0.934 0 0 0.9835 117.36 262.56 Tm -0.0358 Tc 1.992 Tw (The Alzheimer\222s Association Legislative Principles and Guidelines for) Tj ET BT 0.8915 0 0 0.9835 128.88 250.08 Tm -0.0489 Tc 0.0497 Tw (Special Care Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 371.52 250.56 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 497.52 250.8 Tm 0.2881 Tc 0 Tw (153) Tj ET BT 0.934 0 0 0.9835 117.36 238.32 Tm -0.0014 Tc 0.6196 Tw (The Alzheimer\222s Society of Canada-Forthcoming Guidelines . . . . . . . . . . . . . . . . . . . . 153) Tj ET BT 0.9835 0 0 0.9835 117.6 226.32 Tm 0.005 Tc -0.0413 Tw (The Alzheimer\222s Coalition of Connecticut-Forthcoming Guidelines . . . . . . . . . . . . . . 153) Tj ET BT 0.934 0 0 0.9835 118.08 214.08 Tm -0.0016 Tc 0.5091 Tw (U.S. Department of Veterans Affairs-Forthcoming Guidelines . . . . . . . . . . . . . . . . . . . 154) Tj ET BT 0.9835 0 0 0.9835 117.6 202.56 Tm 0.0137 Tc -0.0297 Tw (Multi-Facility Nursing Home Corporations-Special Care Unit Guidelines . . . . . . . . 154) Tj ET BT 0.934 0 0 0.9835 118.08 190.32 Tm -0.0264 Tc 2.4958 Tw (The Joint Commission on Accreditation of Healthcare Organizations-Draft) Tj 12.0769 -12.2018 TD -0.0085 Tc 0.1006 Tw (Surveyor Guidelines . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 274.08 178.8 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 498.24 179.04 Tm 0.0897 Tc 0 Tw (154) Tj ET BT 0.7642 0 0 0.9835 118.32 166.56 Tm -0.0226 Tc (S) Tj ET BT 0.8915 0 0 0.9835 124.08 166.56 Tm -0.0487 Tc 0.2488 Tw (ummary and Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155) Tj ET BT 0.9835 0 0 0.9835 107.28 154.8 Tm -0.0297 Tc 0.1161 Tw (CONCLUSION . . . .) Tj ET BT 0.8491 0 0 0.9835 203.04 154.8 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8066 0 0 0.9835 498.24 155.52 Tm 0.2881 Tc 0 Tw (155) Tj ET BT 0.9795 0 0 0.9795 298.56 123.6 Tm /F7 12 Tf 0.0468 Tc (Figure) Tj ET BT 0.8971 0 0 0.9835 107.28 111.12 Tm /F5 10 Tf 0.0535 Tc (Figure) Tj 432.3017 0.7321 TD 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 107.52 99.12 Tm /F4 10 Tf -0.0088 Tc 0.8822 Tw (5-1. Minimum Data Set for Nursing Home Resident Assessment and) Tj ET BT 0.8915 0 0 0.9835 127.92 87.36 Tm -0.0519 Tc 0.2707 Tw (Care Screening \(MDS\) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137) Tj ET endstream endobj 340 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 341 0 obj <>stream 1.68 w 1 j 0 0 0 RG 63.12 647.04 m 540.96 647.04 l S BT 0.9663 0 0 0.9939 480.48 684.24 Tm 0 0 0 rg /F6 14 Tf -0.0214 Tc 0.991 Tw (Chapter 5) Tj ET BT 0.9857 0 0 0.9857 144.72 659.52 Tm /F6 18 Tf 0.0164 Tc 0.7541 Tw (Regulations And Guidelines For Special Care Units) Tj ET BT 0.9663 0 0 0.9939 126.72 601.92 Tm /F6 14 Tf 0.0585 Tc 0 Tw (INTRODUCTION) Tj ET BT 0.9835 0 0 0.9835 74.64 583.92 Tm /F4 10 Tf 0.038 Tc 1.2238 Tw (In response to concerns about the diversity of) Tj ET BT 0.934 0 0 0.9835 63.84 571.68 Tm -0.027 Tc 1.198 Tw (existing special care units, the lack of standards to) Tj 0.257 -11.9577 TD -0.0157 Tc 0.7469 Tw (assist families, nursing home surveyors, and others) Tj 0.257 -11.9577 TD -0.0196 Tc 0.8795 Tw (in evaluating the units, and widespread allegations) Tj 0.257 -12.4458 TD -0.0342 Tc 0.7055 Tw (that some special care units provide nothing special) Tj ET BT 0.8915 0 0 0.9835 64.32 524.16 Tm 0.0274 Tc 1.3408 Tw (for their residents, six States have developed regula-) Tj 0.5384 -12.2018 TD 0.037 Tc 0.0303 Tw (tions for special care units, and other States are in the) Tj ET BT 0.9835 0 0 0.9835 64.32 500.4 Tm 0.0321 Tc 1.2124 Tw (process of doing so. The Alzheimer\222s Association) Tj ET BT 0.934 0 0 0.9835 64.8 488.4 Tm -0.0512 Tc 1.6414 Tw (has developed legislative principles for special care) Tj 0 -11.9577 TD -0.0087 Tc 0.7884 Tw (units to assist States in formulating regulations. In) Tj ET BT 0.9835 0 0 0.9835 65.04 464.64 Tm 0.0274 Tc 1.5832 Tw (addition, the Alzheimer\222s Association and many) Tj ET BT 0.934 0 0 0.9835 65.28 452.64 Tm -0.0257 Tc 1.7854 Tw (other public and private organizations have devel-) Tj 0 -11.9577 TD -0.0569 Tc 1.6797 Tw (oped or are in the process of developing guidelines) Tj 0.257 -11.9577 TD -0.0335 Tc 0.7659 Tw (for special care units.) Tj 11.563 -21.4751 TD -0.0357 Tc 0.7439 Tw (These regulations and guidelines are or would be) Tj -10.7921 -12.2018 TD -0.0374 Tc 2.3461 Tw (superimposed on the existing regulatory structure) Tj -0.5139 -11.9577 TD -0.022 Tc 1.0962 Tw (for nursing homes\227a complex, multi-layered struc-) Tj ET BT 0.8066 0 0 0.9835 66 372 Tm 0.2695 Tc 0 Tw (ture) Tj ET BT 0.9207 0 0 0.9598 77.52 352.56 Tm /F9 6 Tf -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 77.76 325.68 Tm -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 77.76 311.04 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 78.24 283.68 Tm -0.0185 Tc (l) Tj 0.278 -27.7546 TD -0.0185 Tc (l) Tj ET BT 0.7481 0 0 0.9598 78.72 230.4 Tm 0.065 Tc (l) Tj ET BT 0.934 0 0 0.9835 86.16 372 Tm /F4 10 Tf -0.0167 Tc 0.9621 Tw (that includes six major components:) Tj ET BT 0.8915 0 0 0.9835 88.32 351.36 Tm 0.0533 Tc 1.9502 Tw (Federal regulations for Medicare and Medicaid) Tj ET BT 0.934 0 0 0.9835 88.56 339.12 Tm -0.026 Tc 1.5288 Tw (certification of nursing homes,) Tj -0.257 -15.1302 TD -0.0183 Tc 0.5784 Tw (State licensing regulations for nursing homes,) Tj ET BT 0.8915 0 0 0.9835 88.56 309.6 Tm 0.0399 Tc 1.3909 Tw (State certificate of need regulations for nursing) Tj ET BT 0.934 0 0 0.9835 88.56 297.6 Tm -0.0088 Tc 0 Tw (homes,) Tj 0 -15.3742 TD -0.0252 Tc 2.1274 Tw (other State and local government regulations) Tj ET BT 0.8915 0 0 0.9835 89.04 270.72 Tm 0.0187 Tc 1.6391 Tw (that apply to nursing homes,) Tj ET BT 0.934 0 0 0.9835 88.56 255.6 Tm -0.0393 Tc 1.3718 Tw (the survey and certification procedures associ-) Tj ET BT 0.8915 0 0 0.9835 89.28 243.6 Tm 0.025 Tc 0.6225 Tw (ated with each of these types of regulations, and) Tj ET BT 0.934 0 0 0.9835 89.04 228.96 Tm -0.036 Tc 1.2397 Tw (the oversight and advocacy procedures of each) Tj ET BT 0.8915 0 0 0.9835 89.76 216.96 Tm 0.0362 Tc 2.0905 Tw (State\222s Long-Term Care Ombudsman Program.) Tj ET BT 0.9835 0 0 0.9835 78.48 196.8 Tm 0.0338 Tc 1.5767 Tw (In addition to these six components, Federal,) Tj ET BT 0.934 0 0 0.9835 68.16 184.56 Tm -0.0175 Tc 0.6204 Tw (State, and local government regulations for nursing) Tj -0.5139 -11.9577 TD -0.0282 Tc 1.0001 Tw (homes incorporate standards established by private) Tj 0.5139 -12.2018 TD -0.0205 Tc 1.2231 Tw (organizations, such as the National Fire Protection) Tj ET BT 0.9835 0 0 0.9835 68.16 149.04 Tm 0.0414 Tc 2.838 Tw (Association\222s Life Safety Codes. Because these) Tj ET BT 0.8915 0 0 0.9835 68.64 136.8 Tm 0.0453 Tc 2.1745 Tw (standards are incorporated into government regula-) Tj ET BT 0.934 0 0 0.9835 68.4 124.8 Tm -0.0307 Tc 0.9955 Tw (tions, they become part of the regulatory structure.) Tj ET BT 0.9835 0 0 0.9835 68.4 113.04 Tm 0.0212 Tc 1.315 Tw (Lastly, about 5 percent of nursing homes in the) Tj ET BT 0.934 0 0 0.9835 68.4 100.8 Tm -0.036 Tc 1.7536 Tw (United States choose to be accredited by a private) Tj ET BT 0.9835 0 0 0.9835 68.88 89.52 Tm 0.0284 Tc -0.0772 Tw (organization, the Joint Commission on Accredita-) Tj 0 -12.2018 TD 0.0355 Tc 0.3548 Tw (tion of Healthcare Organizations \(JCAHO\) \(214\).) Tj ET BT 0.934 0 0 0.9835 68.64 65.52 Tm -0.0176 Tc 1.4219 Tw (These nursing homes are surveyed by JCAHO and) Tj ET BT 0.9835 0 0 0.9835 68.64 54 Tm 0.0244 Tc 0.0175 Tw (must meet JCAHO standards, as well as Federal,) Tj ET BT 0.8915 0 0 0.9835 69.12 42 Tm 0.0399 Tc 2.0864 Tw (State, and local government requirements.) Tj ET BT 0.9835 0 0 0.9835 325.2 606.24 Tm 0.0115 Tc 1.1113 Tw (The regulatory structure for nursing homes is) Tj -10.7376 -11.9577 TD 0.0225 Tc 0.2867 Tw (currently undergoing massive changes due to the) Tj ET BT 0.934 0 0 0.9835 314.64 582.48 Tm -0.0291 Tc 1.7891 Tw (implementation of the nursing home reform provi-) Tj ET BT 0.9835 0 0 0.9835 315.12 570.24 Tm 0.0352 Tc 0.2331 Tw (sions of the 1987 Omnibus Budget Reconciliation) Tj -0.244 -11.9577 TD 0.0506 Tc 1.0715 Tw (Act \(OBRA-87\). The provisions of OBRA-87 per-) Tj 0.4881 -12.2018 TD 0.039 Tc 0.7347 Tw (tain to the Federal regulations for Medicare and) Tj -0.244 -12.2018 TD 0.0318 Tc 1.3347 Tw (Medicaid certification of nursing homes and the) Tj ET BT 0.934 0 0 0.9835 315.84 522.48 Tm -0.0401 Tc 1.3726 Tw (survey and certification procedures associated with) Tj ET BT 0.9835 0 0 0.9835 315.36 510.48 Tm 0.0269 Tc 1.1363 Tw (those regulations, but the changes mandated by) Tj ET BT 0.934 0 0 0.9835 315.6 498.72 Tm -0.0333 Tc 1.3286 Tw (OBRA-87 are so extensive they affect other compo-) Tj ET BT 0.8915 0 0 0.9835 315.6 486.72 Tm 0.0387 Tc 1.2576 Tw (nents of the regulatory structure as well.) Tj ET BT 0.9835 0 0 0.9835 326.64 465.84 Tm 0.0229 Tc 1.0998 Tw (This chapter describes the existing regulatory) Tj ET BT 0.934 0 0 0.9835 316.32 454.08 Tm -0.0183 Tc 1.0066 Tw (structure for nursing homes, including the changes) Tj -0.5139 -12.2018 TD -0.0057 Tc 2.1494 Tw (mandated by OBRA-87. It discusses State regula-) Tj 0.5139 -12.4458 TD -0.0371 Tc 0.9197 Tw (tions and other State policies for special care units.) Tj ET BT 0.8915 0 0 0.9835 316.32 418.08 Tm 0.0441 Tc 1.2067 Tw (It also describes the guidelines for special care units) Tj ET BT 0.934 0 0 0.9835 316.56 405.84 Tm -0.0428 Tc 0.8294 Tw (that have been developed or are being developed by) Tj ET BT 0.8915 0 0 0.9835 316.56 394.08 Tm 0.0465 Tc 2.2135 Tw (various public and private organizations.) Tj ET BT 0.934 0 0 0.9835 327.6 372.96 Tm -0.0364 Tc 1.8825 Tw (The policy question addressed by the chapter is) Tj ET BT 0.9835 0 0 0.9835 317.04 360.72 Tm 0.037 Tc 1.8175 Tw (whether there should be special regulations for) Tj 0.4881 -11.7137 TD 0.0158 Tc 0.985 Tw (special care units.) Tj 92.9776 0 TD 0.037 Tc 2.208 Tw (On the one hand, the rapid) Tj -93.7097 -12.2018 TD 0.0323 Tc 3.3911 Tw (proliferation of special care units, the lack of) Tj ET BT 0.8915 0 0 0.9835 317.52 325.2 Tm 0.0309 Tc 1.8946 Tw (standards to help families, nursing home surveyors,) Tj ET BT 0.9835 0 0 0.9835 317.52 313.2 Tm 0.034 Tc 0.6004 Tw (and others evaluate the units, and the pervasive) Tj 0.244 -12.2018 TD 0.0336 Tc 1.3736 Tw (allegations that some special care units provide) Tj -0.244 -11.9577 TD 0.0325 Tc 1.334 Tw (nothing special for their residents argue for the) Tj ET BT 0.934 0 0 0.9835 317.76 277.2 Tm -0.0309 Tc 0.9956 Tw (development of regulations. On the other hand, the) Tj ET BT 0.9835 0 0 0.9835 317.76 265.2 Tm 0.0203 Tc 2.3226 Tw (current lack of agreement about the particular) Tj ET BT 0.8915 0 0 0.9835 317.76 253.44 Tm 0.0511 Tc 0.6904 Tw (features that are necessary in a special care unit and) Tj ET BT 0.934 0 0 0.9835 318.24 241.2 Tm -0.041 Tc 1.1166 Tw (the lack of research-based evidence of the effective-) Tj -0.257 -11.7137 TD -0.024 Tc 1.7086 Tw (ness of any particular features make it difficult to) Tj ET BT 0.8915 0 0 0.9835 318.24 217.44 Tm 0.0359 Tc 0 Tw (determin) Tj ET BT 0.934 0 0 0.9835 357.12 217.44 Tm -0.0211 Tc 1.7377 Tw (e what the regulations should say beyond) Tj ET BT 0.8915 0 0 0.9835 318.48 205.68 Tm 0.0383 Tc 1.5594 Tw (general statements about goals and principles and a) Tj 0 -11.9577 TD 0.0419 Tc 0.5555 Tw (listing of the issues that require special consideration) Tj 0.5384 -12.2018 TD 0.0436 Tc 1.2074 Tw (in the care of nursing home residents with dementia) Tj ET BT 0.934 0 0 0.9835 319.2 169.92 Tm -0.0102 Tc 0.9551 Tw (\(e.g., physical design, staff training, security, activ-) Tj ET BT 0.9835 0 0 0.9835 318.96 158.16 Tm 0.0179 Tc 2.325 Tw (ity programs, family involvement, and resident) Tj ET BT 0.8915 0 0 0.9835 318.72 146.16 Tm -0.0089 Tc 0 Tw (rights\).) Tj ET BT 0.9835 0 0 0.9835 330 125.28 Tm 0.0293 Tc -0.0354 Tw (As this chapter points out, many of the Federal) Tj -11.2256 -11.9577 TD 0.0418 Tc 0.3972 Tw (Medicare and Medicaid regulations mandated by) Tj ET BT 0.8915 0 0 0.9835 319.44 101.52 Tm 0.0411 Tc 1.0564 Tw (OBRA-87 are directly relevant to the complaints and) Tj 0.2692 -11.7137 TD 0.0436 Tc 1.5534 Tw (concerns expressed by families and others about the) Tj 0 -12.2018 TD 0.0403 Tc 1.2111 Tw (care provided by most nursing homes for individuals) Tj ET BT 0.934 0 0 0.9835 319.68 66.24 Tm -0.0237 Tc 1.3978 Tw (with dementia. The OBRA regulations rarely men-) Tj ET BT 0.9835 0 0 0.9835 319.68 54.48 Tm 0.0223 Tc 1.9545 Tw (tion cognitive impairment or dementia, but the) Tj ET BT 0.8915 0 0 0.9835 319.2 42.48 Tm 0.014 Tc 2.3173 Tw (resident assessment system developed to implement) Tj -27.1886 -18.0586 TD 0.0897 Tc 0 Tw (\226133\226) Tj ET endstream endobj 342 0 obj <>/Rotate 0/Type/Page>> endobj 343 0 obj <>stream 0.48 w 1 j 0 0 0 RG 70.56 682.8 m 548.4 682.8 l S BT 0.9835 0 0 0.9835 70.56 688.32 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0313 Tw (134 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 70.8 648.96 Tm /F4 10 Tf -0.0231 Tc 1.2443 Tw (OBRA-87 focuses on the assessment of a resident\222s) Tj -0.257 -12.2018 TD -0.03 Tc 2.0042 Tw (cognitive status and the identification of problems) Tj ET BT 0.9835 0 0 0.9835 71.04 625.2 Tm 0.0188 Tc 0.9644 Tw (and care needs that are common among nursing) Tj ET BT 0.934 0 0 0.9835 70.56 613.44 Tm -0.0315 Tc 2.6481 Tw (home residents with dementia. OBRA regulations) Tj 0 -12.2018 TD -0.0274 Tc 0.5881 Tw (require that residents\222 needs be assessed, using this) Tj 0.5139 -12.2018 TD -0.0157 Tc 0.6398 Tw (or a similar assessment system, and that once their) Tj ET BT 0.9835 0 0 0.9835 71.28 577.44 Tm 0.0505 Tc 0.3803 Tw (needs are identified, appropriate services be pro-) Tj ET BT 0.934 0 0 0.9835 71.28 565.44 Tm -0.0529 Tc 1.1293 Tw (vided to meet those needs.) Tj ET BT 0.8915 0 0 0.9835 82.32 547.68 Tm 0.051 Tc 0.728 Tw (The regulations for special care units now in effect) Tj -12.1137 -12.2018 TD 0.0268 Tc 0.8493 Tw (in six States were not developed in the context of the) Tj ET BT 0.934 0 0 0.9835 71.52 523.44 Tm -0.0213 Tc 1.3953 Tw (new OBRA regulations. The six States\222 regulations) Tj ET BT 0.8915 0 0 0.9835 71.76 511.44 Tm 0.0451 Tc 1.3851 Tw (address some common areas, but their requirements) Tj ET BT 0.9835 0 0 0.9835 71.76 499.68 Tm 0.044 Tc 3.0306 Tw (in each of these) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 157.68 499.68 Tm /F3 9 Tf 0.2886 Tc 3.3484 Tw (areas vary, and each State\222s) Tj ET BT 0.9835 0 0 0.9835 71.28 487.68 Tm /F4 10 Tf 0.0258 Tc 1.0155 Tw (regulations include requirements for) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 245.76 487.68 Tm /F3 9 Tf 0.0336 Tc 1.1128 Tw (features not) Tj ET BT 0.9835 0 0 0.9835 72 475.44 Tm /F4 10 Tf 0.0343 Tc 0.5187 Tw (included in the ) Tj 75.407 0 TD /F2 10 Tf 0.0363 Tc -0.098 Tw (other ) Tj 24.1595 0 TD /F4 10 Tf 0.0235 Tc 2.6854 Tw (States\222 special regulations.) Tj -99.8106 -11.9577 TD 0.0399 Tc -0.1377 Tw (Moreover, ) Tj ET BT 0.9812 0 0 0.9812 121.68 463.68 Tm /F6 11 Tf 0.0326 Tc -0.0943 Tw (some ) Tj ET BT 0.9835 0 0 0.9835 148.32 463.68 Tm /F2 10 Tf 0.0363 Tc 0.0241 Tw (of the ) Tj 26.1118 0 TD /F4 10 Tf 0.0213 Tc 0.4506 Tw (requirements are very ) Tj 108.5959 0 TD /F2 10 Tf 0.0423 Tc 0 Tw (spe-) Tj -212.311 -12.2018 TD /F4 10 Tf 0.0165 Tc 0.2928 Tw (cific. The inclusion of requirements for particular) Tj ET BT 0.8915 0 0 0.9835 72 439.92 Tm 0.043 Tc 1.3234 Tw (features in special care unit regulations implies that) Tj ET BT 0.934 0 0 0.9835 72.24 428.16 Tm -0.026 Tc 1.1327 Tw (these features are important in the care of nursing) Tj -0.257 -12.2018 TD -0.03 Tc 1.79 Tw (home residents with dementia; that other features) Tj ET BT 0.9835 0 0 0.9835 72.48 404.16 Tm 0.0296 Tc 0.1473 Tw (which are not required by the regulations are not) Tj ET BT 0.8915 0 0 0.9835 72.48 392.64 Tm 0.0249 Tc 0.7796 Tw (important in the care of these residents; and that the) Tj ET BT 0.9835 0 0 0.9835 72.48 380.64 Tm 0.0286 Tc 3.453 Tw (limited resources of nursing homes should be) Tj ET BT 0.8915 0 0 0.9835 72.48 368.64 Tm 0.0468 Tc 1.0884 Tw (expended for the required features rather than other) Tj ET BT 0.9835 0 0 0.9835 72.72 356.88 Tm 0.0267 Tc 1.1656 Tw (features. As yet, however, there is no consensus) Tj ET BT 0.8915 0 0 0.9835 72.72 344.64 Tm 0.0491 Tc 1.2011 Tw (about the particular features that are necessary in a) Tj ET BT 0.934 0 0 0.9835 73.2 332.64 Tm -0.0388 Tc 1.5961 Tw (special care unit and no evidence from research to) Tj ET BT 0.8915 0 0 0.9835 73.2 320.88 Tm 0.0403 Tc 1.2649 Tw (support requirements for any particular features.) Tj ET BT 0.934 0 0 0.9835 84 303.12 Tm -0.0197 Tc 1.0938 Tw (OTA concludes from the analysis in this and the) Tj -12.0769 -11.7137 TD -0.0417 Tc 0.9888 Tw (preceding chapters that from a Federal perspective,) Tj ET BT 0.9835 0 0 0.9835 72.96 279.36 Tm 0.0261 Tc 0.8176 Tw (the objective of improving nursing home care for) Tj ET BT 0.934 0 0 0.9835 72.96 267.6 Tm -0.0354 Tc 1.8815 Tw (individuals with dementia will be better served at) Tj -0.257 -12.4458 TD -0.049 Tc 1.5106 Tw (present by initiatives to develop greater knowledge) Tj ET BT 0.8915 0 0 0.9835 73.2 243.12 Tm 0.0444 Tc 0.7834 Tw (and agreement about the particular features that are) Tj 0 -12.2018 TD 0.0403 Tc 0.8409 Tw (important in the care of nursing home residents with) Tj ET BT 0.934 0 0 0.9835 73.2 219.12 Tm -0.0354 Tc 1.753 Tw (dementia, to determin) Tj ET BT 0.9835 0 0 0.9835 172.08 218.88 Tm 0.0457 Tc -0.1436 Tw (e how those features fit into) Tj ET BT 0.934 0 0 0.9835 73.44 206.64 Tm -0.0215 Tc 0.6246 Tw (the regulatory framework created by OBRA-87, and) Tj ET BT 0.9835 0 0 0.9835 73.44 195.12 Tm 0.0367 Tc 2.9567 Tw (to support and monitor the implementation of) Tj ET BT 0.934 0 0 0.9835 73.44 182.88 Tm -0.0129 Tc 0.5726 Tw (OBRA-87 than by the establishment of new Federal) Tj -0.257 -11.9577 TD -0.02 Tc 0.5802 Tw (regulations for special care units. Many of the same) Tj ET BT 0.9835 0 0 0.9835 73.44 158.88 Tm 0.0329 Tc 0.6422 Tw (considerations that lead to this conclusion would) Tj ET BT 0.934 0 0 0.9835 73.92 146.88 Tm -0.0344 Tc 1.7197 Tw (seem to apply equally to the development of State) Tj -0.7709 -12.2018 TD -0.0306 Tc 0.7842 Tw (regulations for special care units.) Tj ET BT 0.9663 0 0 0.9939 84.96 108.96 Tm /F6 14 Tf 0.0582 Tc 2.0263 Tw (THE EXISTING REGULATORY) Tj ET BT 0.9019 0 0 0.9939 73.92 92.88 Tm -0.0138 Tc 2.3686 Tw (STRUCTURE FOR NURSING HOMES) Tj ET BT 0.9835 0 0 0.9835 84.24 74.88 Tm /F4 10 Tf 0.0224 Tc 0.8563 Tw (Nursing homes are said to be among the most) Tj -10.9816 -12.4458 TD 0.0225 Tc 2.4831 Tw (highly regulated entities in this country \(201\).) Tj 0.244 -11.7137 TD 0.0287 Tc 1.045 Tw (Federal State, and local government regulations) Tj 0.244 -12.4458 TD 0.0243 Tc 2.702 Tw (apply to virtually all facets of nursing homes\222) Tj ET BT 0.934 0 0 0.9835 321.12 649.44 Tm -0.0215 Tc 2.0379 Tw (physical design and operation. Nursing homes are) Tj 0.5139 -12.4458 TD -0.0206 Tc 0.5166 Tw (inspected at least annually by surveyors or teams of) Tj ET BT 0.9835 0 0 0.9835 322.08 625.44 Tm 0.0271 Tc 0.6074 Tw (surveyors who evaluate the facilities\222 compliance) Tj ET BT 0.934 0 0 0.9835 321.84 613.44 Tm -0.0334 Tc 0.7658 Tw (with one or more of these types of regulations. Staff) Tj ET BT 0.9835 0 0 0.9835 321.84 601.2 Tm 0.0265 Tc 1.877 Tw (members or volunteers representing the State\222s) Tj 0 -12.4458 TD 0.0085 Tc 0.8703 Tw (Long-Term Care Ombudsman Program also visit) Tj ET BT 0.8915 0 0 0.9835 321.84 577.44 Tm 0.0389 Tc 1.5267 Tw (nursing homes to investigate and resolve complaints) Tj ET BT 0.9835 0 0 0.9835 322.32 565.2 Tm 0.0302 Tc -0.1278 Tw (about resident care. This section describes each of) Tj ET BT 0.8915 0 0 0.9835 322.32 553.44 Tm 0.0366 Tc 1.9151 Tw (the components of the regulatory structure.) Tj ET BT 0.9795 0 0 0.9795 340.08 524.88 Tm /F7 12 Tf 0.0551 Tc 0.8629 Tw (Federal Regulations for Medicare and) Tj -8.086 -14.2118 TD 0.0478 Tc 0.7478 Tw (Medicaid Certification of Nursing Homes) Tj 1.2252 -18.1323 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 355.68 493.2 Tm /F4 10 Tf 0.0398 Tc 0.8385 Tw (legislation that created the Medicare and) Tj -33.6769 -12.2018 TD 0.0333 Tc -0.131 Tw (Medicaid programs gave the Federal Government) Tj ET BT 0.934 0 0 0.9835 323.04 468.96 Tm -0.0211 Tc 1.1381 Tw (the authority to establish requirements for nursing) Tj ET BT 0.9835 0 0 0.9835 322.8 457.2 Tm 0.0275 Tc -0.1251 Tw (homes that choose to participate in the programs.) Tj ET BT 0.934 0 0 0.9835 322.8 445.2 Tm -0.0231 Tc 1.7582 Tw (Nursing homes must be certified as meeting these) Tj ET BT 0.8915 0 0 0.9835 322.56 433.68 Tm 0.0651 Tc 1.5293 Tw (requirements in order to receive Medicare or Medic-) Tj ET BT 0.934 0 0 0.9835 323.28 421.44 Tm -0.0146 Tc 1.2596 Tw (aid payment for any of their residents. As of 1985,) Tj ET BT 0.8915 0 0 0.9835 323.28 409.68 Tm 0.0506 Tc 0.8107 Tw (75 percent of the nursing homes in this country were) Tj ET BT 0.934 0 0 0.9835 323.28 397.68 Tm -0.0411 Tc 1.2635 Tw (certified for Medicare, Medicaid, or both, and these) Tj ET BT 0.9835 0 0 0.9835 323.28 385.92 Tm 0.0313 Tc 1.3004 Tw (facilities accounted for 89 percent of all nursing) Tj ET BT 0.934 0 0 0.9835 323.28 373.92 Tm 0.008 Tc 1.835 Tw (home beds \(467\).) Tj ET BT 0.9835 0 0 0.9835 334.32 355.92 Tm 0.0382 Tc 1.7675 Tw (The requirements for Medicare and Medicaid) Tj -10.7376 -11.9577 TD 0.0288 Tc 0.1582 Tw (certification of nursing homes have been changed) Tj ET BT 0.8915 0 0 0.9835 324 331.92 Tm 0.025 Tc 1.4637 Tw (several times in the past two decades, most recently) Tj ET BT 0.934 0 0 0.9835 323.76 320.4 Tm -0.0111 Tc 0.7954 Tw (as a result of OBRA-87 and amendments to OBRA-) Tj 0.257 -12.2018 TD -0.0203 Tc 1.0944 Tw (87 enacted since 1987. Prior to the implementation) Tj ET BT 0.9835 0 0 0.9835 323.76 296.64 Tm 0.0443 Tc 0.2645 Tw (of OBRA-87, there were separate certification re-) Tj 0.244 -12.2018 TD 0.0233 Tc 2.5635 Tw (quirements for) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 399.6 284.64 Tm /F5 11 Tf 0.0856 Tc 3.6837 Tw (skilled nursing facilities \(SNFs\)) Tj ET BT 0.9835 0 0 0.9835 323.28 272.88 Tm /F4 10 Tf 0.0418 Tc 1.0806 Tw (participating in the Medicare and Medicaid pro-) Tj ET BT 0.8915 0 0 0.9835 324 260.64 Tm 0.0303 Tc 0.4146 Tw (grams and ) Tj ET BT 0.9014 0 0 0.9812 372.48 260.64 Tm /F5 11 Tf -0.0595 Tc 2.7728 Tw (intermediate care facilities) Tj 0 Tc -0.0889 Tw ( ) Tj ET BT 0.8915 0 0 0.9835 487.92 260.64 Tm /F4 10 Tf 0.0002 Tc 3.6787 Tw (\(ICFs\) partici-) Tj ET BT 0.934 0 0 0.9835 323.52 248.64 Tm -0.0149 Tc 1.4557 Tw (pating in the Medicaid program. Effective in 1990,) Tj 0.5139 -12.4458 TD -0.0245 Tc 1.5101 Tw (OBRA-87 eliminated the distinction between SNFs) Tj ET BT 0.9835 0 0 0.9835 324.24 224.4 Tm 0.0455 Tc 1.3818 Tw (and ICFs for Medicaid purposes. A single set of) Tj -0.4881 -11.9577 TD 0.0355 Tc -0.1332 Tw (requirements for Medicaid certification of ) Tj ET BT 0.9812 0 0 0.9812 516.48 212.64 Tm /F5 11 Tf 0.0868 Tc 0 Tw (nursing) Tj -197.8752 -12.4742 TD 0.0652 Tc 0.1171 Tw (facilities \(NFs\) ) Tj ET BT 0.9835 0 0 0.9835 392.16 200.4 Tm /F4 10 Tf 0.0352 Tc 0.3551 Tw (is now in effect. Separate but very) Tj -68.8181 -12.2018 TD 0.0276 Tc 0.1188 Tw (similar requirements for Medicare certification of) Tj ET BT 0.934 0 0 0.9835 324.48 176.64 Tm 0.0092 Tc 1.1142 Tw (SNFs are also in effect \(456,225\).) Tj ET BT 0.8915 0 0 0.9835 335.04 158.64 Tm 0.057 Tc 0.6539 Tw (The current requirements for Medicare and Medic-) Tj ET BT 0.9835 0 0 0.9835 324.72 146.64 Tm 0.0298 Tc 0.3607 Tw (aid certification of nursing homes were first pub-) Tj ET BT 0.8915 0 0 0.9835 324.48 134.64 Tm 0.0462 Tc 1.6082 Tw (lished by the Health Care Financing Administration) Tj ET BT 0.934 0 0 0.9835 324.72 122.88 Tm 0.0011 Tc 0.3328 Tw (\(HCFA\) in February 1989 \(462\). The final version of) Tj ET BT 0.9835 0 0 0.9835 324.48 110.64 Tm 0.0295 Tc 2.1099 Tw (these requirements was published by HCFA in) Tj 0.244 -12.2018 TD 0.0352 Tc 0.0622 Tw (September 1991 \(463\). The requirements address) Tj ET BT 0.934 0 0 0.9835 324 86.88 Tm -0.0345 Tc 2.0518 Tw (residents\222 rights, residents\222 quality of life, resident) Tj ET BT 0.9835 0 0 0.9835 324.72 74.88 Tm 0.021 Tc 0.3207 Tw (assessment, care planning, staff credentials, staff) Tj -0.244 -12.4458 TD 0.022 Tc 2.1465 Tw (training, use of physical restraints, use of psy-) Tj 0 -12.2018 TD 0.0253 Tc 1.016 Tw (chotropic and other medications, quality of care,) Tj ET BT 0.934 0 0 0.9835 324 38.88 Tm -0.0166 Tc 0.6193 Tw (nursing, physician, dietary, social work, dental, and) Tj ET endstream endobj 344 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 345 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60 675.6 m 537.84 675.6 l S BT 0.9835 0 0 0.9835 250.32 680.88 Tm 0 0 0 rg /F5 10 Tf 0.0234 Tc 1.3794 Tw (Chapter 5--Regulatiom And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 514.56 680.88 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 521.04 680.88 Tm /F5 10 Tf 0.2847 Tc 0 Tw (135) Tj ET BT 0.934 0 0 0.9835 60 642.72 Tm /F4 10 Tf -0.0282 Tc 2.5418 Tw (rehabilitative services, activities, handling of resi-) Tj 0.7709 -12.2018 TD -0.0299 Tc 1.3617 Tw (dents\222 funds, record-keeping, physical plant, pread-) Tj ET BT 0.8915 0 0 0.9835 60.48 618.96 Tm 0.0476 Tc 1.8085 Tw (mission screening, and other areas.) Tj 12.3829 -18.3027 TD 0.0502 Tc 1.4691 Tw (Many of the requirements are directly relevant to) Tj ET BT 0.934 0 0 0.9835 60.96 588.48 Tm -0.0268 Tc 1.2482 Tw (the complaints and concerns of families and others) Tj 0.257 -12.2018 TD -0.0257 Tc 1.1001 Tw (about the care provided by most nursing homes for) Tj 0 -11.7137 TD -0.013 Tc 0.4763 Tw (individuals with dementia. \(See table 1-1 inch. 1 for) Tj ET BT 0.9835 0 0 0.9835 61.2 552.72 Tm 0.0238 Tc -0.0908 Tw (a list of these complaints and concerns.\) The most) Tj ET BT 0.8915 0 0 0.9835 61.2 540.96 Tm 0.0543 Tc 0.1859 Tw (relevant of the requirements are quoted here from the) Tj ET BT 0.9835 0 0 0.9835 61.68 528.96 Tm 0.0412 Tc 0.105 Tw (September 1991 version of the \223Requirements for) Tj ET BT 0.934 0 0 0.9835 61.44 517.2 Tm -0.0127 Tc 2.371 Tw (Long-Term Care Facilities\224 \(463\).) 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\222) Tj ET BT 0.9835 0 0 0.9835 85.92 188.4 Tm 0.0272 Tc 0.648 Tw (\223Each resident must receive and the facility) Tj ET BT 0.8915 0 0 0.9835 85.68 176.4 Tm 0.0443 Tc 1.0142 Tw (must provide the necessary care and services to) Tj 0.5384 -12.4458 TD 0.0366 Tc 0.273 Tw (attain or maintain the highest practicable physi-) Tj ET BT 0.9835 0 0 0.9835 85.92 152.16 Tm 0.0195 Tc 1.4937 Tw (cal, mental, and psychosocial well-being, in) Tj ET BT 0.8915 0 0 0.9835 86.16 140.16 Tm 0.0468 Tc 1.944 Tw (accordance with the comprehensive assessment) Tj ET BT 0.934 0 0 0.9835 86.16 128.4 Tm -0.0131 Tc 1.0224 Tw (and plan of care. \222) Tj 0.257 -11.9577 TD -0.0279 Tc 1.6164 Tw (\223Based on the comprehensive assessment of a) Tj ET BT 0.9835 0 0 0.9835 85.68 104.88 Tm 0.0218 Tc -0.1193 Tw (resident, the facility must ensure that a resi-) Tj 0.7321 -12.4458 TD 0.0327 Tc 0.3228 Tw (dent\222s abilities in activities of daily living do) Tj ET BT 0.934 0 0 0.9835 86.16 81.12 Tm -0.0233 Tc 1.1404 Tw (not diminish unless circumstances of the indi-) Tj ET BT 0.9835 0 0 0.9835 86.16 68.88 Tm 0.0227 Tc 1.71 Tw (vidual\222s clinical condition demonstrate that) Tj ET BT 0.934 0 0 0.9835 86.4 57.12 Tm -0.0077 Tc 3.522 Tw (diminution was unavoidable.\222) Tj 0 -11.9577 TD -0.0279 Tc 1.5308 Tw (\223Based on the comprehensive assessment of a) Tj ET BT 0.8915 0 0 0.9835 85.68 33.6 Tm 0.0246 Tc 0.5365 Tw (resident, the facility must ensure that a resident) Tj ET BT 0.8632 0 0 0.9598 323.04 557.76 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0.5561 -63.7606 TD -0.0185 Tc (l) Tj 1.3902 -153.0254 TD -0.0185 Tc (l) Tj 0.278 -64.5107 TD -0.0185 Tc (l) Tj ET BT 0.9835 0 0 0.9835 332.88 642.24 Tm /F4 10 Tf 0.036 Tc -0.0292 Tw (whose assessment did not reveal a mental or) Tj 0 -11.9577 TD 0.0323 Tc 2.1883 Tw (psychosocial adjustment difficulty does not) Tj ET BT 0.8915 0 0 0.9835 333.12 618.24 Tm 0.0402 Tc 1.1214 Tw (display a pattern of decreased social interaction) Tj ET BT 0.934 0 0 0.9835 333.36 606.24 Tm -0.0306 Tc 1.2596 Tw (and/or increased withdrawn, angry, or depres-) Tj ET BT 0.9835 0 0 0.9835 333.84 594 Tm 0.021 Tc 0.9064 Tw (sive behaviors, unless the resident\222s clinical) Tj ET BT 0.8915 0 0 0.9835 333.36 582.24 Tm 0.025 Tc 1.1384 Tw (condition demonstrates that such a pattern was) Tj ET BT 0.9835 0 0 0.9835 333.36 570.24 Tm 0.2589 Tc 0 Tw (unavoidable.) Tj 0.7321 -13.666 TD 0.0271 Tc 2.9664 Tw (\223The facility must provide for an ongoing) Tj -0.4881 -12.2018 TD 0.0322 Tc 2.6765 Tw (program of activities designed to meet, in) Tj 0.4881 -11.9577 TD 0.029 Tc 1.8256 Tw (accordance with the comprehensive assess-) Tj ET BT 0.8915 0 0 0.9835 333.84 521.04 Tm 0.0183 Tc 0.1205 Tw (ment, the interests and the physical, mental, and) Tj ET BT 0.9835 0 0 0.9835 333.6 509.04 Tm 0.0356 Tc -0.0113 Tw (psychosocial well-being of each resident.\224) Tj ET BT 0.934 0 0 0.9835 334.56 495.36 Tm -0.027 Tc 2.0266 Tw (\223If specialized rehabilitative services, such as) Tj ET BT 0.9835 0 0 0.9835 334.08 483.12 Tm 0.0307 Tc 1.0105 Tw (but not limited to physical therapy, speech-) Tj ET BT 0.934 0 0 0.9835 334.08 471.6 Tm -0.012 Tc 1.0213 Tw (language pathology, occupational therapy, and) Tj ET BT 0.8915 0 0 0.9835 334.08 459.36 Tm 0.0508 Tc 1.6838 Tw (health rehabilitative services for mental illness) Tj ET BT 0.9835 0 0 0.9835 334.8 447.6 Tm 0.0296 Tc 0.8896 Tw (and mental retardation, are required in the) Tj -0.4881 -12.2018 TD 0.03 Tc 2.7031 Tw (resident\222s comprehensive plan of care, the) Tj ET BT 0.8915 0 0 0.9835 334.8 424.56 Tm 0.0031 Tc 2.868 Tw (facility must:) Tj ET BT 0.934 0 0 0.9835 346.8 404.88 Tm -0.0491 Tc 1.4336 Tw (1. provide the required services, or) Tj ET BT 0.9835 0 0 0.9835 345.84 391.44 Tm 0.0268 Tc 2.8447 Tw (2. obtain the required services from an) Tj ET BT 0.934 0 0 0.9835 360 379.2 Tm -0.0418 Tc 3.3443 Tw (outside...provider of specialized rehabil-) Tj 0 -10.9816 TD -0.036 Tc 1.4967 Tw (itative services. \222) Tj -26.2095 -20.255 TD -0.0253 Tc 0.643 Tw (\221\221The resident has the right to be flee from any) Tj ET BT 0.9835 0 0 0.9835 335.04 336.48 Tm 0.0227 Tc 1.7344 Tw (physical or chemical restraints imposed for) Tj ET BT 0.934 0 0 0.9835 335.04 324.48 Tm -0.0474 Tc 1.8086 Tw (purposes of discipline or convenience, and not) Tj 0 -11.9577 TD -0.0379 Tc 1.5415 Tw (required to treat the resident\222s medical symp-) Tj ET BT 0.9835 0 0 0.9835 335.52 300.48 Tm 0.3805 Tc 0 Tw (toms.\222) Tj 0.4881 -14.1541 TD 0.0229 Tc 1.1404 Tw (\223Each resident\222s drug regimen must be free) Tj ET BT 0.934 0 0 0.9835 335.76 274.8 Tm -0.0124 Tc 0.9832 Tw (from unnecessary drugs. 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Tj ET BT 0.9835 0 0 0.9835 326.16 111.12 Tm 0.0363 Tc 1.5742 Tw (. \223Based on a comprehensive assessment of a) Tj 35.1411 135.4398 TD 0.0372 Tc 2.1833 Tw (in excessive dose \(including duplicate) Tj ET BT 0.934 0 0 0.9835 360.72 232.32 Tm -0.0259 Tc 0.5865 Tw (drug therapy\); or) Tj 0 -13.91 TD -0.0438 Tc 1.8048 Tw (for excessive duration; or) Tj 0 -13.422 TD -0.0249 Tc 0.8423 Tw (without adequate monitoring; or) Tj 0 -13.666 TD -0.0265 Tc 1.358 Tw (without adequate indications for its use;) Tj ET BT 0.8915 0 0 0.9835 361.2 180 Tm 0.1226 Tc 0 Tw (or) Tj ET BT 0.934 0 0 0.9835 361.2 166.8 Tm -0.0438 Tc 1.839 Tw (in the presence of adverse consequences) Tj ET BT 0.9835 0 0 0.9835 361.44 154.56 Tm 0.0418 Tc 1.6906 Tw (which indicate the dose should be re-) Tj ET BT 0.934 0 0 0.9835 361.44 142.56 Tm -0.054 Tc 1.8157 Tw (duced or discontinued; or) Tj 0 -12.6899 TD -0.0114 Tc 0.8707 Tw (any combinations of the reasons above. \224) Tj ET BT 0.8915 0 0 0.9835 336.24 100.56 Tm 0.0181 Tc 1.2359 Tw (resident, the facility must ensure that:) Tj ET BT 0.6793 0 0 0.9835 348.96 80.88 Tm 0.2439 Tc 0 Tw (1.) 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Tj -135.6725 -18.7907 TD -0.0347 Tc 1.22 Tw (With the exception of the last requirement, none) Tj ET BT 0.9835 0 0 0.9835 76.32 201.84 Tm 0.0274 Tc 0.1679 Tw (of these requirements mentions cognitive impair-) Tj ET BT 0.934 0 0 0.9835 76.32 189.6 Tm -0.0241 Tc 1.0985 Tw (ment or dementia. Many of the requirements refer,) Tj ET BT 0.9835 0 0 0.9835 76.32 177.84 Tm 0.0428 Tc 0.9749 Tw (however, to residents\222 needs as identified by the) Tj ET BT 0.934 0 0 0.9835 76.32 166.08 Tm -0.0326 Tc 1.3645 Tw (required comprehensive assessment. If the compre-) Tj ET BT 0.8915 0 0 0.9835 76.56 154.08 Tm 0.0222 Tc 2.0838 Tw (hensive assessment identifies the needs of residents) Tj ET BT 0.9835 0 0 0.9835 77.04 142.08 Tm 0.0273 Tc -0.0029 Tw (with dementia, the regulations require that these) Tj ET BT 0.934 0 0 0.9835 76.8 130.56 Tm -0.0303 Tc 0.7197 Tw (needs be met.) Tj 12.0769 -18.3027 TD -0.0267 Tc 1.8721 Tw (OBRA-87 mandated the development of a set of) Tj -11.82 -12.2018 TD -0.0507 Tc 1.4482 Tw (core items to be addressed in the required compre-) Tj ET BT 0.8915 0 0 0.9835 77.04 88.8 Tm 0.0308 Tc 1.8049 Tw (hensive assessment. In 1988, HCFA contracted with) Tj ET BT 0.9835 0 0 0.9835 77.28 76.56 Tm 0.022 Tc 0.2873 Tw (a consortium of researchers at Research Triangle) Tj ET BT 0.934 0 0 0.9835 77.28 64.56 Tm -0.0334 Tc 2.5988 Tw (Institute, Hebrew Rehabilitation Center for Aged,) Tj -0.257 -11.9577 TD -0.0171 Tc 1.7762 Tw (Brown University, and the University of Michigan) Tj ET BT 0.8915 0 0 0.9835 77.28 40.8 Tm 0.0136 Tc 1.8947 Tw (to develop a resident assessment system that would) Tj 276.7318 619.6065 TD 0.0339 Tc 1.6028 Tw (include these core items \(308\). The resulting assess-) Tj ET BT 0.934 0 0 0.9835 324 638.16 Tm -0.013 Tc 0.7975 Tw (ment system consists of two parts: 1\) the Minimum) Tj 0 -12.2018 TD -0.0095 Tc 0.4833 Tw (Data Set, a 5-page resident assessment instrument,) Tj ET BT 0.9835 0 0 0.9835 324.24 613.92 Tm 0.0366 Tc 2.8347 Tw (and 2\) 18 Resident Assessment Protocols that) Tj -0.244 -12.2018 TD 0.0316 Tc 1.5301 Tw (provide additional information to assist nursing) Tj 0 -12.2018 TD 0.0338 Tc 0.6413 Tw (home staff members in assessing and developing) Tj ET BT 0.8915 0 0 0.9835 324.48 577.68 Tm 0.039 Tc 1.3663 Tw (care plans for residents with certain problems \(309\).) Tj ET BT 0.934 0 0 0.9835 324.72 565.92 Tm -0.0201 Tc 1.6081 Tw (States may use this assessment system or develop) Tj -0.257 -11.9577 TD -0.0502 Tc 1.4155 Tw (one of their own, provided the system they develop) Tj 0.257 -11.9577 TD -0.0316 Tc 1.235 Tw (incorporates the core items \(308\).) Tj 11.563 -24.6476 TD -0.0019 Tc 1.8884 Tw (The Minimum Data Set emphasizes the assess-) Tj -11.306 -12.4458 TD -0.0195 Tc 1.3505 Tw (ment of a resident\222s cognitive status. Six questions) Tj ET BT 0.8915 0 0 0.9835 325.44 493.92 Tm 0.026 Tc 0.8981 Tw (about cognitive status appear on the first page of the) Tj 0 -12.2018 TD 0.0225 Tc 2.3616 Tw (assessment instrument, immediately after the basic) Tj ET BT 0.9835 0 0 0.9835 325.44 469.92 Tm 0.0342 Tc 0.7954 Tw (identifying information about the resident \(309\).) Tj ET BT 0.934 0 0 0.9835 325.68 457.68 Tm -0.0065 Tc 0.6513 Tw (\(Fig. 5-1 shows the first page of the Minimum Data) Tj 0 -11.9577 TD -0.0233 Tc 2.1683 Tw (Set.\) Other sections of the assessment instrument) Tj ET BT 0.9835 0 0 0.9835 325.68 434.16 Tm 0.0385 Tc 0.2704 Tw (include questions about problems and care needs) Tj ET BT 0.8915 0 0 0.9835 325.92 422.16 Tm 0.027 Tc 1.4054 Tw (that pertain particularly to residents with dementia.) 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That section also asks whether) Tj ET BT 0.9835 0 0 0.9835 326.64 314.4 Tm 0.045 Tc 1.5653 Tw (the \223behavior problem has been addressed by a) Tj 0 -11.7137 TD 0.038 Tc 2.6706 Tw (clinically developed behavior management pro-) Tj 0.244 -11.9577 TD 0.0094 Tc -0.037 Tw (gram. . .\(not including\) only physical restraints or) Tj -0.4881 -12.2018 TD 0.0277 Tc 2.6201 Tw (psychotropic medications\224 \(309\). Other sections) Tj 0.4881 -11.9577 TD 0.0185 Tc 1.8363 Tw (ask about the resident\222s customary routine, the) Tj ET BT 0.8915 0 0 0.9835 326.88 255.6 Tm 0.0402 Tc 2.2879 Tw (resident\222s involvement and preferences in activities,) Tj ET BT 0.934 0 0 0.9835 327.12 243.36 Tm -0.0221 Tc 1.2676 Tw (the number of medications he or she is taking, the) Tj -0.257 -12.2018 TD -0.0307 Tc 0.4888 Tw (number of days in the preceding week he or she has) Tj ET BT 0.8915 0 0 0.9835 326.88 219.36 Tm 0.0334 Tc 1.1515 Tw (received antipsychotic, antianxiety, or antidepressant) Tj ET BT 0.9835 0 0 0.9835 327.12 207.12 Tm 0.033 Tc 0.427 Tw (medications, and the frequency of use of physical) Tj ET BT 0.8491 0 0 0.9835 326.88 195.36 Tm 0.0318 Tc 0 Tw (restraints.) Tj ET BT 0.934 0 0 0.9835 338.4 171.6 Tm -0.0384 Tc 1.5313 Tw (A one-page form to be used for quarterly review) Tj ET BT 0.9835 0 0 0.9835 327.6 159.6 Tm 0.0322 Tc 3.2378 Tw (of a resident\222s comprehensive assessment also) Tj ET BT 0.934 0 0 0.9835 327.6 147.6 Tm -0.0214 Tc 2.6373 Tw (emphasizes cognitive status and certain problems) Tj ET BT 0.8915 0 0 0.9835 327.84 135.6 Tm 0.0383 Tc 1.2133 Tw (and care needs that pertain particularly to residents) Tj ET BT 0.9835 0 0 0.9835 327.84 124.08 Tm 0.0279 Tc -0.0035 Tw (with dementia \(309\). The form includes questions) Tj 0.244 -11.7137 TD 0.025 Tc 0.5282 Tw (about memory, cognitive skills for daily decision-) Tj ET BT 0.934 0 0 0.9835 327.84 100.32 Tm 0.0001 Tc 1.3723 Tw (making, behavioral symptoms, the number of days) Tj ET BT 0.9835 0 0 0.9835 327.84 88.56 Tm 0.0398 Tc 1.222 Tw (in the preceding week the resident has received) Tj ET BT 0.934 0 0 0.9835 328.08 76.32 Tm -0.0215 Tc 1.7381 Tw (antipsychotic, antianxiety, or antidepressant medi-) Tj ET BT 0.9835 0 0 0.9835 328.08 64.08 Tm 0.0327 Tc 3.6348 Tw (cations, and the frequency of use of physical) Tj -0.4881 -11.9577 TD 0.0336 Tc 0.6705 Tw (restraints. 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Several other) Tj ET BT 0.9835 0 0 0.9835 72.48 558.48 Tm 0.0375 Tc 0.3528 Tw (Resident Assessment Protocols address problems) Tj ET BT 0.934 0 0 0.9835 72.72 546.72 Tm -0.0233 Tc 1.4509 Tw (and care needs that are relevant for nursing home) Tj ET BT 0.9835 0 0 0.9835 72.24 534.72 Tm 0.0208 Tc 0.1746 Tw (residents with dementia, including delirium, psy-) Tj 0.4881 -11.9577 TD 0.0191 Tc 0.9816 Tw (chosocial problems, behavioral symptoms, activi-) Tj ET BT 0.8915 0 0 0.9835 72.96 510.72 Tm 0.0234 Tc 1.9479 Tw (ties, psychotropic drug use, and physical restraints.) Tj ET BT 0.9835 0 0 0.9835 84 492.24 Tm 0.0231 Tc 1.0385 Tw (Compared with other assessment instruments) Tj -11.4697 -12.4458 TD 0.0247 Tc 1.403 Tw (used in nursing homes in the past, the resident) Tj 0.4881 -12.4458 TD 0.0291 Tc 0.6054 Tw (assessment system developed by the consortium,) Tj ET BT 0.934 0 0 0.9835 73.44 456 Tm -0.0128 Tc 1.1965 Tw (including the Minimum Data Set and the Resident) Tj -0.257 -12.2018 TD -0.0275 Tc 1.5646 Tw (Assessment Protocols, places much greater empha-) Tj 0.5139 -12.2018 TD -0.024 Tc 0.9515 Tw (sis on assessment of residents\222 cognitive status and) Tj ET BT 0.8915 0 0 0.9835 73.44 420.48 Tm 0.0506 Tc 0.5938 Tw (the problems and care needs that are common among) Tj 0 -11.9577 TD 0.0341 Tc 1.2179 Tw (nursing home residents with dementia. Although the) Tj ET BT 0.9835 0 0 0.9835 73.44 396.48 Tm 0.0347 Tc -0.0917 Tw (existence of this resident assessment system does) Tj ET BT 0.934 0 0 0.9835 73.44 384.72 Tm -0.0244 Tc 1.4521 Tw (not guarantee that a resident\222s needs will be accu-) Tj 0 -12.2018 TD -0.0454 Tc 1.8922 Tw (rately identified or, once identified, that the needs) Tj ET BT 0.9835 0 0 0.9835 73.92 360.72 Tm 0.0265 Tc 0.486 Tw (will be met, the existence of the system certainly) Tj ET BT 0.934 0 0 0.9835 73.92 348.96 Tm -0.029 Tc 1.6176 Tw (makes both outcomes more likely.) Tj ET BT 0.9835 0 0 0.9835 84.96 330.24 Tm 0.0311 Tc 1.0304 Tw (As of January 1992, all States were using the) Tj ET BT 0.934 0 0 0.9835 73.92 318.48 Tm -0.0361 Tc 2.3104 Tw (resident assessment system developed by the con-) Tj 0.5139 -12.2018 TD -0.0148 Tc 0.7949 Tw (sortium \(329\). Eleven States had added some items) Tj -0.257 -11.9577 TD 0.0018 Tc 0.4284 Tw (to the Minimum Data Set.) Tj ET BT 0.9795 0 0 0.9795 118.56 262.08 Tm /F7 12 Tf 0.051 Tc 0.7445 Tw (State Licensing Regulations) Tj ET BT 0.8915 0 0 0.9835 85.44 244.08 Tm /F4 10 Tf 0.0416 Tc 1.3441 Tw (Each State licenses nursing homes on the basis of) Tj ET BT 0.9835 0 0 0.9835 74.88 231.84 Tm 0.0194 Tc 2.7627 Tw (State standards. Although nursing homes that) Tj -0.244 -11.9577 TD 0.0437 Tc 2.8566 Tw (choose not to participate in the Medicare and) Tj -0.244 -12.2018 TD 0.0343 Tc 3.2031 Tw (Medicaid programs are not subject to Federal) Tj 0.244 -12.2018 TD 0.0296 Tc 1.9714 Tw (Medicare and Medicaid regulations, all nursing) Tj 0 -12.2018 TD 0.0232 Tc 0.8961 Tw (homes are subject to State licensing regulations,) Tj ET BT 0.8915 0 0 0.9835 74.88 172.32 Tm 0.0396 Tc 1.5259 Tw (including nursing homes that serve only private-pay) Tj ET BT 0.934 0 0 0.9835 74.64 160.32 Tm 0.009 Tc 2.3479 Tw (residents \(225,320\).) Tj ET BT 0.9835 0 0 0.9835 86.16 141.6 Tm 0.0204 Tc 0.8583 Tw (State licensing regulations vary greatly. Some) Tj ET BT 0.934 0 0 0.9835 75.36 129.36 Tm -0.0211 Tc 0.6242 Tw (States have very complex, stringent, licensing regu-) Tj ET BT 0.9835 0 0 0.9835 75.12 117.84 Tm 0.0273 Tc 1.4613 Tw (lations, whereas other States have simpler, less) Tj 0.4881 -12.2018 TD 0.0255 Tc 1.0971 Tw (stringent regulations \(94,225,318\). In 1984, one-) Tj ET BT 0.8915 0 0 0.9835 75.36 94.08 Tm 0.0329 Tc 1.0511 Tw (fourth of the States were using the Federal Medicaid) Tj ET BT 0.934 0 0 0.9835 74.88 82.32 Tm -0.0205 Tc 1.146 Tw (regulations for State licensing purposes \(318\).) Tj ET BT 0.8915 0 0 0.9835 86.4 63.84 Tm 0.0242 Tc 0.6907 Tw (Administrative rulings and interpretations of State) Tj ET BT 0.934 0 0 0.9835 75.6 51.84 Tm -0.02 Tc 2.3275 Tw (licensing regulations are common. These adminis-) Tj 0 -11.9577 TD -0.0292 Tc 0.7368 Tw (trative rulings and interpretations become part of a) Tj ET BT 0.9835 0 0 0.9835 322.8 648.48 Tm 0.0309 Tc 0.0341 Tw (State\222s licensing regulations and generally add to) Tj ET BT 0.934 0 0 0.9835 322.56 636.48 Tm -0.0401 Tc 1.8864 Tw (their complexity.) Tj 12.0769 -18.0586 TD -0.0188 Tc 1.3926 Tw (Five States have changed their licensing regula-) Tj ET BT 0.8915 0 0 0.9835 323.04 606.72 Tm 0.0381 Tc 1.348 Tw (tions to add requirements for special care units, and) Tj ET BT 0.934 0 0 0.9835 323.28 594.48 Tm -0.027 Tc 1.8724 Tw (one State has established requirements for special) Tj ET BT 0.8915 0 0 0.9835 323.28 582.24 Tm 0.0381 Tc 0.4059 Tw (care units as an interpretation of the State\222s licensing) Tj ET BT 0.934 0 0 0.9835 323.04 570.72 Tm -0.0221 Tc 1.1478 Tw (requirements. These State regulations and require-) Tj ET BT 0.8915 0 0 0.9835 323.28 558.72 Tm 0.0291 Tc 1.1338 Tw (ments are discussed later in this chapter.) Tj ET BT 0.9835 0 0 0.9835 334.56 541.2 Tm 0.0434 Tc -0.0925 Tw (Federal Medicare and Medicaid regulations re-) Tj ET BT 0.8915 0 0 0.9835 323.52 528.96 Tm 0.0404 Tc 1.2446 Tw (quire that nursing homes have a State license \(463\).) Tj ET BT 0.9835 0 0 0.9835 323.52 516.96 Tm 0.0364 Tc 0.2624 Tw (In effect, therefore, for a given State, the Federal) Tj ET BT 0.8915 0 0 0.9835 323.28 504.72 Tm 0.0442 Tc 1.5297 Tw (regulations incorporate that State\222s licensing regula-) Tj ET BT 0.934 0 0 0.9835 324 492.48 Tm -0.0136 Tc 0.3164 Tw (tions. In the ) Tj ET BT 0.9606 0 0 0.9863 380.4 492.48 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (case ) Tj ET BT 0.934 0 0 0.9835 402.24 492.48 Tm /F4 10 Tf -0.0291 Tc 1.2966 Tw (of States whose requirements are) Tj ET BT 0.9835 0 0 0.9835 324 480.72 Tm 0.0136 Tc 0.2551 Tw (more stringent ) Tj ET BT 0.9863 0 0 0.9863 396 480.72 Tm /F3 9 Tf -0.0003 Tc -0.0694 Tw (or ) Tj ET BT 0.9835 0 0 0.9835 407.52 480.72 Tm /F4 10 Tf 0.0341 Tc 0.7833 Tw (just different than the Federal) Tj ET BT 0.934 0 0 0.9835 323.76 468.48 Tm -0.0247 Tc 0.4567 Tw (requirements in ) Tj ET BT 0.9427 0 0 0.9812 396.96 468.48 Tm /F6 11 Tf 0.0234 Tc 0.0243 Tw (some ) Tj ET BT 0.9189 0 0 0.99 422.16 468.48 Tm /F3 8 Tf 0.0229 Tc 0.1021 Tw (other ) Tj ET BT 0.934 0 0 0.9835 443.28 468.48 Tm /F4 10 Tf -0.0258 Tc 1.0147 Tw (way, these different and) Tj ET BT 0.9835 0 0 0.9835 324 456.24 Tm 0.0323 Tc 0.1629 Tw (more stringent State requirements effectively be-) Tj ET BT 0.9189 0 0 0.99 324.24 444.72 Tm /F3 8 Tf 0.0006 Tc 0.1264 Tw (come ) Tj ET BT 0.934 0 0 0.9835 346.08 444.72 Tm /F4 10 Tf -0.0343 Tc 1.2379 Tw (part of the Federal requirements.) Tj ET BT 0.9795 0 0 0.9795 345.6 418.8 Tm /F7 12 Tf 0.0552 Tc 0.4952 Tw (State Certificate of Need Regulations) Tj ET BT 0.8915 0 0 0.9835 335.52 401.04 Tm /F4 10 Tf 0.0342 Tc 0.7948 Tw (State certificate of need laws require explicit State) Tj ET BT 0.9835 0 0 0.9835 324.72 389.04 Tm 0.0618 Tc 2.7684 Tw (approval before) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.99 0 0 0.99 404.64 389.04 Tm /F3 8 Tf -0.085 Tc 0.0434 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 411.6 389.04 Tm /F4 10 Tf 0.0145 Tc 1.8404 Tw (nursing home can be built) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.99 0 0 0.99 542.64 389.04 Tm /F3 8 Tf 0.2419 Tc 0 Tw (or) Tj ET BT 0.9835 0 0 0.9835 324.72 377.04 Tm /F4 10 Tf 0.0392 Tc 1.6627 Tw (expanded. As of 1988, 38 States had such laws) Tj ET BT 0.934 0 0 0.9835 325.2 364.8 Tm -0.0312 Tc 1.5771 Tw (\(333\). Certificate of need laws are intended) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 522.72 364.8 Tm /F3 9 Tf -0.0044 Tc -0.0003 Tw (to limit) Tj ET BT 0.9863 0 0 0.9863 324.72 353.28 Tm 0.0402 Tc -0.1106 Tw (the ) Tj ET BT 0.9835 0 0 0.9835 341.28 353.28 Tm /F4 10 Tf 0.0318 Tc 1.0907 Tw (supply of nursing home beds in) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 493.2 353.28 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 500.88 353.28 Tm /F4 10 Tf 0.0287 Tc 0.3617 Tw (State. It ) Tj ET BT 0.9812 0 0 0.9812 543.12 353.28 Tm /F6 11 Tf 0.2429 Tc 0 Tw (is) Tj ET BT 0.934 0 0 0.9835 325.2 341.04 Tm /F4 10 Tf -0.0436 Tc 1.3763 Tw (generally believed) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 408.24 341.04 Tm /F3 8 Tf -0.0088 Tc 0.1366 Tw (that ) Tj ET BT 0.934 0 0 0.9835 424.08 341.04 Tm /F4 10 Tf -0.0085 Tc 0.9961 Tw (any additional nursing home) Tj -106.3796 -12.2018 TD -0.0406 Tc 1.159 Tw (beds will eventually be filled with Medicaid-eligible) Tj ET BT 0.8915 0 0 0.9835 324.72 317.28 Tm 0.0298 Tc 1.4919 Tw (residents and ultimately increase State expenditures) Tj ET BT 0.934 0 0 0.9835 325.2 305.76 Tm -0.0193 Tc 1.0291 Tw (for nursing home care \(318\). By controlling the bed) Tj ET BT 0.8915 0 0 0.9835 325.44 293.52 Tm 0.0285 Tc 1.5607 Tw (supply, certificate of need laws are expected to limit) Tj 0 -11.7137 TD 0.0213 Tc 2.0399 Tw (these expenditures.) Tj ET BT 0.9835 0 0 0.9835 336.24 264 Tm 0.0374 Tc -0.1352 Tw (The process of obtainin) Tj 108.3518 -0.244 TD 0.0437 Tc 0.1025 Tw (g a certificate of need is) Tj ET BT 0.8915 0 0 0.9835 325.44 252.24 Tm 0.0287 Tc 1.3586 Tw (lengthy and complex in many States. Tables 6-2 and) Tj ET BT 0.934 0 0 0.9835 325.44 240.24 Tm -0.0208 Tc 0.8951 Tw (6-3 in chapter 6 list the steps involved in obtaining) Tj ET BT 0.9835 0 0 0.9835 325.68 228.24 Tm 0.0349 Tc 1.5407 Tw (a certificate of need in Massachusetts and New) Tj ET BT 0.934 0 0 0.9835 325.44 216.24 Tm -0.0306 Tc 0.6771 Tw (York. As discussed later in this chapter, at least six) Tj ET BT 0.9835 0 0 0.9835 325.68 204 Tm 0.0407 Tc 1.9532 Tw (States have altered the process for obtaining a) Tj ET BT 0.8915 0 0 0.9835 325.68 192.24 Tm 0.0297 Tc 1.6267 Tw (certificate of need so that applicants who propose to) Tj ET BT 0.934 0 0 0.9835 325.92 180.24 Tm -0.0471 Tc 2.1938 Tw (create special care units receive special considera-) Tj ET BT 0.8915 0 0 0.9835 325.68 168.24 Tm 0.0109 Tc 0 Tw (tion.) Tj ET BT 0.9795 0 0 0.9795 352.56 142.08 Tm /F7 12 Tf 0.0372 Tc 0.7586 Tw (Other State and Local Government) Tj -20.0926 -13.9668 TD 0.0472 Tc 0.6749 Tw (Regulations That Apply to Nursing Homes) Tj ET BT 0.9835 0 0 0.9835 336.96 110.88 Tm /F4 10 Tf 0.0294 Tc 1.2884 Tw (Many State and local government regulations) Tj ET BT 0.934 0 0 0.9835 326.4 98.88 Tm -0.0207 Tc 1.3839 Tw (apply to nursing homes as well as other buildings,) Tj -0.257 -11.9577 TD -0.0193 Tc 0.8792 Tw (businesses, and health care facilities. These regula-) Tj 0 -12.2018 TD -0.0348 Tc 1.6973 Tw (tions include fire safety codes, zoning codes, build-) Tj ET BT 0.9835 0 0 0.9835 326.4 63.36 Tm 0.038 Tc 2.4092 Tw (ing codes, and sanitation codes. Some of these) Tj ET BT 0.934 0 0 0.9835 326.16 51.6 Tm -0.0383 Tc 1.8332 Tw (regulations are incorporated into the requirements) Tj 0.257 -12.2018 TD -0.0328 Tc 0.651 Tw (for obtaining a State license or a certificate of need.) Tj ET endstream endobj 438 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 439 0 obj <>stream 0.72 w 1 j 0 0 0 RG 61.2 676.08 m 538.32 676.08 l S BT 0.9835 0 0 0.9835 251.28 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0225 Tc 1.5895 Tw (Chapter 5-Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 515.52 681.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522 681.6 Tm /F5 10 Tf 0.2847 Tc 0 Tw (139) Tj ET BT 0.9795 0 0 0.9795 84.48 640.56 Tm /F7 12 Tf 0.0416 Tc 0.6316 Tw (Survey and Certification Procedures) Tj ET BT 0.8875 0 0 0.9795 72.72 619.92 Tm -0.0203 Tc -0.0043 Tw (Nursing ) Tj ET BT 0.8915 0 0 0.9835 112.32 619.92 Tm /F4 10 Tf 0.044 Tc 0.6684 Tw (homes are inspected regularly by individ-) Tj -56.5308 -12.6899 TD 0.0493 Tc 0.9991 Tw (ual surveyors or teams of surveyors who monitor the) Tj ET BT 0.9835 0 0 0.9835 62.16 595.92 Tm 0.0337 Tc 2.553 Tw (facilities\222 compliance with each of the types of) Tj -0.244 -12.2018 TD 0.0226 Tc -0.0155 Tw (regulations discussed thus far in this chapter. Al-) Tj 0.4881 -12.2018 TD 0.0216 Tc 1.6298 Tw (though the regulations are clearly important in) Tj ET BT 0.934 0 0 0.9835 62.4 560.16 Tm -0.0357 Tc 1.7349 Tw (themselves, their impact depends on how they are) Tj ET BT 0.8915 0 0 0.9835 62.4 548.4 Tm 0.0291 Tc 1.7082 Tw (interpreted and applied by the surveyors.) Tj ET BT 0.934 0 0 0.9835 73.44 528.24 Tm -0.0279 Tc 2.0447 Tw (Inspection and certification of nursing homes is) Tj ET BT 0.8915 0 0 0.9835 62.4 516.24 Tm 0.027 Tc 1.572 Tw (primarily a State function \(149,225\). Each State has) Tj ET BT 0.9835 0 0 0.9835 63.12 504.48 Tm 0.0431 Tc 0.3471 Tw (at least one agency--often referred to as a survey) Tj ET BT 0.934 0 0 0.9835 63.12 492.48 Tm -0.0291 Tc 1.1038 Tw (and certification agency\227that performs inspections) Tj -0.257 -11.9577 TD -0.0356 Tc 2.053 Tw (for Medicare and Medicaid certification of nursing) Tj ET BT 0.9835 0 0 0.9835 62.88 468.72 Tm 0.02 Tc 0.2486 Tw (homes. This agency usually also performs inspec-) Tj ET BT 0.934 0 0 0.9835 63.36 456.72 Tm -0.028 Tc 1.9836 Tw (tions for State licensing purposes, but other State) Tj 0 -12.2018 TD -0.0362 Tc 0.9646 Tw (and local agencies are involved in these inspections) Tj 0.257 -11.9577 TD -0.0178 Tc 0.5778 Tw (as well. heal building inspectors, fire marshals, and) Tj ET BT 0.9835 0 0 0.9835 63.84 420.96 Tm 0.0161 Tc 1.0578 Tw (sanitarians inspect nursing homes in connection) Tj ET BT 0.934 0 0 0.9835 63.6 408.96 Tm -0.0339 Tc 3.2289 Tw (with certification requirements, licensing require-) Tj ET BT 0.8915 0 0 0.9835 63.36 397.2 Tm 0.0367 Tc 1.0612 Tw (ments, and other State and local government regula-) Tj ET BT 0.934 0 0 0.9835 63.84 385.44 Tm -0.0192 Tc 0.6528 Tw (tions that apply to nursing homes. The Department) Tj ET BT 0.9835 0 0 0.9835 63.84 373.2 Tm 0.0501 Tc 0.3705 Tw (of Veterans Affairs \(VA\) also inspects all VA and) Tj 0.244 -11.9577 TD 0.0217 Tc -0.0146 Tw (nonVA nursing homes in which it places veterans) Tj ET BT 0.934 0 0 0.9835 64.56 349.2 Tm 0.0551 Tc 0 Tw (\(289\).) Tj ET BT 0.8915 0 0 0.9835 75.12 328.8 Tm 0.0533 Tc 1.0427 Tw (The resources allocated by State and local govern-) Tj ET BT 0.9835 0 0 0.9835 64.08 317.04 Tm 0.019 Tc 0.9294 Tw (ments to nursing home inspections vary. A 1989) Tj ET BT 0.8915 0 0 0.9835 64.8 304.8 Tm 0.0302 Tc 1.1839 Tw (survey of State agencies that perform inspections for) Tj ET BT 0.934 0 0 0.9835 64.32 292.8 Tm -0.0308 Tc 2.1334 Tw (Medicaid certification and/or State licensing found) Tj 0.257 -12.4458 TD -0.0227 Tc 0.526 Tw (that 5 States had fewer than one surveyor for every) Tj 1.2848 -11.9577 TD -0.007 Tc 0.8803 Tw (10 nursing homes, whereas 5 States had 3 or more) Tj -0.5139 -12.2018 TD -0.0086 Tc 1.1247 Tw (surveyors for every 10 nursing homes \(149\).) Tj ET BT 0.9835 0 0 0.9835 76.08 236.4 Tm 0.0353 Tc 0.0296 Tw (OBRA-87 mandated changes in the survey and) Tj ET BT 0.934 0 0 0.9835 65.04 224.4 Tm -0.0491 Tc 1.8961 Tw (certification procedures for Medicare and Medicaid) Tj ET BT 0.9835 0 0 0.9835 65.04 212.16 Tm 0.0289 Tc 0.9716 Tw (certification of nursing homes. Coupled with the) Tj ET BT 0.934 0 0 0.9835 64.8 200.16 Tm -0.0404 Tc 1.1587 Tw (new requirements for Medicare and Medicaid certi-) Tj ET BT 0.8915 0 0 0.9835 65.28 188.16 Tm 0.0323 Tc 1.8032 Tw (fication, the survey procedures mandated by OBRA-) Tj ET BT 0.934 0 0 0.9835 65.76 175.92 Tm -0.0356 Tc 1.1108 Tw (87 are intended to focus more on residents and the) Tj ET BT 0.9835 0 0 0.9835 65.52 163.92 Tm 0.0312 Tc 2.0326 Tw (outcomes of care than on written policies, staff) Tj 0 -11.9577 TD 0.0284 Tc 2.0703 Tw (credentials, physical design features, and other) Tj 0 -11.7137 TD 0.0213 Tc 3.1583 Tw (factors that may affect a facility\222s capacity to) Tj ET BT 0.934 0 0 0.9835 65.52 128.64 Tm -0.0126 Tc 1.8999 Tw (provide care \(309,462,456\). The new survey proce-) Tj 0.257 -11.9577 TD -0.0411 Tc 1.1488 Tw (dures are also intended to allow survey agencies to) Tj 0 -12.2018 TD -0.0234 Tc 1.9971 Tw (concentrate their attention on nursing homes that) Tj 0 -11.7137 TD -0.0145 Tc 1.8077 Tw (provide substandard care \(456\). OBRA-87 requires) Tj ET BT 0.9835 0 0 0.9835 66.24 81.6 Tm 0.0213 Tc 0.776 Tw (that each nursing home receive an unannounced) Tj 0.7321 -12.2018 TD 0.0226 Tc 4.2725 Tw (\223standard survey\224) Tj 96.3941 0 TD 0.0124 Tc 1.1104 Tw (annually. Facilities that are) Tj ET BT 0.8915 0 0 0.9835 66.24 57.6 Tm 0.0229 Tc 1.2305 Tw (found in the standard survey to provide substandard) Tj ET BT 0.9835 0 0 0.9835 66.24 45.36 Tm 0.0265 Tc 0.8521 Tw (care must receive an \223extended survey\224 within 2) Tj ET BT 0.934 0 0 0.9835 66.24 33.6 Tm -0.0449 Tc 1.3777 Tw (weeks. The extended survey is intended to identify) Tj ET BT 0.8915 0 0 0.9835 312 642.24 Tm 0.0371 Tc 1.3684 Tw (the facility\222s policies and procedures that resulted in) Tj 0.5384 -12.4458 TD 0.0308 Tc 0.5487 Tw (the substandard care.) Tj 12.3829 -18.3027 TD 0.0179 Tc 1.8195 Tw (OBRA-87 makes States responsible for the stand-) Tj ET BT 0.934 0 0 0.9835 312.72 600.24 Tm 0.0012 Tc 1.3712 Tw (ard and extended surveys \(320,456\). Annually, the) Tj -0.257 -12.2018 TD -0.0384 Tc 1.6705 Tw (Federal Government is required to conduct valida-) Tj ET BT 0.9835 0 0 0.9835 312.72 576.48 Tm 0.0312 Tc 1.1184 Tw (tion surveys of at least 5 percent of the nursing) Tj ET BT 0.8915 0 0 0.9835 312.48 564.72 Tm 0.0438 Tc 1.4426 Tw (homes surveyed by each State in order to determine) Tj ET BT 0.9835 0 0 0.9835 312.96 552.72 Tm 0.0338 Tc 2.274 Tw (the adequacy of the State survey. The Federal) Tj ET BT 0.8915 0 0 0.9835 313.2 540.72 Tm 0.0342 Tc 2.0703 Tw (Government is also required to inspect State-owned) Tj 0 -11.7137 TD 0.0417 Tc 2.5554 Tw (nursing homes.) Tj ET BT 0.934 0 0 0.9835 324.48 510.96 Tm -0.0219 Tc 0.7535 Tw (OBRA-87 requires that surveys for Medicare and) Tj ET BT 0.9835 0 0 0.9835 313.2 499.44 Tm 0.0329 Tc 1.7404 Tw (Medicaid certification of nursing homes be con-) Tj 0.244 -12.4458 TD 0.0167 Tc 1.7568 Tw (ducted by a multidisciplinary team, including a) Tj ET BT 0.934 0 0 0.9835 313.2 475.44 Tm -0.0192 Tc 0.6527 Tw (registered nurse \(320\). Members of the survey team) Tj ET BT 0.8915 0 0 0.9835 313.44 463.44 Tm -0.0033 Tc 2.0675 Tw (must meet) Tj ET BT 0.934 0 0 0.9835 362.16 463.2 Tm -0.0107 Tc 1.3411 Tw (minimum Federal qualifications, includ-) Tj -51.6481 -11.9577 TD -0.0327 Tc 0.9609 Tw (ing completion of a federally approved training and) Tj 0 -12.2018 TD -0.0146 Tc 1.2168 Tw (testing program. OBRA-87 also requires that State) Tj 0.5139 -12.2018 TD -0.0305 Tc 2.0304 Tw (survey and certification agencies employ sufficient) Tj ET BT 0.9835 0 0 0.9835 314.4 415.44 Tm 0.0319 Tc 2.9209 Tw (staff to investigate complaints and to monitor) Tj ET BT 0.8915 0 0 0.9835 314.16 403.68 Tm 0.0444 Tc 0.8774 Tw (facilities that do not meet the requirements or are in) Tj ET BT 0.934 0 0 0.9835 314.16 391.68 Tm -0.0146 Tc 1.7307 Tw (danger of falling out of compliance \(320\).) Tj ET BT 0.9835 0 0 0.9835 325.44 373.68 Tm 0.0437 Tc -0.1416 Tw (One purpose of the new survey procedures is to) Tj -11.2256 -11.9577 TD 0.0295 Tc 0.8897 Tw (reduce the inconsistency of survey procedures in) Tj 0.244 -12.4458 TD 0.0477 Tc 3.1732 Tw (different States and localities \(320\). OBRA-87) Tj ET BT 0.8915 0 0 0.9835 314.4 337.92 Tm 0.0285 Tc 1.1858 Tw (requires that the standard and extended surveys use) Tj 0.8076 -12.4458 TD 0.0166 Tc 1.1479 Tw (a survey instrument developed, tested, and validated) Tj ET BT 0.934 0 0 0.9835 314.64 313.68 Tm -0.0247 Tc 1.4846 Tw (by the Federal Government. The surveyor training) Tj 0 -12.2018 TD -0.0353 Tc 1.1533 Tw (requirements mentioned above are also intended to) Tj T* -0.0421 Tc 1.1691 Tw (reduce the inconsistency in survey procedures.) Tj ET BT 0.9835 0 0 0.9835 326.16 271.68 Tm 0.0353 Tc 0.8919 Tw (In September 1989, HCFA issued interpretive) Tj ET BT 0.934 0 0 0.9835 315.6 259.68 Tm -0.0409 Tc 0.9329 Tw (guidelines to help surveyors apply the new require-) Tj ET BT 0.9835 0 0 0.9835 315.36 247.92 Tm 0.0404 Tc 0.7566 Tw (ments for Medicare and Medicaid certification of) Tj 0 -12.2018 TD 0.0297 Tc -0.0867 Tw (nursing homes \(320\). The guidelines were revised) Tj ET BT 0.934 0 0 0.9835 315.6 223.92 Tm -0.0246 Tc 0.6815 Tw (following the release in September 1991 of the final) Tj -0.257 -12.2018 TD -0.0372 Tc 2.3973 Tw (requirements for Medicare and Medicaid certifica-) Tj 0.257 -12.6899 TD -0.0081 Tc 0.6245 Tw (tion of nursing homes. In late 1991, HCFA sent the) Tj ET BT 0.9835 0 0 0.9835 315.6 187.68 Tm 0.0363 Tc 0.7201 Tw (revised guidelines out for review. The guidelines) Tj ET BT 0.934 0 0 0.9835 315.84 175.68 Tm -0.04 Tc 1.4459 Tw (prescribe methods to be used in conducting inspec-) Tj ET BT 0.9835 0 0 0.9835 316.08 163.68 Tm 0.0259 Tc 0.6086 Tw (tions, including procedures for interviewing resi-) Tj ET BT 0.934 0 0 0.9835 316.08 151.92 Tm -0.0291 Tc 1.1038 Tw (dents and reviewing resident assessments and care) Tj ET BT 0.8915 0 0 0.9835 316.08 140.16 Tm 0.0015 Tc 0 Tw (plans.) Tj ET BT 0.9795 0 0 0.9795 316.32 110.64 Tm /F7 12 Tf 0.0318 Tc 0.0903 Tw (State Long-Term Care Ombudsman Programs) Tj 11.5165 -17.6423 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 349.44 93.36 Tm /F4 10 Tf 0.0247 Tc 0.0729 Tw (Older Americans Act mandates that every) Tj ET BT 0.8915 0 0 0.9835 316.8 81.36 Tm 0.0449 Tc 1.6096 Tw (State have a Long-Term Care Ombudsman Program) Tj ET BT 0.934 0 0 0.9835 316.8 69.6 Tm -0.039 Tc 0.8208 Tw (to investigate and resolve complaints of residents of) Tj 0 -11.9577 TD -0.03 Tc 1.2761 Tw (nursing homes and other residential care facilities.) Tj 0 -12.2018 TD -0.0036 Tc 0.8196 Tw (The State programs vary, but most States use both) Tj ET BT 0.8915 0 0 0.9835 316.56 33.6 Tm 0.0248 Tc 1.3182 Tw (paid and volunteer staff and have offices at both the) Tj ET endstream endobj 440 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 441 0 obj <>stream 0.72 w 1 j 0 0 0 RG 71.04 684.96 m 548.64 684.96 l S BT 0.9835 0 0 0.9835 71.52 690.48 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (140 ) Tj ET BT 0.9598 0 0 0.9598 89.52 690.48 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 95.76 690.48 Tm /F5 10 Tf 0.0125 Tc 0.9566 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -24.1595 -40.0218 TD /F4 10 Tf 0.0309 Tc 0.7082 Tw (State and local level. In 1990, State ombudsman) Tj ET BT 0.934 0 0 0.9835 71.52 639.12 Tm -0.012 Tc 1.0534 Tw (programs had an average of one paid staff member) Tj ET BT 0.9835 0 0 0.9835 72 627.36 Tm 0.0345 Tc 0.627 Tw (at the State or local level for every 3200 nursing) Tj ET BT 0.934 0 0 0.9835 72 615.6 Tm -0.0206 Tc 1.6729 Tw (home beds; the range in different States was from) Tj ET BT 0.8915 0 0 0.9835 72.24 603.36 Tm 0.0366 Tc 0.8383 Tw (one paid staff member for every 789 beds to one paid) Tj ET BT 0.9835 0 0 0.9835 72.72 591.6 Tm 0.0346 Tc 1.4713 Tw (staff member for every 21,500 beds \(321\). Total) Tj 0 -12.2018 TD 0.0247 Tc 0.561 Tw (spending for State Long-Term Care Ombudsman) Tj ET BT 0.8915 0 0 0.9835 72.48 567.6 Tm 0.0572 Tc 0.9229 Tw (Programs averaged $11.15 per nursing home bed per) Tj ET BT 0.9835 0 0 0.9835 72.48 555.84 Tm 0.0405 Tc 0.0515 Tw (year and ranged from $2.09 to $68.05 per bed per) Tj ET BT 0.8915 0 0 0.9835 72.72 543.84 Tm 0.0133 Tc 1.5105 Tw (year in different States.) Tj 12.9213 -18.0586 TD 0.0421 Tc 0.786 Tw (Ombudsmen have the authority to enter a nursing) Tj ET BT 0.9835 0 0 0.9835 72.72 514.32 Tm 0.0271 Tc 1.7056 Tw (home at any time to investigate a complaint or) Tj ET BT 0.934 0 0 0.9835 73.44 502.32 Tm -0.0142 Tc 1.0879 Tw (advocate for an individual resident \(320\). They can) Tj 0 -12.4458 TD -0.0206 Tc 0.6909 Tw (also visit nursing homes to become acquainted with) Tj ET BT 0.9835 0 0 0.9835 73.44 478.08 Tm 0.0226 Tc 1.7101 Tw (the residents, monitor their care generally, and) Tj 0 -12.2018 TD 0.0216 Tc 2.8703 Tw (inform them of their rights. A 1990 survey of) Tj 0 -11.9577 TD 0.0272 Tc 2.4782 Tw (long-term care ombudsmen found that only 16) Tj ET BT 0.8915 0 0 0.9835 73.44 442.08 Tm 0.0431 Tc 1.5925 Tw (percent reported visiting the nursing homes in their) Tj -0.8076 -12.2018 TD 0.0482 Tc 1.1423 Tw (jurisdiction more than once a month for any of these) Tj ET BT 0.934 0 0 0.9835 73.44 418.08 Tm -0.0091 Tc 2.6242 Tw (purposes \(321\).) Tj ET BT 0.8915 0 0 0.9835 84.96 400.32 Tm 0.0452 Tc 1.5901 Tw (OBRA-87 created a new role for State Long-Term) Tj ET BT 0.934 0 0 0.9835 74.16 388.32 Tm -0.0148 Tc 0.8316 Tw (Care Ombudsman Programs in connection with the) Tj 0.257 -11.9577 TD -0.0423 Tc 1.118 Tw (survey process for Medicare and Medicaid certifica-) Tj -0.257 -12.2018 TD -0.0227 Tc 0.9364 Tw (tion of nursing homes. The law requires the survey) Tj 0.257 -12.2018 TD -0.0264 Tc 2.1716 Tw (and certification agency to contact the Long-Term) Tj ET BT 0.9835 0 0 0.9835 74.4 340.56 Tm 0.0166 Tc 0.0486 Tw (Care Ombudsman Program to inquire about com-) Tj ET BT 0.934 0 0 0.9835 74.16 328.56 Tm -0.0125 Tc 0.5721 Tw (plaints the ombudsman program may have received) Tj ET BT 0.9835 0 0 0.9835 74.88 316.56 Tm 0.0292 Tc 0.5748 Tw (about a facility that is being surveyed \(320\). The) Tj ET BT 0.934 0 0 0.9835 74.88 304.56 Tm -0.0329 Tc 0.8509 Tw (survey and certification agency is required to invite) Tj 0 -12.2018 TD -0.0262 Tc 0.6189 Tw (the ombudsman to attend the exit conference at the) Tj -0.257 -12.2018 TD -0.0202 Tc 1.544 Tw (end of a facility\222s survey when the survey findings) Tj ET BT 0.9835 0 0 0.9835 74.88 268.8 Tm 0.0195 Tc -0.0763 Tw (are discussed. Lastly, the survey and certification) Tj ET BT 0.934 0 0 0.9835 74.88 257.28 Tm -0.0185 Tc 1.1567 Tw (agency is required to inform the ombudsman if the) Tj ET BT 0.9835 0 0 0.9835 74.88 245.52 Tm 0.0255 Tc 3.751 Tw (facility is not in compliance with any of the) Tj ET BT 0.8915 0 0 0.9835 75.12 233.52 Tm 0.0508 Tc 4.1603 Tw (certification requirements.) Tj ET BT 0.9795 0 0 0.9795 120.96 203.28 Tm /F7 12 Tf 0.0392 Tc 1.1241 Tw (Summary and Implications) Tj -35.5296 -18.3774 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 108.72 185.28 Tm /F4 10 Tf 0.0117 Tc 1.9043 Tw (existing regulatory structure for nursing) Tj -34.165 -12.2018 TD 0.0259 Tc 0.1205 Tw (homes is extremely complex, and many aspects of) Tj 0.4881 -12.2018 TD 0.0354 Tc 1.1786 Tw (the structure are in flux now because of OBRA-) Tj -0.244 -12.2018 TD 0.0314 Tc 0.603 Tw (mandated changes in the Federal regulations for) Tj 0 -12.2018 TD 0.0355 Tc 2.5511 Tw (Medicare and Medicaid certification of nursing) Tj ET BT 0.934 0 0 0.9835 75.36 125.52 Tm -0.0353 Tc 1.7957 Tw (homes and the survey and certification procedures) Tj ET BT 0.9835 0 0 0.9835 75.84 113.76 Tm 0.0344 Tc 3.0403 Tw (associated with those regulations. The OBRA-) Tj -0.244 -12.2018 TD 0.0301 Tc 0.6043 Tw (mandated changes are likely to improve the care) Tj ET BT 0.934 0 0 0.9835 75.6 90.24 Tm -0.0314 Tc 1.2776 Tw (received by nursing home residents with dementia.) Tj ET BT 0.8915 0 0 0.9835 75.84 78 Tm 0.0161 Tc 1.8214 Tw (The resident assessment system developed to imple-) Tj -0.2692 -11.7137 TD 0.0319 Tc 1.9382 Tw (ment OBRA-87 focuses much more than assessment) Tj 0.5384 -12.4458 TD 0.0395 Tc 0.7505 Tw (instruments used previously in nursing homes on the) Tj ET BT 0.934 0 0 0.9835 75.6 42.48 Tm -0.0208 Tc 1.8145 Tw (residents\222 cognitive status. The assessment system) Tj 264.4073 619.1184 TD -0.016 Tc 0.7227 Tw (emphasizes the care needs that are common among) Tj 0 -12.2018 TD -0.0231 Tc 1.5257 Tw (nursing home residents with dementia, and OBRA) Tj ET BT 0.8915 0 0 0.9835 322.56 627.84 Tm 0.0471 Tc 1.0496 Tw (regulations require that services be provided to meet) Tj 0.2692 -12.6899 TD 0.0168 Tc 2.5833 Tw (those needs.) Tj ET BT 0.9835 0 0 0.9835 333.84 597.6 Tm 0.0402 Tc 1.0473 Tw (Two factors could limit the benefits of OBRA-) Tj ET BT 0.934 0 0 0.9835 322.8 585.6 Tm -0.0287 Tc 1.1462 Tw (related changes for individuals with dementia. One) Tj ET BT 0.8915 0 0 0.9835 323.28 573.6 Tm 0.0417 Tc 1.1759 Tw (obvious factor is a failure to implement the changes.) Tj ET BT 0.934 0 0 0.9835 323.52 561.6 Tm -0.0243 Tc 1.052 Tw (Such a failure could occur as the result of a lack of) Tj ET BT 0.8915 0 0 0.9835 323.52 549.6 Tm 0.0349 Tc 1.217 Tw (leadership and political will at the Federal, State, or) Tj ET BT 0.9835 0 0 0.9835 323.52 538.08 Tm 0.0314 Tc 3.5857 Tw (local level. It could also occur as a result of) Tj ET BT 0.934 0 0 0.9835 323.76 525.84 Tm -0.0229 Tc 2.4333 Tw (insufficient government funding to implement the) Tj ET BT 0.8915 0 0 0.9835 323.76 513.84 Tm 0.0421 Tc 2.0166 Tw (changes, including insufficient Medicare and Medic-) Tj ET BT 0.934 0 0 0.9835 324 502.08 Tm -0.0161 Tc 1.9036 Tw (aid reimbursement for nursing home care, insuffi-) Tj ET BT 0.8915 0 0 0.9835 324 489.84 Tm 0.038 Tc 0.6752 Tw (cient funding for nurse aide training, and insufficient) Tj ET BT 0.9835 0 0 0.9835 324 477.6 Tm 0.0286 Tc -0.0565 Tw (funding for survey and certification staff and sur-) Tj ET BT 0.934 0 0 0.9835 324 465.84 Tm -0.0195 Tc 0.4512 Tw (veyor training. Some of this funding comes from the) Tj 0.257 -12.2018 TD -0.0236 Tc 1.6118 Tw (Federal Government, but some comes from States,) Tj ET BT 0.9835 0 0 0.9835 324.72 441.6 Tm 0.0361 Tc 0.0288 Tw (so finding problems that affect implementation of) Tj ET BT 0.934 0 0 0.9835 324.48 429.84 Tm -0.0242 Tc 0.8416 Tw (OBRA are likely to vary from State to State.) Tj 11.563 -18.3027 TD -0.0341 Tc 1.2055 Tw (The second factor that could limit the benefits of) Tj -11.306 -12.2018 TD -0.0301 Tc 1.3618 Tw (OBRA-related changes for individuals with demen-) Tj ET BT 0.9835 0 0 0.9835 324.72 387.84 Tm 0.022 Tc 2.9135 Tw (tia is lack of knowledge among nursing home) Tj ET BT 0.8915 0 0 0.9835 324.96 376.08 Tm 0.029 Tc 1.2686 Tw (administrators and staff members and nursing home) Tj 0.2692 -12.4458 TD 0.0478 Tc 1.3179 Tw (surveyors about the implications of the new require-) Tj ET BT 0.934 0 0 0.9835 324.72 351.84 Tm -0.0406 Tc 1.263 Tw (ments for residents with dementia. With respect to) Tj ET BT 0.9835 0 0 0.9835 325.2 339.84 Tm 0.0332 Tc 1.74 Tw (the OBRA-87 requirements cited earlier in this) Tj ET BT 0.934 0 0 0.9835 325.2 327.84 Tm -0.0193 Tc 1.7785 Tw (chapter, these individuals might ask, for example:) Tj 0.257 -12.2018 TD -0.0348 Tc 1.8166 Tw (what constitutes good quality of life for a resident) Tj 0 -12.2018 TD -0.0193 Tc 1.4017 Tw (with dementia; what constitutes unavoidable dimi-) Tj T* -0.0339 Tc 0.9989 Tw (nution in the resident\222s ability to perform activities) Tj ET BT 0.8915 0 0 0.9835 325.44 280.08 Tm 0.0244 Tc 1.0606 Tw (of daily living; what activities meet the interests and) Tj ET BT 0.9835 0 0 0.9835 325.44 268.56 Tm 0.0304 Tc 1.0108 Tw (needs of nursing home residents with dementia;) Tj ET BT 0.934 0 0 0.9835 325.44 256.56 Tm -0.0271 Tc 1.6156 Tw (what rehabilitative services are needed by nursing) Tj ET BT 0.9835 0 0 0.9835 325.44 244.8 Tm 0.0273 Tc 2.3852 Tw (home residents with dementia; what is a safe,) Tj ET BT 0.934 0 0 0.9835 325.44 232.8 Tm -0.0223 Tc 2.3813 Tw (home-like environment, and what are comfortable) Tj ET BT 0.8915 0 0 0.9835 325.92 221.04 Tm 0.0372 Tc 0.8556 Tw (levels of sound, lighting, and temperature? Research-) Tj ET BT 0.934 0 0 0.9835 325.92 208.8 Tm -0.0253 Tc 0.953 Tw (based answers to these and other similar questions) Tj 0 -12.2018 TD -0.0317 Tc 0.7355 Tw (do not exist at present, and certain of the questions) Tj ET BT 0.8915 0 0 0.9835 326.16 184.8 Tm 0.0599 Tc 0.7853 Tw (are not amenable to research. There is also disagree-) Tj ET BT 0.9835 0 0 0.9835 325.92 172.8 Tm 0.0165 Tc 2.7332 Tw (ment among clinicians about the answers. Yet) Tj ET BT 0.934 0 0 0.9835 326.4 160.8 Tm -0.0428 Tc 1.5467 Tw (answers are needed for effective implementation of) Tj ET BT 0.8915 0 0 0.9835 326.4 149.04 Tm 0.0485 Tc 1.2019 Tw (the new requirements.) Tj ET BT 0.9341 0 0 0.9939 326.88 127.2 Tm /F6 14 Tf -0.0903 Tc 1.1348 Tw (STATE REGULATIONS AND OTHER) Tj ET BT 0.9663 0 0 0.9939 334.32 111.6 Tm 0.0225 Tc 1.194 Tw (STATE POLICIES FOR SPECIAL) Tj 65.0734 -15.6962 TD 0.0519 Tc 1.1635 Tw (CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 337.44 78.24 Tm /F4 10 Tf 0.0363 Tc 0.232 Tw (As of early 1992, six States had special regula-) Tj ET BT 0.934 0 0 0.9835 326.88 66.24 Tm -0.0333 Tc 1.4296 Tw (tions for special care units. At least five additional) Tj ET BT 0.8915 0 0 0.9835 326.88 54.24 Tm 0.0271 Tc 1.2707 Tw (States were developing regulations, and other States) Tj 0 -12.2018 TD 0.0411 Tc 1.4794 Tw (were considering doing so. One State had guidelines) Tj ET endstream endobj 442 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 443 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.48 676.32 m 537.36 676.32 l S BT 0.9835 0 0 0.9835 249.84 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0236 Tc 1.0654 Tw (Chapter 5--Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 513.36 681.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 519.6 681.6 Tm /F5 10 Tf 0.2847 Tc 0 Tw (141) Tj ET BT 0.8915 0 0 0.9835 60.48 642.72 Tm /F4 10 Tf 0.0432 Tc 1.2415 Tw (for special care units instead of regulations, and one) Tj ET BT 0.9835 0 0 0.9835 60.48 630.48 Tm 0.0467 Tc 3.5856 Tw (other State was in the process of developing) Tj ET BT 0.934 0 0 0.9835 60.96 618.96 Tm -0.0403 Tc 0.8221 Tw (guidelines. Other policies for special care units that) Tj ET BT 0.9835 0 0 0.9835 60.48 606.96 Tm 0.0427 Tc 1.2888 Tw (have been implemented by a few States include) Tj 0.7321 -12.4458 TD 0.0341 Tc 0.9489 Tw (altering the process for obtaining a certificate of) Tj -0.244 -11.9577 TD 0.0474 Tc 0.6565 Tw (need so that applicants who propose to establish) Tj 0.4881 -12.4458 TD 0.0294 Tc 1.9716 Tw (special care units receive special consideration,) Tj ET BT 0.934 0 0 0.9835 61.2 558.72 Tm -0.0136 Tc 1.901 Tw (funding individual special care units, and funding) Tj ET BT 0.8915 0 0 0.9835 60.96 546.96 Tm 0.0484 Tc 1.0481 Tw (research on special care units. This section discusses) Tj 0.5384 -12.4458 TD 0.0298 Tc 1.8957 Tw (these State regulations and policies.) Tj ET BT 0.9835 0 0 0.9835 72.72 516 Tm 0.0435 Tc 1.0439 Tw (Some of the State regulations and policies for) Tj -10.9816 -12.2018 TD 0.0365 Tc 1.0859 Tw (special care units have been mandated by State) Tj -0.244 -11.9577 TD 0.0338 Tc -0.1316 Tw (legislatures, and others have been put in place by) Tj ET BT 0.8915 0 0 0.9835 61.92 480.48 Tm 0.0474 Tc 1.7414 Tw (executive decision. The initiative for the regulations) Tj ET BT 0.9835 0 0 0.9835 61.92 468.48 Tm 0.0307 Tc 1.824 Tw (and other policies has usually come from State) Tj 0 -12.4458 TD 0.0319 Tc 3.2869 Tw (officials and/or State Alzheimer\222s disease task) Tj ET BT 0.934 0 0 0.9835 61.92 444.72 Tm -0.0339 Tc 1.2191 Tw (forces, but these individuals and groups were often) Tj 0 -12.2018 TD -0.0301 Tc 2.1756 Tw (responding to concerns raised originally by family) Tj 0 -11.9577 TD -0.0219 Tc 1.867 Tw (members, special care unit operators, and nursing) Tj T* -0.0251 Tc 2.1274 Tw (home surveyors.) Tj ET BT 0.9835 0 0 0.9835 73.2 390.48 Tm 0.035 Tc 0.3205 Tw (The regulations and policies differ in their pri-) Tj ET BT 0.934 0 0 0.9835 62.16 378.48 Tm -0.023 Tc 0.6935 Tw (mary intent. Some are intended primarily to assure) Tj ET BT 0.9835 0 0 0.9835 62.64 366.72 Tm 0.0332 Tc 2.0654 Tw (that special care units are not established and) Tj 0 -12.2018 TD 0.0408 Tc -0.1387 Tw (operated solely for marketing purposes and do, in) Tj ET BT 0.934 0 0 0.9835 62.64 342.96 Tm -0.0401 Tc 1.9293 Tw (fact, provide something special for their residents.) Tj ET BT 0.9835 0 0 0.9835 62.88 330.96 Tm 0.0267 Tc 1.4619 Tw (Other regulations and policies are primarily in-) Tj 0 -12.2018 TD 0.0378 Tc 1.4507 Tw (tended to protect the rights of special care unit) Tj -0.244 -11.9577 TD 0.0196 Tc 0.4117 Tw (residents, particularly those in locked units. Still) Tj ET BT 0.934 0 0 0.9835 62.88 295.2 Tm -0.048 Tc 1.8949 Tw (other regulations and policies are intended to pro-) Tj ET BT 0.8915 0 0 0.9835 62.88 283.44 Tm 0.0482 Tc 1.4714 Tw (mote the establishment or evaluation of special care) Tj ET BT 0.8491 0 0 0.9835 62.88 271.2 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.8915 0 0 0.9835 74.16 252.72 Tm 0.0233 Tc 1.6608 Tw (Some industry representatives believe that States) Tj -12.1137 -11.9577 TD 0.0435 Tc 1.1402 Tw (establish regulations for special care units in part to) Tj ET BT 0.934 0 0 0.9835 62.88 229.2 Tm -0.0114 Tc 1.2562 Tw (raise State revenues \(337\). States generally charge) Tj ET BT 0.9835 0 0 0.9835 63.36 217.2 Tm 0.0253 Tc 1.2019 Tw (nursing homes fees in connection with new con-) Tj 0.4881 -12.4458 TD 0.0264 Tc 0.4251 Tw (struction or extensive remodeling. Consequently,) Tj ET BT 0.934 0 0 0.9835 63.84 192.72 Tm -0.0265 Tc 2.0432 Tw (special care unit regulations that include physical) Tj ET BT 0.8915 0 0 0.9835 63.6 180.96 Tm 0.0483 Tc 1.4713 Tw (design requirements are likely to generate fee-based) Tj ET BT 0.934 0 0 0.9835 63.6 168.96 Tm -0.026 Tc 0.7579 Tw (income for the State.) Tj ET BT 0.9795 0 0 0.9795 63.6 136.08 Tm /F7 12 Tf 0.0455 Tc 0.0559 Tw (Six States\222 Regulations for Special Care Units) Tj ET BT 0.9261 0 0 0.9795 74.88 117.36 Tm 0.0174 Tc 0.0897 Tw (Six ) Tj ET BT 0.934 0 0 0.9835 92.88 117.36 Tm /F4 10 Tf -0.0112 Tc 1.8556 Tw (States\227Iowa, Texas, Colorado, Washington,) Tj ET BT 0.8915 0 0 0.9835 63.84 105.84 Tm 0.0439 Tc 1.7902 Tw (Tennessee, and Kansas, have special regulations for) Tj ET BT 0.9835 0 0 0.9835 64.32 93.84 Tm 0.0282 Tc 1.2338 Tw (special care units. Iowa created a new licensing) Tj ET BT 0.934 0 0 0.9835 64.08 82.08 Tm -0.0286 Tc 0.9748 Tw (category for special care units, and Texas created a) Tj ET BT 0.9835 0 0 0.9835 63.84 70.08 Tm 0.0221 Tc 0.3685 Tw (voluntary certification program. Colorado, Wash-) Tj ET BT 0.934 0 0 0.9835 64.08 58.08 Tm -0.0329 Tc 1.2364 Tw (ington, and Tennessee added requirements for spe-) Tj ET BT 0.8915 0 0 0.9835 64.32 46.32 Tm 0.0647 Tc 0.1069 Tw (cial care units to their general licensing requirements) Tj 0 -11.9577 TD 0.0365 Tc 0.5087 Tw (for all nursing homes, and Kansas added an interpre-) Tj ET BT 0.934 0 0 0.9835 311.04 642.48 Tm -0.0343 Tc 1.1415 Tw (tation on special care units to its licensing require-) Tj 0 -11.9577 TD -0.0112 Tc 0.4423 Tw (ments for all nursing homes.) Tj ET BT 0.8915 0 0 0.9835 321.84 610.8 Tm 0.0351 Tc 1.6014 Tw (The regulations developed by these six States are) Tj ET BT 0.9835 0 0 0.9835 311.04 598.8 Tm 0.0285 Tc 1.9307 Tw (presented in some detail in this section. OTA\222s) Tj ET BT 0.934 0 0 0.9835 311.52 586.56 Tm -0.0353 Tc 0.6608 Tw (intent in presenting these regulations in detail is to) Tj ET BT 0.9835 0 0 0.9835 311.76 574.08 Tm 0.0353 Tc 1.3311 Tw (call attention to their diversity and some of the) Tj ET BT 0.8915 0 0 0.9835 311.28 562.32 Tm 0.0522 Tc 0.8387 Tw (particular features they require.) Tj ET BT 0.9812 0 0 0.9812 311.76 530.4 Tm /F6 11 Tf 0.0447 Tc 0.3826 Tw (Iowa\222s Regulations for Special Care Units) Tj ET BT 0.9835 0 0 0.9835 322.8 510.72 Tm /F4 10 Tf 0.0264 Tc 1.0962 Tw (Iowa is the only State that currently requires) Tj ET BT 0.8915 0 0 0.9835 312.48 498.48 Tm 0.0511 Tc 0.3315 Tw (special care units to have a special license in addition) Tj ET BT 0.9835 0 0 0.9835 312.24 486.48 Tm 0.0157 Tc 0.9851 Tw (to the license all nursing homes must have. The) Tj ET BT 0.934 0 0 0.9835 311.76 474.96 Tm -0.0569 Tc 1.3049 Tw (requirements for the special license were developed) Tj ET BT 0.9835 0 0 0.9835 312.48 462.72 Tm 0.0449 Tc 2.1077 Tw (in 1988 by a task force appointed by the Iowa) Tj ET BT 0.8915 0 0 0.9835 312.48 450.48 Tm 0.0155 Tc 1.6426 Tw (Department of Inspections and Appeals. The depart-) Tj ET BT 0.9835 0 0 0.9835 312.48 438.96 Tm 0.0223 Tc 0.6428 Tw (ment\222s intent in creating a special license was to) Tj ET BT 0.934 0 0 0.9835 312.72 426.72 Tm -0.0377 Tc 2.2693 Tw (assure that special care units provide appropriate) Tj 0 -11.9577 TD -0.0367 Tc 0.598 Tw (care for their residents and are not established only) Tj ET BT 0.9835 0 0 0.9835 312.72 403.44 Tm 0.0272 Tc 1.2581 Tw (for marketing purposes \(334\). When first imple-) Tj ET BT 0.934 0 0 0.9835 312.72 391.2 Tm -0.0204 Tc 1.5717 Tw (mented in November 1988, the special license was) Tj ET BT 0.9835 0 0 0.9835 312.72 379.2 Tm 0.0224 Tc 0.0936 Tw (voluntary in the sense that nursing homes had to) Tj 0.4881 -11.7137 TD 0.0334 Tc -0.1311 Tw (obtain a license for a special care unit only if they) Tj ET BT 0.934 0 0 0.9835 313.2 355.44 Tm -0.0222 Tc 0.4541 Tw (were going to advertise they had such a unit. In the) Tj ET BT 0.9835 0 0 0.9835 313.2 343.92 Tm 0.0338 Tc 0.326 Tw (first year, one nursing home applied for a special) Tj ET BT 0.8915 0 0 0.9835 313.2 331.92 Tm 0.0557 Tc 0 Tw (license.) Tj ET BT 0.9835 0 0 0.9835 324 312 Tm 0.0209 Tc 3.1455 Tw (At the urging of the State\222s Task Force on) Tj -10.9816 -12.2018 TD 0.0382 Tc 1.6211 Tw (Alzheimer\222s Disease and Related Disorders, the) Tj ET BT 0.8915 0 0 0.9835 313.44 288 Tm 0.0456 Tc 1.7435 Tw (licensing requirements were made mandatory, effec-) Tj ET BT 0.934 0 0 0.9835 313.44 276 Tm 0.0093 Tc 0.4917 Tw (tive in July 1990. Now, nursing homes must have a) Tj ET BT 0.8915 0 0 0.9835 313.92 264 Tm 0.0494 Tc 1.0999 Tw (special license if they are caring for individuals with) Tj ET BT 0.9835 0 0 0.9835 313.68 252.48 Tm 0.0263 Tc 0.7438 Tw (dementia in a distinct part of the facility, with a) Tj ET BT 0.934 0 0 0.9835 313.92 240.48 Tm -0.0218 Tc 1.1281 Tw (separate staff, and if they care only for individuals) Tj 0 -11.9577 TD -0.0121 Tc 0.6288 Tw (with dementia in that part of the facility \(334\). The) Tj 0 -12.4458 TD -0.0443 Tc 1.32 Tw (license, which was frost referred to as a license for) Tj ET BT 0.9835 0 0 0.9835 314.64 204.48 Tm 0.0347 Tc -0.0918 Tw (\221\221special units for people with Alzheimer\222s disease) Tj ET BT 0.8915 0 0 0.9835 313.92 192.24 Tm 0.039 Tc 1.2124 Tw (or related disorders,) Tj ET BT 0.934 0 0 0.9835 401.76 192.24 Tm -0.0507 Tc 0.87 Tw (\223 is now referred to as a license) Tj -94.0457 -11.9577 TD -0.0344 Tc 1.183 Tw (for \221\221chronic confusion or dementing illness units or) Tj ET BT 0.9835 0 0 0.9835 313.92 168.72 Tm 0.2337 Tc 0 Tw (facilities.\222) Tj 54.664 -0.244 TD 0.0346 Tc 2.0152 Tw (This change is intended to preclude) Tj ET BT 0.8915 0 0 0.9835 314.16 156.72 Tm 0.0361 Tc 0.3483 Tw (facilities from arguing that they do not have to obtain) Tj 0.2692 -12.6899 TD 0.0526 Tc 1.2982 Tw (a special license because their residents do not have) Tj ET BT 0.934 0 0 0.9835 314.64 132.48 Tm -0.0092 Tc 0.7934 Tw (a diagnosis of Alzheimer\222s disease. As of July 1991,) Tj ET BT 0.8915 0 0 0.9835 315.36 120.72 Tm 0.0498 Tc 0.5611 Tw (17 nursing homes had obtained a special license, and) Tj ET BT 0.9835 0 0 0.9835 314.4 109.2 Tm 0.0455 Tc 2.3885 Tw (2 more facilities had applied but not yet been) Tj ET BT 0.934 0 0 0.9835 314.64 97.2 Tm -0.0467 Tc 1.1227 Tw (approved for a license.) Tj 11.306 -20.0109 TD -0.0306 Tc 1.3624 Tw (To obtain a special license, the) Tj ET BT 0.8915 0 0 0.9835 314.16 65.76 Tm 0.0592 Tc 0.7861 Tw (require a unit to have:) Tj ET BT 0.9835 0 0 0.9835 325.92 45.84 Tm 0.0318 Tc 2.799 Tw (. a statement of philosophy,) Tj ET BT 0.934 0 0 0.9835 336.96 34.08 Tm -0.0317 Tc 0.657 Tw (stated in terms of outcomes,) Tj ET BT 0.8915 0 0 0.9835 467.04 77.28 Tm 0.0519 Tc 3.89 Tw (Iowa regulations) Tj ET BT 0.9835 0 0 0.9835 470.64 45.84 Tm 0.0294 Tc 1.8253 Tw (with objectives) Tj ET endstream endobj 444 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 445 0 obj <>stream 0.48 w 1 j 0 0 0 RG 71.04 682.56 m 548.64 682.56 l S BT 0.9835 0 0 0.9835 71.52 687.6 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (142 ) Tj ET BT 0.9598 0 0 0.9598 91.2 687.6 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 97.44 687.6 Tm /F5 10 Tf 0.0125 Tc 0.8211 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9598 0 0 0.9598 82.8 650.16 Tm /F1 6 Tf -0.1002 Tc 0 Tw (\215) Tj ET BT 0.8632 0 0 0.9598 83.28 613.2 Tm /F9 6 Tf -0.0185 Tc (l) Tj 0.278 -12.7521 TD -0.0185 Tc (l) Tj 0 -37.7563 TD -0.0185 Tc (l) Tj 0.5561 -25.0042 TD -0.0185 Tc (l) Tj 0.278 -25.5042 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 84.24 492.48 Tm -0.0556 Tc (l) Tj 0 -12.7521 TD -0.0556 Tc (l) Tj T* -0.0556 Tc (l) Tj 0.5213 -50.5084 TD -0.0556 Tc (l) Tj ET BT 0.934 0 0 0.9835 93.6 648.72 Tm /F4 10 Tf -0.0253 Tc 2.3331 Tw (admission and discharge policies, including a) Tj ET BT 0.9835 0 0 0.9835 93.84 636.48 Tm 0.0263 Tc 0.7709 Tw (policy requiring a physician\222s approval for a) Tj ET BT 0.934 0 0 0.9835 93.84 624.72 Tm -0.0276 Tc 0.6526 Tw (resident\222s admission to the unit,) Tj ET BT 0.8915 0 0 0.9835 93.84 611.76 Tm 0.0608 Tc 1.3675 Tw (an interdisciplinary care plannin) Tj 159.3631 0 TD -0.0022 Tc 1.2587 Tw (g team,) Tj ET BT 0.934 0 0 0.9835 94.08 599.52 Tm -0.0353 Tc 0.8535 Tw (safety policies that specify a method of locking) Tj 0 -12.2018 TD -0.0393 Tc 1.2432 Tw (or otherwise securing the unit and steps to be) Tj 0.257 -12.2018 TD -0.0184 Tc 0.3215 Tw (taken if a resident is missing from the unit,) Tj ET BT 0.8915 0 0 0.9835 93.84 563.04 Tm 0.0403 Tc 1.7494 Tw (policies that explain the programs and services) Tj ET BT 0.934 0 0 0.9835 94.56 551.52 Tm -0.0345 Tc 0.5957 Tw (offered in the unit,) Tj -0.5139 -12.4458 TD -0.0281 Tc 1.531 Tw (policies that describe the numbers, types, and) Tj 0.7709 -12.2018 TD -0.0083 Tc 0.6319 Tw (qualifications of the unit staff,) Tj ET BT 0.9835 0 0 0.9835 94.08 514.8 Tm 0.0271 Tc 1.3395 Tw (policies that assure residents\222 right to have) Tj ET BT 0.8915 0 0 0.9835 94.8 503.28 Tm 0.0096 Tc 0 Tw (visitors,) Tj ET BT 0.934 0 0 0.9835 94.32 491.04 Tm -0.0197 Tc 0.9653 Tw (quality assurance policies,) Tj ET BT 0.8915 0 0 0.9835 94.32 478.8 Tm 0.015 Tc 3.034 Tw (preadmission assessment of residents,) Tj ET BT 0.9835 0 0 0.9835 95.04 466.56 Tm 0.0217 Tc 1.6936 Tw (staff training, including at least 6 hours of) Tj ET BT 0.8915 0 0 0.9835 95.28 454.32 Tm 0.0351 Tc 0.7682 Tw (training for all new staff on nine topics listed in) Tj 0 -12.2018 TD 0.0542 Tc 0.3878 Tw (the regulations and 6 hours of inservice training) Tj ET BT 0.934 0 0 0.9835 95.52 430.56 Tm 0.0049 Tc 0.2966 Tw (annually for all staff,) Tj -0.5139 -12.4458 TD -0.0314 Tc 1.5881 Tw (2 hours of nursing staff time per resident per) Tj ET BT 0.8915 0 0 0.9835 95.52 406.32 Tm 0.0208 Tc 0.6945 Tw (day, and a staff member on the unit at all times) Tj 0.2692 -11.9577 TD 0.0233 Tc 1.4992 Tw (\(Iowa Administrative Code, Sections 10A.104\(5\)) Tj ET BT 0.934 0 0 0.9835 95.76 383.76 Tm 0.0437 Tc 1.7967 Tw (and 135c.14\).) Tj -11.82 -18.3027 TD -0.0225 Tc 1.525 Tw (In October 1990, several physical design specifi-) Tj ET BT 0.9835 0 0 0.9835 73.92 353.52 Tm 0.0391 Tc 0.1768 Tw (cations were added to the Iowa regulations. They) Tj ET BT 0.934 0 0 0.9835 73.44 341.76 Tm -0.0272 Tc 0.4594 Tw (require a special care unit to have:) Tj 12.8478 -18.7907 TD -0.0144 Tc 1.1202 Tw (. a design such that residents, staff, and visitors) Tj ET BT 0.8915 0 0 0.9835 95.76 311.04 Tm 0.0328 Tc 0.2024 Tw (do not pass through the unit to reach other parts) Tj ET BT 0.934 0 0 0.9835 96 299.04 Tm -0.0264 Tc 1.4864 Tw (of the facility,) Tj ET BT 0.9835 0 0 0.9835 85.44 286.56 Tm 0.0212 Tc 1.5285 Tw (. a locking system that meets the Life Safety) Tj ET BT 0.8915 0 0 0.9835 96.48 274.32 Tm 0.045 Tc 1.1161 Tw (Code and is approved by the fire marshal or an) Tj 0 -12.2018 TD 0.0328 Tc 1.2194 Tw (alternate system for securing the unit,) Tj ET BT 0.934 0 0 0.9835 85.68 249.84 Tm -0.031 Tc 1.3628 Tw (. a secure outdoor area with nontoxic plants,) Tj ET BT 0.9835 0 0 0.9835 85.68 238.56 Tm 0.0371 Tc 0.6583 Tw (. no steps or slopes,) Tj 0 -12.9339 TD 0.0341 Tc 2.9492 Tw (. a separate dining area used only for unit) Tj ET BT 0.8915 0 0 0.9835 96 213.84 Tm 0.0096 Tc 0 Tw (residents,) Tj ET BT 0.9835 0 0 0.9835 85.92 201.36 Tm 0.0382 Tc 0.7792 Tw (. a private area for nurses to prepare resident) Tj ET BT 0.934 0 0 0.9835 96.48 189.36 Tm -0.0647 Tc 0 Tw (records,) Tj ET BT 0.9835 0 0 0.9835 86.4 178.08 Tm 0.0251 Tc 1.3686 Tw (. a unisex toilet room that is visible from the) Tj ET BT 0.934 0 0 0.9835 96.72 164.88 Tm -0.0079 Tc 0.3745 Tw (lounge and activity area, and) Tj ET BT 0.9835 0 0 0.9835 86.4 152.16 Tm 0.0229 Tc 2.9707 Tw (. a design that minimizes breakable objects) Tj ET BT 0.934 0 0 0.9835 97.2 141.36 Tm -0.0134 Tc 1.8579 Tw (\(Iowa Administrative Code, Section 61.13\).) Tj ET BT 0.9835 0 0 0.9835 85.92 123.12 Tm 0.0256 Tc -0.1232 Tw (Iowa is enforcing the licensing regulations, and) Tj ET BT 0.8915 0 0 0.9835 75.36 110.88 Tm 0.0618 Tc 1.1869 Tw (several nursing homes have closed their special care) Tj ET BT 0.9835 0 0 0.9835 75.12 99.36 Tm 0.0293 Tc 1.0322 Tw (unit because the unit did not meet the licensing) Tj -0.244 -11.7137 TD 0.036 Tc 2.5913 Tw (requirements \(169\). When officials of the Iowa) Tj 0.244 -11.9577 TD 0.0467 Tc 1.7589 Tw (Department of Inspections and Appeals become) Tj 0.4881 -12.2018 TD 0.0356 Tc 1.038 Tw (aware of a unit that is not licensed, they do not) Tj ET BT 0.8915 0 0 0.9835 75.6 52.56 Tm 0.0437 Tc 0.6688 Tw (charge the facility with a violation of the regulations,) Tj ET BT 0.934 0 0 0.9835 75.36 40.8 Tm -0.0372 Tc 0.5986 Tw (but they do visit the unit to determine whether it is) Tj 264.6642 618.1423 TD -0.0305 Tc 0.9952 Tw (a special care unit within the regulatory definition,) Tj ET BT 0.9835 0 0 0.9835 322.8 636.48 Tm 0.0285 Tc 0.8012 Tw (and if it is, they notify the facility that a special) Tj ET BT 0.934 0 0 0.9835 322.56 624.72 Tm -0.0243 Tc 1.0987 Tw (license is required \(334\).) Tj ET BT 0.9835 0 0 0.9835 333.6 606.72 Tm 0.0259 Tc -0.0537 Tw (The administrator of one nursing home in Iowa) Tj ET BT 0.8915 0 0 0.9835 322.8 594.48 Tm 0.0415 Tc 0.8182 Tw (that has had a special care unit for 5 years told OTA) Tj ET BT 0.934 0 0 0.9835 323.04 582.48 Tm -0.0289 Tc 0.7325 Tw (that although the unit is providing good care for its) Tj ET BT 0.9835 0 0 0.9835 322.56 570.72 Tm 0.033 Tc 0.7408 Tw (residents, it does not meet the licensing require-) Tj 0.4881 -12.2018 TD 0.0386 Tc 3.1407 Tw (ments \(452\). She believes some of the State\222s) Tj ET BT 0.8915 0 0 0.9835 323.04 546.96 Tm 0.0402 Tc 1.6957 Tw (requirements, particularly the physical design speci-) Tj 0.5384 -11.9577 TD 0.0546 Tc 1.3632 Tw (fications added in 1990, are overly rigid and require) Tj ET BT 0.9835 0 0 0.9835 323.52 523.2 Tm 0.0403 Tc 1.5701 Tw (features that are not necessary for good care of) Tj ET BT 0.8915 0 0 0.9835 323.28 511.2 Tm 0.0179 Tc 1.9091 Tw (residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 323.76 487.68 Tm 0.0288 Tc 1.0938 Tw (Texas\222 Regulations for Special Care Units) Tj 10.9816 -18.3027 TD 0.0203 Tc 0.0042 Tw (Texas has a voluntary certification program for) Tj ET BT 0.934 0 0 0.9835 324.48 457.44 Tm -0.0108 Tc 1.3412 Tw (special care units that was mandated by the State) Tj ET BT 0.8915 0 0 0.9835 324 445.68 Tm 0.0621 Tc 1.0327 Tw (legislature in 1987 and became effective in February) Tj ET BT 0.9835 0 0 0.9835 325.2 433.44 Tm 0.0288 Tc 2.6276 Tw (1988. Like the early phase of Iowa\222s licensing) Tj -1.2202 -11.9577 TD 0.0147 Tc 2.1888 Tw (program, nursing homes in Texas only have to) Tj 0.4881 -12.2018 TD 0.0341 Tc 0.3563 Tw (obtain a license for a special care unit if they are) Tj ET BT 0.934 0 0 0.9835 324.48 397.92 Tm -0.0129 Tc 1.372 Tw (going to advertise that they have such a unit. The) Tj -0.257 -12.2018 TD -0.0304 Tc 1.405 Tw (creation of the voluntary certification program was) Tj 0.257 -11.9577 TD -0.0345 Tc 1.752 Tw (intended to encourage the establishment of special) Tj 0.257 -12.2018 TD -0.0137 Tc 1.5691 Tw (care units. As of September 1991, however, only 8) Tj ET BT 0.8915 0 0 0.9835 324.96 350.16 Tm 0.0475 Tc 0.5636 Tw (special care units had been certified, even though the) Tj -0.2692 -11.9577 TD 0.0366 Tc 0.7665 Tw (Department of Health is aware of at least 60 nursing) Tj ET BT 0.8491 0 0 0.9835 324.72 326.16 Tm 0.0494 Tc 0.9374 Tw (homes in the State that have a special care unit \(1 12\).) Tj ET BT 0.9835 0 0 0.9835 335.52 308.16 Tm 0.0303 Tc 0.2207 Tw (To be certified, the Texas regulations require a) Tj ET BT 0.8491 0 0 0.9835 324.72 296.16 Tm 0.0579 Tc 0 Tw (unit) Tj ET BT 0.8632 0 0 0.9598 336.24 279.12 Tm /F9 6 Tf -0.0185 Tc (l) Tj 0 -37.2562 TD -0.0185 Tc (l) Tj 0.278 -24.7541 TD -0.0185 Tc (l) Tj 0.5561 -50.2583 TD -0.0185 Tc (l) Tj 0 -12.7521 TD -0.0185 Tc (l) Tj 0 -12.5021 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 337.2 100.08 Tm -0.0556 Tc (l) Tj ET BT 0.8056 0 0 0.9598 337.44 76.8 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 337.44 53.28 Tm -0.0185 Tc (l) Tj ET BT 0.8915 0 0 0.9835 344.88 295.92 Tm /F4 10 Tf 0.0269 Tc 1.2261 Tw (to have:) Tj ET BT 0.9835 0 0 0.9835 347.04 277.68 Tm 0.0339 Tc 2.3575 Tw (safety measures to prevent residents from) Tj ET BT 0.8066 0 0 0.9835 346.8 265.92 Tm 0.1344 Tc 0 Tw (h) Tj ET BT 0.8915 0 0 0.9835 352.32 265.68 Tm 0.0418 Tc 0.985 Tw (arming themselves or leaving the unit without) Tj -5.6531 -12.4458 TD 0.0322 Tc 0 Tw (supervision,) Tj ET BT 0.934 0 0 0.9835 346.56 241.92 Tm -0.0396 Tc 1.6718 Tw (policies to prevent residents from abusing the) Tj ET BT 0.8915 0 0 0.9835 346.8 230.4 Tm 0.0239 Tc 1.714 Tw (property and rights of other residents,) Tj ET BT 0.9835 0 0 0.9835 347.04 218.16 Tm 0.0217 Tc 1.6936 Tw (staff training, including at least 8 hours of) Tj ET BT 0.934 0 0 0.9835 347.04 206.16 Tm -0.0329 Tc 0.4797 Tw (training for all new staff on five topics listed in) Tj ET BT 0.8915 0 0 0.9835 347.04 194.16 Tm 0.0542 Tc 0.4647 Tw (the regulations and 4 hours of inservice training) Tj 0.5384 -12.4458 TD 0.0293 Tc 1.4925 Tw (annually for all staff,) Tj ET BT 0.934 0 0 0.9835 347.28 169.92 Tm -0.0366 Tc 1.1632 Tw (specified staff-to-resident ratios for each shift,) Tj 0 -12.4458 TD -0.0236 Tc 0.841 Tw (staff who are assigned exclusively to the unit,) Tj ET BT 0.9835 0 0 0.9835 347.28 145.92 Tm 0.0343 Tc 2.3781 Tw (a social worker to assess the residents on) Tj ET BT 0.8915 0 0 0.9835 347.76 133.92 Tm 0.0197 Tc 2.2571 Tw (admission, conduct family support group meet-) Tj ET BT 0.9835 0 0 0.9835 347.52 122.4 Tm 0.0344 Tc 0.4779 Tw (ings, and identify and arrange for the use of) Tj ET BT 0.934 0 0 0.9835 347.52 110.64 Tm -0.0252 Tc 2.6414 Tw (community resources,) Tj ET BT 0.9835 0 0 0.9835 347.76 98.64 Tm 0.0451 Tc 1.3212 Tw (a specified amount of space per resident in) Tj ET BT 0.934 0 0 0.9835 347.52 87.12 Tm -0.0142 Tc 0.4712 Tw (public areas, including the dining area,) Tj ET BT 0.9835 0 0 0.9835 347.76 75.6 Tm 0.031 Tc -0.088 Tw (a specified number of showers, bathtubs, toi-) Tj ET BT 0.8915 0 0 0.9835 347.76 64.08 Tm 0.0276 Tc 1.2925 Tw (lets, and lavatories per resident,) Tj ET BT 0.934 0 0 0.9835 347.76 51.84 Tm -0.0216 Tc 0.639 Tw (a nurses\222 station with a place to write, a chair,) Tj 0.7709 -11.7137 TD -0.0173 Tc 1.3482 Tw (\221\221task ill) Tj ET BT 0.9835 0 0 0.9835 383.76 40.32 Tm -0.0043 Tc 3.3238 Tw (urination, \222) Tj ET BT 0.8915 0 0 0.9835 440.64 40.56 Tm 0.0591 Tc 0.6515 Tw (a telephone or intercom to) Tj ET endstream endobj 446 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 447 0 obj <>stream 0.72 w 1 j 0 0 0 RG 57.6 677.28 m 535.44 677.28 l S BT 0.9835 0 0 0.9835 247.68 682.56 Tm 0 0 0 rg /F5 10 Tf 0.0273 Tc 1.2941 Tw (Chapter 5--Regulations And Guidelines For Special Care Units . 143) Tj ET BT 0.8632 0 0 0.9598 69.36 619.2 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.9207 0 0 0.9598 69.36 593.28 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 69.6 567.12 Tm -0.0185 Tc (l) Tj 0.5561 -64.2607 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 70.08 479.52 Tm -0.0556 Tc (l) Tj 0.2607 -39.5066 TD -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 70.56 427.68 Tm -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 70.56 389.76 Tm -0.0556 Tc (l) Tj ET BT 0.9835 0 0 0.9835 79.92 644.16 Tm /F4 10 Tf 0.0339 Tc 1.3936 Tw (the main staff station, and a place to store) Tj ET BT 0.8915 0 0 0.9835 79.44 632.16 Tm 0.0394 Tc 3.3656 Tw (resident records,) Tj ET BT 0.934 0 0 0.9835 79.92 618 Tm -0.035 Tc 1.9324 Tw (activity and recreational programs tailored to) Tj 0 -11.9577 TD -0.0359 Tc 1.0255 Tw (the individual resident\222s needs,) Tj ET BT 0.8915 0 0 0.9835 79.2 592.32 Tm 0.0547 Tc 0.8247 Tw (resident access to a secure outdoor area with no) Tj ET BT 0.934 0 0 0.9835 80.16 580.32 Tm -0.0246 Tc 0.8421 Tw (toxic plants,) Tj ET BT 0.9835 0 0 0.9835 79.92 566.16 Tm 0.02 Tc 1.5419 Tw (admission practices that limit admission to) Tj 0.244 -11.9577 TD 0.0302 Tc 1.6292 Tw (individuals with a diagnosis of Alzheimer\222s) Tj ET BT 0.934 0 0 0.9835 80.64 542.4 Tm -0.0509 Tc 1.17 Tw (disease or a related dementing disorder whose) Tj 0 -12.2018 TD -0.0196 Tc 2.1215 Tw (attending physician has documented the rea-) Tj 0.257 -11.9577 TD -0.023 Tc 0.6936 Tw (sons for the individual\222s admission to the unit,) Tj ET BT 0.8915 0 0 0.9835 79.92 504.48 Tm 0.0347 Tc 0.8584 Tw (patient care practices that provide for residents\222) Tj 0.5384 -11.9577 TD 0.0449 Tc 1.5289 Tw (privacy during treatment and personal care,) Tj ET BT 0.934 0 0 0.9835 79.92 478.32 Tm -0.0394 Tc 1.5431 Tw (patient care practices that provide for careful,) Tj 1.0278 -12.2018 TD -0.0377 Tc 0.856 Tw (time-limited use of restraints and psychotropic) Tj -0.257 -11.7137 TD -0.0252 Tc 0 Tw (medications,) Tj ET BT 0.8915 0 0 0.9835 80.64 440.4 Tm 0.0004 Tc 1.2558 Tw (at least two exits,) Tj ET BT 0.9835 0 0 0.9835 80.64 426.72 Tm 0.0359 Tc -0.1336 Tw (latches or other fastening devices for the exit) Tj ET BT 0.8915 0 0 0.9835 81.12 414.48 Tm 0.0416 Tc 0.8207 Tw (doors that are easy to release, even in the dark,) Tj ET BT 0.8491 0 0 0.9835 81.36 402.72 Tm 0.2231 Tc 0 Tw (and) Tj ET BT 0.9835 0 0 0.9835 80.88 388.56 Tm 0.0292 Tc 0.4223 Tw (if the exit doors are locked, the facility must) Tj ET BT 0.934 0 0 0.9835 81.12 376.8 Tm -0.0319 Tc 0.703 Tw (have a complete sprinkler system or fire alarm) Tj 0.7709 -12.4458 TD -0.02 Tc 0.623 Tw (system; the locks must release automatically if) Tj -0.5139 -12.2018 TD -0.0313 Tc 0.7208 Tw (the sprinkler or alarm system is activated or if) Tj ET BT 0.9835 0 0 0.9835 81.6 340.32 Tm 0.0355 Tc 0.4904 Tw (there is a power failure; and there may be a) Tj ET BT 0.8915 0 0 0.9835 81.36 328.56 Tm 0.0375 Tc 0.7656 Tw (keypad or buttons at the door for routine use by) Tj 0.2692 -12.2018 TD 0.0121 Tc 1.4221 Tw (the staff \(Texas Department of Health, Chapter) Tj ET BT 0.934 0 0 0.9835 82.8 305.52 Tm 0.0474 Tc 1.4501 Tw (145, Subchapter B, 145.301-145.304\).) Tj ET BT 0.9835 0 0 0.9835 70.56 285.36 Tm 0.026 Tc 1.0153 Tw (At public hearings in October 1989, witnesses) Tj -10.9816 -12.2018 TD 0.0354 Tc 0.1109 Tw (made both positive and negative comments about) Tj 0 -11.9577 TD 0.0168 Tc 0.5202 Tw (Texas\222 voluntary certification program \(443\). The) Tj ET BT 0.934 0 0 0.9835 59.76 249.6 Tm -0.0394 Tc 0.9313 Tw (positive comments focused on the importance of the) Tj ET BT 0.8915 0 0 0.9835 60 237.84 Tm 0.0473 Tc 1.357 Tw (training requirements and the value of the certifica-) Tj ET BT 0.9835 0 0 0.9835 60 225.84 Tm 0.0292 Tc 2.1915 Tw (tion program in providing initial guidelines for) Tj ET BT 0.934 0 0 0.9835 60 214.08 Tm -0.0314 Tc 1.8772 Tw (facilities and preventing facilities from advertising) Tj ET BT 0.9835 0 0 0.9835 60.24 201.84 Tm 0.0208 Tc 1.0409 Tw (a special care unit that does not meet minimum) Tj ET BT 0.934 0 0 0.9835 60.48 189.84 Tm -0.0217 Tc 2.1665 Tw (standards. The negative comments focused on the) Tj ET BT 0.8915 0 0 0.9835 60.48 177.84 Tm 0.0203 Tc 0.9306 Tw (difficulty of setting standards in a changing field and) Tj ET BT 0.934 0 0 0.9835 60.48 165.84 Tm -0.0366 Tc 1.7222 Tw (the need for revisions to the standards that would) Tj ET BT 0.8915 0 0 0.9835 60 154.08 Tm 0.0431 Tc 0.905 Tw (require higher staff levels during some periods of the) Tj ET BT 0.934 0 0 0.9835 60.48 142.08 Tm -0.0116 Tc 1.1494 Tw (day, documentation of staff trainin) Tj 165.9933 -3.1725 TD -0.0028 Tc 0.5618 Tw (g, and programs) Tj ET BT 0.8915 0 0 0.9835 60.72 130.08 Tm 0.0273 Tc 1.091 Tw (and policies to address the needs of family members.) Tj 0 -12.2018 TD 0.0394 Tc 1.3274 Tw (Officials of two companies that have several nursing) Tj -0.2692 -11.9577 TD 0.0358 Tc 0.7076 Tw (homes with special care units in Texas told OTA that) Tj 0 -12.2018 TD 0.0411 Tc 1.928 Tw (the companies consider the State\222s requirements for) Tj ET BT 0.934 0 0 0.9835 60.48 82.8 Tm -0.0324 Tc 1.921 Tw (voluntary certification difficult to meet and costly;) Tj ET BT 0.9835 0 0 0.9835 60.48 70.8 Tm 0.0339 Tc -0.0619 Tw (that some of the companies\222 facilities are certified) Tj ET BT 0.934 0 0 0.9835 60.72 58.8 Tm -0.0241 Tc 1.4126 Tw (and others are not; and that the companies do not) Tj -0.257 -11.9577 TD -0.0514 Tc 1.556 Tw (believe their certified facilities are providing better) Tj 0.257 -12.2018 TD -0.0181 Tc 0.7323 Tw (care than their uncertified facilities \(3,141\).) Tj ET BT 0.9812 0 0 0.9812 308.88 643.44 Tm /F6 11 Tf 0.0463 Tc 0.3809 Tw (Colorado\222s Regulations for Special Care Units) Tj ET BT 0.9835 0 0 0.9835 319.92 624.96 Tm /F4 10 Tf 0.0361 Tc 1.1351 Tw (Colorado has special requirements for \223secure) Tj -11.2256 -11.9577 TD 0.0236 Tc 0.5194 Tw (units\222 which apply to locked special care units as) Tj 0 -11.9577 TD 0.0179 Tc 0.2202 Tw (well as any other locked nursing home units. The) Tj ET BT 0.934 0 0 0.9835 308.64 589.44 Tm -0.0196 Tc 2.2928 Tw (requirements were developed in 1985-1986 by the) Tj ET BT 0.9835 0 0 0.9835 309.12 577.44 Tm 0.0285 Tc 2.2654 Tw (Colorado Department of Health. Their primary) Tj 0 -12.2018 TD 0.037 Tc 0.5668 Tw (intent is to protect individuals who are placed in) Tj T* 0.0279 Tc 0.1185 Tw (locked units \(409\). The requirements are incorpo-) Tj ET BT 0.8915 0 0 0.9835 309.12 541.68 Tm 0.0375 Tc 0.5412 Tw (rated in the State\222s regulations for all nursing homes,) Tj ET BT 0.934 0 0 0.9835 309.6 529.44 Tm -0.0473 Tc 0.77 Tw (and no special license or certification is required for) Tj ET BT 0.8491 0 0 0.9835 309.6 517.44 Tm 0.0467 Tc 1.6858 Tw (the units.) Tj ET BT 0.934 0 0 0.9835 320.4 499.2 Tm -0.0326 Tc 1.5359 Tw (The Colorado regulations require a\221 \221secure unit\222) Tj ET BT 0.8915 0 0 0.9835 309.6 487.2 Tm 0.0269 Tc 1.4953 Tw (to have:) Tj ET BT 0.8632 0 0 0.9598 321.12 469.92 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0 -50.2583 TD -0.0185 Tc (l) Tj 0.8341 -150.775 TD -0.0185 Tc (l) Tj 0.278 -50.0083 TD -0.0185 Tc (l) Tj 0.5561 -62.7604 TD -0.0185 Tc (l) Tj 0 -38.0063 TD -0.0185 Tc (l) Tj 0 -12.7521 TD -0.0185 Tc (l) Tj T* -0.0185 Tc (l) Tj 0 -25.2542 TD -0.0185 Tc (l) Tj 0 -37.2562 TD -0.0185 Tc (l) Tj ET BT 0.934 0 0 0.9835 331.44 468.48 Tm /F4 10 Tf -0.0212 Tc 1.9176 Tw (an admissions evaluation team with specified) Tj ET BT 0.9835 0 0 0.9835 331.44 456.72 Tm 0.0145 Tc 3.0606 Tw (members, including a person with mental) Tj 0 -12.2018 TD 0.0187 Tc 0.7989 Tw (health or social work trainin) Tj 136.4159 -0.4881 TD 0.0327 Tc 2.005 Tw (g who is not a) Tj ET BT 0.934 0 0 0.9835 331.44 432.72 Tm -0.0071 Tc 0.8234 Tw (member of the nursing home staff,) Tj 0.257 -12.6899 TD -0.0276 Tc 1.3078 Tw (admission practices to ensure that individuals) Tj ET BT 0.8915 0 0 0.9835 331.92 408.24 Tm 0.0475 Tc 0.7655 Tw (are not placed on the unit unless the evaluation) Tj ET BT 0.9835 0 0 0.9835 331.92 396.24 Tm 0.0321 Tc 2.5198 Tw (team finds that: 1\) they are dangerous to) Tj 0 -12.2018 TD 0.0263 Tc 1.7471 Tw (themselves or others, or 2\) they habitually) Tj ET BT 0.8915 0 0 0.9835 331.92 372.24 Tm 0.0435 Tc 0.9981 Tw (wander and would not be able to find their way) Tj ET BT 0.9835 0 0 0.9835 331.92 360.24 Tm 0.0226 Tc 1.2628 Tw (back, or 3\) they have significant behavioral) Tj 0 -12.2018 TD 0.0273 Tc 0.5259 Tw (problems that seriously disrupt the rights of) Tj ET BT 0.934 0 0 0.9835 332.4 336 Tm -0.035 Tc 0.9817 Tw (other residents, and 4\) less restrictive alterna-) Tj ET BT 0.9835 0 0 0.9835 332.4 324 Tm 0.0269 Tc 1.7789 Tw (tives have been unsuccessful in preventing) Tj -0.244 -11.9577 TD 0.0274 Tc 1.7226 Tw (harm to themselves or others, and 5\) legal) Tj ET BT 0.8915 0 0 0.9835 332.64 300 Tm 0.0454 Tc 0.9809 Tw (authority for the restrictive placement has been) Tj 0 -12.2018 TD 0.0184 Tc 0 Tw (established,) Tj ET BT 0.934 0 0 0.9835 332.4 275.76 Tm -0.0276 Tc 1.3078 Tw (admission practices to ensure that individuals) Tj ET BT 0.8915 0 0 0.9835 332.64 264 Tm 0.0429 Tc 0.4604 Tw (are not placed on the unit for punishment or the) Tj 0 -12.4458 TD 0.0265 Tc 0.2395 Tw (convenience of staff and that the unit is the least) Tj -0.5384 -11.7137 TD 0.0515 Tc 2.006 Tw (restrictive alternative available,) Tj 0.2692 -12.6899 TD 0.0329 Tc 1.6231 Tw (admission practices to ensure that those placed) Tj ET BT 0.9835 0 0 0.9835 332.64 216 Tm 0.0362 Tc 1.8183 Tw (on the unit because they are dangerous to) Tj ET BT 0.934 0 0 0.9835 332.64 203.76 Tm -0.036 Tc 1.1113 Tw (themselves or wander habitually are protected) Tj 0 -11.9577 TD -0.0439 Tc 1.2298 Tw (from residents who are dangerous to others or) Tj 0.257 -12.4458 TD -0.0338 Tc 0.7662 Tw (whose behavior disrupts the rights of others,) Tj ET BT 0.9835 0 0 0.9835 332.64 167.52 Tm 0.0355 Tc 1.3797 Tw (documentation of the reasons for residents\222) Tj 0.7321 -12.2018 TD 0.027 Tc 1.2002 Tw (admission to the unit and a physician\222s ap-) Tj ET BT 0.934 0 0 0.9835 332.64 143.76 Tm -0.0255 Tc 1.357 Tw (proval of the admission,) Tj ET BT 0.8491 0 0 0.9835 332.64 131.04 Tm 0.0274 Tc 1.5469 Tw (written programs to treat the residents it admits,) Tj ET BT 0.934 0 0 0.9835 332.4 119.04 Tm -0.0472 Tc 1.5514 Tw (practices to allow visitors,) Tj ET BT 0.9835 0 0 0.9835 332.88 106.56 Tm 0.051 Tc -0.149 Tw (sufficient staff to provide for the needs of the) Tj ET BT 0.8915 0 0 0.9835 332.64 94.8 Tm 0.0096 Tc 0 Tw (residents,) Tj ET BT 0.9835 0 0 0.9835 332.88 82.56 Tm 0.0462 Tc -0.1442 Tw (staff who) Tj ET BT 0.8915 0 0 0.9835 332.88 70.8 Tm 0.0289 Tc 1.7622 Tw (needs and) Tj ET BT 0.8491 0 0 0.9835 332.88 58.8 Tm 0.0553 Tc 0 Tw (unit,) Tj ET BT 0.8915 0 0 0.9835 332.88 46.56 Tm 0.03 Tc (additional) Tj ET BT 0.934 0 0 0.9835 333.12 34.56 Tm -0.041 Tc 2.1444 Tw (meet the) Tj 50.6202 48.5631 TD -0.0423 Tc 2.043 Tw (are experienced and trained in the) Tj 0 -11.9577 TD -0.0446 Tc 1.0838 Tw (care of the types of residents in the) Tj ET BT 0.9835 0 0 0.9835 381.6 46.32 Tm 0.0306 Tc 1.0431 Tw (social work and activities staff to) Tj -2.1963 -12.2018 TD 0.0259 Tc 0.3646 Tw (social, emotional, and recreational) Tj ET endstream endobj 448 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 449 0 obj <>stream q 7.2 0 0 -31.68 86.4 105.84 cm BI /W 40 /H 176 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??_? 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Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.8632 0 0 0.9598 85.92 613.44 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj ET BT 0.9207 0 0 0.9598 86.16 577.44 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 86.4 553.68 Tm -0.0185 Tc (l) Tj 0 -24.7541 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 86.64 505.92 Tm -0.0556 Tc (l) Tj ET BT 0.8632 0 0 0.9598 87.12 482.16 Tm -0.0185 Tc (l) Tj ET BT 0.9835 0 0 0.9835 75.84 441.84 Tm /F2 10 Tf 0.1826 Tc (The) Tj ET BT 0.8915 0 0 0.9835 96.48 648.72 Tm /F4 10 Tf 0.0382 Tc 1.3287 Tw (needs of residents and the social and emotional) Tj ET BT 0.934 0 0 0.9835 96.48 636.48 Tm -0.0381 Tc 1.4438 Tw (needs of residents\222 families in coping with the) Tj 0 -11.9577 TD -0.0391 Tc 1.8854 Tw (residents\222 illness,) Tj 0 -12.4458 TD -0.0318 Tc 0.6357 Tw (social services and activities that allow regular) Tj 0 -12.2018 TD -0.0374 Tc 1.6266 Tw (interaction with non-confused residents of the) Tj 0 -11.9577 TD -0.0185 Tc 1.0925 Tw (facility and the outside community,) Tj ET BT 0.9835 0 0 0.9835 96.72 576.48 Tm 0.0342 Tc 0.3561 Tw (a provision that residents may not be locked) Tj ET BT 0.934 0 0 0.9835 96.96 564.48 Tm -0.0462 Tc 1.1221 Tw (into or out of their rooms,) Tj ET BT 0.9835 0 0 0.9835 96.96 552.72 Tm 0.0451 Tc 1.3909 Tw (a specified amount of space per resident in) Tj ET BT 0.8915 0 0 0.9835 96.72 540.48 Tm 0.0538 Tc 2.5418 Tw (public areas,) Tj ET BT 0.9835 0 0 0.9835 96.96 528.72 Tm 0.0363 Tc 1.4928 Tw (a secure outdoor area,) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 206.88 528.72 Tm /F5 11 Tf 0.0975 Tc 0.2065 Tw (if the ) Tj ET BT 0.9835 0 0 0.9835 233.28 528.72 Tm /F4 10 Tf 0.018 Tc 1.9589 Tw (facility has an) Tj ET BT 0.934 0 0 0.9835 97.2 516.72 Tm -0.0435 Tc 0.7338 Tw (outdoor area for residents of other units,) Tj -0.5139 -12.2018 TD -0.0285 Tc 0.8095 Tw (practices that meet the fire safety standards of) Tj 0.7709 -12.2018 TD -0.0041 Tc 1.2312 Tw (the 1985 Life Safety Code, and) Tj ET BT 0.9835 0 0 0.9835 96.96 480.96 Tm 0.0432 Tc 0.4934 Tw (periodic reevaluation of the residents\222 place-) Tj 0.4881 -12.4458 TD 0.0307 Tc 2.739 Tw (ment \(Colorado regulations for Long-Term) Tj ET BT 0.934 0 0 0.9835 97.92 457.68 Tm -0.006 Tc 1.7643 Tw (Care Facilities, sections 19.1-19.9\).) Tj ET BT 0.8915 0 0 0.9835 95.52 441.6 Tm 0.0332 Tc 1.7036 Tw (Colorado regulations specify that residents with) Tj ET BT 0.934 0 0 0.9835 76.08 429.84 Tm -0.0312 Tc 2.0311 Tw (Alzheimer\222s disease whose condition has stabilized) Tj ET BT 0.9835 0 0 0.9835 76.08 418.08 Tm 0.0234 Tc 1.8924 Tw (may remain on the unit if the evaluation team) Tj 0.244 -12.2018 TD 0.0331 Tc 0.8453 Tw (concludes the \223placement is necessary to avoid a) Tj 0 -11.9577 TD 0.0281 Tc 2.2798 Tw (likely recurrence of the condition that was the) Tj -0.244 -12.2018 TD 0.0367 Tc 3.3518 Tw (purpose of the initial placement on the unit\224) Tj ET BT 0.934 0 0 0.9835 76.8 370.32 Tm -0.032 Tc 2.8029 Tw (\(Colorado Regulations for Long-Term Care Facili-) Tj -0.257 -11.9577 TD -0.0032 Tc 1.5901 Tw (ties, section 19.5.3\).) Tj ET BT 0.9835 0 0 0.9835 76.56 337.92 Tm 0.0254 Tc 0.6092 Tw (Washington\222s Regulations for Special Care Units) Tj 11.2256 -18.3027 TD 0.0262 Tc 0.169 Tw (Washington State has special requirements for) Tj -10.4935 -12.2018 TD 0.0304 Tc 3.0932 Tw (\223protective units for cognitively impaired resi-) Tj ET BT 0.8915 0 0 0.9835 76.8 295.92 Tm 0.0298 Tc 1.7612 Tw (dents.\222 One set of requirements was implemented in) Tj ET BT 0.9835 0 0 0.9835 77.76 284.16 Tm 0.0317 Tc 0.4284 Tw (1986 as an interpretation of the State\222s licensing) Tj ET BT 0.934 0 0 0.9835 76.56 271.92 Tm 0.0046 Tc 1.3247 Tw (requirements for all nursing homes \(500\). In 1989,) Tj ET BT 0.9835 0 0 0.9835 76.8 259.92 Tm 0.0436 Tc 1.5363 Tw (the interpretation was replaced by a new set of) Tj -0.4881 -12.2018 TD 0.0279 Tc 0.2812 Tw (requirements that are incorporated in the State\222s) Tj ET BT 0.934 0 0 0.9835 76.56 236.16 Tm -0.029 Tc 0.4797 Tw (regulations for all nursing homes. No special license) Tj ET BT 0.8915 0 0 0.9835 77.04 224.16 Tm 0.0382 Tc 1.2133 Tw (is required for the units.) Tj ET BT 0.934 0 0 0.9835 87.84 205.92 Tm -0.0077 Tc 0.7872 Tw (As of late 1991, Washington State was reviewing) Tj ET BT 0.9835 0 0 0.9835 77.28 194.4 Tm 0.0138 Tc 2.4919 Tw (all its nursing home regulations, including the) Tj -0.244 -12.2018 TD 0.0271 Tc 0.7538 Tw (requirements for \223protective units for cognitively) Tj ET BT 0.934 0 0 0.9835 77.28 170.16 Tm -0.0187 Tc 2.1205 Tw (impaired residents\222 \(179\). Changes in the require-) Tj -0.257 -11.9577 TD -0.0196 Tc 0.4941 Tw (ments are a possibility.) Tj ET BT 0.8915 0 0 0.9835 88.32 140.4 Tm 0.0465 Tc 1.7425 Tw (The Washington State regulations require a \221\221pro-) Tj ET BT 0.9835 0 0 0.9835 77.52 128.16 Tm 0.0313 Tc 0.3998 Tw (tective unit for cognitively impaired residents\224 to) Tj ET BT 0.8915 0 0 0.9835 77.28 116.16 Tm 0.04 Tc 0 Tw (have:) Tj 24.7659 -18.5467 TD 0.0478 Tc 0.6104 Tw (a dining area that may also serve as a day room) Tj 0 -11.7137 TD 0.0209 Tc 1.0982 Tw (for the unit,) Tj ET BT 0.934 0 0 0.9835 99.36 74.4 Tm -0.0388 Tc 0.6289 Tw (a secure outdoor area with 1\) walls or fences of) Tj 0.5139 -11.9577 TD -0.0082 Tc 0.9347 Tw (a specified height, 2\) an ambulation area with) Tj -0.5139 -11.9577 TD -0.0133 Tc 1.6008 Tw (firm stable surfaces that are slip-resistant, 3\)) Tj ET BT 0.8915 0 0 0.9835 99.36 38.88 Tm 0.0406 Tc 0.7877 Tw (exits that release automatically if the fire alarm) Tj ET BT 0.8632 0 0 0.9598 336.72 625.44 Tm /F9 6 Tf -0.0185 Tc 0 Tw (l) Tj 0.278 -12.5021 TD -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 336.96 588.96 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 337.44 552.96 Tm -0.0185 Tc (l) Tj 0 -24.7541 TD -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 337.68 504.72 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 338.4 396.72 Tm -0.0185 Tc (l) Tj ET BT 0.934 0 0 0.9835 347.04 648.72 Tm /F4 10 Tf -0.0173 Tc 1.4949 Tw (is activated, 4\) outdoor furniture, and 5\) non-) Tj ET BT 0.8915 0 0 0.9835 347.28 636.24 Tm 0.008 Tc 2.8624 Tw (toxic plants,) Tj ET BT 0.934 0 0 0.9835 347.04 624.24 Tm -0.028 Tc 0.8457 Tw (a staff toilet room,) Tj ET BT 0.9835 0 0 0.9835 347.04 612 Tm 0.0396 Tc 1.8454 Tw (corridors no less than 10 feet wide in new) Tj ET BT 0.8915 0 0 0.9835 347.52 599.76 Tm 0.0359 Tc 0.9468 Tw (construction and 8 feet wide in renovated units,) Tj -0.5384 -12.2018 TD 0.0388 Tc 1.5268 Tw (floors, walls, and ceiling surfaces of contrasting) Tj ET BT 0.9835 0 0 0.9835 347.76 575.52 Tm 0.0217 Tc 2.3618 Tw (colors; the surfaces may conceal areas the) Tj ET BT 0.8915 0 0 0.9835 347.52 563.76 Tm 0.028 Tc 1.494 Tw (residents should not enter,) Tj ET BT 0.934 0 0 0.9835 347.76 551.52 Tm -0.0291 Tc 1.4709 Tw (door thresholds that are one-half inch high or) Tj ET BT 0.8915 0 0 0.9835 348 539.76 Tm -0.0025 Tc 0 Tw (less,) Tj ET BT 0.934 0 0 0.9835 347.76 527.76 Tm -0.0243 Tc 0.805 Tw (an electrical signaling system in each room for) Tj 0.7709 -12.4458 TD -0.0071 Tc 0.4378 Tw (staff use in an emergency,) Tj ET BT 0.9835 0 0 0.9835 347.76 503.76 Tm 0.0433 Tc 0.591 Tw (no keyed locks on the exit doors or any door) Tj ET BT 0.934 0 0 0.9835 348 491.52 Tm -0.0258 Tc 1.4536 Tw (between a resident and the exit; exits may be) Tj ET BT 0.9835 0 0 0.9835 348.72 479.52 Tm 0.024 Tc 2.6848 Tw (secured by alarms or doors which require) Tj -0.244 -12.4458 TD 0.0379 Tc 0.1084 Tw (cognitive ability to open or by other methods) Tj 0.244 -11.9577 TD 0.0265 Tc 1.3401 Tw (that open automatically if the fire alarm is) Tj 0 -12.4458 TD 0.0386 Tc 0.1077 Tw (activated; the releasing devices for the doors) Tj ET BT 0.934 0 0 0.9835 348.72 431.52 Tm -0.029 Tc 1.7461 Tw (must be labeled with directions, accessible by) Tj ET BT 0.8915 0 0 0.9835 348.48 419.76 Tm 0.0211 Tc 0.7951 Tw (residents, and approved for use by the State fire) Tj 0.2692 -12.4458 TD 0.0353 Tc 0.9475 Tw (marshal, and) Tj ET BT 0.9835 0 0 0.9835 348.48 395.76 Tm 0.0411 Tc 0.6541 Tw (no use of a public address system except for) Tj ET BT 0.8915 0 0 0.9835 349.2 383.76 Tm 0.0351 Tc 3.3705 Tw (emergencies \(Washington Administrative Code) Tj ET BT 0.934 0 0 0.9835 349.2 372.96 Tm 0.0657 Tc 0 Tw (248-14-211\).) Tj ET BT 0.9812 0 0 0.9812 327.6 343.2 Tm /F6 11 Tf 0.0393 Tc 0.3881 Tw (Tennessee\222s Regulations for Special Care Units) Tj ET BT 0.934 0 0 0.9835 338.4 325.44 Tm /F4 10 Tf -0.0354 Tc 2.3953 Tw (Tennessee has special requirements for \223special) Tj -11.563 -12.4458 TD -0.0186 Tc 0.6215 Tw (care units for ambulatory patients with Alzheimer\222s) Tj ET BT 0.8915 0 0 0.9835 327.6 300.96 Tm 0.0454 Tc 1.8783 Tw (disease and related disorders.\222 The regulations were) Tj ET BT 0.934 0 0 0.9835 327.6 289.2 Tm -0.045 Tc 2.1487 Tw (developed on the initiative of the Governor\222s Task) Tj ET BT 0.9835 0 0 0.9835 327.6 277.2 Tm 0.0363 Tc -0.1341 Tw (Force on Alzheimer\222s Disease and went into effect) Tj ET BT 0.934 0 0 0.9835 327.84 264.96 Tm -0.0041 Tc 1.3983 Tw (in March 1991. Nursing homes with a special care) Tj -0.257 -12.2018 TD -0.0212 Tc 1.5772 Tw (unit must apply to the State\222s Board for Licensing) Tj 0.5139 -11.9577 TD -0.0303 Tc 0.738 Tw (Health Care Facilities to have the unit \221designated\224) Tj ET BT 0.9835 0 0 0.9835 328.32 228.96 Tm 0.0334 Tc 0.2756 Tw (as a special care unit. To avoid delays in opening) Tj -0.244 -11.7137 TD 0.0159 Tc 0.1917 Tw (new special care units, nursing homes that are in) Tj ET BT 0.934 0 0 0.9835 328.08 205.44 Tm -0.0207 Tc 2.1226 Tw (compliance with the State\222s general nursing home) Tj -0.5139 -11.9577 TD -0.0253 Tc 1.32 Tw (requirements may open a special care unit without) Tj ET BT 0.9835 0 0 0.9835 328.32 181.68 Tm 0.0387 Tc 0.8396 Tw (waiting for the Board to designate the unit \(36\).) Tj ET BT 0.934 0 0 0.9835 328.32 169.92 Tm -0.0211 Tc 1.1687 Tw (Eventually, however, all special care units must be) Tj ET BT 0.8915 0 0 0.9835 328.32 157.44 Tm 0.0252 Tc 1.9458 Tw (designated by the board.) Tj ET BT 0.9835 0 0 0.9835 339.12 139.68 Tm 0.0382 Tc -0.0818 Tw (As of June 1992, 12 special care units had been) Tj ET BT 0.8915 0 0 0.9835 328.56 127.68 Tm 0.0365 Tc 1.5614 Tw (designated by the board, and one additional nursing) Tj ET BT 0.934 0 0 0.9835 328.32 115.68 Tm -0.0388 Tc 1.0499 Tw (home had applied for designation of its special care) Tj ET BT 0.8915 0 0 0.9835 328.32 103.68 Tm 0.0268 Tc 0.7177 Tw (unit \(36\). Thus far, no nursing home that has applied) Tj 0.2692 -11.9577 TD 0.0512 Tc 0.1819 Tw (for designation for a special care unit has been turned) Tj -0.2692 -12.4458 TD 0.2216 Tc 0 Tw (down.) Tj 12.3829 -17.8146 TD 0.0737 Tc 1.4427 Tw (The Tennessee regulations require a\221 \221special care) Tj ET BT 0.934 0 0 0.9835 328.32 50.4 Tm -0.0183 Tc 1.8632 Tw (unit for ambulatory patients with Alzheimer\222s dis-) Tj 0.257 -12.2018 TD -0.04 Tc 1.5266 Tw (ease and related disorders\222 to have:) Tj ET endstream endobj 450 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 451 0 obj <>stream 0.72 w 1 j 0 0 0 RG 57.6 681.6 m 535.68 681.6 l S BT 0.9835 0 0 0.9835 248.16 686.64 Tm 0 0 0 rg /F5 10 Tf 0.0225 Tc 1.5895 Tw (Chapter 5-Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 512.4 686.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 518.88 686.64 Tm /F5 10 Tf 0.2847 Tc 0 Tw (145) Tj ET BT 0.8632 0 0 0.9598 69.6 649.2 Tm /F9 6 Tf -0.0185 Tc (l) Tj 1.1122 -113.2688 TD -0.0185 Tc (l) Tj 0 -13.0022 TD -0.0185 Tc (l) Tj 0 -13.2522 TD -0.0185 Tc (l) Tj 0.5561 -25.5042 TD -0.0185 Tc (l) Tj 0.278 -38.0063 TD -0.0185 Tc (l) Tj 0.5561 -38.0063 TD -0.0185 Tc (l) Tj 0.5561 -75.2625 TD -0.0185 Tc (l) Tj 0.8341 -113.5188 TD -0.0185 Tc (l) Tj ET BT 0.9207 0 0 0.9598 73.2 211.92 Tm -0.0556 Tc (l) Tj ET BT 0.8056 0 0 0.9598 73.68 163.2 Tm 0.0203 Tc (l) Tj ET BT 0.8915 0 0 0.9835 79.92 648 Tm /F4 10 Tf 0.0378 Tc 1.1241 Tw (admission practices such that each resident has) Tj 0.8076 -12.2018 TD 0.0276 Tc 1.4944 Tw (a diagnosis made by a physician that identifies) Tj ET BT 0.9835 0 0 0.9835 80.64 623.76 Tm 0.0358 Tc 0.6392 Tw (the specific cause of the resident\222s dementia) Tj ET BT 0.934 0 0 0.9835 80.64 611.52 Tm -0.0345 Tc 1.7337 Tw (and each resident\222s need for admission to the) Tj ET BT 0.8915 0 0 0.9835 80.64 599.52 Tm 0.0384 Tc 1.3478 Tw (unit is determined by an interdisciplinary team) Tj 0 -12.2018 TD 0.0477 Tc 1.3181 Tw (that includes a physician who is experienced in) Tj ET BT 0.934 0 0 0.9835 80.64 575.76 Tm -0.0083 Tc 1.8524 Tw (managing individuals with dementia, a social) Tj ET BT 0.8915 0 0 0.9835 81.12 563.52 Tm 0.0562 Tc 0.1501 Tw (worker, a nurse, and a relative or other advocate) Tj 0 -11.7137 TD 0.0241 Tc 1.4983 Tw (for the resident,) Tj ET BT 0.934 0 0 0.9835 80.88 539.28 Tm -0.0505 Tc 0.9212 Tw (access to a protected outdoor area,) Tj ET BT 0.8915 0 0 0.9835 81.36 526.56 Tm 0.029 Tc 2.1659 Tw (separate dining/activity areas,) Tj -0.2692 -12.6899 TD 0.0223 Tc 0.4835 Tw (a stated bed capacity that is not exceeded at any) Tj 0.2692 -11.9577 TD -0.0071 Tc 0 Tw (time,) Tj 0 -13.1779 TD 0.0077 Tc 0.9784 Tw (a design such that visitors and staff do not pass) Tj ET BT 0.9835 0 0 0.9835 82.08 477.6 Tm 0.0283 Tc 0.7587 Tw (through the unit to reach other parts of the) Tj ET BT 0.8915 0 0 0.9835 82.08 465.84 Tm 0.0499 Tc 2.8154 Tw (nursing home,) Tj ET BT 0.9835 0 0 0.9835 82.08 452.88 Tm 0.0334 Tc 0.174 Tw (3.5 hours of direct care per resident per day,) Tj ET BT 0.934 0 0 0.9835 82.08 441.36 Tm -0.0343 Tc 1.6967 Tw (including ,75 hours of direct care provided by) Tj ET BT 0.8915 0 0 0.9835 82.32 429.36 Tm 0.0526 Tc 1.601 Tw (a licensed nurse,) Tj -0.2692 -12.9339 TD 0.035 Tc 1.6207 Tw (resident care plans that are developed, periodi-) Tj ET BT 0.934 0 0 0.9835 82.32 404.64 Tm -0.029 Tc 1.789 Tw (cally reviewed, and implemented by an inter-) Tj ET BT 0.8915 0 0 0.9835 82.56 392.88 Tm 0.0395 Tc 0.9876 Tw (disciplinary team that includes a physician who) Tj ET BT 0.9835 0 0 0.9835 82.56 381.12 Tm 0.0266 Tc 0.3639 Tw (is experienced in managing individuals with) Tj 0 -12.2018 TD 0.0188 Tc 2.4636 Tw (dementia, a social worker, a nurse, and a) Tj ET BT 0.934 0 0 0.9835 82.32 357.12 Tm -0.0482 Tc 0.7817 Tw (relative or other advocate for the resident,) Tj ET BT 0.8915 0 0 0.9835 82.8 344.4 Tm 0.0631 Tc 1.1855 Tw (a 40-hour classroom trainin) Tj 134.0588 0 TD 0.0547 Tc 0.6565 Tw (g program for nurse) Tj ET BT 0.9835 0 0 0.9835 83.28 332.4 Tm 0.037 Tc 0.1397 Tw (aides that is in addition to the 40-hour basic) Tj ET BT 0.8915 0 0 0.9835 83.04 320.4 Tm 0.0547 Tc 1.1949 Tw (training program for all nurse aides and covers) Tj ET BT 0.9835 0 0 0.9835 83.04 308.16 Tm 0.0244 Tc 0.6102 Tw (the causes, progression, and management of) Tj ET BT 0.934 0 0 0.9835 83.28 296.4 Tm -0.0328 Tc 1.8273 Tw (dementia, including methods of responding to) Tj ET BT 0.9835 0 0 0.9835 83.04 284.4 Tm 0.0212 Tc 1.9963 Tw (residents\222 behavioral symptoms, alleviating) Tj ET BT 0.934 0 0 0.9835 83.76 272.16 Tm -0.027 Tc 1.0502 Tw (safety risks, assisting residents with activities) Tj ET BT 0.9835 0 0 0.9835 83.52 260.16 Tm 0.0152 Tc -0.072 Tw (of daily living, and communicating with resi-) Tj ET BT 0.934 0 0 0.9835 83.52 248.16 Tm -0.0188 Tc 2.3775 Tw (dents\222 families.) Tj -0.5139 -12.9339 TD -0.0287 Tc 1.8742 Tw (procedures for identifying and alleviating job-) Tj ET BT 0.8915 0 0 0.9835 83.52 223.68 Tm -0.0063 Tc 1.5325 Tw (related staff stress,) Tj ET BT 0.9835 0 0 0.9835 83.52 210.72 Tm 0.0305 Tc 1.6498 Tw (a family support group that meets at least) Tj ET BT 0.934 0 0 0.9835 83.76 198.72 Tm -0.0211 Tc 1.7633 Tw (quarterly, provides family education and sup-) Tj ET BT 0.9835 0 0 0.9835 83.76 186.72 Tm 0.0314 Tc 2.6599 Tw (port, and allows for family input into the) Tj ET BT 0.934 0 0 0.9835 84.24 174.72 Tm -0.0278 Tc 0.5885 Tw (operation of the unit, and) Tj -0.5139 -12.9339 TD -0.0312 Tc 0.7023 Tw (if the unit is locked, \221extraordinary and accept-) Tj 0.7709 -11.9577 TD -0.0409 Tc 1.2266 Tw (able fire safety features and polices\222 to protect) Tj 0 -12.4458 TD -0.0136 Tc 1.3442 Tw (the residents \(Tennessee State Rule 1200-8-6-) Tj ET BT 0.8915 0 0 0.9835 85.2 127.2 Tm 0.1989 Tc 0 Tw (.10\)) Tj ET BT 0.934 0 0 0.9835 73.68 108.72 Tm -0.0364 Tc 1.3686 Tw (The original intent of the Governor\222s Task Force) Tj ET BT 0.8915 0 0 0.9835 62.88 96.96 Tm 0.0423 Tc 0.1993 Tw (in initiating the special care unit regulations was that) Tj ET BT 0.9835 0 0 0.9835 62.88 85.2 Tm 0.0372 Tc 1.2804 Tw (Medicaid reimbursement would be increased for) Tj 0.4881 -12.2018 TD 0.0328 Tc 0.497 Tw (special care units that met the specified require-) Tj ET BT 0.8915 0 0 0.9835 62.64 61.68 Tm 0.038 Tc 1.4492 Tw (ments, but this objective has not been realized. Like) Tj ET BT 0.9835 0 0 0.9835 63.36 49.68 Tm 0.0358 Tc 2.4695 Tw (all other States, Tennessee provides no higher) Tj ET BT 0.934 0 0 0.9835 62.64 37.92 Tm -0.0311 Tc 2.2623 Tw (reimbursement for Medicaid-eligible individuals in) Tj 264.1503 620.5826 TD -0.0141 Tc 1.5053 Tw (special care units than in any other nursing home) Tj ET BT 0.8915 0 0 0.9835 308.88 636 Tm 0.0305 Tc 1.0426 Tw (unit. In the first year after the regulations went into) Tj ET BT 0.934 0 0 0.9835 309.36 623.76 Tm -0.0345 Tc 1.7337 Tw (effect, the Board for Licensing Health Care Facili-) Tj ET BT 0.8915 0 0 0.9835 309.36 611.76 Tm 0.0464 Tc 1.0504 Tw (ties received many inquiries about the designation of) Tj ET BT 0.9835 0 0 0.9835 309.84 599.52 Tm 0.0294 Tc 0.239 Tw (special care units but relatively few applications.) Tj -0.244 -11.9577 TD 0.0329 Tc 1.1942 Tw (The board\222s director believes this is because the) Tj 0 -12.2018 TD 0.0323 Tc 4.0674 Tw (current level of reimbursement for Medicaid-) Tj 0.244 -12.2018 TD 0.0446 Tc 0.7116 Tw (eligible individuals does not cover the additional) Tj ET BT 0.934 0 0 0.9835 309.84 552 Tm -0.0304 Tc 0.5343 Tw (cost a nursing home would incur to comply with the) Tj ET BT 0.8915 0 0 0.9835 310.32 540.24 Tm 0.056 Tc 1.1934 Tw (special care unit requirements.) Tj ET BT 0.9835 0 0 0.9835 310.32 514.8 Tm 0.0289 Tc 1.1425 Tw (Kansas\222 Regulations for Special Care Units) Tj ET BT 0.8915 0 0 0.9835 321.12 496.56 Tm 0.0441 Tc 0.0146 Tw (Kansas has requirements for special care units that) Tj ET BT 0.9835 0 0 0.9835 310.56 484.8 Tm 0.0405 Tc 1.5699 Tw (were issued in 1989 as an interpretation of the) Tj ET BT 0.934 0 0 0.9835 310.8 472.56 Tm -0.0172 Tc 1.3481 Tw (State\222s licensing regulations for all nursing homes.) Tj ET BT 0.8915 0 0 0.9835 310.56 461.04 Tm 0.0326 Tc 1.2869 Tw (As of September 1991, the Kansas Adult Care Home) Tj ET BT 0.934 0 0 0.9835 310.8 449.04 Tm -0.0318 Tc 0.4643 Tw (Program was in the process of revising the licensing) Tj ET BT 0.8915 0 0 0.9835 310.32 437.04 Tm 0.0307 Tc 1.3564 Tw (regulations and had proposed that the interpretation) Tj 0.8076 -12.2018 TD 0.0615 Tc 0.7386 Tw (on special care units be included as a requirement in) Tj ET BT 0.934 0 0 0.9835 311.04 413.04 Tm -0.019 Tc 0.8361 Tw (the revised regulations \(267\).) Tj ET BT 0.8915 0 0 0.9835 322.08 395.28 Tm 0.059 Tc 1.6387 Tw (The Kansas interpretation requires a special care) Tj ET BT 0.8491 0 0 0.9835 311.04 383.28 Tm 0.0579 Tc 0 Tw (unit) Tj ET BT 0.8632 0 0 0.9598 322.8 366.48 Tm /F9 6 Tf -0.0185 Tc (l) Tj ET BT 0.8056 0 0 0.9598 323.28 330.72 Tm 0.0203 Tc (l) Tj ET BT 0.8632 0 0 0.9598 323.28 306.48 Tm -0.0185 Tc (l) Tj 0 -12.252 TD -0.0185 Tc (l) Tj 0 -25.2542 TD -0.0185 Tc (l) Tj 0.5561 -24.7541 TD -0.0185 Tc (l) Tj 0.278 -25.2542 TD -0.0185 Tc (l) Tj 0 -49.7583 TD -0.0185 Tc (l) Tj ET BT 0.8915 0 0 0.9835 331.44 383.28 Tm /F4 10 Tf 0.0269 Tc 1.2261 Tw (to have:) Tj 2.1536 -18.0586 TD 0.0486 Tc 0.7172 Tw (admission criteria, including a requirement that) Tj ET BT 0.9835 0 0 0.9835 333.36 353.52 Tm 0.0374 Tc 0.6667 Tw (the resident have a medical diagnosis and a) Tj ET BT 0.934 0 0 0.9835 333.12 341.52 Tm -0.0334 Tc 1.3011 Tw (physician\222s order to be admitted,) Tj ET BT 0.8915 0 0 0.9835 333.36 329.52 Tm 0.0271 Tc 0.4631 Tw (a staff training program and documentation that) Tj ET BT 0.934 0 0 0.9835 334.08 317.52 Tm -0.0213 Tc 0.8899 Tw (staff members have completed the program,) Tj -0.5139 -12.4458 TD -0.0044 Tc 0.178 Tw (a staff member on the unit at all times;) Tj 0.257 -11.9577 TD -0.0239 Tc 1.2084 Tw (a nurses\222 sub-station located so that the corri-) Tj 0.257 -12.2018 TD -0.0229 Tc 0.7374 Tw (dors are visible from the sub-station,) Tj -0.7709 -12.2018 TD -0.0126 Tc 1.5144 Tw (nurse-call signals that are visible and audible) Tj 0.7709 -12.4458 TD -0.0231 Tc 0.8404 Tw (from the corridors and nurses\222 sub-station,) Tj 0 -12.2018 TD -0.0167 Tc 1.6559 Tw (living, dining, activity, and recreational areas) Tj ET BT 0.8915 0 0 0.9835 334.32 233.04 Tm 0.035 Tc 1.217 Tw (that are accessible to the residents,) Tj ET BT 0.934 0 0 0.9835 333.84 221.28 Tm -0.0326 Tc 1.5359 Tw (resident care plans that identify the problems) Tj ET BT 0.8915 0 0 0.9835 334.56 209.28 Tm 0.0217 Tc 1.0781 Tw (that justify the resident\222s placement on the unit) Tj 0.2692 -11.9577 TD 0.0427 Tc 1.7467 Tw (and identify interventions that could correct or) Tj ET BT 0.934 0 0 0.9835 334.8 185.52 Tm -0.0371 Tc 1.6263 Tw (compensate for those problems,) Tj -0.7709 -12.2018 TD -0.0243 Tc 0.7133 Tw (methods of securing the unit that are the least) Tj ET BT 0.9835 0 0 0.9835 334.56 161.76 Tm 0.0325 Tc 4.0184 Tw (restrictive possible) Tj ET BT 1.08 0 0 1.08 424.8 166.56 Tm /F4 4 Tf 0.0009 Tc -0.0021 Tw (- ) Tj ET BT 0.9835 0 0 0.9835 427.44 161.76 Tm /F4 10 Tf 0.0314 Tc 1.1521 Tw (and comply with all life) Tj -93.7097 -12.4458 TD 0.032 Tc 1.4565 Tw (safety codes \(Kansas Administrative Rules,) Tj -0.244 -11.7137 TD 0.0585 Tc 0.3924 Tw (28-39-78 \(a\) \(6\) and \(7\) and 28-39-87 \(c\) and) Tj ET BT 0.934 0 0 0.9835 335.52 126.96 Tm -0.0101 Tc 0 Tw (\(e\)\).) Tj ET BT 0.9835 0 0 0.9835 324.24 109.2 Tm 0.0241 Tc 0.1223 Tw (Kansas is enforcing these requirements. At the) Tj -11.2256 -11.7137 TD 0.0212 Tc 0.7179 Tw (beginning of a nursing home inspection, the sur-) Tj ET BT 0.8915 0 0 0.9835 313.44 85.68 Tm 0.0476 Tc 0.3056 Tw (veyor asks whether the facility has a special care unit) Tj 0.5384 -11.9577 TD 0.0255 Tc 1.1379 Tw (and then evaluates the identified unit, if any, on the) Tj ET BT 0.9835 0 0 0.9835 313.44 61.92 Tm 0.0348 Tc 0.251 Tw (basis of the requirements of the interpretation in) Tj ET BT 0.934 0 0 0.9835 313.92 50.16 Tm -0.03 Tc 0.5908 Tw (addition to the general requirements for all nursing) Tj -0.5139 -12.2018 TD -0.0014 Tc 1.1843 Tw (homes \(267\). No information is available about the) Tj ET endstream endobj 452 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 453 0 obj <>stream 0.48 w 1 j 0 0 0 RG 76.56 687.12 m 554.64 687.12 l S BT 0.9835 0 0 0.9835 77.04 692.16 Tm 0 0 0 rg /F5 10 Tf 0.0162 Tc 1.1649 Tw (146 . Special Care Units for People With Alzheimer's and Other Dementias) Tj ET BT 0.8915 0 0 0.9835 77.04 653.52 Tm /F4 10 Tf 0.0409 Tc 0.7318 Tw (number of special care units identified in this way by) Tj 0.2692 -12.2018 TD 0.0339 Tc 1.3192 Tw (the surveyors. The director of the State\222s Adult Care) Tj ET BT 0.934 0 0 0.9835 77.28 629.52 Tm -0.0315 Tc 0.6567 Tw (Home Program told OTA that special care units are) Tj ET BT 0.9835 0 0 0.9835 77.04 617.52 Tm 0.0339 Tc 3.2544 Tw (most likely to have trouble with three of the) Tj ET BT 0.934 0 0 0.9835 77.28 605.28 Tm -0.0162 Tc 1.09 Tw (requirements: 1\) the admission criteria, 2\) the staff) Tj 0.5139 -11.9577 TD -0.007 Tc 0.3827 Tw (training, and 3\) the resident care plan \(267\).) Tj ET BT 0.9795 0 0 0.9795 84.24 565.44 Tm /F7 12 Tf 0.044 Tc 0.6291 Tw (States That Are Developing or Considering) Tj ET BT 0.9261 0 0 0.9795 77.76 551.76 Tm 0.0162 Tc 2.5788 Tw (Developing Regulations for Special Care Units) Tj ET BT 0.8491 0 0 0.9835 89.52 533.76 Tm /F4 10 Tf 0.0347 Tc 1.8211 Tw (State legislatures in four States have mandated the) Tj ET BT 0.934 0 0 0.9835 78.72 522 Tm -0.0452 Tc 2.0633 Tw (development of special regulations for special care) Tj ET BT 0.8915 0 0 0.9835 78.48 510 Tm 0.0245 Tc 2.0363 Tw (units. Two State health departments are developing) Tj ET BT 0.9835 0 0 0.9835 78.48 498.48 Tm 0.0272 Tc 0.8165 Tw (regulations for special care units without a prior) Tj ET BT 0.8915 0 0 0.9835 79.2 486.24 Tm 0.0247 Tc 0.4658 Tw (legislative mandate, and one State health department) Tj ET BT 0.9835 0 0 0.9835 79.2 474.24 Tm 0.0326 Tc 0.1137 Tw (is considering doing so. State Alzheimer\222s disease) Tj ET BT 0.934 0 0 0.9835 79.44 462.24 Tm -0.0409 Tc 1.2878 Tw (task forces and other legislatively appointed bodies) Tj ET BT 0.9835 0 0 0.9835 79.44 450.24 Tm 0.0456 Tc -0.0215 Tw (in several States have recommended the develop-) Tj ET BT 0.8915 0 0 0.9835 79.44 438.24 Tm 0.0469 Tc 0.9644 Tw (ment of regulations for special care units, and in one) Tj 0.5384 -12.4458 TD 0.0165 Tc 1.2377 Tw (State, the legislature has mandated the appointment) Tj 0 -11.9577 TD 0.0477 Tc 1.2028 Tw (of a committee to determine whether regulations are) Tj T* 0.2511 Tc 0 Tw (needed.) Tj ET BT 0.9835 0 0 0.9835 91.44 384.72 Tm 0.0307 Tc 0.3597 Tw (In 1989, the Arkansas legislature passed a bill) Tj -11.4697 -12.4458 TD 0.0235 Tc 1.2618 Tw (requiring the Department of Human Services to) Tj 0.4881 -12.4458 TD 0.0244 Tc 1.8791 Tw (establish a mandatory certification program for) Tj 0.244 -12.4458 TD 0.0244 Tc 0.8542 Tw (special care units. In 1990, after considering the) Tj ET BT 0.934 0 0 0.9835 80.64 336.48 Tm -0.0303 Tc 1.4584 Tw (issue of regulations for special care units and with) Tj ET BT 0.9835 0 0 0.9835 80.88 324.24 Tm 0.0365 Tc 1.0859 Tw (the approval of the bill\222s legislative sponsor, the) Tj 0 -11.9577 TD 0.0498 Tc 3.0944 Tw (department decided not to go ahead with the) Tj 0 -12.6899 TD 0.0286 Tc 3.697 Tw (certification program \(147\). As of early 1992,) Tj ET BT 0.8915 0 0 0.9835 80.88 288.24 Tm 0.0359 Tc 1.2159 Tw (however, the State was reconsidering this issue. One) Tj ET BT 0.9835 0 0 0.9835 80.88 276.24 Tm 0.0404 Tc 0.4544 Tw (possibility being considered was the creation of a) Tj ET BT 0.934 0 0 0.9835 81.36 264.24 Tm -0.0346 Tc 1.281 Tw (new licensing category for special care units.) Tj ET BT 0.8915 0 0 0.9835 92.64 246.48 Tm 0.0393 Tc 1.0199 Tw (In 1989, the Nebraska legislature passed a resolu-) Tj -12.3829 -12.4458 TD 0.0257 Tc 0.7227 Tw (tion mandating a study of special care unit standards) Tj 0.2692 -11.9577 TD 0.0417 Tc 1.4786 Tw (that would result in recommendations for legislation) Tj ET BT 0.934 0 0 0.9835 82.08 210.48 Tm -0.0231 Tc 1.1616 Tw (to regulate the units \(323\). In response, the Gover-) Tj ET BT 0.9835 0 0 0.9835 81.84 198.96 Tm 0.0205 Tc 2.485 Tw (nor\222s Alzheimer\222s Disease Task Force formed a) Tj 0.7321 -12.2018 TD 0.0272 Tc 3.0476 Tw (subcommittee to ex) Tj 96.3941 0.244 TD 0.0176 Tc 2.3253 Tw (amine this issue and make) Tj -97.1262 -12.2018 TD 0.0163 Tc 0.3133 Tw (recommendations. The subcommittee\222s report, re-) Tj 0.7321 -11.9577 TD 0.0327 Tc 3.2861 Tw (leased in November 1989, specifies principles,) Tj ET BT 0.934 0 0 0.9835 82.8 151.2 Tm -0.0256 Tc 1.2714 Tw (goals, and objectives for special care units, a list of) Tj -0.5139 -11.9577 TD -0.0474 Tc 1.2519 Tw (recommended policies and procedures that are very) Tj ET BT 0.8915 0 0 0.9835 83.28 127.68 Tm 0.0546 Tc 0.8248 Tw (similar to Iowa\222s requirements for a special care unit) Tj ET BT 0.934 0 0 0.9835 82.8 115.68 Tm -0.0365 Tc 0.7079 Tw (license, and a proposed training program for special) Tj 0.5139 -11.9577 TD -0.0168 Tc 1.3476 Tw (care unit staff members. The subcommittee recom-) Tj ET BT 0.9835 0 0 0.9835 82.8 92.16 Tm 0.0315 Tc -0.0071 Tw (mended that the Nebraska Department of Health) Tj 0.244 -12.2018 TD 0.0458 Tc 1.0764 Tw (develop regulations based on the content of this) Tj -0.244 -11.9577 TD 0.0261 Tc 0.8931 Tw (report and the Iowa licensing requirements, The) Tj ET BT 0.934 0 0 0.9835 83.52 56.4 Tm -0.0234 Tc 2.2797 Tw (subcommittee concluded that required staffing ra-) Tj -0.257 -12.2018 TD -0.0282 Tc 0.5033 Tw (tios for special care units should be based on \221acuity) Tj ET BT 0.9835 0 0 0.9835 327.6 654 Tm 0.0326 Tc 0.8459 Tw (ratings of the patients\224) Tj 116.649 0.244 TD 0.0372 Tc 0.3531 Tw (and that Medicaid reim-) Tj ET BT 0.934 0 0 0.9835 327.84 642 Tm -0.0344 Tc 0.8526 Tw (bursement for residents of special care units should) Tj 0.5139 -11.9577 TD -0.0209 Tc 0.9152 Tw (also be based on \223acuity ratings\224 and on the cost to) Tj ET BT 0.9835 0 0 0.9835 328.32 618 Tm 0.0239 Tc 2.5629 Tw (the nursing home of complying with the State) Tj ET BT 0.934 0 0 0.9835 328.32 606 Tm -0.0458 Tc 1.55 Tw (requirements for special care units, once developed) Tj ET BT 0.9835 0 0 0.9835 329.04 594.24 Tm 0.0428 Tc 1.219 Tw (\(323\). As of September 1991, the Department of) Tj ET BT 0.934 0 0 0.9835 328.8 582.48 Tm -0.0189 Tc 0.7258 Tw (Health was still working on draft regulations \(447\).) Tj ET BT 0.9835 0 0 0.9835 339.84 562.56 Tm 0.0359 Tc 1.8883 Tw (In 1991, the Oregon legislature passed a bill) Tj ET BT 0.934 0 0 0.9835 329.04 550.56 Tm -0.0232 Tc 0.8834 Tw (requiring nursing homes and residential care facili-) Tj 0.5139 -12.2018 TD -0.0287 Tc 1.1034 Tw (ties that have a special care unit to register with a) Tj ET BT 0.9835 0 0 0.9835 329.76 526.56 Tm 0.0343 Tc 1.861 Tw (State agency, the Senior and Disabled Services) Tj -0.244 -11.9577 TD 0.0023 Tc 4.5372 Tw (Division, by Oct.) Tj 95.4179 0.244 TD 0.0287 Tc 4.0223 Tw (1, 1991 \(335\). Twenty-four) Tj -95.1739 -12.4458 TD 0.0288 Tc 3.0867 Tw (facilities registered by that date, including 20) Tj ET BT 0.8915 0 0 0.9835 329.76 490.8 Tm 0.0447 Tc 1.2061 Tw (nursing homes and 4 residential care facilities \(126\).) Tj 0 -12.4458 TD 0.0575 Tc 1.3264 Tw (The Oregon legislation also requires that by June 1,) Tj ET BT 0.934 0 0 0.9835 331.2 466.8 Tm -0.0075 Tc 0.4812 Tw (1993, facilities with a special care unit must have a) Tj ET BT 0.9835 0 0 0.9835 330.48 454.56 Tm 0.0213 Tc 3.0536 Tw (special \221\221endorsement\222) Tj ET BT 0.934 0 0 0.9835 437.04 454.8 Tm -0.0421 Tc 0.925 Tw (on their general license. To) Tj -114.3452 -12.2018 TD -0.0331 Tc 1.5119 Tw (obtain the endorsement, the special care units will) Tj 0.257 -12.2018 TD -0.0248 Tc 1.4846 Tw (have to meet requirements in three areas: \2231\) care) Tj ET BT 0.8915 0 0 0.9835 330.24 418.8 Tm 0.0556 Tc 0 Tw (plannin) Tj ET BT 0.9835 0 0 0.9835 363.6 417.36 Tm 0.0162 Tc 0.3256 Tw (g, including physical design, staffing, staff) Tj -33.1888 -10.7376 TD 0.0174 Tc 2.7159 Tw (training, safety, egress control, individual care) Tj ET BT 0.934 0 0 0.9835 330.48 394.8 Tm 0.1776 Tc 0 Tw (pl) Tj ET BT 0.9835 0 0 0.9835 339.6 394.8 Tm 0.0125 Tc 2.0865 Tw (anning, admission policy, family involvement,) Tj ET BT 0.934 0 0 0.9835 331.2 382.8 Tm -0.0313 Tc 1.877 Tw (therapeutic activities, and social services; 2\) conti-) Tj 0 -12.4458 TD -0.0102 Tc 1.157 Tw (nuity of basic care requirements; and 3\) marketing) Tj ET BT 0.9835 0 0 0.9835 331.44 358.8 Tm 0.036 Tc 0.0057 Tw (and advertising of the availability of and services) Tj 0 -12.4458 TD 0.0135 Tc 2.0854 Tw (from Alzheimer\222s care units\224) Tj 144.9572 0.244 TD 0.0445 Tc 2.0539 Tw (\(335\). As of early) Tj ET BT 0.8915 0 0 0.9835 332.64 334.8 Tm 0.0455 Tc 1.0898 Tw (1992, the Senior and Disabled Services Division was) Tj ET BT 0.934 0 0 0.9835 331.68 322.8 Tm -0.0408 Tc 2.6067 Tw (developing the requirements for the endorsement.) Tj ET BT 0.9835 0 0 0.9835 331.68 310.8 Tm 0.0303 Tc 1.743 Tw (An advisory committee that includes three Alz-) Tj ET BT 0.934 0 0 0.9835 331.92 298.56 Tm -0.033 Tc 1.8147 Tw (heimer\222s advocates, three industry representatives,) Tj ET BT 0.8915 0 0 0.9835 332.4 286.8 Tm 0.0644 Tc 0.9955 Tw (and one official of an area agency on aging had been) Tj ET BT 0.9835 0 0 0.9835 332.4 274.56 Tm 0.0473 Tc 0.2033 Tw (appointed to assist the division in developing the) Tj ET BT 0.8915 0 0 0.9835 331.92 262.56 Tm 0.0394 Tc 0 Tw (requirements\(126\).) Tj ET BT 0.934 0 0 0.9835 343.44 242.64 Tm -0.0095 Tc 1.0828 Tw (In 1991, the North Carolina legislature passed a) Tj ET BT 0.8915 0 0 0.9835 332.64 230.64 Tm 0.0485 Tc 1.4326 Tw (bill requiring the State Medical Care Commission to) Tj ET BT 0.934 0 0 0.9835 332.64 219.12 Tm -0.0309 Tc 1.4729 Tw (develop standards for special care units in nursing) Tj ET BT 0.9835 0 0 0.9835 332.64 207.12 Tm 0.029 Tc 2.7204 Tw (homes and requiring the State Social Services) Tj 0.7321 -11.9577 TD 0.0404 Tc 0.1058 Tw (Commission to develop standards for special care) Tj -0.244 -11.7137 TD 0.0301 Tc 2.4172 Tw (units in residential care facilities. Both sets of) Tj ET BT 0.934 0 0 0.9835 333.36 171.6 Tm -0.045 Tc 1.2494 Tw (standards are to address \223the type of care provided) Tj ET BT 0.8915 0 0 0.9835 333.36 159.6 Tm 0.0459 Tc 0.5684 Tw (in a special care unit, the type of resident who can be) Tj ET BT 0.9835 0 0 0.9835 333.84 147.84 Tm 0.039 Tc 0.8664 Tw (served on the unit, the ratio of residents to staff) Tj ET BT 0.934 0 0 0.9835 333.6 136.08 Tm -0.0185 Tc 1.1353 Tw (members, and the requirements for the trainin) Tj ET BT 0.9835 0 0 0.9835 542.4 136.56 Tm 0.0675 Tc 2.2746 Tw (g of) Tj ET BT 0.934 0 0 0.9835 334.08 124.08 Tm 0.0039 Tc 0.7601 Tw (staff members\222 \(33 1\). As of early 1992, both sets of) Tj ET BT 0.8915 0 0 0.9835 334.08 112.32 Tm 0.0321 Tc 0.8164 Tw (standards had been drafted and were in the approval) Tj ET BT 0.9835 0 0 0.9835 333.6 100.56 Tm 0.0369 Tc 0.8957 Tw (process \(71\). As a part of that process, the State) Tj 0.4881 -11.9577 TD 0.0292 Tc 1.3373 Tw (legislature asked for a cost impact statement to) Tj ET BT 0.8915 0 0 0.9835 334.08 76.56 Tm 0.0217 Tc 1.9497 Tw (determine the cost implications of the standards.) Tj 11.8446 -20.499 TD 0.0329 Tc 1.3347 Tw (The New Jersey Department of Health is develop-) Tj ET BT 0.9835 0 0 0.9835 334.08 44.64 Tm 0.0249 Tc 1.5509 Tw (ing regulations for special care units \(161\). The) Tj ET endstream endobj 454 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 455 0 obj <>stream 0.72 w 1 j 0 0 0 RG 55.44 680.88 m 533.04 680.88 l S BT 0.9835 0 0 0.9835 245.76 686.16 Tm 0 0 0 rg /F5 10 Tf 0.0236 Tc 1.2397 Tw (Chapter 5--Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 510.72 686.16 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 517.2 686.16 Tm /F5 10 Tf 0.2847 Tc 0 Tw (147) Tj ET BT 0.8915 0 0 0.9835 55.68 647.28 Tm /F4 10 Tf 0.0588 Tc 0.8874 Tw (regulations will require special care units to meet 65) Tj ET BT 0.9835 0 0 0.9835 55.68 635.04 Tm 0.0352 Tc 1.3313 Tw (percent of the requirements if they are going to) Tj ET BT 0.8915 0 0 0.9835 56.16 623.28 Tm 0.0436 Tc 1.0996 Tw (advertise as a special care unit.) Tj ET BT 0.9835 0 0 0.9835 67.2 599.04 Tm 0.0275 Tc 2.1119 Tw (The Oklahoma Department of Health is also) Tj -10.9816 -11.9577 TD 0.0329 Tc 0.3981 Tw (developing regulations for special care units, pri-) Tj ET BT 0.934 0 0 0.9835 56.4 575.28 Tm -0.0305 Tc 0.8117 Tw (marily in response to recommendations of the State) Tj ET BT 0.9835 0 0 0.9835 56.64 563.52 Tm 0.0331 Tc 1.6181 Tw (Task Force on Alzheimer\222s Disease and Related) Tj ET BT 0.8915 0 0 0.9835 56.88 551.52 Tm 0.054 Tc 1.7789 Tw (Disorders \(326\). The regulations will require special) Tj 0 -12.2018 TD 0.0469 Tc 0.8806 Tw (care units to have a special license in addition to the) Tj ET BT 0.934 0 0 0.9835 57.12 527.76 Tm -0.0104 Tc 0.5186 Tw (license all nursing homes must have.) Tj 11.82 -24.4036 TD -0.0382 Tc 0.6731 Tw (The New Mexico Department of Health is consid-) Tj ET BT 0.8915 0 0 0.9835 57.6 491.76 Tm 0.0507 Tc 1.2763 Tw (ering the development of regulations for special care) Tj -0.2692 -12.2018 TD 0.0181 Tc 0.7984 Tw (units \(499\). The department intends to work with the) Tj ET BT 0.934 0 0 0.9835 57.6 467.76 Tm -0.0227 Tc 1.8679 Tw (Alzheimer\222s Association and the School of Nursing) Tj 0.257 -12.2018 TD -0.0322 Tc 1.2677 Tw (at the University of New Mexico on this project.) Tj 11.82 -24.4036 TD -0.021 Tc 1.4989 Tw (In the past few years, State Alzheimer\222s disease) Tj ET BT 0.9835 0 0 0.9835 58.08 419.76 Tm 0.0363 Tc 2.655 Tw (task forces in at least two additional States\227) Tj 0 -11.9577 TD 0.0425 Tc 0.5917 Tw (Arizona, and Indiana-have recommended the de-) Tj 0.244 -12.2018 TD 0.0338 Tc 2.4715 Tw (velopment of regulations for special care units) Tj ET BT 0.8915 0 0 0.9835 58.8 384.24 Tm 0.033 Tc 1.4884 Tw (\(14,65,203\). In its 1989 report, the Arizona Advisory) Tj ET BT 0.9835 0 0 0.9835 58.56 372.24 Tm 0.0418 Tc 1.8615 Tw (Committee on Alzheimer\222s Disease and Related) Tj 0 -11.9577 TD 0.0221 Tc 2.5647 Tw (Disorders cited complaints from many families) Tj ET BT 0.934 0 0 0.9835 59.04 348.24 Tm -0.0306 Tc 0.8485 Tw (about \221difficult and stressful encounters with poorly) Tj ET BT 0.9835 0 0 0.9835 58.32 336.24 Tm -0.0042 Tc 4.5438 Tw (run homes\222) Tj 61.9851 0 TD 0.0373 Tc 0.231 Tw (and about the lack of standards and) Tj -61.497 -11.7137 TD 0.0346 Tc -0.0916 Tw (regulatory guidance in the selection of residential) Tj ET BT 0.934 0 0 0.9835 59.04 312.48 Tm -0.0239 Tc 1.2695 Tw (care homes \(14\). The committee recommended that) Tj ET BT 0.9835 0 0 0.9835 59.04 300.96 Tm 0.0379 Tc 2.4673 Tw (the Arizona Department of Health Services be) Tj 0.4881 -12.2018 TD 0.0412 Tc 0.6418 Tw (authorized \223to develop guidelines, set standards,) Tj ET BT 0.934 0 0 0.9835 59.76 276.96 Tm -0.0294 Tc 0.9757 Tw (and regulate specific Alzheimer\222s patient care units) Tj ET BT 0.8915 0 0 0.9835 59.52 264.96 Tm 0.0391 Tc 1.0329 Tw (in nursing homes that are presented to the public as) Tj ET BT 0.9835 0 0 0.9835 59.28 253.2 Tm 0.0365 Tc 3.2334 Tw (providing specialized care\224 \(14\). Following the) Tj ET BT 0.934 0 0 0.9835 59.28 241.2 Tm -0.0467 Tc 1.4898 Tw (release of its 1989 report, the committee developed) Tj 0.5139 -12.4458 TD -0.0041 Tc 0.5061 Tw (draft standards. As of early 1992, the State had not) Tj ET BT 0.8915 0 0 0.9835 59.76 216.96 Tm 0.025 Tc 1.06 Tw (yet agreed to enforce the standards, and the commit-) Tj ET BT 0.9835 0 0 0.9835 60 204.96 Tm 0.0314 Tc 0.2196 Tw (tee was seeking ways to obtain voluntary compli-) Tj ET BT 0.934 0 0 0.9835 60.24 192.96 Tm 0.0279 Tc 1.5568 Tw (ance \(432\).) Tj ET BT 0.8915 0 0 0.9835 71.04 168.96 Tm 0.0319 Tc 1.2204 Tw (In Indiana, the State\222s Family and Social Services) Tj ET BT 0.9835 0 0 0.9835 60.24 157.2 Tm 0.0219 Tc 2.1379 Tw (Administration contracted with the Alzheimer\222s) Tj 0.244 -12.2018 TD 0.0522 Tc 2.9735 Tw (Association of Greater Indianapolis to develop) Tj 0.244 -12.2018 TD 0.0297 Tc 1.947 Tw (standards for special care units and to make a) Tj -0.4881 -11.7137 TD 0.0341 Tc 0.6003 Tw (recommendation about whether the State should) Tj ET BT 0.8915 0 0 0.9835 60.72 109.92 Tm 0.0425 Tc 1.0548 Tw (institute either a voluntary or a mandatory certifica-) Tj ET BT 0.9835 0 0 0.9835 60.72 97.68 Tm 0.0252 Tc 2.9102 Tw (tion program for special care units \(428\). The) Tj 0.244 -11.9577 TD 0.0195 Tc 2.3234 Tw (contract ran from January 1992 to June 1992.) Tj ET BT 0.8915 0 0 0.9835 60.72 74.16 Tm 0.0321 Tc 1.5343 Tw (Although the standards proposed by the Alzheimer\222s) Tj ET BT 0.934 0 0 0.9835 60.48 62.16 Tm -0.0153 Tc 1.0891 Tw (Association may eventually be the basis for regula-) Tj ET BT 0.9835 0 0 0.9835 60.72 50.16 Tm 0.0316 Tc 2.4026 Tw (tion, the State has not yet committed itself to) Tj ET BT 0.8915 0 0 0.9835 60.72 38.16 Tm 0.0398 Tc 3.6343 Tw (establishing regulations.) Tj ET BT 0.9835 0 0 0.9835 317.52 647.28 Tm 0.0283 Tc 3.4533 Tw (In California, some members of the State\222s) Tj -10.9816 -12.2018 TD 0.0379 Tc 2.1827 Tw (Alzheimer\222s Advisory Committee drafted guide-) Tj 0 -11.9577 TD 0.0283 Tc 1.1552 Tw (lines for special care units but concluded that it) Tj 0.4881 -12.4458 TD 0.0396 Tc 2.4075 Tw (would take several years to get the guidelines) Tj ET BT 0.934 0 0 0.9835 307.2 599.28 Tm -0.0258 Tc 1.6571 Tw (incorporated into the State\222s nursing home regula-) Tj 0.257 -12.6899 TD -0.0214 Tc 1.2562 Tw (tions with or without legislation \(484\). As a result,) Tj 0 -11.7137 TD -0.0216 Tc 2.1236 Tw (the commi) Tj 50.1063 0 TD -0.0266 Tc 1.2554 Tw (ttee is working with California\222s nursing) Tj ET BT 0.9835 0 0 0.9835 307.44 563.28 Tm 0.0251 Tc 1.8296 Tw (home associations and individual nursing home) Tj ET BT 0.934 0 0 0.9835 307.44 551.28 Tm -0.0283 Tc 3.1586 Tw (operators toward eventual voluntary implementa-) Tj ET BT 0.9835 0 0 0.9835 307.68 539.28 Tm 0.0415 Tc 1.2435 Tw (tion of the guidelines. As of July 1992 the draft) Tj ET BT 0.934 0 0 0.9835 308.16 527.28 Tm -0.038 Tc 1.0277 Tw (guidelines were being reviewed by the associations,) Tj -0.257 -11.9577 TD -0.0125 Tc 1.4072 Tw (consumers, policymakers, and others \(255\).) Tj ET BT 0.9835 0 0 0.9835 318.96 497.52 Tm 0.0267 Tc 0.4684 Tw (In Rhode Island, in early 1992, the Long-Term) Tj -10.7376 -12.4458 TD 0.037 Tc 0.2557 Tw (Care Coordinating Committee, a legislatively ap-) Tj -0.244 -12.4458 TD 0.0496 Tc 0.2184 Tw (pointed body, approved draft legislation to create) Tj 0.7321 -11.9577 TD 0.0301 Tc 1.197 Tw (standards for special care units \(284\). The draft) Tj ET BT 0.8915 0 0 0.9835 308.64 449.28 Tm 0.0328 Tc 1.2964 Tw (legislation has been sent to the State legislature.) Tj ET BT 0.9835 0 0 0.9835 319.68 431.28 Tm 0.0114 Tc 1.8435 Tw (Lastly, in Virginia, in March 1992, the State) Tj ET BT 0.934 0 0 0.9835 308.88 419.52 Tm -0.0287 Tc 1.2748 Tw (legislature passed a resolution requiring the estab-) Tj 0 -12.2018 TD -0.0384 Tc 1.7379 Tw (lishment of a committee to determine whether the) Tj ET BT 0.8915 0 0 0.9835 309.36 395.52 Tm 0.04 Tc 1.5959 Tw (State should have regulations for special care units.) Tj ET BT 0.9835 0 0 0.9835 308.88 383.76 Tm 0.0295 Tc 1.7032 Tw (The Virginia Department of Mental Health has) Tj ET BT 0.8915 0 0 0.9835 309.6 371.76 Tm 0.0148 Tc 2.9894 Tw (appointed the committee.) Tj ET BT 0.9795 0 0 0.9795 335.52 347.76 Tm /F7 12 Tf 0.0545 Tc 0.3734 Tw (States That Have Developed or Are) Tj -11.2715 -13.9668 TD 0.0486 Tc 0.5019 Tw (Developing Guidelines for Special Care) Tj 8.5761 -14.2118 TD 0.0433 Tc 0.2798 Tw (Units or for the Care of People With) Tj 9.5562 -13.9668 TD 0.0253 Tc 0.832 Tw (Dementia in All Nursing Homes) Tj -22.0529 -18.1323 TD 0.0155 Tc -0.0769 Tw (New ) Tj ET BT 0.9835 0 0 0.9835 345.12 288.72 Tm /F4 10 Tf 0.0291 Tc -0.0779 Tw (Hampshire has guidelines for special care) Tj ET BT 0.934 0 0 0.9835 310.08 276.48 Tm -0.026 Tc 2.1712 Tw (units, and Missouri is developing such guidelines.) Tj 0 -12.2018 TD -0.026 Tc 0.7334 Tw (The New Hampshire guidelines are published in an) Tj 0.5139 -11.9577 TD -0.028 Tc 0.5567 Tw (8-page booklet that has one section for families who) Tj ET BT 0.8915 0 0 0.9835 310.8 240.48 Tm 0.0529 Tc 1.0287 Tw (are trying to evaluate special care units and another) Tj ET BT 0.9835 0 0 0.9835 311.04 228.72 Tm 0.0312 Tc -0.1289 Tw (section for nursing home operators who are inter-) Tj -0.4881 -12.2018 TD 0.0321 Tc 0.2057 Tw (ested in establishing a special care unit \(325\). By) Tj ET BT 0.8915 0 0 0.9835 310.32 204.72 Tm 0.0448 Tc 1.4751 Tw (providing information for families and nursing home) Tj ET BT 0.934 0 0 0.9835 310.8 192.72 Tm -0.0258 Tc 1.3573 Tw (operators in the same publication, the New Hamp-) Tj ET BT 0.9835 0 0 0.9835 311.04 180.72 Tm 0.0312 Tc 0.4987 Tw (shire booklet directs the attention of the nursing) Tj -0.244 -12.2018 TD 0.038 Tc 1.0539 Tw (home operators to what families are likely to be) Tj ET BT 0.934 0 0 0.9835 311.04 156.96 Tm -0.0315 Tc 0.8923 Tw (looking for in a special care unit.) Tj 11.563 -18.3027 TD -0.0252 Tc 1.1425 Tw (The New Hampshire State agency that produced) Tj -11.306 -11.9577 TD -0.0318 Tc 1.3269 Tw (the booklet chose to publish guidelines rather than) Tj ET BT 0.8915 0 0 0.9835 311.04 115.68 Tm 0.0461 Tc 1.5506 Tw (regulations because of an awareness of the diversity) Tj ET BT 0.934 0 0 0.9835 311.52 103.68 Tm -0.0273 Tc 0.9734 Tw (of opinions about special care units both inside and) Tj ET BT 0.8915 0 0 0.9835 311.52 91.44 Tm 0.0301 Tc 1.7609 Tw (outside the State government \(216\). The agency has) Tj ET BT 0.9835 0 0 0.9835 311.52 79.68 Tm 0.0449 Tc 0.1012 Tw (not ruled out the possibility of developing regula-) Tj ET BT 0.8915 0 0 0.9835 311.52 67.92 Tm 0.0233 Tc 0.8712 Tw (tions in the future.) Tj ET BT 0.9835 0 0 0.9835 322.32 49.68 Tm 0.0338 Tc 2.6575 Tw (In 1990, the Missouri Division of Aging ap-) Tj -11.4697 -12.4458 TD 0.0436 Tc 0.9043 Tw (pointed a special care unit committee to develop) Tj ET endstream endobj 456 0 obj <>/ProcSet 565 0 R/XObject<>>>/Rotate 0/Type/Page>> endobj 457 0 obj [458 0 R 459 0 R] endobj 458 0 obj <>stream q 152.64 0 0 -2.88 149.04 46.56 cm BI /W 848 /H 16 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?? EI Q q 8.64 0 0 -73.44 339.84 320.64 cm BI /W 48 /H 408 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?? EI Q q 8.64 0 0 -200.16 338.4 247.2 cm /im197 Do endstream endobj 459 0 obj <>stream Q 0.48 w 1 j 0 0 0 RG 76.08 689.52 m 554.4 689.52 l S BT 0.9835 0 0 0.9835 76.32 695.76 Tm 0 0 0 rg /F4 10 Tf 0.013 Tc 0.0116 Tw (148 . ) Tj 25.6237 0 TD /F5 10 Tf 0.0125 Tc 0.9566 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -25.1357 -40.2659 TD /F4 10 Tf 0.0372 Tc 2.3461 Tw (guidelines \(153\). One reason Missouri chose to) Tj -0.4881 -12.2018 TD 0.0361 Tc 0.5169 Tw (develop guidelines rather than regulations was a) Tj ET BT 0.934 0 0 0.9835 76.32 632.16 Tm -0.0258 Tc 0.747 Tw (belief in the State that nursing homes would expect) Tj ET BT 0.9835 0 0 0.9835 76.32 620.16 Tm 0.0329 Tc 0.1541 Tw (regulations to be accompanied by increased reim-) Tj 0.4881 -12.4458 TD 0.0259 Tc 2.9096 Tw (bursement for special care units and that the) Tj 0 -12.2018 TD 0.0459 Tc 1.0763 Tw (development of guidelines would not create that) Tj ET BT 0.8915 0 0 0.9835 77.04 583.92 Tm 0.0248 Tc 0 Tw (expectation.) Tj ET BT 0.9835 0 0 0.9835 87.84 566.16 Tm 0.0349 Tc 1.234 Tw (Massachusetts took a different approach than) Tj ET BT 0.934 0 0 0.9835 77.28 553.92 Tm -0.0326 Tc 1.3966 Tw (other States in its \221\221Guidelines for Care of Patients) Tj -0.257 -11.7137 TD -0.0384 Tc 1.2851 Tw (With Alzheimer\222s Disease and Related Disorders in) Tj 0 -12.4458 TD -0.0188 Tc 2.172 Tw (Massachusetts Long-Term Care Facilities. \224 These) Tj 0.5139 -11.9577 TD -0.023 Tc 0.9046 Tw (guidelines, published in 1988, pertain to the care of) Tj ET BT 0.8915 0 0 0.9835 77.52 506.64 Tm 0.041 Tc 1.4794 Tw (individuals with dementia in any nursing home unit) Tj ET BT 0.934 0 0 0.9835 78 494.88 Tm -0.0135 Tc 0.4704 Tw (\(288\). As of late 1991, anew set of guidelines for the) Tj -0.257 -12.4458 TD -0.032 Tc 1.1498 Tw (care of individuals with dementia in nonspecialized) Tj ET BT 0.8915 0 0 0.9835 77.76 471.12 Tm 0.0376 Tc 1.0458 Tw (nursing home units was being reviewed \(362\). At the) Tj 0.8076 -12.4458 TD 0.0191 Tc 0.5426 Tw (same time, the Eastern Massachusetts Chapter of the) Tj ET BT 0.9835 0 0 0.9835 77.76 447.36 Tm 0.0287 Tc 1.3867 Tw (Alzheimer\222s Association, in cooperation with the) Tj ET BT 0.8915 0 0 0.9835 78 435.36 Tm 0.0151 Tc 1.4188 Tw (Massachusetts Department of Health, was drafting a) Tj ET BT 0.934 0 0 0.9835 78.72 423.6 Tm -0.039 Tc 0.6648 Tw (separate set of guidelines for the care of individuals) Tj ET BT 0.8915 0 0 0.9835 78.48 411.36 Tm 0.0397 Tc 1.4809 Tw (with dementia in special care units.) Tj ET BT 0.9835 0 0 0.9835 89.52 393.6 Tm 0.0337 Tc 0.7634 Tw (In its 1991 report, the Maryland Coordinating) Tj ET BT 0.934 0 0 0.9835 78.96 381.84 Tm -0.0361 Tc 1.6253 Tw (Council on Alzheimer\222s Disease and Related Disor-) Tj 0 -12.2018 TD -0.0228 Tc 0.9136 Tw (ders recommended an approach similar to the 1988) Tj ET BT 0.9835 0 0 0.9835 78.72 357.84 Tm 0.0278 Tc 0.6067 Tw (Massachusetts guidelines \(286\). The Council rec-) Tj 0.4881 -11.9577 TD 0.0275 Tc -0.1251 Tw (ommended that the State work with industry and) Tj 0 -12.2018 TD 0.0445 Tc 0.0203 Tw (advocacy groups to develop guidelines that would) Tj ET BT 0.8915 0 0 0.9835 79.44 322.08 Tm 0.034 Tc 0.8592 Tw (apply to the care of individuals with dementia in any) Tj ET BT 0.934 0 0 0.9835 79.2 310.32 Tm -0.0244 Tc 1.4842 Tw (nursing home unit. The Council also recommended) Tj 0.257 -12.4458 TD -0.0266 Tc 0.6607 Tw (that the State collect information about special care) Tj 0 -12.2018 TD -0.0285 Tc 2.131 Tw (units. It recommended against the development of) Tj -0.257 -11.9577 TD -0.004 Tc 3.1326 Tw (regulations, saying,) Tj ET BT 0.9835 0 0 0.9835 172.8 273.84 Tm 0.0336 Tc 0.8449 Tw (\223States and advocacy groups) Tj -94.4418 -11.9577 TD 0.0416 Tc 1.4875 Tw (which have attempted to develop regulations or) Tj 0 -12.2018 TD 0.0402 Tc -0.0683 Tw (detailed guidelines for special care units have not) Tj ET BT 0.934 0 0 0.9835 79.92 238.08 Tm -0.0107 Tc 2.6259 Tw (been particularly successful\224 \(286\).) Tj ET BT 0.9795 0 0 0.9795 102.72 209.76 Tm /F7 12 Tf 0.0418 Tc 0.6314 Tw (States That Have Certificate of Need) Tj 6.6159 -14.7019 TD 0.0507 Tc 0.561 Tw (Exceptions for Special Care Units) Tj ET BT 0.9835 0 0 0.9835 91.44 177.6 Tm /F4 10 Tf 0.0427 Tc 2.0209 Tw (As noted earlier, certificate of need laws are) Tj ET BT 0.8915 0 0 0.9835 80.64 165.6 Tm 0.0266 Tc 1.1665 Tw (intended to limit the supply of nursing home beds in) Tj ET BT 0.9835 0 0 0.9835 80.88 153.6 Tm 0.0247 Tc 1.708 Tw (a State. At least six States--Georgia, Kentucky,) Tj -0.244 -12.2018 TD 0.0223 Tc 3.7847 Tw (Michigan, Mississippi, New Jersey, and Ohio-) Tj ET BT 0.8915 0 0 0.9835 80.64 130.08 Tm 0.0493 Tc 1.0933 Tw (have altered the process for obtainin) Tj ET BT 0.934 0 0 0.9835 238.32 130.08 Tm -0.0386 Tc 0.5145 Tw (g a certificate of) Tj ET BT 0.9835 0 0 0.9835 80.88 118.32 Tm 0.0361 Tc 0.1373 Tw (need, either on an ongoing or a one-time basis, so) Tj ET BT 0.934 0 0 0.9835 81.12 106.56 Tm -0.0447 Tc 2.1484 Tw (that applicants who propose to create special care) Tj ET BT 0.9835 0 0 0.9835 80.88 94.56 Tm 0.0318 Tc 2.276 Tw (units or special nursing homes for people with) Tj 0.244 -11.9577 TD 0.0288 Tc 0.5569 Tw (dementia receive special consideration. To OTA\222s) Tj ET BT 0.934 0 0 0.9835 80.88 70.8 Tm -0.0308 Tc 1.436 Tw (knowledge, only two of these States, Kentucky and) Tj ET BT 0.8915 0 0 0.9835 81.12 59.04 Tm 0.0513 Tc 1.2756 Tw (Michigan, have special requirements for the units or) Tj ET BT 0.934 0 0 0.9835 81.12 47.04 Tm -0.0553 Tc 1.2421 Tw (facilities developed with a certificate of need excep-) Tj ET BT 0.9835 0 0 0.9835 327.6 655.68 Tm 0.0178 Tc 1.593 Tw (tion \(35,155,161,172\). This lack of requirements) Tj 0 -12.2018 TD 0.04 Tc 0.5027 Tw (created consternation in at least one of the other) Tj ET BT 0.8915 0 0 0.9835 327.84 631.68 Tm 0.0366 Tc 0.7921 Tw (States when State surveyors were preparing for their) Tj ET BT 0.9835 0 0 0.9835 327.84 619.92 Tm 0.0337 Tc 0.5701 Tw (annual inspection of a facility that had created a) Tj ET BT 0.8915 0 0 0.9835 328.32 607.68 Tm 0.0456 Tc 1.1042 Tw (special care unit with a certificate of need exception,) Tj ET BT 0.934 0 0 0.9835 328.08 595.68 Tm -0.0379 Tc 1.1418 Tw (and the surveyors wanted to know what to look for) Tj 0 -12.2018 TD -0.0168 Tc 0.6282 Tw (when they inspected the unit \(155\).) Tj ET BT 0.8915 0 0 0.9835 339.12 565.44 Tm 0.0319 Tc 0.8166 Tw (In Kentucky, the legislature created a time-limited) Tj ET BT 0.9835 0 0 0.9835 328.32 553.2 Tm 0.0449 Tc 0.6198 Tw (exception to the State\222s certificate of need law to) Tj ET BT 0.934 0 0 0.9835 328.56 541.44 Tm -0.0274 Tc 2.1812 Tw (allow the establishment of \223free-standing facilities) Tj ET BT 0.9835 0 0 0.9835 328.32 529.68 Tm 0.0318 Tc -0.0685 Tw (limited to the care of patients with Alzheimer\222s or) Tj 0 -11.9577 TD 0.0413 Tc 1.3251 Tw (related disorders\222) Tj 88.829 -0.244 TD 0.0388 Tc 1.3276 Tw (\(172\). The facilities had to be) Tj -88.3409 -12.2018 TD 0.046 Tc 0.9238 Tw (approved by July 1991 and have to meet special) Tj ET BT 0.934 0 0 0.9835 329.04 494.16 Tm -0.026 Tc 1.9356 Tw (licensing requirements. Interestingly, the licensing) Tj ET BT 0.9835 0 0 0.9835 328.56 482.16 Tm 0.029 Tc 0.1784 Tw (requirements for free-standing Alzheimer\222s facili-) Tj 0.4881 -12.2018 TD 0.0421 Tc 1.1073 Tw (ties do not apply to special care units, and free-) Tj ET BT 0.934 0 0 0.9835 329.52 458.16 Tm -0.0288 Tc 1.5073 Tw (standing Alzheimer\222s facilities do not have to meet) Tj -0.257 -11.9577 TD -0.0206 Tc 1.6086 Tw (the State\222s regulatory requirements for all nursing) Tj ET BT 0.9835 0 0 0.9835 329.28 434.4 Tm 0.0308 Tc 2.0949 Tw (homes. As of the cutoff time in July 1991, one) Tj ET BT 0.934 0 0 0.9835 329.52 422.64 Tm -0.0201 Tc 1.3144 Tw (facility had obtained a license, and another facility) Tj 0.257 -12.4458 TD -0.0241 Tc 1.3555 Tw (was in the process of doing so \(343\).) Tj ET BT 0.9835 0 0 0.9835 340.56 392.16 Tm 0.0364 Tc 1.8588 Tw (Effective in 1989, the Michigan Certificate of) Tj ET BT 0.934 0 0 0.9835 329.52 380.4 Tm -0.0252 Tc 1.0354 Tw (Need Commission set aside 200 beds from the total) Tj 0.257 -12.4458 TD -0.0179 Tc 0.9955 Tw (number of allowable new nursing home beds in the) Tj ET BT 0.8915 0 0 0.9835 330.24 356.4 Tm 0.03 Tc 1.2823 Tw (State to be used for special care units. The Commis-) Tj ET BT 0.9835 0 0 0.9835 330.48 344.4 Tm 0.0326 Tc 1.944 Tw (sion determined that special care units created) Tj ET BT 0.934 0 0 0.9835 330.24 332.4 Tm -0.0354 Tc 0.9821 Tw (through this certificate of need exception must:) Tj ET BT 0.8915 0 0 0.9835 352.08 313.68 Tm 0.0472 Tc 1.4725 Tw (admit only patients who require long-term care) Tj ET BT 0.934 0 0 0.9835 352.8 301.92 Tm -0.0197 Tc 0.9653 Tw (and have been appropriately classified as hav-) Tj ET BT 0.9835 0 0 0.9835 352.8 289.92 Tm 0.042 Tc 0.2397 Tw (ing a score below a given level on the Global) Tj ET BT 0.934 0 0 0.9835 352.8 278.16 Tm -0.0333 Tc 1.3653 Tw (Deterioration Scale, a widely used assessment) Tj ET BT 0.8491 0 0 0.9835 352.8 265.92 Tm 0.0333 Tc 0 Tw (instrument,) Tj ET BT 0.8915 0 0 0.9835 352.8 253.2 Tm 0.031 Tc 1.9752 Tw (participate in the State Alzheimer\222s registry,) Tj ET BT 0.934 0 0 0.9835 352.56 240.72 Tm -0.0183 Tc 0.9959 Tw (operate for a minimum of 5 years and conduct) Tj ET BT 0.8915 0 0 0.9835 353.04 228.96 Tm 0.044 Tc 2.0144 Tw (and participate in research programs approved) Tj -0.2692 -12.6899 TD 0.0258 Tc 1.4068 Tw (by the department to evaluate the effectiveness) Tj ET BT 0.934 0 0 0.9835 353.04 204.48 Tm -0.0313 Tc 1.0419 Tw (of special care units and to study the relation-) Tj ET BT 0.8915 0 0 0.9835 353.52 192.48 Tm 0.0329 Tc 1.8026 Tw (ship between the needs of Alzheimer\222s patients) Tj 0 -12.4458 TD 0.036 Tc 1.4466 Tw (and the needs of other nursing home residents,) Tj -0.8076 -12.6899 TD 0.0457 Tc 0.8204 Tw (be affiliated with a research facility or program,) Tj ET BT 0.9835 0 0 0.9835 353.04 155.04 Tm 0.0371 Tc 1.5734 Tw (be attached or geographically adjacent to a) Tj ET BT 0.934 0 0 0.9835 353.52 143.52 Tm -0.0255 Tc 1.357 Tw (licensed nursing home,) Tj -0.5139 -12.2018 TD 0.0006 Tc 0.6095 Tw (have no more than 20 beds,) Tj ET BT 0.8915 0 0 0.9835 353.28 119.04 Tm 0.062 Tc 1.2204 Tw (have direct access to a secure indoor or outdoor) Tj 1.0768 -11.7137 TD 0.0364 Tc 2.023 Tw (area for unsupervised activity,) Tj ET BT 0.9835 0 0 0.9835 353.52 95.04 Tm 0.0366 Tc 0.6588 Tw (have a separate dining room for use only by) Tj ET BT 0.8915 0 0 0.9835 353.52 83.04 Tm 0.0149 Tc 1.5088 Tw (residents of the unit,) Tj ET BT 0.934 0 0 0.9835 353.52 70.8 Tm -0.0213 Tc 0.7528 Tw (have a physical environment designed to mini-) Tj 0.5139 -12.4458 TD -0.0271 Tc 1.1017 Tw (mize noise and light reflections, and) Tj ET BT 0.8915 0 0 0.9835 353.52 47.04 Tm 0.0113 Tc 2.0511 Tw (have trained staff \(304\).) Tj ET endstream endobj 460 0 obj <>/Filter/CCITTFaxDecode/Height 1112/Length 429/Name/im197/Subtype/Image/Type/XObject/Width 48>>stream &iFp>߭ ?4=={]~ <}߯k a]O={k[ ?Az^^aa, xOO= -Ҍ]޽[[[Y4>?3O? m`c@ endstream endobj 461 0 obj <>/ProcSet 565 0 R/XObject<>>>/Rotate 0/Type/Page>> endobj 462 0 obj [463 0 R 464 0 R] endobj 463 0 obj <>stream q 7.2 0 0 -331.2 317.28 586.56 cm /im198 Do endstream endobj 464 0 obj <>stream Q q 8.64 0 0 -7.2 317.28 255.36 cm BI /W 48 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? EI Q q 8.64 0 0 -41.76 315.84 248.16 cm BI /W 48 /H 232 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? EI Q q 10.08 0 0 -2.88 315.84 206.4 cm BI /W 56 /H 16 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? EI Q 0.72 w 1 j 0 0 0 RG 56.16 677.52 m 533.76 677.52 l S 60.72 65.76 m 538.56 65.76 l S BT 0.9835 0 0 0.9835 246.24 682.8 Tm 0 0 0 rg /F5 10 Tf 0.0225 Tc 1.6244 Tw (Chapter 5-Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 510.96 682.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 517.44 682.8 Tm /F5 10 Tf 0.2847 Tc 0 Tw (149) Tj -457.5668 -39.7778 TD /F4 10 Tf 0.0337 Tc 1.0277 Tw (As of March 1991, the first five applicants for) Tj ET BT 0.934 0 0 0.9835 56.64 631.68 Tm -0.0494 Tc 1.4253 Tw (certificate of need exceptions had been disapproved) Tj -0.257 -11.9577 TD -0.0368 Tc 1.5617 Tw (because they did not submit a research protocol or) Tj 0.5139 -11.9577 TD -0.0219 Tc 0.8025 Tw (were not affiliated with a research program \(514\).) Tj ET BT 0.9795 0 0 0.9795 64.8 567.12 Tm /F7 12 Tf 0.0436 Tc 0.4254 Tw (Other State Policies for Special Care Units) Tj ET BT 0.934 0 0 0.9835 68.4 540.48 Tm /F4 10 Tf -0.03 Tc 0.7194 Tw (In addition to regulations, guidelines, and certifi-) Tj ET BT 0.9835 0 0 0.9835 57.6 528.24 Tm 0.0469 Tc 0.6918 Tw (cate of need exceptions, several States have pro-) Tj ET BT 0.934 0 0 0.9835 57.6 516.24 Tm -0.0384 Tc 0.9211 Tw (vided finding for individual special care units or for) Tj ET BT 0.8915 0 0 0.9835 57.6 504.24 Tm 0.0378 Tc 0.7763 Tw (training staff members in special care units. In 1987,) Tj ET BT 0.934 0 0 0.9835 57.6 492.24 Tm -0.0214 Tc 1.7637 Tw (Massachusetts initiated its \223Alzheimer\222s Unit Pilot) Tj ET BT 0.9835 0 0 0.9835 58.08 480 Tm 0.0236 Tc 1.9938 Tw (Program\224 which has provided funding for eight) Tj ET BT 0.934 0 0 0.9835 57.84 468.48 Tm -0.029 Tc 0.9569 Tw (nursing homes to create special care units. Connec-) Tj ET BT 0.9835 0 0 0.9835 58.32 456.24 Tm 0.0345 Tc 0.5999 Tw (ticut has provided funding for a 120-bed nursing) Tj -0.244 -11.9577 TD 0.0433 Tc 1.079 Tw (home and research center devoted to the care of) Tj 0.244 -12.4458 TD 0.0261 Tc 0.1692 Tw (individuals with Alzheimer\222s disease. Florida has) Tj 0 -12.2018 TD 0.0349 Tc 0.1114 Tw (provided funding for a long-term care facility and) Tj T* 0.0235 Tc 1.3432 Tw (research center for individuals with Alzheimer\222s) Tj 0.244 -12.4458 TD 0.0451 Tc 3.1689 Tw (disease. Each of these projects is intended to) Tj ET BT 0.934 0 0 0.9835 58.8 384 Tm -0.0434 Tc 6.7722 Tw (develop, demonstrate,) Tj ET BT 0.9835 0 0 0.9835 166.8 383.76 Tm 0.0485 Tc 2.2939 Tw (and evaluate methods of) Tj ET BT 0.934 0 0 0.9835 59.04 371.76 Tm -0.0368 Tc 1.8829 Tw (specialized dementia care.) Tj ET BT 0.9557 0 0 1.08 175.2 376.56 Tm /F4 4 Tf 0.0359 Tc 0 Tw (1) Tj ET BT 0.9835 0 0 0.9835 70.08 344.64 Tm /F4 10 Tf 0.0462 Tc 1.9128 Tw (California has funded at least two studies of) Tj ET BT 0.934 0 0 0.9835 59.52 332.64 Tm -0.0296 Tc 0.5904 Tw (special care units. One study compared two nursing) Tj -0.5139 -12.2018 TD -0.0298 Tc 0.762 Tw (home special care units, two nonspecialized nursing) Tj ET BT 0.9835 0 0 0.9835 59.04 308.64 Tm 0.0312 Tc 3.2063 Tw (home units, and two specialized programs for) Tj ET BT 0.934 0 0 0.9835 59.52 296.4 Tm -0.0225 Tc 1.317 Tw (individuals with dementia in board and care facili-) Tj 0 -12.4458 TD -0.0221 Tc 0.6395 Tw (ties \(256\). The results of this study are discussed in) Tj ET BT 0.9835 0 0 0.9835 59.76 271.92 Tm 0.0226 Tc 1.5881 Tw (chapter 3. A second study is comparing various) Tj -0.244 -11.9577 TD 0.0349 Tc 0.1602 Tw (methods of preventing individuals with dementia) Tj ET BT 0.8915 0 0 0.9835 59.76 248.16 Tm 0.0355 Tc 1.25 Tw (from wandering away from a care setting. The study) Tj ET BT 0.9835 0 0 0.9835 60 236.4 Tm 0.0384 Tc -0.0316 Tw (is evaluating the effectiveness of door alarms and) Tj ET BT 0.934 0 0 0.9835 60 224.16 Tm -0.0285 Tc 0.6535 Tw (wrist bands vs. a locked perimeter in achieving this) Tj -0.257 -12.6899 TD -0.0093 Tc 2.8813 Tw (purpose \(484\).) Tj 12.3339 -27.332 TD 0.3001 Tc 0 Tw (Beg) Tj 18.7578 -0.244 TD 0.0011 Tc 0.9859 Tw (inning in 1991, Michigan has provided fund-) Tj -30.3208 -11.9577 TD -0.0184 Tc 1.0282 Tw (ing to the Alzheimer\222s Care and Training Center, a) Tj ET BT 0.8915 0 0 0.9835 60.72 160.32 Tm 0.0474 Tc 1.2367 Tw (special care unit in Ann Arbor, Michigan, to support) Tj ET BT 0.9835 0 0 0.9835 60 148.8 Tm 0.032 Tc 0.0795 Tw (research on the care of individuals with dementia) Tj ET BT 0.934 0 0 0.9835 60.72 136.56 Tm -0.0242 Tc 1.5482 Tw (and to provide training about dementia for staff of) Tj 0 -11.9577 TD -0.003 Tc 0.8617 Tw (the State\222s community mental health centers \(384\).) Tj 0 -12.2018 TD -0.0274 Tc 1.2626 Tw (Rhode Island has provided funding for the past six) Tj ET BT 0.8915 0 0 0.9835 60.48 100.8 Tm 0.0446 Tc -0.0388 Tw (years for a training program that has been instrumen-) Tj ET BT 0.9835 0 0 0.9835 60.72 88.8 Tm 0.0267 Tc 0.8519 Tw (tal in establishing several special care units and) Tj ET BT 0.934 0 0 0.9835 61.2 76.8 Tm -0.0198 Tc 1.0297 Tw (specialized adult day centers \(284\).) Tj ET BT 0.9795 0 0 0.9795 352.8 641.76 Tm /F7 12 Tf 0.0392 Tc 1.2467 Tw (Summary and Implications) Tj ET BT 0.9835 0 0 0.9835 318.48 622.56 Tm /F4 10 Tf 0.0318 Tc 0.6026 Tw (Special care units are clearly an area of policy) Tj ET BT 0.934 0 0 0.9835 307.44 610.56 Tm -0.0284 Tc 0.5571 Tw (interest in many States. As discussed in the preced-) Tj 0.257 -11.9577 TD -0.0349 Tc 0.7888 Tw (ing sections, there are now:) Tj ET BT 0.8915 0 0 0.9835 329.76 578.88 Tm 0.0342 Tc 0.641 Tw (six States with regulations for special care units) Tj ET BT 0.9835 0 0 0.9835 330 567.12 Tm -0.0123 Tc 0 Tw (\(IA,TX,CO,WA,TN,KS\);) Tj ET BT 0.934 0 0 0.9835 329.52 553.44 Tm -0.0378 Tc 0.9664 Tw (five States in the process of developing regula-) Tj 0.7709 -12.2018 TD 0.0016 Tc 3.8974 Tw (tions \(NC,NE,NJ,OK,OR\);) Tj ET BT 0.8915 0 0 0.9835 329.76 527.52 Tm 0.0218 Tc 1.5458 Tw (one additional State that has passed legislation) Tj ET BT 0.9835 0 0 0.9835 330.48 515.52 Tm 0.044 Tc 1.5664 Tw (to mandate the development of regulations) Tj 0 -11.9577 TD 0.0533 Tc 0 Tw (\(AR\);) Tj 0 -13.91 TD 0.037 Tc 1.4921 Tw (three additional States in which the State-) Tj ET BT 0.934 0 0 0.9835 330.72 477.84 Tm -0.0382 Tc 1.8844 Tw (appointed Alzheimer\222s task force or long-term) Tj ET BT 0.9835 0 0 0.9835 330.48 466.32 Tm 0.0253 Tc 1.3414 Tw (care advisory council has recommended the) Tj ET BT 0.934 0 0 0.9835 330.72 454.32 Tm -0.0199 Tc 2.807 Tw (development of regulations \(AZ,IN,RI\);) Tj ET BT 0.8915 0 0 0.9835 330.48 440.4 Tm 0.0208 Tc 0.4253 Tw (one State that has passed legislation to establish) Tj ET BT 0.934 0 0 0.9835 331.2 428.4 Tm -0.0359 Tc 1.4782 Tw (a committee to study the need for regulations) Tj 0.257 -12.2018 TD 0.0005 Tc 0 Tw (\(VA\);) Tj -0.5139 -14.1541 TD -0.035 Tc 0.5962 Tw (one State with guidelines for special care units) Tj 0.7709 -13.666 TD 0.0034 Tc 0 Tw (\(NH\);) Tj ET BT 0.9835 0 0 0.9835 330.96 377.04 Tm 0.0465 Tc 1.9705 Tw (one State that is developing guidelines for) Tj ET BT 0.934 0 0 0.9835 331.92 364.8 Tm -0.0229 Tc 1.0971 Tw (special care units \(MO\);) Tj ET BT 0.9835 0 0 0.9835 331.2 351.12 Tm 0.0431 Tc 3.3452 Tw (one State with guidelines for the care of) Tj ET BT 0.8915 0 0 0.9835 331.68 339.36 Tm 0.0424 Tc 1.2536 Tw (individuals with dementia in any nursing home) Tj ET BT 0.934 0 0 0.9835 331.44 326.88 Tm 0.0105 Tc 2.3463 Tw (unit \(MA\);) Tj 0 -13.91 TD -0.027 Tc 1.7256 Tw (one State in which the Alzheimer\222s task force) Tj ET BT 0.9835 0 0 0.9835 331.92 301.2 Tm 0.0472 Tc 0.0989 Tw (has recommended the development of guide-) Tj ET BT 0.934 0 0 0.9835 331.92 289.2 Tm -0.0341 Tc 1.1092 Tw (lines for the care of individuals with dementia) Tj ET BT 0.9835 0 0 0.9835 332.16 277.2 Tm 0.0251 Tc 1.202 Tw (that would apply to any nursing home unit) Tj 0.4881 -11.9577 TD 0.0338 Tc 0 Tw (\(MD\);) Tj -0.4881 -13.91 TD 0.0383 Tc 1.2933 Tw (six States that have altered the process for) Tj ET BT 0.934 0 0 0.9835 332.64 240.24 Tm -0.0347 Tc 0.596 Tw (obtaining a certificate of need to encourage the) Tj ET BT 0.9835 0 0 0.9835 332.64 228 Tm 1.0045 Tc 3.3961 Tw (establishment of special care unit) Tj 0.0041 Tc 0 Tw (s) Tj ET BT 0.934 0 0 0.9835 332.88 216.24 Tm 0.0131 Tc 5.6838 Tw (\(GA,KY,MI,MS,NJ,OH\); and) Tj ET BT 0.9835 0 0 0.9835 332.64 202.32 Tm 0.039 Tc 2.8323 Tw (six States that have provided funding for) Tj 0 -11.9577 TD 0.0213 Tc 1.0526 Tw (individual special care-units, for training in) Tj 0.7321 -12.4458 TD 0.0262 Tc 0.678 Tw (special care units, or for research on special) Tj ET BT 0.934 0 0 0.9835 332.88 167.52 Tm 0.006 Tc 3.1219 Tw (care units \(MA,CA,CT,FL,MI,RI\).) Tj -11.563 -19.7669 TD -0.0346 Tc 0.5958 Tw (These figures and the discussion in the preceding) Tj -11.0491 -12.4458 TD -0.0294 Tc 1.875 Tw (sections reflect information available to OTA as of) Tj ET BT 0.9835 0 0 0.9835 311.52 124.32 Tm 0.0319 Tc 0.1686 Tw (early 1992. The figures indicate that a total of 28) Tj ET BT 0.934 0 0 0.9835 311.76 112.32 Tm -0.0358 Tc 0.7399 Tw (States have, are in the process of developing, or are) Tj ET BT 0.9835 0 0 0.9835 311.52 100.8 Tm 0.0431 Tc 1.4859 Tw (considering developing policies of some kind for) Tj ET BT 0.8915 0 0 0.9835 311.76 88.8 Tm 0.0393 Tc 1.3468 Tw (special care units. \(Five States are included twice in) Tj 0 -11.9577 TD -0.0165 Tc 1.2748 Tw (the list.\)) Tj ET q 0.96 0 0 -4.08 75.36 59.52 cm BI /W 9 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>>>>>>>>>>~ EI Q BT 0.1878 0 0 0.9835 75.36 53.04 Tm 3 Tr /F2 10 Tf 0.1101 Tc 0 Tw (1) Tj 0 Tr ET BT 0.7511 0 0 0.9835 76.32 53.04 Tm 0.0424 Tc 1.3204 Tw ( Several other States, e.g., Illinois and New York, have provided funding for nursing homes to develop improved methods of caring for residents) Tj -20.4511 -9.2734 TD 0.0585 Tc 0.5826 Tw (with dementia in nonspecialized units. The New York Medicaid program pays an additional $4 a day for residents with ) Tj ET q 31.2 0 0 -5.76 435.6 49.68 cm BI /W 219 /H 33 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?3a?????>>>~~>>p?>>?x?>>>>>>?>>>>>>?>>?>?`??>??>x?~?>x?>><~~<~p?x@>8<~>????|< EI Q BT 0.6102 0 0 0.9835 435.6 43.92 Tm 3 Tr -0.0619 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.7511 0 0 0.9835 466.8 43.92 Tm 0.0516 Tc 0.6254 Tw ( disease in any nursing) Tj ET BT 0.798 0 0 0.9835 60.72 35.04 Tm 0.0399 Tc -0.145 Tw (home \(201\). Maine and Oregon subsidize the care of some residents with dementia in specialized board and care facilities \(303,501\).) Tj ET endstream endobj 465 0 obj <>/Filter/CCITTFaxDecode/Height 1840/Length 633/Name/im198/Subtype/Image/Type/XObject/Width 40>>stream &{[Xk 3/ =={[A|! zxO={{} ===={_mml,X@`>a~[X0h$ ma? xOOO{~k~ xO__߯ ?3<'ޞ޿[[[Xa`c ׿߭  endstream endobj 466 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 467 0 obj <>stream 0.72 w 1 j 0 0 0 RG 75.6 684.48 m 553.92 684.48 l S BT 0.9835 0 0 0.9835 76.32 690 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (150 ) Tj ET BT 0.9598 0 0 0.9598 94.32 690 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 100.56 690 Tm /F5 10 Tf 0.0125 Tc 1.038 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 87.36 650.4 Tm /F4 10 Tf -0.0296 Tc 1.2512 Tw (State policies for special care units are changing) Tj -12.0769 -11.9577 TD -0.0367 Tc 1.7972 Tw (rapidly. Interest in the development of regulations) Tj ET BT 0.9835 0 0 0.9835 76.56 626.64 Tm 0.0204 Tc 0.8582 Tw (for special care units is clearly growing. In some) Tj ET BT 0.934 0 0 0.9835 76.56 614.64 Tm -0.0255 Tc 1.6873 Tw (States, this interest is unopposed. In other States,) Tj ET BT 0.8915 0 0 0.9835 77.04 602.64 Tm 0.0327 Tc 1.3349 Tw (such as Illinois, Michigan, Ohio, and Wisconsin, this) Tj ET BT 0.9835 0 0 0.9835 76.56 591.12 Tm 0.022 Tc 1.3854 Tw (issue is controversial, and some groups strongly) Tj 0.244 -12.4458 TD 0.0511 Tc -0.1491 Tw (oppose the development of regulations. Anecdotal) Tj 0 -12.2018 TD 0.0294 Tc -0.127 Tw (evidence suggests that in a few States, regulatory) Tj ET BT 0.934 0 0 0.9835 76.56 555.12 Tm -0.0372 Tc 1.7806 Tw (proposals developed by Alzheimer\222s advocates have) Tj ET BT 0.9835 0 0 0.9835 77.04 543.12 Tm 0.0479 Tc 1.481 Tw (been opposed by other Alzheimer\222s advocates or) Tj 0 -12.2018 TD 0.0245 Tc 0.4148 Tw (nursing home industry representatives who have) Tj 0.244 -12.2018 TD 0.0471 Tc 2.9054 Tw (different ideas about whether there should be) Tj ET BT 0.934 0 0 0.9835 77.04 507.12 Tm -0.0196 Tc 1.681 Tw (regulations, and if so, what the regulations should) Tj ET BT 0.8491 0 0 0.9835 77.76 494.88 Tm 0.0053 Tc 0 Tw (say.) Tj ET BT 0.8915 0 0 0.9835 88.32 475.2 Tm 0.0403 Tc 1.1773 Tw (Thus far, State policies for special care units have) Tj -12.1137 -12.4458 TD 0.048 Tc 1.4332 Tw (been developed without regard for the nursing home) Tj ET BT 0.9835 0 0 0.9835 77.76 451.44 Tm 0.0453 Tc 0.3449 Tw (reform provisions of OBRA-87. Some of the State) Tj 0 -12.2018 TD 0.0432 Tc 0.6317 Tw (regulations for special care units were developed) Tj T* 0.0498 Tc 2.6064 Tw (before OBRA-87 was passed, and many of the) Tj ET BT 0.8915 0 0 0.9835 77.76 415.44 Tm 0.0546 Tc 1.7782 Tw (regulations were developed before the publication in) Tj ET BT 0.9835 0 0 0.9835 78.24 403.68 Tm 0.0342 Tc 0.5086 Tw (February 1989 of the first version of the require-) Tj -0.244 -12.2018 TD 0.0201 Tc 2.1194 Tw (ments to implement OBRA-87. It is surprising,) Tj ET BT 0.934 0 0 0.9835 78.24 379.68 Tm -0.0233 Tc 1.7829 Tw (however, that current discussion and debate about) Tj 0 -12.2018 TD -0.0318 Tc 1.7308 Tw (regulations and guidelines for special care units is) Tj ET BT 0.9835 0 0 0.9835 78.48 355.68 Tm 0.0465 Tc 1.4243 Tw (proceeding with so little reference to the OBRA) Tj ET BT 0.934 0 0 0.9835 78.48 343.68 Tm -0.0359 Tc 2.0104 Tw (requirements. One exception to this observation is) Tj ET BT 0.9835 0 0 0.9835 78.96 331.92 Tm 0.0431 Tc 2.7061 Tw (the 1991 report of the Maryland Coordinating) Tj ET BT 0.934 0 0 0.9835 79.2 320.16 Tm -0.0361 Tc 1.5396 Tw (Council on Alzheimer\222s Disease and Related Disor-) Tj ET BT 0.9835 0 0 0.9835 78.96 308.16 Tm 0.0402 Tc 0.9078 Tw (ders. The report notes the likelihood that OBRA) Tj -0.244 -11.7137 TD 0.0376 Tc -0.1354 Tw (requirements will improve the care of people with) Tj ET BT 0.934 0 0 0.9835 79.2 284.4 Tm -0.0229 Tc 0.9137 Tw (dementia in nursing homes and stresses the impor-) Tj ET BT 0.9835 0 0 0.9835 79.44 272.88 Tm 0.0302 Tc 3.5815 Tw (tance for Alzheimer\222s advocates of monitoring) Tj ET BT 0.934 0 0 0.9835 79.2 260.64 Tm -0.022 Tc 1.6616 Tw (facilities\222 compliance with the requirements \(286\).) Tj 12.0769 -20.0109 TD -0.0339 Tc 0.6593 Tw (Regulations for special care units now in effect in) Tj -11.563 -12.2018 TD -0.0167 Tc 0.7308 Tw (Iowa, Texas, Colorado, Washington, Tennessee, and) Tj -0.257 -12.4458 TD -0.0156 Tc 0.6183 Tw (Kansas have both similarities and differences. Each) Tj 0.5139 -12.6899 TD -0.0201 Tc 2.0193 Tw (State\222s regulations address several common areas,) Tj 0 -12.2018 TD -0.0165 Tc 0.9875 Tw (e.g., admission criteria, security, staff trainin) Tj 214.3009 0 TD 0.0241 Tc 0.0191 Tw (g, and) Tj -213.787 -12.2018 TD -0.0289 Tc 1.7277 Tw (some aspects of physical design, but their require-) Tj -0.5139 -12.2018 TD -0.0302 Tc 1.2014 Tw (ments in each of these areas differ. Moreover, each) Tj ET BT 0.8915 0 0 0.9835 80.16 156.24 Tm 0.0432 Tc 1.4231 Tw (State\222s regulations include requirements for features) Tj ET BT 0.934 0 0 0.9835 79.92 144.48 Tm -0.0331 Tc 2.3929 Tw (not addressed in other States\222 special regulations,) Tj ET BT 0.8915 0 0 0.9835 80.16 132.48 Tm 0.0281 Tc 0.8882 Tw (e.g., Iowa\222s requirement that the unit and its outdoor) Tj ET BT 0.934 0 0 0.9835 80.64 120.48 Tm -0.0269 Tc 0.9546 Tw (area have no steps or slopes, Washington\222s require-) Tj ET BT 0.8915 0 0 0.9835 80.16 108.72 Tm 0.0327 Tc 1.4551 Tw (ment that floors, walls, and ceilings have surfaces of) Tj ET BT 0.934 0 0 0.9835 80.64 96.72 Tm -0.0295 Tc 1.1556 Tw (contrasting colors, and Colorado\222s requirement that) Tj ET BT 0.9835 0 0 0.9835 80.16 84.96 Tm 0.0373 Tc 1.4918 Tw (residents may not be locked into or out of their) Tj ET BT 0.934 0 0 0.9835 80.4 73.2 Tm -0.0301 Tc 0 Tw (rooms.) Tj ET BT 0.8915 0 0 0.9835 91.68 53.04 Tm 0.0326 Tc 0.8607 Tw (What is and is not included in these regulations is) Tj ET BT 0.934 0 0 0.9835 81.36 41.04 Tm -0.0197 Tc 1.3507 Tw (significant because of the implication that features) Tj 262.8655 619.8505 TD -0.0296 Tc 1.5326 Tw (required by the regulations are particularly impor-) Tj ET BT 0.9835 0 0 0.9835 327.6 638.4 Tm 0.0233 Tc 1.4044 Tw (tant in the care of nursing home residents with) Tj ET BT 0.8491 0 0 0.9835 327.6 626.88 Tm 0.0424 Tc 1.5495 Tw (dementia and that other features not addressed by the) Tj ET BT 0.934 0 0 0.9835 327.12 614.88 Tm -0.0305 Tc 1.1053 Tw (regulations are not particularly important for these) Tj 0.257 -11.9577 TD -0.0293 Tc 0.6329 Tw (residents. The inclusion of certain features suggests) Tj ET BT 0.8915 0 0 0.9835 327.6 591.12 Tm 0.0466 Tc 1.4731 Tw (that nursing home resources should be expended for) Tj 0.2692 -12.4458 TD 0.0258 Tc 1.2273 Tw (those features and not others.) Tj 12.1137 -18.3027 TD 0.0507 Tc 1.0647 Tw (Many of the requirements for special care units in) Tj -11.5754 -11.9577 TD 0.0342 Tc 0.5897 Tw (the six States probably are not more important in the) Tj ET BT 0.934 0 0 0.9835 328.32 537.12 Tm -0.0236 Tc 0.9879 Tw (care of nursing home residents with dementia than) Tj 0 -12.4458 TD -0.0295 Tc 1.2327 Tw (other nursing home residents, e.g., an interdiscipli-) Tj ET BT 0.9835 0 0 0.9835 328.32 512.64 Tm 0.0173 Tc 2.6103 Tw (nary care planning team \(IA,TN\); policies that) Tj ET BT 0.8915 0 0 0.9835 328.56 501.12 Tm 0.0398 Tc 0.9087 Tw (explain the programs and services offered in the unit) Tj ET BT 0.934 0 0 0.9835 329.04 488.88 Tm -0.0305 Tc 1.6835 Tw (\(IA\); a social worker to assess residents on admis-) Tj ET BT 0.9835 0 0 0.9835 329.04 477.12 Tm 0.0215 Tc 0.1657 Tw (sion, conduct family support group meetings, and) Tj -0.244 -12.2018 TD 0.0281 Tc 2.3146 Tw (identify and arrange for the use of community) Tj ET BT 0.934 0 0 0.9835 328.8 452.88 Tm -0.0304 Tc 2.2872 Tw (resources \(TX\); activity and recreational programs) Tj 0.257 -12.2018 TD -0.033 Tc 1.8789 Tw (tailored to individual residents\222 needs \(TX\); a staff) Tj ET BT 0.8915 0 0 0.9835 329.04 429.12 Tm 0.0306 Tc 1.2219 Tw (member on the unit at all times \(KS\); and nurse-call) Tj ET BT 0.934 0 0 0.9835 329.52 417.12 Tm -0.0206 Tc 1.3517 Tw (signals that are visible and audible from the corri-) Tj -0.257 -11.9577 TD -0.0096 Tc 0.7746 Tw (dors and the nurses\222 sub-station \(KS\).) Tj ET BT 0.9835 0 0 0.9835 340.56 387.12 Tm 0.0285 Tc 2.5582 Tw (Some of the requirements in the six States\222) Tj -11.7137 -11.7137 TD 0.0412 Tc 0.2514 Tw (regulations duplicate provisions of OBRA-87 that) Tj 0.7321 -12.4458 TD 0.0242 Tc -0.1218 Tw (apply to all nursing home residents. For example,) Tj 0 -12.2018 TD 0.0393 Tc -0.0325 Tw (Iowa and Colorado require that special care units) Tj ET BT 0.934 0 0 0.9835 329.76 339.36 Tm -0.0422 Tc 0.604 Tw (have policies to allow residents to have visitors. The) Tj ET BT 0.9835 0 0 0.9835 330 327.36 Tm 0.0293 Tc 0.6459 Tw (OBRA requirement states, \223The resident has the) Tj ET BT 0.8915 0 0 0.9835 329.76 315.6 Tm 0.0289 Tc 1.3776 Tw (right and the facility must provide immediate access) Tj ET BT 0.934 0 0 0.9835 330.24 303.84 Tm -0.0247 Tc 0.8422 Tw (to any resident. .) Tj ET BT 0.9835 0 0 0.9835 408.96 303.84 Tm 0.0241 Tc 0.4153 Tw (subject to the resident\222s right to) Tj ET BT 0.8915 0 0 0.9835 330 292.08 Tm 0.0318 Tc 1.1196 Tw (deny or withdraw consent at any time, by immediate) Tj ET BT 0.9835 0 0 0.9835 330.48 280.08 Tm 0.0301 Tc 0.035 Tw (family or other relatives of the residents. . and by) Tj 0 -12.2018 TD 0.0306 Tc 1.824 Tw (others who are visiting with the consent of the) Tj -0.244 -11.7137 TD 0.0377 Tc 0.3525 Tw (resident\224 \(463\).) Tj 11.2256 -18.3027 TD 0.0219 Tc 1.4668 Tw (In general, the six States\222 requirements focus) Tj ET BT 0.934 0 0 0.9835 330.48 226.8 Tm -0.0174 Tc 1.0546 Tw (more on staff training and physical design features) Tj ET BT 0.9835 0 0 0.9835 330.96 214.56 Tm 0.0239 Tc 2.0749 Tw (and less on activity programs and programs to) Tj -0.244 -12.4458 TD 0.0294 Tc 0.361 Tw (involve and support residents\222 families. Although) Tj 0.4881 -12.4458 TD 0.0361 Tc -0.1067 Tw (there is no evidence from research that any one of) Tj 0 -12.2018 TD 0.0321 Tc 1.5479 Tw (these features is more likely than the others to) Tj ET BT 0.934 0 0 0.9835 330.72 166.32 Tm -0.0482 Tc 2.4091 Tw (produce positive outcomes, some dementia experts) Tj ET BT 0.8915 0 0 0.9835 331.2 154.08 Tm 0.0454 Tc 1.5898 Tw (would probably favor a greater emphasis on activity) Tj -0.2692 -11.7137 TD 0.0242 Tc 0.8061 Tw (programs and family support programs than exists in) Tj 0.2692 -12.2018 TD 0.0246 Tc 1.9465 Tw (the six States\222 requirements.) Tj ET BT 0.9835 0 0 0.9835 342 113.04 Tm 0.035 Tc -0.1327 Tw (Notably absent from the requirements of five of) Tj -10.4935 -11.9577 TD 0.0381 Tc 3.85 Tw (the six States is any mention of the role of) Tj ET BT 0.8915 0 0 0.9835 331.2 89.52 Tm 0.0301 Tc 2.1916 Tw (physicians, except in approving residents\222 admission) Tj ET BT 0.9835 0 0 0.9835 331.92 77.76 Tm 0.0363 Tc 2.9338 Tw (to the unit. Likewise, except for the Colorado) Tj ET BT 0.8915 0 0 0.9835 331.44 65.52 Tm 0.0459 Tc 0.8459 Tw (regulations, mental health expertise and training are) Tj ET BT 0.934 0 0 0.9835 331.68 53.76 Tm -0.0352 Tc 1.5876 Tw (not mentioned, and their inclusion in the Colorado) Tj ET BT 0.9835 0 0 0.9835 331.68 42 Tm 0.0243 Tc 0.1222 Tw (regulations may simply reflect the fact that these) Tj ET endstream endobj 468 0 obj <>/Rotate 0/Type/Page>> endobj 469 0 obj <>stream 0.72 w 1 j 0 0 0 RG 58.08 680.64 m 535.68 680.64 l S 61.92 59.28 m 539.28 59.28 l S BT 0.9835 0 0 0.9835 248.4 685.92 Tm 0 0 0 rg /F5 10 Tf 0.0273 Tc 1.1856 Tw (Chapter 5--Regulations And Guidelines For Special Care Units . 151) Tj -193.2762 -39.0457 TD /F4 10 Tf 0.0253 Tc 0.0398 Tw (regulations pertain to locked units for psychiatric) Tj ET BT 0.934 0 0 0.9835 58.32 635.28 Tm -0.0323 Tc 0.754 Tw (patients as well as locked units for individuals with) Tj ET BT 0.9835 0 0 0.9835 58.8 623.28 Tm 0.0243 Tc 1.4644 Tw (dementia. Requirements for ongoing physicians\222) Tj ET BT 0.8915 0 0 0.9835 59.04 611.04 Tm 0.0391 Tc 1.9302 Tw (involvement with residents appear in other sections) Tj ET BT 0.934 0 0 0.9835 59.04 599.04 Tm -0.0144 Tc 1.345 Tw (of the States\222 nursing home regulations and in the) Tj ET BT 0.9835 0 0 0.9835 59.04 587.52 Tm 0.283 Tc 3.2756 Tw (Federal regulations for Medicare and Medi-) Tj ET BT 0.934 0 0 0.9835 59.04 575.04 Tm -0.0211 Tc 1.4991 Tw (caid certification of nursing homes, and there may) Tj 0.257 -11.9577 TD -0.0262 Tc 1.1435 Tw (also be requirements for involving individuals with) Tj ET BT 0.8915 0 0 0.9835 59.04 551.52 Tm 0.0339 Tc 0.6798 Tw (mental health training in other sections of the States) Tj ET BT 0.9835 0 0 0.9835 59.04 539.52 Tm 0.0262 Tc 0.405 Tw (nursing home regulations. Omission of these fea-) Tj ET BT 0.8915 0 0 0.9835 59.52 527.52 Tm 0.0402 Tc 1.2111 Tw (tures in the special care unit requirements suggests,) Tj -0.2692 -12.2018 TD 0.0378 Tc 0.7427 Tw (nevertheless, that they are less important in the care) Tj ET BT 0.934 0 0 0.9835 59.76 503.28 Tm -0.0224 Tc 1.5004 Tw (of nursing home residents with dementia than the) Tj ET BT 0.8915 0 0 0.9835 59.76 491.52 Tm 0.0327 Tc 0.9504 Tw (features that are included.) Tj ET BT 0.9835 0 0 0.9835 70.56 473.76 Tm 0.0331 Tc 0.7407 Tw (The overall impact of State regulations on the) Tj -10.7376 -11.9577 TD 0.0264 Tc 0.2246 Tw (growth of special care units is unclear. Anecdotal) Tj 0 -12.2018 TD 0.0324 Tc 2.5543 Tw (evidence suggests that some of the six States\222) Tj ET BT 0.8915 0 0 0.9835 59.76 438.24 Tm 0.0535 Tc 2.0038 Tw (regulatory requirements may discourage the growth) Tj 0.5384 -11.9577 TD 0.0434 Tc 1.2375 Tw (of special care units, primarily because of the cost of) Tj ET BT 0.9835 0 0 0.9835 60.24 414.48 Tm 0.0141 Tc 0.6694 Tw (complying with the requirements. The Hillhaven) Tj 0.244 -11.9577 TD 0.0181 Tc 0.3725 Tw (Corp. estimates that complying with Washington) Tj ET BT 0.934 0 0 0.9835 60.48 390.72 Tm -0.0347 Tc 1.4182 Tw (State\222s requirements increased the remodeling cost) Tj ET BT 0.9835 0 0 0.9835 60.48 378.72 Tm 0.0427 Tc 0.2987 Tw (for a special care unit that opened in one of their) Tj 0 -12.2018 TD 0.0289 Tc 0.0827 Tw (facilities in 1991, from $69,000 to $118,000 \(261\).) Tj T* 0.0334 Tc 1.0585 Tw (As a result, the corporation canceled plans for a) Tj ET BT 0.8915 0 0 0.9835 60.96 342.72 Tm 0.0413 Tc 1.1089 Tw (special care unit in another facility in the State.) Tj ET BT 0.934 0 0 0.9835 71.76 324.96 Tm -0.0247 Tc 0.8055 Tw (In considering the impact of State regulations on) Tj -11.82 -12.2018 TD -0.0374 Tc 1.1698 Tw (the growth of special care units, it is interesting to) Tj ET BT 0.8915 0 0 0.9835 60.72 301.2 Tm 0.0421 Tc 1.1417 Tw (note that despite the growing number of special care) Tj 0 -12.2018 TD 0.022 Tc 0.3343 Tw (units in the United States and the growing interest in) Tj ET BT 0.934 0 0 0.9835 60.48 277.2 Tm -0.0136 Tc 0.4127 Tw (regulations for special care units in many States, as) Tj 0.7709 -11.9577 TD -0.026 Tc 0.6152 Tw (of early 1992, there were fewer than 60 special care) Tj -0.257 -12.4458 TD -0.041 Tc 0.988 Tw (units nationwide that were specially licensed, certi-) Tj ET BT 0.9835 0 0 0.9835 61.2 241.2 Tm 0.0384 Tc 1.1755 Tw (fied, designated, or registered \(17 to 19 units in) Tj ET BT 0.8915 0 0 0.9835 61.2 229.44 Tm 0.0377 Tc 0.6217 Tw (Iowa, 8 units in Texas, 12 units in Tennessee, and 20) Tj ET BT 0.934 0 0 0.9835 61.2 217.2 Tm -0.0228 Tc 0.8686 Tw (units in Oregon\). OTA is not aware of any research) Tj 0 -12.4458 TD -0.0393 Tc 1.6287 Tw (that compares these licensed, certified, designated,) Tj ET BT 0.8915 0 0 0.9835 61.44 192.96 Tm 0.0438 Tc 1.2071 Tw (or registered units to other special care units.) Tj ET BT 0.9663 0 0 0.9939 104.16 159.36 Tm /F6 14 Tf 0.0466 Tc 1.5416 Tw (SPECIAL CARE UNIT) Tj ET BT 0.9939 0 0 0.9939 74.16 143.76 Tm 0.0384 Tc 0.2029 Tw (GUIDELINES DEVELOPED BY) Tj ET BT 0.9663 0 0 0.9939 73.44 127.92 Tm 0.0507 Tc 0.4196 Tw (OTHER PUBLIC AND PRIVATE) Tj 44.7069 -16.1791 TD 0.0442 Tc 0 Tw (ORGANIZATIONS) Tj ET BT 0.9835 0 0 0.9835 72.96 94.8 Tm /F4 10 Tf 0.0384 Tc 0.7005 Tw (In addition to States, several other public and) Tj ET BT 0.934 0 0 0.9835 61.92 82.8 Tm -0.0367 Tc 1.7359 Tw (private organizations have developed or are in the) Tj ET BT 0.9835 0 0 0.9835 61.92 70.8 Tm 0.0463 Tc 1.3606 Tw (process of developing guidelines for special care) Tj 251.1127 585.6855 TD 0.0277 Tc 0.9973 Tw (units. Six of these organizations-the Alzheimer\222s) Tj 0.244 -12.2018 TD 0.0288 Tc 1.2402 Tw (Association, the American Association of Homes) Tj ET BT 0.934 0 0 0.9835 309.36 622.8 Tm -0.0164 Tc 1.9039 Tw (for the Aging, the Massachusetts Alzheimer\222s Dis-) Tj ET BT 0.9835 0 0 0.9835 309.36 610.56 Tm 0.0342 Tc 1.2509 Tw (ease Research Center, the National Institute on) Tj ET BT 0.934 0 0 0.9835 309.36 598.8 Tm -0.0246 Tc 2.3838 Tw (Aging\222s Alzheimer\222s Disease Education and Refer-) Tj ET BT 0.9835 0 0 0.9835 309.36 586.8 Tm 0.0212 Tc -0.049 Tw (ral Center, the University of South Florida\222s Sun-) Tj 0.244 -12.6899 TD 0.0316 Tc 1.3756 Tw (coast Gerontology Center, and the University of) Tj ET BT 0.934 0 0 0.9835 309.6 562.56 Tm -0.036 Tc 1.2397 Tw (Wisconsin-Milwaukee\222s Center for Architecture and) Tj ET BT 0.8915 0 0 0.9835 309.84 550.56 Tm 0.0706 Tc 1.4462 Tw (Urban Plannin) Tj ET BT 0.9835 0 0 0.9835 374.4 550.8 Tm 0.0452 Tc 1.8092 Tw (g Research-have completed guide-) Tj -65.6456 -12.2018 TD 0.0244 Tc 0.2685 Tw (line documents. The Alzheimer\222s Association also) Tj ET BT 0.934 0 0 0.9835 309.6 526.8 Tm -0.0347 Tc 0.9997 Tw (has legislative principles for special care units. The) Tj ET BT 0.9835 0 0 0.9835 309.84 515.04 Tm 0.03 Tc 2.0686 Tw (Alzheimer\222s Society of Canada, the Alzheimer\222s) Tj ET BT 0.934 0 0 0.9835 310.32 502.8 Tm -0.0218 Tc 1.4814 Tw (Coalition of Connecticut, and the U.S. Department) Tj ET BT 0.9835 0 0 0.9835 310.32 490.8 Tm 0.0495 Tc 0.7066 Tw (of Veterans Affairs are developing guidelines for) Tj ET BT 0.8915 0 0 0.9835 310.56 479.04 Tm 0.0393 Tc 1.6608 Tw (special care units. Some multi-facility nursing home) Tj -0.2692 -12.2018 TD 0.0465 Tc 1.5181 Tw (corporations have formal guidelines or standards for) Tj 0.2692 -11.9577 TD 0.0358 Tc 0.6392 Tw (their special care units. Lastly, the Joint Commission) Tj ET BT 0.9835 0 0 0.9835 310.56 443.28 Tm 0.0285 Tc 1.5821 Tw (on Accreditation of Healthcare Organizations, a) Tj ET BT 0.8915 0 0 0.9835 310.32 431.76 Tm 0.0399 Tc 2.0729 Tw (private organization that offers voluntary accredita-) Tj ET BT 0.934 0 0 0.9835 310.8 419.76 Tm -0.0366 Tc 1.6258 Tw (tion for nursing homes, is developing guidelines to) Tj ET BT 0.8915 0 0 0.9835 311.04 408 Tm 0.0402 Tc 0.3699 Tw (assist its surveyors in evaluating special care units in) Tj ET BT 0.934 0 0 0.9835 311.04 395.76 Tm -0.0288 Tc 1.3604 Tw (the nursing homes it accredits. This section briefly) Tj ET BT 0.9835 0 0 0.9835 311.04 383.76 Tm 0.0398 Tc 0.7572 Tw (describes each of these guideline documents and) Tj ET BT 0.8915 0 0 0.9835 311.04 371.76 Tm -0.0145 Tc 0 Tw (efforts.) Tj ET BT 0.9835 0 0 0.9835 322.08 354 Tm 0.0582 Tc 3.7482 Tw (Some of the guidelines developed by these) Tj ET BT 0.8915 0 0 0.9835 311.04 341.76 Tm 0.0471 Tc 0.8188 Tw (organizations are intended as a basis for government) Tj ET BT 0.9835 0 0 0.9835 311.04 330.24 Tm 0.0232 Tc 2.5637 Tw (regulations, but most are not. None of the six) Tj 0.244 -12.4458 TD 0.0414 Tc 1.325 Tw (completed guideline documents is intended as a) Tj -0.244 -11.9577 TD 0.0192 Tc 0.6155 Tw (basis for regulations. It is OTA\222s impression that) Tj ET BT 0.8915 0 0 0.9835 311.52 294.24 Tm 0.06 Tc 0 Tw (obtainin) Tj 40.11 -0.244 TD 0.049 Tc 0.5283 Tw (g agreement among experts in dementia care) Tj ET BT 0.8491 0 0 0.9835 311.76 282.24 Tm 0.0479 Tc 1.4017 Tw (about the features that should be required in a special) Tj ET BT 0.934 0 0 0.9835 311.52 270.48 Tm -0.021 Tc 1.3521 Tw (care unit is more difficult than some organizations) Tj ET BT 0.8915 0 0 0.9835 311.76 258.24 Tm 0.0318 Tc 1.0283 Tw (anticipate. As a result, organizations that begin with) Tj ET BT 0.934 0 0 0.9835 311.76 246.24 Tm -0.0326 Tc 1.1076 Tw (the intention of developing standards that could be) Tj ET BT 0.9835 0 0 0.9835 311.52 234.24 Tm 0.0345 Tc 0.3558 Tw (used for regulatory purposes sometimes conclude) Tj ET BT 0.934 0 0 0.9835 311.76 222.24 Tm -0.021 Tc 0.8382 Tw (later on that there is insufficient agreement among) Tj ET BT 0.9835 0 0 0.9835 311.76 210.24 Tm 0.0425 Tc 0.9404 Tw (experts to support such standards and decide to) Tj ET BT 0.8915 0 0 0.9835 311.76 198 Tm 0.0287 Tc 3.5122 Tw (develop guidelines instead.) Tj ET BT 0.9795 0 0 0.9795 316.08 176.88 Tm /F7 12 Tf 0.0373 Tc 0.5134 Tw (The American Association of Homes for the) Tj 6.6159 -13.9668 TD 0.0598 Tc 0 Tw (Aging\227) Tj 44.8408 0 TD 0.0567 Tc 0.6162 Tw (\223Best Practices for Special Care) Tj -41.4104 -14.2118 TD 0.0257 Tc 0.8929 Tw (Programs for Persons With Alzheimer\222s) Tj 21.5628 -14.4569 TD 0.0469 Tc 0.9325 Tw (Disease or a Related Disorder\224) Tj ET BT 0.9261 0 0 0.9795 323.28 117.84 Tm 0.0203 Tc 0.432 Tw (In 1988, the ) Tj ET BT 0.934 0 0 0.9835 383.52 117.84 Tm /F4 10 Tf -0.0328 Tc 1.6217 Tw (Task Force on Alzheimer\222s Disease) Tj -76.0588 -12.4458 TD -0.0334 Tc 0.6588 Tw (of the American Association of Homes for the Aging) Tj ET BT 0.9835 0 0 0.9835 312.48 94.32 Tm 0.0223 Tc 0.3194 Tw (completed its \221Best Practices\222 document \(10\).) Tj ET BT 1.08 0 0 1.08 516.96 99.12 Tm /F4 4 Tf -0.0024 Tc 0.001 Tw (2 ) Tj ET BT 0.9835 0 0 0.9835 520.56 94.32 Tm /F4 10 Tf 0.0082 Tc 0 Tw (The) Tj -211.5789 -11.9577 TD 0.0453 Tc 2.3378 Tw (document is intended to provide guidelines for) Tj ET BT 0.8915 0 0 0.9835 312.72 70.32 Tm 0.0504 Tc 0.7766 Tw (exemplary special care programs and to help nursing) Tj ET BT 0.8647 0 0 0.9598 76.08 48.96 Tm /F11 5 Tf -0.0054 Tc 0.0035 Tw (2 ) Tj ET q 7.2 0 0 -5.28 79.92 52.32 cm BI /W 43 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~??????????????~??????? EI Q BT 0.9598 0 0 0.9598 79.92 48.96 Tm 3 Tr 0.0268 Tc 0 Tw (TO) Tj 0 Tr ET BT 0.8647 0 0 0.9598 87.12 48.96 Tm 0 Tc -0.0027 Tw ( ) Tj ET q 20.16 0 0 -5.52 88.32 52.32 cm BI /W 117 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ߀????|?<?>~?~?~p~~~?`?`??p?x?????? EI Q BT 1.8158 0 0 0.9598 88.32 48.96 Tm 3 Tr 0.0013 Tc 0 Tw (0~*~) Tj 0 Tr ET BT 0.8647 0 0 0.9598 108.48 48.96 Tm 0 Tc -0.0027 Tw ( ) Tj ET q 35.52 0 0 -7.2 109.68 52.32 cm BI /W 204 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x|8|8|<<< |????>???|??|π|߀|||?|?|~?|~??|~??||???>x?x???0||>||>||>||>||?`||?||||||~~< ?? EI Q BT 1.2105 0 0 0.9598 146.4 48.96 Tm 3 Tr -0.0443 Tc 0 Tw (me) Tj 0 Tr ET BT 0.8647 0 0 0.9598 155.28 48.96 Tm 0 Tc -0.0027 Tw ( ) Tj ET q 30.24 0 0 -5.76 156.48 52.56 cm BI /W 175 /H 32 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @@>8???x~~8~~~~~?q| ~~?|~~?|~~>|~~>~~~>~~>?|~>??~~@??~~|~?>||?x|>x?8=??<? ||~|< EI Q BT 1.8158 0 0 0.9598 156.48 48.96 Tm 3 Tr 0.0015 Tc 0 Tw (~encm) Tj 0 Tr ET BT 0.8647 0 0 0.9598 186.72 48.96 Tm 0 Tc -0.0027 Tw ( ) Tj ET q 36 0 0 -5.52 187.92 54.24 cm BI /W 208 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ; ??????<>>|8<~>8<?~0?8x~~?|~>||~||x߃~x?|x??||???<<?>>><<>~<>>x|<~8>???<??   EI Q BT 1.1241 0 0 0.9598 187.92 48.96 Tm 3 Tr 0.0237 Tc 0 Tw (A~~OCiatiOn) Tj 0 Tr ET BT 0.9393 0 0 0.99 223.92 48.96 Tm /F2 8 Tf 0 Tc 0.044 Tw ( ) Tj ET q 6.48 0 0 -5.28 225.6 54.24 cm BI /W 38 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~~|||||||||||||||>|>|||<<>| EI Q BT 0.9393 0 0 0.99 225.6 48.96 Tm 3 Tr -0.0105 Tc 0 Tw (of) Tj 0 Tr 6.8987 0 TD 0 Tc 0.044 Tw ( ) Tj ET q 21.36 0 0 -5.28 233.76 52.8 cm BI /W 124 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????Á>?Á|~||`||?x|x|x|?|>><?y? EI Q BT 0.8806 0 0 0.99 233.76 48.96 Tm 3 Tr -0.0204 Tc 0 Tw (H~mes) Tj 0 Tr ET BT 0.9393 0 0 0.99 255.12 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 8.64 0 0 -5.52 256.8 54.48 cm BI /W 51 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~?~?0 EI Q BT 0.8806 0 0 0.99 256.8 48.96 Tm 3 Tr 0.0698 Tc 0 Tw (for) Tj 0 Tr ET BT 0.9393 0 0 0.99 265.44 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 8.88 0 0 -5.28 267.12 54.48 cm BI /W 53 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>?>?>?x>?0>?>>>>>?>>?>?>?>>>>~>~> EI Q BT 0.8806 0 0 0.99 267.12 48.96 Tm 3 Tr 0.0113 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9393 0 0 0.99 276 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 24.24 0 0 -7.2 277.68 54.48 cm BI /W 140 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?pppxpxxx<<???>??|||||||||?||?>||?>||>||x>~||x<~||>`|>p>q??y?0?<<?>@x?||~x> EI Q BT 0.8806 0 0 0.99 277.68 48.96 Tm 3 Tr 0.0159 Tc 0 Tw (Aging\222s) Tj 0 Tr ET BT 0.9393 0 0 0.99 301.92 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 0.96 0 0 -1.92 303.6 53.04 cm BI /W 7 /H 11 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~px< EI Q BT 0.3522 0 0 0.99 303.6 48.96 Tm 3 Tr 0.0631 Tc 0 Tw (\221) Tj 0 Tr ET BT 0.9393 0 0 0.99 304.56 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 15.12 0 0 -5.28 306.24 54.24 cm BI /W 89 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~??ǁ~|??|<>|~00px< EI Q BT 0.8806 0 0 0.99 306.24 48.96 Tm 3 Tr 0.0014 Tc 0 Tw (\221Best) Tj 0 Tr ET BT 0.9393 0 0 0.99 321.36 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 31.92 0 0 -5.52 323.04 54.48 cm BI /W 185 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  px????>?|~>||8~~8|||8<|?|||?||8?|<p|x>>x8>><x?>>x? ?`<>? ????> EI Q BT 1.1741 0 0 0.99 323.04 48.96 Tm 3 Tr -0.0308 Tc 0 Tw (~wtiws\224) Tj 0 Tr ET BT 0.9393 0 0 0.99 354.96 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 41.76 0 0 -5.52 356.64 54.48 cm BI /W 240 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?p>??????|<??~<~||~8||||~8?|||a?~|||?~||||?~|||x?~||||?~?|||?|<||~?<||~?><~|<?~>>|~>?>~|?~>???|~?~~||@ EI Q BT 0.99 0 0 0.99 356.64 48.96 Tm 3 Tr 0.076 Tc 0 Tw (document~s) Tj 0 Tr ET BT 0.9393 0 0 0.99 398.4 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 9.6 0 0 -5.04 400.08 53.76 cm BI /W 56 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID A???|??p EI Q BT 0.8806 0 0 0.99 400.08 48.96 Tm 3 Tr 0.0437 Tc 0 Tw (not) Tj 0 Tr ET BT 0.9393 0 0 0.99 409.68 48.96 Tm 0 Tc 0.044 Tw ( ) Tj ET q 14.4 0 0 -5.28 411.36 54.48 cm BI /W 84 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~ ?y98?>>>??~??? EI Q BT 0.8806 0 0 0.99 411.36 48.96 Tm 3 Tr 0.039 Tc 0 Tw (been) Tj 0 Tr ET BT 0.934 0 0 0.9835 425.76 48.96 Tm /F4 10 Tf 0 Tc 0.0449 Tw ( ) Tj ET q 31.2 0 0 -7.2 428.16 54.48 cm BI /W 181 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID A?????????<????>??????x?>9?>?>??>?>?>>>>>?>??>?>??~?|?ρ>??v>p>~?>?>?< EI Q BT 0.6368 0 0 0.9835 428.16 48.96 Tm 3 Tr -0.089 Tc 0 Tw (published.) Tj 0 Tr ET BT 0.9388 0 0 0.9835 459.36 48.96 Tm /F2 10 Tf -0.006 Tc 0.1892 Tw ( It is available from) Tj ET BT 0.798 0 0 0.9835 62.64 37.92 Tm 0.0333 Tc 0.6152 Tw (the Association however.) Tj ET endstream endobj 470 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 471 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.72 685.68 m 550.56 685.68 l S BT 0.9835 0 0 0.9835 72.96 690.24 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (152 ) Tj ET BT 0.9598 0 0 0.9598 90.96 690.24 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 97.2 690.24 Tm /F5 10 Tf 0.0125 Tc 0.9837 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 72.96 651.6 Tm /F4 10 Tf -0.0368 Tc 2.6538 Tw (home operators and others distinguish specialized) Tj ET BT 0.8915 0 0 0.9835 73.44 639.36 Tm 0.0405 Tc 1.1211 Tw (dementia care from standard practice. The document) Tj 0 -12.4458 TD -0.0076 Tc 0.5918 Tw (points out that,) Tj 76.4512 0.244 TD 0.0406 Tc 1.4799 Tw (\221\221although many of the best practices) Tj ET BT 0.9835 0 0 0.9835 74.16 615.36 Tm 0.0396 Tc 0.2965 Tw (appear at first to be the standards of any quality) Tj ET BT 0.934 0 0 0.9835 73.68 603.12 Tm -0.0253 Tc 1.1961 Tw (program, when taken as a whole the best practices) Tj 0.5139 -12.4458 TD -0.0176 Tc 1.3163 Tw (define what is special about dementia care\222 \(10\). It) Tj 0.257 -12.4458 TD -0.0226 Tc 1.9412 Tw (also emphasizes that little research has been con-) Tj 0 -11.9577 TD -0.036 Tc 1.1112 Tw (ducted on specialized dementia care, that the \223Best) Tj ET BT 0.9835 0 0 0.9835 74.4 554.88 Tm 0.0307 Tc 0.1157 Tw (Practices\224 guidelines are based on clinical experi-) Tj ET BT 0.8915 0 0 0.9835 74.88 542.64 Tm 0.0493 Tc 1.1625 Tw (ence, and that with further experience and research,) Tj 0 -12.2018 TD 0.033 Tc 1.45 Tw (the guidelines will be validated, improved upon, and) Tj ET BT 0.934 0 0 0.9835 74.88 518.4 Tm -0.0381 Tc 0.985 Tw (expanded. The document is not intended to be used) Tj ET BT 0.8915 0 0 0.9835 75.12 506.4 Tm 0.0377 Tc 2.8291 Tw (for regulatory purposes.) Tj ET BT 0.9835 0 0 0.9835 86.4 479.52 Tm 0.049 Tc 2.7815 Tw (The 22-page) Tj 67.5979 -0.244 TD 0.0257 Tc 3.7813 Tw (\223Best Practices\224 document ad-) Tj -78.8235 -12.4458 TD 0.0274 Tc 1.7296 Tw (dresses seven areas: commitment, philosophy of) Tj ET BT 0.934 0 0 0.9835 75.84 455.04 Tm -0.0279 Tc 1.1539 Tw (care, therapeutic program, physical design, special-) Tj 0 -12.2018 TD -0.0136 Tc 1.3442 Tw (ized staff, communications program, and education) Tj ET BT 0.8915 0 0 0.9835 76.32 431.04 Tm 0.0574 Tc 1.0722 Tw (and research \(10\). For each of these areas, a general) Tj 0 -12.2018 TD 0.0315 Tc 0.7162 Tw (statement of the best practice is given; the character-) Tj ET BT 0.934 0 0 0.9835 76.32 407.28 Tm -0.0451 Tc 1.4421 Tw (istics or components of the best practice are listed;) Tj ET BT 0.9835 0 0 0.9835 76.32 395.04 Tm 0.0415 Tc 1.2028 Tw (and the desirable outcomes in that area are de-) Tj ET BT 0.8915 0 0 0.9835 76.56 383.04 Tm 0.0388 Tc 0 Tw (scribed.) Tj ET BT 0.9795 0 0 0.9795 91.68 342 Tm /F7 12 Tf 0.0262 Tc 0.8107 Tw (The Massachusetts Alzheimer\222s Disease) Tj 10.0463 -14.7019 TD 0.0342 Tc 1.8644 Tw (Research Center\227) Tj 98.5028 0 TD 0.0314 Tc 0.642 Tw (\223Blueprint for a) Tj ET BT 0.8875 0 0 0.9795 77.04 313.44 Tm -0.0042 Tc 3.3575 Tw (Specialized Alzheimer\222s Disease Nursing Home\224) Tj ET BT 0.8915 0 0 0.9835 88.32 287.04 Tm /F4 10 Tf 0.0214 Tc 1.6167 Tw (In 1989, with funding from the National Institute) Tj ET BT 0.9835 0 0 0.9835 77.52 274.56 Tm 0.0263 Tc 1.6889 Tw (on Aging and the Administration on Aging, the) Tj ET BT 0.934 0 0 0.9835 77.28 262.56 Tm -0.0208 Tc 2.4439 Tw (Massachusetts Alzheimer\222s Disease Research Cen-) Tj ET BT 0.9835 0 0 0.9835 77.76 250.56 Tm 0.0536 Tc 0.2388 Tw (ter held a 2-day workshop to develop a plan for a) Tj ET BT 0.934 0 0 0.9835 78 238.56 Tm -0.0274 Tc 1.8729 Tw (specialized Alzheimer\222s disease nursing home. The) Tj ET BT 0.8915 0 0 0.9835 77.76 226.32 Tm 0.0277 Tc 1.1098 Tw (workshop participants tried to define what should be) Tj ET BT 0.934 0 0 0.9835 78.24 214.32 Tm -0.0346 Tc 2.3088 Tw (special about specialized care for individuals with) Tj -0.257 -12.4458 TD -0.0251 Tc 0.5857 Tw (dementia, what works for these patients, and which) Tj ET BT 0.9835 0 0 0.9835 78 190.08 Tm 0.0163 Tc 2.8147 Tw (patients it works for. The resulting document,) Tj ET BT 0.934 0 0 0.9835 78.24 178.32 Tm -0.0278 Tc 1.7877 Tw (released in 1990, provides general conclusions and) Tj ET BT 0.9835 0 0 0.9835 78.24 166.08 Tm 0.0368 Tc 2.8426 Tw (recommendations but emphasizes the need for) Tj 0.244 -11.9577 TD 0.034 Tc 2.5527 Tw (rigorous research on specialized dementia care) Tj 0.4881 -11.9577 TD 0.0436 Tc 0.2923 Tw (\(287\). It is not intended to be used for regulatory) Tj ET BT 0.8915 0 0 0.9835 78.48 130.32 Tm 0.245 Tc 0 Tw (purposes.) Tj ET BT 0.9835 0 0 0.9835 89.76 103.68 Tm 0.0394 Tc 2.4252 Tw (The 20-page \223Blueprint\224 document addresses) Tj ET BT 0.934 0 0 0.9835 79.44 91.92 Tm -0.0274 Tc 0.7594 Tw (three areas: policy plannin) Tj ET BT 0.8915 0 0 0.9835 197.04 90.72 Tm 0.0291 Tc 1.6723 Tw (g, patient care programs,) Tj ET BT 0.9835 0 0 0.9835 79.44 79.92 Tm 0.0293 Tc 0.7446 Tw (and architectural design \(287\). For each of these) Tj ET BT 0.934 0 0 0.9835 79.68 68.16 Tm -0.036 Tc 1.0256 Tw (areas, a series of interrelated recommendations are) Tj ET BT 0.9835 0 0 0.9835 79.44 55.92 Tm 0.0379 Tc -0.0311 Tw (made based on the workshop discussion and later) Tj ET BT 0.934 0 0 0.9835 79.2 43.92 Tm -0.0341 Tc 0.8951 Tw (review and revisions by the workshop participants.) Tj ET BT 0.9795 0 0 0.9795 338.16 650.64 Tm /F7 12 Tf 0.028 Tc 0.8905 Tw (The Alzheimer\222s Disease Education and) Tj -6.3708 -14.7019 TD 0.0351 Tc 1.3733 Tw (Referral Center\227) Tj 93.1121 0.245 TD 0.0435 Tc 1.1198 Tw (\223Standards for Care for) Tj -91.6419 -14.2118 TD 0.0378 Tc 0.8315 Tw (Dementia Patients in Special Care Units\224) Tj ET BT 0.934 0 0 0.9835 335.76 599.04 Tm /F4 10 Tf -0.0087 Tc 1.5103 Tw (In 1991, the Alzheimer\222s Disease Education and) Tj -11.563 -12.2018 TD -0.0522 Tc 1.3856 Tw (Referral Center completed its guidelines for special) Tj ET BT 0.9835 0 0 0.9835 324.96 575.04 Tm 0.0207 Tc 0.3698 Tw (care units \(6\). The center, which is funded by the) Tj ET BT 0.934 0 0 0.9835 325.2 563.04 Tm -0.0168 Tc 1.6046 Tw (National Institute on Aging, is a clearinghouse for) Tj ET BT 0.9835 0 0 0.9835 325.44 551.52 Tm 0.0395 Tc 0.1067 Tw (information about Alzheimer\222s disease for profes-) Tj ET BT 0.934 0 0 0.9835 326.16 539.28 Tm -0.016 Tc 2.032 Tw (sionals, patients, families, and the general public.) Tj ET BT 0.9835 0 0 0.9835 325.68 527.76 Tm 0.0332 Tc 0.1538 Tw (The \223Standards\224 document is available to anyone) Tj ET BT 0.8915 0 0 0.9835 325.92 515.52 Tm 0.015 Tc 1.6432 Tw (who requests it. Despite its title, the document does) Tj ET BT 0.934 0 0 0.9835 325.92 503.76 Tm -0.0289 Tc 1.1607 Tw (not set standards. It discusses the pros and cons of) Tj 0 -12.4458 TD -0.0355 Tc 2.0529 Tw (developing standards for special care units, points) Tj ET BT 0.9835 0 0 0.9835 326.16 479.28 Tm 0.0305 Tc 0.1159 Tw (out the lack of information about many aspects of) Tj ET BT 0.934 0 0 0.9835 326.64 467.52 Tm -0.0309 Tc 1.3627 Tw (specialized care for individuals with dementia, and) Tj 0 -11.9577 TD -0.0335 Tc 1.6225 Tw (emphasizes the need for research on the costs and) Tj 0 -12.2018 TD -0.0346 Tc 1.2199 Tw (effectiveness of special care units. The document is) Tj 0.257 -11.9577 TD -0.0437 Tc 0.8625 Tw (not intended to be used for regulatory purposes.) Tj ET BT 0.8915 0 0 0.9835 337.68 408.72 Tm 0.031 Tc 2.1905 Tw (The \221Standards\222 document addresses seven areas:) Tj ET BT 0.934 0 0 0.9835 327.36 396.48 Tm -0.0112 Tc 2.4979 Tw (admission, environment, activities, staffing, train-) Tj -0.257 -11.9577 TD -0.025 Tc 1.5766 Tw (ing, expected impacts, and research issues \(6\). For) Tj ET BT 0.9835 0 0 0.9835 327.6 372.48 Tm 0.0219 Tc 1.3753 Tw (each of these areas, a brief summary of current) Tj ET BT 0.8915 0 0 0.9835 327.6 360.24 Tm 0.0304 Tc 1.7605 Tw (thinking is given.) Tj ET BT 0.9795 0 0 0.9795 333.12 322.56 Tm /F7 12 Tf 0.0301 Tc 0.8394 Tw (The University of South Florida\222s Suncoast) Tj -0.7351 -14.2118 TD 0.0473 Tc 0.6258 Tw (Gerontology Center\227) Tj 112.7146 0.245 TD 0.0254 Tc 1.3832 Tw (\223Draft Guidelines for) Tj -110.5093 -14.4569 TD 0.0162 Tc 0.9026 Tw (Dementia Specific Care Units \(DSCUs\) for) Tj 25.2383 -13.9668 TD 0.0436 Tc 0.8746 Tw (Memory Impaired Older Adults\224) Tj ET BT 0.934 0 0 0.9835 339.36 257.52 Tm /F4 10 Tf -0.017 Tc 0.4913 Tw (In 1991, researchers from the Suncoast Gerontol-) Tj -11.82 -12.4458 TD -0.0213 Tc 1.5237 Tw (ogy Center published the findings of a study of 13) Tj ET BT 0.9835 0 0 0.9835 329.04 233.04 Tm 0.0255 Tc 0.2125 Tw (special care units in west central Florida \(64\). As) Tj ET BT 0.8915 0 0 0.9835 328.56 221.28 Tm 0.0316 Tc 0.2449 Tw (discussed in chapter 3, the researchers used the study) Tj ET BT 0.934 0 0 0.9835 329.04 209.28 Tm -0.0366 Tc 0.5979 Tw (findings to create a typology of) Tj ET BT 0.9835 0 0 0.9835 465.12 209.28 Tm -0.0056 Tc 0.3966 Tw (\221\221minimally specific,) Tj ET BT 0.934 0 0 0.9835 328.8 197.28 Tm -0.0294 Tc 2.3033 Tw (moderately specific, and highly specific\224 units. On) Tj 0.257 -12.2018 TD -0.0197 Tc 0.4942 Tw (the basis of the study findings and the typology, the) Tj ET BT 0.9835 0 0 0.9835 329.04 173.52 Tm 0.0446 Tc 0.736 Tw (researchers developed guidelines for special care) Tj ET BT 0.8915 0 0 0.9835 329.04 161.52 Tm 0.0322 Tc 0.6817 Tw (units \(63\). The guidelines are not intended to be used) Tj 0.5384 -11.7137 TD 0.0377 Tc 2.5599 Tw (for regulatory purposes.) Tj ET BT 0.9835 0 0 0.9835 340.32 127.2 Tm 0.049 Tc -0.147 Tw (The 19-page) Tj 62.4731 0 TD 0.0359 Tc 1.5746 Tw (\223Draft Guidelines\224 document ad-) Tj -73.2107 -12.4458 TD 0.0341 Tc 2.1865 Tw (dresses ten areas: goals and philosophy, target) Tj ET BT 0.934 0 0 0.9835 329.76 103.44 Tm -0.0292 Tc 2.3887 Tw (population, admission and discharge criteria, resi-) Tj ET BT 0.9835 0 0 0.9835 330.24 91.92 Tm 0.0149 Tc 1.718 Tw (dent assessment, physical environment, activity) Tj -0.4881 -11.9577 TD 0.0153 Tc 2.0023 Tw (programs, unit size and staffing, staff training,) Tj 0.7321 -12.2018 TD 0.0271 Tc 0.4122 Tw (family involvement, and ongoing evaluation \(63\).) Tj ET BT 0.934 0 0 0.9835 330.48 56.16 Tm -0.0287 Tc 1.1355 Tw (For each of these areas, a theoretical rationale and) Tj 0.5139 -11.9577 TD -0.0395 Tc 1.3719 Tw (several specific guidelines are given.) Tj ET endstream endobj 472 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 473 0 obj <>stream 0.48 w 1 j 0 0 0 RG 59.04 680.88 m 536.16 680.88 l S BT 0.9835 0 0 0.9835 248.64 686.4 Tm 0 0 0 rg /F5 10 Tf 0.0225 Tc 1.5546 Tw (Chapter 5-Regulations And Guidelines For Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 512.64 686.4 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 519.12 686.4 Tm /F5 10 Tf 0.2847 Tc 0 Tw (153) Tj ET BT 0.9795 0 0 0.9795 68.88 645.84 Tm /F7 12 Tf 0.0375 Tc 3.5762 Tw (The University of Wisconsin-Milwaukee) Tj -8.086 -14.4569 TD 0.0268 Tc 0.8918 Tw (Center for Architecture and Urban Planning) Tj 2.6953 -14.4569 TD 0.0327 Tc 0 Tw (Research\227) Tj 61.2579 0 TD 0.0437 Tc 0.3845 Tw (\223Environments for People With) Tj -16.9072 -13.9668 TD 0.0136 Tc 1.5178 Tw (Dementia: Design Guide\224) Tj ET BT 0.8875 0 0 0.9795 70.32 586.08 Tm 0.0043 Tc 0.4411 Tw (In 1987, the American ) Tj ET BT 0.8915 0 0 0.9835 174.24 586.08 Tm /F4 10 Tf 0.0158 Tc 0.7001 Tw (Institute of Architects and) Tj ET BT 0.9835 0 0 0.9835 59.52 573.84 Tm 0.0439 Tc 0.509 Tw (the Association of Collegiate Schools of Architec-) Tj ET BT 0.8915 0 0 0.9835 59.76 562.08 Tm 0.0475 Tc 1.0491 Tw (ture contracted with the Center for Architecture and) Tj ET BT 0.9835 0 0 0.9835 59.76 550.08 Tm -0.0079 Tc -0.0891 Tw (Urban Plannin) Tj 69.5502 0 TD 0.026 Tc 3.3417 Tw (g Research at the University of) Tj -69.5502 -11.9577 TD 0.0425 Tc 3.7642 Tw (Wisconsin-Milwaukee for a project to develop) Tj 0.244 -12.2018 TD 0.0329 Tc 1.0407 Tw (environmental design guidelines for special care) Tj ET BT 0.934 0 0 0.9835 59.76 514.56 Tm -0.0431 Tc 1.2656 Tw (units and other specialized settings for people with) Tj ET BT 0.9835 0 0 0.9835 60 502.32 Tm 0.0329 Tc 1.7403 Tw (dementia. The project resulted in an annotated) Tj -0.244 -12.4458 TD 0.0367 Tc 0.5976 Tw (bibliography \(363\), a book of facility case studies) Tj ET BT 0.934 0 0 0.9835 60.48 478.08 Tm 0.0022 Tc 1.0061 Tw (\(96\), a regulatory analysis \(94\), and a design guide) Tj 0 -12.2018 TD -0.0163 Tc 1.1329 Tw (\(95\). The 97-page design guide discusses particular) Tj ET BT 0.8915 0 0 0.9835 60.48 454.32 Tm 0.0309 Tc 1.9394 Tw (needs of persons with dementia, related therapeutic) Tj ET BT 0.9835 0 0 0.9835 60.72 442.32 Tm 0.0277 Tc 2.1117 Tw (goals for the physical environment, and design) Tj -0.244 -12.2018 TD 0.0286 Tc 1.9888 Tw (principles for achieving those goals. It includes) Tj ET BT 0.8915 0 0 0.9835 60.72 418.56 Tm 0.0323 Tc 2.2967 Tw (facility case examples and illustrations.) Tj ET BT 0.9795 0 0 0.9795 71.52 386.64 Tm /F7 12 Tf 0.0436 Tc 4.1826 Tw (The Alzheimer\222s Association-Legislative) Tj 1.2252 -14.2118 TD 0.0365 Tc 1.7395 Tw (Principles and \223Guidelines for Dignity\224) Tj ET BT 0.8875 0 0 0.9795 72 354.96 Tm -0.0166 Tc 0.7126 Tw (In 1988, the ) Tj ET BT 0.8915 0 0 0.9835 130.56 354.96 Tm /F4 10 Tf 0.049 Tc 2.5473 Tw (Alzheimer\222s Association published a) Tj ET BT 0.934 0 0 0.9835 62.4 342.72 Tm -0.0293 Tc 0.9573 Tw (13-page booklet to help families of individuals with) Tj ET BT 0.9835 0 0 0.9835 61.2 330.48 Tm 0.0315 Tc 1.6198 Tw (dementia evaluate special care units \(276\). The) Tj ET BT 0.934 0 0 0.9835 61.2 318.72 Tm -0.0404 Tc 2.4522 Tw (booklet provides information about specialized de-) Tj 0 -11.9577 TD -0.0117 Tc 1.3743 Tw (mentia care and advises family members to visit a) Tj 0 -12.2018 TD -0.0298 Tc 1.6827 Tw (unit and to observe certain aspects of the physical) Tj 0.257 -11.7137 TD -0.0225 Tc 0.7114 Tw (environment, unit staffing, and resident care before) Tj ET BT 0.8915 0 0 0.9835 61.92 271.44 Tm 0.0424 Tc 1.3433 Tw (deciding to place their relative with dementia in the) Tj ET BT 0.8491 0 0 0.9835 61.68 259.68 Tm 0.0553 Tc 0 Tw (unit.) Tj ET BT 0.8915 0 0 0.9835 72.72 241.68 Tm 0.0481 Tc 0.8995 Tw (As the number of special care units has increased,) Tj ET BT 0.9835 0 0 0.9835 61.92 229.44 Tm 0.0317 Tc 1.4045 Tw (the association\222s national office and many of its) Tj ET BT 0.8915 0 0 0.9835 61.92 217.44 Tm 0.0582 Tc 0.9217 Tw (more than 200 chapters nationwide have received an) Tj 0 -11.9577 TD 0.0501 Tc 1.5141 Tw (increasing number of requests from family members) Tj ET BT 0.934 0 0 0.9835 62.4 193.68 Tm -0.0247 Tc 0.8054 Tw (and others for information and advice about special) Tj ET BT 0.9835 0 0 0.9835 62.4 181.92 Tm 0.0184 Tc 1.267 Tw (care units. Nursing home operators contact Alz-) Tj ET BT 0.934 0 0 0.9835 62.16 169.92 Tm -0.03 Tc 1.2761 Tw (heimer\222s Association chapters for help in establish-) Tj ET BT 0.9835 0 0 0.9835 62.4 158.16 Tm 0.0242 Tc 2.1966 Tw (ing a special care unit, and some chapters are) Tj ET BT 0.934 0 0 0.9835 62.16 145.92 Tm -0.027 Tc 2.0009 Tw (providing formal or informal consultations to such) Tj ET BT 0.9835 0 0 0.9835 62.64 134.4 Tm 0.0329 Tc -0.1306 Tw (facilities \(114,231\). State officials also contact the) Tj -0.244 -12.2018 TD 0.0341 Tc 0.6003 Tw (national office and the chapters for assistance in) Tj 0.244 -11.9577 TD 0.0356 Tc 0.8835 Tw (developing State relations for special care units.) Tj 0.244 -12.4458 TD 0.0321 Tc 0.2188 Tw (For these reasons, and because of concerns about) Tj ET BT 0.934 0 0 0.9835 63.12 86.64 Tm -0.0246 Tc 2.2981 Tw (special care units that are apparently established) Tj ET BT 0.9835 0 0 0.9835 62.88 74.64 Tm 0.033 Tc 0.276 Tw (only for marketing purposes and provide nothing) Tj 0.4881 -12.2018 TD 0.0304 Tc 2.719 Tw (special for their residents, the association has) Tj -0.4881 -11.9577 TD 0.0464 Tc 2.2472 Tw (developed legislative principles for special care) Tj ET BT 0.8915 0 0 0.9835 62.88 39.12 Tm -0.0166 Tc 2.3516 Tw (units \(4\).) Tj ET BT 0.9835 0 0 0.9835 320.4 647.52 Tm 0.0276 Tc 1.5342 Tw (The association\222s legislative principles are in-) Tj ET BT 0.8915 0 0 0.9835 309.84 635.52 Tm 0.0353 Tc 1.3961 Tw (tended to direct legislators\222 and regulators\222 attention) Tj ET BT 0.9835 0 0 0.9835 309.84 623.28 Tm 0.0312 Tc -0.0069 Tw (to the primary areas a State should include when) Tj ET BT 0.934 0 0 0.9835 309.84 611.28 Tm -0.03 Tc 0.9764 Tw (drafting special care unit legislation or regulations.) Tj ET BT 0.8915 0 0 0.9835 309.84 599.52 Tm 0.0514 Tc 0.3312 Tw (The 11 areas cited in the association\222 s principles are:) Tj ET BT 0.9835 0 0 0.9835 311.04 588 Tm 0.0282 Tc 0.2228 Tw (1\) statement of mission, 2\) involvement of family) Tj ET BT 0.934 0 0 0.9835 309.84 575.76 Tm -0.014 Tc 1.3079 Tw (members, 3\) plan of care, 4\) therapeutic programs,) Tj ET BT 0.9835 0 0 0.9835 310.08 563.52 Tm 0.0212 Tc 0.8575 Tw (5\) residents\222 rights, 6\) environment, 7\) safety, 8\)) Tj 0.4881 -11.9577 TD 0.0263 Tc 0.1811 Tw (staffing patterns and training, 9\) cost of care, 10\)) Tj -0.244 -11.9577 TD 0.0238 Tc 1.3835 Tw (quality assurance, and 11\) enforcement \(4\). The) Tj ET BT 0.8915 0 0 0.9835 310.32 528 Tm 0.0356 Tc 1.9701 Tw (legislative principles recommend that States involve) Tj ET BT 0.9835 0 0 0.9835 310.32 516.24 Tm 0.015 Tc 0.4977 Tw (providers, consumers, ombudsmen, activities and) Tj ET BT 0.934 0 0 0.9835 310.56 503.76 Tm -0.028 Tc 1.9378 Tw (occupational therapists, environmental design spe-) Tj 0.257 -12.2018 TD -0.0218 Tc 1.7201 Tw (cialists, fire and safety officials, and licensure and) Tj ET BT 0.8915 0 0 0.9835 311.04 479.76 Tm 0.0345 Tc 1.1021 Tw (survey officials in drafting specific standards in each) Tj -0.2692 -12.2018 TD 0.0315 Tc 1.2209 Tw (of these areas.) Tj ET BT 0.9835 0 0 0.9835 321.84 445.2 Tm 0.0389 Tc 0.8802 Tw (In July 1992, the association released \223Guide-) Tj -10.9816 -12.2018 TD 0.0346 Tc 0.3964 Tw (lines for Dignity: Goals of Specialized Alzheimer/) Tj 0.244 -11.9577 TD 0.0329 Tc 0.7642 Tw (Dementia Care in Residential Settings.\224 The 41-) Tj -0.244 -12.2018 TD 0.0339 Tc -0.0828 Tw (page \223Guidelines\224 document discusses eight goals) Tj 0.4881 -12.4458 TD 0.0317 Tc 0.3587 Tw (and guidelines for achieving the goals. The docu-) Tj -0.4881 -11.9577 TD 0.0404 Tc 2.0581 Tw (ment is not intended to be used for regulatory) Tj ET BT 0.8915 0 0 0.9835 311.04 373.44 Tm 0.0057 Tc 0 Tw (purposes.) Tj ET BT 0.9795 0 0 0.9795 331.92 336.48 Tm /F7 12 Tf 0.0393 Tc 0.6339 Tw (The Alzheimer\222s Society of Canada\227) Tj 32.5892 -14.2118 TD 0.0394 Tc 1.6139 Tw (Forthcoming Guidelines) Tj ET BT 0.9835 0 0 0.9835 322.8 300.48 Tm /F4 10 Tf 0.033 Tc 1.1941 Tw (In 1990, the Alzheimer\222s Society of Canada, a) Tj ET BT 0.934 0 0 0.9835 311.76 288.48 Tm -0.01 Tc 2.3682 Tw (private voluntary association, received a $500,000) Tj 0.7709 -11.9577 TD -0.009 Tc 1.5595 Tw (grant from the Canadian Government for a 3-year) Tj -0.5139 -11.9577 TD -0.0532 Tc 1.0975 Tw (project to develop guidelines for the care of individ-) Tj ET BT 0.9835 0 0 0.9835 312.24 253.2 Tm 0.0302 Tc 3.6372 Tw (uals with Alzheimer\222s disease in a variety of) Tj ET BT 0.934 0 0 0.9835 312.72 240.72 Tm -0.009 Tc 0.7152 Tw (settings, including special care units \(7,313\). In the) Tj ET BT 0.9835 0 0 0.9835 312.48 228.96 Tm 0.0257 Tc 2.012 Tw (first year of the grant, a literature review was) Tj ET BT 0.934 0 0 0.9835 312.48 216.72 Tm -0.023 Tc 2.5363 Tw (conducted; Alzheimer\222s Society staff members vis-) Tj 0 -11.9577 TD -0.0203 Tc 1.0944 Tw (ited various care settings; and a questionnaire was) Tj 0.5139 -11.9577 TD 0.0052 Tc 0.9707 Tw (sent out to 15,000 family caregivers. In 1991, draft) Tj ET BT 0.9835 0 0 0.9835 313.2 181.44 Tm 0.0477 Tc 1.8473 Tw (guidelines were developed by the society\222s staff) Tj ET BT 0.934 0 0 0.9835 312.96 169.44 Tm -0.0131 Tc 0.8297 Tw (with the assistance of an advisory committee \(401\).) Tj ET BT 0.9835 0 0 0.9835 312.72 157.68 Tm 0.0286 Tc 0.2805 Tw (The guidelines, which were circulated for outside) Tj ET BT 0.934 0 0 0.9835 312.48 145.68 Tm -0.0133 Tc 0.4629 Tw (review in early 1992, address 11 areas: involvement) Tj 0.7709 -12.2018 TD -0.0081 Tc 2.2376 Tw (in decisionmaking, assessment, staffing, programs) Tj ET BT 0.8915 0 0 0.9835 313.2 122.16 Tm 0.0425 Tc 1.388 Tw (and activities, training and education for caregivers,) Tj ET BT 0.9835 0 0 0.9835 313.44 110.16 Tm 0.0224 Tc 0.6528 Tw (support for caregivers, physical and chemical re-) Tj ET BT 0.934 0 0 0.9835 313.68 97.92 Tm -0.0203 Tc 1.0087 Tw (straints, preventing and responding to abuse, envi-) Tj -0.5139 -11.7137 TD -0.0238 Tc 2.3316 Tw (ronmental design, and transportation. The society) Tj ET BT 0.9835 0 0 0.9835 313.44 74.64 Tm 0.0391 Tc 1.6411 Tw (intends to publish two documents based on the) Tj 0.244 -12.4458 TD 0.0379 Tc 1.0235 Tw (guidelines--one document intended primarily for) Tj ET BT 0.8915 0 0 0.9835 313.44 50.64 Tm 0.0443 Tc 1.9243 Tw (families and one intended primarily for government) Tj 0.5384 -12.2018 TD 0.0471 Tc 2.2801 Tw (and provider agencies.) Tj ET endstream endobj 474 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 475 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.24 688.56 m 550.08 688.56 l S BT 0.9835 0 0 0.9835 72.72 693.84 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (154 ) Tj ET BT 0.9598 0 0 0.9598 90.72 693.84 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.96 693.84 Tm /F5 10 Tf 0.0125 Tc 0.9837 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9795 0 0 0.9795 77.04 652.56 Tm /F7 12 Tf 0.04 Tc 0.7557 Tw (The Alzheimer\222s Coalition of Connecticut\227) Tj 49.2514 -14.2118 TD 0.0394 Tc 1.3689 Tw (Forthcoming Guidelines) Tj -42.1455 -18.3774 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 107.52 620.64 Tm /F4 10 Tf 0.0301 Tc 3.5937 Tw (Alzheimer\222s Coalition of Connecticut, a) Tj ET BT 0.8915 0 0 0.9835 72.72 608.4 Tm 0.0324 Tc 1.6685 Tw (private nonprofit organization that was formed after) Tj ET BT 0.9835 0 0 0.9835 73.44 596.4 Tm 0.0281 Tc 2.0706 Tw (the expiration of the Governor\222s Task Force on) Tj 0 -11.9577 TD 0.044 Tc 0.5088 Tw (Alzheimer\222s Disease, has developed a draft docu-) Tj 0 -12.2018 TD 0.032 Tc 1.4391 Tw (ment that describes the important features of a) Tj ET BT 0.8915 0 0 0.9835 74.16 560.64 Tm 0.0439 Tc 1.5915 Tw (special care unit. Although State officials have been) Tj ET BT 0.934 0 0 0.9835 73.92 548.88 Tm -0.04 Tc 1.6937 Tw (involved in the development of the document, it is) Tj ET BT 0.8915 0 0 0.9835 73.92 536.88 Tm 0.022 Tc 1.1979 Tw (not intended as the basis for State regulations \(512\).) Tj ET BT 0.9795 0 0 0.9795 91.44 511.44 Tm /F7 12 Tf 0.0177 Tc 0.8398 Tw (U.S. Department of Veterans Affairs\227) Tj 36.0197 -14.4569 TD 0.0394 Tc 1.6139 Tw (Forthcoming Guidelines) Tj ET BT 0.9835 0 0 0.9835 85.44 479.52 Tm /F4 10 Tf 0.0273 Tc -0.0707 Tw (As discussed in chapter 3, a 1989 survey by the) Tj ET BT 0.8915 0 0 0.9835 74.64 467.28 Tm 0.0072 Tc 2.2352 Tw (U.S. Department of Veterans Affairs \(VA\) identified) Tj ET BT 0.9835 0 0 0.9835 74.88 455.76 Tm 0.0369 Tc 1.9532 Tw (special care units at 31 of the 172 VA medical) Tj ET BT 0.934 0 0 0.9835 74.88 443.76 Tm -0.0263 Tc 1.2109 Tw (centers nationwide. In 1991, the VA conducted site) Tj 0 -11.9577 TD -0.0329 Tc 1.5361 Tw (visits to 13 of the special care units and telephone) Tj ET BT 0.9835 0 0 0.9835 74.88 420.48 Tm 0.027 Tc 0.9125 Tw (interviews with staff of many of the other units.) Tj ET BT 0.8915 0 0 0.9835 75.12 408.72 Tm 0.0244 Tc 0.5708 Tw (Partly on the basis of these site visits and interviews,) Tj ET BT 0.9835 0 0 0.9835 75.12 396.72 Tm 0.0515 Tc 1.3554 Tw (the VA is developing guidelines for \223Specialized) Tj 0 -11.9577 TD 0.0202 Tc 0.8096 Tw (Alzheimer\222s/Dementia Units\224 at VA medical cen-) Tj 0.244 -12.4458 TD 0.0398 Tc 0.6991 Tw (ters \(103\). The guidelines describe three types of) Tj 0 -12.2018 TD 1.4804 Tc 0 Tw (units-) Tj -0.0888 Tc (\222) Tj 40.2659 0 TD 0.2313 Tc (diagnostic,\222) Tj 63.6933 -0.244 TD 0.0175 Tc 2.5694 Tw (\223behavioral management,\224) Tj -103.7151 -11.9577 TD 0.0075 Tc 2.0916 Tw (and \221\221long-term care\222) Tj ET BT 0.8915 0 0 0.9835 176.16 348.48 Tm 0.0276 Tc 2.2123 Tw (units. The guidelines discuss) Tj ET BT 0.9835 0 0 0.9835 75.6 336.72 Tm 0.0393 Tc 0.5136 Tw (the goals and objectives of the units, the types of) Tj -0.244 -11.9577 TD 0.0278 Tc 0.8914 Tw (residents served, unit size and location, staffing,) Tj ET BT 0.934 0 0 0.9835 76.08 312.96 Tm -0.0149 Tc 2.1164 Tw (space and environmental factors, program evalua-) Tj ET BT 0.8915 0 0 0.9835 75.84 300.96 Tm 0.0377 Tc 1.4831 Tw (tion, and quality assurance.) Tj ET BT 0.9795 0 0 0.9795 77.52 275.76 Tm /F7 12 Tf 0.0439 Tc 1.1194 Tw (Multi-facility Nursing Home Corporations\227) Tj 40.6753 -14.4569 TD 0.0429 Tc 0.3853 Tw (Special Care Unit Guidelines) Tj ET BT 0.934 0 0 0.9835 91.68 242.64 Tm /F4 10 Tf -0.0229 Tc 2.8959 Tw (Some multi-facility nursing home corporations) Tj -16.7021 -11.9577 TD -0.0261 Tc 0.5224 Tw (have guidelines for special care units in the nursing) Tj ET BT 0.9835 0 0 0.9835 76.08 218.88 Tm 0.0199 Tc 1.2073 Tw (homes they own, Hillhaven Corp., which had 56) Tj ET BT 0.934 0 0 0.9835 76.32 206.64 Tm -0.0109 Tc 0.8917 Tw (nursing homes with special care units in late 1990,) Tj 0 -12.2018 TD -0.0247 Tc 1.4295 Tw (has an extensive policy and procedures manual for) Tj T* -0.0123 Tc 1.3107 Tw (the units \(187\). The manual was first developed in) Tj ET BT 0.9835 0 0 0.9835 77.52 170.64 Tm 0.0476 Tc 0.1527 Tw (1982 and was updated in 1984 and 1988 \(337\). It) Tj ET BT 0.934 0 0 0.9835 76.56 158.4 Tm -0.0348 Tc 1.1099 Tw (delineates the philosophy and treatment modalities) Tj 0.257 -11.7137 TD -0.0266 Tc 1.3214 Tw (of the units, their admission and discharge criteria) Tj ET BT 0.9835 0 0 0.9835 77.04 134.64 Tm 0.0213 Tc -0.0782 Tw (and procedures, family services, use of restraints,) Tj 0.244 -11.9577 TD 0.0197 Tc -0.1172 Tw (staff training, and other features. The manual in-) Tj ET BT 0.934 0 0 0.9835 77.04 111.12 Tm -0.0285 Tc 1.3602 Tw (cludes resident assessment instruments, guidelines) Tj ET BT 0.9835 0 0 0.9835 77.04 99.12 Tm 0.0219 Tc 0.0941 Tw (for running a family support group, and a quality) Tj ET BT 0.8915 0 0 0.9835 77.04 87.12 Tm 0.0491 Tc 3.0855 Tw (assurance checklist.) Tj ET BT 0.934 0 0 0.9835 87.84 69.12 Tm -0.0133 Tc 1.3439 Tw (Unicare Health Facilities, which had 15 nursing) Tj -11.563 -11.9577 TD -0.011 Tc 0.6277 Tw (homes with special care units in late 1990, also has) Tj 0 -12.2018 TD -0.0087 Tc 1.5959 Tw (a manual for its units, called \221\221Lamplighter Units\224) Tj ET BT 0.9835 0 0 0.9835 324 654.72 Tm 0.0347 Tc 2.6217 Tw (\(281\). The manual describes the care needs of) Tj -0.4881 -11.9577 TD 0.0254 Tc 0.4139 Tw (nursing home residents with Alzheimer\222s disease) Tj ET BT 0.934 0 0 0.9835 324 630.72 Tm -0.0227 Tc 1.5081 Tw (and the philosophy, admission criteria, assessment) Tj -0.257 -11.9577 TD -0.0284 Tc 1.6904 Tw (procedures, staffing, and care methods of the com-) Tj ET BT 0.9835 0 0 0.9835 324 606.48 Tm 0.0145 Tc 0.8642 Tw (pany\222s special care units. The manual includes a) Tj ET BT 0.8915 0 0 0.9835 324 594.72 Tm 0.0184 Tc 2.1104 Tw (resident assessment instrument. Other multi-facility) Tj ET BT 0.934 0 0 0.9835 324.24 582.72 Tm -0.0253 Tc 1.1426 Tw (nursing home corporations that have facilities with) Tj 0.5139 -12.4458 TD -0.0253 Tc 1.3246 Tw (special care units may also have guidelines for the) Tj ET BT 0.8491 0 0 0.9835 324.48 558.72 Tm 0.0277 Tc 0 Tw (units.) Tj ET BT 0.9795 0 0 0.9795 333.36 533.04 Tm /F7 12 Tf 0.0511 Tc 0.6219 Tw (The Joint Commission on Accreditation of) Tj 35.0395 -14.4569 TD 0.0428 Tc 2.3456 Tw (Healthcare Organizations\227) Tj 4.9006 -14.2118 TD 0.0211 Tc 1.0201 Tw (Draft Surveyor Guidelines) Tj ET BT 0.9261 0 0 0.9795 336.24 486.72 Tm 0.0405 Tc 0.3239 Tw (Since 1989, the ) Tj ET BT 0.934 0 0 0.9835 411.12 486.72 Tm /F4 10 Tf -0.0295 Tc 1.2756 Tw (Joint Commission on Accredita-) Tj ET BT 0.8915 0 0 0.9835 325.44 474.72 Tm 0.0464 Tc 1.7874 Tw (tion of Healthcare Organizations \(JCAHO\) has been) Tj ET BT 0.9835 0 0 0.9835 325.44 462.96 Tm 0.0228 Tc 1.7274 Tw (working on guidelines to assist its surveyors in) Tj 0 -12.2018 TD 0.025 Tc 2.0737 Tw (evaluating special care units in the facilities it) Tj 0.244 -11.9577 TD 0.0311 Tc 1.6492 Tw (accredits. As noted earlier, JCAHO is a private) Tj 0 -12.2018 TD 0.0237 Tc 1.0013 Tw (organization that currently accredits about 1000) Tj ET BT 0.934 0 0 0.9835 325.44 415.68 Tm -0.0047 Tc 0.417 Tw (nursing homes in the United States \(214\). JCAHO\222s) Tj 0.5139 -12.2018 TD -0.0552 Tc 2.5451 Tw (effort to develop guidelines evolved from concerns) Tj 0.257 -12.2018 TD -0.022 Tc 1.1604 Tw (and questions raised by its surveyors about how to) Tj ET BT 0.8915 0 0 0.9835 326.16 379.68 Tm 0.0578 Tc 1.2683 Tw (evaluate the increasing number of special care units) Tj 0 -12.2018 TD 0.0519 Tc 1.0971 Tw (they were seeing in nursing homes accredited by the) Tj ET BT 0.934 0 0 0.9835 326.16 355.44 Tm 0.007 Tc 4.1486 Tw (commission \(434\).) Tj ET BT 0.9835 0 0 0.9835 336.96 337.68 Tm 0.0202 Tc 0.1264 Tw (JCAHO\222s surveyor guidelines, currently out for) Tj ET BT 0.934 0 0 0.9835 326.16 325.92 Tm -0.0226 Tc 1.3823 Tw (review in a fourth draft, are based on the commis-) Tj ET BT 0.8915 0 0 0.9835 326.88 313.92 Tm 0.0322 Tc 1.6046 Tw (sion\222s standards for all nursing homes \(213,435\). No) Tj ET BT 0.9835 0 0 0.9835 326.64 301.92 Tm 0.0315 Tc 0.847 Tw (changes have been made to the basic standards.) Tj ET BT 0.8915 0 0 0.9835 326.64 290.16 Tm 0.0147 Tc 0.9369 Tw (Instead, statements have been added next to many of) Tj ET BT 0.9835 0 0 0.9835 326.88 277.92 Tm 0.0369 Tc 1.3295 Tw (the standards to explain the implications of the) Tj ET BT 0.8915 0 0 0.9835 326.88 266.16 Tm 0.0291 Tc 1.0554 Tw (standard for the care of residents with dementia and) Tj ET BT 0.9835 0 0 0.9835 326.88 254.16 Tm 0.0378 Tc 0.1085 Tw (to describe the process surveyors should follow in) Tj ET BT 0.934 0 0 0.9835 326.88 242.16 Tm -0.0183 Tc 0.7069 Tw (evaluating and scoring the special care unit on that) Tj ET BT 0.8491 0 0 0.9835 327.36 229.92 Tm 0.0203 Tc 0 Tw (standard.) Tj ET BT 0.934 0 0 0.9835 337.92 212.16 Tm -0.0199 Tc 1.1674 Tw (The 152-page fourth draft of the surveyor guide-) Tj ET BT 0.9835 0 0 0.9835 327.12 200.16 Tm 0.0247 Tc 3.0502 Tw (lines is much longer than the other guideline) Tj 0 -12.4458 TD 0.0285 Tc 1.4601 Tw (documents discussed in this section. It provides) Tj ET BT 0.934 0 0 0.9835 327.36 175.92 Tm -0.0276 Tc 0.5883 Tw (what is, in effect, a detailed answer to the question,) Tj ET BT 0.9835 0 0 0.9835 328.08 164.16 Tm 0.025 Tc 2.3178 Tw (\223What constitutes appropriate care for nursing) Tj ET BT 0.934 0 0 0.9835 327.12 151.92 Tm -0.0258 Tc 2.6421 Tw (home residents with dementia?\224 Some commenta-) Tj ET BT 0.9835 0 0 0.9835 327.6 140.4 Tm 0.0373 Tc 1.7126 Tw (tors will undoubtedly disagree with some of its) Tj ET BT 0.934 0 0 0.9835 327.6 128.88 Tm -0.0283 Tc 1.8738 Tw (components, and certain of the components proba-) Tj ET BT 0.9835 0 0 0.9835 327.6 116.88 Tm 0.04 Tc 0.9429 Tw (bly apply as much to nondemented as demented) Tj ET BT 0.934 0 0 0.9835 327.6 104.64 Tm -0.0248 Tc 0.6954 Tw (nursing home residents. There are also instances in) Tj ET BT 0.9835 0 0 0.9835 327.6 92.88 Tm 0.0302 Tc 0.8889 Tw (which the guidelines tell surveyors to determine) Tj ET BT 0.934 0 0 0.9835 327.6 80.64 Tm -0.0462 Tc 0.0943 Tw (whether ) Tj ET BT 0.9443 0 0 0.9812 366.72 80.64 Tm /F5 11 Tf 0.0483 Tc -0.007 Tw (appropriate ) Tj ET BT 0.934 0 0 0.9835 420.48 80.64 Tm /F4 10 Tf -0.0976 Tc 0.1494 Tw (or ) Tj ET BT 0.9443 0 0 0.9812 432 80.64 Tm /F5 11 Tf 0.0298 Tc 0.1397 Tw (proper care ) Tj ET BT 0.934 0 0 0.9835 485.04 80.64 Tm /F4 10 Tf -0.0007 Tc 0.8164 Tw (has been given,) Tj ET BT 0.9835 0 0 0.9835 327.6 68.64 Tm 0.0472 Tc 0.4475 Tw (leaving open the question of what appropriate or) Tj ET BT 0.934 0 0 0.9835 327.6 56.88 Tm -0.0314 Tc 1.0421 Tw (proper care is; the frequency of these instances has) Tj 0.257 -12.2018 TD -0.0398 Tc 1.5191 Tw (decreased, however, in each successive draft of the) Tj ET endstream endobj 476 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 477 0 obj <>stream 0.72 w 1 j 0 0 0 RG 57.6 679.68 m 535.92 679.68 l S BT 0.9835 0 0 0.9835 247.92 685.2 Tm 0 0 0 rg /F5 10 Tf 0.0263 Tc 1.756 Tw (Chapter 5-Regulations And Guidelines For Special Care Units . 155) Tj ET BT 0.8491 0 0 0.9835 58.08 646.32 Tm /F4 10 Tf 0.0422 Tc 1.4085 Tw (document. The guidelines are informative and thought-) Tj ET BT 0.934 0 0 0.9835 57.6 634.08 Tm -0.026 Tc 1.1576 Tw (provoking at the least, and the commission is to be) Tj ET BT 0.8915 0 0 0.9835 58.32 622.32 Tm 0.0479 Tc 0.6103 Tw (credited with creating comprehensive surveyor guide-) Tj ET BT 0.9835 0 0 0.9835 58.32 610.32 Tm 0.0328 Tc 2.4928 Tw (lines that fit within the broader context of its) Tj ET BT 0.8915 0 0 0.9835 58.56 598.08 Tm 0.0323 Tc 1.4891 Tw (standards for all nursing homes.) Tj ET BT 0.934 0 0 0.9835 69.12 580.32 Tm -0.0431 Tc 1.6328 Tw (JCAHO intends to pilot test the surveyor guide-) Tj ET BT 0.8915 0 0 0.9835 58.56 568.8 Tm 0.0364 Tc 1.1257 Tw (lines in the summ) Tj ET BT 0.934 0 0 0.9835 136.32 568.56 Tm -0.0154 Tc 0.3183 Tw (er 1992 in six special care units in) Tj ET BT 0.9835 0 0 0.9835 58.56 557.04 Tm 0.0291 Tc 0.2219 Tw (the Chicago area \(435\). Using the guidelines, two) Tj ET BT 0.934 0 0 0.9835 58.56 545.04 Tm -0.031 Tc 0.959 Tw (JCAHO surveyors will inspect the six units. Within) Tj ET BT 0.9835 0 0 0.9835 59.04 533.28 Tm 0.0346 Tc 2.674 Tw (2 days, two representatives of the Alzheimer\222s) Tj ET BT 0.8915 0 0 0.9835 58.8 521.28 Tm 0.0376 Tc 1.5986 Tw (Association will visit the same units. The surveyors\222) Tj ET BT 0.9835 0 0 0.9835 59.04 509.28 Tm 0.0345 Tc 0.9659 Tw (findings and the observations of the Alzheimer\222s) Tj 0 -11.9577 TD 0.0401 Tc 1.7167 Tw (Association representatives will be compared to) Tj ET BT 0.8915 0 0 0.9835 59.28 485.52 Tm 0.0359 Tc 0 Tw (determin) Tj ET BT 0.934 0 0 0.9835 98.4 485.52 Tm -0.0421 Tc 0.8608 Tw (e whether the guidelines identify the prob-) Tj -41.8838 -12.2018 TD -0.0218 Tc 0.8391 Tw (lems that concern consumers.) Tj ET BT 0.9795 0 0 0.9795 105.12 449.52 Tm /F7 12 Tf 0.0392 Tc 1.2467 Tw (Summary and Implications) Tj ET BT 0.934 0 0 0.9835 70.56 431.76 Tm /F4 10 Tf -0.0432 Tc 1.6842 Tw (The completed guideline documents discussed in) Tj -11.563 -12.2018 TD -0.0462 Tc 1.526 Tw (the preceding sections are intended to educate and) Tj ET BT 0.9835 0 0 0.9835 59.76 407.76 Tm 0.0252 Tc 1.6262 Tw (inform. They identify areas that require special) Tj ET BT 0.934 0 0 0.9835 59.76 395.76 Tm -0.0348 Tc 0.9631 Tw (consideration in the care of nursing home residents) Tj ET BT 0.9835 0 0 0.9835 59.76 383.76 Tm 0.0246 Tc 1.3827 Tw (with dementia, but unlike the State regulations) Tj 0.244 -11.9577 TD 0.0314 Tc 2.9214 Tw (discussed earlier in the chapter, the guideline) Tj 0.244 -12.2018 TD 0.0286 Tc 1.5821 Tw (documents generally do not prescribe particular) Tj 0 -11.9577 TD 0.0299 Tc 0.6046 Tw (features for special care units. The JCAHO draft) Tj ET BT 0.934 0 0 0.9835 60.72 336 Tm -0.0434 Tc 1.89 Tw (surveyor guidelines differ from the other guideline) Tj -0.257 -11.9577 TD -0.0303 Tc 1.3621 Tw (documents in that they do prescribe many detailed) Tj ET BT 0.9835 0 0 0.9835 60.48 312.24 Tm 0.0298 Tc 2.0689 Tw (features for special care units, but the JCAHO) Tj ET BT 0.8915 0 0 0.9835 60.72 300.24 Tm 0.0449 Tc 0.6675 Tw (guidelines are also intended primarily to educate and) Tj ET BT 0.9835 0 0 0.9835 60.48 287.76 Tm 0.0356 Tc 0.9126 Tw (inform surveyors and to identify areas of special) Tj ET BT 0.8915 0 0 0.9835 60.72 275.52 Tm 0.0397 Tc 1.2116 Tw (consideration in the care of residents with dementia.) Tj ET BT 0.9835 0 0 0.9835 71.52 257.76 Tm 0.0386 Tc 1.5718 Tw (The areas of special concern identified in the) Tj ET BT 0.934 0 0 0.9835 61.2 245.76 Tm -0.0211 Tc 1.2494 Tw (guideline documents are: activity programs, admis-) Tj 0 -12.4458 TD -0.0352 Tc 1.5387 Tw (sion and discharge criteria, conditions of participa-) Tj -0.257 -12.4458 TD -0.019 Tc 2.018 Tw (tion, cost and reimbursement, enforcement, family) Tj ET BT 0.9835 0 0 0.9835 61.2 209.52 Tm 0.0288 Tc 0.0688 Tw (involvement, philosophy and goals, physical envi-) Tj ET BT 0.8915 0 0 0.9835 60.72 197.76 Tm 0.0297 Tc 2.2997 Tw (ronment, physical restraints and psychotropic medi-) Tj ET BT 0.9835 0 0 0.9835 61.2 185.52 Tm 0.0309 Tc 3.4506 Tw (cations, plan of care, policies and procedures,) Tj 0.244 -11.9577 TD 0.0138 Tc 0.1329 Tw (quality assurance, research, resident assessment,) Tj -0.244 -12.2018 TD 0.0293 Tc 1.0933 Tw (resident rights, safety egress control, specialized) Tj 0.7321 -12.4458 TD 0.0041 Tc -0.0607 Tw (services \(e.g., physician, nursing, social work, and) Tj -0.244 -11.7137 TD 0.0304 Tc 3.4511 Tw (dietary services\), and staffing. These areas of) Tj ET BT 0.934 0 0 0.9835 61.92 126 Tm -0.0237 Tc 0.8839 Tw (concern are not necessarily mutually exclusive, and) Tj ET BT 0.9835 0 0 0.9835 62.16 114.24 Tm 0.0497 Tc 1.225 Tw (some are addressed in only one of the guideline) Tj ET BT 0.934 0 0 0.9835 61.92 102.24 Tm -0.0358 Tc 1.3679 Tw (documents. Nevertheless, there appears to be some) Tj ET BT 0.8915 0 0 0.9835 61.92 90.24 Tm 0.0515 Tc 0.6264 Tw (agreement at present about the areas of concern. The) Tj ET BT 0.934 0 0 0.9835 61.92 78.24 Tm -0.0351 Tc 2.0867 Tw (State regulations discussed earlier fit conceptually) Tj 0 -11.9577 TD -0.0228 Tc 0.7374 Tw (within the same areas of concern.) Tj ET BT 0.9835 0 0 0.9835 72.72 48.72 Tm 0.0267 Tc 2.5601 Tw (Having agreement about areas of concern is) Tj ET BT 0.934 0 0 0.9835 61.68 36.72 Tm -0.0155 Tc 1.7317 Tw (helpful in organizing a discussion about particular) Tj ET BT 0.8915 0 0 0.9835 308.88 646.08 Tm 0.0497 Tc 0.2247 Tw (features that might be desirable or required in special) Tj 0.2692 -12.2018 TD 0.0477 Tc 0.3615 Tw (care units. On the other hand, agreement about areas) Tj ET BT 0.9835 0 0 0.9835 309.36 622.08 Tm 0.0308 Tc 1.9459 Tw (of concern is not the same as agreement about) Tj -0.4881 -11.9577 TD 0.02 Tc 0.4194 Tw (particular features. For example, agreement that) Tj 0.7321 -12.4458 TD 0.0182 Tc 1.3485 Tw (activity programs and physical environment are) Tj ET BT 0.8915 0 0 0.9835 309.6 586.56 Tm 0.0493 Tc 0.8163 Tw (areas of concern does not constitute agreement about) Tj ET BT 0.9835 0 0 0.9835 309.6 574.32 Tm 0.0202 Tc 2.9734 Tw (what the activity programs or physical design) Tj ET BT 0.934 0 0 0.9835 309.6 562.8 Tm -0.0183 Tc 1.6062 Tw (features should be. It is OTA\222s observation that in) Tj ET BT 0.9835 0 0 0.9835 309.6 550.8 Tm 0.0329 Tc 1.3336 Tw (discussions about guidelines and regulations for) Tj ET BT 0.8915 0 0 0.9835 310.32 538.8 Tm 0.0598 Tc 1.3045 Tw (special care units, agreement about areas of concern) Tj -0.2692 -12.2018 TD 0.0371 Tc 1.4838 Tw (often masks considerable disagreement about partic-) Tj ET BT 0.9835 0 0 0.9835 309.84 514.8 Tm 0.0304 Tc 0.6346 Tw (ular features of the units and gives a misleading) Tj 0.4881 -11.9577 TD 0.028 Tc 0.3624 Tw (impression that there is consensus about at least) Tj 0.244 -12.2018 TD 0.0333 Tc 1.618 Tw (some particular features that are desirable and) Tj ET BT 0.934 0 0 0.9835 310.8 479.04 Tm -0.0294 Tc 0.419 Tw (should be required in special care units. Each of the) Tj -0.5139 -12.2018 TD -0.0455 Tc 1.07 Tw (completed guideline documents stresses the current) Tj 0 -12.2018 TD -0.02 Tc 1.2226 Tw (uncertainty about the importance of particular fea-) Tj ET BT 0.9835 0 0 0.9835 310.56 443.28 Tm 0.0286 Tc 1.46 Tw (tures and the need for research to clarify many) Tj ET BT 0.8915 0 0 0.9835 310.32 431.28 Tm 0.0448 Tc 1.5425 Tw (unresolved questions in this area.) Tj ET BT 0.9835 0 0 0.9835 321.84 413.28 Tm 0.0313 Tc 1.1522 Tw (Finally, it should be noted that like the State) Tj ET BT 0.934 0 0 0.9835 310.56 401.28 Tm -0.0383 Tc 1.6704 Tw (regulations for special care units discussed earlier,) Tj 0.5139 -12.2018 TD -0.0377 Tc 2.4406 Tw (the completed guideline documents have not been) Tj ET BT 0.8915 0 0 0.9835 311.04 377.28 Tm 0.0425 Tc 1.3432 Tw (developed in the context of the nursing home reform) Tj ET BT 0.9835 0 0 0.9835 311.04 365.52 Tm 0.0467 Tc 2.7024 Tw (provisions of OBRA-87. Moreover, some of the) Tj 0.7321 -12.4458 TD 0.0348 Tc 1.3317 Tw (specific guidelines in these documents duplicate) Tj -0.7321 -11.9577 TD 0.039 Tc 1.153 Tw (provisions of OBRA-87 that apply to all nursing) Tj ET BT 0.8915 0 0 0.9835 311.28 329.52 Tm 0.2481 Tc 0 Tw (homes.) Tj ET BT 0.9663 0 0 0.9939 378 299.28 Tm /F6 14 Tf 0.0433 Tc (CONCLUSION) Tj ET BT 0.9835 0 0 0.9835 322.56 281.28 Tm /F4 10 Tf 0.0348 Tc 0.2335 Tw (As of early 1992, six States had regulations for) Tj ET BT 0.8915 0 0 0.9835 312.24 269.04 Tm 0.0382 Tc 1.2732 Tw (special care units. Five States were in the process of) Tj ET BT 0.934 0 0 0.9835 312 257.04 Tm -0.036 Tc 1.6679 Tw (developing regulations, and other States were con-) Tj ET BT 0.9835 0 0 0.9835 312.48 245.04 Tm 0.0302 Tc 3.1666 Tw (sidering doing so.) Tj 95.906 0 TD 0.0326 Tc 1.7406 Tw (These State regulations are) Tj ET BT 0.934 0 0 0.9835 312.24 233.04 Tm -0.0298 Tc 0.8477 Tw (intended primarily to assure that special care units) Tj ET BT 0.8915 0 0 0.9835 312.48 220.8 Tm 0.0408 Tc 0.6337 Tw (are not established and operated solely for marketing) Tj ET BT 0.934 0 0 0.9835 312 209.04 Tm -0.0369 Tc 1.2406 Tw (purposes and do actually provide something special) Tj ET BT 0.8915 0 0 0.9835 312.48 197.28 Tm 0.0532 Tc 0.2544 Tw (for their residents. The regulations have been and are) Tj ET BT 0.934 0 0 0.9835 312.48 185.28 Tm -0.0282 Tc 0.9927 Tw (being developed in the absence of consensus among) Tj ET BT 0.8915 0 0 0.9835 312.72 173.52 Tm 0.0388 Tc 1.3281 Tw (experts about the particular features that are neces-) Tj ET BT 0.9835 0 0 0.9835 313.2 161.52 Tm 0.029 Tc 2.4532 Tw (sary in a special care unit and research-based) Tj ET BT 0.934 0 0 0.9835 312.72 149.52 Tm -0.0368 Tc 0.8551 Tw (evidence to support requirements for any particular) Tj ET BT 0.8491 0 0 0.9835 312.96 138 Tm 0.0559 Tc 0 Tw (features.) Tj ET BT 0.9835 0 0 0.9835 324 120 Tm 0.0351 Tc 0.9897 Tw (Several public and private organizations have) Tj -10.9816 -11.7137 TD 0.0565 Tc -0.1139 Tw (developed or are developing guidelines for special) Tj -0.244 -12.4458 TD 0.0269 Tc 1.8685 Tw (care units. These guidelines identify areas that) Tj ET BT 0.934 0 0 0.9835 312.72 84.48 Tm -0.0361 Tc 1.3683 Tw (require special consideration in the care of nursing) Tj 0 -12.2018 TD -0.0325 Tc 1.2176 Tw (home residents with dementia but generally do not) Tj -0.257 -12.4458 TD -0.0357 Tc 1.6676 Tw (prescribe particular features for special care units.) 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These six) Tj ET BT 0.934 0 0 0.9835 75.6 615.6 Tm -0.0426 Tc 0.7007 Tw (guideline documents are not intended to be used for) Tj ET BT 0.8915 0 0 0.9835 75.12 603.6 Tm 0.0361 Tc 4.4461 Tw (regulatory purposes.) Tj ET BT 0.934 0 0 0.9835 86.64 585.36 Tm -0.025 Tc 0.9709 Tw (The nursing home reform provisions of OBRA-87) Tj -11.82 -11.7137 TD -0.0336 Tc 1.417 Tw (create a broad, comprehensive regulatory structure) Tj ET BT 0.8915 0 0 0.9835 75.84 561.84 Tm 0.032 Tc 2.0279 Tw (aimed at assuring high-quality, individualized nurs-) Tj ET BT 0.934 0 0 0.9835 75.84 550.08 Tm -0.0363 Tc 0.8831 Tw (ing home care for all residents. 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Tj ET BT 0.934 0 0 0.9835 337.44 611.52 Tm -0.027 Tc 1.487 Tw (If fully implemented, the provisions of OBRA-87) Tj -11.563 -12.4458 TD -0.0387 Tc 1.8483 Tw (would improve the care of nursing home residents) Tj ET BT 0.9835 0 0 0.9835 326.88 587.04 Tm 0.0341 Tc 1.9831 Tw (with dementia. 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Tj ET BT 0.8915 0 0 0.9835 500.64 624 Tm 0.0897 Tc 0 Tw (160) Tj ET BT 0.934 0 0 0.9835 109.44 611.52 Tm -0.0036 Tc 1.7372 Tw (THE IMPACT OF INTERPRETATIONS OF REGULATIONS ON THE) Tj 12.0769 -12.2018 TD 0.022 Tc 0.4378 Tw (DESIGN AND OPERATION OF SPECIAL CARE UNITS . . . . . . . . . . . . . . . . . . . . . . 163) Tj ET BT 0.8915 0 0 0.9835 110.16 587.28 Tm -0.064 Tc 0.37 Tw (CASE EXAMPLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 363.12 587.52 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8915 0 0 0.9835 501.12 588 Tm 0.0897 Tc 0 Tw (166) Tj -426.4038 -13.1779 TD -0.0533 Tc 0.3161 Tw (Unit Design . . . . . . . . . . . . . . . . . . . .) Tj ET BT 0.8491 0 0 0.9835 277.44 575.28 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) 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Tj 94.9713 0.244 TD 0.0897 Tc 0 Tw (168) Tj ET BT 0.9835 0 0 0.9835 110.64 503.76 Tm 0.0061 Tc 0.2627 Tw (METHODS TO ALLOW INN0VATION IN THE DESIGN AND OPERATION) Tj 11.7137 -12.2018 TD 0.0221 Tc 0.8565 Tw (OF SPECIAL CARE UNITS) Tj ET BT 0.8491 0 0 0.9835 259.2 491.52 Tm 0.0449 Tc -0.008 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .) Tj 286.0444 0.9761 TD 0.0897 Tc 0 Tw (168) Tj ET BT 0.8915 0 0 0.9835 110.88 480 Tm -0.0739 Tc 0.2133 Tw (CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170) Tj ET BT 0.8875 0 0 0.9795 304.8 447.84 Tm /F7 12 Tf 0.1863 Tc 0 Tw (Tables) Tj ET BT 0.99 0 0 0.99 111.36 436.32 Tm /F7 8 Tf 0.2424 Tc (Table) Tj ET BT 0.8971 0 0 0.9835 498.96 436.32 Tm /F5 10 Tf 0.0765 Tc (Page) Tj ET BT 0.934 0 0 0.9835 111.36 424.56 Tm /F4 10 Tf -0.0154 Tc 0.9023 Tw (6-l. Regulations and Standards That Interfere With the Use of Physical Design) Tj 21.8412 -11.9577 TD -0.0218 Tc 1.1603 Tw (Features in Special Care Units) Tj ET BT 0.8915 0 0 0.9835 274.32 412.32 Tm -0.0897 Tc 0.2465 Tw (. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ) Tj ET BT 0.8056 0 0 0.9598 474.96 412.32 Tm /F9 3 Tf 0.0101 Tc 0.0471 Tw (l ) Tj ET BT 0.8915 0 0 0.9835 477.6 412.32 Tm /F4 10 Tf -0.0897 Tc 0 Tw (.,.,,..) Tj ET BT 0.8066 0 0 0.9835 502.8 412.32 Tm 0.2881 Tc (161) Tj ET BT 0.934 0 0 0.9835 111.6 400.32 Tm 0.0145 Tc 0.0605 Tw (6-2. Massachusetts Agencies Regulating Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . 164) Tj 0 -11.9577 TD 0.0106 Tc 0.0538 Tw (6-3. 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Even with the) Tj ET BT 0.8491 0 0 0.9835 321.84 449.28 Tm 0.0224 Tc 1.7952 Tw (admission and recognition of the problem by most) Tj 0 -10.9816 TD 0.0419 Tc 0.8434 Tw (Federal, State, and code bodies, the regulatory and) Tj 0 -11.2256 TD 0.0433 Tc 0.8418 Tw (code environment continues to become increasingly) Tj 0.2827 -11.2256 TD 0.0232 Tc 1.2895 Tw (convoluted instead of coalescing into simpler bases) Tj ET BT 0.8066 0 0 0.9835 322.32 405.6 Tm 0.0329 Tc 2.1363 Tw (of information. These problems afford little opportu-) Tj ET BT 0.8915 0 0 0.9835 322.32 395.04 Tm 0.04 Tc 1.2114 Tw (nity for design or construction efficiencies to de-) Tj ET BT 0.8491 0 0 0.9835 322.56 383.76 Tm 0.0332 Tc 1.2575 Tw (velop. The lack of regulatory consistency drives up) Tj ET BT 0.934 0 0 0.9835 322.56 372.72 Tm -0.0427 Tc 1.8036 Tw (the cost of professional services, each project\222s) Tj ET BT 0.8915 0 0 0.9835 322.8 361.92 Tm 0.0357 Tc 0.1842 Tw (development timeline, and, in turn, each project\222s) Tj ET BT 0.8066 0 0 0.9835 322.8 351.12 Tm 0.0609 Tc 0.7131 Tw (cost. This unnecessary increase in project cost is then) Tj ET BT 0.8491 0 0 0.9835 322.56 340.32 Tm 0.0258 Tc 0.8625 Tw (passed onto the resident ) Tj ET BT 0.8449 0 0 0.9835 425.28 340.32 Tm /F2 10 Tf 0.0849 Tc 0 Tw (\(11\).) Tj ET BT 0.9388 0 0 0.9835 324.24 321.36 Tm 0.0508 Tc 0.0009 Tw (In ) Tj ET BT 0.934 0 0 0.9835 334.56 321.36 Tm /F4 10 Tf -0.0127 Tc 1.2148 Tw (1987, members of the American Association of) Tj ET BT 0.9835 0 0 0.9835 313.44 309.12 Tm 0.0298 Tc 3.3936 Tw (Homes for the Aging formed a subgroup, the) Tj ET BT 0.934 0 0 0.9835 313.44 297.36 Tm -0.0377 Tc 2.3121 Tw (Environmental Code Work Group, to identify, call) Tj ET BT 0.8915 0 0 0.9835 313.92 285.12 Tm 0.0366 Tc 1.7535 Tw (attention to, and eventually change regulations that) Tj ET BT 0.9835 0 0 0.9835 313.92 273.36 Tm 0.0324 Tc 2.1359 Tw (interfere with innovative design in all kinds of) Tj ET BT 0.934 0 0 0.9835 313.44 261.6 Tm -0.0287 Tc 1.2135 Tw (residential facilities for older people \(380\). In 1990,) Tj ET BT 0.8915 0 0 0.9835 313.92 249.6 Tm 0.0453 Tc 0.8208 Tw (the Association received a grant from the Retirement) Tj ET BT 0.934 0 0 0.9835 313.92 237.6 Tm -0.0196 Tc 1.6504 Tw (Research Foundation to establish a national clear-) Tj 0.257 -11.9577 TD -0.0213 Tc 1.3953 Tw (inghouse on aging and environmental design codes) Tj ET BT 0.9835 0 0 0.9835 314.64 213.6 Tm 0.0269 Tc 2.5599 Tw (\(379\). The clearinghouse is a central source of) Tj ET BT 0.934 0 0 0.9835 314.4 202.08 Tm -0.0216 Tc 1.8667 Tw (information about research and trends in environ-) Tj ET BT 0.8915 0 0 0.9835 314.4 190.08 Tm 0.0446 Tc 0.6005 Tw (mental design for older people and about Federal and) Tj ET BT 0.934 0 0 0.9835 314.64 177.84 Tm -0.0248 Tc 0.5853 Tw (State regulations and codes that affect the design of) Tj ET BT 0.9835 0 0 0.9835 314.64 165.84 Tm 0.0437 Tc 0.1024 Tw (facilities for older people. The primary purpose of) Tj ET BT 0.934 0 0 0.9835 314.64 153.84 Tm -0.0354 Tc 0.7067 Tw (the clearinghouse is to assist facilities whose design) Tj ET BT 0.9835 0 0 0.9835 314.64 141.84 Tm 0.0324 Tc 1.8629 Tw (plans are challenged by government officials or) Tj ET BT 0.8915 0 0 0.9835 315.36 129.84 Tm 0.0387 Tc 0 Tw (surveyors.) Tj ET BT 0.934 0 0 0.9835 325.92 110.88 Tm -0.0311 Tc 1.9196 Tw (The extent to which regulations and interpreta-) Tj ET BT 0.9835 0 0 0.9835 315.36 98.64 Tm 0.0363 Tc 0.2146 Tw (tions of regulations interfere with the design and) Tj -0.244 -11.9577 TD 0.0321 Tc -0.0077 Tw (operation of special care units is unclear. Many of) Tj 0.244 -11.9577 TD 0.0402 Tc 0.045 Tw (the respondents to a 1987 survey of a nonrandom) Tj ET BT 0.8915 0 0 0.9835 315.36 62.88 Tm 0.0363 Tc 1.1258 Tw (sample of 99 special care units in 34 States reported) Tj ET BT 0.9835 0 0 0.9835 315.36 51.36 Tm 0.0324 Tc 1.5781 Tw (that regulations had made the creation of their) Tj ET BT 0.934 0 0 0.9835 315.6 39.36 Tm -0.0347 Tc 1.1098 Tw (special care unit) Tj ET BT 0.9835 0 0 0.9835 392.88 39.36 Tm 0.03 Tc 0.8485 Tw (\223difficult, expensive, or impossi-) Tj ET BT 0.8915 0 0 0.9835 290.64 21.6 Tm 0.0897 Tc 0 Tw (\226159\226) Tj ET endstream endobj 488 0 obj <>/Filter/CCITTFaxDecode/Height 920/Length 309/Name/im199/Subtype/Image/Type/XObject/Width 48>>stream & txAu} k!AEz]?am`cC/@[[[[X3eoL ޿X0X@ endstream endobj 489 0 obj <>/Rotate 0/Type/Page>> endobj 490 0 obj <>stream 0.48 w 1 j 0 0 0 RG 72.72 689.04 m 551.76 689.04 l S BT 0.9835 0 0 0.9835 73.44 694.32 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0756 Tw (160 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj 0 -39.7778 TD /F4 10 Tf 0.6072 Tc 0 Tw (ble:\224) Tj 31.7246 0.244 TD 0.0459 Tc 1.9711 Tw (17 percent of the respondents cited local) Tj -31.7246 -12.6899 TD 0.0347 Tc 1.0064 Tw (building code regulations; 18 percent cited State) Tj ET BT 0.8915 0 0 0.9835 73.68 631.44 Tm 0.0526 Tc 1.6458 Tw (nursing home licensing regulations: 26 percent cited) Tj 0.2692 -12.2018 TD 0.0435 Tc 0.9719 Tw (local fire code regulations; and 37 percent cited State) Tj ET BT 0.934 0 0 0.9835 74.16 607.44 Tm -0.0216 Tc 0.6675 Tw (fire code regulations \(494\). OTA is not aware of any) Tj ET BT 0.9835 0 0 0.9835 74.16 595.68 Tm 0.0414 Tc 0.3794 Tw (other data on the proportion of special care units) Tj ET BT 0.934 0 0 0.9835 74.4 583.68 Tm -0.024 Tc 1.3553 Tw (affected by this problem.) Tj ET BT 0.9835 0 0 0.9835 85.44 566.16 Tm 0.0239 Tc 0.0006 Tw (To learn ) Tj 42.2182 0 TD /F2 10 Tf 0.0321 Tc 0.2113 Tw (more about the problem, ) Tj 102.983 0 TD /F4 10 Tf 0.0236 Tc 1.099 Tw (OTA contracted) Tj -156.1828 -12.2018 TD 0.0281 Tc -0.1258 Tw (for an exploratory study of regulations that might) Tj 0.244 -11.9577 TD 0.0447 Tc 0.206 Tw (interfere with the design and operation of special) Tj ET BT 0.934 0 0 0.9835 74.88 530.16 Tm -0.045 Tc 0.093 Tw (care ) Tj ET BT 0.9388 0 0 0.9835 96 530.16 Tm /F2 10 Tf 0.0447 Tc 0.0074 Tw (units ) Tj ET BT 0.934 0 0 0.9835 116.88 530.16 Tm /F4 10 Tf -0.014 Tc 0.745 Tw (\(201\). The study focused on regulations in) Tj ET BT 0.9835 0 0 0.9835 74.88 518.16 Tm 0.0165 Tc 0.6588 Tw (two States, Massachusetts and New York. OTA\222s) Tj 0 -11.9577 TD /F2 10 Tf 0.0191 Tc -0.0805 Tw (contractor ) Tj 43.9264 0 TD /F4 10 Tf 0.0426 Tc 0.5428 Tw (and OTA staff also interviewed Federal) Tj -43.4383 -11.9577 TD 0.0361 Tc 3.5267 Tw (and State officials,) Tj 0 Tc -0.0972 Tw ( ) Tj 100.5427 0 TD /F2 10 Tf 0.2569 Tc 3.9483 Tw (consumer groups, architects,) Tj -100.2987 -12.2018 TD 0.0272 Tc 2.3516 Tw (staff members of two national nursing home associa-) Tj -0.244 -11.9577 TD 0.2749 Tc 2.9234 Tw (tions, and others in the nursing home industry to) Tj 0 -12.2018 TD 0.0227 Tc 3.1581 Tw (obtain their opinions about the problem. The results) Tj 0.244 -12.2018 TD 0.0185 Tc 2.7571 Tw (of the study and these interviews are summarized in) Tj 0 -11.9577 TD 0.0133 Tc 2.9584 Tw (this chapter. Examples of instances in which regula-) Tj 0.244 -12.4458 TD 0.0204 Tc 3.0093 Tw (tions or interpretations of regulations have interfered) Tj -0.244 -11.7137 TD 0.0155 Tc 2.3094 Tw (with the design or operation of special care units are) Tj 0 -11.9577 TD 0.0068 Tc 3.8366 Tw (described. The last section of the chapter discusses) Tj 0.244 -12.2018 TD 0.5 Tc 2.6031 Tw (the need for a waiver process that would allow) Tj 0.4881 -12.4458 TD 0.2376 Tc 3.1444 Tw (special care units to implement a wide variety of) Tj 0 -11.7137 TD 0.4842 Tc 2.8631 Tw (innovative physical design features, patient care) Tj -0.4881 -12.4458 TD 0.0175 Tc 3.5004 Tw (practices, and staffing arrangements. Such a process) Tj 0.4881 -12.4458 TD 0.0129 Tc 4.0745 Tw (would have to include mechanisms to evaluate the) Tj 0 -12.2018 TD 0.0284 Tc 2.8037 Tw (innovations, The process would also have to include) Tj T* 0.2506 Tc 2.6823 Tw (mechanisms to protect residents\222 rights in units in) Tj 0.244 -12.2018 TD 0.2644 Tc 4.2254 Tw (which innovative approaches to care were being) Tj 0 -11.9577 TD 0.1777 Tc 0 Tw (tested.) Tj ET BT 0.9663 0 0 0.9939 81.6 267.6 Tm /F6 14 Tf 0.035 Tc 1.181 Tw (THE IMPACT OF REGULATIONS) Tj ET BT 0.9939 0 0 0.9939 117.84 251.28 Tm 0.0262 Tc 0.0945 Tw (ON THE DESIGN AND) Tj -14.2473 -15.6962 TD 0.0112 Tc 1.1962 Tw (OPERATION OF SPECIAL) Tj ET BT 0.9663 0 0 0.9939 148.08 219.36 Tm 0.0519 Tc 1.4119 Tw (CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 87.84 201.6 Tm /F4 10 Tf 0.0317 Tc 0.0798 Tw (To understand the impact of regulations on the) Tj ET BT 0.8915 0 0 0.9835 77.04 189.6 Tm 0.0272 Tc 0.7172 Tw (design of special care units, it is useful to understand) Tj ET BT 0.934 0 0 0.9835 77.28 177.36 Tm -0.024 Tc 0.7313 Tw (the way design decisions are made \(201\). Architects) Tj ET BT 0.8915 0 0 0.9835 77.04 165.84 Tm 0.0509 Tc -0.1468 Tw (usually ) Tj ET BT 0.9126 0 0 0.9863 111.12 165.84 Tm /F3 9 Tf -0.0093 Tc 0.312 Tw (create a list ) Tj ET BT 0.8915 0 0 0.9835 159.6 165.84 Tm /F4 10 Tf 0.0533 Tc 0.9272 Tw (of all the requirements a building) Tj ET BT 0.9835 0 0 0.9835 77.28 153.84 Tm /F2 10 Tf 0.2503 Tc 3.9028 Tw (must meet to serve its designated purpose. Each) Tj -0.244 -11.9577 TD 0.504 Tc 3.6158 Tw (requirement defines a range of possible design) Tj 0.7321 -11.9577 TD 0.2547 Tc 2.9988 Tw (solutions. Regulations are among the requirements) Tj 0 -11.7137 TD -0.006 Tc 4.0124 Tw (an architect must include.) Tj ET BT 0.934 0 0 0.9835 88.56 101.04 Tm /F4 10 Tf -0.0219 Tc 1.4632 Tw (As described in chapter 5, nursing home regula-) Tj ET BT 0.9835 0 0 0.9835 77.76 89.28 Tm /F2 10 Tf 0.0028 Tc 5.5489 Tw (tions include:) Tj 11.7137 -18.0586 TD 0.0053 Tc 4.2448 Tw (. Federal regulations for Medicare and Medicaid) Tj 10.7376 -12.2018 TD 0.0212 Tc 4.5541 Tw (certification of nursing homes,) Tj ET BT 0.9598 0 0 0.9598 89.28 47.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 96.24 47.76 Tm /F2 10 Tf 0.2299 Tc 4.5859 Tw (State licensing regulations,) Tj ET BT 0.9598 0 0 0.9598 336.24 655.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 342.48 655.44 Tm /F4 10 Tf 0.0476 Tc -0.1455 Tw (State ) Tj ET BT 0.99 0 0 0.99 370.32 655.44 Tm /F3 8 Tf -0.0422 Tc 0.0001 Tw (certificate ) Tj ET BT 0.9835 0 0 0.9835 410.4 655.44 Tm /F4 10 Tf 0.0418 Tc 0.8365 Tw (of need regulations, and) Tj -75.407 -12.6899 TD 0.0277 Tc 0.4848 Tw (. other State and local government regulations) Tj 10.9816 -12.2018 TD 0.014 Tc 0.1326 Tw (that apply to nursing homes, such as zoning,) Tj 0 -11.7137 TD 0.026 Tc -0.0626 Tw (building, fire safety, and ) Tj 116.8931 0 TD /F2 10 Tf 0.0119 Tc 0.0488 Tw (sanitation code regula-) Tj -116.405 -11.4697 TD 0.2035 Tc 0 Tw (tions.) Tj -10.9816 -18.7907 TD 0.0112 Tc 3.9542 Tw (In addition, Federal, State, and local government) Tj -11.2256 -11.9577 TD 0.512 Tc 4.2381 Tw (nursing home regulations incorporate standards) Tj 0 -12.2018 TD 0.2847 Tc 4.8352 Tw (developed by various nongovernmental organiza-) Tj 0.4881 -12.2018 TD 0.2486 Tc 3.1027 Tw (tions. Federal regulations for Medicare and Medi-) Tj 0 -11.7137 TD 0.0285 Tc 4.3433 Tw (caid certification of nursing homes require nursing) Tj 0 -12.2018 TD 0.0199 Tc 3.2539 Tw (homes to comply with the Life Safety Code of the) Tj T* 0.0206 Tc 4.3514 Tw (National Fire Protection Association \(NPFA\) or an) Tj 0 -11.9577 TD 0.2574 Tc 2.9892 Tw (equivalent State fire and safety code \(463\). Other) Tj 0.7321 -12.2018 TD 0.5154 Tc 3.5147 Tw (standards incorporated into some nursing home) Tj -0.7321 -12.2018 TD 0.4684 Tc 4.0994 Tw (regulations are the) Tj 99.5665 0 TD 0.4792 Tc 5.0645 Tw (\223Specifications for Making) Tj -98.8344 -12.2018 TD 0.0021 Tc 2.7607 Tw (Buildings and Facilities Accessible to and Usable by) Tj 0 -11.9577 TD 0.2639 Tc 3.2336 Tw (Physically Handicapped People\224 developed by the) Tj 0 -12.4458 TD 0.2535 Tc 2.9024 Tw (American National Standards Institute \(ANSI\), the) Tj 0.7321 -11.9577 TD 0.5075 Tc 3.474 Tw (\223Guidelines for Construction and Equipment of) Tj -0.4881 -12.2018 TD 0.2345 Tc 3.0357 Tw (Hospital and Medical Facilities\224 developed by the) Tj -0.244 -11.9577 TD 0.0147 Tc 3.3406 Tw (American Institute of Architects, and building codes) Tj 0.244 -12.2018 TD 0.4985 Tc 4.1094 Tw (developed by the Building Officials and Code) Tj 0 -11.9577 TD 0.0124 Tc 4.0749 Tw (Administrators International, Inc.) Tj 0 Tc -0.061 Tw ( ) Tj 149.3498 0 TD /F4 10 Tf 0.4738 Tc 0 Tw (\(BOCA\).) Tj ET BT 0.8915 0 0 0.9835 338.4 368.88 Tm 0.0456 Tc 0.5321 Tw (All these regulations and standards create require-) Tj ET BT 0.9835 0 0 0.9835 327.36 356.64 Tm 0.03 Tc 0.0118 Tw (ments that restrict design options. Because of the) Tj ET BT 0.934 0 0 0.9835 327.6 344.88 Tm -0.0233 Tc 1.0976 Tw (large number and specificity of the regulations and) Tj ET BT 0.9835 0 0 0.9835 327.84 332.4 Tm 0.0354 Tc 0.2504 Tw (standards, there may be few design solutions left) Tj ET BT 0.8915 0 0 0.9835 327.84 320.64 Tm 0.0301 Tc 1.0205 Tw (\(201\). As a result, nursing homes are sometimes said) Tj ET BT 0.934 0 0 0.9835 327.84 308.64 Tm -0.0402 Tc 1.5011 Tw (to have been designed \223with a cookie cutter. \224) Tj 12.0769 -18.7907 TD -0.0269 Tc 3.2214 Tw (OTA\222s contractor analyzed Federal regulations,) Tj -11.82 -12.2018 TD -0.0141 Tc 1.2591 Tw (State regulations in Massachusetts and New York,) Tj 0.257 -11.9577 TD -0.0332 Tc 2.136 Tw (and incorporated standards to identify regulations) Tj 0 -12.2018 TD -0.0209 Tc 0.471 Tw (and standards that might preclude use of particular) Tj -0.7709 -11.7137 TD -0.0232 Tc 0.8405 Tw (physical design features in special care units. Table) Tj ET BT 0.9835 0 0 0.9835 328.32 230.4 Tm 0.0323 Tc -0.008 Tw (6-1 shows the results of the analysis. Federal and) Tj ET BT 0.8915 0 0 0.9835 328.32 218.16 Tm 0.0198 Tc 1.6378 Tw (State regulations and standards were identified that) Tj ET BT 0.9835 0 0 0.9835 328.08 206.16 Tm 0.0365 Tc 2.1667 Tw (might preclude the use of nine design features) Tj 0.244 -12.2018 TD 0.0413 Tc 0.9765 Tw (intended to serve three purposes: 1\) coping with) Tj ET BT 0.934 0 0 0.9835 328.32 182.16 Tm -0.0174 Tc 0.9628 Tw (resident wandering, 2\) reducing agitation and cata-) Tj ET BT 0.9835 0 0 0.9835 329.04 170.4 Tm 0.0162 Tc 1.2111 Tw (strophic reactions, and 3\) making the unit more) Tj ET BT 0.934 0 0 0.9835 328.32 158.64 Tm -0.0178 Tc 1.7158 Tw (home-like in appearance \(201\). Some of the design) Tj ET BT 0.8915 0 0 0.9835 328.56 146.88 Tm 0.0161 Tc 1.5843 Tw (features, e.g., placement of resident rooms off sitting) Tj ET BT 0.934 0 0 0.9835 328.32 135.36 Tm -0.0342 Tc 0.8523 Tw (rooms, are specifically prohibited by the regulations) Tj ET BT 0.9835 0 0 0.9835 329.04 123.6 Tm 0.0199 Tc 0.0046 Tw (and standards. Other design features, e.g., secure) Tj ET BT 0.934 0 0 0.9835 329.04 111.84 Tm -0.0251 Tc 1.5813 Tw (exits and use of familiar furniture, are not specifi-) Tj 0 -11.7137 TD -0.024 Tc 0.8415 Tw (cally prohibited in these States, but the regulations) Tj 0 -12.4458 TD -0.0194 Tc 0.7081 Tw (and standards limit the ways in which these design) Tj ET BT 0.8915 0 0 0.9835 329.04 76.56 Tm 0.0359 Tc 2.2031 Tw (features can be implemented.) Tj ET BT 0.934 0 0 0.9835 339.84 58.32 Tm -0.027 Tc 1.3585 Tw (Another analysis of Federal regulations, Wiscon-) Tj ET BT 0.8915 0 0 0.9835 329.52 46.32 Tm 0.0265 Tc 0.4189 Tw (sin State regulations, and incorporated standards had) Tj ET endstream endobj 491 0 obj <>/Rotate 0/Type/Page>> endobj 492 0 obj <>stream 0.48 w 1 j 0 0 0 RG 61.92 686.16 m 540 686.16 l S 0.72 w 62.16 639.84 m 540.72 639.84 l S 62.16 621.84 m 540.72 621.84 l S 180 59.52 m 544.32 59.52 l S 66.48 58.8 m 181.44 58.8 l S BT 0.9835 0 0 0.9835 133.68 691.2 Tm 0 0 0 rg /F5 10 Tf 0.0212 Tc 1.768 Tw (Chapter Regulations That Interfere With The Design and Operation of Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 516 691.2 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 522.48 691.2 Tm /F5 10 Tf 0.4474 Tc 0 Tw (161) Tj ET BT 0.9863 0 0 0.9863 153.6 655.44 Tm /F3 9 Tf 0.0387 Tc 0.7562 Tw (Table 6-l\227Regulations and Standards That Interfere With the Use of) Tj 47.6925 -10.2198 TD 0.0487 Tc 0.1647 Tw (Physical Design Features in Special Care Units) Tj ET BT 0.9262 0 0 0.9939 227.28 633.36 Tm /F3 7 Tf 0.0695 Tc 0 Tw (Federal) Tj ET BT 0.9939 0 0 0.9939 349.44 633.36 Tm 0.0038 Tc (State) Tj ET BT 0.8645 0 0 0.9939 472.8 633.6 Tm 0.2045 Tc (Incorporated) Tj ET BT 0.9262 0 0 0.9939 62.88 625.44 Tm 0.0605 Tc 0.5792 Tw (Design Features) Tj ET BT 0.8645 0 0 0.9939 220.32 624.96 Tm 0.1931 Tc 0 Tw (Regulations) Tj 137.6963 0.2415 TD 0.1931 Tc (Regulations) Tj ET BT 0.9262 0 0 0.9939 475.92 625.44 Tm 0.0534 Tc (Standards) Tj ET BT 0.9939 0 0 0.9939 63.6 613.44 Tm /F11 7 Tf 0.0417 Tc -0.0574 Tw (To Cope ) Tj 30.1849 0 TD 0.0054 Tc -0.0209 Tw (With Wandering) Tj 95.6259 -8.6933 TD /F3 7 Tf 0.4619 Tc 4.0275 Tw (Public law 100-203 Section) Tj ET BT 0.9262 0 0 0.9939 188.64 596.88 Tm 0.0212 Tc 0.3107 Tw (4201 \(181 9\)\(6\)\(D\)\(d\) \(2\)\(B\) \223A ) Tj ET BT 0.8647 0 0 0.9598 283.44 596.88 Tm /F3 6 Tf -0.0281 Tc 0 Tw (Skilled) Tj ET BT 0.9262 0 0 0.9939 188.64 588.72 Tm /F3 7 Tf 0.0521 Tc 1.3009 Tw (facility must meet such provisions) Tj ET BT 0.8645 0 0 0.9939 188.64 580.56 Tm -0.0579 Tc 0.8965 Tw (of. .) Tj ET BT 0.9939 0 0 0.9939 203.04 580.56 Tm 0.0269 Tc 2.0342 Tw (the Life Safety Code of the) Tj ET BT 0.9262 0 0 0.9939 189.12 572.4 Tm 0.0745 Tc 1.0305 Tw (NFPA as are applicable to nursing) Tj ET BT 0.8645 0 0 0.9939 189.12 564.48 Tm 0.2016 Tc 0 Tw (homes.\224) Tj ET BT 0.9262 0 0 0.9939 311.04 604.8 Tm 0.0437 Tc 2.7998 Tw (MA105CMR150.017\(B\) \(5\) \223Activity) Tj 0 -7.9688 TD 0.0707 Tc 0.1018 Tw (Areas: All facilities shall provide on) Tj ET BT 0.9939 0 0 0.9939 311.04 588.72 Tm 0.0039 Tc 1.832 Tw (every floor and for every unit a) Tj 0 -7.9688 TD 0.2523 Tc 2.8699 Tw (comfortable, convenient, well-) Tj ET BT 0.9262 0 0 0.9939 311.04 572.64 Tm 0.0736 Tc 0.5651 Tw (Iighted and ventilated sitting room,) Tj 0 -8.2103 TD 0.072 Tc 0.5668 Tw (day room, or solarium with a direct) Tj ET BT 0.9939 0 0 0.9939 311.04 556.56 Tm 0.0102 Tc 0.578 Tw (outside exposure that is separate) Tj ET BT 0.8645 0 0 0.9939 311.04 548.4 Tm -0.0473 Tc 2.5499 Tw (from patient or resident rooms.\224) Tj ET BT 0.9262 0 0 0.9939 70.8 605.04 Tm 0.0748 Tc 0.4602 Tw (1. Create walking loops by build-) Tj 10.8826 -8.2103 TD 0.0925 Tc 0.4583 Tw (ing around interior courtyard,) Tj 0 -8.2103 TD 0.0515 Tc 0.589 Tw (atrium, or activity area) Tj ET BT 0.8645 0 0 0.9939 433.44 605.04 Tm -0.0341 Tc 1.9795 Tw (NFPA: 12-2.4.2) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8648 0 0 0.99 480.48 605.04 Tm /F3 8 Tf 0.0176 Tc 1.5024 Tw (\223Egress shall not) Tj ET BT 0.8108 0 0 0.99 433.44 596.88 Tm 0.0993 Tc 0.4658 Tw (require return through the ) Tj ET BT 0.8267 0 0 0.99 520.08 596.88 Tm /F5 8 Tf 0.0354 Tc -0.0107 Tw (zone ) Tj ET BT 0.8027 0 0 0.9939 534.48 596.88 Tm /F3 7 Tf 0.2824 Tc 0 Tw (of) Tj ET BT 0.8645 0 0 0.9939 433.44 588.72 Tm -0.0217 Tc 1.6875 Tw (fire origin.\224) Tj ET BT 0.99 0 0 0.99 71.04 535.44 Tm /F2 8 Tf 0.0299 Tc -0.0911 Tw (2. ) Tj ET BT 0.9939 0 0 0.9939 78.96 535.44 Tm /F3 7 Tf -0.0185 Tc 0.0032 Tw (Secure exits) Tj ET BT 0.8645 0 0 0.9939 433.68 534.96 Tm -0.0182 Tc 1.0588 Tw (NFPA: 12-2.5.5 \223Every corridor shall) Tj ET BT 0.9939 0 0 0.9939 433.68 526.8 Tm 0.0119 Tc 1.6629 Tw (provide access to at least two) Tj ET BT 0.9262 0 0 0.9939 433.68 518.88 Tm 0.0626 Tc 0.0587 Tw (approved exits.\224 12-2.2.2.4 \223Doors) Tj 0 -7.9688 TD 0.0605 Tc 0.061 Tw (within a required means of egress) Tj ET BT 0.8645 0 0 0.9939 433.92 502.8 Tm -0.057 Tc 1.5062 Tw (shall not be equipped with a) Tj 0 Tc -0.0033 Tw ( ) Tj ET BT 0.8919 0 0 0.9835 523.2 502.8 Tm /F2 10 Tf 0.0383 Tc 0 Tw (latch) Tj ET BT 0.9262 0 0 0.9939 433.92 494.64 Tm /F3 7 Tf 0.0586 Tc 0.8034 Tw (or lock that requires the use of a) Tj -0.2591 -8.2103 TD 0.0608 Tc 0.0607 Tw (tool or key from the egress side.\224) Tj ET BT 0.9939 0 0 0.9939 64.8 472.8 Tm /F11 7 Tf 0.0274 Tc 0.621 Tw (To Reduce Agitation, Control Ca-) Tj -0.2415 -8.2103 TD 0.0147 Tc 1.9016 Tw (tastrophic Reactions) Tj ET BT 0.9595 0 0 0.9835 72 450.72 Tm /F8 10 Tf 0.001 Tc -0 Tw (1. ) Tj ET BT 0.9262 0 0 0.9939 89.28 450.72 Tm /F3 7 Tf 0.064 Tc 0.5754 Tw (Use of interior finishes that) Tj -7.7733 -8.2103 TD 0.0705 Tc 0.0502 Tw (reduce noise and glare) Tj 248.2263 7.4859 TD 0.0495 Tc 0.7638 Tw (MA105CMR1 50.017B \(12\)\(b\) \223Walls) Tj ET BT 0.9939 0 0 0.9939 312 442.08 Tm 0.0143 Tc 1.2379 Tw (shall have a water-proof, glazed,) Tj ET BT 0.9262 0 0 0.9939 312.24 433.92 Tm 0.065 Tc 0.7298 Tw (painted, or similar surface that will) Tj -0.2591 -7.9688 TD 0.0654 Tc 1.3513 Tw (withstand washing; floors shall be) Tj ET BT 0.9939 0 0 0.9939 312 417.84 Tm 0.0198 Tc 0.85 Tw (water-proof, grease-proof and re-) Tj ET BT 0.9262 0 0 0.9939 312.48 409.92 Tm 0.0411 Tc 0.0819 Tw (sistant to heavy wear.\224) Tj 131.6273 40.3271 TD 0.0742 Tc 0.7587 Tw (NFPA: 12-3.3.1 \223Interior finish on) Tj -0.2591 -7.9688 TD 0.0669 Tc 0.0541 Tw (walls and ceilings shall be Class A) Tj ET BT 0.9939 0 0 0.9939 434.16 433.92 Tm 0.0079 Tc 0.701 Tw (or Class B.\224 12-3.3.2 \223Newly in-) Tj ET BT 0.9262 0 0 0.9939 434.64 426 Tm 0.0845 Tc 0.0351 Tw (stalled interior floor finish in corri-) Tj -0.5182 -8.4518 TD 0.0654 Tc 0.0557 Tw (dors and exits shall be Class L\223) Tj ET BT 0.9393 0 0 0.99 72.24 397.2 Tm /F2 8 Tf 0.066 Tc -0.0263 Tw (2. ) Tj ET BT 0.9262 0 0 0.9939 79.68 397.2 Tm /F3 7 Tf 0.0692 Tc 0.0516 Tw (Use of clutch doors) Tj ET BT 0.8645 0 0 0.9939 312.48 396.72 Tm -0.0489 Tc 3.2921 Tw (Massachusetts Department of Public) Tj ET BT 0.8027 0 0 0.9939 312.48 388.8 Tm 0.0243 Tc 1.8499 Tw (Health, Division of Health Care Quality:) Tj ET BT 0.9262 0 0 0.9939 312.48 380.88 Tm 0.0658 Tc 1.1436 Tw (\223We have strong objections to the) Tj 0 -7.9688 TD 0.0703 Tc 0.3527 Tw (use of clutch doors.\224 New York Bu-) Tj T* 0.0631 Tc 0.0582 Tw (reau of Long Term Services: \223Dutch) Tj 0 -8.4518 TD 0.0726 Tc 0.6093 Tw (doors are frowned on. They can be) Tj ET BT 0.8645 0 0 0.9939 312.72 348.48 Tm -0.0503 Tc 1.5222 Tw (used as a way of locking people into) Tj ET BT 0.9262 0 0 0.9939 312.48 340.32 Tm 0.0609 Tc 1.097 Tw (their rooms. Our fire safety people) Tj 0.2591 -7.9688 TD 0.0744 Tc 0.046 Tw (are not thrilled about them.\224) Tj ET BT 0.8645 0 0 0.9939 434.88 396.72 Tm -0.0406 Tc 1.9869 Tw (NFPA: 12-3.6.3.6 \223Dutch doors may) Tj ET BT 0.9262 0 0 0.9939 434.88 388.8 Tm 0.0822 Tc 0.2104 Tw (be used. . .) Tj 40.9392 0 TD 0.0879 Tc 0.2906 Tw (Both upper and lower) Tj ET BT 0.8645 0 0 0.9939 434.88 380.88 Tm -0.0484 Tc 1.7184 Tw (leaf shall be equipped with a latch-) Tj ET BT 0.9262 0 0 0.9939 434.88 372.96 Tm 0.0605 Tc 0.061 Tw (ing device, and the meeting edges) Tj ET BT 0.8645 0 0 0.9939 434.88 364.8 Tm -0.0388 Tc 1.4759 Tw (of the upper and lower leaves shall) Tj ET BT 0.9262 0 0 0.9939 435.12 356.64 Tm 0.0676 Tc 0.0533 Tw (be equipped with an astragal, rab-) Tj -0.2591 -8.2103 TD 0.0759 Tc 0.0444 Tw (bet, or bevel.\224) Tj ET BT 0.9939 0 0 0.9939 65.28 319.68 Tm /F11 7 Tf 0.0079 Tc 2.1499 Tw (Residential Ambiance) Tj ET BT 0.9262 0 0 0.9939 73.2 311.76 Tm /F3 7 Tf 0.0734 Tc 0.5653 Tw (1. Bedrooms off sitting rooms or) Tj 127.4816 -0.2415 TD 0.0647 Tc 0.769 Tw (Reg. 405-1134 \223The skilled nursing) Tj ET BT 0.8645 0 0 0.9939 190.8 303.36 Tm -0.0527 Tc 1.8899 Tw (facility must meet the applicable pro-) Tj 0 -8.2103 TD -0.0592 Tc 1.4136 Tw (visions of the 1985 edition of the Life) Tj ET BT 0.9262 0 0 0.9939 191.04 287.28 Tm 0.0555 Tc 1.1028 Tw (Safety Code\224 and \223Each room has) Tj -0.2591 -7.9688 TD 0.0632 Tc 0.0581 Tw (direct access to a corridor.\224) Tj ET BT 0.9939 0 0 0.9939 313.2 311.28 Tm 0.0009 Tc 0.5149 Tw (New York Public Health Law Sec.) Tj 0 -8.2103 TD 0.0136 Tc 0.0916 Tw (414.4\(b\) \223The facility shall comply) Tj ET BT 0.8645 0 0 0.9939 312.96 295.2 Tm -0.0538 Tc 1.447 Tw (with the pertinent provisions of NFPA) Tj ET BT 0.9262 0 0 0.9939 313.44 287.28 Tm 0.0452 Tc 0.5958 Tw (101, Life Safety Codes.\224) Tj ET BT 0.9939 0 0 0.9939 435.36 311.04 Tm 0.0073 Tc 0.4602 Tw (NFPA Life Safety Code: 12-2.3.3) Tj ET BT 0.9262 0 0 0.9939 435.36 303.12 Tm 0.0763 Tc 1.0804 Tw (\223Aisles, corridors, and ramps re-) Tj -0.2591 -7.9688 TD 0.0607 Tc 0.0608 Tw (quired for exit access in a hospital) Tj ET BT 0.8645 0 0 0.9939 435.36 287.28 Tm -0.0479 Tc 1.5195 Tw (or nursing home shall be at least 8) Tj ET BT 0.9939 0 0 0.9939 435.12 279.12 Tm 0.0243 Tc 1.6907 Tw (ft \(244 cm\) in clear and unob-) Tj 0.483 -7.9688 TD 0.011 Tc 0.698 Tw (structed width.\224 12-2.5.1 \223Every) Tj ET BT 0.9262 0 0 0.9939 435.6 263.28 Tm 0.0605 Tc 0.7347 Tw (habitable room shall have an exit) Tj 0 -7.9688 TD 0.0628 Tc 0.1104 Tw (access door leading directly to an) Tj ET BT 0.8645 0 0 0.9939 435.6 247.44 Tm -0.0129 Tc 2.7877 Tw (exit access corridor.\224) Tj ET BT 0.9262 0 0 0.9939 84 303.84 Tm 0.0492 Tc 0.0732 Tw (residential scale hallways) Tj ET BT 0.9939 0 0 0.9939 73.2 233.76 Tm -0.0099 Tc -0.0055 Tw (2. Private rooms) Tj 119.0494 -0.483 TD 0.0027 Tc 1.4307 Tw (Medicaid will reimburse at semi-) Tj ET BT 0.9262 0 0 0.9939 191.52 225.36 Tm 0.0608 Tc 0.0606 Tw (private rate only.) Tj ET BT 0.8645 0 0 0.9939 313.68 233.28 Tm -0.042 Tc 1.711 Tw (Rumor among providers in New York) Tj ET BT 0.9262 0 0 0.9939 313.2 225.36 Tm 0.0506 Tc 0.2197 Tw (that the State will not allow over 1/3) Tj 0.5182 -8.2103 TD 0.0474 Tc 0.6581 Tw (private rooms. State agency denies) Tj -0.5182 -8.2103 TD 0.048 Tc 0.0745 Tw (this, says there are several Medicaid) Tj ET BT 0.8645 0 0 0.9939 313.44 200.88 Tm -0.0328 Tc 2.1167 Tw (facilities with all single rooms.) Tj -140.4725 -14.2473 TD -0.0427 Tc 3.0998 Tw (Uniform Federal Accessibility Stand-) Tj ET BT 0.9262 0 0 0.9939 191.52 178.56 Tm 0.0463 Tc 0.1195 Tw (ards: 6.3\(2\) and \(3\): \223Each bed shall) Tj ET BT 0.8645 0 0 0.9939 191.76 170.4 Tm -0.0467 Tc 1.8552 Tw (have a minimum clear floor space of) Tj ET BT 0.9939 0 0 0.9939 191.76 162.24 Tm 0.0018 Tc 0.828 Tw (42 in \(1065 mm\), preferably 48 in) Tj ET BT 0.9262 0 0 0.9939 192.24 154.08 Tm 0.0335 Tc 0.7811 Tw (\(1220 mm\), between the foot of the) Tj ET BT 0.8645 0 0 0.9939 192 146.16 Tm -0.0522 Tc 0.418 Tw (bed and the wall; 36 in \(91 5 mm\). . .on) Tj ET BT 0.9262 0 0 0.9939 191.76 138.24 Tm 0.0608 Tc 0.0607 Tw (each side of the bed.\224) Tj 263.2546 48.7789 TD 0.0657 Tc 2.1282 Tw (ANSI Standards) Tj ET BT 0.8645 0 0 0.9939 73.44 187.2 Tm 0.1338 Tc 0 Tw (3.) Tj 0.5552 -65.1995 TD -0.005 Tc (4.) Tj ET BT 0.8027 0 0 0.9939 74.16 86.4 Tm 0.0696 Tc (5.) Tj ET BT 0.9262 0 0 0.9939 83.52 186.96 Tm 0.0736 Tc 0.3707 Tw (Allow residents to control fur-) Tj ET BT 0.8645 0 0 0.9939 84.96 178.8 Tm -0.0338 Tc 1.7014 Tw (niture arrangements, Allow res-) Tj ET BT 0.9262 0 0 0.9939 84.96 170.64 Tm 0.0582 Tc 1.5318 Tw (idents in semi-private rooms) Tj -0.2591 -8.2103 TD 0.0517 Tc 0.6535 Tw (equal access to windows and) Tj ET BT 0.8645 0 0 0.9939 84.72 154.32 Tm 0.1627 Tc 0 Tw (doors) Tj ET BT 0.9939 0 0 0.9939 84.24 122.4 Tm 0.0059 Tc -0.0214 Tw (Eliminate formal nurses\222 sta-) Tj ET BT 0.8027 0 0 0.9939 84.24 114.48 Tm 0.2292 Tc 0 Tw (tion) Tj ET BT 0.8645 0 0 0.9939 192.24 122.16 Tm -0.0418 Tc 1.9883 Tw (Reg. 405.1 134\(d\) \223Each nursing unit) Tj ET BT 0.9262 0 0 0.9939 192.24 114.24 Tm 0.0611 Tc 0.1036 Tw (has at least the following:. . nurses\222) Tj ET BT 0.9939 0 0 0.9939 192.24 106.32 Tm 0.0206 Tc 0.3985 Tw (station. . equipped to register pa-) Tj ET BT 0.8645 0 0 0.9939 192 98.16 Tm -0.0223 Tc 2.521 Tw (tient calls.\224) Tj ET BT 0.9262 0 0 0.9939 84 86.4 Tm 0.0632 Tc 0.058 Tw (Allow residents to use familiar) Tj ET BT 0.9939 0 0 0.9939 436.56 86.88 Tm 0.0135 Tc 0.2125 Tw (NFPA 31-4.5.2 Bedding, furnish-) Tj 0.2415 -7.7273 TD 0.0087 Tc 0.6399 Tw (ings, decorations in health care) Tj ET BT 0.8645 0 0 0.9939 436.56 71.28 Tm 0.2126 Tc 0 Tw (occupancies.) Tj ET BT 0.9939 0 0 0.9939 481.2 71.52 Tm 0.0021 Tc 0.4654 Tw (. shall be flame re-) Tj ET BT 0.8645 0 0 0.9939 437.04 63.36 Tm -0.0453 Tc 0 Tw (sistant.) Tj -406.9814 15.2132 TD 0.1946 Tc (furniture) Tj -21.0986 -28.2531 TD -0.0411 Tc 1.895 Tw (SOURCE: J. Hyde, \223Federal Policy in the Regulation and Funding of Special Care) Tj 0 Tc -0.0033 Tw ( ) Tj ET q 33.12 0 0 -5.52 319.92 55.92 cm BI /W 198 /H 31 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >|x<x|>x|>x|>x>|>x>>|>xx><>x|>?x<?x|<?x>>?|>|~||>|0|>>~px>~>?`# >?>?  EI Q BT 0.8027 0 0 0.9939 319.92 50.4 Tm 3 Tr 0.0416 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.8645 0 0 0.9939 353.04 50.4 Tm -0.0487 Tc 2.1814 Tw ( Units; The Role of Federal, State, and Municipal Regulation,\224) Tj -292.327 -7.7273 TD -0.0472 Tc 1.9251 Tw (contract report prepared for the) Tj 0 Tc -0.0033 Tw ( ) Tj ET q 16.56 0 0 -7.2 200.16 49.68 cm BI /W 101 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??~~?|?x?xxx|?|??|?~????~?<  EI Q BT 0.9939 0 0 0.9939 200.16 42.72 Tm 3 Tr 0.0039 Tc 0 Tw (~fice) Tj 0 Tr ET BT 0.8645 0 0 0.9939 216.72 42.72 Tm -0.0582 Tc 3.2565 Tw ( of Technology-Assessment, August 1990.) Tj ET endstream endobj 493 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 494 0 obj <>stream 0.72 w 1 j 0 0 0 RG 69.12 673.92 m 547.44 673.92 l S BT 0.9835 0 0 0.9835 69.36 679.44 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (162 ) Tj ET BT 0.9598 0 0 0.9598 89.04 679.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 95.28 679.44 Tm /F5 10 Tf 0.0125 Tc 0.8211 Tw (Special Care Units for People With Alzheimer\222s and Other Dementias) Tj -25.8678 -39.5338 TD /F4 10 Tf 0.0171 Tc 0.2921 Tw (similar findings \(94\). ) Tj ET BT 0.99 0 0 0.99 169.68 640.56 Tm /F3 8 Tf -0.0408 Tc -0.0013 Tw (That ) Tj ET BT 0.9835 0 0 0.9835 188.64 640.56 Tm /F4 10 Tf 0.043 Tc 0.9572 Tw (analysis also idenitfied) Tj -121.2857 -11.9577 TD 0.0308 Tc 0.0342 Tw (regulations and standards ) Tj ET BT 0.99 0 0 0.99 192.96 628.8 Tm /F3 8 Tf -0.0302 Tc -0.012 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 209.52 628.8 Tm /F4 10 Tf 0.0255 Tc 0.1209 Tw (might preclude the) Tj ET BT 0.9388 0 0 0.9835 69.84 616.8 Tm /F2 10 Tf -0.0147 Tc 0.0706 Tw (use ) Tj ET BT 0.934 0 0 0.9835 84.96 616.8 Tm /F4 10 Tf -0.0398 Tc 1.3723 Tw (of design features intended) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9189 0 0 0.99 208.8 616.8 Tm /F3 8 Tf 0.0118 Tc 0.1142 Tw (to ) Tj ET BT 0.934 0 0 0.9835 218.16 616.8 Tm /F4 10 Tf -0.1016 Tc 0.1536 Tw (cope ) Tj ET BT 0.9388 0 0 0.9835 240.24 616.8 Tm /F2 10 Tf 0.0263 Tc 0.027 Tw (with ) Tj ET BT 0.934 0 0 0.9835 259.68 616.8 Tm /F4 10 Tf 0.1664 Tc 0 Tw (resident) Tj ET BT 0.9835 0 0 0.9835 69.84 604.8 Tm 0.0155 Tc -0.1129 Tw (wandering, ) Tj ET BT 0.99 0 0 0.99 126.24 604.8 Tm /F3 8 Tf -0.019 Tc -0.0233 Tw (to ) Tj ET BT 0.9835 0 0 0.9835 136.08 604.8 Tm /F4 10 Tf 0.0297 Tc 2.069 Tw (reduce agitation and catastrophic) Tj -67.3538 -12.2018 TD /F2 10 Tf 0.015 Tc 3.8893 Tw (reactions, and to make the unit more home-like in) Tj 0.4881 -11.9577 TD 0.4967 Tc 4.1927 Tw (appearance. In addition to the regulations and) Tj 0.244 -11.9577 TD 0.0214 Tc 4.1878 Tw (standards identified by OTA\222s contractor, the Wis-) Tj 0 -12.4458 TD 0.2503 Tc 4.3212 Tw (consin analysis identified a Wisconsin regulation) Tj 0 -11.7137 TD 0.0208 Tc 2.0836 Tw (and a Life Safety Code standard that require frequent) Tj 0 -12.2018 TD 0.2478 Tc 3.4086 Tw (testing of alarms on the unit, which the analysts) Tj T* -0.0015 Tc 4.1298 Tw (believe might increase resident agitation. They also) Tj 0.244 -11.9577 TD 0.0223 Tc 4.0649 Tw (identified a Wisconsin regulation for resident room) Tj 0.4881 -12.2018 TD -0.0057 Tc 4.4071 Tw (size which allows little flexibility in arranging the) Tj -0.7321 -11.9577 TD 0.0449 Tc 3.0658 Tw (room for other than sleep purposes.) Tj 11.7137 -20.255 TD 0.0256 Tc 3.0041 Tw (Although both of these analyses identified regula-) Tj -10.9816 -12.2018 TD 0.5007 Tc 3.4738 Tw (tions and standards that might preclude use of) Tj 0 -12.2018 TD 0.2355 Tc 4.1967 Tw (certain design features in special care units, the) Tj 0 -11.9577 TD 0.2789 Tc 2.6884 Tw (number of such regulations and standards and the) Tj T* 0.0215 Tc 2.7061 Tw (number of design features affected are much smaller) Tj 0.244 -12.2018 TD 0.0149 Tc 4.177 Tw (than one would expect, given the complaints cited) Tj 0 -12.2018 TD 0.0164 Tc 4.1755 Tw (earlier. Moreover, many of the design features are) Tj 0 -11.9577 TD 0.0141 Tc 3.9512 Tw (not specifically prohibited. Instead, as noted above,) Tj 0.244 -12.2018 TD 0.0145 Tc 2.1205 Tw (the regulations and standards limit the ways in which) Tj 0.244 -12.4458 TD 0.008 Tc 3.6402 Tw (the design features can be implemented.) Tj 10.9816 -20.255 TD 0.0196 Tc 2.8126 Tw (For several reasons, the impact of regulations and) Tj -10.4935 -12.2018 TD 0.4918 Tc 2.6418 Tw (standards on the design of special care units is) Tj -0.244 -12.2018 TD 0.0117 Tc 3.8859 Tw (greater than is indicated by the results of the two) Tj 0.244 -12.2018 TD 0.2416 Tc 3.6676 Tw (analyses. First, the analyses do not include local) Tj 0 -12.2018 TD 0.2636 Tc 4.0148 Tw (government regulations which may interfere with) Tj -0.4881 -11.9577 TD 0.0141 Tc 3.5852 Tw (use of certain design features. Second, the analyses) Tj 0.4881 -12.2018 TD 0.2738 Tc 3.077 Tw (do not address combinations of regulations which) Tj 0 -11.9577 TD 0.0211 Tc 2.8459 Tw (together preclude use of design features that are not) Tj 0.4881 -12.2018 TD 0.0216 Tc 3.2521 Tw (specifically prohibited by any one regulation. Third,) Tj -0.244 -12.4458 TD 0.0167 Tc 3.3792 Tw (the analyses generally do not address interpretations) Tj 0 -12.2018 TD 0.0211 Tc 2.8459 Tw (of regulations that may preclude the use of physical) Tj T* 0.0224 Tc 4.3495 Tw (design features not explicitly prohibited by regula-) Tj 0.244 -12.2018 TD 0.0046 Tc 3.8998 Tw (tions or standards. The case examples later in this) Tj 0 -12.4458 TD -0.0071 Tc 3.8995 Tw (chapter illustrate each of these situations.) Tj 11.4697 -19.7669 TD 0.2488 Tc 3.9566 Tw (In addition, cost constraints often increase the) Tj -11.2256 -12.2018 TD 0.0314 Tc 2.5914 Tw (impact of regulations and standards on the design of) Tj 0.244 -11.9577 TD 0.2324 Tc 2.8751 Tw (special care units. Due to cost constraints, special) Tj 0 -12.2018 TD 0.4878 Tc 3.6962 Tw (care units frequently are designed to meet the) Tj 0 -11.7137 TD 0.0203 Tc 4.7503 Tw (minimum allowable standards. Design options may) Tj 0 -11.9577 TD 0.011 Tc 2.9783 Tw (exist that would meet the standards and fulfill other) Tj 0.244 -12.2018 TD 0.0039 Tc 2.4058 Tw (objectives of the special care unit planners, but these) Tj 0 -11.9577 TD 0.2661 Tc 2.8409 Tw (options are ruled out because they cost too much) Tj 0.4881 -11.7137 TD 0.024 Tc 3.026 Tw (\(41,201\). In such instances, it is the combination of) Tj -0.244 -12.4458 TD 0.0152 Tc 3.9908 Tw (cost constraints and regulations, not the regulations) Tj 0 -11.9577 TD 0.2531 Tc 2.9238 Tw (alone, that precludes use of particular design fea-) Tj 0 -12.2018 TD 0.2052 Tc 0 Tw (tures.) Tj 262.3383 617.8983 TD /F4 10 Tf 0.0546 Tc 0.0914 Tw (One example of ) Tj ET BT 0.9863 0 0 0.9863 406.56 640.56 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 414 640.56 Tm /F4 10 Tf 0.0323 Tc 0.1141 Tw (combination of ) Tj ET BT 0.99 0 0 0.99 485.04 640.56 Tm /F3 8 Tf -0.0445 Tc 0.9722 Tw (cost constraints) Tj ET BT 0.9835 0 0 0.9835 321.12 628.56 Tm /F4 10 Tf 0.0302 Tc 2.8005 Tw (and regulations) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 401.28 628.56 Tm /F3 9 Tf 0.0106 Tc -0.0805 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 421.44 628.56 Tm /F2 10 Tf 0.0165 Tc 3.0133 Tw (interferes with innovative de-) Tj -101.7629 -11.9577 TD /F4 10 Tf 0.0217 Tc -0.1192 Tw (sign in special care ) Tj 90.7813 0 TD /F2 10 Tf 0.0124 Tc -0.0737 Tw (units ) Tj 21.9632 0 TD /F4 10 Tf 0.0325 Tc -0.1302 Tw (pertains ) Tj ET BT 0.9863 0 0 0.9863 473.04 616.8 Tm /F3 9 Tf 0.0085 Tc -0.0784 Tw (to ) Tj ET BT 0.9835 0 0 0.9835 483.84 616.8 Tm /F4 10 Tf 0.0216 Tc -0.1191 Tw (regulations in) Tj -165.2121 -12.4458 TD /F2 10 Tf 0.0273 Tc -0.0888 Tw (some ) Tj 26.1118 0 TD /F4 10 Tf 0.0403 Tc -0.1382 Tw (States ) Tj ET BT 0.99 0 0 0.99 382.08 604.56 Tm /F3 8 Tf -0.0302 Tc -0.012 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 400.32 604.56 Tm /F4 10 Tf 0.0289 Tc -0.1265 Tw (require ) Tj ET BT 0.99 0 0 0.99 440.16 604.56 Tm /F3 8 Tf -0.085 Tc 0.0434 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 447.12 604.56 Tm /F2 10 Tf 0.026 Tc 3.2477 Tw (nurses\222 station on each) Tj -128.1187 -12.2018 TD 0.2809 Tc 3.7206 Tw (nursing home unit. The Wisconsin nursing home) Tj 0 -11.9577 TD 0.0024 Tc 4.4918 Tw (regulations state, for example:) Tj 21.2311 -17.0825 TD 0.0149 Tc 0.7779 Tw (A centrally located nursing station having visual) Tj -10.7376 -11.2256 TD 0.2541 Tc 2.8531 Tw (access to all resident room corridors must be) Tj 0 -10.7376 TD 0.0356 Tc 1.8246 Tw (provided. The station should consist of a desk or) Tj ET BT 0.9388 0 0 0.9835 331.68 531.36 Tm 0.0177 Tc 1.0588 Tw (work counter, operational telephone, and a nurse call) Tj ET BT 0.9835 0 0 0.9835 331.92 520.32 Tm 0.0139 Tc 1.7246 Tw (system and should be situated next to a medicine) Tj ET BT 0.9388 0 0 0.9835 331.68 509.52 Tm 0.0314 Tc 2.3223 Tw (preparation room \(351\).) Tj ET BT 0.9835 0 0 0.9835 332.88 491.76 Tm 0.0207 Tc 2.6634 Tw (Because of the cost of constructing and staffing a) Tj -11.2256 -11.9577 TD 0.2579 Tc 3.744 Tw (nurses\222 station, regulations that require a nurses\222) Tj 0.7321 -12.6899 TD 0.008 Tc 2.7198 Tw (station on each unit, and particularly regulations that) Tj -0.7321 -11.9577 TD 0.2648 Tc 2.9642 Tw (require a nurses\222) Tj 83.4602 -0.244 TD 0.2195 Tc 3.181 Tw (station with visual access to all) Tj -83.2162 -12.2018 TD 0.2768 Tc 2.8787 Tw (resident room corridors, encourage construction of) Tj 0.4881 -11.9577 TD 0.0208 Tc 3.619 Tw (large units with long, institution-like corridors \(94\).) Tj 0 -11.9577 TD 0.0136 Tc 3.7809 Tw (In contrast, if cost were not a factor, a variety of) Tj 0 -12.2018 TD 0.2503 Tc 3.1707 Tw (innovative designs could be used to create small,) Tj 0 -11.9577 TD 0.0048 Tc 2.7405 Tw (home-like units with a nurses\222 station that meets the) Tj 0 -12.2018 TD 0.2348 Tc 0 Tw (regulations.) Tj 11.4697 -18.3027 TD 0.0059 Tc 4.0816 Tw (Financing considerations also increase the impact) Tj -10.9816 -12.4458 TD 0.0293 Tc 2.441 Tw (of regulations and standards on the design of special) Tj 0 -12.4458 TD 0.4985 Tc 3.4993 Tw (care units. Agencies that provide financing for) Tj 0 -11.9577 TD 0.0328 Tc 3.2176 Tw (nursing home construction, such as banks and State) Tj 0 -12.4458 TD 0.4803 Tc 4.0873 Tw (bond agencies,) Tj 79.0676 -0.244 TD 0.7225 Tc 3.1089 Tw (are often wary of special use) Tj -79.0676 -11.9577 TD 0.2496 Tc 4.1998 Tw (buildings, since the buildings have limited reuse) Tj 0 -12.2018 TD 0.2494 Tc 4.078 Tw (potential \(201\). The agencies are more likely to) Tj 0 -11.9577 TD 0.2427 Tc 3.7188 Tw (provide financing for facilities that meet generic,) Tj 0.4881 -12.2018 TD 0.4852 Tc 2.9028 Tw (albeit minimum, standards. Therefore, even if a) Tj 0 -11.7137 TD 0.2568 Tc 3.013 Tw (facility receives approval for a design innovation,) Tj 0 -12.4458 TD 0.0148 Tc 1.7786 Tw (the facility may not be able to find financing to build) Tj 0.244 -12.2018 TD 0.0192 Tc 2.8478 Tw (or remodel the unit.) Tj 11.2256 -18.7907 TD 0.4815 Tc 4.1267 Tw (State certificate of need programs may also) Tj -10.9816 -11.7137 TD 0.0197 Tc 3.5446 Tw (increase the impact of regulations and standards on) Tj 0 -12.4458 TD -0.0003 Tc 3.4778 Tw (the design of special care units. Certificate of need) Tj -0.244 -12.2018 TD 0.2615 Tc 3.0896 Tw (programs sometimes disapprove plans that include) Tj 0.244 -11.9577 TD 0.0108 Tc 4.5158 Tw (features which exceed minimum requirements, e.g.,) Tj -0.244 -11.9577 TD 0.25 Tc 2.6132 Tw (resident room size that exceeds the required mini-) Tj 0.244 -12.2018 TD 0.2711 Tc 2.8764 Tw (mum square footage. These plans are disapproved) Tj 0 -11.9577 TD -0.0087 Tc 3.1812 Tw (because it is assumed that the features will increase) Tj 0.4881 -11.7137 TD -0.0018 Tc 2.4625 Tw (the cost of the facility and that these increased costs) Tj 0 -11.9577 TD 0.0212 Tc 2.9504 Tw (will eventually be passed on to Medicaid \(202,378\).) Tj 11.2256 -17.8146 TD 0.0051 Tc 2.7402 Tw (A final factor that increases the impact of regula-) Tj -10.9816 -12.2018 TD 0.2731 Tc 2.9964 Tw (tions and standards and discourages innovation in) Tj 0.244 -11.9577 TD 0.2449 Tc 2.6794 Tw (special care units is the large number of agencies) Tj -0.244 -12.2018 TD 0.5156 Tc 3.726 Tw (involved in regulating nursing homes in many) Tj 0.244 -11.9577 TD 0.4957 Tc 4.0716 Tw (States. Tables 6-2 and 6-3 show the agencies) Tj -0.244 -12.2018 TD 0.0328 Tc 3.7288 Tw (involved in regulating nursing homes in Massachu-) Tj ET endstream endobj 495 0 obj <>/Rotate 0/Type/Page>> endobj 496 0 obj <>stream 0.48 w 1 j 0 0 0 RG 60.48 685.44 m 538.56 685.44 l S BT 0.9835 0 0 0.9835 132 690.72 Tm 0 0 0 rg /F5 10 Tf 0.0212 Tc 1.7883 Tw (Chapter Regulations That Interfere With The Design and Operation of Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 514.56 690.72 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 521.04 690.72 Tm /F5 10 Tf 0.4474 Tc 0 Tw (163) Tj ET BT 0.9863 0 0 0.9863 61.2 651.6 Tm /F3 9 Tf 0.031 Tc -0.1011 Tw (setts ) Tj ET BT 0.9835 0 0 0.9835 84.96 651.6 Tm /F4 10 Tf 0.0273 Tc 0.677 Tw (and New York. The agencies listed in these) Tj -24.4036 -12.2018 TD 0.0458 Tc 1.0764 Tw (tables are responsible for) Tj 0 Tc -0.0972 Tw ( ) Tj 124.7022 0 TD /F2 10 Tf -0.0579 Tc -0.0021 Tw (site ) Tj 16.5944 0 TD /F4 10 Tf 0.0085 Tc -0.1058 Tw (control, ) Tj ET BT 0.99 0 0 0.99 238.32 639.6 Tm /F3 8 Tf -0.0422 Tc 0.0001 Tw (certificate ) Tj ET BT 0.9835 0 0 0.9835 278.88 639.6 Tm /F4 10 Tf 0.2253 Tc 0 Tw (of) Tj ET BT 0.934 0 0 0.9835 60.72 627.84 Tm -0.0218 Tc 2.3808 Tw (need evaluations,) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9388 0 0 0.9835 143.04 627.84 Tm /F2 10 Tf 0.0168 Tc 1.571 Tw (licensure, financing,) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.934 0 0 0.9835 225.12 627.84 Tm /F4 10 Tf -0.0314 Tc 3.6758 Tw (Medicare and) Tj -175.7576 -11.9577 TD -0.0452 Tc 0.0932 Tw (Medicaid ) Tj ET BT 0.9388 0 0 0.9835 104.4 616.08 Tm /F2 10 Tf 0.0018 Tc 0.0532 Tw (certification, ) Tj ET BT 0.934 0 0 0.9835 155.04 616.08 Tm /F4 10 Tf -0.0086 Tc 1.3389 Tw (and/or final inspections \(201\).) Tj ET BT 0.9835 0 0 0.9835 60.96 603.84 Tm 0.0328 Tc 0.6321 Tw (The large number of agencies involved in each of) Tj 0.244 -12.2018 TD 0.0303 Tc 3.0445 Tw (these regulatory) Tj 0 Tc -0.0972 Tw ( ) Tj 85.1684 0 TD /F2 10 Tf 0.0156 Tc 2.6075 Tw (functions is daunting. It increases) Tj -84.9244 -12.4458 TD 0.0127 Tc 3.6911 Tw (the difficulty special care unit operators and others) Tj -0.244 -11.9577 TD 0.2705 Tc 2.5924 Tw (have in obtaining approval for innovative physical) Tj 0.244 -12.2018 TD 0.0404 Tc 3.8722 Tw (design features or even understanding how to seek) Tj 0.7321 -11.9577 TD 0.0388 Tc 2.7931 Tw (such approval. The large number of agencies proba-) Tj -0.244 -12.2018 TD 0.7191 Tc 3.1821 Tw (bly also increases the likelihood that even if) Tj 0.4881 -12.4458 TD 0.2644 Tc 2.9036 Tw (approval for the use of the innovative features is) Tj 0 -11.9577 TD 0.2563 Tc 2.6881 Tw (granted by one agency, it will later be denied by) Tj 0.244 -12.2018 TD 0.2376 Tc 0 Tw (another.) Tj 10.9816 -18.3027 TD 0.0041 Tc 4.4901 Tw (Like physical design features, some patient care) Tj -11.2256 -12.2018 TD 0.2575 Tc 3.8745 Tw (practices, staffing arrangements, and other opera-) Tj 0.244 -12.4458 TD 0.0078 Tc 3.0425 Tw (tional aspects of special care units are precluded by) Tj 0 -11.9577 TD 0.014 Tc 4.0733 Tw (regulations and standards. These operational aspects) Tj 0.4881 -12.2018 TD 0.4998 Tc 3.3354 Tw (of the units are probably more likely than the) Tj -0.4881 -11.9577 TD 0.0163 Tc 2.8508 Tw (physical design features to be affected by interpreta-) Tj 0.4881 -12.2018 TD 0.26 Tc 2.7076 Tw (tions of regulations, as discussed in the following) Tj 0.4881 -11.9577 TD -0.0024 Tc 2.9744 Tw (section. Operational aspects of special care units are) Tj 0 -12.2018 TD 0.0155 Tc 4.1764 Tw (also affected by cost constraints which require the) Tj -0.244 -11.9577 TD 0.002 Tc 3.872 Tw (unit to operate as close to the minimum allowable) Tj 0.7321 -12.2018 TD 0.2578 Tc 4.1915 Tw (standards as possible. Although patient care and) Tj 0 -11.9577 TD 0.0165 Tc 4.1754 Tw (staffing options exist that would meet the require-) Tj -0.244 -12.4458 TD 0.7251 Tc 3.0017 Tw (ments and fulfill other objectives of the unit) Tj 0.244 -11.9577 TD 0.0273 Tc 3.3277 Tw (operators and staff, these options frequently are not) Tj 0 -11.9577 TD 0.0124 Tc 3.831 Tw (implemented because they cost too much.) Tj ET BT 0.9663 0 0 0.9939 122.4 285.84 Tm /F6 14 Tf 0.0196 Tc 0.8244 Tw (THE IMPACT OF) Tj -23.0986 -16.1791 TD 0.0354 Tc 1.6773 Tw (INTERPRETATIONS OF) Tj -31.7916 -15.9376 TD 0.0486 Tc 1.5809 Tw (REGULATIONS ON THE DESIGN) Tj 6.706 -16.1791 TD 0.0302 Tc 1.4344 Tw (AND OPERATION OF SPECIAL) Tj 62.0929 -16.1791 TD 0.0519 Tc 0.9151 Tw (CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 75.84 203.76 Tm /F2 10 Tf 0.4983 Tc 2.6657 Tw (Interpretations of regulations are unavoidable.) Tj -10.9816 -12.4458 TD 0.0451 Tc 4.2858 Tw (When nursing home surveyors, building inspectors,) Tj 0.4881 -11.7137 TD 0.2384 Tc 2.686 Tw (and fire marshals inspect a special care unit, they) Tj -0.4881 -12.4458 TD 0.0319 Tc 2.6955 Tw (have to apply their understanding of existing regula-) Tj 0.4881 -12.2018 TD 0.2349 Tc 3.7441 Tw (tions to the particular characteristics of the unit.) Tj 0 -11.7137 TD 0.0211 Tc 4.359 Tw (Likewise, when government officials review design) Tj -0.244 -11.9577 TD 0.0167 Tc 2.2403 Tw (plans for a new special care unit, they have to apply) Tj 0.244 -12.4458 TD 0.0237 Tc 2.8433 Tw (their understanding of the regulations to the particu-) Tj 0.244 -11.7137 TD 0.0068 Tc 2.3995 Tw (lar features of the plan. Unless there is a compelling) Tj -0.244 -12.4458 TD 0.2634 Tc 3.5757 Tw (reason for allowing innovations, these individuals) Tj 0.4881 -12.2018 TD 0.0028 Tc 3.248 Tw (are likely to be conservative in their interpretations.) Tj 10.7376 -18.0586 TD 0.2633 Tc 2.8089 Tw (The format of most regulations is conducive to) Tj -10.9816 -12.2018 TD 0.0269 Tc 4.7313 Tw (conservative interpretations \(233,378\). Existing reg-) Tj -0.244 -11.9577 TD 0.0156 Tc 3.8974 Tw (ulations usually consist of a series of requirements) Tj 250.3806 618.8744 TD 0.0248 Tc 3.8671 Tw (without accompanying statements about the purpose) Tj 0 -12.2018 TD 0.7447 Tc 2.7203 Tw (or desired outcomes for the requirements. An) Tj 0 -11.9577 TD 0.4897 Tc 3.4676 Tw (explicit statement about the purpose or desired) Tj 0 -12.2018 TD 0.2767 Tc 2.8707 Tw (outcome of a requirement would give government) Tj 0.244 -12.4458 TD 0.2545 Tc 3.2594 Tw (officials, surveyors, and others justification for at) Tj 0 -12.2018 TD 0.009 Tc 3.1023 Tw (least considering an innovation that might fulfill the) Tj T* 0.7338 Tc 2.7488 Tw (purpose of the requirement, if not its precise) Tj 0.7321 -11.9577 TD 0.2157 Tc 0 Tw (stipulation.) Tj 55.3961 0 TD 0.2803 Tc 3.3145 Tw (In the absence of such) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 479.52 567.84 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 488.64 567.84 Tm /F2 10 Tf 0.9448 Tc 0 Tw (statement) Tj -0.061 Tc (,) Tj -178.8781 -12.2018 TD 0.5078 Tc 3.7176 Tw (government officials, surveyors, and others are) Tj -0.244 -11.9577 TD 0.0184 Tc 3.0012 Tw (unlikely to take the risk of allowing the innovation.) Tj 11.4697 -18.0586 TD 0.0263 Tc 3.8168 Tw (Individual surveyors differ in their interpretations) Tj -10.9816 -12.6899 TD 0.012 Tc 3.9127 Tw (of the same regulations.) Tj 0 Tc -0.061 Tw ( ) Tj 114.2087 0 TD /F4 10 Tf 0.2615 Tc 3.7856 Tw (OTA has heard about) Tj ET BT 0.9189 0 0 0.99 313.2 501.84 Tm /F3 8 Tf 0.0357 Tc 0.3494 Tw (instances in ) Tj ET BT 0.934 0 0 0.9835 359.28 501.84 Tm /F4 10 Tf -0.0481 Tc 1.895 Tw (which surveyors interpreted) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9427 0 0 0.9812 487.92 501.84 Tm /F6 11 Tf 0.0106 Tc 0 Tw (regulations) Tj ET BT 0.9388 0 0 0.9835 313.2 489.6 Tm /F2 10 Tf 0.0187 Tc 0.0352 Tw (that ) Tj ET BT 0.934 0 0 0.9835 329.52 489.6 Tm /F4 10 Tf -0.032 Tc 0.6444 Tw (could have been obstacles for ) Tj ET BT 0.9606 0 0 0.9863 460.08 489.6 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.934 0 0 0.9835 467.04 489.6 Tm /F4 10 Tf -0.0347 Tc 0.9813 Tw (special care unit) Tj ET BT 0.9835 0 0 0.9835 313.2 477.6 Tm 0.0041 Tc -0.1013 Tw (in ) Tj ET BT 0.9863 0 0 0.9863 325.68 477.6 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 333.6 477.6 Tm /F4 10 Tf 0.0235 Tc -0.121 Tw (way ) Tj 22.9394 0 TD /F2 10 Tf -0.0305 Tc -0.03 Tw (that ) Tj 18.5467 0 TD /F4 10 Tf 0.0439 Tc -0.1418 Tw (made ) Tj 30.0164 0 TD /F2 10 Tf 0.0209 Tc 1.1379 Tw (them not) Tj 0 Tc -0.061 Tw ( ) Tj 40.5099 0 TD /F4 10 Tf 0.0405 Tc 2.302 Tw (obstacles and) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 512.64 477.6 Tm /F6 11 Tf 0.222 Tc 0 Tw (other) Tj ET BT 0.9606 0 0 0.9863 313.44 465.84 Tm /F3 9 Tf -0.0068 Tc 0.0022 Tw (instances in ) Tj ET BT 0.8915 0 0 0.9835 365.04 465.84 Tm /F4 10 Tf 0.0496 Tc 2.5466 Tw (which surveyors interpreted regulations) Tj ET BT 0.9388 0 0 0.9835 313.92 453.6 Tm /F2 10 Tf 0.0187 Tc 0.0352 Tw (that ) Tj ET BT 0.934 0 0 0.9835 330.48 453.6 Tm /F4 10 Tf -0.0697 Tc 0.1195 Tw (need ) Tj ET BT 0.9388 0 0 0.9835 354.24 453.6 Tm /F2 10 Tf 0.0836 Tc -0.034 Tw (not ) Tj ET BT 0.934 0 0 0.9835 368.88 453.6 Tm /F4 10 Tf -0.0172 Tc 0.6414 Tw (have been obstacles in ) Tj ET BT 0.9388 0 0 0.9835 470.64 453.6 Tm /F2 10 Tf -0.0965 Tc 0.1579 Tw (a ) Tj ET BT 0.934 0 0 0.9835 477.12 453.6 Tm /F4 10 Tf 0.0122 Tc 0.0318 Tw (way ) Tj ET BT 0.9606 0 0 0.9863 497.52 453.6 Tm /F3 9 Tf -0.004 Tc -0.0007 Tw (that ) Tj ET BT 0.934 0 0 0.9835 515.52 453.6 Tm /F4 10 Tf 0.1869 Tc 0 Tw (made) Tj ET BT 0.9835 0 0 0.9835 313.68 441.6 Tm /F2 10 Tf -0 Tc -0.061 Tw (them ) Tj 22.6953 0 TD /F4 10 Tf 0.0238 Tc 0 Tw (obstacles.) Tj -11.4697 -17.8146 TD 0.021 Tc 1.3946 Tw (Surveyors\222 attitudes about nursing homes are) Tj -10.9816 -11.9577 TD 0.0172 Tc -0.1147 Tw (likely ) Tj 30.5045 0 TD /F2 10 Tf 0.0122 Tc 2.2449 Tw (to influence their interpretations of the regula-) Tj -30.5045 -12.2018 TD 0.0411 Tc 3.7103 Tw (tions. A study of nursing home regulation in New) Tj 0 -12.2018 TD 0.0261 Tc 3.2476 Tw (York, Virginia, and England identified two different) Tj 0 -11.9577 TD 0.2874 Tc 3.0632 Tw (regulatory models \(117\). In one model, surveyors) Tj 0.244 -12.2018 TD 0.2772 Tc 3.5268 Tw (regard the nursing home operator as an \221\221amoral) Tj 0.4881 -12.4458 TD 0.2569 Tc 3.4908 Tw (calculator who will risk breaking the rules for a) Tj -0.244 -11.9577 TD 0.0271 Tc 3.3822 Tw (profit. \224 In this model, the surveyor functions as a) Tj 0 -12.2018 TD 0.2511 Tc 4.239 Tw (policeman, and the inspection process is formal,) Tj 0.7321 -11.9577 TD 0.4771 Tc 3.9685 Tw (legalistic, and adversarial. In the other model,) Tj 0.244 -11.9577 TD 0.525 Tc 3.4317 Tw (surveyors regard the nursing home operator as) Tj -0.244 -11.9577 TD 0.0184 Tc 3.8736 Tw (fallible but well-intentioned. The surveyor functions) Tj 0.244 -12.2018 TD 0.486 Tc 4.1512 Tw (as a consultant, and the inspection process is) Tj 0 -11.9577 TD 0.0123 Tc 2.9595 Tw (informal and cooperative. In the United States, most) Tj 0.244 -12.2018 TD 0.0409 Tc 3.035 Tw (surveyors probably function more in the first model) Tj -0.244 -12.2018 TD 0.0061 Tc 3.9729 Tw (than the second; thus, they are less likely to trust) Tj 0 -11.7137 TD 0.5287 Tc 3.4454 Tw (nursing home operators or to be supportive of) Tj 0.244 -12.4458 TD 0.2294 Tc 5.5626 Tw (facility-initiated innovations.) Tj 11.2256 -18.3027 TD 0.7333 Tc 2.8539 Tw (As noted earlier, OTA has been told about) Tj -10.7376 -12.4458 TD 0.0389 Tc 3.804 Tw (instances in which surveyors and other government) Tj 0 -11.9577 TD 0.4914 Tc 3.4659 Tw (officials have disallowed the use of innovative) Tj -0.244 -12.2018 TD 0.0161 Tc 2.18 Tw (physical design or other features of special care units) Tj 0.4881 -12.4458 TD 0.0248 Tc 2.5982 Tw (on the basis of regulations that were later found not) Tj 0.244 -11.7137 TD 0.2452 Tc 3.1061 Tw (to exist. In these instances, the officials probably) Tj 0.244 -11.9577 TD 0.0063 Tc 4.1219 Tw (assumed the regulations existed because \223that\222s the) Tj -0.244 -12.2018 TD 0.2624 Tc 3.2106 Tw (way it\222s always been done. \222 Thus, tradition and) Tj -0.4881 -11.9577 TD 0.2505 Tc 3.5075 Tw (precedent can preclude innovation in special care) Tj 0.4881 -12.2018 TD 0.0561 Tc 5.7388 Tw (units \(201,378\).) Tj 11.2256 -18.3027 TD 0.0275 Tc 3.2229 Tw (Given the large number and complexity of exist-) Tj -11.2256 -12.4458 TD 0.0145 Tc 3.5848 Tw (ing regulations and standards, it can be difficult to) Tj -0.244 -12.2018 TD 0.2551 Tc 3.3889 Tw (determine whether a given regulation exists.) Tj 0 Tc -0.061 Tw ( ) Tj 211.5789 0 TD /F4 10 Tf 1.2388 Tc 0 Tw (Fo) Tj -0.0498 Tc (r) Tj -211.0908 -12.2018 TD 0.0321 Tc -0.0078 Tw (special care ) Tj 57.5924 0 TD /F2 10 Tf 0.0124 Tc -0.0737 Tw (unit ) Tj 18.3027 0 TD /F4 10 Tf 0.0498 Tc -0.0257 Tw (operators and ) Tj 67.8419 0 TD /F2 10 Tf 0.0323 Tc -0.0939 Tw (others ) Tj 27.332 0 TD /F4 10 Tf 0.0525 Tc 0.2155 Tw (who are told) Tj ET endstream endobj 497 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 498 0 obj <>stream 0.72 w 1 j 0 0 0 RG 73.44 681.36 m 551.52 681.36 l S 73.44 639.6 m 551.76 639.6 l S 73.44 626.4 m 552.24 626.4 l S 78.72 52.8 m 398.88 52.8 l S 0.24 w 381.12 52.32 m 557.04 52.32 l S BT 0.9835 0 0 0.9835 73.44 686.4 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 1.0756 Tw (164 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.9863 0 0 0.9863 175.92 647.04 Tm /F3 9 Tf 0.0575 Tc 0.2613 Tw (Table 6-2\227Massachusetts Agencies Regulating Nursing ) Tj ET BT 0.9835 0 0 0.9835 420.48 647.04 Tm /F2 10 Tf 0.0413 Tc 0 Tw (Homes) Tj ET BT 0.8648 0 0 0.99 73.68 630 Tm /F3 8 Tf 0.0411 Tc (Agency) Tj ET BT 0.9262 0 0 0.9939 229.68 630.24 Tm /F3 7 Tf 0.0942 Tc (Function) Tj ET BT 0.9939 0 0 0.9939 396.72 630.72 Tm 0.0112 Tc (Codes/regulations/standards) Tj ET BT 0.8648 0 0 0.99 74.16 616.8 Tm /F3 8 Tf 0.0348 Tc 1.205 Tw (1. Site Control) Tj 7.4928 -8.7275 TD 0.0464 Tc 0.7753 Tw (Local Planning Department) Tj ET BT 0.8108 0 0 0.99 229.92 608.4 Tm 0.0755 Tc 0.6802 Tw (Certifies that the site is zoned for nursing home) Tj ET BT 0.8648 0 0 0.99 229.92 600 Tm 0.025 Tc 0.0137 Tw (use or is eligible for zoning variance) Tj 0.555 -14.7883 TD 0.0292 Tc 0.7951 Tw (Reviews environmental impact) Tj ET BT 0.9262 0 0 0.9939 397.44 608.88 Tm /F3 7 Tf 0.0885 Tc 1.8445 Tw (Local zoning ordinances) Tj ET BT 0.9939 0 0 0.9939 397.44 585.84 Tm 0.0036 Tc 0.9468 Tw (Massachusetts Environmental Policy Act, Na-) Tj ET BT 0.9262 0 0 0.9939 397.44 577.44 Tm 0.0591 Tc 0.3216 Tw (tional Environmental Policy Act \(especially when) Tj 0 -8.6933 TD 0.0614 Tc 0.06 Tw (the project ) Tj ET BT 0.9189 0 0 0.99 433.44 568.8 Tm /F3 8 Tf 0.0497 Tc 0.2688 Tw (will receive Federal funding\), and) Tj ET BT 0.8648 0 0 0.99 397.44 560.4 Tm 0.0178 Tc 0.8084 Tw (other laws, as applicable) Tj -363.8169 24.728 TD 0.0304 Tc 0.7937 Tw (State Executive Office of Environmental) Tj ET BT 0.8108 0 0 0.99 82.56 576.96 Tm 0.0599 Tc 0 Tw (Affairs) Tj ET BT 0.9189 0 0 0.99 74.88 551.52 Tm 0.0331 Tc 1.0487 Tw (Il. Determination of Need) Tj ET BT 0.8648 0 0 0.99 83.52 543.12 Tm 0.0402 Tc 0.949 Tw (Determination of Need Office, State De-) Tj -0.2775 -8.7275 TD 0.0491 Tc 0.6796 Tw (partment of Public Health) Tj ET BT 0.7567 0 0 0.99 230.88 543.12 Tm -0.0057 Tc 0 Tw (1.) Tj ET BT 0.8645 0 0 0.9939 230.88 504.72 Tm /F11 7 Tf -0.005 Tc (2,) Tj ET BT 0.9939 0 0 0.9939 231.12 474.72 Tm -0.0309 Tc (3) Tj ET BT 0.8648 0 0 0.99 239.76 543.12 Tm /F3 8 Tf 0.0468 Tc 1.0986 Tw (Determines that applicant has control of a) Tj ET BT 0.8108 0 0 0.99 240.48 534.48 Tm 0.0566 Tc 0.9626 Tw (site which can reasonably be expected to be) Tj 0 -8.7275 TD 0.081 Tc 1.2285 Tw (appropriately zoned and have environmental) Tj ET BT 0.8648 0 0 0.99 240.96 517.2 Tm 0.0469 Tc 0.4972 Tw (impact approved) Tj -1.3876 -12.6064 TD 0.0408 Tc 1.0592 Tw (Determines bed need) Tj ET BT 0.8108 0 0 0.99 398.16 504.72 Tm 0.0612 Tc 0.7266 Tw (Uses a rate of 35 beds per 1000 population over) Tj ET BT 0.8648 0 0 0.99 398.16 496.32 Tm 0.0373 Tc 0.6123 Tw (age 65 based on a State census broken down) Tj 0 -8.4851 TD 0.034 Tc -0.0429 Tw (by 6 regions) Tj ET BT 0.9189 0 0 0.99 398.16 475.2 Tm 0.0126 Tc 1.071 Tw (Square footage must meet the Federal and) Tj ET BT 0.8108 0 0 0.99 239.04 474.96 Tm 0.0601 Tc 0.7362 Tw (Determines \222\222reasonableness of capital costs\224) Tj ET BT 0.8919 0 0 0.9835 398.4 466.56 Tm /F2 10 Tf 0.0338 Tc -0.1177 Tw (State ) Tj ET BT 0.8648 0 0 0.99 418.32 466.56 Tm /F3 8 Tf 0.0668 Tc 0.3817 Tw (minimum of 318 sq ft per bed but be no) Tj -22.7559 -8.4851 TD 0.0513 Tc 0.3533 Tw (more than 400 sq ft per bed;) Tj ET BT 0.9189 0 0 0.99 398.88 449.28 Tm 0.0242 Tc 0.1007 Tw (uses Marshall\222s Evaluation Service to deter-) Tj ET BT 0.8648 0 0 0.99 398.88 441.12 Tm 0.0418 Tc 0.1145 Tw (mine allowed construction costs, including ar-) Tj -0.2775 -8.97 TD 0.0419 Tc 2.3761 Tw (chitecture, site evaluation, and construction) Tj 0 -8.4851 TD 0.0406 Tc 0.671 Tw (costs; currently about$100 per sq ft) Tj ET BT 0.8108 0 0 0.99 231.6 415.2 Tm 0.0893 Tc 1.2774 Tw (4. Follows approved projects through Iicensure) Tj ET BT 0.8648 0 0 0.99 241.68 406.32 Tm 0.0351 Tc 0.3721 Tw (to assure compliance) Tj ET BT 0.99 0 0 0.99 232.08 394.08 Tm -0.0423 Tc 0.0002 Tw (Determines ) Tj ET BT 0.9939 0 0 0.9939 278.64 394.08 Tm /F3 7 Tf 0.0108 Tc 0.9396 Tw (if projected operating costs are) Tj -47.0885 -8.4518 TD -0.0038 Tc 0 Tw (reasonable) Tj ET BT 0.8648 0 0 0.99 84.72 394.32 Tm /F3 8 Tf 0.0513 Tc 1.0471 Tw (Rate Setting Commission) Tj 363.8169 0 TD 0.044 Tc 0.6393 Tw (Projected operating costs must be within one) Tj ET BT 0.8108 0 0 0.99 398.88 385.68 Tm 0.0662 Tc 1.0776 Tw (standard deviation of the median costs of other) Tj ET BT 0.8648 0 0 0.99 398.88 377.28 Tm 0.0218 Tc 0.8037 Tw (facilities in the area) Tj -362.9843 -8.4851 TD 0.0193 Tc 1.5003 Tw (Medicaid Division, State Public Welfare) Tj 0 -8.97 TD 0.0515 Tc 0 Tw (Department) Tj 0 -11.6367 TD 0.0206 Tc 0.6664 Tw (Executive Office of Elder Affairs) Tj 170.6693 20.3643 TD 0.0323 Tc 0.5141 Tw (Reviews application to ensure need) Tj ET BT 0.9939 0 0 0.9939 232.56 348.24 Tm /F3 7 Tf 0.0111 Tc 0.2149 Tw (Reviews for appropriate affiliation agreements) Tj ET BT 0.9262 0 0 0.9939 232.56 339.36 Tm 0.0645 Tc 1.1363 Tw (and the management history of proposed oper-) Tj ET BT 0.9939 0 0 0.9939 232.56 330.48 Tm 0.0038 Tc 0 Tw (ators) Tj ET BT 0.9189 0 0 0.99 77.04 316.32 Tm /F3 8 Tf 0.0658 Tc 0.3166 Tw (Ill. Licensure) Tj 11.4922 -8.7275 TD 0.0244 Tc 0.5183 Tw (Division of Health Care Quality, State) Tj ET BT 0.8108 0 0 0.99 87.84 299.28 Tm 0.0699 Tc 0.0581 Tw (Department of Public Health and Architec-) Tj ET BT 0.8648 0 0 0.99 87.12 290.4 Tm 0.0376 Tc 1.396 Tw (ture Department and Patient Care Sur-) Tj 0.2775 -8.2427 TD 0.0033 Tc 0 Tw (veyors) Tj 168.1716 25.4553 TD 0.032 Tc 0.5144 Tw (License the facility, assuring compliance with) Tj ET BT 0.8108 0 0 0.99 232.56 299.04 Tm 0.0654 Tc 1.2971 Tw (State and Federal Iaws concerning the physical) Tj ET BT 0.8648 0 0 0.99 232.8 290.4 Tm 0.0455 Tc 0.6838 Tw (plant and patient care) Tj 193.1476 17.4551 TD 0.0266 Tc 0.2986 Tw (Massachusetts: 105CMI 50-1 59 Federal: Medi-) Tj ET BT 0.9189 0 0 0.99 399.84 299.04 Tm 0.0501 Tc 1.2914 Tw (care and Medicaid law, HCFA rulings, and) Tj ET BT 0.8648 0 0 0.99 399.84 290.64 Tm 0.0385 Tc 1.3857 Tw (related standards \(e.g., Life Safety Code and) Tj -0.2775 -8.7275 TD 0.0301 Tc 0 Tw (ANSI\)) Tj ET BT 0.9189 0 0 0.99 90 264.48 Tm 0.0297 Tc 1.1395 Tw (Fire department for the municipality) Tj ET BT 0.8648 0 0 0.99 90 256.32 Tm 0.0328 Tc 0.1805 Tw (in which the facility is located) Tj 165.119 8.2427 TD 0.0308 Tc -0.0392 Tw (Assures fire safety and compliance with codes) Tj 193.7027 0 TD 0.0388 Tc 0.673 Tw (Life Safety Code and local ordinances) Tj ET BT 0.9189 0 0 0.99 90.24 239.28 Tm 0.0455 Tc 0.1428 Tw (Building inspector for the municipal-) Tj ET BT 0.8648 0 0 0.99 90.24 230.64 Tm 0.0328 Tc 0.1434 Tw (ity in which the facility is located) Tj ET BT 0.8108 0 0 0.99 233.28 238.8 Tm 0.0694 Tc 1.5388 Tw (Ensures compliance with State building codes;) Tj ET BT 0.8648 0 0 0.99 233.28 230.16 Tm 0.0423 Tc -0.0525 Tw (decisions maybe appealed to the State inspec-) Tj ET BT 0.8108 0 0 0.99 233.04 221.28 Tm 0.1071 Tc 1.4923 Tw (tion Division, Building Section) Tj ET BT 0.8919 0 0 0.9835 400.08 238.56 Tm /F2 10 Tf 0.0338 Tc -0.1177 Tw (State ) Tj ET BT 0.8648 0 0 0.99 419.76 238.56 Tm /F3 8 Tf 0.0612 Tc 0.7582 Tw (Building Code) Tj ET BT 0.9189 0 0 0.99 77.76 204.72 Tm 0.051 Tc 0.8551 Tw (IV. Obtaining Construction Financing) Tj ET BT 0.99 0 0 0.99 90.48 195.84 Tm -0.0421 Tc 0.2425 Tw (State Health Care Finance Agency,) Tj ET BT 0.8648 0 0 0.99 90.72 187.44 Tm 0.0458 Tc 0.2209 Tw (HUD, or financial institutions) Tj 165.3965 8.4851 TD 0.0344 Tc 0.1786 Tw (Ensure financial viability of the project) Tj 193.4252 0 TD 0.0161 Tc 0.8565 Tw (Review all other approvals, apply own criteria) Tj ET BT 0.8108 0 0 0.99 400.56 187.2 Tm 0.0625 Tc 1.0046 Tw (which may include requirements that the facility) Tj ET BT 0.8648 0 0 0.99 400.56 178.8 Tm 0.0514 Tc -0.063 Tw (could be used for other purposes) Tj ET BT 0.99 0 0 0.99 77.76 165.12 Tm -0.0404 Tc 0.1438 Tw (V. Certification for Medicare and Medi-) Tj ET BT 0.8648 0 0 0.99 99.36 156 Tm 0.0224 Tc 0 Tw (caid) Tj -9.9904 -8.4851 TD 0.0471 Tc 1.3295 Tw (State Rate Setting Commission) Tj ET BT 0.8108 0 0 0.99 234 147.36 Tm 0.058 Tc 1.7305 Tw (Sets allowed reimbursement rates for Medicare) Tj ET BT 0.8648 0 0 0.99 234 138.96 Tm 0.0357 Tc 1.3427 Tw (and Medicaid) Tj 193.1476 8.4851 TD 0.0253 Tc 1.0772 Tw (State policies) Tj -358.2667 -22.7886 TD 0.0193 Tc 0.3209 Tw (Medicaid Division, State Public Welfare) Tj 0.2775 -8.4851 TD 0.0515 Tc 0 Tw (Department) Tj 165.119 8.4851 TD 0.0178 Tc 1.3633 Tw (Enrolls provider) Tj 0 Tc -0.0036 Tw ( ) Tj ET BT 0.8645 0 0 0.9939 291.84 124.8 Tm /F3 7 Tf -0.0375 Tc 2.8162 Tw (in Medicaid) Tj ET BT 0.8648 0 0 0.99 401.52 125.04 Tm /F3 8 Tf 0.0374 Tc 0.2306 Tw (Must have a Determination of Need certificate,) Tj ET BT 0.9189 0 0 0.99 401.28 116.16 Tm 0.0364 Tc 0.0875 Tw (be licensed, have rate set, and be in compli-) Tj ET BT 0.8648 0 0 0.99 401.04 108 Tm 0.0222 Tc 1.6358 Tw (ance with Federal Medicaid laws and regula-) Tj ET BT 0.8108 0 0 0.99 401.04 99.6 Tm 0.0853 Tc 0 Tw (tions) Tj ET BT 0.9189 0 0 0.99 78.48 82.8 Tm 0.0535 Tc 1.1136 Tw (VI. Final Inspections) Tj ET BT 0.8648 0 0 0.99 90.96 74.4 Tm 0.0201 Tc 0.2506 Tw (All agencies) Tj 165.3965 -0.4849 TD 0.0373 Tc -0.0468 Tw (Any agency which has had prior authority may) Tj 0.2775 -8.4851 TD 0.0294 Tc 0.3787 Tw (review for compliance before occupancy) Tj 0.555 -8.4851 TD 0.0455 Tc 0.2907 Tw (Inspect for health code compliance) Tj -165.6741 0 TD 0.0436 Tc 1.4723 Tw (Local Health Departments) Tj 357.9892 -0.4849 TD 0.0393 Tc 1.061 Tw (State and local health codes) Tj ET BT 0.9262 0 0 0.9939 78.72 44.88 Tm /F3 7 Tf 0.0746 Tc 0.0458 Tw (SOURCE: J. Hyde, \223Federal Policy in the Regulation and Funding of Special Care ) Tj ET q 33.12 0 0 -5.28 331.92 49.92 cm BI /W 198 /H 30 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8x<x?<x<x|<x|<x~?x<x>>|<?x|?~<?x<?x<?x|<?x|<?>|<?|?|<||<>~<>?<<<<~7?<<<><> EI Q BT 0.8027 0 0 0.9939 331.92 44.88 Tm 3 Tr 0.0416 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9262 0 0 0.9939 365.04 44.88 Tm 0.0771 Tc 0.0431 Tw ( Units: The Role of Federal, State, and Municipal Regulation,\224) Tj -272.8416 -7.9688 TD 0.066 Tc 0.0551 Tw (contract report prepared for the ) Tj ET q 17.04 0 0 -6.48 213.12 43.68 cm BI /W 102 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? p<?x~~?|?|?߁߀π~||??~?~???@~> EI Q BT 0.9939 0 0 0.9939 213.12 36.96 Tm 3 Tr 0.0039 Tc 0 Tw (~fice) Tj 0 Tr ET BT 0.9262 0 0 0.9939 230.16 36.96 Tm 0.0828 Tc 0.0369 Tw ( of Technology ) Tj ET q 38.64 0 0 -8.16 278.88 43.68 cm BI /W 228 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |?|?>~>>>>>?<<??`<?<?<??<??<? <<?<????????? EI Q BT 0.8027 0 0 0.9939 278.88 36.96 Tm 3 Tr 0.034 Tc 0 Tw (-Asse\224=ment,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 317.52 36.96 Tm 0.0546 Tc 0.0673 Tw ( August 1990.) Tj ET endstream endobj 499 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 500 0 obj <>stream 0.72 w 1 j 0 0 0 RG 63.12 686.64 m 541.44 686.64 l S 65.04 644.4 m 541.92 644.4 l S 0.96 w 64.08 630.24 m 541.92 630.24 l S 0.72 w 69.36 69.6 m 547.44 69.6 l S BT 0.9835 0 0 0.9835 134.88 691.44 Tm 0 0 0 rg /F5 10 Tf 0.0234 Tc 1.176 Tw (Chapter 6-Regulations That Interfere With The Design and Operation of Special Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 518.16 691.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 524.64 691.44 Tm /F5 10 Tf 0.2847 Tc 0 Tw (165) Tj ET BT 0.9863 0 0 0.9863 178.32 652.8 Tm /F3 9 Tf 0.0548 Tc 0.8886 Tw (Table 6-3-New York Agencies Regulating Nursing Homes) Tj ET BT 0.8648 0 0 0.99 63.84 634.32 Tm /F3 8 Tf 0.2723 Tc 0 Tw (Agency) Tj 180.6597 0.2424 TD 0.08 Tc (Function) Tj ET BT 0.9189 0 0 0.99 386.64 634.8 Tm 0.0384 Tc (Codes/regulations/standards) Tj ET BT 0.99 0 0 0.99 64.56 620.16 Tm -0.0208 Tc 0.0997 Tw (L Site Control) Tj ET BT 0.9189 0 0 0.99 71.28 611.28 Tm 0.0288 Tc 0.4875 Tw (Local Planning Department) Tj ET BT 0.8648 0 0 0.99 219.84 611.52 Tm 0.0294 Tc 1.2112 Tw (Site control, zoning requirements, availability) Tj 0 -8.97 TD 0.0389 Tc 0.4509 Tw (of utilities, historical, land, environmental and) Tj ET BT 0.9189 0 0 0.99 220.08 593.52 Tm 0.059 Tc 0.7419 Tw (building issues, soil testing, and financing) Tj ET BT 0.8648 0 0 0.99 219.84 584.64 Tm 0.0102 Tc 0 Tw (vehicle) Tj ET BT 0.9189 0 0 0.99 386.88 611.76 Tm 0.0308 Tc 0.3982 Tw (Local and State zoning and land-use codes) Tj ET BT 0.8648 0 0 0.99 64.8 566.64 Tm -0.0036 Tc 0 Tw (Il.) Tj ET BT 0.9606 0 0 0.9863 73.68 566.16 Tm /F3 9 Tf -0.0055 Tc 0.0008 Tw (Certificate ) Tj ET BT 0.9189 0 0 0.99 117.6 566.16 Tm /F3 8 Tf 0.0093 Tc 0.3781 Tw (of Need) Tj -47.7969 -8.97 TD 0.0022 Tc 1.3261 Tw (State Department of Health, Office of) Tj ET BT 0.8648 0 0 0.99 74.16 548.4 Tm 0.0325 Tc 3.0115 Tw (Health Systems Management \(OHSM\),) Tj ET BT 0.9189 0 0 0.99 74.16 539.28 Tm 0.0205 Tc 1.2148 Tw (Bureau of Project Management. Cop-) Tj ET BT 0.99 0 0 0.99 74.16 530.4 Tm -0.0458 Tc 1.8463 Tw (ies then submitted to local Health) Tj 0 -9.2124 TD -0.0338 Tc 0.5977 Tw (Systems Agency \(HSA\), internal re-) Tj ET BT 0.9189 0 0 0.99 73.92 512.4 Tm 0.025 Tc 0.8834 Tw (view bureaus, and OHSM Area Office) Tj 159.8454 45.5771 TD 0.0365 Tc 0.0874 Tw (Reviews for need, financial feasibility, char-) Tj -0.5224 -8.97 TD 0.0096 Tc 1.1613 Tw (acter and competence) Tj ET BT 0.99 0 0 0.99 387.6 558 Tm -0.0497 Tc 0.4117 Tw (10NYGRR 410-416; 420-422; 730-734) Tj ET BT 0.9189 0 0 0.99 74.64 494.64 Tm 0.0406 Tc 0.0829 Tw (Bureau of Facility Planning) Tj ET BT 0.8648 0 0 0.99 221.28 494.64 Tm 0.0367 Tc 0.6939 Tw (Ensures that the application is in accordance) Tj -0.2775 -9.2124 TD 0.0234 Tc 1.4031 Tw (with the current State Medical Facilities Plan) Tj ET BT 0.9189 0 0 0.99 221.52 476.4 Tm 0.009 Tc 0.6396 Tw (\(as devised by HSA and OHSM\)) Tj 181.2626 18.4248 TD 0.0487 Tc 0.4658 Tw (Medical Facilities Plan) Tj -340.8468 -36.6072 TD 0.0254 Tc 0.6218 Tw (Bureau of Facility and Service Review) Tj 0.5224 -17.9399 TD 0.0168 Tc 0.2655 Tw (Bureau of Long Term Care Services) Tj ET BT 0.8648 0 0 0.99 222 458.64 Tm 0.0326 Tc 0.7912 Tw (Ensures there is a public need for the facility) Tj ET BT 0.9388 0 0 0.9835 388.56 458.4 Tm /F2 10 Tf -0.0142 Tc 0.0702 Tw (State ) Tj ET BT 0.9189 0 0 0.99 409.44 458.4 Tm /F3 8 Tf 0.0433 Tc 0.994 Tw (Need Methodology Regulations) Tj -22.2008 -17.9399 TD -0.0052 Tc 1.4908 Tw (10NYCRR: NY State Public Health Law) Tj -181.785 0 TD 0.0138 Tc 1.1568 Tw (Ensures that the proposed operator meets) Tj ET BT 0.8648 0 0 0.99 221.52 431.76 Tm 0.0372 Tc 2.2428 Tw (the character and competence requirements) Tj ET BT 0.9189 0 0 0.99 221.76 422.64 Tm 0.02 Tc 0.1488 Tw (and that the proposed programs meet regu-) Tj 0 -8.7275 TD 0.0237 Tc 0.7803 Tw (latory requirements and address the needs) Tj 0 -8.97 TD 0.034 Tc 0.0901 Tw (of the population to be served) Tj ET BT 0.8648 0 0 0.99 75.6 387.12 Tm 0.038 Tc 2.2419 Tw (Bureau of Architectural and Engineer-) Tj ET BT 0.9189 0 0 0.99 75.6 378 Tm 0.0578 Tc 0.0641 Tw (ing Facility Planning) Tj ET BT 0.99 0 0 0.99 222.48 387.12 Tm -0.0454 Tc 0.6337 Tw (Ensures that the proposed facility meets) Tj 0 -9.2124 TD -0.0397 Tc 0.3612 Tw (State construction standards, Federal re-) Tj ET BT 0.9189 0 0 0.99 222.24 368.88 Tm 0.0237 Tc 0.7977 Tw (quirements, and ANSI standards) Tj 182.0462 18.6672 TD -0.0119 Tc 0.9235 Tw (10 NYCRR 710, ANSI) Tj -341.108 -36.3647 TD 0.0366 Tc 0.0872 Tw (Bureau of Financial Analysis Review) Tj ET BT 0.99 0 0 0.99 222.96 351.36 Tm -0.0474 Tc 0.0538 Tw (Ensures that the application is financially) Tj -0.4849 -8.97 TD -0.0504 Tc 1.1236 Tw (feasible, i.e., the applicant has sufficient) Tj ET BT 0.9189 0 0 0.99 222.48 333.6 Tm 0.0417 Tc 0.3429 Tw (financial resources to build the facility, and) Tj 0 -8.97 TD 0.0391 Tc 1.2598 Tw (when the facility is in operation, sufficient) Tj ET BT 0.8648 0 0 0.99 222.96 315.84 Tm 0.0455 Tc 1.5395 Tw (income to remain financially sound) Tj ET BT 0.99 0 0 0.99 390 351.36 Tm -0.0462 Tc 0.2465 Tw (Depending on the financing vehicle, both) Tj ET BT 0.8648 0 0 0.99 390 342.48 Tm 0.0408 Tc 1.1055 Tw (Federal and State regulations come into play) Tj ET BT 0.99 0 0 0.99 67.68 298.08 Tm -0.0488 Tc 0.4916 Tw (Ill. 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Certification for Medicare and Medi-) Tj ET BT 0.9189 0 0 0.99 89.04 151.44 Tm 0.0471 Tc 0 Tw (caid) Tj -9.4027 -8.97 TD 0.0212 Tc 1.1488 Tw (Division of Health Care Standards &) Tj ET BT 0.99 0 0 0.99 79.92 133.2 Tm -0.0393 Tc 2.4215 Tw (Surveillance, State Department of) Tj ET BT 0.9189 0 0 0.99 80.4 124.56 Tm 0.0179 Tc 0 Tw (Health) Tj ET BT 0.8648 0 0 0.99 224.4 142.56 Tm 0.0199 Tc 2.7485 Tw (Assures compliance with Medicare/Medicaid) Tj ET BT 0.9189 0 0 0.99 224.64 133.2 Tm 0.0288 Tc 0.7487 Tw (operational and patient care standards) Tj ET BT 0.99 0 0 0.99 391.44 142.56 Tm -0.085 Tc 0.0434 Tw (42 ) Tj 10.9094 0 TD -0.0465 Tc 0.1257 Tw (CRF 442; 483) Tj -336.4951 -33.4556 TD -0.0486 Tc 1.0975 Tw (VI. Final Inspections) Tj 11.6367 -8.7275 TD -0.0418 Tc 0.3028 Tw (Division of Health Facility Planning) Tj ET BT 0.8648 0 0 0.99 80.4 91.44 Tm 0.0373 Tc 1.2297 Tw (and Division of Health Care Standards) Tj ET BT 0.9189 0 0 0.99 80.64 82.8 Tm 0.0084 Tc 2.0115 Tw (& Surveillance, State Department of) Tj 0 -8.97 TD 0.0179 Tc 0 Tw (Health) Tj ET BT 0.99 0 0 0.99 225.36 100.8 Tm -0.0416 Tc 0.8723 Tw (Inspect building for compliance with ap-) Tj ET BT 0.8648 0 0 0.99 225.12 91.68 Tm 0.0407 Tc 2.4469 Tw (proved plans) Tj ET BT 0.9189 0 0 0.99 392.4 100.8 Tm -0.0263 Tc 0.8086 Tw (10 NYCRR 710) Tj ET BT 0.8645 0 0 0.9939 69.84 60.72 Tm /F3 7 Tf -0.0453 Tc 1.639 Tw (SOURCE: J. Hyde, \223FederalPolicy in the Regulation and Funding of Special Care Units: The Role of Federal, State, and Municipal Regulation, \222\222contract report) Tj 39.1435 -7.7273 TD -0.0504 Tc 2.4147 Tw (prepared for the Office of Technology Assessment, August 1990.) 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Sometimes it is) Tj 0.4881 -11.9577 TD 0.0226 Tc 3.5765 Tw (almost impossible to prove a given regulation does) Tj -0.4881 -11.7137 TD 0.0453 Tc 4.2855 Tw (not exist \(201,378\).) Tj 11.4697 -18.3027 TD 0.0059 Tc 3.6341 Tw (Architects, special care unit operators, and others) Tj -10.7376 -12.2018 TD 0.2655 Tc 3.6143 Tw (often fear that disputing government officials\222 or) Tj 0 -11.9577 TD 0.2627 Tc 3.4788 Tw (surveyors\222 interpretations of regulations will have) Tj -0.244 -11.7137 TD 0.0255 Tc 4.3545 Tw (negative consequences beyond the particular design) Tj 0.244 -12.4458 TD 0.0176 Tc 3.4596 Tw (or other feature in question. They fear the officials) Tj 0 -12.4458 TD 0.5004 Tc 3.2737 Tw (will delay or deny final approval for the unit.) Tj 0.244 -11.7137 TD 0.0217 Tc 2.6013 Tw (Likewise, they fear that if they annoy the surveyors,) Tj 0 -12.4458 TD 0.0088 Tc 3.3736 Tw (the nursing home or special care unit will be cited) Tj 0.244 -11.9577 TD 0.0157 Tc 3.7927 Tw (later for violations of other regulations. Because of) Tj 0 -12.2018 TD 0.041 Tc 4.0459 Tw (the large number and complexity of nursing home) Tj -0.244 -11.9577 TD 0.2637 Tc 3.5754 Tw (regulations, virtually all nursing homes-even very) Tj 0.7321 -12.2018 TD 0.4906 Tc 3.8328 Tw (good facilities-are out of compliance with one) Tj -0.4881 -11.9577 TD 0.0175 Tc 3.7342 Tw (regulation or another at any one time. Given these) Tj 0.244 -12.2018 TD 0.2358 Tc 3.2378 Tw (fears, some architects, special care unit operators,) Tj 0.4881 -12.4458 TD 0.7435 Tc 2.5995 Tw (and others choose not to dispute officials\222 or) Tj 0.244 -11.9577 TD 0.0292 Tc 4.3425 Tw (surveyors\222 interpretations of the regulations and to) Tj 0.4881 -11.9577 TD 0.2418 Tc 2.6826 Tw (\223keep a low profile\224 instead.) Tj 10.4935 -18.0586 TD 0.0125 Tc 3.0173 Tw (Fire safety regulations and interpretations of these) Tj -11.7137 -12.2018 TD 0.243 Tc 3.627 Tw (regulations are often cited as limiting the use of) Tj 0.4881 -12.4458 TD 0.2462 Tc 2.9017 Tw (innovative physical design features in special care) Tj 0 -12.4458 TD 0.2549 Tc 3.1369 Tw (units. Requirements of NFPA\222s Life Safety Code,) Tj 0.244 -12.4458 TD 0.0051 Tc 3.4723 Tw (which is primarily a fire safety code, are identified) Tj 0.244 -11.9577 TD 0.019 Tc 2.6312 Tw (as regulatory barriers with respect to six of the nine) Tj -0.244 -12.2018 TD 0.0064 Tc 3.2879 Tw (design features listed in table 6-1. As noted earlier,) Tj 0.244 -12.4458 TD 0.4816 Tc 2.8309 Tw (State and local fire code requirements were the) Tj -0.244 -11.7137 TD 0.03 Tc 2.9415 Tw (regulations cited most frequently in the 1987 survey) Tj 0.244 -12.4458 TD 0.0133 Tc 1.9509 Tw (of 99 special care units as making the creation of the) Tj 0.4881 -12.4458 TD 0.2128 Tc 2.773 Tw (special care unit) Tj 79.0676 0 TD 0.2506 Tc 3.3447 Tw (\223difficult, expensive, or impossi-) Tj -79.5556 -11.7137 TD 0.2596 Tc 4.3117 Tw (ble\224 \(494\).) Tj 11.4697 -18.3027 TD 0.5113 Tc 3.3724 Tw (Fire safety inspection procedures for nursing) Tj -11.2256 -12.2018 TD 0.497 Tc 2.7586 Tw (homes vary in different States, but most of the) Tj 0 -12.4458 TD 0.2531 Tc 4.359 Tw (inspections are conducted by local fire marshals) Tj 0.4881 -12.4458 TD 0.2553 Tc 2.6484 Tw (\(522\). These local fire marshals have considerable) Tj -0.244 -11.9577 TD 0.5064 Tc 3.5727 Tw (independence in interpreting and enforcing fire) Tj 0.4881 -12.4458 TD 0.4983 Tc 2.8488 Tw (safety regulations. It is OTA\222s impression from) Tj -0.4881 -11.9577 TD 0.4856 Tc 2.8617 Tw (discussions with Federal and State officials and) Tj 0 -12.2018 TD 0.7467 Tc 2.8809 Tw (nursing home operators that within their own) Tj -0.4881 -11.9577 TD 0.2439 Tc 3.1563 Tw (jurisdictions, local fire marshals\222 interpretations of) Tj 0.9761 -11.9577 TD 0.0167 Tc 3.3385 Tw (the regulations carry great weight and are generally) Tj 0.244 -11.9577 TD -0.0149 Tc 3.8587 Tw (accepted as final.) Tj 10.9816 -18.0586 TD 0.7138 Tc 3.1178 Tw (As noted earlier, the Federal Medicare and) Tj -11.2256 -11.9577 TD 0.4882 Tc 2.6639 Tw (Medicaid regulations incorporate the NFPA Life) Tj 0.244 -12.2018 TD 0.009 Tc 3.5904 Tw (Safety Code, but the Federal regulations also allow) Tj 0.244 -11.9577 TD 0.0143 Tc 2.7986 Tw (States to use their own fire and safety codes. Many) Tj 250.8686 619.3625 TD /F4 10 Tf 0.0357 Tc 0.9473 Tw (localities also have fire safety codes. The Health) Tj 0.4881 -12.4458 TD 0.0108 Tc -0.0593 Tw (Care Financing Administration, NFPA, and State) Tj 0 -12.2018 TD 0.0217 Tc 1.345 Tw (fire marshals\222 offices) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 423.36 618.48 Tm /F6 11 Tf 0.0481 Tc 1.3575 Tw (offer training) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 491.52 618.48 Tm /F4 10 Tf 0.0415 Tc 1.0809 Tw (for local fire) Tj ET BT 0.8915 0 0 0.9835 322.32 606.72 Tm 0.0384 Tc 0.9888 Tw (marshals about fire safety regulations and inspection) Tj ET BT 0.9835 0 0 0.9835 322.32 594.72 Tm 0.0239 Tc 2.2213 Tw (procedures, but fire marshals generally are) Tj 0 Tc -0.0972 Tw ( ) Tj 217.1917 0 TD /F2 10 Tf 0.2116 Tc 0 Tw (not) Tj -217.1917 -11.9577 TD /F4 10 Tf 0.0395 Tc -0.1373 Tw (required ) Tj 42.7062 0 TD /F2 10 Tf -0.0083 Tc -0.0526 Tw (to take the ) Tj 44.1705 0 TD /F4 10 Tf 0.0159 Tc 0.3747 Tw (training \(217,298,522\).) Tj -75.407 -18.3027 TD 0.0378 Tc 3.525 Tw (The objectives of fire safety regulations for) Tj -10.9816 -12.2018 TD 0.0121 Tc 0.1346 Tw (nursing homes are ) Tj ET BT 0.9863 0 0 0.9863 411.36 552.96 Tm /F3 9 Tf 0.0085 Tc 0 Tw (to) Tj 14.3564 0 TD 0.0257 Tc 2.3375 Tw (minimize the) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 486.96 552.96 Tm /F4 10 Tf 0.0455 Tc 4.9814 Tw (possibility of) Tj -166.9204 -11.9577 TD 0.0542 Tc 0.2138 Tw (frees and ) Tj 47.3429 0 TD /F2 10 Tf -0.0314 Tc 0.3776 Tw (to limit their ) Tj 53.9319 0 TD /F4 10 Tf 0.0346 Tc 2.3081 Tw (effects \(217,522\). Although) Tj ET BT 0.9388 0 0 0.9835 323.04 529.44 Tm /F2 10 Tf -0.0122 Tc 0.068 Tw (there ) Tj ET BT 0.934 0 0 0.9835 344.88 529.44 Tm /F4 10 Tf -0.0209 Tc 1.5233 Tw (have been few deaths) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9388 0 0 0.9835 445.44 529.44 Tm /F2 10 Tf 0.0348 Tc 1.2962 Tw (from nursing) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.934 0 0 0.9835 499.44 529.44 Tm /F4 10 Tf -0.045 Tc 3.1765 Tw (home frees) Tj -188.6054 -12.2018 TD -0.0126 Tc 0.6294 Tw (in the United States in past 15 years \(probably less) Tj ET BT 0.9835 0 0 0.9835 323.28 505.2 Tm 0.04 Tc 1.5094 Tw (than 30\), the prospect of) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 444.96 505.2 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 452.88 505.2 Tm /F4 10 Tf 0.0155 Tc 1.8394 Tw (nursing home fire) Tj 0 Tc -0.0972 Tw ( ) Tj 91.2693 0 TD /F2 10 Tf 0.0796 Tc 0 Tw (is) Tj -223.2926 -11.7137 TD /F4 10 Tf 0.0115 Tc -0.1088 Tw (horrifying ) Tj 52.9557 0 TD /F2 10 Tf 0.0406 Tc 1.1178 Tw (to many) Tj 0 Tc -0.061 Tw ( ) Tj 37.8255 0 TD /F4 10 Tf 0.0545 Tc 2.3488 Tw (people, and the objectives of) Tj -90.7813 -12.4458 TD 0.0169 Tc 4.0343 Tw (preventing such) Tj 0 Tc -0.0972 Tw ( ) Tj 85.4125 0 TD /F2 10 Tf -0.0498 Tc -0.0104 Tw (a ) Tj 7.5651 0 TD /F4 10 Tf 0.0444 Tc -0.1423 Tw (fire ) Tj 20.743 0 TD /F2 10 Tf -0.0148 Tc 1.9063 Tw (or limiting its) Tj 0 Tc -0.061 Tw ( ) Tj 62.4731 0 TD /F4 10 Tf 0.0543 Tc -0.1523 Tw (effects ) Tj 36.1173 0 TD /F2 10 Tf 0.3473 Tc 0 Tw (take) Tj -212.067 -12.2018 TD /F4 10 Tf 0.0385 Tc 0.4331 Tw (precedence in their ) Tj 94.1978 0 TD /F2 10 Tf 0.041 Tc 0.304 Tw (view over other ) Tj 67.5979 0 TD /F4 10 Tf 0.0537 Tc 1.8005 Tw (possible objec-) Tj -161.5516 -12.2018 TD /F2 10 Tf -0.0285 Tc -0.0321 Tw (tives. ) Tj 26.1118 0 TD /F4 10 Tf 0.0242 Tc 3.7828 Tw (Fire marshals and fire safety inspectors) Tj -26.3559 -12.2018 TD 0.043 Tc 2.7875 Tw (probably are) Tj 0 Tc -0.0972 Tw ( ) Tj 67.1098 0 TD /F2 10 Tf 0.0266 Tc 2.3522 Tw (more likely than other people to hold) Tj -66.6217 -12.2018 TD 0.0151 Tc 3.1503 Tw (this view. As a result, they are unlikely to approve) Tj 0.244 -11.9577 TD 0.0159 Tc 4.0714 Tw (innovations they believe might increase the risk of) Tj 0 -12.4458 TD 0.2474 Tc 3.5309 Tw (a fire, regardless of the potential benefits of the) Tj 0 -11.7137 TD 0.2522 Tc 0 Tw (innovations.) Tj ET BT 0.9663 0 0 0.9939 378.72 375.6 Tm /F6 14 Tf 0.0259 Tc 2.4323 Tw (CASE EXAMPLES) Tj ET BT 0.9835 0 0 0.9835 334.8 357.84 Tm /F2 10 Tf 0.0199 Tc -0.0812 Tw (The ) Tj 18.5467 0 TD /F4 10 Tf 0.0443 Tc -0.1422 Tw (following ) Tj ET BT 0.9863 0 0 0.9863 399.12 357.84 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (case ) Tj ET BT 0.9835 0 0 0.9835 422.4 357.84 Tm /F4 10 Tf 0.0398 Tc -0.1376 Tw (examples ) Tj 48.075 0 TD /F2 10 Tf -0.0283 Tc 1.554 Tw (illustrate the impact) Tj -147.8856 -12.2018 TD 0.0277 Tc 4.3441 Tw (of regulations and interpretations of regulations on) Tj 0 -12.4458 TD 0.0173 Tc 2.6973 Tw (the design and operation of special care units. Some) Tj 0.244 -12.4458 TD 0.7491 Tc 3.3258 Tw (of the examples show how a combination of) Tj -0.4881 -12.2018 TD 0.0237 Tc 3.2268 Tw (regulations or a combination of cost constraints and) Tj 0.244 -11.9577 TD 0.2659 Tc 2.7364 Tw (regulations preclude the use of physical design or) Tj 0.4881 -12.4458 TD 0.0127 Tc 3.2379 Tw (other features that are not specifically prohibited by) Tj 0.244 -12.2018 TD 0.0289 Tc 2.289 Tw (any one regulation. Some of the examples also show) Tj -0.244 -11.9577 TD 0.2744 Tc 3.3612 Tw (how regulations that are probably appropriate for) Tj 0 -12.2018 TD 0.4979 Tc 3.0118 Tw (nondemented residents interfere with the use of) Tj 0 -12.4458 TD 0.0163 Tc 3.4086 Tw (design and other features that may benefit residents) Tj 0.244 -11.7137 TD 0.2167 Tc 2.8911 Tw (with dementia.) Tj ET BT 0.9795 0 0 0.9795 367.2 205.68 Tm /F7 12 Tf 0.0379 Tc 0.3904 Tw (Case Examples: Unit Design) Tj ET BT 0.8875 0 0 0.9795 336.24 187.68 Tm 0.0485 Tc -0.0819 Tw (One ) Tj ET BT 0.8915 0 0 0.9835 357.6 187.68 Tm /F4 10 Tf 0.0679 Tc 0.3725 Tw (nursing home received ) Tj ET BT 0.9126 0 0 0.9863 456.72 187.68 Tm /F3 9 Tf -0.01 Tc 0.1374 Tw (a ) Tj ET BT 0.8915 0 0 0.9835 463.68 187.68 Tm /F4 10 Tf 0.0127 Tc 3.3956 Tw (State demonstration) Tj -155.0559 -12.4458 TD 0.0415 Tc 0.2675 Tw (grant for ) Tj ET BT 0.9126 0 0 0.9863 366 175.44 Tm /F3 9 Tf -0.01 Tc 0.1374 Tw (a ) Tj ET BT 0.8915 0 0 0.9835 372.96 175.44 Tm /F4 10 Tf 0.0531 Tc 0.5237 Tw (special care unit. An ) Tj ET BT 0.9017 0 0 0.9812 463.92 175.44 Tm /F6 11 Tf 0.0051 Tc -0.0956 Tw (innovative ) Tj ET BT 0.8915 0 0 0.9835 512.64 175.44 Tm /F4 10 Tf 0.0301 Tc 1.7609 Tw (plan was) Tj ET BT 0.9835 0 0 0.9835 325.2 163.2 Tm /F2 10 Tf 0.0752 Tc -0.1375 Tw (drawn ) Tj 31.4806 0 TD /F4 10 Tf 0.0516 Tc 1.8027 Tw (up for) Tj 0 Tc -0.0972 Tw ( ) Tj 34.165 0 TD /F2 10 Tf -0 Tc 1.4032 Tw (a unit) Tj 0 Tc -0.061 Tw ( ) Tj 28.0641 0 TD /F4 10 Tf 0.0644 Tc 3.7419 Tw (composed of) Tj 0 Tc -0.0972 Tw ( ) Tj 66.6217 0 TD /F2 10 Tf 0.2176 Tc 4.3544 Tw (several discrete) Tj ET BT 0.934 0 0 0.9835 325.2 151.68 Tm /F4 10 Tf -0.0257 Tc 0.3293 Tw (modules in which six ) Tj ET BT 0.9606 0 0 0.9863 419.52 151.68 Tm /F3 9 Tf -0.0029 Tc -0.0019 Tw (to ) Tj ET BT 0.934 0 0 0.9835 429.84 151.68 Tm /F4 10 Tf -0.0412 Tc 1.1167 Tw (eight residents would share) Tj ET BT 0.9835 0 0 0.9835 325.44 139.44 Tm /F2 10 Tf -0.0498 Tc -0.0104 Tw (a ) Tj 7.8091 0 TD /F4 10 Tf 0.2824 Tc 3.0322 Tw (single sleeping) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 413.52 139.44 Tm /F3 9 Tf 0.021 Tc 3.3156 Tw (area, living) Tj 0 Tc -0.0698 Tw ( ) Tj ET BT 0.9835 0 0 0.9835 469.44 139.44 Tm /F2 10 Tf 0.2439 Tc 3.1074 Tw (room, and activity) Tj -146.1773 -11.9577 TD 0.0318 Tc 3.6369 Tw (areas. The sleeping room would have fewer square) Tj -0.244 -11.7137 TD 0.0167 Tc 4.2797 Tw (feet per resident than the traditional nursing home) Tj 0 -11.9577 TD 0.0195 Tc 2.6767 Tw (unit, but that space would be made up in the living) Tj T* 0.4898 Tc 3.9033 Tw (room and activity areas. This unit design was) Tj 0.244 -11.7137 TD 0.4946 Tc 2.8525 Tw (considered more appropriate than the traditional) Tj 0 -12.2018 TD 0.49 Tc 3.508 Tw (design for residents with dementia because the) Tj -0.244 -11.9577 TD 0.2531 Tc 2.9238 Tw (residents would interact with a smaller number of) Tj 0.7321 -11.9577 TD 0.0322 Tc 1.9501 Tw (other residents and staff members every day and thus) Tj 0 -12.2018 TD 0.0133 Tc 3.2877 Tw (would be less agitated. The unit could not be built) Tj ET endstream endobj 503 0 obj <>/Rotate 0/Type/Page>> endobj 504 0 obj <>stream 0.48 w 1 j 0 0 0 RG 59.76 683.52 m 536.88 683.52 l S BT 0.9835 0 0 0.9835 131.04 689.52 Tm 0 0 0 rg /F5 10 Tf 0.0268 Tc 1.0448 Tw (Chapter 6--Regulations That Interfere With The Design and Operation of Special Care Units . 167) Tj ET BT 0.9812 0 0 0.9812 60 650.64 Tm /F6 11 Tf 0.0357 Tc -0.0974 Tw (because ) Tj ET BT 0.9835 0 0 0.9835 98.88 650.64 Tm /F4 10 Tf 0.0369 Tc -0.1346 Tw (of regulations ) Tj ET BT 0.9863 0 0 0.9863 164.64 650.64 Tm /F3 9 Tf 0.0106 Tc -0.0805 Tw (that ) Tj ET BT 0.9835 0 0 0.9835 183.36 650.64 Tm /F4 10 Tf 0.0239 Tc -0.1215 Tw (require: 1\) ) Tj 51.0034 0 TD /F2 10 Tf 0.0523 Tc -0.1142 Tw (no more than) Tj -176.1937 -12.2018 TD 0.0449 Tc 1.7967 Tw (four residents per room, 2\) a) Tj 125.9224 -0.7321 TD 0.2826 Tc 2.7021 Tw (minimum of110 square) Tj -125.9224 -10.9816 TD 0.0183 Tc 3.364 Tw (feet of space per resident in the sleeping room \(as) Tj 0 -12.4458 TD 0.2667 Tc 2.8945 Tw (opposed to the 40 square feet per resident in the) Tj -0.244 -11.9577 TD 0.0614 Tc 3.7811 Tw (proposed design\), and 3\) bedroom doors that open) Tj 0.4881 -12.2018 TD 0.0507 Tc 2.8769 Tw (onto a main corridor \(202\).) Tj 10.9816 -18.5467 TD /F4 10 Tf 0.0475 Tc 0.2206 Tw (A hospital ) Tj 51.9796 0 TD /F2 10 Tf -0.0305 Tc -0.03 Tw (that ) Tj 17.8146 0 TD /F4 10 Tf 0.0496 Tc -0.1475 Tw (received ) Tj ET BT 0.9863 0 0 0.9863 181.92 572.88 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 189.6 572.88 Tm /F4 10 Tf 0.0351 Tc 3.0396 Tw (State demonstration) Tj -131.0471 -12.4458 TD 0.0191 Tc 0.2495 Tw (grant for ) Tj ET BT 0.9863 0 0 0.9863 105.36 560.64 Tm /F3 9 Tf 0.0458 Tc 0.4313 Tw (a special care unit ) Tj ET BT 0.9835 0 0 0.9835 188.4 560.64 Tm /F4 10 Tf 0.0517 Tc -0.1497 Tw (wanted ) Tj 38.5576 0 TD /F2 10 Tf 0.0124 Tc -0.0737 Tw (to ) Tj 10.4935 0 TD /F4 10 Tf 0.0385 Tc -0.1363 Tw (build ) Tj 27.576 0 TD /F2 10 Tf -0 Tc 0.6711 Tw (a unit) Tj -206.6982 -12.2018 TD -0 Tc 1.8913 Tw (with the) Tj 0 Tc -0.061 Tw ( ) Tj 38.8017 0 TD /F4 10 Tf 0.2688 Tc -0.3705 Tw (residents\222 ) Tj 53.1998 0 TD /F2 10 Tf 0.0402 Tc 2.7777 Tw (rooms arranged in a large loop) Tj -91.5134 -11.9577 TD 0.249 Tc 2.6549 Tw (around a central dining/activity room. This central) Tj -0.4881 -12.2018 TD 0.275 Tc 2.6923 Tw (room would not have windows. The committee of) Tj 0.244 -12.2018 TD 0.0151 Tc 3.0612 Tw (experts assembled to advise the hospital thought the) Tj 0.244 -11.9577 TD 0.0298 Tc 3.2946 Tw (lack of windows in the central room would benefit) Tj 0 -12.4458 TD -0.001 Tc 3.6615 Tw (the residents because it would allow the facility to) Tj 0 -12.2018 TD 0.0104 Tc 3.3856 Tw (maintain even light levels and reduce environmental) Tj 0.244 -11.9577 TD 0.2266 Tc 4.1012 Tw (stimulation, thus) Tj 78.3354 -0.7321 TD 0.2789 Tc 4.0481 Tw (minimizing sundowning behavior) Tj -78.0914 -11.4697 TD 0.249 Tc 2.6142 Tw (and other manifestations of resident agitation. The) Tj -0.244 -11.9577 TD 0.0132 Tc 3.4946 Tw (lack of windows in the central room violated State) Tj -0.244 -11.9577 TD 0.0303 Tc 3.4467 Tw (regulations, however. After months of meetings and) Tj 0.244 -12.4458 TD 0.2661 Tc 2.8103 Tw (hundreds of hours of architect and staff time, the) Tj 0.4881 -12.2018 TD 0.4941 Tc 3.3412 Tw (State granted a waiver for the innovation. The) Tj -0.244 -12.2018 TD 0.0213 Tc 2.6714 Tw (waiver was temporary, however, and the facility had) Tj 0.244 -11.9577 TD 0.2509 Tc 2.775 Tw (to demonstrate that the dining/activity room could) Tj -0.4881 -12.2018 TD -0.006 Tc 1.3483 Tw (be moved to an outside wall at a later date if the State) Tj 0 -11.9577 TD 0.0474 Tc 3.1852 Tw (required such a change \(201\).) Tj ET BT 0.9795 0 0 0.9795 86.88 333.84 Tm /F7 12 Tf 0.0517 Tc 0.8663 Tw (Case Example: Room Arrangement) Tj ET BT 0.9835 0 0 0.9835 72.72 316.08 Tm /F4 10 Tf 0.0127 Tc -0.0287 Tw (A nursing home ) Tj 76.8712 0 TD /F2 10 Tf -0.005 Tc -0.0559 Tw (with a ) Tj 27.088 0 TD /F4 10 Tf 0.0321 Tc -0.1298 Tw (special care ) Tj 57.1043 0 TD /F2 10 Tf 0.0182 Tc 0.0425 Tw (unit wanted to) Tj -172.2892 -11.7137 TD /F4 10 Tf 0.0529 Tc 3.5584 Tw (place the beds in 2-bed resident) Tj 0 Tc -0.0972 Tw ( ) Tj 172.2892 0 TD /F2 10 Tf 0.4977 Tc 2.6053 Tw (rooms along) Tj -172.0451 -12.4458 TD 0.2537 Tc 3.9923 Tw (opposite walls to increase residents\222 privacy and) Tj 0.244 -12.2018 TD 0.0227 Tc 3.4544 Tw (allow them equal access to the windows and door.) Tj 0 -12.2018 TD 0.0125 Tc 3.1292 Tw (State regulations require that each bed must have 3) Tj -0.244 -12.2018 TD 0.0104 Tc 1.7383 Tw (feet of space on either side and 4 feet of space at the) Tj 0.244 -12.2018 TD 0.2653 Tc 2.9332 Tw (foot. \(The reasons for this requirement are: 1\) to) Tj 0.244 -12.2018 TD 0.4762 Tc 3.952 Tw (assure that beds are accessible to residents in) Tj -0.244 -12.2018 TD 0.006 Tc 2.1902 Tw (wheelchairs; and 2\) to assure that beds are accessible) Tj 0 -12.4458 TD 0.0125 Tc 1.9599 Tw (to staff and equipment on all three sides.\) Because of) Tj 0.244 -12.2018 TD 0.0098 Tc 2.6134 Tw (these State regulations, the beds could not be placed) Tj 0.244 -11.9577 TD 0.013 Tc 3.2446 Tw (along the walls and instead had to jut out into the) Tj -0.7321 -12.2018 TD 0.0329 Tc 2.7797 Tw (room. To allow for two beds, each jutting out from) Tj 0.7321 -12.2018 TD 0.0088 Tc 2.0349 Tw (opposite walls with a 4-foot space between their feet,) Tj 0 -12.2018 TD 0.0367 Tc 1.5286 Tw (the rooms would have to be wider and shallower than) Tj T* 0.5021 Tc 2.7534 Tw (the typical nursing home room. This was not a) Tj -0.244 -11.9577 TD 0.0221 Tc 2.1433 Tw (problem in itself, but wider rooms, one after another,) Tj -0.244 -12.2018 TD 0.5079 Tc 2.717 Tw (require longer corridors. The NFPA Life Safety) Tj 0.7321 -12.4458 TD 0.0347 Tc 2.7712 Tw (Code requires that nursing home corridors be 8 feet) Tj -0.244 -11.9577 TD 0.0213 Tc 3.5473 Tw (wide. \(The reason for this requirement is to assure) Tj 0 -12.4458 TD 0.2426 Tc 3.6701 Tw (that in the event of a fire when, it is assumed,) Tj -0.244 -11.7137 TD 0.0069 Tc 3.8017 Tw (residents will be evacuated on stretchers, the corri-) Tj 0.244 -12.4458 TD 0.5041 Tc 3.052 Tw (dors will be wide enough to accommodate two) Tj 0.244 -11.7137 TD 0.2692 Tc 3.9184 Tw (stretchers side by side.\) Even though the rooms) Tj 10.7376 -26.1118 TD 0.1126 Tc 1.8377 Tw (328-405 - 92 - 7) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9598 0 0 0.9598 150.96 15.36 Tm /F3 6 Tf 0.0827 Tc -0.0042 Tw (QL ) Tj ET BT 0.99 0 0 0.99 162.24 15.36 Tm /F7 8 Tf 0.1206 Tc 0 Tw (3) Tj ET BT 0.934 0 0 0.9835 311.04 649.68 Tm /F4 10 Tf -0.0165 Tc 0.503 Tw (would have the same square footage, each ) Tj ET BT 0.9606 0 0 0.9863 498 649.68 Tm /F3 9 Tf -0.0051 Tc 0.0005 Tw (extra foot) Tj ET BT 0.9835 0 0 0.9835 311.04 637.68 Tm /F2 10 Tf 0.035 Tc 2.0997 Tw (of room width would require 8 additional square feet) Tj 0 -11.9577 TD 0.0194 Tc 3.4713 Tw (of corridor space. Because of the cost of the extra) Tj 0 -12.2018 TD 0.4947 Tc 2.9222 Tw (corridor space, the facility had to abandon this) Tj T* 0.054 Tc 5.9849 Tw (innovation \(201\).) Tj ET BT 0.9795 0 0 0.9795 340.32 581.52 Tm /F7 12 Tf 0.0517 Tc 0.7438 Tw (Case Examples: Keypad-Operated) Tj 43.3706 -14.4569 TD 0.041 Tc 0.3872 Tw (Locking Systems) Tj -61.748 -18.3774 TD -0.0303 Tc -0.0301 Tw (One ) Tj ET BT 0.9835 0 0 0.9835 346.32 549.36 Tm /F4 10 Tf 0.0316 Tc 1.823 Tw (nursing home remodeled) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 467.76 549.36 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 475.44 549.36 Tm /F4 10 Tf 0.0782 Tc -0.1767 Tw (41-bed ) Tj 35.3852 0 TD /F2 10 Tf 0.0124 Tc 1.1465 Tw (unit to) Tj -202.3056 -11.7137 TD -0.0238 Tc 2.7696 Tw (create a special care unit.) Tj 0 Tc -0.061 Tw ( ) Tj 116.649 0 TD /F4 10 Tf 0.2898 Tc 3.7567 Tw (After considerable) Tj 0 Tc -0.0972 Tw ( ) Tj 100.0546 0 TD /F2 10 Tf 0.5279 Tc 0 Tw (re-) Tj -216.2156 -12.4458 TD /F4 10 Tf 0.0295 Tc 0.8141 Tw (search, the staff decided the best locking system) Tj -0.4881 -12.2018 TD 0.0629 Tc 0.2049 Tw (would be ) Tj 45.8787 0 TD /F2 10 Tf 0.0211 Tc 0.2429 Tw (one with a ) Tj 45.8787 0 TD /F4 10 Tf 0.0521 Tc 1.07 Tw (keypad and) Tj 0 Tc -0.0972 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 459.6 513.6 Tm /F3 9 Tf 0.1038 Tc -0.175 Tw (a ) Tj ET BT 0.9835 0 0 0.9835 467.28 513.6 Tm /F4 10 Tf 0.0358 Tc 2.7949 Tw (4-number code) Tj -158.3791 -11.9577 TD 0.0206 Tc 0.3699 Tw (which staff ) Tj 55.8842 0 TD /F2 10 Tf 0.0342 Tc 0.8454 Tw (members could use to open the exit doors) Tj -56.1282 -12.4458 TD 0.0341 Tc 3.0462 Tw (but which the residents probably would not be able) Tj 0.4881 -12.2018 TD 0.0198 Tc 1.9626 Tw (to use. The doors would automatically unlock in case) Tj 0 -11.9577 TD 0.0202 Tc 2.6028 Tw (of fire. The facility received approval for use of the) Tj -0.244 -12.2018 TD 0.5025 Tc 3.9671 Tw (keypad-operated locking system from the local) Tj 0.244 -12.2018 TD 0.2477 Tc 2.9641 Tw (building inspector, the local fire marshal, and the) Tj 0.244 -12.2018 TD 0.4998 Tc 2.6032 Tw (State official responsible for approving physical) Tj -0.4881 -12.2018 TD 0.0301 Tc 2.2674 Tw (plans for all nursing homes. The system had been in) Tj 0.244 -11.9577 TD 0.0177 Tc 3.0121 Tw (place for several months when the unit had its first) Tj 0.7321 -12.2018 TD 0.0248 Tc 3.5201 Tw (survey. The survey went well, but the next day, a) Tj 0 -12.2018 TD 0.0219 Tc 3.2286 Tw (senior official from the State survey agency arrived) Tj -0.244 -11.9577 TD 0.0209 Tc 3.1309 Tw (to examine the keypad-operated locking system. His) Tj 0.244 -11.9577 TD 0.2516 Tc 3.5063 Tw (assessment, expressed in no uncertain terms, was) Tj 0 -12.2018 TD 0.0146 Tc 3.2012 Tw (that the keypad locking system constituted a locked) Tj -0.244 -12.2018 TD 0.2539 Tc 3.1889 Tw (unit and was not allowable. Only when the local) Tj 0 -11.9577 TD 0.0136 Tc 4.8059 Tw (Alzheimer\222s Association chapter intervened did the) Tj 0.4881 -12.2018 TD 0.2599 Tc 2.9517 Tw (survey agency agree to allow this locking system) Tj 0.244 -11.9577 TD 0.079 Tc 0 Tw (\(201\).) Tj 10.4935 -18.3027 TD 0.0299 Tc 3.9177 Tw (In 1991, the Texas Department of Health began) Tj -10.9816 -12.2018 TD 0.5036 Tc 3.5755 Tw (disallowing keypad-operated locking systems in) Tj 0 -12.2018 TD 0.4972 Tc 3.1346 Tw (Texas nursing homes and other residential care) Tj 0.244 -12.2018 TD 0.4872 Tc 3.9408 Tw (facilities \(78\). This decision was based on an) Tj 0 -11.9577 TD 0.2515 Tc 3.2043 Tw (interpretation of the Life Safety Code which was) Tj 0.244 -12.6899 TD 0.0268 Tc 3.0493 Tw (apparently endorsed by the Dallas regional office of) Tj 0 -12.2018 TD 0.4834 Tc 3.1079 Tw (the Health Care Financing Administration, even) Tj 0.244 -11.9577 TD 0.2774 Tc 4.684 Tw (though keypad-operated locking systems are ap-) Tj -0.7321 -12.2018 TD 0.0479 Tc 1.7449 Tw (proved for use in other parts of the country and were) Tj 0.7321 -12.2018 TD 0.0198 Tc 3.498 Tw (allowed previously in Texas.) Tj ET BT 0.9795 0 0 0.9795 355.68 153.12 Tm /F7 12 Tf 0.0368 Tc 0.5549 Tw (Case Example: Dutch Doors) Tj ET BT 0.934 0 0 0.9835 324 135.36 Tm /F4 10 Tf -0.0391 Tc 1.4572 Tw (A nursing home decided) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 435.36 135.36 Tm /F3 9 Tf -0.0051 Tc 0.1253 Tw (to install ) Tj ET BT 0.934 0 0 0.9835 473.76 135.36 Tm /F4 10 Tf -0.0444 Tc 1.7626 Tw (clutch doors in) Tj ET BT 0.9835 0 0 0.9835 313.2 123.84 Tm /F2 10 Tf 0.2244 Tc 2.7612 Tw (its new special care unit. The certificate) Tj 0 Tc -0.061 Tw ( ) Tj 190.5918 0 TD /F4 10 Tf 0.4987 Tc 3.0563 Tw (of need) Tj ET BT 0.8915 0 0 0.9835 313.44 111.6 Tm 0.039 Tc 1.4144 Tw (application for the unit included) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9606 0 0 0.9863 456.48 111.6 Tm /F3 9 Tf -0.0097 Tc 0.0053 Tw (a ) Tj ET BT 0.8915 0 0 0.9835 463.44 111.6 Tm /F4 10 Tf 0.0275 Tc 2.033 Tw (description of the) Tj -168.2465 -12.2018 TD 0.0336 Tc 0.5725 Tw (clutch doors, and the additional ) Tj ET BT 0.9126 0 0 0.9863 450.96 99.6 Tm /F3 9 Tf -0.0262 Tc 0.1553 Tw (cost ) Tj ET BT 0.8915 0 0 0.9835 470.4 99.6 Tm /F4 10 Tf 0.0262 Tc 0.6884 Tw (of the doors was) Tj ET BT 0.934 0 0 0.9835 313.44 87.84 Tm -0.0344 Tc 1.4522 Tw (approved as part of the facility\222s Medicaid) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9388 0 0 0.9835 504.96 87.84 Tm /F2 10 Tf -0.0101 Tc 1.0883 Tw (rate. The) Tj ET BT 0.9835 0 0 0.9835 313.68 75.6 Tm 0.0202 Tc 2.1147 Tw (State project engineer approved the clutch doors after) Tj -0.4881 -11.9577 TD 0.0239 Tc 5.4054 Tw (lengthy negotiations, meetings, and correspondence) Tj 0 -12.2018 TD 0.022 Tc 3.3331 Tw (but required additional latches which could be used) Tj 0.244 -12.2018 TD 0.2552 Tc 3.0611 Tw (to attach the top and bottom doors. Nevertheless,) Tj ET endstream endobj 505 0 obj <>/Rotate 0/Type/Page>> endobj 506 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72.48 677.28 m 550.08 677.28 l S BT 0.9835 0 0 0.9835 72.96 682.56 Tm 0 0 0 rg /F5 10 Tf 0.0167 Tc 0.9869 Tw (168 . Special Care Units for People With Alzheimer\222s and Other Dementias) Tj ET BT 0.934 0 0 0.9835 73.2 643.68 Tm /F4 10 Tf -0.025 Tc 0.7461 Tw (when the State surveyors came for the final inspec-) Tj ET BT 0.9835 0 0 0.9835 73.44 631.44 Tm /F2 10 Tf 0.2593 Tc 3.8239 Tw (tion before the unit opened, they disallowed the) Tj 0 -11.9577 TD 0.0149 Tc 2.7607 Tw (doors on the basis that they constituted \221restraints. \222) Tj 0 -11.7137 TD 0.0152 Tc 2.4684 Tw (The doors continued to be disallowed despite facility) Tj 0.244 -11.9577 TD 0.0156 Tc 2.991 Tw (guidelines that described the rationale for the doors,) Tj -0.244 -11.9577 TD 0.0321 Tc 2.7127 Tw (how they would be used to protect resident privacy,) Tj 0.7321 -12.4458 TD 0.0083 Tc 3.5301 Tw (and how they fit with the facility\222s restraint policy) Tj 0 -11.9577 TD 0.2824 Tc 0 Tw (\(201\).) Tj ET BT 0.9795 0 0 0.9795 106.08 539.04 Tm /F7 12 Tf 0.055 Tc 0.3729 Tw (Case Example: Dietary Practices) Tj -21.5628 -17.8873 TD 0.0055 Tc -0.0666 Tw (The ) Tj ET BT 0.9835 0 0 0.9835 108 521.52 Tm /F4 10 Tf 0.0632 Tc 0.3267 Tw (staff of ) Tj 37.0934 0 TD /F2 10 Tf 0.0647 Tc -0.1268 Tw (one ) Tj 18.0586 0 TD /F4 10 Tf 0.0321 Tc 1.5785 Tw (special care) Tj 0 Tc -0.0972 Tw ( ) Tj 60.2768 0 TD /F2 10 Tf 0.0021 Tc 1.401 Tw (unit wanted to seat) Tj ET BT 0.9388 0 0 0.9835 74.64 509.52 Tm -0.0416 Tc 0.0994 Tw (small ) Tj ET BT 0.934 0 0 0.9835 97.68 509.52 Tm /F4 10 Tf -0.044 Tc 1.8907 Tw (groups of special care unit residents together) Tj ET BT 0.9835 0 0 0.9835 74.64 497.52 Tm /F2 10 Tf -0.0735 Tc 0.0137 Tw (at ) Tj 10.2495 0 TD /F4 10 Tf 0.0207 Tc -0.1182 Tw (meal ) Tj ET BT 0.9863 0 0 0.9863 111.6 497.52 Tm /F3 9 Tf 0.017 Tc -0.087 Tw (times ) Tj ET BT 0.9835 0 0 0.9835 139.2 497.52 Tm /F4 10 Tf 0.0847 Tc 1.2809 Tw (and feed) Tj 0 Tc -0.0972 Tw ( ) Tj 45.6347 0 TD /F2 10 Tf -0.0037 Tc 2.0781 Tw (them family style. The staff) Tj -111.2803 -12.2018 TD 0.0034 Tc 2.6199 Tw (also wanted to serve some meals that) Tj 0 Tc -0.061 Tw ( ) Tj 169.6048 0 TD /F4 10 Tf 0.2712 Tc 4.0197 Tw (consisted of) Tj ET BT 0.934 0 0 0.9835 74.64 473.52 Tm -0.0283 Tc 0.0751 Tw (only ) Tj ET BT 0.9388 0 0 0.9835 96.48 473.52 Tm /F2 10 Tf 0.0249 Tc 0.0286 Tw (two ) Tj ET BT 0.934 0 0 0.9835 113.52 473.52 Tm /F4 10 Tf -0.0409 Tc 2.1443 Tw (foods because they believed) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9388 0 0 0.9835 241.68 473.52 Tm /F2 10 Tf 0.0284 Tc 0.0248 Tw (this ) Tj ET BT 0.934 0 0 0.9835 258 473.52 Tm /F4 10 Tf 0.1976 Tc 0 Tw (approach) Tj ET BT 0.9835 0 0 0.9835 74.64 461.52 Tm 0.0446 Tc 2.0539 Tw (would reduce resident) Tj 0 Tc -0.0972 Tw ( ) Tj 112.2564 0 TD /F2 10 Tf 0.0433 Tc 2.3353 Tw (confusion. They planned to) Tj -112.2564 -11.9577 TD 0.2449 Tc 4.229 Tw (meet the residents\222 additional nutritional require-) Tj 0.244 -12.2018 TD 0.0222 Tc 3.2283 Tw (ments with snacks. These plans were questioned by) Tj 0.4881 -12.2018 TD 0.2577 Tc 3.0934 Tw (surveyors who cited State regulations that require) Tj 0.244 -12.2018 TD -0.0055 Tc 3.9033 Tw (\223at least three meals a day that are nutritious and) Tj 0 -11.7137 TD 0.0128 Tc 2.4578 Tw (suited to special needs of patients and residents\222 and) Tj 0.244 -12.4458 TD 0.4869 Tc 2.779 Tw (\223trays...large enough to accommodate all of the) Tj -0.7321 -11.9577 TD 0.0184 Tc 3.4065 Tw (dishes necessary for a complete meal, arranged and) Tj 0.4881 -12.2018 TD 0.2466 Tc 3.4707 Tw (served attractively\224 \(201\).) Tj ET BT 0.9795 0 0 0.9795 130.08 344.88 Tm /F7 12 Tf 0.0327 Tc 0.5181 Tw (Case Example: Staffing) Tj ET BT 0.9835 0 0 0.9835 86.64 327.12 Tm /F4 10 Tf 0.0416 Tc 2.0568 Tw (Several special) Tj 0 Tc -0.0972 Tw ( ) Tj 76.8712 0 TD /F2 10 Tf 0.0124 Tc -0.0737 Tw (unit ) Tj 19.0348 0 TD /F4 10 Tf 0.0447 Tc 3.3959 Tw (operators interviewed by) Tj -106.8876 -12.4458 TD 0.2345 Tc -0.3356 Tw (OTA\222s ) Tj 35.6292 0 TD /F2 10 Tf 0.2523 Tc 3.953 Tw (contractor complained about State regula-) Tj -35.8732 -12.4458 TD 0.0221 Tc 2.4484 Tw (tions that require specific types and numbers of staff) Tj 0 -12.2018 TD 0.2641 Tc 2.9954 Tw (members. One unit operator said, \223I am not con-) Tj 0 -11.7137 TD 0.0285 Tc 2.0758 Tw (vinced you need separate people to do recreation and) Tj 0.244 -12.2018 TD 0.0145 Tc 2.267 Tw (nursing. Each person has a piece of the patient. It is) Tj 0 -12.2018 TD 0.0004 Tc 2.3789 Tw (not as holistic as it could be. \222) Tj 140.5645 -0.7321 TD 0.031 Tc 4.1781 Tw (Other unit operators) Tj -140.8086 -11.4697 TD 0.4991 Tc 3.9461 Tw (pointed out the value of occupational therapy,) Tj 0 -11.7137 TD 0.0081 Tc 3.5913 Tw (recreational therapy, and other therapies in the care) Tj 0.7321 -12.4458 TD 0.4881 Tc 3.4692 Tw (of residents with dementia. If cost were not a) Tj 0 -11.9577 TD 0.0095 Tc 2.9972 Tw (determining factor, a special care unit could employ) Tj 0 -12.2018 TD 0.5155 Tc 3.3194 Tw (the number and types of staff required by the) Tj -0.244 -11.9577 TD 0.2544 Tc 3.0154 Tw (regulations plus additional staff members of these) Tj 0.244 -12.4458 TD 0.248 Tc 2.7198 Tw (other types. Given cost constraints, this is usually) Tj 0 -11.9577 TD 0.0452 Tc 3.9196 Tw (not possible \(201\).) Tj ET BT 0.9663 0 0 0.9939 113.76 136.56 Tm /F6 14 Tf 0.0352 Tc 2.0501 Tw (METHODS TO ALLOW) Tj -24.3404 -15.4547 TD 0.0494 Tc 0.9178 Tw (INNOVATION IN THE DESIGN) Tj -2.4837 -15.6962 TD 0.0302 Tc 1.4344 Tw (AND OPERATION OF SPECIAL) Tj 62.0929 -16.1791 TD 0.0519 Tc 0.9151 Tw (CARE UNITS) Tj ET BT 0.9835 0 0 0.9835 87.84 72.24 Tm /F4 10 Tf 0.0371 Tc 2.8546 Tw (As discussed in the preceding) Tj 0 Tc -0.0972 Tw ( ) Tj 154.7186 0 TD /F2 10 Tf 0.227 Tc 2.8806 Tw (sections, some) Tj -165.9442 -12.2018 TD 0.0125 Tc 3.2207 Tw (Federal, State, and local government regulations and) Tj 0.244 -12.2018 TD 0.0208 Tc 4.0664 Tw (standards interfere with the use of physical design) Tj 0 -11.9577 TD 0.0056 Tc 3.3498 Tw (features, patient care practices, and staffing arrange-) Tj 251.1127 617.6542 TD 0.2479 Tc 3.5915 Tw (ments that special care unit operators and others) Tj 0 -12.4458 TD 0.0244 Tc 4.272 Tw (consider appropriate for the care of residents with) Tj 0 -11.9577 TD 0.0192 Tc 4.605 Tw (dementia. Interpretations of regulations and combi-) Tj T* 0.2577 Tc 3.5001 Tw (nations of regulations, cost constraints, and other) Tj 0.244 -12.2018 TD 0.0076 Tc 3.2257 Tw (factors also interfere with the use of these features.) Tj 0 -11.9577 TD -0.0013 Tc 2.5201 Tw (As a result, potentially effective design features, care) Tj 0 -12.2018 TD 0.4922 Tc 4.4656 Tw (practices, and staffing arrangements cannot be) Tj 0.4881 -12.4458 TD 0.2444 Tc 3.534 Tw (implemented and evaluated. Several commentators) Tj 0 -11.9577 TD 0.0152 Tc 2.1503 Tw (have pointed out that despite the diversity of existing) Tj 0.4881 -12.4458 TD 0.2257 Tc 3.7055 Tw (special care units, all the variation is within the) Tj -0.244 -11.7137 TD 0.0307 Tc 3.373 Tw (limited framework of existing regulations \(200,273\).) Tj 11.4697 -20.499 TD 0.0275 Tc 2.9788 Tw (One possible approach to allow innovation in the) Tj -11.2256 -11.7137 TD 0.4918 Tc 2.6418 Tw (design and operation of special care units is to) Tj 0 -12.4458 TD 0.016 Tc 2.7117 Tw (eliminate regulations and standards that are found to) Tj -0.4881 -12.2018 TD 0.256 Tc 3.7459 Tw (restrict innovative physical design and other fea-) Tj 0.7321 -12.2018 TD 0.265 Tc 3.8588 Tw (tures. Although this approach may eventually be) Tj 0 -12.2018 TD 0.0135 Tc 4.4806 Tw (appropriate, lack of agreement about the particular) Tj 0 -12.4458 TD 0.0004 Tc 2.5687 Tw (features that are necessary in a special care unit and) Tj 0.244 -11.7137 TD 0.0172 Tc 2.9719 Tw (lack of research-based evidence for the effectiveness) Tj 0 -12.4458 TD 0.2388 Tc 3.3974 Tw (of particular features make decisions to eliminate) Tj 0 -11.9577 TD 0.4943 Tc 3.6338 Tw (existing regulations and standards premature at) Tj -0.244 -11.9577 TD 0.2239 Tc 0 Tw (present.) Tj 11.7137 -20.499 TD 0.4906 Tc 4.1988 Tw (It is possible some existing regulations and) Tj -10.7376 -12.2018 TD 0.2533 Tc 4.2367 Tw (standards should be eliminated because they are) Tj -0.244 -12.2018 TD 0.2699 Tc 3.0322 Tw (inappropriate for all nursing homes\227for example,) Tj -0.244 -12.4458 TD 0.016 Tc 3.7459 Tw (regulations that were adopted directly from hospital) Tj 0 -12.2018 TD 0.0361 Tc 3.1154 Tw (regulations without regard for the different purposes) Tj 0.4881 -12.4458 TD 0.0325 Tc 2.5598 Tw (and clients of hospitals and nursing homes. Some of) Tj 0 -12.4458 TD 0.4971 Tc 4.1109 Tw (the regulations and standards discussed in the) Tj -0.244 -11.7137 TD 0.0165 Tc 2.4236 Tw (preceding sections may be in that category, but most) Tj 0 -11.9577 TD 0.0412 Tc 3.3136 Tw (probably are not.) Tj 11.4697 -20.499 TD 0.489 Tc 3.997 Tw (As noted earlier, fire safety regulations and) Tj -10.7376 -11.9577 TD 0.0069 Tc 2.8604 Tw (interpretations of these regulations are often cited as) Tj 0 -11.9577 TD 0.4905 Tc 4.2396 Tw (limiting the use of innovative physical design) Tj 0 -12.2018 TD 0.0036 Tc 2.7243 Tw (features in special care units. The preceding sections) Tj T* 0.4908 Tc 3.1411 Tw (have noted several innovative design ideas that) Tj T* 0.256 Tc 3.6879 Tw (could not be implemented because of fire safety) Tj 0 -11.9577 TD 0.0048 Tc 3.9781 Tw (requirements of the Life Safety Code. Special care) Tj 0 -12.4458 TD 0.0349 Tc 3.3199 Tw (unit operators and others whose ideas could not be) Tj 0.4881 -11.7137 TD 0.2496 Tc 3.5409 Tw (implemented because of these requirements might) Tj 0.244 -12.4458 TD 0.015 Tc 2.4338 Tw (argue that the requirements should be eliminated. On) Tj 0 -11.9577 TD 0.2652 Tc 3.2994 Tw (the other hand, it is OTA\222s impression based on) Tj 0 -11.4697 TD 0.2503 Tc 3.8738 Tw (informal discussions with many special care unit) Tj 0 -12.2018 TD 0.2451 Tc 2.7809 Tw (operators and experts in specialized dementia care) Tj 0 -11.9577 TD 0.0104 Tc 2.667 Tw (that there are few, if any, Life Safety Code require-) Tj -0.244 -11.7137 TD 0.4812 Tc 3.1102 Tw (ments that all these individuals would agree to) Tj 0.244 -12.4458 TD -0.0144 Tc 2.9362 Tw (eliminate. In fact, at a recent meeting of the patient) Tj 0 -12.2018 TD 0.2441 Tc 2.6192 Tw (care and public policy committees of the National) Tj 0 -11.9577 TD 0.2549 Tc 3.8894 Tw (Alzheimer\222s Association, some Alzheimer\222s advo-) Tj 0 -12.2018 TD 0.0172 Tc 4.2096 Tw (cates argued that fire safety precautions should be) Tj ET endstream endobj 507 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 508 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.48 686.64 m 537.84 686.64 l S BT 0.9835 0 0 0.9835 131.76 691.92 Tm 0 0 0 rg /F5 10 Tf 0.026 Tc 1.2547 Tw (Chapter 6-Regulations That Interfere With The Design and Operation of Special Care Units . 169) Tj -71.9905 -39.7778 TD /F4 10 Tf 0.0356 Tc -0.1333 Tw (increased ) Tj 49.5392 0 TD /F2 10 Tf 0.0095 Tc 1.5155 Tw (rather than decreased for special care units) Tj -49.2952 -11.9577 TD 0.0704 Tc 0 Tw (\(21\).) Tj 10.9816 -20.255 TD 0.2323 Tc 3.8514 Tw (Rather than attempting to eliminate regulations) Tj -10.7376 -11.9577 TD 0.2578 Tc 4.0346 Tw (and standards that interfere with the design and) Tj -0.244 -12.4458 TD 0.009 Tc 2.7188 Tw (operation of special care units, an alternate approach) Tj 0.244 -12.4458 TD 0.0181 Tc 2.9303 Tw (to allow innovation is to create a process by which) Tj 0 -12.4458 TD 0.0097 Tc 3.0668 Tw (individual special care units could obtain waivers to) Tj 0 -12.2018 TD 0.4768 Tc 2.8707 Tw (implement physical design features, patient care) Tj 0 -11.9577 TD 0.2479 Tc 4.5676 Tw (practices, and staffing arrangements they believe) Tj 0.4881 -12.2018 TD 0.0052 Tc 3.1061 Tw (will benefit residents with dementia. Such a process) Tj 0 -12.2018 TD 0.2662 Tc 3.2475 Tw (would have to include mechanisms for protecting) Tj T* 0.2586 Tc 2.9531 Tw (residents\222 rights in units in which innovative fea-) Tj 0.244 -12.4458 TD 0.0239 Tc 4.3073 Tw (tures were being implemented. The process should) Tj 0.244 -11.7137 TD 0.0198 Tc 3.7421 Tw (also include mechanisms for evaluating the innova-) Tj 0 -12.4458 TD 0.2035 Tc 0 Tw (tions.) Tj 11.2256 -20.499 TD 0.0135 Tc 3.0977 Tw (Most existing regulatory codes, including the Life) Tj -10.7376 -11.9577 TD 0.0331 Tc 4.054 Tw (Safety Code, have provisions for granting waivers.) Tj -0.244 -11.9577 TD -0.0014 Tc 2.1367 Tw (In at least some States, however, the waivers that are) Tj 0.4881 -12.4458 TD 0.0183 Tc 2.7573 Tw (granted are for relatively trivial changes. A study of) Tj 0 -11.9577 TD 0.0158 Tc 3.014 Tw (waivers granted by the Massachusetts Department of) Tj -0.244 -11.9577 TD 0.0472 Tc 2.3924 Tw (Public Health between 1985 and 1987 found that 98) Tj 0.244 -12.2018 TD 0.0145 Tc 3.9915 Tw (waivers were granted for physical characteristics of) Tj 0.244 -11.7137 TD 0.0136 Tc 2.4875 Tw (the facilities \(200\). Almost half of these waivers \(43) Tj -0.244 -12.2018 TD 0.0113 Tc 3.6795 Tw (percent\) were to allow the use of mobile medicine) Tj 0.4881 -11.9577 TD 0.2272 Tc 3.3685 Tw (carts. The remainin) Tj 89.073 -0.244 TD 0.0338 Tc 4.1142 Tw (g waivers were for exemptions) Tj -89.073 -11.9577 TD 0.5045 Tc 3.0865 Tw (from the paper towel requirement \(16 percent\),) Tj 0.244 -11.9577 TD 0.0401 Tc 3.1621 Tw (changes in tub design \(9 percent\), number of baths) Tj -0.4881 -12.4458 TD 0.2583 Tc 4.1387 Tw (per resident \(9 percent\), minor variations in the) Tj 0.4881 -11.9577 TD 0.0306 Tc 2.5573 Tw (dimensions of various spaces \(7 percent\), changes in) Tj 0 -12.2018 TD 0.5074 Tc 3.2971 Tw (the number of residents on a unit \(6 percent\),) Tj 0.244 -12.2018 TD 0.0257 Tc 3.5734 Tw (furniture specifications \(4 percent\), and other minor) Tj 0 -11.9577 TD 0.0252 Tc 3.7366 Tw (modifications \(5 percent\). No waivers were granted) Tj 0.244 -12.2018 TD 0.0263 Tc 4.3048 Tw (for innovative design features.) Tj 11.2256 -20.255 TD 0.275 Tc 4.052 Tw (The purpose of creating a waiver process for) Tj -10.7376 -11.9577 TD 0.0031 Tc 2.2846 Tw (special care units would be to allow the implementa-) Tj -0.244 -12.2018 TD 0.0206 Tc 3.9853 Tw (tion and evaluation of nontrivial innovations. Since) Tj 0.244 -11.9577 TD 0.0389 Tc 2.5838 Tw (such innovations would change the care of individu-) Tj 0.244 -12.2018 TD 0.239 Tc 2.6243 Tw (als with dementia in significant ways, the waivers) Tj 0.244 -12.2018 TD 0.0222 Tc 2.7403 Tw (should only be granted on a facility-by-facility basis) Tj 0 -11.9577 TD 0.018 Tc 3.1203 Tw (after careful prior review by a panel of health care) Tj -0.4881 -12.2018 TD 0.2617 Tc 2.7843 Tw (professionals, Alzheimer\222s advocates, industry rep-) Tj 0 -12.4458 TD 0.244 Tc 3.1684 Tw (resentatives, architects, designers, lawyers, survey-) Tj 0.7321 -12.2018 TD 0.0195 Tc 2.4292 Tw (ors, fire marshals, and building inspectors. The panel) Tj 0 -12.2018 TD 0.0313 Tc 3.8117 Tw (would have to determin) Tj 107.6197 0 TD 0.0518 Tc 2.9977 Tw (e whether a proposed inno-) Tj -107.6197 -12.2018 TD 0.0231 Tc 3.9828 Tw (vation was worth evaluating and whether sufficient) Tj 0.4881 -11.7137 TD 0.0266 Tc 2.0472 Tw (safeguards had been built into the proposal to protect) Tj -0.4881 -12.2018 TD 0.0204 Tc 3.0906 Tw (residents of the unit. The panel would also have to) Tj 0 -12.2018 TD 0.2827 Tc 3.8002 Tw (monitor the waivered innovations on an ongoing) Tj 0.244 -11.7137 TD 0.2551 Tc 3.9197 Tw (basis to assure the safety and well-being of the) Tj 0 -11.9577 TD 0.0221 Tc 3.0889 Tw (residents. Although such panels could be established) Tj ET BT 0.9388 0 0 0.9835 311.76 653.04 Tm 0.0115 Tc 0.1706 Tw (at any ) Tj ET BT 0.934 0 0 0.9835 337.68 653.04 Tm /F4 10 Tf -0.0304 Tc 1.9189 Tw (level of government, they probably would be) Tj ET BT 0.9835 0 0 0.9835 311.52 641.04 Tm /F2 10 Tf 0.0155 Tc -0.0768 Tw (most ) Tj 23.4274 0 TD /F4 10 Tf 0.0488 Tc -0.1468 Tw (appropriately ) Tj 70.5263 0 TD /F2 10 Tf -0.0449 Tc -0.0154 Tw (set ) Tj 14.1541 0 TD /F4 10 Tf 0.0506 Tc -0.1486 Tw (up ) Tj 15.6183 0 TD /F2 10 Tf -0.0344 Tc 0.34 Tw (at the ) Tj 25.6237 0 TD /F4 10 Tf 0.0402 Tc 2.4243 Tw (State level since) Tj ET BT 0.8915 0 0 0.9835 311.76 629.28 Tm 0.0429 Tc 1.4389 Tw (States have the dominant role in regulating nursing) Tj ET BT 0.934 0 0 0.9835 311.52 617.28 Tm -0.0088 Tc 0 Tw (homes.) Tj ET BT 0.8915 0 0 0.9835 322.8 597.12 Tm 0.0175 Tc 1.2366 Tw (In addition) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.9126 0 0 0.9863 373.44 597.12 Tm /F3 9 Tf -0.0425 Tc 0.1731 Tw (to ) Tj ET BT 0.8915 0 0 0.9835 383.52 597.12 Tm /F4 10 Tf 0.064 Tc -0.1615 Tw (creating ) Tj ET BT 0.8919 0 0 0.9835 421.44 597.12 Tm /F2 10 Tf 0.1317 Tc -0.2275 Tw (a ) Tj ET BT 0.8915 0 0 0.9835 427.68 597.12 Tm /F4 10 Tf 0.0531 Tc 1.3761 Tw (waiver process for special) Tj ET BT 0.9835 0 0 0.9835 312 584.88 Tm 0.018 Tc -0.1155 Tw (care ) Tj 22.2072 0 TD /F2 10 Tf 0.0086 Tc -0.0698 Tw (units, several other ) Tj 78.3354 0 TD /F4 10 Tf 0.0503 Tc -0.1483 Tw (approaches could be used ) Tj ET BT 0.9863 0 0 0.9863 529.44 584.88 Tm /F3 9 Tf 0.0085 Tc 0 Tw (to) Tj -219.9693 -12.4098 TD 0.0222 Tc -0.0923 Tw (allow ) Tj ET BT 0.9835 0 0 0.9835 339.36 572.64 Tm /F2 10 Tf 0.0184 Tc 2.6454 Tw (innovation in special care units. One approach) Tj -27.576 -12.2018 TD 0.038 Tc 2.7475 Tw (would be to encourage government officials, survey-) Tj 0.244 -11.9577 TD 0.2613 Tc 3.9265 Tw (ors, fire marshals, and building inspectors to be) Tj 0.4881 -12.4458 TD 0.2622 Tc 3.3329 Tw (supportive of innovations. As noted earlier, these) Tj -0.4881 -11.7137 TD 0.0162 Tc 3.0601 Tw (individuals tend to be conservative in their interpre-) Tj 0.244 -12.4458 TD 0.2608 Tc 2.8869 Tw (tations of regulations and standards. Training ma-) Tj 0 -12.4458 TD 0.0225 Tc 2.1124 Tw (terials and programs could be created to inform them) Tj 0.4881 -11.9577 TD 0.2588 Tc 3.8651 Tw (about nursing home residents with dementia, the) Tj -0.4881 -11.9577 TD 0.033 Tc 3.9494 Tw (need to develop more appropriate methods of care) Tj 0.4881 -12.4458 TD 0.4878 Tc 3.1577 Tw (for them, and the role of special care units in) Tj 0 -12.2018 TD 0.03 Tc 3.3947 Tw (developing those methods of care. A training effort) Tj T* 0.0236 Tc 2.7946 Tw (of this kind would be essential for the success of a) Tj 0.244 -12.2018 TD 0.022 Tc 4.0652 Tw (waiver process for special care units because gov-) Tj 0 -11.9577 TD 0.4952 Tc 3.5841 Tw (ernment officials, surveyors, fire marshals, and) Tj 0 -12.2018 TD 0.5136 Tc 3.606 Tw (building inspectors would have to approve the) Tj 0.4881 -11.9577 TD 0.4988 Tc 4.4589 Tw (waivered innovations and cooperate with their) Tj 0 -11.9577 TD 0.2172 Tc 0 Tw (implementation.) 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Tj -0.4881 -14.3981 TD 0.258 Tc 4.2157 Tw (Relevant regulations and standards could be) Tj 0.4881 -11.9577 TD 0.0102 Tc 2.552 Tw (compiled in a clear and easy to use format.) Tj -0.4881 -14.1541 TD 0.5011 Tc 2.8459 Tw (Any new regulations could be written in a) Tj 0.7321 -12.2018 TD -0.0034 Tc 2.4525 Tw (format that includes an explicit statement of the) Tj -0.244 -11.9577 TD 0.2796 Tc 3.1932 Tw (purpose or desired outcome of each require-) Tj 0.244 -12.2018 TD 0.504 Tc 3.8801 Tw (ment, thus providing government officials,) Tj 0.4881 -12.2018 TD 0.0337 Tc 2.7286 Tw (surveyors, and others with a basis for allowing) Tj -0.4881 -11.9577 TD 0.2571 Tc 3.3381 Tw (innovations that meet the purpose if not the) Tj 0 -12.2018 TD 0.008 Tc 4.4455 Tw (precise stipulations of the requirement.) 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If) Tj 0 Tc -0.061 Tw ( ) Tj 41.9741 0 TD /F4 10 Tf 0.0321 Tc 2.0665 Tw (special care) Tj 0 Tc -0.0972 Tw ( ) Tj 61.497 0 TD /F2 10 Tf -0.0127 Tc 1.9042 Tw (units are to fulfill the societal) Tj -103.4711 -12.6899 TD /F4 10 Tf 0.0497 Tc 0.3404 Tw (objective of developing better methods of care for) Tj 0 -12.4458 TD 0.0196 Tc 0.2083 Tw (nursing home residents ) Tj 113.7206 0 TD /F2 10 Tf 0.0062 Tc -0.0673 Tw (with ) Tj 20.499 0 TD /F4 10 Tf 0.035 Tc 0.2333 Tw (dementia, policies ) Tj 87.8528 0 TD /F2 10 Tf 0.0124 Tc 0 Tw (to) Tj -221.8284 -12.4458 TD 0.0106 Tc 2.508 Tw (allow and encourage innovation must receive at least) Tj 0.244 -12.2018 TD 0.0066 Tc 2.7692 Tw (as much attention as policies to regulate and control) Tj -0.244 -12.4458 TD -0.0027 Tc 3.6022 Tw (the units.) 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endstream endobj 514 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 515 0 obj <>stream 1.68 w 1 j 0 0 0 RG 64.08 655.92 m 541.44 655.92 l S 0.72 w 66 386.4 m 126.24 386.4 l S BT 0.9939 0 0 0.9939 468.96 693.12 Tm 0 0 0 rg /F6 14 Tf -0.0165 Tc 0.1374 Tw (Appendix A) Tj ET BT 0.9857 0 0 0.9857 183.36 668.64 Tm /F6 18 Tf 0.0104 Tc 0.8413 Tw (Diseases and Conditions That Cause Dementia) Tj ET BT 0.9835 0 0 0.9835 74.16 615.84 Tm /F2 10 Tf 0.0229 Tc 0.3099 Tw (Dementia can be caused by more than 70 diseases and conditions, including the following:) Tj ET BT 0.8632 0 0 0.9598 74.88 594.24 Tm /F9 6 Tf -0.0185 Tc 0.022 Tw (l ) Tj ET BT 0.8491 0 0 0.9835 80.4 594.24 Tm /F4 10 Tf 0.0243 Tc 1.5426 Tw (progressive degenerative diseases, including those in which dementia is inevitable, such) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.8449 0 0 0.9835 445.2 594.24 Tm /F2 10 Tf 0.0725 Tc 1.1049 Tw (as Alzheimer\222s disease and) Tj ET BT 0.9835 0 0 0.9835 84.72 583.44 Tm 0.019 Tc 0.1349 Tw (Pick\222s disease, and those in which dementia mayor may not occur, such as amyotrophic lateral sclerosis \(ALS\) and) Tj 0.244 -10.9816 TD 0.0351 Tc 0.1473 Tw (Parkinson\222s and Huntington\222s diseases;) Tj ET BT 0.9388 0 0 0.9835 75.36 556.32 Tm 0.0085 Tc 0.9347 Tw (. cardiovascular diseases that decrease blood supply to the brain: this can cause loss of brain tissue in the form of many) Tj ET BT 0.9835 0 0 0.9835 85.44 545.52 Tm 0.0135 Tc 1.6792 Tw (small strokes \(multi-infarct dementia\) or one or more large strokes; bleeding into the brain, usually related to) Tj -0.4881 -10.9816 TD 0.0166 Tc 0.2708 Tw (hypertension, can also cause loss of brain tissue;) Tj ET BT 0.9598 0 0 0.9598 75.6 518.4 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 82.08 518.4 Tm /F2 10 Tf 0.0219 Tc 2.6011 Tw (severe depression;) Tj ET BT 0.9598 0 0 0.9598 75.6 502.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 81.84 502.8 Tm /F2 10 Tf 0.0322 Tc 0.5773 Tw (intoxication caused by prescription and nonprescription drugs and alcohol;) Tj -6.3449 -16.3504 TD 0.0154 Tc 1.7066 Tw (. infections that affect the brain, including Creutzfeldt-Jakob Disease and acquired immune deficiency syndrome) Tj ET BT 0.8919 0 0 0.9835 85.68 475.92 Tm -0.0124 Tc 0 Tw ({AIDS\);) Tj ET BT 0.9598 0 0 0.9598 75.84 460.8 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9863 0 0 0.9863 82.08 460.8 Tm /F3 9 Tf 0.0344 Tc -0.1046 Tw (metabolic ) Tj ET BT 0.9835 0 0 0.9835 126.24 460.8 Tm /F2 10 Tf 0.0316 Tc 0 Tw (disorders;) Tj ET BT 0.9598 0 0 0.9598 76.08 443.76 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 82.32 443.76 Tm /F2 10 Tf 0.0168 Tc 3.0943 Tw (nutritional disorders;) Tj -6.1009 -16.1064 TD 0.0402 Tc 1.3013 Tw (. normal pressure hydrocephalus; and) Tj 0 -16.5944 TD 0.0286 Tc 0.7233 Tw (. space-occupying lesions, such as brain tumors and subdural hematoma.) Tj ET BT 0.9262 0 0 0.9939 66.72 375.36 Tm /F3 7 Tf 0.0627 Tc 0.9367 Tw (SOURCE: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, \223Differential Diagnosis of ) Tj ET q 32.4 0 0 -6.96 510.72 380.64 cm BI /W 185 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?88|x`<8>|?~|||?||~~|?|~>||~?~>||??<||<>|<>|<><>~<>|~<>|~?|???|??~~>< EI Q BT 0.8645 0 0 0.9939 510.72 375.36 Tm 3 Tr -0.0718 Tc 0 Tw (Dementing) Tj 0 Tr ET BT 0.9262 0 0 0.9939 100.8 367.2 Tm 0.0499 Tc 0.3685 Tw (Diseases,\224 NIH Consensus Development Conference Statement 6\(1 ) Tj ET q 17.76 0 0 -6.96 315.6 372.48 cm BI /W 105 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?????~>>>>>>~??<<|? EI Q BT 0.8027 0 0 0.9939 315.6 367.2 Tm 3 Tr 0.0436 Tc 0 Tw (1\):1-6,) Tj 0 Tr ET BT 0.9262 0 0 0.9939 333.36 367.2 Tm 0.021 Tc 0.2764 Tw ( Oct. 19-21, 1987.) Tj ET q 25.2 0 0 -7.2 293.76 65.52 cm BI /W 141 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>>>?x|>|<>88<?|??> EI Q BT 0.9835 0 0 0.9835 293.76 58.8 Tm 3 Tr /F2 10 Tf 0.122 Tc 0 Tw (\226173\226) Tj 0 Tr ET endstream endobj 516 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 517 0 obj <>stream 1.92 w 1 j 0 0 0 RG 69.36 621.12 m 546.72 621.12 l S BT 0.9663 0 0 0.9939 69.36 677.28 Tm 0 0 0 rg /F6 14 Tf -0.0187 Tc 1.9817 Tw (Appendix B) Tj ET BT 0.9857 0 0 0.9857 69.84 653.28 Tm /F6 18 Tf 0.0168 Tc 0.64 Tw (Conceptual and Methodological Issues in Research) Tj 0 -19.4774 TD 0.0129 Tc 0.5952 Tw (on Special Care Units) Tj ET BT 0.9835 0 0 0.9835 79.68 581.76 Tm /F2 10 Tf 0.0231 Tc 3.82 Tw (Numerous difficult conceptual and methodological) Tj -9.7614 -11.2256 TD 0.0244 Tc 0.6462 Tw (issues complicate the process of designing and conduct-) Tj 0 -10.9816 TD 0.0034 Tc 0.1796 Tw (ing special care unit research. Table 1-3 in chapter 1 lists) Tj T* 0.0102 Tc 0.7963 Tw (many of these issues. Most of the issues were identified) Tj 0.4881 -11.2256 TD 0.0171 Tc 2.606 Tw (and discussed at a 1990 special care unit conference) Tj ET BT 0.9388 0 0 0.9835 70.56 527.04 Tm -0.0155 Tc 1.4593 Tw (sponsored by the Alzheimer\222s Disease Research Center at) Tj ET BT 0.9835 0 0 0.9835 70.08 516 Tm 0.031 Tc 1.0666 Tw (Washington University in St. Louis, MO \(26\). Some of) Tj 0 -10.9816 TD 0.0205 Tc 1.1078 Tw (the issues are being addressed by subcommittees of the) Tj 0.244 -11.4697 TD 0.0303 Tc 0.6054 Tw (Workgroup on Research and Evaluation of Special Care) Tj 0 -11.2256 TD 0.0437 Tc 0.7486 Tw (Units, an ad hoc group of researchers formed following) Tj 0.244 -10.9816 TD 0.0187 Tc 1.2215 Tw (the St. Louis conference, and by the 10 research teams) Tj 0 -11.4697 TD 0.0385 Tc 1.0154 Tw (funded through the National Institute on Aging\222s \223Spe-) Tj 0.244 -10.9816 TD -0.0236 Tc 0.8781 Tw (cial Care Units Initiative. \222) Tj 113.2325 -0.244 TD 0.0238 Tc 0.5656 Tw (This appendix discusses five) Tj -113.2325 -10.9816 TD 0.0068 Tc 0.4201 Tw (of the most difficult issues.) Tj ET BT 0.9427 0 0 0.9812 89.28 413.76 Tm /F6 11 Tf -0.024 Tc 0.5838 Tw (Definition of the Term ) Tj ET BT 0.9261 0 0 0.9795 193.68 413.76 Tm /F7 12 Tf 0.0244 Tc 1.8962 Tw (Special Care Unit) Tj ET BT 0.9795 0 0 0.9795 81.12 396.48 Tm -0.0303 Tc -0.0301 Tw (One ) Tj ET BT 0.9835 0 0 0.9835 105.6 396.48 Tm /F2 10 Tf 0.0008 Tc 1.3719 Tw (of the most difficult issues in special care unit) Tj -35.3852 -10.9816 TD -0.0036 Tc 0.6016 Tw (research at this time is the definition of the term ) Tj 201.0854 0 TD /F5 10 Tf -0.0054 Tc 0 Tw (special) Tj -200.5973 -11.4697 TD 0.0026 Tc 0.0583 Tw (care unit. ) Tj 41.242 0 TD /F4 10 Tf 0.0506 Tc -0.1486 Tw (As ) Tj 14.6421 0 TD /F2 10 Tf 0.0222 Tc 0.265 Tw (noted in chapters 1 and 3, most descriptive) Tj -55.6401 -10.9816 TD 0.006 Tc 2.7393 Tw (studies have used self-report-i. e., the statement of a) Tj ET BT 0.9388 0 0 0.9835 71.28 352.8 Tm 0.0101 Tc 0.8842 Tw (nursing home administrator or special care unit operator\227) Tj ET BT 0.9835 0 0 0.9835 71.28 341.76 Tm 0.0118 Tc 0.5065 Tw (to identify special care units. This method of identifying) Tj 0.4881 -10.9816 TD 0.0073 Tc 0.5112 Tw (special care units misses some units, since some nursing) Tj -0.4881 -10.9816 TD -0.0024 Tc 1.6801 Tw (homes that place residents with dementia in a separate) Tj 0 -11.2256 TD 0.0264 Tc 1.8644 Tw (unit and provide special services for them-an arrange-) Tj 0.244 -10.7376 TD 0.0085 Tc -0.0155 Tw (ment that most researchers would regard as a special care) Tj -0.244 -10.9816 TD 0.0274 Tc 1.3754 Tw (unit-do not use the term) Tj 0 Tc -0.061 Tw ( ) Tj 105.6674 0 TD /F5 10 Tf -0.0003 Tc 1.6475 Tw (special care) Tj 0 Tc -0.061 Tw ( ) Tj 54.664 0 TD /F2 10 Tf 0.0387 Tc 2.34 Tw (for this arrange-) Tj ET BT 0.9388 0 0 0.9835 71.52 276.96 Tm 0.0184 Tc 1.4232 Tw (ment. Such nursing homes may not respond affirmatively) Tj ET BT 0.9835 0 0 0.9835 71.52 265.68 Tm 0.0137 Tc 0.3155 Tw (to a question about whether they have a special care unit) Tj ET BT 0.8919 0 0 0.9835 72 254.64 Tm 0.2314 Tc 0 Tw (\(436\).) Tj ET BT 0.9835 0 0 0.9835 81.6 237.36 Tm 0.0237 Tc 0.2504 Tw (On the other hand, using self-report to identify special) Tj -10.0055 -11.2256 TD 0.0198 Tc 1.7491 Tw (care units includes some units and other care arrange-) Tj 0 -11.2256 TD 0.028 Tc 3.571 Tw (ments that perhaps should not be included.) Tj 0 Tc -0.061 Tw ( ) Tj 199.6212 0 TD /F4 10 Tf 0.2652 Tc 2.8057 Tw (A few) Tj -199.8652 -11.2256 TD /F2 10 Tf 0.0055 Tc 2.7804 Tw (researchers have used additional criteria to determine) Tj 0.244 -10.9816 TD 0.0232 Tc 0.4034 Tw (which units should be included in their samples \(see, for) Tj ET BT 0.9388 0 0 0.9835 72 182.64 Tm 0.0099 Tc 0.249 Tw (example, Sloane et al [413]\). ) Tj ET BT 0.934 0 0 0.9835 184.56 182.64 Tm /F4 10 Tf -0.0269 Tc 0.3948 Tw (By doing so, they ) Tj ET BT 0.9388 0 0 0.9835 262.56 182.64 Tm /F2 10 Tf -0.0453 Tc 0 Tw (necessar-) Tj ET BT 0.9835 0 0 0.9835 72 171.84 Tm -0.0004 Tc 3.307 Tw (ily focus on a subset of all facilities that might be) Tj -0.244 -11.2256 TD 0.006 Tc 0.3861 Tw (considered special care units and thereby eliminate some) Tj 0 -11.4697 TD 0.0084 Tc 2.4623 Tw (of the diversity that characterizes the full universe of) Tj ET BT 0.9388 0 0 0.9835 72 138.72 Tm 0.0465 Tc 0 Tw (units.) Tj ET BT 0.9835 0 0 0.9835 81.84 121.68 Tm /F4 10 Tf -0.0042 Tc -0.0929 Tw (For ) Tj 20.0109 0 TD /F2 10 Tf 0.0019 Tc 1.5537 Tw (some purposes, the use of criteria that limit the) Tj -30.0164 -11.4697 TD /F4 10 Tf 0.0582 Tc 0.2097 Tw (definition of ) Tj 60.5208 0 TD /F5 10 Tf 0.0031 Tc 0.3425 Tw (special care unit ) Tj 71.0144 0 TD /F2 10 Tf 0.0231 Tc 0.8102 Tw (is appropriate. For most) Tj ET BT 0.9388 0 0 0.9835 71.76 99.6 Tm 0.036 Tc 1.1244 Tw (public policy purposes, however, the definition of) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 270.72 99.6 Tm /F5 10 Tf -0.0192 Tc 0 Tw (special) Tj ET BT 0.9835 0 0 0.9835 72.24 88.32 Tm 0.0105 Tc -0.0718 Tw (care unit ) Tj 38.5576 0 TD /F2 10 Tf 0.0115 Tc 0.0668 Tw (should be inclusive rather than exclusive at this) Tj -38.8017 -10.9816 TD -0.0047 Tc 0.0902 Tw (early stage in special care unit research. In this context, it) Tj 0 -10.9816 TD 0.0114 Tc 1.2832 Tw (is important to note that the first information about the) Tj T* 0.0146 Tc 0.1925 Tw (large number of cluster units in some States came from a) Tj 0.7321 -10.9816 TD 0.019 Tc -0.0803 Tw (study that did not use the term ) Tj 123.9701 0 TD /F5 10 Tf 0.0031 Tc -0.0642 Tw (special care unit ) Tj 69.0621 0 TD /F2 10 Tf -0.0246 Tc -0.036 Tw (at all and) Tj ET BT 0.9388 0 0 0.9835 72.24 34.32 Tm 0.0188 Tc 1.6115 Tw (instead asked abroad question about \221living arrangements) Tj ET BT 0.9835 0 0 0.9835 320.88 581.04 Tm 0.0134 Tc 0.6575 Tw (available for cognitively impaired \(demented\) residents\222) Tj ET BT 0.8919 0 0 0.9835 320.88 570 Tm 0.2314 Tc 0 Tw (\(177\).) Tj ET BT 0.9812 0 0 0.9812 321.12 539.04 Tm /F6 11 Tf 0.0501 Tc 0.1325 Tw (Individual Variation in Symptom Progression in) Tj ET BT 0.9427 0 0 0.9812 321.12 527.04 Tm 0.2015 Tc 0 Tw (Dementia) Tj ET BT 0.934 0 0 0.9835 330.72 508.32 Tm /F4 10 Tf -0.0295 Tc 0.0765 Tw (A ) Tj ET BT 0.9388 0 0 0.9835 340.32 508.32 Tm /F2 10 Tf 0.0043 Tc 1.5843 Tw (second issue that has received considerable attention) Tj ET BT 0.9835 0 0 0.9835 321.12 497.28 Tm 0.0015 Tc 2.7439 Tw (in the general literature on Alzheimer\222s disease) Tj 0 Tc -0.061 Tw ( ) Tj 210.8468 0 TD /F4 10 Tf 0.5384 Tc 0 Tw (and) Tj -210.8468 -11.4697 TD /F2 10 Tf -0.0206 Tc 0.814 Tw (dementia but relatively little attention in the special care) Tj 0 -11.2256 TD 0.0158 Tc 0.472 Tw (unit literature is the variation in symptom progression in) Tj 0.244 -10.9816 TD -0.0039 Tc -0.0571 Tw (diseases that cause dementia. Although cognitive abilities) Tj 0.244 -11.2256 TD -0.0006 Tc 2.7765 Tw (decline over time in Alzheimer\222s disease, the rate of) Tj ET BT 0.9388 0 0 0.9835 321.6 442.08 Tm 0.0335 Tc 0.0705 Tw (decline varies greatly indifferent individuals \(25,37,57,145,) Tj ET BT 0.9835 0 0 0.9835 321.6 431.52 Tm 0.0332 Tc 2.1016 Tw (228,338,479\). Some individuals with Alzheimer\222s dis-) Tj 0 -11.2256 TD 0.0305 Tc 1.1552 Tw (ease show no decline, and a few show improvement in) Tj T* 0.0162 Tc 1.9793 Tw (their cognitive abilities over l-year to 2-year followup) Tj ET BT 0.9388 0 0 0.9835 321.6 398.64 Tm 0.03 Tc 1.5204 Tw (periods \(145,338\). Most studies have found no character-) Tj ET BT 0.9835 0 0 0.9835 321.84 387.6 Tm 0.0173 Tc 0.1898 Tw (istics of an individual \(e.g., age, age of onset, duration of) Tj 0 -11.4697 TD 0.0083 Tc 2.1573 Tw (illness, family history of dementia, or entry point test) Tj 0.4881 -10.9816 TD 0.006 Tc 2.4342 Tw (scores\) that predict the rate at which the individual\222s) Tj -0.4881 -10.9816 TD -0.0096 Tc 4.4878 Tw (cognitive abilities will decline. Moreover, particular) Tj 0 -10.9816 TD 0.0032 Tc 0.4645 Tw (cognitive abilities decline at different rates \(37,368\).) Tj 10.0055 -18.7907 TD 0.0019 Tc 1.4555 Tw (The rate of decline in ability to perform activities of) Tj -9.7614 -11.2256 TD 0.02 Tc 1.6573 Tw (daily living also varies in different individuals and for) Tj ET BT 0.9388 0 0 0.9835 322.08 303.84 Tm 0.0456 Tc 1.1386 Tw (different activities \(127,145,235,338\). A pilot study of 54) Tj ET BT 0.9835 0 0 0.9835 321.84 293.28 Tm 0.0307 Tc 3.6729 Tw (nursing home residents with dementia found that 6) Tj 0.244 -11.2256 TD 0.012 Tc 0.3063 Tw (months after their admission to the facility, 46 percent of) Tj 0.244 -11.2256 TD 0.0346 Tc 0.4732 Tw (those who survived showed no change in their ability to) Tj -0.244 -11.2256 TD 0.0182 Tc 1.5372 Tw (perform activities of daily living; 29 percent showed a) Tj ET BT 0.9388 0 0 0.9835 322.32 248.88 Tm 0.036 Tc 0.6813 Tw (decline in only one activity of daily living; and 24 percent) Tj 0.2556 -11.2256 TD 0.0244 Tc 0.8727 Tw (showed a decline in more than one activity of daily living) Tj 0 -11.2256 TD 0.017 Tc 1.3151 Tw (\(62\). The progression of behavioral symptoms also varies) Tj ET BT 0.9835 0 0 0.9835 322.56 215.76 Tm 0.0321 Tc 4.1769 Tw (in different individuals and for different symptoms) Tj ET BT 0.9388 0 0 0.9835 322.56 204.96 Tm 0.0847 Tc 0 Tw (\(127,235,394,441\).) Tj ET BT 0.9835 0 0 0.9835 332.16 186.96 Tm 0.0295 Tc 0.6411 Tw (This variation in symptom progression means that for) Tj -9.5174 -11.4697 TD 0.005 Tc 1.9777 Tw (a given individual, it is difficult to determine whether) Tj -0.244 -10.9816 TD 0.0419 Tc 0.5797 Tw (changes or lack of changes in his or her symptoms over) Tj 0 -11.2256 TD 0.0072 Tc 0.9078 Tw (time reflect the course of the individual\222s disease or the) Tj 0.244 -10.9816 TD -0.0018 Tc 1.4355 Tw (effects of a treatment intervention \(e.g., placement in a) Tj 0.4881 -11.4697 TD 0.0207 Tc 0.8053 Tw (special care unit\). In a study with a long duration and a) Tj -0.4881 -10.7376 TD 0.0225 Tc 1.421 Tw (large sample, individual variation in symptom progres-) Tj 0.244 -11.4697 TD 0.0202 Tc 3.945 Tw (sion might have a negligible effect on the study\222s) Tj -0.4881 -10.9816 TD 0.0022 Tc 2.6516 Tw (findings. Subject attrition is high in special care unit) Tj 0 -10.9816 TD 0.0111 Tc 1.4616 Tw (research, however. Some special care unit studies have) Tj ET BT 0.9388 0 0 0.9835 322.8 77.28 Tm 0.0246 Tc 0.9236 Tw (lost one-third or more of their subjects in a year \(80,265\).) Tj ET BT 0.9835 0 0 0.9835 322.56 66.48 Tm -0.0054 Tc 0.3715 Tw (As a result, it is difficult to maintain a large sample for a) Tj 0.244 -10.9816 TD 0.0144 Tc 2.3158 Tw (long period of time. In a study with a small sample,) Tj 0.244 -10.7376 TD 0.0261 Tc 0.0752 Tw (individual variation in symptom progression could easily) Tj 0 -10.9816 TD 0.0089 Tc 0.3367 Tw (obscure the effects of the treatment intervention.) Tj -25.3797 -17.8146 TD /F5 10 Tf 0.3097 Tc 0 Tw (\226174-) Tj ET endstream endobj 518 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 519 0 obj <>stream 0.72 w 1 j 0 0 0 RG 62.64 676.08 m 540.24 676.08 l S BT 0.9835 0 0 0.9835 156.48 681.6 Tm 0 0 0 rg /F5 10 Tf 0.0301 Tc 1.4132 Tw (Appendix B-Conceptual and Methodological Issues in Research on Special Care Units . 175) Tj ET BT 0.9812 0 0 0.9812 63.36 642.24 Tm /F6 11 Tf 0.0239 Tc 0.465 Tw (Lack of Validated Measurement Instruments) Tj ET BT 0.9835 0 0 0.9835 72.96 625.68 Tm /F2 10 Tf 0.0034 Tc 0.2018 Tw (A third issue in special care unit research is the lack of) Tj -9.7614 -11.4697 TD 0.0103 Tc 0.3119 Tw (validated instruments to measure many of the potentially) Tj 0.244 -11.2256 TD -0.0022 Tc 0.8128 Tw (important characteristics of the units, the residents, their) Tj ET BT 0.9388 0 0 0.9835 63.6 592.56 Tm 0.0047 Tc 0.7147 Tw (families, and the unit staff members. As noted in table 1-3) Tj ET BT 0.9835 0 0 0.9835 63.84 581.52 Tm 0.0107 Tc 1.4228 Tw (in chapter 1, many of the available instruments exhibit) Tj 0 -10.9816 TD 0.0212 Tc 2.5205 Tw (ceiling or floor effects that obscure the full range of) Tj -0.244 -10.9816 TD 0.017 Tc 3.6868 Tw (positive or negative changes in resident and family) Tj ET BT 0.9388 0 0 0.9835 64.08 549.12 Tm 0.0367 Tc 2.1889 Tw (characteristics \(57,1 13,145,228,265\).) Tj ET BT 0.9835 0 0 0.9835 73.92 532.56 Tm 0.0072 Tc 3.5922 Tw (Measuring subjective variables in individuals with) Tj -9.7614 -11.4697 TD 0.0125 Tc 4.7093 Tw (dementia is particularly difficult \(244,272\). Several) Tj 0 -10.9816 TD 0.0377 Tc 0.1853 Tw (innovative instruments and methods have been proposed) Tj 0 -11.2256 TD 0.0149 Tc 1.0045 Tw (to measure feelings, comfort, and degree of satisfaction) Tj 0.4881 -11.2256 TD 0.0419 Tc -0.1036 Tw (\(197,271,442\), but this remains a formidable problem for) Tj 0.244 -11.2256 TD -0.005 Tc 0.188 Tw (special care unit researchers.) Tj 10.0055 -17.3265 TD 0.0105 Tc 3.5539 Tw (Some special care unit studies have used staging) Tj -10.2495 -10.9816 TD 0.0035 Tc 1.0336 Tw (instruments to classify their subjects. These instruments) Tj ET BT 0.9388 0 0 0.9835 64.8 438.72 Tm -0.0099 Tc 0.9284 Tw (define stages of dementia or Alzheimer\222s disease based on) Tj ET BT 0.9835 0 0 0.9835 65.52 427.92 Tm 0.0251 Tc 2.3945 Tw (a combination of cognitive impairments, mood, func-) Tj -0.4881 -10.9816 TD 0.0178 Tc 1.8732 Tw (tional impairments, and behavioral symptoms \(see, for) Tj 0.4881 -11.2256 TD 0.011 Tc 0.869 Tw (example, Reisberg et al. [372]\). Staging instruments are) Tj 0 -11.2256 TD 0.2805 Tc 3.0703 Tw (useful for many purposes, but they tend to mask) Tj ET BT 0.9388 0 0 0.9835 65.52 384.24 Tm 0.0302 Tc 1.6846 Tw (individual variation in symptom patterns and progression) Tj ET BT 0.9835 0 0 0.9835 65.52 373.2 Tm 0.0429 Tc 0.3486 Tw (\(53,127\). Many studies have found only modest correla-) Tj 0 -10.9816 TD 0.0145 Tc 1.8417 Tw (tions between the cognitive impairments caused by an) Tj ET BT 0.9388 0 0 0.9835 66 351.36 Tm 0.0209 Tc 1.3536 Tw (individual\222s dementing disease and either the individual\222s) Tj ET BT 0.9835 0 0 0.9835 66.24 340.08 Tm 0.9533 Tc 3.0369 Tw (ability to perform activities of daily living) Tj ET BT 0.9388 0 0 0.9835 66 329.04 Tm 0.0647 Tc 2.4786 Tw (\(43,124,344,369,410,472,508\) or the individual\222s behav-) Tj ET BT 0.9835 0 0 0.9835 66 318 Tm 0.0495 Tc 4.3423 Tw (ioral symptoms \(111,394,431,441\). Moreover, many) Tj 0.244 -10.9816 TD -0.0052 Tc 0.4628 Tw (dementia experts expect special care units to affect these) Tj 0 -11.4697 TD 0.0161 Tc 3.3043 Tw (domains differently: few experts expect the units to) Tj ET BT 0.9388 0 0 0.9835 66.24 285.12 Tm 0.0067 Tc 1.6244 Tw (reduce residents\222 cognitive impairments, for example, but) Tj ET BT 0.9835 0 0 0.9835 66.24 274.08 Tm 0.0173 Tc 4.1397 Tw (many experts expect the units to reduce residents\222) Tj 0 -11.4697 TD 0.019 Tc 0.847 Tw (behavioral symptoms. Staging instruments that combine) Tj 0 -11.2256 TD 0.0175 Tc 2.3073 Tw (these domains are likely to obscure any effect of the) Tj 0.7321 -10.9816 TD 0.0081 Tc 1.8482 Tw (special care units. For this reason, staging instruments) Tj -0.244 -10.9816 TD 0.0272 Tc 1.1586 Tw (probably should not be used to classify subjects in this) Tj 0 -11.2256 TD -0.0091 Tc 0.5583 Tw (research, especially in studies with small samples.) Tj ET BT 0.9812 0 0 0.9812 67.2 200.88 Tm /F6 11 Tf 0.037 Tc 0.1459 Tw (Accuracy of Proxy Responses) Tj ET BT 0.9835 0 0 0.9835 77.04 184.08 Tm /F2 10 Tf 0.0079 Tc 2.8594 Tw (A fourth issue in special care unit research is the) Tj -9.7614 -11.4697 TD 0.0346 Tc 2.8729 Tw (accuracy of proxy-derived responses. Because of the) Tj -0.244 -11.2256 TD 0.0238 Tc 2.1111 Tw (cognitive impairments of nursing home residents with) Tj 0.244 -11.2256 TD 0.0195 Tc 3.0916 Tw (dementia, researchers sometimes must rely on proxy) Tj -0.244 -10.7376 TD 0.034 Tc 2.3854 Tw (respondents-usually family members or friends of the) Tj 0 -11.2256 TD 0.0219 Tc 3.2844 Tw (resident\227to provide information about the residents.) Tj 250.8686 522.9684 TD 0.019 Tc 1.9329 Tw (Little is known about the accuracy of these responses) Tj 0 -11.7137 TD 0.057 Tc -0.119 Tw (\(278\). One study of 53 nursing home residents who were) Tj 0 -10.9816 TD 0.0489 Tc -0.1108 Tw (not ) Tj 17.3265 0 TD /F5 10 Tf -0.0402 Tc -0.0202 Tw (severely ) Tj 39.2897 0 TD /F2 10 Tf 0.2731 Tc 2.7117 Tw (cognitively impaired found that proxy) Tj -56.6163 -10.9816 TD 0.0151 Tc 3.7236 Tw (responses were more likely to match the residents\222) Tj 0.244 -10.9816 TD 0.0375 Tc 3.114 Tw (responses on questions about readily observable and) Tj 0.244 -10.9816 TD 0.0098 Tc 2.8574 Tw (long-lasting conditions and less likely to match their) Tj -0.244 -11.2256 TD 0.0354 Tc 2.384 Tw (responses on questions about subjective or temporary) Tj 0.244 -11.2256 TD 0.0617 Tc 1.9331 Tw (conditions \(280\). Another study of 152 nursing home) Tj 0 -10.7376 TD 0.0331 Tc 1.7762 Tw (residents who were not) Tj 0 Tc -0.061 Tw ( ) Tj 102.983 0 TD /F5 10 Tf -0.0402 Tc -0.0202 Tw (severely ) Tj 37.5815 0 TD /F2 10 Tf 0.0095 Tc 6.5182 Tw (cognitively impaired) Tj -140.3205 -10.9816 TD 0.0317 Tc 0.2423 Tw (found that proxy responses with respect to the residents\222) Tj 0.4881 -11.4697 TD 0.01 Tc 1.3581 Tw (satisfaction with specific aspects of their nursing home) Tj ET BT 0.9388 0 0 0.9835 314.88 523.2 Tm -0.0063 Tc 0.7435 Tw (care were no more likely to match the residents\222 responses) Tj 0 -10.9816 TD 0.0081 Tc 1.3246 Tw (than would be expected by chance \(239\). The researchers) Tj ET BT 0.9835 0 0 0.9835 315.12 501.12 Tm 0.0179 Tc 0.1953 Tw (concluded that the ability of family members and friends) Tj -0.244 -11.2256 TD 0.0186 Tc 2.5231 Tw (to represent residents\222 satisfaction with nursing home) Tj 0.7321 -10.9816 TD -0.0071 Tc 0.3732 Tw (services is limited and inconsistent.) Tj ET BT 0.9812 0 0 0.9812 315.6 449.04 Tm /F6 11 Tf 0.029 Tc 0.2152 Tw (Number and Complexity of Variables) Tj ET BT 0.9388 0 0 0.9835 325.2 432.48 Tm /F2 10 Tf 0.0089 Tc 0.8892 Tw (A final issue is the sheer number and complexity of the) Tj ET BT 0.9835 0 0 0.9835 315.6 421.44 Tm 0.0005 Tc 0.8062 Tw (variables in special care unit research. As noted in table) Tj 0.9761 -11.2256 TD 0.0125 Tc 0.503 Tw (1-3 in chapter 1, it is difficult to determine which of the) Tj -0.4881 -11.2256 TD -0.0007 Tc 3.1121 Tw (many characteristics of the units, the residents, their) Tj 0 -10.9816 TD 0.0052 Tc 2.4045 Tw (families, and the unit staff members are important to) Tj 0.244 -11.4697 TD -0.0041 Tc 0.2481 Tw (study. The experimental variable, the special care unit, is) Tj 0 -10.7376 TD 0.0125 Tc 0.2313 Tw (multidimensional. As Lawton has noted:) Tj 20.0109 -17.8146 TD 0.0095 Tc 1.1901 Tw (The experimental variable \(is\) not a redecorated) Tj -10.0055 -11.2256 TD 0.0276 Tc 3.8155 Tw (ward or a new building, but an entire system) Tj 0 -11.4697 TD 0.0281 Tc 1.1712 Tw (composed of countless physical and staff changes,) Tj 0.4881 -10.9816 TD 0.0012 Tc 1.4426 Tw (sometimes a new resident mix, different treatment) Tj -0.244 -11.2256 TD 0.025 Tc 2.0285 Tw (programs, and not least, changed expectations by) Tj 0.4881 -10.2495 TD 0.0189 Tc 0.1028 Tw (staff, residents, and administrators \(241\).) Tj ET BT 0.9388 0 0 0.9835 326.88 277.68 Tm 0.0115 Tc 0.6271 Tw (Some people argue that it is the ) Tj ET BT 0.9444 0 0 0.9835 452.88 277.68 Tm /F5 10 Tf -0.0178 Tc 0.059 Tw (milieu ) Tj ET BT 0.9388 0 0 0.9835 479.52 277.68 Tm /F2 10 Tf -0.0335 Tc 1.0281 Tw (of a special care) Tj ET BT 0.9835 0 0 0.9835 316.8 266.88 Tm -0.0012 Tc 1.4044 Tw (unit rather than any of its particular characteristics that) Tj 0.244 -11.2256 TD 0.001 Tc 2.2807 Tw (constitutes the experimental variable. Their contention) Tj 0.244 -11.2256 TD 0.0212 Tc 0.1266 Tw (may be valid, but defining the concept ) Tj 158.3791 0 TD /F5 10 Tf -0.0204 Tc -0.0403 Tw (milieu ) Tj 27.576 0 TD /F2 10 Tf 0.0213 Tc 0.4054 Tw (has caused) Tj ET BT 0.9388 0 0 0.9835 317.28 234 Tm 0.0086 Tc 1.0684 Tw (difficulties in research on inpatient psychiatric care for 30) Tj ET BT 0.9835 0 0 0.9835 317.28 222.96 Tm 0.0066 Tc 0.376 Tw (years and is unlikely to be any easier in special care unit) Tj ET BT 0.9388 0 0 0.9835 317.28 212.16 Tm 0.0013 Tc 2.3545 Tw (research \(436\).) Tj ET BT 0.9835 0 0 0.9835 326.88 194.88 Tm 0.0177 Tc 0.1955 Tw (The number and complexity of the variables in special) Tj -9.5174 -11.4697 TD 0.0215 Tc 2.0219 Tw (care unit research and the many other conceptual and) Tj 0.244 -10.9816 TD 0.0109 Tc -0.0024 Tw (methodological issues discussed above and listed in table) Tj 0.7321 -11.2256 TD 0.0352 Tc -0.0968 Tw (1-3 contribute to the difficulty of designing and conduct-) Tj -0.4881 -10.9816 TD 0.0001 Tc 1.159 Tw (ing special care unit research. These factors account, at) Tj 0 -10.9816 TD 0.0114 Tc 1.6356 Tw (least in part, for the current lack of definitive answers) Tj 0.244 -11.2256 TD 0.0031 Tc 0.3426 Tw (about the effectiveness of special care units.) Tj ET endstream endobj 520 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 521 0 obj <>stream 1.44 w 1 j 0 0 0 RG 72.24 654.72 m 550.32 654.72 l S BT 0.9663 0 0 0.9939 477.36 693.12 Tm 0 0 0 rg /F6 14 Tf -0.0329 Tc 0.0095 Tw (Appendix ) Tj ET BT 0.957 0 0 0.9939 537.36 693.12 Tm /F14 14 Tf -0.1013 Tc 0 Tw (C) Tj ET BT 0.9515 0 0 0.9857 403.2 668.4 Tm /F6 18 Tf 0.0757 Tc (Acknowledgements) Tj ET BT 0.9835 0 0 0.9835 83.28 613.2 Tm /F2 10 Tf 0.0206 Tc 0.2482 Tw (OTA is grateful for the assistance of the contractors and many other individuals and organizations that contributed to) Tj -10.2495 -10.9816 TD 0.0278 Tc 0.2157 Tw (this report. In addition, OTA thanks the following individuals who reviewed the report.) 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Tj ET BT 0.9835 0 0 0.9835 95.04 629.52 Tm -0.0163 Tc 2.884 Tw (Ablowitz, M.,) Tj 65.4016 0 TD 0.0061 Tc 3.5933 Tw (\223Pairing Rational and Demented) Tj -65.4016 -11.4697 TD -0.0182 Tc 0.2015 Tw (Patients in ) Tj ET q 43.92 0 0 -8.88 139.44 625.2 cm BI /W 245 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~|||` '?????????|??>??x?~<????????|?~??~??|>?|?>????? p<?|<<<||p@ EI Q BT 0.9388 0 0 0.9835 139.44 618.24 Tm 3 Tr 0.003 Tc 0 Tw (Lmg-Terrn) Tj 0 Tr ET BT 0.9835 0 0 0.9835 183.36 618.24 Tm -0.0404 Tc 0.5169 Tw ( Care Facilities,\224 letter to the) Tj -89.8051 -11.2256 TD 0.0033 Tc -0.0644 Tw (editor, ) Tj 29.0402 0 TD /F5 10 Tf 0.0071 Tc 0.9567 Tw (Journal of the American Geriatrics Society) Tj ET q 64.56 0 0 -8.64 95.28 603.36 cm BI /W 360 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x~|x>x?>???|?~?~?~~?~~>x?~???x|?x???~~??|~??>~???>~?`~?|>?|?>>|>~~|?~|>|>| ||?>@8?>?<?>>?>x|??>|~??>?~?||?>?<?x 0 EI Q BT 0.9444 0 0 0.9835 95.28 595.92 Tm 3 Tr 0.0488 Tc 0 Tw (31\(10\):627-628,) Tj 0 Tr 68.3625 0 TD 0.0723 Tc 0.726 Tw ( 1983.) Tj ET q 36.24 0 0 -9.36 95.04 591.36 cm BI /W 202 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8qxx<<?<??>???||~??????|??x|x?x|x?<|<8??<<<x?>>>x???x????>8<x|?|80x EI Q BT 1.086 0 0 0.9835 95.04 584.64 Tm 3 Tr 0.0582 Tc 0 Tw (Aivisory) Tj 0 Tr ET BT 0.9835 0 0 0.9835 131.28 584.64 Tm /F2 10 Tf 0.0313 Tc 2.5916 Tw ( Panel on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 178.32 591.6 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID {?p@~?????>???>??|????`~??????~?<?>? >?>?><<?`?@>>x<<>?~~?><?~<<| EI Q BT 0.9835 0 0 0.9835 178.32 584.64 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.2208 Tc 2.6429 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj 46.1227 0 TD /F5 10 Tf 0.8227 Tc 0 Tw (Third) Tj -180.5864 -11.2256 TD 0.2627 Tc 3.2836 Tw (Report of the Advisory Panel on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 251.52 580.56 cm BI /W 264 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @~>?>???<~~~C~'~>>~x>>~<>>?|>|~~~|>~|?~????>~?>?|p~??~x??>?>~?>~>>?>?????? ??|?|?~>???? EI Q BT 0.9835 0 0 0.9835 251.52 573.6 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr -159.1112 -10.9816 TD -0.0017 Tc -0.0593 Tw (Disease, ) Tj 39.0457 0 TD /F2 10 Tf 0.0258 Tc 2.1579 Tw (U.S. Department of Health and Human) Tj -38.3136 -11.4697 TD 0.0238 Tc 0.0978 Tw (Services, Washington, DC, December 1991.) Tj -0.7321 -11.4697 TD 0.0151 Tc 2.4047 Tw (Allison, K., Director of Special Programs, ARA) Tj ET BT 0.9388 0 0 0.9835 95.52 529.44 Tm 0.0156 Tc 1.5723 Tw (Living Centers, Houston, TX, personal communica-) Tj ET BT 0.9835 0 0 0.9835 95.76 518.4 Tm 0.0336 Tc 0.3116 Tw (tion, Feb. 5, 1991.) Tj ET q 48.96 0 0 -7.2 95.52 513.84 cm BI /W 273 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||????????<??x??8~?0??~?~?~??~??~x|??~<?~<0?~>8?~~8?~>8?><~?|>????<|<??>?0?x?xx8x` EI Q BT 0.9835 0 0 0.9835 95.52 506.64 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0062 Tc 3.8372 Tw ( Association, \223Alzheimer\222s Associa-) Tj ET BT 0.9388 0 0 0.9835 96.48 495.6 Tm 0.0101 Tc 0.1465 Tw (tion Legislative Principles for Specialized ) Tj ET q 42.24 0 0 -9.36 257.76 502.8 cm BI /W 244 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~~><1<A߃??????y~?9??~9?<?~???~??~??~?~??~?~??~>?~>?~~?~>|?~??~x?~x@?~|?~?|<>?|<?<?>>?`1??<||8? EI Q BT 0.9388 0 0 0.9835 257.76 495.6 Tm 3 Tr -0.0277 Tc 0 Tw (Alzheimer/) Tj 0 Tr ET BT 0.9835 0 0 0.9835 96.48 484.8 Tm -0.0169 Tc 0.973 Tw (Dementia Care in a Residential Setting,\224 Chicago,) Tj ET BT 0.9388 0 0 0.9835 96.48 473.76 Tm 0.0423 Tc 1.2881 Tw (IL, January 1992.) Tj ET q 48.48 0 0 -7.2 96.48 469.2 cm BI /W 270 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ;???`????????~?|?p<?p>?0>???p~?? ~??~??>~??~??~??~?~?~0?~0?~p??????????x????|x?<?>?p0 >???????| EI Q BT 0.9388 0 0 0.9835 96.48 462.24 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 144.96 462.24 Tm 0.003 Tc 0.424 Tw ( Association,) Tj 56.6163 -0.244 TD 0.0039 Tc 2.0093 Tw (\223Public Policy Update,\224) Tj ET q 28.08 0 0 -8.16 96.48 458.16 cm BI /W 156 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??~?~8>|?|~~||~<|~<|~>|~>|>~~>????????`~~|~|x~|<~?>|??d EI Q BT 0.9388 0 0 0.9835 96.48 450.96 Tm 3 Tr 0.0739 Tc 0 Tw (30:8-9,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 124.56 450.96 Tm 0 Tc -0.061 Tw ( ) Tj ET q 16.56 0 0 -9.36 126.96 458.16 cm BI /W 92 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>|>???|<~~?~?~x~8<<???p EI Q BT 0.9835 0 0 0.9835 126.96 450.96 Tm 3 Tr 0.0398 Tc 0 Tw (July) Tj 0 Tr 16.8385 0 TD 0.0854 Tc 0.0962 Tw ( 1991.) Tj ET q 48.72 0 0 -7.2 96.48 446.64 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??????x??||??x?|~?8~>8>?8p?8~???????????8~x?~xx߀xx?<??0~8 8?~`?~~x~|??` EI Q BT 0.9835 0 0 0.9835 96.48 439.68 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0079 Tc 1.1999 Tw ( Disease Education and Referral Cen-) Tj -49.5392 -11.2256 TD 0.0063 Tc 2.1289 Tw (ter, \223Standards of Care for Dementia Patients in) Tj 0.244 -10.7376 TD -0.0117 Tc 1.4151 Tw (Special Care Units,\222) Tj ET BT 0.9388 0 0 0.9835 181.92 417.84 Tm 0.0291 Tc 0.8549 Tw (final draft, Silver Spring, MD,) Tj -91.0081 -10.9816 TD 0.0765 Tc 1.5074 Tw (July 1991.) Tj ET q 46.56 0 0 -6.96 96.48 402.72 cm BI /W 265 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID a~{??????~>|?y<?~|?9?~?>?1~?~??~?~???~???~???~>??~>???~>??~>??~??~??~?~??~`??>x????>x??<??p?<?|>?A0>??????~ EI Q BT 0.8919 0 0 0.9835 96.48 396 Tm 3 Tr 0.0033 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9388 0 0 0.9835 143.04 396 Tm 0.0165 Tc 0.8555 Tw ( Society of Canada, \223Developing Guide-) Tj ET BT 0.9835 0 0 0.9835 96.72 385.2 Tm 0.0142 Tc 2.4695 Tw (lines for Care of Individuals With Dementia: A) Tj 0 -11.2256 TD 0.0419 Tc 4.289 Tw (Proposal for Funding,\224 Toronto, ON, Canada,) Tj ET BT 0.8919 0 0 0.9835 97.68 363.12 Tm 0.0717 Tc 0 Tw (1990.) Tj ET BT 0.9388 0 0 0.9835 96.48 351.6 Tm 0.0291 Tc 1.3023 Tw (Ambrogi, D. M.,) Tj ET BT 0.9835 0 0 0.9835 167.76 351.36 Tm 0.0295 Tc 2.0442 Tw (\223Legal Issues in Nursing Home) Tj -71.9905 -10.7376 TD 0.0295 Tc 0 Tw (Admissions,\222) Tj 61.9851 -0.4881 TD -0.0066 Tc -0.0543 Tw (Law, ) Tj 24.8916 0 TD /F5 10 Tf 0.012 Tc 3.3433 Tw (Medicine, and Health Care) Tj ET q 58.8 0 0 -8.64 97.92 336.72 cm BI /W 328 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08p<>x|>>8?||??|?|??|~??>>~>>?|~p??0x?<||><|?x~>?<|~>?<>~x??<~<?~>~>~~~~?|~>??8?||~?????x?~>?<>>|?<?<<?|| 8?`?||8?p??><?p??>|?x?>~8?>>?>>~?~????>?<0?00 EI Q BT 0.9444 0 0 0.9835 97.92 330 Tm 3 Tr 0.0466 Tc 0 Tw (18\(3\):254-262,) Tj 0 Tr 62.2633 0 TD 0.0723 Tc 0.726 Tw ( 1990.) Tj ET BT 0.9835 0 0 0.9835 96.72 318.48 Tm 0.018 Tc -0.0793 Tw (American ) Tj 45.1466 0 TD /F2 10 Tf 0.036 Tc 2.5379 Tw (Association of Homes for the Aging,) Tj -43.9264 -11.4697 TD 0.0161 Tc 0.0446 Tw (\221\221NursingHomes Report Decreased Restraint Use,\224) Tj -0.7321 -11.2256 TD 0.0197 Tc 0.285 Tw (news release, Washington, DC, March 2, 1992.) Tj -0.4881 -11.7137 TD 0.0306 Tc 2.7143 Tw (American Association of Homes for the Aging,) Tj 0.4881 -10.7376 TD 0.043 Tc 1.7255 Tw (Task Force on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 161.76 281.04 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `>??|?>????~??>?~?>?~?~?~??~~???`~??~??~?~?~?~??~x?~x?~|?~~8<0??~|?8<8??~>?ǀ<<?>|???>?><<<~<|??~|?~|?~8|88 EI Q BT 0.9835 0 0 0.9835 161.76 274.08 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0186 Tc 2.6423 Tw ( Disease, \223Best Prac-) Tj -115.1848 -11.2256 TD 0.0221 Tc 1.3807 Tw (tices for Special Care programs for Persons With) Tj ET q 48.96 0 0 -7.2 97.44 259.44 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <0?~>???????<???????p?p?~???~???|???????|???|??|??|??<??>><???<???><|~? ????p? xp<>~?|<?>|p< EI Q BT 0.9835 0 0 0.9835 97.44 252.24 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0106 Tc 2.0431 Tw ( Disease or a Related Disorder,\224 un-) Tj -50.0273 -11.2256 TD 0.0328 Tc 0.1497 Tw (published manuscript, Washington, DC, 1988.) Tj 0 -11.7137 TD 0.0072 Tc 3.1041 Tw (American Institute of Architects, Association of) Tj 0.7321 -11.4697 TD 0.0085 Tc 3.7373 Tw (Collegiate Schools of Architecture, Council on) Tj -0.244 -10.9816 TD -0.0093 Tc 2.3887 Tw (Architectural Research,) Tj 101.2748 -0.4881 TD 0.0071 Tc 1.8027 Tw (\223Facilities for Aging: An) Tj -101.2748 -10.7376 TD 0.032 Tc 0.8521 Tw (Agenda for Action in the 1990s: A White Paper,\224) Tj 0 -11.2256 TD 0.0458 Tc -0.1076 Tw (Washington, DC, August 1991.) Tj -0.244 -11.4697 TD 0.0356 Tc 0.0655 Tw (American Journal of ) Tj ET q 48.96 0 0 -7.2 182.16 181.2 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  w ??>????>?????~x?~8??~?`~ ?? ~ ??~?~??s?~??~??~??~?x??~?x??~?|?~?8< ?~??8<p?|??8p??xxx???~????0??0@??x?x?|? ?xx?8? EI Q BT 0.9835 0 0 0.9835 182.16 174.24 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0152 Tc 0.1984 Tw ( Care and Related) Tj -135.4398 -11.2256 TD 0.0113 Tc 0.8222 Tw (Disorders and Research, \223Nancy Orr: Specialist in) Tj 0.244 -11.4697 TD -0.0294 Tc 4.1175 Tw (Special Care,\224) Tj 66.3777 0 TD /F5 10 Tf 0.262 Tc -0.3275 Tw (American ) Tj ET q 31.2 0 0 -7.2 208.8 158.64 cm BI /W 174 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x||??~?????>>??0|????0???|||~>>??>?|?<>||~??~>?x0x<8 < EI Q BT 0.9835 0 0 0.9835 208.8 151.92 Tm 3 Tr 0.0505 Tc 0 Tw (Journul) Tj 0 Tr 31.7246 0 TD 0.0124 Tc 0.2924 Tw ( of ) Tj ET q 47.52 0 0 -6.96 253.92 158.64 cm BI /W 264 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @8v~~>????<~|g~|p>>8>>>>|?||~~|>|>???||>?>|`~>|??~p>?|??>8?>??|???~??~??>>>>?? ?|?|?|?<>~# EI Q BT 0.9835 0 0 0.9835 253.92 151.92 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 97.92 141.36 Tm -0.0075 Tc 1.6153 Tw (Care and Related Disorders and Research 2\(1\):23-) Tj 0 -10.9816 TD 0.0703 Tc 0.9823 Tw (28, 1987.) Tj ET BT 0.9835 0 0 0.9835 97.44 119.04 Tm /F2 10 Tf 0.0343 Tc 1.0022 Tw (Annas, G., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 28.56 0 0 -8.16 162.24 126 cm BI /W 159 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<< ????~?~~?~@?~?~???~???~??~?~?~?~?~?~?~?~??~?|???p0? EI Q BT 0.9835 0 0 0.9835 162.24 119.04 Tm 3 Tr -0.0194 Tc 0 Tw (Glantz,) Tj 0 Tr 29.0402 0 TD -0.0014 Tc 1.0629 Tw ( L., \223Rules for Research in) Tj -94.4418 -10.9816 TD 0.0399 Tc 2.8268 Tw (Nursing Homes,\224) Tj 77.3593 -0.244 TD 0.0481 Tc -0.1099 Tw (New ) Tj 21.9632 0 TD /F5 10 Tf 0.0715 Tc -0.1337 Tw (England ) Tj ET q 31.68 0 0 -6.96 232.56 114.72 cm BI /W 176 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8?|>||?|?~?|y>?<>>>>~~|?>|?~>~???@|~~~~>|~|~|~~~ EI Q BT 0.9835 0 0 0.9835 232.56 108 Tm 3 Tr 0.0505 Tc 0 Tw (Journul) Tj 0 Tr 32.2127 0 TD 0.0067 Tc 0.2982 Tw ( of Medi-) Tj ET BT 0.9444 0 0 0.9835 98.16 97.44 Tm -0.0373 Tc 0.0796 Tw (cine ) Tj ET q 21.12 0 0 -6.96 116.4 104.16 cm BI /W 120 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ' ~|~0||x>|><><>>>>~>~~~~~`??` pp|c>??0p EI Q BT 0.8499 0 0 0.9835 116.4 97.44 Tm 3 Tr 0.0757 Tc 0 Tw (315;1) Tj 0 Tr ET BT 0.9444 0 0 0.9835 137.52 97.44 Tm 0.0669 Tc 0.7318 Tw ( 157-1158, 1986.) Tj ET BT 0.9835 0 0 0.9835 97.44 85.92 Tm /F2 10 Tf 0.029 Tc 0.5196 Tw (Arizona Advisory Committee on ) Tj ET q 48.48 0 0 -7.2 233.04 92.88 cm BI /W 270 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `???????<~|??~|? ?~p?| ?~p??~8??~??~`???~???~???~??~?~?~>?~?|??~?|?~?8<p?~?x<p??πxx??|x|?>????????|0?` ???x?|??p~|~p0 EI Q BT 0.9388 0 0 0.9835 233.04 85.92 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 281.52 85.92 Tm 0.0242 Tc 0.4024 Tw ( Dis-) Tj -186.6873 -10.9816 TD 0.0032 Tc 2.376 Tw (ease and Related Disorders,) Tj 0 Tc -0.061 Tw ( ) Tj 123.482 0 TD /F5 10 Tf 0.0084 Tc 2.1268 Tw (Final Report of the) Tj ET q 31.68 0 0 -7.2 97.44 71.04 cm BI /W 177 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >????~?|||`~??~p~s8?~?|~||??>~?~?~??y?????????? EI Q BT 0.9835 0 0 0.9835 97.44 64.08 Tm 3 Tr 0.0402 Tc 0 Tw (Arizonu) Tj 0 Tr 32.2127 0 TD 0.0076 Tc 1.2328 Tw ( Advisory Committee on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 231.6 71.28 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<`<???~??>c8>c>~>>~>>~p>8|~~~~~|?~~??||~???~~>?|?~>>?>?>p??>>x?>|y??????||~~?>??x? EI Q BT 0.9835 0 0 0.9835 231.6 64.08 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 13.68 0 0 -7.2 281.52 71.04 cm BI /W 77 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????><<8?8??~08~8~8x???????? EI Q BT 0.9835 0 0 0.9835 281.52 64.08 Tm 3 Tr 0.0041 Tc 0 Tw (Dis) Tj 0 Tr 13.91 0 TD 0.0846 Tc 0.0969 Tw ( -) Tj ET BT 0.8449 0 0 0.9835 328.56 595.68 Tm /F2 10 Tf 0.0908 Tc 0 Tw (15.) Tj 0.5681 -34.409 TD 0.0908 Tc (16.) Tj ET q 10.8 0 0 -7.2 329.28 524.4 cm BI /W 61 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @??||>>>>xx||~g~??0 EI Q BT 0.8449 0 0 0.9835 329.28 517.44 Tm 3 Tr 0.0908 Tc (17.) Tj 0 Tr 0.5681 -45.3906 TD 0.0908 Tc (18.) Tj 0.284 -44.9026 TD 0.0908 Tc (19.) Tj ET BT 0.8066 0 0 0.9835 329.52 384.72 Tm /F4 10 Tf 0.2235 Tc (20.) Tj 0.2975 -34.165 TD 0.0252 Tc (21.) Tj 0.2975 -33.921 TD 0.0252 Tc (22.) Tj 0.2975 -56.1282 TD 0.0252 Tc (23.) Tj 0.2975 -45.3906 TD 0.2235 Tc (24.) Tj 0.2975 -45.1466 TD 0.0252 Tc (25.) Tj 0.2975 -44.9026 TD 0.0252 Tc (26.) Tj -0.2975 -44.9026 TD 0.0252 Tc (27.) Tj ET BT 0.9835 0 0 0.9835 345.6 629.52 Tm /F5 10 Tf 0.0253 Tc 0.0353 Tw (ease and Related Disorders ) Tj 114.4527 0 TD /F2 10 Tf 0.0332 Tc 0.1493 Tw (\(Phoenix, AZ: Arizona) Tj ET BT 0.9388 0 0 0.9835 345.6 618.48 Tm 0.0192 Tc 1.2276 Tw (Department of Economic Security, Aging and Adult) Tj 0 -11.4697 TD 0.0187 Tc 0.5464 Tw (Administration, Oct. 1, ) Tj ET BT 0.934 0 0 0.9835 437.76 607.2 Tm /F4 10 Tf 0.0687 Tc 0 Tw (1989\).) Tj ET q 36.24 0 0 -8.16 345.6 602.4 cm BI /W 202 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<8C`??????~?>?????~???x?A~?x?<??<???<|??>px@ EI Q BT 0.9388 0 0 0.9835 345.6 595.68 Tm 3 Tr /F2 10 Tf 0.0454 Tc (Aronson,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 381.84 595.68 Tm 0 Tc -0.061 Tw ( ) Tj ET q 23.04 0 0 -8.16 384.24 602.64 cm BI /W 129 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px>&??/??????x>????; EI Q BT 0.9835 0 0 0.9835 384.24 595.68 Tm 3 Tr -0.0391 Tc 0 Tw (M.K.,) Tj 0 Tr 23.4274 0 TD 0.0179 Tc 3.0933 Tw ( Associate Professor, Albert Ein-) Tj ET BT 0.9388 0 0 0.9835 346.32 584.64 Tm 0.0066 Tc 1.0706 Tw (stein College of Medicine, New York, NY, personal) Tj ET BT 0.9835 0 0 0.9835 346.32 573.6 Tm 0.0243 Tc 0.321 Tw (communication, Mar. 19, 1991.) Tj ET q 36.24 0 0 -8.16 345.6 569.04 cm BI /W 202 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>8>???~?????|~~? ?? ????????????|?||`<|<|>|??>?????||~||x8 EI Q BT 0.9388 0 0 0.9835 345.6 561.84 Tm 3 Tr 0.0454 Tc 0 Tw (Aronson,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 381.84 561.84 Tm 0 Tc -0.061 Tw ( ) Tj ET q 23.04 0 0 -8.16 384.48 569.04 cm BI /W 129 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>|\?????~8???<????> EI Q BT 0.9835 0 0 0.9835 384.48 561.84 Tm 3 Tr -0.0391 Tc 0 Tw (M.K.,) Tj 0 Tr 23.4274 0 TD 0.0105 Tc 1.3926 Tw ( Cox, D.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 58.56 0 0 -9.36 450.24 569.28 cm BI /W 326 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?pxxxxx|? ?>>?????~????????????????????`?????<??????????????? ????????????<?~?~~`????0??? 8?~??? EI Q BT 0.9835 0 0 0.9835 450.24 561.84 Tm 3 Tr 0.0077 Tc 0 Tw (Guastadisegni,) Tj 0 Tr 59.5447 0 TD -0.0543 Tc 1.4584 Tw ( P., et al.,) Tj -164.7241 -10.9816 TD 0.0178 Tc 3.3374 Tw (\223Dementia and the Nursing Home: Association) Tj ET BT 0.9388 0 0 0.9835 346.32 539.76 Tm -0.0195 Tc 0.7575 Tw (With Care Needs,\224 ) Tj ET BT 0.9444 0 0 0.9835 422.64 539.76 Tm /F5 10 Tf -0.011 Tc 1.386 Tw (Journal of the American Geriat-) Tj ET BT 0.9835 0 0 0.9835 346.32 529.2 Tm -0.0202 Tc 0.0815 Tw (rics Society ) Tj ET q 49.68 0 0 -8.64 394.8 535.92 cm BI /W 276 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|~>p|??|>???>>>~x~>~~~|~?|~>>~~?~~|7~~|~~|~~>~>|?~~?~?>?~~x`~||>p>x?|>>??||>|???~ EI Q BT 0.9444 0 0 0.9835 394.8 529.2 Tm 3 Tr 0.0409 Tc 0 Tw (40\(1\):27-33,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 444.48 529.2 Tm 0.0854 Tc 0.0962 Tw ( 1992.) Tj -100.0546 -11.9577 TD /F2 10 Tf -0.0039 Tc 1.9929 Tw (Barnes, R.D., and Raskind, M.A., \223DSM) Tj 0 Tc -0.061 Tw ( ) Tj ET q 9.6 0 0 -6.96 521.28 524.4 cm BI /W 54 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????????????????? EI Q BT 0.9388 0 0 0.9835 521.28 517.44 Tm 3 Tr -0.0085 Tc 0 Tw (III) Tj 0 Tr ET BT 0.9835 0 0 0.9835 530.88 517.44 Tm -0.0031 Tc 1.1623 Tw ( Cri-) Tj -186.9313 -11.2256 TD -0.0035 Tc 2.348 Tw (teria and the Clinical Diagnosis of Dementia: A) Tj 0 -11.2256 TD 0.048 Tc 2.4525 Tw (Nursing Home Study,\224) Tj 102.495 0 TD /F5 10 Tf 0.0402 Tc 2.3385 Tw (Journal of Gerontology) Tj ET q 49.2 0 0 -8.64 347.04 491.28 cm BI /W 275 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <x|>??????~??~8>??|~|~|~|~~~x~<~|?>~<??|?X||~|>|>?~??~??~?>?|>||~`~~@~p~?>xp?<|x?x~|????>??? EI Q BT 0.9444 0 0 0.9835 347.04 484.08 Tm 3 Tr 0.0409 Tc 0 Tw (36\(1\):20-27,) Tj 0 Tr 52.0978 0 TD 0.0723 Tc 0.726 Tw ( 1980.) Tj ET BT 0.9835 0 0 0.9835 347.04 473.04 Tm /F2 10 Tf -0.0159 Tc 0.8499 Tw (Beardsley, R. S., Larson, D. B., Burns, B.J., et al.,) Tj 0.7321 -11.4697 TD 0.0353 Tc 2.3922 Tw (\223Prescribing of Psychotropic in Elderly Nursing) Tj -0.7321 -11.4697 TD -0.0088 Tc 1.4122 Tw (Home Patients,\224) Tj 0 Tc -0.061 Tw ( ) Tj 71.0144 0 TD /F5 10 Tf 0.0211 Tc 1.4428 Tw (Journal of the American Geriat-) Tj -71.0144 -10.7376 TD -0.0202 Tc 0.0815 Tw (rics Society ) Tj ET q 59.52 0 0 -8.64 395.52 446.88 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x<?? x????>??>???<?>?p|p|?|8|||||x||xx||||<||~|~~>?~>?~>|?< ||~|~?~>??~>??????x|?<>>>|?<8@<@`><?`p<?pxx?x~~|???|<??x?   EI Q BT 0.9444 0 0 0.9835 395.52 439.92 Tm 3 Tr 0.0466 Tc 0 Tw (37\(4\):327-330,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 455.04 439.92 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj -109.816 -11.4697 TD /F2 10 Tf -0.0182 Tc 1.0382 Tw (Beers, M., Avom, J., Soumerai, S.B., et al.,) Tj 183.7589 0 TD 0.239 Tc 0 Tw (\223Psy-) Tj -183.5148 -11.2256 TD -0.0048 Tc 4.3365 Tw (choactive Medication Use in Intermediate-Care) Tj -0.244 -10.7376 TD -0.0283 Tc 2.4081 Tw (Facility Residents,\224) Tj ET BT 0.9444 0 0 0.9835 429.12 406.8 Tm /F5 10 Tf -0.0034 Tc 0.425 Tw (Journal of the American ) Tj ET q 19.68 0 0 -7.2 525.6 413.76 cm BI /W 113 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID H8 ?~p??p?????~ ~g~~~~~~????????|>|~????????? EI Q BT 0.9444 0 0 0.9835 525.6 406.8 Tm 3 Tr 0.0063 Tc 0 Tw (Medi) Tj 0 Tr 20.8391 0 TD -0.0278 Tc 0.0696 Tw ( -) Tj ET BT 0.9835 0 0 0.9835 347.52 396 Tm 0.0096 Tc 0.0513 Tw (cal Association ) Tj ET q 79.68 0 0 -8.64 410.88 402.96 cm BI /W 443 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||><?|???????>??~?????????|x|?~~~<>~>>~>~?|~>~??x~>x??|~8??|~x?|~<~|~?>~~?|~~>~8~~~?~~~~~~~~?~~|?`???~??~p~? x~?|>p<???~>8x>?~>?|?<~?~??x>?~??|??~???p?< @ EI Q BT 0.9444 0 0 0.9835 410.88 396 Tm 3 Tr 0.0541 Tc 0 Tw (260\(20\):3016-3020,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 490.56 396 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj ET q 28.8 0 0 -8.16 347.04 391.2 cm BI /W 161 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<???~a?~~p~0~~~~~~@~~??????|p0?bp0 EI Q BT 0.9835 0 0 0.9835 347.04 384.24 Tm 3 Tr /F2 10 Tf -0.0565 Tc 0 Tw (Beitler,) Tj 0 Tr 29.2843 0 TD 0.0002 Tc 0.9149 Tw ( D., \223Secured Units, Dilemma #1: Resident) Tj -28.7962 -10.7376 TD 0.0228 Tc 0.2412 Tw (Protection or Confinement?\222 ) Tj ET q 48.96 0 0 -7.2 464.64 380.64 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <p??????>????????<???????p ?`?????|? |  <p??|>p~|?x?><??>????~|? ??<?>??~?8?|x0x EI Q BT 0.9835 0 0 0.9835 464.64 373.68 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0165 Tc 0.4103 Tw ( Associa-) Tj -168.8727 -11.4697 TD 0.029 Tc 0.1535 Tw (tion, Chicago, IL, January 1990.) Tj ET q 28.8 0 0 -8.16 347.28 358.08 cm BI /W 161 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|8?~????A?~p0||~~|~~|?|~~????x?>x8x|~x0| EI Q BT 0.9835 0 0 0.9835 347.28 351.12 Tm 3 Tr -0.0565 Tc 0 Tw (Beitler,) Tj 0 Tr 29.2843 0 TD 0.0096 Tc 1.4422 Tw ( D., Director for State Issues,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 502.32 358.08 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 7?????????|??>?>?x??<?`?? ??.????p|?|?<?<??>8?<<~?|?<>>|????||???|>>??<?~~|<8??~ EI Q BT 0.9388 0 0 0.9835 502.32 351.12 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 347.76 340.08 Tm 0.0144 Tc 3.8289 Tw (Association, Chicago, IL, personal communica-) Tj 0 -11.2256 TD 0.0402 Tc 0.2467 Tw (tions, Oct. 15, 1991, and Jan. 14, 1992.) Tj 0.7321 -11.4697 TD -0.0107 Tc 1.4838 Tw (Bell, P.A., and Smith, J.M., \223An Empirical Com-) Tj 0 -11.4697 TD 0.0138 Tc 0.3317 Tw (parison of Specialized ) Tj ET q 48.96 0 0 -7.2 440.4 313.44 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?`??????~???>??x?~<?~~??p~?? ????????|??|?<? <?~>8?~|À<??|?>?>>??~??????80?|?<????~~~||~x??~p8< EI Q BT 0.9835 0 0 0.9835 440.4 306.48 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0597 Tc 0.4883 Tw ( Nursing Home) Tj -143.2489 -11.2256 TD -0.0105 Tc 0 Tw (Units,\224) Tj 35.8732 0 TD 0.0243 Tc 3.0867 Tw (unpublished manuscript, Colorado State) Tj -35.8732 -10.9816 TD 0.0295 Tc 1.8124 Tw (University, Department of Psychology, Fort Col-) Tj 0 -10.9816 TD -0.0041 Tc 0.1872 Tw (lins, CO, no date.) Tj 0 -11.4697 TD -0.0235 Tc 0.573 Tw (Benedict, S. P.,) Tj 70.7703 -0.244 TD 0.2357 Tc 3.0548 Tw (\223The Decision To Establish a) Tj -70.7703 -10.9816 TD 0.0075 Tc 0.3381 Tw (Closed Psychiatric Unit: Some Ethical and Admin-) Tj 0 -10.9816 TD -0.0055 Tc 3.8491 Tw (istrative Considerations,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.68 0 0 -7.2 458.64 247.68 cm BI /W 176 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8p>?~?~|??~??????x|~~>??|?~~?|~>?????>  ||~~>?>?? EI Q BT 0.8971 0 0 0.9835 458.64 240.72 Tm 3 Tr /F5 10 Tf 0.0861 Tc 0 Tw (JournaZ) Tj 0 Tr ET BT 0.9835 0 0 0.9835 490.32 240.72 Tm 0.0577 Tc 2.0766 Tw ( of Long-Term) Tj -144.2251 -11.4697 TD 0.013 Tc 0.1698 Tw (Care Administration ) Tj ET q 48.96 0 0 -8.64 433.44 236.64 cm BI /W 273 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8x<p>x|>>x~x||?~~>???|~??8x߀>??x8>?<???p?8?<??|?|>?<?>?>??xx?<?|?<????>?>|?>|~?|~?|~?|~?|p?>x~g?|??????<?0p8?0 EI Q BT 0.9444 0 0 0.9835 433.44 229.44 Tm 3 Tr 0.0409 Tc 0 Tw (11\(4\):22-26,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 482.4 229.44 Tm 0.0854 Tc 0.0962 Tw ( 1983.) Tj -136.1719 -11.7137 TD /F2 10 Tf 0.003 Tc 1.1561 Tw (Benson, D. M., Cameron, D.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.04 0 0 -8.16 472.32 225.12 cm BI /W 229 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??????pp~0~?~?~??~???????????????????~??~??0? ?@??????? EI Q BT 0.9835 0 0 0.9835 472.32 217.92 Tm 3 Tr 0.0409 Tc 0 Tw (Humbach,) Tj 0 Tr 41.7301 0 TD -0.0612 Tc 0.6519 Tw ( E., et al.,) Tj -167.1644 -11.2256 TD 0.0046 Tc 3.1474 Tw (\223Establishment and Impact of a Dementia Unit) Tj -0.4881 -11.2256 TD 0.0248 Tc 0.5848 Tw (Within the Nursing Home,\224 ) Tj 117.6252 0 TD /F5 10 Tf 0.0215 Tc 0.8119 Tw (Journal of the Ameri-) Tj -117.3811 -10.9816 TD -0.002 Tc 0.2664 Tw (can Geriatrics Society ) Tj ET q 59.52 0 0 -8.64 440.64 192 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >x|>??|???????>?x>????x??x~x|~x|~||~|@|~|x|~|<|~?>~? ?~~~~~~?~~?~~??~>|?~|>x~~?<|~>~@>x<xxxx~?>|???~??>????|?|?8`> EI Q BT 0.9444 0 0 0.9835 440.64 185.04 Tm 3 Tr 0.0466 Tc 0 Tw (35\(4\):319-323,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 500.16 185.04 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -154.2305 -11.7137 TD /F2 10 Tf -0.0008 Tc 1.6132 Tw (Berg, G., Edwards, D.F., Danzinger, W.L., et al.,) Tj 0.7321 -11.2256 TD 0.0193 Tc 1.53 Tw (\221\221hngitudinal Change in Three Brief Assessments) Tj -0.4881 -11.2256 TD 0.0577 Tc 2.5647 Tw (of SDAT,\222) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.68 0 0 -6.96 399.12 158.4 cm BI /W 177 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p??????~???~yπ??~?~=8>>??|~~??~?~~~??~??~ ~~~??>~>~>??? EI Q BT 0.9835 0 0 0.9835 399.12 151.44 Tm 3 Tr /F5 10 Tf 0.0505 Tc 0 Tw (Journul) Tj 0 Tr 32.2127 0 TD 0.0004 Tc 3.3551 Tw ( of the American Geriatrics) Tj -83.7042 -10.9816 TD -0.0143 Tc -0.0465 Tw (Society ) Tj ET q 59.28 0 0 -8.64 379.68 147.6 cm BI /W 330 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88x<x|>>??`e7?>?><<?|~>|<?> |?><~p>p~x x>?<~<x>?<~|>??~|??~x~?~<~?~>~~~~~~|?~|~|~>~>~?~??~~?~~~|~|>?~>?~?|~`>|~x|<~|x<?~?>?x??~~?p??x~?<??0 EI Q BT 0.9444 0 0 0.9835 379.68 140.64 Tm 3 Tr 0.0466 Tc 0 Tw (35\(3\):205-212,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 438.96 140.64 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -92.0014 -11.4697 TD /F2 10 Tf -0.0237 Tc 1.2443 Tw (Berg, L., BuckWalter, K. 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EI Q BT 0.8971 0 0 0.9835 348.48 107.52 Tm 3 Tr /F5 10 Tf 0.0461 Tc 0 Tw (JournaloftheAmerican) Tj 0 Tr ET BT 0.9444 0 0 0.9835 433.2 107.52 Tm 0 Tc 0.0402 Tw ( ) Tj ET q 62.64 0 0 -9.36 435.36 114.48 cm BI /W 359 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8???px~?|?|??~?p?|<?0g?|<?~?~?|~~?|~?~|??~??|??~??~??p??~?~?p?|>?~?8?~?~π8?~????<~??|<~?~<?~?8?<??|<|?><~?|?|~??|???<| ??8`??@??? ` EI Q BT 0.9835 0 0 0.9835 435.36 107.52 Tm 3 Tr -0.0012 Tc 0 Tw (Ge&\224csSociety) Tj 0 Tr ET BT 0.9444 0 0 0.9835 498 107.52 Tm 0.0443 Tc 1.264 Tw ( 39\(12\):1229-) Tj -157.5642 -10.9816 TD 0.0723 Tc 0.4719 Tw (1236, 1991.) Tj ET BT 0.8919 0 0 0.9835 348.48 84.96 Tm /F2 10 Tf 0.0014 Tc 1.2641 Tw (Berger, E. 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EI Q BT 0.9388 0 0 0.9835 61.2 678.72 Tm 3 Tr 0 0 0 rg /F2 10 Tf 0.1101 Tc 0 Tw (179) Tj 0 Tr ET BT 0.9598 0 0 0.9598 75.6 678.72 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw ( l ) Tj ET BT 0.9835 0 0 0.9835 83.76 678.72 Tm /F5 10 Tf 0.0024 Tc 1.3031 Tw (Special Care Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 233.76 685.44 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<x???????|<~a>#| >>p>>8?|?|~~~~>??~?????~~??>~p>?~?>8??~?>8???>???????~~~?~?x????p EI Q BT 0.9835 0 0 0.9835 233.76 678.72 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.3698 Tw ( and Other ) Tj ET q 42.48 0 0 -6.96 329.04 685.44 cm BI /W 237 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `~>??~?~||~<?qx?> ?1Ox????8???0???|?~~?~~~|>~|>~??>~??~>>??p>>??~p??>x?|x~~?~??|~<?????`? EI Q BT 0.9835 0 0 0.9835 329.04 678.72 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8919 0 0 0.9835 66.24 640.56 Tm /F2 10 Tf 0.0465 Tc (28.) Tj 0.2691 -46.1227 TD 0.2258 Tc (29.) Tj ET BT 0.8066 0 0 0.9835 66.96 549.84 Tm /F4 10 Tf 0.0252 Tc (30.) Tj 0.2975 -23.6715 TD 0.0252 Tc (31.) Tj 0.5951 -45.8787 TD 0.0252 Tc (32.) Tj 0.2975 -45.3906 TD 0.0252 Tc (33.) Tj 0.5951 -57.3484 TD 0.0252 Tc (34.) Tj 0.2975 -57.3484 TD 0.0252 Tc (35.) Tj 0.5951 -34.6531 TD 0.0252 Tc (36.) Tj 0 -35.1411 TD 0.2235 Tc (37.) Tj 0.2975 -46.1227 TD 0.0252 Tc (38.) Tj ET BT 0.7642 0 0 0.9835 69.84 175.68 Tm 0.0748 Tc (39.) Tj ET BT 0.8491 0 0 0.9835 69.6 119.52 Tm 0.0748 Tc (40.) Tj 0.2827 -34.165 TD 0.0748 Tc (41.) Tj 0 -45.6347 TD 0.0748 Tc (42.) Tj ET q 24.72 0 0 -9.12 83.76 647.76 cm BI /W 138 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?<?>?`ǃ????~~>????????8|~~>||< EI Q BT 0.9835 0 0 0.9835 83.76 640.8 Tm 3 Tr /F2 10 Tf -0.0589 Tc (Billig,) Tj 0 Tr 25.1357 0 TD 0.0111 Tc 2.8968 Tw ( N., Cohen-Mansfield, J., and Lipson, S.,) Tj -23.9155 -11.2256 TD 0.0035 Tc 4.572 Tw (\223Pharmacological Treatment of Agitation in a) Tj -0.7321 -11.4697 TD 0.042 Tc 3.0687 Tw (Nursing Home,\224) Tj 73.6988 -0.244 TD /F5 10 Tf 0.0256 Tc 1.4381 Tw (Journal of the American Geria-) Tj -73.2107 -10.9816 TD -0.0266 Tc 0.21 Tw (trics Society ) Tj ET q 74.16 0 0 -8.64 136.08 614.64 cm BI /W 413 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x>||??|~?|???~?>?>?>?~x>?|~||~|~?~||<|x~~|~x~~~~~x?|~~?x?|~~??||>????|???|?????~????~?|??>?~??~??|~???|~~??|~??~|??~|??>>>~~~?~>~?ǀ~>~~~?~?~???>???~?~?~?|?|>xp?@ EI Q BT 0.9444 0 0 0.9835 136.08 607.44 Tm 3 Tr 0.0525 Tc 0 Tw (39\(10\):1002-1005,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 210.24 607.44 Tm 0.0854 Tc 0.3402 Tw ( 1991.) Tj ET q 46.32 0 0 -8.64 84.24 602.16 cm BI /W 258 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8< 8x>?x<????????>?|~|8|?>??0<xx8|~??~> EI Q BT 0.9835 0 0 0.9835 84.24 595.2 Tm 3 Tr /F2 10 Tf 0.0133 Tc 0 Tw (Birenbaum,) Tj 0 Tr 47.0989 0 TD 0.2564 Tc 3.3387 Tw ( R.,) Tj 26.1118 -0.244 TD 0.0303 Tc 4.4635 Tw (\223Doctor Proposes New Ethics) Tj -72.9667 -10.9816 TD 0.0498 Tc 3.0608 Tw (Protocol for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 141.12 591.12 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~???>????????????<?????~?p??0?????????????????<?? <?? 8??|8??|<??>?<<?|?????|8|>>>?>?~><?> EI Q BT 0.9388 0 0 0.9835 141.12 584.16 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 190.08 584.16 Tm -0.0176 Tc 2.8853 Tw ( Research,\224) Tj 0 Tc -0.061 Tw ( ) Tj 54.4199 0 TD /F5 10 Tf 0.7093 Tc 0 Tw (Canadian) Tj -162.0397 -10.9816 TD 0.5051 Tc 2.8419 Tw (Medical Association Journal) Tj 0 Tc -0.061 Tw ( ) Tj ET q 65.76 0 0 -8.64 222.24 580.56 cm BI /W 366 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08<<xxx0??|~~|>|~<>>~x~>|><~><~{?><~?> ~?>?~?>?~?~?~?~|??|??<???`?>x>?<|~><|||>||x@~?|π>?`x>px~x<~x?|??<????><??x?px0 EI Q BT 0.9444 0 0 0.9835 222.24 573.36 Tm 3 Tr 0.0488 Tc 0 Tw (144\(3\):335-336,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 85.44 562.32 Tm 0.0456 Tc (1991.) Tj ET q 40.8 0 0 -8.64 84.48 557.04 cm BI /W 227 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  0<@?????????????>~|<x~?<<8~??<?x<~??9~??~?~?~|?~?~`~~~?~??~?<|?>?|~~??|>~~???~~?~?~???~~?~?????| EI Q BT 0.9835 0 0 0.9835 84.48 550.08 Tm 3 Tr /F2 10 Tf -0.0405 Tc (Blakeslee,) Tj 0 Tr 41.4861 0 TD -0.0147 Tc 3.1264 Tw ( J.A.,) Tj 30.7485 -0.4881 TD -0.0077 Tc 2.9973 Tw (\223Untie the Elderly,\224) Tj 0 Tc -0.061 Tw ( ) Tj 91.7574 0 TD /F5 10 Tf 0.4451 Tc 0 Tw (American) Tj -163.992 -10.7376 TD 0.0367 Tc 0.3084 Tw (Journal of Nursing ) Tj ET q 47.52 0 0 -8.16 164.16 545.76 cm BI /W 264 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID X<<??0?>?|??|?|?~?|?>|~>|||| >||>~>|>???~???~?>~?~?>????||?|??|||?~<~|?~>>x|<|>|~ |x|>?|?>???~~??|?<p EI Q BT 0.9444 0 0 0.9835 164.16 539.04 Tm 3 Tr 0.057 Tc 0 Tw (88:833-834,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 211.68 539.04 Tm 0.0854 Tc 0.3402 Tw ( 1988.) Tj -129.0949 -12.4458 TD /F2 10 Tf 0.0003 Tc 3.7944 Tw (Bloom, S.M., Public Policy Analyst, American) Tj 0.9761 -11.2256 TD 0.0189 Tc 1.2315 Tw (Association of Homes for the Aging, letter to the) Tj 0 -11.2256 TD 0.0271 Tc 0.6923 Tw (Office of Technology Assessment, U.S. Congress,) Tj T* 0.033 Tc 0.0275 Tw (Washington, DC, May 8, 1992.) Tj 0 -12.2018 TD 0.0069 Tc 2.1283 Tw (Blumenthal Jewish Home,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48 0 0 -7.2 198.72 488.64 cm BI /W 267 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `4 ????????|????p??8??8???>?~|??~?~?>?~?>??????~??????x x?<??>?????>  EI Q BT 0.9835 0 0 0.9835 198.72 481.68 Tm 3 Tr -0.0065 Tc 0 Tw (\223Alzheimer) Tj 0 Tr 48.8071 0 TD 0.0074 Tc 1.1516 Tw ( Unit: De-) Tj -163.7479 -11.2256 TD 0.057 Tc 1.874 Tw (sign and Program for Self-Help Workshop,\224 un-) Tj 0 -10.9816 TD 0.0255 Tc 1.6212 Tw (published manuscript,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.88 0 0 -8.64 178.8 467.04 cm BI /W 250 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<?߃????~??~?~?~?~ ??~?a?~???~??~??~??~??~??~??~`?~??????||| ??| EI Q BT 0.9388 0 0 0.9835 178.8 459.84 Tm 3 Tr 0.0111 Tc 0 Tw (Clemrnons,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 223.68 459.84 Tm 0.009 Tc 1.15 Tw ( NC, September) Tj ET BT 0.8919 0 0 0.9835 86.4 449.04 Tm 0.0717 Tc 0 Tw (1985.) Tj ET q 28.8 0 0 -8.88 85.68 443.76 cm BI /W 160 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~<|>>???????? ??????????????|??|??~??~??~??~??????????????>???????>??? EI Q BT 0.9388 0 0 0.9835 85.68 436.8 Tm 3 Tr 0.0599 Tc (Boling,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 114.48 436.8 Tm 0.0282 Tc 2.5947 Tw ( K., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 36.72 0 0 -9.36 156.24 444 cm BI /W 204 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~0x|<>`x<<??~?~?~p~8~?~?~~~~~x~x~|~<~~>~? ~??|????Bp<??p ??? EI Q BT 0.9388 0 0 0.9835 156.24 436.8 Tm 3 Tr 0.0086 Tc 0 Tw (Gwyther,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 192.96 436.8 Tm 0.4642 Tc 3.2902 Tw ( L.P., \223Defining the) Tj -108.5959 -10.9816 TD 0.0236 Tc 0.5076 Tw (Quality of Care for Nursing Home Residents With) Tj -0.244 -11.7137 TD -0.0211 Tc -0.0396 Tw (Dementia,\224 ) Tj 51.9796 0 TD /F5 10 Tf 0.0137 Tc 1.8773 Tw (Dementia Units in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 19.92 0 0 -8.88 217.68 421.44 cm BI /W 111 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|<~>~>>??`??~~>>>?~?>~|~|~~|~~~~>?~?~|~?01????? EI Q BT 1.086 0 0 0.9835 217.68 414.48 Tm 3 Tr 0.0372 Tc 0 Tw (Lmg) Tj 0 Tr ET BT 0.9835 0 0 0.9835 237.6 414.48 Tm 0.0054 Tc 1.8858 Tw ( Term Care,) Tj ET q 17.04 0 0 -7.2 85.92 410.88 cm BI /W 95 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8??????|???????????????????????? EI Q BT 0.9388 0 0 0.9835 85.92 403.92 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 102.96 403.92 Tm 0.0323 Tc 2.1024 Tw ( Sloane and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 14.4 0 0 -7.2 157.92 410.88 cm BI /W 80 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<?~~|~<~~~~G EI Q BT 0.9388 0 0 0.9835 157.92 403.92 Tm 3 Tr 0.0187 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 172.32 403.92 Tm -0.0146 Tc 2.3941 Tw ( Mathew) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.88 214.08 411.12 cm BI /W 120 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x<>>|8~||>~>>?~~?>~?>|?>|??>|??|>?>??>??>???????| >|?>|?>|>~>~~|~?|>|???????><<xp EI Q BT 0.9388 0 0 0.9835 214.08 403.92 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 235.68 403.92 Tm 0.2018 Tc 3.6384 Tw ( \(Baltimore,) Tj -152.2782 -11.2256 TD 0.0422 Tc 0.1401 Tw (MD: Johns Hopkins University Press, 1991\).) Tj ET q 28.8 0 0 -9.12 85.92 387.36 cm BI /W 161 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x?<???ps???x>>>???????|? ??? EI Q BT 0.9388 0 0 0.9835 85.92 380.64 Tm 3 Tr 0.0599 Tc 0 Tw (Boling,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 114.72 380.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -8.16 117.12 387.12 cm BI /W 100 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ! 00ppp ~? EI Q BT 0.8919 0 0 0.9835 117.12 380.64 Tm 3 Tr -0.0178 Tc 0 Tw (T.E.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 135.12 380.64 Tm 0.0647 Tc 0.2392 Tw ( and ) Tj ET q 29.28 0 0 -9.12 155.76 387.36 cm BI /W 163 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxx8???????~?~?~?~?~~?~~?~?~~?~~?~~?~?~?~?~?~?~?~~????? EI Q BT 0.9835 0 0 0.9835 155.76 380.64 Tm 3 Tr 0.0037 Tc 0 Tw (Boling,) Tj 0 Tr 29.7723 0 TD 0.0051 Tc 1.2516 Tw ( K., \223Life and Death in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 3.84 0 0 -4.56 285.6 385.44 cm BI /W 22 /H 27 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~??<|~~~? EI Q BT 0.8449 0 0 0.9835 285.6 380.64 Tm 3 Tr 0.1013 Tc 0 Tw (a) Tj 0 Tr ET BT 0.9835 0 0 0.9835 85.92 369.36 Tm 0.0039 Tc 1.8873 Tw (Dementia Special Care Unit: Some Demographic) Tj 0.4881 -11.2256 TD 0.0319 Tc 0 Tw (Comparisons,\222) Tj 66.6217 0 TD /F5 10 Tf 0.0307 Tc 2.1041 Tw (American Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 242.64 365.28 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p>???????|?|~>c|~ >c>~x>|?|?||<?|~~~~~~?~>|???|?????~|?|?~`~?~?>p>?>>8??<~??|?|||>?>x?@|?|?p EI Q BT 0.9835 0 0 0.9835 242.64 358.32 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 86.4 347.52 Tm -0.0075 Tc 1.6153 Tw (Care and Related Disorders and Research 4\(3\):12-) Tj 0.7624 -10.9816 TD 0.0703 Tc -0.0343 Tw (16, 1989.) Tj ET q 29.28 0 0 -9.12 86.16 331.2 cm BI /W 163 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px???????~~~~~~~>~~~~~?????? EI Q BT 0.9835 0 0 0.9835 86.16 324.24 Tm 3 Tr /F2 10 Tf 0.0037 Tc 0 Tw (Boling,) Tj 0 Tr 29.7723 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -8.16 117.84 330.96 cm BI /W 100 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |8xxx8@_ EI Q BT 0.8919 0 0 0.9835 117.84 324.24 Tm 3 Tr -0.0178 Tc 0 Tw (T.E.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 135.84 324.24 Tm 0.0145 Tc 2.1206 Tw ( and Sommers, K. M., \223Alzheirner\222s) Tj -50.2713 -10.9816 TD 0.0093 Tc 1.9306 Tw (Disease and Public Policy Issues,\224 draft,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.24 0 0 -7.2 260.16 320.4 cm BI /W 168 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8p~?8?<?||c~~~~~~~~~~~~~?Ǐ~?~?~?~?~x?x<><<>x8p0x|~|8 EI Q BT 0.9835 0 0 0.9835 260.16 313.44 Tm 3 Tr -0.0089 Tc 0 Tw (Witten-) Tj 0 Tr -176.4378 -11.2256 TD 0.0265 Tc 0.3024 Tw (berg University, Springfield, OH, no date.) Tj -0.244 -12.2018 TD 0.0156 Tc 0.4518 Tw (Bonkowski, H.J., Director, State Board for Licens-) Tj 0.4881 -11.4697 TD -0.0105 Tc 0.7224 Tw (ing Health Care Facilities, Nashville, TN, personal) Tj 0 -10.9816 TD 0.0375 Tc 0.1449 Tw (communication, June 19, 1992.) Tj -0.4881 -12.9339 TD -0.0014 Tc 3.9495 Tw (Botwinick, J., Storandt, M., and Berg, L., \223A) Tj ET q 53.28 0 0 -9.12 86.88 251.52 cm BI /W 297 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x|>|<0| >€|???????~?????|????????????|??????????????????~??~????????~??>??????~????x?x~<9?????p? ?|` EI Q BT 0.8919 0 0 0.9835 86.88 244.32 Tm 3 Tr 0.0254 Tc 0 Tw (Lxmgitudinal,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 140.16 244.32 Tm 0.0105 Tc 0.1723 Tw ( Behavioral Study of Senile Dementia) Tj -53.9319 -11.2256 TD 0.0363 Tc 0.3901 Tw (of the ) Tj ET q 42 0 0 -7.2 114.24 240.48 cm BI /W 234 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8@???????????|???~??p??`??????????~|?|?|?><8?>À><?>?<?????<|?~?~~|?~x<8 EI Q BT 0.9835 0 0 0.9835 114.24 233.28 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.7062 0 TD 0.0118 Tc 1.1472 Tw ( Type,\224) Tj 0 Tc -0.061 Tw ( ) Tj 34.8971 0 TD /F5 10 Tf 0.0069 Tc 3.4705 Tw (Archives of Neurology) Tj ET q 58.08 0 0 -8.64 87.12 229.68 cm BI /W 324 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   @,0?????????x?<?>?|?>|?~??x~|?><???>?????|x~~<~<?|<~?|@~?x?|?x>?x?|?|??~?????|?<?xp~p EI Q BT 0.9444 0 0 0.9835 87.12 222.48 Tm 3 Tr 0.0606 Tc 0 Tw (43:1124-1127,) Tj 0 Tr 61.5009 0 TD 0.0723 Tc 0.726 Tw ( 1986.) Tj ET BT 0.9388 0 0 0.9835 87.84 210.24 Tm /F2 10 Tf 0.0166 Tc 1.3156 Tw (Bowsher, M.,) Tj ET BT 0.9835 0 0 0.9835 144 210 Tm 0.0443 Tc 0.016 Tw (\223A Unique and Successful Approach) Tj -57.1043 -10.9816 TD 0.0074 Tc 0.3219 Tw (to Care for Moderate Stage ) Tj ET q 48.96 0 0 -7.2 199.92 206.16 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8 ????|??>?????~??~x?~~<??~?p~?0~ ?~?~>?~?~?~??~<?~<?~ ?~|8?~|8?~<<><>?|????πx<>>8?|>><?|0 EI Q BT 0.9835 0 0 0.9835 199.92 199.2 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0353 Tc 0.951 Tw ( Victims,\224) Tj -163.992 -11.4697 TD 0.0019 Tc 0.2856 Tw (Green Hills Center, West Liberty, OH, no date.) Tj -0.4881 -12.2018 TD 0.0006 Tc 0.3654 Tw (Boyd, J.R., Frieden, S., ) Tj ET q 29.28 0 0 -9.12 183.6 182.64 cm BI /W 163 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~>>8????ǀ|ǀ~?~?~~~~??????H EI Q BT 0.9835 0 0 0.9835 183.6 175.92 Tm 3 Tr 0.0051 Tc 0 Tw (Higley,) Tj 0 Tr 29.7723 0 TD -0.0092 Tc 0.3388 Tw ( K. O., et al., \223How) Tj -127.6306 -11.2256 TD 0.0219 Tc -0.0833 Tw (To Cope With ) Tj ET q 48.96 0 0 -7.2 146.16 171.84 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pq????~???>?>??>??~???~8??~??~??`~???~???~???~??~?~?~???~~?|??~~?<| ?~?<<p?~?~x?À<>x?~?~|<|??>|????>??0p?x?<?<?|??||?|~x|88 EI Q BT 0.9835 0 0 0.9835 146.16 164.88 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.001 Tc -0.062 Tw ( Disease: Training Man-) Tj -109.572 -11.2256 TD -0.0305 Tc 1.4342 Tw (ual,\224 St.) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.84 0 0 -7.2 124.56 160.8 cm BI /W 122 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?@g??|~?x??p?p``?~?~?|>|?x|??  EI Q BT 1.2205 0 0 0.9835 124.56 153.84 Tm 3 Tr 0.0256 Tc 0 Tw (Imis) Tj 0 Tr ET BT 0.9835 0 0 0.9835 146.4 153.84 Tm -0.0017 Tc 1.649 Tw ( Chapter,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 188.16 161.04 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8????|??>???~?>?~?>?~x?~?~8?~?~??`~???~`~??~~???~~?~?~~???~~0???~~?|?~~?|?~~?|?~~?8<8?~~?8<8?~~x?ǀ8<??|x??>x?????>x? p?|?<?>?~??|x88 EI Q BT 0.9388 0 0 0.9835 188.16 153.84 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 236.88 153.84 Tm 0.0069 Tc 2.2503 Tw ( Disease and) Tj -152.0342 -10.9816 TD 0.0063 Tc 1.3154 Tw (Related Disorders Association, St. Louis, MO, no) Tj 0.244 -10.9816 TD -0.0272 Tc 0 Tw (date.) Tj ET q 25.92 0 0 -8.16 87.36 126.48 cm BI /W 144 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>?x~@?????~?>??p~???~??~?~?~?~??~~??~?~~?|~~0?~~x?~>>??>????~????????>??????? EI Q BT 0.9835 0 0 0.9835 87.36 119.76 Tm 3 Tr -0.0065 Tc (Brach,) Tj 0 Tr 26.3559 0 TD -0.0197 Tc -0.041 Tw ( L.A., ) Tj 25.8678 0 TD /F5 10 Tf 0.0292 Tc 0.6414 Tw (Improving Person-Environment Fit in) Tj -51.4915 -11.2256 TD 0.004 Tc 0.179 Tw (the Special Care Unit ) Tj 90.7813 0 TD /F2 10 Tf -0.004 Tc 0.4311 Tw (\(Cleveland, OH: Case West-) Tj -91.0253 -10.9816 TD 0.0328 Tc 0.2106 Tw (ern Reserve University, June 1987\).) Tj ET q 36 0 0 -9.12 87.6 92.88 cm BI /W 200 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|||<<>>>pp?<>>?????x<~~?pǀxx|<<<>>~| ~|???>??||? EI Q BT 0.9835 0 0 0.9835 87.6 86.16 Tm 3 Tr -0.0049 Tc 0 Tw (Brawley,) Tj 0 Tr 36.6053 0 TD 0.0055 Tc 0.1774 Tw ( E. C., President, Design Concepts Unlim-) Tj -36.3613 -10.9816 TD -0.0366 Tc -0.0238 Tw (ited, ) Tj ET q 38.16 0 0 -8.64 107.76 82.56 cm BI /W 213 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p p????????~?~?~?~??~??~?~??~~?~?~?~?~??80~|p?~?~~?~~?~???p <????r EI Q BT 0.9388 0 0 0.9835 107.76 75.36 Tm 3 Tr 0.0177 Tc 0 Tw (Sausalito,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 145.92 75.36 Tm 0.0054 Tc 0.4215 Tw ( CA, letter to the Office of Technol-) Tj -58.8126 -11.4697 TD 0.0255 Tc 0.6939 Tw (ogy Assessment, U.S. Congress, Washington, DC,) Tj -0.244 -10.9816 TD -0.0125 Tc -0.0483 Tw (May ) Tj ET q 11.04 0 0 -8.16 108.96 60.24 cm BI /W 62 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|8?~~~~~~~~~~~~~~~~~~~~>p EI Q BT 0.8449 0 0 0.9835 108.96 53.28 Tm 3 Tr 0.0908 Tc 0 Tw (11,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 120 53.28 Tm 0.0854 Tc 0.8283 Tw ( 1992.) Tj ET q 41.28 0 0 -9.36 87.6 48 cm BI /W 230 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |||<p????????????|?~|<~<8x|<<>>>>~~??|?<>?? EI Q BT 0.7642 0 0 0.9835 320.4 183.36 Tm 3 Tr 0.0748 Tc (53,) Tj 0 Tr ET BT 0.8066 0 0 0.9835 320.88 106.32 Tm 0.0252 Tc (54.) Tj 0 -44.6585 TD 0.0252 Tc (55.) Tj ET BT 0.9835 0 0 0.9835 334.32 640.56 Tm /F5 10 Tf 0.0242 Tc 3.5749 Tw (American Journal of Hospice Care) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.64 0 0 -9.12 493.68 647.76 cm BI /W 248 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x`|>?8 >>||߀~~~>|?|?~??~p|?>0||>0<?>??????||?>>??8?|?????????>?>x?}|~|?~|@|?>~?>>?~???????>?x<p8? EI Q BT 0.9444 0 0 0.9835 493.68 640.56 Tm 3 Tr 0.0374 Tc 0 Tw (4\(3\):27-30,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 335.52 629.28 Tm 0.0456 Tc (1989.) Tj ET BT 0.9835 0 0 0.9835 334.56 617.52 Tm /F2 10 Tf -0.0269 Tc 2.4372 Tw (Breen, A.R., Larson, E. B., Reifier, B.V., et al.,) Tj 0.9761 -11.2256 TD 0.0236 Tc 2.7824 Tw (\223Cognitive Performance and Functional Compe-) Tj -0.4881 -10.9816 TD 0.0083 Tc 3.2494 Tw (tence in Coexisting Dementia and Depression,\224) Tj -0.244 -11.4697 TD /F5 10 Tf 0.0121 Tc -0.0733 Tw (Journal of the American Geriatrics ) Tj ET q 28.56 0 0 -9.36 476.16 591.6 cm BI /W 159 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x` x><?<???~???~???~??p?p?|~0?~0?x>??x?~?x?>?x?>x??p0?p??x?8<~?~>???~>??~~?~??|?||>x?x EI Q BT 0.9835 0 0 0.9835 476.16 584.4 Tm 3 Tr 0.0005 Tc 0 Tw (Socie~) Tj 0 Tr 29.0402 0 TD 0.1113 Tc -0.1742 Tw ( 32:132-) Tj ET BT 0.9444 0 0 0.9835 336 573.6 Tm 0.0714 Tc 0.2187 Tw (137, 1984.) Tj ET BT 0.9835 0 0 0.9835 335.04 562.08 Tm /F2 10 Tf -0.0314 Tc 1.6792 Tw (Brice, G.,) Tj 45.8787 -0.244 TD 0.0338 Tc 2.1009 Tw (\223Caring for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 432.24 568.8 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @~a????>????>~??~?p?~0?~~??~~??~|?~|???~??~~?~|?~<~?>?~?/>?>??>??>~`?x?>?x  |>~~?~~?|?<?8@>8 EI Q BT 0.9835 0 0 0.9835 432.24 561.84 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.01 Tc 2.5115 Tw ( Residents: A) Tj ET q 23.76 0 0 -7.2 335.52 557.76 cm BI /W 133 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p~@?????????????????~????>?>>?????????????<?<???|??~>> EI Q BT 1.3613 0 0 0.9835 335.52 550.8 Tm 3 Tr 0.0632 Tc 0 Tw (ST~) Tj 0 Tr ET BT 0.9835 0 0 0.9835 359.28 550.8 Tm 0.3924 Tc 3.6886 Tw ( Unit,\224) Tj 41.7301 0 TD /F5 10 Tf 0.0406 Tc 4.209 Tw (Contemporary Long Term Care) Tj ET q 66.96 0 0 -8.64 335.52 546.96 cm BI /W 373 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>?>? ?||~?~>~>???|?~~?>~>>~~?~~~?~~~~~?~?~~?~?~~??~?p~?~?~?~~??~?~~?~??~?~?~?~x~?~<~?~>~?~~?x8~~?||~?~??>>~?~??>~x~?|???|~| ??~~?>~|?~?~>~|??><>|??~x?>??~~>~>p??> EI Q BT 0.9444 0 0 0.9835 335.52 539.76 Tm 3 Tr 0.0483 Tc 0 Tw (9\(10\):83-86,104,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 402.48 539.76 Tm 0.0854 Tc -0.1478 Tw ( 1986.) Tj -68.0859 -11.4697 TD /F2 10 Tf -0 Tc 1.6473 Tw (Brody, E.M.,) Tj 60.0328 -0.244 TD 0.033 Tc 2.1017 Tw (\223The Long Haul: A Family Odys-) Tj -59.3007 -10.9816 TD -0.0053 Tc -0.0557 Tw (sey,\224 ) Tj 24.6476 0 TD /F5 10 Tf 0.0084 Tc 2.1268 Tw (Treatments for the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.04 0 0 -7.2 442.32 524.64 cm BI /W 228 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |??????|??q` x|~<~~~~~~~~|~~????~???~?????~??????p??x<|?~?~?~???>p>?????o` EI Q BT 0.9835 0 0 0.9835 442.32 517.44 Tm 3 Tr -0.007 Tc 0 Tw (Alzheimer) Tj 0 Tr 41.7301 0 TD 0.0088 Tc 2.2484 Tw ( Patient: The) Tj -150.326 -11.2256 TD 0.0665 Tc 1.8236 Tw (Long Haul,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 15.84 0 0 -6.96 387.36 513.12 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|???>? EI Q BT 0.9388 0 0 0.9835 387.36 506.4 Tm 3 Tr /F2 10 Tf 0.0483 Tc 0 Tw (L.F.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 403.2 506.4 Tm 0 Tc -0.061 Tw ( ) Tj ET q 24.48 0 0 -6.96 405.6 513.36 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~??~~?~0?~???~???~?~?~??x~?x~?<~?<~??>~?~|?~?~|?~Ϗ~~????~||p8 EI Q BT 0.9835 0 0 0.9835 405.6 506.4 Tm 3 Tr 0.0323 Tc 0 Tw (Jarvik) Tj 0 Tr 24.8916 0 TD 0.0647 Tc 0.2392 Tw ( and ) Tj ET q 18 0 0 -7.2 450.96 513.36 cm BI /W 100 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?p??????~ EI Q BT 0.9388 0 0 0.9835 450.96 506.4 Tm 3 Tr 0.0043 Tc 0 Tw (C.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 468.96 506.4 Tm 0.0622 Tc 1.828 Tw ( Winograd) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 517.44 513.36 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|>??~????~??~???~~?~~?~~~~?~~?~??~??~? ~?~~~~?~~?<~|~??????>||` EI Q BT 0.9388 0 0 0.9835 517.44 506.4 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.24 495.6 Tm 0.0572 Tc -0.1192 Tw (\(New ) Tj ET q 21.6 0 0 -8.16 360.96 502.32 cm BI /W 120 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<??????x????????~?~??????x|?|?|>??? EI Q BT 0.9835 0 0 0.9835 360.96 495.6 Tm 3 Tr 0.1064 Tc 0 Tw (York) Tj 0 Tr 21.9632 0 TD 0.0433 Tc 0.2854 Tw ( NY: Springer Publishing Co., 1988\).) Tj -47.0989 -11.4697 TD -0 Tc 0.3051 Tw (Brody, E. M.,) Tj 62.9612 0 TD 0.0232 Tc 4.0639 Tw (\223The Social Aspects of Nursing) Tj -62.9612 -11.7137 TD -0.0017 Tc 1.8929 Tw (Home Care,\224) Tj 0 Tc -0.061 Tw ( ) Tj 59.0566 0 TD /F5 10 Tf 0.0381 Tc 2.0965 Tw (The Teaching Nursing Home,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.32 0 0 -7.2 522.72 480 cm BI /W 91 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |o ~8xxpp00>? @ EI Q BT 0.9388 0 0 0.9835 522.72 472.8 Tm 3 Tr /F2 10 Tf 0.0385 Tc 0 Tw (E.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.24 462.24 Tm 0.2633 Tc -0.3288 Tw (Schneider, ) Tj ET q 14.4 0 0 -7.2 386.16 469.2 cm BI /W 80 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @~??~~>@????????????????????????????? EI Q BT 0.9388 0 0 0.9835 386.16 462.24 Tm 3 Tr 0.0064 Tc 0 Tw (C.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 400.56 462.24 Tm 0.0336 Tc 2.8333 Tw ( Wendland,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 19.68 0 0 -7.2 454.56 469.2 cm BI /W 110 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????~?<<>?x?||~?||<8 EI Q BT 0.8919 0 0 0.9835 454.56 462.24 Tm 3 Tr -0.0366 Tc 0 Tw (A.W.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 474.24 462.24 Tm -0.0368 Tc 2.4167 Tw ( Zimmer, et al,) Tj ET q 21.6 0 0 -8.64 336.48 458.4 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<<~>|>~>>?~~?>~??>|?>|?>|??????>??>????>?????????>|? >|?>|?~|~~<|~|>?|?x?????x><|?p` EI Q BT 0.9388 0 0 0.9835 336.48 451.2 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 358.08 451.2 Tm 0.0572 Tc 0.0028 Tw ( \(New ) Tj ET q 21.6 0 0 -8.16 385.44 458.16 cm BI /W 120 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<????x????????????????x|>>??????@ EI Q BT 0.8919 0 0 0.9835 385.44 451.2 Tm 3 Tr 0.0132 Tc 0 Tw (Yorlq) Tj 0 Tr ET BT 0.9835 0 0 0.9835 407.04 451.2 Tm 0.0358 Tc 0.4516 Tw ( NY: Raven Press, 1985\).) Tj -71.9905 -11.4697 TD -0 Tc 1.6473 Tw (Brody, E.M.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.96 0 0 -8.16 393.84 446.88 cm BI /W 172 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~ D???|?>~~?????>?>|><>?? EI Q BT 0.9835 0 0 0.9835 393.84 439.92 Tm 3 Tr 0.0119 Tc 0 Tw (Kleban,) Tj 0 Tr 31.4806 0 TD -0.0319 Tc 1.4356 Tw ( M.H., Lawton, M.P., et al.,) Tj -89.073 -10.9816 TD 0.2307 Tc 2.6328 Tw (\223Excess Disabilities of the Mentally Impaired) Tj -0.7321 -10.9816 TD 0.0126 Tc 1.5124 Tw (Aged: Impact of Individualized Treatment,\224) Tj 0 Tc -0.061 Tw ( ) Tj 187.1753 0 TD /F5 10 Tf 0.2191 Tc 0 Tw (Ger-) Tj -186.9313 -11.2256 TD 0.0234 Tc -0.0848 Tw (ontologist ) Tj ET q 59.04 0 0 -8.64 381.12 414 cm BI /W 328 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<>x<<>><n|p 8?>|~?~~?>~?>>?~?>?~?|~>?~?>~~?>~?>~??>~??~??~|??~|>??~|??~>~?~>?~>?>>~?~??~?~?~>~?|>x~?>||~?~|>~?|~?~?`~?p~?x~|?|G >?>??~?>~??<>p8|< EI Q BT 0.9444 0 0 0.9835 381.12 407.28 Tm 3 Tr 0.0466 Tc 0 Tw (11\(2\):124-133,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 440.16 407.28 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 442.56 414 cm BI /W 116 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |`????~~~~~~~~~~~~?~~|~?|~?>~?>~?>~?~?~??~~~~~~|~?~p EI Q BT 0.8971 0 0 0.9835 442.56 407.28 Tm 3 Tr 0.0456 Tc 0 Tw (1971.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.48 395.52 Tm /F2 10 Tf -0.0066 Tc 2.2466 Tw (Brody, E. M., Lawton, M.P., and Liebowitz, B.,) Tj 0.7321 -11.4697 TD 0.0036 Tc 3.8399 Tw (\223Senile Dementia: Public Policy and Adequate) Tj -0.4881 -10.9816 TD -0.0136 Tc 5.0775 Tw (Institutional Care,\224) Tj 86.3886 0 TD /F5 10 Tf 0.0222 Tc 3.0889 Tw (American Journal of Public) Tj -86.3886 -10.9816 TD 0.0161 Tc -0.0774 Tw (Health ) Tj ET q 74.64 0 0 -8.64 367.68 369.36 cm BI /W 415 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|>?||<>?`x ?x ?|??~??|||~?~x0>?~xxx??>>||?~ >||?~>|| ~?|~|~?~|?~??~~?~???~????????|??????~???~???~>???~>?~~?~x??|>?>!c|>x|~????>???><??x?|xp0> EI Q BT 0.9444 0 0 0.9835 367.68 362.64 Tm 3 Tr 0.0525 Tc 0 Tw (74\(12\):1381-1383,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 442.32 362.64 Tm 0.0854 Tc 1.3164 Tw ( 1984.) Tj ET q 36.72 0 0 -8.16 336.72 357.6 cm BI /W 204 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~`p??~~~~~p?8?8?~~~?~?~?~?~?~??~?~|>|?????>80 EI Q BT 0.9388 0 0 0.9835 336.72 350.88 Tm 3 Tr /F2 10 Tf 0.0086 Tc 0 Tw (Brouwer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 373.44 350.88 Tm -0.0007 Tc 0.9647 Tw ( A., Administrator, Christian Rest Home,) Tj -37.0934 -10.9816 TD 0.0283 Tc 2.8386 Tw (Lynden, WA, personal communication, Jan. 13,) Tj ET BT 0.8919 0 0 0.9835 337.92 329.04 Tm 0.0717 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 336.96 317.76 Tm 0.0043 Tc 1.0938 Tw (Brown, J., Lyon, P. C., and Sellers, T.D., \223Caring) Tj 0.4881 -11.4697 TD 0.0084 Tc 0.9879 Tw (for the Family Caregivers,\224) Tj 0 Tc -0.061 Tw ( ) Tj 116.8931 0 TD /F5 10 Tf 0.0107 Tc 3.3445 Tw (Clinical Management) Tj ET q 54.48 0 0 -8.64 337.44 302.4 cm BI /W 309 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>|>>`x?|||??~~?~>?~~|~?>|||??x?8??8?|?8~?||?0~x||??8~|?~?>~~x>~~~?>>??>?|?|?~|~0>|~?p>p~~x?x?>x?|?矀~x??~??>?{~>>?>?|~~>>~?~ EI Q BT 0.9444 0 0 0.9835 337.44 295.44 Tm 3 Tr -0.0229 Tc 0 Tw (ofAlzheirner\222s) Tj 0 Tr 57.6888 0 TD -0.047 Tc 0.3441 Tw ( Disease, ) Tj ET BT 0.9388 0 0 0.9835 429.6 295.44 Tm /F2 10 Tf 0.0036 Tc 0.3069 Tw (L. Volicer, ) Tj ET q 14.88 0 0 -6.96 474 302.16 cm BI /W 84 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????? ??? EI Q BT 0.8919 0 0 0.9835 474 295.44 Tm 3 Tr -0.061 Tc 0 Tw (K.J.) Tj 0 Tr ET BT 0.9388 0 0 0.9835 488.88 295.44 Tm 0 Tc 0.055 Tw ( ) Tj ET q 49.44 0 0 -8.16 491.04 302.4 cm BI /W 280 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>08x0;߀8?x??|??|??>?~?>?|?<???  pp??? ?p0p|?x|?~x>??>?p??p??0<0`<~?~?~?<` EI Q BT 0.9388 0 0 0.9835 491.04 295.44 Tm 3 Tr -0.0061 Tc 0 Tw (Fabiszewski,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 337.68 284.64 Tm 0.0647 Tc -0.1268 Tw (and ) Tj ET q 15.84 0 0 -6.96 357.12 291.36 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?????????~?>?????????????????x??|?<?>?????? EI Q BT 0.8449 0 0 0.9835 357.12 284.64 Tm 3 Tr 0.0297 Tc 0 Tw (Y.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 372.96 284.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 37.44 0 0 -7.2 375.6 291.6 cm BI /W 209 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID n??~?>??????~?>~|?>|~|>~~?~?~??~??????????ap EI Q BT 0.9835 0 0 0.9835 375.6 284.64 Tm 3 Tr 0.0049 Tc 0 Tw (Rheaume) Tj 0 Tr 38.0696 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 415.68 291.6 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p x|<??|?~>?~~~~?>~??>|??>|?>|???>??>???????~|~|?~|?~||~~|>?|>?????<<|` EI Q BT 0.9388 0 0 0.9835 415.68 284.64 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 437.28 284.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.64 439.92 291.6 cm BI /W 244 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0 x`o?p?x?????>??>?~?|~~<~~??|??À??????~?~||>~??~~>?p<? ?|?> EI Q BT 0.9835 0 0 0.9835 439.92 284.64 Tm 3 Tr -0.0078 Tc 0 Tw (\(Rockville,) Tj 0 Tr 44.6585 0 TD 0.2378 Tc 2.9917 Tw ( MD: Aspen) Tj ET BT 0.9388 0 0 0.9835 337.44 273.6 Tm 0.0455 Tc 3.0742 Tw (Publishers, 1988\).) Tj ET BT 0.9835 0 0 0.9835 337.2 262.08 Tm 0.2395 Tc 3.1119 Tw (Buchanan, R.J.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 27.36 0 0 -8.16 411.36 269.04 cm BI /W 153 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|> ~????????|?????p??8?????????x??<??????????????????????????? EI Q BT 0.9835 0 0 0.9835 411.36 262.08 Tm 3 Tr -0.0409 Tc 0 Tw (Madel,) Tj 0 Tr 27.8201 0 TD 0.0128 Tc 3.3424 Tw ( R.P., and Persons, D.,) Tj -102.2509 -11.2256 TD 0.0159 Tc 3.2905 Tw (\223Medicaid Payment Policies for Nursing Home) Tj -0.244 -11.7137 TD 0.0086 Tc 0.3573 Tw (Care: A National Survey,\224 ) Tj 111.0362 0 TD /F5 10 Tf 0.0237 Tc 1.0131 Tw (Health Care Financing) Tj -111.7683 -10.9816 TD -0.0573 Tc -0.0028 Tw (Review ) Tj ET q 48.96 0 0 -8.64 370.08 235.92 cm BI /W 272 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 00p<`>xx<>?~8? ?|||~?~?<xxx?8|~?|<~?|>?|x>?|@<>?~|~?~|~?~~~~?>~?>~??~?~??~?x~??~~?~~>?~~~~|?~|x?p?~|x?~x?|8p|<x>>|~>???>?><px 0~00 EI Q BT 0.9444 0 0 0.9835 370.08 228.72 Tm 3 Tr 0.0409 Tc 0 Tw (13\(1\):55-72,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 419.04 228.72 Tm /F2 10 Tf 0.0854 Tc 2.0485 Tw ( 1991.) Tj ET BT 0.9388 0 0 0.9835 338.4 217.2 Tm 0.0171 Tc 0.8768 Tw (Buck, J. A., \223Psychotropic Drug Practice in Nursing) Tj ET BT 0.9835 0 0 0.9835 338.4 206.4 Tm 0.0329 Tc -0.0944 Tw (Homes,\222 ) Tj 37.5815 0 TD /F5 10 Tf 0.0155 Tc 0.7041 Tw (Journal of the American Geriatrics Soci-) Tj -37.5815 -11.4697 TD -0.0656 Tc 0.0057 Tw (ety ) Tj ET q 47.52 0 0 -8.16 352.08 202.08 cm BI /W 265 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<`????>?>>~>>|p>~>8 ?>~???~?????~??~~~>~~>~?~>~??~>~??x~>8~>?<~>~>~?x>??<>?~π?~~?~~?????~?~~???~?>> EI Q BT 0.9835 0 0 0.9835 352.08 195.12 Tm 3 Tr 0.0999 Tc 0 Tw (36:409418,) Tj 0 Tr 48.3191 0 TD 0.0854 Tc 0.0962 Tw ( 1988.) Tj ET BT 0.9388 0 0 0.9835 337.68 183.36 Tm /F2 10 Tf 0.006 Tc 1.199 Tw (BuckWalter, K. C.,) Tj ET BT 0.9835 0 0 0.9835 419.76 183.36 Tm 0.0012 Tc 4.3304 Tw (\223Applied Services Research:) Tj -82.7281 -10.9816 TD -0.0044 Tc 1.977 Tw (Clinical Issues and Directions,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48 0 0 -7.2 473.28 179.52 cm BI /W 267 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<?????>?>??>?~p~??~~?x~~?x?~><?~?~??|?~?~??~??????????p?x|??~????~?w~??@0???|<>>?? ~<` EI Q BT 0.9444 0 0 0.9835 473.28 172.56 Tm 3 Tr /F5 10 Tf -0.0463 Tc 0 Tw (AZzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 521.28 172.56 Tm 0.0242 Tc 1.1345 Tw ( Dis-) Tj -185.9552 -11.2256 TD 0.0138 Tc 1.4298 Tw (ease Treatment and Family Stress; Directions for) Tj -0.7321 -10.7376 TD 0.9812 Tc -1.0588 Tw (Research, ) Tj 54.908 0 TD /F2 10 Tf 0.5038 Tc 3.2092 Tw (E. Light and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -6.96 458.64 157.68 cm BI /W 101 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <p??x????????q EI Q BT 0.9388 0 0 0.9835 458.64 150.96 Tm 3 Tr 0.0043 Tc 0 Tw (B.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 476.64 150.96 Tm 0 Tc -0.061 Tw ( ) Tj ET q 37.2 0 0 -7.2 479.76 157.92 cm BI /W 207 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>pp?>x?>?????>??x>??~???????<?@???????? EI Q BT 1.1266 0 0 0.9835 479.76 150.96 Tm 3 Tr -0.0404 Tc 0 Tw (hbowitz) Tj 0 Tr ET BT 0.9835 0 0 0.9835 516.96 150.96 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.88 520.08 158.16 cm BI /W 120 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @>|?~>?>??>??~???~~??~~??~~?~~~?~~?~~?~??l??????~??~|??<~|?<~~<~|~??????????>||> EI Q BT 0.9388 0 0 0.9835 520.08 150.96 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET q 44.64 0 0 -8.16 338.4 146.88 cm BI /W 249 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px><|>?8 ?????>????~~~?|~~>~?~~~~?~~~p~?~~~p~~~~0~~~~~~~~~~~?~~~?~~~?x~~~?x~~~|~~~~<~~~~|>>~~~~?~?>~~?~???~~~~~?~~?>~~|~~~~~~~~~~~~8~~||x??~8?|<~>~?`>?>>~?~?~???????<0 p ??~ EI Q BT 0.9388 0 0 0.9835 338.4 62.4 Tm 3 Tr -0.005 Tc 0 Tw (Buckwalter,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 385.92 62.4 Tm -0.0165 Tc 0.0913 Tw ( K. C., and Hall, G. R., \223Families of the) Tj -48.075 -10.9816 TD 0.0019 Tc 3.7928 Tw (Institutionalized Older Adult: A Neglected Re-) Tj 0.244 -11.7137 TD 0.0163 Tc -0.0776 Tw (source,\224 ) Tj 36.8494 0 TD /F5 10 Tf 0.0254 Tc 0.6452 Tw (Aging, Health and Family, ) Tj ET q 16.08 0 0 -7.2 487.2 47.04 cm BI /W 90 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID t??8@? EI Q BT 0.8449 0 0 0.9835 487.2 40.08 Tm 3 Tr /F2 10 Tf 0.0297 Tc 0 Tw (T.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 503.28 40.08 Tm 0 Tc -0.061 Tw ( ) Tj ET q 36.96 0 0 -7.2 505.68 47.28 cm BI /W 206 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p??g????????????~??~???~~???~????~??~???~???~??~??~<??~|??~?p?~~?~~?????????|?0??????????? 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EI Q BT 0.9388 0 0 0.9835 245.04 526.32 Tm 3 Tr 0.0225 Tc 0 Tw (Gottlieb) Tj 0 Tr 33.7446 0 TD 0 Tc 0.055 Tw ( ) Tj ET q 21.12 0 0 -8.64 278.88 533.28 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @@x<x?|<x|?|><|>?~~??<~?~<~??>~>?>~~?~~|?>|?>>????>~? >~?>|>|?~~<|>||>|??x??|<p` EI Q BT 0.8919 0 0 0.9835 278.88 526.32 Tm 3 Tr -0.0283 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 98.4 515.28 Tm 0.0132 Tc 1.5728 Tw (\(Washington, DC: American Psychiatric Associa-) Tj ET BT 0.9388 0 0 0.9835 98.4 504.24 Tm 0.0748 Tc 0.9979 Tw (tion, 1990\).) Tj ET q 37.2 0 0 -8.16 98.4 498.48 cm BI /W 207 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<<>p8c???x??~|?~|~@?~~~?~~~?~~?~~?~?~?~~?~~?~~?~|~?~|~?~ |~?~0~~?~p>~??p~??8x?????>~?n~~~~~?~? EI Q BT 0.9388 0 0 0.9835 98.4 491.52 Tm 3 Tr 0.0251 Tc 0 Tw (Burnside,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 135.6 491.52 Tm -0.0117 Tc -0.0084 Tw ( I. 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Tj 0 Tr ET BT 0.9835 0 0 0.9835 275.28 457.68 Tm 0 Tc -0.061 Tw ( ) Tj ET q 24.24 0 0 -6.96 277.92 464.4 cm BI /W 135 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|???~?|~??~?|~?~~?~~~?~?~|?~>?~?~?p~??x~?8~?8~?<~x?~|?~|?<|~>?>????8|||8x EI Q BT 0.798 0 0 0.9835 277.92 457.68 Tm 3 Tr 0.0001 Tc 0 Tw (.Tarvik) Tj 0 Tr ET BT 0.9835 0 0 0.9835 98.64 446.64 Tm 0.0647 Tc -0.1268 Tw (and ) Tj ET q 18 0 0 -7.2 116.64 453.6 cm BI /W 100 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID i0A??x@??/???< EI Q BT 0.9388 0 0 0.9835 116.64 446.64 Tm 3 Tr 0.0043 Tc 0 Tw (C.H.) 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Tj -62.2291 -12.4458 TD 0.0005 Tc 0.5486 Tw (Burton, L. C., German, P. S., ) Tj ET q 31.68 0 0 -8.16 219.84 430.56 cm BI /W 176 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?8>8'?????||~>~?~??~??~??x~>~8~~~<~~~>?~>?~??~?~?~?|~~?>>????>?? EI Q BT 0.9835 0 0 0.9835 219.84 423.6 Tm 3 Tr 0.0364 Tc 0 Tw (Rovner,) Tj 0 Tr 32.2127 0 TD -0.0556 Tc 0.4836 Tw ( B.W., et al.,) Tj -154.7186 -10.9816 TD 0.24 Tc 2.6234 Tw (\221\221Mental Illness and the Use of Restraints in) Tj -0.7321 -11.7137 TD 0.2665 Tc 2.5964 Tw (Nursing Homes,\224) Tj 84.1923 -0.244 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 58.8 0 0 -8.64 243.36 408.24 cm BI /W 327 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8xx< >|? π><>?><?<x?~|<>|?~>x|>`pxpx8?|x<?||p?'|?|8?<?|?>????π???????|??<??>??>??x?|<?|<?||??|~>|~>>`~>`~<p~|?x|s>????<??p<>?080< EI Q BT 0.9444 0 0 0.9835 243.36 401.04 Tm 3 Tr 0.0466 Tc 0 Tw (32\(2\):164-170,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 99.6 390.48 Tm 0.0456 Tc (1992.) Tj ET q 32.64 0 0 -8.64 98.64 385.2 cm BI /W 182 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx|||x|>??>?|??<??~??~???~?>?~~??~??~??>???>>~~|?? EI Q BT 0.9388 0 0 0.9835 98.64 378 Tm 3 Tr /F2 10 Tf 0.0145 Tc (Cabello,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 131.28 378 Tm 0.0025 Tc 0.3896 Tw ( M.M., and Durnas, C., \223Change in ) Tj 146.6654 0 TD /F4 10 Tf -0.015 Tc 0 Tw (Func-) Tj -179.6102 -11.2256 TD /F2 10 Tf -0.0056 Tc 2.2455 Tw (tional Capacity for Elderly People,\224 letter to the) Tj 0.244 -11.2256 TD 0.0033 Tc -0.0644 Tw (editor, ) Tj 29.0402 0 TD /F5 10 Tf 0.0071 Tc 0.9567 Tw (Journal of the American Geriatrics Society) Tj ET q 41.28 0 0 -8.64 102 352.08 cm BI /W 230 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <||x>|<<@?~??~?`??>?>? >>?>?~?~?~??x~?<|~?x>~~?<~~?~~?~~?|~????y=??????><x~|???߀?x  EI Q BT 0.9444 0 0 0.9835 102 345.12 Tm 3 Tr 0.0439 Tc 0 Tw (40\(1\):104,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 143.28 345.12 Tm 0.0854 Tc -0.1478 Tw ( 1992.) Tj ET q 21.6 0 0 -8.16 99.12 339.36 cm BI /W 121 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<?|@?~????????????|???|~??8????????0??x?? EI Q BT 0.9388 0 0 0.9835 99.12 332.4 Tm 3 Tr /F2 10 Tf -0.0027 Tc 0 Tw (Cairl,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 120.72 332.4 Tm 0.0013 Tc 1.0358 Tw ( R., \223Draft Guidelines for Dementia Specific) Tj -21.7192 -11.2256 TD -0.007 Tc 1.1662 Tw (Care Units) Tj 0 Tc -0.061 Tw ( ) Tj ET q 36 0 0 -8.64 146.4 328.56 cm BI /W 201 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?| ~ 0>?>>>??>??>?~>>~>?p>|?<?x~|xx|x?x|p?80~8<?<<88<|?<|8<|8<|8|?~<>~<>><>><?<?<|?<<<8<?<?~|??>?8 EI Q BT 0.8919 0 0 0.9835 146.4 321.36 Tm 3 Tr 0.0148 Tc 0 Tw (\(DSCUS\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 182.4 321.36 Tm 0.0401 Tc 1.6064 Tw ( for Memory Impaired Older) Tj -84.4363 -10.9816 TD 0.006 Tc -0.0672 Tw (Adults,\224 ) Tj ET q 35.52 0 0 -7.2 135.84 317.76 cm BI /W 198 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  y?p??????~???~???~? ??> ??a>????????????????????????`??~`??????|?>~??? ?|???????? EI Q BT 0.9388 0 0 0.9835 135.84 310.56 Tm 3 Tr 0.0214 Tc 0 Tw (Suncoast) Tj 0 Tr ET BT 0.9835 0 0 0.9835 171.36 310.56 Tm 0.0269 Tc 1.1318 Tw ( Gerontology Center, University) Tj -73.2107 -10.9816 TD 0.0336 Tc 0.1488 Tw (of South Florida, Tampa, FL, 1992.) Tj ET q 21.6 0 0 -8.16 99.36 294 cm BI /W 121 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08< ?'??~?<??????????????x???|~??|? 8x????????0????p EI Q BT 0.9388 0 0 0.9835 99.36 287.04 Tm 3 Tr -0.0027 Tc 0 Tw (Cairl,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 120.96 287.04 Tm 0.2431 Tc 3.3523 Tw ( R., Kosberg, J., Henderson, N., et al.,) Tj ET BT 0.9388 0 0 0.9835 100.08 275.76 Tm -0.0131 Tc 0.5803 Tw (\221\221Special Care for ) Tj ET q 48.24 0 0 -7.68 172.08 283.2 cm BI /W 272 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0`>???<?>??????8??? ?` ?p??????????|?? <??|<??|??|~<?~<p?|<??????>x~x? ?p?8?<?|??x|xx?|800 EI Q BT 0.9388 0 0 0.9835 172.08 275.76 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 51.3838 0 TD -0.0196 Tc 0.8429 Tw ( Disease Patients: An) Tj ET BT 0.9835 0 0 0.9835 99.36 264.96 Tm 0.0192 Tc 2.6527 Tw (Exploratory Study of Dementia Specific Units,\224) Tj ET q 35.52 0 0 -7.2 100.08 260.88 cm BI /W 198 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p>`?????????x???||?q~?q~?>??????????????~? ?0?p?p??|p~~????p?@@8~>~>~>~? EI Q BT 0.9388 0 0 0.9835 100.08 253.92 Tm 3 Tr 0.0214 Tc 0 Tw (Suncoast) Tj 0 Tr ET BT 0.9835 0 0 0.9835 135.6 253.92 Tm 0.0365 Tc 0.5852 Tw ( Gerontology Center, University of South) Tj -36.6053 -10.9816 TD 0.0275 Tc -0.089 Tw (Florida, Tarnpa, FL, 1991.) Tj 0 -12.6899 TD -0.0063 Tc -0.0547 Tw (California ) Tj ET q 48.96 0 0 -7.68 145.68 237.84 cm BI /W 273 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~???~?>????|???~?p?~??p?~~0?~~?~|??~|??~|?~|??~|@|?~<?~?<??~?? <?~> ?~??~?p?x<<D>?>~>??~<??>80 EI Q BT 0.9835 0 0 0.9835 145.68 230.64 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0025 Tc 1.8887 Tw ( Disease Task Force,) Tj 0 Tc -0.061 Tw ( ) Tj 93.7097 0 TD /F5 10 Tf 0.366 Tc 0 Tw (The) Tj -190.1038 -10.9816 TD 0.0027 Tc -0.0638 Tw (California ) Tj ET q 47.76 0 0 -7.2 145.2 226.8 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |???|??>??>|?|a>>1|?>~>|~~~x~|~~<~|~?|>?~??>?|??|???|~?~?~>?~~p?>>8><>}???|????|??x>|`>>|???`????`?@ EI Q BT 0.9835 0 0 0.9835 145.2 219.84 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0148 Tc 1.6322 Tw ( Disease Task Force-Final) Tj -95.1739 -10.9816 TD 0.0161 Tc -0.0774 Tw (Report ) Tj 30.0164 0 TD /F2 10 Tf 0.0265 Tc 0.5221 Tw (\(Sacramento, CA: 1987\).) Tj ET q 32.4 0 0 -8.16 99.6 203.52 cm BI /W 180 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?x??x||???~~??~?~??~?~?~?x~?~??<~?~?~?~~?~~>~~~~~0?8?~x?~<x?x??|~~~~?~?~~~~~? EI Q BT 0.9835 0 0 0.9835 99.6 196.32 Tm 3 Tr -0.0167 Tc 0 Tw (Calkins,) Tj 0 Tr 32.9448 0 TD -0.0053 Tc 2.0593 Tw ( M.P., \223Designing Special Care Units: A) Tj -32.2127 -11.2256 TD 0.0114 Tc 3.3439 Tw (Systematic Approach,\224) Tj 100.2987 0 TD /F5 10 Tf 0.0307 Tc 1.3719 Tw (American Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 15.84 0 0 -6.96 287.52 192 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x~8~p8||?|?~~>>px?? EI Q BT 0.9835 0 0 0.9835 287.52 185.28 Tm 3 Tr -0.0031 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.56 0 0 -7.2 100.08 181.44 cm BI /W 192 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >0> 8|~>|<>~>?~>x?|?|?||~|>|>>>|~>||>>>|?>|?|~~?>~>?>?߀>??>w?>?px|||x0 EI Q BT 0.9835 0 0 0.9835 100.08 174.48 Tm 3 Tr 0.0165 Tc (heimer\222s) Tj 0 Tr 35.1411 0 TD 0.0315 Tc 0.273 Tw ( Care and Research ) Tj ET q 44.16 0 0 -8.64 217.68 181.2 cm BI /W 246 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<x8<<<|`~x||?>??>||?<~>|<<>@8>>>?p??p8??8<??<x?x<?|>>>>>`||xx?x?x<?||>??<??xp @x EI Q BT 0.9444 0 0 0.9835 217.68 174.48 Tm 3 Tr 0.0374 Tc 0 Tw (2\(2\):16-22,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 261.84 174.48 Tm 0.0854 Tc 0.3402 Tw ( 1987.) Tj ET q 32.4 0 0 -8.16 100.08 169.2 cm BI /W 180 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `}?x?|||??~??~?????~?x~??<~?~~~?~?~?~?~0?~?8?~x~>x?~x?~?~|~~????~~~~~?~? EI Q BT 0.8971 0 0 0.9835 100.08 162 Tm 3 Tr 0.0002 Tc 0 Tw (Ca.lkins,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 132.48 162 Tm /F2 10 Tf -0.0486 Tc 1.6966 Tw ( M.P.,) Tj 0 Tc -0.061 Tw ( ) Tj 30.0164 0 TD /F5 10 Tf 0.2683 Tc 3.2453 Tw (Design for Dementia: Planning) Tj -63.2052 -10.9816 TD 0.0193 Tc 3.0105 Tw (Environments for the Elderly and the Confused) Tj ET q 33.84 0 0 -9.36 100.56 147.12 cm BI /W 188 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<xx8<<?<?>~?>~??>?~??|~??>|???|??|~?||{?|?????p?p?|x?|8?|<?|<~|~?>>?~>>? <1 EI Q BT 0.9835 0 0 0.9835 100.56 140.16 Tm 3 Tr 0.0366 Tc 0 Tw (\(Owings) Tj 0 Tr 34.409 0 TD /F2 10 Tf -0.0107 Tc 2.1462 Tw ( Mills, MD: National Health Publishing,) Tj ET BT 0.8919 0 0 0.9835 101.04 129.12 Tm 0.2668 Tc 0 Tw (1988\).) Tj ET q 31.68 0 0 -8.64 100.08 124.08 cm BI /W 179 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???x?x?||????~????x?~?>?~?~~~~?~0?~p?~<p?~p~>>x~???|>0???| EI Q BT 0.9388 0 0 0.9835 100.08 116.88 Tm 3 Tr 0.0194 Tc (Calkins,) Tj 0 Tr 33.7446 0 TD 0.0322 Tc 0.9581 Tw ( M. P., Innovative Designs in Environments) Tj ET BT 0.9835 0 0 0.9835 100.56 105.84 Tm 0.0067 Tc 0.6337 Tw (for an Aging Society, Milwaukee, WI, letter to the) Tj 0.244 -10.9816 TD 0.0345 Tc 0.2699 Tw (Office of ) Tj ET q 46.08 0 0 -9.36 140.64 101.76 cm BI /W 256 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @x8x??|?|?~?~?~?~?~>?~??~?~?~??~>?~?~????π??????x??~?x??~~?x?>|??w???~~`x| EI Q BT 0.9835 0 0 0.9835 140.64 95.04 Tm 3 Tr 0.0799 Tc 0 Tw (Twhnology) Tj 0 Tr 46.8548 0 TD 0.0142 Tc 1.3074 Tw ( Assessment, U.S. Congress,) Tj -87.8528 -11.2256 TD 0.0459 Tc 0.1364 Tw (Washington, DC, Apr. 30, 1992.) Tj ET q 30.48 0 0 -8.16 100.56 78.96 cm BI /W 170 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8> ???`?8 ?<????? ?x?~????x?x><?>~?????d EI Q BT 0.9388 0 0 0.9835 100.56 72 Tm 3 Tr -0.0003 Tc 0 Tw (Carneli,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 131.04 72 Tm -0.0241 Tc 2.1598 Tw ( S.,) Tj 20.743 0 TD 0.0083 Tc 2.2488 Tw (\223Pairing Rational and Demented Pa-) Tj -51.4915 -11.4697 TD -0.0061 Tc 1.572 Tw (tients in Long-Term Care Facilities, Continued, \224) Tj 0 -10.9816 TD -0.0157 Tc 3.5342 Tw (letter to the editor,) Tj 0 Tc -0.061 Tw ( ) Tj 90.2932 0 TD /F5 10 Tf 0.2567 Tc 4.3146 Tw (Journal of the American) Tj -90.2932 -11.2256 TD -0.0138 Tc 0.197 Tw (Geriatrics Society ) Tj ET q 41.04 0 0 -8.64 175.44 45.6 cm BI /W 228 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <xx|<>???>?|>?>|?|<x?<8?p<xx|<|?||~~????||p?>x?> <?<???~??~~??~~??~> ?@?>?x<|x?>~<|?<?#  EI Q BT 0.9444 0 0 0.9835 175.44 38.88 Tm 3 Tr 0.0439 Tc 0 Tw (32\(5\):409,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 216.48 38.88 Tm 0.0854 Tc 0.0962 Tw ( 1984.) Tj ET BT 0.8066 0 0 0.9835 329.76 649.44 Tm /F4 10 Tf 0.0252 Tc 0 Tw (70.) Tj ET q 11.52 0 0 -6.48 330 611.52 cm BI /W 65 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x ?|?|?~?>>x||`<>x>C~???p EI Q BT 0.8066 0 0 0.9835 330 604.8 Tm 3 Tr 0.0252 Tc (71.) Tj 0 Tr 0.2975 -34.165 TD 0.2235 Tc (72.) Tj 0.5951 -56.3722 TD 0.0252 Tc (73.) Tj 0.5951 -34.165 TD 0.0252 Tc (74.) Tj 0 -33.921 TD 0.0252 Tc (75.) Tj 0.2975 -45.1466 TD 0.2235 Tc (76.) Tj ET BT 0.6793 0 0 0.9835 331.92 348.48 Tm 0.0757 Tc (7\2227.) Tj ET BT 0.8066 0 0 0.9835 332.16 304.08 Tm 0.0252 Tc (78.) Tj 0.5951 -56.6163 TD 0.0252 Tc (79.) Tj ET BT 0.7642 0 0 0.9835 333.12 204.24 Tm 0.2841 Tc (80.) Tj ET BT 0.7217 0 0 0.9835 333.36 170.64 Tm 0.256 Tc (81) Tj ET BT 0.7642 0 0 0.9835 334.08 104.64 Tm 0.0748 Tc (82.) Tj 0 -44.6585 TD 0.0748 Tc (83.) Tj ET BT 0.9835 0 0 0.9835 347.28 649.44 Tm /F2 10 Tf -0.0149 Tc 1.2789 Tw (Cameron, D.J., Gambert, S.R., Bashian, N., et al.,) Tj 0.9761 -11.2256 TD -0.0099 Tc 2.1454 Tw (\223A Specialized Dementia Unit: Cost and Benefit) Tj -0.4881 -11.4697 TD 0.0119 Tc 0.1709 Tw (Analysis,\224 New ) Tj 66.8658 0 TD /F5 10 Tf 0.0368 Tc 0.6337 Tw (York Medical Quarterly 7\(3\):103-) Tj ET BT 0.9444 0 0 0.9835 348.48 616.56 Tm 0.0714 Tc 0.2187 Tw (107, 1987.) Tj ET BT 0.9835 0 0 0.9835 347.76 604.8 Tm /F2 10 Tf 0.0062 Tc 2.9099 Tw (Campbell, L., Nurse Consultant, North Carolina) Tj 0 -10.9816 TD -0.0129 Tc 3.3198 Tw (Department of Facilities Services, Raleigh, NC,) Tj 0.244 -11.2256 TD 0.0283 Tc 0.2762 Tw (personal communication, Jan. 9, 1992.) Tj ET q 32.64 0 0 -9.36 348 578.4 cm BI /W 182 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |pxxx <?????? ???>?~?~?~??~??|~?|?>???~?~?p~~?~~?>|>?>?|>~??p???? >??> EI Q BT 0.9388 0 0 0.9835 348 571.2 Tm 3 Tr -0.0162 Tc 0 Tw (Cariaga,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 380.64 571.2 Tm -0.0365 Tc 1.9284 Tw ( J.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 29.76 0 0 -9.12 398.16 577.92 cm BI /W 166 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pxxx>??????|?>?|~????>?????~?~??>?~~????} EI Q BT 0.9388 0 0 0.9835 398.16 571.2 Tm 3 Tr 0.0543 Tc 0 Tw (Burgio,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 427.92 571.2 Tm 0.4489 Tc 2.8177 Tw ( L., Flynn, W., et al., \223A) Tj ET BT 0.9388 0 0 0.9835 348.48 560.4 Tm 0.0269 Tc 0.2821 Tw (Controlled Study of Disruptive Vocalizations Among) Tj ET BT 0.9835 0 0 0.9835 348.48 549.6 Tm 0.0088 Tc 0.5157 Tw (Geriatric Residents in Nursing Homes,\224 ) Tj 165.9442 0 TD /F5 10 Tf 0.042 Tc 0.8724 Tw (Journal of) Tj -165.7002 -11.2256 TD -0.0041 Tc 3.9291 Tw (the American Geriatrics Society) Tj 0 Tc -0.061 Tw ( ) Tj ET q 59.04 0 0 -8.64 493.2 545.76 cm BI /W 329 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <|`x<>~ ???>?>??>?<??|??>?p ??|~|<~~x>~|?>?|??|??|????????????|?~??~>??>|???>~??> ??>??>>|<~~|>!~~0???~????~<?<??p?< _   EI Q BT 0.9444 0 0 0.9835 493.2 538.56 Tm 3 Tr 0.0466 Tc 0 Tw (39\(5\):501-507,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 349.44 527.76 Tm 0.0456 Tc (1991.) Tj ET q 27.6 0 0 -8.16 348.48 522.96 cm BI /W 154 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??????|?| ~|p~|8?~8~~?~?~~A~0~0~p|p||x>?x?????? EI Q BT 0.9388 0 0 0.9835 348.48 515.76 Tm 3 Tr /F2 10 Tf -0.0356 Tc (Cassel,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 376.08 515.76 Tm 0.0008 Tc 0.3448 Tw ( C.K., \223Research in Nursing Homes: Ethical) Tj -27.576 -10.7376 TD 0.0104 Tc -0.0716 Tw (Issues,\224 ) Tj 33.921 0 TD /F5 10 Tf 0.0071 Tc -0.0194 Tw (Journal of the American Geriatrics Society) Tj ET q 64.08 0 0 -8.64 348.96 500.88 cm BI /W 357 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x|8>x``xp>???>?|>>>?~|~p>??<x|~?|<>x~~>>x|~>||~??||~?|~|~???~???~~~??|~?|~|~~?~||~??~|~??>>~?x>>~?|?>~~>>~~?x~?8|~ ?<|?>|?x?|~|~?<~??x|?~x?x`0@ EI Q BT 0.9444 0 0 0.9835 348.96 494.16 Tm 3 Tr 0.0488 Tc 0 Tw (33\(11\):795-799,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 413.04 494.16 Tm 0.0854 Tc -0.1478 Tw ( 1985.) Tj ET q 27.36 0 0 -8.16 348.96 489.12 cm BI /W 153 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>0` ????????>?<?<<??~8??~p?~0?~??~???????~?~ ?~p?|p??||>?~ ????????? EI Q BT 0.9388 0 0 0.9835 348.96 482.16 Tm 3 Tr /F2 10 Tf -0.0356 Tc 0 Tw (Cassel,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 376.32 482.16 Tm -0.0342 Tc 2.9021 Tw ( C.K.,) Tj 32.9448 0 TD 0.0116 Tc 2.9044 Tw (\223Ethical Issues in the Conduct of) Tj -60.7649 -10.9816 TD -0.004 Tc 1.8953 Tw (Research in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 20.16 0 0 -9.12 401.28 478.32 cm BI /W 113 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~|< 8????|?>?????~?~?~|>|~?>????~o EI Q BT 0.9388 0 0 0.9835 401.28 471.36 Tm 3 Tr 0.0242 Tc 0 Tw (Imng) Tj 0 Tr ET BT 0.9835 0 0 0.9835 421.44 471.36 Tm -0.0163 Tc 1.4198 Tw ( Term Care,\224) Tj 0 Tc -0.061 Tw ( ) Tj 59.0566 0 TD /F5 10 Tf 0.0358 Tc 5.5154 Tw (Gerontologist 28) Tj ET BT 0.9444 0 0 0.9835 349.44 460.32 Tm 0.0494 Tc 2.7834 Tw (\(Suppl.\):90-96, 1988.) Tj ET q 32.64 0 0 -8.64 349.2 456 cm BI /W 182 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x |????????~>>?>??x ||~??x???`? EI Q BT 0.9388 0 0 0.9835 349.2 448.8 Tm 3 Tr /F2 10 Tf -0.0162 Tc 0 Tw (Chafetz,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 381.84 448.8 Tm -0.0073 Tc -0.0536 Tw ( P.K.,) Tj 26.5999 0 TD 0.0431 Tc 0.3832 Tw (\223Environmental Control of Inappro-) Tj -59.7887 -10.7376 TD 0.0115 Tc 2.2456 Tw (priate Exiting Behavior in Dementia: Two Stud-) Tj 0 -11.2256 TD 0.1461 Tc 0 Tw (ies,\224) Tj 23.6715 0 TD 0.0308 Tc 0.5177 Tw (unpublished manuscript, University of Texas) Tj -23.1834 -11.2256 TD -0.0033 Tc 0.3491 Tw (Southwestern Medical Center, Dallas, TX, no date.) Tj -0.4881 -11.7137 TD -0.0171 Tc 1.9086 Tw (Chafetz, P.K.,) Tj ET q 40.32 0 0 -7.2 412.08 411.36 cm BI /W 224 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>|??????|>>~>~??~À?????8?8??x??~~?~~?~~?~?<~?<?~<x~ p~?p>>???>`>|x|>|?x8 EI Q BT 0.9388 0 0 0.9835 412.08 404.4 Tm 3 Tr -0.0034 Tc 0 Tw (\223Fa.rnilies) Tj 0 Tr ET BT 0.9835 0 0 0.9835 452.4 404.4 Tm 0.0098 Tc 2.1253 Tw ( of Institutionalized De-) Tj -104.6913 -10.9816 TD 0.0316 Tc 1.5338 Tw (mented: Does SCU Progra) Tj ET q 27.84 0 0 -9.36 459.6 400.32 cm BI /W 155 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>?~~>q??????~?~?~?~??~??~??~?~x?~|?~?|?~?~?~?~?~??~??~~????|q >~>< EI Q BT 0.9388 0 0 0.9835 459.6 393.36 Tm 3 Tr 0.0395 Tc 0 Tw (rnming) Tj 0 Tr ET BT 0.9835 0 0 0.9835 487.44 393.36 Tm 0.0126 Tc 1.3903 Tw ( Make a Differ-) Tj -140.0765 -10.9816 TD 0.0191 Tc 3.7021 Tw (ence for Them?\224) Tj 80.7758 -0.4881 TD 0.0113 Tc 3.0999 Tw (presented at the 41st) Tj 0 Tc -0.061 Tw ( ) Tj ET q 29.04 0 0 -7.2 524.64 389.52 cm BI /W 162 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??????A??~?~~??~??~??~?~?~?~?~~?~~|?~~|?~~|?~<?~~>?~~?~0|`||8p | EI Q BT 0.9388 0 0 0.9835 524.64 382.08 Tm 3 Tr 0.033 Tc 0 Tw (Annual) Tj 0 Tr ET BT 0.9835 0 0 0.9835 349.92 371.52 Tm 0.0089 Tc 0.3367 Tw (Meeting of the Gerontological Society of America,) Tj 0 -11.4697 TD 0.0374 Tc 0.145 Tw (San Francisco, CA, Nov. 20, 1988.) Tj 0 -11.9577 TD -0.0171 Tc 0.4444 Tw (Chafetz, P.K.,) Tj 61.2529 -0.244 TD 0.0311 Tc 1.0461 Tw (\223Two-Dirnensional Grid is Ineffec-) Tj -61.2529 -10.7376 TD 0.0157 Tc 2.2658 Tw (tive Against Demented Patients Exiting Through) Tj 0 -11.2256 TD 0.0252 Tc -0.0866 Tw (Glass Doors,\224 ) Tj 59.0566 0 TD /F5 10 Tf 0.0241 Tc -0.0856 Tw (Psychology ) Tj ET q 40.8 0 0 -9.36 456 333.84 cm BI /W 227 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|>||<x|>||>||~>x`<8???|||~>~~?~??~~?|>?~~??|?~~?~>>~>?>??>??x??x?||?><|??~??????~?p||~~????? EI Q BT 0.9835 0 0 0.9835 456 326.64 Tm 3 Tr 0.0778 Tc 0 Tw (andAging) Tj 0 Tr 41.4861 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 54 0 0 -8.64 499.2 333.6 cm BI /W 301 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p88>x<|p0???????|~??|x~p??||~??><>8?><>??<>?>??>??~??~???~???~????>x?><??~?~?x|?|?|?>?|??x? ????||?|>????<?|??|x p EI Q BT 0.9444 0 0 0.9835 499.2 326.64 Tm 3 Tr 0.044 Tc 0 Tw (5\(1\):146-147,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 350.88 316.08 Tm 0.0456 Tc (1990.) Tj ET BT 0.9835 0 0 0.9835 349.92 304.08 Tm /F2 10 Tf 0.0106 Tc 1.6364 Tw (Chafetz, P.K., Assistant Professor, Department of) Tj 0.244 -10.9816 TD 0.0244 Tc 1.3783 Tw (Gerontology and Geriatric Services, University of) Tj 0 -11.2256 TD -0.0056 Tc 2.141 Tw (Texas Southwestern Medical Center, Dallas, TX,) Tj ET BT 0.9388 0 0 0.9835 350.64 271.2 Tm 0.0107 Tc 0.3845 Tw (letter to Cheryl ) Tj ET q 27.6 0 0 -8.16 411.6 278.4 cm BI /W 156 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????>??>????????????????????????>?<??<<>????>p EI Q BT 0.9388 0 0 0.9835 411.6 271.2 Tm 3 Tr 0.036 Tc 0 Tw (Riskin,) Tj 0 Tr 29.3987 0 TD 0.0185 Tc 0.7384 Tw ( Levine Institute, Detroit, MI,) Tj -94.3315 -11.2256 TD 0.0718 Tc 1.129 Tw (Apr. 22, 1991.) Tj ET BT 0.9835 0 0 0.9835 350.4 248.64 Tm 0.0106 Tc 1.0263 Tw (Chafetz, P. K., Assistant Professor, Department of) Tj 0.244 -10.9816 TD 0.0244 Tc 1.3295 Tw (Gerontology and Geriatric Services, University of) Tj 0.244 -10.9816 TD -0.0056 Tc 2.0434 Tw (Texas Southwestern Medical Center, Dallas, TX,) Tj 0 -11.2256 TD 0.0273 Tc 1.1314 Tw (personal communication, May 8,1991.) Tj ET q 32.16 0 0 -8.16 350.88 211.44 cm BI /W 179 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~?????>????~??>??>???>?>??>|?????????>??0?>?8??<??>?>?~??>??>~??~ EI Q BT 0.9388 0 0 0.9835 350.88 204.48 Tm 3 Tr -0.0162 Tc 0 Tw (Chafetz,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 383.04 204.48 Tm -0.0073 Tc 3.6069 Tw ( P.K.,) Tj 33.4329 -0.244 TD 0.0161 Tc 4.2339 Tw (\223Behavioral and Cognitive Out-) Tj ET BT 0.8919 0 0 0.9835 351.12 193.44 Tm 0.045 Tc 0.2734 Tw (comes of SCU Care,\224 ) Tj ET BT 0.8971 0 0 0.9835 433.2 193.44 Tm /F5 10 Tf 0.0032 Tc 2.043 Tw (Clinical Gerontologist 11\(1\):19-) Tj ET BT 0.9444 0 0 0.9835 351.12 182.4 Tm 0.0703 Tc 0.7281 Tw (38, 1991.) Tj ET BT 0.9835 0 0 0.9835 350.88 170.88 Tm /F2 10 Tf -0.0096 Tc 0.3392 Tw (Chafetz, P.K., and West, H.L., ) Tj ET q 56.64 0 0 -9.12 475.44 177.84 cm BI /W 315 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x<>?????????????~0~??~~???~?~???~?~??~?~??~?~??~?~??~|?~??~?~???~~???~~??~~??~~??~?~|????~?~~????~?~~???>~??>~??_~?~~??~??~x?~> ~?~?~?~?~>`~>~x< EI Q BT 0.8919 0 0 0.9835 475.44 170.88 Tm 3 Tr 0.0355 Tc 0 Tw (\2231.mngitudinal) Tj 0 Tr ET BT 0.9835 0 0 0.9835 532.08 170.88 Tm 0.061 Tc 0.121 Tw ( Con-) Tj -184.2469 -11.2256 TD 0.0211 Tc 1.6867 Tw (trol Group Evaluation of a Special Care Unit for) Tj 0 -10.7376 TD -0.0071 Tc 2.1426 Tw (Dementia Patients: Initial Findings,\224 presented at) Tj 0.244 -11.2256 TD 0.0214 Tc 3.0083 Tw (the 40th Annual Meeting of the Gerontological) Tj 0.244 -11.2256 TD 0.0239 Tc 2.7211 Tw (Society of America, Washington, DC, Nov. 22,) Tj ET BT 0.8919 0 0 0.9835 352.08 116.4 Tm 0.0717 Tc 0 Tw (1987.) Tj ET BT 0.9388 0 0 0.9835 351.36 104.88 Tm 0.0115 Tc 0.65 Tw (Chandler, J. D., and Chandler, J. E., \221The Prevalence) Tj ET BT 0.9835 0 0 0.9835 351.36 94.32 Tm 0.1033 Tc -0.1661 Tw (of ) Tj ET q 68.16 0 0 -9.12 362.64 101.04 cm BI /W 379 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID | ???????C?||???>?~x?~????`8?~???`?8?~?~??~??ǁ?~??ǁ?????????????????~?????~|p~???~~?>?||>~x??>|~~???|?~???????~?y<>0<?@?x?8??x?>???????| EI Q BT 0.9835 0 0 0.9835 362.64 94.32 Tm 3 Tr 0.0249 Tc 0 Tw (Neuropsychiatric) Tj 0 Tr 69.3061 0 TD 0.0443 Tc 0.9188 Tw ( Disorders in a Nursing Home) Tj -80.7758 -11.2256 TD 0.0173 Tc -0.0786 Tw (Population,\224 ) Tj 55.8842 0 TD /F5 10 Tf 0.0164 Tc 1.8745 Tw (Journal of Geriatric Psychiatry and) Tj -56.3722 -10.9816 TD 0.0243 Tc -0.0857 Tw (Neurology ) Tj ET q 32.16 0 0 -8.16 396.24 79.68 cm BI /W 179 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@|~??~???>~?????||~>?||<|0>> |x?|8?C|>??????p @ EI Q BT 0.8971 0 0 0.9835 396.24 72.48 Tm 3 Tr 0.0082 Tc 0 Tw (1:71-76,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 428.4 72.48 Tm 0.0854 Tc 0.3402 Tw ( 1988.) Tj ET q 35.28 0 0 -8.64 351.36 67.92 cm BI /W 197 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx?B???>??>?~?~?~~~~?|~?>~~~~~?p~x~x~<|~~<<~?>>?>?????p??|??x~ EI Q BT 0.9388 0 0 0.9835 351.36 60.72 Tm 3 Tr /F2 10 Tf 0.0503 Tc 0 Tw (Chavkin,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 386.64 60.72 Tm -0.0083 Tc 3.1199 Tw ( D.,) Tj 24.1595 0 TD 0.227 Tc -0.2919 Tw (\223Interstate ) Tj ET q 41.04 0 0 -9.36 458.88 67.92 cm BI /W 229 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??? 8;x?>?????????~~??~??~?~~?~?~~???~~?~~?~~?~~?~~x0?~~||?~~|?~~<??~~?>|?~?|~?~~?~~~?~| ~ ~~~~p<~ 0|?~~?~=8p EI Q BT 0.9388 0 0 0.9835 458.88 60.72 Tm 3 Tr 0.0306 Tc 0 Tw (W.riability) Tj 0 Tr ET BT 0.9835 0 0 0.9835 499.92 60.72 Tm -0.0185 Tc 3.0082 Tw ( in Medicaid) Tj -151.3021 -10.9816 TD 0.0049 Tc 0.422 Tw (Policies Regarding ) Tj ET q 43.92 0 0 -9.36 430.32 57.12 cm BI /W 244 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~|<<?>`?????????~?>?~?<~>8??>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 531 0 obj <>stream 0.48 w 1 j 0 0 0 RG 61.68 677.28 m 539.28 677.28 l S BT 0.9835 0 0 0.9835 61.92 683.04 Tm 0 0 0 rg /F2 10 Tf 0.0762 Tc 0.1055 Tw (181 . ) Tj 23.6715 0 TD /F5 10 Tf 0.0024 Tc 0.7499 Tw (Special Care Units for People With ) Tj ET q 47.76 0 0 -7.2 233.04 690.24 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID py??????|?|>?|~>#?#|~x>?~8?~?~~~~|??~???~~???~~?~?>p??~À>8???<??>??????|???~~~?>?x?`||?x EI Q BT 0.9835 0 0 0.9835 233.04 683.04 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0357 Tc 1.1228 Tw ( and Other Dementias) Tj ET BT 0.8919 0 0 0.9835 67.2 621.84 Tm /F2 10 Tf 0.0465 Tc 0 Tw (84.) Tj 0.2691 -35.1411 TD 0.0465 Tc (85.) Tj ET BT 0.8449 0 0 0.9835 67.92 541.68 Tm 0.2802 Tc (86.) Tj 0.284 -57.1043 TD 0.2802 Tc (87.) Tj ET BT 0.8919 0 0 0.9835 68.16 451.2 Tm 0.0465 Tc (88.) Tj 0.2691 -46.1227 TD 0.0465 Tc (89.) Tj ET BT 0.8491 0 0 0.9835 68.16 371.28 Tm /F4 10 Tf 0.0748 Tc (90.) Tj ET BT 0.8066 0 0 0.9835 68.4 315.6 Tm 0.0252 Tc (91.) Tj 0.2975 -46.3668 TD 0.0252 Tc (92.) Tj 0 -46.3668 TD 0.0252 Tc (93.) Tj 0.2975 -34.8971 TD 0.2235 Tc (94.) Tj 0.2975 -57.3484 TD 0.2235 Tc (95.) Tj 0 -57.3484 TD 0.0252 Tc (96.) Tj ET BT 0.9835 0 0 0.9835 84.96 645.6 Tm /F2 10 Tf 0.0345 Tc 0.1479 Tw (Office of ) Tj ET q 46.08 0 0 -9.36 124.56 652.32 cm BI /W 256 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxx????|???? ?~?~?~??~??~??>??~?~?~??π?~??π?~??~?x?~?x??~~|??>|???~>8`???8 EI Q BT 0.9835 0 0 0.9835 124.56 645.6 Tm 3 Tr 0.0799 Tc 0 Tw (Twhnology) Tj 0 Tr 46.8548 0 TD 0.0142 Tc 1.3074 Tw ( Assessment, U.S. Congress,) Tj ET BT 0.9388 0 0 0.9835 84.96 634.32 Tm 0.0518 Tc 1.9172 Tw (Washington, DC, 1986.) Tj ET q 44.64 0 0 -7.2 84.96 629.04 cm BI /W 248 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p ?p???x???????x?p8p80~?~?~?~?~??????~|?>}?>?p|<?? ?` EI Q BT 0.9388 0 0 0.9835 84.96 621.84 Tm 3 Tr 0.0205 Tc 0 Tw (Chenoweth) Tj 0 Tr ET BT 0.9835 0 0 0.9835 129.6 621.84 Tm -0.008 Tc 2.062 Tw ( B., and Spencer, B., \223Dementia: The) Tj -45.3906 -10.9816 TD 0.0095 Tc 1.5562 Tw (Experience of Family Caregivers,\224) Tj 0 Tc -0.061 Tw ( ) Tj 148.6177 0 TD /F5 10 Tf 0.0226 Tc 0 Tw (Gerontologist) Tj ET q 59.28 0 0 -8.88 84.96 607.2 cm BI /W 332 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||x>< >>???||?|?|>|||?>>|<?>>?????x|?<<|~|x?>>>???|?|?|||?||||p>~0~>~~>~~~|0>~~~|8>p?|8x?~x|?x~>|??<<>?x?|?>????> EI Q BT 0.9444 0 0 0.9835 84.96 600.24 Tm 3 Tr 0.0466 Tc (26\(3\):267-272,) Tj 0 Tr 62.7715 0 TD 0.0723 Tc 0.726 Tw ( 1986.) Tj ET q 30.48 0 0 -8.64 84.96 594.48 cm BI /W 170 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x< ?????????<x?8???????????????????????|??|0???px EI Q BT 0.9388 0 0 0.9835 84.96 587.28 Tm 3 Tr /F2 10 Tf 0.0067 Tc 0 Tw (Cheren,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 115.44 587.28 Tm 0.0089 Tc 1.8009 Tw ( C., Director, Florida Office of Licensure) Tj -30.7485 -11.2256 TD -0.0077 Tc 1.5737 Tw (and Certification, Tallahassee, FL, remarks to the) Tj ET BT 0.9388 0 0 0.9835 85.92 565.2 Tm 0.1101 Tc -0.0622 Tw (1990 ) Tj ET q 47.76 0 0 -7.2 107.76 572.4 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??~????>?~?>????x?p~ ?p~  ~??????~?|~ < ?~<p??|<p~?|?<x~?><?? <x@x?<?<?~??x||<x`80 EI Q BT 0.9388 0 0 0.9835 107.76 565.2 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 50.8725 0 TD 0.0259 Tc 0.6665 Tw ( Association Public Policy Forum,) Tj ET BT 0.9835 0 0 0.9835 84.96 554.16 Tm 0.0361 Tc 0.1463 Tw (Washington, DC, April 4, 1990.) Tj 0.244 -12.6899 TD 0.0408 Tc 2.0938 Tw (Church Home,) Tj 0 Tc -0.061 Tw ( ) Tj 66.3777 0 TD /F5 10 Tf 0.0315 Tc 1.8592 Tw (The Glass Half Full: A Common) Tj -66.1337 -11.2256 TD 0.0518 Tc 0.7811 Tw (Sense Approach to Understanding and Caring for) Tj 0.244 -10.9816 TD 0.0055 Tc -0.0666 Tw (the Person With ) Tj ET q 47.52 0 0 -7.2 151.44 527.04 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?????????<~g?~>>~?~x?8~~~~|>?~?>??~??~~|??>??>~?????>x????|????3x|~~>p?>x?x?|~??x@ EI Q BT 0.9835 0 0 0.9835 151.44 519.84 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0067 Tc -0.0679 Tw ( Disease ) Tj 36.6053 0 TD /F2 10 Tf 0.0395 Tc 0 Tw (\(Washington,) Tj ET BT 0.9388 0 0 0.9835 85.44 508.8 Tm 0.0002 Tc 1.0773 Tw (DC: American Association of Homes for the Aging,) Tj ET BT 0.8919 0 0 0.9835 86.4 498 Tm 0.2668 Tc 0 Tw (1992\).) Tj ET BT 0.9835 0 0 0.9835 85.44 485.52 Tm -0.0194 Tc -0.0413 Tw (Clarke, ) Tj ET q 9.36 0 0 -8.16 119.52 492.24 cm BI /W 53 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ EI Q BT 1.0796 0 0 0.9835 119.52 485.52 Tm 3 Tr 0.0271 Tc 0 Tw (T,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 135.36 485.28 Tm 0.0314 Tc 3.2259 Tw (\223A Special Nursing Home Unit for) Tj ET BT 0.9388 0 0 0.9835 85.68 474.48 Tm 0.0019 Tc 1.5868 Tw (Ambulatory Demented Patients,\222) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 216.72 474.48 Tm /F5 10 Tf 0.0015 Tc 3.0882 Tw (Generations 7:46-) Tj -138.504 -11.2256 TD 0.0703 Tc 0.7281 Tw (54, 1982.) Tj ET q 28.56 0 0 -9.36 85.68 458.16 cm BI /W 159 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8qxx|<<<>^8@???????|?~????|????xxx?|?<??<?????<?>??<????? EI Q BT 0.9835 0 0 0.9835 85.68 451.2 Tm 3 Tr /F2 10 Tf -0.0194 Tc 0 Tw (Cleary,) Tj 0 Tr 29.0402 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 18.96 0 0 -8.16 117.12 457.92 cm BI /W 106 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>}???????||<<@||8 EI Q BT 0.8919 0 0 0.9835 117.12 451.2 Tm 3 Tr -0.0246 Tc 0 Tw (T.A.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 136.08 451.2 Tm 0 Tc -0.061 Tw ( ) Tj ET q 33.36 0 0 -8.64 138.96 458.16 cm BI /W 186 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<><p<pp???????|>~~ ~?~?~??~?~?????~~~|~>?~?|???8?|<@? @???? EI Q BT 0.9388 0 0 0.9835 138.96 451.2 Tm 3 Tr 0.0096 Tc 0 Tw (Clamon,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 172.32 451.2 Tm 0.1853 Tc 3.1671 Tw ( C., Price, M., et al., \223A) Tj -88.0969 -10.9816 TD -0.0006 Tc -0.0197 Tw (Reduced Stimulation Unit: Effects on Patients With) Tj ET q 48.96 0 0 -7.2 85.68 436.8 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID > ?>????????<????p~0?~??|????? @|<<??><<?<???><?~???p??|x <?<~~||~x?<08 EI Q BT 0.9388 0 0 0.9835 85.68 429.6 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 134.64 429.6 Tm 0.0014 Tc 0.4256 Tw ( Disease and Related Disorders,\224 ) Tj 137.3921 0 TD /F5 10 Tf 0.0361 Tc 0 Tw (Ger-) Tj -186.9313 -11.4697 TD 0.0234 Tc -0.0848 Tw (ontologist ) Tj ET q 59.52 0 0 -8.64 128.16 425.28 cm BI /W 331 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |x|<>x??<?~~?~?|??|??|~??|~?>|~??>~x?~?x?~|?<~|?~|~??~????~?>~~?|??~|?~|~?~~~?~~?~?x?~|?<|~|??<~>|?~?x|?~<|?@>|??|?x?p>x?x><<|??>???|?~>< ` EI Q BT 0.9444 0 0 0.9835 128.16 418.32 Tm 3 Tr 0.0466 Tc 0 Tw (28\(4\):511-514,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 187.68 418.32 Tm 0.0854 Tc -0.1478 Tw ( 1988.) Tj ET q 44.88 0 0 -8.64 85.68 413.04 cm BI /W 250 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<ax|?????????>x ~~8~~~?~~~?||~|?~~|?~>|?0|8 ???À<  EI Q BT 0.9835 0 0 0.9835 85.68 405.84 Tm 3 Tr /F2 10 Tf -0.0201 Tc 0 Tw (Clendaniel,) Tj 0 Tr 45.6347 0 TD -0.003 Tc 0.4301 Tw ( B.P., and ) Tj ET q 36.48 0 0 -8.64 173.52 412.8 cm BI /W 203 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0~?????~?????|??x?p?|xp<p~ ` ??~~||<||><|>>?~~@x>????~ EI Q BT 0.9835 0 0 0.9835 173.52 405.84 Tm 3 Tr -0.0365 Tc 0 Tw (Fleishell,) Tj 0 Tr 37.0934 0 TD 0.024 Tc 0.3213 Tw ( A., \223An ) Tj ET q 41.76 0 0 -7.2 247.68 413.04 cm BI /W 233 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0q8g?????~?~p??~8??~8??~??~???~??~~??~~??~??~??~x?~x?~~?x0?~?~?<8?~?>8??|??>???????<?? ??????xxx0p EI Q BT 0.9388 0 0 0.9835 247.68 405.84 Tm 3 Tr -0.0091 Tc 0 Tw (Alzheirner) Tj 0 Tr ET BT 0.9835 0 0 0.9835 85.92 395.04 Tm 0.0169 Tc 3.5823 Tw (Day Care Center for Nursing Home Patients,\224) Tj -0.4881 -11.4697 TD /F5 10 Tf 0.0305 Tc 0.091 Tw (American Journal of Nursing ) Tj ET q 58.8 0 0 -8.64 204.96 390.72 cm BI /W 327 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8xx<<|?>8?>||||~?|>>??>>?>~<x~|?<|||?|><||~~?>|>??>|>~>>~?<?|?~???>?>x?~8??<>?>??<>?x?~>8?p>?8>?~>~<>~?~>|>~~>8>~π~||~~~||?~>x????|????|?|?~?|~~>?>?>?>?x8 EI Q BT 0.9444 0 0 0.9835 204.96 383.76 Tm 3 Tr 0.0466 Tc 0 Tw (89\(7\):944-945,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 263.76 383.76 Tm 0.0854 Tc -0.1478 Tw ( 1989.) Tj ET BT 0.9388 0 0 0.9835 85.92 371.28 Tm /F2 10 Tf 0.0464 Tc 0.3891 Tw (Cohen, E. S.,) Tj ET BT 0.9835 0 0 0.9835 141.12 370.8 Tm 0.0006 Tc 1.6466 Tw (\223Caring for the Mentally Ill Elderly) Tj ET BT 0.9388 0 0 0.9835 86.16 360.48 Tm 0.006 Tc 1.787 Tw (Without DeFacto Commitments to Nursing Homes:) Tj ET BT 0.9835 0 0 0.9835 86.16 349.68 Tm 0.0019 Tc 0.5878 Tw (The Right To The Least Restrictive Environment,\222) Tj 0.244 -10.9816 TD 0.0049 Tc 1.1542 Tw (Community Services Institute, Inc.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 37.44 0 0 -8.16 233.76 345.84 cm BI /W 208 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<@8|c~<?????????x???~8??????? ?????????????Ð?????????|??|??<~?x @??? EI Q BT 0.9388 0 0 0.9835 233.76 338.88 Tm 3 Tr 0.0033 Tc 0 Tw (Narberth,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 271.2 338.88 Tm 0.0286 Tc 0.398 Tw ( PA,) Tj ET BT 0.8919 0 0 0.9835 87.12 328.08 Tm 0.0717 Tc 0 Tw (1985.) Tj ET BT 0.9835 0 0 0.9835 86.4 315.84 Tm 0.0284 Tc -0.0899 Tw (Cohen, ) Tj ET q 21.6 0 0 -8.16 118.8 322.56 cm BI /W 120 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>~??????`??????????????????????????????????? EI Q BT 0.9835 0 0 0.9835 118.8 315.84 Tm 3 Tr 0.0022 Tc 0 Tw (G.D.,) Tj 0 Tr 27.576 -0.4881 TD 0.0028 Tc 2.6205 Tw (\223One Psychiatrist\222s View,\224) Tj 0 Tc -0.061 Tw ( ) Tj 119.0894 0 TD /F5 10 Tf 0.2237 Tc 0 Tw (Treat-) Tj -179.6102 -10.7376 TD 0.0088 Tc 0.0927 Tw (ments for the ) Tj ET q 47.76 0 0 -7.2 140.88 312 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x@ ??~???|??|??~?|?q~?q|`~x||~~x~~~<~~>|~?~>?~?|??|????~~?|~~?~>p??>>8???8<}x??|??|???~>>>x?><>p>??~`<` EI Q BT 0.9835 0 0 0.9835 140.88 304.8 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0348 Tc 0.2697 Tw ( Patient: The Long Haul,) Tj ET q 15.84 0 0 -7.2 86.4 300.72 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????``` >? EI Q BT 0.9388 0 0 0.9835 86.4 294 Tm 3 Tr /F2 10 Tf 0.0483 Tc 0 Tw (L.F.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 102.24 294 Tm 0 Tc -0.061 Tw ( ) Tj ET q 24.48 0 0 -7.2 104.88 300.72 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ???|??~|~??~~?~?~?~~?~~?~|?~??~?p~?x~?x~??8~?<~?<~x?~<?ߟ|~???>|x||0 EI Q BT 0.9835 0 0 0.9835 104.88 294 Tm 3 Tr 0.0323 Tc 0 Tw (Jarvik) Tj 0 Tr 24.8916 0 TD 0.0647 Tc 0.3612 Tw ( and ) Tj ET q 17.76 0 0 -7.2 150.48 300.72 cm BI /W 99 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????? EI Q BT 0.9388 0 0 0.9835 150.48 294 Tm 3 Tr 0.0043 Tc 0 Tw (C.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 168.24 294 Tm 0.0622 Tc 2.072 Tw ( Winograd) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.64 217.2 300.96 cm BI /W 119 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x|<<8>>>>>?~?<?~???|??|~??||~~?|?|?~~??~|>?~|>?|??|??|? |>?||>?|><|<~~>?><???????<x<?  EI Q BT 0.9388 0 0 0.9835 217.2 294 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 238.56 294 Tm 0.0572 Tc 1.101 Tw ( \(New) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.16 268.08 300.72 cm BI /W 119 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>~??`?????????????~???x<>????~ EI Q BT 0.9835 0 0 0.9835 268.08 294 Tm 3 Tr 0.1064 Tc 0 Tw (York) Tj 0 Tr -184.735 -11.4697 TD 0.0433 Tc 0.2 Tw (NY: Springer Publishing Co., 1988\).) Tj 0 -12.6899 TD 0.0156 Tc 2.8515 Tw (Cohen, U., and Weisman,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.64 202.08 276.96 cm BI /W 119 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<<~<~????|?????????????????????????????????????8 EI Q BT 0.9388 0 0 0.9835 202.08 270.24 Tm 3 Tr 0.0066 Tc 0 Tw (G.D.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 223.44 270.24 Tm 0.2231 Tc 3.6167 Tw ( \223Experimental) Tj -139.3443 -11.2256 TD 0.0329 Tc 1.0443 Tw (Design To Maximize Autonomy for Older Adults) Tj ET BT 0.9388 0 0 0.9835 86.4 248.16 Tm 0.0462 Tc 0.0059 Tw (With ) Tj ET q 72.24 0 0 -9.84 107.76 255.36 cm BI /W 412 /H 55 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?~||>???8?????>?w??~?p?8??8???|?~~?~~?~?~~~?~~???~??@~??~?~???߀???????|0~|~0????x??><?!pp?<?<??? EI Q BT 0.9388 0 0 0.9835 107.76 248.16 Tm 3 Tr 0.022 Tc 0 Tw (Cogni&eIrn@nnm) Tj 0 Tr ET q 11.28 0 0 -8.64 180 254.64 cm BI /W 69 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?>???~?<?<??px<x<x< EI Q BT 0.798 0 0 0.9835 180 247.44 Tm 3 Tr -0.0205 Tc (ts,\224) Tj 0 Tr ET BT 0.8919 0 0 0.9835 191.28 247.44 Tm 0 Tc -0.0798 Tw ( ) Tj ET q 39.84 0 0 -7.2 193.44 254.64 cm BI /W 237 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0||`x<~?>>>?>/??>??x~|~~~~~<~~?~?~?>?|>~?>~~?>??>~????~~??>~|????~|???>~~?>~?~>|>~>?~8?8|8?>|>x????????0|0 ~`>?8 EI Q BT 0.8449 0 0 0.9835 193.44 247.44 Tm 3 Tr 0.0423 Tc 0 Tw (Generatilm) Tj 0 Tr ET BT 0.8919 0 0 0.9835 233.28 247.44 Tm -0.0002 Tc 2.6114 Tw ( M@uppl.\):75-) Tj ET BT 0.9388 0 0 0.9835 86.64 236.88 Tm 0.0963 Tc 0.7194 Tw (78, 1990.) Tj ET BT 0.9835 0 0 0.9835 86.4 224.4 Tm 0.0283 Tc 2.5946 Tw (Cohen, U., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 38.88 0 0 -8.16 156.24 231.36 cm BI /W 216 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<80<78?x??x>?<~??<~??0?<8~?~?8~??~0~?~~~~~?~~~>~?~?~??~~?~???~?????~??>>~?>>?~>?~>?p??x?|<@<<>?? EI Q BT 0.9388 0 0 0.9835 156.24 224.4 Tm 3 Tr -0.0196 Tc 0 Tw (Weisman,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 195.12 224.4 Tm 0.0022 Tc 1.1569 Tw ( G. D.,) Tj 0 Tc -0.061 Tw ( ) Tj 32.9448 0 TD /F5 10 Tf 0.0599 Tc 3.4165 Tw (Holding on to) Tj -143.737 -10.9816 TD 0.0666 Tc -0.1287 Tw (Home ) Tj 27.332 0 TD /F2 10 Tf 0.0216 Tc 1.2592 Tw (\(Baltimore, MD: Johns Hopkins University) Tj -27.088 -10.9816 TD 0.0432 Tc -0.105 Tw (Press, 1991.) Tj ET BT 0.9388 0 0 0.9835 86.4 190.56 Tm 0.0088 Tc 0.7274 Tw (Cohen, U., Weisman, ) Tj ET q 21.12 0 0 -8.16 172.8 197.28 cm BI /W 119 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<~<~?????x???????????????????????@?????????????ǀ EI Q BT 0.9388 0 0 0.9835 172.8 190.56 Tm 3 Tr 0.0066 Tc 0 Tw (G.D.,) Tj 0 Tr 22.4964 0 TD 0.0019 Tc 0.2575 Tw ( Day, K., et al., ) Tj ET BT 0.9444 0 0 0.9835 254.88 190.56 Tm /F5 10 Tf 0.0015 Tc 0 Tw (Environ-) Tj -177.6409 -11.2256 TD -0.0119 Tc 1.1964 Tw (ments for People with Dementia: Regulatory Analy-) Tj ET BT 0.9835 0 0 0.9835 87.12 168.48 Tm -0.0333 Tc -0.0271 Tw (sis, ) Tj 16.3504 0 TD /F2 10 Tf 0.0297 Tc 2.5443 Tw (Center for Architecture and Urban Planning) Tj ET BT 0.9388 0 0 0.9835 86.88 157.68 Tm 0.0068 Tc 1.4539 Tw (Research, University of Wisconsin-Milwaukee, Mil-) Tj ET BT 0.9835 0 0 0.9835 87.12 146.64 Tm 0.0462 Tc -0.108 Tw (waukee, WI, January 1989.) Tj ET BT 0.9388 0 0 0.9835 86.88 134.16 Tm 0.007 Tc 0.3032 Tw (Cohen, U., Weisman, G. D., Ray, K., et al., ) Tj ET BT 0.9444 0 0 0.9835 255.36 134.16 Tm /F5 10 Tf 0.0015 Tc 0 Tw (Environ-) Tj ET BT 0.9835 0 0 0.9835 87.12 123.12 Tm 0.0145 Tc 2.1612 Tw (ments for People with Dementia: Design Guide,) Tj 0 -11.2256 TD /F2 10 Tf 0.0278 Tc 2.046 Tw (Center for Architecture and Urban) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30 0 0 -6.96 236.16 118.56 cm BI /W 167 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` ???~~~~~~~~~~~~~~~~~~~~>~~?~~~~x~~~~~~|~|~???>?||?~~~~08 EI Q BT 0.9388 0 0 0.9835 236.16 112.08 Tm 3 Tr 0.0508 Tc 0 Tw (Plannin) Tj 0 Tr ET BT 0.9835 0 0 0.9835 267.12 111.6 Tm 0.018 Tc 1.6289 Tw (g Re-) Tj -182.7827 -10.7376 TD 0.008 Tc 1.6391 Tw (search, University of Wisconsin-Milwaukee, Mil-) Tj -0.244 -11.4697 TD 0.0491 Tc -0.111 Tw (waukee, WI, August 1988.) Tj -0.244 -12.4458 TD 0.007 Tc 2.1282 Tw (Cohen, U., Weisman,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.16 180.72 84.48 cm BI /W 119 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<~0|~???????|????????????????????????? ?????????????@a EI Q BT 0.9388 0 0 0.9835 180.72 77.52 Tm 3 Tr 0.0066 Tc 0 Tw (G.D.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 202.08 77.52 Tm -0.0323 Tc 1.2408 Tw ( Steiner, V. L., et al.,) Tj -117.6252 -10.9816 TD /F5 10 Tf 0.0118 Tc 3.8804 Tw (Environments for People with Dementia: Case) Tj 0.4881 -11.2256 TD 0.0091 Tc -0.0703 Tw (Studies, ) Tj 35.6292 0 TD /F2 10 Tf 0.0269 Tc 1.6687 Tw (Center for Architecture and Urban Plan-) Tj -35.6292 -10.7376 TD 0.6868 Tc 3.8773 Tw (ning Research,) Tj 81.0198 -0.7321 TD 0.732 Tc 3.5874 Tw (University of Wisconsin-) Tj -81.2639 -10.2495 TD 0.0045 Tc 0.4835 Tw (Milwaukee, Milwaukee, WI, May 1988.) Tj ET BT 0.8919 0 0 0.9835 317.52 644.4 Tm 0.0465 Tc 0 Tw (97.) Tj 0 -46.3668 TD 0.0465 Tc (98.) Tj 0.2691 -35.1411 TD 0.0465 Tc (99.) Tj ET BT 0.8449 0 0 0.9835 314.16 508.08 Tm 0.0954 Tc (100.) Tj ET BT 0.7642 0 0 0.9835 314.16 484.8 Tm /F4 10 Tf 0.0785 Tc (101.) Tj 0.3141 -56.8603 TD 0.0785 Tc (102.) Tj 0.3141 -46.6108 TD 0.0785 Tc (103.) Tj 0.3141 -45.1466 TD 0.0785 Tc (104.) Tj 0 -34.6531 TD 0.0785 Tc (105.) Tj 0.3141 -46.3668 TD 0.0785 Tc (106.) Tj 0 -34.8971 TD 0.0785 Tc (107.) Tj 0.3141 -45.8787 TD 0.314 Tc (108.) Tj 0 -45.8787 TD 0.0785 Tc (109.) Tj T* 0.0785 Tc (110.) Tj 0 -45.6347 TD 0.0785 Tc (111.) Tj ET BT 0.9835 0 0 0.9835 335.28 644.64 Tm /F2 10 Tf 0.0036 Tc 0.6326 Tw (Cohen-Mansfield, J., Werner, P., and Marx, M. S.,) Tj 0.7321 -11.4697 TD 0.0225 Tc 0.209 Tw (\221\221Screaming in Nursing Home Residents,\224 ) Tj 174.7295 0 TD /F5 10 Tf 0.0505 Tc 0 Tw (Journal) Tj ET BT 0.9812 0 0 0.9812 335.52 622.32 Tm /F5 11 Tf 0.1212 Tc -0.1846 Tw (of ) Tj ET BT 0.9835 0 0 0.9835 347.04 622.32 Tm /F5 10 Tf -0.0041 Tc 0.6753 Tw (the American Geriatrics Society ) Tj ET q 59.04 0 0 -8.64 479.76 629.04 cm BI /W 329 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <`|x|>p|?8~??|>>|>??>~>~???|~?x|??|??x |||>|??|~?~?>??????||? ?~~?~?>?>>~?~?~~|>~>~??<?`~~~>||?x><~>~???~???|< ?  EI Q BT 0.9444 0 0 0.9835 479.76 622.32 Tm 3 Tr 0.0466 Tc 0 Tw (38\(7\):785-792,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 336.24 611.52 Tm 0.0456 Tc (1990.) Tj ET BT 0.9388 0 0 0.9835 335.52 598.8 Tm /F2 10 Tf 0.0198 Tc 0.705 Tw (Cohen-Mansfield, J., Werner, P., Marx, M. S., et al.,) Tj ET BT 0.9835 0 0 0.9835 336.24 588 Tm 0.0289 Tc 2.2105 Tw (\223Two Studies of Pacing in the Nursing Home,\224) Tj -1.2202 -11.4697 TD /F5 10 Tf 0.0536 Tc 0.0675 Tw (Journal of Gerontology 46\(3\) ) Tj ET q 45.12 0 0 -8.64 456.48 583.92 cm BI /W 251 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?<p|~p|?p~?>?>???~x?<x??x?xxx?x|?x|x~xx~|x><x?>x??x?x<x~xy|{<>{>|>~>||<|>~>p>?x>?|?????????~????o EI Q BT 0.9444 0 0 0.9835 456.48 576.72 Tm 3 Tr 0.0457 Tc 0 Tw (:M77-M83,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 501.6 576.72 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 504 583.92 cm BI /W 116 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~ ??~~~~?~~~~~~~?~??~?~?~?~?~?~?~?~~~~~c~~>??>?8 EI Q BT 0.8971 0 0 0.9835 504 576.72 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 335.52 564.24 Tm /F2 10 Tf 0.2308 Tc 2.8768 Tw (Coleman, E.A.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42 0 0 -8.16 407.76 571.2 cm BI /W 234 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|>>>????>~?~?8??~??~?`~???~??~>???~~??~?~??~`????~????~~???~~??~??~?????????>>~???????x?|~~< EI Q BT 0.9835 0 0 0.9835 407.76 564.24 Tm 3 Tr -0.0285 Tc 0 Tw (Barbaccia,) Tj 0 Tr 42.7062 0 TD -0.0077 Tc 1.411 Tw ( J. C., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.76 0 0 -9.12 497.28 571.2 cm BI /W 233 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<<>>~|~???`??~|???~??????????????>?????????????????????????????~?~???????8~<???? EI Q BT 0.9388 0 0 0.9835 497.28 564.24 Tm 3 Tr 0.0455 Tc 0 Tw (Croughan-) Tj 0 Tr ET q 38.88 0 0 -8.16 335.52 560.4 cm BI /W 223 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>~:??????????~?p?~?~?~?~??~~?~?~~?~?~??~?~?~?~?~x?~?~<?~?~<?~??~<?~??~?~?~>?~?~~?~?~????~???>p<?8?|??~|0 EI Q BT 0.9388 0 0 0.9835 335.52 553.44 Tm 3 Tr 0.034 Tc (Minihane,) Tj 0 Tr 41.4138 0 TD 0.0557 Tc -0.0043 Tw ( M. S.,) Tj ET BT 0.9835 0 0 0.9835 403.68 552.96 Tm 0.0011 Tc 0.8326 Tw (\223Hospitalization Rates in Nursing) Tj -69.0621 -10.7376 TD 0.01 Tc 1.0095 Tw (Home Residents With Dementia: A Pilot Study of) Tj 0 -11.2256 TD -0.002 Tc 0.7079 Tw (the Impact of a Special Care Unit,\222 ) Tj 148.1296 0 TD /F5 10 Tf 0.0294 Tc 1.1292 Tw (Journal of the) Tj -148.1296 -10.9816 TD -0.0036 Tc 0.4307 Tw (American Geriatrics Society ) Tj ET q 59.28 0 0 -8.64 452.16 527.52 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8><|>|>|??????????>??~>~?~~x|||@>|x|< ~~??~??~?~????|??~??>?????~?~??????~~?????~??>? ?0?~x??@8?><~>| x?|?|>?>?|?>~????p  EI Q BT 0.9444 0 0 0.9835 452.16 520.56 Tm 3 Tr 0.0466 Tc 0 Tw (38\(2\):108-112,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 511.44 520.56 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj -178.6341 -12.6899 TD /F2 10 Tf 0.0171 Tc 1.1418 Tw (Colorado Regulations for Long Term Care Facili-) Tj 0.244 -11.4697 TD 0.0137 Tc 0.1691 Tw (ties, sections 19.1-19.9.) Tj 0 -12.4458 TD 0.0294 Tc 1.7393 Tw (Commonwealth Department of Community Serv-) Tj 0.244 -10.9816 TD 0.0216 Tc 0.6898 Tw (ices and Health, \221\221Commonwealth Policy and Pro-) Tj 0 -10.9816 TD 0.0145 Tc 3.8288 Tw (grams for Dementia Care in Australia, 1990,\224) Tj 0 -11.2256 TD 0.0294 Tc 1.6783 Tw (Commonwealth Department of Community Serv-) Tj 0 -10.9816 TD 0.0074 Tc 0.3707 Tw (ices and Health, Canberra, Australia, 1990.) Tj 0 -12.6899 TD 0.0095 Tc 2.6137 Tw (Community Services Institute, Inc., \223A Training) Tj ET BT 0.9388 0 0 0.9835 336.24 417.36 Tm 0.0126 Tc 1.4659 Tw (Program for Nursing Home Staff Caring for People) Tj ET BT 0.9835 0 0 0.9835 336.24 406.32 Tm -0 Tc -0.061 Tw (With ) Tj ET q 48.72 0 0 -7.68 358.56 413.76 cm BI /W 271 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ {y?????|?<?~??~??~p?? ?~8???~???~???~?????~??~???~????x???x???8|`??8<p??߀x<p??|x>|?????8?????x?xx?p EI Q BT 0.9835 0 0 0.9835 358.56 406.32 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0014 Tc 0.4866 Tw ( Disease and Related Disorders,\224) Tj ET q 36.96 0 0 -8.16 336.24 402.24 cm BI /W 208 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<>`????????x???~8?>?? ?????????????? ?????????Ǐ~?|>??0?????? EI Q BT 0.9388 0 0 0.9835 336.24 395.28 Tm 3 Tr 0.0033 Tc 0 Tw (Narberth,) Tj 0 Tr 39.3687 0 TD 0.0682 Tc 0.4937 Tw ( PA, 1990.) Tj ET q 30.24 0 0 -9.36 336.24 390 cm BI /W 169 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??? ?px><0???????~~||~?>??>????~x??~<?><??????~?~|>???x???? EI Q BT 0.9388 0 0 0.9835 336.24 382.8 Tm 3 Tr 0.0418 Tc 0 Tw (Cooley,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 366.48 382.8 Tm 0.0017 Tc 0.5473 Tw ( S., Chief, Research and Evaluation, Office) Tj -30.5045 -10.9816 TD 0.0116 Tc 0.822 Tw (of Geriatrics and Extended Care, U.S. Department) Tj 0.244 -10.9816 TD 0.026 Tc 3.5243 Tw (of Veterans Affairs, Washington, DC, personal) Tj 0 -10.9816 TD 0.0253 Tc 0.1573 Tw (communication, May 5, 1992.) Tj -0.244 -12.4458 TD 0.0221 Tc 0.6486 Tw (Coons, D.H.,) Tj 58.0805 0 TD -0.0168 Tc 2.1523 Tw (\223The Therapeutic Milieu,\224) Tj 0 Tc -0.061 Tw ( ) Tj 115.1848 0 TD /F5 10 Tf 0.1786 Tc 0 Tw (Clinical) Tj ET BT 0.9444 0 0 0.9835 336.24 327.6 Tm 0.0036 Tc 0.5446 Tw (Aspects of Aging, ) Tj ET BT 0.9388 0 0 0.9835 406.8 327.6 Tm /F2 10 Tf 0.0343 Tc 0.0185 Tw (W. ) Tj ET q 30.24 0 0 -7.2 420.72 334.56 cm BI /W 170 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `` ??????xp~80~~~~~?~~~~~~||?~>?~~~~~~?< EI Q BT 0.9835 0 0 0.9835 420.72 327.6 Tm 3 Tr -0.0438 Tc 0 Tw (Reichel) Tj 0 Tr ET BT 0.9388 0 0 0.9835 450.96 327.6 Tm -0.0014 Tc 1.0791 Tw ( \(cd.\) \(Baltimore, MD:) Tj ET q 36 0 0 -6.96 336.72 323.52 cm BI /W 200 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0}??px?~?>~~?~?~~~~~?~~~?~?~ ~~~?~~<?|?xx?`|`x<<<p|??n~~0{@8<< EI Q BT 0.9835 0 0 0.9835 336.72 316.56 Tm 3 Tr -0.0411 Tc 0 Tw (Williams) Tj 0 Tr 36.6053 0 TD 0.0647 Tc -0.1268 Tw ( and ) Tj ET q 33.6 0 0 -8.16 392.16 323.52 cm BI /W 187 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08<|?|||?~?~?~~?~?~?~?~??~?~?~?~?~?~??~?~~?~~?~Ǐ?~~?Ǐ?~~8??~|x??~x?~x~~x~?|~|?<~<~~~~~<>???>< EI Q BT 0.9835 0 0 0.9835 392.16 316.56 Tm 3 Tr -0.003 Tc 0 Tw (Wilkins,) Tj 0 Tr 34.165 0 TD 0.0853 Tc 0.3404 Tw ( 1983\).) Tj -90.5372 -12.4458 TD 0.0221 Tc 0.6486 Tw (Coons, D.H.,) Tj 58.0805 -0.244 TD -0.0063 Tc 1.9586 Tw (\223Designing a Residential Care Unit) Tj -57.8364 -10.7376 TD 0.0221 Tc 1.6655 Tw (for Persons With Dementia,\224 contract report pre-) Tj -0.244 -11.2256 TD 0.0406 Tc 1.789 Tw (pared for the Office of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 46.08 0 0 -9.36 437.52 289.44 cm BI /W 256 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<x9??x?|????~~~?~~?~??~??~?~?~>?~??~??~??ߟ?~??π?~?π?~??~?x?~??x???<x?>|?????<p??0 EI Q BT 0.9835 0 0 0.9835 437.52 282.48 Tm 3 Tr 0.0799 Tc 0 Tw (Twhnology) Tj 0 Tr 46.8548 0 TD 0.0032 Tc 5.0604 Tw ( Assessment,) Tj -149.3498 -11.2256 TD 0.0335 Tc 0.0879 Tw (U.S. Congress, Washington, DC, 1986.) Tj 0 -12.9339 TD 0.0231 Tc 2.3559 Tw (Coons, D.H., \223Wandering,\224) Tj 0 Tc -0.061 Tw ( ) Tj 121.0417 0 TD /F5 10 Tf 0.018 Tc -0.0793 Tw (American ) Tj ET q 31.68 0 0 -7.2 499.2 265.92 cm BI /W 177 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???|????~???~???~?~?8>>??~|~~??~???????|~~~>>??? EI Q BT 0.9835 0 0 0.9835 499.2 258.72 Tm 3 Tr 0.0505 Tc 0 Tw (Journal) Tj 0 Tr 32.2127 0 TD 0.0124 Tc 0.4144 Tw ( of) Tj ET q 47.52 0 0 -7.2 336.24 254.88 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<<~>~?????|<~c||~p>>x>>8>>?>?~?|~~~~~??|?????||??|`~?~??|p>?>?>x??>??>?>??||||p?|x?~x>|>|???x EI Q BT 0.9835 0 0 0.9835 336.24 247.92 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0322 Tc 1.3704 Tw ( Care and Related Disorders and Re-) Tj -47.587 -11.4697 TD 0.0282 Tc -0.0897 Tw (search ) Tj ET q 44.16 0 0 -8.64 366 243.6 cm BI /W 246 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<>x<xx|>????><|x|>~~?~x~~?x~~?x~~?|>|?|>?|???|??????????~>?>@?~?~?||||<x?|?>>>x!|~?|<?????<|x|?~`? EI Q BT 0.9444 0 0 0.9835 366 236.64 Tm 3 Tr 0.0374 Tc 0 Tw (3\(1\):31-36,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 410.16 236.64 Tm 0.0854 Tc -0.1478 Tw ( 1988.) Tj -74.4309 -12.4458 TD /F2 10 Tf 0.0221 Tc 0.6486 Tw (Coons, D.H.,) Tj 58.3245 0 TD 0.0043 Tc 1.8259 Tw (\223Residential Care for Persons With) Tj -58.3245 -11.2256 TD -0.0211 Tc -0.0396 Tw (Dementia,\224 ) Tj 50.2713 0 TD /F5 10 Tf 0.0105 Tc 1.8196 Tw (Dementia Care: Patient, Family, and) Tj -50.2713 -10.9816 TD 0.002 Tc 0.303 Tw (Community, N. ) Tj 64.4254 0 TD /F2 10 Tf -0.0007 Tc 0.9768 Tw (Mace \(cd.\) \(Baltimore, MD: Johns) Tj -64.4254 -10.9816 TD 0.0441 Tc 0.0568 Tw (Hopkins University Press, 1990\).) Tj 0 -12.6899 TD 0.0221 Tc 2.1128 Tw (Coons, D.H.,) Tj 61.741 -0.244 TD 0.0099 Tc 3.1013 Tw (\223Activities and Staff Approaches:) Tj -61.741 -10.4935 TD 0.0186 Tc 1.1403 Tw (The Impact on Behaviors,\224) Tj 0 Tc -0.061 Tw ( ) Tj 115.9169 0 TD /F5 10 Tf 0.0107 Tc 3.5886 Tw (Specialized Dementia) Tj -115.6729 -11.2256 TD -0.0122 Tc -0.0486 Tw (Care, ) Tj ET q 18.72 0 0 -6.96 364.32 164.4 cm BI /W 104 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |~?~?<???????????????????????? EI Q BT 0.9388 0 0 0.9835 364.32 157.68 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 383.04 157.68 Tm 0.0184 Tc 3.0439 Tw ( Coons \(cd.\) \(Baltimore, MD: Johns) Tj -46.8548 -10.9816 TD 0.0441 Tc 0.0568 Tw (Hopkins University Press, 1991\).) Tj 0 -12.6899 TD 0.0221 Tc 0.6486 Tw (Coons, D.H.,) Tj 58.5686 -0.244 TD -0.0092 Tc 2.3073 Tw (\223The Therapeutic Milieu: Concepts) Tj -58.0805 -11.2256 TD -0.0172 Tc 2.6408 Tw (and Criteria,\224) Tj 0 Tc -0.061 Tw ( ) Tj 61.9851 0 TD /F5 10 Tf 0.0059 Tc 3.4715 Tw (Specialized Dementia Care,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.48 0 0 -7.2 521.52 130.08 cm BI /W 103 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x????|?0????????????????????????????`0 EI Q BT 0.9388 0 0 0.9835 521.52 123.12 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 337.44 112.32 Tm 0.031 Tc 1.0463 Tw (Coons \(cd.\) \(Baltimore, MD: Johns Hopkins Uni-) Tj -0.4881 -10.9816 TD 0.0346 Tc 0.0258 Tw (versity Press, 1991\).) Tj ET BT 0.9388 0 0 0.9835 336.96 89.04 Tm 0.0142 Tc 1.3181 Tw (Coons, D.H., Director,) Tj 0 Tc 0.055 Tw ( ) Tj ET q 48.72 0 0 -7.2 428.64 96.24 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ 8???????>?<?????p~?`??~??~?????~|~|?~ <?~<?~~?>À<??<|????>?<x<><~~~|?|?~8<|` EI Q BT 0.9835 0 0 0.9835 428.64 89.04 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9388 0 0 0.9835 477.36 89.04 Tm -0.0292 Tc 1.4922 Tw ( Disease Project) Tj ET BT 0.9835 0 0 0.9835 337.2 78.24 Tm 0.0324 Tc 0.4429 Tw (on Environmental Intervention, Institute of Geron-) Tj 0 -10.9816 TD 0.029 Tc 2.2888 Tw (tology, University of Michigan, Ann) Tj 0 Tc -0.061 Tw ( ) Tj ET q 25.92 0 0 -8.16 496.32 74.4 cm BI /W 145 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<??????~??|???<?<~?>~?>>???>9~~|<8p EI Q BT 0.9835 0 0 0.9835 496.32 67.44 Tm 3 Tr 0.0506 Tc 0 Tw (A.bor,) Tj 0 Tr 26.3559 0 TD -0.0287 Tc 1.1883 Tw ( MI,) Tj -188.3955 -11.2256 TD 0.035 Tc 0.2085 Tw (personal communication, Apr. 4, 1992.) Tj 0 -12.4458 TD 0.0203 Tc 0.0159 Tw (Cooper, J.K., Mungas, D., and ) Tj ET q 28.08 0 0 -8.16 460.32 50.88 cm BI /W 157 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<|xxx?????<x?<  ~~|||| ????>|>|><?>xx||<>?? EI Q BT 0.9388 0 0 0.9835 460.32 44.16 Tm 3 Tr -0.0103 Tc 0 Tw (Weiler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 488.4 44.16 Tm -0.0183 Tc 0.0796 Tw ( P., \221Relation) Tj -153.7425 -10.9816 TD 0.0265 Tc 2.4744 Tw (of Cognitive Status and Abnormal Behaviors in) Tj ET endstream endobj 532 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 533 0 obj <>stream 0.72 w 1 j 0 0 0 RG 71.28 683.52 m 549.36 683.52 l S BT 0.9443 0 0 0.9812 475.68 689.52 Tm 0 0 0 rg /F5 11 Tf -0.0248 Tc 0.0705 Tw (References ) Tj ET BT 0.9207 0 0 0.9598 525.6 689.52 Tm /F9 6 Tf -0.0556 Tc -0.0442 Tw (l ) Tj ET BT 0.9443 0 0 0.9812 531.6 689.52 Tm /F5 11 Tf 0.2578 Tc 0 Tw (182) Tj ET BT 0.8449 0 0 0.9835 72.72 625.92 Tm /F2 10 Tf 0.3084 Tc (112.) Tj 0.5681 -35.6292 TD 0.3084 Tc (113.) Tj 0.5681 -46.8548 TD 0.3084 Tc (114.) Tj 0.5681 -35.3852 TD 0.3084 Tc (115.) Tj 0.284 -46.3668 TD 0.3084 Tc (116.) Tj 0.5681 -35.6292 TD 0.3084 Tc (117.) Tj 0.284 -35.3852 TD 0.3084 Tc (118.) Tj 0.5681 -57.5924 TD 0.3084 Tc (119.) Tj 0.5681 -46.8548 TD 0.3084 Tc (120.) Tj 0.284 -35.8732 TD 0.3084 Tc (121.) Tj 0.284 -35.3852 TD 0.3084 Tc (122.) Tj 0.5681 -58.5686 TD 0.3084 Tc (123.) Tj 0.5681 -57.8364 TD 0.3084 Tc (124.) Tj 0.5681 -45.6347 TD 0.0954 Tc (125.) Tj ET q 48.24 0 0 -7.2 95.04 657.84 cm BI /W 269 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?????x>?|x??|0??~??x>?8~??~~?~~?~~?~?~?~????`???????????|?|?p|<?? EI Q BT 0.9388 0 0 0.9835 95.04 650.64 Tm 3 Tr -0.034 Tc (Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 143.28 650.64 Tm 0.1907 Tc 2.6734 Tw ( Disease,\224) Tj 51.0034 0 TD /F5 10 Tf 0.0249 Tc 2.8421 Tw (Journal of the American) Tj -99.8106 -11.4697 TD -0.0138 Tc 0.197 Tw (Geriatrics Society ) Tj ET q 59.52 0 0 -8.88 169.68 646.56 cm BI /W 331 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x~>#`x???????|~??>|>?~?>|~~>?|~>>|~>~~?~~~|~?~|~~?~??>??>???????????|?~?>~?>>?>>?|?~||>~|||>|?>?????|???? EI Q BT 0.9444 0 0 0.9835 169.68 639.36 Tm 3 Tr 0.0466 Tc 0 Tw (38\(8\):867-870,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 229.2 639.36 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj ET BT 0.9388 0 0 0.9835 95.28 625.92 Tm /F2 10 Tf 0.0106 Tc 0.0437 Tw (Craig, ) Tj ET BT 0.934 0 0 0.9835 120.72 625.92 Tm /F4 10 Tf -0.037 Tc 0.213 Tw (M.H., Director, ) Tj ET q 46.8 0 0 -7.2 188.88 632.88 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >p????~??|????>??~?>?~x?> ?~8?~??~??????`??~??~??~???~??~??~?|??~?| ?~?|p??8<x???<|??|<??>?|??????8p??x?<?|??p|<8p EI Q BT 0.9388 0 0 0.9835 188.88 625.92 Tm 3 Tr /F2 10 Tf -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.85 0 TD -0.0008 Tc 0.3116 Tw ( Program, Texas) Tj ET BT 0.9835 0 0 0.9835 95.28 614.88 Tm 0.0182 Tc 1.1406 Tw (Department of Health, Austin, TX, personal com-) Tj 0 -10.9816 TD 0.0264 Tc 0.3188 Tw (munication, Sept. 20, 1991.) Tj 0 -13.1779 TD -0.0091 Tc 1.8191 Tw (Davis, P. B., Morris, J. C., and Grant, E., \223Brief) Tj 0.4881 -11.4697 TD 0.0005 Tc 1.3213 Tw (Screening Tests Versus Clinical Staging in Senile) Tj -0.4881 -11.2256 TD 0.0063 Tc 1.3968 Tw (Dementia of the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42 0 0 -7.2 165.36 576 cm BI /W 234 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pp@w'??????????~x?8?????`~?~?~?~??~???~?~|?~|?~<8??~?<<?~?<?~~|ǀ???>?????~?8>|???????|?~|x?~8?| EI Q BT 0.9835 0 0 0.9835 165.36 568.8 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.7062 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 27.36 0 0 -9.36 209.76 576 cm BI /W 153 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????p?x?x????????~??> ???????????~?????????????px<@xx|?w| EI Q BT 1.4552 0 0 0.9835 209.76 568.8 Tm 3 Tr 0.0002 Tc 0 Tw (T~,\224) Tj 0 Tr ET BT 0.9835 0 0 0.9835 237.12 568.8 Tm /F5 10 Tf 0.0294 Tc 1.1292 Tw ( Journal of the) Tj -144.2251 -10.9816 TD -0.0036 Tc 0.5121 Tw (American Geriatrics Society ) Tj ET q 59.04 0 0 -8.64 212.16 565.2 cm BI /W 328 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <`x|>|0>?>????>??|||?>0??8x?|||xx~<<~?~?????????|~~?>>??~|>??>~???> ??>p?0?x??x?@x>8?8<<<|<x1|???~?<?x?>x` EI Q BT 0.9444 0 0 0.9835 212.16 558 Tm 3 Tr 0.0466 Tc 0 Tw (38\(2\):129-135,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 271.2 558 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj ET BT 0.8919 0 0 0.9835 95.52 545.04 Tm /F2 10 Tf -0.0023 Tc -0.0772 Tw (Davis, ) Tj ET BT 0.8915 0 0 0.9835 121.44 545.04 Tm /F4 10 Tf 0.0337 Tc 0.5006 Tw (T.K., Executive Director, ) Tj ET q 45.6 0 0 -7.2 229.44 552 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID w< p???|???>???>?>?x??8~?p ???~??~<??<?>?0?<x?~x?<x?|?|?>????~?? 8??80?x?<?<?<??~?~?|<x@ EI Q BT 0.8919 0 0 0.9835 229.44 545.04 Tm 3 Tr /F2 10 Tf 0.0047 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 51.1281 0 TD -0.0406 Tc 1.3112 Tw ( Asso-) Tj ET BT 0.9835 0 0 0.9835 96 534 Tm 0.0086 Tc 3.6721 Tw (ciation, Hampton Roads Chapter,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 33.36 0 0 -8.16 244.8 540.72 cm BI /W 186 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?~????????????~?~~~~~~~~~~~~~?~??~??>??x?~?|~?~~~?~x?~??p EI Q BT 1.0796 0 0 0.9835 244.8 534 Tm 3 Tr 0.0058 Tc 0 Tw (Norfo~) Tj 0 Tr ET BT 0.9835 0 0 0.9835 278.16 534 Tm 0.0444 Tc 1.8461 Tw ( VA,) Tj -185.2231 -11.2256 TD 0.0271 Tc 0.2774 Tw (personal communication, Oct. 31, 1990.) Tj ET q 35.04 0 0 -8.16 95.76 516.96 cm BI /W 195 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~> p<8?<??<??~??~?~??????   ???????~?|>????|?? EI Q BT 0.9835 0 0 0.9835 95.76 510.24 Tm 3 Tr 0.0485 Tc 0 Tw (Dawson,) Tj 0 Tr 35.6292 0 TD -0.0153 Tc 1.5814 Tw ( P., Kline, K.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 38.16 0 0 -8.16 193.44 516.96 cm BI /W 213 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ 8><<??|~???>????~??~?????~>?>?>?>~?>??????<?~~?>~?x?x?x|< <>>>8|??~?~~< EI Q BT 0.9835 0 0 0.9835 193.44 510.24 Tm 3 Tr 0.0225 Tc 0 Tw (Wiancko,) Tj 0 Tr 38.8017 0 TD -0.023 Tc 1.7926 Tw ( D., et al., \223Pre-) Tj -137.6361 -11.4697 TD -0.0023 Tc 2.9674 Tw (venting Excess Disability in Patients With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -6.96 282.72 505.92 cm BI /W 97 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>?? ??|?<<0<pxx?||88 EI Q BT 0.9388 0 0 0.9835 282.72 498.96 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.56 0 0 -7.2 96.24 495.36 cm BI /W 193 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?~???????|????~??p??p??????????????????~|~>?@>>??p?x <<<????>?|> EI Q BT 0.9835 0 0 0.9835 96.24 488.16 Tm 3 Tr 0.0165 Tc (heimer\222s) Tj 0 Tr 35.1411 0 TD 0.1907 Tc 3.4056 Tw ( Disease,\224) Tj 52.7117 0 TD /F5 10 Tf 0.0404 Tc 2.7043 Tw (Geriatric Nursing 7\(6\):298-) Tj ET BT 0.9444 0 0 0.9835 96.72 477.36 Tm 0.0714 Tc 0.9811 Tw (330, 1986.) Tj ET q 34.8 0 0 -8.16 96 471.36 cm BI /W 194 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>0  0 0?p????x???|?????>???<~??<~~?<???À?????????x|x>?|????8? EI Q BT 0.9388 0 0 0.9835 96 464.4 Tm 3 Tr /F2 10 Tf -0.0016 Tc 0 Tw (Dawson,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 130.8 464.4 Tm -0.0034 Tc 1.309 Tw ( P., and Reid, D.W., \223Behavioral) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.24 0 0 -6.96 270.24 471.36 cm BI /W 168 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x??????~??~?~?~?~?~?~?~?~?~?~?~?~?~?~?????? EI Q BT 0.8449 0 0 0.9835 270.24 464.4 Tm 3 Tr 0.0267 Tc 0 Tw (Dimens-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 97.2 453.6 Tm 0.0195 Tc 0.3724 Tw (ions of Patients at Risk of Wandering,\222 ) Tj ET q 43.44 0 0 -7.2 257.04 460.8 cm BI /W 242 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?x|~??~|~??|~~~~?~`|~|a~~>|?~>>??>?|>??|>~??~>>~??~>??~???~?~??~~~?~~?? ~|?|~|>??||~>??~??>?@ `??8 EI Q BT 0.9444 0 0 0.9835 257.04 453.6 Tm 3 Tr /F5 10 Tf 0.0013 Tc 0 Tw (Gerontolo-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 96.72 442.32 Tm -0.015 Tc -0.0458 Tw (gist ) Tj ET q 59.76 0 0 -8.64 113.52 449.28 cm BI /W 332 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |x|>???~??>??߀?????>?$7>?>?À?x>?ǟ?|<~??|~?~~>|~>|~|~?x>>?<>>????????|?~??~??~??~?~ ???ǀx|>{><??|x?>~~?8?<@ EI Q BT 0.9444 0 0 0.9835 113.52 442.32 Tm 3 Tr 0.0466 Tc 0 Tw (27\(1\):104-107,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 173.28 442.32 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj ET BT 0.9388 0 0 0.9835 97.2 429.6 Tm /F2 10 Tf 0.0234 Tc 0.7971 Tw (Day, P., and Klein, R.,) Tj 97.9104 -0.244 TD 0.0275 Tc 1.3039 Tw (\221\221The Regulation of Nursing) Tj ET BT 0.9835 0 0 0.9835 97.2 418.56 Tm 0.2485 Tc 2.8587 Tw (Homes: A Comparative Perspective,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 33.84 0 0 -7.2 267.36 425.76 cm BI /W 189 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <> x??|?p??|?x?|x?~|~p>?>p|~0>`?p>`>>?p?>>? ?|~???|?|~|~~?>?~>?>?>???????|?<~x~<~|߀>?>>>y??``??????0|x EI Q BT 0.9835 0 0 0.9835 267.36 418.56 Tm 3 Tr /F5 10 Tf 0.0121 Tc 0 Tw (Milbank) Tj 0 Tr -172.7772 -10.9816 TD 0.008 Tc -0.0691 Tw (Quarterly ) Tj ET q 59.28 0 0 -8.64 138.96 414.72 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|<x|>??>??>??>??<?>|>|>?>>?`?~| ?~>~?>~?|?? |?>???????????~?~???||?<|??~?~>>>>~>x<~>|>~>?~>?~8><?>8|?~<xx?~?|????>~?|?x 8 EI Q BT 0.9444 0 0 0.9835 138.96 407.76 Tm 3 Tr 0.0466 Tc 0 Tw (65\(3\):303-347,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 198.24 407.76 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -102.739 -13.422 TD /F2 10 Tf 0.0059 Tc 3.1543 Tw (Deaton, G., Executive Director, Oklahoma City) Tj 0.244 -10.9816 TD 0.0191 Tc -0.0804 Tw (Chapter of the ) Tj ET q 48.72 0 0 -7.2 156.24 390.96 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xdx???|???~~<>?~~~~??~~??~??~`?~?~~?~~?~~??~~?~~~?0 ?8xp?xxp?xx|x?|x<>>??>?<0>p8?x<<|p?~`` EI Q BT 0.9835 0 0 0.9835 156.24 383.76 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0138 Tc -0.075 Tw ( Association, remarks to) Tj -109.328 -10.9816 TD 0.0024 Tc 0.4856 Tw (the session on \223Special Care Units: To Regulate or) Tj 0 -11.2256 TD 0.0022 Tc -0.0633 Tw (Not,\224 ) Tj ET q 48.96 0 0 -7.2 121.92 368.88 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @>a??~??>????????<????p?????????|| < <>><?~>À<???<??|???p?x?8<??<?~~|~|~8~0 EI Q BT 0.9835 0 0 0.9835 121.92 361.92 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0163 Tc 0.8375 Tw ( Association Public Policy Con-) Tj -74.1868 -10.9816 TD 0.028 Tc 0.1058 Tw (ference, Washington, DC, March 23, 1992.) Tj ET BT 0.9388 0 0 0.9835 97.2 338.16 Tm 0.0267 Tc 0.5379 Tw (Diamond, E.L., ) Tj ET q 35.52 0 0 -8.88 160.08 345.12 cm BI /W 199 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx<8><|>`#8???`???~?~?~?|~?~?~x?~|?8?~????~????~??~?~?~?~??~??????~??~??~??~?~ϟ??~|>?>??>88|8 EI Q BT 0.9388 0 0 0.9835 160.08 338.16 Tm 3 Tr 0.0174 Tc 0 Tw (Jernigan,) Tj 0 Tr 37.8349 0 TD 0.0083 Tc 0.174 Tw ( J.A., ) Tj ET q 35.76 0 0 -9.12 218.4 344.88 cm BI /W 201 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x~<?>~>?>?????????<<~?|~?<~>?? ??~<?????? EI Q BT 0.9388 0 0 0.9835 218.4 338.16 Tm 3 Tr 0.0135 Tc 0 Tw (Moseley,) Tj 0 Tr 38.0905 0 TD 0.0046 Tc 0.3058 Tw ( R.A., et al.,) Tj ET BT 0.9835 0 0 0.9835 98.64 327.12 Tm 0.0125 Tc 1.4514 Tw (\223Decision-Making Ability and Advance Directive) Tj -0.7321 -11.2256 TD 0.033 Tc 1.8577 Tw (Preferences in Nursing Home Patients and Prox-) Tj 0.244 -11.7137 TD -0.0491 Tc -0.0111 Tw (ies,\224 ) Tj 21.4751 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.28 0 0 -8.88 180.72 311.76 cm BI /W 330 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8><||<>8?@?????~???|?>???~>>p~~>x0?~~?<~|?xp~?<<~?p?8?<?|?|~|~>~?~~||? ~~??~~?@~?~~`?~~?px>?x?x<?|<8?|?????|???<0~? 8 EI Q BT 0.9444 0 0 0.9835 180.72 304.56 Tm 3 Tr 0.0466 Tc 0 Tw (29\(5\):622-626,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 240 304.56 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -7.2 242.4 312 cm BI /W 115 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?~?~??????~?~~~~~~~~~>~~~~|~??~????? EI Q BT 0.8971 0 0 0.9835 242.4 304.56 Tm 3 Tr 0.0456 Tc 0 Tw (1989.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 97.68 292.08 Tm /F2 10 Tf -0.0022 Tc 1.0219 Tw (Dietch, J.T., Hewett, L.J., and Jones, S., \223Adverse) Tj 0.4881 -11.4697 TD -0.0078 Tc 3.8515 Tw (Effects of Reality Orientation,\224) Tj 0 Tc -0.061 Tw ( ) Tj 143.493 0 TD /F5 10 Tf 0.0294 Tc 3.4476 Tw (Journal of the) Tj -143.737 -10.9816 TD -0.0036 Tc -0.0574 Tw (American Geriatrics Society ) Tj ET q 64.08 0 0 -8.64 212.4 277.2 cm BI /W 357 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x|>x|?>?>?>??|~~?||>|~|x||~||~||~~<|?|~<~?|~<~~|?|~|~~<~~>|~~><?|~|?|~||~|~~~?~|>~?|?>~?|?~>|~>|>>x~?=~?@ ?<?<?x?||~~?|<??|??x<x <  EI Q BT 0.9444 0 0 0.9835 212.4 270 Tm 3 Tr 0.0488 Tc 0 Tw (37\(10\):974-976,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 276.48 270 Tm 0.0854 Tc -0.1478 Tw ( 1989.) Tj -181.5625 -13.422 TD /F2 10 Tf 0.0086 Tc 2.6146 Tw (Drinka, P.J., and Bobbe, M., \223Screaming in the) Tj 0.4881 -11.4697 TD 0.042 Tc 2.0926 Tw (Nursing Home,\224) Tj 72.4786 0.244 TD -0.0157 Tc 0.138 Tw (letter to the editor, ) Tj 77.1153 0 TD /F5 10 Tf 0.0294 Tc 0.3971 Tw (Journal of the) Tj -150.0819 -11.2256 TD -0.0036 Tc 0.5934 Tw (American Geriatrics Society ) Tj ET q 50.88 0 0 -8.88 215.04 241.92 cm BI /W 283 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<x|>???>??~|>~~?|?|??>???????0??|>?<??|??|????~??????|??|??>?????|?>~?>>|?x>|> <???>???>??>?>?>~?<|?~xx???<?? EI Q BT 0.9444 0 0 0.9835 215.04 234.72 Tm 3 Tr 0.05 Tc 0 Tw (38\(12\):1380,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 265.92 234.72 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj ET q 29.52 0 0 -8.16 98.16 228.24 cm BI /W 166 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx|q8???????<??~???????????~??>???~|?p EI Q BT 0.9388 0 0 0.9835 98.16 221.28 Tm 3 Tr /F2 10 Tf 0.0192 Tc 0 Tw (Dubler,) Tj 0 Tr 31.4438 0 TD 0.0066 Tc 0.2184 Tw ( N. N., ) Tj ET q 27.6 0 0 -9.12 156.24 228.48 cm BI /W 155 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~~~>8~?<?~~~~~~|?~|~~~~~~?~~~?~>~>~~?~~?~~~?x|<? EI Q BT 0.9835 0 0 0.9835 156.24 221.28 Tm 3 Tr 0.0342 Tc 0 Tw (\223hga.1) Tj 0 Tr ET BT 0.9388 0 0 0.9835 183.84 221.28 Tm 0.0024 Tc 1.024 Tw ( Issues in Research on Institu-) Tj ET BT 0.9835 0 0 0.9835 98.88 210.48 Tm -0.0132 Tc 4.101 Tw (tionalized Demented Patients,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 235.2 217.44 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<??????||8~c~c~>>>>x?>8???|~~|~??|~???~~>??~>>?~?~`?>?~?>x????|?????π|x|?À|~>?>>x?x?/p EI Q BT 0.8971 0 0 0.9835 235.2 210.48 Tm 3 Tr /F5 10 Tf 0.0473 Tc 0 Tw (AZzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 282.72 210.48 Tm 0.044 Tc 1.6025 Tw ( De-) Tj -186.9313 -11.2256 TD 0.2486 Tc 3.3468 Tw (mentia: Dilemmas in Clinical Research,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.56 0 0 -6.96 285.36 206.4 cm BI /W 92 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<?|~?~??x?<<>>? EI Q BT 0.8919 0 0 0.9835 285.36 199.44 Tm 3 Tr /F2 10 Tf -0.0109 Tc 0 Tw (V.L.) Tj 0 Tr ET q 35.28 0 0 -8.16 99.12 195.36 cm BI /W 196 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????~>?~??~??~?~??????>?x>?x>?<??<???~?~x?~<~??~?~??~??~~~~~~~~~~>????>> EI Q BT 0.9835 0 0 0.9835 99.12 188.4 Tm 3 Tr -0.0465 Tc (Melnic~) Tj 0 Tr 35.8732 0 TD 0.0647 Tc 2.8016 Tw ( and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -7.2 159.36 195.12 cm BI /W 104 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID a<~????????????|0 EI Q BT 0.9388 0 0 0.9835 159.36 188.4 Tm 3 Tr -0.0055 Tc 0 Tw (N.N.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 178.08 188.4 Tm 0 Tc -0.061 Tw ( ) Tj ET q 27.84 0 0 -7.2 181.2 195.6 cm BI /W 155 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8? ??????|??|~|~~~?~?~?~?????~?|?<?>??>??` EI Q BT 0.9835 0 0 0.9835 181.2 188.4 Tm 3 Tr 0.0464 Tc 0 Tw (Dubler) Tj 0 Tr 28.3081 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.88 212.16 195.6 cm BI /W 121 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>| ||<??>>>>>~?~?~|??|??~??~?~~~~~?~~?~??>>?|>>?<?|||??<?>80 EI Q BT 0.9388 0 0 0.9835 212.16 188.4 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 233.76 188.4 Tm 0.6701 Tc 3.4062 Tw ( \(Clifton, NJ;) Tj ET q 33.84 0 0 -7.2 99.12 184.32 cm BI /W 189 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p><~?????????~??~???????????????|??????????>?????????|<<? EI Q BT 0.9835 0 0 0.9835 99.12 177.12 Tm 3 Tr 0.0444 Tc 0 Tw (Humana) Tj 0 Tr 34.409 0 TD 0.0467 Tc -0.1085 Tw ( Press, 1985\).) Tj ET q 29.52 0 0 -8.16 99.12 171.12 cm BI /W 164 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @??????~?~?~~?p?~?8~~?8~?~~?~~?~~?~~?~~?~~?~~?~~_~?~?~?|???~?@???????Ä EI Q BT 0.9388 0 0 0.9835 99.12 164.16 Tm 3 Tr 0.0192 Tc 0 Tw (Dubler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 128.64 164.16 Tm 0.0022 Tc 0.9129 Tw ( N.N.,) Tj 30.0164 -0.244 TD -0.0151 Tc 1.7846 Tw (\223The Legal and Ethical Dilemma,\224) Tj -59.7887 -11.2256 TD /F5 10 Tf 0.5215 Tc -0.5913 Tw (Confronting ) Tj ET q 47.76 0 0 -7.2 158.4 159.84 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????????|??|<?s?1|~?~~x|~~<~~~~~~~~|>?~???~??????~|?~?>>?~??p>???x<|??|?~?~??~>>x??8><?>|?|??? EI Q BT 0.9835 0 0 0.9835 158.4 152.88 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD -0.0017 Tc 2.8692 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -7.2 250.56 159.84 cm BI /W 100 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????||<<???x0 EI Q BT 0.9388 0 0 0.9835 250.56 152.88 Tm 3 Tr /F2 10 Tf 0.0043 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 268.56 152.88 Tm 0 Tc -0.061 Tw ( ) Tj ET q 31.2 0 0 -8.64 271.2 159.84 cm BI /W 174 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx@|p????????8????||x|>||>>x EI Q BT 0.9835 0 0 0.9835 271.2 152.88 Tm 3 Tr -0.0291 Tc 0 Tw (Kalicki,) Tj 0 Tr -174.4855 -10.9816 TD 0.0361 Tc -0.0977 Tw (\(cd.\) ) Tj ET q 33.6 0 0 -8.88 121.2 149.04 cm BI /W 187 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<xx88x??8??8??>?|>>|?<>~?~8~??~8~??~8|??~8|?|?|???~?~?~???~?~??~??????~???x?~>??x?~>|?|??>|>~?~~??~>>`?|?> EI Q BT 0.9388 0 0 0.9835 121.2 142.08 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 154.8 142.08 Tm -0.0051 Tc 1.2864 Tw ( Mills, MD: Rynd Communications,) Tj -56.1282 -11.2256 TD 0.0233 Tc 3.3318 Tw (and Washington, DC: American Association of) Tj -0.244 -10.9816 TD 0.056 Tc 0.065 Tw (Homes for the Aging, 1987\).) Tj -0.244 -12.9339 TD -0.0088 Tc 1.4121 Tw (Eastwood, M.R.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 67.44 0 0 -8.88 170.64 114.48 cm BI /W 375 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x<<x<<|<x?~<x`{????????0????~?8??8~p<?<~8 ~<?>~~~8 ?>~?~~??~~~?~??~?~?~?|@?~`|?~|??|~>?~?>|~~?||~~?>?|?~?~_ |~>?? EI Q BT 0.9835 0 0 0.9835 170.64 107.52 Tm 3 Tr 0.0011 Tc 0 Tw (Lautenschlaeger,) Tj 0 Tr 68.574 0 TD 0.0206 Tc 0.8129 Tw ( E., and Corbin,) Tj -140.3205 -11.2256 TD 0.0167 Tc -0.0083 Tw (S., \223A Comparison of Clinical Methods for Assess-) Tj -0.244 -10.7376 TD 0.0054 Tc 2.8619 Tw (ing Dementia,\222) Tj 65.4016 0 TD /F5 10 Tf 0.0121 Tc -0.0123 Tw (Journal of the American Geriatrics) Tj -65.1575 -11.2256 TD -0.0143 Tc -0.0465 Tw (Society ) Tj ET q 47.76 0 0 -8.64 131.28 82.08 cm BI /W 266 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>?<?|||~|>?|?|>0~~x|<<|~|` ||~?~?~??>~|?~>0~>?|x~8|~<|?~||>~x>?x~<>?x~<<~~??|??~~???~?>?8 EI Q BT 0.9444 0 0 0.9835 131.28 74.88 Tm 3 Tr 0.057 Tc 0 Tw (31:342-347,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 179.04 74.88 Tm 0.0854 Tc 0.0962 Tw ( 1983.) Tj ET q 34.32 0 0 -8.16 99.6 69.12 cm BI /W 191 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<~?0??~@??????@?p???p???8??????????~p??p?????????||>p??p0???>????? EI Q BT 0.9835 0 0 0.9835 99.6 62.4 Tm 3 Tr /F2 10 Tf 0.0197 Tc 0 Tw (Edelson,) Tj 0 Tr 34.8971 0 TD 0.0192 Tc -0.0805 Tw ( J. S., and Lyons, W. H., ) Tj 100.5427 0 TD /F5 10 Tf 0.0073 Tc -0.0684 Tw (Institutional Care) Tj -134.9517 -10.9816 TD -0.0024 Tc 0.5515 Tw (of the Mentally Impaired Elderly \(New ) Tj 161.7956 0 TD /F2 10 Tf 0.0577 Tc 1.1005 Tw (York, NY:) Tj ET q 14.64 0 0 -6.96 100.08 47.52 cm BI /W 82 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?>>~?~?~?~?~|?~~?~??~?~?~?~?~?~x?~x<?~<~?~?<~?~?>?? EI Q BT 0.798 0 0 0.9835 100.08 40.56 Tm 3 Tr -0.0144 Tc 0 Tw (Vim) Tj 0 Tr ET BT 0.9835 0 0 0.9835 114.72 40.56 Tm 0.0384 Tc 0.1439 Tw ( Nostrand Reinhold Co., 1985\).) Tj ET BT 0.8499 0 0 0.9835 323.28 651.12 Tm /F5 10 Tf 0.2821 Tc 0 Tw (126.) Tj 0.5647 -35.8732 TD 0.2821 Tc (127.) Tj 0.2824 -46.1227 TD 0.2821 Tc (128.) Tj 0.8471 -57.1043 TD 0.2821 Tc (129.) Tj 0.8471 -68.33 TD 0.2821 Tc (130.) Tj 0.8471 -57.1043 TD 0.0703 Tc (131.) Tj 0.2824 -57.3484 TD 0.2821 Tc (132.) Tj 0.2824 -35.3852 TD 0.2821 Tc (133.) Tj 0.5647 -46.3668 TD 0.0703 Tc (134.) Tj ET BT 0.8027 0 0 0.9835 327.36 208.56 Tm 0.0804 Tc (135) Tj ET BT 0.8267 0 0 1.08 339.84 206.64 Tm /F5 4 Tf -0.0873 Tc (<) Tj ET BT 0.8499 0 0 0.9835 328.08 151.92 Tm /F5 10 Tf 0.0703 Tc (136.) Tj 0 -23.6715 TD 0.2821 Tc (137.) Tj 0.2824 -34.165 TD 0.0703 Tc (138.) Tj ET BT 0.9388 0 0 0.9835 345.6 650.88 Tm /F2 10 Tf 0.0349 Tc 0.0178 Tw (Edens, P., ) Tj ET BT 0.934 0 0 0.9835 385.92 650.88 Tm /F4 10 Tf 0.0026 Tc 0.0421 Tw (Chair, ) Tj ET BT 0.9388 0 0 0.9835 416.4 650.88 Tm /F2 10 Tf 0.0265 Tc 0.0268 Tw (Oregon ) Tj ET q 47.28 0 0 -7.2 447.6 658.08 cm BI /W 273 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p ?:|???????~<?~??p~??p~??0~?~?~?~???~??>?>8?8?~~<?~~~>?>>?{?>~?|>??<?|~~<??|x0 EI Q BT 0.9388 0 0 0.9835 447.6 650.88 Tm 3 Tr -0.0375 Tc 0 Tw (AIzheimer\222s) Tj 0 Tr 50.3613 0 TD 0.041 Tc 0.1392 Tw ( Public Policy) Tj ET BT 0.9835 0 0 0.9835 345.84 639.6 Tm -0.0154 Tc 0.4427 Tw (Committee, Beaverton, ) Tj 97.1262 0 TD /F4 10 Tf 0.0082 Tc -0.1055 Tw (OR, ) Tj 20.743 0 TD /F2 10 Tf 0.0289 Tc 1.8619 Tw (personal communica-) Tj -117.8692 -11.2256 TD 0.0473 Tc -0.1091 Tw (tion, Nov. 5, 1991.) Tj 0 -12.9339 TD -0.0042 Tc 1.1939 Tw (Eisdorfer, C., Cohen, D., Paveza, G.J., et al., \223An) Tj 0 -11.2256 TD 0.0066 Tc 2.0797 Tw (Empirical Evaluation of the Global Deterioration) Tj 0.244 -10.9816 TD 0.0177 Tc -0.0791 Tw (Scale for Staging ) Tj ET q 48.96 0 0 -7.2 416.4 601.2 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |??????????~???x??<???????p?????????@?|?|?<?><?|<?|???~?~>????>???????|???x?|?>?>??<~~~~||8~< EI Q BT 0.9835 0 0 0.9835 416.4 594 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0262 Tc -0.0344 Tw ( Disease,\224 ) Tj ET BT 0.9812 0 0 0.9812 507.36 594 Tm /F5 11 Tf 0.0014 Tc 0 Tw (American) Tj ET BT 0.9443 0 0 0.9812 345.84 582.96 Tm 0.0184 Tc 0.3636 Tw (Journal of Psychiatry ) Tj ET q 61.92 0 0 -8.64 440.64 589.92 cm BI /W 355 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||~><<?????????>???>????~?~??|~?|~? ~|?~~??x~~<~?~??'?????~??x~???|~???>~??>~???|?~????~?~????>?~??x?~??~????p?~?~???x??~?8???<~??>>~|~~x?????|?>?   p EI Q BT 0.8155 0 0 0.9812 440.64 582.96 Tm 3 Tr 0.0164 Tc 0 Tw (149\(2\):190-194,) Tj 0 Tr ET BT 0.9443 0 0 0.9812 502.56 582.96 Tm 0 Tc 0.0442 Tw ( ) Tj ET q 20.16 0 0 -7.2 504.96 589.68 cm BI /W 117 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~????|?>?????~????~???8 EI Q BT 0.7726 0 0 0.9812 504.96 582.96 Tm 3 Tr 0.0795 Tc 0 Tw (1992.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 345.84 570.24 Tm /F2 10 Tf -0.0095 Tc 2.3889 Tw (Esposito, B.J.,) Tj 65.6456 0.4881 TD 0.0129 Tc 3.3424 Tw (\223Support Services for Families,\224) Tj -65.1575 -11.4697 TD /F5 10 Tf 0.5215 Tc -0.5913 Tw (Confronting ) Tj ET q 47.76 0 0 -7.2 406.56 566.64 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 3????|?~|?~?s@~~ x<~~~~~~|???~???~???~?~??~???x???À?8<}?|?|?~?~ >???x?<@>>?~?~p EI Q BT 0.9835 0 0 0.9835 406.56 559.44 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD -0.0017 Tc 3.6013 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.24 0 0 -7.2 499.92 566.88 cm BI /W 102 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????>>>??><?< EI Q BT 0.9388 0 0 0.9835 499.92 559.44 Tm 3 Tr /F2 10 Tf 0.0043 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 518.16 559.44 Tm 0 Tc -0.061 Tw ( ) Tj ET q 29.04 0 0 -7.2 520.8 566.64 cm BI /W 162 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|????????x?<?<?π|>?~|?<?pjp  EI Q BT 0.9835 0 0 0.9835 520.8 559.44 Tm 3 Tr -0.0246 Tc 0 Tw (Kalicki) Tj 0 Tr ET q 17.76 0 0 -8.64 346.8 555.84 cm BI /W 99 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |>0 |x~???>~?~?~??0~|?|?|?????????????~?~?~~????>>||< EI Q BT 0.8449 0 0 0.9835 346.8 548.64 Tm 3 Tr 0.0405 Tc (\(wL\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 364.56 548.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 33.84 0 0 -9.36 366.96 555.84 cm BI /W 188 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<x<<|?<???<??>?>??~?>???<~??<~??~8~??~???|~???|??????????????~?x?~?x??~??|?~?~?<???~?>~???~???? ?>?? EI Q BT 0.9388 0 0 0.9835 366.96 548.64 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 400.8 548.64 Tm -0.0051 Tc 1.6524 Tw ( Mills, MD: Rynd Communications,) Tj -54.664 -10.9816 TD 0.0233 Tc 3.3806 Tw (and Washington, DC: American Association of) Tj -0.4881 -11.2256 TD 0.056 Tc 0.065 Tw (Homes for the Aging, 1987\).) Tj -0.244 -12.6899 TD 0.0131 Tc 1.8779 Tw (Evans, D.A.,) Tj 58.3245 0.244 TD -0.0002 Tc 2.3796 Tw (\223Estimating the Prevalence of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -6.96 533.28 521.52 cm BI /W 96 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~?????@?x|<>?p  EI Q BT 0.9388 0 0 0.9835 533.28 514.56 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.56 0 0 -7.2 346.8 510.48 cm BI /W 193 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xc?~???????????|??p???p??0???????????????? ?? ????|?~~?>>px>?>||>?8>???0 EI Q BT 0.9835 0 0 0.9835 346.8 503.28 Tm 3 Tr 0.0165 Tc (heimer\222s) Tj 0 Tr 35.1411 0 TD -0.0262 Tc 3.6261 Tw ( Disease,\224) Tj 47.831 0 TD 0.0324 Tc 1.0041 Tw (paper presented to the confer-) Tj -82.7281 -10.9816 TD 0.01 Tc 1.759 Tw (ence on \223Alzheimer\222s Disease: The Coming Epi-) Tj ET BT 0.9388 0 0 0.9835 347.04 481.68 Tm 0.028 Tc 1.346 Tw (demic,\224 sponsored by the Administration on Aging,) Tj ET BT 0.9835 0 0 0.9835 347.52 470.88 Tm 0.0188 Tc 1.7908 Tw (U.S. Department of Health and Human Services,) Tj 0.244 -10.9816 TD 0.0339 Tc 0.0876 Tw (Washington, DC, Sept. 13, 1991.) Tj 0 -12.9339 TD 0.0106 Tc 0.5208 Tw (Evans, D.A., statement to the conference on ) Tj ET q 23.28 0 0 -7.2 528.24 454.32 cm BI /W 130 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?????????????1>8<<????x<>??>? EI Q BT 0.9835 0 0 0.9835 528.24 447.36 Tm 3 Tr -0.003 Tc 0 Tw (\223Alz-) Tj 0 Tr ET q 34.56 0 0 -7.2 347.76 443.52 cm BI /W 192 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????~??>??>?~x??~8?~~?~p~~~~~?~~??~~?~~~??8?8??x?x?|????0|p~x~8~<~<>x?` EI Q BT 0.9835 0 0 0.9835 347.76 436.32 Tm 3 Tr 0.0165 Tc (heimer\222s) Tj 0 Tr 35.1411 0 TD 0.0113 Tc 1.8798 Tw ( Disease: The Coming Epidemic,\224 spon-) Tj ET BT 0.9388 0 0 0.9835 348 425.28 Tm 0.0258 Tc 1.0501 Tw (sored by the Administration on Aging, U.S. Depart-) Tj ET BT 0.9835 0 0 0.9835 347.76 414.72 Tm 0.0248 Tc 0.8085 Tw (ment of Health and Human Services, Washington,) Tj 0 -11.2256 TD 0.0328 Tc 0.1497 Tw (DC, Sept. 13, 1991.) Tj ET BT 0.9388 0 0 0.9835 347.76 391.2 Tm 0.0217 Tc 0.5112 Tw (Evans, D.A., Funkenstein, H.H., Albert, M. S., et al.,) Tj ET BT 0.9835 0 0 0.9835 348.48 380.16 Tm 0.0291 Tc 0.2754 Tw (\221\221Prevalence of ) Tj ET q 48.96 0 0 -7.2 413.28 387.12 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 1~???????~???>??>?????~@?p?~?0?~???x??????>?>?>?~?>?>?>? |x|>|@<>?>~><??|> EI Q BT 0.9388 0 0 0.9835 413.28 380.16 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 462.24 380.16 Tm 0.009 Tc 0.4789 Tw ( Disease in a Commu-) Tj -116.161 -11.2256 TD 0.0369 Tc 1.3656 Tw (nity Population of Older Persons,\222) Tj 0 Tc -0.061 Tw ( ) Tj 147.6416 0 TD /F5 10 Tf 0.0294 Tc 1.3733 Tw (Journal of the) Tj -147.8856 -10.9816 TD 0.0083 Tc 0.0932 Tw (American Medical Association ) Tj ET q 79.2 0 0 -8.64 472.56 365.28 cm BI /W 440 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>>|~> ?>?????~~?????>>?|?|?????>>?>p?????????????x??<x??|?>||?>?>>?>???????????????>????????~>?~~>>>?>?>>|?>?>||?|?|c>>0?O>~??>??????????p8  EI Q BT 0.9444 0 0 0.9835 472.56 358.32 Tm 3 Tr 0.0541 Tc 0 Tw (262\(18\):2551-2556,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 349.2 347.28 Tm 0.0456 Tc (1989.) Tj ET BT 0.9835 0 0 0.9835 347.76 334.8 Tm /F2 10 Tf 0.0031 Tc 0.1798 Tw (Evans, L.K.,) Tj ET BT 0.9388 0 0 0.9835 401.04 334.56 Tm 0.0425 Tc 2.3105 Tw (\221\221Sundown Syndrome in Institutional-) Tj ET BT 0.9835 0 0 0.9835 348.48 323.76 Tm 0.0016 Tc 0.4254 Tw (ized Elderly, \222) Tj 61.497 -0.244 TD /F5 10 Tf 0.0121 Tc 1.0248 Tw (Journal of the American Geriatrics) Tj ET q 28.56 0 0 -9.12 348.48 319.68 cm BI /W 159 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<8 <?>??>~??????????????~~p?80?p?~~ ??p~~?~?p~p?~|p~~?|p0~~?|x>?8?8<~|?>?>>>>~~~?><?p|< |~~~?> EI Q BT 0.8971 0 0 0.9835 348.48 312.48 Tm 3 Tr 0.0261 Tc 0 Tw (Socie@) Tj 0 Tr ET BT 0.9835 0 0 0.9835 377.04 312.48 Tm 0 Tc -0.061 Tw ( ) Tj ET q 59.52 0 0 -8.88 379.44 319.68 cm BI /W 331 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <||1??????>??~|~>??|?8>~~?~?|~> x~~?|~~?|~|?|x~?|<~~~?~~??~~???~?~?|~???~?~???|?~?~?~?~?~?|??~??~~?~???>?~??> ?~??p?~~?@x?~~?8?~~?<>~?~x><1?~||x???????x~~|<?<p EI Q BT 0.9444 0 0 0.9835 379.44 312.48 Tm 3 Tr 0.0466 Tc 0 Tw (35\(2\):101-108,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 438.96 312.48 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -92.2455 -12.6899 TD /F2 10 Tf 0.0163 Tc 0.4104 Tw (Evans, L.K., and ) Tj ET q 36.24 0 0 -9.12 419.28 306.96 cm BI /W 202 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?<?>????0?p`~???????????????~??|???|??>?~???~??~??~???~??~?~?~?~???????????????????x|x ~>?????` EI Q BT 0.9388 0 0 0.9835 419.28 300 Tm 3 Tr 0.0442 Tc 0 Tw (Strumph,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 455.52 300 Tm -0.0197 Tc 0.081 Tw ( N.E., ) Tj ET q 28.08 0 0 -9.36 481.44 306.96 cm BI /W 156 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~~~~~>???????`ppxxx||> EI Q BT 1.2205 0 0 0.9835 481.44 300 Tm 3 Tr -0.0063 Tc 0 Tw (\223~ing) Tj 0 Tr ET BT 0.9835 0 0 0.9835 509.52 300 Tm 0.059 Tc 0.6111 Tw ( Down the) Tj -163.7479 -11.2256 TD 0.0071 Tc 2.2326 Tw (Elderly: A Review of the Literature on Physical) Tj 0.4881 -11.2256 TD -0.0334 Tc 0 Tw (Restraint,\224) Tj 51.0034 0 TD /F5 10 Tf 0.0121 Tc 3.5872 Tw (Journal of the American Geriatrics) Tj -51.0034 -10.9816 TD -0.0143 Tc -0.0465 Tw (Society ) Tj ET q 49.2 0 0 -8.64 380.16 274.32 cm BI /W 274 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <8|>|>??>p?>????>>??>?|?|~???~??0~?|>?| ~|<>?~~>>?x~>>?x~?|?|??|??|???>?>|>|?~?>>?>>??>>?x>|?<>|?<>>??>|@|~>><>|x???x??<~?߀  EI Q BT 0.9444 0 0 0.9835 380.16 267.12 Tm 3 Tr 0.0409 Tc 0 Tw (37\(1\):65-74,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 429.36 267.12 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj -82.24 -12.9339 TD /F2 10 Tf -0.0212 Tc 1.8779 Tw (Everitt, D.E., Fields, D.R., Soumerai, S.S., et al.,) Tj 1.2202 -11.2256 TD 0.2439 Tc 3.0262 Tw (\223Resident Behavior and Staff Distress in the) Tj -0.244 -11.4697 TD 0.042 Tc 1.6045 Tw (Nursing Home,\224) Tj 72.2346 0 TD /F5 10 Tf 0.0211 Tc 1.1377 Tw (Journal of the American Geriat-) Tj -72.2346 -10.7376 TD -0.0202 Tc 0.0815 Tw (rics Society ) Tj ET q 59.28 0 0 -8.64 397.92 228.24 cm BI /W 330 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <8|<|0>???>????>?>?~>?x|????|>>x||??|~|>~|?>?w|>????????|?>??>?|? ?|???~??>???>?>?~|???||?~|?>>ǀ~?À~?>?~?>?~?|?|?x?~~>~???~???x<?<> EI Q BT 0.9444 0 0 0.9835 397.92 221.52 Tm 3 Tr 0.0466 Tc 0 Tw (39\(8\):792-798,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 457.2 221.52 Tm 0.0854 Tc 0.0962 Tw ( 1991.) Tj ET q 50.4 0 0 -8.16 349.44 215.76 cm BI /W 281 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<p???????????~>??|?xp~?~pq?~pqp?~p?1x??~`?8?~?|?x?????<?><?~?~?~??<?<|?~???|~|>???????x>??????>p EI Q BT 0.9388 0 0 0.9835 349.44 208.8 Tm 3 Tr /F2 10 Tf -0.0061 Tc 0 Tw (Fabiszewski,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 399.84 208.8 Tm 0.2293 Tc 2.6342 Tw ( K.J.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.44 0 0 -8.16 429.84 215.76 cm BI /W 175 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<>`????????x?>?8??||~~~~|~~x|~?||>??<~>>???" EI Q BT 0.9388 0 0 0.9835 429.84 208.8 Tm 3 Tr -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 461.28 208.8 Tm 0.2419 Tc 2.6214 Tw ( B., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.2 0 0 -8.64 504 216 cm BI /W 174 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x08<&???????????||<<~ ~~||?|??|?À<~|?>??~>?????? EI Q BT 0.9388 0 0 0.9835 504 208.8 Tm 3 Tr -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 535.2 208.8 Tm 0.1178 Tc 3.2356 Tw ( L.,) Tj -188.3955 -11.2256 TD 0.0138 Tc 2.894 Tw (\223Effect of Antibiotic Treatment on Outcome of) Tj -0.4881 -11.4697 TD 0.0029 Tc 3.7186 Tw (Fevers in Institutionalized) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42 0 0 -7.2 465.84 193.92 cm BI /W 234 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |0???????????~?~x?~~<??~~??~~??`~??~?~~??~~??~~?~~?x?~~|?~~|8?~?~<8?~~|?ǀ><??|??>???????~?8?x??????|~x8|08 EI Q BT 0.9835 0 0 0.9835 465.84 186.48 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.7062 0 TD -0.0318 Tc 4.3639 Tw ( Patients,\224) Tj -161.3076 -11.2256 TD /F5 10 Tf 0.0228 Tc 1.0546 Tw (Journal of the American Medical Association 263) Tj ET q 63.84 0 0 -8.88 349.92 171.6 cm BI /W 357 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <||>? <<?~0?>?|?>>?>|?>x~>>>~~~>>|~@|~|~<~~~~~~~?~~?|~|~??~?~~~???~~?~~??~||?~|||~|~|?~||>~||?~?~||?>πx~<>|~>>?x>~>0?|?~8?~?~8<?~~8<~?~<~9?????|~|?<<??|?? EI Q BT 0.9444 0 0 0.9835 349.92 164.4 Tm 3 Tr 0.0488 Tc 0 Tw (\(23\):3168-3172,) Tj 0 Tr 67.6001 0 TD 0.0723 Tc 0.726 Tw ( 1990.) Tj ET q 17.52 0 0 -8.16 349.2 159.12 cm BI /W 98 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|@|?????x~8< a7|x<<p?`x EI Q BT 0.9835 0 0 0.9835 349.2 151.92 Tm 3 Tr /F2 10 Tf -0.0511 Tc 0 Tw (Feil,) Tj 0 Tr 17.8146 0 TD -0.0083 Tc 0.1915 Tw ( N., ) Tj ET q 43.68 0 0 -7.2 384.72 158.88 cm BI /W 243 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|@>?~?????@?0?|~?|~?|?||?>|?>~>~?>~>~|?~??~~?>x?~?|><???~~?<??~~?x?~~~?<??????~???8?x|<?????cx EI Q BT 0.9835 0 0 0.9835 384.72 151.92 Tm 3 Tr /F5 10 Tf 0.0074 Tc 0 Tw (Vali&tion:) Tj 0 Tr 44.4145 0 TD 0.0406 Tc 0.2637 Tw ( The ) Tj ET q 16.32 0 0 -7.2 449.52 159.12 cm BI /W 91 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|~~?~~??|??~?~~?x??x??0????y EI Q BT 0.9835 0 0 0.9835 449.52 151.92 Tm 3 Tr -0.0642 Tc 0 Tw (Feil) Tj 0 Tr 16.5944 0 TD 0.0303 Tc 1.1284 Tw ( Method) Tj 0 Tc -0.061 Tw ( ) Tj 38.3136 0 TD /F2 10 Tf 0.2183 Tc 0 Tw (\(Cleveland,) Tj -156.1828 -11.2256 TD 0.0511 Tc -0.113 Tw (OH: Edward ) Tj ET q 15.36 0 0 -6.96 402.96 147.84 cm BI /W 86 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???|?~~0pp~?>??p?0>? EI Q BT 0.9835 0 0 0.9835 402.96 140.88 Tm 3 Tr 0.0406 Tc 0 Tw (Fed) Tj 0 Tr 15.6183 0 TD 0.0535 Tc 0.0066 Tw ( Productions, 1982\).) Tj -70.2823 -12.2018 TD -0.014 Tc 4.5899 Tw (Fitzgerald, P.,) Tj 68.0859 -0.244 TD 0.0024 Tc 4.2478 Tw (Senior Research Associate, The) Tj ET BT 0.9388 0 0 0.9835 350.16 117.84 Tm 0.0035 Tc 1.5851 Tw (Circle, Inc., McLean, VA, personal communication,) Tj ET BT 0.9835 0 0 0.9835 349.92 107.28 Tm 0.068 Tc -0.0082 Tw (June 16, 1991.) Tj ET BT 0.9388 0 0 0.9835 349.92 95.04 Tm 0.0356 Tc 0.7841 Tw (Foley, W. J.,) Tj ET BT 0.9835 0 0 0.9835 406.8 95.28 Tm 0.0398 Tc 3.8031 Tw (\223Dementia Among Nursing Home) Tj -57.5924 -11.2256 TD -0.0011 Tc 0.5746 Tw (Patients: Defining the Condition, Characteristics of) Tj 0.244 -10.9816 TD 0.2556 Tc 2.9213 Tw (the Demented, and Dementia on the RUG II) Tj 0.244 -10.9816 TD -0.0189 Tc 1.9105 Tw (Classification System,\224) Tj ET BT 0.9388 0 0 0.9835 447.36 62.88 Tm 0.0095 Tc 1.2379 Tw (contract report prepared for) Tj ET BT 0.9835 0 0 0.9835 350.64 51.84 Tm 0.0269 Tc 1.5385 Tw (the Office of Technology Assessment, U.S. Con-) Tj 0 -11.2256 TD 0.0332 Tc 0.0272 Tw (gress, Washington, DC, April 1986.) Tj ET endstream endobj 534 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 535 0 obj <>stream 0.72 w 1 j 0 0 0 RG 65.04 682.8 m 542.64 682.8 l S BT 0.9835 0 0 0.9835 65.52 688.32 Tm 0 0 0 rg /F5 10 Tf 0.0114 Tc 1.0081 Tw (183 . Special Care Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 238.32 695.28 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 80~>|??????<~~gx~~|>><>>?~?~|~~?~???~>|??~~??~p~??~8?~???<??????????~?~?>>>???? EI Q BT 0.9835 0 0 0.9835 238.32 688.32 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.3698 Tw ( and Other ) Tj ET q 42.48 0 0 -6.96 333.36 695.04 cm BI /W 237 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |pp@??x???x~|~<~?p|>?x????8??0~?~~?|~~~|>~~??>??|>~??>>???x >??|p??>p~?x~??x?~>~>???p? EI Q BT 0.9835 0 0 0.9835 333.36 688.32 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8449 0 0 0.9835 66.24 650.88 Tm /F2 10 Tf 0.3084 Tc (139.) Tj ET BT 0.8919 0 0 0.9835 66.48 616.8 Tm 0.0622 Tc (140.) Tj ET BT 0.8449 0 0 0.9835 66.96 583.44 Tm 0.3084 Tc (141.) Tj 0.284 -34.165 TD 0.3084 Tc (142.) Tj 0.284 -33.6769 TD 0.3084 Tc (143.) Tj 0.284 -33.921 TD 0.3084 Tc (144.) Tj 0.5681 -45.6347 TD 0.3084 Tc (145.) Tj 0.284 -44.9026 TD 0.3084 Tc (146.) Tj 0.5681 -45.1466 TD 0.3084 Tc (147.) Tj 0.284 -45.8787 TD 0.3084 Tc (148.) Tj 0.5681 -45.1466 TD 0.3084 Tc (149.) Tj 0.284 -67.1098 TD 0.3084 Tc (150.) Tj 0.5681 -56.1282 TD 0.3084 Tc (151.) Tj 0.5681 -67.1098 TD 0.0954 Tc (152.) Tj ET BT 0.2347 0 0 0.9835 87.84 650.88 Tm 0.112 Tc (1) Tj ET q 29.52 0 0 -8.64 89.28 657.84 cm BI /W 165 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?@p???~??????????|~??0?p?p???~?<?~~?>~?À?~??~?p?p0>x0 EI Q BT 0.9388 0 0 0.9835 89.28 650.88 Tm 3 Tr 0.0052 Tc (Folmar,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 118.8 650.88 Tm 0.0106 Tc 1.2529 Tw ( S., and Wilson, H., \223Social Behavior and) Tj -30.0164 -11.4697 TD -0.0172 Tc 1.9087 Tw (Physical Restraints,\224) Tj 87.6088 -0.244 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.04 0 0 -8.88 233.04 646.56 cm BI /W 329 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|p|>||><??????>???~~|>????|>π~|><8~>~>?~>|~|~|~x~|<~~~~??~??????|?|?|?|?|??|~?~?~>?~~~>?~?|`??~??>?x>>||?~>x8~?x?<???8  EI Q BT 0.9444 0 0 0.9835 233.04 639.36 Tm 3 Tr 0.0466 Tc 0 Tw (29\(5\):650-653,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 89.28 628.56 Tm 0.0456 Tc (1989.) Tj ET BT 0.9388 0 0 0.9835 89.28 616.8 Tm /F2 10 Tf 0 Tc 1.5888 Tw (Frank, B.W., Associate Director, National Citizens\222) Tj ET BT 0.9835 0 0 0.9835 89.28 605.76 Tm 0.0317 Tc 0.59 Tw (Coalition for Nursing Home Reform, Washington,) Tj 0 -10.9816 TD 0.025 Tc 0.2064 Tw (DC, personal communication, Sept. 23, 1991.) Tj 0 -11.7137 TD 0.0273 Tc 0.3993 Tw (French, D. H., Senior Director for Aging Services,) Tj ET q 33.84 0 0 -6.96 89.28 579.12 cm BI /W 188 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|??????|?<??~~|?|0|x~>>>>?~ |>?? EI Q BT 0.9835 0 0 0.9835 89.28 572.4 Tm 3 Tr 0.038 Tc 0 Tw (Buckner) Tj 0 Tr 34.409 0 TD -0.0084 Tc 3.5104 Tw ( Baptist Benevolence, Dallas, TX, per-) Tj -34.165 -11.4697 TD 0.0345 Tc 0.0869 Tw (sonal communication, Nov. 5, 1991.) Tj -0.244 -11.4697 TD -0.0102 Tc -0.0507 Tw (Fries, ) Tj ET q 19.44 0 0 -8.16 116.64 556.56 cm BI /W 109 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px8/?0<<||<?? EI Q BT 0.9388 0 0 0.9835 116.64 549.84 Tm 3 Tr 0.032 Tc 0 Tw (B.E.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 142.8 549.6 Tm 0.0182 Tc 3.581 Tw (\223Comparing Case-Mix Systems for) Tj -54.4199 -10.9816 TD 0.0334 Tc 1.0032 Tw (Nursing Home Payment,\224) Tj 0 Tc -0.061 Tw ( ) Tj 110.0601 0 TD /F5 10 Tf 0.0237 Tc 1.5011 Tw (Health Care Financing) Tj -110.0601 -10.9816 TD -0.0573 Tc -0.0028 Tw (Review ) Tj ET q 58.8 0 0 -8.64 120.48 535.2 cm BI /W 327 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<|<>|0"x?~???|??|?>|?>????x???~??~>??|>????????~????`???????????xp????<???<?????>?>?x?>?|?< ?>?|?>?|????>??||>?~??>~~??c~???>|>~?????x8x0`? EI Q BT 0.9444 0 0 0.9835 120.48 528 Tm 3 Tr 0.0466 Tc 0 Tw (11\(4\):103-119,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 179.28 528 Tm 0.0854 Tc 0.5843 Tw ( 1990.) Tj -91.5134 -11.4697 TD /F2 10 Tf -0.0102 Tc -0.0507 Tw (Fries, ) Tj ET q 19.92 0 0 -8.16 114.72 523.68 cm BI /W 111 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>8>|<~?~<~<p?x?<?8????~? EI Q BT 0.9835 0 0 0.9835 114.72 516.72 Tm 3 Tr -0.0561 Tc 0 Tw (B.E.,) Tj 0 Tr 20.255 0 TD -0.0174 Tc 1.6039 Tw ( Associate Research Scientist, Institute) Tj -45.6347 -11.2256 TD 0.039 Tc 4.4872 Tw (of Gerontology, University of Michigan, Ann) Tj 0 -10.9816 TD 0.0318 Tc 0.1913 Tw (Arbor, MI, personal communication, Feb. 6, 1992.) Tj -0.4881 -11.9577 TD -0.0102 Tc -0.0507 Tw (Fries, ) Tj ET q 19.92 0 0 -8.16 117.6 489.84 cm BI /W 111 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<<0xS?xpxx~~?|?? EI Q BT 0.9835 0 0 0.9835 117.6 483.12 Tm 3 Tr -0.0561 Tc 0 Tw (B.E.,) Tj 0 Tr 20.255 0 TD -0.0149 Tc 2.9872 Tw ( Mehr, D. R., Schneider, D., et al.,) Tj ET BT 0.9388 0 0 0.9835 90.48 472.32 Tm 0.0121 Tc 1.4482 Tw (\221\221Mental Dysfunction and Resource Use in Nursing) Tj ET BT 0.9835 0 0 0.9835 90 461.28 Tm 0.0242 Tc -0.0369 Tw (Homes,\224 draft, Institute of Gerontology, University) Tj 0 -11.4697 TD 0.0465 Tc 0.1358 Tw (of Michigan, Ann Arbor, MI, Nov. 6, 1991.) Tj 0 -11.9577 TD 0.0106 Tc 4.1256 Tw (Galasko, D., Corey-Bloom, J., and Thai,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.8 0 0 -8.64 276.48 445.2 cm BI /W 94 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|< ???80~~~~ EI Q BT 0.9388 0 0 0.9835 276.48 438.24 Tm 3 Tr 0.0259 Tc 0 Tw (L.J.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 90.72 427.44 Tm 0.0429 Tc 0.058 Tw (\221\221Monitoring Progression in ) Tj ET q 48.72 0 0 -7.2 205.2 434.4 cm BI /W 271 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????????????~x????x?|??x||x?8x EI Q BT 0.9835 0 0 0.9835 205.2 427.44 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0112 Tc 0.1944 Tw ( Disease,\222) Tj -166.6763 -11.2256 TD /F5 10 Tf 0.0071 Tc 1.3472 Tw (Journal of the American Geriatrics Society) Tj 0 Tc -0.061 Tw ( ) Tj ET q 23.04 0 0 -8.64 270.48 423.6 cm BI /W 129 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x|?~>?>??>>?~|?<|x|||?~|?~~~~_??????|~??|~?<~ ?>~>?>~>?~|~x??p??8~>??x<  EI Q BT 0.8971 0 0 0.9835 270.48 416.4 Tm 3 Tr -0.0205 Tc 0 Tw (39\(9\):) Tj 0 Tr ET BT 0.9444 0 0 0.9835 90.48 405.36 Tm 0.0658 Tc 2.0035 Tw (932-941, 1991.) Tj ET BT 0.9835 0 0 0.9835 90.24 394.08 Tm /F2 10 Tf -0.0036 Tc 3.4811 Tw (Gallo, J.J., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.64 0 0 -8.16 161.52 401.04 cm BI /W 182 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<|?8???????~8?<x?8? ?~~?~?~?~?????~?~|?~??||??><?>??~??8??~?~?? ?/~8 EI Q BT 0.9835 0 0 0.9835 161.52 394.08 Tm 3 Tr -0.0459 Tc 0 Tw (Reichel,) Tj 0 Tr 33.1888 0 TD 0.002 Tc 2.9142 Tw ( W., \223The Role of the) Tj -105.1794 -11.2256 TD -0.0038 Tc 2.3832 Tw (Physician in Dementia Care Units,\224) Tj 0 Tc -0.061 Tw ( ) Tj 157.647 0 TD /F5 10 Tf 0.2272 Tc 0 Tw (Specialized) Tj ET BT 0.9444 0 0 0.9835 90.72 372.24 Tm -0.0275 Tc 1.34 Tw (Dementia Care Units,) Tj 0 Tc 0.0402 Tw ( ) Tj ET q 18.48 0 0 -6.96 179.52 378.96 cm BI /W 104 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` <>???>??????????????????????????` EI Q BT 0.9388 0 0 0.9835 179.52 372.24 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) Tj 0 Tr 19.6843 0 TD 0.0096 Tc 1.323 Tw ( Coons \(cd.\) \(Baltimore,) Tj ET BT 0.9835 0 0 0.9835 90.72 360.96 Tm 0.0422 Tc 0.1401 Tw (MD: Johns Hopkins University Press, 1991\).) Tj 0 -11.7137 TD 0.0108 Tc 1.9209 Tw (Gamble, S., Assistant Deputy Director, Office of) Tj 0 -10.9816 TD 0.0334 Tc 0.6371 Tw (Long-Term Care, Arkansas Department of Human) Tj 0.4881 -11.2256 TD 0.0007 Tc 2.3786 Tw (Services, Little Rock, AR, personal communica-) Tj 0 -11.4697 TD 0.0388 Tc 0.2133 Tw (tions, Sept. 26, 1990, and Jan. 3, 1992.) Tj -0.4881 -11.7137 TD 0.0058 Tc 1.2579 Tw (Gang, R., and Ackerman, J. O., \223Pairing Rational) Tj 0.7321 -10.9816 TD 0.0063 Tc 0.8273 Tw (and Demented Patients in Long-Term Care Facili-) Tj 0 -11.2256 TD -0.0261 Tc 0.7464 Tw (ties,\224 letter to the editor, ) Tj 103.7151 0 TD /F5 10 Tf 0.0249 Tc 1.5406 Tw (Journal of the American) Tj -103.7151 -11.4697 TD -0.0138 Tc 0.197 Tw (Geriatrics Society ) Tj ET q 64.08 0 0 -8.64 166.08 278.88 cm BI /W 356 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID < ||>8?|???|?>?|>?~??<|>>>|??>?~`|??>||||<?~~|x<~~p||~x||?~<|?~|?~|?~|?~~??~>??|??>????~~>??|?~|?~|?8~>|<?`>?p>?|?|~>?|?|?>??????x?8? EI Q BT 0.9444 0 0 0.9835 166.08 271.68 Tm 3 Tr 0.0488 Tc 0 Tw (31\(10\):627-628,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 230.16 271.68 Tm 0.0854 Tc 0.0962 Tw ( 1983.) Tj -141.2966 -11.7137 TD /F2 10 Tf 0.0219 Tc 0.4657 Tw (Gardiner, J. A., and ) Tj ET q 26.88 0 0 -8.16 174.24 267.12 cm BI /W 150 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx||~??|??????????><?><>>>~~~??????x EI Q BT 0.9835 0 0 0.9835 174.24 260.16 Tm 3 Tr -0.0695 Tc 0 Tw (Malec,) Tj 0 Tr 27.332 0 TD 0.0029 Tc 0.6193 Tw ( K. L., Office of Social) Tj ET BT 0.9388 0 0 0.9835 91.92 249.12 Tm 0.0044 Tc 1.4564 Tw (Science Research, University of Illinois at Chicago,) Tj 0.2556 -10.9816 TD 0.0031 Tc 1.6495 Tw (\223Enforcementof Nursing Home Regulations: OBRA) Tj ET BT 0.9835 0 0 0.9835 91.68 227.76 Tm 0.0203 Tc 4.0669 Tw (Plus Two,\224) Tj 54.908 -0.4881 TD 0.0012 Tc 2.3293 Tw (report to the Special Committee on) Tj -54.908 -10.7376 TD 0.0159 Tc 3.2579 Tw (Aging, U.S. Senate, Washington, DC, Oct. 23,) Tj ET BT 0.8919 0 0 0.9835 92.64 205.92 Tm 0.0717 Tc 0 Tw (1989.) Tj ET BT 0.9835 0 0 0.9835 91.68 193.92 Tm 0.0032 Tc 2.437 Tw (Garrard, J., Makris, L., Dunham,T,etal.,\221\221Evalua-) Tj 0.4881 -10.9816 TD 0.0427 Tc 1.1157 Tw (tion of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 46.8 0 0 -9.36 123.36 190.32 cm BI /W 260 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???߀?|??>>???~?~?~p???~??~?~~?~~?~~?~~?~~?|~~??~~~??~~???>????>??|??? <0~>????8 EI Q BT 0.9835 0 0 0.9835 123.36 183.12 Tm 3 Tr 0.0097 Tc 0 Tw (Neuroleptic) Tj 0 Tr 47.587 0 TD 0.0693 Tc 2.0648 Tw ( Drug Use by Nursing Home) Tj -79.3116 -10.9816 TD 0.021 Tc 2.358 Tw (Elderly Under Proposed Medicare and Medicaid) Tj 0 -11.4697 TD -0.0066 Tc -0.0543 Tw (Regulations,\224 ) Tj 62.2291 0 TD /F5 10 Tf 0.0152 Tc 2.852 Tw (Journal of the American Medical) Tj -62.2291 -10.4935 TD 0.0144 Tc -0.0757 Tw (Association ) Tj ET q 64.8 0 0 -8.88 142.8 157.68 cm BI /W 360 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8xx<0p >| ?~~|?|>|ǀ|??|?||>|?x?~>||~>|>>|0?|>||?>~>??x?<??>?>?~~>|?>??|??|~x?||8??|<|?||x?|~?8?|><?|6?>xp|?0>x|x|x ?>><|~xp?~|~??|~~|߀?`|x~?| >x>~>|~~??>??|??xx>00 EI Q BT 0.9444 0 0 0.9835 142.8 150.72 Tm 3 Tr 0.0488 Tc 0 Tw (265\(4\):463-467,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 207.6 150.72 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.68 210 157.68 cm BI /W 117 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|~??~?l??~~~???~~~~~~???>|?p>~p @ EI Q BT 0.8971 0 0 0.9835 210 150.72 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 92.16 138.96 Tm /F2 10 Tf 0.0379 Tc -0.0995 Tw (George, ) Tj ET q 17.76 0 0 -6.96 126.72 145.68 cm BI /W 99 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<??|??p EI Q BT 0.9388 0 0 0.9835 126.72 138.96 Tm 3 Tr 0.0165 Tc 0 Tw (L.K.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 149.28 138.72 Tm 0.0067 Tc 1.3964 Tw (\223Services Research: Research Prob-) Tj -57.8364 -10.9816 TD -0.0088 Tc 0.1106 Tw (lems and Possibilities,\222 ) Tj ET q 47.52 0 0 -7.2 186.48 134.88 cm BI /W 264 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>??~x~~s~<>'>~>?~p8<|~|~|~?~>?~?~>?>~??|??~?~???x????~|?y??>??>?~~????|?~?~>>????? EI Q BT 0.8971 0 0 0.9835 186.48 127.92 Tm 3 Tr /F5 10 Tf 0.0473 Tc 0 Tw (AZzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 234 127.92 Tm 0.013 Tc 0.2918 Tw ( Disease Treat-) Tj ET BT 0.9444 0 0 0.9835 92.64 116.88 Tm -0.0227 Tc 0.7177 Tw (ment and Family Stress; Directions for Research, ) Tj ET BT 0.9388 0 0 0.9835 287.04 116.88 Tm /F2 10 Tf 0.0385 Tc 0 Tw (E.) Tj ET BT 0.9835 0 0 0.9835 92.4 106.32 Tm 0.2729 Tc 2.8339 Tw (Light and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -6.96 141.12 113.04 cm BI /W 101 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>~????????? EI Q BT 0.9388 0 0 0.9835 141.12 106.32 Tm 3 Tr 0.0043 Tc 0 Tw (B.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 159.12 106.32 Tm 0 Tc -0.061 Tw ( ) Tj ET q 36.96 0 0 -6.96 162 113.04 cm BI /W 206 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ ?p??>???|??08?~8?8??~?~?~?|?>???????????08??|?<???? EI Q BT 1.1266 0 0 0.9835 162 106.32 Tm 3 Tr -0.0404 Tc 0 Tw (hbowitz) Tj 0 Tr ET BT 0.9835 0 0 0.9835 198.96 106.32 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.64 201.84 113.52 cm BI /W 119 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @`x<>>|>~>~??|??|??||??~?~~?~~?~>??~???~???~??? ~???|?||?|<|<~~>?>???????^|<? EI Q BT 0.9388 0 0 0.9835 201.84 106.32 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 223.2 106.32 Tm 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.64 226.08 113.28 cm BI /W 245 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |x????<?|?~~?????|?~????~>?~>?~~~~????~?~?|~|~?~?~>~?~>??|p|?|? EI Q BT 0.9835 0 0 0.9835 226.08 106.32 Tm 3 Tr -0.0078 Tc 0 Tw (\(Rockville,) Tj 0 Tr 44.6585 0 TD 0.2888 Tc 2.8178 Tw ( MD:) Tj -180.3423 -11.2256 TD -0.0033 Tc 1.7726 Tw (National Institute of Mental Health, U.S. Depart-) Tj 0 -10.9816 TD 0.0318 Tc 0.1913 Tw (ment of Health and Human Services, 1989\).) Tj -0.244 -11.7137 TD 0.011 Tc 0.1718 Tw (George, L.K., and Gwyther, L.P., \223Caregiver Well-) Tj 0.4881 -10.9816 TD 0.0032 Tc 0.2285 Tw (Being: A Multidimensional Examination of Family) Tj 0.244 -10.9816 TD 0.0167 Tc 1.6302 Tw (Caregivers of Demented Adults,\224) Tj 0 Tc -0.061 Tw ( ) Tj 143.737 0 TD /F5 10 Tf 0.0226 Tc 0 Tw (Gerontologist) Tj ET q 59.28 0 0 -8.64 92.88 47.52 cm BI /W 331 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><|>>?????????>?|??~x~>~??>>??|??|>|>|x>x~<~>~>~~x~~|?~?>?~??~~~?>>?????||?~~~~~~~~~~@>8~x?<~pp|>~>|xx><?=>|????|?>????~?` EI Q BT 0.9444 0 0 0.9835 92.88 40.56 Tm 3 Tr 0.0466 Tc (26\(3\):253-259,) Tj 0 Tr 62.7715 0 TD 0.0723 Tc 0.726 Tw ( 1986.) Tj ET BT 0.8449 0 0 0.9835 316.8 650.4 Tm /F2 10 Tf 0.3084 Tc 0 Tw (153.) Tj 0.284 -34.409 TD 0.3084 Tc (154.) Tj 0.5681 -45.1466 TD 0.3084 Tc (155.) Tj 0.5681 -33.921 TD 0.0954 Tc (156.) Tj ET q 15.84 0 0 -6.96 318.24 501.36 cm BI /W 88 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??xx||||||||?>>?>?????>8<? EI Q BT 0.7041 0 0 0.9835 318.24 494.4 Tm 3 Tr 0.0578 Tc (15\2227.) Tj 0 Tr ET BT 0.8449 0 0 0.9835 318.48 460.8 Tm 0.0954 Tc (158.) Tj 0.284 -34.409 TD 0.0954 Tc (159.) Tj 0.284 -56.3722 TD 0.3084 Tc (160.) Tj 0.8521 -56.3722 TD 0.3084 Tc (161.) Tj 0.284 -56.6163 TD 0.3084 Tc (162.) Tj 0.5681 -44.9026 TD 0.0954 Tc (163.) Tj 0.284 -45.1466 TD 0.0954 Tc (164.) Tj 0.284 -33.921 TD 0.0954 Tc (165.) Tj 0.284 -55.6401 TD 0.0954 Tc (166.) Tj ET BT 0.9835 0 0 0.9835 338.4 650.4 Tm 0.026 Tc 0.8073 Tw (Gifford, S., Aging Program Specialist, Division of) Tj 0.4881 -11.2256 TD 0.021 Tc 2.5044 Tw (Aging, Department of Social Services, Jefferson) Tj 0.244 -11.4697 TD 0.0124 Tc 0.4144 Tw (City, MO, personal communication, Oct. 2, 1990.) Tj -0.244 -11.7137 TD 0.2806 Tc -0.3463 Tw (Gold, ) Tj ET q 19.2 0 0 -8.16 367.92 623.52 cm BI /W 107 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????>?? ? EI Q BT 0.9835 0 0 0.9835 367.92 616.56 Tm 3 Tr -0.0094 Tc 0 Tw (D.T,) Tj 0 Tr 19.5229 0 TD 0.2362 Tc 2.8713 Tw ( Sloane, P.D., Mathew,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -8.16 497.28 623.76 cm BI /W 97 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|< ??????~~?~8????????? EI Q BT 0.9835 0 0 0.9835 497.28 616.56 Tm 3 Tr -0.0366 Tc 0 Tw (L.J.,) Tj 0 Tr 17.5706 0 TD -0.0693 Tc 2.0838 Tw ( et al.,) Tj -177.6579 -10.9816 TD -0.015 Tc 1.0117 Tw (\223Special Care Units: A) Tj 0 Tc -0.061 Tw ( ) Tj ET q 37.2 0 0 -9.12 436.56 612.72 cm BI /W 207 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~?>>?????????~??>?~??~????????????????|???|???~????~??~?߀?~??~????~x??~|??????|?`?p??????? EI Q BT 1.2205 0 0 0.9835 436.56 605.76 Tm 3 Tr -0.0361 Tc 0 Tw (T~logy) Tj 0 Tr ET BT 0.9835 0 0 0.9835 473.76 605.76 Tm 0.0051 Tc 0.9099 Tw ( of Care Settings) Tj -136.904 -11.2256 TD 0.0421 Tc 1.6044 Tw (for Memory-Impaired Older) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.72 0 0 -8.16 458.88 601.68 cm BI /W 171 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0>|<C>~?~~?~?~??~?~??~?~?~>?~<?~<?~?~8<?~8>???? ?~` ??|??|?x0< EI Q BT 1.2205 0 0 0.9835 458.88 594.72 Tm 3 Tr -0.0238 Tc 0 Tw (kiults,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 489.6 594.72 Tm -0.0498 Tc -0.0104 Tw ( \224 ) Tj ET q 43.68 0 0 -7.2 498.96 601.68 cm BI /W 243 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x_|?~??~?~??~~~>? ??1?|?????~????~?>??????~????~???~?|?~?~???~| ??~~?~?~??~?~????????~?``>??8 EI Q BT 0.9444 0 0 0.9835 498.96 594.72 Tm 3 Tr /F5 10 Tf 0.0013 Tc 0 Tw (Gerontolo-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 339.12 583.68 Tm -0.015 Tc -0.0458 Tw (gist ) Tj ET q 59.28 0 0 -8.64 356.88 590.88 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<x<||>`?`>???????|x>?>?>>|~|~||~?|||p~~|~~|>~|??|??|?~??|>?>??|x|<|??~?~x>?<???|?@?>>x|??|x????|?>?`x[ EI Q BT 0.9444 0 0 0.9835 356.88 583.68 Tm 3 Tr 0.0466 Tc 0 Tw (31\(4\):467-475,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 416.16 583.68 Tm 0.0854 Tc 2.0485 Tw ( 1991.) Tj -78.3354 -11.9577 TD /F2 10 Tf 0.0024 Tc 2.3768 Tw (Goldman, A., Executive Assistant, Georgia State) Tj 0.7321 -10.9816 TD 0.0238 Tc 0.4842 Tw (Office on Aging, Atlanta, GA, personal ) Tj ET q 40.32 0 0 -7.2 502.56 568.32 cm BI /W 225 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????~x??<?<???|0?|~?~~?>???????????x EI Q BT 0.8449 0 0 0.9835 502.56 561.12 Tm 3 Tr 0.0478 Tc 0 Tw (communic-) Tj 0 Tr ET q 26.16 0 0 -8.16 339.84 556.8 cm BI /W 146 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>` ??????????>>x??<<?~??||~?|~?>??????<? EI Q BT 1.1266 0 0 0.9835 339.84 550.08 Tm 3 Tr -0.024 Tc (ation,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 366 550.08 Tm 0.0395 Tc 0.0615 Tw ( Mar. 17, 1988.) Tj -26.5999 -11.7137 TD 0.0012 Tc 3.8423 Tw (Goldstein, M.K., and Shadlen, M., \223Misuse of) Tj 0 -10.9816 TD 0.0173 Tc 0.3746 Tw (Durable Power of Attorney for Health Care,\224 letter) Tj 0 -11.4697 TD 0.0019 Tc 1.0352 Tw (to the editor,) Tj 0 Tc -0.061 Tw ( ) Tj 56.6163 0 TD /F5 10 Tf 0.0121 Tc 2.184 Tw (Journal of the American Geriatrics) Tj -56.6163 -10.9816 TD -0.0143 Tc -0.0465 Tw (Society ) Tj ET q 41.04 0 0 -8.88 370.8 512.88 cm BI /W 228 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <xxx<>x ?>??>|??|~?~||>?|?>?x||?||~|>|>~>?~??~~~~?~~~??~?~|||?>|>|`>|@p>>0~x><8|?x<x|????~???<? p EI Q BT 0.9444 0 0 0.9835 370.8 505.68 Tm 3 Tr 0.0439 Tc 0 Tw (39\(7\):730,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 411.84 505.68 Tm 0.0854 Tc 0.0962 Tw ( 1991.) Tj -73.2107 -11.7137 TD /F2 10 Tf 0.0152 Tc 1.0217 Tw (Goldstein-Smith, M., Quality Standards Coordina-) Tj 0.244 -11.2256 TD 0.0167 Tc 0.8982 Tw (tor, Manor Care Inc., Silver Spring, MD, personal) Tj 0.244 -10.9816 TD 0.0282 Tc 0.1543 Tw (communication, Feb. 5, 1991.) Tj ET BT 0.9388 0 0 0.9835 339.84 460.56 Tm 0.0366 Tc 0.6977 Tw (Goodman, G., \223Confronting ) Tj ET q 47.04 0 0 -7.2 451.92 467.76 cm BI /W 267 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `> og?<?|???x??p ??p??p??`???~?A??~???????????~?|??<@??<?~>|?8|?|?????? ?<0p>??~||??8> EI Q BT 0.9388 0 0 0.9835 451.92 460.56 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 50.1056 0 TD -0.033 Tc 0.0902 Tw ( at ) Tj ET q 33.12 0 0 -7.2 510.48 467.76 cm BI /W 189 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0@ `<>?>???????|??~??~~?~?~?~??~??ǀ~??ǀ~?~?~?~???~?~?>~?>??~?2~>?? EI Q BT 0.8919 0 0 0.9835 510.48 460.56 Tm 3 Tr 0.0341 Tc 0 Tw (Newton-) Tj 0 Tr ET BT 0.9388 0 0 0.9835 340.32 449.52 Tm -0.0011 Tc 2.1013 Tw (WellesleyNursing Home,\222) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 445.44 449.52 Tm /F5 10 Tf 0.0032 Tc 2.324 Tw (Nursing Home 35\(2\):30-) Tj -110.8032 -11.2256 TD 0.0703 Tc 0.474 Tw (34, 1986.) Tj ET BT 0.9835 0 0 0.9835 340.32 426.72 Tm /F2 10 Tf 0.0133 Tc -0.0339 Tw (Goodwin, M., Director, Geriatrics and Grants Man-) Tj 0.7321 -11.2256 TD 0.0092 Tc 1.2718 Tw (agement, Office of Geriatrics and Extended Care,) Tj -0.4881 -10.9816 TD 0.0209 Tc 0.845 Tw (Department of Veterans Affairs, Washington, DC,) Tj 0.244 -10.9816 TD 0.0345 Tc 0.0259 Tw (personal communications, Nov. 5,1990, and Jan. 3,) Tj ET BT 0.8919 0 0 0.9835 341.76 383.04 Tm 0.0717 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 340.8 371.28 Tm -0.002 Tc 1.2658 Tw (Greene, J.A., Asp, J., and Crane, N., \223Specialized) Tj 0.4881 -10.9816 TD 0.0111 Tc 2.3681 Tw (Management of the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 427.44 367.44 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x????>??>?x??<? ??????` ??`??????|??<? < ?<p??>x?~|?|??~?~<?|????<8?8???x?<?>?>? ?x~||?8p EI Q BT 0.9835 0 0 0.9835 427.44 360.48 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0235 Tc 1.9152 Tw ( Patient: Does it) Tj -137.3921 -11.2256 TD 0.0146 Tc 2.2831 Tw (Make a Difference? 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C., \223Progressively) Tj ET BT 0.9388 0 0 0.9835 95.28 515.52 Tm 0.0149 Tc 1.36 Tw (Lowered Stress Threshold: A Conceptual Model for) Tj ET BT 0.9835 0 0 0.9835 95.76 504.72 Tm 0.0166 Tc 2.3624 Tw (Care of Adults With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 188.16 511.68 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 33x???|????|???~?x?~?x?????~? 0< x<<~8?|x?8 EI Q BT 0.9835 0 0 0.9835 188.16 504.72 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0262 Tc 2.4059 Tw ( Disease,\224) Tj 0 Tc -0.061 Tw ( ) Tj 47.831 0 TD /F5 10 Tf 0.5163 Tc 0 Tw (Ar-) Tj -191.3239 -11.2256 TD -0.0024 Tc 0.3075 Tw (chives of Psychiatric Nursing ) Tj ET q 54 0 0 -8.64 216.24 500.64 cm BI /W 300 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||>x~????~~<>|||??<?>??>???~?~?~~~~~~~??~??~~~?~~>~>~x>~<?~<~~~~~~>???p?~x<||~?x???|??|>???À@ EI Q BT 0.9835 0 0 0.9835 216.24 493.68 Tm 3 Tr 0.0974 Tc 0 Tw (1\(6\):399405,) Tj 0 Tr 54.908 0 TD 0.0854 Tc 0.3402 Tw ( 1987.) Tj -177.902 -11.4697 TD /F2 10 Tf -0.0416 Tc -0.0187 Tw (Hall, ) Tj ET q 20.88 0 0 -8.16 117.84 489.12 cm BI /W 116 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID $=?????????????????? ??????????????????` EI Q BT 0.9835 0 0 0.9835 117.84 482.4 Tm 3 Tr -0.0342 Tc 0 Tw (G.R.,) Tj 0 Tr 21.2311 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 44.16 0 0 -9.12 141.12 489.36 cm BI /W 246 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?|xxx||<<@???????????|??????~?~~?~?~?~|?|~?|~?|?~|~~<0~0>x>p>|?>p?ǀ?~???~?~?~?|>p>?`??~~?0?~x EI Q BT 0.9835 0 0 0.9835 141.12 482.4 Tm 3 Tr 0.0143 Tc 0 Tw (Kirschling,) Tj 0 Tr 44.9026 0 TD 0.0126 Tc 0.9023 Tw ( M.V., and Todd, S., \223Shel-) Tj -91.0253 -11.4697 TD 0.0355 Tc 1.3671 Tw (tered Freedom\227An) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 180.48 478.08 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p;???????>??????>??>??x>?8?`~~?p ???~???~????|?<?<?<0?~88~~x?ǀ<<?<<?|???>??|~ x<<>?8?|~~?~~~<?~<8 EI Q BT 0.9835 0 0 0.9835 180.48 471.12 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0152 Tc 0.2285 Tw ( Unit in an ) Tj ET q 23.28 0 0 -8.16 275.28 477.84 cm BI /W 130 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<p??|p??????????`ppp808xx?x???????~?p`8 EI Q BT 0.9835 0 0 0.9835 275.28 471.12 Tm 3 Tr -0.0122 Tc 0 Tw (ICF,\224) Tj 0 Tr -182.5387 -10.9816 TD /F5 10 Tf 0.0038 Tc 0.1791 Tw (Geriatric Nursing ) Tj ET q 54.48 0 0 -8.64 169.92 467.28 cm BI /W 303 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<x8<>>|? `x|8|?|>>~>?|>??|>?`?>>p`?>?8?><??|x??????|?|?p>???????>?|>?<>?||?||?x|?|`>x??|>|??|x>>?~~?|??????>??80` EI Q BT 0.9444 0 0 0.9835 169.92 460.32 Tm 3 Tr 0.044 Tc 0 Tw (7\(3\):132-137,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 224.4 460.32 Tm 0.0854 Tc 0.0962 Tw ( 1986.) Tj -131.2912 -11.7137 TD /F2 10 Tf 0.0374 Tc 4.1105 Tw (Hammonds, G., Long-Term Care Ombudsman,) Tj 0.4881 -10.9816 TD 0.026 Tc 2.3528 Tw (Frankfort, KY, personal communication, May 5,) Tj ET BT 0.8919 0 0 0.9835 96.72 426.96 Tm 0.0717 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 95.52 415.2 Tm 0.0247 Tc 2.8423 Tw (Hanczaryk, D.P., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 29.52 0 0 -8.16 191.28 422.16 cm BI /W 165 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx~????3?~p~~p~~ ~?>?>?>@~~<~?|?||?|?~||||<<| |?? EI Q BT 0.9835 0 0 0.9835 191.28 415.2 Tm 3 Tr -0.0386 Tc 0 Tw (Batzka,) Tj 0 Tr 30.0164 0 TD 0.0216 Tc 3.5775 Tw ( D.L., \223Adventure) Tj -126.8985 -11.4697 TD 0.0076 Tc 2.4204 Tw (program,\224 Taylor Care Center, Jacksonville, FL,) Tj 0 -10.9816 TD 0.0499 Tc 0.0103 Tw (Feb. 1, 1986.) Tj -0.244 -11.7137 TD 0.0005 Tc 0.1012 Tw (Hansen, S. S., Patterson, M. A., and Wilson, R. W.,) Tj 1.2202 -11.2256 TD 0.0111 Tc 3.0188 Tw (\223Family Involvement on a Dementia Unit: The) Tj -0.4881 -10.9816 TD 0.0124 Tc 0.6097 Tw (Resident Enrichment and Activity Program,\224 ) Tj 187.4194 0 TD /F5 10 Tf 0.0361 Tc 0 Tw (Ger-) Tj -187.4194 -11.4697 TD 0.0234 Tc -0.0848 Tw (ontologist ) Tj ET q 59.28 0 0 -8.64 138.96 355.68 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><|x|> ?|??|????~??>???>?>~?~|||?~||?|||?||?|||x|>??~?~q?>?>>>|?~|?>??||???||???|? ??||???|~~|???|>~x???|>xx~<?~?~?~?~>p>px|x|p|>|??>?x>?~<~?|?8?@@ EI Q BT 0.9444 0 0 0.9835 138.96 348.48 Tm 3 Tr 0.0466 Tc 0 Tw (28\(4\):508-510,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 198.24 348.48 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj ET BT 0.9388 0 0 0.9835 96 337.2 Tm /F2 10 Tf 0.016 Tc 0.4641 Tw (Harper, M. S., and Lebowitz, B.D., ) Tj ET BT 0.9444 0 0 0.9835 234.48 337.2 Tm /F5 10 Tf 0.0009 Tc 0.8016 Tw (Mental Illness in) Tj ET BT 0.9835 0 0 0.9835 96.24 326.16 Tm 0.044 Tc 1.6025 Tw (Nursing Homes:) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.48 0 0 -9.36 167.52 333.36 cm BI /W 170 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?0`p|?|??~???~??>?0?O?|??|~?>?>|>??~~>?>~~??~??~?>~?~|~??>??>?~|?>~??~~~>>????? EI Q BT 0.8971 0 0 0.9835 167.52 326.16 Tm 3 Tr 0.0643 Tc 0 Tw (AgendQ) Tj 0 Tr ET BT 0.9835 0 0 0.9835 198 326.16 Tm 0.0131 Tc 0.5764 Tw ( for Research ) Tj ET q 43.44 0 0 -8.64 256.32 333.36 cm BI /W 242 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<x`>ps ????????><~?8~?|| |~ |~|~?~?~?|?~~~>><|?|||||||<|~?>|~~?>>`??<? EI Q BT 0.9388 0 0 0.9835 256.32 326.16 Tm 3 Tr /F2 10 Tf 0.0226 Tc 0 Tw (\(Rockville,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 96.48 315.36 Tm -0.0114 Tc 3.6517 Tw (MD; National Institute of Mental Health, U.S.) Tj 0 -11.4697 TD 0.0298 Tc 0.2747 Tw (Department of Health and Human Services, 1986\).) Tj -0.244 -11.9577 TD 0.0191 Tc -0.0804 Tw (Haycox, J.A.,) Tj ET BT 0.9388 0 0 0.9835 153.12 291.84 Tm -0.0019 Tc 1.4631 Tw (\221\221A Simple, Reliable, Clinical Behav-) Tj ET BT 0.9835 0 0 0.9835 96.96 281.52 Tm 0.0025 Tc 4.4754 Tw (ioral Scale for Assessing Demented Patients,\224) Tj -0.4881 -11.4697 TD /F5 10 Tf 0.0004 Tc 1.1587 Tw (Journal of Clinical Psychiatry) Tj 0 Tc -0.061 Tw ( ) Tj ET q 38.16 0 0 -8.16 222.96 277.2 cm BI /W 212 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~0?x?|~??@xx<<~>?||||x|~<x>||8>||<?p~>?x~ ?<~p?π|~8?<p<?<x>>???||0? EI Q BT 0.9444 0 0 0.9835 222.96 270.24 Tm 3 Tr 0.0518 Tc 0 Tw (45:23-24,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 261.12 270.24 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -6.96 263.52 277.2 cm BI /W 115 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ????x~??<???~?????~~~?~?? EI Q BT 0.8971 0 0 0.9835 263.52 270.24 Tm 3 Tr 0.0456 Tc 0 Tw (1984.) Tj 0 Tr ET BT 0.9388 0 0 0.9835 96.96 258.96 Tm /F2 10 Tf -0.01 Tc 1.2344 Tw (Hebrew Home for the Aged at Riverdale, \223Arrange-) Tj ET BT 0.9835 0 0 0.9835 96.96 248.16 Tm 0.0207 Tc 0.0399 Tw (ments for Cognitively Impaired Patients in Nursing) Tj 0 -11.4697 TD 0.0156 Tc 3.0955 Tw (Homes: Preliminary Results of a Survey of all) Tj 0 -10.9816 TD -0.015 Tc 2.6386 Tw (Facilities in Five Northeastern States, Riverdale,) Tj ET BT 0.9388 0 0 0.9835 96.96 215.28 Tm 0.0537 Tc 1.3272 Tw (NY, unpublished report, Nov. 14, 1990.) Tj ET BT 0.9835 0 0 0.9835 96.96 204 Tm 0.2537 Tc 3.0162 Tw (Hegeman, C., and Tobin, S., \223Enhancing the) Tj 0.244 -10.9816 TD 0.0401 Tc 2.5826 Tw (Autonomy of Mentally Impaired Nursing Home) Tj 0 -11.9577 TD -0.0201 Tc -0.0406 Tw (Residents,\224 ) Tj 50.0273 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 92.16 0 0 -9.36 205.92 188.64 cm BI /W 512 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p||xx < <>?~????|~x?>~?>|?~>8|???~?????>?>>?>?>?>?>?>?>?>??~>?>??x>??????<~????~????x??~??|??|~?>|???~?>>?>?>>?>???>|>???>?~|>?>??~|????||?|?|>?>|??>?~`x???|~??|`~ ??>~??>p~<??>x>>x?|>?|?~~|<|x??`x0? EI Q BT 0.9444 0 0 0.9835 205.92 181.44 Tm 3 Tr 0.0522 Tc 0 Tw (28\(Suppl.\):71-75,1988.) Tj 0 Tr ET q 33.84 0 0 -8.16 97.2 177.6 cm BI /W 191 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<> ?????|?~?<?~?~~?>?>~?>~?>??????????0??~~?~>??>???8?c EI Q BT 0.9388 0 0 0.9835 97.2 170.64 Tm 3 Tr /F2 10 Tf 0.004 Tc (Helmon,) Tj 0 Tr 36.0454 0 TD 0.0379 Tc 1.1906 Tw ( F., Nursing Consultation Advisor, Nursing) Tj ET BT 0.9835 0 0 0.9835 97.44 159.6 Tm 0.0116 Tc 1.5134 Tw (Home Services, Department of Social and Health) Tj 0.4881 -11.2256 TD 0.0132 Tc 1.0847 Tw (Services, Olympia, WA, personal communication,) Tj -0.4881 -10.9816 TD 0.0465 Tc 0.0137 Tw (Jan. 3, 1992.) Tj -0.244 -11.2256 TD -0.0288 Tc 2.8967 Tw (Helms, P.M.,) Tj 61.0089 -0.4881 TD 0.0144 Tc 2.4257 Tw (\223Efficacy of Antipsychotics in the) Tj -60.5208 -10.4935 TD 0.0061 Tc 4.5694 Tw (Treatment of the Behavioral Complications of) Tj 0 -11.2256 TD -0.0077 Tc 0.5976 Tw (Dementia: A Review of the Literature,\224 ) Tj ET q 31.68 0 0 -7.2 260.64 111.6 cm BI /W 176 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~x>~?>???~|?~???8|?>8??|?||~~>??|>|~>~>???~? ?||~|~>>>?? EI Q BT 0.8971 0 0 0.9835 260.64 104.88 Tm 3 Tr /F5 10 Tf 0.0861 Tc 0 Tw (JournaZ) Tj 0 Tr ET BT 0.9835 0 0 0.9835 292.32 104.88 Tm 0.0124 Tc 0.1704 Tw ( of) Tj -197.6689 -11.2256 TD -0.0041 Tc 3.8477 Tw (the American Geriatrics Society) Tj 0 Tc -0.061 Tw ( ) Tj ET q 59.04 0 0 -8.64 241.92 101.04 cm BI /W 328 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `<px8x|@??>???>??>?|>>??>?0<|~?>||>>~|||xp|~||<|>~||??|??~???~??~???~|???<??x??|??<>>?>????|??8x|???<~?~?>>????|??|>~`0|<|~p8|||~p<x~|??>>???~x?<??   EI Q BT 0.9444 0 0 0.9835 241.92 93.84 Tm 3 Tr 0.0466 Tc 0 Tw (33\(3\):206-209,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 98.64 82.8 Tm 0.0456 Tc (1985.) Tj ET BT 0.9835 0 0 0.9835 97.2 72 Tm /F2 10 Tf 0.0485 Tc 4.0382 Tw (Hepburn, K.,) Tj 64.4254 -0.7321 TD 0.2063 Tc 2.9017 Tw (Severance, J., Gates, B., et al.,) Tj -63.4493 -10.7376 TD -0.0104 Tc 1.3324 Tw (\223Institutional Care of Dementia Patients: A State-) Tj -0.7321 -10.9816 TD 0.0187 Tc 2.889 Tw (Wide Survey of Long-Term Care Facilities and) Tj 0.4881 -11.2256 TD -0.0174 Tc 3.6172 Tw (Special Care Units,) Tj 0 Tc -0.061 Tw ( ) Tj 90.5372 0 TD /F5 10 Tf 0.2567 Tc 2.7691 Tw (American Journal of Alz-) Tj ET BT 0.8449 0 0 0.9835 323.28 625.68 Tm /F2 10 Tf 0.0954 Tc 0 Tw (182.) Tj 0.284 -57.8364 TD 0.3084 Tc (183.) Tj ET q 15.6 0 0 -7.2 324 530.64 cm BI /W 87 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<|~~~~?~~~||8||~||~||||?|~~>>~~||~~~~~x~?x~?<~?~~~~|~||>>~p> EI Q BT 0.8449 0 0 0.9835 324 523.44 Tm 3 Tr 0.0954 Tc (184.) Tj 0 Tr 0.284 -56.8603 TD 0.3084 Tc (185.) Tj 0.5681 -57.5924 TD 0.3084 Tc (186.) Tj 0 -34.8971 TD 0.3084 Tc (187.) Tj 0.5681 -23.6715 TD 0.0954 Tc (188.) Tj 0.284 -34.8971 TD 0.0954 Tc (189.) Tj 0 -46.3668 TD 0.0954 Tc (190.) Tj 0.284 -34.6531 TD 0.3084 Tc (191.) Tj 0.5681 -56.6163 TD 0.3084 Tc (192.) Tj 0.284 -56.8603 TD 0.0954 Tc (193.) Tj 0.284 -45.1466 TD 0.0954 Tc (194.) Tj -0.284 -34.8971 TD 0.0954 Tc (195.) Tj ET q 33.84 0 0 -7.2 344.88 655.92 cm BI /W 191 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|Xx||~~~|~> ~? ????|||~|~|>?~~>x?>>|><~>|?~ |~>~|~~|<~~?>>> ||| EI Q BT 0.9444 0 0 0.9835 344.88 648.72 Tm 3 Tr /F5 10 Tf -0.0555 Tc (heimer\222s) Tj 0 Tr 35.8331 0 TD -0.0154 Tc 1.2001 Tw ( Care and Related Disorders and Research) Tj ET q 44.4 0 0 -8.64 344.88 644.88 cm BI /W 248 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8xpx<>>|<??x>|~?|>???|>?>??~?<~x>>p8x~|?~>>??>??||>~x~><||~|>>|?|>?|p?|xg~~~~~~??|?x?x8<px~x EI Q BT 0.9444 0 0 0.9835 344.88 637.92 Tm 3 Tr 0.0374 Tc 0 Tw (4\(2\):19-23,) Tj 0 Tr 47.0151 0 TD 0.0723 Tc 0.726 Tw ( 1989.) Tj ET q 21.84 0 0 -8.64 344.64 632.88 cm BI /W 122 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <??????8?~>?~?~?~?~~?~??~?~?~?~?~?~?~<?~~?~~?~>?~>???~>?0 EI Q BT 0.9835 0 0 0.9835 344.64 625.68 Tm 3 Tr /F2 10 Tf -0.0509 Tc 0 Tw (Hiatt,) Tj 0 Tr 22.2072 0 TD 0.0248 Tc -0.0166 Tw ( L. G., \223Interventions With People Who Wan-) Tj -21.4751 -11.7137 TD 0.0032 Tc 0.4645 Tw (der: Contradictions in Practice,\224 paper presented at) Tj 0.244 -10.9816 TD 0.0185 Tc 1.1403 Tw (the 38th Annual Scientific Meeting of the Geron-) Tj 0 -11.2256 TD 0.0052 Tc 2.0486 Tw (tological Society of America, New Orleans, LA,) Tj ET BT 0.8919 0 0 0.9835 346.08 581.52 Tm 0.0717 Tc 0 Tw (1985.) Tj ET q 20.64 0 0 -8.16 345.6 576 cm BI /W 119 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @x<<~|~x~#?~@~?~??~??~??~??~??~~??~?~?~?~?~??~?~?Ǚ~>>~?>?xx8p0<||a | EI Q BT 0.8919 0 0 0.9835 345.6 568.8 Tm 3 Tr -0.0299 Tc (Hiatt,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 366.24 568.8 Tm 0.0242 Tc 0.0292 Tw ( L. G.,) Tj ET BT 0.9835 0 0 0.9835 395.76 568.8 Tm 0.0132 Tc 1.7965 Tw (\223Environmental Design and Mentally) Tj -51.0034 -10.9816 TD 0.0183 Tc 1.5066 Tw (Impaired Older People,\224) Tj ET q 47.76 0 0 -7.2 448.8 564.96 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `<p?>????????|?>8~q?3>>?~>~?8??~~~~~>|~>???|~>?~?~>????>?????>x??>?????||~~?>x?>x>|?|~??|8 EI Q BT 0.9835 0 0 0.9835 448.8 558 Tm 3 Tr /F5 10 Tf 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0413 Tc 0.8731 Tw ( Disease and) Tj -153.2544 -11.2256 TD 0.0106 Tc 1.4535 Tw (Dementia: Problems, Prospects and Perspectives,) Tj ET q 15.12 0 0 -7.2 345.84 542.88 cm BI /W 85 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~? ??~ EI Q BT 0.9388 0 0 0.9835 345.84 535.92 Tm 3 Tr /F2 10 Tf -0.0034 Tc 0 Tw (H.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 360.96 535.92 Tm 0.0415 Tc 0.2454 Tw ( Altman \(cd.\) \(New York, NY: Plenum, 1986\).) Tj -15.3742 -12.6899 TD -0.0367 Tc 1.4405 Tw (Hiatt, L.G.,) Tj 52.4677 0 TD 0.0348 Tc 2.0389 Tw (\223Supportive Design for People With) Tj -52.4677 -10.9816 TD 0.0139 Tc 4.3175 Tw (Memory Impairments,\224) Tj ET q 48.24 0 0 -8.88 449.04 519.84 cm BI /W 269 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >> >>>>>? ?x>?x????|??~>?~p?~>~?0~0?~??>|?|?~|?|?~~??~??~??x~???~?~~?>??~?????|?~???????? ``|?|>0x??x?p EI Q BT 0.9835 0 0 0.9835 449.04 512.64 Tm 3 Tr /F5 10 Tf 0.0392 Tc 0 Tw (Con.onting) Tj 0 Tr 49.0512 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 47.76 0 0 -7.2 502.08 519.6 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 00>~????????|~??~?sa?~~x?~?#~~8~?<~|~~?~~?~|?~???~??>??~?8??>?<?>??|???|???~~`>?>?x`||~?p@x EI Q BT 0.9835 0 0 0.9835 502.08 512.64 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr -158.8672 -10.9816 TD 0.4863 Tc -0.5555 Tw (Disease, ) Tj 43.6824 0 TD /F2 10 Tf 0.018 Tc -0.0793 Tw (A. ) Tj ET q 29.28 0 0 -7.2 402.96 509.04 cm BI /W 163 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>|???<~~~ ~~~?~~|~|~?x~|~|~~x~>~>~~??|>?`<|?~| EI Q BT 0.9835 0 0 0.9835 402.96 501.84 Tm 3 Tr -0.0246 Tc 0 Tw (Kalicki) Tj 0 Tr 29.7723 0 TD 0.0361 Tc 2.0986 Tw ( \(cd.\)) Tj 0 Tc -0.061 Tw ( ) Tj ET q 33.6 0 0 -9.36 460.08 509.04 cm BI /W 187 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x8<|? `@px??>?>??~>???|~?x~?x?|p?p?`????ǀ??À???????????????~??~~??|??~|~??>~??>? ??< EI Q BT 0.9388 0 0 0.9835 460.08 501.84 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 493.68 501.84 Tm 0.1548 Tc 3.3201 Tw ( Mills, MD:) Tj -150.326 -10.9816 TD 0.2509 Tc 2.8075 Tw (National Health Publishing and the American) Tj 0.4881 -11.2256 TD 0.0442 Tc 0.1787 Tw (Association of Homes for the Aging, 1987\).) Tj -0.4881 -12.6899 TD -0.0367 Tc 0.2203 Tw (Hiatt, L. G.,) Tj 54.4199 -0.244 TD 0.0003 Tc 4.0873 Tw (\223Designing Specialized Institutional) Tj -54.1759 -10.7376 TD 0.0225 Tc 0.209 Tw (Environments for People With Dementia,\222 ) Tj 174.7295 0 TD /F5 10 Tf 0.0502 Tc 0 Tw (Demen-) Tj -174.2415 -11.4697 TD 0.0197 Tc 0.4883 Tw (tia Units in Long Term Care, ) Tj ET q 17.04 0 0 -7.2 468 452.4 cm BI /W 95 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 89|??????|?8?????????????????????????????? EI Q BT 0.9388 0 0 0.9835 468 445.44 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 485.04 445.44 Tm 0.0323 Tc 0.2315 Tw ( Sloane and ) Tj ET q 14.16 0 0 -7.2 535.2 452.4 cm BI /W 79 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08?|?|x~~~ EI Q BT 0.9388 0 0 0.9835 535.2 445.44 Tm 3 Tr 0.0187 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 346.32 434.4 Tm -0.0146 Tc -0.0462 Tw (Mathew ) Tj ET q 21.36 0 0 -8.64 384.72 441.6 cm BI /W 119 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|8>8<<>>>>?<?|~??||????||~??||~?||?~|?~|??~|??~|??~??~??~??? ~?? ||>?||||||~>?>?????<|< EI Q BT 0.9388 0 0 0.9835 384.72 434.4 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 406.08 434.4 Tm 0.0216 Tc 3.5776 Tw ( \(Baltimore, MD: Johns Hopkins) Tj -60.7649 -11.2256 TD 0.0354 Tc -0.097 Tw (University Press, 1991\).) Tj ET q 21.6 0 0 -8.64 346.08 418.32 cm BI /W 123 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????????????????????????????? x? EI Q BT 0.9388 0 0 0.9835 346.08 410.88 Tm 3 Tr -0.0027 Tc 0 Tw (Hiatt,) Tj 0 Tr 23.0077 0 TD 0.0242 Tc 0.0292 Tw ( L. G., ) Tj ET BT 0.9444 0 0 0.9835 394.56 410.88 Tm /F5 10 Tf -0.0079 Tc 1.3192 Tw (Nursing Home Renovation Designed) Tj ET BT 0.9835 0 0 0.9835 537.12 410.64 Tm 0.6632 Tc 0 Tw (for) Tj -194.0083 -11.2256 TD 0.012 Tc -0.0732 Tw (Reform ) Tj ET q 44.64 0 0 -8.64 378.72 406.8 cm BI /W 249 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|>@|0??????????????~???~~~?>?~8~~<??8~|<??~|8??~|8??~|0??~|??~???~??~?~?~|?~|??~|?||~>?<?~?~?>~?|@0~0<p~~~~x<>? EI Q BT 0.9388 0 0 0.9835 378.72 399.6 Tm 3 Tr /F2 10 Tf 0.016 Tc 0 Tw (\(Stoneham,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 423.36 399.6 Tm 0.0145 Tc 1.9986 Tw ( MA: Butterworth-Heinemann,) Tj ET BT 0.8919 0 0 0.9835 347.52 388.8 Tm 0.0426 Tc 0 Tw (1991\).) Tj ET BT 0.9388 0 0 0.9835 346.32 376.56 Tm 0.0328 Tc 3.8547 Tw (Hillhaven Corporation,) Tj ET BT 0.9835 0 0 0.9835 441.12 376.08 Tm -0.021 Tc 0.6924 Tw (\223Special Care Unit Policies) Tj ET BT 0.9388 0 0 0.9835 347.28 365.52 Tm 0.0229 Tc 1.3599 Tw (and Procedures Manual, Takoma, WA, 1988.) Tj ET BT 0.9835 0 0 0.9835 346.56 353.04 Tm 0.0017 Tc -0.0628 Tw (Hindlian, N. S.,) Tj 69.0621 -0.244 TD 0.0114 Tc 3.3438 Tw (\223Case Histories of Wandering,\224) Tj -69.3061 -10.7376 TD /F5 10 Tf 0.0307 Tc -0.0109 Tw (American Journal of ) Tj ET q 47.52 0 0 -7.2 431.04 349.2 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><???||~<>g~|~>C~~?>x?>8??~~~~?????~?|?>?À|p~???~|???>?>>?߀???~~~>??x??x?|>~~???~??< EI Q BT 0.9835 0 0 0.9835 431.04 342.24 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0217 Tc -0.0831 Tw ( Care and Related) Tj -133.9756 -11.2256 TD 0.0358 Tc 0.1466 Tw (Disorders and Research ) Tj ET q 44.64 0 0 -8.64 446.64 338.4 cm BI /W 249 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88x<`x<>??~|||~~?>>|>?~>?|~|8?>?>?~>>?>????????????|??~?????|?|x~|<?~x0>?~??|~|~| ~|?|?~|??>?~|?|?>?~??>|>xp 0, EI Q BT 0.9444 0 0 0.9835 446.64 331.2 Tm 3 Tr 0.0374 Tc 0 Tw (3\(1\):38-39,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 491.28 331.2 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj ET q 21.84 0 0 -9.36 346.8 325.92 cm BI /W 122 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?????~???~~~|~?? ??? EI Q BT 0.9444 0 0 0.9835 346.8 318.72 Tm 3 Tr 0.0215 Tc 0 Tw (Hing,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 368.64 318.72 Tm /F2 10 Tf -0.0147 Tc 4.1025 Tw ( E., Statistician, Division of Health Care) Tj -21.4751 -11.4697 TD -0.0234 Tc 3.6233 Tw (Statistics, National Center for Health Statistics,) Tj ET q 45.36 0 0 -9.36 347.52 303.6 cm BI /W 252 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID Axx<|@< 0<x??<x_>x?~???|?<?? ~? ~?????????px??x@??x?~<><>>???????08?p????`????0@ EI Q BT 0.9835 0 0 0.9835 347.52 296.64 Tm 3 Tr -0.0244 Tc 0 Tw (Hyattsville,) Tj 0 Tr 46.1227 0 TD 0.0152 Tc 0.9484 Tw ( MD, personal communication, Feb. 5,) Tj ET BT 0.8919 0 0 0.9835 348.24 285.6 Tm 0.0717 Tc 0 Tw (1991.) Tj ET BT 0.9388 0 0 0.9835 347.52 273.36 Tm 0.0071 Tc 2.3483 Tw (Hoffman, B.R.,) Tj ET BT 0.9835 0 0 0.9835 411.6 273.12 Tm 0.0121 Tc 0.366 Tw (\223Future Trends in the Legal Rights) Tj -65.1575 -10.9816 TD 0.0276 Tc 0.3502 Tw (of Patients in Nursing Homes,\222 ) Tj 130.071 0 TD /F5 10 Tf 0.0308 Tc 1.6159 Tw (Canadian Medical) Tj -130.071 -10.9816 TD 0.0285 Tc 0.2761 Tw (Association Journal ) Tj ET q 54 0 0 -8.64 430.8 258.48 cm BI /W 301 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||x>p????????`x<x?|?<?~~~|~<>>?>~>~>>????~0?x?~8?|?<<><?|G>~|??>??pp00 < EI Q BT 0.9444 0 0 0.9835 430.8 251.52 Tm 3 Tr 0.044 Tc 0 Tw (141\(1\):21-25,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 484.8 251.52 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj -139.5884 -12.4458 TD /F2 10 Tf 0.0159 Tc -0.0772 Tw (Hoffman, S. B., ) Tj ET q 20.16 0 0 -8.16 412.32 246.24 cm BI /W 113 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<?O????????~|~?~~x8~|~~?~~~????? EI Q BT 0.9835 0 0 0.9835 412.32 239.28 Tm 3 Tr -0.0588 Tc 0 Tw (Platt,) Tj 0 Tr 20.499 0 TD 0.0007 Tc -0.0618 Tw ( C.A., and Barry, K.E., \223Man-) Tj ET BT 0.9388 0 0 0.9835 347.76 228.24 Tm 0.0055 Tc 1.0352 Tw (aging the Difficult Dementia Patient: The Impact on) Tj ET BT 0.9835 0 0 0.9835 347.52 217.44 Tm 0.0323 Tc -0.0939 Tw (Untrained Nursing Home Staff,\224 ) Tj 133.9756 0 TD /F5 10 Tf 0.0332 Tc 0.1493 Tw (American Journal) Tj -133.7315 -10.9816 TD 0.0124 Tc -0.0737 Tw (of ) Tj ET q 47.52 0 0 -7.2 358.8 213.6 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8?|>~??||x~c8~C>>>>>p>?8>??|?|?~?~>|~~~~?~~>>?~>`????>p???>|??}>???`|||?~>x>?????? EI Q BT 0.9835 0 0 0.9835 358.8 206.64 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0351 Tc 2.7341 Tw ( Care and Related Disorders and) Tj -59.7887 -10.9816 TD 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.4 0 0 -8.64 387.12 202.8 cm BI /W 247 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px><>|>||??~?p~?~?>pp~~?>< ~~?><~?>|??>|??x???<???????~??x?>|?>p|?x>>?8~??>||?|<?x >?xp????π??x?p|?x>??|>??<x?p< EI Q BT 0.9444 0 0 0.9835 387.12 195.84 Tm 3 Tr 0.0374 Tc 0 Tw (2\(4\):26-31,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 431.52 195.84 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -85.1684 -12.6899 TD /F2 10 Tf 0.012 Tc 2.1637 Tw (Hogan, J.H., \223Mental Health in Nursing Homes:) Tj 0.244 -10.9816 TD 0.0094 Tc 2.4104 Tw (Barriers and Solutions,\224 Statement to the House) Tj 0.4881 -11.4697 TD 0.0103 Tc 3.9725 Tw (Select Committee on Aging on Behalf of the) Tj -0.244 -10.9816 TD 0.0306 Tc 2.6329 Tw (American Association of Homes for the Aging,) Tj 0 -10.9816 TD 0.0443 Tc 0.0159 Tw (Washington, DC, Aug. 3, 1989.) Tj -0.4881 -12.2018 TD 0.0099 Tc 1.5395 Tw (Holmes, D., Director, Research Division, Hebrew) Tj 0.7321 -10.9816 TD 0.4817 Tc 3.5164 Tw (Home for the Aged at Riverdale, \223Memo:) Tj 0 -10.9816 TD 0.0397 Tc 1.9119 Tw (Workgroup and Subcommittee Membership Ros-) Tj T* 0.0115 Tc 0.4641 Tw (ters,\224 Riverdale, NY, Dec. 12, 1991.) Tj ET BT 0.9388 0 0 0.9835 348 83.04 Tm 0.007 Tc 0.7049 Tw (Holmes, D., Teresi, J. A., and Monaco, C.,) Tj ET BT 0.9835 0 0 0.9835 517.44 82.8 Tm 0.1858 Tc 0 Tw (\223Special) Tj -171.8011 -10.9816 TD 0.0154 Tc 1.1086 Tw (Care Units in Nursing Homes: Prevalence in Five) Tj 0 -11.4697 TD -0.0428 Tc -0.0175 Tw (States,\224 ) Tj 33.921 0 TD /F5 10 Tf 0.0166 Tc -0.0779 Tw (Gerontologist, ) Tj ET q 59.04 0 0 -8.64 443.76 67.68 cm BI /W 329 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <p<xx<|~0g?>?????>????~?|?p|?xxA|x~`<x???????? ?|???~????~|???~???~????0?| ?0?~p>8?>p><?x|??x|?~?<1x>??~~?????||?<<?  EI Q BT 0.9444 0 0 0.9835 443.76 60.72 Tm 3 Tr 0.0466 Tc 0 Tw (32\(2\):191-196,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 502.8 60.72 Tm 0.0854 Tc 0.5843 Tw ( 1992.) Tj -157.647 -11.9577 TD /F2 10 Tf -0.0119 Tc 1.7508 Tw (Holmes, D., Teresi, J.A., Weiner, A., et al., \223Im-) Tj 0.7321 -11.4697 TD 0.0025 Tc 0.808 Tw (pacts Associated With Special Care Units in Long) Tj ET endstream endobj 538 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 539 0 obj <>stream 0.72 w 1 j 0 0 0 RG 60.48 673.68 m 537.36 673.68 l S BT 0.9835 0 0 0.9835 61.2 679.44 Tm 0 0 0 rg /F5 10 Tf 0.122 Tc -0.1851 Tw (185 ) Tj ET BT 0.9598 0 0 0.9598 79.44 679.44 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 85.92 679.44 Tm /F5 10 Tf 0.0024 Tc 0.9614 Tw (Special Care Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 234 686.16 cm BI /W 264 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0<>~>~>>????~?<~|C|||x~~<>~>>?>?|??~~~~??>???|~??|~?|?~x?~??>x????>???????G?|||?~>>???? EI Q BT 0.9835 0 0 0.9835 234 679.44 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.2884 Tw ( and Other ) Tj ET q 42.48 0 0 -6.96 328.8 686.16 cm BI /W 237 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0p~x~x~?|?~??~?>~?<<>?< ? ?G?<8?|||~||~~|>~?~>>?~??~>??>?~??~0?>88~~x~??x?????????> ??p @?? EI Q BT 0.9835 0 0 0.9835 328.8 679.44 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8449 0 0 0.9835 62.16 617.52 Tm /F2 10 Tf 0.3084 Tc (196.) Tj ET BT 0.8919 0 0 0.9835 62.4 550.56 Tm 0.0622 Tc (197.) Tj ET BT 0.8449 0 0 0.9835 62.88 494.88 Tm 0.3084 Tc (198.) Tj 0.5681 -46.6108 TD 0.3084 Tc (199.) Tj ET BT 0.8919 0 0 0.9835 62.88 393.6 Tm 0.2641 Tc (200.) Tj 0.5382 -57.1043 TD 0.2641 Tc (201.) Tj 0.2691 -69.0621 TD 0.2641 Tc (202.) Tj 0.2691 -35.1411 TD 0.2641 Tc (203.) Tj 0 -46.1227 TD 0.2641 Tc (204.) Tj 0.2691 -46.1227 TD 0.2641 Tc (205.) Tj 0 -34.6531 TD 0.0622 Tc (206.) Tj 0.5382 -23.1834 TD 0.2641 Tc (207.) Tj -0.2691 -45.8787 TD 0.2641 Tc (208.) Tj ET BT 0.9835 0 0 0.9835 83.52 641.04 Tm -0.0368 Tc 4.125 Tw (Term Care Facilities,\224) Tj 102.983 -0.4881 TD /F5 10 Tf 0.0593 Tc 1.5869 Tw (Gerontologist 30\(2\):178-) Tj ET BT 0.9444 0 0 0.9835 84.96 630 Tm 0.0714 Tc 0.2187 Tw (183, 1990.) Tj ET BT 0.8915 0 0 0.9835 83.76 617.52 Tm /F4 10 Tf -0.0096 Tc -0.079 Tw (Hunt, ) Tj ET BT 0.8919 0 0 0.9835 110.88 617.52 Tm /F2 10 Tf -0.0291 Tc 0 Tw (A.R.,) Tj ET q 27.6 0 0 -9.12 135.6 624 cm BI /W 154 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?||>08?x?<?? ? ?????????G?|?|???~?|???<>x<> EI Q BT 1.2674 0 0 0.9835 135.6 616.8 Tm 3 Tr -0.0551 Tc (\223bgal) Tj 0 Tr ET BT 0.9835 0 0 0.9835 163.2 616.8 Tm 0.042 Tc 1.1571 Tw ( Issues Involved in the Use of) Tj -80.2877 -10.4935 TD -0.0001 Tc 1.2813 Tw (Restraints: Analyzing the Risks,\224 presented to the) Tj 0.4881 -11.2256 TD 0.0077 Tc 0.2158 Tw (symposium \223Untie the Elderly: Quality Care With-) Tj -0.4881 -10.7376 TD -0.0049 Tc 1.1642 Tw (out Restraints, \222) Tj 71.7465 -0.4881 TD 0.0238 Tc 1.44 Tw (sponsored by the Senate Special) Tj -71.5024 -10.9816 TD 0.0229 Tc 0.4526 Tw (Committee on Aging, U.S. Congress, Washington,) Tj -0.244 -10.9816 TD 0.0268 Tc 0.1557 Tw (DC, Dec. 4, 1989.) Tj ET q 29.76 0 0 -9.12 84 557.52 cm BI /W 166 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxx||<8<>?????x?8?8??????3?x??x??|??<?>~?|>|??0??? EI Q BT 0.9388 0 0 0.9835 84 550.56 Tm 3 Tr 0.0192 Tc 0 Tw (Hurley,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 113.76 550.56 Tm 0.0282 Tc 0.2357 Tw ( A., and ) Tj ET q 31.2 0 0 -8.16 148.8 557.76 cm BI /W 174 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx ?>????????xx8<~ ~~~~~~x|||<>|?<>>??>??~?<8?p EI Q BT 0.9388 0 0 0.9835 148.8 550.56 Tm 3 Tr -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 180 550.56 Tm -0.0064 Tc 0.824 Tw ( L., \223Evaluation of a Scale) Tj -97.1262 -10.9816 TD 0.0149 Tc 1.7948 Tw (to Measure Discomfort in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 195.84 546.72 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0????????|?>??|??>>8~~`?? ???????~@~??~<??~?<?~?8<0?~??88?~??x8??|x>???????<x|?x|?? ?~?|<?8p EI Q BT 0.9835 0 0 0.9835 195.84 539.76 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0318 Tc 2.6557 Tw ( Patients,\224) Tj -162.5277 -10.9816 TD 0.2553 Tc 2.8169 Tw (presented at the 44th Annual Meeting of the) Tj 0.244 -10.9816 TD 0.0128 Tc 0.3164 Tw (Gerontological Society of America, San Francisco,) Tj 0 -10.9816 TD -0.0162 Tc -0.0445 Tw (CA, ) Tj ET q 18.96 0 0 -6.96 103.44 514.08 cm BI /W 106 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?????~~?~?~>~??????? EI Q BT 0.7217 0 0 0.9835 103.44 507.36 Tm 3 Tr /F4 10 Tf -0.002 Tc 0 Tw (NOV.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 122.4 507.36 Tm /F2 10 Tf 0.0853 Tc 0.0963 Tw ( 22-26, 1991.) Tj -38.5576 -12.6899 TD 0.0216 Tc 1.8083 Tw (Hussian, R.A., and Brown, D. C., \223Use of Two-) Tj 0.4881 -11.2256 TD 0.0136 Tc 3.1464 Tw (Dimensional Grid Patterns To Limit Hazardous) Tj 0 -11.2256 TD 0.0032 Tc 4.0844 Tw (Ambulation in Demented Patients,\224) Tj 0 Tc -0.061 Tw ( ) Tj 162.0397 0 TD /F5 10 Tf 0.042 Tc 4.5329 Tw (Journal of) Tj -162.0397 -11.2256 TD 0.0387 Tc -0.1004 Tw (Gerontology ) Tj ET q 59.52 0 0 -8.64 139.68 468.72 cm BI /W 331 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >||x>~p??~?||?>>~?|? x~~x|||~<<<|~?>?<|~?@<|~?>|??>~??>>~?>>~~~?|>?~?<??????????????π????x>~=~<p~<x|>|>?<?>?x?~>???<@0 EI Q BT 0.9444 0 0 0.9835 139.68 461.76 Tm 3 Tr 0.0466 Tc 0 Tw (42\(5\):558-560,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 199.2 461.76 Tm 0.0854 Tc 0.8283 Tw ( 1987.) Tj -116.161 -12.9339 TD /F2 10 Tf 0.0165 Tc 0.6195 Tw (Hyde, J., \223The Physical Environment and the Care) Tj 0.7321 -10.9816 TD 0.1033 Tc -0.1661 Tw (of ) Tj ET q 48.96 0 0 -7.2 96.48 445.44 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~8~~?~?>???????x?~<????p? ?p?? ???~????|?| <?<0|>x~|x?><|?????<xx<~<?~~~||~8<  EI Q BT 0.9388 0 0 0.9835 96.48 438.24 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 145.44 438.24 Tm 0.0152 Tc 0.1675 Tw ( Patients: An Experiential Survey of) Tj ET BT 0.9388 0 0 0.9835 85.68 427.44 Tm -0.0208 Tc 0.0772 Tw (Massachusetts\222 ) Tj ET q 47.52 0 0 -7.2 147.84 434.64 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID w?~??|??x?~?p? ?~p ?~?p ?~?`?~??~??~???~??~??~???~??~7?~?<??~?<?~?~>`?~??|p?~??8|p?|??|x?????????x?@p?????????~??~<?< EI Q BT 0.9388 0 0 0.9835 147.84 427.44 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 50.6169 0 TD 0.0135 Tc 0.2964 Tw ( Units,\222 ) Tj ET BT 0.9444 0 0 0.9835 227.04 427.44 Tm /F5 10 Tf -0.0337 Tc 0.0759 Tw (American ) Tj ET q 20.64 0 0 -7.2 267.6 434.64 cm BI /W 117 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?|~~|>?>??|??||~~>>???~~~?~>>x|~ EI Q BT 0.9444 0 0 0.9835 267.6 427.44 Tm 3 Tr -0.0137 Tc 0 Tw (Jour-) Tj 0 Tr -192.6349 -10.9816 TD 0.0539 Tc 0.1102 Tw (nal of ) Tj ET q 47.76 0 0 -7.2 110.64 423.36 cm BI /W 267 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pa?>?>????<q`? ?x||@<~~~~~~~~~?>|>??~???~??~???~~?~??~?????x<~|??~?~?~??~>>?x??8<@>>?~>? EI Q BT 0.9835 0 0 0.9835 110.64 416.64 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 158.4 416.64 Tm -0.0056 Tc 1.0627 Tw ( Care and Related Disorders and) Tj ET BT 0.9835 0 0 0.9835 85.68 405.84 Tm 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.88 0 0 -8.64 124.8 413.04 cm BI /W 250 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <8x<>x|?p>>>>><>|~|?`x||x||?|?~?~??~?<???x???|??<???>?||>~x|>?<~|?>|???|???xx<?x EI Q BT 0.9835 0 0 0.9835 124.8 405.84 Tm 3 Tr 0.0925 Tc 0 Tw (4\(3\):3643,) Tj 0 Tr 45.6347 0 TD 0.0854 Tc -0.1478 Tw ( 1989.) Tj ET BT 0.9388 0 0 0.9835 85.68 393.36 Tm /F2 10 Tf 0.0041 Tc 1.4993 Tw (Hyde, J., \223A Policy Recommendation With Respect) Tj ET BT 0.9835 0 0 0.9835 85.68 382.56 Tm 0.0225 Tc 3.8512 Tw (to the Effect of Regulation on the Design of) Tj ET q 48.96 0 0 -7.2 85.68 378.72 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <??>??????????<????~?`??`~??~?~??~?~????x? |?>|8?~><8?>?<><?|??`?~8x<|?~?~|~|~x8<8 EI Q BT 0.9835 0 0 0.9835 85.68 371.76 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0267 Tc 0.4609 Tw ( Units,\222 Gerontology Institute, Univer-) Tj -49.2952 -11.4697 TD -0.0004 Tc 3.1525 Tw (sity of Massachusetts, Boston, MA, draft, May) Tj ET BT 0.8919 0 0 0.9835 86.64 349.68 Tm 0.0717 Tc 0 Tw (1989.) Tj ET BT 0.9835 0 0 0.9835 85.68 336.96 Tm 0.0084 Tc 2.5102 Tw (Hyde, J., \223Federal Policy in the Regulation and) Tj 0.244 -10.9816 TD 0.0249 Tc 1.9473 Tw (Funding of Special Care) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 192.72 333.36 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x ?O?????<???<??>?x>?8~???`?? ????~?~????|???<??<??88?~|?88~~|8<?>x???p8<<?<?~~~~>~<??|<<@ EI Q BT 0.9835 0 0 0.9835 192.72 326.16 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0 Tc 1.7693 Tw ( Units: The) Tj -158.1351 -11.2256 TD -0.0068 Tc 0.4746 Tw (Role of Federal, State, and Municipal Regulation,\224) Tj 0.244 -11.4697 TD 0.0323 Tc 0.3593 Tw (contract report prepared for the Office of Technol-) Tj 0 -11.2256 TD 0.0255 Tc 0.6451 Tw (ogy Assessment, U.S. Congress, Washington, DC,) Tj ET BT 0.9388 0 0 0.9835 86.16 282 Tm 0.0666 Tc 2.2849 Tw (August 1990.) Tj -0.2556 -12.6899 TD 0.0283 Tc 0.9835 Tw (Hyde, J., and Koenig, J.,) Tj ET BT 0.9835 0 0 0.9835 186.24 269.04 Tm 0.0086 Tc 0.1743 Tw (\223The Effect of Regulation) Tj -101.5188 -10.9816 TD 0.0486 Tc 1.2724 Tw (on the Design of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 160.08 265.44 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0B|`x???|???~??>?~x?>?~8?>?~~?~?~??~???`~???~?~???~??~???~???~?|?~?|?~~?8<?~|?8<8?~|π8><~?~>x>???|? x8<>~8|??||?|8<` EI Q BT 0.9835 0 0 0.9835 160.08 258.24 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0127 Tc 1.8783 Tw ( Units,\224 draft, Sep-) Tj -124.4582 -10.9816 TD 0.042 Tc -0.1037 Tw (tember 1988.) Tj -0.244 -12.6899 TD 0.0546 Tc 3.117 Tw (Indiana Governor\222s Task Force on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.48 0 0 -7.2 241.44 241.92 cm BI /W 270 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????x?~|?~~|?~p~??~0~??~>??|~??~~??~~?~~~?~~??~~|??~x?~8?~0<?~?p8?~?p8?|?<?|????????|??? 0<p????? ?x||x?x00 EI Q BT 0.9388 0 0 0.9835 241.44 234.96 Tm 3 Tr -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 86.4 223.92 Tm 0.0049 Tc 1.8049 Tw (Disease and Other Senile) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.4 0 0 -8.16 195.36 230.88 cm BI /W 247 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>'?x???|???x???x<???p??~?p?~?0?>c?| ?~#?|~~?>~~?|??|??~>???>???>????>?|~?>??|~>~?||?~?~|???><>???0~@?????? EI Q BT 0.9835 0 0 0.9835 195.36 223.92 Tm 3 Tr -0.0148 Tc 0 Tw (Dementias,) Tj 0 Tr 45.1466 0 TD /F5 10 Tf 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 242.16 231.12 cm BI /W 264 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|>~?>???~<~~~|C| ~<x>>8>>>|>?|?~|>~~>~~?|>???|~??~p~?|??>8??~??><???>|??>???||||?~?>>@>??@ EI Q BT 0.9835 0 0 0.9835 242.16 223.92 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr -158.3791 -10.9816 TD 0.0388 Tc 2.0144 Tw (Task Force Annual Report\2271989) Tj 0 Tc -0.061 Tw ( ) Tj 147.1535 0 TD /F2 10 Tf 0.2509 Tc 0 Tw (\(Indianapolis,) Tj ET BT 0.9388 0 0 0.9835 86.64 202.08 Tm -0.0013 Tc 2.2294 Tw (IN: December 1989\).) Tj ET BT 0.9835 0 0 0.9835 86.4 189.6 Tm 0.0315 Tc 0.8831 Tw (In re Gertrude Hyman, District of Columbia Gov-) Tj 0.4881 -11.4697 TD 0.0281 Tc 0.3985 Tw (ernment, Department of Consumer and Regulatory) Tj 0 -11.2256 TD 0.0216 Tc 1.186 Tw (Affairs, Office of Adjudication, Washington, DC,) Tj -0.244 -11.2256 TD 0.0608 Tc 0.0602 Tw (No. 91-OAD-008, Mar. 5, 1991.) Tj ET q 72 0 0 -8.64 87.6 150.96 cm BI /W 401 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??xC0`0??????????????<?x~???<~p?~??~?8??????? ?~???~x~??~>?x~?????<~????<~?????<~????~????~????|?~|??<?~?|>>?~~?|||~~?>?~~|????~??? <8~|π|?p08 EI Q BT 0.9835 0 0 0.9835 87.6 144.24 Tm 3 Tr 0.0272 Tc 0 Tw (ktergovernmental) Tj 0 Tr 73.2107 0 TD -0.0028 Tc 2.0772 Tw ( Health Policy Project, \223Report) Tj -73.2107 -10.9816 TD 0.0194 Tc 1.658 Tw (on Issues of Policy: The Mentally Ill in Nursing) Tj -0.7321 -10.9816 TD 0.0341 Tc 0.6364 Tw (Homes,\224 Washington, DC, July 1986.) Tj -0.244 -12.4458 TD 0.0271 Tc 1.1926 Tw (Iowa Administrative Code, Sections 1OA.1O4\(5\),) Tj ET q 33.12 0 0 -8.16 87.84 106.32 cm BI /W 185 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>|???|?|??|>?|~~?|~?x||<|<|< >>>>>~~>~>||0||x|?>|>|||||x|<|>|`ppxx0<<??????|<0` EI Q BT 0.9388 0 0 0.9835 87.84 99.6 Tm 3 Tr 0.0705 Tc 0 Tw (135c.14,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 120.96 99.6 Tm 0.0622 Tc 0.1197 Tw ( and 61.13.) Tj ET q 22.8 0 0 -8.64 86.88 94.08 cm BI /W 128 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x<x8~??><????????|?xx~>~?>????~?~~?~p|~~~ ~~~?|?~? EI Q BT 0.9388 0 0 0.9835 86.88 87.36 Tm 3 Tr -0.0157 Tc 0 Tw (Jager,) Tj 0 Tr 24.2859 0 TD 0.0197 Tc 1.3634 Tw ( L., Staff Development Coordinator, Christian) Tj ET BT 0.9835 0 0 0.9835 87.12 76.56 Tm -0.0096 Tc 1.901 Tw (Rest Home,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -8.88 139.68 83.28 cm BI /W 180 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????>x???q??q?x?18?~<~?????????|?????????? EI Q BT 0.9388 0 0 0.9835 139.68 76.56 Tm 3 Tr 0.0601 Tc 0 Tw (Lynden,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 172.08 76.56 Tm 0.0299 Tc 2.9997 Tw ( WA, personal communica-) Tj -86.3886 -10.9816 TD 0.0362 Tc 1.2851 Tw (tions, Oct. 19, 1990, Dec. 30, 1991, and Jan. 13,) Tj ET BT 0.8919 0 0 0.9835 87.84 54.96 Tm 0.0717 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 86.64 42.24 Tm 0.0146 Tc 0.0055 Tw (Jencks, S.F., and ) Tj ET q 32.16 0 0 -8.64 155.76 49.44 cm BI /W 179 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >?????|??|xxp?`p??0|????~|>|>|~>|?|???<~@??? EI Q BT 0.9388 0 0 0.9835 155.76 42.24 Tm 3 Tr -0.0113 Tc 0 Tw (Clauser,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 187.92 42.24 Tm 0.0029 Tc 0.0581 Tw ( S. B., \223Managing Behav-) Tj -102.495 -10.9816 TD 0.0356 Tc 1.1229 Tw (ior Problems in Nursing Homes, \224) Tj 0 Tc -0.061 Tw ( ) Tj 147.1535 0 TD /F5 10 Tf 0.0294 Tc 1.3733 Tw (Journal of the) Tj ET BT 0.8971 0 0 0.9835 311.76 616.08 Tm 0.2375 Tc 0 Tw (209.) Tj 0.2675 -57.8364 TD 0.2375 Tc (210.) Tj 0.535 -35.1411 TD 0.2375 Tc (211.) Tj 0 -35.8732 TD 0.2375 Tc (212.) Tj 0.535 -35.8732 TD 0.0369 Tc (213.) Tj 0.2675 -35.8732 TD 0.2375 Tc (214.) Tj 0 -46.3668 TD 0.2375 Tc (215.) Tj 0.535 -35.8732 TD 0.0369 Tc (216.) Tj 0.2675 -58.5686 TD 0.2375 Tc (217.) Tj 0.2675 -58.3245 TD 0.0369 Tc (218.) Tj 0.535 -58.3245 TD 0.0369 Tc (219.) Tj 0 -46.3668 TD 0.0369 Tc (220,) Tj 0.2675 -68.0859 TD 0.0369 Tc (221.) Tj ET BT 0.9835 0 0 0.9835 334.08 640.56 Tm 0.2523 Tc 2.8549 Tw (American Medical Association) Tj 0 Tc -0.061 Tw ( ) Tj ET q 64.08 0 0 -8.88 473.28 648 cm BI /W 357 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?>|@????????????~|x>8 ~x~~|||~~@|||~~||||~~>|~|~~~|~~>~?~>~?~?~??~??~?~??~?~?x|?~<???????????@???~?`8?~8~<?~<?>|?|0~~?~~?????>???????< @ EI Q BT 0.9444 0 0 0.9835 473.28 640.56 Tm 3 Tr 0.0488 Tc 0 Tw (265\(4\):502-503,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 335.28 629.52 Tm 0.0456 Tc (1991.) Tj ET BT 0.9835 0 0 0.9835 334.32 615.84 Tm /F2 10 Tf 0.0245 Tc -0.0859 Tw (Johnson, C.J.,) Tj 60.5208 -0.244 TD 0.0319 Tc 1.2488 Tw (\223Sociological Intervention Through) Tj -60.5208 -10.7376 TD 0.0314 Tc 2.2254 Tw (Developing Low Stimulus) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 448.08 612 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08>0??????????<????p??p??0?????????????~??>?>?????>??>??>?p?|x|><?>?~~<?~| EI Q BT 0.9388 0 0 0.9835 448.08 605.04 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 497.04 605.04 Tm 0.0366 Tc 1.1219 Tw ( Wings in) Tj -165.4562 -11.2256 TD 0.0495 Tc 2.085 Tw (Nursing Homes,\222) Tj 73.6988 0 TD /F5 10 Tf 0.0332 Tc -0.0948 Tw (American Journal ) Tj ET q 56.64 0 0 -9.36 481.2 601.2 cm BI /W 315 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???>|~>p<????~~>????~x~??|>~??<?~>~?~?~?|???~?~~?~~?~?~?????p????8`?~~??~???~??????????@>>?x><?<p>>?~?0~ EI Q BT 0.9835 0 0 0.9835 481.2 594 Tm 3 Tr 0.0046 Tc 0 Tw (ofAlzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 334.8 582.96 Tm -0.0075 Tc 1.6153 Tw (Care and Related Disorders and Research 4\(2\):33-) Tj -0.2541 -10.9816 TD 0.0703 Tc 0.7281 Tw (41, 1989.) Tj ET BT 0.9835 0 0 0.9835 334.32 559.2 Tm /F2 10 Tf 0.0115 Tc 1.3101 Tw (Johnson, J., Director of Social Services, Christian) Tj 0.4881 -10.9816 TD -0.0096 Tc 1.901 Tw (Rest Home,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -8.88 387.6 555.12 cm BI /W 181 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??x8???>?~????>??;?xx`xxxxxx?xx8888x8x8x<x<x<x?<x<x<y888<<<<<~?' EI Q BT 0.9388 0 0 0.9835 409.44 513.6 Tm 3 Tr 0.0304 Tc 0 Tw (L.P.N.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 434.88 513.6 Tm -0.0059 Tc 2.8734 Tw ( Nursing Facilities, Inc.,) Tj -101.5188 -11.2256 TD 0.0573 Tc -0.1193 Tw (Newark, OH, Spring 1984.) Tj -0.244 -13.666 TD 0.0413 Tc 0.141 Tw (Johnson, S.H.,) Tj 62.9612 0.244 TD 0.0063 Tc 1.0714 Tw (\223The Fear of Liability and the Use) Tj -62.2291 -11.4697 TD 0.0204 Tc 1.0408 Tw (of Restraints in Nursing Homes,\222 Law,) Tj 0 Tc -0.061 Tw ( ) Tj 164.9681 0 TD /F5 10 Tf -0.022 Tc 0 Tw (Medicine,) Tj -165.2121 -11.2256 TD 0.0356 Tc 0.2282 Tw (and Health Care ) Tj ET q 58.8 0 0 -8.64 405.84 474 cm BI /W 327 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p88<x<<~>0 ?||???|?||?~>|>|>>~>>x>x??p??|>?x0?<>???<>?~?x>??~?<>?~?|~?|~?|?>?>|>~~>??x??|??~>>>>?x>|?|?|p>p?|| ?p?<x?@?>| x`?>>?<p?>>?>x?>||~???<x~2 p00  EI Q BT 0.9444 0 0 0.9835 405.84 467.04 Tm 3 Tr 0.0466 Tc 0 Tw (18\(3\):263-273,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 464.64 467.04 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj -131.7793 -13.422 TD /F2 10 Tf 0.0198 Tc 1.5661 Tw (Joint Commission on Accreditation of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42.96 0 0 -7.2 496.32 460.8 cm BI /W 239 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 80< A ?????~???????x????<?????a???~???~?~???????????????<|?~??~???88??? EI Q BT 0.9835 0 0 0.9835 496.32 453.84 Tm 3 Tr -0.014 Tc 0 Tw (Healthcare) Tj 0 Tr ET BT 0.8919 0 0 0.9835 335.76 442.8 Tm 0.1952 Tc (Org) Tj ET BT 0.9388 0 0 0.9835 350.64 442.8 Tm 0.0101 Tc 0.0443 Tw (animations, ) Tj ET q 47.28 0 0 -7.2 396.72 449.76 cm BI /W 274 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID c~????????|~|~>~pq`~01~~~?~?~?~~~~~?~~?x|????|?~??~x~??|~8?<~x<<~` ~~~~~?xx<??? @ EI Q BT 0.8919 0 0 0.9835 396.72 442.8 Tm 3 Tr -0.0043 Tc 0 Tw (\221Alzheimer\222s) Tj 0 Tr ET BT 0.9388 0 0 0.9835 444 442.8 Tm 0.0273 Tc 0.1964 Tw ( Protocol: Fourth Draft,\224) Tj -115.0384 -11.2256 TD 0.0263 Tc 1.7313 Tw (Chicago, IL, September 1991.) Tj ET BT 0.9835 0 0 0.9835 335.28 418.8 Tm 0.0198 Tc 1.5661 Tw (Joint Commission on Accreditation of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42.72 0 0 -7.2 496.56 425.76 cm BI /W 238 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <L?߀???????>???????|????<????? ??~?~?~??~? ??????????????8?~?~???~????8xx?????f EI Q BT 0.9835 0 0 0.9835 496.56 418.8 Tm 3 Tr 0.0196 Tc 0 Tw (Heakhcare) Tj 0 Tr ET BT 0.9388 0 0 0.9835 336 407.76 Tm 0.0118 Tc (Organizations,) Tj ET BT 0.9835 0 0 0.9835 398.16 407.76 Tm 0.0226 Tc 1.5022 Tw (\223Public Interest Forum on Quality) Tj -63.4493 -10.7376 TD 0.0233 Tc 0.4034 Tw (of Care Issues in ) Tj ET q 20.16 0 0 -8.88 406.8 403.92 cm BI /W 113 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?||>?????~???????~~~~?>????????<0 EI Q BT 0.8449 0 0 0.9835 406.8 397.2 Tm 3 Tr 0.0464 Tc 0 Tw (I.mng) Tj 0 Tr ET BT 0.9835 0 0 0.9835 426.96 397.2 Tm -0.0225 Tc 1.0601 Tw ( Term Care Facilities: Issue) Tj -92.2455 -11.2256 TD 0.0285 Tc 0.5445 Tw (Outline,\224 Washington, DC, July 31, 1991.) Tj -0.7321 -13.666 TD -0.0082 Tc 2.3877 Tw (Jones, M.,) Tj 0 Tc -0.061 Tw ( ) Tj 48.5631 0 TD /F5 10 Tf 0.0234 Tc 4.0637 Tw (The Therapeutic) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -9.36 458.88 379.92 cm BI /W 272 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8xp??||||?||~>~~y~p>~>?~?|?~>~?>?~ ?>?~??~~??~~??~?p??x~??x~??x~~?x>|p?~x~?x?????????>?~ p?`@x0p???  EI Q BT 0.9835 0 0 0.9835 458.88 372.72 Tm 3 Tr 0.0465 Tc 0 Tw (Communi~:) Tj 0 Tr 49.7833 0 TD -0.0579 Tc 1.7061 Tw ( A New) Tj -174.4855 -10.9816 TD 0.0136 Tc 0.5596 Tw (Treatment Method in Psychology \(New ) Tj 163.5039 0 TD /F2 10 Tf 0.0729 Tc -0.1352 Tw (York, ) Tj ET q 16.08 0 0 -7.2 522.96 369.12 cm BI /W 90 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????|~>???\ EI Q BT 0.8919 0 0 0.9835 522.96 361.92 Tm 3 Tr -0.003 Tc 0 Tw (NY:) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.24 350.88 Tm 0.0279 Tc 0.0326 Tw (Basic Books, 1953\).) Tj ET BT 0.9388 0 0 0.9835 335.76 337.44 Tm 0.0319 Tc 0.6346 Tw (Jordan, J. A., Coordinator for ) Tj ET q 48.24 0 0 -7.2 453.36 344.64 cm BI /W 272 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8`zN~?????>???????????~<??~?~~??`?? ?~`?~?~?~??~g??~|?~ |?~|??~~?>8?~>?<<??|>??x<?<~~||~<|88 EI Q BT 0.9388 0 0 0.9835 453.36 337.44 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr 51.3838 0 TD -0.011 Tc 1.3449 Tw ( Services,) Tj ET BT 0.9835 0 0 0.9835 336.24 326.64 Tm 0.262 Tc 2.6417 Tw (Division of Elderly and Adult Services, New) Tj ET BT 0.9388 0 0 0.9835 336.24 315.6 Tm -0.0062 Tc 1.7234 Tw (Hampshire Department of Health and Human Serv-) Tj ET BT 0.9835 0 0 0.9835 336.48 304.32 Tm 0.0137 Tc 1.1452 Tw (ices, Concord, NH, personal communication, Oct.) Tj ET BT 0.9388 0 0 0.9835 337.2 293.28 Tm 0.0944 Tc -0.0455 Tw (1, 1990.) Tj ET BT 0.9835 0 0 0.9835 336.24 280.08 Tm 0.0073 Tc 3.9989 Tw (Jordin, J., Life Safety Engineer, National Fire) Tj 0.244 -11.2256 TD 0.0187 Tc 0.5707 Tw (Protection Association, remarks to the annual con-) Tj 0.244 -11.2256 TD 0.0048 Tc 0.0387 Tw (ference of the Association of Health Facility ) Tj ET q 25.44 0 0 -7.2 514.8 264.96 cm BI /W 142 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >w???|>???????>?>?>ó>?<~~???`@ EI Q BT 0.9388 0 0 0.9835 514.8 258 Tm 3 Tr -0.0065 Tc 0 Tw (Licen-) Tj 0 Tr -189.4299 -11.2256 TD 0.0011 Tc 1.119 Tw (sure and Certification Directors, San Francisco, CA,) Tj -0.2556 -11.2256 TD 0.0791 Tc 0.9934 Tw (Nov. 7, 1990.) Tj ET BT 0.9835 0 0 0.9835 336.48 222.72 Tm -0.0004 Tc 2.8678 Tw (Kahana, E.,) Tj 56.6163 0 TD 0.0433 Tc 3.6164 Tw (\223A Congruence Model of Person-) Tj -56.3722 -10.7376 TD 0.0242 Tc 1.1345 Tw (Environment Interaction,\222) Tj 0 Tc -0.061 Tw ( ) Tj 109.572 0 TD /F5 10 Tf 0.0474 Tc 0.6229 Tw (Aging and the Environ-) Tj -109.328 -11.4697 TD 0.0224 Tc 1.1363 Tw (ment: Theoretical Approaches,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -6.96 465.84 207.84 cm BI /W 104 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~~<??|<??? EI Q BT 0.9388 0 0 0.9835 465.84 200.88 Tm 3 Tr /F2 10 Tf 0.0559 Tc 0 Tw (M.P.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 484.56 200.88 Tm 0.0172 Tc 0.1655 Tw ( Lawton, ) Tj ET q 16.8 0 0 -7.2 522.96 207.84 cm BI /W 94 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??>???p???????`?~ EI Q BT 0.9388 0 0 0.9835 522.96 200.88 Tm 3 Tr 0.0263 Tc 0 Tw (P.G.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.96 189.84 Tm 0.0297 Tc 2.1051 Tw (Windley, and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.08 0 0 -7.2 396.96 197.04 cm BI /W 90 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 9??????????????? EI Q BT 0.8449 0 0 0.9835 396.96 189.84 Tm 3 Tr 0.0297 Tc 0 Tw (T.O.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 413.04 189.84 Tm 0 Tc -0.061 Tw ( ) Tj ET q 25.44 0 0 -9.12 415.44 196.8 cm BI /W 142 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |xxG|?|?<~?À??0pp>px>p|(~ p0 EI Q BT 0.9388 0 0 0.9835 415.44 189.84 Tm 3 Tr -0.0082 Tc 0 Tw (Byerts) Tj 0 Tr ET BT 0.9835 0 0 0.9835 440.88 189.84 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.36 0 0 -8.64 443.28 197.04 cm BI /W 119 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <||>?<<>>>>?<?|~??||???||??||~?~|~?~|??~?~??~|?~?||>?|||>~~>??>???????<||>? @ EI Q BT 0.9388 0 0 0.9835 443.28 189.84 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 464.64 189.84 Tm 0.0575 Tc 1.7514 Tw ( \(New York, NY:) Tj -129.5829 -11.2256 TD 0.0445 Tc 0.0564 Tw (Springer Publishing Co., 1982\).) Tj ET q 23.52 0 0 -8.16 336.72 172.32 cm BI /W 131 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?????????????~??~?~~?~~~?~?~?????>?|???????? 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Tj ET BT 0.9444 0 0 0.9835 72.48 538.08 Tm 0.0703 Tc (225.) Tj ET BT 0.8971 0 0 0.9835 72.72 504.72 Tm 0.2375 Tc (226.) Tj 0.535 -56.1282 TD 0.2375 Tc (227.) Tj 0.2675 -22.6953 TD 0.2375 Tc (228.) Tj 0.2675 -55.6401 TD 0.2375 Tc (229.) Tj 0.2675 -34.409 TD 0.2375 Tc (230.) Tj 0.2675 -34.165 TD 0.2375 Tc (231.) Tj 0 -33.921 TD 0.2375 Tc (232.) Tj 0.2675 -45.3906 TD 0.2375 Tc (233.) Tj 0.2675 -34.165 TD 0.2375 Tc (234.) Tj 0.2675 -44.9026 TD 0.2375 Tc (235.) Tj 0.2675 -56.1282 TD 0.2375 Tc (236.) Tj ET BT 0.9444 0 0 0.9835 75.12 49.92 Tm 0.0703 Tc (237.) Tj ET BT 0.9835 0 0 0.9835 93.84 649.2 Tm /F2 10 Tf 0.0027 Tc 2.2546 Tw (Kane, R.A., and CapIan, A.L.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 37.44 0 0 -9.12 227.28 656.16 cm BI /W 209 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|xx88~???????<??x??>8??><??~?>~?~>|??~>|~~~~|>~?~?||>?7??p?p?0??@|~~~?? EI Q BT 0.9835 0 0 0.9835 227.28 649.2 Tm 3 Tr 0.059 Tc 0 Tw (Every&y) Tj 0 Tr 38.0696 0 TD /F5 10 Tf -0.0054 Tc 2.6288 Tw ( Ethics:) Tj -173.5093 -11.2256 TD 0.0251 Tc 2.1098 Tw (Resolving Dilemmas in Nursing Home) Tj 0 Tc -0.061 Tw ( ) Tj ET q 15.12 0 0 -9.12 259.2 645.12 cm BI /W 85 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????0>>>???~? ??`??}? EI Q BT 1.1805 0 0 0.9835 259.2 638.16 Tm 3 Tr 0.0075 Tc 0 Tw (Lfe) Tj 0 Tr ET BT 0.9835 0 0 0.9835 274.32 638.16 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.12 0 0 -8.64 276.72 645.12 cm BI /W 118 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID | px>?>~?~|~>|????|~~|~???????????~?~>>??}=?  EI Q BT 0.9835 0 0 0.9835 276.72 638.16 Tm 3 Tr -0.0337 Tc 0 Tw (\(New) Tj 0 Tr -185.2231 -11.2256 TD /F2 10 Tf 0.0474 Tc -0.0604 Tw (York, NY: Springer Publishing Co., 1990\).) Tj -0.4881 -11.7137 TD 0.0347 Tc 1.1239 Tw (Kansas Administrative Rules, 28-39-78 \(a\)\(6\) and) Tj 0.9761 -11.2256 TD 0.0733 Tc -0.1355 Tw (\(7\) and 28-39-87 \(c\) and \(e\).) Tj ET q 23.28 0 0 -9.36 95.04 599.76 cm BI /W 130 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???0x<@0????? ?~????????????~???????? ??????~??~??????????~????????? EI Q BT 0.9388 0 0 0.9835 95.04 592.8 Tm 3 Tr 0.0225 Tc 0 Tw (Kapp,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 118.32 592.8 Tm -0.0127 Tc 0.5445 Tw ( M. B., \223Legal Liability Issues,\224 presented to) Tj -23.6715 -11.2256 TD 0.0367 Tc 1.854 Tw (the symposium) Tj 68.33 0 TD -0.008 Tc 2.2655 Tw (\223Untie the Elderly: Quality Care) Tj -68.33 -10.9816 TD 0.2202 Tc 2.6435 Tw (Without Restraints,\224) Tj 97.3702 -0.244 TD 0.0407 Tc 3.9649 Tw (sponsored by the Senate) Tj ET BT 0.9388 0 0 0.9835 95.28 559.92 Tm 0.0112 Tc 0.9805 Tw (Special Committee on Aging, U.S. Congress, Wash-) Tj ET BT 0.9835 0 0 0.9835 95.28 549.36 Tm 0.029 Tc 0.2146 Tw (ington, DC, Dec. 4, 1989.) Tj ET q 23.76 0 0 -9.36 95.04 544.56 cm BI /W 133 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<??????||~~~?~????<<? EI Q BT 0.9388 0 0 0.9835 95.04 537.6 Tm 3 Tr 0.0225 Tc 0 Tw (Kapp,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 118.8 537.6 Tm 0.0002 Tc 0.7929 Tw ( M. B., \223State of the Law: Nursing Homes,\224) Tj -24.1595 -10.9816 TD -0.0066 Tc -0.0543 Tw (Law, ) Tj 24.8916 0 TD /F5 10 Tf 0.012 Tc 2.6111 Tw (Medicine, and Health Care) Tj 0 Tc -0.061 Tw ( ) Tj ET q 58.32 0 0 -8.64 240.48 534 cm BI /W 325 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |?<|x0?>???????|~?~>~??>||?|>|x`>~<x>?~<?~x~><|>?>~>~???~|~||~~~??|>>??~|?>????>??|80~?|<~x?~?~8?~?>?<?~?>|?><||>||?||?~<>??x~x0`?<@ EI Q BT 0.9444 0 0 0.9835 240.48 526.8 Tm 3 Tr 0.0466 Tc 0 Tw (18\(3\):282-289,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 96.24 516.24 Tm 0.0456 Tc (1990.) Tj ET BT 0.9835 0 0 0.9835 95.04 504.72 Tm /F2 10 Tf -0.0031 Tc -0.0273 Tw (Karp, H. R., \223Principles for the Health Care Team,\224) Tj ET q 48.48 0 0 -9.36 95.76 500.64 cm BI /W 270 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>>? x?|?~~~?~??|~?~?8|~?|c???~|>???~??|?>?~???>??|?~?||??~?~>~?>~??~|?|?~~|?|?>~||?~~~~?~???????~?xpp``~>|~??x? > EI Q BT 0.8971 0 0 0.9835 95.76 493.68 Tm 3 Tr /F5 10 Tf 0.0175 Tc 0 Tw (Con@onting) Tj 0 Tr ET BT 0.9835 0 0 0.9835 144.24 493.68 Tm 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 147.6 500.88 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??????|?s~<~s>~>?~?x?8?|~~|~~|~~?~??|??~??~?>|??>?>p>??????x>????}????|?||~>?>p??|<~~~??p EI Q BT 0.9835 0 0 0.9835 147.6 493.68 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.9744 Tc 3.3408 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -7.2 249.12 500.64 cm BI /W 100 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????||||<???~||8 EI Q BT 0.9388 0 0 0.9835 249.12 493.68 Tm 3 Tr /F2 10 Tf 0.0043 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 267.12 493.68 Tm 0 Tc -0.061 Tw ( ) Tj ET q 28.8 0 0 -7.2 270.48 500.64 cm BI /W 161 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`?????~p?~x??8????@??|~???|?>`?? EI Q BT 0.9835 0 0 0.9835 270.48 493.68 Tm 3 Tr -0.0246 Tc 0 Tw (Kalicki) Tj 0 Tr -177.4139 -11.2256 TD 0.0361 Tc -0.0977 Tw (\(cd.\) ) Tj ET q 33.84 0 0 -8.88 117.6 489.84 cm BI /W 189 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|<p>` x???????~??|~?>~?~??~~?~~??~|??x~?x~?<`>?<>?<?>?|>?~??~???|?? EI Q BT 0.9388 0 0 0.9835 117.6 482.64 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 151.44 482.64 Tm -0.0051 Tc 1.2254 Tw ( Mills, MD: Rynd Communications,) Tj -56.1282 -10.9816 TD 0.0233 Tc 3.3318 Tw (and Washington, DC: American Association of) Tj -0.4881 -11.2256 TD 0.056 Tc 0.126 Tw (Homes for the Aging, 1987\).) Tj ET q 38.16 0 0 -8.16 95.52 456.24 cm BI /W 213 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8 >?????????????x?<???????????????|?~?<~>||~ EI Q BT 0.9388 0 0 0.9835 95.52 449.52 Tm 3 Tr -0.0085 Tc 0 Tw (Katznmn,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 133.68 449.52 Tm -0.0689 Tc 1.9613 Tw ( R.,) Tj ET q 54.72 0 0 -7.2 155.28 456.24 cm BI /W 305 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8???????????|<pp?x~8?????>????>??>??|???~??~?<px<??x>xx??>????????| ` EI Q BT 0.9835 0 0 0.9835 155.28 449.28 Tm 3 Tr 0.0027 Tc 0 Tw (\223Alzheimer\222s) Tj 0 Tr 55.6401 0 TD -0.0076 Tc 2.265 Tw ( Disease,\224 New) Tj 0 Tc -0.061 Tw ( ) Tj ET q 19.2 0 0 -8.64 280.08 456 cm BI /W 107 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?8?>|~>>>~?~??p?0?@7<0 EI Q BT 0.9444 0 0 0.9835 280.08 449.28 Tm 3 Tr /F5 10 Tf 0.0298 Tc 0 Tw (Eng-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 96.24 438.48 Tm 0.0547 Tc 1.5916 Tw (land Journal of Medicine 314\(15\)%4-973, 1986.) Tj ET q 35.76 0 0 -7.92 95.76 433.44 cm BI /W 213 /H 44 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >0~p|~?????????????????<?????????????|??>?>?<>?? EI Q BT 0.7642 0 0 0.9835 95.76 426.72 Tm 3 Tr /F4 10 Tf -0.0229 Tc 0 Tw (Katzman,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 131.52 426.72 Tm 0.0182 Tc 0.2488 Tw ( R., Brown, ) Tj ET q 8.64 0 0 -7.92 181.44 433.68 cm BI /W 52 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ``` EI Q BT 0.6793 0 0 0.9835 181.44 426.72 Tm 3 Tr 0.0429 Tc 0 Tw (T,,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 190.08 426.72 Tm 0.0088 Tc 0.0798 Tw ( Thai, L.J., ) Tj ET BT 0.8919 0 0 0.9835 238.32 426.72 Tm /F2 10 Tf -0.013 Tc -0.0652 Tw (et al., ) Tj ET BT 0.8915 0 0 0.9835 260.16 426.72 Tm /F4 10 Tf 0.0359 Tc 0 Tw (\221Compar-) Tj ET BT 0.8919 0 0 0.9835 96.48 416.4 Tm /F2 10 Tf 0.0016 Tc 0.1875 Tw (ison of ) Tj ET BT 0.8915 0 0 0.9835 124.32 416.4 Tm /F4 10 Tf 0.03 Tc 1.2226 Tw (Rate of Annual Change of Mental Status) Tj ET BT 0.8066 0 0 0.9835 96.48 405.36 Tm 0.0382 Tc 1.4638 Tw (Score in Four Independent Studies of Patients With) Tj ET BT 0.8491 0 0 0.9835 96.48 394.56 Tm 0.0146 Tc 3.4195 Tw (Alzheimer\222sDisease, \222\222Annals) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 62.88 0 0 -9.36 217.68 401.52 cm BI /W 386 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?|x<xx|x|8x <|<<?|~~????>?~?~??>~~?߀??>??>??|<?1>|?< /?x>>?<x8~<~<~~>~~8|??>|????|~?~?>~?~|?|>?~|~~>>??~<??>?~?<???~|<~~<|?>~_~x~~?8~???>??~~~~???>?> >π<߀`?p?x|8|||><~??>~??|?<8 | 0 EI Q BT 0.8066 0 0 0.9835 217.68 394.56 Tm 3 Tr 0.0235 Tc 0 Tw (ofNeurolo~24\(3\)) Tj 0 Tr ET BT 0.8491 0 0 0.9835 280.56 394.56 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 16.8 0 0 -9.36 282.72 401.76 cm BI /W 104 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?88?|?>?8?x|<?pxx<>~~|? EI Q BT 0.7217 0 0 0.9835 282.72 394.56 Tm 3 Tr 0.0282 Tc 0 Tw (:384-) Tj 0 Tr ET BT 0.8491 0 0 0.9835 96.48 383.28 Tm 0.0797 Tc 1.0816 Tw (389, 1988.) Tj ET q 28.56 0 0 -8.64 96.48 378.96 cm BI /W 159 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||< 8x????xx|<< ??~~~|||<?>>?|~8?????? EI Q BT 0.8066 0 0 0.9835 96.48 372 Tm 3 Tr 0.0219 Tc 0 Tw (Keeler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 125.04 372 Tm -0.0075 Tc 0.8053 Tw ( E.B., Kane, R.L., and Solomon, D.H.,) Tj ET BT 0.934 0 0 0.9835 97.2 360.96 Tm -0.0176 Tc 2.1194 Tw (\223Short- and Long-Term Residents of Nursing) Tj ET BT 0.9835 0 0 0.9835 96.48 350.16 Tm 0.0023 Tc -0.0995 Tw (Homes,\224 ) Tj 41.7301 0 TD /F5 10 Tf -0.008 Tc 0.0691 Tw (Medical Care ) Tj ET q 46.8 0 0 -8.64 194.88 357.12 cm BI /W 261 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08??????>>?~||?<>???????~??~~?~8~~~~|~~~~>?>?0><~~<?|~~?~?????p EI Q BT 0.8971 0 0 0.9835 194.88 350.16 Tm 3 Tr 0.0278 Tc 0 Tw (19:363-369,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 241.68 350.16 Tm 0.0854 Tc 0.0962 Tw ( 1981.) Tj -147.6416 -11.7137 TD /F2 10 Tf 0.0022 Tc 0.39 Tw (Kemper, P., and Murtaugh, C.M., \223Lifetime Use of) Tj 0.244 -11.2256 TD 0.0263 Tc 3.4508 Tw (Nursing Home Care,\224) Tj 100.0546 -0.4881 TD 0.0481 Tc -0.1099 Tw (New ) Tj 23.1834 0 TD /F5 10 Tf 0.0549 Tc 3.1776 Tw (England Journal of) Tj -123.482 -10.7376 TD -0.0171 Tc -0.0436 Tw (Medicine ) Tj ET q 64.56 0 0 -8.88 136.08 324 cm BI /W 359 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<?x|<>>|x~| ?@||??||~~~?|?|8~~>?<~>~?>?>~>|x>??~?|<8>??|?|?~??|?~?~?~~?~?~߀?????????x??~|>>|>?><>~~~~~|~|~??|~???@?~?~>?~~?|?~x?>x?~>?~?~???<??x? ` EI Q BT 0.9444 0 0 0.9835 136.08 316.56 Tm 3 Tr 0.0488 Tc 0 Tw (324\(9\):595-600,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 200.64 316.56 Tm 0.0854 Tc 0.0962 Tw ( 1991.) Tj -105.9115 -11.7137 TD /F2 10 Tf -0.0034 Tc -0.0575 Tw (Keyes, B., Executive Director, ) Tj ET q 48.72 0 0 -7.2 219.12 312.24 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x????|? ?~~?|?~~x?>?~~8?~~|?8<?~?<x<?>x??x?????~???x?0 ?|?<??~?8?|~?~|<|?8` EI Q BT 0.9835 0 0 0.9835 219.12 305.04 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0259 Tc -0.0874 Tw ( Associ-) Tj -173.5093 -11.2256 TD 0.0091 Tc 2.7971 Tw (ation, Southeastern Wisconsin Chapter, Milwau-) Tj -0.244 -10.9816 TD 0.0334 Tc 0.1897 Tw (kee, WI, personal communication, Nov. 30, 1990.) Tj -0.4881 -11.9577 TD -0.0012 Tc 1.6484 Tw (Knoefel, J.E.,) Tj 61.0089 -0.244 TD 0.0451 Tc 1.3573 Tw (\223A Comparison of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42 0 0 -7.2 236.4 278.16 cm BI /W 234 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x??????????~???~x??~~?~?>?~|??~|???~>?~ <|??x?x?00 EI Q BT 0.9835 0 0 0.9835 236.4 271.2 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.7062 0 TD -0.0249 Tc 1.1845 Tw ( Care) Tj -184.491 -11.2256 TD 0.0031 Tc 3.8404 Tw (Units: Veterans Administration, State, and Pri-) Tj 0.244 -10.9816 TD 0.3982 Tc 0 Tw (vate,\222) Tj 29.0402 0 TD 0.0288 Tc -0.0903 Tw (unpublished manuscript, Veterans Adminis-) Tj -29.0402 -11.2256 TD -0.0082 Tc 0.5574 Tw (tration Medical Center, Boston, MA, no date.) Tj -0.244 -11.7137 TD 0.0044 Tc 1.9356 Tw (Krauss, R., Principal, Arrowstreet Inc. Architects) Tj 0.4881 -11.4697 TD 0.0196 Tc 0.4071 Tw (and Planners, Somerville, MA, personal communi-) Tj 0 -10.9816 TD 0.0371 Tc 0.1453 Tw (cation, June 22, 1990.) Tj -0.4881 -11.7137 TD 0.0419 Tc 1.93 Tw (Kromm, D., and Kromm,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 19.68 0 0 -8.16 207.84 200.16 cm BI /W 110 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx<0< x??>?~~?<~0888<8<8<88888?8?8?89<?<?<|?<>?<?<?<~?0 EI Q BT 0.8919 0 0 0.9835 207.84 193.2 Tm 3 Tr -0.0315 Tc 0 Tw (Y.N.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 227.52 193.2 Tm 0.0411 Tc 1.6054 Tw ( \223A Nursing Unit) Tj -132.2673 -10.9816 TD 0.0518 Tc -0.1137 Tw (Designed for ) Tj ET q 48.96 0 0 -7.2 151.68 189.6 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <a 8?????>?????~?<?~???~?p?~0?~~?~~??~~?~???~?~>?~ >?~ >??~???>?>??<?|?~??p?x<>~?>?<?>|0  EI Q BT 0.9835 0 0 0.9835 151.68 182.4 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0119 Tc 0.0121 Tw ( Disease Patients at New-) Tj ET BT 0.9388 0 0 0.9835 97.2 171.36 Tm 0.0251 Tc 1.4343 Tw (ton Presbyterian Manor,\222) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 198.48 171.36 Tm /F5 10 Tf -0.0008 Tc 2.5823 Tw (Nursing Homes 34\(3\):30-) Tj -106.4829 -10.9816 TD 0.0703 Tc 0.7281 Tw (31, 1985.) Tj ET BT 0.9835 0 0 0.9835 97.2 149.04 Tm /F2 10 Tf -0.002 Tc 0.5816 Tw (Kumar, V., Peterson, K., Kumar, N., et al., \223Meas-) Tj 0.4881 -11.2256 TD 0.0293 Tc 0.1532 Tw (uring Cognitive and Behavior Changes in ) Tj ET q 34.8 0 0 -7.2 266.4 145.2 cm BI /W 194 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????????|??~?~?~?~????~?~??????0< ??? EI Q BT 0.9388 0 0 0.9835 266.4 138 Tm 3 Tr -0.0076 Tc 0 Tw (Commu-) Tj 0 Tr ET q 53.52 0 0 -9.6 97.68 134.16 cm BI /W 298 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~>> `?????p?????????x?????8????????????翼???~???|????|?????|?????~?????~?????~?????~????????????~?|??????????? ??????????|??<???????~???~??>|?<|0 EI Q BT 0.9835 0 0 0.9835 97.68 126.72 Tm 3 Tr 0.0122 Tc (nityDwelling) Tj 0 Tr 54.4199 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -8.16 153.6 133.68 cm BI /W 272 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0|????|???>?>????8???<??p??0 ???~????~?|?<?<??~|<<?>|?>??|<?>?>??<?~~|<~<?> EI Q BT 0.9835 0 0 0.9835 153.6 126.72 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0245 Tc 0.5333 Tw ( Disease Patients, ) Tj ET q 24.96 0 0 -6.96 276.24 133.44 cm BI /W 139 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |`???~>#~>~?~|?~??~??|??>????????{??@ EI Q BT 0.8971 0 0 0.9835 276.24 126.72 Tm 3 Tr /F5 10 Tf 0.0063 Tc 0 Tw (Ameri-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 97.92 115.92 Tm 0.0477 Tc 3.551 Tw (can Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -6.96 168.96 122.64 cm BI /W 265 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????|?>a| ?3A>|x><?|~~|>~~??~?|????|?~?~p~?>?~8>???><??>?????|?~{~>?>?>?x<<~~~?~| EI Q BT 0.9835 0 0 0.9835 168.96 115.92 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.2483 Tc 3.0217 Tw ( Care and Related) Tj -121.0417 -10.7376 TD 0.0358 Tc 2.0989 Tw (Disorders and Research) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.4 0 0 -8.64 202.56 112.56 cm BI /W 247 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8xx<>@>x?>|??|<?|>>x>~~88p~|~<~<~<~>~>?~>?~?~~~>~~~0?~|~~?~~~~|>x|~>0><|~>>~|>~`~px>???~|x>|<80?8 EI Q BT 0.9444 0 0 0.9835 202.56 105.36 Tm 3 Tr 0.0374 Tc 0 Tw (4\(1\):13-18,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 246.96 105.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -7.2 249.36 112.56 cm BI /W 115 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p| ??>????????~????~~~~~G~|?>??p EI Q BT 0.8971 0 0 0.9835 249.36 105.36 Tm 3 Tr 0.0456 Tc 0 Tw (1989.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 97.2 93.84 Tm 0.0052 Tc -0.0663 Tw (Lair, ) Tj 22.2072 0 TD /F2 10 Tf 0.0071 Tc 0.1758 Tw (T. J., Service Fellow, Agency for Health Care) Tj -21.4751 -10.9816 TD 0.0016 Tc 1.5643 Tw (Policy and Research, Public Health Service, U.S.) Tj 0 -10.9816 TD 0.0203 Tc 0.5691 Tw (Department of Health and Human Services, ) Tj ET q 23.76 0 0 -6.96 277.68 79.2 cm BI /W 133 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????C~|~>???~~?~~|||>>>|π|~?|p? EI Q BT 0.9388 0 0 0.9835 277.68 72.24 Tm 3 Tr 0.0176 Tc 0 Tw (Rock-) Tj 0 Tr ET q 20.16 0 0 -8.16 97.92 68.4 cm BI /W 112 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?? ?~@xx?~<~<~?~??~??~???????????????>~>< EI Q BT 0.9835 0 0 0.9835 97.92 61.44 Tm 3 Tr -0.0467 Tc (ville,) Tj 0 Tr 20.499 0 TD 0.0266 Tc 0.278 Tw ( MD, personal communication, Jan. 31, 1991.) Tj ET BT 0.9388 0 0 0.9835 97.44 49.92 Tm 0.0197 Tc 0.3749 Tw (Lair, T.J., and ) Tj ET q 42.24 0 0 -8.16 154.56 56.88 cm BI /W 237 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88| ?<??>??>??>?~~?~~?????~y??|???~?????~?x |?x0>x8~||~????????<?  EI Q BT 0.9388 0 0 0.9835 154.56 49.92 Tm 3 Tr 0.0091 Tc 0 Tw (Lefkowitz,) Tj 0 Tr 44.9928 0 TD 0.002 Tc 0.7687 Tw ( D. C., \223Mental Health and) Tj ET BT 0.9835 0 0 0.9835 97.92 39.36 Tm 0.0268 Tc 3.5722 Tw (Functional Status of Residents of Nursing and) Tj ET BT 0.8971 0 0 0.9835 322.8 593.52 Tm /F5 10 Tf 0.2375 Tc 0 Tw (238.) Tj 0.535 -45.3906 TD 0.2375 Tc (239.) Tj 0.535 -56.3722 TD 0.2375 Tc (240.) Tj 0.2675 -56.3722 TD 0.2375 Tc (241.) Tj 0.535 -67.5979 TD 0.2375 Tc (242.) Tj 0.2675 -56.8603 TD 0.2375 Tc (243.) Tj 0.535 -79.3116 TD 0.0369 Tc (244.) Tj 0.2675 -56.6163 TD 0.2375 Tc (245.) Tj 0.2675 -33.921 TD 0.0369 Tc (246.) Tj 0.2675 -67.3538 TD 0.2375 Tc (247.) Tj ET BT 0.9835 0 0 0.9835 345.6 649.2 Tm /F2 10 Tf 0.0053 Tc 0.1776 Tw (Personal Care Homes,\224 National Medical Expendi-) Tj 0 -11.2256 TD 0.0314 Tc 0.4358 Tw (ture Survey Research Findings, Agency for Health) Tj T* -0.0014 Tc 1.4453 Tw (Care Policy and Research, Public Health Service,) Tj T* 0.0665 Tc 1.4576 Tw (DHHS Pub. No.) Tj 0 Tc -0.061 Tw ( ) Tj ET q 24.24 0 0 -8.64 417.36 623.28 cm BI /W 135 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|>?<????>??>?~>~~~|||||x|~x0?|||~|?~~??||???ǀp EI Q BT 0.9388 0 0 0.9835 417.36 616.08 Tm 3 Tr 0.0078 Tc 0 Tw (\(PHS\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 441.6 616.08 Tm 0.0944 Tc 1.3072 Tw ( 90-3470,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.04 0 0 -8.16 485.28 623.04 cm BI /W 228 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x??`0|?x??????????>?|~?<?????????????<?~~~?|>~~>?|x|???? EI Q BT 0.9835 0 0 0.9835 485.28 616.08 Tm 3 Tr -0.0415 Tc 0 Tw (Roclwille,) Tj 0 Tr 41.7301 0 TD -0.0245 Tc 1.4281 Tw ( MD,) Tj ET BT 0.9388 0 0 0.9835 345.6 605.04 Tm 0.0281 Tc 2.8371 Tw (September 1990.) Tj ET q 28.08 0 0 -8.16 345.6 600.48 cm BI /W 157 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0y?????????????~?>??????~?????????????<~|??>??????>?>0 EI Q BT 1.1266 0 0 0.9835 345.6 593.28 Tm 3 Tr 0.0205 Tc 0 Tw (L&in,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 373.68 593.28 Tm -0.0124 Tc 2.758 Tw ( J., Rheaume,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 10.32 0 0 -8.64 437.52 600.48 cm BI /W 58 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08<>????|>>? EI Q BT 0.9835 0 0 0.9835 437.52 593.28 Tm 3 Tr 0.018 Tc 0 Tw (Y,) Tj 0 Tr 10.4935 0 TD -0.0362 Tc 2.6602 Tw ( Seltzer, B., et al., \223An) Tj -103.9592 -11.2256 TD 0.0224 Tc 4.1868 Tw (In-Hospital Respite Program for Alzheirner\222s,\224) Tj 0 -11.2256 TD /F5 10 Tf 0.0307 Tc -0.0923 Tw (American Journal of ) Tj ET q 47.76 0 0 -7.2 430.08 578.4 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >7p<>?????|x|<>s~|~>~#|~?~|x?>8??~~~~????~?~?~??|p~???~x?~|?>>??|?@|?~~~???|<>>~~?? ~8 EI Q BT 0.9835 0 0 0.9835 430.08 571.2 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0217 Tc -0.0831 Tw ( Care and Related) Tj -134.4636 -10.9816 TD 0.0358 Tc 0.2279 Tw (Disorders and Research ) Tj ET q 44.64 0 0 -8.88 445.68 567.6 cm BI /W 249 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>px<?<??~~?||~?>?<|?~~|8?<x|||?<>|<?>|?>|?>|??~~?~~????|?>???~????>~?x?~?~?~~?~~~>|?|x??| ??@?|x>|???~?>?>x?~pp  EI Q BT 0.9444 0 0 0.9835 445.68 560.4 Tm 3 Tr 0.0374 Tc 0 Tw (3\(3\):26-30,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 490.32 560.4 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj -147.1535 -11.7137 TD /F2 10 Tf 0.0022 Tc 0.4248 Tw (Lavizzo-Mourey, R. J.,) Tj 99.8106 0 TD 0.0062 Tc 3.1051 Tw (Zinn, J., and Taylor, L.,) Tj -98.8344 -10.9816 TD 0.0153 Tc 0.0861 Tw (\223Ability of Surrogates To Represent Satisfaction of) Tj -0.7321 -11.4697 TD 0.0139 Tc 1.8771 Tw (Nursing Home Residents With Quality of Care,\224) Tj ET BT 0.9444 0 0 0.9835 345.84 515.76 Tm /F5 10 Tf -0.0106 Tc 1.5762 Tw (Journal of the American Geriatrics Society40\(l\):39-) Tj 0.2541 -10.7376 TD 0.0703 Tc 0.7281 Tw (47, 1992.) Tj ET BT 0.9835 0 0 0.9835 345.84 493.44 Tm /F2 10 Tf -0.0102 Tc 2.1457 Tw (Lawton, M.P.,) Tj 65.4016 0 TD 0.0234 Tc 3.0876 Tw (\223Psychosocial and Environmental) Tj -64.9135 -10.9816 TD 0.0132 Tc 2.3659 Tw (Approaches to the Care of Senile Dementia Pa-) Tj 0 -11.4697 TD -0.0397 Tc -0.0206 Tw (tients,\224 ) Tj 30.7485 0 TD /F5 10 Tf 0.0301 Tc -0.0916 Tw (Psychopathology in the Aged, ) Tj ET q 15.36 0 0 -7.2 497.04 478.32 cm BI /W 86 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~??|~~~????? EI Q BT 0.9388 0 0 0.9835 497.04 471.36 Tm 3 Tr /F2 10 Tf -0.0034 Tc 0 Tw (J.O.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 512.4 471.36 Tm 0.0121 Tc -0.0733 Tw ( Cole and) Tj ET q 14.4 0 0 -7.2 346.32 467.52 cm BI /W 80 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~~~><~x~x~<<~ EI Q BT 0.9388 0 0 0.9835 346.32 460.32 Tm 3 Tr 0.0187 Tc 0 Tw (J.E.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 360.72 460.32 Tm -0.0299 Tc 1.1896 Tw ( Barrett) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 395.28 467.52 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x~>?|??|?~>?~~?<?~??~~???~|~??~|~?~|~?~||~|?~|??~`????|?? ~|??~|?~|~~~~|>>>?????>>|?x` EI Q BT 0.9388 0 0 0.9835 395.28 460.32 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 416.88 460.32 Tm 0.0347 Tc 2.0024 Tw ( \(New York, NY: Raven Press,) Tj ET BT 0.8919 0 0 0.9835 347.52 449.76 Tm 0.0426 Tc 0 Tw (1980\).) Tj ET BT 0.9835 0 0 0.9835 347.04 438 Tm 0.0162 Tc 0.0852 Tw (Lawton, M.P., \223Sensory Deprivation and the Effect) Tj 0 -10.9816 TD 0.0209 Tc 0.7544 Tw (of the Environment on Management of the Patient) Tj 0 -11.4697 TD -0.0167 Tc 2.6403 Tw (With Senile Dementia,\224) Tj 0 Tc -0.061 Tw ( ) Tj 106.1555 0 TD /F5 10 Tf -0.0186 Tc 2.1542 Tw (Clinical Aspects of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.08 0 0 -7.2 534.24 422.88 cm BI /W 90 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @||< x<?|~?~?~>?p?x?|??? EI Q BT 0.9835 0 0 0.9835 534.24 415.92 Tm 3 Tr -0.0031 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.08 0 0 -7.2 347.04 412.08 cm BI /W 191 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p~x~~|~~><~?~????||||~|>?~>?>~?>|??~ ~~|~|>~~|??~>~??~>?|@ EI Q BT 0.9444 0 0 0.9835 347.04 405.12 Tm 3 Tr -0.0555 Tc (heimer\222s) Tj 0 Tr 36.0873 0 TD -0.0208 Tc 0.8246 Tw ( Disease and Senile Dementia ) Tj ET BT 0.9388 0 0 0.9835 501.12 405.12 Tm /F2 10 Tf 0.0488 Tc 0.0031 Tw (\(Aging, ) Tj ET q 15.6 0 0 -7.2 534 412.08 cm BI /W 89 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>??|?<?>@` EI Q BT 0.8449 0 0 0.9835 534 405.12 Tm 3 Tr 0.0244 Tc 0 Tw (Vol.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 347.76 394.08 Tm 0.0669 Tc -0.129 Tw (15\), ) Tj ET q 17.76 0 0 -7.2 366.24 401.28 cm BI /W 99 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 3A???` <??? EI Q BT 0.9388 0 0 0.9835 366.24 394.08 Tm 3 Tr 0.0165 Tc 0 Tw (N.E.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 384 394.08 Tm -0.0191 Tc 0.1211 Tw ( Miller and ) Tj ET q 18.48 0 0 -7.2 430.56 401.28 cm BI /W 103 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|??????x????????????????????????`????????????? EI Q BT 0.9388 0 0 0.9835 430.56 394.08 Tm 3 Tr -0.0055 Tc 0 Tw (G.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 449.04 394.08 Tm 0.0463 Tc 0.0139 Tw ( Cohen ) Tj ET q 21.6 0 0 -8.88 480.24 401.52 cm BI /W 120 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|<>0@>>>~~??`~~?~~??>~?>~~?>|~??|~??~??~????????|??|?>|>~?~~?~|~??|??|?>>|?x` EI Q BT 0.9388 0 0 0.9835 480.24 394.08 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 501.84 394.08 Tm 0.0572 Tc -0.1192 Tw ( \(New ) Tj ET q 21.36 0 0 -8.64 528.96 401.28 cm BI /W 119 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<<~@@x ??h???????>|~>?????? EI Q BT 0.8919 0 0 0.9835 528.96 394.08 Tm 3 Tr 0.0132 Tc 0 Tw (Yorlq) Tj 0 Tr ET BT 0.9835 0 0 0.9835 347.04 383.28 Tm 0.0358 Tc 0.1466 Tw (NY: Raven Press, 1981\).) Tj 0 -12.2018 TD 0.0033 Tc 0.4847 Tw (Lawton, M.P., \223Competence, Environmental Press,) Tj ET BT 0.9388 0 0 0.9835 347.28 360.24 Tm 0.0218 Tc 0.8839 Tw (and the Adaptation of Older People,\222 ) Tj ET BT 0.9444 0 0 0.9835 495.12 360.24 Tm /F5 10 Tf 0.0414 Tc 1.0129 Tw (Aging and the) Tj ET BT 0.9835 0 0 0.9835 347.04 349.44 Tm 0.255 Tc 0 Tw (Environment:) Tj 67.1098 0 TD 0.5085 Tc 3.3265 Tw (Theoretical Approaches,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 19.44 0 0 -7.2 530.88 356.16 cm BI /W 109 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?? ???<>???????? EI Q BT 0.9835 0 0 0.9835 530.88 349.44 Tm 3 Tr /F2 10 Tf -0.0455 Tc 0 Tw (M.P.) Tj 0 Tr -186.9313 -10.9816 TD 0.0172 Tc -0.0785 Tw (Lawton, ) Tj ET q 17.04 0 0 -6.96 382.08 345.36 cm BI /W 95 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??????p?????????>?~ EI Q BT 0.9388 0 0 0.9835 382.08 338.64 Tm 3 Tr 0.0263 Tc 0 Tw (P.G.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 399.12 338.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 36.48 0 0 -9.36 401.52 345.84 cm BI /W 203 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  `p`8<??|?|?~?~???????????|~~>?x?x~}|<<>8?|\x0 EI Q BT 0.9835 0 0 0.9835 401.52 338.64 Tm 3 Tr 0.0166 Tc 0 Tw (Windley,) Tj 0 Tr 37.0934 0 TD 0.0647 Tc -0.1268 Tw ( and ) Tj ET q 16.56 0 0 -7.2 457.2 345.36 cm BI /W 92 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????????@? EI Q BT 0.8919 0 0 0.9835 457.2 338.64 Tm 3 Tr -0.0109 Tc 0 Tw (T.O.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 473.76 338.64 Tm -0.0021 Tc -0.0589 Tw ( Byerts ) Tj ET q 21.6 0 0 -8.64 504.24 345.6 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|>>|?|~?~?>>?>???>?@?>????~?~~??~?|?|~>~>?>?~???????x|<|? EI Q BT 0.9388 0 0 0.9835 504.24 338.64 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 525.84 338.64 Tm 0.0572 Tc -0.1192 Tw ( \(New) Tj -181.3185 -11.2256 TD 0.0474 Tc -0.1092 Tw (York, NY: Springer Publishing Co., 1982\).) 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Tj -20.499 -11.9577 TD 0.0239 Tc 0.5247 Tw (Lawton, M.P., Remarks to the Speakers Workshop) Tj 0.4881 -11.4697 TD 0.0234 Tc 0.2987 Tw (on Evaluating Special Care Units sponsored by the) Tj ET q 48.72 0 0 -7.2 348 222.72 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |????x????|x?|?8?|? ?~??~?~~?~~??~~?~?~?~~~?~~?~~??~~??~~ `?~px`?~pxp??p8x~?|<???8`|`>~~??x?x?|?`?p` EI Q BT 0.9388 0 0 0.9835 348 215.52 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 396.72 215.52 Tm 0.0039 Tc 0.4841 Tw ( Disease Research Center, Washington) Tj ET BT 0.9388 0 0 0.9835 347.76 204.72 Tm 0.0256 Tc 1.0503 Tw (University School of Medicine, St. Louis, MO, Oct.) Tj 0.2556 -11.4697 TD 0.0944 Tc 0.7215 Tw (9, 1990.) Tj ET BT 0.9835 0 0 0.9835 347.76 181.92 Tm -0.0102 Tc 3.1218 Tw (Lawton, M.P.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 40.08 0 0 -8.16 413.04 188.88 cm BI /W 223 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<>~x??????>~>~?p~??~?~??~??~?>~?>~?~`~~~~~?~?~?~?~?~??~?~??~?~??s??``>8 EI Q BT 0.9388 0 0 0.9835 413.04 181.92 Tm 3 Tr 0.0056 Tc 0 Tw (Fulcomer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 453.12 181.92 Tm -0.0063 Tc 1.1655 Tw ( M., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.96 0 0 -8.16 492 188.88 cm BI /W 172 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?~??|??~~~?p?>>?|?~~?>??| EI Q BT 0.9835 0 0 0.9835 492 181.92 Tm 3 Tr 0.0119 Tc 0 Tw (Kleban,) Tj 0 Tr 31.4806 0 TD -0.0391 Tc 2.6632 Tw ( M.H.,) Tj -177.4139 -10.9816 TD 0.0041 Tc 1.3014 Tw (\223Architecture for the Mentally Impaired Elderly,\224) Tj -0.7321 -10.9816 TD /F5 10 Tf 0.0375 Tc 1.365 Tw (Environment and Behavior) Tj 0 Tc -0.061 Tw ( ) Tj ET q 58.8 0 0 -8.64 461.76 167.28 cm BI /W 327 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` xx>x<><| x`|?||~|?~~|?~~>>~~~8?|??~?@|`???x>??|>~??|?~?|?~?|~?|?~???~???~???~??~?|??|??>??>?~>???~????~?x?|?||?|x`|>?`>@||p?p|~xx|>p?|~x??>????????>~|?p?x8??p<0 EI Q BT 0.9444 0 0 0.9835 461.76 160.32 Tm 3 Tr 0.0466 Tc 0 Tw (16\(6\):730-757,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 520.56 160.32 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -7.2 522.96 167.28 cm BI /W 115 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~?????x??|?>???????~????? 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EI Q BT 0.9835 0 0 0.9835 233.28 684.24 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.2884 Tw ( and Other ) Tj ET q 42.48 0 0 -7.2 328.08 691.2 cm BI /W 236 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |x?|||~~?~??~????<??>? ?<~g?<~|<|~~|>~~?~~???~???>??~~~|>~??>>???0>?|p?>p~?p??????|<??<???p? EI Q BT 0.9835 0 0 0.9835 328.08 684.24 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8919 0 0 0.9835 60.96 622.56 Tm /F2 10 Tf 0.2641 Tc (248.) Tj 0.8073 -57.8364 TD 0.2641 Tc (249.) Tj 0.8073 -80.0437 TD 0.2641 Tc (250.) Tj 0.5382 -34.8971 TD 0.2641 Tc (251.) Tj 0.8073 -78.8235 TD 0.2641 Tc (252.) Tj 0.5382 -46.6108 TD 0.2641 Tc (253.) Tj 0.5382 -46.3668 TD 0.2641 Tc (254.) Tj 0.2691 -69.0621 TD 0.2641 Tc (255.) Tj 0.8073 -57.5924 TD 0.2641 Tc (256.) Tj 0.5382 -79.5556 TD 0.2641 Tc (257.) Tj 0.2691 -34.8971 TD 0.2641 Tc (258.) Tj ET q 1.44 0 0 -6.72 83.52 652.8 cm BI /W 8 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? 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EI Q BT 0.8971 0 0 0.9835 167.76 578.16 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET q 21.12 0 0 -8.16 84.96 572.16 cm BI /W 118 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~~????~?~?~?~?~~~???? 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Tj ET q 45.36 0 0 -8.16 84.96 459.6 cm BI /W 253 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>>??? 00?xπx??|??~???~<?~??~?~?~?~?~?~?~8?~8??~x??~|??~|??~|~x>>x>?|>x?88|@?? EI Q BT 1.0796 0 0 0.9835 84.96 452.64 Tm 3 Tr /F2 10 Tf 0.0288 Tc 0 Tw (hwin/ICF,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 130.32 452.64 Tm -0.0056 Tc 1.8481 Tw ( and James Bell Associates, \223Descrip-) Tj -45.3906 -10.9816 TD 0.0386 Tc 1.7706 Tw (tions of and Supplemental Information on Board) Tj 0.7321 -10.9816 TD 0.0338 Tc 2.833 Tw (and Care Homes Included) Tj 0 Tc -0.061 Tw ( ) Tj ET q 7.44 0 0 -6.96 203.52 438 cm BI /W 42 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~?~?~?~?~?~?~?~?~?~?~?~?~?~?~?~ EI Q BT 0.9388 0 0 0.9835 203.52 431.04 Tm 3 Tr 0.0703 Tc 0 Tw (in) Tj 0 Tr ET BT 0.9835 0 0 0.9835 210.96 431.04 Tm 0.0215 Tc 1.9304 Tw ( the Update of the) Tj -126.6545 -10.9816 TD 0.0335 Tc 1.906 Tw (National Health Provider Inventory,\224 report sub-) Tj 0 -10.7376 TD 0.0126 Tc 1.0068 Tw (mitted to the Assistant Secretary for Planning and) Tj 0 -10.9816 TD 0.0194 Tc 0.2039 Tw (Evaluation, U.S. Department of Health and Human) Tj 0 -11.2256 TD 0.0315 Tc 0.1022 Tw (Services, Washington, DC, Aug. 8, 1990.) Tj 0 -12.9339 TD 0.0157 Tc 2.4854 Tw (Lichtenberg, P.A., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 36.48 0 0 -9.36 185.76 382.08 cm BI /W 203 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?0? 89?????8~???|?x?<?~q~!p~`|?|~~|?~|?~~_~0<?<<8><>????????>?~~>? ???π EI Q BT 0.9388 0 0 0.9835 185.76 375.12 Tm 3 Tr 0.0076 Tc 0 Tw (Strzepek,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 222.24 375.12 Tm -0.0049 Tc 2.6284 Tw ( D.M., \223Assess-) Tj -138.1242 -11.2256 TD -0.0048 Tc 0.0903 Tw (ments of Jnstitutionalized Dementia Patients\222 ) Tj ET q 21.84 0 0 -7.2 268.08 371.28 cm BI /W 122 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????????>??|?|?~?~????~????????? EI Q BT 0.9388 0 0 0.9835 268.08 364.08 Tm 3 Tr -0.0101 Tc 0 Tw (Com-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 86.4 353.04 Tm -0.0142 Tc 0.1974 Tw (petencies To Participate in Intimate Relationships,\224) Tj 0.4881 -11.4697 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.28 0 0 -8.88 144.72 348.96 cm BI /W 330 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|8<x<>?0????>??>??|???||???0| ~~|~|~|~|~~~|?x~|?<~~?>~>?>?~~~?~?~?~|?|~~>~>@>?|x~??????|?<?>  EI Q BT 0.9444 0 0 0.9835 144.72 341.76 Tm 3 Tr 0.0466 Tc 0 Tw (30\(1\):117-120,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 204 341.76 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj -119.5775 -12.6899 TD /F2 10 Tf -0.0051 Tc 2.4252 Tw (Liebowitz, B., Lawton, M.P., and Waldman, A.,) Tj 1.2202 -11.2256 TD 0.0348 Tc 0.0988 Tw (\221\221Evaluation: Designing for Confused Elderly Peo-) Tj -0.4881 -10.9816 TD 0.0028 Tc 0.7496 Tw (ple: Lessons From the Weiss Institute,\224 ) Tj 165.9442 0 TD /F5 10 Tf 0.018 Tc 0 Tw (American) Tj -166.4323 -11.2256 TD -0.0009 Tc 0.489 Tw (Institute of Architects Journal ) Tj ET q 49.2 0 0 -8.88 209.52 303.6 cm BI /W 274 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <|8<>x<<>?>?>??>?<????|<??~|??|??~~~>~~?~p~|?~?<??????????~?~~???<~||~||>~?>|~><?>|~>?>~|??~|?x~?xx~~|<>~?>>??~?|?x?8<`8 EI Q BT 0.9444 0 0 0.9835 209.52 296.4 Tm 3 Tr 0.0409 Tc 0 Tw (68\(2\):59-61,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 258.72 296.4 Tm 0.0854 Tc 0.3402 Tw ( 1979.) Tj -174.9736 -12.9339 TD /F2 10 Tf 0.0094 Tc -0.0706 Tw (Lindeman, D. A.,) Tj 75.651 -0.244 TD 0.0011 Tc 2.6223 Tw (\223State Regulations for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.68 0 0 -9.12 258.96 290.4 cm BI /W 177 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~~~~~~?9?><?~~|>?~|?~>~>??~???~?~?~??@?~?>?~?>?~?>?~?>?~?>~?<~~?>~~???p???????@ EI Q BT 0.9388 0 0 0.9835 258.96 283.44 Tm 3 Tr -0.0082 Tc 0 Tw (Special-) Tj 0 Tr -182.2719 -10.7376 TD -0.0155 Tc 1.2646 Tw (izedAlzheimer\222s Disease Nursing Homes or Units, \222) Tj ET BT 0.9835 0 0 0.9835 87.84 261.84 Tm 0.0271 Tc 1.3146 Tw (unpublished summary listing, Northern California) Tj ET q 48.72 0 0 -7.2 87.84 258.24 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?Lϴ>x??????<?|~??~~>???~~? ?~8???~?~??~?~??~??~??~???~8`??~8?x?xxx??|<??><?>???9?|?? |`p?x?<?<?~???`p EI Q BT 0.9388 0 0 0.9835 87.84 251.04 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 136.56 251.04 Tm 0.0062 Tc 0.3719 Tw ( Disease Center, University of Califor-) Tj -49.5392 -10.9816 TD -0.0215 Tc -0.0392 Tw (nia, ) Tj ET q 56.88 0 0 -8.16 106.8 247.2 cm BI /W 316 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~~>??x>?~????????<?<?? ???8??<???<????|p?|?|??<| |?<|>?<|???>???>????>?<???????<??~~??>P EI Q BT 0.9835 0 0 0.9835 106.8 240.24 Tm 3 Tr 0.0138 Tc 0 Tw (Davis/Herrick) Tj 0 Tr 57.8364 0 TD -0.0002 Tc 3.7827 Tw ( Hospital and Health Center,) Tj -77.1153 -11.4697 TD 0.0397 Tc 0.0612 Tw (Davis, CA, November 1990.) Tj ET BT 0.9388 0 0 0.9835 87.84 215.76 Tm 0.0075 Tc 1.3764 Tw (Lindeman, D. A., Administrative Director, Northern) Tj ET BT 0.9835 0 0 0.9835 88.08 204.96 Tm -0.0063 Tc -0.0547 Tw (California ) Tj ET q 48.96 0 0 -7.2 131.28 211.92 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?????~~???>?????<?~?p??  ???????|???<?>?>0>|8?~|x?~>?<|???<?????> C?h~? ??>?????~??????x?????8????8????~x???|?>?<?>??>?>???~???~????? ??|??||?|?>?<|???x~>?????>????~??` ?~x?~? ?~8???~???~`??~??~??~??~?~?~??~x?|??~?|?~?0|`?~?8<p?~??8<p???πx|??|x?>??????<? ?x?x?<??xx?0 EI Q BT 0.9835 0 0 0.9835 147.12 137.28 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0173 Tc 1.8275 Tw ( Disease in Specialized) Tj -109.328 -11.4697 TD 0.0143 Tc 2.7308 Tw (Versus Non-Specialized Long-Term Care Facili-) Tj 0.244 -11.2256 TD 0.372 Tc 0 Tw (ties,\222) Tj 29.2843 0.244 TD 0.0119 Tc 3.506 Tw (presented at the Annual Meeting of the) Tj -29.2843 -11.2256 TD 0.0231 Tc 2.6405 Tw (American Society on Aging, New Orleans, LA,) Tj 0 -10.9816 TD -0.034 Tc -0.0265 Tw (Mar. ) Tj ET q 11.28 0 0 -8.16 110.4 100.32 cm BI /W 63 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>>0~||~>`>??x@||C>>????x EI Q BT 0.8449 0 0 0.9835 110.4 93.36 Tm 3 Tr 0.0908 Tc 0 Tw (17,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 121.68 93.36 Tm 0.0854 Tc 0.5843 Tw ( 1991.) Tj -33.921 -12.6899 TD -0.0079 Tc 0.191 Tw (Lindsley, O.R.,) Tj 64.4254 -0.244 TD -0.0024 Tc 0.3075 Tw (\221\221Geriatric Behavioral Prosthetics,\224) Tj -64.1814 -10.9816 TD 0.0481 Tc -0.1099 Tw (New ) Tj 23.1834 0 TD /F5 10 Tf 0.0553 Tc 1.6724 Tw (Thoughts on Old Age,) Tj 0 Tc -0.061 Tw ( ) Tj 98.3464 0 TD /F2 10 Tf -0.0729 Tc 0.0131 Tw (R. ) Tj ET q 49.44 0 0 -6.96 220.08 76.56 cm BI /W 275 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~p|????~??~?~???~x~?? ~8~?? 8~? ~?~?~|~??~>?~|?~?~?~?@?`x??~??~?~~??>a ?~>?? EI Q BT 0.9835 0 0 0.9835 220.08 69.84 Tm 3 Tr 0.0254 Tc 0 Tw (Kastenbaum) Tj 0 Tr 50.2713 0 TD 0.0361 Tc 1.6105 Tw ( \(cd.\)) Tj -183.2708 -11.2256 TD 0.0572 Tc -0.1192 Tw (\(New ) Tj ET q 21.6 0 0 -8.16 114 66 cm BI /W 120 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<???????x???????????????χ|????|~?????` EI Q BT 0.9835 0 0 0.9835 114 58.8 Tm 3 Tr 0.1064 Tc 0 Tw (York) Tj 0 Tr 21.9632 0 TD 0.0433 Tc 0.139 Tw ( NY: Springer Publishing Co., 1964\).) Tj -47.831 -12.4458 TD -0.0053 Tc 2.4254 Tw (Liu, K., and Manton, K.G., \223The Characteristics) Tj 0.9761 -10.9816 TD 0.0211 Tc 0.789 Tw (and Utilization Pattern of an Admission Cohort of) Tj ET BT 0.8971 0 0 0.9835 311.76 623.04 Tm /F5 10 Tf 0.2375 Tc 0 Tw (259.) Tj 0.2675 -46.3668 TD 0.2375 Tc (260.) Tj 0.535 -34.6531 TD 0.2375 Tc (261.) Tj 0.535 -35.1411 TD 0.2375 Tc (262.) Tj 0.535 -57.1043 TD 0.2375 Tc (263.) Tj 0.535 -45.6347 TD 0.2375 Tc (264.) Tj 0.8025 -57.5924 TD 0.2375 Tc (265.) Tj 0 -45.8787 TD 0.2375 Tc (266.) Tj 0.8025 -57.1043 TD 0.2375 Tc (267.) Tj 0.535 -46.3668 TD 0.0369 Tc (268.) Tj 0.2675 -35.1411 TD 0.2375 Tc (269.) Tj 0.2675 -45.8787 TD 0.2375 Tc (270.) Tj 0.535 -56.6163 TD 0.2375 Tc (271.) Tj ET BT 0.2347 0 0 0.9835 334.08 577.44 Tm /F2 10 Tf 0.112 Tc (1) Tj ET BT 0.2816 0 0 0.9835 334.08 646.8 Tm 0.1133 Tc (1) Tj 0 -23.9155 TD 0.1133 Tc (1) Tj ET BT 0.9388 0 0 0.9835 335.52 646.56 Tm 0.0015 Tc 1.4594 Tw (Nursing Home Patients,\224) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.9443 0 0 0.9812 436.32 646.56 Tm /F5 11 Tf 0.0274 Tc 0.0152 Tw (Gerontologist ) Tj ET q 37.68 0 0 -8.16 499.92 653.76 cm BI /W 211 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>|?~?????????À?> | <|>???|?~?????????~~??`~?x~?~?x?|??~??>??~?~???? EI Q BT 0.8585 0 0 0.9812 499.92 646.56 Tm 3 Tr 0.057 Tc 0 Tw (23:92-96,) Tj 0 Tr ET BT 0.7726 0 0 0.9812 335.52 635.52 Tm 0.0795 Tc (1983.) Tj ET q 22.56 0 0 -8.16 335.52 630 cm BI /W 126 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxp?>??|~?~?????~?~???????xx|<>|>~?>? EI Q BT 1.0731 0 0 0.9812 335.52 623.04 Tm 3 Tr 0.0235 Tc (bew,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 358.08 623.04 Tm /F4 10 Tf 0 Tc -0.0972 Tw ( ) Tj ET q 20.64 0 0 -8.16 360.72 630.24 cm BI /W 115 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID i@??????????>>????>> EI Q BT 0.8915 0 0 0.9835 360.72 623.04 Tm 3 Tr -0.0363 Tc 0 Tw (C.A.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 381.36 623.04 Tm /F2 10 Tf 0.0184 Tc 0.7744 Tw ( and Silverstone, B.M., \223A Program of) Tj ET q 41.28 0 0 -7.2 335.52 618.96 cm BI /W 230 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ } ?????|??|??~??<?~?~?~?~???????????????8~?8>?8>?~x??????x?|~<~8~?|||x~?|~?|?>?~?|~|>>>?~~?~?~~~|~|~8>~?|~??|~?>~~>?~?~?p>??? ?`?>?pc>?x|??||>?>~?|?~x?0` p?@ EI Q BT 0.9444 0 0 0.9835 479.28 600.96 Tm 3 Tr 0.0466 Tc 0 Tw (11\(1\):341-347,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 335.52 590.16 Tm 0.0456 Tc (1971.) Tj ET q 41.76 0 0 -8.16 335.52 584.4 cm BI /W 233 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x< H?????~~?~|~>x~>?~?~?~?~?~~~~~~~?|~?~~?~~?>~~????p?|?8?<~~0~~~~~0 EI Q BT 1.0796 0 0 0.9835 335.52 577.44 Tm 3 Tr /F2 10 Tf 0.0479 Tc (kmbardo,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 377.28 577.44 Tm 0.0012 Tc 1.4426 Tw ( N. E., Senior Research Associate, He-) Tj -42.4622 -11.2256 TD 0.0115 Tc 1.4322 Tw (brew Rehabilitation Center for the Aged, Boston,) Tj 0 -10.9816 TD 0.025 Tc 0.2064 Tw (MA, personal communication, Feb. 6, 1992.) Tj 0 -12.4458 TD 0.0095 Tc 0.9054 Tw (Lucas-Warren, C., Specialty Programs Consultant,) Tj ET q 38.4 0 0 -6.96 335.52 539.04 cm BI /W 217 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8Ds?????????????????p??0?????x??x??8??< ?<?>??????????~???????~???????????????????o EI Q BT 0.9388 0 0 0.9835 335.52 532.56 Tm 3 Tr 0.0181 Tc 0 Tw (Hillhaven) Tj 0 Tr 40.9025 0 TD 0.0084 Tc 1.3243 Tw ( Corp., Aurora, CO, personal communica-) Tj ET BT 0.9835 0 0 0.9835 335.52 521.28 Tm 0.0449 Tc 0.056 Tw (tion, Apr. 1, 1992.) Tj ET q 23.76 0 0 -9.12 335.52 516 cm BI /W 132 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~}x<<??|?|>|@?xx<<<0?x??p??? x EI Q BT 0.9388 0 0 0.9835 335.52 509.04 Tm 3 Tr 0.0106 Tc 0 Tw (Lyles,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 359.28 509.04 Tm -0.0391 Tc 0.5889 Tw ( Y. M.,) Tj 37.5815 0 TD 0.2469 Tc 2.8604 Tw (\223Impact of Medicare Diagnosis-) Tj -61.741 -11.2256 TD 0.0195 Tc 1.1393 Tw (Related Groups) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.96 0 0 -8.88 402.24 505.2 cm BI /W 172 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >x|>;?????>?~?~~?~`|@||??|?|||w~|~|>?>?><|?|? EI Q BT 0.9388 0 0 0.9835 402.24 498 Tm 3 Tr -0.0389 Tc 0 Tw (\(DRGs\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 433.2 498 Tm 0.0481 Tc 0.671 Tw ( on Nursing Homes in the) Tj -99.0785 -11.2256 TD 0.0194 Tc 1.1395 Tw (Portland, Oregon Metropolitan Area,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9812 0 0 0.9812 493.68 486.96 Tm /F5 11 Tf 0.1088 Tc 1.2957 Tw (Journal of) Tj -160.4525 -11.4958 TD 0.0622 Tc 0.059 Tw (the American Geriatrics Society ) Tj ET q 59.04 0 0 -8.88 480.24 483.12 cm BI /W 329 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|x|<|>??>s>>???>??>~?>?>????~?>?>8~x~~|?|||?~|~~?~~???~???~????????????? ?????|?x?~?||?~?|>?~~?~~?>>>????>>>>>0|>xx||??x ?>???~|???>???? EI Q BT 0.8585 0 0 0.9812 480.24 475.68 Tm 3 Tr 0.0512 Tc 0 Tw (34\(8\):573-578,) Tj 0 Tr ET BT 0.8155 0 0 0.9812 336.72 464.88 Tm 0.0501 Tc (1986.) Tj ET BT 0.9835 0 0 0.9835 335.76 452.64 Tm /F2 10 Tf -0.0563 Tc 1.9485 Tw (Maas, M.L.,) Tj 55.3961 0 TD -0.0026 Tc 1.9753 Tw (\223Management of Patients With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -6.96 522.72 459.84 cm BI /W 97 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p????>?<?>>88<????~~?|< EI Q BT 0.9388 0 0 0.9835 522.72 452.64 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.56 0 0 -6.96 336.24 448.56 cm BI /W 192 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????>?>?>?8????p?p ???????????????|?~|?~?><|?~8x?x<>?~~<p EI Q BT 0.9835 0 0 0.9835 336.24 441.84 Tm 3 Tr 0.0165 Tc (heimer\222s) Tj 0 Tr 35.1411 0 TD -0.0111 Tc 1.7805 Tw ( Disease in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.88 421.68 448.56 cm BI /W 245 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|<p??x8??????????~??>??x?< ??????~?>|?Ç|??>`88`88|x EI Q BT 0.9388 0 0 0.9835 421.68 441.84 Tm 3 Tr -0.0122 Tc 0 Tw (Imng-Term) Tj 0 Tr ET BT 0.9835 0 0 0.9835 465.6 441.84 Tm -0.049 Tc 4.1374 Tw ( Care Facilities,\224) Tj -131.7793 -10.9816 TD /F5 10 Tf 0.0014 Tc 3.7201 Tw (Nursing Clinics of North America) Tj 0 Tc -0.061 Tw ( ) Tj ET q 49.44 0 0 -8.64 490.32 438.24 cm BI /W 275 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||x>?>.???????~x|?<x?<8?>?>>>|~|~|p>?~~??~?>?>?|???|?~<?~>?????x x|>??>?|?|?|>?~??  EI Q BT 0.9444 0 0 0.9835 490.32 431.04 Tm 3 Tr 0.0409 Tc 0 Tw (23\(1\):57-68,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 337.2 420.24 Tm 0.0456 Tc (1988.) Tj ET BT 0.9835 0 0 0.9835 336.24 408 Tm /F2 10 Tf -0.0284 Tc 0.5372 Tw (Maas, M.L., and ) Tj ET q 48.24 0 0 -8.16 405.84 414.72 cm BI /W 268 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |08`?? ??? ??1??<?p?~|0?~ǿ<>~~~~|~|<?>?>8?~?|>~>??????????????N ??<??x?8?? EI Q BT 0.9835 0 0 0.9835 405.84 408 Tm 3 Tr -0.0101 Tc 0 Tw (Buckwilter,) Tj 0 Tr 49.0512 0 TD 0.0039 Tc 1.0738 Tw ( K.C., \223Evaluation of) Tj -119.0894 -11.2256 TD -0.0277 Tc 0.0892 Tw (a Special ) Tj ET q 48.96 0 0 -6.96 375.36 403.68 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >8????~??>??<????? ???p? ??? ???????????<??<?<??? ?|?|~?>??>~??|?x<>>8~~?|~?~|<??~>8 EI Q BT 0.9835 0 0 0.9835 375.36 396.96 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0131 Tc 0.2917 Tw ( Care Unit: Phase I Report of) Tj -88.829 -10.9816 TD -0.036 Tc 3.8802 Tw (Baseline Data,\224) Tj 70.7703 -0.244 TD 0.0386 Tc 1.608 Tw (unpublished manuscript, Univer-) Tj -70.2823 -11.2256 TD 0.0311 Tc 0.3141 Tw (sity of Iowa College of Nursing, Iowa City, IA, no) Tj ET BT 0.9388 0 0 0.9835 336.96 363.84 Tm 0.0005 Tc 0 Tw (date.) Tj ET BT 0.9835 0 0 0.9835 336.96 351.12 Tm -0.0173 Tc 0.5841 Tw (Maas, M.L., and Buckwalter, K. C., \223Final Report:) Tj 0.244 -11.2256 TD 0.0148 Tc 3.8285 Tw (Nursing Evaluation Research:) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 469.44 347.04 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >_?????~??>?????|??>?????p~?????~??~?|???|??<? <??>8?~<??>?>???<?<?|??8?}??>|>~?~||<~8~ EI Q BT 0.9835 0 0 0.9835 469.44 340.08 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0249 Tc 1.9166 Tw ( Care) Tj ET BT 0.9388 0 0 0.9835 337.2 329.04 Tm 0.0159 Tc 1.3894 Tw (Unit,\224 University of Iowa College of Nursing, Iowa) Tj ET BT 0.9835 0 0 0.9835 337.68 318.24 Tm 0.0218 Tc 0.1608 Tw (City, IA, December 1990.) Tj -0.7321 -12.4458 TD -0.0563 Tc 0.1182 Tw (Maas, M.L., ) Tj ET q 48 0 0 -8.16 387.84 312.96 cm BI /W 267 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|????????|a?????qq~~|??~?<>??|??|?|~?>8~?>|??|???<?????????~??????8?x?8???_ EI Q BT 0.9835 0 0 0.9835 387.84 306 Tm 3 Tr 0.0252 Tc 0 Tw (Buckwaker,) Tj 0 Tr 48.8071 0 TD -0.0342 Tc -0.0263 Tw ( K. C., ) Tj ET q 28.8 0 0 -9.12 464.16 312.96 cm BI /W 160 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >8|||<>>>#????>|? ?<?~?~x|x~<~'8<>??~?|>???~??<x EI Q BT 0.9835 0 0 0.9835 464.16 306 Tm 3 Tr -0.0194 Tc 0 Tw (Kelley,) Tj 0 Tr 29.2843 0 TD -0.0511 Tc 0.1739 Tw ( L. S., et al.,) Tj -157.403 -11.2256 TD 0.0168 Tc 1.6301 Tw (\223Family Members\222 Perceptions: How They View) Tj -0.244 -11.2256 TD 0.0178 Tc 0.0429 Tw (Care of ) Tj ET q 48.96 0 0 -6.96 370.32 290.64 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8????????|??>??>??<???~???p??`???????|?|?<?<? <8?~~<?~>???~<?<`|?~?|~x|>??|~?~|?<??8~| < EI Q BT 0.9835 0 0 0.9835 370.32 283.92 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0131 Tc 0.609 Tw ( Patients in a Nursing Home,\224) Tj ET BT 0.9444 0 0 0.9835 337.2 272.88 Tm /F5 10 Tf 0.0191 Tc 0.0199 Tw (Journal ) Tj ET q 27.84 0 0 -8.88 369.6 279.84 cm BI /W 160 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>|~>>>>??? ???y???~~~~????~??π~~>~~?~>?????????@??~??||<>>߀^ EI Q BT 0.9444 0 0 0.9835 369.6 272.88 Tm 3 Tr 0.0607 Tc 0 Tw (ofLong) Tj 0 Tr 29.4797 0 TD 0.0005 Tc 0.7386 Tw ( Term Care Administration 19\(1\):21-) Tj -62.5174 -10.7376 TD 0.0703 Tc 0.2199 Tw (25, 1991.) 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EI Q BT 0.9444 0 0 0.9835 373.44 182.4 Tm 3 Tr 0.0492 Tc 0 Tw (11\(10\):37,38,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 426.48 182.4 Tm 0.0854 Tc 0.3402 Tw ( 1985.) Tj -89.5611 -12.6899 TD /F2 10 Tf -0.0419 Tc 1.4458 Tw (Mace, N.L.,) Tj 53.4438 0.244 TD 0.0325 Tc 1.6752 Tw (\223Home and Community Services for) Tj ET q 48.96 0 0 -7.2 338.64 165.84 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 3~???????|??>??|?<????~?p?? ????????x?|?8|0??8<8~??8<8~|x<|x????>?? 0x|>~??x80x EI Q BT 0.9835 0 0 0.9835 338.64 158.88 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0262 Tc 2.1619 Tw ( Disease,\224) Tj 46.6108 0 TD /F5 10 Tf 0.0328 Tc 0.7598 Tw (Physical and Occupational) Tj -96.15 -11.2256 TD 0.0036 Tc 1.7249 Tw (Therapy in Geriatrics \(New) Tj 0 Tc -0.061 Tw ( ) Tj 120.5536 0 TD /F2 10 Tf 0.0558 Tc 2.5666 Tw (York, NY: Haworth) Tj ET BT 0.9388 0 0 0.9835 338.64 136.8 Tm 0.0319 Tc 2.0662 Tw (Press, 1986\).) 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EI Q BT 0.8919 0 0 0.9835 98.16 600.24 Tm 3 Tr 0.0759 Tc (pared) Tj 0 Tr ET BT 0.9835 0 0 0.9835 119.04 600.24 Tm 0.0387 Tc 1.6078 Tw ( for the Office of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 45.84 0 0 -9.36 196.8 607.2 cm BI /W 255 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @|xx?~??>?~|?~~?~>?~??~???~??~?|À?~?>?~???~???~??π?~?ǀ?~??~???~~???~|x?>|???0`????? EI Q BT 0.9388 0 0 0.9835 196.8 600.24 Tm 3 Tr 0.0719 Tc 0 Tw (Twhnology) Tj 0 Tr ET BT 0.9835 0 0 0.9835 242.64 600.24 Tm 0.2251 Tc 3.6147 Tw ( Assessment,) Tj -146.9095 -11.2256 TD 0.0062 Tc -0.0673 Tw (U.S. ) Tj 20.255 0 TD 0.0374 Tc -0.0991 Tw (Congress, Washington, DC, 1990.) Tj ET q 22.32 0 0 -6.96 98.16 584.64 cm BI /W 125 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|??????????????x?>x??<??<? >~~~??? EI Q BT 0.8919 0 0 0.9835 98.16 577.68 Tm 3 Tr 0.0537 Tc 0 Tw (kface.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 120.48 577.68 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -8.16 123.36 584.64 cm BI /W 115 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????>??????g` EI Q BT 0.9835 0 0 0.9835 123.36 577.68 Tm 3 Tr -0.0197 Tc 0 Tw (N.L.,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 147.6 577.68 Tm 0.0039 Tc 1.9043 Tw (\221\221The Management of Problem Behav-) Tj ET BT 0.9835 0 0 0.9835 98.16 566.88 Tm 0.0018 Tc -0.0629 Tw (iors,\224 ) Tj 25.1357 0 TD /F5 10 Tf 0.0155 Tc 1.1433 Tw (Dementia Care: Patient, Family, and Com-) Tj -25.1357 -10.9816 TD 0.0051 Tc -0.0662 Tw (munity, ) Tj ET q 17.76 0 0 -6.48 132.48 562.56 cm BI /W 99 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `~??????????????? EI Q BT 0.9388 0 0 0.9835 132.48 556.08 Tm 3 Tr /F2 10 Tf 0.0165 Tc 0 Tw (N.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 150.24 556.08 Tm -0.0007 Tc 2.4288 Tw ( Mace \(cd.\) \(Baltimore, MD: Johns) Tj ET BT 0.9388 0 0 0.9835 98.4 545.28 Tm 0.0318 Tc 2.0663 Tw (Hopkins University Press, 1990\).) Tj ET BT 0.9835 0 0 0.9835 98.4 533.28 Tm -0.064 Tc 0.0041 Tw (Mace, ) Tj ET q 20.4 0 0 -8.16 127.44 540.24 cm BI /W 114 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <y??~> ????? EI Q BT 0.9835 0 0 0.9835 127.44 533.28 Tm 3 Tr -0.0197 Tc 0 Tw (N.L.,) Tj 0 Tr 27.8201 0 TD 0.0102 Tc 3.7112 Tw (\223Dementia Care Units in Nursing) Tj -57.3484 -11.2256 TD 0.0137 Tc -0.0749 Tw (Homes,\224 ) Tj 40.0218 0 TD /F5 10 Tf 0.0062 Tc 1.9663 Tw (Specialized Dementia Care Units,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -6.96 282.24 528.96 cm BI /W 104 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >#>?>???????????????????????????????0 EI Q BT 0.9388 0 0 0.9835 282.24 522.24 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 98.4 511.44 Tm 0.031 Tc 1.0463 Tw (Coons \(cd.\) \(Baltimore, MD: Johns Hopkins Uni-) Tj ET BT 0.9388 0 0 0.9835 98.4 500.64 Tm 0.0264 Tc 1.8164 Tw (versity Press, 1991\).) Tj ET BT 0.9835 0 0 0.9835 98.4 489.12 Tm 0.424 Tc -0.4922 Tw (Mace, ) Tj ET q 20.4 0 0 -8.16 130.8 495.84 cm BI /W 114 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p??~?>????? EI Q BT 0.9835 0 0 0.9835 130.8 489.12 Tm 3 Tr -0.0197 Tc 0 Tw (N.L.,) Tj 0 Tr 20.743 0 TD 0.0647 Tc 2.0695 Tw ( and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 36.96 0 0 -9.36 174.72 496.32 cm BI /W 206 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??|>x|xp??p???>?????p?88??ǀpǀxx<?<?>>x~x?~?<??>??????`0?p0???? EI Q BT 0.9388 0 0 0.9835 174.72 489.12 Tm 3 Tr 0.0086 Tc 0 Tw (Gwyther,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 211.68 489.12 Tm 0.2042 Tc 3.0868 Tw ( L. 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S., and Coons, D., ) Tj ET q 26.4 0 0 -6.96 275.76 452.16 cm BI /W 148 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??g????`???????a?????>???????~|x8xpx<>>x EI Q BT 0.9835 0 0 0.9835 275.76 445.2 Tm 3 Tr 0.0099 Tc 0 Tw (\223Anti-) Tj 0 Tr -180.0983 -11.2256 TD 0.2757 Tc 2.6278 Tw (psychotic Drugs in the Nursing Home: Some) Tj 0 -10.7376 TD -0.0052 Tc 3.3607 Tw (Evaluative Guidelines,\224) Tj 102.2509 -0.244 TD /F5 10 Tf 0.0307 Tc 0.4771 Tw (American Journal of ) Tj ET q 15.84 0 0 -6.96 286.08 430.08 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x8p ?|>||~>p>x>>?? EI Q BT 0.9835 0 0 0.9835 286.08 423.36 Tm 3 Tr -0.0031 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.08 0 0 -6.96 98.88 419.04 cm BI /W 192 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx|~||?>~?>>?|?x|?|||~|>~>>|>|>~|~~>?~??~?|>>~>~?>>~?><??<~> EI Q BT 0.9444 0 0 0.9835 98.88 412.08 Tm 3 Tr -0.0555 Tc (heimer\222s) Tj 0 Tr 36.0873 0 TD -0.0154 Tc 1.1154 Tw ( Care and Related Disorders and Research) Tj ET q 44.64 0 0 -8.64 98.88 408.48 cm BI /W 249 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 80x8<>?|<||~x<>~>~~~?~?<?|>x?>x?>|?>|?>|>?>|>??|~??|~??|~?~|~????x?|??<???~??????x??>~<?>|?>8||||>?????~?x<??08 EI Q BT 0.9835 0 0 0.9835 98.88 401.28 Tm 3 Tr 0.0925 Tc 0 Tw (5\(5\):3640,) Tj 0 Tr 45.3906 0 TD 0.0854 Tc -0.1478 Tw ( 1990.) Tj ET q 44.64 0 0 -8.88 98.64 396.72 cm BI /W 248 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID _x<> ??<?x?????|?~>?x>?<??<????x??`?~|?~?~?0>??? 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EI Q BT 0.9388 0 0 0.9835 285.84 378.96 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.56 0 0 -7.2 99.36 374.64 cm BI /W 193 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~?????????x???<???~??p?~?0????????????????????~??|~?|~?>?|>??x|?<>?8?~~~>< EI Q BT 0.9388 0 0 0.9835 99.36 367.68 Tm 3 Tr -0.0028 Tc (heirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 133.92 367.68 Tm 0.0147 Tc 0.0461 Tw ( Disease and Other Severe Cognitive Defi-) Tj -35.1411 -11.2256 TD 0.0124 Tc 0.6585 Tw (cits,\224 prepared for the Conference on Special Care) Tj 0 -11.2256 TD 0.0487 Tc 1.8417 Tw (Units sponsored by the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 200.64 352.56 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`'?~8?~?~???~ ???~ ???@~??~???|?~?|??~???~?x?~?x?~?8x0?~?8<8??~|?8<8??|x<?<x???? >` x<>?0||x?8|x EI Q BT 0.9835 0 0 0.9835 200.64 345.6 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0175 Tc 2.031 Tw ( Disease Re-) Tj -152.0342 -10.9816 TD 0.0263 Tc 2.499 Tw (search Center, Washington University School of) Tj -0.4881 -10.9816 TD 0.0003 Tc 0.3454 Tw (Medicine, St. Louis, MO, Oct. 9, 1990.) Tj ET q 44.64 0 0 -8.88 98.88 319.44 cm BI /W 249 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<p?o?>??>~?~?~?~ ~?~?~|~>>~~<~~~?~?~0~| ??|p8?~p?~|>???8???? EI Q BT 0.9835 0 0 0.9835 98.88 312.72 Tm 3 Tr -0.0139 Tc 0 Tw (Magaziner,) Tj 0 Tr 45.3906 0 TD 0.0271 Tc 1.6196 Tw ( J., Director, Division of Gerontology,) Tj -44.9026 -11.2256 TD 0.0242 Tc -0.0368 Tw (Department of Epidemiology and Preventive Medi-) Tj 0.244 -11.2256 TD -0.0002 Tc 4.4782 Tw (cine, University of Maryland, Baltimore, MD,) Tj 0 -11.4697 TD 0.0302 Tc 0.3353 Tw (personal communication, May 11, 1992.) Tj ET q 44.64 0 0 -8.64 99.36 274.56 cm BI /W 249 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|<x? A??~~<?~? ~ ~?~?~A~~~~~<|~<~~??~0?~| ~p8?p?|x~?~??????? EI Q BT 0.9835 0 0 0.9835 99.36 267.84 Tm 3 Tr -0.0139 Tc 0 Tw (Magaziner,) Tj 0 Tr 45.3906 0 TD -0.0365 Tc 0.0981 Tw ( J., ) Tj ET q 25.92 0 0 -8.16 157.92 274.8 cm BI /W 145 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<>??????>?|?8p8???>>>??????|????' EI Q BT 0.9835 0 0 0.9835 157.92 267.84 Tm 3 Tr -0.0065 Tc 0 Tw (Hebel,) Tj 0 Tr 26.3559 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 17.52 0 0 -8.16 186.24 274.56 cm BI /W 98 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<??~?~~?~~|? <~?~~~~~????????????????? EI Q BT 0.9835 0 0 0.9835 186.24 267.84 Tm 3 Tr -0.0511 Tc 0 Tw (J.R.,) Tj 0 Tr 17.8146 0 TD 0.0162 Tc 0.8376 Tw ( and Warren, J.W., \223The) Tj -105.6674 -11.4697 TD 0.0435 Tc 0.1388 Tw (Use of Proxy Responses for Aged Patients in Long) Tj 0 -10.9816 TD -0.011 Tc 1.2924 Tw (Term Care Settings,\224) Tj 91.0253 -0.244 TD /F5 10 Tf 0.0272 Tc 0.3993 Tw (Comprehensive Gerontology) Tj -87.8528 -10.9816 TD -0.0083 Tc -0.0526 Tw (Series ) Tj 29.0402 0 TD /F2 10 Tf -0.0729 Tc 0.0131 Tw (B, ) Tj ET q 42.24 0 0 -8.16 143.76 241.44 cm BI /W 235 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????>|??~~?|>?|>?|~~~p~<~>~~~>~~~~~~???~?|?~?~~~~~~~x~a|~>|??>??>x 0` EI Q BT 0.9388 0 0 0.9835 143.76 234.72 Tm 3 Tr 0.0848 Tc 0 Tw (1:118-121,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 186 234.72 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.12 0 0 -7.2 188.4 241.68 cm BI /W 118 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  x|?|>?~>>p~~~~8~|????xx|?<~?<~?>C>~~?~|??x EI Q BT 0.8919 0 0 0.9835 188.4 234.72 Tm 3 Tr 0.0717 Tc 0 Tw (1987.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 100.32 222.96 Tm -0.0491 Tc 3.6494 Tw (Malz, A.,) Tj 48.8071 -0.244 TD 0.2431 Tc 3.5964 Tw (\223The Lamplighter:) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 235.44 229.68 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?|?<>???>??>>p>>8???` ?p> ?>??~??7??|?<<0?0~x<8~|?<8?<<???|????|| p8<<~?x~~<<?x EI Q BT 0.9835 0 0 0.9835 235.44 222.72 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0647 Tc 2.3135 Tw ( and) Tj -187.1753 -10.7376 TD -0.0006 Tc 4.7389 Tw (Related Disorders Guideline Manual,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 31.2 0 0 -7.2 272.88 219.12 cm BI /W 174 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||????????x??8??C? ??|??>?p????~?x~>|<><~ ?@`px??|0 EI Q BT 0.9835 0 0 0.9835 272.88 212.16 Tm 3 Tr 0.0082 Tc 0 Tw (Unicare) Tj 0 Tr -175.4616 -11.2256 TD -0.0183 Tc 0.6897 Tw (Health Facilities, Milwaukee, WI, no date.) Tj ET q 32.4 0 0 -8.16 100.56 196.32 cm BI /W 181 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<<?~?~????~??~??~~?~?~~?>?~~???~~??~??~~??~~??~~??~~x??~x?~?~???~??????????@? EI Q BT 0.9388 0 0 0.9835 100.56 189.6 Tm 3 Tr 0.0531 Tc 0 Tw (Manton,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 132.96 189.6 Tm 0.0195 Tc 3.5797 Tw ( K. G., Research Professor, Center for) Tj -32.9448 -11.4697 TD 0.0302 Tc 1.9216 Tw (Demographic Studies, Duke University, Durham,) Tj 0 -11.2256 TD 0.0283 Tc 0.3495 Tw (NC, personal communication, Feb. 20, 1991.) Tj ET q 32.16 0 0 -8.64 100.56 162.96 cm BI /W 183 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<<x|1?????????????????????????????x??|??<?>????~?????x8??? EI Q BT 0.9388 0 0 0.9835 100.56 156 Tm 3 Tr 0.0531 Tc 0 Tw (Manton,) Tj 0 Tr 34.2559 0 TD 0.0212 Tc 0.6167 Tw ( K.G., Vertrees, J. C., and Woodbury, M.A.,) Tj ET BT 0.9835 0 0 0.9835 101.28 144.96 Tm 0.0308 Tc -0.0435 Tw (\223Functionally and Medically Defined Subgroups of) Tj -0.4881 -11.4697 TD 0.0365 Tc 0.4712 Tw (Nursing Home Populations,\224 ) Tj 121.7738 0 TD /F5 10 Tf 0.0097 Tc 0.1732 Tw (Health Care ) Tj ET q 31.44 0 0 -7.2 272.88 140.64 cm BI /W 175 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~??w?|???|?|?>|>~?||8~?<~~q|~|?|??8 ? ?? EI Q BT 0.8971 0 0 0.9835 272.88 133.68 Tm 3 Tr 0.04 Tc 0 Tw (Firuznc-) Tj 0 Tr ET q 12.48 0 0 -8.88 101.04 129.6 cm BI /W 70 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>>>>`?|pp~~|~><~??~????|??~|?~~>????|~>????~ EI Q BT 0.9444 0 0 0.9835 101.04 122.64 Tm 3 Tr 0.0583 Tc (ing) Tj 0 Tr ET BT 0.9835 0 0 0.9835 113.52 122.64 Tm -0.0573 Tc 0.2413 Tw ( Review ) Tj ET q 48.96 0 0 -8.64 147.6 129.84 cm BI /W 272 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px@~?|>>|p`>????|??|>??|>~?~>|?~0>|>>|>?~??>??>x??<x??<??>???????????x??>~>|~p>|~x>>|<>>~|x??>`?>p??px?x~|x<>><>?<??||||<8 x EI Q BT 0.9444 0 0 0.9835 147.6 122.64 Tm 3 Tr 0.0409 Tc 0 Tw (12\(1\):47-62,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 196.56 122.64 Tm 0.0854 Tc 0.5843 Tw ( 1990.) Tj -97.6143 -11.7137 TD /F2 10 Tf 0.0014 Tc 2.3779 Tw (Markoff, J. M., President,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 214.08 118.32 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID | ????>??>?<?????~??p?~~?p??????????>?>~??<?>????>??>??<|??`8~|>~?>~~>~<~?>x EI Q BT 0.9835 0 0 0.9835 214.08 111.12 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0081 Tc 3.3637 Tw ( Research) Tj ET BT 0.9388 0 0 0.9835 101.04 100.32 Tm 0.0092 Tc 1.6302 Tw (Demonstration Project, Cranston, RI, personal com-) Tj ET BT 0.9835 0 0 0.9835 101.28 89.52 Tm 0.0277 Tc 0.3175 Tw (munication, Feb. 6, 1992.) Tj -0.4881 -11.7137 TD -0.0143 Tc 0.9296 Tw (Martin, R. J., and Whitehouse, P. J., \223The Clinical) Tj 0.7321 -11.2256 TD -0.0111 Tc 0.4871 Tw (Care of Patients With Dementia,\224 ) Tj 140.0765 0 TD /F5 10 Tf 0.0176 Tc 1.6293 Tw (Dementia Care:) Tj -140.3205 -10.9816 TD 0.0095 Tc 1.3122 Tw (Patient, Family, and Community,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.76 0 0 -7.2 240.48 62.88 cm BI /W 99 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID > `??~>????? EI Q BT 0.9388 0 0 0.9835 240.48 56.16 Tm 3 Tr /F2 10 Tf 0.0165 Tc 0 Tw (N.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 258.24 56.16 Tm -0.0087 Tc 0.802 Tw ( Mace \(cd.\)) Tj -159.1112 -10.7376 TD 0.0197 Tc 1.1879 Tw (\(Baltimore, MD: Johns Hopkins University Press,) Tj ET BT 0.8919 0 0 0.9835 102.48 34.8 Tm 0.2668 Tc 0 Tw (1990\).) Tj 248.9133 620.8267 TD 0.2641 Tc (286.) Tj 0.5382 -46.6108 TD 0.2641 Tc (287.) Tj 0.8073 -57.1043 TD 0.2641 Tc (288.) Tj 0.5382 -57.5924 TD 0.2641 Tc (289.) Tj 0.8073 -79.0676 TD 0.0622 Tc (290.) Tj 0.8073 -46.6108 TD 0.0622 Tc (291.) Tj 0 -57.1043 TD 0.2641 Tc (292.) Tj 0.8073 -58.0805 TD 0.0622 Tc (293.) Tj 0 -46.1227 TD 0.0622 Tc (294.) Tj 0.8073 -57.3484 TD 0.2641 Tc (295.) Tj 0 -23.9155 TD 0.2641 Tc (296.) Tj 0.2691 -34.8971 TD 0.2641 Tc (297.) Tj 0.5382 -34.409 TD 0.2641 Tc (298.) Tj ET q 1.44 0 0 -6.72 347.04 652.56 cm BI /W 8 /H 37 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >? EI Q BT 0.2816 0 0 0.9835 347.04 645.84 Tm 3 Tr 0.1133 Tc (1) Tj 0 Tr 0.8521 -11.4697 TD 0.1133 Tc (1) Tj ET BT 0.1878 0 0 0.9835 347.76 623.52 Tm 0.1101 Tc (1) Tj ET BT 0.2816 0 0 0.9835 347.28 600 Tm 0.1133 Tc (1) Tj ET q 36.72 0 0 -8.88 348.48 652.56 cm BI /W 204 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??<>@xx8p<<|?~?~????????|????~?~???x?~??8?~???<~??<?~??>~???>??~>?x?|?~?>x?|?~????>???~~~~~~@~?~?~?~~~?~ EI Q BT 0.9835 0 0 0.9835 348.48 645.84 Tm 3 Tr 0.0537 Tc (Wryland) Tj 0 Tr 37.3375 0 TD 0.032 Tc 3.323 Tw ( Coordinating Council on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 501.84 653.04 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p06`;???????|?~?~?~?>?~???~8???~~???`~??~??~~??~~???~~???~~?|??~?|?~~?<?~?<8?~?>8?~?~?<<?~??<>??~|???|?????~??8>x???x?x?|?8?||8?|8 EI Q BT 0.9388 0 0 0.9835 501.84 645.84 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr -163.0989 -11.4697 TD -0.0167 Tc 0.3924 Tw (Disease and Related Disorders, ) Tj ET q 51.36 0 0 -9.36 469.92 641.76 cm BI /W 297 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<~0?????~|?|?~~p>??~|?~~?~??~??~~????~???~??~~??~~??~~????~??p~??x~??0???????????o EI Q BT 0.9444 0 0 0.9835 469.92 634.56 Tm 3 Tr /F5 10 Tf 0.0158 Tc 0 Tw (FinaZReport,) Tj 0 Tr ET BT 0.934 0 0 0.9835 521.28 634.56 Tm /F4 10 Tf 0.0217 Tc 0.2786 Tw ( Mary-) Tj ET BT 0.9835 0 0 0.9835 348.72 623.52 Tm /F2 10 Tf 0.0116 Tc 1.9201 Tw (land Department of Health and Mental Hygiene,) Tj 0 -11.4697 TD 0.0076 Tc 0.094 Tw (Baltimore, MD, September 1991.) Tj 0 -12.6899 TD -0.0161 Tc -0.0446 Tw (Massachusetts ) Tj ET q 48.96 0 0 -6.96 408.48 606.48 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8? ??????>?/~?>?~~???~~?|??~~??~~~?`??~?~~?~~??~??~~??~x?~|~ <8~?~<8~~|?<??~>?À<>?><??|?????>???8x?<????<|~||~x?|80x EI Q BT 0.9835 0 0 0.9835 408.48 599.76 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0062 Tc 0.1893 Tw ( Disease Research Cen-) Tj -110.5481 -11.2256 TD -0.0053 Tc 1.1645 Tw (ter, \223Blueprint for a Specialized) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 482.4 595.92 cm BI /W 272 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0|??????>?>???>???<??p ?? ???~??~??|< >0?8?~|8?~?|?><??|?????8>|?x?<?<?>?~?0?~||8p EI Q BT 0.9835 0 0 0.9835 482.4 588.72 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0242 Tc 0.6464 Tw ( Dis-) Tj -185.7111 -11.2256 TD 0.0239 Tc 0.8908 Tw (ease Nursing Home: Recommendations for Policy) Tj 0 -10.9816 TD 0.0093 Tc 0.1247 Tw (Planning, Patient Care Programs, and Architectural) Tj ET BT 0.9388 0 0 0.9835 348.72 556.08 Tm 0.0122 Tc 0 Tw (Design,) Tj ET BT 0.9835 0 0 0.9835 379.44 556.08 Tm 0.0274 Tc 0.8059 Tw (\223 Boston, MA, 1990.) Tj -30.9925 -12.9339 TD 0.0171 Tc 2.1179 Tw (Massachusetts Executive Office of Human Serv-) Tj 0 -11.2256 TD -0.0005 Tc 2.1358 Tw (ices, \223Guidelines for Care of Patients With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -7.2 534.96 539.52 cm BI /W 96 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???|???? ?3x|?|?<`>ppx?|x8 EI Q BT 0.9388 0 0 0.9835 534.96 532.32 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET q 34.08 0 0 -6.96 348.96 528.24 cm BI /W 190 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????~?~~|~~~~~p~~0~~~~~?~~~~~~~~~~~~ ~~ppp??|?<@@x0 EI Q BT 0.9388 0 0 0.9835 348.96 521.52 Tm 3 Tr -0.0302 Tc (heimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 383.04 521.52 Tm 0.0022 Tc 0.8315 Tw ( Disease and Related Disorders in Massa-) Tj -34.6531 -11.7137 TD -0.0031 Tc -0.0578 Tw (chusetts ) Tj ET q 20.16 0 0 -8.64 384.24 516.96 cm BI /W 112 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<xx?~>?????~?>>?>?????~?~~|~|~>?>???8  EI Q BT 0.9388 0 0 0.9835 384.24 510 Tm 3 Tr 0.0881 Tc 0 Tw (Long) Tj 0 Tr ET BT 0.9835 0 0 0.9835 404.4 510 Tm -0.0225 Tc 0.938 Tw ( Term Care Facilities,\224 Boston, MA,) Tj ET BT 0.9388 0 0 0.9835 348.96 499.2 Tm 0.0281 Tc 2.8371 Tw (September 1988.) Tj ET BT 0.9835 0 0 0.9835 348.96 486.72 Tm -0.0195 Tc 1.6671 Tw (Mather, J.H.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 39.12 0 0 -8.16 406.32 493.92 cm BI /W 218 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <Dxx|?????~??????~??~????~?x???x?<?~~?~~~>??>???????<|`??`?? ` EI Q BT 0.9835 0 0 0.9835 406.32 486.72 Tm 3 Tr 0.0435 Tc 0 Tw (Gmdwin,) Tj 0 Tr 39.7778 0 TD -0.0103 Tc 0.6816 Tw ( M., and Kelly, ) Tj ET q 17.76 0 0 -8.16 511.2 493.44 cm BI /W 99 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>????~><~?~~???????? EI Q BT 0.9835 0 0 0.9835 511.2 486.72 Tm 3 Tr -0.0511 Tc 0 Tw (J.R.,) Tj 0 Tr 18.0586 0 TD 0.0025 Tc 1.4007 Tw ( \223The) Tj -183.0267 -11.2256 TD 0.0051 Tc -0.0662 Tw (U.S. Veterans Administration Health Care Delivery) Tj 0.244 -10.9816 TD 0.0188 Tc 2.1569 Tw (System: One Health Care System\222s Approach to) Tj 0.244 -10.9816 TD 0.0182 Tc 2.1168 Tw (Quality Assurance in Long-Term Care,\224) Tj 0 Tc -0.061 Tw ( ) Tj 175.2176 0 TD /F5 10 Tf 0.2664 Tc 0 Tw (Danish) Tj -175.4616 -10.7376 TD 0.0126 Tc 0.9023 Tw (Medical Bulletin, Gerontology Special Supplement) Tj 0 -11.2256 TD 0.2519 Tc 3.262 Tw (Series No. 5-Quality of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.64 461.04 439.2 cm BI /W 244 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<p?p>{?|>???>?????~??~?~~?p~ ?~0~?>>?>? ~~~?~>?>??>?~??????x>|p}>|~~|?|||???`?? ~< EI Q BT 1.086 0 0 0.9835 461.04 432.48 Tm 3 Tr 0.0399 Tc 0 Tw (hng-Term) Tj 0 Tr ET BT 0.9835 0 0 0.9835 504.96 432.48 Tm -0.0122 Tc 2.6358 Tw ( Care,) Tj 0 Tc -0.061 Tw ( ) Tj 32.7008 0 TD /F2 10 Tf 1.3422 Tc 0 Tw (pp) Tj -0.061 Tc (.) Tj ET BT 0.9388 0 0 0.9835 349.44 421.44 Tm 0.0893 Tc 1.2381 Tw (54-60, 1987.) Tj ET BT 0.9835 0 0 0.9835 349.2 409.2 Tm -0.0034 Tc 0.1516 Tw (Mathew, L.J., and Sloane, P.D., \223Care on Dementia) Tj 0.244 -11.7137 TD -0.0064 Tc -0.0545 Tw (Units in Five States,\222 ) Tj 86.6327 0 TD /F5 10 Tf 0.0318 Tc -0.0934 Tw (Dementia Units in Long Term) Tj -86.3886 -11.2256 TD -0.0122 Tc -0.0486 Tw (Care, ) Tj ET q 17.04 0 0 -6.96 376.8 393.6 cm BI /W 95 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88|?????|?8???????????????????????????????: EI Q BT 0.9388 0 0 0.9835 376.8 386.64 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 393.84 386.64 Tm 0.0323 Tc 1.7364 Tw ( Sloane and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 14.16 0 0 -6.96 447.84 393.36 cm BI /W 79 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?|?|x~8~ p EI Q BT 0.9388 0 0 0.9835 447.84 386.64 Tm 3 Tr 0.0187 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 462 386.64 Tm -0.0146 Tc 2.1501 Tw ( Mathew) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 503.28 393.6 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p>x|~>>>>~?~?>?~~??~|??~|?~|?~~~~~|???|??~???|?~|?~|?~|?~~~>>>?>?????|>>| EI Q BT 0.9388 0 0 0.9835 503.28 386.64 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 524.88 386.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 25.44 0 0 -8.64 527.52 393.6 cm BI /W 142 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x???????~~?~~??~~~?~~~?~~??~????????~<?~~?~~?~~?~>?~??>?>??????>>???<?~|>??~| EI Q BT 0.9835 0 0 0.9835 527.52 386.64 Tm 3 Tr 0.0099 Tc 0 Tw (\(Baki-) Tj 0 Tr -180.5864 -11.2256 TD 0.04 Tc -0.1017 Tw (more, MD: Johns Hopkins University Press, 1991\).) Tj -0.244 -12.6899 TD 0.0093 Tc 1.8818 Tw (Mathew, L.J., and Sloane, P.D., \223Organizing and) Tj 0.7321 -11.2256 TD 0.0078 Tc 0.3377 Tw (Staffing Dementia Units,\222 ) Tj 108.1078 0 TD /F5 10 Tf 0.0327 Tc 0.3938 Tw (Dementia Units in Long) Tj -108.3518 -10.7376 TD 0.0054 Tc 3.106 Tw (Term Care,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.04 0 0 -6.96 404.16 348 cm BI /W 95 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0|??????|?0??????????????????????{ EI Q BT 0.9388 0 0 0.9835 404.16 341.52 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 421.2 341.52 Tm 0.0323 Tc 1.9804 Tw ( Sloane and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 14.16 0 0 -6.48 475.92 348 cm BI /W 79 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||>?~|>?~|??~~??~~??~~?>~?>~~??~~??~~??~????~?~? ~~~>?~~?<~~<~?|???>||>? EI Q BT 0.9388 0 0 0.9835 531.84 341.52 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 350.64 330.48 Tm 0.0197 Tc 1.1391 Tw (\(Baltimore, MD: Johns Hopkins University Press,) Tj ET BT 0.8919 0 0 0.9835 351.12 319.68 Tm 0.0426 Tc 0 Tw (1991\).) Tj ET BT 0.9835 0 0 0.9835 349.92 306.96 Tm -0.014 Tc 0.8989 Tw (Mathew, L.J., Sloan, P., Kirby, M., et al., \223What\222s) Tj 0.7321 -10.9816 TD 0.0107 Tc 0.9042 Tw (Different About a Special Care Unit for Dementia) Tj 0 -11.2256 TD 0.0034 Tc 1.3184 Tw (Patients? A Comparative Study,\224) Tj 0 Tc -0.061 Tw ( ) Tj 140.8086 0 TD /F5 10 Tf 0.0335 Tc 2.3453 Tw (American Jour-) Tj ET BT 0.9444 0 0 0.9835 350.88 273.84 Tm 0.0539 Tc 0.1102 Tw (nal of ) Tj ET q 47.52 0 0 -7.2 375.84 281.04 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p` ?????|?|?~<>c?~~>?~~??~~x?8?<|||~~~|>~|>??~~>??>>??~?>p??>?>x???x}???|??~~>?>>x>x?||?|8 EI Q BT 0.9835 0 0 0.9835 375.84 273.84 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 423.36 273.84 Tm -0.0056 Tc 1.1135 Tw ( Care and Related Disorders and) Tj ET BT 0.9835 0 0 0.9835 350.88 262.8 Tm 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.64 0 0 -8.64 390 269.76 cm BI /W 248 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px <px<>|~x c???|?||<0~||||x~|~p?~|<>|>>~>>>| >~?>|>~??|?|??~???~??????|?|>?~>???>0>?~~||x?p|x<<x?>~??<?x`p>` EI Q BT 0.9444 0 0 0.9835 390 262.8 Tm 3 Tr 0.0374 Tc 0 Tw (3\(2\):16-23,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 434.64 262.8 Tm 0.0854 Tc -0.1478 Tw ( 1988.) Tj ET BT 0.9388 0 0 0.9835 350.88 250.08 Tm /F2 10 Tf 0.0216 Tc 0.7989 Tw (Mattis, S.,) Tj 45.5041 0 TD 0.0118 Tc 1.6402 Tw (\221\221Mental Status Examination for Organic) Tj ET BT 0.9835 0 0 0.9835 350.88 239.28 Tm 0.0016 Tc 0.1 Tw (Mental Syndrome in the Elderly Patient,\224 ) Tj 169.6048 0 TD /F5 10 Tf -0.0164 Tc 0 Tw (Geriatric) Tj ET q 44.64 0 0 -9.12 350.88 235.44 cm BI /W 249 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????pxx<<>p?8pp|`?<<?<~?>~???~?0?~|8??~~?|~~?|?>~}?|?>?|?~??|`?>p?>??p>~8?8|~?~?<>|~<>?>~|>?}~|???~??<?<0~~?~?x?|8?|?~?>?>?~~ EI Q BT 0.9835 0 0 0.9835 350.88 228.48 Tm 3 Tr -0.0155 Tc (Psychiat~,) Tj 0 Tr 45.3906 0 TD /F2 10 Tf -0.0729 Tc 0.3791 Tw ( R. ) Tj ET q 30.48 0 0 -7.2 410.64 235.44 cm BI /W 170 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x77??~?~?~?~?~?~p?~?~?0?~?@~?~??~?~?~??~?~?~?~?~?>?~~???~~|?~||??~??~???~?~~?~~?~~?~~? EI Q BT 0.9835 0 0 0.9835 410.64 228.48 Tm 3 Tr -0.0438 Tc 0 Tw (Bellack) Tj 0 Tr 30.9925 0 TD 0.0097 Tc 1.0273 Tw ( and B.) Tj 0 Tc -0.061 Tw ( ) Tj ET q 28.08 0 0 -7.2 474.96 235.44 cm BI /W 156 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8???|?~??~???~?????????????????????8??8?~x?>x?|x|??~? EI Q BT 0.9835 0 0 0.9835 474.96 228.48 Tm 3 Tr 0.0361 Tc 0 Tw (Karasu) Tj 0 Tr 28.5522 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 505.68 235.68 cm BI /W 121 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>`|?>>??????~~?~~?~??|??~??????~?~?~?~??~??~>???>?~||?|>>?<8 EI Q BT 0.9388 0 0 0.9835 505.68 228.48 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 527.28 228.48 Tm 0.0572 Tc 2.5652 Tw ( \(New) Tj -179.1222 -11.4697 TD 0.049 Tc -0.1109 Tw (York, NY: Grune and Stratton, 1976\).) Tj -0.244 -12.9339 TD -0.0098 Tc 1.8199 Tw (Mayers, K., and Block, C., \223Specialized Services) Tj 0.4881 -10.9816 TD 0.0222 Tc 0.0791 Tw (for Demented Residents in Washington State Nurs-) Tj 0 -11.2256 TD 0.0378 Tc -0.0995 Tw (ing Homes: Report of a Survey,\222 ) Tj 133.9756 0 TD /F5 10 Tf 0.0332 Tc 0.1493 Tw (American Journal) Tj -133.9756 -11.2256 TD 0.0124 Tc -0.0737 Tw (of ) Tj ET q 47.76 0 0 -7.2 362.4 178.56 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>?>?????>??|>c|x>>~>>~>~>|8>~|~~|~?~>?|~>?~?~>>?>>?????>x??>???????|||~?>p>x>x??/x EI Q BT 0.9835 0 0 0.9835 362.4 171.6 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0351 Tc 2.6365 Tw ( Care and Related Disorders and) Tj -60.0328 -10.9816 TD 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.64 0 0 -8.64 390.72 167.76 cm BI /W 248 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<>x<>~|x|||?~?x>?x||>p|?||?| <?><?>>>>?~?x~|?>0?x?|<??>>?~?~?|x|xx?< Ȁ>??>?|=@ EI Q BT 0.9444 0 0 0.9835 390.72 160.8 Tm 3 Tr 0.0374 Tc 0 Tw (5\(4\):17-21,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 435.36 160.8 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj ET q 46.32 0 0 -9.36 351.12 155.28 cm BI /W 267 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?p?????????>||?<~??>???? ????????????>???<>??>?????`?>`?~??~|?>?????p?8?<?|??x????????x??0 EI Q BT 0.9388 0 0 0.9835 351.12 148.08 Tm 3 Tr /F2 10 Tf 0.0191 Tc 0 Tw (McCloskey,) Tj 0 Tr 49.3387 0 TD 0.0259 Tc 0.0274 Tw ( L. J.,) Tj ET BT 0.9835 0 0 0.9835 421.68 148.08 Tm 0.012 Tc 0.1098 Tw (\221\221The Silent Heart Sings,\222 ) Tj 106.8876 0 TD /F5 10 Tf 0.0361 Tc 0 Tw (Gener-) Tj -178.39 -11.2256 TD 0.0307 Tc -0.0922 Tw (ations ) Tj ET q 48.72 0 0 -8.88 378.72 144.24 cm BI /W 271 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08p<>x<>>>0~| p?xx?|??|??>~??>|>|?~>@?p|>?||<>`~~~???x<p????>~|y|?|??>`?p1x?|~???|<p8<0p 8 EI Q BT 0.9444 0 0 0.9835 378.72 137.04 Tm 3 Tr 0.0409 Tc 0 Tw (14\(1\):63-65,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 427.44 137.04 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj -77.3593 -12.6899 TD /F2 10 Tf -0.015 Tc 1.1744 Tw (McCracken, A.L.,) Tj 77.6033 0 TD 0.0183 Tc 1.2626 Tw (\223Meeting the Needs of Persons) Tj -77.1153 -11.4697 TD -0 Tc -0.061 Tw (With ) Tj ET q 48.96 0 0 -7.2 374.16 120.48 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|@8???|?????>?~??>?~??~<??~~?`~?~??~?~??~??~???~ ?|?~|?~<??~<8?~|?<8?~|?<<?~<?<><?????|~x<?||||8~8|p EI Q BT 0.9835 0 0 0.9835 374.16 113.28 Tm 3 Tr 0.0484 Tc 0 Tw (Akheirner\222s) Tj 0 Tr 49.7833 0 TD -0.0262 Tc 0.0876 Tw ( Disease,\224 ) Tj 43.1943 0 TD /F5 10 Tf 0.0549 Tc 0.4933 Tw (Journal of Long-Term) Tj -115.4289 -10.9816 TD 0.013 Tc 0.2918 Tw (Care Administration ) Tj ET q 48.96 0 0 -8.64 437.28 109.44 cm BI /W 273 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08<>px<>>||~??||?~>~?>|??||~?>~>>>> ~??x?<???????x???>>?<|?|x?|??||~?>|~?G~c~9?~????~>??<8pp 8? EI Q BT 0.9444 0 0 0.9835 437.28 102.48 Tm 3 Tr 0.0409 Tc 0 Tw (19\(1\):17-20,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 486.24 102.48 Tm 0.0854 Tc 0.0962 Tw ( 1991.) Tj -136.66 -12.4458 TD /F2 10 Tf -0.0017 Tc 2.8691 Tw (McCracken, A.L., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 40.08 0 0 -8.16 450.72 97.2 cm BI /W 223 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|<@>`8~<?>?>>??~????<??????????~?~?ǀ|0??|x?|x?????~ ???0~??8~>?<??>G~??`?`v>?~9 EI Q BT 0.9835 0 0 0.9835 450.72 90.24 Tm 3 Tr -0.027 Tc 0 Tw (Fitzwater,) Tj 0 Tr 40.754 0 TD -0.0133 Tc 1.9048 Tw ( E., \223The Right) Tj -141.0526 -10.7376 TD 0.0539 Tc 0.3723 Tw (Environment for ) Tj ET q 57.6 0 0 -7.92 422.64 86.64 cm BI /W 320 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||s< ???|????>????x??<????????` ??~??????x|?<?<?><??<?|>?~?>?<??|?@?߁?>8x?x|?<>?>?>???<?~~~|~<?~8?~8p EI Q BT 0.9835 0 0 0.9835 422.64 79.68 Tm 3 Tr -0.0022 Tc 0 Tw (Alzheimer\222s,\224) Tj 0 Tr 58.5686 0 TD /F5 10 Tf 0.0038 Tc 1.0332 Tw ( Geriatric Nursing) Tj ET q 58.56 0 0 -8.64 353.04 75.84 cm BI /W 326 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0px|>|>|<|0|;||@||?||>?~>~??~~p~?>pp>>x0?~><~?x~?|????????|?|?x>~?<>?<>?~?|~?|x|?x~|?|~>>`~~~>~?~?p~?|?~?x?>|?|??~>??~>?>|?pp EI Q BT 0.9444 0 0 0.9835 353.04 68.88 Tm 3 Tr 0.0466 Tc 0 Tw (10\(6\):293-294,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 411.6 68.88 Tm 0.0854 Tc -0.1478 Tw ( 1989.) Tj -60.5208 -12.6899 TD /F2 10 Tf 0.0106 Tc 2.8973 Tw (McDermott, W., Deputy Director, Office of the) Tj 0.7321 -10.7376 TD -0.0084 Tc 4.2588 Tw (California State Fire Marshall, remarks to the) Tj 0 -10.7376 TD 0.0216 Tc 2.8861 Tw (annual conference of the Association of Health) Tj ET endstream endobj 546 0 obj <> endobj 547 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 548 0 obj <>stream 0.72 w 1 j 0 0 0 RG 59.76 675.36 m 537.84 675.36 l S BT 0.9835 0 0 0.9835 60.48 681.36 Tm 0 0 0 rg /F4 10 Tf 0.0497 Tc -0.1477 Tw (189 ) Tj ET BT 0.9598 0 0 0.9598 80.4 681.36 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 86.64 681.36 Tm /F5 10 Tf 0.0024 Tc 0.6686 Tw (Special Care Units for People With ) Tj ET q 47.52 0 0 -7.2 233.76 688.56 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<0>?>????|~~~cA~' >>x>?<?|??|?|~~>~????|???~~??~p~?~?~8>?>??<???????||~~?~?>??????p EI Q BT 0.9835 0 0 0.9835 233.76 681.36 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.2071 Tw ( and Other ) Tj ET q 42.48 0 0 -7.2 328.32 688.32 cm BI /W 237 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ```'~>?~?~|x~||>?1x?>??8?????8??0??~?~~~~~|>~??~??|~~?? >>???|p?>p?p~?~???~~??|<g<?x | ???p ?? EI Q BT 0.9835 0 0 0.9835 328.32 681.36 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8066 0 0 0.9835 60.48 619.68 Tm /F4 10 Tf 0.2645 Tc (299.) Tj 0.8926 -46.1227 TD 0.2645 Tc (300.) Tj 0.2975 -34.6531 TD 0.2645 Tc (301.) Tj 0.2975 -35.1411 TD 0.0413 Tc (302.) Tj 0.2975 -56.8603 TD 0.0413 Tc (303.) Tj 0.5951 -56.3722 TD 0.2645 Tc (304.) Tj 0.2975 -57.3484 TD 0.2645 Tc (305.) Tj 0.2975 -56.8603 TD 0.0413 Tc (306.) Tj 0.2975 -34.8971 TD 0.0413 Tc (307.) Tj 0 -23.6715 TD 0.2645 Tc (308.) Tj 0.2975 -46.3668 TD 0.0413 Tc (309.) Tj 0 -34.8971 TD 0.2645 Tc (310.) Tj 0.5951 -45.6347 TD 0.0413 Tc (311.) Tj 0.2975 -34.8971 TD 0.2645 Tc (312.) Tj ET BT 0.9835 0 0 0.9835 83.28 643.2 Tm /F2 10 Tf -0.0396 Tc -0.0208 Tw (Facility ) Tj ET q 39.12 0 0 -7.2 116.4 650.4 cm BI /W 218 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID #??????~?a|??xppp? ?G?????????~??~?|?|>??????8 x@ EI Q BT 0.9835 0 0 0.9835 116.4 643.2 Tm 3 Tr 0.0091 Tc 0 Tw (Licensure) Tj 0 Tr 39.7778 0 TD 0.0019 Tc 0.9132 Tw ( and Certification Directors, San) Tj -73.4547 -11.4697 TD 0.0334 Tc 0.21 Tw (Francisco, CA, Nov. 7, 1990.) Tj -0.4881 -12.4458 TD 0.0148 Tc 0.3306 Tw (McGrowder-Lin, R., and Bhatt, A., \223A Wanderer\222s) Tj ET BT 0.9388 0 0 0.9835 83.52 608.64 Tm 0.0176 Tc 1.4849 Tw (Lounge Program for Nursing Home Residents With) Tj ET q 48.96 0 0 -7.2 83.52 605.04 cm BI /W 273 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~p??~?????|????p?0?~??~??|?|?~? ??|??<??>???>????>|?p?|x8 <?>>~?~~|<>|<< EI Q BT 0.9388 0 0 0.9835 83.52 597.84 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 132.48 597.84 Tm 0.1907 Tc 3.4056 Tw ( Disease,\224) Tj 52.7117 -0.4881 TD /F5 10 Tf 0.0593 Tc 1.831 Tw (Gerontologist 28\(5\):607-) Tj ET BT 0.9444 0 0 0.9835 84 586.8 Tm 0.0714 Tc 0.9811 Tw (609, 1988.) Tj ET q 52.56 0 0 -8.16 83.28 581.52 cm BI /W 292 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0????0~~~p~???~???~??~??~??~?|?~?>?~??~??~~>~>~~8|?~~??????~?<?p`~~|~~? ~????= EI Q BT 0.9835 0 0 0.9835 83.28 574.56 Tm 3 Tr /F2 10 Tf 0.0109 Tc 0 Tw (McHutchion,) Tj 0 Tr 53.4438 0 TD -0.0165 Tc 3.5349 Tw ( E., and Morse, J. M., \223Releasing) Tj -52.7117 -10.9816 TD -0.0014 Tc 1.8927 Tw (Restraints: A Nursing Dilemma,\224) Tj 0 Tc -0.061 Tw ( ) Tj 143.981 0 TD /F5 10 Tf 0.0425 Tc 1.482 Tw (Journal of Ge-) Tj -143.981 -11.2256 TD 0.0271 Tc 0.2775 Tw (rontological Nursing ) Tj ET q 48.72 0 0 -8.64 171.12 559.92 cm BI /W 271 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `08>x<<<|~<f??|||~~>?|>?`><<?|?~~|?~<?~<?~>?~>?~>?~~|?~|~>?|~?>?`??~~??~??|?|`??| <?>???>?<p`|0 EI Q BT 0.9444 0 0 0.9835 171.12 552.72 Tm 3 Tr 0.0409 Tc 0 Tw (15\(2\):16-21,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 219.84 552.72 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj ET q 34.8 0 0 -8.16 84.24 547.2 cm BI /W 194 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>x???p?????>???>~?~>>~?~?x~?<~??~?? ~??~??~??~??~>?>?~>x?~>x?~<x?~>?|?>?>???80??p EI Q BT 0.9388 0 0 0.9835 84.24 540.48 Tm 3 Tr /F2 10 Tf 0.0245 Tc 0 Tw (Melnick,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 119.04 540.48 Tm 0 Tc -0.061 Tw ( ) Tj ET q 19.44 0 0 -8.16 121.44 547.2 cm BI /W 108 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   <>>?x?|<<>?d EI Q BT 0.9388 0 0 0.9835 121.44 540.48 Tm 3 Tr 0.0242 Tc 0 Tw (V.L.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 140.88 540.48 Tm 0.0647 Tc -0.1268 Tw ( and ) Tj ET q 29.52 0 0 -8.16 160.32 547.44 cm BI /W 165 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx>??????8???????? ??|????|????????????????x?<߀?>??~x?w0 EI Q BT 0.9388 0 0 0.9835 160.32 540.48 Tm 3 Tr 0.0192 Tc 0 Tw (Dubler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 189.84 540.48 Tm 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -7.2 192.24 547.2 cm BI /W 104 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  |~????|????????? EI Q BT 0.9388 0 0 0.9835 192.24 540.48 Tm 3 Tr -0.0055 Tc 0 Tw (N.N.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 210.96 540.48 Tm 0 Tc -0.061 Tw ( ) Tj ET q 24 0 0 -8.64 213.36 547.44 cm BI /W 134 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||>x||<>>>?>?@~??|~??||?~|?~|~?~||?~||?~|?~~?~~?~|?~|? ||>||?||?|~~~>>????????<<x EI Q BT 0.9388 0 0 0.9835 213.36 540.48 Tm 3 Tr 0.007 Tc 0 Tw (\(eds.\),) Tj 0 Tr ET BT 0.9835 0 0 0.9835 237.36 540.48 Tm /F5 10 Tf 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 239.76 547.44 cm BI /W 265 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x?~????||~g~ >>~x>|>~<>|?||~|>~>~|??~?????~??~`~?|?>p>?~?>8??><>???À||~?>?x?@x?p EI Q BT 0.8971 0 0 0.9835 239.76 540.48 Tm 3 Tr 0.0473 Tc 0 Tw (AZzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 84.24 529.44 Tm 0.0075 Tc -0.0687 Tw (Dementia: Dilemmas in Clinical Research ) Tj 172.5332 0 TD /F2 10 Tf -0.0027 Tc 0 Tw (\(Clifton,) Tj -172.5332 -11.4697 TD 0.0041 Tc -0.0652 Tw (NJ: ) Tj ET q 33.84 0 0 -7.2 100.32 525.12 cm BI /W 189 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  G?????????????????????~???????????????????????~??~>?~ EI Q BT 0.9835 0 0 0.9835 100.32 518.16 Tm 3 Tr 0.0444 Tc 0 Tw (Humana) Tj 0 Tr 34.409 0 TD 0.0467 Tc 0.0135 Tw ( Press, 1985\).) Tj ET q 35.04 0 0 -8.16 84.24 512.88 cm BI /W 195 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x@? ?????????~???|?~<?~?~?~???~?~??~?~?~ ?~x~x~<~<~~?x>|?>?>??????<p??8 EI Q BT 0.9835 0 0 0.9835 84.24 505.92 Tm 3 Tr -0.0276 Tc 0 Tw (Melnick,) Tj 0 Tr 35.6292 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 19.2 0 0 -8.16 121.92 512.64 cm BI /W 107 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<<~??~?~?x?|<<>???x8 EI Q BT 0.8919 0 0 0.9835 121.92 505.92 Tm 3 Tr -0.0246 Tc 0 Tw (V.L.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 141.12 505.92 Tm 0 Tc -0.061 Tw ( ) Tj ET q 29.76 0 0 -8.64 143.76 512.88 cm BI /W 166 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx8>????<??? ?|?|??~?~?~?~????|?|?<>?8??~8 EI Q BT 0.9388 0 0 0.9835 143.76 505.92 Tm 3 Tr 0.0192 Tc 0 Tw (Dubler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 173.52 505.92 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 176.16 512.64 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<@x>??~<p?????????0 EI Q BT 0.9835 0 0 0.9835 176.16 505.92 Tm 3 Tr 0.0022 Tc 0 Tw (N.N.,) Tj 0 Tr 21.9632 0 TD -0.0159 Tc 2.2734 Tw ( Weisbard, A., et al.,) Tj -114.6968 -11.7137 TD 0.2223 Tc 2.804 Tw (\223Clinical Research in Senile Dementia of the) Tj ET q 42 0 0 -7.2 84.24 490.8 cm BI /W 235 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????>????p??0?~?~??~??|?|??~???>??<??>???7???>>>~?~?>?<?> EI Q BT 0.9835 0 0 0.9835 84.24 483.84 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr ET BT 0.9388 0 0 0.9835 126.24 483.84 Tm 0.022 Tc 1.885 Tw ( Type: Suggested Guidelines Addressing) Tj ET BT 0.9835 0 0 0.9835 84.24 472.8 Tm -0.0045 Tc 3.9091 Tw (the Ethical and Legal Issues,\224) Tj 0 Tc -0.061 Tw ( ) Tj 141.2966 0 TD /F5 10 Tf 0.2531 Tc 2.9761 Tw (Journal of the) Tj -141.2966 -10.7376 TD -0.0036 Tc 1.1628 Tw (American Geriatrics Society) Tj 0 Tc -0.061 Tw ( ) Tj ET q 59.04 0 0 -8.64 202.32 469.2 cm BI /W 328 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<x<x|>c?>??>>|??|>|?>x|>~?<0~>|>`|>xxxx<|x?||???x?|~?>???w|?~?>>|?~|>>~|>>~?~|~|~Dx???~????|??<8?0 EI Q BT 0.9444 0 0 0.9835 202.32 462.24 Tm 3 Tr 0.0466 Tc 0 Tw (32\(7\):531-536,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 261.36 462.24 Tm 0.0854 Tc 0.5843 Tw ( 1984.) Tj -180.0983 -12.4458 TD /F2 10 Tf -0.0097 Tc 2.3079 Tw (Meyer, D.L., Jacques, J.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.52 0 0 -8.16 193.44 456.96 cm BI /W 231 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>p??????`???~~?~???????~?????~???w??~???~??????|????????>????????????????v EI Q BT 0.9388 0 0 0.9835 193.44 450 Tm 3 Tr 0.0199 Tc 0 Tw (O\222Rourke,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 234.96 450 Tm -0.0435 Tc 1.1424 Tw ( J., et al., \223A) Tj -152.5223 -10.9816 TD 0.0119 Tc 1.8792 Tw (Special Care Home for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 185.76 446.4 cm BI /W 271 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8|????|???x?>??~~?~?~?`~?~??~?~?~~??~~?~?|?~?<?|?<?|?<<?~>?<?x??~??8<`x<~8|~?~||?|88 EI Q BT 0.9388 0 0 0.9835 185.76 439.2 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 234.48 439.2 Tm 0.0069 Tc 2.0062 Tw ( Disease and) Tj -152.2782 -10.7376 TD 0.0259 Tc -0.0874 Tw (Related Disorders: An 18-Month Progress Report,\224) Tj -0.244 -11.4697 TD /F5 10 Tf 0.0307 Tc -0.0923 Tw (American Journal of ) Tj ET q 47.52 0 0 -7.2 168.96 424.32 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>|?>??}<~w|C~>|~><~p?>~8>>|?~1~~~~~??>?>|?|?>??|p~????~x????~|???>>??|?|?|~~~?>x>|?||??x EI Q BT 0.9835 0 0 0.9835 168.96 417.36 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0217 Tc -0.0831 Tw ( Care and Related) Tj -134.2196 -10.9816 TD 0.0358 Tc 1.1227 Tw (Disorders and Research) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.4 0 0 -8.64 186.72 413.76 cm BI /W 247 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08x<x<>?>p?||?||?~?>|~??~~|<?p>>|<>||>? <>?>>>>>~>>>?|??||??<~x??>><|p?|?||x?|||>|0|>~~8>~<8>|?||<p8 @ EI Q BT 0.9444 0 0 0.9835 186.72 406.56 Tm 3 Tr 0.0374 Tc 0 Tw (5\(1\):18-23,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 231.12 406.56 Tm 0.0854 Tc 0.8283 Tw ( 1990.) Tj -149.1058 -12.4458 TD /F2 10 Tf 0.0113 Tc 1.6763 Tw (Michigan Department of Public Health, Office of) Tj 0.4881 -10.9816 TD -0.0068 Tc 1.9388 Tw (Health and Medical Affairs, \223Certificate of Need) Tj 0 -11.2256 TD 0.03 Tc 0.4941 Tw (Review Standards for Long-Term Care ) Tj ET q 43.2 0 0 -7.2 246 379.44 cm BI /W 241 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0;??<?<??~>|~?~À>p~?~>8~~~~~p~~ ~~??~~@~~~p~~x~恁~8~~<~~<~>~8~<x<|??|>?|??~?? ?0?????8|?~| EI Q BT 0.9835 0 0 0.9835 246 372.48 Tm 3 Tr 0.0024 Tc 0 Tw (Services\227) Tj 0 Tr -163.5039 -11.2256 TD 0.0428 Tc 1.6037 Tw (Addendum for Special Population Groups,\224 Lan-) Tj 0.4881 -11.2256 TD 0.0279 Tc 0.1546 Tw (sing, MI, Dec. 18, 1989.) Tj -0.7321 -12.6899 TD 0.0097 Tc 1.2539 Tw (Miles, S.H., and Irvine, P., \223Common Features of) Tj 0.244 -10.9816 TD 0.0015 Tc 0.3442 Tw (Deaths Caused by Physical Restraint,\224 presented at) Tj 0 -11.2256 TD 0.0214 Tc 2.9676 Tw (the 44th Annual Meeting of the Gerontological) Tj 0.4881 -11.2256 TD 0.0146 Tc 3.7473 Tw (Society of America, San Francisco, CA, Nov.) Tj 0 -10.9816 TD 0.0853 Tc -0.1477 Tw (22-26, ) Tj ET q 20.88 0 0 -7.2 114.96 301.2 cm BI /W 117 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >=???|?~??????~?~??????????????????????~??~??>??c??~??8 EI Q BT 0.8919 0 0 0.9835 114.96 294.24 Tm 3 Tr 0.0717 Tc 0 Tw (1991.) Tj 0 Tr ET q 38.16 0 0 -8.16 84.96 288.72 cm BI /W 212 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |q?????~~<~8?????????????|???<??????|?>????~?~??||?p~1x>>>x>~>p>~>0?~?0?~?0~>~?|~|>~>?~?~|?|>>?|?>?|>?||>~~?>??? ?p EI Q BT 0.8499 0 0 0.9835 264.48 271.2 Tm 3 Tr /F5 10 Tf 0.074 Tc 0 Tw (SociaZ) Tj 0 Tr ET BT 0.9444 0 0 0.9835 85.68 259.92 Tm -0.0172 Tc 0.0584 Tw (Work ) Tj ET q 59.28 0 0 -8.64 109.2 267.12 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |x|<  x?d???>~?>~~?~?~>>~>~~~x~~<~~~|~|~x|~?|~><>>x>>8?>??|?|?~?π?~~?~|?|> ||<?~x?x???<??pp> EI Q BT 0.9835 0 0 0.9835 109.2 259.92 Tm 3 Tr 0.0993 Tc 0 Tw (27\(5\):411416,) Tj 0 Tr ET BT 0.9444 0 0 0.9835 168.48 259.92 Tm 0.0723 Tc 0.726 Tw ( 1982.) Tj ET BT 0.9835 0 0 0.9835 85.2 247.44 Tm /F2 10 Tf 0.0124 Tc -0.0736 Tw (Moody, H. R., \221Ethical Dilemmas in Nursing Home) Tj 0.4881 -10.7376 TD -0.028 Tc -0.0326 Tw (Placement,\224 ) Tj 53.6878 0 TD /F5 10 Tf 0.0287 Tc -0.0902 Tw (Generations ) Tj ET q 48.48 0 0 -8.64 192.96 243.84 cm BI /W 270 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<x<<>|>?||?|<~x~?~|<|>>~<<?~><?>~?>?>|?>?>?>???>???>???~??x??<??>???>?>?x>??x~?<~?|?|??|??x?π?`?|p?<8??< ??>??<x~`0@ EI Q BT 0.8971 0 0 0.9835 192.96 236.88 Tm 3 Tr -0.0014 Tc 0 Tw (11\(4\):16-23,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 241.44 236.88 Tm 0.0854 Tc 1.3164 Tw ( 1987.) Tj ET BT 0.9388 0 0 0.9835 85.44 224.64 Tm /F2 10 Tf 0.0004 Tc 0.3869 Tw (Morris, J. N., Hawes, C., Fries, B. E., et al., \223Design-) Tj ET BT 0.9835 0 0 0.9835 86.4 213.6 Tm 0.0089 Tc 1.6382 Tw (ing the National Resident Assessment Instrument) Tj ET q 11.04 0 0 -7.2 86.4 209.52 cm BI /W 62 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????~?~~?~???|~>x? |||~>p EI Q BT 0.8919 0 0 0.9835 86.4 202.32 Tm 3 Tr -0.0322 Tc 0 Tw (for) Tj 0 Tr ET BT 0.9835 0 0 0.9835 97.44 202.32 Tm 0.0399 Tc 3.4369 Tw ( Nursing Homes,\224) Tj 86.1446 -0.4881 TD /F5 10 Tf 0.0593 Tc 5.9796 Tw (Gerontologist 30\(3\):293-) Tj ET BT 0.9444 0 0 0.9835 86.16 191.04 Tm 0.0714 Tc 0.9811 Tw (307, 1990.) Tj ET BT 0.9388 0 0 0.9835 85.68 179.04 Tm /F2 10 Tf 0.0144 Tc 0.4871 Tw (Morris, J.N., Hawes, C., Murphy, K., et al., ) Tj ET q 34.08 0 0 -7.2 255.84 186 cm BI /W 193 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8F>???????~>????~~?>????|???~?|~>>|>>~x?>>??x0??|??<?????? EI Q BT 0.9835 0 0 0.9835 255.84 179.04 Tm 3 Tr /F5 10 Tf -0.0063 Tc 0 Tw (Resiaknt) Tj 0 Tr -173.2653 -11.4697 TD 0.0371 Tc 1.8535 Tw (Assessment Instrument Training Manual and Re-) Tj 0.7321 -11.2256 TD 0.033 Tc 0.1494 Tw (source Guide ) Tj ET q 31.68 0 0 -8.16 142.56 163.68 cm BI /W 176 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `xx<><<?????|p???>??>??~|~|~|~||||||~>8~?>|~>|~~|~?~?????~`@?|?>??? EI Q BT 0.9835 0 0 0.9835 142.56 156.72 Tm 3 Tr /F2 10 Tf -0.0223 Tc 0 Tw (\(Natic~) Tj 0 Tr 32.2127 0 TD 0.0134 Tc 0.3524 Tw ( MA: Eliot Press, 1991\).) Tj -90.0492 -12.4458 TD -0.0056 Tc 2.385 Tw (Moss, M. S., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.56 0 0 -8.16 164.64 151.44 cm BI /W 193 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|> ?8?~?~?<~~?~??~????>~??~???~?~?~???~?~??|~??|~?|?????|8???????????` EI Q BT 0.9388 0 0 0.9835 164.64 144.48 Tm 3 Tr 0.0306 Tc 0 Tw (Kurland,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 199.2 144.48 Tm -0.0241 Tc 0.4516 Tw ( P., ) Tj ET q 33.84 0 0 -9.36 216.48 150.96 cm BI /W 189 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x??????~??~??~??~??~?~??~??~?~~ ?~p??~p?~?~?~?~?????>p|? p ???><xxx<0 EI Q BT 0.9388 0 0 0.9835 216.48 144.48 Tm 3 Tr 0.0217 Tc 0 Tw (\223Farni.ly) Tj 0 Tr ET BT 0.9835 0 0 0.9835 250.32 144.48 Tm 0.2091 Tc 2.8988 Tw ( Visiting) Tj -167.1644 -11.2256 TD 0.001 Tc 2.6834 Tw (With Institutionalized Mentally Impaired Aged,\224) Tj -0.244 -10.9816 TD /F5 10 Tf 0.044 Tc 1.5537 Tw (Journal of Gerontological Social Work 1\(4\):271-) Tj ET BT 0.9444 0 0 0.9835 86.4 111.84 Tm 0.0714 Tc 0.9811 Tw (278, 1979.) Tj ET BT 0.9835 0 0 0.9835 85.92 99.6 Tm /F2 10 Tf 0.2349 Tc 2.8726 Tw (Moss, R.J., and La Puma, J., \223The Ethics of) Tj 0.4881 -11.2256 TD -0.0302 Tc 5.5825 Tw (Mechanical Restraints,\224) Tj 106.1555 -0.244 TD /F5 10 Tf 0.0122 Tc 2.855 Tw (Hastings Center Report) Tj ET q 49.44 0 0 -8.64 86.4 84.72 cm BI /W 276 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||> 7????'?x8?<~x~<~xx~<<~>~~|~|~~~>>?>|>~>>????|??~ ?p?~~8?|~8?<<<x?>xG<|~x?x??|?!~ > EI Q BT 0.9444 0 0 0.9835 86.4 77.76 Tm 3 Tr 0.0409 Tc 0 Tw (21\(1\):22-25,) Tj 0 Tr 52.352 0 TD 0.0723 Tc 0.726 Tw ( 1991.) Tj ET q 75.12 0 0 -8.64 86.16 72.48 cm BI /W 418 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <`x???????????<0??|< ?~?|8~??~8~??~8~??~?~????~~~??~~?~?~~???~<~???~>~??~??~?>?~?~~?>~?~~???~|???~<?<||<<|?~??~~?<<x8 EI Q BT 0.9835 0 0 0.9835 86.16 65.52 Tm 3 Tr /F2 10 Tf -0.0029 Tc 0 Tw (Murnmah-Castillo,) Tj 0 Tr 76.3832 0 TD 0.1544 Tc 3.1985 Tw ( H.,) Tj 25.8678 -0.4881 TD 0.0216 Tc 4.5537 Tw (\223Many Problems, Some) Tj -101.5188 -10.7376 TD 0.0051 Tc 3.5943 Tw (Solutions: The Menni Unit,\224) Tj 0 Tc -0.061 Tw ( ) Tj 131.7793 0 TD /F5 10 Tf 0.2775 Tc -0.3432 Tw (Confronting ) Tj ET q 15.84 0 0 -6.96 273.84 60.96 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x8p8?|?|~>p>????? EI Q BT 0.8027 0 0 0.9835 273.84 54.48 Tm 3 Tr -0.0157 Tc 0 Tw (AZz-) Tj 0 Tr ET q 34.32 0 0 -7.2 86.64 50.88 cm BI /W 192 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >xp|~~>~>>~?~>?|?|?|?|~|~|>~>?>~|>~?>?|?>~?~>~~~>???矀?>???~~>>||p EI Q BT 0.9444 0 0 0.9835 86.64 43.68 Tm 3 Tr -0.0555 Tc (heimer\222s) Tj 0 Tr 36.3414 0 TD -0.047 Tc 0.4712 Tw ( Disease, ) Tj ET q 17.76 0 0 -7.2 159.12 50.64 cm BI /W 101 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????~|<<??~?~~|8? EI Q BT 0.9388 0 0 0.9835 159.12 43.68 Tm 3 Tr /F2 10 Tf 0.0043 Tc 0 Tw (A.C.) Tj 0 Tr 18.9174 0 TD -0.0005 Tc 0.3964 Tw ( Kalicki \(cd.\) ) Tj ET q 33.36 0 0 -9.36 230.88 50.88 cm BI /W 187 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <pxx??88>0?8?|???|?<?~?8?8???8>??x0~??0~??|?|??|?|???~??????|x??~x?>~x?>~?<???>~>??>~?>???`?>? EI Q BT 0.9388 0 0 0.9835 230.88 43.68 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr 35.5341 0 TD 0.0236 Tc 0.2855 Tw ( Mills,) Tj ET BT 0.9835 0 0 0.9835 86.4 33.12 Tm 0.0206 Tc -0.082 Tw (MD: Rynd Communications, and Washington, DC:) Tj ET BT 0.8919 0 0 0.9835 311.52 619.92 Tm 0.0622 Tc 0 Tw (313.) Tj 0.2691 -33.921 TD 0.0622 Tc (314.) Tj 0 -33.921 TD 0.2641 Tc (315.) Tj 0.8073 -68.0859 TD 0.0622 Tc (316.) Tj 0 -44.6585 TD 0.0622 Tc (317.) Tj 0.5382 -67.1098 TD 0.2641 Tc (318.) Tj 0.2691 -45.3906 TD 0.0622 Tc (319.) Tj 0.2691 -45.1466 TD 0.0622 Tc (320.) Tj 0 -33.921 TD 0.2641 Tc (321.) Tj 0.5382 -56.6163 TD 0.0622 Tc (322.) Tj 0 -67.8419 TD 0.2641 Tc (323.) Tj 0.5382 -55.8842 TD 0.0622 Tc (324.) Tj 0.2691 -33.921 TD 0.0622 Tc (325.) Tj ET BT 0.9835 0 0 0.9835 333.84 642.72 Tm 0.0306 Tc 2.6329 Tw (American Association of Homes for the Aging,) Tj ET BT 0.8919 0 0 0.9835 334.8 631.68 Tm 0.0426 Tc 0 Tw (1987\).) Tj ET BT 0.9835 0 0 0.9835 333.36 619.92 Tm 0.0075 Tc 0.6634 Tw (Murray, D., Executive Director, ) Tj ET q 48.96 0 0 -7.68 465.6 627.36 cm BI /W 272 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  p???~????>????|??<???p ?? ???????@???|?? <??<???>8??|<><?~|?<>??~>???~????????8x?|?|?>?>??<~||~|~8<` EI Q BT 0.9835 0 0 0.9835 465.6 619.92 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 20.4 0 0 -7.2 516.96 627.12 cm BI /W 114 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0xy????~?~~~?????`????? >>~~~???????? EI Q BT 0.9388 0 0 0.9835 516.96 619.92 Tm 3 Tr 0.0193 Tc 0 Tw (Soci-) Tj 0 Tr ET q 11.76 0 0 -8.16 334.08 614.88 cm BI /W 66 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|<~????<~xx||<>>??????>? EI Q BT 0.9388 0 0 0.9835 334.08 608.88 Tm 3 Tr 0.0147 Tc (ety) Tj 0 Tr ET BT 0.9835 0 0 0.9835 345.84 608.88 Tm 0.0259 Tc 3.3698 Tw ( of Canada, Toronto, ON, Canada, personal) Tj -11.4697 -10.9816 TD 0.0356 Tc 0.0654 Tw (communication, July 10, 1991.) Tj ET BT 0.9388 0 0 0.9835 334.56 586.56 Tm -0.0216 Tc 1.3562 Tw (Namazi, K.H., Director of Research,) Tj 0 Tc 0.055 Tw ( ) Tj ET q 31.44 0 0 -6.96 480 593.52 cm BI /W 176 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????????|??>?????~??????~ ?????????????p?>?? EI Q BT 0.9388 0 0 0.9835 480 586.56 Tm 3 Tr 0.0327 Tc 0 Tw (Corinne) Tj 0 Tr 33.489 0 TD 0 Tc 0.055 Tw ( ) Tj ET q 23.76 0 0 -6.96 513.6 593.28 cm BI /W 134 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p 3????????????~~? ??| EI Q BT 0.9388 0 0 0.9835 513.6 586.56 Tm 3 Tr 0.0176 Tc 0 Tw (Dolan) Tj 0 Tr ET q 41.76 0 0 -7.2 334.56 582.48 cm BI /W 232 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID Cf???|?|??<??>????>?~p?~8?8??~?c~?~>??B?~??~?@?~???x??>x???` EI Q BT 0.9388 0 0 0.9835 334.56 575.52 Tm 3 Tr -0.0091 Tc (Alzheirner) Tj 0 Tr ET BT 0.9835 0 0 0.9835 376.32 575.52 Tm 0.0303 Tc 0.0546 Tw ( Center, Chardon, OH, personal commu-) Tj -42.4622 -10.9816 TD 0.0192 Tc 0.1635 Tw (nication, May 6, 1991.) Tj 0 -11.7137 TD 0.0201 Tc 1.3014 Tw (Narnazi, K.H., and Johnson, B.D., \223Pertinent Au-) Tj 0.244 -11.4697 TD 0.0332 Tc -0.0947 Tw (tonomy for Residents ) Tj 89.317 0 TD /F4 10 Tf -0.0083 Tc -0.0887 Tw (With ) Tj ET q 44.64 0 0 -7.2 447.84 548.88 cm BI /W 248 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<0s?>??????><>>?~?q~?y??9??~~~??? ???>?~??|???>|8 ? ? EI Q BT 0.8066 0 0 0.9835 447.84 541.92 Tm 3 Tr 0.0436 Tc 0 Tw (Dementias:) Tj 0 Tr ET BT 0.9835 0 0 0.9835 492.48 541.92 Tm 0.0576 Tc -0.1557 Tw ( Modifica-) Tj ET BT 0.9388 0 0 0.9835 334.8 530.88 Tm /F2 10 Tf 0.0369 Tc 0.2713 Tw (tions of the ) Tj ET BT 0.934 0 0 0.9835 381.12 530.88 Tm /F4 10 Tf -0.0109 Tc 2.5405 Tw (Physical Environment To Enhance) Tj ET BT 0.8491 0 0 0.9835 334.8 519.6 Tm 0.0326 Tc 0 Tw (Independence,\224) Tj ET BT 0.9835 0 0 0.9835 401.76 519.6 Tm /F5 10 Tf 0.0307 Tc 1.616 Tw (American Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 491.04 526.8 cm BI /W 265 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p4@~??>????|~~ca>' ~>x>|?<?~?~~~~>~~?????????~??>~??~À~x???><?~????????||~~?>x?>x>??????@` EI Q BT 0.9835 0 0 0.9835 491.04 519.6 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 334.8 508.56 Tm -0.0075 Tc 1.6153 Tw (Care and Related Disorders and Research 7\(1\):16-) Tj 0 -10.9816 TD 0.0703 Tc 0.7281 Tw (21, 1992.) Tj ET BT 0.9835 0 0 0.9835 334.8 486 Tm 0.2598 Tc -0.3252 Tw (Namazi, ) Tj 40.754 0 TD /F2 10 Tf 0.2571 Tc 2.606 Tw (K.H., Rosner,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.56 0 0 -8.16 440.16 492.72 cm BI /W 92 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0 EI Q BT 0.8449 0 0 0.9835 440.16 486 Tm 3 Tr 0.0864 Tc 0 Tw (T.T.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 456.72 486 Tm 0.0647 Tc 1.0934 Tw ( and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -8.64 478.56 492.96 cm BI /W 180 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|~߇??~~?~?~~?~~?~??~??~??~~?~~~~~~~~0?~p?~~p?~|p?~?~~???~?>?~~?~~~~ EI Q BT 0.8919 0 0 0.9835 478.56 486 Tm 3 Tr -0.0069 Tc 0 Tw (Calki.ns,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 510.96 486 Tm -0.0486 Tc 3.4049 Tw ( M.P.,) Tj -178.39 -11.2256 TD 0.2636 Tc 2.6604 Tw (\223Visual Barriers To Prevent Ambulatory) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -6.96 521.28 481.92 cm BI /W 97 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8@@?????????~?>>88<????>>< EI Q BT 0.9388 0 0 0.9835 521.28 474.96 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 334.8 464.4 Tm 0.0318 Tc 0.5574 Tw (heirner\222s Patients From Exiting Through an Emer-) Tj 0.244 -11.2256 TD 0.0528 Tc 0.2513 Tw (gency Door,\224 ) Tj 58.3245 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.52 0 0 -8.64 451.2 460.32 cm BI /W 331 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>|||>x??>?>????~??~??>~|??>>?~|x>?~?<8~~???~~???~~?x~?<~?~?|??||?>~>??~??~?~~?~?|>?~??~???@~?~~?~?p>?x>?x<??~x|?~~??>??? ? EI Q BT 0.9444 0 0 0.9835 451.2 453.36 Tm 3 Tr 0.0466 Tc 0 Tw (29\(5\):699-702,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 510.72 453.36 Tm 0.0854 Tc 0.3402 Tw ( 1989.) Tj -178.8781 -11.4697 TD /F2 10 Tf -0.0163 Tc 0.5656 Tw (Namazi, K. H., Whitehouse, P. J., Rechlin, L.R., et) Tj ET BT 0.9388 0 0 0.9835 335.52 431.28 Tm 0.011 Tc 0 Tw (al.,) Tj ET BT 0.9835 0 0 0.9835 352.08 431.28 Tm 0.0021 Tc 2.6213 Tw (\223Environmental Modifications in a Specially) Tj -17.0825 -10.7376 TD 0.2503 Tc 2.9267 Tw (Designed Unit for the Care of Patients With) Tj ET q 48.72 0 0 -7.2 335.52 416.64 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0Ύ????|???|??~x?~?8?~??????? ???????????????????x??x??8|0?x?x<8~?|x<>????|???<px x8<>0?|px`0 EI Q BT 0.9835 0 0 0.9835 335.52 409.44 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD 0.0371 Tc 1.2679 Tw ( Disease: An Overview and Introduc-) Tj -49.7833 -11.2256 TD -0.0102 Tc -0.0507 Tw (tion,\224 ) Tj 26.1118 0 TD /F5 10 Tf 0.0307 Tc 1.3719 Tw (American Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.76 0 0 -7.2 449.76 405.36 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0>?|????|??|?~?s~x~a?~8>?~?|x?~~8?~~????~?????~?~~>?>~???>x??|??????|~~~x?>x??|?|??x  EI Q BT 0.9835 0 0 0.9835 449.76 398.4 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0522 Tc 0.984 Tw ( Care and) Tj -165.2121 -10.7376 TD 0.0242 Tc 1.0532 Tw (Related Disorders and Research) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.56 0 0 -8.64 470.64 394.56 cm BI /W 192 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ppx>|<>|p||~>|?~x~~~p??~~>??~?~?~>~~?~??~?~??~?~???~????~?~?~??~??>p?>?>?~?~??|x??||??p>????? ?|?|?>?~<x~`|p? EI Q BT 0.9444 0 0 0.9835 470.64 387.84 Tm 3 Tr 0.0278 Tc 0 Tw (6\(6\):3-9,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 505.2 387.84 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 507.6 394.8 cm BI /W 117 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID b???~?~~~~~??~?~~?~????~>~~~~~~???p EI Q BT 0.8971 0 0 0.9835 507.6 387.84 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 335.04 376.32 Tm /F2 10 Tf 0.0062 Tc 1.3969 Tw (National Academy of Sciences, Institute of Medi-) Tj 0.7321 -11.4697 TD -0.0272 Tc -0.0334 Tw (cine, ) Tj 23.4274 0 TD /F5 10 Tf 0.0226 Tc 2.6411 Tw (Improving the Quality of Care in Nursing) Tj ET BT 0.9444 0 0 0.9835 335.28 354.24 Tm -0.0673 Tc 0.1114 Tw (Homes ) Tj ET BT 0.9388 0 0 0.9835 365.04 354.24 Tm /F2 10 Tf 0.0043 Tc 1.9678 Tw (\(Washington, DC: National Academy Press,) Tj ET BT 0.8919 0 0 0.9835 336.48 343.2 Tm 0.0426 Tc 0 Tw (1986\).) Tj ET BT 0.9835 0 0 0.9835 335.28 331.44 Tm 0.0121 Tc 3.7336 Tw (National Citizen\222s Coalition for Nursing Home) Tj 0.244 -10.9816 TD 0.0233 Tc -0.0848 Tw (Reform, \221Documents Relating to HCFA\222S Interpre-) Tj 0 -11.4697 TD 0.007 Tc 1.0707 Tw (tive Guidelines Limiting the Use of Antipsychotic) Tj 0.4881 -10.9816 TD 0.0401 Tc 0.5693 Tw (Drugs,\224 Washington, DC, October 1990.) Tj -0.4881 -11.7137 TD 0.0121 Tc 3.7336 Tw (National Citizen\222s Coalition for Nursing Home) Tj 0.4881 -11.2256 TD 0.0245 Tc 2.6392 Tw (Reform, \223Nursing Home Reform Law: The Ba-) Tj 0.4881 -11.2256 TD 0.0281 Tc 0.5815 Tw (sics,\224 Washington, DC, January 1991.) Tj -0.9761 -11.2256 TD 0.0121 Tc 3.7336 Tw (National Citizen\222s Coalition for Nursing Home) Tj 0.7321 -11.2256 TD 0.0364 Tc 0.0646 Tw (Reform, \221As Congress ) Tj ET q 24 0 0 -6.96 428.4 249.6 cm BI /W 134 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<#???x?~?|>?|??????????????0?p~?x>?x????????~0??????? 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Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.24 131.52 Tm 0.0401 Tc 1.0371 Tw (Nebraska Task Force on) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 439.68 138.48 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????????<??<??p??p??0????????????????<?? >??>??|??|?>?>~??p?x <ǀ<>?>>~~<?~<>8@ EI Q BT 0.9388 0 0 0.9835 439.68 131.52 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 488.64 131.52 Tm 0.0069 Tc 1.0301 Tw ( Disease and) Tj -154.4746 -10.9816 TD 0.0152 Tc 0.0862 Tw (Related Disorders, \221Report of the Subcommittee on) Tj 0.244 -10.9816 TD 0.0137 Tc 1.3893 Tw (Special Care Units for Persons With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -6.96 491.28 116.64 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~7???~????>??????<???p? ? ?????????????~??<?? <??>?~~?<?><<||>>~?>~~>?<>@ EI Q BT 0.9388 0 0 0.9835 491.28 109.92 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 336.72 98.88 Tm 0.0063 Tc -0.0187 Tw (Disease,\224 Nebraska Department of Health, Lincoln,) Tj ET BT 0.9388 0 0 0.9835 336.72 87.84 Tm 0.0284 Tc 1.8143 Tw (NE, November 1989.) 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EI Q BT 0.9835 0 0 0.9835 229.68 515.04 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD -0 Tc 1.8913 Tw ( Care) Tj -182.5387 -10.9816 TD 0.034 Tc 4.114 Tw (and Related Disorders and Research) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.32 0 0 -8.64 267.12 511.44 cm BI /W 191 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08<x8><<>|~?|~|~?~~~>|>||?||?~>?~>??~>?~>??>??>?~???>~ ~?~?|??|x?`|?<?|??~?~?~~~?|x|~?|x|~|`<|~>|~~|?~?>????>~>~<>`8< EI Q BT 0.9444 0 0 0.9835 267.12 504.24 Tm 3 Tr 0.0278 Tc 0 Tw (5\(4\):4-9,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 98.64 493.44 Tm 0.0456 Tc (1990.) Tj ET BT 0.9835 0 0 0.9835 97.2 480.96 Tm /F2 10 Tf 0.0276 Tc 2.4976 Tw (Nonemaker, S., Analyst, Nursing Home Branch,) Tj 0.9761 -11.2256 TD 0.023 Tc 3.1287 Tw (Office of Survey and Certification, Division of) Tj ET q 19.92 0 0 -8.88 98.16 465.84 cm BI /W 111 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|<>xx??~?????~~~|?>???߀~????||~?~??>??~`????? EI Q BT 0.8919 0 0 0.9835 98.16 459.12 Tm 3 Tr 0.0337 Tc 0 Tw (Imng) Tj 0 Tr ET BT 0.9835 0 0 0.9835 118.08 459.12 Tm -0.0006 Tc 1.5258 Tw ( Term Care Services, Health Care Financing) Tj -20.255 -10.9816 TD 0.0078 Tc 1.3343 Tw (Administration, Baltimore, MD, personal commu-) Tj 0 -11.2256 TD 0.0237 Tc 0.1589 Tw (nication, March 20, 1992.) Tj 0 -12.6899 TD 0.0315 Tc 1.8593 Tw (Norman, A.,) Tj 0 Tc -0.061 Tw ( ) Tj 56.8603 0 TD /F5 10 Tf 0.0153 Tc 2.6688 Tw (Severe Dementia: The Provision of) Tj ET q 35.76 0 0 -8.88 98.16 420.72 cm BI /W 199 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >π>>>>?ppx|?||~~>?~>~??~??|???|~???|?~??~?~|p~?p?8?<?~~~?|>~?~>?~?~~~?~<| ~ EI Q BT 0.9444 0 0 0.9835 98.16 413.76 Tm 3 Tr 0.0203 Tc 0 Tw (Longstay) Tj 0 Tr ET BT 0.9835 0 0 0.9835 133.92 413.76 Tm -0 Tc -0.061 Tw ( Care ) Tj ET q 35.28 0 0 -8.16 158.4 420.72 cm BI /W 197 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <xx`@>?|?>~~?~~~~~~~~~~|~|~|~~~~~~~~|~||~?~~|~?~|>?~?~>>~?> ?0||>p EI Q BT 0.9388 0 0 0.9835 158.4 413.76 Tm 3 Tr /F2 10 Tf 0.0534 Tc 0 Tw (\(1.mdon,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 193.68 413.76 Tm 0.0289 Tc -0.0904 Tw ( England: ) Tj ET q 25.92 0 0 -7.2 234.24 420.96 cm BI /W 145 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>??????????a???????????????????????????????>????? EI Q BT 0.9388 0 0 0.9835 234.24 413.76 Tm 3 Tr -0.0147 Tc 0 Tw (Centre) Tj 0 Tr ET BT 0.9835 0 0 0.9835 260.16 413.76 Tm 0.0379 Tc -0.0995 Tw ( for Policy) Tj -164.48 -10.9816 TD 0.0674 Tc -0.1295 Tw (on Ageing, 1987\).) Tj -0.244 -12.4458 TD 0.0093 Tc 3.1019 Tw (North Carolina Legislature, House Bill No. 75,) Tj 0.4881 -11.2256 TD 0.0487 Tc 0.0115 Tw (Chapter 222, 1991.) Tj ET q 21.12 0 0 -8.16 98.64 374.64 cm BI /W 118 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx|~ ?~?~~~?~~~~~~~~~~~?~~?~?~?~~?~@?~ EI Q BT 0.9388 0 0 0.9835 98.64 367.68 Tm 3 Tr 0.0066 Tc 0 Tw (Ohta,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 119.76 367.68 Tm -0.0077 Tc 2.2651 Tw ( R.J., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.12 0 0 -8.64 165.84 374.88 cm BI /W 118 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<|x??~~?????p0?? EI Q BT 0.9388 0 0 0.9835 165.84 367.68 Tm 3 Tr 0.0066 Tc 0 Tw (Ohta,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 186.96 367.68 Tm 0.2195 Tc 3.0102 Tw ( B.M., \223Special Units for) Tj ET q 48.96 0 0 -7.2 98.64 363.84 cm BI /W 273 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >????~???????>???????p?~??0?~??|??|?|?????|??|??|?><<<???>?~?`????x |@?>~~|||?~~8<8 EI Q BT 0.9388 0 0 0.9835 98.64 356.64 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 147.6 356.64 Tm -0.0328 Tc 2.6567 Tw ( Disease Patients: A Critical) Tj 0 Tc -0.061 Tw ( ) Tj ET q 28.56 0 0 -8.16 273.12 363.36 cm BI /W 159 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxs8??|~~??????????||~<>?~~~x<>xx> EI Q BT 1.2674 0 0 0.9835 273.12 356.64 Tm 3 Tr -0.0732 Tc 0 Tw (hok,\224) Tj 0 Tr ET BT 0.9835 0 0 0.9835 98.64 345.36 Tm /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.52 0 0 -8.64 156.48 352.56 cm BI /W 331 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|>??????|~?>>?>??~??~>x?~>?x?|>?|?p|??|x~?>??|?|~>??|?|||?~??~?|>~>~~~|`?|??>??>?x?>x?>?>?>??<~?~x?~~~|??>??? EI Q BT 0.9444 0 0 0.9835 156.48 345.36 Tm 3 Tr 0.0466 Tc 0 Tw (28\(6\):803-808,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 216 345.36 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj -119.3334 -12.4458 TD /F2 10 Tf 0.0062 Tc 0.6159 Tw (Older American Reports, \223State and ) Tj ET q 21.84 0 0 -7.2 247.68 340.32 cm BI /W 122 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8??|~~~~?~???~?~?~|?~~~?|?| EI Q BT 1.3143 0 0 0.9835 247.68 333.12 Tm 3 Tr -0.0588 Tc 0 Tw (bcal) Tj 0 Tr ET BT 0.9835 0 0 0.9835 269.52 333.12 Tm 0.0076 Tc 0.6633 Tw ( News,\224) Tj -173.2653 -10.7376 TD /F5 10 Tf 0.0169 Tc 1.142 Tw (Older American Reports) Tj 0 Tc -0.061 Tw ( ) Tj ET q 35.52 0 0 -8.64 202.32 329.52 cm BI /W 198 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<xx||>p>|x?|<?|>|??>|?>|~ |~|>>|~0>>|>>>|~|~|~?>?>|||>>p??>~xx`| p>|x|Cx>|?~??>8?p0> EI Q BT 0.8971 0 0 0.9835 202.32 322.56 Tm 3 Tr -0.0062 Tc 0 Tw (13\(8\):77,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 237.84 322.56 Tm /F2 10 Tf 0.0559 Tc 0.6143 Tw ( Feb. 24, 1989.) Tj -141.5407 -12.4458 TD -0.0014 Tc 3.7961 Tw (Oliver, M., Executive Assistant, Department of) Tj 0 -10.9816 TD 0.0145 Tc 0.0869 Tw (Inspections and Appeals, Division of Health Facili-) Tj 0 -11.2256 TD 0.0062 Tc 3.5932 Tw (ties, Des Moines, IA, personal communication,) Tj 0.4881 -10.9816 TD 0.0441 Tc -0.1059 Tw (Sept. 20, 1991.) Tj ET BT 0.9388 0 0 0.9835 98.88 265.2 Tm 0.012 Tc 1.1926 Tw (Oregon Legislative Assembly, Senate Bill 801, May) Tj 0.2556 -10.9816 TD 0.0963 Tc 0.7194 Tw (22, 1991.) Tj ET BT 0.9835 0 0 0.9835 98.64 242.16 Tm 0.0258 Tc 1.8651 Tw (Orr, N.,) Tj 39.0457 0 TD 0.0225 Tc 3.2513 Tw (\223Integrating Care Improves Solutions,\224) Tj -39.0457 -10.7376 TD /F5 10 Tf 0.0074 Tc -0.0686 Tw (Provider ) Tj ET q 48.96 0 0 -8.64 137.04 238.32 cm BI /W 272 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88@x<x>0?>xx?{|||>??>??|?>x?p?????x~<~?~~?????x??????|?|><~~>>~>8>`|?||?p>xg|?>?????p<?88<8? EI Q BT 0.9444 0 0 0.9835 137.04 231.6 Tm 3 Tr 0.0409 Tc 0 Tw (12\(5\):36-38,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 186 231.6 Tm 0.0854 Tc 0.5843 Tw ( 1986.) Tj ET q 47.28 0 0 -9.6 98.88 226.32 cm BI /W 263 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |xx<<<>0>` ????????8?0???~?? ?????????????~p??|x???8??8<??<??<??~??~|??~|??~>?ϟ?~???~?|?~??p8?????????x??x EI Q BT 0.9388 0 0 0.9835 98.88 219.36 Tm 3 Tr /F2 10 Tf -0.0005 Tc 0 Tw (Orr-Rainey,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 146.16 219.36 Tm 0.0134 Tc 0.7062 Tw ( N., Corporate Director, Specialty Pro-) Tj -47.587 -11.2256 TD 0.0204 Tc 2.8466 Tw (grams, Hillhaven Corp., Takoma, WA, personal) Tj 0 -11.2256 TD 0.0408 Tc 1.8904 Tw (communications, Sept. 26, 1990, Nov. 15, 1991,) Tj T* 0.0501 Tc 0.0507 Tw (and March 31, 1992.) Tj 0 -12.4458 TD 0.0137 Tc 1.1103 Tw (Ortof, E., and Crystal, H.A., \223Rate of Progression) Tj 0 -11.2256 TD 0.1033 Tc -0.1661 Tw (of ) Tj ET q 48.96 0 0 -7.2 110.4 169.92 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????<???p???0?~@???????p???????@???<??<??>??~??>>?|>???<<|?~?~?<?8 EI Q BT 0.9835 0 0 0.9835 110.4 162.96 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0112 Tc 0.1944 Tw ( Disease, \222 ) Tj 45.3906 0 TD /F5 10 Tf 0.0249 Tc 0.8085 Tw (Journal of the American) Tj -106.1555 -10.9816 TD -0.0138 Tc 0.197 Tw (Geriatrics Society ) Tj ET q 59.52 0 0 -8.64 174.24 159.12 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x<>x????>~?~??>????~>x~`?|>||x?<||??<||?>||?>|?>|?~~?~?~?????|??|??<????>|?>|??|?|??x>???<>??>??????? p?`x?p~>| ?x|??|???|??>|??` EI Q BT 0.9444 0 0 0.9835 174.24 152.16 Tm 3 Tr 0.0466 Tc 0 Tw (37\(6\):511-514,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 233.76 152.16 Tm 0.0854 Tc 0.3402 Tw ( 1989.) Tj ET q 42.72 0 0 -8.16 99.36 147.12 cm BI /W 238 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx| 8|???????~x?~<??~~ ?~~?~ ?~?~~?~~>?~~?~~?~~?~~?~~??~~?~~@<?~~~~?~~~~~>?~~??????????@ EI Q BT 0.9388 0 0 0.9835 99.36 140.16 Tm 3 Tr /F2 10 Tf 0.0091 Tc 0 Tw (Ouslander,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 142.08 140.16 Tm -0.0147 Tc 0.32 Tw ( J. G.,) Tj 31.2366 -0.244 TD -0.0008 Tc 3.5393 Tw (\223Medical Care in the Nursing) Tj -74.6749 -10.7376 TD 0.0363 Tc -0.0979 Tw (Home,\222 ) Tj 33.4329 0 TD /F5 10 Tf 0.0172 Tc 0.6535 Tw (Journal of the American Medical Associa-) Tj -32.9448 -11.2256 TD 0.0124 Tc -0.0737 Tw (tion ) Tj ET q 79.68 0 0 -8.88 117.6 125.28 cm BI /W 443 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|><<|>?@?????????????~?>?~~??|??||p8x?x|<x?||>><>>>>???|?|?>?>???|??|~?|~|~?~>~0~?@~>~8~?<~?|?~>p~|??xx~~x?>>x|?||<|~???>?x>??|??>????~??~`~`?0> EI Q BT 0.9444 0 0 0.9835 117.6 118.32 Tm 3 Tr 0.0541 Tc 0 Tw (262\(18\):2582-2590,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 197.28 118.32 Tm 0.0854 Tc -0.1478 Tw ( 1989.) Tj ET q 42.72 0 0 -8.64 99.36 113.28 cm BI /W 238 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx`8|???????????~<?~?~~ ?~~~ ?~?~~?~~?~?~~??~~?~~?~~?~x~??~~?~~?~~`|?~~~~?~~~~?>?~~????@< ??????0 EI Q BT 0.9388 0 0 0.9835 99.36 106.08 Tm 3 Tr /F2 10 Tf 0.0091 Tc 0 Tw (Ouslander,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 142.08 106.08 Tm 0.0125 Tc 2.3667 Tw ( J. G., Tymchuk, A., and Rahbar, B.,) Tj ET BT 0.9388 0 0 0.9835 100.32 95.04 Tm 0.0018 Tc 2.0471 Tw (\221\221Health Care Decisions Among Elderly Long-term) Tj ET BT 0.9835 0 0 0.9835 100.08 84.24 Tm -0.0008 Tc 1.8432 Tw (Care Residents and Their Potential Proxies,\224) Tj 0 Tc -0.061 Tw ( ) Tj 192.5441 0 TD /F5 10 Tf 0.1909 Tc 0 Tw (Ar-) Tj -192.5441 -11.2256 TD -0.0002 Tc 0.4273 Tw (chives of Internal Medicine ) Tj ET q 62.16 0 0 -8.64 212.88 80.4 cm BI /W 346 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8< < ?>|>>?|>?|?|~~|?>xx?~~?>|???>?????????????|?~?<??|??<???>??|???|??|??>??>?|?~|?<?~<~|~|?>~>}~~?>~??~~0>~?~~x~ ?~~|~??c~????~??p|? EI Q BT 0.9444 0 0 0.9835 212.88 73.2 Tm 3 Tr 0.062 Tc 0 Tw (149:1367-1372,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 275.04 73.2 Tm 0.0854 Tc 0.3402 Tw ( 1989.) Tj -178.6341 -11.9577 TD /F2 10 Tf -0.0119 Tc 0.1463 Tw (Pagel, M.D., Becker, J., and ) Tj ET q 30.48 0 0 -8.88 213.36 68.16 cm BI /W 170 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???<????~>>?x8<? ???||??>????px?? EI Q BT 0.9388 0 0 0.9835 213.36 61.44 Tm 3 Tr 0.0418 Tc 0 Tw (Coppel,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 243.84 61.44 Tm -0.0342 Tc -0.0263 Tw ( D.B., ) Tj ET q 23.76 0 0 -6.48 269.76 68.16 cm BI /W 132 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|?x~|>|???????0p~~p>p ?< ???<p<x|>{ EI Q BT 1.3613 0 0 0.9835 269.76 61.44 Tm 3 Tr -0.0317 Tc 0 Tw (\223hss) Tj 0 Tr ET BT 0.9835 0 0 0.9835 293.52 61.44 Tm 0.1033 Tc -0.1661 Tw ( of) Tj ET BT 0.9388 0 0 0.9835 100.08 50.4 Tm 0.0098 Tc 1.6296 Tw (Control, Self-Blame, and Depression: An Investiga-) Tj ET BT 0.9835 0 0 0.9835 99.84 39.6 Tm 0.039 Tc 0.6803 Tw (tion of Spouse Caregivers of ) Tj ET q 48.96 0 0 -7.2 220.56 46.56 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @|??????<???>??????<?p?~??`?~?????>?????~|?~<?<??>??~?~>><~~>??<~|?|?>x<?<~?~~~|~<<x EI Q BT 0.9835 0 0 0.9835 220.56 39.6 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0178 Tc 1.4213 Tw ( Disease) Tj ET BT 0.8971 0 0 0.9835 324.72 627.36 Tm /F5 10 Tf 0.2375 Tc 0 Tw (342.) Tj 0.535 -45.1466 TD 0.0369 Tc (343.) Tj 0.8025 -45.1466 TD 0.0369 Tc (344.) Tj 0.2675 -56.6163 TD 0.2375 Tc (345.) Tj 0 -22.9394 TD 0.0369 Tc (346.) Tj 0.2675 -23.1834 TD 0.0369 Tc (347.) Tj 0.2675 -33.921 TD 0.0369 Tc (348.) Tj 0.2675 -34.165 TD 0.0369 Tc (349.) Tj 0.535 -56.6163 TD 0.0369 Tc (350.) Tj 0.2675 -78.5795 TD 0.0369 Tc (351.) Tj 0 -33.6769 TD 0.0369 Tc (352.) Tj 0.535 -56.1282 TD 0.0369 Tc (353.) Tj 0 -67.1098 TD 0.0369 Tc (354.) Tj 0.2675 -33.6769 TD 0.0369 Tc (355.) Tj ET BT 0.9444 0 0 0.9835 347.04 650.16 Tm 0.0059 Tc 0.4151 Tw (Patients, \222\222Journal ) Tj ET q 94.56 0 0 -9.36 422.64 657.12 cm BI /W 535 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x`???~??x<xx8~??<>~<??>??>??>?~~????~???????????<???????q??~~'???~~???>????~?8~?|~?~?<?|p~~><x~~~?>8??~~?~~>?~?~????~?~????~???~|~??~}~?>~~'~>??>?>?~?>?????~?<`?8?~??~????~????~??|>|?~?>??>????? EI Q BT 0.9835 0 0 0.9835 422.64 650.16 Tm 3 Tr 0.0377 Tc 0 Tw (ofAbnormalPsychology) Tj 0 Tr ET BT 0.9444 0 0 0.9835 517.2 650.16 Tm 0.0494 Tc 1.0044 Tw ( 94:169-) Tj -179.1657 -11.4697 TD 0.0714 Tc 0.2187 Tw (182, 1985.) Tj ET BT 0.9835 0 0 0.9835 347.04 627.6 Tm /F2 10 Tf -0.0081 Tc 4.0145 Tw (Parrnelee, P.A., Katz, I.R., and Lawton, M.P.,) Tj 0.9761 -11.2256 TD 0.0263 Tc 3.0847 Tw (\223Depression Among Institutionalized Aged: As-) Tj -0.244 -11.2256 TD -0.002 Tc 2.3814 Tw (sessment and Prevalence Estimation,\224) Tj 0 Tc -0.061 Tw ( ) Tj 164.236 0 TD /F5 10 Tf 0.042 Tc 2.3366 Tw (Journal of) Tj ET BT 0.9444 0 0 0.9835 347.76 594.48 Tm 0.0094 Tc 1.3009 Tw (Gerontology 44\() Tj 0 Tc 0.0402 Tw ( ) Tj ET q 43.92 0 0 -8.88 415.44 601.44 cm BI /W 247 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |><<>?~?#x????>>=p|<x0>< ?~>|~>~||>~?>??>?À???C?~?~~???>~?<<?x?>~ EI Q BT 0.9444 0 0 0.9835 415.44 594.48 Tm 3 Tr 0.0303 Tc 0 Tw (I\):M22-29,) Tj 0 Tr 46.5068 0 TD 0.0723 Tc 0.4719 Tw ( 1989.) Tj ET BT 0.9835 0 0 0.9835 347.28 582.96 Tm /F2 10 Tf 0.0214 Tc 0.2833 Tw (Parrish, F., Section Supervisor, Division of Licens-) Tj 0.7321 -10.9816 TD 0.0196 Tc 0.2038 Tw (ing and Regulation, Cabinet for Human Resources,) Tj -0.244 -10.9816 TD 0.026 Tc 2.3528 Tw (Frankfort, KY, personal communication, May 5,) Tj ET BT 0.8919 0 0 0.9835 348.96 550.56 Tm 0.0717 Tc 0 Tw (1992.) Tj ET BT 0.9835 0 0 0.9835 347.76 538.56 Tm -0.0174 Tc 0.9938 Tw (Pearson, J.L., Teri, L., Reifier, B.V., et al., \223Func-) Tj 0.4881 -11.2256 TD 0.0081 Tc 3.1032 Tw (tional Status and Cognitive Impairment in) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.28 0 0 -7.2 534.96 534.72 cm BI /W 97 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x???>?????8|?|<p<p>x||?8 EI Q BT 0.9388 0 0 0.9835 534.96 527.52 Tm 3 Tr -0.0351 Tc 0 Tw (Alz-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 348.24 516.72 Tm 0.0126 Tc 1.5856 Tw (heimer\222s Patients With and Without Depression,\224) Tj ET BT 0.9444 0 0 0.9835 348 505.44 Tm /F5 10 Tf 0.0191 Tc 0.0199 Tw (Journal ) Tj ET q 94.08 0 0 -9.12 380.64 512.64 cm BI /W 531 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?|y~<|x?~?>>??>|x?|??>?>||~|?>????~>||?|???~8>~~|~ 㿀??>~|??g??~>~~??~?`?~?~?~??~??>x?~????|????~?>?~??~?~~?~~~?π??~?π~|??~|~~?~~~????~~~~?~0~~?~~?|?~??~?|?~|?????????8???<|xy <` x8<8?p?8|8|<?>~~?x?x0> EI Q BT 0.9444 0 0 0.9835 380.64 505.44 Tm 3 Tr -0.0219 Tc 0 Tw (oftheAmericanGetitn\224cs) Tj 0 Tr 99.6212 0 TD 0 Tc 0.0402 Tw ( ) Tj ET q 75.12 0 0 -9.6 476.88 512.64 cm BI /W 425 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <~ <|<|0?~|?>?>?>>??|~>~?~|~???|x~??x~??p??|p?|?|~:0~?>>0~>??>>???~?>???>|???~|??~~?|>?~>??????|??~??~?>|??~??>|>?p?>|~?x?<??x?|p??8 ?<?>G1?????|?>??|`? p EI Q BT 0.9444 0 0 0.9835 476.88 505.44 Tm 3 Tr 0.0117 Tc 0 Tw (Society37\(12\):ll17-) Tj 0 Tr ET q 20.88 0 0 -8.16 349.2 501.6 cm BI /W 117 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx??xx<0~~?~?~?????x?|?>????~?~?~?~? ~?~?~?~?G ??p EI Q BT 0.8971 0 0 0.9835 349.2 494.64 Tm 3 Tr 0.0456 Tc (1121,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 370.08 494.64 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj -21.7192 -11.7137 TD /F2 10 Tf 0.013 Tc 0.9019 Tw (Peppard, N.R.,) Tj ET q 48 0 0 -7.2 413.28 490.32 cm BI /W 267 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?????????|???p??0??????????????????>??>????~??|>?>??|???@x>x??<~<?`< EI Q BT 0.9835 0 0 0.9835 413.28 483.12 Tm 3 Tr -0.0065 Tc 0 Tw (\223Alzheimer) Tj 0 Tr 48.8071 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 51.12 0 0 -9.36 463.68 490.32 cm BI /W 285 /H 54 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????0?p9????????~?~x?8???`??~@?????????@??~~`?~~?~~|????|????????`?>  EI Q BT 0.9835 0 0 0.9835 463.68 483.12 Tm 3 Tr -0.0179 Tc 0 Tw (Special-Cme) Tj 0 Tr 51.9796 0 TD 0.0661 Tc 2.5561 Tw ( Nursing) Tj -168.8727 -11.2256 TD 0.0109 Tc 1.148 Tw (Home Units,\224) Tj 0 Tc -0.061 Tw ( ) Tj 60.7649 0 TD /F5 10 Tf 0.0406 Tc 1.3619 Tw (Nursing Homes) Tj 0 Tc -0.061 Tw ( ) Tj ET q 49.44 0 0 -8.64 475.92 479.28 cm BI /W 275 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~|<>????????????????|>x??<???>|?~|~|~x~?~<<~?~~?~|?>|?>??????~|??~?~|?~??~x?>?????p?x?@x<>>x|x|~>?||???????|< EI Q BT 0.9444 0 0 0.9835 475.92 472.08 Tm 3 Tr 0.0409 Tc 0 Tw (34\(5\):25-28,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 525.36 472.08 Tm 0.0854 Tc 1.0723 Tw ( 1985.) Tj -179.6102 -11.7137 TD /F2 10 Tf 0.013 Tc 0.4138 Tw (Peppard, N.R.,) Tj 64.4254 0 TD 0.0009 Tc 1.7073 Tw (\223Effective Design of Special Care) Tj -64.4254 -11.4697 TD -0.0105 Tc -0.0503 Tw (Units,\224 ) Tj 33.1888 0 TD /F5 10 Tf 0.0074 Tc -0.0686 Tw (Provider ) Tj ET q 48.96 0 0 -8.64 421.68 456.24 cm BI /W 273 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<pp<?><?|<>||~>?|>?>???>???|?|8x|>gx<<8?|?|?|~>|~>~~|~~`~|8>|?>|>8x~>?8x?<|??῀??????><<x880>00 EI Q BT 0.9444 0 0 0.9835 421.68 449.28 Tm 3 Tr 0.0409 Tc 0 Tw (12\(5\):14-17,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 470.64 449.28 Tm 0.0854 Tc 1.8044 Tw ( 1986.) Tj -123.9701 -11.7137 TD -0.0416 Tc -0.0187 Tw (Pies, ) Tj 22.2072 0 TD /F2 10 Tf -0.0036 Tc 0.9187 Tw (R., \223Pharmacologic Restraint vs. Therapeutic) Tj -21.7192 -11.2256 TD -0.0067 Tc 0.0434 Tw (Intent,\222 letter to the editor, ) Tj 108.3518 0 TD /F5 10 Tf 0.0249 Tc 0.1577 Tw (Journal of the American) Tj -108.8399 -10.9816 TD 0.004 Tc 1.6432 Tw (Medical Association) Tj 0 Tc -0.061 Tw ( ) Tj ET q 46.08 0 0 -8.64 435.12 422.88 cm BI /W 257 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x~|>>|?????|~|<~~~>~`~~|~~>?~|?>>|>~?~~?~~?~?~?~~?~<~<?x|9|?<??>????>|~?>@ EI Q BT 0.9444 0 0 0.9835 435.12 415.92 Tm 3 Tr 0.0472 Tc 0 Tw (266\(2\):216,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 481.2 415.92 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 483.6 422.88 cm BI /W 116 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x1>??~~~?~~~~?~~~~??~?~??~?~?~?~?~?~~~~~~~~?~?0 EI Q BT 0.8971 0 0 0.9835 483.6 415.92 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET q 35.52 0 0 -8.16 348.72 411.12 cm BI /W 198 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x||<?????~???~?|??~???~??~p~??~p??~??~??~??~??~??~??~??~??~??~>???~>??~??~??~?~???~|?~?~?~?~?~?~?~??~|>< EI Q BT 0.9835 0 0 0.9835 348.72 404.4 Tm 3 Tr /F2 10 Tf -0.0325 Tc (Pillemer,) Tj 0 Tr 36.1173 0 TD 0.0157 Tc 0.4808 Tw ( K., and Moore, D.W., \223Abuse of Patients) Tj ET q 7.2 0 0 -6.96 349.2 400.32 cm BI /W 41 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>?~~~??? EI Q BT 0.8919 0 0 0.9835 349.2 393.36 Tm 3 Tr 0.0094 Tc 0 Tw (in) Tj 0 Tr ET BT 0.9835 0 0 0.9835 356.4 393.36 Tm 0.0534 Tc 2.8131 Tw ( Nursing Homes: Findings From a Survey of) Tj -7.3211 -11.4697 TD -0.0055 Tc -0.0554 Tw (Staff,\224 ) Tj 29.5283 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.76 0 0 -8.88 437.28 389.28 cm BI /W 333 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|~>|???????????><~|~`??>`|??> |x~|>~<~~<~~~~~~?~~~~x~|~~<~~|~~~~~~>~~??~?x?@|`?~p?p?xx?x|??<>?>?|?<~x???|?|??  EI Q BT 0.9444 0 0 0.9835 437.28 382.08 Tm 3 Tr 0.0466 Tc 0 Tw (29\(3\):314-320,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 497.04 382.08 Tm 0.0854 Tc 0.5843 Tw ( 1989.) Tj -150.57 -11.7137 TD /F2 10 Tf -0.0419 Tc 3.3981 Tw (Pratt, C.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.56 0 0 -8.16 392.88 377.52 cm BI /W 192 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?8????????????~??0|x??x??x0??p|??p???`????????????x?????????|~????~??????????? 8???????????????????? EI Q BT 0.9835 0 0 0.9835 392.88 370.56 Tm 3 Tr -0.0198 Tc 0 Tw (Schmall,) Tj 0 Tr 35.1411 0 TD -0.0156 Tc 3.3713 Tw ( V., Wright, S., et al., \223The) Tj -79.5556 -11.2256 TD 0.0051 Tc 0.91 Tw (Forgotten Client: Family Caregivers to Institution-) Tj 0.7321 -11.4697 TD -0.0256 Tc 0.2091 Tw (alized Dementia Patients, ) Tj 104.9353 0 TD /F5 10 Tf 0.0373 Tc 0.0637 Tw (Aging, Health, and ) Tj ET q 21.36 0 0 -7.2 531.84 355.44 cm BI /W 119 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??8??~??????????>~????x?`???? EI Q BT 0.9444 0 0 0.9835 531.84 348.24 Tm 3 Tr -0.0172 Tc 0 Tw (Fam-) Tj 0 Tr ET q 11.76 0 0 -8.88 349.92 344.4 cm BI /W 66 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>> `x?@||~|~~~~>>?>??????? EI Q BT 0.7555 0 0 0.9835 349.92 337.44 Tm 3 Tr 0.0696 Tc (iZy,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 361.68 337.44 Tm /F4 10 Tf 0 Tc -0.0972 Tw ( ) Tj ET q 16.08 0 0 -6.96 364.32 344.4 cm BI /W 90 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |@?p EI Q BT 0.7642 0 0 0.9835 364.32 337.44 Tm 3 Tr 0.0389 Tc 0 Tw (T.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 380.4 337.44 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 36.96 0 0 -7.2 383.04 344.4 cm BI /W 206 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xp????????????????~???????x??|?????<?~?|~??????|x?8??????` EI Q BT 0.8066 0 0 0.9835 383.04 337.44 Tm 3 Tr 0.0428 Tc 0 Tw (Brubaker) Tj 0 Tr ET BT 0.9835 0 0 0.9835 420 337.44 Tm 0.0272 Tc -0.0028 Tw ( \(cd.\) ) Tj ET q 39.84 0 0 -9.36 445.2 344.4 cm BI /W 222 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <><>?~>~?~??>??~???~|~~{?~~?~?~??x?x~??x~?<~<C~?>~>?~?>?????? EI Q BT 0.8491 0 0 0.9835 445.2 337.44 Tm 3 Tr 0.0734 Tc 0 Tw (\(Newbury) Tj 0 Tr ET BT 0.9835 0 0 0.9835 485.04 337.44 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 20.16 0 0 -8.64 487.68 344.64 cm BI /W 113 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px<>?>?????|???~?>???????|?|?~?~?~~???p EI Q BT 0.8915 0 0 0.9835 487.68 337.44 Tm 3 Tr 0.067 Tc 0 Tw (Park) Tj 0 Tr ET BT 0.9835 0 0 0.9835 507.84 337.44 Tm 0.0437 Tc 0.3465 Tw ( CA: Sage) Tj ET BT 0.8491 0 0 0.9835 349.68 326.4 Tm 0.0525 Tc 1.1136 Tw (Publications, 1987\).) Tj ET BT 0.8915 0 0 0.9835 349.2 314.88 Tm 0.0263 Tc 1.0024 Tw (President\222s Commission for the Study of Ethical) Tj ET BT 0.8491 0 0 0.9835 349.68 304.08 Tm 0.0266 Tc 1.4268 Tw (Problems in Medicine and Biomedical and Behav-) Tj ET BT 0.9835 0 0 0.9835 349.92 293.28 Tm /F2 10 Tf -0.0117 Tc 2.6352 Tw (ioral Research,) Tj 0 Tc -0.061 Tw ( ) Tj 67.8419 0 TD /F5 10 Tf 0.0417 Tc 5.6314 Tw (Implementing Human Research) Tj -68.574 -11.4697 TD 0.2693 Tc 2.5936 Tw (Regulations: The Adequacy and Uniformity of) Tj 0.4881 -10.9816 TD 0.0236 Tc 0.037 Tw (Federal Rules and of Their Implementation ) Tj 177.6579 0 TD /F2 10 Tf 0.0543 Tc 0 Tw (\(Wash-) Tj -177.4139 -10.9816 TD 0.0228 Tc 4.1132 Tw (ington, DC: U.S. Government Printing Office,) Tj ET BT 0.8919 0 0 0.9835 350.64 249.6 Tm 0.0426 Tc 0 Tw (1983\).) Tj ET BT 0.9835 0 0 0.9835 349.44 237.84 Tm 0.0198 Tc 1.8711 Tw (Prestegard, O., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.32 0 0 -8.16 433.2 244.56 cm BI /W 191 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<>?_?~?|??x??x?~`?p?~p?~`|?~~?~~?~~?~~?~~?~~?~~??~~?~~?~~?~?~???|?~||>~??0 EI Q BT 0.9388 0 0 0.9835 433.2 237.84 Tm 3 Tr 0.0662 Tc 0 Tw (Poulson,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 467.52 237.84 Tm 0.018 Tc 0.1647 Tw ( G. ) Tj ET q 24.24 0 0 -8.64 482.88 244.8 cm BI /W 135 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p<xx>x<<~~>~>|>~?|~??~~???~|?>|?>|~?>|~?>|??|??~?????????>|>?>|>?~|~||>~~?~?>?? ??|<?x ` EI Q BT 0.9388 0 0 0.9835 482.88 237.84 Tm 3 Tr 0.007 Tc 0 Tw (\(eds.\),) Tj 0 Tr ET BT 0.9835 0 0 0.9835 507.12 237.84 Tm /F5 10 Tf 0.0121 Tc 3.3431 Tw ( Wisconsin) Tj -160.3314 -10.9816 TD -0 Tc 4.3316 Tw (Administrative Code) Tj 0 Tc -0.061 Tw ( ) Tj 93.7097 0 TD /F2 10 Tf 0.0248 Tc 3.5743 Tw (\(Madison, WI: Revisor of) Tj -92.9776 -11.4697 TD 0.0185 Tc 0.1642 Tw (Statutes Bureau, 1988\).) Tj -0.4881 -11.4697 TD -0.0065 Tc 1.7759 Tw (Pynoos, J., and Stacey, C.A., \223Specialized Facili-) Tj 0.4881 -11.2256 TD -0.0155 Tc 0.394 Tw (ties for Senile Dementia Patients,\224 ) Tj 142.7609 0 TD /F5 10 Tf 0.0406 Tc -0.1023 Tw (The ) Tj ET q 45.6 0 0 -7.2 508.08 200.4 cm BI /W 254 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  p?????~????|??|?<|?yx ~?<?p~??p?>??p??????~||~|~|~~|~~|>>~~>?`?~~??`>???~x???~|?~?>???|?x?p <0 ??? EI Q BT 0.9835 0 0 0.9835 508.08 193.44 Tm 3 Tr 0.0241 Tc 0 Tw (Dementias:) Tj 0 Tr -160.5755 -10.9816 TD 0.0297 Tc -0.0912 Tw (Policy and Management, ) Tj ET q 19.2 0 0 -6.96 451.68 189.12 cm BI /W 107 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?????>???? EI Q BT 0.9388 0 0 0.9835 451.68 182.64 Tm 3 Tr /F2 10 Tf 0.0462 Tc 0 Tw (M.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 470.88 182.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 37.44 0 0 -9.12 473.28 189.6 cm BI /W 209 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?p?x>|>|??????~~|~~~?~???~???~x~~<~?<~<~?~?~~?~~|~>??~?~?~?~~~~??>8 EI Q BT 0.9388 0 0 0.9835 473.28 182.64 Tm 3 Tr 0.0579 Tc 0 Tw (Gilhooly,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 510.72 182.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 16.8 0 0 -7.2 513.12 189.84 cm BI /W 94 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?<`:?`{~???~?<?@??????????t EI Q BT 0.9388 0 0 0.9835 513.12 182.64 Tm 3 Tr 0.0263 Tc 0 Tw (S.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 529.92 182.64 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 532.32 189.84 cm BI /W 120 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|<>>??q?? `~~~?~~~?~~x|@???y?8|8|<<<>>??C> EI Q BT 0.9835 0 0 0.9835 532.32 182.64 Tm 3 Tr -0.0388 Tc 0 Tw (Zarit,) Tj 0 Tr -184.735 -11.4697 TD 0.0291 Tc -0.0906 Tw (and J. ) Tj ET q 25.2 0 0 -7.2 376.08 178.32 cm BI /W 140 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID #??~>~~?~?~~~~~~~~~~~~>?~?~?~?~?>|?p? 8| EI Q BT 0.9835 0 0 0.9835 376.08 171.36 Tm 3 Tr 0.0099 Tc 0 Tw (Birren) Tj 0 Tr 25.6237 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 403.68 178.56 cm BI /W 121 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x<<x?|>|>~>>?~~>~??|???|??|??|??>??>????????|?|??|??|?~|>~?>><??|x??<?<80 EI Q BT 0.9388 0 0 0.9835 403.68 171.36 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 425.28 171.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 48.48 0 0 -9.12 427.68 178.32 cm BI /W 270 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>x< ~?>??ߟ??????0?~??>??~>??~?~~??~??~?}~>~?~?>~?x?<?x?~|<?~?<~?~?~~?>>???>x???<??`8?<???|>??> EI Q BT 0.9388 0 0 0.9835 427.68 171.36 Tm 3 Tr 0.0432 Tc 0 Tw (\(Englewood) Tj 0 Tr ET BT 0.9835 0 0 0.9835 476.16 171.36 Tm -0.013 Tc -0.0478 Tw ( Cliffs, NJ: Prentice) Tj -127.8747 -10.7376 TD 0.0276 Tc -0.0891 Tw (Hall, 1986\).) Tj ET BT 0.9388 0 0 0.9835 350.16 149.28 Tm 0.0087 Tc 0.8127 Tw (Rabins, P. V., Behavior Problems in the Demented,\224) Tj ET q 47.76 0 0 -7.2 349.92 145.44 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  x????????|??|?|?s~~x>q|!?|~~|>||~~<|~~~>~>>?~>||???~??~???>~?~>p~?>?0????8<|????|???~???~ >?>x??8<???? EI Q BT 0.9835 0 0 0.9835 349.92 138.48 Tm 3 Tr /F5 10 Tf 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0182 Tc 0.6038 Tw ( Disease Treatment and Family Stress;) Tj -48.3191 -11.2256 TD 0.0026 Tc 0.343 Tw (Directions for Research, ) Tj 102.983 0 TD /F2 10 Tf 0.0158 Tc 0.0856 Tw (E. Light and ) Tj ET q 18 0 0 -7.2 503.76 134.4 cm BI /W 100 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????? EI Q BT 0.9388 0 0 0.9835 503.76 127.44 Tm 3 Tr 0.0043 Tc 0 Tw (B.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 521.76 127.44 Tm 0 Tc -0.061 Tw ( ) Tj ET q 30.24 0 0 -7.2 524.16 134.64 cm BI /W 168 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @<8?<|?~?~??~|??>????????p?9??~??~??>?>???????o>???????? EI Q BT 0.9388 0 0 0.9835 524.16 127.44 Tm 3 Tr 0.0119 Tc 0 Tw (Lebow-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 350.64 116.4 Tm -0.0814 Tc 0.0217 Tw (itz ) Tj ET q 21.6 0 0 -8.64 364.8 123.6 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<>~>~<?~~??~~????~|??~|?>|~?>|~?~~?~~??~???~|?~|?~|??~|?|~~~~>?>?>???<>x?p` EI Q BT 0.9388 0 0 0.9835 364.8 116.4 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 386.4 116.4 Tm 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.64 389.04 123.6 cm BI /W 244 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x?~?08>?x???x?????<?>~~<~~??~|??|||??????|<?|~~||~|>|>~>~?~??~>??8? EI Q BT 0.9835 0 0 0.9835 389.04 116.4 Tm 3 Tr -0.0078 Tc 0 Tw (\(Rockville,) Tj 0 Tr 44.6585 0 TD 0.2306 Tc 3.304 Tw ( MD: National Institute of) Tj -83.7042 -10.9816 TD 0.001 Tc 3.3951 Tw (Mental Health, U.S. Department of Health and) Tj 0 -11.2256 TD 0.0394 Tc -0.1011 Tw (Human Services, 1989\).) Tj -0.4881 -11.4697 TD -0.0061 Tc 1.4093 Tw (Rabins, P.V.,) Tj 60.5208 0 TD 0.0009 Tc -0.062 Tw (\223Establishing ) Tj ET q 48.96 0 0 -6.96 469.92 90 cm BI /W 273 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID '??~8???>????????x??<????p??0??????????????|_???<?>?8??|8|8>>??>?~???|?>||>>>??~?~<?<>p EI Q BT 0.9388 0 0 0.9835 469.92 83.28 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 518.88 83.28 Tm -0.0178 Tc 2.6415 Tw ( Disease) Tj -171.069 -10.9816 TD 0.0351 Tc 0.1125 Tw (Units in Nursing Homes: Pros and Cons,\224 ) Tj 172.7772 0 TD /F5 10 Tf 0.023 Tc 0 Tw (Hospital) Tj -172.7772 -10.9816 TD 0.0232 Tc 0.2408 Tw (and Community Psychiatry ) Tj ET q 59.52 0 0 -8.64 462.24 68.4 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>||< >???????????p?~>~~~ x>~p~~x~~x`|~|~~<>||~?|||~?x||>~?<|~~~~~||~|||~~||~?>||~??>~~~>~~~?~~>~?~>?~?~`?~?p?~?x~?x?~|~x<>?~~x>|~c>|?x???>~?8?` EI Q BT 0.9444 0 0 0.9835 462.24 61.68 Tm 3 Tr 0.0466 Tc 0 Tw (37\(2\):120-121,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 521.76 61.68 Tm 0.0854 Tc 0.0962 Tw ( 1986.) Tj ET q 29.52 0 0 -8.64 350.4 57.36 cm BI /W 166 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx? A??|?|?~~?~~?~~|?~|?~|?~?||?~?~?~?~?~~?~~?~??~p?~?~?~8?~8??x~?????| EI Q BT 0.9388 0 0 0.9835 350.4 50.16 Tm 3 Tr /F2 10 Tf 0.0178 Tc 0 Tw (Rabins,) Tj 0 Tr 31.4438 0 TD -0.0082 Tc 1.2568 Tw ( P. V., \223Management of Irreversible Demen-) Tj ET BT 0.9835 0 0 0.9835 350.88 39.36 Tm -0.071 Tc 0.0112 Tw (tia,\224 ) Tj 21.7192 0 TD /F5 10 Tf 0.5076 Tc -0.5771 Tw (Psychosomatic ) Tj ET q 59.52 0 0 -8.16 442.8 46.08 cm BI /W 331 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x<> ????????????xx~xx0~|><~|?~~8~|~>~|~?|~~8?~~>>|~~~>~x?~|?x~|?|~~C?>~>??>?>?>>?`??p ?x?~x<?ǀ|<>>?><x?x~>???ǀ# EI Q BT 0.9444 0 0 0.9835 442.8 39.36 Tm 3 Tr 0.0466 Tc 0 Tw (22\(7\):591-597,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 502.32 39.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 504.96 46.56 cm BI /W 116 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x;?~~~~~~~~??~~~?~?~?~?~???~?~?~~~~~~~~|~~???>?0 EI Q BT 0.8971 0 0 0.9835 504.96 39.36 Tm 3 Tr 0.0456 Tc 0 Tw (1981.) Tj 0 Tr ET endstream endobj 551 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 552 0 obj <>stream q 1.44 0 0 -2.88 331.2 514.08 cm BI /W 8 /H 16 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID > EI Q 0.72 w 1 j 0 0 0 RG 57.6 679.2 m 535.44 679.2 l S BT 0.9835 0 0 0.9835 57.84 684.48 Tm 0 0 0 rg /F5 10 Tf 0.0114 Tc 1.043 Tw (191 . Special Care Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -6.96 230.88 691.2 cm BI /W 265 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p`<|>>????<~~gx|~x~><~>>?????~?~~~~??|???~~???~x~?|??>|??~??>???????????'||?|?~?>>>????? EI Q BT 0.9835 0 0 0.9835 230.88 684.48 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.3698 Tw ( and Other ) Tj ET q 42.48 0 0 -6.96 326.16 691.44 cm BI /W 237 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |pp?x???~|||~<?|<~ ?x?>??x???0?? ?|?~?~||~~~|>>|>?|??>~??~>???~??>p?p|~?p?????~|?|? ???`??? EI Q BT 0.9835 0 0 0.9835 326.16 684.48 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8919 0 0 0.9835 58.32 646.56 Tm /F2 10 Tf 0.2641 Tc (356.) Tj 0.8073 -79.7997 TD 0.2641 Tc (357.) Tj 0.8073 -68.33 TD 0.0622 Tc (358.) Tj 0.2691 -45.3906 TD 0.0622 Tc (359.) Tj 0.2691 -34.8971 TD 0.2641 Tc (360.) Tj 0.2691 -34.6531 TD 0.2641 Tc (361.) Tj 0.5382 -35.1411 TD 0.2641 Tc (362.) Tj 0.2691 -34.8971 TD 0.2641 Tc (363.) Tj 0.5382 -57.1043 TD 0.2641 Tc (364.) Tj 0.2691 -46.8548 TD 0.2641 Tc (365.) Tj 0.2691 -34.8971 TD 0.2641 Tc (366.) Tj 0.5382 -57.1043 TD 0.2641 Tc (367.) Tj 0 -34.8971 TD 0.0622 Tc (368.) Tj 0 -45.6347 TD 0.0622 Tc (369.) Tj ET BT 0.2816 0 0 0.9835 80.64 646.56 Tm 0.1133 Tc (1) Tj ET q 28.08 0 0 -8.16 82.08 653.76 cm BI /W 157 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >??|~?>??>??|?|?~?~??~~???~???????~?~?~<?~<<|~???? EI Q BT 0.8919 0 0 0.9835 82.08 646.56 Tm 3 Tr 0.0154 Tc (Rabins,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 110.16 646.56 Tm 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -8.16 112.56 653.76 cm BI /W 105 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|<`????????~<???π?|<>?>??? EI Q BT 0.8919 0 0 0.9835 112.56 646.56 Tm 3 Tr -0.0222 Tc 0 Tw (P.V.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 131.28 646.56 Tm 0.0281 Tc 0.1545 Tw ( Department of Psychiatry and Behav-) Tj ET BT 0.9388 0 0 0.9835 82.08 635.76 Tm 0.0241 Tc 1.5632 Tw (ioral Sciences, Johns Hopkins University School of) Tj ET BT 0.9835 0 0 0.9835 82.08 624.48 Tm -0.0005 Tc 1.4037 Tw (Medicine, Baltimore, MD, remarks to the confer-) Tj 0 -11.2256 TD 0.2599 Tc 2.8471 Tw (ence on special care units, sponsored by the) Tj ET q 48.24 0 0 -7.2 82.08 609.84 cm BI /W 269 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @À'?????x?~?~8??|~0??|~??q>??!>~~??~~~~?~~?~~?~~??~??`~???~???~????~~?~?~??~x~?pxy~???~~ EI Q BT 0.8919 0 0 0.9835 82.08 602.64 Tm 3 Tr 0.021 Tc 0 Tw (Alzheixner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 130.32 602.64 Tm 0.0039 Tc 0.4841 Tw ( Disease Research Center, Washington) Tj ET BT 0.9388 0 0 0.9835 82.08 591.84 Tm 0.0289 Tc 0.7401 Tw (University School of Medicine, St. ) Tj ET q 24 0 0 -8.16 220.8 598.56 cm BI /W 135 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>@?~???p@??|~?|>??>??x|?>> >??? EI Q BT 0.9388 0 0 0.9835 220.8 591.84 Tm 3 Tr 0.0024 Tc 0 Tw (Imuis,) Tj 0 Tr 25.5641 0 TD -0.0051 Tc 0.6995 Tw ( MO, Oct.) Tj -173.3245 -11.7137 TD 0.0944 Tc 0.4658 Tw (9, 1990.) Tj ET q 29.04 0 0 -8.16 82.08 575.28 cm BI /W 162 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <p??????>?>???????????????????????>??>>` EI Q BT 0.9388 0 0 0.9835 82.08 568.08 Tm 3 Tr 0.0178 Tc 0 Tw (Rabins,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 111.12 568.08 Tm 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -8.16 115.44 575.04 cm BI /W 104 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<?~?~<p????|||>? EI Q BT 0.8919 0 0 0.9835 115.44 568.08 Tm 3 Tr -0.0222 Tc 0 Tw (P.V.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 139.44 568.08 Tm 0.0025 Tc -0.0635 Tw (\223The ) Tj ET q 30.24 0 0 -9.36 163.2 575.28 cm BI /W 169 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |ax<< > ?>>>?>>?~??????????????????????????x???x??x???<?x???<?}??>?<??>>???????????C???????8?~~~> EI Q BT 0.9835 0 0 0.9835 163.2 568.08 Tm 3 Tr 0.0336 Tc 0 Tw (V&My) Tj 0 Tr 30.7485 0 TD 0.0091 Tc 2.2887 Tw ( of a Caregiver-Rated) Tj -113.2325 -10.9816 TD 0.0146 Tc 0.6969 Tw (Brief Behavior Symptom Rating Scale \(BSRS\) for) Tj 0 -11.2256 TD 0.0225 Tc 3.7719 Tw (Use in the Cognitively Impaired,\224 unpublished) Tj T* 0.0239 Tc 1.086 Tw (manuscript, Department of Psychiatry and Behav-) Tj T* 0.0312 Tc 0.0292 Tw (ioral Sciences, Johns Hopkins University School of) Tj 0 -10.9816 TD -0.0082 Tc 0.6795 Tw (Medicine, Baltimore, MD, 1992.) Tj ET q 29.52 0 0 -8.16 82.08 507.84 cm BI /W 165 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ><??|~??~??~~??~??~????~??~???~?~~?~?~~~?~8~8x?x????~?`??p EI Q BT 0.9388 0 0 0.9835 82.08 500.88 Tm 3 Tr 0.0178 Tc 0 Tw (Rabins,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 111.6 500.88 Tm 0 Tc -0.061 Tw ( ) Tj ET q 18.72 0 0 -8.16 114.48 507.6 cm BI /W 105 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|>????>| 8????xx|<?>?>?????0  EI Q BT 0.8919 0 0 0.9835 114.48 500.88 Tm 3 Tr -0.0222 Tc 0 Tw (P.V.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 133.2 500.88 Tm 0.4544 Tc 2.7714 Tw ( Merrill, E., Johnson, L., et al.,) Tj -51.0034 -10.9816 TD -0.0062 Tc 1.4095 Tw (\223Perspectives on a Special Care Unit,\224) Tj 0 Tc -0.061 Tw ( ) Tj 165.2121 0 TD /F5 10 Tf 0.2315 Tc 0 Tw (American) Tj ET BT 0.9444 0 0 0.9835 82.08 478.8 Tm 0.0191 Tc 0.0199 Tw (Journal ) Tj ET q 56.88 0 0 -9.36 115.2 486 cm BI /W 318 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>p|>?????????~???>??x??x>?8?|?<~??|?~x?~??|?>?|?<|?>?~>~??~???x??<???|??||?|~~>8?|?~><?|Ǟ~?<x?|~?<x????||??<?xx~??0|?||~~~|<<x EI Q BT 0.9835 0 0 0.9835 115.2 478.8 Tm 3 Tr 0.0046 Tc 0 Tw (ofAlzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 172.08 478.8 Tm -0.0169 Tc 1.3287 Tw ( Care and Related Disorders) Tj ET BT 0.9835 0 0 0.9835 82.56 468.24 Tm 0.043 Tc 0.0173 Tw (and Research ) Tj ET q 44.64 0 0 -8.64 139.92 475.2 cm BI /W 248 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<|<<|?p|>?>??~?x?|~>?>?>x?>|?>|?>|??|??x??|?>?~?????!??>???>??>?| ?|???>?|?>?@x??~?>??<p`  EI Q BT 0.9444 0 0 0.9835 139.92 468.24 Tm 3 Tr 0.0374 Tc 0 Tw (5\(5\):13-21,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 184.56 468.24 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj ET q 25.92 0 0 -8.16 82.08 462.96 cm BI /W 145 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|> ??????|???????????xp|>?~?s EI Q BT 0.9835 0 0 0.9835 82.08 456.24 Tm 3 Tr /F2 10 Tf -0.0065 Tc 0 Tw (Rader,) Tj 0 Tr 26.3559 0 TD -0.0365 Tc 2.4165 Tw ( J.,) Tj 19.2788 0 TD 0.0371 Tc 2.3416 Tw (\223A Comprehensive Staff Approach to) Tj -44.9026 -10.9816 TD 0.033 Tc 5.7623 Tw (Problem Wandering,\224) Tj 101.7629 -0.244 TD /F5 10 Tf 0.0593 Tc 2.5631 Tw (Gerontologist 27\(6\):756-) Tj ET BT 0.9444 0 0 0.9835 82.8 434.4 Tm 0.0714 Tc 1.2352 Tw (760, 1987.) Tj ET q 25.92 0 0 -8.16 82.56 428.88 cm BI /W 144 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<0p????????> ?|??>?>???pp?|~??~???c0 EI Q BT 0.9835 0 0 0.9835 82.56 421.92 Tm 3 Tr /F2 10 Tf -0.0065 Tc 0 Tw (Rader,) Tj 0 Tr 26.3559 0 TD 0.2888 Tc 2.8177 Tw ( J.,) Tj 22.6953 0 TD 0.0124 Tc 4.258 Tw (\223The Joyful Road to Restraint-Free) Tj -48.075 -10.9816 TD -0.0078 Tc 1.8178 Tw (Care,\224 Benedictine Institute for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 20.16 0 0 -9.36 216.48 418.32 cm BI /W 113 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>|<?` 0????>?????~??~??~????>@px EI Q BT 0.9388 0 0 0.9835 216.48 411.12 Tm 3 Tr 0.0242 Tc 0 Tw (Imng) Tj 0 Tr ET BT 0.9835 0 0 0.9835 236.64 411.12 Tm -0.0126 Tc 1.294 Tw ( Term Care,) Tj -155.6947 -10.9816 TD 0.0253 Tc 0.2183 Tw (Mt. Angel, OR, January 1992.) Tj ET q 25.2 0 0 -8.64 83.52 394.8 cm BI /W 141 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ߀??????~8?~<??~??~??~??~?~???????~?~?À||??>?????? EI Q BT 0.9388 0 0 0.9835 83.52 387.84 Tm 3 Tr -0.0106 Tc 0 Tw (Rader,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 108.72 387.84 Tm 0.0198 Tc 0.7323 Tw ( J., Doan, J., and Schwab, Sr. M., \223How To) Tj ET BT 0.9388 0 0 0.9835 83.52 376.8 Tm -0.0015 Tc 1.3775 Tw (Decrease Wandering, a Form of Agenda Behavior,\224) Tj ET BT 0.9835 0 0 0.9835 83.52 365.76 Tm /F5 10 Tf 0 Tc 0.061 Tw (Geriatric Nursing, ) Tj 77.3593 0 TD /F2 10 Tf 0.0633 Tc 0.1186 Tw (pp. 196-199, July/Aug., 1985.) Tj -77.3593 -12.4458 TD -0.0086 Tc 2.144 Tw (Raia, P., Acting Executive Director,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 238.56 360.48 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????x??|?~~?|?~~x?~?~~8???~~8???~`~??~~??~~???~~??~~??~~?|??~~?|?~~?|?~?<?~??88?~?x<?~?xx>?>??????<x??0???x?|?|??8|O||8?|8 EI Q BT 0.9388 0 0 0.9835 238.56 353.52 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 83.52 342.24 Tm 0.004 Tc 0.9721 Tw (Association of Eastern Massachusetts, Cambridge,) Tj 0.244 -11.2256 TD 0.0266 Tc 0.3024 Tw (MA, personal communication, Jan. 13, 1992.) Tj ET BT 0.9388 0 0 0.9835 83.52 318.96 Tm 0.0234 Tc 0.2005 Tw (Rand, J., Steiner, V.L., Toyne, R. M., et al., ) Tj ET BT 0.9444 0 0 0.9835 252.96 318.96 Tm /F5 10 Tf 0.0015 Tc 0 Tw (Environ-) Tj ET BT 0.9835 0 0 0.9835 84 308.16 Tm 0.0126 Tc 0.5769 Tw (ments for People With Dementia: Annotated Bibli-) Tj 0 -10.9816 TD 0.0639 Tc -0.126 Tw (ography, ) Tj 40.0218 0 TD /F2 10 Tf 0.0269 Tc 0.8877 Tw (Center for Architecture and Urban Plan-) Tj -39.7778 -10.9816 TD 0.6868 Tc 4.1214 Tw (ning Research,) Tj 81.2639 -0.4881 TD 0.732 Tc 3.5874 Tw (University of Wisconsin-) Tj -81.5079 -10.7376 TD 0.0116 Tc 0.4153 Tw (Milwaukee, Milwaukee, WI, October 1987.) Tj -0.244 -13.1779 TD 0.0192 Tc 3.1326 Tw (Rango, N., \223The Nursing Home Resident With) Tj 0.4881 -11.2256 TD -0.0142 Tc 0.9296 Tw (Dementia: Clinical Care, Ethics, and Policy Impli-) Tj 0.244 -11.2256 TD -0.0165 Tc -0.0443 Tw (cations,\224 ) Tj 40.754 0 TD /F5 10 Tf 0.0399 Tc 3.2539 Tw (Annals of Internal Medicine 102:835-) Tj -40.2659 -11.4697 TD 0.0813 Tc 0 Tw (841,1985.) Tj -0.9761 -12.6899 TD /F2 10 Tf -0.0036 Tc 1.5114 Tw (Rau, B.L., Day Charge Nurse, Special Care Unit,) Tj 0.9761 -11.2256 TD 0.0187 Tc 0.4487 Tw (Christian Rest Home, Lynden, WA, personal com-) Tj 0 -10.9816 TD 0.0336 Tc 0.2534 Tw (munications, Oct. 19, 1990, and Dec. 30, 1991.) Tj 0 -12.6899 TD -0.0045 Tc 0.1388 Tw (Ray, W.A., Federspiel, C.F., and ) Tj ET q 40.32 0 0 -8.16 217.44 189.36 cm BI /W 224 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>0>??????~|~x|~?~?p~~~?`?~?~??~??~?~?~??~~~???????`q~~?~?~? >?>>?|>?~ EI Q BT 0.9388 0 0 0.9835 217.44 182.4 Tm 3 Tr 0.0021 Tc 0 Tw (Schaffher,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 257.76 182.4 Tm -0.0005 Tc 0.0615 Tw ( W., \223A) Tj -175.7057 -11.2256 TD 0.2853 Tc 2.618 Tw (Study of Antipsychotic Drug Use in Nursing) Tj 0 -10.9816 TD 0.0163 Tc 1.4476 Tw (Homes: Epidemiologic Evidence Suggesting Mis-) Tj 0 -11.4697 TD -0.0053 Tc -0.0557 Tw (use,\224 ) Tj 23.4274 0 TD /F5 10 Tf 0.0385 Tc 1.3152 Tw (American Journal of Public Health 70:485-) Tj ET BT 0.9444 0 0 0.9835 84.96 138.72 Tm 0.0714 Tc 1.2352 Tw (491, 1980.) Tj ET BT 0.9835 0 0 0.9835 84.96 126.48 Tm /F2 10 Tf -0.0269 Tc 3.8709 Tw (Read, S.L.,) Tj ET q 50.16 0 0 -8.64 138.96 132.72 cm BI /W 279 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~~><????? ??~??~x~||||~~~?~?~????????0~?8>|?8? ???>?>|?>|?~>? EI Q BT 0.8919 0 0 0.9835 138.96 126 Tm 3 Tr 0.0381 Tc 0 Tw (\2231.mng-Term) Tj 0 Tr ET BT 0.9835 0 0 0.9835 189.12 126 Tm 0.0091 Tc 3.2242 Tw ( Care for Dementia: If) Tj -105.6674 -10.7376 TD 0.0185 Tc 0.4082 Tw (Appropriate, Why Special?\224 ) Tj 118.6013 0 TD /F5 10 Tf 0.0215 Tc 0.4051 Tw (Journal of the Ameri-) Tj -118.1133 -11.2256 TD -0.002 Tc 0.2664 Tw (can Geriatrics Society ) Tj ET q 59.52 0 0 -8.64 177.36 111.6 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >|~x>?pπ?????~?|?~??>?~?x?~?|8?~?>?~??~~??~c??~~~??~~~??~|~??~|~??|<~??>~??~>~??~~?~~?~~?~???~~x?~~?~??~?????;>?<~|x?~~>?????~? @ EI Q BT 0.9444 0 0 0.9835 177.36 104.4 Tm 3 Tr 0.0466 Tc 0 Tw (40\(1\):101-102,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 236.88 104.4 Tm 0.0854 Tc 0.0962 Tw ( 1992.) Tj ET BT 0.9388 0 0 0.9835 84.96 92.16 Tm /F2 10 Tf 0.0298 Tc 0.6368 Tw (Rebok, G., Brandt, J., and ) Tj ET q 33.84 0 0 -8.64 189.36 99.36 cm BI /W 190 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xxx??~?????~??x?~?<?~??~? ?~? ?~???~??~??~`??~??~??~???~~?0??~~p??~??|?~??|?>?|?~ EI Q BT 0.9388 0 0 0.9835 189.36 92.16 Tm 3 Tr 0.0304 Tc 0 Tw (Folstein,) Tj 0 Tr 36.0454 0 TD 0.0542 Tc -0.0027 Tw ( M., ) Tj ET q 47.28 0 0 -8.88 241.2 99.12 cm BI /W 264 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >x<?<>>a????????~????????????????????~??~?~?~~?>?????~??>?~`88?c??>>x<>0 EI Q BT 0.9835 0 0 0.9835 241.2 92.16 Tm 3 Tr 0.0233 Tc 0 Tw (\223longitudi-) Tj 0 Tr ET q 12 0 0 -6.96 85.68 88.08 cm BI /W 68 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID c??????????????~????????????~?????? EI Q BT 0.9835 0 0 0.9835 85.68 81.36 Tm 3 Tr -0.0083 Tc (nal) Tj 0 Tr ET BT 0.9388 0 0 0.9835 97.68 81.36 Tm 0.0145 Tc 0.4998 Tw ( Cognitive Decline in Patients ) Tj ET BT 0.934 0 0 0.9835 216.24 81.36 Tm /F4 10 Tf -0.0262 Tc 0.0729 Tw (With ) Tj ET q 48 0 0 -7.2 240.96 88.32 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID s~oG????????|?~?|?~x?>?~8?>?~8?~?~???`~??~??~??~~???~~?~??~~?<?~?<?~~?>?~~?8?~?~?8<?~?~?ǀ8<??|8>?>x?x???>x? p???x?x?|??8~?~~?<<~| EI Q BT 0.9388 0 0 0.9835 240.96 81.36 Tm 3 Tr /F2 10 Tf -0.034 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 85.44 70.32 Tm 0.2222 Tc -0.287 Tw (Disease\224 ) Tj 43.1943 0 TD /F5 10 Tf 0.2526 Tc 2.9156 Tw (Journal of Geriatric Psychiatry and) Tj -43.6824 -10.9816 TD 0.0243 Tc -0.0857 Tw (Neurology ) Tj ET q 33.12 0 0 -8.16 129.84 66.48 cm BI /W 184 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<p?|~~~~?? | ?|~>?~>~>~>~~p~~~?~~~|p~|~@|`~>>~?|>????> EI Q BT 0.9444 0 0 0.9835 129.84 59.52 Tm 3 Tr 0.0483 Tc 0 Tw (3:91-97,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 162.96 59.52 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj -79.3116 -12.4458 TD /F4 10 Tf 0.0715 Tc -0.1699 Tw (Reed, ) Tj 30.0164 0 TD /F2 10 Tf -0.0172 Tc 1.3394 Tw (B.R., Jagust, W.J., and Scab, J.P., \223Mental) Tj -29.2843 -10.9816 TD 0.024 Tc 0.4942 Tw (Status as a Predictor of Daily Function in Progres-) Tj ET BT 0.8449 0 0 0.9835 309.6 623.76 Tm 0.3084 Tc 0 Tw (370.) Tj ET BT 0.8919 0 0 0.9835 309.84 546.24 Tm 0.0622 Tc (371.) Tj 0.8073 -78.5795 TD 0.2641 Tc (372.) Tj 0.5382 -44.4145 TD 0.0622 Tc (373.) Tj 0.2691 -34.165 TD 0.0622 Tc (374.) Tj 0.5382 -34.409 TD 0.0622 Tc (375.) Tj 0.2691 -67.1098 TD 0.2641 Tc (376.) Tj 0.5382 -45.6347 TD 0.0622 Tc (377.) Tj 0 -34.6531 TD 0.0622 Tc (378.) Tj 0.5382 -34.165 TD 0.0622 Tc (379.) Tj 0.2691 -44.6585 TD 0.0622 Tc (380.) Tj ET BT 0.8449 0 0 0.9835 313.68 91.2 Tm 0.3084 Tc (381.) Tj ET BT 0.8919 0 0 0.9835 313.44 46.8 Tm 0.0622 Tc (382.) Tj ET BT 0.2816 0 0 0.9835 331.2 624 Tm 0.1133 Tc (1) Tj ET q 2.16 0 0 -4.08 330.24 593.28 cm BI /W 13 /H 23 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|8xxxxx888 EI Q BT 0.358 0 0 0.9835 330.24 588.96 Tm 3 Tr /F1 10 Tf -0.0996 Tc (./) Tj 0 Tr ET q 16.56 0 0 -6.96 332.64 653.76 cm BI /W 92 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0xx?pp0? ?p?p|?8\ p EI Q BT 0.9835 0 0 0.9835 332.64 646.8 Tm 3 Tr /F2 10 Tf -0.0031 Tc (sive) Tj 0 Tr 16.8385 0 TD 0.4316 Tc 3.5267 Tw ( Dementia, \222) Tj 70.5263 0 TD /F5 10 Tf 0.5261 Tc 4.7728 Tw (Gerontologist 29\(6\):804-) Tj ET BT 0.9444 0 0 0.9835 332.64 635.76 Tm 0.0714 Tc -0.0354 Tw (807, 1989.) Tj ET BT 0.9835 0 0 0.9835 332.64 624 Tm /F2 10 Tf -0.0339 Tc 1.1937 Tw (Reifier, B.V.,) Tj 61.741 0 TD 0.0141 Tc 3.8292 Tw (\223Alzheimer\222s Disease in Nursing) Tj -61.741 -11.2256 TD 0.0111 Tc 1.1479 Tw (Homes: Current Practice and Implications for Re-) Tj 0 -11.2256 TD 0.0116 Tc -0.0729 Tw (search,\222 ) Tj 34.409 0 TD /F5 10 Tf 0.0195 Tc 0.3096 Tw (Mental Illness in Nursing Homes: ) Tj ET q 30.48 0 0 -9.36 505.2 609.12 cm BI /W 170 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<8>~>???????????~??0~?~~?~????????~??~~????????~??|??~?~?~????????????@? EI Q BT 0.9835 0 0 0.9835 505.2 601.92 Tm 3 Tr 0.0413 Tc 0 Tw (Agen&) Tj 0 Tr ET q 51.84 0 0 -8.16 332.64 597.6 cm BI /W 290 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>`?`px??|??>~?~?|?>?<?x~????? ?p?????~??~??>????~~~??|~~?~|~|?~|~>~ |~~~>~?~0|>~|~|?|??~>~?~>???~~?pp~?>>>~?~~?? EI Q BT 0.9444 0 0 0.9835 332.64 590.4 Tm 3 Tr -0.0344 Tc (~orResearch,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 384.48 590.4 Tm /F2 10 Tf 0 Tc 0.055 Tw ( ) Tj ET q 18.48 0 0 -7.2 386.64 597.84 cm BI /W 104 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?<{~~?~<???`@|<>????????? EI Q BT 0.9388 0 0 0.9835 386.64 590.4 Tm 3 Tr 0.0559 Tc 0 Tw (M.S.) Tj 0 Tr 19.6843 0 TD -0.0047 Tc 0.5713 Tw ( Harper and ) Tj ET q 17.76 0 0 -6.96 454.08 597.6 cm BI /W 100 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p ????????? EI Q BT 0.9388 0 0 0.9835 454.08 590.4 Tm 3 Tr 0.0043 Tc 0 Tw (B.D.) Tj 0 Tr 18.9174 0 TD 0 Tc 0.055 Tw ( ) Tj ET q 36.72 0 0 -7.2 474 597.6 cm BI /W 206 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~8<??|?~~???~?|<<????π???~?~@?|>?????8?`p??????????? EI Q BT 1.0796 0 0 0.9835 474 590.4 Tm 3 Tr 0.0156 Tc 0 Tw (IAowitz) Tj 0 Tr ET BT 0.9388 0 0 0.9835 510.72 590.4 Tm 0 Tc 0.055 Tw ( ) Tj ET q 21.36 0 0 -8.88 512.88 597.6 cm BI /W 120 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x>|>|?>?~?>?>??~???~~??~|?~|?~~?~~?~~?~???? ~?~??~~?<~~<~~????????|>>| EI Q BT 0.9388 0 0 0.9835 512.88 590.4 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET q 44.64 0 0 -8.64 332.64 587.04 cm BI /W 248 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >px< ?8>???|?>?|<?||?|>?~|~~?~??~????~?~??>??xx?~<|?~?|???|<|>>px< p EI Q BT 0.9835 0 0 0.9835 332.64 580.08 Tm 3 Tr -0.0078 Tc (\(Rockville,) Tj 0 Tr 45.3906 0 TD 0.2235 Tc 3.8116 Tw ( MD: National Institute of Mental) Tj -45.3906 -10.9816 TD 0.0172 Tc 3.0126 Tw (Health, U.S. Department of Health and Human) Tj ET BT 0.9388 0 0 0.9835 332.64 558.24 Tm 0.0259 Tc 2.5839 Tw (Services, 1986\).) Tj 0 -11.9577 TD 0.0131 Tc 1.0636 Tw (Reifier, B.V., and Larson, E.,) Tj ET BT 0.9835 0 0 0.9835 450.96 546.72 Tm 0.0023 Tc 0.0586 Tw (\221\221Excess Disability in) Tj -120.3096 -11.2256 TD 0.0063 Tc 2.0069 Tw (Dementia of the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 404.64 542.88 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????>?????~?~<??~?p~???0?????~???C~`~?x??x???|`??<???<>??|<?><?|?<?0?? ?|?<?~`p? EI Q BT 0.9835 0 0 0.9835 404.64 535.68 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0118 Tc 1.3912 Tw ( Type,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 488.64 542.88 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x@ ??~???????|?~?>?| ?3|>~x?~~~|~~~>>~~~?~?????~??~???~?~??>>~?~?~x??>?~x???~?????||~?~?>?>????? EI Q BT 0.9835 0 0 0.9835 488.64 535.68 Tm 3 Tr /F5 10 Tf 0.0031 Tc 0 Tw (A/zheimer\222s) Tj 0 Tr -158.6232 -11.2256 TD 0.0132 Tc 1.7802 Tw (Disease Treatment and Family Stress; Directions) Tj 0 -11.4697 TD 0.0069 Tc 2.8604 Tw (for Research,) Tj 0 Tc -0.061 Tw ( ) Tj 62.2291 0 TD /F2 10 Tf 0.0158 Tc 1.6312 Tw (E. Light and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -7.2 450.48 520.56 cm BI /W 101 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???0????????> EI Q BT 0.9388 0 0 0.9835 450.48 513.36 Tm 3 Tr 0.0043 Tc 0 Tw (B.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 468.48 513.36 Tm 0.0043 Tc 2.1309 Tw ( Lebowitz) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -9.12 514.8 520.56 cm BI /W 120 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `~~?~~?>>?>~?>?~??~~?~~?~~?~~~?~~?~?~????? ~??~~?~~?<~~<~???? ?????><|@ EI Q BT 0.9388 0 0 0.9835 514.8 513.36 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET q 44.64 0 0 -8.88 333.12 509.76 cm BI /W 249 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|x<>x|?{??>????~>~~~~~~?~~~8~~~~~~?~~~|?~~~p~~~~p~~~~~~~??~~~?~~~?~~~?x~~x~~||~~||<~||?>?>~~~?>~~?~~?~?~~|>?~~???~~8~~~~~~~0~|~|x~< EI Q BT 0.9835 0 0 0.9835 333.12 502.56 Tm 3 Tr -0.03 Tc (\(Roclwille,) Tj 0 Tr 45.3906 0 TD 0.2235 Tc 3.8116 Tw ( MD: National Institute of Mental) Tj -45.8787 -11.2256 TD 0.0172 Tc 3.1346 Tw (Health, U.S. Department of Health and Human) Tj ET BT 0.9388 0 0 0.9835 333.36 480.24 Tm 0.0259 Tc 2.5839 Tw (Services, 1989\).) Tj ET BT 0.9835 0 0 0.9835 332.64 469.44 Tm -0.0105 Tc -0.0233 Tw (Reisberg, B., Ferris, S.H., DeLeon, M., et al., \221 \221The) Tj 0.7321 -11.2256 TD 0.0165 Tc 1.1423 Tw (Global Deterioration Scale for Assessment of Pri-) Tj 0.244 -10.9816 TD 0.0029 Tc 1.4002 Tw (mary Degenerative Dementia,\224) Tj 0 Tc -0.061 Tw ( ) Tj 131.5352 0 TD /F5 10 Tf 0.0332 Tc 2.3456 Tw (American Journal) Tj -131.5352 -10.9816 TD -0.0052 Tc 1.6525 Tw (of Psychiatry) Tj 0 Tc -0.061 Tw ( ) Tj ET q 38.88 0 0 -8.16 391.44 443.76 cm BI /W 217 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x<0????|???||~0|?|?|<~~?~?~?????????????>?|x?|????????p>?  EI Q BT 0.8971 0 0 0.9835 391.44 436.8 Tm 3 Tr 0.0386 Tc 0 Tw (139:1136,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 430.32 436.8 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 432.72 443.76 cm BI /W 117 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?8????@p~p~<>?|????~~?~?~?~?x>~|???~?~? EI Q BT 0.8971 0 0 0.9835 432.72 436.8 Tm 3 Tr 0.0456 Tc 0 Tw (1982.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 333.12 425.52 Tm /F2 10 Tf -0.0335 Tc 1.4373 Tw (Retsinas, J.,) Tj 53.1998 -0.244 TD 0.0418 Tc 1.1777 Tw (\223Needs of the Nondemented Nursing) Tj ET BT 0.9388 0 0 0.9835 334.08 414.72 Tm -0.0147 Tc 0.5819 Tw (Home Resident,\224 ) Tj ET BT 0.9444 0 0 0.9835 402.96 414.72 Tm /F5 10 Tf -0.0301 Tc 0.5803 Tw (Geriatric Medicine ) Tj ET q 22.56 0 0 -9.12 479.52 421.68 cm BI /W 129 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~|>?|??????>?~>????????|?~|>?~~?~~~??~??~~>??~~ǀ~`>>?p?x?|????? EI Q BT 0.8499 0 0 0.9835 479.52 414.72 Tm 3 Tr 0.0803 Tc 0 Tw (Toduy) Tj 0 Tr ET BT 0.9444 0 0 0.9835 502.08 414.72 Tm 0.0263 Tc 1.283 Tw ( 7\(4\):84-) Tj -177.895 -11.7137 TD 0.0703 Tc 0.7281 Tw (90, 1988.) Tj ET BT 0.9835 0 0 0.9835 334.08 391.68 Tm /F2 10 Tf -0.0185 Tc 1.3407 Tw (Retzke, R., Vice President, Unicare Health Facili-) Tj 0 -11.2256 TD 0.0013 Tc 4.8183 Tw (ties, Milwaukee, WI, personal communication,) Tj ET BT 0.9388 0 0 0.9835 334.08 369.36 Tm 0.0816 Tc 1.1185 Tw (Nov. 30, 1990.) Tj ET BT 0.9835 0 0 0.9835 334.08 357.84 Tm -0.0033 Tc -0.0577 Tw (Rheaume, ) Tj ET q 18.72 0 0 -8.16 376.56 364.8 cm BI /W 105 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x|>`??????????~?8 ?|?>???????????????????||>>????? EI Q BT 0.9835 0 0 0.9835 376.56 357.84 Tm 3 Tr -0.0094 Tc 0 Tw (YL.,) Tj 0 Tr 19.0348 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 51.6 0 0 -8.64 397.68 365.04 cm BI /W 287 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8<|x ?? ??|????>~?>@>~???????~? ??~?p?????x?x<7<0?<<p?<?<|?pp|`?~0 ????p?pp EI Q BT 0.9835 0 0 0.9835 397.68 357.84 Tm 3 Tr 0.0009 Tc 0 Tw (Fabiszewski,) Tj 0 Tr 52.4677 0 TD -0.016 Tc 0.1992 Tw ( K.J., Brown, J., et al.,) Tj -116.405 -11.2256 TD 0.02 Tc 0.4067 Tw (\223Education and Training of Interdisciplinary Team) Tj -0.7321 -10.9816 TD 0.0264 Tc 0.5629 Tw (Members Caring for ) Tj ET q 42.24 0 0 -6.96 420 342.72 cm BI /W 235 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??????????~??p??8?0??~??~??~??~?~?>??>????????~ ??~>?<?? EI Q BT 0.9835 0 0 0.9835 420 336 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.9503 0 TD -0.0318 Tc 0.3373 Tw ( Patients,\224 ) Tj ET q 31.68 0 0 -7.68 506.16 343.44 cm BI /W 177 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |????????|?<~ ~????~|~~~~??~~~~~~~>?????? ~~~~???????????0 EI Q BT 0.8027 0 0 0.9835 506.16 336 Tm 3 Tr /F5 10 Tf 0.0204 Tc 0 Tw (CZinicaZ) Tj 0 Tr ET BT 0.9835 0 0 0.9835 334.08 325.2 Tm 0.0415 Tc 3.0693 Tw (Management of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48 0 0 -6.96 404.88 331.92 cm BI /W 267 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~????|A?|?>>?>~?qa??~x?~~?|?~~<~~??w?????|?~??~~?~~p????8???<?>?????~???~~8~|??<?????? EI Q BT 0.9835 0 0 0.9835 404.88 325.2 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.8071 0 TD -0.0017 Tc 1.893 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj 42.9503 0 TD /F2 10 Tf -0.0368 Tc -0.0236 Tw (L. ) Tj ET q 30.96 0 0 -7.92 506.88 331.92 cm BI /W 172 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?>?????????x|?8~??>~<?>??|?|?? EI Q BT 0.9388 0 0 0.9835 506.88 325.2 Tm 3 Tr -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET q 15.36 0 0 -7.2 334.32 321.12 cm BI /W 86 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0?|????~4 EI Q BT 0.9388 0 0 0.9835 334.32 314.16 Tm 3 Tr -0.0034 Tc (K.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 349.68 314.16 Tm 0 Tc -0.061 Tw ( ) Tj ET q 51.36 0 0 -8.64 353.04 321.12 cm BI /W 286 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ??<|?|?~?~~??>|?????????~???~????????????>?0?>?p????????????????>?0??~??px???p?|???|???????p???p?|>81@??>?????????????x????` EI Q BT 0.9835 0 0 0.9835 353.04 314.16 Tm 3 Tr 0.0009 Tc 0 Tw (Fabiszewski,) Tj 0 Tr 52.2236 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 15.84 0 0 -7.2 407.76 321.12 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????????|?>?????????????????x|>??? EI Q BT 0.9835 0 0 0.9835 407.76 314.16 Tm 3 Tr 0.0078 Tc 0 Tw (YL.) Tj 0 Tr 16.1064 0 TD 0.9468 Tc 2.8808 Tw ( Rheaume, et al.) Tj 0 Tc -0.061 Tw ( ) Tj ET q 21.6 0 0 -8.64 516.24 321.36 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `>||?>><?~??>>>??~???~??~~?~~?~~?~~~?~~?~??~????????~~??~~??~~<~~<~~|??????>~|? EI Q BT 0.9388 0 0 0.9835 516.24 314.16 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET q 43.68 0 0 -8.64 334.8 310.32 cm BI /W 243 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x8`0p? |??>???>??>?>~|x~~<|>?|?? |?????ǀ??>??>?>??~~>~>||~||~>>???~~ >x?|? x@ EI Q BT 0.9388 0 0 0.9835 334.8 303.36 Tm 3 Tr 0.0226 Tc (\(Rockville,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 378.48 303.36 Tm 0.037 Tc 0.2674 Tw ( MD: Aspen Publishers, 1988\).) Tj -45.1466 -11.4697 TD -0.0211 Tc 0.7972 Tw (Rheaume, Y., Riley, M.E., and Volicer, L., \223Meet-) Tj 0.7321 -11.4697 TD 0.0237 Tc 1.1351 Tw (ing Nutritional Needs of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42.24 0 0 -7.2 438.24 288 cm BI /W 235 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????????>???p?~?p?~~??~~?~|??~~??~|?~<~>?~>?~?<??<???o?>? <~~~?|?<> EI Q BT 0.9835 0 0 0.9835 438.24 280.8 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.9503 0 TD 0.0099 Tc 1.2711 Tw ( Patients Who) Tj -148.1296 -10.9816 TD -0.0085 Tc 5.3164 Tw (Pace Constantly,\224) Tj 82.9721 -0.244 TD /F5 10 Tf 0.0123 Tc 3.648 Tw (Journal of Nutrition for the) Tj -83.4602 -11.2256 TD -0.0246 Tc -0.036 Tw (Elderly ) Tj ET q 44.64 0 0 -8.64 366 265.68 cm BI /W 248 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 00p<?px|>>>||||?|?|>?||~>?x|~?x?x>~??|>~?|@?~|~||~~>~?~~?~~~~?~>~>~?~x?~?~~?~~>?~~>x?~~~??~|0?p?~~x?~|x?|||x|><>~>?|~|?>??>?>8pp 0 EI Q BT 0.9444 0 0 0.9835 366 258.72 Tm 3 Tr 0.0374 Tc 0 Tw (7\(1\):43-52,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 410.64 258.72 Tm 0.0854 Tc 0.3402 Tw ( 1987.) Tj -77.6033 -11.9577 TD /F2 10 Tf 0.0148 Tc 2.2666 Tw (Rhodes, F.,and Houser, G., \223Provider Initiatives:) Tj ET BT 0.9388 0 0 0.9835 335.28 235.68 Tm -0.0091 Tc 0.6897 Tw (Caring is the Heart of the Matter at ARA,\224 ) Tj ET BT 0.9444 0 0 0.9835 504.24 235.68 Tm /F5 10 Tf -0.0302 Tc 0 Tw (Provider) Tj ET q 70.8 0 0 -8.64 336 231.84 cm BI /W 394 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `0x|?|>>|x?p ???~??|???>~?~~?|~~|~|?>pp~>x~><~>|~?~x?|?~<>???????|?~??x>>?~~~||~0|?>~x?~~@>~?|~??|<~x><?~x?x>~~?~?????|~?>|?x?p~`p`?p` EI Q BT 0.9444 0 0 0.9835 336 224.88 Tm 3 Tr 0.0502 Tc (12\(5\):28-32,1986.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 334.8 213.12 Tm -0.039 Tc 2.419 Tw (Riskin, C.,) Tj 0 Tc -0.061 Tw ( ) Tj 48.5631 0 TD /F2 10 Tf 0.0037 Tc -0.0648 Tw (Director, ) Tj ET q 29.28 0 0 -7.2 424.32 220.32 cm BI /W 163 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>?>~?|<@~?|~?|?>|??>>?????0 EI Q BT 1.1735 0 0 0.9835 424.32 213.12 Tm 3 Tr -0.0229 Tc 0 Tw (kVine) Tj 0 Tr ET BT 0.9835 0 0 0.9835 453.6 213.12 Tm 0.0265 Tc 2.8404 Tw ( Institute on Aging,) Tj -120.0655 -10.9816 TD 0.0062 Tc 4.0324 Tw (Detroit, MI, personal communications, Dec. 6,) Tj 0.7321 -11.2256 TD 0.067 Tc -0.0246 Tw (1989, Feb. 22, 1990, and Apr. 29, 1992.) Tj -0.7321 -11.9577 TD 0.0049 Tc 2.5371 Tw (Riskin, C., Director, LeVine Institute on Aging,) Tj 0 -10.9816 TD 0.0077 Tc 3.1036 Tw (Detroit, MI, letter to the Office of Technology) Tj T* 0.0136 Tc 0.4132 Tw (Assessment, U.S. Congress, Washington, DC, Oct.) Tj ET BT 0.9388 0 0 0.9835 335.52 146.88 Tm 0.0944 Tc 0.7215 Tw (4, 1990.) Tj ET BT 0.9835 0 0 0.9835 335.52 135.6 Tm -0.0051 Tc 1.083 Tw (Riskin, C., Goldberg, S., and Beitler, D.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.56 0 0 -6.96 505.2 142.56 cm BI /W 192 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????????~>|>~|>>|>>|?>>?????|<?>~~||x<8x0 EI Q BT 0.9835 0 0 0.9835 505.2 135.6 Tm 3 Tr 0.0677 Tc 0 Tw (\223AHAA) Tj 0 Tr -172.2892 -10.9816 TD 0.0406 Tc 0.5687 Tw (Work Group Encourages Collaboration,\224 ) Tj 171.8011 0 TD /F5 10 Tf 0.0277 Tc 0 Tw (Contem-) Tj -172.0451 -11.2256 TD 0.0445 Tc 1.2359 Tw (porary Long-Term Care,) Tj 0 Tc -0.061 Tw ( ) Tj 107.1316 0 TD /F2 10 Tf 0.0547 Tc 1.8356 Tw (pp. 126-128, September) Tj ET BT 0.8919 0 0 0.9835 336.96 102.96 Tm 0.0717 Tc 0 Tw (1990.) Tj ET BT 0.9835 0 0 0.9835 335.52 91.44 Tm -0.0082 Tc 0.1914 Tw (Risse, S. C., and Barnes, R., \223Pharmacologic Treat-) Tj 0.7321 -10.9816 TD 0.0011 Tc 3.6472 Tw (ment of Agitation Associated With Dementia,\224) Tj ET BT 0.9444 0 0 0.9835 335.76 69.6 Tm /F5 10 Tf 0.0191 Tc 0.0199 Tw (Journal ) Tj ET q 97.2 0 0 -9.12 368.16 76.56 cm BI /W 555 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??<|~>>?p8 8<8`~?|???~?~???~~~?~?|~~~~?~??~?>~~~8?~??x??>|~??x~??8?~????A??????????????~??~?~~??~|~?~?~|??~~?~~??~~~~?>~??~>~?~?>~??~??????~??????>??~??8???~?0?~?|~??>|߀????~@???>~??~???~?~<|xp 0??~~8p<>>><?>>p|~~~~~~ EI Q BT 0.9444 0 0 0.9835 368.16 69.6 Tm 3 Tr -0.0234 Tc 0 Tw (oftheArnericanGeriatrics) Tj 0 Tr 102.925 0 TD 0.0114 Tc 0.7905 Tw ( Society 34\(5\):368-) Tj -136.725 -10.9816 TD 0.0714 Tc 0.9811 Tw (376, 1986.) Tj ET q 22.08 0 0 -8.16 335.52 54 cm BI /W 123 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|???????s??????`?`????????|?x88>~?< EI Q BT 0.9835 0 0 0.9835 335.52 47.04 Tm 3 Tr /F2 10 Tf -0.0509 Tc 0 Tw (Riter,) Tj 0 Tr 22.4513 0 TD -0.0001 Tc 3.4253 Tw ( R.N., and Fries, B.E., \223Predictors of the) Tj -21.9632 -10.9816 TD 0.0115 Tc 2.4164 Tw (Placement of Cognitively Impaired Residents on) Tj ET endstream endobj 553 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 554 0 obj <>stream 0.72 w 1 j 0 0 0 RG 72 680.64 m 550.32 680.64 l S BT 0.9835 0 0 0.9835 476.88 686.64 Tm 0 0 0 rg /F5 10 Tf -0.0212 Tc -0.0395 Tw (References ) Tj ET BT 0.9598 0 0 0.9598 526.08 686.64 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 532.8 686.64 Tm /F5 10 Tf 0.4474 Tc 0 Tw (192) Tj ET BT 0.8919 0 0 0.9835 73.2 624.24 Tm /F2 10 Tf 0.2641 Tc (383.) Tj 0.2691 -35.1411 TD 0.0622 Tc (384.) Tj 0.2691 -34.6531 TD 0.2641 Tc (385.) Tj 0.5382 -34.6531 TD 0.0622 Tc (386.) Tj 0.2691 -46.1227 TD 0.2641 Tc (387.) Tj 0.5382 -56.6163 TD 0.0622 Tc (388.) Tj 0.2691 -45.8787 TD 0.2641 Tc (389.) Tj 0.5382 -45.8787 TD 0.2641 Tc (390.) Tj 0.2691 -45.3906 TD 0.2641 Tc (391.) Tj 0.2691 -57.5924 TD 0.2641 Tc (392.) Tj 0.5382 -57.3484 TD 0.0622 Tc (393.) Tj 0.2691 -34.8971 TD 0.0622 Tc (394.) Tj 0.2691 -46.1227 TD 0.2641 Tc (395.) Tj 0 -34.6531 TD 0.2641 Tc (396.) Tj ET BT 0.9835 0 0 0.9835 95.76 647.76 Tm -0.0192 Tc 1.3007 Tw (Special Care Units,\224) Tj 87.8528 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 59.04 0 0 -8.64 240.24 654.96 cm BI /W 328 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <`xx<|???|?>>??>><|?>|?>|>?` pxxx8?x<p|8?|<?????????|?|?>>~?>p~?|8~?|<~?~~?|~>|~?|~||>`~>>>p~<>߀px?x|s??x?>?|?~??>~?x?< ?? EI Q BT 0.9444 0 0 0.9835 240.24 647.76 Tm 3 Tr 0.0466 Tc 0 Tw (32\(2\):184-190,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 96.48 636.72 Tm 0.0456 Tc (1992.) Tj ET BT 0.9835 0 0 0.9835 95.52 624.48 Tm /F2 10 Tf 0.0057 Tc 2.1295 Tw (Robbins, L.J.,) Tj 63.4493 -0.244 TD -0.0112 Tc 3.1228 Tw (\223Restraining the Elderly Patient,\224) Tj -63.2052 -11.4697 TD /F5 10 Tf -0.0085 Tc 0.4008 Tw (Clinics in Geriatric Medicine: Ethical Issues in the) Tj 0.244 -11.2256 TD -0.0108 Tc 0.255 Tw (Care of the Elderly ) Tj ET q 54.72 0 0 -8.64 175.44 608.88 cm BI /W 304 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xpx<x???|??>>>?>>??|?????|x><?| xx|x||~<|~~|?|p?`p??x??|????|>|>~<|~<8?`~|??|x??p|?p>p~~?xx~~~~||>>~????~~????>?p<88`x EI Q BT 0.9444 0 0 0.9835 175.44 601.92 Tm 3 Tr 0.044 Tc 0 Tw (2\(3\):591-599,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 230.16 601.92 Tm 0.0854 Tc 0.3402 Tw ( 1986.) Tj -136.66 -12.2018 TD /F2 10 Tf 0.2625 Tc 3.5766 Tw (Robinson, A., Director,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -6.96 207.12 596.64 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `????|????>??>?~?x>?~<??~~`~~ ~?~?~~?????~~?~|?~?<?~?<??~~?~|?<??~>?ǀ<<?@>x?<px<>8|~?~||~<<` EI Q BT 0.9835 0 0 0.9835 207.12 589.92 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0135 Tc 3.0977 Tw ( Care and) Tj -162.7718 -10.9816 TD 0.0331 Tc 0.2714 Tw (Training Center, Ann Arbor, MI, personal commu-) Tj 0.4881 -11.2256 TD 0.0288 Tc 0.1538 Tw (nication, April 22, 1992.) Tj 0 -12.4458 TD 0.0161 Tc 0.5502 Tw (Robinson, A., Spencer, B., and White, L., \223Under-) Tj 0.4881 -11.2256 TD 0.0062 Tc 0.4208 Tw (standing Difficult Behaviors, \224 Geriatric Education) Tj -0.244 -11.2256 TD 0.0065 Tc 0.4692 Tw (Center of Michigan, Ypsilanti, MI, 1989.) Tj 0 -12.2018 TD -0.0012 Tc 3.1126 Tw (Ronch, J.L.,) Tj 58.5686 -0.4881 TD 0.2193 Tc -0.284 Tw (\223Specialized ) Tj ET q 48.96 0 0 -7.2 213.12 528.24 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0fyπ0??????|?>???>???x?8~`?`??>??>?>?>??|?<~<~?<0~p~x8x?x?8|>x????|?88xx?x?<?<? |?x~?~|<8x@ EI Q BT 0.9835 0 0 0.9835 213.12 521.28 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0089 Tc 2.2483 Tw ( Units in) Tj -168.1406 -11.2256 TD 0.0421 Tc 0.677 Tw (Nursing Homes: Pros and Cons,\224 ) Tj 141.2966 0 TD /F5 10 Tf 0.0335 Tc 2.1012 Tw (American Jour-) Tj -140.8086 -10.9816 TD 0.0343 Tc 1.3683 Tw (nal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.76 0 0 -7.2 125.28 506.64 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8<?~??>????x?|~x>~a|~8'>|>|>x>|8|~~~~~~~~>???>~?>|?>?|???|p>?~x??~|?>>>???|?>~?|?||p|x?~|?>>>??x0 EI Q BT 0.9835 0 0 0.9835 125.28 499.44 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0238 Tc 3.3923 Tw ( Care and Related Disorders) Tj ET q 44.88 0 0 -8.64 97.2 495.6 cm BI /W 250 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x <>~|<??x|~?~<??>???~>?~?~?~?~?<?>? ?|??x<<<?~?~?~~??~>~??~><?~|<p||?~x<x?x~??<??;>?????> ?>x8 EI Q BT 0.9444 0 0 0.9835 97.2 488.64 Tm 3 Tr 0.0374 Tc 0 Tw (2\(4\):11-19,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 142.08 488.64 Tm 0.0854 Tc -0.1478 Tw ( 1987.) Tj ET q 31.44 0 0 -7.92 96.72 482.88 cm BI /W 175 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>x?x ???????<??~~~~~??|?|?p|?p~x8?~<?<>>>@?~??x8~> EI Q BT 0.9388 0 0 0.9835 96.72 476.4 Tm 3 Tr /F2 10 Tf 0.0362 Tc 0 Tw (Rovner,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 128.16 476.4 Tm 0.0137 Tc 0.6978 Tw ( B. W., Assistant Professor, Department of) Tj ET BT 0.9388 0 0 0.9835 97.2 465.6 Tm 0.0172 Tc 1.8262 Tw (Psychiatry and Behavioral Sciences, Johns Hopkins) Tj ET BT 0.9835 0 0 0.9835 97.2 454.56 Tm 0.0011 Tc 2.9151 Tw (University School of Medicine, Baltimore, MD,) Tj 0 -10.7376 TD 0.0352 Tc 0.2692 Tw (personal communications, May 13, 1991, and Apr.) Tj ET BT 0.9388 0 0 0.9835 97.44 433.2 Tm 0.0944 Tc 0.9771 Tw (2, 1992.) Tj ET q 31.44 0 0 -8.16 97.2 427.44 cm BI /W 175 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>x?p<?????~??~??~?~>?~??~??p~?p~?x 8?<?~<?>?||~??>0~ EI Q BT 0.9388 0 0 0.9835 97.2 420.72 Tm 3 Tr 0.0362 Tc 0 Tw (Rovner,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 128.64 420.72 Tm 0 Tc -0.061 Tw ( ) Tj ET q 21.84 0 0 -8.16 131.28 427.44 cm BI /W 122 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<0?pp<<>?>?~p??x?x|<<???? EI Q BT 0.8919 0 0 0.9835 131.28 420.72 Tm 3 Tr -0.0428 Tc 0 Tw (B.W.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 153.12 420.72 Tm -0.0194 Tc 1.8195 Tw ( German, P. S., Brant, L. S., et al.,) Tj -55.8842 -10.7376 TD 0.0227 Tc 3.0884 Tw (\223Depression and Mortality in Nursing Homes,\224) Tj -0.9761 -11.7137 TD /F5 10 Tf 0.0228 Tc 1.0546 Tw (Journal of the American Medical Association 265) Tj ET q 49.44 0 0 -8.64 97.92 395.04 cm BI /W 276 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|>>????~????x~>??|~|~|~?|||~||~||~???~???~???~???|?~?~>x~<?|~>߀~~~~?????~??~??>?~|?<?~~x??~>????p? EI Q BT 0.9444 0 0 0.9835 97.92 387.84 Tm 3 Tr 0.0409 Tc 0 Tw (\(8\):993-996,) Tj 0 Tr 52.352 0 TD 0.0723 Tc 0.726 Tw ( 1991.) Tj ET q 31.68 0 0 -8.16 97.2 382.32 cm BI /W 176 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @x<?N x????>~|?~?~??????~?~??x~?x~?x?~?<?<~~|~??????> EI Q BT 0.9835 0 0 0.9835 97.2 375.6 Tm 3 Tr /F2 10 Tf 0.0364 Tc 0 Tw (Rovner,) Tj 0 Tr 32.2127 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.84 0 0 -8.16 131.28 382.08 cm BI /W 122 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x08?<<?|?~x~??xx<<>>????????????? EI Q BT 0.8919 0 0 0.9835 131.28 375.6 Tm 3 Tr -0.0428 Tc 0 Tw (B.W.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 153.12 375.6 Tm -0.0053 Tc 0.8159 Tw ( German, P. S., Broadhead, J., et al.,) Tj ET BT 0.9388 0 0 0.9835 98.64 364.56 Tm -0.007 Tc 1.6389 Tw (\223The Prevalence and Management of Dementia and) Tj ET BT 0.9835 0 0 0.9835 98.4 353.28 Tm 0.0263 Tc 2.255 Tw (Other Psychiatric Disorders in Nursing Homes,\224) Tj 0 -10.9816 TD /F5 10 Tf 0.0146 Tc 0.2901 Tw (International Psychogeriatrics ) Tj ET q 44.16 0 0 -8.64 223.92 349.44 cm BI /W 246 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @0<|<<<||x|?|~>|<><>??x?<x>x?<?>>p?>|~|~~|@~~~?x||<>??|>?<<8?` ` EI Q BT 0.9444 0 0 0.9835 223.92 342.48 Tm 3 Tr 0.0374 Tc 0 Tw (2\(1\):13-24,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 268.08 342.48 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj ET q 30.96 0 0 -8.16 98.4 336.96 cm BI /W 173 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8?<?|??|???8?? ??x?|~?????? ??????? EI Q BT 0.9388 0 0 0.9835 98.4 330.24 Tm 3 Tr /F2 10 Tf 0.0362 Tc 0 Tw (Rovner,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 129.36 330.24 Tm 0 Tc -0.061 Tw ( ) Tj ET q 22.08 0 0 -8.16 131.76 336.96 cm BI /W 123 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?<?>?~|~8~?????x|<<??????????????x? EI Q BT 0.9388 0 0 0.9835 131.76 330.24 Tm 3 Tr 0.0303 Tc 0 Tw (B.W.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 153.84 330.24 Tm 0.0032 Tc 0.9118 Tw ( Kafonek, S., Filipp, L., \223Prevalence) Tj ET BT 0.9388 0 0 0.9835 98.64 319.44 Tm 0.0165 Tc 0.2931 Tw (of Mental ) Tj ET q 25.44 0 0 -7.2 139.2 326.4 cm BI /W 143 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>??|?|~?~???p? ???88?x?x??>xx~~?????8 EI Q BT 0.8919 0 0 0.9835 139.2 319.44 Tm 3 Tr -0.0098 Tc 0 Tw (Ulness) Tj 0 Tr ET BT 0.9388 0 0 0.9835 164.64 319.44 Tm 0.0123 Tc 1.0645 Tw ( in a Community Nursing Home, \224) Tj ET BT 0.9835 0 0 0.9835 98.4 308.64 Tm /F5 10 Tf 0.0161 Tc 3.3391 Tw (American Journal of Psychiatry) Tj 0 Tc -0.061 Tw ( ) Tj ET q 61.68 0 0 -8.16 240.48 315.6 cm BI /W 343 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p8<>  0>||||||<>|>`|?||?|?|?~~?~??~?~~??~?|~><~?>|~?|?x?|8?~|<?|x???x?|8?|8?||<?|ǀ|>pp|~xxx||<<~>>>w>??>??~?~???>???~???|<x<| EI Q BT 0.9444 0 0 0.9835 240.48 308.64 Tm 3 Tr 0.062 Tc 0 Tw (143:1446-1449,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 99.36 297.84 Tm 0.0456 Tc (1986.) Tj ET q 31.2 0 0 -8.16 98.4 292.32 cm BI /W 174 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|8??<?>~?~x<~?|?~~~~pxx|?|>??<?>~??o|?| EI Q BT 0.9388 0 0 0.9835 98.4 285.6 Tm 3 Tr /F2 10 Tf 0.0362 Tc (Rovner,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 129.6 285.6 Tm -0.0169 Tc 1.9084 Tw ( B. W., Lucas, M.J., and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 34.08 0 0 -8.16 238.56 292.32 cm BI /W 190 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px8?0|?|?>?x~???8~?~? ~~ ~>>?~~`p|~0~?p|>p|?>??`| ?> EI Q BT 0.9835 0 0 0.9835 238.56 285.6 Tm 3 Tr -0.0107 Tc 0 Tw (Folstein,) Tj 0 Tr 34.6531 0 TD -0.0486 Tc 1.5746 Tw ( M. F.,) Tj -176.1937 -11.4697 TD 0.0318 Tc 0.0286 Tw (\221\221The Assessment of an ) Tj ET q 48.72 0 0 -7.2 196.08 281.52 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |@???????|??~??>?~~|?>?~~?>?~~?~?~~???~`~???~~??~~??~~???~~???~~|??~~x?~~|?~~?<?~~|?>?~~<?88?~~>?8<??8>?x?????~??x8x??x?<???~??<?~|~|~<~8?< EI Q BT 0.9835 0 0 0.9835 196.08 274.32 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0091 Tc 0.0092 Tw ( Care Unit in a) Tj -148.3737 -11.2256 TD 0.0432 Tc 1.4406 Tw (Community Nursing Home,\224 unpublished) Tj 0 Tc -0.061 Tw ( ) Tj 177.902 0 TD /F6 10 Tf 0.249 Tc 0 Tw (manu-) Tj -177.4139 -11.2256 TD /F2 10 Tf 0.0345 Tc 0.9207 Tw (script, Johns Hopkins University School of Medi-) Tj -0.4881 -11.4697 TD -0.0163 Tc 0.5656 Tw (cine, Baltimore, MD, no date.) Tj ET q 31.68 0 0 -8.64 98.4 235.92 cm BI /W 176 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x< ?8?????>x~~>?>??????>p>?x>8><? ?<???~`?||>?????8~cp EI Q BT 0.9835 0 0 0.9835 98.4 228.72 Tm 3 Tr 0.0364 Tc 0 Tw (Rovner,) Tj 0 Tr 32.2127 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.84 0 0 -8.64 132.72 235.92 cm BI /W 122 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @0x8?<<??<?~x~0~???xx<<<???????????>0 EI Q BT 0.8919 0 0 0.9835 132.72 228.72 Tm 3 Tr -0.0428 Tc 0 Tw (B.W.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 154.56 228.72 Tm 0 Tc -0.061 Tw ( ) Tj ET q 66.96 0 0 -8.64 157.2 235.92 cm BI /W 372 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID > ??????????????>>?<?<?8??<?x8??8?80?8p?8~0??0?????0?????>????????? ????????????????x>???|?>??>?<>?>>>??x???????|8?0>??~~>~<~~||~?~| EI Q BT 0.9835 0 0 0.9835 157.2 228.72 Tm 3 Tr -0.0109 Tc 0 Tw (Lucas-Blaustein,) Tj 0 Tr 68.0859 0 TD -0.0365 Tc 0.4642 Tw ( J., ) Tj ET q 34.32 0 0 -8.64 239.76 235.92 cm BI /W 191 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>?<8~???~|??|??~~?<?~?~~?~?~~?~?~~?~~~?~~?~~??~~~?~ ~~|?~0~~~?~p~~?~p~~??~>~??~?~8>?~?~8>?~?~x>?~?~x~?~?p~0~?>`~~~~~< EI Q BT 0.9835 0 0 0.9835 239.76 228.72 Tm 3 Tr -0.0107 Tc 0 Tw (Folstein,) Tj 0 Tr 34.8971 0 TD 0.1466 Tc 2.9623 Tw ( M.F.,) Tj -177.902 -10.9816 TD -0.0693 Tc 0.4975 Tw (et al.,) Tj 25.8678 -0.244 TD 0.001 Tc 0.5074 Tw (\223Stability Over One Year in Patients ) Tj ET q 27.84 0 0 -6.96 274.8 224.4 cm BI /W 155 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>????~?~~~~?~~~~|<<~<?~|?>??| `p~~<<x0 EI Q BT 0.8449 0 0 0.9835 274.8 217.68 Tm 3 Tr 0.017 Tc 0 Tw (Admitt-) Tj 0 Tr ET q 12.24 0 0 -6.96 98.88 213.84 cm BI /W 68 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88|?|??>?????~?~~?~?|~?|~?|~?~?~???>??>??>>??????? EI Q BT 1.2674 0 0 0.9835 98.88 206.88 Tm 3 Tr -0.0835 Tc (ed) Tj 0 Tr ET BT 0.9835 0 0 0.9835 111.12 206.88 Tm 0.0159 Tc 1.2243 Tw ( to a Nursing Home Dementia Unit,\224) Tj 0 Tc -0.061 Tw ( ) Tj 159.3553 0 TD /F5 10 Tf 0.2636 Tc 0 Tw (Interna-) Tj -171.313 -11.4697 TD 0.0064 Tc 3.715 Tw (tional Journal of Geriatric Psychiatry) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.64 0 0 -8.64 270.24 202.8 cm BI /W 182 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px|ǀ~?|@xx|||||<>p<>8>>>>x~|?~?~x||?>>?|?>|?|~~~88>|㿃??0| EI Q BT 0.8971 0 0 0.9835 270.24 195.6 Tm 3 Tr 0.0082 Tc 0 Tw (5:77-82,) Tj 0 Tr -189.667 -10.9816 TD 0.0456 Tc (1990.) Tj ET q 31.68 0 0 -8.16 98.64 179.04 cm BI /W 176 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>>0??????~? ~??~??>???~??~??x~?x~?|??<?<?<??|~????|? EI Q BT 0.9835 0 0 0.9835 98.64 172.56 Tm 3 Tr /F2 10 Tf 0.0364 Tc (Rovner,) Tj 0 Tr 32.2127 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 21.84 0 0 -8.16 132.72 179.28 cm BI /W 122 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>8?<|||?~?x?xxx<<>??????~????  EI Q BT 0.8919 0 0 0.9835 132.72 172.56 Tm 3 Tr -0.0428 Tc 0 Tw (B.W.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 154.56 172.56 Tm -0.0077 Tc 2.0211 Tw ( and Rabins, P. V., \223Mental Illness) Tj -56.1282 -11.2256 TD 0.0318 Tc 3.3231 Tw (Among Nursing Home Patients,\224) Tj 0 Tc -0.061 Tw ( ) Tj 149.8379 0 TD /F5 10 Tf 0.2718 Tc 2.591 Tw (Hospital and) Tj -149.8379 -11.4697 TD 0.0076 Tc 0.1753 Tw (Community Psychiatry ) Tj ET q 41.04 0 0 -8.64 192.96 157.44 cm BI /W 228 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x|<>?7???>?~>???~>??x~~|~?|~|~|~|p~~8~~~~~~~?~~~~ ~~|?~~?~|>?~|>?~>?~>?~p?~@x?~x~?<>~x><~x?~??x?<>  EI Q BT 0.9444 0 0 0.9835 192.96 150.24 Tm 3 Tr 0.0439 Tc 0 Tw (36\(2\):119,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 234 150.24 Tm 0.0797 Tc 0.1019 Tw ( 120, 128, 1985.) Tj -137.3921 -12.2018 TD /F2 10 Tf -0.003 Tc 3.1145 Tw (Rubin, E.H., Morris, J. C., and Berg, L., \223The) Tj 0.4881 -11.2256 TD 0.0272 Tc 1.3756 Tw (Progression of Personality Changes in Senile De-) Tj 0.244 -10.9816 TD 0.0031 Tc 1.644 Tw (mentia of the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 158.88 123.36 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0 ~q????~?>???x?<??????p? ???p????~?????????@~???<??<?? <?| ?|~<?~??<?px?  |<?<?~|~|8~8?>0 EI Q BT 0.9388 0 0 0.9835 158.88 116.4 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 207.84 116.4 Tm 0.0118 Tc 1.3912 Tw ( Type,\224) Tj 0 Tc -0.061 Tw ( ) Tj 35.3852 0 TD /F5 10 Tf 0.0294 Tc 2.4714 Tw (Journal of the) Tj -146.1773 -11.4697 TD -0.0036 Tc 0.5934 Tw (American Geriatrics Society ) Tj ET q 59.04 0 0 -8.64 216.24 112.08 cm BI /W 328 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x@x<||?>>>2?>?>>?>?|>???|<???||>?xp<|?><?0?x?x??x??|?|?|>|x|>>< ?>??>?<|~|??|<~<>>|?>>||>>~>`>|p>|x8??8~<><?x>>?|<>???<??<x? EI Q BT 0.9444 0 0 0.9835 216.24 105.12 Tm 3 Tr 0.0466 Tc 0 Tw (35\(8\):721-725,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 275.28 105.12 Tm 0.0854 Tc 0.3402 Tw ( 1987.) Tj ET BT 0.9388 0 0 0.9835 99.6 92.88 Tm /F2 10 Tf 0.0045 Tc 1.6267 Tw (Sachs, G., Assistant Professor of Medicine, Univer-) Tj ET BT 0.9835 0 0 0.9835 100.08 81.84 Tm -0.0053 Tc 4.337 Tw (sity of Chicago Medical Center, Chicago, IL,) Tj -0.7321 -10.9816 TD 0.0273 Tc 0.3993 Tw (personal communication, May 4, 1992.) Tj 0.244 -12.6899 TD -0.0091 Tc -0.0518 Tw (Sager, M.A., ) Tj ET q 41.52 0 0 -8.16 152.64 65.28 cm BI /W 231 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<~>???????~<???~???~??~q??~1??~??~??~x??~x?~|x?~<?~<?~<??~??~>??~>?~?>~?~~?~~>8?~~~~~~~???~[< EI Q BT 1.0796 0 0 0.9835 152.64 58.56 Tm 3 Tr 0.0672 Tc 0 Tw (bventhal,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 194.16 58.56 Tm -0.0007 Tc 0.1227 Tw ( E.A., and Easterling, D.V.,) Tj -95.4179 -10.7376 TD 0.011 Tc 2.1729 Tw (\223The Impact of Medicare\222s Prospective Payment) Tj -0.244 -11.2256 TD 0.0393 Tc 0.5335 Tw (System on Wisconsin Nursing Homes,\222 ) Tj 165.7002 0 TD /F5 10 Tf 0.042 Tc 0.8724 Tw (Journal of) Tj ET BT 0.8971 0 0 0.9835 324.24 624.96 Tm 0.0369 Tc 0 Tw (397.) Tj 0.535 -56.3722 TD 0.0369 Tc (398.) Tj 0.2675 -33.921 TD 0.2375 Tc (399.) Tj 0.2675 -56.6163 TD 0.2375 Tc (400.) Tj ET BT 0.8919 0 0 0.9835 325.44 403.68 Tm /F2 10 Tf 0.2641 Tc (401.) Tj 0.8073 -45.3906 TD 0.2641 Tc (402.) Tj 0.2691 -44.9026 TD 0.2641 Tc (403.) Tj 0.2691 -34.165 TD 0.2641 Tc (404.) Tj 0.2691 -45.3906 TD 0.2641 Tc (405.) Tj 0.2691 -45.1466 TD 0.2641 Tc (406.) Tj 0.5382 -34.165 TD 0.2641 Tc (407.) Tj 0 -33.921 TD 0.2641 Tc (408.) Tj 0 -44.9026 TD 0.2641 Tc (409.) Tj 0.2691 -22.6953 TD 0.2641 Tc (410.) Tj ET BT 0.9835 0 0 0.9835 346.56 647.76 Tm /F5 10 Tf 0.0387 Tc 1.6078 Tw (the American Medical Association 257\(13\):1762-) Tj ET BT 0.9444 0 0 0.9835 347.28 636.72 Tm 0.0723 Tc 0.4719 Tw (1766, 1987.) Tj ET BT 0.9835 0 0 0.9835 346.56 624.96 Tm /F2 10 Tf -0.0168 Tc 0.2001 Tw (Saitlin, A., and Cole, J. O.,) Tj 112.5004 0.4881 TD 0.0327 Tc 0 Tw (\223Psychopharmacologic) Tj -112.0124 -11.7137 TD 0.0193 Tc -0.0807 Tw (Interventions,\224 ) Tj 66.1337 0 TD /F5 10 Tf 0.0084 Tc 1.3947 Tw (Treatments for the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 40.8 0 0 -7.2 491.76 621.12 cm BI /W 227 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 81>????????x?<~g?>'?#>?x?8?<~~~~~?~?????~??~~~??~?>x~?????????????~?~~~????????? EI Q BT 0.9835 0 0 0.9835 491.76 613.92 Tm 3 Tr -0.007 Tc 0 Tw (Alzheimer) Tj 0 Tr 41.4861 0 TD 0.0647 Tc 0.8493 Tw ( Pa-) Tj -188.3955 -10.9816 TD 0.0325 Tc 2.4276 Tw (tient: The Long Haul,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 15.84 0 0 -6.96 445.44 610.08 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????@0pp`>` EI Q BT 0.9388 0 0 0.9835 445.44 603.12 Tm 3 Tr /F2 10 Tf 0.0483 Tc 0 Tw (L.F.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 461.28 603.12 Tm 0 Tc -0.061 Tw ( ) Tj ET q 24.48 0 0 -6.96 463.92 610.08 cm BI /W 137 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~?|~???~???~????~??~???????x??x??<??<??<?<?>?~??~??|~>~???~? xx8 EI Q BT 0.9835 0 0 0.9835 463.92 603.12 Tm 3 Tr 0.0323 Tc 0 Tw (Jarvik) Tj 0 Tr 24.8916 0 TD 0.0647 Tc 0.3612 Tw ( and ) Tj ET q 18 0 0 -7.2 509.76 610.32 cm BI /W 100 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID G>?????ǀ EI Q BT 0.9388 0 0 0.9835 509.76 603.12 Tm 3 Tr 0.0043 Tc 0 Tw (C.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 527.76 603.12 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.4 0 0 -6.96 530.4 610.08 cm BI /W 114 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @p<>~?~??????????????????????????x|<<|<0|>>>?~~<< EI Q BT 0.9835 0 0 0.9835 530.4 603.12 Tm 3 Tr 0.0454 Tc 0 Tw (Win-) Tj 0 Tr -186.4432 -10.9816 TD 0.0801 Tc -0.1425 Tw (ograd ) Tj ET q 21.6 0 0 -8.64 372.96 599.28 cm BI /W 120 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px>x~>?~?|~?>?~~??~~??~~?~|~?>|~?>|?>|?>|?>~????~|?~|?~|??~|>?~|?~~|~>>>?????x<<x?` EI Q BT 0.9388 0 0 0.9835 372.96 592.32 Tm 3 Tr -0.001 Tc 0 Tw (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 394.56 592.32 Tm 0.0503 Tc 0.864 Tw ( \(New York, NY: Springer Publishing) Tj ET q 15.6 0 0 -7.92 347.28 588 cm BI /W 89 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID P<<?????x ??????? EI Q BT 0.9388 0 0 0.9835 347.28 581.28 Tm 3 Tr 0.0483 Tc 0 Tw (Co.,) Tj 0 Tr 16.6167 0 TD 0.0811 Tc 0.9912 Tw ( 1988\).) Tj ET q 39.12 0 0 -8.88 347.04 576.48 cm BI /W 218 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0~?{??>??>?????>????????????????>???????????????? ???~~8?~x?>~x~~?~~~?~?~~~~~~~~~~~|?|??|8 EI Q BT 0.9388 0 0 0.9835 347.04 569.76 Tm 3 Tr 0.0345 Tc 0 Tw (Salisbury,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 386.16 569.76 Tm 0.022 Tc 1.2414 Tw ( S., and Goehner, P., \223Separation of the) Tj -39.2897 -11.2256 TD 0.0291 Tc -0.0499 Tw (Confused or Integration With the Lucid?\222 ) Tj 170.0928 0 TD /F5 10 Tf -0.0164 Tc 0 Tw (Geriatric) Tj -170.3369 -10.9816 TD 0.0298 Tc -0.0914 Tw (Nursing ) Tj ET q 54.72 0 0 -8.64 381.84 554.88 cm BI /W 305 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8`xx8<| ?`~>?x>>??|>??|?|?|>>||<|8<>p`@<<?x?~|??<x>?>|<x?|?~?>x??xx>xx|x|>~<<y<>>?| >x8>8?~?c~~???x|88? EI Q BT 0.9444 0 0 0.9835 381.84 547.92 Tm 3 Tr 0.044 Tc 0 Tw (4\(4\):231-233,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 436.56 547.92 Tm 0.0854 Tc -0.1478 Tw ( 1983.) Tj -90.5372 -11.9577 TD /F2 10 Tf 0.0189 Tc 3.0922 Tw (Sands, D.,) Tj 51.4915 0 TD 0.0287 Tc 3.0822 Tw (\223Philosophy of Care,\224) Tj 0 Tc -0.061 Tw ( ) Tj 101.2748 0 TD /F5 10 Tf 0.4772 Tc 0 Tw (Confronting) Tj ET q 47.52 0 0 -7.2 347.28 532.32 cm BI /W 265 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?@x?<~>~~?~???>8?||G||||x~>8~>?>?~|?~~?~~?>~|???||??>|p>?|?~x?>??>??>?>?>???||x?~x?>|>|???0 EI Q BT 0.8971 0 0 0.9835 347.28 525.36 Tm 3 Tr 0.0473 Tc (AZzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 394.8 525.36 Tm -0.0017 Tc 3.3572 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -6.96 440.16 532.08 cm BI /W 101 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????????w||<<?|xx0? EI Q BT 0.9388 0 0 0.9835 440.16 525.36 Tm 3 Tr /F2 10 Tf 0.0043 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 458.16 525.36 Tm 0 Tc -0.061 Tw ( ) Tj ET q 29.28 0 0 -7.2 460.8 532.08 cm BI /W 163 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?|????????x?<~~ ~~~~~~~~|~|p~~~>~?~?>>?8|??p|8 EI Q BT 0.9835 0 0 0.9835 460.8 525.36 Tm 3 Tr -0.0246 Tc 0 Tw (Kalicki) Tj 0 Tr 29.7723 0 TD 0.0361 Tc 1.8546 Tw ( \(cd.\)) Tj 0 Tc -0.061 Tw ( ) Tj ET q 33.84 0 0 -9.12 517.44 532.32 cm BI /W 188 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>|xx<|  |0?x??x?|????>???<?<?8~|8~0~??~~?~?~~?????~????~???~??p?~??x??~?x??~?|?>>?|????| EI Q BT 0.9388 0 0 0.9835 517.44 525.36 Tm 3 Tr 0.0075 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 347.76 514.08 Tm 0.0113 Tc 1.1477 Tw (Mills, MD: Rynd Communications, and Washing-) Tj 0 -11.2256 TD 0.022 Tc 1.4505 Tw (ton, DC: American Association of Homes for the) Tj ET BT 0.9388 0 0 0.9835 348 492.24 Tm 0.0697 Tc 1.7703 Tw (Aging, 1987\).) Tj ET BT 0.9835 0 0 0.9835 347.76 480.48 Tm 0.0046 Tc 1.015 Tw (Sawyer, J. C., and Mendlovitz, A.A., \223A Manage-) Tj 0.244 -10.9816 TD 0.0258 Tc 4.2444 Tw (ment Program for Ambulatory Institutionalized) Tj 0.244 -10.9816 TD -0.0173 Tc 3.373 Tw (Patients With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -6.96 410.64 465.6 cm BI /W 272 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |p<00??????~???>????<???p?`?????????|< <?<8?><?>>??<}|??p?xx<<~~?~~~|~|?>88 EI Q BT 0.9388 0 0 0.9835 410.64 458.88 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 459.6 458.88 Tm -0.0139 Tc 3.5323 Tw ( Disease and Related) Tj -113.2325 -10.9816 TD 0.0132 Tc 1.0644 Tw (Disorders,\224 Blumenthal Jewish Home,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 44.88 0 0 -8.16 507.12 455.04 cm BI /W 250 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<???~>< EI Q BT 0.9388 0 0 0.9835 534 426.24 Tm 3 Tr 0.0139 Tc 0 Tw (MA,) Tj 0 Tr ET q 18.72 0 0 -7.2 348.48 422.4 cm BI /W 105 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???~????~??~?~~>???? EI Q BT 0.6793 0 0 0.9835 348.48 415.2 Tm 3 Tr /F4 10 Tf -0.0384 Tc (NOV.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 367.2 415.2 Tm /F2 10 Tf 0.0762 Tc 0.1055 Tw ( 21, 1982.) Tj ET q 25.92 0 0 -8.64 348.48 410.88 cm BI /W 145 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08?8?߇???8?@???????~~>p ??x??|>? EI Q BT 0.9388 0 0 0.9835 348.48 403.68 Tm 3 Tr 0.0205 Tc 0 Tw (Schiff,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 374.4 403.68 Tm 0.0046 Tc 4.571 Tw ( M.R., Director, Guidelines/Standards of) Tj ET BT 0.9388 0 0 0.9835 348.96 392.88 Tm -0.0119 Tc 0.4512 Tw (Care Project, ) Tj ET q 41.52 0 0 -7.2 402 399.84 cm BI /W 234 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<A???????~???~~x?~~<??~~??~~??~`~?~~?~~?~~?~~??~~|??~~|?~~|?~~<?~?~|?<0?~?~|?8?~?~>ǀ<????????>?0??????|||~|8~8?|8 EI Q BT 0.9835 0 0 0.9835 402 392.88 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr ET BT 0.9388 0 0 0.9835 443.52 392.88 Tm 0.01 Tc 0.7602 Tw ( Society of Canada, letter to) Tj ET BT 0.9835 0 0 0.9835 348.72 381.6 Tm 0.0269 Tc 1.6198 Tw (the Office of Technology Assessment, U.S. Con-) Tj 0.4881 -10.9816 TD 0.0262 Tc 0.1563 Tw (gress, Washington, DC, Mar. 2, 1992.) Tj -0.244 -11.7137 TD 0.0031 Tc 1.156 Tw (Schneider, L. S.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -8.16 420.48 366.24 cm BI /W 181 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~~??????`????????????@?????|?~?>?~?>?|??????>???????8 EI Q BT 0.9835 0 0 0.9835 420.48 359.28 Tm 3 Tr 0.0008 Tc 0 Tw (Polloc~) Tj 0 Tr 32.9448 0 TD 0.0102 Tc 1.1487 Tw ( V.E., and Lyness, S.A.,) Tj -104.9353 -11.2256 TD 0.0096 Tc 0.1326 Tw (\221\221A Metaanalysis of Controlled Trials of ) Tj ET q 39.84 0 0 -9.36 512.88 355.44 cm BI /W 222 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ? x b?????|~??~??~??>?~???~?????>??>?~?>|?~??~~???????>?x????8C????? EI Q BT 0.9388 0 0 0.9835 512.88 348.24 Tm 3 Tr 0.0094 Tc 0 Tw (Neurolep-) Tj 0 Tr ET BT 0.9835 0 0 0.9835 349.2 337.2 Tm -0.0231 Tc 0.6336 Tw (tic Treatment in Dementia,\224 ) Tj 117.6252 0 TD /F5 10 Tf 0.0215 Tc 0.8119 Tw (Journal of the Ameri-) Tj -117.3811 -10.9816 TD -0.002 Tc 0.2664 Tw (can Geriatrics Society ) Tj ET q 59.28 0 0 -8.88 441.36 333.6 cm BI /W 330 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>|x|>@??<????????|?>?|>?>|?0~|~ ~|?>|>?x|>?x|>~?x|>x~?|?|?|?????????????~???|??|?|????~~?x>~??|>?>????> >x<x?||?p?|?>???|>??|?` EI Q BT 0.9444 0 0 0.9835 441.36 326.4 Tm 3 Tr 0.0466 Tc 0 Tw (38\(5\):553-563,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 500.64 326.4 Tm 0.0854 Tc 0.3402 Tw ( 1990.) Tj -153.9865 -11.4697 TD /F2 10 Tf 0.0018 Tc 0.1812 Tw (Schwab, Sr. M., Rader, J., and Doan, J., \223Relieving) Tj 0 -11.2256 TD 0.0082 Tc 2.7615 Tw (the Anxiety and Fear in Dementia,\224) Tj 0 Tc -0.061 Tw ( ) Tj 162.2837 0 TD /F5 10 Tf 0.2589 Tc 2.6041 Tw (Journal of) Tj -162.0397 -11.2256 TD 0.0268 Tc 0.2778 Tw (Gerontological Nursing ) Tj ET q 43.92 0 0 -8.64 448.08 300.24 cm BI /W 244 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px>>|0|?|~?~~p?>>>???~???????}??????>??>x?>?~~|>|p~~<||<|><<?>|?x0p0 EI Q BT 0.9444 0 0 0.9835 448.08 293.04 Tm 3 Tr 0.0374 Tc 0 Tw (11\(5\):8-15,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 492 293.04 Tm 0.0854 Tc 0.0962 Tw ( 1985.) Tj ET q 31.44 0 0 -8.64 349.2 288.48 cm BI /W 175 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>~p???|????s`??#?~??~@?~?~?????????>?@|??>~~?~???C??~~>??? EI Q BT 0.9388 0 0 0.9835 349.2 281.28 Tm 3 Tr /F2 10 Tf -0.0052 Tc 0 Tw (Seckler,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 380.64 281.28 Tm -0.0345 Tc 1.8653 Tw ( A. B., Meier, D.E.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 39.84 0 0 -8.64 468.96 288.48 cm BI /W 222 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x| p?p?????~?~??~??~?~?~?~<?~?~?~??~??~?~?~~?~?????|???~p ?<<< EI Q BT 0.9835 0 0 0.9835 468.96 281.28 Tm 3 Tr -0.029 Tc 0 Tw (Mulvihill,) Tj 0 Tr 40.5099 0 TD -0.072 Tc 1.4764 Tw ( M., et al.,) Tj -161.5516 -10.9816 TD 0.0288 Tc 2.0084 Tw (\223Substituted Judgment: How Accurate are Proxy) Tj ET BT 0.9444 0 0 0.9835 349.44 259.44 Tm /F5 10 Tf 0.0027 Tc 0.0374 Tw (Predictions? \222\222Annals ) Tj ET q 73.68 0 0 -9.36 435.36 266.64 cm BI /W 427 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|||>>?p|??<>>????>~????|???>?>|~>~s~y~7?3??9~?>x?>~?>?~x?>>~x????~x?>8~><|~?<~>|?<~?|~?~~~>~???>?~>~~?|??~??|>?|>??|??>~?>~8?8?~ 0?|~|<>>|?~?~?~??~?| EI Q BT 0.9444 0 0 0.9835 435.36 259.44 Tm 3 Tr 0.0006 Tc 0 Tw (ofInternalMedicine) Tj 0 Tr 78.0197 0 TD 0.0371 Tc 0.5092 Tw ( 115\(2\):92-) Tj -168.7461 -11.4697 TD 0.0703 Tc 0.7281 Tw (98, 1991.) Tj ET BT 0.9835 0 0 0.9835 349.44 236.64 Tm /F2 10 Tf -0.0312 Tc 1.6789 Tw (Seltzer, P.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 39.6 0 0 -8.16 397.68 243.6 cm BI /W 221 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  8 >?~|~??~?>?~??~??~?~~~~?~~~~~|~~~~~~`~?~??~??~?????< EI Q BT 0.9835 0 0 0.9835 397.68 236.64 Tm 3 Tr -0.0033 Tc 0 Tw (Rheaume,) Tj 0 Tr 40.2659 0 TD -0.0257 Tc 1.4293 Tw ( Y., Volicer, L., et al., \223The) Tj -88.829 -10.9816 TD 0.0207 Tc 1.6668 Tw (Short-Term Effects of In-Hospital Respite on the) Tj -0.244 -11.2256 TD -0.02 Tc 1.1794 Tw (Patient With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 403.68 221.76 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????<>??>??~>?~x??~8??~??~` ??~`??~??????|??|??<?<p??>p?~?|<x??|?<x???<?|???<x|????|?<?<? ?|xxp EI Q BT 0.9835 0 0 0.9835 403.68 214.8 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0262 Tc 0.4537 Tw ( Disease,\224 ) Tj 44.6585 0 TD /F5 10 Tf 0.0226 Tc 0 Tw (Gerontologist) Tj ET q 59.28 0 0 -8.64 349.92 210.72 cm BI /W 331 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |x|<> 8`??????????????~??~?>p~?~~x~ ~~<~~~~xx~~~<~~~~~~?~>~?~~~?|~~~??~~|~?~~|~?>>~?>>~?>~~??>~~~x?|?~~~|?|~~><|~~>~~~`?~~~p??~~~p~~~xp~~|x<~?~c><x?????>?~?>>x EI Q BT 0.9444 0 0 0.9835 349.92 203.76 Tm 3 Tr 0.0466 Tc (28\(1\):121-124,) Tj 0 Tr 62.7715 0 TD 0.0723 Tc 0.726 Tw ( 1988.) Tj ET BT 0.9835 0 0 0.9835 349.92 192.24 Tm /F2 10 Tf 0.0159 Tc 0.4109 Tw (Sherman, D. S.,) Tj 71.7465 0 TD 0.0179 Tc 4.3134 Tw (\223Psychoactive Drug Misuse in) Tj -71.7465 -11.2256 TD 0.019 Tc 4.4954 Tw (Long-Term Care: Some Contributing Factors,\224) Tj -0.244 -11.2256 TD /F5 10 Tf 0.0208 Tc 0.2839 Tw (Journal of Pharmacy Practice ) Tj ET q 54 0 0 -8.64 474 177.36 cm BI /W 300 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||>>>`?? ?????>?????????????????~??~?????????????????????|???>??????|??>??>???? ????~??~~1?<?????x??|?|0? EI Q BT 0.9444 0 0 0.9835 474 170.16 Tm 3 Tr 0.044 Tc 0 Tw (1\(3\):189-194,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 528 170.16 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj -180.8304 -11.4697 TD /F2 10 Tf 0.0323 Tc 1.7771 Tw (Shoham, H., and Neuschatz, S., \223Group Therapy) Tj 0 -11.4697 TD -0.022 Tc 3.6219 Tw (With Senile Patients,\224) Tj 101.0308 0.244 TD /F5 10 Tf 0.0169 Tc 1.8741 Tw (Social Work) Tj 0 Tc -0.061 Tw ( ) Tj ET q 49.2 0 0 -8.64 504.48 154.8 cm BI /W 274 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<<>|>> 8???Ox>??>???|?~~~x~~>xx||?~~?<|?~?|?~?|?~??~ ?~???|~|?>|??|???|???~??~??~?????? ?? ????|>|?||x?|~?~???|??? EI Q BT 0.9444 0 0 0.9835 504.48 147.84 Tm 3 Tr 0.0409 Tc 0 Tw (30\(1\):69-72,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 351.36 137.04 Tm 0.0456 Tc (1985.) Tj ET BT 0.9835 0 0 0.9835 350.16 125.52 Tm /F2 10 Tf 0.0283 Tc 3.8148 Tw (Shomaker, D.,) Tj 69.3061 0.244 TD 0.0096 Tc 4.8099 Tw (\223Problematic Behavior and the) Tj ET q 42 0 0 -7.2 350.4 121.68 cm BI /W 234 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @?|???????????~|?~<?~?`~? ~??~?~?~??~???~?~?~|?~<?~?<?~?<?~~?<?>??>???x~?|~|8??~~8 EI Q BT 0.9835 0 0 0.9835 350.4 114.72 Tm 3 Tr -0.0017 Tc 0 Tw (Alzheimer) Tj 0 Tr 42.7062 0 TD -0.0009 Tc 2.0142 Tw ( Patient: Retrospection as a Method of) Tj -42.7062 -11.2256 TD 0.036 Tc 2.7087 Tw (Understanding and Counseling,\224) Tj 0 Tc -0.061 Tw ( ) Tj 142.7609 0 TD /F5 10 Tf 0.2478 Tc 0 Tw (Gerontologist) Tj ET q 59.28 0 0 -8.64 350.64 99.84 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<xx<>@???|?~>?|?~??>p?|>??~|>~x|>?~x>~x>~|?8~|?<~|?~?~?|~|~?|~~~|?>~|>~?|?~>|>>~|?>|?~?|~?|~|?| |`<p8|>|~>x<<~~x>|x~|?xx??|???<?????  EI Q BT 0.9444 0 0 0.9835 350.64 92.88 Tm 3 Tr 0.0466 Tc (27\(3\):370-375,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 409.92 92.88 Tm 0.0854 Tc -0.1478 Tw ( 1987.) Tj -60.5208 -11.9577 TD /F2 10 Tf 0.0159 Tc 1.8751 Tw (Simmons, M., Long-Term Care Consultant, Den-) Tj 0 -10.9816 TD 0.031 Tc 0.3142 Tw (ver, CO, personal communication, Nov. 8, 1990.) Tj ET q 27.6 0 0 -8.64 350.64 66 cm BI /W 154 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p?<???????????????~???????????||?~?~>?>????x??????? EI Q BT 0.9388 0 0 0.9835 350.64 58.8 Tm 3 Tr 0.0374 Tc 0 Tw (Skurla,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 378.24 58.8 Tm 0.0121 Tc 3.4478 Tw ( W., Rogers, J. C., and Sunderland, T.,) Tj ET BT 0.9388 0 0 0.9835 351.36 48 Tm 0.0005 Tc 1.077 Tw (\221\221Direct Assessment of Activities of Daily Living in) Tj ET q 48.96 0 0 -7.2 350.64 44.4 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID s?x????????>??>????<????`~~?`~????????~?~|?~<? <?~>?~<?>?ǀ<>?~<|@?>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 556 0 obj <>stream 0.72 w 1 j 0 0 0 RG 58.32 678.72 m 536.16 678.72 l S BT 0.9835 0 0 0.9835 58.8 684 Tm 0 0 0 rg /F2 10 Tf 0.122 Tc -0.1851 Tw (193 ) Tj ET BT 0.9598 0 0 0.9598 77.04 684 Tm /F9 6 Tf 0.0036 Tc 0.0781 Tw (l ) Tj ET BT 0.9835 0 0 0.9835 83.52 684 Tm /F5 10 Tf 0.0024 Tc 1.0102 Tw (Special Care Units for People With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.52 0 0 -7.2 231.84 690.96 cm BI /W 265 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?>~>>?????|~~~~x~>8>>?|??|??~|?~?>~??~?|??|~??~p>?~?>x?>??>|???>?>?????? |?~?~>>???? EI Q BT 0.9835 0 0 0.9835 231.84 684 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.3191 0 TD 0.0563 Tc 0.2884 Tw ( and Other ) Tj ET q 42.48 0 0 -6.96 326.64 690.72 cm BI /W 237 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~px?x|?|???~???~?><><?<??<??'?<?|8~~~|>~~?~?~??~~??~>??|>~~??|?~0>8~8~~翀?x??x߃??~??|>??p? EI Q BT 0.9835 0 0 0.9835 326.64 684 Tm 3 Tr 0.0174 Tc 0 Tw (Dementias) Tj 0 Tr ET BT 0.8919 0 0 0.9835 59.04 623.04 Tm /F2 10 Tf 0.2641 Tc (411.) Tj 0.5382 -46.3668 TD 0.2641 Tc (412.) Tj 0.5382 -57.3484 TD 0.2641 Tc (413.) Tj ET BT 0.9388 0 0 0.9835 60.24 476.16 Tm 0.0963 Tc (414.) Tj 0.5113 -57.3484 TD 0.0963 Tc (415.) Tj ET BT 0.8919 0 0 0.9835 61.2 364.08 Tm 0.2641 Tc (416.) Tj ET q 16.8 0 0 -6.96 61.44 336.48 cm BI /W 94 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p`??|~>>?|<xxpxx||@|<<>??|x0 EI Q BT 0.9388 0 0 0.9835 61.44 329.76 Tm 3 Tr 0.0963 Tc (417.) Tj 0 Tr 0 -23.4274 TD 0.0963 Tc (418.) Tj ET BT 0.8919 0 0 0.9835 61.92 261.12 Tm 0.2641 Tc (419.) Tj 0.2691 -34.8971 TD 0.2641 Tc (420.) Tj 0 -23.6715 TD 0.2641 Tc (421.) Tj 0.5382 -45.6347 TD 0.2641 Tc (422.) Tj 0.2691 -90.7813 TD 0.2641 Tc (423.) Tj ET q 12.48 0 0 -6.96 81.84 653.52 cm BI /W 70 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |~?~~~`~~>~??>?>~?~~~?>?~???~`|p| EI Q BT 0.9444 0 0 0.9835 81.84 646.56 Tm 3 Tr /F5 10 Tf 0.0583 Tc (nal) Tj 0 Tr ET BT 0.9835 0 0 0.9835 94.32 646.56 Tm 0.022 Tc 1.8689 Tw ( of the American Geriatrics Society 36\(2\):97-) Tj ET BT 0.9444 0 0 0.9835 82.8 635.52 Tm 0.0714 Tc 0.2187 Tw (103, 1988.) Tj ET BT 0.9835 0 0 0.9835 82.08 623.04 Tm /F2 10 Tf 0.0051 Tc -0.0662 Tw (Sloane, ) Tj ET q 19.92 0 0 -8.16 115.44 629.76 cm BI /W 111 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>>8~????~?<p??????????????????????????????? EI Q BT 0.9835 0 0 0.9835 115.44 623.04 Tm 3 Tr -0.0073 Tc 0 Tw (P.D.,) Tj 0 Tr 20.255 0 TD 0.0218 Tc 1.9911 Tw ( Associate Professor, Department of) Tj -53.9319 -10.9816 TD 0.0079 Tc 2.8105 Tw (Family Medicine, University of North Carolina,) Tj 0 -11.4697 TD 0.0073 Tc 2.079 Tw (Chapel Hill, NC, personal communications, June) Tj 0 -10.9816 TD 0.0615 Tc 0.0717 Tw (28, 1991, and Feb. 4, 1992.) Tj 0 -13.1779 TD 0.0051 Tc -0.0662 Tw (Sloane, ) Tj ET q 20.16 0 0 -8.16 115.92 584.16 cm BI /W 112 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<8:~?~?|????????????????????????????????? EI Q BT 0.9835 0 0 0.9835 115.92 577.2 Tm 3 Tr -0.0073 Tc 0 Tw (P.D.,) Tj 0 Tr 20.499 0 TD 0.0647 Tc 0.1172 Tw ( and ) Tj ET q 34.56 0 0 -8.64 156.24 584.4 cm BI /W 193 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x<@`?>xy`???~<~x?~8?ǿ<|<>???>|~~?|?????@??? EI Q BT 0.9835 0 0 0.9835 156.24 577.2 Tm 3 Tr -0.0212 Tc 0 Tw (Mathew,) Tj 0 Tr 35.1411 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 16.8 0 0 -8.16 193.2 584.16 cm BI /W 94 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<|px??g EI Q BT 0.9388 0 0 0.9835 193.2 577.2 Tm 3 Tr 0.0259 Tc 0 Tw (L.J.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 210 577.2 Tm 0.0094 Tc 1.3936 Tw ( \223The Future Role) Tj -129.5829 -10.9816 TD -0.013 Tc 0.5013 Tw (of Specialized Dementia Care,\224 ) Tj 131.5352 0 TD /F5 10 Tf 0.0137 Tc 0.7791 Tw (Dementia Units in) Tj -131.7793 -10.9816 TD 0.2832 Tc 3.3115 Tw (Long-Term Care,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 16.8 0 0 -6.48 164.64 562.08 cm BI /W 94 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p????p??????????? EI Q BT 0.9388 0 0 0.9835 164.64 555.6 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 181.44 555.6 Tm 0.0323 Tc 2.3464 Tw ( Sloane and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 14.16 0 0 -6.48 237.12 562.08 cm BI /W 79 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `?<~~?|8 EI Q BT 0.9388 0 0 0.9835 237.12 555.6 Tm 3 Tr 0.0187 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 251.28 555.6 Tm 0 Tc -0.061 Tw ( ) Tj ET q 31.92 0 0 -6.96 253.92 562.32 cm BI /W 178 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????????p???p????x?x|??8<???<?~?~?~??|??~?|?11?????? EI Q BT 0.9388 0 0 0.9835 253.92 555.6 Tm 3 Tr -0.011 Tc 0 Tw (Mathew) Tj 0 Tr ET q 21.6 0 0 -8.64 83.04 551.52 cm BI /W 121 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<>|?>|?~>>>>>??~?~?||?|?|??>?>??>????????~??~>>~~>?|??|??><x0 EI Q BT 0.9388 0 0 0.9835 83.04 544.56 Tm 3 Tr -0.001 Tc (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 104.64 544.56 Tm 0.024 Tc 0.4026 Tw ( \(Baltimore, Johns Hopkins University Press,) Tj ET BT 0.8919 0 0 0.9835 83.52 533.52 Tm 0.2668 Tc 0 Tw (1991\).) Tj ET BT 0.9835 0 0 0.9835 82.8 521.04 Tm 0.9813 Tc -1.0588 Tw (Sloane, ) Tj ET q 20.16 0 0 -8.16 124.08 527.76 cm BI /W 112 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<?<~????_~?<????????????????????????????????? EI Q BT 0.9835 0 0 0.9835 124.08 521.04 Tm 3 Tr -0.0073 Tc 0 Tw (P.D.,) Tj 0 Tr 20.499 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 34.8 0 0 -8.16 147.36 528 cm BI /W 194 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<` |>;p????<?p?x?8?<?<?????????????`??? EI Q BT 0.9835 0 0 0.9835 147.36 521.04 Tm 3 Tr -0.0212 Tc 0 Tw (Mathew,) Tj 0 Tr 35.3852 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 17.04 0 0 -8.16 185.28 527.52 cm BI /W 95 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<@?x?xp`? EI Q BT 0.9835 0 0 0.9835 185.28 521.04 Tm 3 Tr -0.0366 Tc 0 Tw (L.J.,) Tj 0 Tr 17.3265 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 24.48 0 0 -8.16 205.44 528 cm BI /W 137 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<?y ????|>??  |~?~~||~??@x??>~~?~??? EI Q BT 0.9388 0 0 0.9835 205.44 521.04 Tm 3 Tr -0.0385 Tc 0 Tw (Desai,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 229.92 521.04 Tm 0.1608 Tc 3.3546 Tw ( J.R., et al.,) Tj ET BT 0.9388 0 0 0.9835 83.52 509.76 Tm -0.0064 Tc 1.6383 Tw (\221\221Specialized Dementia Units in Nursing Homes: A) Tj ET BT 0.9835 0 0 0.9835 83.28 498.96 Tm 0.0152 Tc 2.6079 Tw (Study of Settings in Five States,\224 University of) Tj -0.244 -10.9816 TD 0.0079 Tc 0.4597 Tw (North Carolina, Chapel Hill, NC, March 1990.) Tj ET BT 0.9388 0 0 0.9835 83.04 475.92 Tm 0.0248 Tc 0.0286 Tw (Sloane, ) Tj ET q 19.92 0 0 -8.16 114.24 482.88 cm BI /W 112 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8<~g~~???~?<x???????????????????????????????? EI Q BT 0.9835 0 0 0.9835 114.24 475.92 Tm 3 Tr -0.0073 Tc 0 Tw (P.D.,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 134.16 475.92 Tm 0 Tc 0.055 Tw ( ) Tj ET q 34.08 0 0 -8.16 136.32 482.88 cm BI /W 193 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<@ ?0???x?x??<~x~8?~?~~~~<<??~?~?~~|?|???`??????. EI Q BT 0.9388 0 0 0.9835 136.32 475.92 Tm 3 Tr -0.0016 Tc 0 Tw (Mathew,) Tj 0 Tr 36.301 0 TD 0.0322 Tc 0.4468 Tw ( L. J., Scarborough, M., et al.,) Tj ET BT 0.9835 0 0 0.9835 84 464.88 Tm 0.0237 Tc 0.1589 Tw (\221\221Physical and Pharmacologic Restraint of Nursing) Tj -0.4881 -10.9816 TD -0.0014 Tc 0.9165 Tw (Home Patients With Dementia: Impact of Special-) Tj 0.244 -11.2256 TD 0.2206 Tc 3.3752 Tw (ized Units,\222) Tj 59.3007 -0.4881 TD /F5 10 Tf 0.0152 Tc 3.6451 Tw (Journal of the American Medical) Tj -60.0328 -10.4935 TD 0.0144 Tc -0.0757 Tw (Association ) Tj ET q 79.2 0 0 -8.64 134.16 438.96 cm BI /W 441 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `08<|<<>L|?x??~??~>?~|~?p||~?x0|~`x~`?<|~xx~x|?|~<x?~<|?||?~>?|x|?~>?~<|~>??>~~??>~~~?~~~?~~?|~~??>x~~|??|~~??>?~???~??|~?~?~?~~~??~0~>??~??~ 0@~??8? ~8?~?~?~?|?p?x~??|?x<<?||>9?x|>0??>?~?|~~|| >p EI Q BT 0.9444 0 0 0.9835 134.16 432.24 Tm 3 Tr 0.0541 Tc 0 Tw (265\(10\):1278-1282,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 213.36 432.24 Tm 0.0854 Tc 1.3164 Tw ( 1991.) Tj -132.0233 -12.6899 TD 0.04 Tc -0.1017 Tw (Sloane, ) Tj ET q 19.92 0 0 -8.16 118.8 426.48 cm BI /W 111 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|<>~x????|?8p????????????????????????????? EI Q BT 0.9835 0 0 0.9835 118.8 419.76 Tm 3 Tr /F2 10 Tf -0.0073 Tc 0 Tw (P.D.,) Tj 0 Tr 20.255 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 34.56 0 0 -8.16 141.36 426.72 cm BI /W 193 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<> `??p??G~8~~?~p?~0~<x<????~~??|????@????@ EI Q BT 0.9835 0 0 0.9835 141.36 419.76 Tm 3 Tr -0.0212 Tc 0 Tw (Mathew,) Tj 0 Tr 35.1411 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 17.04 0 0 -8.16 178.56 426.48 cm BI /W 95 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<>|}?|~~?|0pp EI Q BT 0.9835 0 0 0.9835 178.56 419.76 Tm 3 Tr -0.0366 Tc 0 Tw (L.J.,) Tj 0 Tr 17.3265 0 TD 0.0004 Tc 3.0297 Tw ( and Weissert, W.G.,) Tj -113.2325 -10.9816 TD -0.0025 Tc 5.7983 Tw (\223Financial Considerations,\224) Tj 0 Tc -0.061 Tw ( ) Tj 125.1903 0 TD /F5 10 Tf 0.0137 Tc 3.7076 Tw (Dementia Units in) Tj -125.9224 -11.2256 TD 0.2832 Tc 3.3115 Tw (Long-Term Care,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 17.04 0 0 -6.48 165.6 404.4 cm BI /W 95 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?????x??????? EI Q BT 0.9388 0 0 0.9835 165.6 397.92 Tm 3 Tr /F2 10 Tf 0.0263 Tc 0 Tw (P.D.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 182.64 397.92 Tm 0.0323 Tc 2.2244 Tw ( Sloane and) Tj 0 Tc -0.061 Tw ( ) Tj ET q 14.4 0 0 -6.96 238.08 404.4 cm BI /W 80 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>??~~>~~~~? EI Q BT 0.9388 0 0 0.9835 238.08 397.92 Tm 3 Tr 0.0187 Tc 0 Tw (L.J.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 252.48 397.92 Tm 0 Tc -0.061 Tw ( ) Tj ET q 32.16 0 0 -6.96 255.12 404.64 cm BI /W 179 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID < ???????p??0??0????8?<<?????>?~~~??|??????? EI Q BT 0.9835 0 0 0.9835 255.12 397.92 Tm 3 Tr -0.0146 Tc 0 Tw (Mathew) Tj 0 Tr ET q 21.6 0 0 -8.64 84.24 393.84 cm BI /W 121 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>|?|~>>?>?>???`~~?||?|????>?????|||?|??~??~|>>~?>>>?<|?<>?80 EI Q BT 0.9388 0 0 0.9835 84.24 386.88 Tm 3 Tr -0.001 Tc (\(eds.\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 105.84 386.88 Tm 0.024 Tc 0.4026 Tw ( \(Baltimore, Johns Hopkins University Press,) Tj ET BT 0.8919 0 0 0.9835 84.72 376.32 Tm 0.2668 Tc 0 Tw (1991\).) Tj ET BT 0.9835 0 0 0.9835 84.24 363.84 Tm -0.0243 Tc -0.0364 Tw (Smits, H.L.,) Tj 51.9796 -0.244 TD 0.0058 Tc 0.6042 Tw (\223Incentives in Case-Mix Measures for) Tj -51.9796 -10.9816 TD 0.0183 Tc 0.6525 Tw (Imng-Term Care,\224) Tj 79.0676 0 TD /F5 10 Tf 0.0042 Tc 1.0735 Tw (Health Care Financing Review) Tj ET q 44.4 0 0 -8.64 84.72 348.96 cm BI /W 248 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @ px>x<<??|p@?>0x~|||>|~?|>~?>>x~>>x~?>x~?>|~?>~???x??|??>??~???>??>p>~?/|~|~~?p~?~?x~?x~?x8??<p?~x?~>??<?xpB EI Q BT 0.9444 0 0 0.9835 84.72 342 Tm 3 Tr 0.0374 Tc 0 Tw (6\(2\):53-59,) Tj 0 Tr 47.0151 0 TD 0.0723 Tc 0.726 Tw ( 1984.) Tj ET BT 0.9835 0 0 0.9835 84.24 329.52 Tm /F2 10 Tf 0.0242 Tc 0.6464 Tw (Snyder, L. H.,) Tj 65.1575 0 TD -0.0036 Tc 4.0912 Tw (Rupprecht, P., Pyrek, J., et al.,) Tj ET BT 0.9388 0 0 0.9835 84.96 318.72 Tm 0.0267 Tc 0 Tw (\221\221Wandering,) Tj ET q 4.8 0 0 -2.4 138.24 325.44 cm BI /W 27 /H 14 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|<????~< EI Q BT 1.0796 0 0 0.9835 138.24 318.48 Tm 3 Tr 0.0031 Tc (\223) Tj 0 Tr ET BT 0.9835 0 0 0.9835 143.04 318.48 Tm /F5 10 Tf 0.0226 Tc 0.038 Tw ( Gerontologist ) Tj ET q 58.56 0 0 -8.64 203.28 325.44 cm BI /W 326 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px>xx<x|>pxx>?x>|>||>x<`~>?>>`>~x>>>>?|>?>|~>>?|~>>?|>~??<???~??~?~?>?x?>8?>><>>~>p>~>>~?~>~|~??|x>??|8>>?`>~?|~~y?|~~??~x|?~<>><><|~x~????<~|>x>? p``@`0 EI Q BT 0.9444 0 0 0.9835 203.28 318.48 Tm 3 Tr 0.0466 Tc 0 Tw (18\(3\):491-495,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 261.84 318.48 Tm 0.0854 Tc 0.0962 Tw ( 1978.) Tj -180.5864 -12.2018 TD /F2 10 Tf -0.0035 Tc 4.3352 Tw (Spencer, B.,) Tj 61.497 0 TD 0.2379 Tc 3.4064 Tw (\223Partners in Care: The Role of) Tj -61.2529 -10.9816 TD -0.0191 Tc 3.1918 Tw (Families in Dementia Care Units,\224) Tj 0 Tc -0.061 Tw ( ) Tj 156.6709 0 TD /F5 10 Tf 0.4491 Tc 0 Tw (Specialized) Tj -156.9149 -10.9816 TD 0.0067 Tc -0.0678 Tw (Dementia Care Units, ) Tj ET q 18.48 0 0 -6.96 173.28 291.36 cm BI /W 103 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8&|????~?<??????????????? ?????????????? EI Q BT 0.9388 0 0 0.9835 173.28 284.88 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 191.76 284.88 Tm 0.0121 Tc -0.0733 Tw ( Coons \(cd.\) \(Baltimore,) Tj -108.8399 -11.4697 TD 0.0422 Tc 0.1401 Tw (MD: Johns Hopkins University Press, 1991\).) Tj ET q 31.44 0 0 -9.36 84.72 267.84 cm BI /W 176 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x~<~<~~~~?0~8<y???????~~8|~~|p~~?8~~?~~`~>`~??~?~?~?~?~~??~????x???? ?? ?????????` EI Q BT 0.9388 0 0 0.9835 84.72 260.88 Tm 3 Tr 0.0255 Tc 0 Tw (Splaine,) Tj 0 Tr 33.489 0 TD -0.0007 Tc 1.4873 Tw ( M., Associate Director, Chapter Advocacy,) Tj ET q 48.96 0 0 -7.2 84.96 257.28 cm BI /W 273 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~??????|????????p?0?~??~??|?|???~??|?|?<??<?><?>?????>?|~ ??p?x<?>~|<>~8@ EI Q BT 0.9835 0 0 0.9835 84.96 250.08 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0206 Tc 3.3345 Tw ( Association, Washington, DC, per-) Tj -49.2952 -11.2256 TD 0.0349 Tc 0.0865 Tw (sonal communication, June 12, 1990.) Tj -0.4881 -12.6899 TD 0.0337 Tc 2.7355 Tw (Spring, J., \223Applying Due Process Safeguards,\224) Tj 0.244 -10.9816 TD /F5 10 Tf 0.0287 Tc -0.0902 Tw (Generations ) Tj ET q 48.96 0 0 -8.64 137.04 222.48 cm BI /W 272 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08`<x<>>?>8?||||||?<>>?>????x0??0??? ????x?<??~?~?~??~?~?~?p~?x|x~?<?<~??~?>?><?<|>??|8?π??|??|?|?>x??|?????~??<p8~0 EI Q BT 0.9444 0 0 0.9835 137.04 215.76 Tm 3 Tr 0.0409 Tc 0 Tw (11\(4\):32-40,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 186 215.76 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -102.739 -12.6899 TD /F2 10 Tf 0.0051 Tc 1.2585 Tw (Stahler, G.J., Frazer, D., and Rappaport, H., \223The) Tj 0 -10.7376 TD 0.0281 Tc 1.3746 Tw (Evaluation of an Environmental Remodeling Pro-) Tj 0.4881 -11.2256 TD 0.0082 Tc 0.7441 Tw (gram on a Psychiatric Geriatric Ward,\224 ) Tj 165.2121 0 TD /F5 10 Tf 0.042 Tc 1.3605 Tw (Journal of) Tj -165.2121 -11.2256 TD 0.0227 Tc 0.282 Tw (Social Psychology ) Tj ET q 51.84 0 0 -8.64 162 177.6 cm BI /W 289 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08??y?????x|?><?<?>>> ??p??<?~?~??~~~??~?~???~~~~>xx>?||?>>?>?>?~p?!~|~??>??~>8 ?p|? EI Q BT 0.8971 0 0 0.9835 162 170.64 Tm 3 Tr 0.0322 Tc 0 Tw (123:101-113,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 213.84 170.64 Tm 0.0854 Tc 0.3402 Tw ( 1984.) Tj ET BT 0.9388 0 0 0.9835 85.44 158.4 Tm /F2 10 Tf 0.0311 Tc 0.1923 Tw (Stehrnan, J. M., ) Tj ET q 33.36 0 0 -8.16 148.8 165.36 cm BI /W 190 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx|8>.??????|????<??~~~?~?~?~??~?|?|?|?~??~??~???~~>?~|>?~>À>?~>???`(???? EI Q BT 0.9835 0 0 0.9835 148.8 158.4 Tm 3 Tr -0.0073 Tc 0 Tw (Glemer,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 182.16 158.4 Tm 0.0294 Tc 0.0238 Tw ( J., and ) Tj ET q 39.84 0 0 -8.16 211.68 165.36 cm BI /W 227 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>?????~>???~?|??~??|?p~?>?0~>>?~~>?~~>?~|??~~?~>?~??~??~??~??~??????~~??8 EI Q BT 0.9388 0 0 0.9835 211.68 158.4 Tm 3 Tr 0.0024 Tc 0 Tw (Neubauer,) Tj 0 Tr 42.4364 0 TD 0.0089 Tc 0.3012 Tw ( J., \221 \221The) Tj ET BT 0.9835 0 0 0.9835 85.44 147.36 Tm 0.0217 Tc 2.6013 Tw (University of California, San Diego, Continuing) Tj 0.244 -10.9816 TD 0.0009 Tc 3.1105 Tw (Medical Education and the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.72 0 0 -7.2 206.4 143.76 cm BI /W 271 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0????|????>???>?>?x>?~?`?`?~?}?|~????<??<?<??>0??8?|?ǀ<<~<<?????p 8>xx<<p?~?~<<?x` EI Q BT 0.9835 0 0 0.9835 206.4 136.56 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.5392 0 TD -0.0079 Tc 3.6076 Tw ( Family) Tj -172.0451 -11.4697 TD 0.0208 Tc 1.8701 Tw (Center\222s School of Dementia Care Training Pro-) Tj ET BT 0.9388 0 0 0.9835 85.68 114.48 Tm -0.0076 Tc 0.9761 Tw (gram for Licensed Residential Care Facilities for the) Tj ET BT 0.9835 0 0 0.9835 85.68 103.44 Tm -0.0043 Tc -0.0566 Tw (Elderly,\224 ) Tj 41.7301 0 TD /F5 10 Tf 0.0307 Tc 2.1041 Tw (American Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.76 0 0 -7.2 217.68 110.16 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  >??????x?x??|??a|>a>~~ ?~x||~8|~|~|~|~?|~??~~?????>~??~>??~?`???p<}?|?|?7~>>?>??x?8||~x@ EI Q BT 0.9835 0 0 0.9835 217.68 103.44 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD -0 Tc 1.6473 Tw ( Care) Tj -182.7827 -11.2256 TD 0.034 Tc 2.1007 Tw (and Related Disorders and Research) Tj 0 Tc -0.061 Tw ( ) Tj ET q 43.92 0 0 -8.64 245.04 99.36 cm BI /W 245 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px|>x<8|~p????~|||||?>~?>>~?>~?>~?>????????????>?~~>>?>~?>|#||?x?????>?x~||~<~|{>?<x8pxp EI Q BT 0.9444 0 0 0.9835 245.04 92.4 Tm 3 Tr 0.0374 Tc 0 Tw (6\(1\):15-19,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 86.88 81.6 Tm 0.0456 Tc (1991.) Tj ET BT 0.9835 0 0 0.9835 85.68 69.36 Tm /F2 10 Tf 0.0113 Tc 0.1715 Tw (Stein Gerontological Institute, \223Pathways: Program) Tj 0 -11.2256 TD 0.0268 Tc 1.5386 Tw (Development Plan,\224 prepared for the Florida De-) Tj 0.244 -11.2256 TD -0.0023 Tc 3.8459 Tw (partment of Health and Rehabilitative Services) Tj 0 -10.9816 TD 0.0251 Tc 0.1575 Tw (Under Contract ) Tj ET q 29.76 0 0 -8.16 150.48 43.44 cm BI /W 166 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx???~?~~?|~~?~x<?>??????? EI Q BT 0.9388 0 0 0.9835 150.48 36.48 Tm 3 Tr 0.0208 Tc 0 Tw (JGB12,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 180.24 36.48 Tm 0.0177 Tc 0.3114 Tw ( Miami, FL, Aug. 2, 1989.) Tj ET BT 0.8919 0 0 0.9835 309.6 646.8 Tm 0.0622 Tc 0 Tw (424.) Tj 0.5382 -59.0566 TD 0.2641 Tc (425.) Tj 0.5382 -69.5502 TD 0.2641 Tc (426.) Tj 0.5382 -35.8732 TD 0.2641 Tc (427.) Tj 0.2691 -47.0989 TD 0.2641 Tc (428.) Tj 0.5382 -35.6292 TD 0.2641 Tc (429.) Tj 0.2691 -47.3429 TD 0.2641 Tc (430.) Tj 0.2691 -46.3668 TD 0.2641 Tc (431.) Tj 0.5382 -58.5686 TD 0.2641 Tc (432.) Tj 0.2691 -47.0989 TD 0.2641 Tc (433.) Tj 0.2691 -46.8548 TD 0.2641 Tc (434.) Tj ET BT 0.9388 0 0 0.9835 313.44 104.4 Tm 0.0963 Tc (435.) Tj ET BT 0.9835 0 0 0.9835 331.92 646.56 Tm 0.0043 Tc -0.0654 Tw (Stephens, M.A.P., Kinney, J.M., and ) Tj ET q 34.56 0 0 -9.12 478.8 653.52 cm BI /W 192 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?`>|>|~<? ?< ???????????>?x~??~??~???????~8~|>|?q??~?8s???~?~< EI Q BT 0.9388 0 0 0.9835 478.8 646.56 Tm 3 Tr 0.0306 Tc 0 Tw (Ogrocki,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 513.36 646.56 Tm -0.0073 Tc -0.0536 Tw ( P.K.,) Tj -183.2708 -11.2256 TD 0.0227 Tc 2.0634 Tw (\223Stressors and Well-Being Among Caregivers to) Tj -0.244 -11.2256 TD 0.0236 Tc 0.037 Tw (Older Adults With Dementia: The In-Home Versus) Tj ET BT 0.9388 0 0 0.9835 332.88 613.44 Tm 0.0003 Tc 0.0547 Tw (NursingHomeExperience,\224 ) Tj ET q 61.92 0 0 -9.36 441.6 620.64 cm BI /W 348 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??~||||~~|<@<?<?x?~????????????~?>?~?s?~?1?~?~?~??~??~~?~???~~?~???????~?????~????~???????8 ???~~8??y~?~<??~~?~<???~?x???~????|???< ~>`x8p9??????8?<< EI Q BT 0.8971 0 0 0.9835 441.6 613.44 Tm 3 Tr /F5 10 Tf 0.0323 Tc 0 Tw (Gerontologist31) Tj 0 Tr ET BT 0.9444 0 0 0.9835 503.52 613.44 Tm 0 Tc 0.0402 Tw ( ) Tj ET q 30.48 0 0 -9.36 505.68 620.4 cm BI /W 173 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >~|~>|?>~~~?>???>?~<~>~~~|>|>?|<|~~~~~~~???>|?p<~p?>x>p>x|x>||x>??~?????<??  EI Q BT 0.8971 0 0 0.9835 505.68 613.44 Tm 3 Tr -0.0205 Tc 0 Tw (\(2\):217-) Tj 0 Tr ET BT 0.9444 0 0 0.9835 332.88 602.4 Tm 0.0714 Tc 0.727 Tw (223, 1991.) Tj ET BT 0.9835 0 0 0.9835 332.88 588.72 Tm /F2 10 Tf 0.014 Tc 0.3315 Tw (Steinberg, J., Spector, W.D., and Drugovich, M.L.,) Tj 0.4881 -11.2256 TD 0.037 Tc 2.1383 Tw (\223Use of Psychoactive Drugs in Nursing Homes:) Tj ET BT 0.9388 0 0 0.9835 332.88 566.88 Tm -0.0108 Tc 2.3673 Tw (Prevalence and Residents\222 Characteristics,\224 Agency) Tj ET BT 0.9835 0 0 0.9835 333.12 556.08 Tm 0.0107 Tc 0.6602 Tw (for Health Care Policy and Research, U.S. Depart-) Tj 0.244 -11.4697 TD 0.0208 Tc 2.3582 Tw (ment of Health and Human Services,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 41.04 0 0 -8.64 496.08 552 cm BI /W 228 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x? 8??p??????????????>?<~?????????ǀ????>>~~|>?~?????p <????` EI Q BT 0.9835 0 0 0.9835 496.08 544.8 Tm 3 Tr -0.0171 Tc 0 Tw (Rockville,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 333.36 534 Tm 0.0671 Tc 1.5174 Tw (MD, 1990.) Tj 0 -13.91 TD 0.0232 Tc 1.5641 Tw (Stevens P.,) Tj ET BT 0.9835 0 0 0.9835 380.16 520.32 Tm 0.0132 Tc 0.3323 Tw (\223Design for Dementia: ) Tj ET q 48.48 0 0 -9.36 474.24 527.52 cm BI /W 270 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `??x<<<|8??????????~?????x0~???|8~????~??~??~????`@?~???~???~????????x??|?>???~??? ??x??p?` EI Q BT 0.9835 0 0 0.9835 474.24 520.32 Tm 3 Tr -0.0091 Tc 0 Tw (Re-Creating) Tj 0 Tr 49.2952 0 TD -0.0083 Tc 0.1915 Tw ( the) Tj -192.5441 -11.7137 TD 0.0253 Tc 0.4013 Tw (Loving Family,\222 ) Tj 70.2823 0 TD /F5 10 Tf 0.0307 Tc 0.4771 Tw (American Journal of ) Tj ET q 47.76 0 0 -7.2 489.36 516 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p ??????|?~>?s~~>#!?~~x??~|?~~<?~~~?~???????~???~p?~?>8???À?<?~????|?,~w~~>?>??x??`|?|???x EI Q BT 0.9835 0 0 0.9835 489.36 508.8 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr -158.1351 -10.9816 TD 0.0315 Tc 0.0696 Tw (Care and Research ) Tj ET q 44.64 0 0 -8.64 413.52 504.96 cm BI /W 249 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<x|<>?0<|<?||~??|>??>??~?|?><?????x?<x~<x|?>~~?~~?~~|~?~|???|~???~~>??~~<|~|80`||8?|8?x>~<?|>~>~????~>p8p EI Q BT 0.9444 0 0 0.9835 413.52 498 Tm 3 Tr 0.0374 Tc 0 Tw (2\(1\):16-22,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 458.16 498 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj -126.6545 -13.422 TD /F2 10 Tf -0.0118 Tc 0.683 Tw (Stiebling, M., Scher, J., Morris, J., et al., \223Morbid-) Tj 0.4881 -10.9816 TD 0.0059 Tc 1.2995 Tw (ity of Physical Restraints Among Institutionalized) Tj -0.244 -11.4697 TD -0.0125 Tc 0.1143 Tw (Elderly, \224 abstract, ) Tj 78.0914 0 TD /F5 10 Tf 0.0256 Tc 0.401 Tw (Journal of the American Geria-) Tj ET BT 0.9444 0 0 0.9835 334.32 451.92 Tm -0.0143 Tc 0.6484 Tw (trics Society 38\(8\) ) Tj ET q 21.12 0 0 -8.64 408.48 458.88 cm BI /W 119 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |<~8|~|x8x||x|||<~?~~?~?~???|x<?<?|?8?????3 EI Q BT 0.9444 0 0 0.9835 408.48 451.92 Tm 3 Tr 0.0319 Tc 0 Tw (:A45,) Tj 0 Tr 22.3639 0 TD 0.0723 Tc 0.726 Tw ( 1990.) Tj ET BT 0.9835 0 0 0.9835 334.08 438.48 Tm /F2 10 Tf 0.0163 Tc 1.1832 Tw (Surratt, C., Program Director, Indiana Family and) Tj 0.4881 -10.9816 TD -0.0071 Tc 2.3866 Tw (Social Services) Tj 0 Tc -0.061 Tw ( ) Tj ET q 29.52 0 0 -6.96 402 434.64 cm BI /W 165 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????~???????~?|?|?<?>??~?????~ 0~x~||8x80 EI Q BT 0.9388 0 0 0.9835 402 427.68 Tm 3 Tr -0.0389 Tc 0 Tw (Adrmm) Tj 0 Tr ET q 1.2 0 0 -1.2 422.4 434.64 cm BI /W 7 /H 7 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx0 EI Q BT 0.2347 0 0 0.9835 422.4 427.44 Tm 3 Tr -0.3505 Tc (\223) Tj 0 Tr ET BT 0.9835 0 0 0.9835 423.6 427.44 Tm 0.0102 Tc 2.0436 Tw ( \223stration, Indianapolis, IN,) Tj -90.7813 -10.9816 TD 0.0283 Tc 0.2762 Tw (personal communication, Jan. 2, 1992.) Tj 0 -13.422 TD 0.0153 Tc 1.0622 Tw (Svarstaad, B.L., and Mount, J.K., \223Nursing Home) Tj ET BT 0.9388 0 0 0.9835 334.8 392.64 Tm 0.0058 Tc 1.6253 Tw (Resources and Tranquilizer Use Among the Institu-) Tj ET BT 0.9835 0 0 0.9835 334.8 381.36 Tm -0.004 Tc 3.1155 Tw (tionalized Elderly,\222) Tj 83.2162 0 TD /F5 10 Tf 0.0218 Tc 0.3439 Tw (Journal of the American Geri-) Tj -83.2162 -10.9816 TD -0.0152 Tc 0.1984 Tw (atrics Society ) Tj ET q 59.28 0 0 -8.64 391.2 377.52 cm BI /W 330 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <<xx|> ?>???????>??~>?>~? >~|? ~||?|~~|~~|?|~>x|~|>|~~?>|~?`>?????(|?????????~?~???>~>?>~ ~~~?~~?>~?|~>?x|??~|?~~???|?~?<?????  EI Q BT 0.9444 0 0 0.9835 391.2 370.56 Tm 3 Tr 0.0466 Tc 0 Tw (39\(9\):869-875,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 450.48 370.56 Tm 0.0854 Tc 0.3402 Tw ( 1991.) 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EI Q BT 0.9835 0 0 0.9835 336.24 150.24 Tm 3 Tr -0.008 Tc (creditation) Tj 0 Tr 42.9503 0 TD 0.0168 Tc -0.0781 Tw ( Services, Joint Commission on Accredi-) Tj -42.9503 -10.9816 TD 0.0137 Tc 1.3893 Tw (tation of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 42.72 0 0 -6.96 374.88 146.16 cm BI /W 238 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<~~?????~??|??~?x??~?<??~?~~? ~~?~|?~?~?~0?~?~??~?~?~|>?~?|?>???<>?????>???>??x?? EI Q BT 0.9835 0 0 0.9835 374.88 139.44 Tm 3 Tr -0.014 Tc 0 Tw (Healthcare) Tj 0 Tr 43.4383 0 TD 0.0086 Tc 3.3467 Tw ( Organizations, Chicago, IL,) Tj -82.7281 -11.2256 TD 0.038 Tc 1.1612 Tw (personal communications, Nov. 3, 1989, and July) Tj ET BT 0.9388 0 0 0.9835 336.48 117.36 Tm 0.0963 Tc 0.4637 Tw (31, 1991.) 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EI Q BT 0.9835 0 0 0.9835 130.08 482.16 Tm 3 Tr -0.0321 Tc 0 Tw (Baer,) Tj 0 Tr 21.2311 0 TD -0.0116 Tc 2.3911 Tw ( L. C., Orr, N.K., et al., \223Training) Tj -56.1282 -11.2256 TD 0.0477 Tc 1.794 Tw (Nursing Home Staff To Work With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 250.56 478.32 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p@ 8?????|???>?>x?<???` ?`~~?~?~?????<<>?|<~<À<?>?<|?|?P x<>?<?~~~~?~~<?>8@ EI Q BT 0.9835 0 0 0.9835 250.56 471.12 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr -157.403 -10.9816 TD 0.2036 Tc 3.1484 Tw (Disease Patients,\224) Tj 86.3886 -0.4881 TD /F5 10 Tf 0.0274 Tc 4.3038 Tw (Gerontology and Geriatrics) Tj -86.3886 -10.4935 TD 0.0392 Tc -0.1009 Tw (Education ) Tj ET q 49.2 0 0 -8.64 141.84 456.96 cm BI /W 274 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <0x<8>?|>|?>~|?~>|?|??~?|>~x~?>>~|?>`||~x~x~|||~|~|>|~>?>>??<????????????>?>|?<8?||?x |~?||8~?||<~?>~>|~?????>?<`0p8? EI Q BT 0.9444 0 0 0.9835 141.84 449.52 Tm 3 Tr 0.0409 Tc 0 Tw (11\(3\):77-83,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 191.04 449.52 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 193.44 456.48 cm BI /W 117 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >?????~????????~?~????????????????~?~?~?~?~~~~~~~c~~??>0 EI Q BT 0.8971 0 0 0.9835 193.44 449.52 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET q 17.28 0 0 -8.16 95.76 444 cm BI /W 97 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @px<????|???C?????????????q@ <>??? EI Q BT 0.8919 0 0 0.9835 95.76 437.04 Tm 3 Tr /F2 10 Tf -0.0133 Tc (Teri,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 113.04 437.04 Tm -0.0092 Tc 0.7347 Tw ( L., Larson, E. B., and Reifier, B. V., \223Behav-) Tj -16.8385 -10.9816 TD 0.0092 Tc 1.345 Tw (ioral Disturbance in Dementia of the) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 251.28 433.44 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08=??|???>??x?<????p ?0?????????????????>???? ??|?|~><~??<|?<?~~>~<` EI Q BT 0.9388 0 0 0.9835 251.28 426.24 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET q 27.6 0 0 -9.36 96 422.16 cm BI /W 154 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID pxxxx??x?x??||>|?߀?߀?߀??????????? ?8?<x`<p>p???0 EI Q BT 0.9835 0 0 0.9835 96 415.2 Tm 3 Tr -0.0202 Tc (TWe,\224) Tj 0 Tr 28.0641 0 TD /F5 10 Tf 0.0071 Tc 0.6639 Tw ( Journal of the American Geriatrics Society) Tj ET q 39.6 0 0 -8.64 96.48 411.36 cm BI /W 221 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||<>0??|??|?~ ?|~|~~|>|~|~~~~~~~~~~?>?~??~???p???@~??p?>x<|x?|??x EI Q BT 0.9444 0 0 0.9835 96.48 404.16 Tm 3 Tr 0.0331 Tc 0 Tw (36\(1\):1-6,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 136.08 404.16 Tm 0.0854 Tc -0.1478 Tw ( 1988.) Tj ET q 17.28 0 0 -8.16 95.76 399.12 cm BI /W 97 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p|<{????|?C???????|??0`>??? EI Q BT 0.8919 0 0 0.9835 95.76 392.16 Tm 3 Tr /F2 10 Tf -0.0133 Tc 0 Tw (Teri,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 113.04 392.16 Tm 0.0171 Tc 1.3045 Tw ( L., and Logsdon, R.G., \223Identifying Pleasant) Tj -17.0825 -11.2256 TD -0.0048 Tc 2.6283 Tw (Activities for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 156 388.32 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID q ~~w??|???>???????x????p?~ ?p?????????????????|?? <?? <??|??<~?>?>??p|x <?<?~~?|<?80@ EI Q BT 0.9388 0 0 0.9835 156 381.12 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 204.96 381.12 Tm -0.0194 Tc 2.8872 Tw ( Disease Patients: The) Tj -110.0601 -10.9816 TD 0.0102 Tc 1.6369 Tw (Pleasant Events Schedule-AD,\224) Tj 0 Tc -0.061 Tw ( ) Tj 134.7077 0 TD /F5 10 Tf 0.0358 Tc 2.5869 Tw (Gerontologist 31) Tj ET q 49.2 0 0 -8.64 97.2 366.24 cm BI /W 276 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID < <> <??????>???>>~~?p~~<p<?||~>>x>?||?><?>?|?|~?~~~>??`~~p~x>?|<?>x?|??x? EI Q BT 0.9444 0 0 0.9835 97.2 359.28 Tm 3 Tr 0.0409 Tc 0 Tw (\(1\):124-127,) Tj 0 Tr 52.0978 0 TD 0.0723 Tc 0.726 Tw ( 1991.) Tj ET BT 0.9835 0 0 0.9835 96.24 347.28 Tm /F2 10 Tf 0.0217 Tc 0.0796 Tw (Texas Council on ) Tj ET q 48.96 0 0 -7.2 168.96 354.24 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <o?>??>???>??<????~?~?p ??~?~~?~?8~|?~|?~ <?~~<8?~><~>?<~?<???x?x<x?<??????<?~~~|<?~8?< EI Q BT 0.9835 0 0 0.9835 168.96 347.28 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD -0.0139 Tc 0.1972 Tw ( Disease and Related) Tj -122.994 -11.2256 TD 0.0327 Tc 0 Tw (Disorders,) Tj 47.3429 -0.244 TD 0.001 Tc 3.4764 Tw (\223Biennial Report,\224 Austin, TX, Sep-) Tj -47.3429 -11.2256 TD 0.042 Tc -0.1037 Tw (tember 1990.) Tj -0.4881 -12.2018 TD 0.0238 Tc 2.5178 Tw (Texas Department of Health, Chapter 145, Sub-) Tj 0.7321 -11.2256 TD 0.0521 Tc -0.114 Tw (chapter B, 145.301-145.304.) Tj -0.7321 -12.2018 TD 0.0017 Tc 1.1086 Tw (Texas Department of Health, \223Certification Stand-) Tj 0.7321 -11.2256 TD 0.0658 Tc 1.0923 Tw (ards for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 132.96 286.08 cm BI /W 273 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ?<?>????????x??<??~???p??0??????????~?????~???<??<??>0??|8??<<??>>G>???????? x<>?~~?><>p> EI Q BT 0.9388 0 0 0.9835 132.96 278.88 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 181.92 278.88 Tm 0.0029 Tc 2.2544 Tw ( Disease and Related Disor-) Tj -86.1446 -10.9816 TD 0.027 Tc 0.6924 Tw (ders,\224 Austin, TX, Feb. 1, 1989.) Tj -0.244 -12.4458 TD 0.2043 Tc 3.8798 Tw (Tinetti, M.E., Liu, W.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 39.6 0 0 -8.16 208.08 262.56 cm BI /W 221 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8` ?|??>???|?~?~|?~?~~?~?~?~?<?~?<~????|??~?|?>|?|?x?s?p????@ EI Q BT 0.9835 0 0 0.9835 208.08 255.84 Tm 3 Tr -0.0281 Tc 0 Tw (Marottoli,) Tj 0 Tr 40.2659 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -8.16 250.56 262.32 cm BI /W 117 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |?|8x|???????? EI Q BT 0.9835 0 0 0.9835 250.56 255.84 Tm 3 Tr -0.0342 Tc 0 Tw (R.A.,) Tj 0 Tr 21.2311 0 TD -0.0693 Tc 2.8159 Tw ( et al.,) Tj -176.4378 -11.4697 TD 0.0007 Tc 2.8667 Tw (\223Mechanical Restraint Use Among Residents of) Tj -0.244 -11.2256 TD -0.0103 Tc 1.6577 Tw (Skilled Nursing Facilities,\224) Tj 0 Tc -0.061 Tw ( ) Tj 116.649 0 TD /F5 10 Tf 0.042 Tc 0.3843 Tw (Journal of ) Tj ET q 11.52 0 0 -7.2 258 240.72 cm BI /W 65 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8~<`?~?~|>~????||>|?~~???p EI Q BT 0.9444 0 0 0.9835 258 233.52 Tm 3 Tr -0.0091 Tc 0 Tw (the) Tj 0 Tr ET BT 0.9835 0 0 0.9835 269.52 233.52 Tm 0.0058 Tc 1.3973 Tw ( Ameri-) Tj -174.7295 -10.9816 TD 0.0126 Tc 1.1463 Tw (can Medical Association) Tj 0 Tc -0.061 Tw ( ) Tj ET q 64.08 0 0 -8.64 201.36 229.68 cm BI /W 356 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|><x@8x|?|>||??@|~|||||?||?x~<~>~~~~>~x|8|<|??|>x|>~|~>~@||>~x|>|>>?>π?~>??p?x|ǀ<?~>??<~|?x|>x|?~8 EI Q BT 0.9835 0 0 0.9835 201.36 222.72 Tm 3 Tr 0.1009 Tc 0 Tw (265\(4\):468471,) Tj 0 Tr 65.1575 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 267.84 229.92 cm BI /W 116 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0??~~?~~~2?~||~|?~?~?~?~?~>~~~~||~???>?  EI Q BT 0.8971 0 0 0.9835 267.84 222.72 Tm 3 Tr 0.0456 Tc 0 Tw (1991.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 96.96 210.48 Tm /F2 10 Tf 0.0124 Tc 3.9936 Tw (Titus, C., Division Director for Licensing and) Tj 0.244 -10.9816 TD 0.003 Tc 3.8893 Tw (Training, Nebraska Bureau of Health Facilities) Tj 0.7321 -11.4697 TD 0.0174 Tc 1.4464 Tw (Standards, Lincoln, NE, personal communication,) Tj 0 -10.9816 TD 0.0441 Tc -0.1059 Tw (Sept. 27, 1991.) Tj -0.7321 -12.2018 TD -0.0006 Tc 1.1598 Tw (Tomlinson, B.E., Blessed, G., and Roth, M., \223Ob-) Tj 0.9761 -11.4697 TD 0.0228 Tc 0.1599 Tw (servations on the Brains of Demented Old People,\222) Tj -0.7321 -10.9816 TD /F5 10 Tf 0.0169 Tc 0.5319 Tw (Journal of Neurological Science ) Tj ET q 28.8 0 0 -8.16 231.12 150.72 cm BI /W 160 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `p|>???????~?~|x~<8~p<~x~<~~~~~~?~?~?~??~|??~|?~~?~??~?~??~~~~~~~~~~? |~\?>? EI Q BT 0.8971 0 0 0.9835 231.12 143.52 Tm 3 Tr 0.0267 Tc 0 Tw (11:205,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 259.92 143.52 Tm 0.0854 Tc 0.3402 Tw ( 1970.) Tj -165.4562 -12.4458 TD /F2 10 Tf 0.0399 Tc -0.1016 Tw (Tornlinson, ) Tj ET q 9.36 0 0 -8.16 147.84 138 cm BI /W 52 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?' EI Q BT 1.0796 0 0 0.9835 147.84 131.28 Tm 3 Tr 0.0271 Tc 0 Tw (T,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 157.2 131.28 Tm -0.0052 Tc 0.7809 Tw ( Howe, K., Notman, M., et al., \223An) Tj -60.2768 -10.9816 TD 0.0359 Tc 3.6037 Tw (Empirical Study of Proxy Consent for Elderly) Tj 0 -11.4697 TD 0.0269 Tc -0.0884 Tw (Persons,\224 ) Tj 41.9741 0 TD /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 49.2 0 0 -8.64 198.24 116.4 cm BI /W 274 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <x<x<>  <??>>?>?>>~|?>?x|?~>|?~>x>>|?|~?|~??|???|?|???|????<?>?<>?>~>?>?>x>x>?|?>|?x>|?|?<>~p?>>x><>@>`<p>x?<|x>~?x~<?|88~ EI Q BT 0.9444 0 0 0.9835 198.24 109.2 Tm 3 Tr 0.0409 Tc 0 Tw (30\(1\):54-64,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 247.44 109.2 Tm 0.0854 Tc 0.5843 Tw ( 1990.) Tj -152.2782 -11.9577 TD /F2 10 Tf 0.2223 Tc 2.8854 Tw (Trainer, TV.,) Tj 66.3777 -0.4881 TD 0.2533 Tc 3.0979 Tw (\223Progress Report: Legal Issues) Tj -66.1337 -10.9816 TD 0.0285 Tc 1.9843 Tw (Affecting Persons With) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.96 0 0 -7.2 199.92 93.12 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  p?????|?????>??>?~>?~x~?~~?`~ ??`~??~~??~~?~??~~|~|?<?~~<?~~<><?~~?8<?~~|?8??????????>>@x<<>??<~?~~?~|~<~~@8 EI Q BT 0.9835 0 0 0.9835 199.92 86.16 Tm 3 Tr 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0069 Tc 1.5181 Tw ( Disease and) Tj -153.4984 -11.2256 TD 0.0036 Tc 0.8301 Tw (Their Families,\224 David M. Thorns and Associates,) Tj 0 -10.9816 TD 0.0157 Tc 0.4111 Tw (Detroit, MI, Dec. 23, 1991.) Tj ET q 39.36 0 0 -8.16 97.44 59.04 cm BI /W 219 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ;?y?????????~?~~?~~?~~?~>?~??~?~?~?~?~??~?~?~??~???~??~?~~~|p<????p@ EI Q BT 0.8449 0 0 0.9835 97.44 52.08 Tm 3 Tr 0.0454 Tc 0 Tw (Uhlman_n,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 136.8 52.08 Tm -0.0042 Tc 1.8955 Tw ( R.F., Pearlrnan,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -8.16 209.28 59.04 cm BI /W 117 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x???>x|<??????? EI Q BT 0.9835 0 0 0.9835 209.28 52.08 Tm 3 Tr -0.0342 Tc 0 Tw (R.A.,) Tj 0 Tr 21.2311 0 TD -0.0113 Tc 1.3537 Tw ( and Cain, K. C.,) Tj -133.4875 -10.9816 TD 0.0291 Tc 1.6664 Tw (\223Physicians\222 and Spouses\222 Predictions of Elderly) Tj ET BT 0.8919 0 0 0.9835 322.8 628.8 Tm 0.2641 Tc 0 Tw (452.) Tj 0.2691 -33.921 TD 0.2641 Tc (453.) Tj 0.5382 -45.1466 TD 0.2641 Tc (454.) Tj 0.2691 -45.8787 TD 0.2641 Tc (455.) Tj 0.5382 -68.33 TD 0.2641 Tc (456.) Tj 0 -55.6401 TD 0.2641 Tc (457.) Tj 0.5382 -45.3906 TD 0.2641 Tc (458.) Tj 0.2691 -56.3722 TD 0.2641 Tc (459.) Tj 0.5382 -56.1282 TD 0.2641 Tc (460.) Tj 0.5382 -67.8419 TD 0.2641 Tc (461.) Tj 0 -44.9026 TD 0.2641 Tc (462.) Tj ET BT 0.9835 0 0 0.9835 345.6 651.6 Tm -0.0079 Tc 3.3635 Tw (Patients\222 Resuscitation Preferences,\224) Tj ET BT 0.9443 0 0 0.9812 501.6 651.6 Tm /F5 11 Tf 0.0449 Tc 1.5216 Tw (Journal of) Tj ET BT 0.9014 0 0 0.9812 345.6 640.32 Tm 0.0011 Tc -0.0902 Tw (Gerontology ) Tj ET q 45.36 0 0 -8.16 400.08 647.04 cm BI /W 269 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?߀x??????|??x?|?|@?|x?~<?~?~?~?~|?>???????~?~>????????????|?0?>?8??8??<1>?????|8x ? EI Q BT 0.8155 0 0 0.9812 400.08 640.32 Tm 3 Tr 0.0306 Tc 0 Tw (43:115-121,) Tj 0 Tr ET BT 0.9014 0 0 0.9812 445.44 640.32 Tm 0.0529 Tc 0.6511 Tw ( 1988.) Tj ET q 29.76 0 0 -8.16 345.6 635.52 cm BI /W 166 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x??|??>????p?~ ?~?~??~~??~?????????????????????????~??~?~??~?~?>>> EI Q BT 0.9388 0 0 0.9835 345.6 628.56 Tm 3 Tr /F2 10 Tf 0.0107 Tc 0 Tw (Ullrich,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 375.36 628.56 Tm 0 Tc -0.061 Tw ( ) Tj ET q 22.8 0 0 -8.16 377.76 635.52 cm BI /W 127 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|< ?~{8?|??????~?|?8?~?~???~?~?~?~?~?~?~???????~?? ????~?~?? EI Q BT 0.9388 0 0 0.9835 377.76 628.56 Tm 3 Tr 0.0253 Tc 0 Tw (Sr.D.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 400.56 628.56 Tm 0.0121 Tc 2.1229 Tw ( Administrator,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 35.52 0 0 -7.2 467.76 635.76 cm BI /W 198 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0x??????0???????q~?9~???????????????????>p>>?????p EI Q BT 0.8449 0 0 0.9835 467.76 628.56 Tm 3 Tr 0.0883 Tc 0 Tw (Stonehil.1) Tj 0 Tr ET BT 0.9835 0 0 0.9835 503.28 628.56 Tm -0.0035 Tc 1.5287 Tw ( Care Cen-) Tj -160.3314 -10.9816 TD 0.0316 Tc -0.0931 Tw (ter, Dubuque, IA, personal communication, Nov. 5,) Tj ET BT 0.8919 0 0 0.9835 346.56 606.96 Tm 0.0717 Tc 0 Tw (1991.) Tj ET BT 0.9835 0 0 0.9835 345.6 595.2 Tm 0.0216 Tc 0.2099 Tw (U.S. Congress, General Accounting Office, \223Board) Tj 0.7321 -11.2256 TD 0.0111 Tc 0.9526 Tw (and Care: Insufficient Assurances That Residents\222) Tj -0.4881 -10.9816 TD 0.009 Tc 0.4179 Tw (Needs Are Identified and Met,\224 ) Tj ET q 73.68 0 0 -8.16 475.68 580.32 cm BI /W 410 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8>o|???|???|???|???||?~?~|x>>?~~x?>?~<???~<??????<????>???~>?~????~?||<< >?????????????????p????????|?~?|?~~?~>?~8????~????>??|?x?8?f EI Q BT 0.9388 0 0 0.9835 475.68 573.36 Tm 3 Tr 0.0108 Tc 0 Tw (GAO/HRD-89-50,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 345.84 562.56 Tm 0.0464 Tc -0.1082 Tw (Washington, DC, February 1989.) Tj 0 -12.2018 TD 0.0264 Tc 0.5466 Tw (U.S. Congress, General Accounting Office, \223Nurs-) Tj 0.4881 -10.9816 TD 0.0285 Tc 3.0825 Tw (ing Homes:) Tj 57.1043 0 TD 0.0239 Tc 3.8193 Tw (Admission Problems for Medicaid) Tj ET BT 0.9388 0 0 0.9835 346.32 528.72 Tm -0.0043 Tc 1.0822 Tw (Recipients andAttemptsToSolve Them,\224 GAO/HRD-) Tj ET BT 0.9835 0 0 0.9835 346.56 517.2 Tm 0.0445 Tc 0.0157 Tw (90-135, Washington, DC, September 1990.) Tj -0.4881 -11.7137 TD 0.0074 Tc 2.6159 Tw (U.S. Congress, House of Representatives, Select) Tj 0.7321 -11.2256 TD 0.0158 Tc 0.0856 Tw (Committee on Aging, Subcommittee on Health and) Tj -0.244 -11.2256 TD 0.0232 Tc 2.1117 Tw (Long-Term Care,) Tj 80.2877 0 TD 0.0328 Tc 3.9932 Tw (\221\221Board and Care Homes in) Tj -80.0437 -10.9816 TD 0.0017 Tc 2.4264 Tw (America: A National Tragedy,\224 Committee Pub.) Tj 0 -11.4697 TD 0.0484 Tc 1.1588 Tw (No. 101-711 \(Washington, DC: U.S. Government) Tj 0.244 -11.2256 TD 0.0279 Tc 0.1546 Tw (Printing Office, March 1989\).) Tj -0.4881 -11.9577 TD 0.0315 Tc 0.151 Tw (U.S. Congress, Library of Congress, Congressional) Tj 0.4881 -10.9816 TD 0.0005 Tc 1.6467 Tw (Research Service, \223Medicare and Medicaid Nurs-) Tj 0 -10.9816 TD 0.0394 Tc 3.9662 Tw (ing Home Reform Provisions in the Omnibus) Tj 0.244 -10.9816 TD 0.0145 Tc 0.1194 Tw (Budget Reconciliation Act of 1987, ) Tj ET q 15.84 0 0 -6.96 491.28 413.04 cm BI /W 89 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >???|< ? EI Q BT 0.9388 0 0 0.9835 491.28 406.32 Tm 3 Tr 0.0483 Tc 0 Tw (P.L.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 507.12 406.32 Tm 0.0784 Tc 0.1033 Tw ( 100-203,\224) Tj -162.7718 -11.2256 TD 0.0365 Tc -0.0981 Tw (EPW ) Tj ET q 29.52 0 0 -8.16 370.56 402.24 cm BI /W 165 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ????~x~||x||0|~|?|?|||?~??x<??????`?????{??~????||?~??? EI Q BT 0.9835 0 0 0.9835 370.56 395.28 Tm 3 Tr 0.0915 Tc 0 Tw (89463,) Tj 0 Tr 30.0164 0 TD 0.0473 Tc 0.3301 Tw ( Washington, DC, Aug. 10, 1989.) Tj -54.1759 -11.9577 TD 0.0271 Tc 0.9363 Tw (U.S. Congress, Office of Technology Assessment,) Tj ET BT 0.9444 0 0 0.9835 347.04 372.72 Tm /F5 10 Tf 0.0135 Tc 2.3131 Tw (Life-Sustaining Technologies) Tj 0 Tc 0.0402 Tw ( ) Tj ET q 62.16 0 0 -9.36 464.64 379.92 cm BI /W 347 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 88>w|?~<???>??>?????x???p|??8?~@?8~???~~~??~~~??>??>??>~??>???~????@|?~~??~>~??|~???~~p?~?|p~>~?>~x~>??~x~??~?<x~??~?|~?~~?~?????|????<?|ǀ?8?0a 0x8888|~~????<< EI Q BT 0.9835 0 0 0.9835 464.64 372.72 Tm 3 Tr 0.0077 Tc 0 Tw (andtheElderly,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 526.8 372.72 Tm /F2 10 Tf 0 Tc 0.055 Tw ( ) Tj ET q 21.84 0 0 -7.2 528.96 379.68 cm BI /W 123 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~ ???????? EI Q BT 0.8919 0 0 0.9835 528.96 372.72 Tm 3 Tr 0.0135 Tc 0 Tw (OTA-) Tj 0 Tr ET q 31.68 0 0 -7.2 347.76 368.88 cm BI /W 176 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?p?|?|~~xx~xx~<|||?~?????{???|????< EI Q BT 0.9388 0 0 0.9835 347.76 361.92 Tm 3 Tr 0.0381 Tc (BA-306) Tj 0 Tr ET BT 0.9835 0 0 0.9835 379.44 361.92 Tm 0.0302 Tc -0.0918 Tw ( \(Washington, DC: U.S. Government Print-) Tj ET BT 0.9388 0 0 0.9835 347.76 351.12 Tm 0.0342 Tc 1.5525 Tw (ing Office, 1987\).) 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EI Q BT 0.9835 0 0 0.9835 250.08 367.68 Tm 3 Tr /F5 10 Tf 0.0361 Tc 0 Tw (Advance-) Tj 0 Tr -168.1406 -10.9816 TD 0.0717 Tc -0.0119 Tw (data 147, ) Tj ET q 45.6 0 0 -8.88 125.52 363.6 cm BI /W 254 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~<>x|~?xg||?~~?~?~?~?~x?x?pxx<?x<<><<?8?8??p>x?~?|?<xxxx880?x8 EI Q BT 0.9835 0 0 0.9835 125.52 356.88 Tm 3 Tr /F2 10 Tf -0.0244 Tc 0 Tw (Hyattsville,) Tj 0 Tr 46.3668 0 TD 0.0442 Tc 0.2601 Tw ( MD, 1988.) Tj -88.0969 -13.422 TD /F4 10 Tf -0.0636 Tc -0.0325 Tw (U.S. ) Tj 22.4513 0 TD /F2 10 Tf 0.0107 Tc -0.0719 Tw (Department ) Tj 49.7833 0 TD /F4 10 Tf 0.0466 Tc -0.1445 Tw (of Health and ) Tj 66.3777 0 TD /F2 10 Tf 0.0198 Tc -0.0812 Tw (Human Services,) Tj ET BT 0.8915 0 0 0.9835 84.96 332.88 Tm /F4 10 Tf 0.0568 Tc -0.1534 Tw (Public Health Service, ) Tj ET BT 0.8919 0 0 0.9835 180.48 332.88 Tm /F2 10 Tf 0.0011 Tc 0.0536 Tw (Centers for ) Tj ET BT 0.8915 0 0 0.9835 223.2 332.88 Tm /F4 10 Tf 0.0429 Tc -0.1379 Tw (Disease ) Tj ET BT 0.8919 0 0 0.9835 258.24 332.88 Tm /F2 10 Tf 0.0022 Tc 0 Tw (Control,) Tj ET BT 0.9835 0 0 0.9835 84.96 321.84 Tm -0.0113 Tc 0.4874 Tw (National Center for Health Statistics, \223TheNational) Tj 0 -10.9816 TD 0.0625 Tc 1.0956 Tw (Nursing Home Survey, 1985:) Tj 0 Tc -0.061 Tw ( ) Tj 126.4105 0 TD /F4 10 Tf -0.0278 Tc -0.0689 Tw (Summary ) Tj 49.7833 0 TD /F2 10 Tf 0.0971 Tc -0.1598 Tw (for ) Tj 14.8862 0 TD /F4 10 Tf 0.2033 Tc 0 Tw (the) Tj -191.0799 -11.2256 TD /F2 10 Tf -0.0176 Tc 4.1054 Tw (United States,\224) Tj ET q 26.64 0 0 -7.2 153.36 306.72 cm BI /W 148 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @>8????????>?|xxxp??????? ? EI Q BT 0.8491 0 0 0.9835 153.36 300 Tm 3 Tr /F4 10 Tf -0.058 Tc 0 Tw (DHHS) Tj 0 Tr ET BT 0.9835 0 0 0.9835 180 300 Tm -0.0362 Tc 0.1837 Tw ( Pub. ) Tj ET q 13.92 0 0 -6.96 207.12 306.48 cm BI /W 78 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p~? ???~~~~~>????? EI Q BT 0.8491 0 0 0.9835 207.12 300 Tm 3 Tr 0.0572 Tc 0 Tw (No.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 221.04 300 Tm /F2 10 Tf 0 Tc -0.061 Tw ( ) Tj ET q 24.24 0 0 -8.64 223.44 306.72 cm BI /W 135 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|x> ??????????>?<><~8~0~0~~?~~~?~~~?~~>?~??<?x|? EI Q BT 0.9388 0 0 0.9835 223.44 300 Tm 3 Tr 0.0078 Tc 0 Tw (\(PHS\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 247.68 300 Tm 0.0944 Tc 1.7952 Tw ( 89-1758,) Tj ET q 45.6 0 0 -8.88 84.96 296.4 cm BI /W 256 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >|<<<<??>q>?????~p????~?????~?????~??~`~p??~xx??~8~x??~<|??~<<??~<??~??~` ??~??~??~?<?~<?~?|?~>|??~????~?~?~|?~|?~<x?~8?~ >> EI Q BT 0.8066 0 0 0.9835 84.96 289.44 Tm 3 Tr /F4 10 Tf 0.0369 Tc 0 Tw (Hyattsville,) Tj 0 Tr ET BT 0.934 0 0 0.9835 130.56 289.44 Tm 0.0102 Tc 0.1624 Tw ( MD, ) Tj ET BT 0.9388 0 0 0.9835 155.28 289.44 Tm /F2 10 Tf 0.0472 Tc 2.0499 Tw (January 1989.) Tj ET BT 0.934 0 0 0.9835 84.96 275.76 Tm /F4 10 Tf 0.0694 Tc -0.0294 Tw (U.S. ) Tj ET BT 0.9388 0 0 0.9835 106.32 275.76 Tm /F2 10 Tf -0.0198 Tc 0.0761 Tw (Department ) Tj ET BT 0.934 0 0 0.9835 154.08 275.76 Tm /F4 10 Tf -0.0233 Tc 0.4981 Tw (of Health and ) Tj ET BT 0.9388 0 0 0.9835 217.68 275.76 Tm /F2 10 Tf -0.0115 Tc 0.0673 Tw (Human ) Tj ET BT 0.934 0 0 0.9835 248.4 275.76 Tm /F4 10 Tf -0.031 Tc 0 Tw (Services,) Tj ET BT 0.8915 0 0 0.9835 85.2 264.72 Tm 0.0568 Tc 0.4747 Tw (Public Health Service, ) Tj ET BT 0.8919 0 0 0.9835 183.12 264.72 Tm /F2 10 Tf 0.0049 Tc 1.2602 Tw (Centers for Disease Control,) Tj ET BT 0.9835 0 0 0.9835 85.44 253.92 Tm 0.0098 Tc 1.8813 Tw (National Center for) Tj 0 Tc -0.061 Tw ( ) Tj 86.1446 0 TD /F4 10 Tf 0.0258 Tc -0.1234 Tw (Health ) Tj 37.3375 0 TD /F2 10 Tf -0.0084 Tc 5.5603 Tw (Statistics, \223Nursing) Tj -123.482 -10.9816 TD -0.0098 Tc 1.6572 Tw (Home Utilization) Tj 0 Tc -0.061 Tw ( ) Tj 75.651 0 TD /F4 10 Tf 0.0169 Tc 1.1058 Tw (by Current) Tj 0 Tc -0.0972 Tw ( ) Tj 56.3722 0 TD /F2 10 Tf -0.0069 Tc 3.6065 Tw (Residents: United) Tj -131.7793 -11.4697 TD 0.0065 Tc 2.3727 Tw (States, 1985,\224) Tj 0 Tc -0.061 Tw ( ) Tj ET q 26.64 0 0 -7.2 148.08 238.8 cm BI /W 148 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>?><<880??????q`? EI Q BT 0.8491 0 0 0.9835 148.08 231.84 Tm 3 Tr /F4 10 Tf -0.058 Tc 0 Tw (DHHS) Tj 0 Tr ET BT 0.9835 0 0 0.9835 174.72 231.84 Tm -0.0316 Tc 1.1552 Tw ( Pub. No.) Tj 0 Tc -0.0972 Tw ( ) Tj ET q 24 0 0 -8.64 222.72 238.8 cm BI /W 134 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||>???????>?>~~|~|~x|x|p`?|||||~~>??????x>>???>8q???~??0?????????????~`x??~xx??8>x??~<?<??~<<??~??~??~???~ ??~ ??~???~?<??~?<?~???~~??~?/?~?~?~~?~><?~8?~?~?~>??> EI Q BT 0.9388 0 0 0.9835 85.44 221.04 Tm 3 Tr 0.0093 Tc 0 Tw (Hyattsville,) Tj 0 Tr 47.8048 0 TD 0.0139 Tc 0.0403 Tw ( MD, ) Tj ET BT 0.934 0 0 0.9835 152.64 221.04 Tm /F4 10 Tf -0.0592 Tc 0.1083 Tw (October ) Tj ET BT 0.9388 0 0 0.9835 190.08 221.04 Tm /F2 10 Tf 0.0991 Tc 0 Tw (1989.) Tj ET BT 0.9835 0 0 0.9835 85.2 207.36 Tm /F4 10 Tf -0.0636 Tc -0.0325 Tw (U.S. ) Tj 22.4513 0 TD /F2 10 Tf 0.0107 Tc -0.0719 Tw (Department ) Tj 49.7833 0 TD /F4 10 Tf 0.0466 Tc -0.1445 Tw (of Health and ) Tj 66.3777 0 TD /F2 10 Tf 0.0198 Tc -0.0812 Tw (Human Services,) Tj ET BT 0.8915 0 0 0.9835 85.68 196.32 Tm /F4 10 Tf 0.0568 Tc -0.0637 Tw (Public Health Service, ) Tj ET BT 0.8919 0 0 0.9835 181.44 196.32 Tm /F2 10 Tf 0.0011 Tc 0.0536 Tw (Centers for ) Tj ET BT 0.8915 0 0 0.9835 224.16 196.32 Tm /F4 10 Tf 0.0429 Tc -0.1379 Tw (Disease ) Tj ET BT 0.8919 0 0 0.9835 259.2 196.32 Tm /F2 10 Tf 0.0022 Tc 0 Tw (Control,) Tj ET BT 0.9835 0 0 0.9835 85.68 185.28 Tm 0.0098 Tc 2.6134 Tw (National Center for) Tj 0 Tc -0.061 Tw ( ) Tj 88.3409 0 TD /F4 10 Tf 0.0258 Tc -0.1234 Tw (Health ) Tj 38.3136 0 TD /F2 10 Tf 0.1803 Tc 2.9281 Tw (Statistics, \223Mental) Tj -126.1664 -10.9816 TD /F4 10 Tf 0.0055 Tc -0.1028 Tw (Illness in Nursing ) Tj 86.3886 0 TD /F2 10 Tf 0.0116 Tc -0.0728 Tw (Homes: United States, 1985,\224) Tj ET q 26.64 0 0 -7.2 85.92 170.4 cm BI /W 149 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x???????pp???? EI Q BT 0.8491 0 0 0.9835 85.92 163.68 Tm 3 Tr /F4 10 Tf -0.058 Tc 0 Tw (DHHS) Tj 0 Tr ET BT 0.9835 0 0 0.9835 112.56 163.68 Tm -0.0316 Tc 0.0163 Tw ( Pub. No. ) Tj ET q 24 0 0 -8.16 157.2 170.16 cm BI /W 134 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|>8????>|~x~x|p|||`??|?||?|?~?~>???????????<??xx< EI Q BT 0.9388 0 0 0.9835 157.2 163.68 Tm 3 Tr /F2 10 Tf 0.0078 Tc 0 Tw (\(PHS\)) Tj 0 Tr ET BT 0.9835 0 0 0.9835 181.2 163.68 Tm 0.0944 Tc -0.035 Tw ( 91-1766, ) Tj ET q 45.6 0 0 -8.64 222.48 170.4 cm BI /W 254 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<<x||>~ ?|?#|?>??~??~???????x???x~?|?<x<x?>?x?<?8<?x>?x?>?>??~?~?? x8p0 ?x8 EI Q BT 0.9835 0 0 0.9835 222.48 163.68 Tm 3 Tr -0.0244 Tc 0 Tw (Hyattsville,) Tj 0 Tr 46.3668 0 TD -0.0245 Tc 0.208 Tw ( MD,) Tj ET BT 0.9388 0 0 0.9835 85.92 152.64 Tm 0.052 Tc 2.556 Tw (February 1991.) Tj ET BT 0.9835 0 0 0.9835 85.68 139.44 Tm /F4 10 Tf -0.0636 Tc -0.0325 Tw (U.S. ) Tj 22.4513 0 TD /F2 10 Tf 0.0107 Tc -0.0719 Tw (Department ) Tj 49.7833 0 TD /F4 10 Tf 0.0466 Tc -0.1445 Tw (of Health and ) Tj 66.3777 0 TD /F2 10 Tf 0.0198 Tc -0.0812 Tw (Human Services,) Tj -137.8801 -11.2256 TD /F4 10 Tf 0.0099 Tc -0.1072 Tw (Secretary\222s ) Tj 56.6163 0 TD /F2 10 Tf 0.0254 Tc 0.4012 Tw (Task Force ) Tj ET BT 0.99 0 0 0.99 190.8 128.4 Tm /F3 8 Tf -0.0402 Tc -0.0019 Tw (on ) Tj ET q 48.96 0 0 -7.2 203.04 135.36 cm BI /W 272 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??????|????<???>?|?>?~?>?~?8>??~~?8?>?8??>x??|?x<<>><~~~>~<~< EI Q BT 0.99 0 0 0.99 203.04 128.4 Tm 3 Tr -0.0289 Tc 0 Tw (Alz.heimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 252 128.4 Tm /F2 10 Tf -0.0232 Tc 1.6708 Tw ( Disease,) Tj ET q 47.28 0 0 -7.2 85.68 124.56 cm BI /W 267 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <????>?>??>?~9|??q~0~?~p~~?~8~~`~>|~~~>~??~???|?~?~??~~?~?~~>>p??>@8?<0?>|??~??~????~``~>>|?<??p????`p EI Q BT 0.9835 0 0 0.9835 85.68 117.6 Tm 3 Tr /F5 10 Tf 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 132.96 117.6 Tm -0.032 Tc 1.0059 Tw ( Disease: Report of the Secretary\222s Task) Tj ET BT 0.9835 0 0 0.9835 85.92 106.32 Tm 0.038 Tc 0.3884 Tw (Force on ) Tj ET q 47.76 0 0 -7.2 126.24 113.52 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >??|?|??~|??q><>q?#~~>?~~?|~x?~<?~>~~?~?|??~????~~??~?~???~>????>x?|?????~~~??x??||~~|` EI Q BT 0.9835 0 0 0.9835 126.24 106.32 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.0067 Tc 0.2982 Tw ( Disease ) Tj 38.3136 0 TD /F2 10 Tf 0.0395 Tc -0.1012 Tw (\(Washington, ) Tj 60.0328 0 TD /F4 10 Tf 0.1709 Tc 0 Tw (DC:) Tj ET BT 0.8915 0 0 0.9835 86.4 95.52 Tm -0.0927 Tc 0.0143 Tw (U.S. ) Tj ET BT 0.8919 0 0 0.9835 106.8 95.52 Tm /F2 10 Tf 0.0567 Tc -0.1434 Tw (Government ) Tj ET BT 0.8915 0 0 0.9835 155.28 95.52 Tm /F4 10 Tf 0.0294 Tc 0.2811 Tw (Printing Office, ) Tj ET BT 0.8919 0 0 0.9835 223.2 95.52 Tm /F2 10 Tf 0.0521 Tc 1.7454 Tw (September 1984\).) Tj ET BT 0.9835 0 0 0.9835 85.92 82.08 Tm 0.0059 Tc 1.2751 Tw (Vermeersch, P.E.H., Greene,) Tj 0 Tc -0.061 Tw ( ) Tj 122.7499 0 TD /F4 10 Tf 0.0089 Tc 0.1378 Tw (R., and ) Tj 36.8494 0 TD /F2 10 Tf -0.033 Tc -0.0274 Tw (Meade, ) Tj 32.9448 0 TD /F4 10 Tf 0.0855 Tc 0 Tw (H.,) Tj ET BT 0.8915 0 0 0.9835 87.12 71.52 Tm 0.024 Tc 0.1526 Tw (\223Managing the Client With ) Tj ET BT 0.8919 0 0 0.9835 203.04 71.52 Tm /F2 10 Tf 0.0324 Tc -0.1161 Tw (Dementia: ) Tj ET BT 0.8915 0 0 0.9835 242.64 71.52 Tm /F4 10 Tf 0.079 Tc 0.0908 Tw (A Resource) Tj ET BT 0.934 0 0 0.9835 86.88 60.24 Tm 0.0175 Tc 0.0261 Tw (and ) Tj ET BT 0.9388 0 0 0.9835 106.56 60.24 Tm /F2 10 Tf 0.0176 Tc 1.1867 Tw (Training Guide for Nursing Homes) Tj 0 Tc 0.055 Tw ( ) Tj ET BT 0.934 0 0 0.9835 247.68 60.24 Tm /F4 10 Tf 0.0175 Tc 0.0261 Tw (and ) Tj ET BT 0.9388 0 0 0.9835 267.36 60.24 Tm /F2 10 Tf 0.043 Tc 0 Tw (Adult) Tj ET BT 0.934 0 0 0.9835 86.4 49.68 Tm /F4 10 Tf -0.0141 Tc 0.3169 Tw (Day Care ) Tj ET BT 0.9388 0 0 0.9835 131.04 49.68 Tm /F2 10 Tf -0.0208 Tc 0 Tw (Centers,\224) Tj ET BT 0.9835 0 0 0.9835 170.88 49.44 Tm 0.0058 Tc 0.8279 Tw (New Jersey State Department) Tj ET BT 0.934 0 0 0.9835 86.4 38.64 Tm /F4 10 Tf -0.0293 Tc 0.2048 Tw (of Health, ) Tj ET BT 0.9388 0 0 0.9835 132.24 38.64 Tm /F2 10 Tf 0.0475 Tc 0.0045 Tw (Trenton, NJ, 1988.) Tj ET BT 0.8971 0 0 0.9835 310.08 649.2 Tm /F5 10 Tf 0.2375 Tc 0 Tw (472.) Tj 0.2675 -45.1466 TD 0.2375 Tc (473.) Tj 0 -23.1834 TD 0.2375 Tc (474.) Tj 0.8025 -56.8603 TD 0.2375 Tc (475.) Tj 0.2675 -56.3722 TD 0.2375 Tc (476.) Tj 0.535 -45.1466 TD 0.2375 Tc (477.) Tj 0.2675 -33.921 TD 0.2375 Tc (478.) Tj 0.535 -56.3722 TD 0.2375 Tc (479.) Tj ET BT 0.9444 0 0 0.9835 312.72 293.52 Tm 0.0703 Tc (480.) Tj ET BT 0.8971 0 0 0.9835 313.2 260.4 Tm 0.2375 Tc (481.) Tj 0 -11.7137 TD 0.2375 Tc (482.) Tj 0 -45.3906 TD 0.2375 Tc (483.) Tj 0.535 -45.1466 TD 0.2375 Tc (484.) Tj 0.2675 -33.921 TD 0.2375 Tc (485.) Tj 0 -44.6585 TD 0.2375 Tc (486.) Tj 0.2675 -33.921 TD 0.2375 Tc (487.) Tj ET BT 0.934 0 0 0.9835 332.64 649.2 Tm /F4 10 Tf -0.0116 Tc 0.0573 Tw (Vitaliano, ) Tj ET BT 0.9388 0 0 0.9835 379.2 649.2 Tm /F2 10 Tf 0.0195 Tc 0.2899 Tw (P.P., Breen, A.R., Russo, ) Tj ET BT 0.934 0 0 0.9835 478.32 649.2 Tm /F4 10 Tf 0.0598 Tc -0.0192 Tw (J., ) Tj ET BT 0.9606 0 0 0.9863 491.28 649.2 Tm /F3 9 Tf -0.006 Tc 0.2512 Tw (et al., \223The) Tj ET BT 0.9835 0 0 0.9835 333.36 637.68 Tm /F2 10 Tf -0.0478 Tc 1.4518 Tw (Clinical Utility) Tj 0 Tc -0.061 Tw ( ) Tj 64.9135 0 TD /F4 10 Tf 0.0657 Tc 0.2021 Tw (of the ) Tj 30.5045 0 TD /F2 10 Tf -0.0041 Tc 1.6514 Tw (Dementia Rating Scale for) Tj ET BT 0.934 0 0 0.9835 332.88 626.88 Tm /F4 10 Tf -0.0192 Tc 0.0654 Tw (Assessing ) Tj ET q 41.28 0 0 -8.64 379.44 634.08 cm BI /W 235 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0???????????|?<?p?p?0 ???????>?>?~>8?8|<|<?>?????>|?x??~<<??|x@ EI Q BT 0.9388 0 0 0.9835 379.44 626.88 Tm 3 Tr /F2 10 Tf -0.0342 Tc 0 Tw (Alzheimer) Tj 0 Tr 43.9702 0 TD -0.0029 Tc 0.186 Tw ( Patients,\224 ) Tj ET BT 0.9444 0 0 0.9835 462.24 626.88 Tm /F5 10 Tf 0.0135 Tc 0.7883 Tw (Journal of Chronic) Tj ET BT 0.9835 0 0 0.9835 332.88 616.08 Tm 0.0067 Tc -0.0679 Tw (Disease ) Tj ET q 47.76 0 0 -8.16 368.88 623.04 cm BI /W 266 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<># ??????~|?> p ||||||?~?>?>~??~??>?||?|~?~?~~?~?>?>>>??|x~|?>????>?~???|8 EI Q BT 0.9444 0 0 0.9835 368.88 616.08 Tm 3 Tr 0.057 Tc 0 Tw (37:743-753,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 416.64 616.08 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 419.04 623.28 cm BI /W 117 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????~??x??|<????~?~??c??~??~? EI Q BT 0.8971 0 0 0.9835 419.04 616.08 Tm 3 Tr 0.0456 Tc 0 Tw (1984.) Tj 0 Tr ET q 30.96 0 0 -8.16 332.88 611.76 cm BI /W 172 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8xss8|?|???~?~?p~?x~?a8~?8~?~??~~??~~??~??~??~??????x?|??||?|???<?>????~????????|?~~?~?~8 EI Q BT 0.9388 0 0 0.9835 332.88 604.56 Tm 3 Tr /F2 10 Tf -0.0052 Tc (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 363.84 604.56 Tm /F4 10 Tf -0.093 Tc -0.0026 Tw ( L.,) Tj 19.0348 0.244 TD /F2 10 Tf 0.0162 Tc -0.0775 Tw (\223\222Ideal\222 ) Tj 34.409 0 TD /F4 10 Tf 0.0292 Tc 0.1985 Tw (SCU Not So ) Tj 59.7887 0 TD /F2 10 Tf -0.0313 Tc 0.2149 Tw (Ideal,\224 letter ) Tj ET BT 0.9863 0 0 0.9863 527.52 604.8 Tm /F3 9 Tf 0.0085 Tc 0 Tw (to) Tj ET BT 0.9606 0 0 0.9863 333.12 593.76 Tm -0.0051 Tc 0.1254 Tw (the editor, ) Tj ET BT 0.9444 0 0 0.9835 378 593.76 Tm /F5 10 Tf 0.0053 Tc 0.0345 Tw (Gerontologist ) Tj ET q 40.8 0 0 -8.64 434.88 600.72 cm BI /W 230 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >||>?????|?0q?|x?x||8>0|>~<~~~~~~~~~?||>~|?~>?~>~~???~??~? ~~~@>x?>~?||??>??? EI Q BT 0.9444 0 0 0.9835 434.88 593.76 Tm 3 Tr 0.0439 Tc 0 Tw (32\(1\):129,) Tj 0 Tr 43.2031 0 TD 0.0723 Tc 0.726 Tw ( 1992.) Tj ET q 30.96 0 0 -8.16 332.88 588.72 cm BI /W 173 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?<<?>??~??~???x?q8?1??????????x??|??|xx|?||<??>??><?>???> EI Q BT 0.9388 0 0 0.9835 332.88 581.76 Tm 3 Tr /F2 10 Tf -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 363.84 581.76 Tm /F4 10 Tf -0.093 Tc 0.1194 Tw ( L., ) Tj ET q 39.6 0 0 -8.16 381.36 588.96 cm BI /W 221 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   ???>?~?|~?>?~??~?~~?~~~~~~~~~?~????>??>? ? ? EI Q BT 0.9835 0 0 0.9835 381.36 581.76 Tm 3 Tr /F2 10 Tf -0.0033 Tc 0 Tw (Rheaume,) Tj 0 Tr 40.2659 0 TD 0.0283 Tc 0.3169 Tw ( Y., Brown, ) Tj 51.4915 0 TD /F4 10 Tf -0.0482 Tc -0.0481 Tw (J., ) Tj ET BT 0.9863 0 0 0.9863 485.52 581.76 Tm /F3 9 Tf -0.0133 Tc 0.1871 Tw (et al., ) Tj ET q 24.96 0 0 -7.2 511.44 588.72 cm BI /W 139 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~??????????????<<<???|?||>?>/ EI Q BT 0.9863 0 0 0.9863 511.44 581.76 Tm 3 Tr 0.0622 Tc 0 Tw (\223Hos-) Tj 0 Tr ET q 16.56 0 0 -9.36 333.36 577.92 cm BI /W 92 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~?~~~~~Gp~ ~~~~~~?????>x|0 EI Q BT 0.9126 0 0 0.9863 333.36 570.96 Tm 3 Tr 0.0318 Tc (pice) Tj 0 Tr ET BT 0.9835 0 0 0.9835 349.92 570.96 Tm /F2 10 Tf 0.0712 Tc 0.2326 Tw ( Approach ) Tj ET BT 0.9863 0 0 0.9863 395.52 570.96 Tm /F3 9 Tf 0.0275 Tc 0.1456 Tw (to the ) Tj ET BT 0.9835 0 0 0.9835 423.12 570.96 Tm /F2 10 Tf -0.0139 Tc -0.0469 Tw (Treatment ) Tj 44.9026 0 TD /F4 10 Tf 0.1033 Tc -0.2022 Tw (of ) Tj 11.4697 0 TD /F2 10 Tf -0.0259 Tc -0.0347 Tw (Patients ) Tj 35.1411 0 TD /F4 10 Tf 0.1747 Tc 0 Tw (With) Tj -182.7827 -11.2256 TD /F2 10 Tf 0.021 Tc 3.5782 Tw (Advanced Dementia) Tj 0 Tc -0.061 Tw ( ) Tj 92.2455 0 TD /F4 10 Tf 0.0657 Tc 1.0562 Tw (of the) Tj 0 Tc -0.0972 Tw ( ) Tj ET q 48.96 0 0 -7.68 455.04 567.12 cm BI /W 272 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @??????>>??>?????x??<?????p??  ??????|??|??|?|p??<p?~?|?>x?~?|?<??><???????>8??x?x?<?>?>? ?|xxp@ EI Q BT 0.9835 0 0 0.9835 455.04 559.92 Tm 3 Tr /F2 10 Tf 0.0074 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 49.7833 0 TD 0.0118 Tc 2.6114 Tw ( Type,\224) Tj -173.5093 -11.4697 TD /F5 10 Tf 0.0243 Tc 0.5244 Tw (Journal of the American Medical Association 256:) Tj ET BT 0.9444 0 0 0.9835 333.84 537.6 Tm 0.0678 Tc 2.0015 Tw (2210-2213, 1986.) Tj ET q 30.96 0 0 -8.16 333.36 532.8 cm BI /W 173 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p<>>??~???x?8?q? ??????????????x??|?|<|<?~>>>??0p>?>???>> EI Q BT 0.8449 0 0 0.9835 333.36 526.08 Tm 3 Tr /F2 10 Tf 0.0543 Tc 0 Tw (Vol.icer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 364.32 526.08 Tm /F4 10 Tf -0.093 Tc 1.9497 Tw ( L.,) Tj 0 Tc -0.0972 Tw ( ) Tj ET q 39.84 0 0 -8.16 385.44 533.04 cm BI /W 222 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x|>:?????>~?~??~??~?~??~???~?~?~?~???~???~???????~~?~~?~????? EI Q BT 0.9835 0 0 0.9835 385.44 526.08 Tm 3 Tr /F2 10 Tf -0.0033 Tc 0 Tw (Rheaume,) Tj 0 Tr 40.5099 0 TD 0.2013 Tc 3.1508 Tw ( Y., Riley, M.E.,) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 508.8 526.08 Tm /F3 9 Tf 0.3922 Tc 2.6959 Tw (et al.,) Tj ET BT 0.9126 0 0 0.9863 334.56 514.8 Tm 0.0346 Tc 0.0886 Tw (\221\221Discontinuation ) Tj ET BT 0.8915 0 0 0.9835 404.88 514.8 Tm /F4 10 Tf 0.005 Tc -0.0953 Tw (of ) Tj ET BT 0.8919 0 0 0.9835 415.2 514.8 Tm /F2 10 Tf 0.1065 Tc -0.1992 Tw (Tube ) Tj ET BT 0.8915 0 0 0.9835 436.56 514.8 Tm /F4 10 Tf 0.0569 Tc 0.2503 Tw (Feeding in ) Tj ET BT 0.8919 0 0 0.9835 484.56 514.8 Tm /F2 10 Tf 0.0078 Tc -0.0885 Tw (Patients ) Tj ET BT 0.8915 0 0 0.9835 515.76 514.8 Tm /F4 10 Tf 0.1788 Tc 0 Tw (With) Tj ET BT 0.9388 0 0 0.9835 334.08 503.76 Tm /F2 10 Tf -0.0374 Tc 0.0949 Tw (Dementia ) Tj ET BT 0.934 0 0 0.9835 373.92 503.76 Tm /F4 10 Tf -0.0436 Tc 0.3485 Tw (of the ) Tj ET q 41.52 0 0 -7.2 402 510.96 cm BI /W 235 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?<????????|<?p??  ??????|??<??< ?>p?>x?~||?~?>??????????88??????|~~|<~8| EI Q BT 0.8197 0 0 0.9812 402 503.76 Tm 3 Tr /F6 11 Tf -0.0015 Tc 0 Tw (Alzheimer) Tj 0 Tr ET BT 0.934 0 0 0.9835 443.52 503.76 Tm /F4 10 Tf 0 Tc 0.0449 Tw ( ) Tj ET q 27.12 0 0 -9.36 445.92 510.96 cm BI /W 154 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0?|<~??~???߀?????????x<`xp|p<x~?< EI Q BT 1.1038 0 0 0.9835 445.92 503.76 Tm 3 Tr -0.0004 Tc 0 Tw (~pe,\224) Tj 0 Tr ET BT 0.9444 0 0 0.9835 473.04 503.76 Tm /F5 10 Tf -0.026 Tc 1.2114 Tw ( American Jour-) Tj -147.1446 -10.9816 TD 0.0539 Tc 0.1102 Tw (nal of ) Tj ET q 47.52 0 0 -7.2 359.04 499.92 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >??????|?~<~c>#~>>>?x>8?~|~~~?~?~?~~>?~???~~?????????????????|???|`~~~?>x?|?|???0 EI Q BT 0.9835 0 0 0.9835 359.04 492.96 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 406.56 492.96 Tm -0.0056 Tc 1.1135 Tw ( Care and Related Disorders and) Tj ET BT 0.9835 0 0 0.9835 333.6 482.16 Tm 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.4 0 0 -8.64 373.2 489.12 cm BI /W 247 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|><>>|p?|~|~?~p||| ~p<<<|>x >|?<>|?>|?>~?|>~?>?~?>?|?>~?|?>~>>x~??<~?>~?|?|??? |?>????>?|x`p| EI Q BT 0.9444 0 0 0.9835 373.2 482.16 Tm 3 Tr 0.0374 Tc 0 Tw (5\(4\):22-25,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 417.6 482.16 Tm 0.0854 Tc 0.0962 Tw ( 1990.) Tj ET q 30.96 0 0 -8.16 333.84 477.6 cm BI /W 173 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <?<~?~????x??q?>???>?~???> EI Q BT 0.9388 0 0 0.9835 333.84 470.64 Tm 3 Tr /F2 10 Tf -0.0052 Tc 0 Tw (Volicer,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 364.8 470.64 Tm /F4 10 Tf -0.093 Tc -0.0026 Tw ( L., ) Tj 17.5706 0 TD /F2 10 Tf -0.0338 Tc -0.0267 Tw (Seltzer, ) Tj 32.9448 0 TD /F4 10 Tf -0.0324 Tc -0.0642 Tw (B., ) Tj ET q 39.6 0 0 -8.16 429.84 477.6 cm BI /W 221 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID   ????~??~?~?~?~?~~?~~>?~~>~~?~???????????~ EI Q BT 0.99 0 0 0.99 429.84 470.64 Tm 3 Tr /F3 8 Tf -0.0524 Tc 0 Tw (Rheaume,) Tj 0 Tr 40.0012 0 TD -0.0426 Tc 0.0612 Tw ( Y., et al., ) Tj ET q 31.2 0 0 -8.88 505.92 477.36 cm BI /W 174 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?|<<< |pp`?????????pp??????p?p0????p>>0>~|>  EI Q BT 1.2972 0 0 0.99 505.92 470.64 Tm 3 Tr -0.0108 Tc 0 Tw (\223Eatig) Tj 0 Tr ET BT 0.9835 0 0 0.9835 334.56 459.84 Tm /F2 10 Tf -0.0039 Tc 0.6344 Tw (Difficulties in Patients With Probable Dementia ) Tj 199.1331 0 TD /F4 10 Tf 0.1033 Tc 0 Tw (of) Tj ET BT 0.934 0 0 0.9835 334.8 448.8 Tm -0.0352 Tc 0.0825 Tw (the ) Tj ET q 41.76 0 0 -7.2 352.08 455.76 cm BI /W 234 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p}|>???????~??~??~x??~8??~???`~???~~???~??~??~~???~~???~~?|?~?<?~?<8?~?<8?~?~?><??|<??~????????~? @?8>|???????|||8?x EI Q BT 0.8197 0 0 0.9812 352.08 448.8 Tm 3 Tr /F6 11 Tf -0.0015 Tc 0 Tw (Alzheimer) Tj 0 Tr ET BT 0.9427 0 0 0.9812 393.84 448.8 Tm 0 Tc 0.0491 Tw ( ) Tj ET q 27.12 0 0 -9.36 396.24 455.52 cm BI /W 152 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ~~~~~~x~|~~|~~?~>?~>??~>??~??~?~~?~?~??~?~?~?~???>x<xx EI Q BT 0.9017 0 0 0.9812 396.24 448.8 Tm 3 Tr -0.0056 Tc 0 Tw (ljqw,\224) Tj 0 Tr ET BT 0.9444 0 0 0.9835 423.36 448.8 Tm /F5 10 Tf -0.0172 Tc 1.202 Tw ( Journal of Geriatric Psychi-) Tj ET BT 0.9835 0 0 0.9835 334.8 437.52 Tm 0.0358 Tc 0.0653 Tw (atry and Neurology ) Tj ET q 54.72 0 0 -8.88 415.44 444.96 cm BI /W 304 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<x>x<?8?>||???|||~??>?~?>|7x|0??>?>G??>???x??>??????x<x?<?|?~?~?>~>>x`| |~|~x>?>x???<?C??>?~~??~??x>?88p EI Q BT 0.9444 0 0 0.9835 415.44 437.52 Tm 3 Tr 0.044 Tc 0 Tw (2\(4\):188-195,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 470.16 437.52 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj ET BT 0.8919 0 0 0.9835 334.8 426 Tm /F2 10 Tf 0.0389 Tc -0.1233 Tw (Wagner, ) Tj ET BT 0.8915 0 0 0.9835 368.4 426 Tm /F4 10 Tf -0.0004 Tc 0.1799 Tw (L., \223Nursing ) Tj ET BT 0.8919 0 0 0.9835 422.4 426 Tm /F2 10 Tf 0.0598 Tc 0.2568 Tw (Homes Develop ) Tj ET BT 0.8915 0 0 0.9835 484.32 426 Tm /F4 10 Tf 0.0607 Tc 1.1881 Tw (Special Care) Tj ET BT 0.9835 0 0 0.9835 334.8 415.2 Tm /F2 10 Tf -0.0105 Tc -0.0503 Tw (Units,\224 ) Tj 31.2366 0 TD /F5 10 Tf 0.0307 Tc 0.0704 Tw (American Journal of ) Tj ET q 48 0 0 -7.2 450.72 422.16 cm BI /W 267 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  `>?????~??>|??><?q?3~?~?~x<~~~~~|~~?????~~??~??~???~?~??????p??x?|}???|~~~~>??x<>~~???| EI Q BT 0.9835 0 0 0.9835 450.72 415.2 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.8071 0 TD 0.0522 Tc 0.1299 Tw ( Care and) Tj -166.6763 -11.2256 TD 0.0133 Tc -0.0746 Tw (Research ) Tj ET q 44.64 0 0 -8.64 375.84 411.12 cm BI /W 249 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 08x<`>x<> ?~<||||>?>>?>~?`?|>x???????~?|~?<~????~<x?|x?<|?|~|~~|<?~|8>`||p~x~>|??>????>|p0 EI Q BT 0.9835 0 0 0.9835 375.84 404.16 Tm 3 Tr 0.0925 Tc 0 Tw (2\(3\):3641,) Tj 0 Tr 45.3906 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.2 422.88 411.36 cm BI /W 116 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?|~~>??????????~???~~~~???  EI Q BT 0.8971 0 0 0.9835 422.88 404.16 Tm 3 Tr 0.0456 Tc 0 Tw (1987.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 334.8 392.4 Tm /F2 10 Tf -0.0478 Tc -0.0124 Tw (Wallace, ) Tj 37.5815 0 TD /F4 10 Tf -0.0289 Tc 0 Tw (C.J.,) Tj 28.7962 0.244 TD 0.0547 Tc -0.1528 Tw (\223A ) Tj 15.3742 0 TD /F2 10 Tf 0.2671 Tc 2.5958 Tw (Therapeutic Environment) Tj 0 Tc -0.061 Tw ( ) Tj ET BT 0.9863 0 0 0.9863 529.92 392.64 Tm /F3 9 Tf 0.3777 Tc 0 Tw (at) Tj ET BT 0.9835 0 0 0.9835 334.8 381.36 Tm /F2 10 Tf 0.0378 Tc (MorningsideHouse,\222) Tj ET q 91.92 0 0 -9.36 422.64 388.56 cm BI /W 517 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>??px|?|?>~?|??~?~??>~?~?????~????~?8>??<??c????~??~??>?~???~|?~???~???|?>??~?~?>???~?~????~|????|???>?~???|??|???~~~?? |?~?~~|?~>??~~~~x?~>?~~~|?~~?~?|????????pppp |>~~|~|~~~?~~|<x EI Q BT 0.9835 0 0 0.9835 422.64 381.36 Tm 3 Tr /F5 10 Tf 0.0134 Tc (ConfiontingAlzheimer\222) Tj 0 Tr ET BT 0.9444 0 0 0.9835 514.56 381.36 Tm 0 Tc 0.0402 Tw ( ) Tj ET q 21.6 0 0 -9.36 516.72 388.56 cm BI /W 122 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID o??x?xp?0?~???~? ??~`?~p?~??~??~~???? EI Q BT 0.9835 0 0 0.9835 516.72 381.36 Tm 3 Tr 0.0219 Tc 0 Tw (sDis-) Tj 0 Tr -184.735 -10.9816 TD -0.0053 Tc -0.0557 Tw (ease, ) Tj ET q 18 0 0 -7.2 357.84 377.52 cm BI /W 101 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????~>>>??~|<8ǀ| EI Q BT 0.8915 0 0 0.9835 357.84 370.56 Tm 3 Tr /F4 10 Tf -0.0229 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 375.84 370.56 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 29.28 0 0 -6.96 378.48 377.28 cm BI /W 163 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <???????x?<?<?|~???~>?x|@x EI Q BT 0.8491 0 0 0.9835 378.48 370.56 Tm 3 Tr 0.0247 Tc 0 Tw (Kalicki) Tj 0 Tr ET BT 0.9835 0 0 0.9835 407.76 370.56 Tm 0.0272 Tc -0.0028 Tw ( \(cd.\) ) Tj ET q 33.84 0 0 -9.36 432.96 377.76 cm BI /W 188 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?<x||?8?|?|?>~?>>??~?<~??8~??8~??~8|?0???????????????????x??|?|?~>|?|>~|???~?~???~>p `??|?> EI Q BT 0.8491 0 0 0.9835 432.96 370.56 Tm 3 Tr 0.0383 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.9835 0 0 0.9835 466.8 370.56 Tm /F2 10 Tf -0.0214 Tc 0.4488 Tw ( Mills, MD: Rynd) Tj ET BT 0.9388 0 0 0.9835 335.52 359.76 Tm 0.0126 Tc 0.0416 Tw (Communications, ) Tj ET BT 0.934 0 0 0.9835 405.6 359.76 Tm /F4 10 Tf 0.0175 Tc 0.0261 Tw (and ) Tj ET BT 0.9388 0 0 0.9835 424.8 359.76 Tm /F2 10 Tf 0.0478 Tc 0.0041 Tw (Washington, ) Tj ET BT 0.934 0 0 0.9835 475.92 359.76 Tm /F4 10 Tf -0.017 Tc 1.6048 Tw (DC: American) Tj ET BT 0.9388 0 0 0.9835 335.28 348.96 Tm /F2 10 Tf 0.0043 Tc 0.0504 Tw (Association ) Tj ET BT 0.934 0 0 0.9835 384 348.96 Tm /F4 10 Tf -0.0562 Tc 0.105 Tw (of ) Tj ET BT 0.9388 0 0 0.9835 394.8 348.96 Tm /F2 10 Tf -0.008 Tc 0.66 Tw (Homes for the ) Tj ET BT 0.934 0 0 0.9835 453.6 348.96 Tm /F4 10 Tf 0.0077 Tc 0.0367 Tw (Aging, ) Tj ET BT 0.9388 0 0 0.9835 485.52 348.96 Tm /F2 10 Tf 0.0811 Tc 0 Tw (1987\).) Tj -160.5425 -11.7137 TD 0.0092 Tc 0.0453 Tw (Walsh, ) Tj ET BT 0.934 0 0 0.9835 363.36 337.44 Tm /F4 10 Tf 0.0689 Tc -0.0289 Tw (J. S., ) Tj ET BT 0.9388 0 0 0.9835 387.12 337.44 Tm /F2 10 Tf 0.0027 Tc 0.0522 Tw (Welch, ) Tj ET BT 0.934 0 0 0.9835 416.16 337.44 Tm /F4 10 Tf -0.0002 Tc 0.045 Tw (H. G., and ) Tj ET BT 0.9388 0 0 0.9835 462.96 337.44 Tm /F2 10 Tf 0.0207 Tc 0.033 Tw (Larson, E. B., \223Sur-) Tj ET BT 0.9835 0 0 0.9835 335.28 326.64 Tm -0 Tc -0.061 Tw (vival ) Tj 22.6953 0 TD /F4 10 Tf 0.1033 Tc -0.2022 Tw (of ) Tj 11.2256 0 TD /F2 10 Tf -0.0009 Tc 0.1839 Tw (Outpatients With ) Tj ET q 64.32 0 0 -9.36 439.44 333.84 cm BI /W 358 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |??q|| <>??>??????????xx?<<???p??p  ???????????x|??|<??<>??>><|>|<~?>??~>???????????>?8|0? ?8?8?x?x?x?|~~|<?~8< EI Q BT 1.1266 0 0 0.9835 439.44 326.64 Tm 3 Tr 0.0179 Tc 0 Tw (Alzheimer-T~) Tj 0 Tr ET BT 0.9835 0 0 0.9835 503.76 326.64 Tm 0.0381 Tc 0.3883 Tw ( Demen-) Tj -171.069 -10.9816 TD 0.3464 Tc 0 Tw (tia,\222) Tj 24.1595 0 TD /F5 10 Tf 0.0156 Tc 3.5023 Tw (Annals of Internal Medicine) Tj 0 Tc -0.061 Tw ( ) Tj ET q 52.32 0 0 -8.16 486.72 322.8 cm BI /W 291 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<8???????<??|?~?xp>??<>?>?>?~???π????O?x~?<??>???x???<|?|?>>?<>?>??~߀?~`?~x???xC?|??~?????????0 EI Q BT 0.9444 0 0 0.9835 486.72 315.84 Tm 3 Tr 0.059 Tc 0 Tw (113:429-434,) Tj 0 Tr ET BT 0.8971 0 0 0.9835 336.24 305.04 Tm 0.0456 Tc (1990.) Tj ET BT 0.9835 0 0 0.9835 335.52 293.52 Tm /F2 10 Tf 0.2527 Tc 2.6104 Tw (Warren, J.W.,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 24.96 0 0 -8.64 401.28 300.72 cm BI /W 139 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @p?????~???????~????????8||~~~?~???|~~~???~ EI Q BT 0.8491 0 0 0.9835 401.28 293.52 Tm 3 Tr /F4 10 Tf 0.0301 Tc 0 Tw (Sobal,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 426.24 293.52 Tm -0.0112 Tc 2.5986 Tw ( J., Tenney,) Tj 0 Tc -0.0972 Tw ( ) Tj 64.4254 0 TD /F2 10 Tf -0.0147 Tc -0.0461 Tw (J.H., ) Tj 23.9155 0 TD /F6 10 Tf -0.0104 Tc 3.122 Tw (et al.,) Tj -179.8543 -10.9816 TD /F4 10 Tf 0.0399 Tc -0.1377 Tw (\223Informed ) Tj 53.1998 0 TD /F2 10 Tf 0.0209 Tc -0.0823 Tw (Consent ) Tj 37.8255 0 TD /F4 10 Tf -0.0012 Tc 1.6123 Tw (by Proxy,\224 New) Tj 0 Tc -0.0972 Tw ( ) Tj 78.8235 0 TD /F5 10 Tf 0.2806 Tc 0 Tw (England) Tj -170.5809 -11.2256 TD 0.0142 Tc 0.2499 Tw (Journal of Medicine ) Tj ET q 79.44 0 0 -8.64 419.28 278.64 cm BI /W 442 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0|<>|||?>?~d???|?????|??~>?|~8?? |?>|?|??g|??~??~??~|~|~~~??>>?????????||>?~?@>?>>?>|?>||#?>1|>~?~>~???????|?x<|?p 8 EI Q BT 0.9444 0 0 0.9835 419.28 271.68 Tm 3 Tr 0.0541 Tc 0 Tw (315\(18\):1124-1128,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 498.72 271.68 Tm 0.0854 Tc 0.3402 Tw ( 1986.) Tj ET BT 0.9388 0 0 0.9835 335.52 260.16 Tm /F2 10 Tf 0.0396 Tc 2.7397 Tw (Washington Administrative Code, 248-14-211.) Tj 0 -11.7137 TD 0.0104 Tc 0.044 Tw (Weaverdyck, ) Tj ET BT 0.934 0 0 0.9835 388.32 248.64 Tm /F4 10 Tf 0.045 Tc 0 Tw (S.E.,) Tj ET BT 0.9835 0 0 0.9835 412.8 248.64 Tm /F2 10 Tf 0.0196 Tc -0.081 Tw (\223Intervention-Based ) Tj ET q 41.76 0 0 -9.12 497.76 255.6 cm BI /W 233 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  `g??>??p?p??`?π??ǀ??>?????~~??~??|?|?|?~????~ EI Q BT 0.9388 0 0 0.9835 497.76 248.64 Tm 3 Tr 0.0226 Tc 0 Tw (Neuropsy-) Tj 0 Tr ET q 41.04 0 0 -8.88 336 244.56 cm BI /W 229 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @<8???????~??????<????x?~0?|~?~???~???~??~??????|??8?|p??|?>?~~?>?>?~????|~~?~?????x?????????? 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Tj ET BT 0.9388 0 0 0.9835 335.52 204 Tm /F2 10 Tf 0.0104 Tc 0.044 Tw (Weaverdyck, ) Tj ET BT 0.934 0 0 0.9835 389.04 204 Tm /F4 10 Tf 0.045 Tc 0 Tw (S.E.,) Tj ET BT 0.9388 0 0 0.9835 415.92 204 Tm /F2 10 Tf 0.0258 Tc 0.0276 Tw (\223Intervention ) Tj ET BT 0.934 0 0 0.9835 470.4 204 Tm /F4 10 Tf -0.0602 Tc 2.0365 Tw (To Address De-) Tj ET BT 0.9835 0 0 0.9835 336.24 193.2 Tm /F2 10 Tf -0.0245 Tc -0.0361 Tw (mentia ) Tj ET BT 0.9863 0 0 0.9863 366 193.2 Tm /F3 9 Tf 0.0547 Tc 0.1992 Tw (as a Cognitive ) Tj ET BT 0.9835 0 0 0.9835 430.8 193.2 Tm /F2 10 Tf 0.0265 Tc -0.088 Tw (Disorder,\224 ) Tj 45.8787 0 TD /F5 10 Tf 0.0137 Tc 1.6333 Tw (Specialized De-) Tj -141.7847 -11.4697 TD 0.0046 Tc 0.4224 Tw (mentia Care Units, ) Tj ET q 18.72 0 0 -6.96 416.4 188.88 cm BI /W 104 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>???~????????????????????????? EI Q BT 0.9388 0 0 0.9835 416.4 181.92 Tm 3 Tr /F2 10 Tf -0.0055 Tc 0 Tw (D.H.) 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EI Q BT 0.8919 0 0 0.9835 336 159.6 Tm 3 Tr -0.0184 Tc 0 Tw (Weiler,) Tj 0 Tr ET BT 0.934 0 0 0.9835 363.6 159.6 Tm /F4 10 Tf 0.0322 Tc 0.0104 Tw ( P., ) Tj ET BT 0.9388 0 0 0.9835 380.16 159.6 Tm /F2 10 Tf -0.0025 Tc 0.3985 Tw (Director, Center for ) Tj ET BT 0.934 0 0 0.9835 458.4 159.6 Tm /F4 10 Tf -0.0065 Tc 1.2082 Tw (Aging and Health,) Tj ET BT 0.8919 0 0 0.9835 336.48 148.8 Tm /F2 10 Tf 0.0001 Tc -0.0798 Tw (University ) Tj ET BT 0.8915 0 0 0.9835 377.04 148.8 Tm /F4 10 Tf 0.0575 Tc -0.0196 Tw (of California ) Tj ET BT 0.8919 0 0 0.9835 432.24 148.8 Tm /F2 10 Tf 0.0762 Tc -0.1652 Tw (School ) Tj ET BT 0.8915 0 0 0.9835 459.84 148.8 Tm /F4 10 Tf 0.0266 Tc 0.5534 Tw (of Medicine, Davis,) Tj ET BT 0.9835 0 0 0.9835 336.96 138 Tm 0.0323 Tc -0.13 Tw (CA, ) Tj 20.0109 0 TD /F2 10 Tf 0.0361 Tc -0.0367 Tw (personal communication, Nov. 7, 1990.) Tj ET BT 0.8919 0 0 0.9835 336.24 126.48 Tm 0.0102 Tc -0.0912 Tw (Weiner, ) Tj ET BT 0.8491 0 0 0.9835 366.96 126.48 Tm /F4 10 Tf 0.0347 Tc 0.3808 Tw (A. 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Tj ET BT 0.9388 0 0 0.9835 336.24 82.08 Tm /F2 10 Tf 0.0067 Tc 0.0479 Tw (Weisberg, ) Tj ET BT 0.934 0 0 0.9835 377.04 82.08 Tm /F4 10 Tf -0.0025 Tc 0.1118 Tw (J., \223A Success Story: ) Tj ET BT 0.9388 0 0 0.9835 468 82.08 Tm /F2 10 Tf 0.0275 Tc 0.1535 Tw (Grouping the Alert) Tj ET BT 0.9835 0 0 0.9835 336.96 71.28 Tm -0 Tc -0.061 Tw (With ) Tj 23.6715 0 TD /F4 10 Tf 0.0406 Tc -0.1385 Tw (the ) Tj 18.5467 0 TD /F2 10 Tf -0.007 Tc 2.1424 Tw (Mentally Impaired,\224) Tj 0 Tc -0.061 Tw ( ) Tj 88.3409 0 TD /F5 10 Tf 0.021 Tc 3.8221 Tw (Nursing Research) Tj ET q 58.8 0 0 -8.88 337.2 67.68 cm BI /W 329 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID p|x|x|8?>~x?????>??~?|>??>~~?| |~>~|x>~|~>~x>~|>_~>~>~>~~|~?>?~?????~??~??~??~~~?~~?|~|>>~~>?~>??~?>~?>~?|?~?|?~?|??|???<?>? EI Q BT 0.9444 0 0 0.9835 337.2 60.24 Tm 3 Tr 0.0466 Tc 0 Tw (33\(5\):312-316,) Tj 0 Tr 62.2633 0 TD 0.0723 Tc 0.726 Tw ( 1984.) Tj ET BT 0.9835 0 0 0.9835 336.48 48.96 Tm /F2 10 Tf 0.0173 Tc -0.0786 Tw (Weisberg, ) Tj 43.6824 0 TD /F4 10 Tf -0.0482 Tc 0 Tw (J.,) Tj 18.7907 0 TD 0.0287 Tc 0.1177 Tw (\223Reaching the ) Tj 68.574 0 TD /F2 10 Tf 0.0041 Tc 0 Tw (Mentally-Impaired) Tj -130.5591 -11.2256 TD 0.0103 Tc -0.0715 Tw (Elderly ) Tj 31.9687 0 TD /F4 10 Tf 0.0119 Tc -0.1092 Tw (and Their Families ) Tj 91.5134 0 TD /F2 10 Tf 0.0326 Tc 0.0278 Tw (Through Music: The) Tj ET endstream endobj 561 0 obj <>/Rotate 0/Type/Page>> endobj 562 0 obj <>stream 0.48 w 1 j 0 0 0 RG 73.2 686.16 m 551.04 686.16 l S BT 0.9835 0 0 0.9835 477.6 691.92 Tm 0 0 0 rg /F5 10 Tf 0.0066 Tc 3.9588 Tw (References . 196) Tj ET BT 0.8971 0 0 0.9835 73.92 631.44 Tm 0.2375 Tc 0 Tw (488.) Tj ET BT 0.9444 0 0 0.9835 74.16 576 Tm 0.0703 Tc (489.) Tj ET BT 0.8971 0 0 0.9835 74.88 520.56 Tm 0.2375 Tc (490.) Tj ET BT 0.9444 0 0 0.9835 74.88 475.92 Tm 0.0703 Tc (491.) Tj ET BT 0.8971 0 0 0.9835 75.36 442.8 Tm 0.2375 Tc (492.) Tj ET BT 0.9444 0 0 0.9835 75.6 398.16 Tm 0.0703 Tc (493.) Tj ET BT 0.8971 0 0 0.9835 76.08 354 Tm 0.2375 Tc (494.) Tj 0.2675 -45.1466 TD 0.2375 Tc (495.) Tj ET BT 0.9444 0 0 0.9835 76.32 276.24 Tm 0.0703 Tc (496.) Tj 0.2541 -34.165 TD 0.0703 Tc (497.) Tj 0.2541 -45.3906 TD 0.0703 Tc (498.) Tj ET BT 0.8971 0 0 0.9835 77.04 164.4 Tm 0.2375 Tc (499.) Tj 0.535 -44.9026 TD 0.2375 Tc (500.) Tj 0 -56.3722 TD 0.2375 Tc (501.) Tj ET BT 0.8915 0 0 0.9835 96.72 654 Tm /F4 10 Tf 0.0516 Tc -0.013 Tw (Account of ) Tj ET BT 0.9018 0 0 0.9835 143.28 654 Tm /F6 10 Tf 0.0225 Tc 0.0018 Tw (a Nursing ) Tj ET BT 0.8915 0 0 0.9835 183.84 654 Tm /F4 10 Tf 0.0543 Tc 0.1185 Tw (Home Social Worker,\222 ) Tj ET BT 0.8971 0 0 0.9835 277.2 654 Tm /F5 10 Tf 0.0228 Tc 0 Tw (Triad,) Tj ET BT 0.8491 0 0 0.9835 96.72 642.72 Tm /F4 10 Tf 0.0588 Tc 0.8235 Tw (pp. 17-18, February/March 1985.) Tj ET BT 0.8915 0 0 0.9835 96.72 631.44 Tm -0.0062 Tc 0.2761 Tw (Weisman, G.D., Cohen, U., Ray, K., ) Tj ET BT 0.9018 0 0 0.9835 247.2 631.44 Tm /F6 10 Tf 0.0108 Tc 0.1478 Tw (et al., \223Archi-) Tj -166.8722 -11.2256 TD 0.0574 Tc -0.1699 Tw (tectural ) Tj ET BT 0.8915 0 0 0.9835 129.6 620.4 Tm /F4 10 Tf 0.0545 Tc 0.7105 Tw (Planning and Design for Dementia Care) Tj -36.3412 -11.2256 TD -0.0452 Tc 0 Tw (Units,\224) Tj ET BT 0.9835 0 0 0.9835 133.2 609.12 Tm /F5 10 Tf 0.0062 Tc 2.9425 Tw (Specialized Dementia Care Units,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18.48 0 0 -6.48 281.52 615.84 cm BI /W 103 /H 38 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8|??~?8????????????? ??????? $ EI Q BT 0.8491 0 0 0.9835 281.52 609.12 Tm 3 Tr /F4 10 Tf 0.0203 Tc 0 Tw (D.H.) Tj 0 Tr ET BT 0.8915 0 0 0.9835 97.44 598.32 Tm 0.0166 Tc 0.5647 Tw (Coons \(cd.\) \(Baltimore, MD: Johns Hopkins Uni-) Tj ET BT 0.8491 0 0 0.9835 97.2 587.52 Tm 0.0333 Tc 0.571 Tw (versity Press, 1991\).) Tj -0.2827 -11.7137 TD 0.0018 Tc 0.0427 Tw (Wells, ) Tj ET q 9.12 0 0 -8.16 124.8 582.72 cm BI /W 57 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID px< ?m????x??x|>??? EI Q BT 0.8915 0 0 0.9835 124.8 576 Tm 3 Tr -0.0675 Tc 0 Tw (Y,) Tj 0 Tr ET BT 0.8491 0 0 0.9835 133.92 576 Tm 0.0547 Tc 0.7813 Tw ( and Jorm, A.F., \223Evaluation of ) Tj ET BT 0.8648 0 0 0.99 264.72 576 Tm /F3 8 Tf -0.0072 Tc 0.0047 Tw (a ) Tj ET BT 0.8491 0 0 0.9835 270.48 576 Tm /F4 10 Tf 0.2413 Tc 0 Tw (Special) Tj ET BT 0.934 0 0 0.9835 97.2 565.2 Tm -0.0204 Tc 0.8804 Tw (Nursing Home Unit for Dementia Sufferers: A) Tj ET BT 0.8915 0 0 0.9835 97.2 554.4 Tm 0.0348 Tc 1.7556 Tw (Randomized Controlled Comparison With Com-) Tj ET BT 0.9835 0 0 0.9835 97.68 543.6 Tm /F2 10 Tf 0.0032 Tc 0.0577 Tw (munity Care, ) Tj 55.1521 0 TD /F5 10 Tf 0.0366 Tc 0.3898 Tw (Australian and New Zealand Journal) Tj -54.908 -11.2256 TD -0.0052 Tc 0.1883 Tw (of Psychiatry ) Tj ET q 48 0 0 -8.64 153.36 539.52 cm BI /W 267 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?????????????||x>xx0|<||x|<~~?~?~~~x>8?<?| |||~?~`?xpx?x8|??<>????p`|< EI Q BT 0.9444 0 0 0.9835 153.36 532.56 Tm 3 Tr 0.057 Tc 0 Tw (21:524-531,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 201.36 532.56 Tm 0.0854 Tc 0.0962 Tw ( 1987.) Tj ET BT 0.8915 0 0 0.9835 97.2 520.56 Tm /F4 10 Tf 0.0205 Tc 0.4257 Tw (Werner, P., Cohen-Mansfield, J., Braun, J., ) Tj ET BT 0.8919 0 0 0.9835 281.76 520.56 Tm /F2 10 Tf 0.0204 Tc -0.1027 Tw (et ) Tj ET q 10.32 0 0 -8.64 290.4 527.76 cm BI /W 63 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<~?x<~~?~~||>?8|~~>>? EI Q BT 0.8449 0 0 0.9835 290.4 520.56 Tm 3 Tr 0.0672 Tc 0 Tw (al,,) Tj 0 Tr ET BT 0.934 0 0 0.9835 98.4 509.76 Tm /F4 10 Tf -0.011 Tc 0.8274 Tw (\223Physical Restraints and Agitation in Nursing) Tj -0.5139 -11.4697 TD -0.0418 Tc 1.3743 Tw (Home Residents,\222) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 177.36 498.48 Tm /F5 10 Tf -0.011 Tc 0.5601 Tw (Journal of the American Geriat-) Tj -84.1189 -10.7376 TD -0.0403 Tc 0.4641 Tw (rics Society ) Tj ET q 32.64 0 0 -8.64 145.44 494.88 cm BI /W 183 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |>x>>?>|||>|`|<|x| ||||~|~|~~~~~~|~>~~|~|~~|>|>~~>@>@`px?|<?|<? EI Q BT 0.8971 0 0 0.9835 145.44 487.92 Tm 3 Tr 0.0047 Tc 0 Tw (37\(12\):1) Tj 0 Tr ET BT 0.9444 0 0 0.9835 178.08 487.92 Tm 0.0669 Tc 1.24 Tw ( 122-1126, 1989.) Tj ET BT 0.8491 0 0 0.9835 97.68 475.92 Tm /F4 10 Tf 0.0513 Tc 1.115 Tw (Whitcomb, J.B.,) Tj ET BT 0.8915 0 0 0.9835 164.88 475.68 Tm 0.0208 Tc 0.2907 Tw (\223Thanks for the Memory,\224 ) Tj ET BT 0.8971 0 0 0.9835 276.24 475.68 Tm /F5 10 Tf 0.0063 Tc 0 Tw (Ameri-) Tj ET BT 0.9835 0 0 0.9835 98.4 465.12 Tm 0.0477 Tc 3.551 Tw (can Journal of) Tj 0 Tc -0.061 Tw ( ) Tj ET q 47.76 0 0 -7.2 169.44 472.32 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ` >????x???|?|>3|~8~a>|~>>|~>?p>88 ~||~|~?~?|>?|~?~~>?~~>??>?>????>p??x}?|????|?||~~?>x>x?||?x? EI Q BT 0.9835 0 0 0.9835 169.44 465.12 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD 0.2483 Tc 3.0217 Tw ( Care and Related) Tj -121.5298 -11.2256 TD 0.0358 Tc 0.2279 Tw (Disorders and Research ) Tj ET q 44.64 0 0 -8.88 197.76 461.28 cm BI /W 248 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0xpx<?>0|x|||~<?>>~?x|<8x8<wx<??|x||?<x>x<<|~~?>|>~~<<~x|< ~}||~|?>x|>p|?p~|>??xx8> EI Q BT 0.9444 0 0 0.9835 197.76 454.08 Tm 3 Tr 0.0374 Tc 0 Tw (4\(4\):22-33,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 242.4 454.08 Tm 0.0854 Tc 0.0962 Tw ( 1989.) Tj -147.1535 -11.4697 TD /F6 10 Tf -0.0123 Tc -0.0485 Tw (White, ) Tj ET q 17.76 0 0 -8.16 130.32 449.28 cm BI /W 99 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????>?????~? 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Tj ET BT 0.9835 0 0 0.9835 98.16 398.16 Tm -0.0185 Tc -0.0422 Tw (White, ) Tj ET q 17.52 0 0 -8.16 126.96 404.88 cm BI /W 98 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0<>p????????? ?? EI Q BT 0.8066 0 0 0.9835 126.96 398.16 Tm 3 Tr /F4 10 Tf -0.0611 Tc 0 Tw (B.J.,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 144.48 398.16 Tm 0.0503 Tc -0.1483 Tw ( and ) Tj ET q 26.4 0 0 -8.16 167.04 405.12 cm BI /W 147 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <?<~>~??????s???????????xx|?<??>?~?| ~? EI Q BT 0.8491 0 0 0.9835 167.04 398.16 Tm 3 Tr 0.0987 Tc 0 Tw (Kwon,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 193.44 398.16 Tm 0.0141 Tc -0.1115 Tw ( O., \223Physical Aspects of) Tj ET q 80.64 0 0 -8.16 98.64 394.56 cm BI /W 467 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >??xx? @??F?????~?????~???~???8?~~?~?~?~>?~?~>|x?~~?|?~H@~?|??~~>??~|??|??|?|??>~<8??>>~?|??<<?>~???>????x>?p????`>?8||>`8 EI Q BT 0.8197 0 0 0.9812 98.64 387.36 Tm 3 Tr /F6 11 Tf -0.0004 Tc 0 Tw (Alzheimer/Dementia) Tj 0 Tr ET BT 0.9427 0 0 0.9812 179.28 387.36 Tm 0.0033 Tc 0.0456 Tw ( Units: A National Survey,\224) Tj ET BT 0.8607 0 0 0.9812 98.64 376.32 Tm 0.0251 Tc 1.3087 Tw (Kansas State University, Manhattan,) Tj 0 Tc 0.0366 Tw ( ) Tj ET BT 0.8491 0 0 0.9835 255.6 376.32 Tm /F4 10 Tf 0.0514 Tc 1.9629 Tw (KS, unpub-) Tj -184.5721 -10.9816 TD 0.0056 Tc 0.0383 Tw (lished manuscript, ) Tj ET BT 0.8567 0 0 0.9835 174.96 365.52 Tm /F6 10 Tf 0.0391 Tc -0.026 Tw (no ) Tj ET BT 0.8491 0 0 0.9835 186 365.52 Tm /F4 10 Tf 0.0387 Tc 0 Tw (date.) Tj ET BT 0.9388 0 0 0.9835 98.64 353.76 Tm /F2 10 Tf 0.0239 Tc 0.0296 Tw (White, ) Tj ET BT 0.934 0 0 0.9835 126.48 353.76 Tm /F4 10 Tf 0.0309 Tc 0.0118 Tw (B. J., and ) Tj ET q 25.68 0 0 -8.16 170.88 360.72 cm BI /W 148 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  <?<~>?~??????????????p?xxx<<??>?|??~8>|U EI Q BT 0.8491 0 0 0.9835 170.88 353.76 Tm 3 Tr 0.0987 Tc 0 Tw (Kwon,) Tj 0 Tr ET BT 0.934 0 0 0.9835 196.56 353.76 Tm -0.0262 Tc 0.7796 Tw ( O., \223Physical Aspects of) Tj ET q 80.4 0 0 -8.16 98.88 350.16 cm BI /W 466 /H 45 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <>>?p`?>?$????g???????>~??>?x~??8~??<??~p?~~?0?~~??~~??|~?|~?~~???~???|~|??|x??|?<?>>?x<?>~?|?<?>???>x0???|ǀ` @p >?~p|?|?8 EI Q BT 0.8197 0 0 0.9812 98.88 342.96 Tm 3 Tr /F6 11 Tf -0.0004 Tc 0 Tw (Alzheimer/Dementia) Tj 0 Tr ET BT 0.9427 0 0 0.9812 179.28 342.96 Tm 0.0033 Tc 0.1093 Tw ( Units: A National Survey,\224) Tj ET BT 0.9444 0 0 0.9835 98.4 331.92 Tm /F5 10 Tf 0.0191 Tc 0.0199 Tw (Journal ) Tj ET q 50.4 0 0 -9.36 130.8 339.12 cm BI /W 289 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?>>p?8????|?~?~???~|>>??~?~`~>?~ >>~>>~~??>??|??~?>???~??|??~|~??|?~|~|???|~~?~?|?~?>?>?>?>?>???>~?~???>????~>?~???|?? ~0>0>8>8<??:< EI Q BT 0.8971 0 0 0.9835 130.8 331.92 Tm 3 Tr 0.028 Tc 0 Tw (ofL.ong-Term) Tj 0 Tr ET BT 0.9444 0 0 0.9835 181.2 331.92 Tm 0.0109 Tc 0.791 Tw ( Care Administration 19\(1\):26-) Tj -86.6603 -10.9816 TD 0.0703 Tc 0.7281 Tw (30, 1991.) Tj ET BT 0.8491 0 0 0.9835 99.36 309.6 Tm /F4 10 Tf 0.0616 Tc 0.1842 Tw (Whitehouse, P. J., Director, ) Tj ET q 36.96 0 0 -7.2 212.64 316.56 cm BI /W 233 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ``<'???????~??~p??~p??~8???~???~|??~|??~|??~~?~?~|???~???~?x?~~?|?~~?|0?|??<8?? ߀<<?|??????????0~p`??????x|||x80 EI Q BT 0.8449 0 0 0.9835 212.64 309.6 Tm 3 Tr /F2 10 Tf 0.0405 Tc 0 Tw (Alzheimer) Tj 0 Tr ET BT 0.8491 0 0 0.9835 249.6 309.6 Tm /F4 10 Tf 0.0684 Tc 0.3883 Tw ( Center, Uni-) Tj ET BT 0.934 0 0 0.9835 99.36 298.8 Tm -0.037 Tc 0.8554 Tw (versity Hospitals of Cleveland, Cleveland, OH,) Tj ET BT 0.8491 0 0 0.9835 99.36 287.76 Tm 0.025 Tc 0.0154 Tw (personal ) Tj ET BT 0.8607 0 0 0.9812 136.08 287.76 Tm /F6 11 Tf 0.0546 Tc -0.0268 Tw (communication, Apr. 3, 1992.) Tj ET q 26.88 0 0 -8.16 99.36 283.2 cm BI /W 164 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???~~p~x~8~??x?|???|?|?~?|~|>?|~~~8|>>~>?8~`>G`?>?~0?|???~|?|?>~?|?>?~|p????>|p???>|x???|8?|~8?>?~p?>>x>|x|x|?><x~|>8?>8~|~<~|<?|<~>??|~>??8~?>???~}??>0=`8??|<|?||||?@~>?~>>~>~?>|?????>|> EI Q BT 0.99 0 0 0.99 195.84 265.44 Tm 3 Tr /F7 8 Tf 0.0087 Tc 0 Tw (\221MiZbankQuurterZy) Tj 0 Tr ET BT 0.8687 0 0 0.99 266.16 265.44 Tm 0 Tc -0.0664 Tw ( ) Tj ET q 34.32 0 0 -9.6 267.84 272.4 cm BI /W 207 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `8?8px9>>?><?~><??>|~?~?|>||~?0|>?~>>>>~?~?~??|????????>~>~>>~?>|>?>>?x>|?<>|?>|? >>?>>??????~x>8>( EI Q BT 0.99 0 0 0.99 267.84 265.44 Tm 3 Tr 0.0235 Tc 0 Tw (64\(Suppl.) Tj 0 Tr -170.187 -11.1519 TD 0.4847 Tc 2.6011 Tw (2\), 1986.) Tj ET q 32.88 0 0 -9.12 99.36 249.6 cm BI /W 193 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?p?x?<>>?`?????~?8~??????|?|x??|~~??????x  EI Q BT 0.8915 0 0 0.9835 99.36 242.64 Tm 3 Tr /F4 10 Tf -0.0068 Tc 0 Tw (Will&g,) Tj 0 Tr ET BT 0.934 0 0 0.9835 132.24 242.64 Tm 0.0699 Tc -0.03 Tw ( S., ) Tj ET q 35.52 0 0 -9.12 148.32 249.6 cm BI /W 207 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~x||<<>???~~~~~~??~~?~~??~~?~~?|~~<~~<~~>8?~<~|~|~|~~>>?>?????<C?8x/x EI Q BT 0.8491 0 0 0.9835 148.32 242.64 Tm 3 Tr 0.0507 Tc 0 Tw (Dowling,) Tj 0 Tr ET BT 0.934 0 0 0.9835 183.84 242.64 Tm -0.0127 Tc 0.1012 Tw ( V.B., and Heeren, T. C., \223A) Tj ET BT 0.8491 0 0 0.9835 99.84 231.6 Tm 0.0317 Tc 0.0075 Tw (Comparative ) Tj ET BT 0.9018 0 0 0.9835 156.24 231.6 Tm /F6 10 Tf 0.0521 Tc -0.1641 Tw (Prospective ) Tj ET BT 0.8491 0 0 0.9835 202.8 231.6 Tm /F4 10 Tf 0.0331 Tc 1.3485 Tw (Study of Falls and Frac-) Tj ET BT 0.8919 0 0 0.9835 99.36 220.8 Tm /F2 10 Tf 0.0425 Tc 0.3211 Tw (tures on an ) Tj ET q 46.56 0 0 -7.2 142.8 228 cm BI /W 272 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `|??>???????|?<???p?p?????????|? <? <??G?>?<???<|@?p~x<?>~?~~?>|<0 EI Q BT 0.8919 0 0 0.9835 142.8 220.8 Tm 3 Tr 0.0033 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.8915 0 0 0.9835 189.36 220.8 Tm /F4 10 Tf 0.0132 Tc 0.6133 Tw ( Treatment Unit, ) Tj ET BT 0.8971 0 0 0.9835 265.44 220.8 Tm /F5 10 Tf 0.0462 Tc 1.46 Tw (Journal of) Tj ET BT 0.9835 0 0 0.9835 100.08 209.52 Tm 0.0127 Tc -0.074 Tw (the American Geriatrics Society 38\(8\) ) Tj ET q 21.36 0 0 -8.88 253.2 216.72 cm BI /W 119 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID xx<<~<>~|>~<`|<<???p>?x~<px~|<<|?>π>?>~ EI Q BT 0.9444 0 0 0.9835 253.2 209.52 Tm 3 Tr 0.0319 Tc 0 Tw (:A48,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 274.56 209.52 Tm 0.0854 Tc -0.1478 Tw ( 1990.) Tj -178.146 -11.7137 TD 0.1859 Tc 4.3867 Tw (Williams, Cc.,) Tj ET BT 0.8915 0 0 0.9835 166.32 198 Tm /F4 10 Tf 0.0408 Tc -0.1355 Tw (\223Liberation: ) Tj ET BT 0.9018 0 0 0.9835 220.32 198 Tm /F6 10 Tf 0.0383 Tc 1.315 Tw (Alternative to Physi-) Tj ET BT 0.9835 0 0 0.9835 99.84 187.2 Tm -0.0083 Tc -0.0526 Tw (cal ) Tj 17.3265 0 TD /F4 10 Tf 0.6804 Tc 0 Tw (Restraints,) Tj 69.5502 -0.4881 TD /F5 10 Tf 0.5261 Tc 5.9929 Tw (Gerontologist 29\(5\):585-) Tj ET BT 0.9444 0 0 0.9835 100.08 176.16 Tm 0.0714 Tc 1.2352 Tw (586, 1989.) Tj ET BT 0.8915 0 0 0.9835 99.6 164.64 Tm /F4 10 Tf 0.0327 Tc 1.6234 Tw (Williams, G., Complaint Coordinator, Licensing) Tj ET BT 0.8491 0 0 0.9835 100.08 153.6 Tm 0.0461 Tc 2.2518 Tw (and Certification Section, Department of Health,) Tj ET BT 0.934 0 0 0.9835 100.08 142.8 Tm 0.0042 Tc 0.2973 Tw (Santa Fe, NM, personal ) Tj ET BT 0.9468 0 0 0.9835 207.36 142.8 Tm /F6 10 Tf 0.0362 Tc -0.0049 Tw (communication, May ) Tj ET BT 0.9444 0 0 0.9835 295.92 142.8 Tm /F5 10 Tf 0.0603 Tc 0 Tw (5,) Tj ET BT 0.8971 0 0 0.9835 100.8 131.76 Tm 0.0456 Tc (1992.) Tj ET BT 0.8066 0 0 0.9835 99.84 120.24 Tm /F4 10 Tf 0.0399 Tc 1.6318 Tw (Wills, M., Director, Residential Rates and Licensure) Tj 0.5951 -10.9816 TD 0.0334 Tc 2.4729 Tw (Services, Aging and Adult Services Administration,) Tj ET BT 0.8491 0 0 0.9835 100.08 98.64 Tm 0.0342 Tc 0.5295 Tw (Department of Social and Health Services, State of) Tj ET BT 0.8915 0 0 0.9835 100.08 87.36 Tm 0.0083 Tc 0.2374 Tw (Washington, Olympia, WA, letter ) Tj ET BT 0.8919 0 0 0.9835 241.92 87.36 Tm /F2 10 Tf 0.0153 Tc 0.0376 Tw (to nursing ) Tj ET BT 0.8915 0 0 0.9835 280.8 87.36 Tm /F4 10 Tf 0.0723 Tc 0 Tw (home) Tj ET BT 0.9468 0 0 0.9835 100.08 76.32 Tm /F6 10 Tf 0.0193 Tc 0.013 Tw (administrators, ) Tj ET BT 0.9388 0 0 0.9835 164.64 76.32 Tm /F2 10 Tf -0.0192 Tc 0.0755 Tw (Oct. ) Tj ET BT 0.9606 0 0 0.9863 182.64 76.32 Tm /F3 9 Tf -0.0085 Tc 0.004 Tw (17, 1986.) Tj ET BT 0.8915 0 0 0.9835 100.08 64.8 Tm /F4 10 Tf -0.0107 Tc 3.1526 Tw (Wilson, K.B.,) Tj ET BT 0.934 0 0 0.9835 162.72 64.56 Tm -0.0323 Tc 1.6212 Tw (\223Assisted Living: The Merger of) Tj -67.0654 -10.7376 TD -0.0221 Tc 1.4047 Tw (Housing and Long Term Care Services,\224) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 283.2 54 Tm /F5 10 Tf 0.258 Tc 0 Tw (Long) Tj -193.9056 -10.9816 TD -0.0324 Tc 0.3287 Tw (Term Care Advances 1\(4\), Duke ) Tj ET BT 0.934 0 0 0.9835 226.08 43.2 Tm /F4 10 Tf 0.0149 Tc 0.7998 Tw (University, 1990.) Tj ET BT 0.8971 0 0 0.9835 324.72 653.76 Tm /F5 10 Tf 0.2375 Tc 0 Tw (502.) Tj 0 -23.6715 TD 0.2375 Tc (503.) Tj 0.535 -35.1411 TD 0.2375 Tc (504.) Tj 0.2675 -34.6531 TD 0.0369 Tc (505.) Tj 0.535 -57.3484 TD 0.0369 Tc (506.) Tj 0.2675 -46.1227 TD 0.0369 Tc (507.) Tj 0.535 -46.1227 TD 0.0369 Tc (508.) Tj 0.2675 -35.1411 TD 0.2375 Tc (509.) Tj 0 -45.8787 TD 0.0369 Tc (510.) Tj 0.535 -45.3906 TD 0.0369 Tc (511.) Tj 0.2675 -45.8787 TD 0.0369 Tc (512.) Tj 0 -34.8971 TD 0.2375 Tc (513.) Tj ET q 16.32 0 0 -7.2 328.08 162 cm BI /W 91 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?~<x|<<>>>>~~xx<???? EI Q BT 0.8971 0 0 0.9835 328.08 154.8 Tm 3 Tr 0.0369 Tc (514,) Tj 0 Tr 0.2675 -56.8603 TD 0.0369 Tc (515.) Tj 0 -35.1411 TD 0.0369 Tc (516.) Tj ET BT 0.8915 0 0 0.9835 347.28 653.76 Tm /F4 10 Tf -0.0107 Tc 0.326 Tw (Wilson, K. B.,) Tj ET BT 0.934 0 0 0.9835 411.12 653.76 Tm -0.0158 Tc 1.3466 Tw (\223Segregation Isn\222t the) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9468 0 0 0.9835 511.2 653.76 Tm /F6 10 Tf 0.0011 Tc 0 Tw (Answer,\224) Tj ET BT 0.9835 0 0 0.9835 347.28 642.48 Tm /F5 10 Tf 0.0325 Tc 1.3701 Tw (Aging Connection) Tj 0 Tc -0.061 Tw ( ) Tj ET q 30.72 0 0 -8.88 424.56 649.92 cm BI /W 171 /H 50 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8< ?>~<?||~?|??>~?????~??<???????????????<?~??????|>~>?>|?~?|?|?~>?>???x>x0<< EI Q BT 0.8971 0 0 0.9835 424.56 642.48 Tm 3 Tr -0.0171 Tc 0 Tw (11\(5\):3,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 455.28 642.48 Tm 0 Tc -0.061 Tw ( ) Tj ET q 20.88 0 0 -7.92 457.68 650.16 cm BI /W 116 /H 43 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >>??|?~~~?~>???~?????????????~~~~~~~~?~????p?x EI Q BT 0.8971 0 0 0.9835 457.68 642.48 Tm 3 Tr 0.0456 Tc 0 Tw (1990.) Tj 0 Tr ET BT 0.8915 0 0 0.9835 347.28 630.24 Tm /F4 10 Tf -0.0107 Tc 1.5374 Tw (Wilson, K.B.,) Tj 68.1062 0 TD 0.0378 Tc 1.483 Tw (\223\222Special Care\222 for the Demented:) Tj -67.5678 -11.2256 TD 0.0285 Tc 1.3589 Tw (Segregation Isn\222t the) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.8919 0 0 0.9835 440.64 619.2 Tm /F2 10 Tf 0.0184 Tc -0.1003 Tw (Answer,\224 ) Tj ET BT 0.8971 0 0 0.9835 478.56 619.2 Tm /F5 10 Tf 0.0182 Tc 0.4211 Tw (Senior Patient, ) Tj ET BT 0.8915 0 0 0.9835 536.88 619.2 Tm /F4 10 Tf 0.2687 Tc 0 Tw (pp.) Tj -212.1251 -10.9816 TD 0.0279 Tc -0.121 Tw (29-32, ) Tj ET q 19.44 0 0 -9.36 376.32 615.36 cm BI /W 116 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?{>??~??>??????????????|?|?<?<?>??|?????8???????~?|?88? EI Q BT 0.934 0 0 0.9835 376.32 608.4 Tm 3 Tr -0.0566 Tc 0 Tw (Apti) Tj 0 Tr ET BT 0.8915 0 0 0.9835 395.76 608.4 Tm 0.0538 Tc 0.3883 Tw ( 1990.) Tj -54.1081 -12.6899 TD 0.0134 Tc 0.7028 Tw (Wilson, K.B., president, Concepts in Community) Tj ET BT 0.934 0 0 0.9835 347.76 584.88 Tm -0.0216 Tc 0.7104 Tw (Living, Portland, OR, personal ) Tj ET BT 0.9468 0 0 0.9835 485.76 584.88 Tm /F6 10 Tf 0.0392 Tc 0 Tw (communication,) Tj -145.7469 -10.9816 TD 0.0382 Tc -0.0071 Tw (Mar. ) Tj ET q 10.8 0 0 -8.16 370.8 580.8 cm BI /W 62 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<<||>>>?|||?p EI Q BT 0.8449 0 0 0.9835 370.8 574.08 Tm 3 Tr /F2 10 Tf 0.0908 Tc 0 Tw (17,) Tj 0 Tr ET BT 0.9388 0 0 0.9835 381.6 574.08 Tm 0.0991 Tc 0.4608 Tw ( 1991.) Tj ET BT 0.8491 0 0 0.9835 347.52 561.6 Tm /F4 10 Tf 0.0454 Tc 0.6778 Tw (Wilson, R.W., and Patterson, M. A., \223Planning and) Tj ET BT 0.8915 0 0 0.9835 348.48 551.04 Tm 0.0228 Tc -0.1153 Tw (Implementing ) Tj ET BT 0.8919 0 0 0.9835 411.12 551.04 Tm /F2 10 Tf 0.1317 Tc -0.2275 Tw (a ) Tj ET BT 0.8915 0 0 0.9835 417.36 551.04 Tm /F4 10 Tf 0.0094 Tc 1.1111 Tw (30-Bed Unit for Residents With) Tj ET BT 0.8491 0 0 0.9835 348 540 Tm -0.0735 Tc 0.1314 Tw (Mild ) Tj ET BT 0.8567 0 0 0.9835 369.12 540 Tm /F6 10 Tf 0.0343 Tc -0.0204 Tw (to ) Tj ET BT 0.8491 0 0 0.9835 378.48 540 Tm /F4 10 Tf 0.0365 Tc 0.6614 Tw (Moderate Dementia,\224 presented ) Tj ET BT 0.8567 0 0 0.9835 509.52 540 Tm /F6 10 Tf 0.0352 Tc -0.0216 Tw (at the ) Tj ET BT 0.8491 0 0 0.9835 532.8 540 Tm /F4 10 Tf 0.0872 Tc 0 Tw (13th) Tj -217.0772 -11.2256 TD 0.0537 Tc 1.3948 Tw (International Congress of Gerontology, New) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 19.44 0 0 -8.64 532.08 535.92 cm BI /W 120 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x<>? x???p???????????????χ???x|>>???? EI Q BT 0.8491 0 0 0.9835 532.08 528.96 Tm 3 Tr 0.0472 Tc 0 Tw (York) Tj 0 Tr ET BT 0.8915 0 0 0.9835 348.24 517.68 Tm -0.0714 Tc -0.0097 Tw (NY, ) Tj ET q 15.12 0 0 -9.12 366.72 524.64 cm BI /W 92 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>???|?|~8~?~?~~~x~8~<~~~~~~~~ ????? EI Q BT 0.8915 0 0 0.9835 366.72 517.68 Tm 3 Tr 0.0033 Tc 0 Tw (Jdy) Tj 0 Tr 16.9592 0 TD 0.0448 Tc 0.1292 Tw ( 12, 1985.) Tj ET BT 0.8491 0 0 0.9835 347.76 505.2 Tm 0.0448 Tc -0.008 Tw (Wilson, R. W., and Patterson, M. A., \223Perceptions of) Tj ET BT 0.934 0 0 0.9835 348.72 494.16 Tm -0.0169 Tc 0.5126 Tw (Stress Among Nursing Personnel ) Tj ET BT 0.9388 0 0 0.9835 497.28 494.16 Tm /F2 10 Tf 0.1101 Tc -0.0622 Tw (on ) Tj ET BT 0.934 0 0 0.9835 509.28 494.16 Tm /F4 10 Tf -0.0229 Tc 0 Tw (Dementia) Tj -172.1602 -11.2256 TD 0.002 Tc 0.0427 Tw (Units,\224 ) Tj ET BT 0.9444 0 0 0.9835 382.56 483.12 Tm /F5 10 Tf -0.0024 Tc 0.7204 Tw (American Journal of ) Tj ET q 47.28 0 0 -7.2 466.08 490.32 cm BI /W 266 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `>??????|???|?a~x>1~~<~c>~~??~~?~p?8?~~~~~~~?~???~~??~?~?????>?????>x??|????~8|~~>??x?||~~|'<` EI Q BT 0.9835 0 0 0.9835 466.08 483.12 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.9444 0 0 0.9835 513.36 483.12 Tm 0.0077 Tc 0.6673 Tw ( Care and) Tj ET BT 0.9835 0 0 0.9835 348.48 472.32 Tm 0.0242 Tc 0.3414 Tw (Related Disorders and Research ) Tj ET q 44.4 0 0 -8.64 481.92 479.52 cm BI /W 247 /H 49 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `px|?x<>|?~@??x|?|~x~?~x>x>|>|>|>~|??????????x??x>?xx>p?<<~>?~~>|>|x~ ~??~? ?~?|?~?>???~????~|??>|p` ?0 EI Q BT 0.9444 0 0 0.9835 481.92 472.32 Tm 3 Tr 0.0374 Tc 0 Tw (3\(4\):34-39,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 526.32 472.32 Tm 0.0854 Tc 0.0962 Tw ( 1988.) Tj -180.8304 -12.6899 TD /F4 10 Tf -0.0182 Tc -0.0787 Tw (Wiltzius, F. Sr., Gambert, S.R., Duthie, E.H.,) Tj 0.9761 -10.9816 TD 0.0283 Tc -0.1259 Tw (\223Importance of Resident Placement Within ) Tj 201.5734 0 TD /F6 10 Tf 0.122 Tc 0 Tw (a) Tj ET BT 0.8915 0 0 0.9835 349.2 437.76 Tm /F4 10 Tf 0.0235 Tc 1.4991 Tw (Skilled Nursing Facility,\224) Tj 0 Tc -0.0897 Tw ( ) Tj ET BT 0.8971 0 0 0.9835 461.52 437.76 Tm /F5 10 Tf 0.0461 Tc 0.9251 Tw (Journal of the American) Tj ET BT 0.9835 0 0 0.9835 349.2 426.72 Tm -0.0138 Tc 1.4172 Tw (Geriatrics Society) Tj 0 Tc -0.061 Tw ( ) Tj ET q 59.76 0 0 -8.64 425.52 433.92 cm BI /W 332 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <|<>~ 0???????>|?~~~>~>?~|>~~|~~~|~x~?~8x~?~<>?~x~<~~>x><||>?~~>?~~??>>???~??`?`?y?πpp?=~|xp?~|xx~|<<>|>>>><??|?x????`8?` EI Q BT 0.9835 0 0 0.9835 425.52 426.72 Tm 3 Tr 0.0993 Tc 0 Tw (29\(9\):418421,) Tj 0 Tr 60.7649 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 20.64 0 0 -7.68 487.68 433.92 cm BI /W 115 /H 42 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 0~??~????~????????~?>??~~~????~< EI Q BT 0.8971 0 0 0.9835 487.68 426.72 Tm 3 Tr 0.0456 Tc 0 Tw (1981.) Tj 0 Tr ET BT 0.8915 0 0 0.9835 348.72 414.72 Tm /F4 10 Tf -0.0013 Tc 2.6037 Tw (Winograd, C.H.,) Tj ET BT 0.934 0 0 0.9835 424.8 414.48 Tm -0.0042 Tc 0.4348 Tw (\223Mental Status Tests and the) Tj ET BT 0.8915 0 0 0.9835 349.44 403.2 Tm 0.0189 Tc 0.8313 Tw (Capacity for Self-Care,\224) Tj ET BT 0.9835 0 0 0.9835 452.4 403.2 Tm /F5 10 Tf 0.0249 Tc 1.2966 Tw (Journal of the American) Tj -104.9353 -10.9816 TD -0.0135 Tc -0.0473 Tw (Geriatrics ) Tj ET q 28.56 0 0 -9.12 392.88 399.36 cm BI /W 159 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x8<|`?>????~?p?8~??|? ??0?x~>??x>>??p>>p?>~0?>|p0?>|00~?8~??8?~??|>??|>~>??><? |< <~~~~8?p EI Q BT 0.9835 0 0 0.9835 392.88 392.4 Tm 3 Tr 0.0005 Tc 0 Tw (Socie~) Tj 0 Tr 29.0402 0 TD 0 Tc -0.061 Tw ( ) Tj ET q 37.92 0 0 -8.64 423.84 399.6 cm BI /W 211 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?????????~x>xpxxx|x<|x~||p~|?~?~?~~|~><x?~<??????>??????????x?|?~??? EI Q BT 0.9444 0 0 0.9835 423.84 392.4 Tm 3 Tr 0.0518 Tc 0 Tw (32:49-55,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 461.76 392.4 Tm 0.0854 Tc 0.3402 Tw ( 1984.) Tj ET BT 0.8915 0 0 0.9835 348.96 380.16 Tm /F4 10 Tf 0.0355 Tc -0.1296 Tw (Wisconsin ) Tj ET q 45.6 0 0 -7.2 394.56 387.12 cm BI /W 273 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????~???~>?~??~?p?~??p?~~0?~~?~~??~|?~|??~|?~?~?>?~?>?~???????>p?x?L><???>?>??~<>0 EI Q BT 0.8066 0 0 0.9835 394.56 380.16 Tm 3 Tr 0.0518 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr ET BT 0.8915 0 0 0.9835 440.16 380.16 Tm 0.0494 Tc 0.9316 Tw ( Information and Training) Tj ET BT 0.9835 0 0 0.9835 349.68 369.12 Tm /F6 10 Tf 0.003 Tc -0.0641 Tw (Center, ) Tj ET q 54.72 0 0 -7.2 385.2 376.32 cm BI /W 305 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||2o7???>?????|??<??~??p??p?? ???????~????f`???<??<????|0??|8~?<<>??????>|x<?>???>?<?>x?x~?<><???> @ EI Q BT 0.9468 0 0 0.9835 385.2 369.12 Tm 3 Tr 0.0291 Tc 0 Tw (\223Alzheimer\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 439.92 369.12 Tm 0.0285 Tc 1.2522 Tw ( Disease and Dementia: A) Tj -92.2455 -10.9816 TD 0.0165 Tc 2.1673 Tw (Training Tape Series for Nursing Assistants,\224) Tj ET BT 0.9018 0 0 0.9835 349.68 347.52 Tm -0.0249 Tc -0.0787 Tw (Milwaukee, ) Tj ET BT 0.8915 0 0 0.9835 397.92 347.52 Tm /F4 10 Tf 0.0025 Tc 1.2534 Tw (WI, 1990.) Tj -54.1081 -12.9339 TD -0.0259 Tc 1.5545 Tw (Wolfson, S.,) Tj ET BT 0.934 0 0 0.9835 404.64 334.8 Tm -0.0258 Tc 0.4836 Tw (\223A Policy of Pairing Patients With) Tj ET BT 0.8915 0 0 0.9835 349.68 324 Tm 0.0315 Tc 0.3461 Tw (Different Cognitive Skills in the Same Room of ) Tj ET BT 0.8648 0 0 0.99 549.6 324 Tm /F3 8 Tf -0.0072 Tc 0 Tw (a) Tj ET BT 0.99 0 0 0.99 349.92 313.2 Tm -0.024 Tc -0.0183 Tw (Nursing ) Tj ET BT 0.9835 0 0 0.9835 382.56 313.2 Tm /F4 10 Tf 0.002 Tc 0 Tw (Home,\224) Tj ET BT 0.8915 0 0 0.9835 420.72 313.2 Tm 0.0313 Tc -0.1249 Tw (letter ) Tj ET BT 0.9018 0 0 0.9835 447.12 313.2 Tm /F6 10 Tf 0.0466 Tc 0.1969 Tw (to the editor, ) Tj ET BT 0.8971 0 0 0.9835 500.64 313.2 Tm /F5 10 Tf 0.0413 Tc 0.9304 Tw (Journal of the) Tj ET BT 0.9835 0 0 0.9835 349.92 302.4 Tm -0.0036 Tc 0.4307 Tw (American Geriatrics Society ) Tj ET q 29.52 0 0 -8.64 466.32 309.6 cm BI /W 165 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ||?|?|?|?|?|??|~x||||<~<~>~>~>x>|~>~~>>|||||?0>x=?| ????pp EI Q BT 0.9444 0 0 0.9835 466.32 302.4 Tm 3 Tr 0.0592 Tc 0 Tw (31:246,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 495.84 302.4 Tm 0.0854 Tc 0.3402 Tw ( 1983.) Tj ET BT 0.8491 0 0 0.9835 349.92 290.16 Tm /F4 10 Tf 0.0466 Tc -0.01 Tw (Workgroup ) Tj ET BT 0.8449 0 0 0.9835 397.92 290.16 Tm /F2 10 Tf 0.109 Tc -0.0745 Tw (on ) Tj ET BT 0.8491 0 0 0.9835 408.96 290.16 Tm /F4 10 Tf 0.0451 Tc 1.2636 Tw (Research and Evaluation of Special) Tj -69.2499 -10.9816 TD 0.0388 Tc 1.2994 Tw (Care Units, \223Elements of Special Care) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.8919 0 0 0.9835 510.48 279.36 Tm /F2 10 Tf 0.0033 Tc -0.0834 Tw (as ) Tj ET q 33.12 0 0 -9.6 519.84 286.32 cm BI /W 205 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID >C~g<<>~>|~?~??~??~`?~~~?>~?~???p~~~?|?|~?|?|?|?<|>?~??| ?~~~~~?? > EI Q BT 0.7217 0 0 0.9835 519.84 279.36 Tm 3 Tr /F4 10 Tf -0.0716 Tc 0 Tw (WriOusly) Tj 0 Tr ET BT 0.8915 0 0 0.9835 349.92 268.08 Tm 0.0385 Tc 1.6976 Tw (Defined by Regulation, Guidelines, and Recom-) Tj ET BT 0.8491 0 0 0.9835 349.92 257.04 Tm 0.0498 Tc 1.0602 Tw (mendations,\224 draft, Washington, DC, Aug. 5,1991.) Tj 0 -12.2018 TD 0.0521 Tc 1.6794 Tw (Wright, A., Planning Supervisor, Connecticut De-) Tj 0.2827 -11.2256 TD 0.0331 Tc 0.0058 Tw (partment ) Tj ET BT 0.8919 0 0 0.9835 391.44 234 Tm /F2 10 Tf 0.1096 Tc -0.2026 Tw (on ) Tj ET BT 0.8491 0 0 0.9835 402.72 234 Tm /F4 10 Tf 0.0334 Tc 1.4188 Tw (Aging, Hartford,) Tj 0 Tc 0.0449 Tw ( ) Tj ET q 11.76 0 0 -8.16 473.04 241.2 cm BI /W 74 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8<> ???????8xxx EI Q BT 0.6793 0 0 0.9835 473.04 234 Tm 3 Tr -0.0247 Tc 0 Tw (CT,) Tj 0 Tr ET BT 0.8567 0 0 0.9835 484.8 234 Tm /F6 10 Tf 0.0405 Tc 1.2329 Tw ( personal commu-) Tj ET BT 0.9468 0 0 0.9835 350.16 223.2 Tm 0.0361 Tc -0.0048 Tw (nication, Jan. ) Tj ET BT 0.9444 0 0 0.9835 406.8 223.2 Tm /F5 10 Tf 0.0689 Tc -0.0328 Tw (2, 1992.) Tj ET q 51.36 0 0 -8.16 349.92 217.92 cm BI /W 289 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID `x|<`9`?p??????G?><?<?~~~??~??~??~???~?ǀ>?~?À>?>?>??>~?<~~~~?~~?|?||?@px8|<???? EI Q BT 0.8491 0 0 0.9835 349.92 210.96 Tm 3 Tr /F4 10 Tf 0.0441 Tc 0 Tw (Yankelovich,) Tj 0 Tr ET BT 0.934 0 0 0.9835 401.28 210.96 Tm -0.0041 Tc 0.5631 Tw ( Skelly, and ) Tj ET q 57.12 0 0 -9.6 457.2 218.16 cm BI /W 321 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???p?x <<>?<?`|8|<?|?||~>?~>??|?|>??<?>p?????~??~??~~|??~<?|<??|>??|???|?Ǐ??~???>|?~??>|>??>?????x??~|??<x ?<>?|p??>0|?<?>?>?>???????}8 ` EI Q BT 0.8491 0 0 0.9835 457.2 210.96 Tm 3 Tr 0.0563 Tc 0 Tw (White/Clancy,) Tj 0 Tr ET BT 0.934 0 0 0.9835 514.32 210.96 Tm 0 Tc 0.0449 Tw ( ) Tj ET q 36.48 0 0 -8.64 516.72 218.16 cm BI /W 206 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x||`x?A?????~~?~?~~?~?~~?~?~~?~?~>??~??~??~??~?~?~?~?~?~?~?~?~???~>??~>?~?~??~?~???~?~~~?~<~?~~~~?~?~??~~ EI Q BT 0.7642 0 0 0.9835 516.72 210.96 Tm 3 Tr -0.0551 Tc 0 Tw (Shulman,) Tj 0 Tr ET BT 0.8491 0 0 0.9835 350.4 199.92 Tm 0.0318 Tc (Inc.,) Tj ET BT 0.934 0 0 0.9835 374.4 199.68 Tm -0.0261 Tc 1.3576 Tw (\223Caregivers of Patients With Dementia,\224) Tj ET BT 0.9018 0 0 0.9835 350.64 188.64 Tm /F6 10 Tf 0.0615 Tc 0.6239 Tw (contract report prepared for the Office of Technol-) Tj ET BT 0.8919 0 0 0.9835 350.64 177.84 Tm /F2 10 Tf 0.1096 Tc -0.2026 Tw (ogy ) Tj ET BT 0.8491 0 0 0.9835 366.48 177.84 Tm /F4 10 Tf 0.0289 Tc 2.3427 Tw (Assessment, U.S. Congress, Washington, DC,) Tj ET q 19.44 0 0 -9.12 350.64 174 cm BI /W 116 /H 51 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?}|?>?????????????|?|?<?<???<???????y???????????|x8 EI Q BT 0.8066 0 0 0.9835 350.64 167.04 Tm 3 Tr 0.0176 Tc 0 Tw (April) Tj 0 Tr ET BT 0.8915 0 0 0.9835 370.08 167.04 Tm 0.0538 Tc 0.6575 Tw ( 1986.) Tj ET q 25.44 0 0 -8.16 350.4 161.76 cm BI /W 156 /H 47 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID  ???????|?>???????0??~?~??xx|>|???|@8 EI Q BT 0.7217 0 0 0.9835 350.4 154.8 Tm 3 Tr -0.0735 Tc 0 Tw (Yerian,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 375.84 154.8 Tm 0.0303 Tc 0.1454 Tw ( R.D., Chief Medical Consultant, Bureau of) Tj ET BT 0.8491 0 0 0.9835 350.64 143.76 Tm 0.0309 Tc 0.7999 Tw (Health Facilities, Michigan Department of Health,) Tj ET BT 0.9835 0 0 0.9835 350.64 132.96 Tm 0.0091 Tc 0.1376 Tw (Lansing, MI, letter ) Tj 91.5134 0 TD /F2 10 Tf 0.0212 Tc 0.1004 Tw (to the Office of ) Tj 64.9135 0 TD /F6 10 Tf 0.0306 Tc 0 Tw (Technology) Tj ET BT 0.8491 0 0 0.9835 350.64 122.16 Tm /F4 10 Tf 0.0284 Tc 0.5767 Tw (Assessment, U.S. Congress, Washington, DC, Mar.) Tj 1.1306 -11.2256 TD 0.0785 Tc -0.0476 Tw (11, 1991.) Tj ET BT 0.8915 0 0 0.9835 350.64 98.64 Tm 0.004 Tc 0.0852 Tw (York, J.L., and ) Tj ET q 27.12 0 0 -9.6 414.96 106.08 cm BI /W 164 /H 53 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ????>|/??>????~?<~?|??????<><~<?~???????  EI Q BT 0.7642 0 0 0.9835 414.96 98.64 Tm 3 Tr 0.0028 Tc 0 Tw (Caslyn,) Tj 0 Tr ET BT 0.8915 0 0 0.9835 442.08 98.64 Tm 0.0201 Tc 0.4261 Tw ( R.J., \223Family Involvement) Tj ET q 7.2 0 0 -6.96 350.64 94.8 cm BI /W 42 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID <4???~?~?~?~?~?~?~?~?~?~?~???~?~?~?? EI Q BT 0.7642 0 0 0.9835 350.64 87.84 Tm 3 Tr -0.0789 Tc 0 Tw (in) Tj 0 Tr ET BT 0.934 0 0 0.9835 357.84 87.84 Tm -0.015 Tc 0.4892 Tw ( Nursing Homes, \224) Tj ET BT 0.9835 0 0 0.9835 445.44 87.84 Tm /F5 10 Tf 0.0226 Tc -0.084 Tw (Gerontologist ) Tj ET q 47.04 0 0 -8.64 507.36 95.04 cm BI /W 262 /H 48 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID |????~~|>~|p~`|~~|x~~||?||?||?~|?~|??~~?~?~????p??????????????`??~~|~|~~?????~?p? EI Q BT 0.8971 0 0 0.9835 507.36 87.84 Tm 3 Tr 0.0278 Tc 0 Tw (17:500-505,) Tj 0 Tr -173.8837 -11.4697 TD 0.0456 Tc (1977.) Tj ET BT 0.8491 0 0 0.9835 350.64 64.32 Tm /F4 10 Tf 0.0229 Tc 1.9964 Tw (Zarit, S.H.,) Tj ET BT 0.934 0 0 0.9835 402 64.08 Tm -0.0312 Tc 1.4487 Tw (\223The Burdens of Caregivers,\224) Tj 0 Tc 0.0449 Tw ( ) Tj ET BT 0.9444 0 0 0.9835 534.96 64.08 Tm /F5 10 Tf 0.0168 Tc 0 Tw (Con-) Tj ET BT 0.9835 0 0 0.9835 350.64 53.52 Tm 0.0261 Tc -0.0876 Tw (fronting ) Tj ET q 47.76 0 0 -7.2 388.8 60.48 cm BI /W 266 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID x?/?????|??~?~>>qc?~>#?3~~x ??~8?~?|<?~~~~??~?|??~???~~??~p??~>8???<???>}???|???|?~~>x??<?<???> EI Q BT 0.9835 0 0 0.9835 388.8 53.52 Tm 3 Tr 0.0031 Tc 0 Tw (Alzheimer\222s) Tj 0 Tr 48.5631 0 TD -0.0017 Tc 2.1371 Tw ( Disease,) Tj 0 Tc -0.061 Tw ( ) Tj ET q 18 0 0 -7.2 479.28 60.48 cm BI /W 101 /H 41 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ???????~<>>???~~< EI Q BT 0.8915 0 0 0.9835 479.28 53.52 Tm 3 Tr /F4 10 Tf -0.0229 Tc 0 Tw (A.C.) Tj 0 Tr ET BT 0.9835 0 0 0.9835 497.28 53.52 Tm 0 Tc -0.0972 Tw ( ) Tj ET q 29.28 0 0 -7.2 500.16 60.48 cm BI /W 163 /H 40 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID @~8}|>???|?<??|||~x>|??????? <~?????~|@< EI Q BT 0.8491 0 0 0.9835 500.16 53.52 Tm 3 Tr 0.0247 Tc 0 Tw (Kalicki) Tj 0 Tr ET BT 0.9835 0 0 0.9835 529.44 53.52 Tm 0.0272 Tc 2.3155 Tw ( \(cd.\)) Tj ET q 31.92 0 0 -9.36 350.64 49.44 cm BI /W 187 /H 52 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ?x<8x<<p? 8??<??|<~?<??8?x8~?>0~??~???>?~~{?~?~??~p?~?x?><>?<?><?~>?<|??~?`0x>? EI Q BT 0.8066 0 0 0.9835 350.64 42.48 Tm 3 Tr 0.0298 Tc 0 Tw (\(Owings) Tj 0 Tr ET BT 0.8915 0 0 0.9835 382.56 42.48 Tm 0.0219 Tc 1.7162 Tw ( Mills, MD: Rynd Communications, and) Tj ET endstream endobj 563 0 obj <>/ProcSet 565 0 R>>/Rotate 0/Type/Page>> endobj 564 0 obj <>stream 0.48 w 1 j 0 0 0 RG 56.64 679.68 m 534 679.68 l S BT 0.9835 0 0 0.9835 56.88 684.72 Tm 0 0 0 rg /F5 10 Tf 0.0114 Tc 0.9733 Tw (197 . 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EI Q BT 0.9835 0 0 0.9835 150.48 624.72 Tm 3 Tr -0.0561 Tc 0 Tw (J.M.,) Tj 0 Tr 20.255 0 TD 0.0569 Tc 1.2233 Tw ( and Rosenberg-Thompson,) Tj -91.2693 -10.9816 TD 0.2888 Tc 0 Tw (s.,) Tj 16.5944 0 TD 0.0027 Tc 3.2308 Tw (\223A Special Treatment Unit for) Tj 0 Tc -0.061 Tw ( ) Tj ET q 48.48 0 0 -6.96 235.2 620.88 cm BI /W 270 /H 39 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID ??????????p??~8??~0?~?~~??~~?~~??~|?~|?~<0?0<8p>8???|???????|p|~<?xx?0 EI Q BT 0.9388 0 0 0.9835 235.2 613.92 Tm 3 Tr -0.0131 Tc 0 Tw (Alzheirner\222s) Tj 0 Tr ET BT 0.9835 0 0 0.9835 80.64 603.12 Tm -0.0033 Tc 1.8336 Tw (Disease: Medical, Behavioral, and Environmental) Tj 0 -11.2256 TD -0.0089 Tc -0.052 Tw (Features,\224 ) Tj 44.4145 0 TD /F5 10 Tf 0.0007 Tc 1.4025 Tw (Clinical Gerontologist) Tj 0 Tc -0.061 Tw ( ) Tj ET q 32.4 0 0 -8.16 218.4 599.04 cm BI /W 181 /H 46 /BPC 1 /D [ 1 0 ] /CS /DeviceGray ID 8x||?|??|~|~~~~~~|~?|~|~~?~>?~>?~?@??~?~~?|~?|~|~?|~?|~?|~?|~?|~?x|~?<|~?>~~~~~~|~?~>?||>< EI Q BT 0.8971 0 0 0.9835 218.4 592.08 Tm 3 Tr 0.0082 Tc 0 Tw (9:47-61,) Tj 0 Tr ET BT 0.9835 0 0 0.9835 250.8 592.08 Tm 0.0854 Tc 0.5843 Tw ( 1990.) 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