Hearthstone Alzheimer Care is the only leading Assisted Living company in the United States to maintain an active research division. The research Hearthstone carries out is dedicated to providing answers to the many elusive questions regarding how to improve care for people with dementia and others requiring supportive environments. Particular areas of research focus include design of the physical environment, long-term care regulation, medication management, the impact high-quality treatment alternatives have on quality of life, and methodological issues regarding the relationship of structure and process to outcomes.

The following are summaries of projects by members of Hearthstone's Research Division:

Environmental Contributors to Health Outcomes in Dementia Special Care Units

This project, funded by the National Institute of Aging, studied the effects of eight environmental design features on agitation, aggression, depression, social withdrawal, and psychotic symptoms of residents with Alzheimer's disease in Special Care Units. The eight design criteria, which were found to have varying levels of correlation to improved outcomes in a dementia population, include:

Dr. Zeisel was the Principal Investigator of this project. Preliminary findings of the study were published in the American Journal of Alzheimer Care and Research, and a final report has received preliminary acceptance for publication in a leading gerontological journal. The findings have also been presented at numerous national and international professional and trade conferences to enthusiastic audiences. A workbook resulted on Special Care Unit Design.

Other Environmental Design Research

Dr. Zeisel, in developing the research on Special Care Unit design, built on his prior research in the design of seniors housing, which has been published as a series of books: Congregate Housing for the Elderly, Low-Rise Housing for the Elderly, and Mid-Rise Elevator Housing for the Elderly. Hearthstone's Dementia SCU research draws on methodologies Dr. Zeisel developed for the Canadian Government, published in Hospital Post-Occupancy Evaluation. Further research on design in the field of Assisted Living for people with dementia was undertaken under contract with the Canadian Government and published as Housing Options for People with Dementia. This document is available on the web at http://www.cmhc-schl.gc.ca/cmhc.html.

Dr. Zeisel also teaches a course every year in the Harvard School of Design on Assisted Living Design which is based, in part, on his research findings in this area. A concentration in design research through the Research Division is also expressed in Hearthstone's relationship to its existing sites. Those sites are subject to formal Post-Occupancy Evaluation. Evaluations have been commissioned with Jacqueline Vischer, Ph.D., who serves on the Hearthstone Advisory Board. Dr. Vischer's publications on topics of environment design research include Environmental Quality in Offices.

The Effects of Regulation on the Ability of Providers to Serve People with Dementia

Dr. Hyde has led the Research Department's efforts to study the effects of regulation on dementia care. The United State Congress Office of Technology Assessment funded her first project in this area, under the auspices of the Gerontology Institute of the University of Massachusetts at Boston. Manor Care corporation funded a second project, which looked specifically at Assisted Living, as opposed to nursing home, regulations. Findings of that study were published in the American Journal of Alzheimer's Care and in a book length publication available through Hearthstone Press. Dr. Hyde also served as a collaborating investigator in one of the NIA-funded SCU collaborative projects on dementia care, analyzing differences in dementia care from state to state based on differences in their regulatory climates. The lead chapter in the forthcoming book on Assisted Living, written by Dr. Hyde, will present an overview of the role of regulation in assisted living.

Medication Management in Assisted Living

Funded by the American Society of Consulting Pharmacists' research foundation, this project allowed Dr. Hyde to analyze medication management practices in a sample of Massachusetts' assisted living residences, to look for correlations between medication management practices and both error rates and resident satisfaction. The most surprising finding of this study was that medication errors were as low or lower when direct care workers in assisted living facilities provided assistance as when such assistance was provided by nurses. Involvement of pharmacists in review and training, and a well developed training program were also correlated with low error rates. This research was published in the American Journal of Health Research.

Home Adaptation for Dementia Populations

This study was completed by Dr. Nina Silverstein, who has regularly served as a researcher or advisory to Hearthstone's Research Division, along with Joan Hyde, under the auspices of the University of Massachusetts Gerontology Institute. Findings were published in the American Journal of Alzheimer's Care and in the book Changing the Places Instead of the People: Home Adaptation for the Elderly and Disabled, co-authored by Joan Hyde.

Outcomes Measurement

Hearthstone has sponsored a wide range of research projects involving outcomes measurement. A key area of interest has been the measurement of quality of life and its relationship to more traditional health outcomes. A methodology-development paper by Joan Hyde, et al on outcomes in dementia care was published in the American Journal of Alzheimer Care. More recent research on outcomes in end-of-life care was presented at the Assisted Living Federation of America's annual conference. In keeping with her interest in outcomes measurement in the dementia population, Dr. Hyde serves on the advisory board of the Boston Alzheimer's Research Consortium, an NIH-funded Consortium that includes Boston University Medical School and the Bedford Veterans' Administration Administration Hospital, and which collects longitudinal data on Alzheimer's patients and their caregivers.

Resident-Centered Information Systems for Assisted Living

Under a grant from the National Institute of Aging, Hearthstone has been funded to develop and test a software system - AlphaPLAN. One of the purposes of the AlphaPLAN project is to develop standardized outcome measures for use as benchmarks of quality in the assisted living industry. (See the AlphaPLAN web page for more details). This project also has a regulatory purpose, as it is the hope of Principal Investigator Joan Hyde that it will help regulators find ways to measure the quality of assisted living that are more helpful and less restrictive than those currently in place in other parts of the long-term care continuum. Hearthstone is proud that the software developed under this grant was chosen to be showcased by the National Institute of Health at its Annual SBIR conference in July of this year.

Coordinated Non-Pharmacological Treatment for Dementia

Despite considerable experiential evidence to the contrary, research by many groups over the last decade have failed to find statistically significant correlations between most "best practice" factors in dementia care and improved patient outcomes. The researchers at Hearthstone hypothesize that outcomes are related less to individual "best practices" such as staff training or appropriate activities, and more to the overall correct coordination of such factors. The Hearthstone Research Division is currently engaged in initial research and methodology development on this important topic. A preliminary paper on the topic was the subject of a poster session at the International Alzheimer's Conference in July of this year.

Hearthstone does research in a number of fields related to the treatment of Alzheimer's disease. For further information on Hearthstone research efforts, contact Joan Hyde or John Zeisel directly.