Optimizing Dementia Care through Improved Assessment Practice: Training Nursing Home Staffs to Proficiently Administer the Brief Cognitive Assessment Tool (BCAT)

Abstract

The prevalence of cognitive impairment in U.S. nursing homes is high. There is ample evidence that accurate identification of cognitive abilities (and disabilities) can significantly optimize care. Moreover, an explicit goal of the Centers for Medicare and Medicaid Services (CMS) is to ensure that nursing home staffs adequately assess cognition. Yet, the use of measures not sensitive to the full spectrum of cognitive levels and an overreliance on subjective methods are barriers to accurately assessing nursing home residents. The Brief Interview for Mental Status (BIMS) is the mandated cognitive measure in U.S. nursing homes, but it has been shown to have poor sensitivity in differentiating among cognitive levels. The purpose of this study is to improve resident care outcomes by increasing the proficiency of skilled nursing facility staffs in the cognitive assessment of their residents. Ninety-six nursing and clinical staff (n = 54, long-term care staff; n = 42, short stay staff) were recruited from 18 Maryland skilled nursing facilities. Participating nursing home staffs were trained in using a brief objective instrument that is sensitive to the continuum of cognitive functioning (Brief Cognitive Assessment Tool; BCAT), and they were tested for proficiency subsequent to training. Then, participating staffs collectively completed 345 BCATs with residents in their facilities and participated in an online survey to assess their experience with BCAT training and test administration. The survey also asked participants to estimate levels of cognitive impairment in their facilities. Key findings: (1) All participating nursing home staffs demonstrated mastery of course material in the post-assessment following the training, (2) a one-way analysis of variance (p > .05) suggested that BCAT scores were not significantly different among the four administrator types (nursing, social work, recreation, therapist), (3) facility staffs reported strong clinical utility of the BCAT in improving care, and (4) staff estimates of the prevalence of dementia in their facilities (53.43%) were lower than rates of dementia based on BCAT scores (71.70%). We discuss implications of these empirical findings in terms of training staffs to improving cognitive assessment in nursing homes.

Full text

!"#$%&'(#!%")
*+#,%&-)
.'$.%-+) $+-'/#-)
• !"#$%&#'()#*+#$,-$+,.*/0'#$/1%(/&1#*2$/*$
3454$*6&7/*.$",1#7$/7$"/."4$!"#&#$/7$(1%)#$
#'/8#*+#$2"(2$(++6&(2#$/8#*09+(0,*$,-$
+,.*/0'#$(:/)/0#7$;(*8$8/7(:/)/0#7<$+(*$
7/.*/9+(*2)=$,%01/>#$+(&#4$$
$
• ?*$#@%)/+/2$.,()$,-$2"#$A#*2#&7$-,&$
B#8/+(&#$(*8$B#8/+(/8$5#&'/+#7$;AB5<$/7$
2,$#*76&#$2"(2$*6&7/*.$",1#$72(C7$
(8#D6(2#)=$(77#77$+,.*/0,*4$E#2F$2"#$67#$
,-$1#(76&#7$*,2$7#*7/0'#$2,$2"#$-6))$
7%#+2&61$,-$+,.*/0'#$)#'#)7$(*8$(*$
,'#&&#)/(*+#$,*$76:G#+0'#$1#2",87$(&#$
:(&&/#&7$2,$(++6&(2#)=$(77#77/*.$*6&7/*.$
",1#$&#7/8#*274$$
• !"#$H&/#-$I*2#&'/#J$-,&$B#*2()$52(267$
;HIB5<$/7$2"#$1(*8(2#8$+,.*/0'#$1#(76&#$
/*$3454$*6&7/*.$",1#7F$:62$/2$"(7$:##*$
7",J*$2,$"('#$%,,&$7#*7/0'/2=$/*$
8/C#&#*0(0*.$(1,*.$+,.*/0'#$)#'#)74$$
• ?$%6&%,7#$,-$2"/7$7268=$/7$2,$/1%&,'#$
&#7/8#*2$+(&#$,62+,1#7$:=$/*+&#(7/*.$2"#$
%&,9+/#*+=$,-$7K/))#8$*6&7/*.$-(+/)/2=$72(C7$
/*$2"#$+,.*/0'#$(77#771#*2$,-$2"#/&$
&#7/8#*274$$
(%"(/'-!%"-)
!"#$%&'%(#)*+%,-./0*$%('%12#-3+%4.22.#5%6'%(#$/7#)8+%98':'+%;/#7*22#%6'%<.-08%
L I*72&6+2$*6&7/*.$",1#$72(C7$-&,1$
8/C#&#*2$8#%(&21#*27$2,$:#$2&(/*#8$/*$
(81/*/72#&/*.$2"#$HA?!$(2$($"/."$(*8$
+,1%(&(:)#$%&,9+/#*+=4$
$
M B#(76&#$2"#$#@2#*2$2,$J"/+"$*6&7/*.$
",1#$72(C7$&#%,&2$2"(2$HA?!$"#)%#8$
2"#1$/*$%&,'/8/*.$+(&#$2,$&#7/8#*274$
$
N A,1%(&#$72(C$#701(2#7$,-$2"#$
%&#'()#*+#$,-$8#1#*0($/*$2"#/&$-(+/)/0#7$
2,$)#'#)7$,-$+,.*/0'#$/1%(/&1#*2$
&#%,&2#8$:=$2"#$HA?!4$$
• O/."2=P-,6&$*6&7/*.$(*8$+)/*/+()$72(C$;$%Q$
RSF$),*.P2#&1$+(&#$72(CT$$%Q$RSF$7",&2P
2#&1$&#"(:/)/2(0,*$72(C<$J#&#$&#+&6/2#8$
-&,1$UV$B(&=)(*8$7K/))#8$*6&7/*.$-(+/)/0#74$
W(&0+/%(0*.$72(C$J#&#$2&(/*#8$/*$67/*.$
2"#$HA?!$(*8$2"#=$J#&#$2#72#8$-,&$
%&,9+/#*+=$76:7#D6#*2$2,$2&(/*/*.4$
• !"#*F$%(&0+/%(0*.$72(C$+,))#+0'#)=$
+,1%)#2#8$XRX$HA?!7$J/2"$&#7/8#*27$/*$
2"#/&$-(+/)/0#7$(*8$2,,K$(*$,*)/*#$76&'#=$2,$
(77#77$2"#/&$#@%#&/#*+#$J/2"$HA?!$2&(/*/*.$
(*8$2#72$(81/*/72&(0,*4$!"#$76&'#=$()7,$
(7K#8$%(&0+/%(*27$2,$#701(2#$&(2#7$,-$
+,.*/0'#$/1%(/&1#*2$/*$2"#/&$-(+/)/0#74$$
)
)
)
)
)
• W(&0+/%(0*.$*6&7/*.$",1#$72(C7$8#1,*72&(2#8$+,.*/0'#$(77#771#*2$%&,9+/#*+=$2"&,6."$
%,7Y#72$7+,&#7$(*8$*,*P7/.*/9+(*2$8/C#&#*+#7$/*$HA?!$(81/*/72&(0,*$(1,*.$2"#$8/7+/%)/*#74$
• Z(+/)/2=$72(C$&#%,&2#8$72&,*.$+)/*/+()$60)/2=$,-$2"#$HA?!$/*$/1%&,'/*.$*6&7/*.$",1#$+(&#4$
• 52(C$#701(2#7$,-$+,.*/0'#$/1%(/&1#*2$&(2#7$J#&#$),J#&$2"(*$2",7#$:(7#8$,*$HA?!$7+,&#74$
• 56:G#+0'#$(77#771#*27$,-$+,.*/0,*$(&#$,[#*$/*(++6&(2#U4$!"#$8/7+&#%(*+=$/*$#701(2#8$
+,.*/0'#$/1%(/&1#*2$&(2#7$6*8#&7+,&#7$2"#$/1%,&2(*+#$,-$/*+)68/*.$,:G#+0'#$(77#771#*274$
%01234356)&727518)(897)#:9;<6:)!209;=7>)?@@7@@275A).98B1B7C)#9835356)"<9@356)
,;27)-A8D)A;).9;EB375AFG)?>2353@A79)A:7)H937I)(;6531=7)?@@7@@275A)#;;F)JH(?#K)
Long%term*care*staff*(N*=*LM)* Short%term*rehabilita8on*staff*(n)N)LMK*
($=#(&7$/*$.#&/(2&/+7$Q$US4XV$;\$]4U]<$($=#(&7$/*$.#&/(2&/+7$Q$U^4VS$;\$_4`X<$
($=#(&7$/*$),*.P2#&1$+(&#$Q$US4XV$;\$]4U]<$(%=#(&7$/*$7",&2P2#&1$&#"(:/)/2(0,*$Q$V4SR$;\$]4XX<$
SUa$b6&7#$B(*(.#&F$U`a$5,+/()$5#&'/+#$c#7/.*##F$
U_4]a$c/&#+2,&$,-$5,+/()$5#&'/+#7$$
R]a$5,+/()$d,&K#&F$SXa$e#"(:/)/2(0,*$!"#&(%/72F$U]a$
e#+&#(0,*$52(C$
:#0#%=*-*%)>22*)0*?%#/%@#-0%>A%#%B-#$0%#=#-?*?%0>%
08*%C*#)>$%;$/D0E0*%7"%08*%(#-"2#$?%FG)*%>A%
H*#208%1#-*%IE#2.0"J%K;5@->L.$B%:*5*$D#%1#-*%
M8->EB8%;5@->L*?%&//*//5*$0%9-#)D)*'N%
Crosstabula8on*of*BCAT*cogni8ve*levels*iden8fied*by*nursing*home*staff*discipline**
HA?!$$
A,.*/0'#$$
f#'#)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
c/7+/%)/*#$,-$*6&7/*.$",1#$72(C$
!,2()$
5,+/()$d,&K$ e#+&#(0,*$ b6&7/*.$ !"#&(%=$
b,$8#1#*0($ gU$;gS4_aT$S_4]a<$U`$;U`4_aT$XX4Xa<$SX$;SX4]aT$S_4Ra<$R$;R4UaT$g^4^a<$`]$;SV4Xa<$
c#1#*0($ UR^$;g_4`aT$]X4Xa<$XV$;Ug4RaT$__4]a<$_R$;S_4^aT$]X4_a<$R$;U4_aT$g^4^a<$
$SR_$;]U4]a<$
!,2()$ U`U$;gg4]a<$ g]$;U_4_a<$ V]$;Sg4Ra<$ V$;S4Xa<$ XRX$;U^^a<$
O>0*4$hi$;XF$XRX<$Q$S4`_F$@$Q$4R^4$$b61:#&7$/*$%(&#*2"#7#7$/*8/+(2#j$;&,J$aT$+,)61*$a<4$H&/#-$A,.*/0'#$?77#771#*2$!,,)$;HA?!<$I8#*09#8$A,.*/0'#$f#'#)7$
J#&#$8#2#&1/*#8$:=$%(&0+/%(*2$HA?!$7+,&#74$
Demonstra8on*of*BCAT*Proficiency*
• W(&0+/%(0*.$72(C$+,1%)#2#8$($%,7Y#72$-,)),J/*.$HA?!$(81/*/72&(0,*$2&(/*/*.$;(%.&(8#$Q$`g4`Va<4$
• ?*$#@2#&*()$(68/2$,-$7+,&/*.$%&(+0+#7$&#'#()#8$/*2#&1/Y#*2$(*8$&(*8,1$%,/*2P7+,&/*.$#&&,&74$k,J#'#&F$
HA?!$+,.*/0'#$)#'#)$/8#*09+(0,*$J(7$`]4Xa$(++6&(2#4$
• ?$,*#PJ(=$16)0'(&/(2#$(*()=7/7$,-$'(&/(*+#$/*8/+(2#8$2"(2$HA?!$2,2()$7+,&#7$8/8$*,2$7/.*/9+(*2)=$8/C#&$(7$($
-6*+0,*$,-$*6&7/*.$",1#$72(C$8/7+/%)/*#F$<%;XF$XXV<$Q$4S]F$@%Q$4Vg4$
Survey*of*the*Clinical*Applica8on*of*the*BCAT*
• `Ra$(.&##8$2"(2$2"#$HA?!$%&,'/8#8$.&#(2#&$/*7/."2$/*2,$2"#$+6&&#*2$+,.*/0'#$72(267$,-$%(0#*274$
• `V4_a$(.&##8$2"(2$2"#$HA?!$%&,'/8#8$&#)#'(*2$+)/*/+()$/*-,&1(0,*4$
• ]X4_a$(.&##8$2"(2$2"#$HA?!$J(7$67#-6)$/*$/1%&,'/*.$,62+,1#7$/*$(&#(7$,-$7%#+/()/>(0,*4$
• _V4Ua$(.&##8$2"(2$2"#$HA?!$"#)%#8$+&#(2#$1,&#$#C#+0'#$2&#(21#*27F$%&,.&(17F$,&$/*2#&'#*0,*74$
• _Ua$&#%,&2#8$"('/*.$($1,1#*2$,-$7688#*$/*7/."2$(:,62$2"#$+,.*/0'#$-6*+0,*/*.$,-$2"#/&$&#7/8#*274$
*********************************************************Long%term*care*staff*
A,.*/0'#$A(2#.,&=$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$52(C$#701(2#7$ H(7#8$,*$HA?!$
5+,&#7$
b,$8#1#*0($ RU4]a$ SU4Xa$
c#1#*0($ gV4Xa$ ]V4]a$
B/)8$8#1#*0($ SU4Ra$ SS4Xa$
B,8#&(2#$8#1#*0($ ]V4_a$ ]]4]a$
Short%term*rehabilita8on*staff*
52(C$#701(2#7$ H(7#8$,*$HA?!$
5+,&#7$
R]4Sa$ XV4_a$
gS4Va$ _U4Ra$
]_a$ RRa$
SRa$ g_a$
U$A("/))$5F$c/(>PW,*+#$?BF$A,#*$eZF$d()7"$A4$;S^U^<4$!"#$6*8#&8#2#+0,*$,-$+,.*/0'#$/1%(/&1#*2$/*$*6&7/*.$",1#7$/*$2"#$c6:)/*$(&#(4$!"#$*##8$-,&$,*P.,/*.$+,.*/0'#$(77#771#*24$&B*%&B*.$B+%PQ+$USVPUXU4$
$