Residents with dementia in assisted living facilities. The role of behavior in discharge decisions

The purpose of this exploratory qualitative study was to identify behaviors that contribute to the decision to discharge the resident with dementia from an assisted living facility to a skilled nursing facility. Administrators of 14 assisted living facilities in Missouri were interviewed. The administrators were asked to describe occasions when residents with dementia were discharged. The findings of the study were based on analysis of the audiotapes of the interviews. According to the administrators, resident behaviors that influenced discharge decisions included behaviors indicating progression of dementia, behaviors indicating the need for more assistance with activities of daily living, incontinence, wandering, behaviors that did not meet the facility's expectations, behaviors reflecting changes in physical condition, and aggressive behaviors. These findings have implications for the role of nurses in assisted living facilities and for further research.