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Small, homelike care environments for older people with dementia: a literature review

Published online by Cambridge University Press:  23 December 2008

Hilde Verbeek ,
Erik van Rossum ,
Sandra M. G. Zwakhalen ,
Gertrudis I. J. M. Kempen  and
Jan P. H. Hamers
Hilde Verbeek*
Affiliation:
School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
Erik van Rossum
Affiliation:
School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
Sandra M. G. Zwakhalen
Affiliation:
School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
Gertrudis I. J. M. Kempen
Affiliation:
School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
Jan P. H. Hamers
Affiliation:
School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
*
Correspondence should be addressed to: Hilde Verbeek, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Phone: +31 433 881513; Fax: +31 433 884162. Email: [email protected].
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Abstract

Background: There is large cross-national variation in the characteristics of small, domestic-style care settings which emphasize normalized living. However, a systematic overview of existing types is lacking. This study provides an international comparison of the care concepts which have adopted a homelike philosophy in a small-scale context. Insight into their characteristics is vital for theory, planning and implementation of such dementia care settings.

Method: A literature search was performed using various electronic databases, including PubMed, Medline, CINAHL and PsycINFO. In addition, “gray” literature was identified on the internet. Concepts were analyzed according to five main characteristics: physical setting, number of residents, residents' characteristics, domestic characteristics and care concept.

Results: 75 papers were included covering 11 different concept types in various countries. Similarities among concepts reflected a focus on meaningful activities centered around the daily household. Staff have integrated tasks and are part of the household, and archetypical home-style features, such as kitchens, are incorporated in the buildings. Differences among concepts were found mainly in the physical settings, numbers of residents and residents' characteristics. Some concepts have become regular dementia care settings, while others are smaller initiatives.

Conclusion: The care concepts are implemented in various ways with a changing staff role. However, many aspects of these small, homelike facilities remain unclear. Future research is needed, focusing on residents' characteristics, family, staff and costs.

Keywords

small-scale housinggroup livingnursing home facilitiesdeinstitutionalizationlong-term care
Type
Review Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 252 - 264
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Ahlund, Ö. (1999). Group living for elderly with Alzheimer's disease: the importance of environmental design. STRIDE – Excellence in Long Term Care, Fall/Winter, 4–7.Google Scholar
Alfredson, B. B. and Annerstedt, L. (1994). Staff attitudes and job satisfaction in the care of demented elderly people: group living compared with long-term care institutions. Journal of Advanced Nursing, 20, 964–974.CrossRefGoogle ScholarPubMed
Andren, S. and Elmstahl, S. (2002). Former family carers' subjective experiences of burden: a comparison between group living and nursing home environments in one municipality in Sweden. Dementia, 1, 241–254.CrossRefGoogle Scholar
Andren, S. and Elmstahl, S. (2007). Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study. International Journal of Nursing Studies, 44, 435–446.CrossRefGoogle Scholar
Angelelli, J. (2006). Promising models for transforming long-term care. The Gerontologist, 46, 428–430.CrossRefGoogle ScholarPubMed
Annerstedt, L. (1993). Development and consequences of group living in Sweden: a new mode of care for the demented elderly. Social Science Medicine, 37, 1529–538.CrossRefGoogle ScholarPubMed
Annerstedt, L. (1994). An attempt to determine the impact of group living care in comparison to traditional long-term care on demented elderly patients. Aging (Milan), 6, 372–380.Google ScholarPubMed
Annerstedt, L. (1997). Group-living care: an alternative for the demented elderly. Dementia and Geriatric Cognitive Disorders, 8, 136–142.CrossRefGoogle ScholarPubMed
Annerstedt, L. et al. (1993a). Group Living for People with Dementia. Stirling: Dementia Services Development Centre, University of Stirling.Google Scholar
Annerstedt, L., Gustafson, L. and Nilsson, K. (1993b). Medical outcome of psychosocial intervention in demented patients: one-year clinical follow-up after relocation into group living units. International Journal of Geriatric Psychiatry, 8, 833–841.CrossRefGoogle Scholar
Annerstedt, L., Sanada, J. and Gustafson, L. (1996). A dynamic long-term care system for the demented elderly. International Psychogeriatrics, 8, 561–574.CrossRefGoogle ScholarPubMed
Annerstedt, L., Elmstahl, S., Ingvad, B. and Samuelsson, S. M. (2000). Family caregiving in dementia: an analysis of the caregiver's burden and the “breaking-point” when home care becomes inadequate. Scandinavian Journal of Public Health, 28, 23–31.Google ScholarPubMed
Arehart-Treichel, J. (2001). Innovative Alzheimer's residence tries new models of care. Psychiatric News, 36, 14–57.Google Scholar
Atkinson, A. (1995). Managing people with dementia: CADE units. Nursing Standard, 9, 29–32.CrossRefGoogle ScholarPubMed
Beecham, J., Cambridge, P., Hallam, A. and Knapp, M. (1993). The costs of domus care. International Journal of Geriatric Psychiatry, 8, 827–831.CrossRefGoogle Scholar
Briller, S. H. and Calkins, M. (2000). Defining place-based models of care: conceptualizing care settings as home, resort or hospital. Alzheimer's Care Quarterly, 1, 17–23.Google Scholar
Calkins, M. P. (2001). Creating Successful Dementia Care Settings, Baltimore: Health Professions Press.Google Scholar
Carr, J. S. and Marshall, M. (1993). Innovations in long-stay care for people with dementia. Reviews in Clinical Gerontology, 3, 157–167.CrossRefGoogle Scholar
Cohen, U. and Weisman, G. (1991). Holding on to Home. Designing Environments for People with Dementia. London: John Hopkins University Press.Google Scholar
Danes, S. (2002). Creating an environment for community. Alzheimer's Care Quarterly, 3, 61–66.Google Scholar
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia: a review of the empirical research. Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
de Vugt, M. E. et al. (2006). Cognitive functioning in spousal caregivers of dementia patients: findings from the prospective MAASBED study. Age and Ageing, 35, 160–166.CrossRefGoogle ScholarPubMed
Dean, R., Briggs, K. and Lindesay, J. (1993a). The domus philosophy: A prospective evaluation of two residential units for the elderly mentally ill. International Journal of Geriatric Psychiatry, 8, 807–817.CrossRefGoogle Scholar
Dean, R., Proudfoot, R. and Lindesay, J. (1993b). The quality of interactions schedule (QUIS): development, reliability and use in the evaluation of two domus units. International Journal of Geriatric Psychiatry, 8, 819–826.CrossRefGoogle Scholar
Depla, M. and te Boekhorst, S. (2007). Kleinschalig Wonen voor Mensen met Dementie: Doen of Laten? (Small-Scale Living for People with Dementia: Do or Don't?). Utrecht: Trimbos-Institute.Google Scholar
Dettbarn-Reggentin, J. (2005). Studie zum Einfluss von Wohngruppenmilieus auf demenziell Erkrankte in stationären Einrichtungen. [Study of the influence of environmental residential groups on demented old people in nursing home residents]. Zeitschrift für Gerontologie Geriatrie, 38, 95–100.CrossRefGoogle Scholar
Elmstahl, S., Annerstedt, L. and Ahlund, O. (1997). How should a group living unit for demented elderly be designed to decrease psychiatric symptoms? Alzheimer Disease and Associated Disorders, 11, 47–52.CrossRefGoogle ScholarPubMed
Elmstahl, S., Ingvad, B. and Annerstedt, L. (1998a). Family caregiving in dementia: prediction of caregiver burden 12 months after relocation to group-living care. International Psychogeriatrics, 10, 127–146.CrossRefGoogle ScholarPubMed
Elmstahl, S., Stenberg, I., Annerstedt, L. and Ingvad, B. (1998b). Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving: a two-year follow-up. International Psychogeriatrics, 10, 239–252.CrossRefGoogle Scholar
Engström, M., Ljunggren, B., Lindqvist, R. and Carlsson, M. (2005). Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care. Journal of Telemedicine and Telecare, 11, 304–309.CrossRefGoogle ScholarPubMed
Fahrenfort, M. (1997). In search of the best environment. Results of five experiments in the institutional organization of care for demented people. InMiesen, B. M. L. and Jones, G. M. M. (eds.), Care-Giving in Dementia. Research and Applications. London and New York: Routledge.Google Scholar
Faxen-Irving, G., Andren-Olsson, B., Af Geijerstam, A., Basun, H. and Cederholm, T. (2002). The effect of nutritional intervention in elderly subjects residing in group-living for the demented. European Journal of Clinical Nutrition, 56, 221–227.CrossRefGoogle ScholarPubMed
Finnema, E., Droes, R. M., Ribbe, M. and van Tilburg, W. (2000). A review of psychosocial models in psychogeriatrics: implications for care and research. Alzheimer Disease and Associated Disorders, 14, 68–80.CrossRefGoogle ScholarPubMed
Fleming, R. and Bowles, J. (1994). Small, specialised long stay units for the dementing: their role and effectiveness. Paper presented at Alzheimers Disease International Conference, Edinburgh.Google Scholar
Funaki, Y., Kaneko, F. and Okamura, H. (2005). Study of factors associated with changes in quality of life of demented elderly persons in group homes. Scandinavian Journal of Occupational Therapy, 12, 4–9.CrossRefGoogle ScholarPubMed
Hertogh, C. M., The, B. A., Miesen, B. M. and Eefsting, J. A. (2004). Truth telling and truthfulness in the care for patients with advanced dementia: an ethnographic study in Dutch nursing homes. Social Science and Medicine, 59, 1685–1693.CrossRefGoogle ScholarPubMed
Hirakawa, Y., Masuda, Y., Uemura, K., Kuzuya, M., Kimata, T. and Iguchi, A. (2006). End-of-life care at group homes for patients with dementia in Japan: findings from an analysis of policy-related differences. Archives of Gerontology Geriatrics, 42, 233–245.CrossRefGoogle ScholarPubMed
Horttana, B. M., Ahlstrom, G. and Fahlstrom, G. (2007). Patterns of and reasons for relocation in dementia care. Geriatric Nursing, 28, 193–200.CrossRefGoogle ScholarPubMed
Janzen, W. M. (2000). Family members caring for relatives with Alzheimer Disease in long-term care facilities. Unpublished dissertation, University of Alberta.Google Scholar
Jensen, J., Lundin Olsson, L., Nyberg, L. and Gustafson, Y. (2002). Falls among frail older people in residential care. Scandinavian Journal of Public Health, 30, 54–61.CrossRefGoogle ScholarPubMed
Judd, S., Marshall, M. and Phippen, P. (1998). Design for Dementia. London: Hawker Publications.Google Scholar
Kane, R. A., Lum, T. Y., Cutler, L. J., Degenholtz, H. B. and Yu, T.-C. (2007). Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial Green House Program. Journal of the American Geriatrics Society, 55, 832–839.CrossRefGoogle ScholarPubMed
Kihlgren, M., Brane, G., Karlsson, I., Kuremyr, D., Leissner, P. and Norberg, A. (1992). Long-term influences on demented patients in different caring milieus, a collective living unit and a nursing home: a descriptive study. Dementia, 3, 342–349.Google Scholar
Kuremyr, D., Kihlgren, M., Norberg, A., Astrom, S. and Karlsson, I. (1994). Emotional experiences, empathy and burnout among staff caring for demented patients at a collective living unit and a nursing home. Journal of Advanced Nursing, 19, 670–679.CrossRefGoogle Scholar
Leichsenring, K., Strümpel, C. and Group, S. (1998). The Use of Small Housing Units for Older Persons Suffering from Dementia. Eurosocial Reports. Vienna: European Centre for Social Welfare Policy and Research.Google Scholar
Lindesay, J., Briggs, K., Lawes, M., Macdonald, A. and Herzberg, J. (1991). The domus philosophy: a comparative evaluation of a new approach to residential care for the demented elderly. International Journal of Geriatric Psychiatry, 6, 727–736.CrossRefGoogle Scholar
Macdonald, A., Philpot, M. and Briggs, C. (2004). An attempt to determine the benefits of a “home-for-life” principle in residential care for people with dementia and behavioural problems: a comparative cohort study. Dementia and Geriatric Cognitive Disorders, 18, 6–14.CrossRefGoogle ScholarPubMed
Malmberg, B. and Zarit, S. H. (1993). Group homes for people with dementia: a Swedish example. The Gerontologist, 33, 682–686.Google ScholarPubMed
Marshall, M. (1993). Small Scale, Domestic Style, Long Stay Accommodation for People with Dementia. Stirling: Dementia Services Development Centre, University of Stirling.Google Scholar
Marshall, M. and Archibald, C. (1998). Long-stay care for people with dementia: recent innovations. Reviews in Clinical Gerontology, 8, 331–343.CrossRefGoogle Scholar
McAllister, C. L. and Silverman, M. A. (1999). Community formation and community roles among persons with Alzheimer's disease: a comparative study of experiences in a residential Alzheimer's facility and a traditional nursing home. Qualitative Health Research, 9, 65–85.CrossRefGoogle Scholar
Moise, P., Schwarzinger, M. and Um, M. (2004). Dementia Care in 9 OECD Countries: A Comparative Analysis. Paris: OECD.Google Scholar
Nagy, J. W. (2002). Kitchens that help residents reestablish home. Alzheimer's Care Quarterly, 3, 74–77.Google Scholar
Nakanishi, M. and Honda, T. (2008). Process of decision making and end-of-life care for patients with dementia in group homes in Japan. Archives of Gerontology and Geriatrics, doi: 10.1016/j.archger.2008.02.009 (e-published ahead of print).CrossRefGoogle Scholar
Norbergh, K. G., Nordahl, G., Sandman, P. O. and Asplund, K. (2001). A retrospective study of functional ability among people with dementia when admitted to group-dwelling. Scandinavian Journal of Primary Health Care, 19, 39–42.CrossRefGoogle ScholarPubMed
Norbergh, K. G., Hellzen, O., Sandman, P. O. and Asplun, K. (2002). The relationship between organizational climate and the content of daily life for people with dementia living in a group-dwelling. Journal of Clinical Nursing, 11, 237–246.CrossRefGoogle Scholar
Onishi, J. et al. (2006). Behavioral, psychological and physical symptoms in group homes for older adults with dementia. International Psychogeriatrics, 18, 75–86.CrossRefGoogle ScholarPubMed
Peters, H. J. and Duine, T. J. (1987). [The Normalized Living Project at the De Landrijt nursing home in Eindhoven: various results of an experiment in psychogeriatric care]. Tijdschrift voor Gerontologie en Geriatrie, 18, 187–191.Google Scholar
Rabig, J., Thomas, W., Kane, R. A., Cutler, L. J. and Mcalilly, S. (2006). Radical redesign of nursing homes: applying the green house concept in Tupelo, Mississippi. Gerontologist, 46, 533–539.CrossRefGoogle ScholarPubMed
Radzey, B., Kuhn, C., Rauh, J. and Heeg, S. (2001). Qualitätsbeurteilung der institutionellen Versorgung und Betreuung dementiell Erkrankter (Literatur-Expertise). Stuttgart: Bundesministerium für Familie, Senioren, Frauen und Jugend.Google Scholar
Reggentin, H. and Dettbarn-Reggentin, J. (2004a). [Group homes for patients with dementia: the possibility of social interaction]. Pflege Zeitschrift, 57, 181–184.Google ScholarPubMed
Reggentin, H. and Dettbarn-Reggentin, J. (2004b). Wohngruppen fur Menschen mit Demenz: Belastung wird durch Motivation kompensiert. (Group homes for patients with dementia: stress is compensated by motivation). Pflege Zeitschrift, 57, 489–492.Google ScholarPubMed
Reimer, M.-A., Slaughter, S., Donaldson, C., Currie, G. and Eliasziw, M. (2004). Special care facility compared with traditional environments for dementia care: a longitudinal study of quality of life. Journal of the American Geriatrics Society, 52, 1085–1092.CrossRefGoogle Scholar
Ritchie, K. and Ledésert, B. (1992). The families of the institutionalized dementing elderly: a preliminary study of stress in a French caregiver population. International Journal of Geriatric Psychiatry, 7, 5–14.CrossRefGoogle Scholar
Ritchie, K., Colvez, A., Ankri, J., Ledésert, B., Gardent, H. and Fontaine, A. (1992). The evaluation of long-term care for the dementing elderly: a comparative study of hospital and collective non-medical care in France. International Journal of Geriatric Psychiatry, 7, 549–557.CrossRefGoogle Scholar
Roscrow, S. (1996). Small units specialising in dementia care in West Lothian. Health Bulletin, 54, 294–300.Google ScholarPubMed
Sandman, P. O. and Wallblom, A. (1996). Characteristics of the demented living in different settings in Sweden. Acta Neurologica Scandinavica, 168 (Suppl.), 96–100.CrossRefGoogle ScholarPubMed
Saxton, J., Silverman, M., Ricci, E., Keane, C. and Deeley, B. (1998). Maintenance of mobility in residents of an Alzheimer special care facility. International Psychogeriatrics, 10, 213–224.CrossRefGoogle ScholarPubMed
Skea, D. and Lindesay, J. (1996). An evaluation of two models of long-term residential care for elderly people with dementia. International Journal of Geriatric Psychiatry, 11, 233–241.3.0.CO;2-0>CrossRefGoogle Scholar
Slaughter, S., Calkins, M., Eliasziw, M. and Reimer, M. (2006). Measuring physical and social environments in nursing homes for people with middle- to late-stage dementia. Journal of the American Geriatrics Society, 54, 1436–1441.CrossRefGoogle ScholarPubMed
Sloane, P. D., Mitchell, C. M., Preisser, J. S., Phillips, C., Commander, C. and Burker, E. (1998). Environmental correlates of resident agitation in Alzheimer's disease special care units. Journal of the American Geriatrics Society, 46, 862–869.CrossRefGoogle ScholarPubMed
Svensson, M., Edebalk, P. G. and Persson, U. (1996). Group living for elderly patients with dementia: a cost analysis. Health Policy, 38, 83–100.CrossRefGoogle ScholarPubMed
Taft, L. B., Fazio, S., Seman, D. and Stansell, J. (1997). A psychosocial model of dementia care: theoretical and empirical support. Archives of Psychiatric Nursing, 11, 13–20.CrossRefGoogle ScholarPubMed
te Boekhorst, S. (2007). Kleinschalig wonen voor ouderen met dementie: een kwaliteitsverbetering? [Small-scale living for older people with dementia: a quality improvement?]. Kwaliteit in Beeld, 3, 8–9.Google Scholar
te Boekhorst, S., Depla, M. F. I. A., De Lange, J., Pot, A. M. and Eefsting, J. A. (2007). Kleinschalig wonen voor ouderen met dementie: een begripsverheldering. [Small-scale group living for elderly with dementia: a clarification]. Tijdschrift voor Gerontologie en Geriatrie, 38, 17–26.CrossRefGoogle Scholar
te Boekhorst, S., Willemse, B., Depla, M. F. I. A., Eefsting, J. A. and Pot, A. M. (2008). Working in group living homes for older people with dementia: the effects on job satisfaction and burnout and the role of job characteristics. International Psychogeriatrics, 20, 927–940.CrossRefGoogle ScholarPubMed
van Audenhove, C., Declercq, A., De Coster, I., Spruytte, N., Molenberghs, C. and van den Heuvel, B. (2003). Kleinschalig Genormaliseerd Wonen voor Personen met Dementie [Small-scale normalized living for persons with dementia]. Antwerp/Apeldoorn: Garant.Google Scholar
van Waarde, H. and Wijnties, M. (2007). De Toekomst van Kleinschalig Wonen voor Mensen met Dementie. Utrecht: Aedes-Actiz Kenniscentrum Wonen-Zorg.Google Scholar
Verbeek, H., van Rossum, E., Zwakhalen, S. M. G., Kempen, G. I. J. M. and Hamers, J. P. H. (2008). Kleinschalig Wonen voor Ouderen met Dementie. Een Beschrijvend Onderzoek naar de Situatie in de Provincie Limburg. [Small-scale living for older people with dementia. A descriptive study of the situation in the province of Limburg]. Maastricht: Maastricht University Press.Google Scholar
Warren, S., Janzen, W., Andiel-Hett, C., Liu, L., Mckim, H. R. and Schalm, C. (2001). Innovative dementia care: functional status over time of persons with Alzheimer disease in a residential care centre compared to special care units. Dementia and Geriatric Cognitive Disorders, 12, 340–347.CrossRefGoogle Scholar
Warren, S., Janzen, W. M. and McKim, R. (2002). Innovative dementia care: the impact of residential care centers on the functional status of residents. Annals of Long-Term Care, 10, 51–56.Google Scholar
Wimo, A. and Morthenson Ekelöf, C. (2004). OECD Case Study on Dementia. Stockholm: Stiftelsen Stockholms Iäns Äldrecentrum.Google Scholar
Wimo, A. et al. (1991). Group living, an alternative for dementia patients: a cost analysis. International Journal of Geriatric Psychiatry, 6, 21–29.CrossRefGoogle Scholar
Wimo, A., Adolfsson, R. and Sandman, P. O. (1995a). Care for demented patients in different living conditions: effects on cognitive function, ADL-capacity and behaviour. Scandinavian Journal of Primary Health Care, 13, 205–210.CrossRefGoogle ScholarPubMed
Wimo, A., Asplund, K., Mattsson, B., Adolfsson, R. and Lundgren, K. (1995b). Patients with dementia in group living: experiences 4 years after admission. International Psychogeriatrics, 7, 123–127.CrossRefGoogle ScholarPubMed
Wimo, A., Mattson, B., Krakau, I., Eriksson, T., Nelvig, A. and Karlsson, G. (1995c). Cost-utility analysis of group living in dementia care. International Journal of Technology Assessment in Health Care, 11, 49–65.CrossRefGoogle ScholarPubMed
Yokota, O. et al. (2006). Effects of group-home care on behavioral symptoms, quality of life, and psychotropic drug use in patients with frontotemporal dementia. Journal of the American Medical Directors Association, 7, 335–337.CrossRefGoogle ScholarPubMed
Zeisel, J., Hyde, J. and Levkoff, S. (1994). Best practices: an environment behavior (E-B) model for Alzheimer special care units. American Journal of Alzheimer's Disease and Other Dementias, 9, 4–21.Google Scholar