Small group homes are better for many
dementia patients and their families
September 15, 2011--Small group homes for
people with dementia provide good quality
care and a domestic environment where people
can live as individuals and families can get
involved. But tension can arise when it
comes to deciding who takes responsibilities
for certain practical and caring tasks.
Those are the key findings of a study of two
group living care homes in the Netherlands,
published in the September issue of the Journal
of Clinical Nursing.
"It's estimated that 80 million people
worldwide will suffer from dementia by 2040"
says Ezra van Zadelhoff from Maastricht
University. "Up until now, traditional care
for people with dementia has mostly been
provided in large nursing homes.
"However, a number of countries are
increasingly providing care in small group
homes, which offer a more domestic
environment focusing on normal daily life.
These include group living concepts in the
Netherlands, Sweden, Germany and Japan.
"Our study focused on two group living units
that had been established for approximately
30 months, each providing care for ten
residents with dementia. Both were located
in the grounds of a traditional large-scale,
non-profit making nursing home in an urban
area in southern Netherlands."
The units both centre around a communal
living room and kitchen. Eight residents
have a private bedroom with their own
furniture, 12 share a bedroom with someone
else and the units are both decorated to
create a homely feel.
All residents require 24-hour care and this
is provided by nine nursing staff (7.2
full-time equivalents) aged from 20 to 60
years, with experience in geriatric care.
Nursing staff work with the residents to
perform household tasks like washing,
cleaning and preparing meals in the kitchen
and organise activities like walking,
exercises and singing.
A multidisciplinary team - nursing home
physician, psychologist, physiotherapist and
occupational therapist - are involved as
required. Both units adhere to a 'home for
life' principle, with residents staying
there until the end of their lives.
The research team carried out 32 hours of
observation over eight days and carried out
in-depth interviews with five residents,
four family members and four staff.
The key headline findings and observations
Residents felt at home and most gathered in
the living room during the day to talk,
drink coffee or read. Everyday activities
provided stability and clarity. People were
also able to get involved in familiar
activities, like laying the table or
washing-up, and this helped them to maintain
their identity and feel more at home.
"I can go to my room when I like. But I
don't often do so, I prefer to stay in the
living room with others."
"I always do the washing here. I always did
this at home as well."
Family members were able to get more
involved in the group home than they could
do in a nursing home. They were treated as
members, rather than visitors, had a key and
tended to visit more regularly, often
helping with personal care and chores. Some
family members found this level of
involvement more difficult than others and
this could lead to tension. But most were
happy to visit, get involved in everyday
activities at the home and take their
relatives to medical appointments, church or
the hairdresser, as required.
"It is like being at home. For the visitors
this is far more pleasant."
"My mother is at home here. In the
traditional unit there were many people who
did not know each other. Here she knows
Nurses built good relationships with the
residents and were able to provide
individual care tailored to their needs.
However, this could make them feel more
emotionally attached and compromise their
clinical or professional distance. In most
cases they were able to work with family
members to provide aspects of personal care,
but in some cases there were disagreements
about who should be responsible for some
"As a staff member I feel that there is more
engagement compared with regular care. When
something is the matter with a resident I
feel more involved, more close."
"People get on well with each other,
experience the group as a household, we live
as a family."
"The findings of our study indicate that the
key to providing person-centred care for
people with dementia is to enable people to
be themselves and live in an environment
where they and their families can get
involved in normal daily activities" says
Ezra van Zadelhoff.
"However the model is not without its
problems. Nursing staff get more involved
with residents and this can conflict with
their clinical and professional distance.
And the families in our study varied in how
much they wanted to get involved in the care
provided by the home, which sometimes led to