Care housing for people with dementia : towards an evaluation

Abstract

This study set out to evaluate a small scale model of care for people with dementia that aimed to support residents within a daily household routine (termed household care). Stemming from a pluralistic evaluation, this thesis examines issues identified as important to residents' experience, namely the ability of the care houses to provide a home for life, the process and effectiveness of recreating a homely environment and the implications of group-living. Three case studies were investigated with multiple methods, including semi-structured interviews with staff, relatives and representatives of managing agencies, structured observation and assessment of dependency. Respondents believed care housing was superior to its alternatives and attributed perceived improvements in residents' well-being to the nature of staff support and the 'homely' setting. Agency representatives were preoccupied with their relationships with each other and how to sustain and expand this model of care. Staff focused on the nature and conditions of the work. Kin were keen that residents should settle and stay in the care houses. Residents' support needs at least matched entry criteria but over half had to move out to hospital because of physical illness and behavioural problems. This study suggests that it was very difficult for residents to accept the houses as 'home'. Residents' and their relatives' participation was, in practice, limited but one house was particularly successful in implementing household care; reasons are suggested for this. Residents' interactions with each other seemed to be increased by household care but their relationships were influenced by a number of factors, including the presence of dementia. The latter exacerbated the tensions of group-living. The challenge for care houses was to sustain care as dementia progressed and extend good quality care to those with more substantial behavioural and physical support needs.