The NACA Position on Alzheimer Disease and related dementias no. 23

6. HOUSING

Traditionally, people with Alzheimer Disease or other dementias were cared for in their own homes by immediate or extended family. Today, however, those with dementia have many housing options available to them and their family or caregivers. The issues regarding residing in private homes and long-term care institutions have already been addressed. Other housing options for those with dementia include:⁴²

6.1 Group homes

These are typically large single unit homes (new or converted) that house 8-10 residents. They are characterized by a family-like atmosphere and life-style. These homes have varying degrees of modification to accommodate those with dementia, are staffed with qualified personnel during the day and an on-call person during night hours. Like family homes, these residences have a living and dining room, kitchen and bedrooms. Often, there are communal activities including preparation and taking of meals, recreation and entertainment.

6.2 Assisted living

This is housing in which there is a home setting combined with support services, sometimes including health care services. Typically, assisted living accommodates 30-120 people and has the appearance of an oversized house or small apartment building. Older terms for assisted living includes "lodges", "personal care homes" or "boarding homes".

6.3 Supportive housing

Includes a variety of types of accommodation and a mix of on-site personnel support, homemaking services and 24-hour supervision. Supportive housing is increasingly viewed as a substitute for unnecessary institutionalization. Supportive housing is gaining attention as an attractive option for people with ADRD - especially those in the early and middle stages.

6.4 Important principles for housing people with dementia

Regardless of the type of housing option chosen, there are some important principles that must be respected if those with dementia are to occupy housing that maintains their health and adds to their quality of life to the maximum degree possible:

• aging in place: for a person with dementia, changing residency can be disorienting and disturbing. To minimize the disruptiveness of such a change in their environment, it is best that careful planning to ensure the necessary support services, recreational activities, etc., are in place so that a continuum of care allows for "aging in place."

• good management: managing housing for those with dementia requires that certain conditions exist:
• knowledge of the disease;
• focus on individual dignity;
• suitable training of staff;
• maintaining family contact; and
• integration of residents into community.
  
  

• home-like atmosphere: for the residence to feel like home, there needs to be: low-turnover of staff to allow them to get to know residents; a home-like setting; and activities of daily living intended to maximize residents' functioning.⁴³

• housing designed for people with dementia: it is important that specific problems related to AD be addressed through proper physical design:⁴⁴
• exits that are safe in an unobtrusive way;
• hallways in which to walk and wander;
• private rooms and small sitting areas;
• a residential "feel";
• supports that enable residents to maintain their independence (e.g., handrails, non-slip flooring);
• understandable sounds, smells, colours and views (e.g., consistent with their life experiences, backgrounds, cultures);
• adjacent outdoor space that is secure and planned (accommodates wandering);
• useful adaptations to the home environment (e.g., locks, safe furniture).⁴⁵

NACA RECOMMENDS THAT:

• The federal government take a leadership role to increase research and knowledge about the current and future demand for community housing for people with dementia (group homes, assisted living, supportive housing, emerging models) in the context of an aging population.

• The federal government allocate new financial investments for all types of community housing for people with dementia by either funding individuals or housing providers, as appropriate, directly through subsidies, or indirectly through transfer payments to the provincial/territorial governments and/or municipal governments.

• Provincial and territorial governments ensure that local health and social services are adequately financed, integrated and available to residents in housing for people with dementia, just as they would be to any other member of the community.

• Provincial and territorial governments work together with municipal governments, housing providers and operators and potential/current consumers of housing for people with dementia, in order to develop the necessary consumer protection, legislation, regulation and policies appropriate to a supportive/assistive housing environment and to retirement homes.

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