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