Exploring Non-institutional living options for people living with Dementia

The following information and summary is taken directly from the article “A roadmap of noninstitutional living options for people with dementia: “Don’t fence me in.” “ by Dr. Maude Lévesque, PhD, Université du Québec à Montréal and Dr. Margaret Oldfield, PhD, Independent Social Scientist & Disability Scholar. This is a precis of a longer article to be published in the Canadian Journal on Ageing. The full article, including examples of options and more details, and full references, is here: https://www.preprints.org/manuscript/202401.1968/v1

Picture Source: A roadmap of noninstitutional living options for people with dementia: “Don’t fence me in.” by Dr. Maude Lévesque, PhD, Université du Québec à Montréal and Dr. Margaret Oldfield, PhD, Independent Social Scientist & Disability Scholar

According to the published article, “Canadians overwhelmingly do not want to live in long-term-care facilities (nursing homes) when they age; however, many end up there for lack of homecare, because family care partners burn out, or because they and their professional advisors are unaware of alternatives to institutions.“

The published article outlines various non-institutional support options for people with dementia in Canada and other countries, categorized into minimal in-home supports, extensive domestic and medical in-home supports, and out-of-home supports.

1. Minimal In-Home Supports

- Unpaid Care Partners: Whereby Friends and family provide essential emotional and physical support, which saves healthcare costs but can lead to caregiver burnout, particularly among women juggling multiple responsibilities.

- Circles of Support: Whereby Groups of community members create a safety net for individuals with dementia, facilitating supported decision-making.

- Protective Technology: Devices like wearable alerts and medic-alert bracelets help individuals remain safe at home.

- Home Sharing Programs: Seniors can share their homes with students or others for companionship and support, though compatibility and zoning issues may arise.

- Naturally Occurring Retirement Communities (NORCs): Apartment buildings where a significant portion of residents are seniors can offer in-home support services through partnerships with senior-serving agencies.

- Hub-and-Spokes Model: This approach connects seniors in various living arrangements to centralized health and social services.

2. Extensive Domestic and Medical In-Home Supports

- Community-Based Geriatric Assessment: Early assessments can significantly reduce the need for institutionalization.

- Paid Home Care: More affordable than long-term care institutions, though underfunded in Canada compared to other countries.

- Reablement Programs: Focus on restoring independence and skills among seniors, which can reduce the need for institutional care.

- Healthcare Cooperatives: Community-based initiatives fill gaps in traditional home care, allowing seniors to hire their own support workers.

3. Out-of-Home Supports

- Community-Based Supportive Housing (CBSH): Alternatives to traditional long-term care facilities, CBSH provides smaller, more home-like settings for individuals with dementia.

- Multigenerational Housing: Expanding homes to accommodate family members allows seniors to stay close to family while receiving support.

- Cohousing and Nonprofit Housing Cooperatives: These models promote communal living with shared resources, fostering a supportive community.

- Pocket Neighborhoods: Small, car-free communities encourage neighborly interaction and can include provisions for caregivers, reducing isolation for seniors with dementia.

The article emphasizes that while many of these options exist, there is a significant need for improved funding and support from government and community structures to enhance the quality of life for people with dementia and their caregivers.

Long term care facilities and Retirement Communities have been a long existing living solution for people with dementia, but if there is anything that this article helps us understand, is that there are other living options to consider, based on the individual preference and case scenario. With that we need to be proactive both in understanding the options available, but also understand the cost and funding associated for each. This is becoming increasingly important, as more and more news publications out there are touching on the fact that a significant percentage of Canadians will be diagnosed with dementia in the coming decade. To read the full publication, click the link below.