Understanding the need for change in long-term care
Our population is aging rapidly, and this is having a significant impact on the way we live, work, and provide care for older adults. As more people require intensive and continuous long-term care, the demand for high-quality services is increasing. However, the group of people available to provide this care is decreasing, creating tremendous shortages in the health and social care labor markets.
Traditional long-term care facilities are often associated with poor resident outcomes, including inactivity, high levels of neuropsychiatric symptoms, use of physical restraints, and high levels of psychotropic drug use. These facilities may even be harmful to the wellbeing of residents. As a result, there is an urgent need for alternative care environments that can better support the everyday functioning and quality of life of older adults, especially those living with dementia.
Rethinking the long-term care environment
A fundamental shift in thinking about long-term care environments has emerged, supported by a cultural change movement. Increasingly, older people wish to remain in their own homes and age-in-place, as this is an essential part of their identity, social network, and overall wellbeing. However, a substantial proportion of older adults will become frail, develop chronic and complex diseases, and require intensive long-term care, such as that provided in nursing homes or assisted living facilities.
In response, long-term care facilities are progressively aiming to provide care and service delivery in a more home-like environment, supporting residents’ autonomy, identity, and meaningful engagement in activities and social networks. Values such as autonomy, retaining one’s own identity, and meaningful engagement are now key priorities. Technology, including e-health applications, home electronics, and robotics, plays an important role in enabling these goals and supporting both residents and staff.
An interdisciplinary approach to improving long-term care environments
Current evidence indicates that traditional long-term care facilities are often not effective in supporting the everyday functioning and wellbeing of residents. Researchers have aimed to develop evidence-based interventions to improve the wellbeing and daily life of residents with dementia, especially in nursing homes, with mixed results. What is often neglected in practice and research is the need for congruence between the different environmental components (physical, social, and organizational) in order to promote wellbeing and adapted behaviors for both residents and their caregivers.
An interdisciplinary approach is needed to disentangle the environmental working mechanisms that influence daily functioning in older adults, especially those with dementia, in their real-life context. This will increase the effectiveness of quality improvement initiatives and interventions, and inform practitioners and policymakers in the evidence-based design of care environments for older people.
Innovative long-term care environments
Innovative, alternative care environments are being developed that have radically changed the traditional long-term care model. Examples include community-based living concepts, green care farms, shared housing arrangements, and dementia care villages. These projects have in common that they aim to provide a more homelike environment for older people, encouraging remaining capacity and increasing engagement, autonomy, and participation in normal daily life.
The role of staff is also changing, with more focus on encouraging residents’ remaining capacities, instead of taking over tasks, and forming partnerships with family caregivers. Furthermore, most projects explicitly aim for embedding the care environment within the local community and social networks.
Implementing an interdisciplinary approach
Optimizing the long-term care environment requires the input of multiple disciplines to solve the complex problems highlighted in this article. Long-term care environments can include the home, the community, assisted living facilities, care homes, or any facility where people receive long-term care. This necessitates considering the physical, social, and organizational aspects of the environment and how they interact to influence the wellbeing of residents, families, staff, and the broader care community.
Researchers, practitioners, and policymakers must work together to develop a deeper understanding of the environmental working mechanisms that impact daily functioning in older adults, especially those living with dementia. This will inform the design and implementation of effective, evidence-based interventions and quality improvement initiatives that can be tailored to the unique needs of each long-term care environment.
By adopting an interdisciplinary approach and focusing on the interactions between the physical, social, and organizational components of the care environment, we can move towards creating home-like, supportive, and person-centered long-term care settings that truly enhance the quality of life for all who are involved.
Practical tips for improving home-like environments in long-term care
Based on the insights from the research reviewed, here are some practical tips for creating more home-like, supportive environments in long-term care units:
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Prioritize small, homelike settings: Research suggests that smaller, home-like care environments with 7-8 residents can have a positive impact on resident wellbeing and behavior. These settings help foster a sense of community and support.
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Encourage staff-resident interactions: Opportunities for staff and residents to interact, share meals, and engage in activities together can enhance social connections and quality of life. Staff clothing that is more casual and homelike can also facilitate these interactions.
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Implement multidisciplinary assessments: Involving an interdisciplinary team of professionals (e.g., social worker, dietician, nurse, physical therapist, geriatrician) to assess residents can help identify and address a wide range of needs, potentially reducing adverse outcomes like falls.
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Utilize person-centered, enabling approaches: Interventions that focus on residents’ remaining capacities and enable them to participate in meaningful daily activities can have benefits for mood, behavior, and overall wellbeing. Examples include Montessori-based methods and horticultural therapy.
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Leverage technology thoughtfully: Technologies like telehealth, tablet computers, and activity monitors can support resident care, facilitate connections with loved ones, and provide valuable data to inform care practices. However, their implementation should be carefully considered to ensure they enhance, rather than replace, human interactions.
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Empower and educate staff: Providing staff with the knowledge, skills, and autonomy to implement person-centered care approaches is crucial. Ongoing training, feedback, and opportunities for staff to contribute to decision-making can foster an organizational culture that supports high-quality, home-like care.
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Adopt a dynamic, adaptive approach: Long-term care environments must be able to continuously adapt to changing resident needs and environmental conditions. Organizational structures, processes, and leadership that enable this type of dynamic capability can help ensure the care environment remains responsive and supportive over time.
By adopting an interdisciplinary, evidence-based approach to designing and operating long-term care environments, we can create more home-like, person-centered settings that enhance the quality of life for residents, families, and staff. This is an essential step in addressing the growing demand for high-quality long-term care services.
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