Current developments in institutional dementia care aim at the downsizing of facilities and increasing their homelike appearance. Small-scale living facilities are an example of this movement, in which a small group of residents (usually six to eight) live together in a homelike environment. Residents are encouraged to participate in normal daily activities and nursing staff is part of the household with integrated tasks. Despite the increase of these facilities, little is known about experiences of family caregivers of residents and nursing staff.
The objective of this study was to gain an in-depth insight into the experiences of family caregivers and nursing staff with small-scale living facilities.
A process evaluation was conducted alongside the final measurement of an effectiveness study, using a cross-sectional, descriptive design within two types of institutional dementia care in the Netherlands: small-scale living facilities and regular wards in nursing homes. In total, 130 family caregivers and 309 nursing staff workers participated in a survey questionnaire. Additional in-depth interviews were conducted small-scale living facilities with a random selection of 13 family caregivers and 11 nursing staff workers.
Both family caregivers and staff mainly reported positive experiences with small-scale living facilities, especially the personal attention that nursing staff provides to residents, their involvement with residents, and the emphasis on autonomy in daily life. Barriers mainly related to nursing staff working alone during a large part of the day. Family caregivers in small-scale living facilities were more satisfied with the care facility and nursing staff than those in regular wards.
The primary limitation of this study was that the interviews were conducted only in the small-scale living facilities and that they further limited the number of participant interviews. Further, family caregivers’ opinions were given priority over residents, who were excluded from the study.