Changes in Long-Term Care for Elderly People with Dementia

SUMMARY Recent changes in dementia care in Canada, based primarily on successes in Sweden and Australia, include clustering small numbers of residents together, delivering care in a flexible and individualized manner, and permanent scheduling of front line multi-skilled staff. This model, generically referred to as “resident-centred” care, has been embraced by practice leaders across Canada, and yet there remain challenges to its implementation in the front lines. An exploratory, qualitative study focussing on front line workers' experience in British Columbia was conducted in 2000. Results revealed five key barriers to full implementation of resident-centred dementia care: workload, resistance to change at all levels, operational realities, resident characteristics, and the design and scale of the built environment. Keys to successfully implementing this approach were identified as: higher staff-to-resident ratios, effective leadership, formal involvement of front line staff in decision making, on-going education and training for all providers, and some rotation of staff scheduling.