Changes in nursing home environment improves Alzheimer’s care

  • Nursing homes of old were modeled for the efficiency of the staff, many being replicas of WWII military hospitals. Times are, thankfully, changing.


    Much of this change in the US has been lead by people involved in the Pioneer Network, an organization dedicated to culture change in elder care. However, world-wide, culture change in the care of the aged is happening in a big way.

    An article on ABC News titled Alzheimer’s Disease: Dutch Village Doubles as Nursing Home, describes a Dutch Village that resembles, according to the article, a stage setting in that the residents live in such a village like atmosphere with a familiar, homey feel, while the actual nursing home activity goes on “backstage.”

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    The article quotes Marianne Smith, assistant professor of nursing specializing in dementia care at the University of Iowa. Smith says, "I'm personally fascinated by the concept of a self-contained village…I don't think it is living out a fantasy as much as it is accommodating the person's desire to live a normal life in a community-like environment. … The program is surely better than the usual care nursing homes that can resemble hospitals."


    The director of the home adds, “…they feel like they're living a normal life, and that's what we think is very important."

    The changing face of nursing homes

    Culture change in nursing homes refers to an evolving change from old models of hospital-like care to newer models that give residents a chance to feel that they are really at home. Often, that home has an old fashioned feel that feels familiar to elders with dementia.


    A couple of years ago, I visited a local nursing home that had been recently remodeled. I was impressed by their small village atmosphere. Rooms were grouped in a private, homey arrangement, with old fashioned gathering places conveniently located to encourage people to mingle. These places were much like local “mom and pop” cafes in small towns and the old neighborhood beauty shops.  Each shop, library, café or other room had a slightly different feel, but all were homey and familiar enough to encourage serenity and a sense of security in an elder.


    The staff at the home dressed in casual clothing and acted as much like friends as is possible when caring for elders with health problems, often including dementia.


    Other homes in my community have “main streets” that are so convincing I can momentarily feel as though I really am visiting a small town. They have kitchens where residents can bake if they choose, game rooms, exercise rooms, art rooms and abundant music, but the feeling of community remains. Small groupings, in cozy environments, often sooth people who are prone to anxiety and confusion.


    Of course, staff members are part of the group, walking around doing their work while they visit with the elders, joking and teasing with those who enjoy a jolly approach, comforting those who need comfort. The residents are shielded from the more medical aspects of the nursing home when possible.


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    Slow is better than not at all

    I’ve been intimately involved with nursing homes for about 25 years, and have seen many changes locally and nationally. I’ve read about many changes worldwide as well. However, the old idea that people go to nursing homes to die, so that as long as they are fed and reasonably comfortable all is well, hasn’t been easy to eradicate.


    Nursing home administrators worry about the cost effectiveness of changing to new, more hands-on, approaches. However, slowly, most companies are finding that seniors who live in a pleasant, homelike environment, and are treated as living beings with stories to tell and interests to explore, need less medical attention and fewer drugs. Problem “behaviors” are lower in these environments, leading to more staff time for pleasant activities rather than simply coping with one crisis after another.


    If your loved one needs nursing home care, what type of home would you choose? I’d guess you’d want one that gives you a feeling that your loved one is enjoying his or her last months or years as much as possible, rather than just waiting to die. I know I did, and still do.


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    Moisse, K. (2012 April 9) Alzheimer's Disease: Dutch Village Doubles as Nursing Home. Yahoo News. Retrieved from


    Bursack, C.B. (2011, August 11) Training frontline caregivers essential to care and can be cost effective. HealthCentral. Retrieved from

Published On: April 17, 2012