What constitutes ‘good’ home care for people with dementia? An investigation of the views of home care service recipients and providers

Background Our objective was to explore what people receiving and providing care consider to be ‘good’ in-home care for people living with dementia. Methods We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke’s six-step approach. Results Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers’ understanding of dementia and its impact; 2) Home care workers’ demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers’ knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers. Conclusions It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services. Trial registration ACTRN 12619000251123.

Digital Technologies in Dementia Care

Dementia is characterized by significant cognitive deterioration, behavioral and psychological symptoms, and expanding disability. The well-being of people with dementia is influenced by the support provided by caregivers and health professionals. Especially in the past two decades, advancements in digital technology have helped reshape the way care and treatment are delivered. The main goal of the chapter is to describe technological solutions aimed at supporting the independence and safe participation of people with dementia in meaningful activities, as well as promoting their involvement in engaging experiences that seek to delay cognitive decline and diminish behavioral and psychological symptoms. These technologies include distributed systems, robotics, wearable devices, application software, and virtual reality.

Salutogenic Approaches to Dementia Care

In this chapter, the authors address salutogenic approaches in dementia care support, using a resident-centred model of care. Securing patients’ sense of coherence in care settings requires shifting the locus of decision-making power from only staff, to include residents. In this approach, patients manage more tasks themselves, they get not only what they need but also what they want and they engage meaningfully with others and with life in general. The authors explain that implementing salutogenic models of dementia care is not a simple task. It involves reimagining approaches to interpersonal communication, the thoughtful development of meaningful and enjoyable activities, and creative inclusion and engagement of friends and family. Supportive design of facilities includes spaces that provide choice, opportunities for social interaction, and memory-triggering cues that inform persons living with dementia about where they are, who they are, what there is to do to keep occupied, who other people are – in sum, environments that remind them that they are meaningfully engaged, safe and happy. The authors contend that replacing old-fashioned approaches to care with life-affirming environments is richly rewarding. They explain that success in making this switch requires professionals to pivot away from models that see dementia primarily as a disease to be cured, towards seeing living with dementia in terms of maximum health and well-being. They conclude that salutogenesis is a useful theory to guide this transition.