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2017: Standards for Residential Care Facilities in Europe

Country comparisons

It gives me great pleasure to present this comparative report on standards for residential care facilities in Europe. Most people with dementia live in the community. However, some, due to dementia or other conditions, may need to move into residential care, or some people living in residential care facilities may develop dementia at some point of their lives. Moving into residential care is a significant life event and can be quite challenging for many people, this decision may be even more difficult for a person with dementia. Several issues, such as when to make decision, which care home to choose, or other practical aspects of care, such as having to share a room or not being able to decide about meals or when to go to bed, are often concerns expressed by older people and may make moving into residential care particularly difficult.  

Every person living in these settings should have the same rights and opportunities to enjoy a meaningful and good quality of life. People with dementia often have more complex needs than other residents. Also, as dementia progresses, the person may be less able to defend his/her interests and rights, make decisions or communicate preferences.  

This report provides an overview of the existing care standards and regulatory requirements that residential care facilities need to meet. The report addresses key areas that have a great impact on the lives of residents, namely, the physical environment, the staff providing care, health and social care and human rights, end-of-life care and abuse and restraint. Some important oversights are identified with regard to how dementia is currently addressed in frameworks and standards in Europe, however, it also provides some examples of good practices and standards where the specific needs of residents with dementia have been taken into account.  

The report also draws attention to the use of restraint and end-of-life care for people living in residential care settings. This is a great concern as many people, with and without dementia, will spend their last days and moments of life in a residential care facility. Abuse, and specifically, the use of restraint, is also an important topic in dementia care. Alzheimer Europe carried out work in 2012 on the area of restrictions of freedom and the use of restraint. The use of restraint, particularly on frail, older people with dementia, is generally considered unethical or harmful and is rarely if ever justifiable. There may be exceptional cases when this is not so and it could be considered lawful and/or ethically justifiable.

In closing, I want to acknowledge the important work of our member associations and other national experts who provided the information for this report, and Ana Diaz, Project Officer, who coordinated this work. A special mention goes to the members of the European Working Group of People with Dementia and their supporters, who have provided very insightful personal accounts and thoughts on this important topic.

Some of the key issues that still need to be considered at policy level are the formulation of clear and legally binding standards with specific considerations of the needs of residents with dementia, appropriate training for staff, and awareness raising and providing better information to residents, families and staff about their rights and what they should be able to expect from care. We hope this comparative report will be useful in advancing the understanding of this topic and improving the standards of care and the quality of life of people with dementia in residential care.

Jean Georges

Executive Director, Alzheimers Europe



Last Updated: Tuesday 28 May 2019