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2017: Standards for Residential Care Facilities

The quality of care provided in residential care facilities in Europe is a complex and challenging topic. There are differences in the way long-term care is organised and provided across Europe due to cultural, economic and political factors. This makes meaningful comparison difficult. In this report, we focused on existing care standards and regulatory requirements that residential care facilities need to meet when providing care. The report does not address other relevant aspects such as the access to or the cost of this type of care.

A high percentage of the population in residential care settings has dementia, not all of whom have a diagnosis. Even though many of the existing standards and requirements for older people in residential care are relevant to people with dementia, only a few address their specific needs. This oversight is important as people with dementia have different and often more complex needs and therefore require a different approach or provisions.

People with dementia in these settings should have the same rights and opportunities as other residents to have a good quality of life. People in more advanced stages of dementia may be less able to defend their interests and rights and to communicate their preferences. Clear, accessible, legally binding standards and appropriate training for staff to address this issue are not yet widespread in Europe. In this way, staff, residents and supporters could be aware and well-informed about their rights and what they should be able to expect from care.

The size of the private and common spaces, access to outdoor spaces, privacy and the right to choose (e.g. whether or not to share a room or what or where you want to eat) are all essential to the wellbeing of residents. Some standards recognise this and provide clear rules, whereas in other countries these factors are often not addressed and it may be possible for residents to share their room with up to 4 other people.

The quality of the care provided is not dependent solely on the number of staff but also on having the right skill mix and on the qualifications, training and experience of the staff. Several countries have strict ratios for personnel or qualifications, whereas others allow for more flexibility. Only a handful of countries had specific legal requirements related to dementia training for professionals on the issues addressed in this report. Dementia training on challenging behaviours or supported decision making would be helpful for the staff providing care and could also have a great impact on the lives of residents.

The use of restraint and end-of-life care for people living in residential care settings are some of the most concerning gaps identified in the report, especially as a lot of people with dementia spend their last days of life and die in these settings. The use of restraint also represents significant ethical and legal challenges and is a topic of particular relevance to people with dementia who may be vulnerable and unable to understand and express their wishes. Restraint should seldom if ever be used on people with dementia, and if used monitored and for the shortest period of time.

Whilst many national dementia strategies have been developed in recent years in Europe, in some countries dementia is not recognised as a public health priority. We hope this comparative report will be useful in advancing the understanding of this topic and improving the stand- ards of care and the quality of life of people with dementia in residential care.






Last Updated: Friday 31 January 2020

  • Acknowledgements

    This Dementia in Europe Yearbook received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
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