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Areas of interest to this report


The impact of the physical environment on health, wellbeing and quality of life is well established (Nordin et al., 2015). In particular, the general layout of the building, the sensory environment and the privacy and autonomy of the residents have received a lot of attention from research (Barnes et al., 2002). A design that promotes independence and supports function is very relevant to residents. This includes for example the existence of handrails and seating along corridors (Potter et al., 2017). Some other elements, that can be particularly relevant to people with dementia, are those related to spatial orientation and wayfinding in the building (Barnes et al., 2002). In relation to stimulation, the existence of specific areas dedicated to sensory stimulation are of great importance, but also, the existence of outdoor spaces (gardens) and the lighting of the building can have an important impact on stimulation. In the 80’s, Ulrich’s work evidenced that patients with rooms with windows looking at a natural scene had shorter hospital stays (Ulrich, 1984 as referenced by Potter et al., 2017). There is also some research evidence highlighting the significance of artificial and natural light on various behaviours in care setting environments, with some research suggesting a relationship between appropriate lighting and improved quality of life (Sorensen and Brunnstron, 1995 as cited by Barnes et al., 2002). Privacy and control over the environment are also important aspects. Private space and home-like environments can enhance the person’s wellbeing (Papoulias et al., 2014). In addition, having control over the environment, (as for example, having (or not) control of heating and ventilation in the resident’s bedroom) has been associated with residents’ satisfaction.

A well-performing health workforce is described by the World Health Organisation (WHO) as one where “there are sufficient staff, fairly distributed, they are competent, responsive and productive” (2007, p.6). Care workers are crucial to the quality of care and quality of life of residents in long-term care settings (Bowers et al., 2000). However, working in residential care has been described as stressful, and often, staff experience work-related stress and burnout (Baker et al., 2015) with the level of turnover in these settings being an ongoing concern among scholars and policy makers (Mukamel et al., 2009). Job satisfaction, on the other hand, has been associated with (i) the opportunity to provide high-quality person-centred care, (ii) effective leadership and teamwork and (iii) resident satisfaction (Schwendimann et al., 2016). In the case of dementia, lack of appropriate training and managing behaviours that challenge can be particularly stressful.

People living in residential care settings should receive care which respects, enhances and protects their human rights. The WHO has recognised the importance of ensuring a human rights-based approach for people with dementia (both living in the community and in residential care settings) and has recommended adopting the PANEL approach, which addresses participation, accountability, non-discrimination, empowerment and legality. People with dementia living in residential care should be able to exercise their human rights in all aspects of their daily lives including respect for dignity, privacy and autonomy, and should be enabled to participate in decisions affecting their lives and in the formulation and implementation of policies that affect them. There is concern that people with dementia may be at particular risk of abuse (Manthorpe, 2014). In the UK, for example, work carried out by the Alzheimer’s Society (2011) has drawn attention to the risks of financial abuse among people with dementia living in the community and in care homes; they are more at risk than others of money management problems, and potentially more vulnerable to financial abuse (2011, p.52).

In sum, the organisation and provision of residential care in Europe is heterogeneous, with relevant differences in the type of facilities providing care, the funding mechanisms and the regulatory systems for the implementation and overseeing of the quality of the care and support provided in these care settings.  The environment, workforce and the care provided are key elements of the quality of care provided and are often part of the minimum requirements regulated in Europe. In addition to those, recent evidence suggest that, residents’ rights (particularly choice and involvement), end-of-life care and abuse (particularly the unlawful or inappropriate use of restraint) may be also key aspects which are highly relevant to the people receiving the care provided in these care settings (European Commission, 2008).






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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