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Regulatory framework

Legislative frameworks


Dementia in the regulatory framework

According to the information provided by the participating countries, overall, dementia is not always sufficiently addressed in the regulatory context for residential care. 

In some countries, dementia is addressed in relation to existing facilities (e.g. dementia-specific care units) for the care of people with dementia with behaviours that challenge (e.g. Croatia, France, Italy, Netherlands, Norway, Slovakia, Slovenia). Likewise, in Belgium (Wallonia), the Code of Social Action and Health has specific requirements for facilities with dedicated units for the care of people with dementia. However, the word dementia itself is not used in the legislation [18], as in Wallonia, this word is perceived in a negative way.

In some National Standards (e.g. in Ireland, Malta, UK-Northern Ireland and Wales) there are references to the needs of people with dementia (or of people with cognitive problems). For example, in Northern Ireland, in the Standards for Nursing Homes, in recognition of the high numbers of residents in nursing homes who present with some degree of the condition, three standards (i.e. standards 24 to 26) are specific to the needs of residents with dementia: (standard 24 “Recognising the signs of dementia and responding to need”; standard 25 “Approach to care for residents with dementia” and standard 26 “Understanding and responding to distressed behaviour in residents with dementia”). Also, standard 10, refers to the use of memory, life story work and reminiscence and requires that staff are trained in effective reminiscence work and use a range of aids to stimulate memory and assist with memory (e.g. diaries and note books, visual stimuli and pictures).

Currently in Greece, there is an ongoing consultation, by the Ministry of Health, about introducing dementia-specific requirements into the existing national legislation for state-funded hospices. These requirements will apply to the new five hospices/palliative care units for people at advanced stages of dementia that are planned to operate in different cities in Greece. The National Observatory for dementia-Alzheimer and the Panhellenic Federation of Alzheimer’s disease and related disorders are involved in this consultation.

Some other examples include:

A number of countries have developed guidelines on dementia care. In some cases, this guidance is specific for the care provided in residential care facilities, whilst in others, it refers to dementia care in general:

  • In Ireland, the Health Information and Quality Authority (HIQA) developed guidance for dementia care in residential centres for older people to guide service providers in the provision of high quality, safe and effective care for residents with dementia  (“Guidance on Dementia Care for Designated Centres for Older People”, 2016).
  • France has guidance documents with recommendations, for example: “Support provided to people with Alzheimer's disease or related dementias in health and social institutions”, 2009 and “Support for people with a neuro-degenerative disease in specialised units”, 2017. Both guidance documents were published by the National Agency for the Evaluation and Quality of Social and Health and Social Institutions and Services (ANESM).
  • In Belgium (Flanders), the Centre of Expertise on Dementia has developed an integral frame of reference for the quality of life and care of people with dementia.
  • Scotland has developed standards for dementia care applicable to care in general (published the Scottish Government).
  • An expert group in Germany is currently developing standards for the care of people with dementia.

In Belgium (Flanders), additional funding can be granted to residential care facilities with at least 25 residents with ‘dementia category C’ (i.e. who are incontinent and/or require assistance when eating and are physically dependent on others for moving around, going to the toilet and washing and dressing independently). In addition, dementia officers (i.e. professionals who have completed specific training on dementia accredited by the Flemish Government) can provide guidance on care and optimisation measures to residential care facilities providing care to people with dementia.

In the UK (Scotland), the Care Inspectorate has carried out “dementia-focused inspections” in care homes for older people across Scotland, looking to support improvement by promoting and showcasing best practice and innovation in services which care and support people living with dementia.

In some countries, there are references to the care that people with dementia should receive in residential care facilities in the National Dementia Strategy or Plan:

  • In Finland, the National Memory Programme (2012–2020) states that: “Local authorities and joint authorities will be responsible for providing 24-hour care to people with dementia according to national guidelines. The objective is to reduce the amount of residential care and to increase the availability of treatment alternatives based on housing and personalised services. The Finnish Ministry of Social Affairs and Health, the Finnish Ministry of the Environment and the Housing Finance and Development Centre of Finland will be responsible for coordinating local authorities and joint authorities in their efforts to ensure the quality of the living environments for people requiring 24-hour care and for promoting the development of alternatives based on housing and personalised services. Local authorities and joint authorities will be responsible for providing 24-hour care, in a manner that ensures that the rights of people with mild, moderate and severe dementia are guaranteed and that the chosen service providers have the sufficient know-how to provide care to individuals with dementia”.
  • In France, the different national plans for dementia have aimed at increasing the number of beds in long-term care for people with dementia.
  • In Norway, the Dementia Plan 2020 states that “in nursing homes and assisted living facilities with 24-hour care, new buildings and the modernisation of existing buildings, will make residential facilities more dementia-friendly by creating small departments and housing collectives with space for community living and social activities. The grant scheme of the State Housing Bank imposes certain requirements on the design of living units. They must be based on universal design principles, adapted to people with dementia and cognitive impairment, and equipped for the use of electronic aids to daily living, communication and alarm technology, and other forms of welfare technology”.

Footnotes: 

18 The term used is “disoriented people”.


In Italy, “Nuclei Alzheimer” are nursing and care units for people with dementia with major behavioural disorders.

These units (“Nuclei Alzheimer”) can be found within “RSA” (residential care facilities for people with moderate to severe dementia) and “IDR” (focus on providing rehabilitation, temporary stay).

 

 

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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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