Small, homelike care environments for older people with dementia: a literature review

Int Psychogeriatr. 2009 Apr;21(2):252-64. doi: 10.1017/S104161020800820X. Epub 2008 Dec 23.


Background: There is large cross-national variation in the characteristics of small, domestic-style care settings which emphasize normalized living. However, a systematic overview of existing types is lacking. This study provides an international comparison of the care concepts which have adopted a homelike philosophy in a small-scale context. Insight into their characteristics is vital for theory, planning and implementation of such dementia care settings.

Method: A literature search was performed using various electronic databases, including PubMed, Medline, CINAHL and PsycINFO. In addition, "gray" literature was identified on the internet. Concepts were analyzed according to five main characteristics: physical setting, number of residents, residents' characteristics, domestic characteristics and care concept.

Results: 75 papers were included covering 11 different concept types in various countries. Similarities among concepts reflected a focus on meaningful activities centered around the daily household. Staff have integrated tasks and are part of the household, and archetypical home-style features, such as kitchens, are incorporated in the buildings. Differences among concepts were found mainly in the physical settings, numbers of residents and residents' characteristics. Some concepts have become regular dementia care settings, while others are smaller initiatives.

Conclusion: The care concepts are implemented in various ways with a changing staff role. However, many aspects of these small, homelike facilities remain unclear. Future research is needed, focusing on residents' characteristics, family, staff and costs.

Publication types

  • Review

MeSH terms

  • Activities of Daily Living / psychology
  • Aged
  • Alzheimer Disease / diagnosis
  • Alzheimer Disease / psychology
  • Alzheimer Disease / therapy*
  • Consumer Behavior
  • Cross-Cultural Comparison
  • Deinstitutionalization
  • Facility Design and Construction
  • Group Homes*
  • Health Facility Size
  • Homes for the Aged
  • Humans
  • Long-Term Care / psychology
  • Nursing Homes
  • Social Environment*