Exploring how residential care facilities can enhance the autonomy of people with dementia and improve informal care

Jogé Boumans,Leonieke C Van Boekel,Katrien G Luijkx,Caroline A Baan,Marjolein Ea Verbiest

doi:10.1177/14713012211030501

Abstract

Background and objectivesResidential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, although this is difficult. This study explored how RCF staff can enhance autonomy and improve informal care by looking at the influence of interactions (contact and approachability between residents, staff members and informal caregivers) and the physical environment, including the use of technologies.Research design and methodsA realist evaluation multiple-case study was conducted using document analyses, eight semi-structured interviews with staff members and relatives and 56 hours of observations of residents across two RCFs aiming to provide person-centred care. Realist logic of analysis was performed, involving Context-Mechanism-Outcome configurations.FindingsThe behaviour, attitudes and interactions of staff members with residents and informal caregivers appeared to contribute to the autonomy of people with dementia and enhance informal care provision. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, although they can support staff members in providing person-centred care in daily practice.Discussion and implicationsThe findings add to those of other studies regarding the importance of interaction between residents, staff members and informal caregivers. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care.

Highlights

Background and objectivesResidential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, this is difficult
residential care facilities (RCFs) staff must be aware of the fact that people with dementia may not have the capacity to carry out a decision, they maintain the right to be involved in the decisionmaking itself (Kitwood, 1997; McCormack, 2001)
The findings below are presented as Context-Mechanism-Outcome configuration (CMOC), which we have themed by elements of the RCF – namely, interactions, physical environment and use of technology and the influence of these elements on outcomes, autonomy and informal care provision

Summary

Introduction

Background and objectivesResidential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, this is difficult. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, they can support staff members in providing person-centred care in daily practice. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care. To gain insight into how RCF staff behaviours enhance the autonomy of residents with dementia, we chose a definition of autonomy used in relation to person-centred care This definition has two elements: (a) decisional autonomy, which refers to the ability and freedom to make choices, and (b) executional autonomy, which refers to the ability and freedom to carry out and implement those choices (Collopy, 1988; McCormack, 2001). The current study focuses on these two essential elements of person-centred care: autonomy and informal care provision (Edvardsson et al, 2010; McCormack, 2001)

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