The tradeoff between an open or closed unit for residents with dementia: a qualitative study

Abstract

There is growing attention for freedom of movement as part of person-centred dementia care. Although a closed door can reduce safety risks, it also reduces quality of life. Care organization tanteLouise strives for maximum responsible freedom for residents with dementia. Nevertheless, residents are sometimes transferred from an open to a closed psychogeriatrics (PG) department. To explore healthcare professionals' considerations in transferring residents from an open to a closed psychogeriatrics [PG] ward within tanteLouise. Semi-structured in-depth interviews with carers and nurses from open and closed PG and a multidisciplinary focus group. The data has been analyzed thematically. According to the participants, both open and closed PG can provide a suitable living environment, depending on individual residents. Open PG facilitates freedom and self-direction, and closed PG offers security, structure and expert guidance. Before a transfer, the multidisciplinary team discusses possibilities and risks on open PG. Despite this, residents regularly move to closed PG without a valid reason. Participants strive for more freedom for residents with dementia, for which they believe preconditions are still lacking. The provided structure and expert guidance on closed PG must also be present on open PG to maintain freedom for residents with dementia. In addition, a culture change and preconditions from the organization are necessary.