Shared-housing Arrangements Research Articles

Palliative (farewell) culture in shared housing arrangements : The perspective of everyday nursing practice.

Shared housing arrangements (SHA) are alternatives to long-term care facilities for care-dependent people. The collective perspective of nursing professionals working in SHA in dealing with death and dying is missing in recent studies. This study aimed to investigate the perspective of professionals concerning apalliative (farewell) culture in SHA. In this study two group discussions were conducted with nurses and nursing assistants working in SHA. Data were analyzed using the documentary method, with the aim of working out the professional orientation framework concerning acollective palliative culture. Nurses enable apalliative (farewell) culture. This leads to the fact that hospice services are not used in these SHA. The distance to relatives as well as ashort dying process or incomplete dying support can make asuccessful palliative culture difficult. Depending on the conscious assumption of responsibility for apalliative culture in the nursing concept of SHA, death and dying are discussed at an early stage with the relatives and care-dependent people. The constantly progressing palliative culture in SHA is based on nurses' experiences, general practitioners (GP) and relatives. The family carers' role is ambiguous. If they do what they are supposed to do from the professional nurses' point of view and are closely connected to the nurses, they are viewed positively and as enablers of apalliative culture. If family carers' responsibilities are not communicated and they are not in close contact with professional nurses, they are viewed as opponents of apalliative culture. The GPs are seen as enablers of apalliative culture in both discussions. Atimely discussion on what might happen in the end of life phase, formalized or not, helps all involved groups to be prepared.

DEMENTIA-FRIENDLY ENVIRONMENTS IN THE COMMUNITY – AN INTERNATIONAL PERSPECTIVE ON CONCEPTS AND INTERVENTIONS

Abstract Dementia is one of the major age-related societal challenges and causes enormous demands for persons living with dementia (PlwD). Although dementia is one of the major reasons for relocation into a nursing home, most PlwD want to live as long as possible in a familiar domesticity. Therefore, innovative care concepts for community-dwelling PlwD are being developed worldwide as alternative to traditional long-term care settings. Efforts are made to learn more about dementia-friendly environments in order to improve quality of care and quality of life of PlwD. This international symposium will therefore provide four presentations as well as a concluding discussion addressing new concepts for innovative care environments and measuring dementia-friendliness of the built environment as well as nonpharmacological interventions to support high quality person-centred care. The first presentation explores the functions of 24-hour green care farms as alternative to nursing homes and how these can be transferred to other care settings. The second presentation discusses the impact of moving from traditional care environments to innovative care settings for residents and staff. The third presentation presents results of a cluster randomized controlled trial in German shared housing arrangements where a complex nonpharmacological intervention led to significantly less hospital admissions for PlwD. And the final presentation describes an innovative approach to evaluate the wayfinding infrastructure in urban areas for PlwD and to promote dementia-friendliness in urban living structures. The discussant will synthesize the research findings and lead a discussion of research implications and future directions for policy and practice.

S9: Green care farms and other innovative care environments for older people living with dementia: concept, mechanisms and impact on residents

Key goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable the own lifestyle of older people living with dementia for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed across the world that have radically changed of the physical, social and organizational aspects. This symposium presents examples of these facilities in the Netherlands (Green Care Farms) and Germany (Shared Housing Arrangements) for people living with dementia. These presentations cover the whole spectrum of long-term care from day-care services, assisted living facilities and nursing home care. It focuses on the concepts and their impact on older people living with dementia. Furthermore, it presents an overview of other innovative long-term care environments across the world, aiming to provide care for older people living with dementia. The first presentation will highlight working mechanisms of green care farms as alternative to nursing homes in the Netherlands and how these mechanisms can be transferred to other regular care settings. The second presentation focuses on the potential of green care farming as a daycare service for older people living with dementia from ethnic minority backgrounds. The third presentation discusses shared housing arrangements in Germany and has investigated the impact of a complex care intervention to reduce the number of hospital admissions for people living with dementia in these facilities. The final presentation provides an overview of international concepts of innovative care environments for older people living with dementia and gives insights in their characteristics.

Long-term housing challenges: the tenure trajectories of EU migrant workers in the Netherlands

Finding a new house is an essential but challenging undertaking for migrant workers. Current understanding of these migrant housing trajectories is rudimentary, contrasting migrants with non-migrants, or looks at the housing situation at a certain point in time. This article presents a fine-grained and longitudinal perspective on housing trajectories including less-studied alternative tenures. Using sequence and clustering techniques on Dutch register data, it identifies patterns in tenure registrations of EU migrant workers in the Netherlands, over time. In the first years, alternative private rental arrangements are common, after which some migrants move on to more secure accommodation, while others leave the Netherlands or continue to stay in precarious and/or shared-housing arrangements. A distinction is made between relatively progressive improvement (leading to social rental or homeownership) and stagnating trajectories (long-term private rent, long-term informal registration and long-term shared housing). Regression analyses show how these housing trajectories are differentiated across socio-demographic variables and the structural conditions of the arrival city, as well as by employment sector. The findings contribute to the literature on migrant housing careers and underline the wide diversity of housing challenges. Although migrant workers play a crucial role in the economy, especially lower-income, older and single migrants have limited access to permanent and secure housing.

Assessment of innovative living and care arrangements for persons with dementia: a systematic review

BackgroundAlternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents’ quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects.MethodsSearches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute.ResultsA total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct.DiscussionThe positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations’ preferences with regards to housing in the event of dementia.

An overview of innovative living arrangements within long-term care and their characteristics: a scoping review

BackgroundWithin long-term care, a culture change (e.g. focus on increasing autonomy in everyday life) is leading to the development of innovative living arrangements for older adults. Insight into characteristics of innovative living arrangements, which are described as an alternative to regular nursing homes, is lacking. This review aims to provide an overview of innovative living arrangements and to describe their defining characteristics.MethodsA scoping review was performed following the framework of Arksey and O’Malley. The preferred reporting items for systematic reviews and meta-analyses with extension, for scoping reviews (PRISMA-ScR) was also followed. The databases PubMed, PsycInfo, CINAHL, and Web of Science were searched. Articles, published between 2012 and 2023 were included when they presented an innovative living arrangement as an alternative to regular nursing homes. A thematic analysis was performed, describing the physical, social, and organizational environment of the innovative living arrangements.ResultsFifty-six articles were identified describing seven types of distinct innovative living arrangements: small-scale living, the green house model, shared housing arrangements, green care farms, dementia villages, group homes, intergenerational living, and an ‘other’ category. The themes included supporting autonomy and creating a small-scale and/or homelike environment, which were emphasized in most innovative living arrangements. Other themes, such as involvement of the community, focus on nature, integration of work tasks, and involvement of family members, were emphasized in a subsection of the described living arrangements. Twenty-eight articles reported on the effects of the innovative living environment on residents, family members, or staff members. Most articles (N = 22) studied resident-related outcomes, focusing mainly on quality of life and aspects of daily life.ConclusionMore insight into the mechanisms of the social and organizational environments is needed, which may lead to greater transparency and homogeneity regarding the description of living arrangements. This review shows that more knowledge is needed about the potential key elements of innovative living arrangements, especially related to their social and organizational environment. This may provide a better guide for developers within long-term care.

Agitation and aggression in people living with dementia and mild cognitive impairment in shared-housing arrangements – validation of a German version of the Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF)

BackgroundThe Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF) is a 14-item scale for assessing agitation and aggression, derived from the original 29-item CMAI, and completed by a proxy. Because the CMAI-SF has not yet been validated in German language, the aim of this study is to explore its construct validity.MethodsBaseline data from a cluster-randomized trial to evaluate a non-pharmacological complex intervention for people living with dementia (PlwD) and mild cognitive impairment (MCI) were analyzed. The study sample consisted of 97 shared-housing arrangements (SHAs) in Germany, comprising N = 341 residents with mild to severe dementia and MCI. Trained nursing staff collected data by proxy-rating the CMAI-SF, Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and QUALIDEM. They also conducted the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).ResultsIn an exploratory factor analysis, three factors emerged: “aggressive behavior”, “verbally agitated behavior”, and “physically non-aggressive behavior”. The CMAI-SF total score showed good internal consistency (α = .85), and the factors themselves showed adequate internal consistency (α = .75/.76/.73). The CMAI-SF showed convergent validity with the NPI-NH agitation item (r = .66) and the NPI-NH “agitation & restless behavior” factor (r = .82). Discriminant validity was confirmed by a low (r = .28) correlation with the NPI-NH apathy item. Quality of life decreased significantly with agitation, as the CMAI-SF showed a moderate negative correlation with the QUALIDEM total score (r = -.35).ConclusionsThe 14-item CMAI-SF is a time-efficient, reliable, and valid assessment instrument. Three factors emerged that were similar to those already found in nursing home samples for the original CMAI and the CMAI-SF and in day care samples for the CMAI-SF. The findings provide preliminary evidence that the CMAI-SF can be used instead of the CMAI to reduce time, costs, and burden in future trials.Trial registrationThe DemWG study from which data were used to draft this manuscript was prospectively registered on 16 July 2019 at ISRCTN registry (ISRCTN89825211).

RISK REDUCTION OF HOSPITAL ADMISSIONS FOR PEOPLE WITH DEMENTIA IN SHARED-HOUSING ARRANGEMENTS: THE DEMWG STUDY

Abstract People living with dementia (PlwD) have an increased risk of hospital admission which may result in severe consequences. The DemWG-study therefore aims to investigate whether a complex intervention in shared housing arrangements (SHA) for PlwD reduces the number of hospital admissions. Furthermore, quality of life, risk of falls, and stabilization of cognitive abilities are assessed. The intervention includes motor and cognitive training for PlwD and education of caregivers and general practitioners. The study is conducted in 88 SHA in Germany with a total of 330 PlwD and a 6 months intervention. Data are collected up to 18 months after baseline, including quantitative and qualitative data. Results from caregivers’ perspectives on the intervention designate a perceived improved social interaction, which in turn has a positive effect on living together in the SHA. Based also on the results of the ongoing quantitative assessments recommendations for better care and support will be derived.

INNOVATIVE CARE ENVIRONMENTS FOR PEOPLE WITH DEMENTIA

Abstract As part of the ongoing culture movement within long-term care several innovative care concepts for people with dementia are developing. These concepts radically change their physical, social and/or organizational environment in order to align care services with needs and demands of people with dementia, and providing meaningful activities. The current symposium will discuss the effects and possible working mechanisms of innovative caring environments for people with dementia across three European countries and the US. The symposium will start with a presentation describing the Homestead care model in the Netherlands, which is a care model that was developed following a co-creation study focused on translating scientific knowledge on nursing home care environments into practice. This is followed by three presentations about the effects of three types of innovative care environments for people with dementia: (1) farm based day care in Norway, (2) shared housing arrangements in Germany, (3) green care farms providing 24-hour nursing care in the Netherlands. The three studies on the effects of innovative care environments present a variety of designs (case study, cluster randomized controlled multi-center intervention study, and a qualitative study with semi-structured interviews) to study the effects on various outcomes (activities, physical effort, social interaction, mood, the number of hospital admissions for people with dementia, quality of life, challenging behavior, risk of falls, stabilization of cognitive abilities, daily life). The symposium will conclude with a reflection on these innovative care concepts from a US perspective.

Housing Insecurity Among the Poor Today

Recent events have brought attention to the millions of Americans who struggle to find and pay for housing. Housing has historically been of interest to sociologists, but it has long been subsumed within research on crime, residential mobility, and neighborhoods. In the past decade, there has been a surge of scholarship in an emerging sociology of housing that focuses on housing insecurity, forced moves, landlords, shared housing arrangements, and the stratification effects of housing policy. While other fields typically define housing insecurity as affordability, this new literature shows how housing insecurity is not only rooted in financial constraints but also situated within social relationships that create or dissolve housing arrangements, and is exacerbated or remediated by supply-side institutions and policy. This work makes clear that housing insecurity is not a one-time discrete event but a dynamic process, and that sociologists can contribute not only to measuring housing insecurity but also to understanding the social forces that shape it.

The DemWG study: reducing the risk of hospitalisation through a complex intervention for people with dementia and mild cognitive impairment (MCI) in German shared-housing arrangements: study protocol of a prospective, mixed-methods, multicentre, cluster-randomised controlled trial

IntroductionShared-housing arrangements (SHAs) are small, home-like care environments in Germany. Residents are predominantly people with dementia. The risk for all-cause hospitalisation is consistently higher for people with dementia compared with...

Health-related outcomes in shared-housing arrangements-results of a rapid review

Shared-housing arrangements are relevant as apossible living arrangement alternative to living in anursing home or residing in their own home for people in need of care. The aim was to record demonstrable differences in health-related outcomes between residents of shared-housing arrangements and residents of nursing homes. Arapid review was conducted to identify health-related outcomes in shared-housing arrangements. The literature search was carried out in September 2017 in the databases PubMed, CINAHL, Gerolit and LIVIVO. Comparative studies of German or English language were included when the nursing home was examined as acontrol group. The majority of the 21studies included describes afavorable contribution of shared-housing arrangements compared to nursing homes. Quality of life is afrequently examined outcome that provides evidence of an advantage of shared-housing arrangements, especially for persons with dementia. Avariety of health-related outcomes were examined. The results provide indications of favorable contributions of shared-housing arrangements. For the most part, there is still no conclusive evidence for outcomes based on studies of higher levels of evidence.

What place is there for shared housing with individualized disability support?

Background Individualized funding of disability support services has implications for people’s choices about when to share their home. This paper examines how people with disabilities made choices about who to live with and the factors influencing these choices. Methods This paper discusses data from interviews with 30 people with mostly intellectual disabilities using individualized support services, 21 interviews with family members, four interviews with service managers, and a focus group with five support workers. The data come from a large evaluation of individualized housing support programs in New South Wales, Australia. Results Only some people had the opportunity to choose whether to share and with whom. Their choices were constrained by the range of housing options and their limited experience of them, even when they had support to make choices about shared housing or living alone. In some cases, the choices reflected a conceptualization of people with disabilities as different to other citizens in their rights and expectations about their social arrangements. Conclusion The results have implications for information sharing, housing stock, and the need to challenge the positioning of people with disabilities relative to other people regarding choices about where and with whom to live. Implications for rehabilitation Many people preferred not to live alone, so as to improve their economic and social circumstances, and their choice and control. The choices about shared housing that many people and their supporters made were constrained by their limited experience of housing options or their familiarity with the range of choices made by other people with disabilities. Being able to draw on the material, social, and information resources of family made a big difference to their housing choices. It raises questions for policy implementation about whether individualized support may lock some people into shared housing arrangements by failing to include housing costs in the individual package.

More staff\u2009=\u2009better quality of life for people with dementia? results of a secondary data analysis in German shared-housing arrangements

BackgroundShared-housing arrangements (SHAs) in Germany are an alternative care arrangement for people with dementia. They are disconnected from traditional nursing homes and are often situated in ordinary apartment buildings. Community health care providers serve persons with dementia in SHAs, and there is no official regulation regarding the staff-resident ratio. The association between the staff-resident ratio and the quality of life (QoL) of persons with dementia has not yet been investigated in SHAs.MethodA cross-sectional study was performed in SHAs in Berlin, Germany, using ANCOVA models to analyse whether residents’ QoL (QUALIDEM), as assessed by staff in SHAs, can be explained by the staff-resident ratio, adjusted for residents’ sex, age, length of stay, challenging behaviour (CMAI), cognitive impairment (GDS) and level of care dependency according to the German statutory health care insurance.ResultsIn this study, 58 SHAs with 396 residents (mean age 78.4 years, 69.4% female) participated. The staff-resident ratio was 0.2 and 0.6 for registered nurses and certified nursing assistants, respectively. Associations with QoL were found predominantly for challenging behaviour and cognitive impairment. The analysis showed that there was no significant effect of the total staff-resident ratio (p > 0.05) in explaining the variation in residents’ QoL (total and subdomains). In general, the proportion of explained variance was weak (R2 < 0.216).ConclusionsThe present study did not show a significant association between staffing and residents’ QoL in SHAs. However, further investigation is required regarding the direct interaction between staff and residents. A main focus should be to educate users about the benefits and disadvantages of shared-housing arrangements.

Would you share your home? The multifaceted determinants of preference for shared housing among young adults

Young adults often face barriers in finding affordable housing due to their economic constraints and the fact that they are experiencing a distinct phase of the family life cycle. In response to this situation, there is a growing interest in shared housing as one of the solutions for housing difficulties of young single households in Korea. In spite of numerous studies highlighting the characteristics and benefits of shared housing, we still have a limited understanding regarding which young single households have particular interests in shared housing. This study fills this gap by examining various determinants of preference for shared housing among young single households in Seoul, South Korea. Based on a household drop-off survey of 1000 respondents, this study utilized a binary logistic regression model to identify various determinants—socio-demographic, personal, dwelling, and locational characteristics of young singles—that may affect the preference for shared housing. Furthermore, our analyses accounted for rental housing submarkets to specify how these determinants of preference for shared housing vary across a city as well as neighborhoods stratified by housing rent. Our findings may help planning practitioners and policymakers to provide better shared housing options across neighborhoods and develop housing policies to encourage young people to choose shared housing arrangements.

Shared Housing Arrangements in Germany-An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?

Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”), where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany.

Nutritional status of care-dependent people with dementia in shared-housing arrangements--a one-year follow-up.

Malnutrition in the elderly is an important nursing challenge. Persons with dementia disease are often affected by malnutrition. During recent years, shared-housing arrangements (SHA) for older care-dependent people, frequently with dementia disease, have evolved in Germany. SHA can be an alternative to traditional residential care in nursing homes. The prevalence of malnutrition in SHA is compared to the prevalence in community dwellings and lower than the prevalence of malnutrition in nursing homes. There are no scientific data about the development of the nutritional status of older care-dependent people in SHA over one year. The aim of this study is to describe the nutritional status of care-dependent people with dementia disease living in SHA and to investigate changes over a period of one year. A longitudinal study with a one-year follow-up was performed. Standardised interviews with nurses were conducted concerning nutritional status (Mini Nutritional Assessment--MNA), cognitive capacities (Mini Mental State Examination--MMSE), activities of daily living (Extended Barthel-Index--EBI) and socio-demographic characteristics. Nutritional data were available for 45 residents at baseline and 36 residents at follow-up. At baseline, 45 residents with an average age of 78.4 years living in SHA in the state of Berlin, Germany, were included in the study. Predominantly, residents were female (73.3%) and diagnosed with dementia (88.9%), with a moderate to severe cognitive impairment (MMSE: 10.8) and low daily living abilities (EBI: 33.7). Most residents (80.6%) have a risk of malnutrition regarding the MNA. The average MNA score did decline slightly within one year (t0 = 20.8 vs. t1 = 19.7). Regular screenings for malnutrition using validated standardised assessments, which are easy to apply, should be implemented in SHA to avoid nutritional and health-related problems arising from malnutrition. Flexible structures for care, as in SHA, can facilitate coping with nutritional problems.

Family visits in shared-housing arrangements for residents with dementia--a cross-sectional study on the impact on residents' quality of life.

BackgroundShared-housing arrangements (SHA) are a German type of small-scale living arrangements for people with dementia (PwD). The involvement of family members is one core domain of SHA. But it has not been investigated yet, what are factors associated with family visits and if family involvement within SHA contributes to better residents’ quality of life (QoL).MethodA cross-sectional study including all SHA in Berlin/Germany was performed. Main parameters of interest were residents’ QoL (QUALIDEM) and frequencies of family visits within the SHA. Besides descriptive analyses we used logistic regression and ANCOVA to analyze the data.Results58 SHA with 396 residents (78.4 years, 69.4% female) participated in the study. Older (OR: 1.034; 95% CI: 1.005; 1.064) and female residents (OR: 2.006; 95% CI: 1.018; 3.950) got more often visited by family members. An active participation of family members in SHA contributes on average to a better QoL in terms of social relationship and social isolation (all ANCOVA p < 0.005). A decreased QoL was found for people without family visits compared to those without family members.ConclusionsThe involvement of family members in SHA is common but on a similar level compared to other care arrangements. Staff should convince available family members to visit PwD, in order to improve residents QoL. However, the response rate in the present study was about 13%, which may limit the results.

Influence of living situation on vulnerable elderly: focus on nutritional status.

We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements). For this secondary analysis, a cross-sectional study was performed. For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study. The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs. Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE). Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting. Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings.

Quality of Care and Its Impact on Quality of Life for Care-Dependent Persons With Dementia in Shared-Housing Arrangements: Results of the Berlin WGQual-Study

AimThe aim of study was to evaluate setting-specific quality indicators (QIs) for shared-housing arrangements (SHA) regarding effects of a guided quality development process on resident's quality of life (QoL). BackgroundSHA are a specific German kind of small-scale living facilities for care-dependent persons with dementia. SHA are disconnected from residential facilities and served by community care services. MethodIn a longitudinal cluster-randomised design 104 residents of 34 SHA were surveyed for 1year; the intervention group took part in a quality development process. QIs, physical and psychological health outcomes including QoL were surveyed. ResultsDuring the 1year follow-up, analyses show a positive trend regarding QI-outcomes in the intervention group, but no statistically significant differences could be proved regarding QoL. ConclusionsSetting-sensitive QIs are absolutely essential to measure quality of care in multi-professional settings like SHA. Further research as well as longer study intervals is essential.