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Homelike Models in Long Term Care: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet].


Gray C, Farrah K.


Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jun.
CADTH Rapid Response Reports.


Canada’s population is rapidly aging. The percentage of Canadians aged 65 years and older increased from 12.1% to 13.2% between 1996 and 2006 – by 2016 the percentage had reached 16.5%.1 Based on these Census data,1 it has been forecasted that 263,000 Canadians will require long-term care by 2035.2 Long-term care facilities offer accommodations and 24-hour care (e.g., health services, personal care, and meals) for people who are unable to live at home.3 In Canada, long-term care is under provincial and territorial legislation, and there is wide variation in delivery and cost coverage across jurisdictions.3 Traditional long-term care facilities are large institutions with rigid schedules that provide little autonomy for residents, and residents in these settings have reported feeling bored, lonely, and helpless.4 Alternative models of long-term care have been developed to overcome the limitations of traditional models, with the aim of improving quality of life, quality of care, and satisfaction of residents. “Homelike models of care” broadly represent one such alternative model. In terms of the physical environment, homelike care facilities are designed to feel less like medical institutions and more like homes. Although required components are not strictly defined, common elements of homelike care models include: small group living clusters; high staff-to-patient ratios; staff wearing their own clothes instead of uniforms; comfortable, homelike furnishings; and natural elements such as plants, natural sunlight, and access to the outdoors. From a patient perspective, sense of home is determined by psychological factors (i.e., feeling acknowledged, preserving one’s habits and values, perceiving autonomy and control, and coping), social factors (interactions and relationships with staff, other residents, family, and friends; pets), and the built environment (i.e., private- and public space, personal belongings, technology, look and feel, outdoors spaces, and location).5 The objective of the report is to summarize the evidence regarding the clinical effectiveness, cost-effectiveness, and guidelines regarding homelike models of care for residents of long-term care facilities.

Copyright © 2019 Canadian Agency for Drugs and Technologies in Health.


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