Table 2 An overview of the identified types of innovative living arrangements and their characteristics
Living arrangement | Articles; Country | Number of residents | Articles design | General description | Physical environment | Social environment | Organizational environment |
|---|---|---|---|---|---|---|---|
Small-scale living | 14 Articles [15, 16, 18, 29,30,31,32,33,34,35,36,37,38,39]; the Netherlands, Belgium | 6–16 residents per household | (Quasi-)experimental quantitative (N = 11) [15, 16, 31,32,33,34,35,36,37,38,39], observational quantitative (N = 1) [29], | A small group of older people forming a household together in a home-like environment. Normalization of daily life is emphasized, by supporting their capabilities and focusing on meaningful activities (e.g. social participation and household chores). | The facility resembles an archetypal house, with homelike features (e.g. a kitchen, living room, single bedrooms, and an entrance). | Daily household tasks are centred around activities of daily life (e.g. doing laundry, preparing meals together, and cleaning). Daily life is largely determined by the residents, family caregivers, and nursing staff. There is more personal contact due to the fixed team of nursing staff and person-centred care. | The tasks of staff members are integrated, meaning they carry out domestic, social, and recreational tasks in addition to care tasks. There is often a fixed team of staff members that take care of the residents. |
Green house model | 8–12 residents per household | The green house model was developed by William Thomas and is based on the Eden Alternative in the US. The model emphasizes a homelike environment and significantly transformed care staff roles. | This model includes small-scale and homelike facilities, with a family-style physical environment. | Normalized daily activities are promoted, such as doing laundry or cooking, and green house homes encourage and support autonomy. | Certified nursing assistants, referred to as the ‘Shahbazim’, are at the centre of the green house model. They work in self-managed teams and have integrated tasks (e.g. resident care, household chores, and staff scheduling). Nurses have a more visiting and clinical role. The so-called ‘Guide’, whose office is outside the home, often guides staff members. Green houses are often opened alongside a large nursing home, called a ‘legacy home’. | ||
Shared housing arrangements | 6–8 residents | (Quasi-)experimental quantitative (N = 5) [49,50,51, 53, 54], Observational quantitative (N = 1) [52], Qualitative (N = 1) [48] | This approach is an alternative to regular nursing homes, where a small group of older people in need of care live together in a small-scale, homelike living facility. | It is a regular apartment building, usually in an urban setting, with a small-scale, homelike appearance. | The daily routines focus on ‘family living’ and living as self-determinedly and normally as possible, by doing household chores together. Family is also involved by participating in the daily life in shared housing arrangements and acting as legal representatives. As shared housing arrangements are located in residential districts, residents are encouraged to participate in the social life of the community. | Shared housing arrangements are not connected with residential care, as care is provided by community care services. Shared housing arrangements are long-term, meaning that residents do not have to move to a nursing home when their care needs are increasing. | |
Green care farms | 6–60 residents | In green care farms, agricultural activities are combined with care services for several groups, such as older people with dementia. They provide care in a small-scale, homelike environment on the terrain of a farm. | Green care farms offer a familiar and small-scale, homelike environment. The facility often resembles an archetypal house. Animals, plants, and natural aspects are present. | Green care farms focus on meaningful activities in everyday life as well as autonomy. Residents are encouraged to participate in a range of activities that are meaningful and stimulating, such as domestic (e.g. cooking, doing laundry), work-related (e.g. feeding animals, gardening), social (e.g. coffee break), and recreational (e.g. reading, playing games) activities. Due to free access to outdoor areas, residents always have the opportunity to go outside. | Green care farms differ in the degree of farming and care, meaning that some farms are actual farms with a profitable production. For other locations, care is the main source of income. The farmers are often personally involved in developing the care vision and motivating staff members. Staff members have integrated tasks | ||
Dementia village | 6 Articles [40, 62,63,64,65,66]; The Netherlands, Denmark, Germany | 52–152 Residents, but divided into smaller group homes | Qualitative (N = 5) [40, 62,63,64,65] (Quasi-)experimental quantitative (N = 1) [66] | A dementia village introduces a non-institutional village-type of accommodation, often located in a mid-sized town. It originates from the dementia village of Hogeweyk in the Netherlands. It aims to create an environment that enables residents to live as normally as possible, while still feeling part of the local community. | The village is developed in such a way as to resemble a familiar environment for the residents (e.g. a high street, town square, supermarket, activity centre, connecting paths between residences, and gardens). | Residents are matched and placed into the same home, based on their background. Autonomy is encouraged by normalizing daily life and being able to choose what to do during the day. | The environment is designed to protect, but not restrict the residents. Professional and institutional features are hidden as well as possible. Staff members and caregivers wear clothing that fits the lifestyle, so no uniforms are worn. |
Group homes | 5–12 residents | (Quasi-)experimental quantitative (N = 2) [67, 69], Observational quantitative (N = 1) [68] | A group-living based facility for residents with dementia. | A small-scale and homelike environment in a familiar community. | There is particular attention paid to familiar relationships and each patient’s lifestyle. Staff members live together with residents. | At least one staff member per three residents is allocated as full-time personnel. | |
Intergenerational living | 166 residents | In this living environment, students and older residents live together. This living environment is based on social reciprocity and a feeling of community. | The setting is a large institutional building. | There is one student for every 25 residents in the intergenerational living environment. The students act as ‘good neighbours’ and share experiences and perform activities with the older residents. In return, older residents share their experiences. Reciprocity is key within this vision. The location has a central place in the community. Older people, students, and others in need of support live together and the broader community is welcome as well. | Students who study nursing or medicine are not allowed, to promote a more natural environment. In exchange for free accommodation, students perform 30 hours per month of social-type work. Caregivers and volunteers are in charge of care services and the annual budget. There is a ‘yes’-culture within the organization, to motivate all those involved to propose ideas and solutions. | ||
Other: | |||||||
Household model of residential aged care [73] | Australia | 16–30 residents per household | Qualitative | A homelike environment that focuses on positive ageing and maintaining a sense of ‘self’. | A home-like appearance with a kitchen, dining room, and self-contained apartments. | There are no fixed schedules. Continuous access to food and the ability to choose is central to this model. | The staff member responsible for coordinating the household is named ‘Homemaker’. Staff members are encouraged to work autonomously and perform integrated tasks. |
2 Articles; Ireland | 16–18 residents | (Quasi-)experimental quantitative (N = 2) | This homelike environment emphasizes autonomy and privacy. | This homelike environment features open plan areas. | There are no fixed schedules and autonomy is encouraged by offering choices. | There is a new staff role, called ‘Homemaker’. This person’s role is defined by the kitchen and household tasks. He/she has a constant monitoring presence in the open plan area. | |
Intensive service housing [76] | Finland | / | Qualitative | Homelike housing units located in intensive service housing facilities. ‘Home’ is a strongly emphasized word. | The unit is decorated with the residents’ belongings. Movement is restricted. | The central idea of this arrangement is homemaking, thus prioritizing homelike and domestic-style care. | The resident pays for all services (e.g. Rent, care, meals, cleaning) separately. |
Non-traditional residential care facility [77] | Australia | / | Qualitative | This approach utilizes principles of environmental design to create a dementia-friendly environment. | The building has an open floor plan and a homelike, domestic appearance. | Employees initiate spontaneous group activities, instead of planning them. | / |
Woodside place model [78] | Canada | 12 residents per Household | (Quasi-)experimental quantitative | This approach provides a supportive and secure homelike environment, with a focus on supporting autonomy. | The environment is a small and homelike setting, with a household with a small dining room, kitchen, and bedrooms as the core component. | The social environment emphasizes a normal way of living, adapted to cultural values | / |
small-scale homelike unit [79] | Canada | 12 residents | (Quasi-)experimental quantitative | This approach creates a small-scale homelike unit. | The environment includes a short corridor with single bedrooms and a single-loaded floor plan. | / | In the daytime, 1.5 nurses and two care aides work at the location. |
Homelike dementia care facility [80] | China | 20 residents | Qualitative | This approach aims to create a homelike environment for people with dementia | This environment includes a residential area, activity areas, and common areas | Residents can engage in various activities, including homelike activities (e.g. household chores, exercising). | / |