Normalcy, Choice, Personhood: Characterizing Multidimensional Wellbeing in Two Congregate Memory Care Living Environments

Congregate living for memory care is complicated especially when considering how multidimensional wellbeing can be supported. Wellbeing is naturally linked to quality-of-life, a concept that’s been studied from various perspectives and involves subjective and objective factors that have been represented through various frameworks. Further, quality-of-life is multidimensional as it relates to individuals, sociocultural contexts and networks, and environmental factors including people’s interactions with and supports from objects and spatiality. The Stroud/ADI dementia quality framework was created to better understand how people with dementia might be better supported by considering a breadth of factors. Our study takes a deep dive into two longitudinal ethnographic studies of memory care congregate living environments, one in the Netherlands and the other in Canada. Collectively across these ethnographies, we engaged in in-depth observations across many years that were augmented by taking fieldnotes and photos, and capturing video; interviews with numerous staff, residents, family, and friends; and content reviews of websites, social media and other publicly facing information. The study herein examined video, photos, and interview transcripts through the Stroud/ADI framework to better understand quality-of-life in these two care environments. The results of this study illustrate how each care space has re-conceptualized traditional nursing home design environments including residents’ sociocultural environment based on creating a home-like ‘normal’ environment and providing layered choices for residents that promote respect of personhood where residents’ physical, psychological, social and emotional needs are ‘met where they’re at’. Through our analysis, five interrelated domains with subdomains emerged including: social and physical environment; quality of care and interdependence; personhood and individual choice; communication and connection; and health. While a perfect congregate care environment cannot exist, the details of our findings highlight how two very different memory care environments provide levels of normalcy, and choice that supports personhood through their designed environments.