Department of Design and Merchandising, Oklahoma State University, Stillwater, OK USA.
Inquiry. 2023 Jan-Dec;60:469580221150565. doi: 10.1177/00469580221150565.
Dementia care organizations face a range of daunting environmental changes and challenges. Internationally, there is a long history of efforts to improve quality of care and life for individuals with dementia. In a time of particular attention to the images of older adults confined to a single or shared room in a care facility due to COVID-19, autonomy becomes the overarching problem, not only because in general institutions limit the freedom of frail elders, but because the existential conditions that create the need for long term care such as chronic disease, cognitive decline, and the need for general support with activities of daily living (ADLs) rail against the autonomy of independent self-sufficiency. Additionally, these environments are institutional in design and size, with little access to outdoor spaces and other amenities. This perspective manuscript addresses the ethics of past and future memory care models, looking specifically at the European Dementia Village (DV) model. This model allows for autonomy and continuation of patterns of daily living through housing integrated with exterior walks, gardens, restaurants, and amenities within familiar and normal surroundings. This pioneering health care experiment negotiates rivaling discourses of intimacy, professionalization, and medicalization. In order to get a deeper understanding of the culture and ethics of this integrated care model, the first two dementia village sites were visited which included meetings with care staff and administrators. Those conversations and observations led to a series of aligned themes relating to the ethics of the DV model which include: the strength of the social approach, clinical support, resident/staff collaborations, and advocating for ethical dementia care. Rethinking the ethics of dementia care entails individual perspectives and group discussions on what can keep individuals social connected within their care community, including focusing on strengths of the individual and normalized daily routines.
痴呆症护理组织面临着一系列艰巨的环境变化和挑战。在国际上，长期以来一直致力于提高痴呆症患者的护理质量和生活质量。在一个特别关注因 COVID-19 而将老年人限制在护理机构的单人或共享房间中的形象的时代，自主性成为首要问题，这不仅是因为机构通常限制脆弱老年人的自由，还因为导致需要长期护理的存在条件，如慢性病、认知能力下降以及日常生活活动（ADL）的一般支持，这与独立自给自足的自主性相悖。此外，这些环境在设计和规模上都是机构化的，几乎没有机会接触户外空间和其他便利设施。本观点文章探讨了过去和未来记忆护理模式的伦理问题，特别关注欧洲痴呆症村（DV）模式。该模式通过与外部步道、花园、餐厅和熟悉正常环境中的便利设施相结合的住房，允许自主性和日常生活模式的延续。这种开创性的医疗保健实验涉及到亲密、专业化和医学化的相互竞争的话语。为了更深入地了解这种综合护理模式的文化和伦理，我们参观了前两个痴呆症村的地点，包括与护理人员和管理人员的会面。这些对话和观察导致了一系列与 DV 模式伦理相关的主题，包括：社会方法的力量、临床支持、居民/工作人员合作以及倡导道德痴呆症护理。重新思考痴呆症护理的伦理问题需要个人观点和小组讨论，以确定哪些因素可以使个人在护理社区中保持社交联系，包括关注个人的优势和正常的日常生活。
