Quality Statement 9: Safe Living Environment - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

Safe Living Environment

People living with dementia have access to a safe living environment that meets their specific needs, including design modifications and a range of housing options.

Background

People living with dementia should have a living environment that is safe and helps them to live as comfortably and independently as possible. As the disease progresses, dementia impacts peoples’ ability to interact with and make sense of their environment. Environments that are familiar, home-like, and easy to understand are important.

Over the course of a person’s dementia, living environments need to be modified to help the person navigate their surroundings, support their independence, and reduce their feelings of confusion and stress. Design modifications may include nonslip floor coverings, handrails in the shower and beside the toilet to provide support and balance, heat and smoke sensors, and memory cues.

When people living with dementia are no longer able to live safely and independently in their home, they may consider moving to a more supported care setting, such as an assisted-living facility, a dementia-friendly group home, a retirement residence, or a long-term care home.

Housing options for people living with dementia should ideally be financially accessible and in close proximity to their caregivers and family. They should meet the needs and preferences of both the person and their caregivers. Spouses wishing to remain living with each other should have access to environments where this is possible.

What This Quality Statement Means

For Caregivers

You should have a safe living environment that meets your needs. Your health care team can help you understand what changes might be needed, such as memory cues or better lighting. Your team can also connect you with services to assess your living environment. Depending on your needs, you may decide to move to a different living environment.

For Clinicians

Ensure connection with service providers who can help ensure that housing is safe and meets the needs of the person living with dementia and their caregivers.

For Health Services

Ensure that systems, processes, and resources are in place to a make people’s living environments safe and to address individual needs. This includes appropriate design modifications and housing options offering more supported living environments.

Quality Indicators

Process Indicator

Percentage of people living with dementia in the community who reside in a safe living environment that meets their specific needs

Denominator: number of people living with dementia in the community
Numerator: number of people in the denominator who reside in a safe living environment that meets their specific needs
Data source: local data collection

Definitions Used Within This Quality Statement

Safe living environment

A living environment that helps the person living with dementia navigate their place of residence and their community and that supports their caregivers by helping to keep the person safe. The environment should have appropriate stimuli and address potential safety and security hazards inside and outside the residence (e.g., stoves and ovens, unlocked doors, clutter on floors and surfaces, and unfenced yards). A person’s living environment needs should be documented in their individualized care plan (see Quality Statement 3).

Design modifications

These are tailored to the person’s needs and preferences and adapted as needed during the course of their dementia.

Modifications can include changes to:

Lighting
Surfaces to minimize reflections and glare
Floor coverings
Colour schemes and contrasts
Noise and room acoustics (e.g., locate bedrooms away from, and not adjacent to, high-noise areas, minimize background noise)

Modifications can include the use of:

Signage
Glass-fronted cupboard doors so people can see what is inside
Memory cues
Notice boards
Assistive technology (e.g., prompts and reminders, orientation devices) and devices (e.g., handrails)
Safety devices for hazardous items, such as heat and smoke sensors for the stove
Fencing in yards

Housing options

These include:

The person’s own home (independent living)
Assisted-living facilities or supportive housing, such as seniors’ housing, retirement residences, or retirement communities
Dementia-friendly group homes
Long-term care homes

Evidence to Improve Care