Skip to main content

Evidence to Improve Care

Dementia

Care for People Living in the Community

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment and Diagnosis
People suspected to have mild cognitive impairment or dementia receive a comprehensive assessment when signs are first identified. If diagnosed with either condition, they are then reassessed on a regular basis or when there is a significant change in their condition.

Quality Statement 2: Interprofessional Care Team
People living with dementia have access to community-based dementia care from an interprofessional team with expertise in dementia care, of which the person living with dementia and their caregivers are integral team members.

Quality Statement 3: Individualized Care Plan
People living with dementia have an individualized care plan that guides their care. The plan identifies their individual needs, those of their caregivers, and goals of care. The plan is reviewed and updated on a regular basis, including documentation of changing needs and goals and the person’s response to interventions.

Quality Statement 4: Named Point of Contact
People living with dementia and their caregivers have one or more named providers on the interprofessional care team who serve as a point of contact to facilitate care coordination and transitions across settings.

Quality Statement 5: Education and Training for People Living With Dementia and Their Caregivers
People living with dementia and their caregivers have access to education and training on dementia and available support services.

Quality Statement 6: Education and Training for Health Care Providers
Health care providers delivering care and services to people living with dementia receive education and training in dementia care.

Quality Statement 7: Access to Support Services
People living with dementia and their caregivers have access to support services that are individualized and meet their ongoing goals and needs.

Quality Statement 8: Caregiver Assessment and Support
Caregivers of people living with dementia are assessed on an ongoing basis and offered supports to address their individual needs.

Quality Statement 9: 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.

Quality Statement 10: Access to Primary Care
People living with mild cognitive impairment or dementia have regular visits with a primary care physician or nurse practitioner who provides effective primary care that meets both their general health care needs and their specific needs related to cognitive impairment or dementia.

7

Access to Support Services

People living with dementia and their caregivers have access to support services that are individualized and meet their ongoing goals and needs.


People living with dementia can live independently for some time; as their condition progresses, they require increasing levels of support to help them remain in their homes and local communities for as long as possible. As such, they and their caregivers need access to a range of services that are timely, responsive, flexible, close to home, and tailored to their individual needs, strengths, capabilities, and choices. They need access to the right services, at the right time, and in the right place to help them in their journey.

For People Living With Dementia and Their Caregivers

Your health care professional should link you with support services that meet your changing goals and needs. Examples of support services include assistance with personal care, help around the house, support groups, and transportation services.


For Clinicians

Offer support services to people living with dementia and their caregivers to help them meet their goals and needs. Advise them on available services and how to access them.


For Health Services

Through adequately resourced systems and services, ensure that people living with dementia and their caregivers can access the support services they need, when they need them. Involve people living with dementia and caregivers in the design, planning, delivery, and evaluation of services. Ensure that health care professionals are aware of and able to connect or refer people to these services.

Process Indicators

Percentage of people living with dementia who have access to individualized support services

  • Denominator: number of people living with dementia
  • Numerator: number of people in the denominator who have access to individualized support services
  • Data source: local data collection

Percentage of caregivers of people living with dementia who have access to individualized support services

  • Denominator: number of caregivers of people living with dementia
  • Numerator: number of people in the denominator who have access to individualized support services
  • Data source: local data collection

Percentage of people living with dementia who have received support services that met their needs

  • Denominator: number of people living with dementia
  • Numerator: number of people in the denominator who have received support services that met their needs
  • Data source: local data collection

Percentage of caregivers of people living with dementia who have received support services that met their needs

  • Denominator: number of caregivers of people living with dementia
  • Numerator: number of people in the denominator who have received support services that met their needs
  • Data source: local data collection
Structural Indicator

Local availability of support services for people living with dementia and their caregivers

Support services

These are a variety of flexible and accessible home care services and community support services are needed to support community-dwelling people living with dementia, as well as their caregivers. Services should be responsive to people’s goals and preferences and tailored to their changing physical, psychological, and social needs. Support services include:

  • Health professional services, such as nursing, occupational therapy, pharmacy, physiotherapy, social work, speech-language pathology, and dietitian services
  • Assistance with personal daily care (e.g., grooming, bathing, dressing)
  • Help to maintain a safe and comfortable home (e.g., cleaning, doing laundry, preparing meals)
  • Help with minor household repairs and maintenance (e.g., yard work, snow removal)
  • Help performing errands (e.g., shopping, banking)
  • Social or recreational opportunities and programs (e.g., adult day programs, support groups, exercise programs, friendly visiting programs)
  • Respite care—this provides caregivers with temporary relief from their caregiving duties. Examples include adult day programs, in-home respite, overnight care, and short stays in a long-term care home (see Quality Statement 8)
  • Transportation—help getting to and from medical appointments, adult day programs, social activities, stores, etc. Examples include public transportation, taxis, and assisted or escorted transportation for those unable to take public transportation
  • End-of-life care (e.g., pain management, medical supplies, hospice services)

People living with dementia and their caregivers should have up-to-date verbal and written information about local services and how to access them.

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone