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 Statements in Brief

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.

Resources Quality Statements Advisory Committee About

Caregiver Assessment and Support

Caregivers of people living with dementia are assessed on an ongoing basis and offered supports to address their individual needs.

Background

Caregivers play a critical role in supporting the health, well-being, and functional independence of people living with dementia. As dementia progresses, cognitive changes interfere with a person’s ability to perform everyday activities and manage their personal affairs. They increasingly require more support and assistance from their caregivers.

While caregiving can be a rewarding experience, it is often described as stressful and can result in considerable physical, psychological, social, and financial impacts. For example, caregivers experience high levels of stress and social isolation and have an increased risk of psychological and physical health problems (e.g., depression, anxiety, cardiovascular problems, and lower immunity). Caregivers also have to balance their caregiving with other responsibilities, such as their careers, family obligations, and own health needs.

Caregivers should be assessed on an ongoing basis to see how they are managing. They should be offered supports that are responsive to their individual needs and the person’s stage of dementia. Supports such as transportation or respite care services should be provided for caregivers to enable them to participate in services or activities.

What This Quality Statement Means

For Caregivers

Caregiving can be a rewarding experience, but it can also be stressful. You should be assessed on an ongoing basis by a member of the health care team or your own primary care provider to see how you are coping and to help you get the supports you need to help you with your caregiving responsibilities. Supports can include training, support groups, home care, and temporary respite care for the person you are caring for. Respite care can give you a break from the caregiving routine and give you time to take care of yourself.

For Clinicians

Ensure that you assess caregivers on an ongoing basis to see how they are managing. If needed, offer supports that are responsive to their needs and the person’s stage of dementia.

For Health Services

Ensure systems, processes, and resources are in place for providers and teams to assess caregivers. Ensure supports are available to address caregivers’ needs.

Quality Indicators

Process Indicators

Percentage of caregivers of people living with dementia who receive an assessment

Denominator: number of caregivers of people living with dementia
Numerator: number of people in the denominator who receive an assessment
Data source: local data collection

Percentage of caregivers of people living with dementia who have received an assessment and are offered supports to address their individual needs

Denominator: number of caregivers of people living with dementia who have received an assessment
Numerator: number of people in the denominator who are offered supports to address their individual needs
Data source: local data collection

Structural Indicator

Local availability of a comprehensive range of respite services for caregivers of people living with dementia that meet the needs of both the caregiver and the person living with dementia

Definitions Used Within This Quality Statement

Caregiver assessment

Caregivers of people living with dementia should receive an ongoing assessment of their individual needs and preferences. This includes, at a minimum, assessment of their emotional, psychological, and social needs.

Caregivers who experience psychological distress and negative psychological impact should be referred to their primary care provider or mental health specialist for assessment and treatment.

Supports

Caregivers of people with dementia should have access to a range of tailored supports. These may include:

Individual or group psychoeducation and counselling
Peer support groups, tailored to the needs of individuals, depending on the dementia stage of the person being cared for and other characteristics
Support and information available by telephone and through the Internet
Training courses about dementia, services, and communication and problem-solving in the care of people living with dementia
Respite services, including planned and emergency respite, such as adult day programs, overnight care, and short-term residential care. These should meet the needs of both the caregiver (in terms of location, flexible timing and duration, and timeliness) and the person living with dementia (in terms of involving meaningful and therapeutic activities and being in an environment that meets their needs).

Supports such as transport or respite care services should be provided for caregivers to enable them to participate in the services and activities described above.

Evidence to Improve Care