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Evidence to Improve Care


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.

Advisory Committee Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

Linda Lee (co-chair)
Family Practice Physician and Director, Centre for Family Medicine Memory Clinic
Schlegel Research Chair in Primary Care for Elders, Schlegel-UW Research Institute for Aging Associate Clinical Professor, McMaster University

Jane McKinnon Wilson (co-chair)
Regional Geriatric Program Central, Hamilton Health Sciences

Gillian Barrie
Occupational Therapist, Adult Physical Medicine and Geriatric Health Clinical Lead
VHA Rehab Solutions

Nirmala Bowman
Lived Experience Advisor

Beryl Cable-Williams
Lived Experience Advisor

Jo-Anne Clark
North East Specialized Geriatric Centre, Health Sciences North

Phyllis Fehr
Lived Experience Advisor

Jami Finlay
Support Services, Alzheimer Society of Elgin–St. Thomas

Carol Holmes-Kerr
Lived Experience Advisor

Kelly Kay
Executive Director
Seniors Care Network

Donna Kearney
Nurse Practitioner
Cottage Country Family Health Team—Muskoka

Lori Lawson
Director of Community Support Services
St. Joseph’s Home Care, St. Joseph’s Healthcare Hamilton

Sandy Linseman
Grand River Hospital Corporation

Carrie McAiney
Associate Professor
McMaster University

Scott McKay
Family Practice Physician, London Health Sciences Centre
Associate Chair, Department of Family Medicine, Western University

Kelly Milne
Regional Geriatric Program of Eastern Ontario, The Ottawa Hospital

Rakhi Mistry
Care Coordinator
Mississauga Halton Community Care Access Centre

Frank Molnar
Geriatrician, Medical Director
Regional Geriatric Program of Eastern Ontario, The Ottawa Hospital

Craig O’Brien
Nurse Practitioner
Lakelands Family Health Team

Dawn Robinson
Psychogeriatric Resource Consultant
Alzheimer Society of Peel

Dallas Seitz
Geriatric Psychiatrist, Providence Care
Assistant Professor, Queen’s University

Deana Stephen
Community Support Services—System Navigation
Canadian Red Cross

Carmela Tartaglia
Toronto Western Hospital

Natalie Warrick
Senior Research Associate
Dementia Capacity Planning Team, Ontario Renal Network, Cancer Care Ontario

Julie Wheeler
Community Programs, Region of Waterloo

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