# Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process

## TL;DR

This study evaluates how a nursing home can become a dementia-friendly community by analyzing the challenges and successes of a quality improvement project.

## Contribution

The study provides insights into the mechanisms that facilitate or hinder the implementation of dementia-friendly care in long-term care settings.

## Key findings

- Nursing staff play a crucial role in promoting residents' freedom and autonomy.
- Sustainable change in dementia care requires strong organizational commitment and collaboration with external stakeholders.
- Creating dementia-friendly communities involves rethinking care processes and engaging both residents and the local community.

## Abstract

Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core.

For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research.

Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home.

Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents’ autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.

The online version contains supplementary material available at 10.1186/s12913-024-10765-y.