Background

In nursing homes, people living with dementia represent a large group of residents. As a result, person-centred care — where the individual is placed at the center of care — has high relevance for nursing practice. This care approach is increasingly replacing traditional models and is considered a quality indicator for dementia-specific long-term residential care. Various guidelines and national standards, such as the German expert standard ‘Fostering and sustaining relationships in care for people living with dementia’, call for the implementation of this approach. Managers of nursing homes are therefore expected to operationalize person-centred care for people living with dementia and implement it in daily nursing practice within their nursing homes. International studies show that policies and internal regulations on person-centred dementia care can provide guidance and support for nursing staff in their practice. At the same time, they can facilitate the implementation of this approach in residential long-term dementia care. Policies and internal regulations are often used synonymously with terms such as guidelines, standards, or written procedural instructions.

To measure and describe the existence of facility-specific policies and internal regulations on person-centred behavioral management of people living with dementia, Barbara Resnick and colleagues developed the American “Assessment of Policies for Person-Centred Management of BPSD.” As no comparable instrument exists for the German context, this tool was used by the DZNE to develop the Dementia Policy Questionnaire. The instrument aims to capture person-centred care approaches in nursing homes in Germany.

The Dementia Policy Questionnaire (DemPol-Q) is a tool (questionnaire) designed to assess the existence of policies and internal regulations regarding person-centred care for people living with dementia in nursing homes in Germany. The instrument consists of 19 dichotomous items, 14 of which were translated and culturally adapted from the “Assessment of Policies for Person-Centred Management of BPSD”. In addition, five items were developed based on the literature, focusing on the assessment of regulations and policies related to the implementation of non-pharmacological interventions. The DemPol-Q is intended for use at the organizational level in nursing homes and aims to demonstrate progress in the implementation of person-centred dementia care.

The instrument was first used between June and December 2020 in a national survey study with a randomized sample of 134 nursing homes. Subsequently, an exploratory analysis was conducted to examine whether the DemPol-Q represents the intended construct of person-centred dementia care in nursing homes.

Project Objectives

The aim of the project is to provide an in-depth examination of internal policies and regulations related to person-centred dementia care in nursing homes in Germany. To this end, the study investigates the extent to which the DemPol-Q can be further developed for use in nursing homes.

Methods

The project comprises two phases:

1. A two-stage analysis of internal policies and regulations on person-centred dementia care in nursing homes. This included examining whether and why dementia-specific care units differ in the presence of such regulations compared to conventional units, and how these differences correspond to the facilities’ mission statements.
2. A two-stage exploratory study on the meaning of person-centred dementia care and the role of internal policies and regulations in nursing homes, based on expert perspectives gathered through focus group discussions.

Results

Dementia care units provide more policies and internal regulations regarding person-centred dementia care than conventional units in nursing homes. However, analysis of mission statements showed that these do not align with the goals formulated in those mission statements. Rather, the analysis revealed differing normative understandings of person-centred care across nursing homes in Germany.

The results of the focus group discussions provide insights into the understanding of person-centred dementia care and the role of internal policies and regulations in German-speaking nursing homes, and a description of the development of a person-centred mindset and the regulation of person-centred dementia care in nursing homes.

Implications for Future Research

Based on these findings, future research should explore how policies and internal regulations on person-centred dementia care should be evaluated, and whether such evaluation should be based on a standardized instrument or a formative approach, such as observation.

Furthermore, it is particularly important to continue investigating the nature and design of internal policies and regulations in nursing homes in Germany, and how they should be structured to promote the implementation of person-centred dementia care.