Small Houses for Individuals with Cognitive Impairment

groups of individuals are institutionalized for the remainder of their lives: convicted murderers and frail older adults. Deinstitutionalization movements have liberated those who traditionally require care and services. Orphanages, psychiatric hospitals, state schools, and institutions for individuals who are developmentally disabled have all been replaced by more humane, community-based treatment options. However, ageism, ignorance, and the lack of an adequately resourced activist group have left intact a failed nursing home system that spends $99 billion annually to care for 1.6 million residents (American Health Care Association, 2002). Background The modern nursing home has its roots in the poor houses and government hospitals of the 18th and 19th centuries. While much about the nursing home has changed, at its core, it remains an institution, closely resembling the total institution described by Goffman (1961) in structure, operation, and outcomes. aBstract The small house model of elder care emphasizes deinstitutionalization as a strategy to reduce the negative outcomes associated with nursing home care. The small house changes the philosophy, architecture, and organizational design of the institution and has been associated with higher quality of life and good quality of care. The intended benefits to individuals with cognitive impairment include better staff understanding of dementia care, improved physical environment, and safe, familiar patterns of everyday living. Initial research has been conducted, and additional research is underway to determine whether the outcomes match the intentions.