ABSTRACT
Residential care settings for individuals living with dementia have evolved radically over the past 50 years both in terms of design and in the underlying principles that guide those designs. While the design trends have been similar across Northern Europe, Australia, and the US, there are also some notable differences. The traditional, medical model or institutional settings that were common in the mid-20th century have given way to smaller household-based designs where people live in close relationship with other residents and care partners. However, care communities in the US continue to congregate larger groups of residents, often 16–24, and occasionally more, while in other parts of the world six to eight residents is viewed reflecting a residential scale. New models continue to evolve that support individuals in maintaining dignity and contributing to personal and communal well-being. The underlying principles also continue to evolve to reflect greater respect for the personhood, preferences, and capacities of these individuals, as opposed to focusing solely on their needs and deficits. There is clear evidence of what works: the question is how care systems can shift to provide this.
