While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.

Der Umgang mit möglicher Selbstgefährdung demenzerkrankter Bewohner durch das selbständige Verlassen des Wohnbereichs wird in Altenpflegeeinrichtungen häufig und kontrovers diskutiert. In dieser Studie wurde untersucht, ob eine milieutherapeutische Intervention in Form eines Vorhangs vor der Ausgangstür die Bewohner am Verlassen des Wohnbereichs hindert. Das wesentliche Untersuchungsziel war es dabei zu erfassen, ob Veränderungen in Verhalten und Wohlbefinden der Bewohner zu verzeichnen sind.

Der Umgang mit möglicher Selbstgefährdung demenzerkrankter Bewohner durch das selbständige Verlassen des Wohnbereichs wird in Altenpflegeeinrichtungen häufig und kontrovers diskutiert. In dieser Studie wurde untersucht, ob eine milieutherapeutische Intervention in Form eines Vorhangs vor der Ausgangstür die Bewohner am Verlassen des Wohnbereichs hindert. Das wesentliche Untersuchungsziel war es dabei zu erfassen, ob Veränderungen in Verhalten und Wohlbefinden der Bewohner zu verzeichnen sind.