Living Alone with Dementia: Testing Community Capacity
More people are living alone in the western world. As people live longer, more older people live alone, the majority of whom are women. Dementia is a major social problem in all ageing societies and the prevalence rate of dementia increases with age. For example, the number of older people living with dementia in Australia is expected to nearly double by 2020. Those who live alone are more likely to be poorer, to be women, and to be less likely to use health services. The policy of ‘Ageing in Place’ is intended to meet the objectives of offering options and choices to clients and their carers, to contain the costs of residential aged care and to strengthen community capacity to look after their own. Early identification, risk assessment and monitoring are becoming key intervention strategies aimed at enabling people to continue living at home with a good enough quality of life. The complexity and uncertainty at end-of-life are particularly marked for people with dementia who live alone when risk factors increase.
This paper reports on the results of qualitative research on the Dementia Monitoring Program undertaken in 2003 at Mercy Family Centre (MFC) New South Wales. The Program is an innovative aged care program that provides intensive support for older persons who live alone at home with dementia. It explored the views of MFC practitioners about what constitutes ‘good practices’ to address the needs of this client group.
A thematic analysis of the research data highlights inter-personal, intra-organisational and systemic tensions which practitioners face in their day-to-day practice. As they continually review the changing risks for clients, relatives, neighbours and community members, the strengths and limitations of community capacity emerge. The paper describes how these sophisticated practitioners use formal and informal sources of social support to ensure the older person’s staying at home with ‘acceptable’ risk for as long as possible. It highlights what causes limits to be reached, what then ensues in terms of formal intervention and how the practitioners manage these tensions.