The Small House Model to Support Older Adults in Long-Term Care

Key Messages

• The small house model of long-term care (LTC) is identified internationally by several model names. Although some differences exist between the characteristics of these models (e.g., number of residents, degree of resident freedom, facility design), there are 3 recurring components: functional units with a small group of residents, replication of familiar domestic routines, and some form of decentralized staff.
• The key philosophic difference between the small house model and the traditional LTC model is the heavy focus on person-centred care. This approach to care in the small house model is firmly rooted in freedom of choice and autonomy for the residents.
• Small house models eliminate the strict delineation of roles; staff at all levels are included in the decision-making process. Self-managed and universal work teams are prominent features of the small house model. Frontline staff with strong interpersonal skills are essential for successful implementation.
• No strong trend emerges from the literature with respect to the impact of the small house model on resident-centred outcomes compared with more traditional models of LTC. This is likely due to lack of consistency in the outcomes that are measured and variability among the different small house models. This finding is consistent with other reviews on the topic.
• Literature exploring the Canadian experience with small house models is limited. The majority of identified studies used data from the US or European jurisdictions, which potentially limits its generalizability to the Canadian context.