The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents. The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this. Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found. Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of family care givers. Those in small-scale living facilities were found to be less burdened and more satisfied with nursing staff contact than those in traditional style wards. In terms of the general effect of the different settings upon the well-being of residents, there seems to be much less difference between the small-scale care setting and the regular setting of traditional institutions. The greatest differences are within the satisfaction levels experienced by family care givers and individual nursing staff members.

When therefore considered in terms of their effect upon residents, those receiving care, and those who are presumably the most important component of dementia care, it appears that physical setting makes little difference to well-being when all other things are equal. This is an important finding and a potential focus of future research not only for dementia care, but for elderly care in general.

In terms of emotional well-being Lyness (2009) focuses on the general effects of aging, one of which is the rise in the rate of depressive conditions. These in themselves are a problematic healthcare concern, especially in the light of an increasingly aging society. Again, the effect of healthcare setup and institutionalization, as well as the effect of family involvement, make rich grounds for research to find effective ways of mitigating the harsher effects of aging.

If seen in the light of the above, this does not necessarily mean that home or family care is better than institutional care for the elderly who are dependent upon others for their daily care and activities. Depressive symptoms can be as prevalent in a home type setting as in an institution. When considered in terms of the psychosocial support that visiting family members can provide, residents in institutions might even be less prone to depression than those in home settings. Indeed, in a home setting the lack of expertise and general fatigue in family members might be the cause of problems such as abuse or neglect, which would certainly be conducive to the depressive effect.

Youngmee and Schultz (2009) focus their research on cancer and terminal illness, but compare the role of family...

It is undeniable that the home care setting would create various burdens for the family taking care of the elderly loved one. Burdens such as the emotional, financial, and psychological must be taken into account before making the decision to care for an elderly loved one. It is not a decision that should be taken lightly, and one that certainly cannot be made across the board for all families and all situations. In some cases, it is simply better to provide institutional care for elderly persons, especially if they suffer from conditions that require constant clinical care. All families also do not have the stability and emotional and/or psychological rigor it requires to constantly care for an infirm elderly person.
In conclusion, it is difficult to take a position regarding the ideal setting of elderly care that applies to all situations. The best position is perhaps an investigative one. Conditions such as financial stability, emotional prowess, psychological make-up, and like as they manifest in a family unit should be thoroughly assessed before making the decision to care for an elderly person in a family home. Some families, on the other hand, prefer the burden of this type of care to what is perceived as a relatively impersonal institutional setting.

On the other hand, institutional settings are best for families who are already burdened with responsibilities such as work for both life partners, children who are already in the marriage, and/or the drive to establish a career before taking too many family or home responsibilities.

The best approach is therefore probably to individualize the decision according to circumstances in the family home as well as the condition of the elderly person, and to remember that institutionalization does not mean abandonment.