Artículo

ISSUES AND INNOVATIONS IN NURSING PRACTICE
Promoting a good life among people with Alzheimer’s disease
Karin Zingmark Licentiate MSc RN
Department of Nursing, Umea˚ University, Umea˚, Sweden
P.O. Sandman PhD RN
Professor, Department of Nursing, Umea˚ University, Umea˚, Sweden
and A. Norberg PhD RN
Professor, Department of Nursing, Umea˚ University, Umea˚, Sweden
Received for publication 19 September 2001
Accepted for publication 3 January 2002
Introduction
Being at home somewhere is important to human beings.
According to Kelly (1975) the home functions not only as a
description of a possible place in space or time but also as a
symbol of the match between the concrete and abstract arenas
of life. Dovey (1985, pp. 33–61) describes spatial and temporal
order, andidentification as important dimensions of home.The
phenomena of being given a home, creating a home, sharing a
home, and offering a home have been identified as part of the
processofmaintaininga senseof ‘at-homeness’throughvarious
stages of life (Zingmark et al. 1995). People with Alzheimer’s
disease (AD) in advanced stages may show that they do not feel
at home (Sandman et al. 1986, 1988, Zingmark et al. 1993).
50 Ó 2002 Blackwell Science Ltd
Correspondence:
Karin Zingmark,
Department of Nursing,
Umea˚ University,
S-90187,
Umea˚,
Sweden.
E-mail: karin.zingmark@nll.sc
ZINGMARK K S ANDMAN P O & NO RBER G A (2002)ZINGMARK K., SANDMAN P.O. & N ORBE RG A. (2002) Journal of Advanced
Nursing 38(1), 50–58
Promoting a good life among people with Alzheimer’s disease
Aim. To illuminate the meaning of offering care and a place to live to people with
Alzheimer’s disease in a special care unit.
Rationale. There is a need to gain a deeper understanding about so called ‘homelike’
care settings, and about how to promote experiences of being at home in residents
with Alzheimer’s disease. The study is part of a long-term study in a special care unit.
Methods. The study comprises phenomenological hermeneutic interpretation of
interviews with 10 care providers.
Results. The analyses revealed a number of caring aspects such as, for example,
‘viewing dignity and striving to preserve a sense of self in the resident’, ‘encouraging
a sense of belonging’, ‘offering relief’ and ‘promoting a sense of power and control in
the resident’, although integrated and reflected in each other. The caring aspects
constituted the themes confirmation, familiarity, communion and agency considered
as dimensions of the good life.
Conclusion. To avoid simplification in which, for example, the furniture from a
certain decade become the standard for good care, it seems important to focus upon
the meaning of the good life. Care that promotes a good life of people with
Alzheimer’s disease seemed relationship centred.
Keywords: Alzheimer’s disease, agency, at-homeness, care providers, communion,
confirmation, familiarity, interview, phenomenological hermeneutics

Caring for people with AD
The creation of special care units (SCUs) has been suggested
as a way of facilitating the interaction between people with
dementia and their new living place (Cohen & Day 1994).
SCUs with a small number of residents and care providers,
and a homely, domestic setting, labelled variously, collective
living units (Kihlgren et al. 1992), group-living units
(Annerstedt et al. 1993), and group-dwellings (Zingmark
et al. 1993) in Sweden, have been developed to meet the
unique needs of people with AD (Annerstedt 1993, Ha¨gg-
stro¨m & Norberg 1996). In comparison with nursing home
care SCU care has been found to offer a more individualized
care setting, more activation and supervision, and to be more
relationship orientated. Residents have been found to show
more involvement in social activities, and less deterioration in
intellectual functions (Karlsson & Paulsson 1991, Kihlgren
et al. 1992, Kuremyr et al. 1994). However, the special
nature of SCUs has also been questioned (Holmes et al. 1997)
as, in a sample of SCUs and traditional nursing homes, only a
few significant differences in terms of the amount of care
provided in the respective settings were revealed.
The development of SCU care is considered to be a result of
reactions to an institutionalized care culture with its concom-
itant risks of isolation and estrangement, and many studies
exploring the efficacy of inventions in the care of people with
AD have shown positive outcomes to person-centred care, and
‘homely’, or ‘homelike’ care settings (Sixsmith et al. 1993,
Kitwood et al. 1995). SCU care has also been found to affect
care providers. Comparing SCU care and care in traditional
nursing home settings, Kuremyr et al. (1994) found that care
providers in the SCU showed significantly lower scores on a
burnout measure, although they also reported, in addition to
very positive attitudes towards their residents, emotional
exhaustion and a feeling of being over-utilized connected with
the close caring relationships that had developed. In a
long-term study of three SCUs, Melin-Emilsson (1998,
pp. 251–255) found that those who considered their work
meaningful were those who spent much of their time with
residents. Those who expressed disappointment were more
likely to engage in tasks that did not directly involve residents.
The study
Background and aim
This study is part of a field study in a SCU, entailing
20 months of participant and nonparticipant observations of
the care provided, and interviews with care providers. The
general aim is to gain a deeper understanding about the
everyday life of people suffering from AD, and about how to
promote experiences of being at home in the environment
and with the care offered (Zingmark et al. 1993). The
particular aim in this study is to illuminate the meaning of
offering care and a place to live to people with AD in a SCU.
Setting
The SCU was located in a house built at the beginning of the
20th century in the northern part of Sweden. Residents
owned the furniture and all the things in their private rooms.
Shared spaces were furnished to look as homelike as possible.
Both residents and care providers wore ordinary clothes.
They had meals and coffee together. The activities of daily
life were ordered in such a way as to be as natural and
homelike as possible. Residents were encouraged to partici-
pate in activities as much as they could.
Six women with a long history of observed cognitive
decline (8–17 years) lived in the SCU. As long-term partici-
pants in a community-based medical project (Andreasen
2000, p. 34) they had previously been examined at the
neurogeriatric section of the hospital, and clinically assessed,
which included classification of the dementia according to
DSM-III criteria (APA 1987), while the diagnostic subgroup
(AD) had been classified according to NINCDS ARDRA
criteria (McKhann et al. 1984). The Mini-Mental State
Examination (MMSE) was used for the estimation of the
degree of dementia (scores 0–30). At the time of the study
care recipients MMSE-scores were 0, 0, 1, 2, 2 and 9, which
means that they were suffering from severe dementia
(Folstein et al. 1975). They were 67–80 years old.
The staff/resident ratio at the SCU was 1:20 including night
personnel. Two care providers working different shifts were
primarily responsible for the care plans of one resident, while
the daily life activities were performed as team-work. The
care work, was in many ways organized as at home. Apart
from the chief physician’s regular visits to the SCU, physi-
cians from the hospital could be consulted when needed, as
could physiotherapists and occupational therapists.
Methods
Subjects
Interviews were conducted with nine enrolled nurses (ENs),
with 2 years of nursing education at upper secondary level,
and one registered nurse (RN) with 3 years of nursing
education at academic level. They had been caring for
people with dementia for 3–25 years (Md. 10Æ5), and were
30–52 years old. From among 70 applicants, the care
providers had been carefully selected to work at the SCU
Issues and innovations in nursing practice Promoting a good life among people with Alzheimer’s disease
Ó 2002 Blackwell Science Ltd, Journal of Advanced Nursing, 38(1), 50–58 51

for their skill and their interest in developing care to people
with dementia. Nine women and one man were interviewed.
Interviews
Personal interviews were conducted by the second and third
authors 2 years and 4 months after the establishment of the
SCU. An interview guide was used, with questions focused on
the meaning of offering care and of being a care provider in a
SCU. The guide included both broad open-ended questions
seeking views of the care in general, and what care providers
considered beneficial/less beneficial/negative in the model of
care, and more specific questions about the content of the care
(for example, How do you handle situations with communi-
cation problems?), and care context (for example, What do
you mean by a homelike environment?). Each interview was
tape-recorded, and lasted for between 1 and 1.5 hours.
Selection of data
Before they were transcribed verbatim the tape-recorded
interviews were listened to. The transcribed interviews were
read through several times and a selection of data was made.
In this article data about the meaning of offering care in a
SCU are presented, while data expressing experiences of
being a care provider will be presented elsewhere.
Data interpretation
A phenomenological hermeneutic method of interpretation
was used inspired by Ricoeur (1971, 1976), and further
developed in nursing research at the universities in Scandi-
navia for illuminating the meaning of particular caring
phenomena. The method described, and used by So¨derberg
(1999, pp. 22–23) and Talseth et al. (1999), involves move-
ments between the whole and the parts of the text, between
understanding and explanation, nearness and distance, and
between de-contextualization and re-contextualization. The
interpretation was performed using the following steps, that
went back and forth and thus were not as linear as the
description suggests:
• Impressions of the text as a whole were used as the starting
point for the structural analysis.
• Meaning units (a sentence or sentences connected by their
meaning content) were identified and read through several
times.
• In the structural analysis all meaning units were compared
with each other, sorted according to their meaning, in a
back and forth movement, condensed and abstracted into
eight themes (caring aspects).
• Each of the eight themes was interpreted and reflected upon
regarding its meaning in the context of care of people with
dementia. The findings in all steps of the analysis were
reflected upon, the original text was read through in the
light of the findings revealed, and, finally, comprehensively
interpreted as a whole.
Ethics
The Research Ethics Committee of the Medical Faculty,
Umea˚ University, approved the study. The care providers
gave their informed consent to the study and were guaranteed
confidentiality.
Results
All care providers considered the model of care beneficial for
the residents and their relatives, and from the view of
providing care. The care provided was described as good
and care providers said that they wanted ‘the same’ for their
parents or themselves if they should ever suffer from dementia
and need care. Experiences from institutional care were
spontaneously referred to, and all care providers felt it was
easier to fulfil their caring intentions in the SCU than in their
previous care settings. Dissatisfaction with the setting was
found in descriptions of residents becoming totally bedridden
for a long period. Because of lack of some facilities there could
be no guarantee that residents could be cared for until their
death, as had been the intention. The text entailed reflections
about the insoluble dilemma that, while residents in the SCU
were offered a ‘homely’ or ‘homelike’ place to live, they were
simultaneously forced to cohabit with unknown people, and
become part of a group constituted by others. Care failures,
difficulties and impossibilities were also expressed. However,
residents’ wellbeing was the focus of the text, explicitly
expressed in such terms as ‘I want them to live as good a life as
possible’, and ‘I want the best for them’. The overall impres-
sion was that the text provided a picture of how the wellbeing
of SCU residents could be promoted. Therefore, the meaning
of promoting wellbeing for people with AD, from the view of
being a care provider, became the subject to illuminate further.
Caring aspects promoting wellbeing among people
with AD
The themes identified as caring aspects promoting the
wellbeing of people suffering from AD are presented in
Table 1, with examples of original meaning units followed by
a summarized description of each theme.
Viewing dignity and striving to preserve a sense
of self in the resident
Expressed both explicitly and implicitly, residents’ worth and
rights permeated the text. Descriptions of their dignity and
K. Zingmark et al.
52 Ó 2002 Blackwell Science Ltd, Journal of Advanced Nursing, 38(1), 50–58

right to be respected were well represented. The process of AD
was described as being connected with visible destructiveness
and problematic behaviour, and the meaning of protecting
residents’ feelings that they were of value, for example by
discretely providing help and sheltering them from disres-
pectful treatment from others, was stressed. The meaning of
looking for residents’ personalities was stressed. The text
revealed how their personal characteristics, over time, had
become evident to care providers. The importance of providing
residents with the chance to preserve their external appearance
was also expressed, for example in being dressed in line with
their previous style, andhavingtheir hairdonein theusual way.
Accepting residents’ ways of being
An acceptance of the way residents spoke and acted was
expressed, as was the intention to make them feel accepted
and allowed to be just as they were. The text revealed that
care providers, as part of the daily activities, talked about and
Table 1 Caring aspects identified, presented with examples of original meaning units
Themes Examples of original text
Viewing dignity and striving to
preserve a sense of self in the resident
It’s about respect, and I want them to live as good life as possible. It’s their right. It’s about treating
others as I want to be treated myself
I have to find their personality, and figure out how they want to be treated, even if they cannot
speak. We learn a lot about the women’s previous lives from their relatives. They often start to
tell spontaneously, and they don’t mind us asking
Accepting the resident’s way of being Even if their talking sounds confusing to me, it’s of importance to them. Often I think they are
dealing with old events that are not finished in their minds
One of the women often thinks that she is on a bus. We try to tell her where she is, but sometimes
she hesitates to believe what we say. Then it’s better to let her go on with her bursting than
arguing pointlessly. She doesn’t bother anyone, and she seems to feel happy with it
Sharing everyday life in a sense
of nearness
It’s very positive to work in such a small unit. One becomes familiar with each other in a special
way. It’s possible to find out how to care for each of them
It’s not always about doing things. An important part of the care is the community. We sit
together, and they can rest. They feel well
Encouraging a sense of belonging In the mornings we usually drink coffee in the kitchen together before they are dressed for the day,
like they are used to
They often return to talk about their mother, and they don’t want to hear that she’s not alive, it’s
the same about the husband, and other family members. But the mother means something in
particular. She’s always been there, as a means of safety, as someone to lean on, that’s what
I believe
Adjusting oneself to the resident
and striving for mutual
understanding
Not always, but mostly I can see what her agony stands for even she can’t tell. It’s not the same
if hungry, tired, or if having pain, for example
It’s the present moment that counts, that’s how I reason. The main thing is that the situation
is good when experiencing it, even if soon forgotten....I have to adjust to their rhythm
Offering relief They are in great need of help, and to me it’s essential not to give help such that they feel
humiliated and not to call attention to the things they do wrong…I have to do my very best to be
their memory and support
Making them feel safe in all their helplessness, that is what I think is important. They feel safe with
us, I think. They don’t know our names, but they recognize us, are familiar with our faces
Providing opportunities for occupation As far as I can see, the kitchen is the place they like most. It’s the centre of the house. A lot of
things happen there, and they are part of what’s going on. When we are baking, for example,
they can participate, and if not, they are at least familiar with it. They recognize what’s going on
One of the women is totally unable to wash the dishes. She can’t manage it and everything
goes wrong. But she can still do the drying-up, and she likes that. It is important to find out
what works
Promoting power and control in the
resident
One must not take things for granted. Even if I have to feed one of the women today, that doesn’t
mean that she always needs to be fed. When less tired she can manage her eating by herself
We usually sings old songs together, songs they all remember. Then they can participate, and
I think one feels well when still able to do things. That gives self-confidence

focused on the present time and place, but descriptions in this
area made it obvious that wellbeing was seen as more
important than orientation. If a woman thought the SCU
was a store, or any other place, in any other time, and
appeared to feel good, care providers just let it be. A similar
attitude was found regarding activities, such as carrying
things around. As long as the person doing it seemed to
perceive the activity as a meaningful occupation, and as long
as no one else was disturbed, no one made anything of it.
Sharing everyday life in a sense of nearness
The sense of nearness established while sharing everyday life
was described as an end for the care in the sense that in itself
it was the most important part of the care. Both the small
number of residents and care providers, and the small-scale
environment were considered to facilitate the development of
close, relaxed relationships, which in turn were seen as
increasing the possibilities of meeting residents’ individual
needs. Residents were described as not particularly connected
with each other, yet the very presence of care providers was
repeatedly mentioned as essential for residents’ wellbeing,
since otherwise it would be chaos.
Encouraging a sense of belonging
Bringing the past of each resident into the present context, for
example certain habits, was described as an important part of
care, but also as a difficult matter since six people with
different lives, who had not themselves chosen to live
together, shared the living place. Becoming familiar with
residents’ life histories was stressed as a condition for care.
Residents’ private belongings, not least photographs from
their pasts, were mentioned as important in the sense of
coming to know about their lives, and so were also conver-
sations with their relatives. In collaboration with relatives,
previous homes and places that had been of significance for
residents were visited as part of the care. Residents did not
say explicitly that they were emotionally attached to their
personal belongings. However, a conviction was expressed
that being surrounded by furniture and things from previous
homes had meaning both for residents and their relatives. The
short distance between the rooms was described as facilita-
ting the creation of a good place for residents to live in. The
concept ‘homelike’ was described as a familiar, safe, pleasing,
functional and comfortable environment, and as meaningful
and familiar activities.
Adjusting oneself to the resident, and striving for mutual
understanding
Care providers expressed the importance of grasping and
valuing the moments that residents perceived as good, even if
they directly forgot them. Pliability, in the sense of synchron-
izing their own rhythm with that of the resident, for example
when walking and talking, stood out as important. The text
also revealed that care providers adapted themselves to
residents’ ways of living by using words that made sense, by
adjusting sound and other stimuli to the level residents could
tolerate, and by not claiming that the way the resident
perceived the world was incorrect. The importance both of
understanding residents and being understood by the them
was stressed. A perceived mutual meaning-making process, in
which fragmented and disoriented verbal communication was
described as containing meaning and relevance, was
expressed. Residents’ behaviour was described as language,
for example ‘the only way they can express themselves’.
Descriptions of wandering, and agony that was interpreted as
expressing basic needs, were found in the text. Women’s
search for their mothers, or talk about going home to their
childhood homes to meet their parents, were understood as
expressing a need for safety, while talk about going home to
take care of small children was interpreted as telling about
concern and a will to do meaningful things. When talking
about the prospects of understanding, care providers used the
expressions ‘reading between the lines’ and ‘seeing’.
Offering relief
Care providers did not use terms such as agnosia, but the
consequences of such problems were often described in the
text. Residents’ difficulties in expressing themselves were
enhanced, and the meaning of understanding expressions of
unspoken needs, and learning how to act and handle things so
that residents were relieved of the burden of the disease were
stressed. Life with AD was described as a safety problem.
Promoting emotional safety by being near was considered
important for relief. So was substituting for losses, preventing
failures and feelings of inferiority, and reducing stress-related
behaviour by always being at hand and when needed,
initiating, preventing or performing on behalf of the resident.
‘Timing’ appeared as a key concept for offering relief through
the process of increasing dependency in residents (not acting
too fast to preserve threatened abilities, not too late to relieve
agony). Previous experiences in the field of care for people
with AD were thought to improve the possibilities of offering
residents relief. The text contained descriptions of care
providers sensing the needs of residents. Having an insight
into the process of AD was described as important, but only a
few descriptions stressing the importance of theoretical
knowledge were found. A need to discuss care situations
with someone outside the setting concerned, with both
theoretical and practical knowledge in the field, was
expressed.
K. Zingmark et al.

Providing opportunity for occupation
The importance of not becoming bound by routine and
thereby setting bounds for residents’ abilities was stressed.
Allowing residents to use their remaining capacity was
stressed as important, and seemed to require flexibility,
creativeness, understanding of AD, and of individual fluctu-
ations. The daily condition the people cared for were in, for
example how they had slept, affected care providers’ choice
of activities. Play and joy were seen as important, for example
having fun together when performing daily activities. The
kitchen appeared to be an occupational arena of great value.
Situations when care providers performed activities and
residents sat beside them were described in terms of occupa-
tion, for example a resident sitting in the kitchen while a care
provider was baking, and watching, smelling and participa-
ting by being there. Drinking coffee, talking and just being
together in silence were also situations described as mean-
ingful occupation.
Promoting a sense of power and control in the resident
A striving to provide opportunity for, and facilitate
autonomy in residents was found, for example by creating
individual hygiene, and eating procedures, and by presenting
options in order to facilitate the residents making their own
choices. Both the need to promote decision-making, and the
importance of not pushing residents to choose and decide
more than they could manage were described. Community
and safety were seen as increasing the residents’ opportunity
to manage everyday situations. The meaning of offering, and
respecting private space was stressed, although the import-
ance of meeting expressed needs not to be left alone was a
dominant subject. Promoting a sense of power and control in
residents was described as a very important and very difficult
matter. On the one hand residents’ right to cry and be angry
were expressed, while on the other hand preventing conflicts
and the exaggeration of anxiety was described as a caring
duty, and responsibilities that were essential for residents’
well-being.
Comprehensive understanding
As illustrated in Fig. 1, the caring aspects identified in this
study were interpreted as promoting confirmation, famili-
arity, communion and agency considered as dimensions of a
good life in people with advanced AD.
Confirmation
According to Buber (1957) every person wishes to be
confirmed in what they are and can become. Confirmation
presupposes a genuine relationship in which both parties are
free to reveal themselves and be just as they are (Friedman
1985, pp. 133–135), and in which messages about the other’s
existence, significance and valid perceptions are given (Cissna
& Sieburg 1981, p. 259). Weil (1962, pp. 9–11) describes
dignity as a sacred self that all human beings share and,
according to So¨derberg et al. (1997), active defence of
another person’s dignity becomes a way of being. ‘Viewing
dignity and striving to preserve a sense of self’, and ‘accepting
the other person’s way of being’ are seen here as interrelated,
and integrated expressions of confirming care of people with
AD. The intention to preserve a sense of self presupposes the
belief that there is a self to preserve, and that the others are
accepted as they are even if their appearance is coloured by
disorientation and fragmentation. The interpretation is that
the identified caring aspects are conditions necessary if a good
life is to be promoted.
Familiarity
Steinbock (1995) describes the homeworld as ‘normal and
typically familiar’ (p. 183). Familiarity concerns the partic-
ular and typical such as style of dress, smells of food, accent,
handling a knife and fork (p. 224), and community. In this
study ‘sharing everyday life in a sense of nearness’, and
‘encouraging a sense of belonging’ were seen as familiarity.
Private belongings were considered of great importance to
residents and also to care providers, as daily reflectors of
residents’ personhood, and as means to gaining familiarity
with their past. Nyman (1989, p. 419) argues that the
phenomenon of ‘thinghood’ carries human values as symbols,
along with practical use. Therefore great openness towards
incorporating residents’ individual meanings of the familiar
in both the environment and care appears to be a prerequisite
Confirmation Familiarity
Communion Agency
· Viewing dignity and striving to
promote a sense of self in the
resident
· Accepting residents’ way of
being
· Sharing everyday life in a sense
of nearness
· Encouraging a sense of
belonging
· Adjusting oneself to the
resident and striving for mutual
understanding
· Offering relief
·Providing opportunities for
occupation
·Promoting a sense of power and
control in the resident
Figure 1 Caring aspects, considered as promoting dimensions of a
good life for people with Alzheimer’s Disease.

for the creation of care units to which the people with AD can
feel related.
Communion
Communion is described as nurturance and expressivity
(von der Lippe & Torgersen 1986), as a sense of mutual
presence and ‘at-one-ment’ (Vest 1987). Marcel (1963, pp.
114–135) describes communion as presence, and claims that
deep in human beings there is a global feeling of a ‘we’
which makes true communion possible. The caring aspects
‘adjusting oneself to the person cared for, and striving for
mutual understanding’ and ‘offering relief’ were interpreted
as expressing both the conditions for communion and
communion itself. Perceived mutuality was expressed, and
situations when care providers felt it possible to understand
fragmented communication, and unspoken dependency
needs, were described. The results correspond to the
suggestion by Berg et al. (1998) and Ha¨ggstro¨m et al.
(1998) that care providers could achieve understanding of
people with dementia by tuning into their affective states,
and rely on their own feelings in the shared situation.
According to Stern (1985, pp. 134–148) the sense of self
starts with the parent and infant being in communion, it
gradually develops to also include cognitive dimensions, and
it is created in interaction with others throughout one’s
history. The process of AD has been described as an ingress
to the core of one’s being (Norberg 1996). As the cognitive
abilities decrease it stands to reason that a person with
dementia increasingly needs to be in communion if their
vulnerable self is to be reached and a feeling of safety is to
be experienced.
Agency
Agency is described as self-assertion, independence, domin-
ance and power (von der Lippe & Torgersen 1986, James &
Lewkowicz 1997, pp. 109–143). It is related to separateness
and needs for autonomy and privacy, manifested in for
example producing and striving for mastery (Bonanno &
Singer 1995, pp. 435–470). In this study ‘providing oppor-
tunity for occupation’, and ‘promoting a sense of power and
control’ were seen as expressions of agentic care. Human
occupation is defined by Kielhofner (1995, p. 3) as ‘doing
culturally meaningful work, play or daily living tasks in the
stream of time and in the context of one’s physical and social
world’. Relating to this study it seemed that giving space for
agency, in the sense of viewing the capacity in the people
cared for and providing opportunity for performance, was an
active support of remaining functions and abilities.
Reflections
The aim with this study was to illuminate the meaning of
offering care and a place to live to people with AD in a SCU.
After a first interpretation aimed at gaining a sense of the text
as a whole, the meaning of promoting wellbeing among
people with AD emerged as the subject to be further
illuminated, which in turn revealed a number of caring
aspects. The caring aspects identified in this study embrace
values, for example, ‘viewing dignity’, intentions, for
example, ‘striving to preserve a sense of self’, and actions,
for example, ‘offering relief’, although integrated and
reflected in each other.
The importance of skill and experiences in the care of
people with dementia was disclosed, and so was knowledge
of AD and its consequences. The caring aspects also reveal
care providers’ view of residents, and what it is good to do
about, for example, sensibility, pliability and flexibility. In a
study of hospice care, Rasmussen (1999, p. 69) argues that
care providers ‘doing’ cannot be separated from their ‘being’,
and that ‘embodied nursing care’ is a prerequisite for the
development of spiritual care promoting meaningful living
amidst dying. In line with this, the interpretation is that care
promoting a good life for people with AD is achieved through
a unification of the personal and professional characteristics
of care providers.
According to the interpretation presented above, promo-
ting confirmation, familiarity, communion and agency
became the meaning of care. Such care presupposes mutu-
ality. Instead of focusing on differences in ways of relating –
to time and place through talking and acting – and striving to
convert the other to a nondementia world, the essence of the
care of people with AD in advanced stages might be to strive
to foster a feeling of being at home in a life world coloured by
AD. Such care presupposes a permissive climate, and a
striving for helping people with dementia to achieve
normality in the midst of an ongoing process of partial
change from what earlier constituted their typical and normal
everyday lives. Without intersubjective community, being
near might mean being intrusive, and being offered care in a
small-scale unit when in need of care is no guarantee of a
good life. On the other hand, the environmental structures
affect residents, and are of great importance for the fulfilment
of care providers’ intentions.
According to the findings in this study, it is desirable for
the environment to be as familiar as possible, for example
having a communal kitchen where everyday activities can
be performed. AD was described as a safety problem to
which care providers responded by being near. The feeling
of being secure is liberating and broadens the space for
K. Zingmark et al.

action, while insecurity and perceived chaos are paralysing
when seen from an agency perspective. Within a close
relationship a secure space for acting could be provided,
and autonomy could be enhanced, at least at some level (by
promoting power and control). According to this study,
care promoting a good life for people with AD seemed
relationship-centred.
Methodological considerations
This study should not be considered as describing an optimal
or idealized care unit. Instead it is to be seen as an
interpretation in which a good life is focused upon. The
understanding about a good life for people with dementia is
in this study gained from care providers, not from residents
themselves.
Practical implications
Terms such as ‘good care’ for people with dementia,
homelike environment and offering a home are often used
without further reflection. Since they appear so obvious from
the individual perspective, there is a risk that they are never
given a shared meaning in the care context concerned.
Without a common view it is difficult for the caring team to
create the ‘special’ that is implied in SCU care. Although a
‘homelike’ setting is a major characteristic of SCUs, the
actual concept has not been accorded much attention in the
literature in this particular field. To avoid reduction and
simplification in which, for example, the furniture and
decorations from a certain decade become the standard for
good SCU care, it is important to focus on the meaning of
offering care in a homelike environment. The concept ‘a
good life’ appears appropriate for care settings to broaden
the perspective, and focus on the fact that people being
cared for are living their lives, with all that means, in the
form and content of care offered. By promoting confirma-
tion, familiarity, communion and agency, a good life can be
promoted. Good dementia care must not merely deal with
the homelike, but with the very essence of the meaning of
being at home.
Acknowledgements
This study was supported by grants from the Joint Committee
of the Northern Health Region of Sweden, and the Depart-
ment of Community Health in the County Council of
Norrbotten. We are grateful to the care providers, and we
thank Ms Patricia Shrimpton, foreign lecturer, Umea˚ Univer-
sity for revising the English.
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