Margaret MacAdam, PhD
Senior Vice President and Vice President,
Community Services,
Baycrest Centre for Geriatric Care,
Toronto, ON.

Two of the biggest problems facing patients with cognitive impairment and their families are access to a safe and appropriate physical environment, and access to supportive services throughout the course of the patient's disease. These problems arise because it may become increasingly difficult for the patient to obtain an appropriate level of care in his or her original residence. The options that are currently available to these patients vary widely from province to province but include staying at home, moving to one of the supportive housing projects that are becoming available in many communities, or moving to a long-term care facility. To determine which of these options is most appropriate, one must take into account the needs of the individual patient, his or her prognosis and the resources that are available to the family for maintaining their relative in the community. Because of the progressive nature of many forms of cognitive impairment, housing and care decisions are subject to change during the patient's life span.

The first step in deciding what type of housing is most appropriate is to make an assessment of the individual's needs.