Residential Long-Term Care in Luxembourg: Capacity, Quality and Changing Expectations

Moving into residential long-term care is rarely a single service decision. In Luxembourg, it can bring together accommodation, daily living, nursing and personal assistance, long-term care insurance, family involvement and the governance responsibilities of the establishment in which a person will now live. For an older person and their family, however, the question is more immediate: can this place become a home while providing the support that is no longer sustainable elsewhere?

That question is becoming more important as Luxembourg ages and as policy continues to support people to remain at home for as long as this is appropriate. Successful ageing at home does not remove the need for residential provision. It changes the population likely to require it. People may enter an establishment later, with greater dependency, dementia, multiple long-term conditions or more complex nursing and support needs. Residential services therefore have to function simultaneously as homes, care environments and increasingly sophisticated components of the wider health and long-term care system.

This article develops the residential-care strand of the Luxembourg Ageing, Long-Term Care & Community Support Knowledge Hub. It examines how Luxembourg’s establishments fit alongside assurance dépendance, how capacity should be understood beyond bed numbers, how quality is experienced in everyday life, and why future sustainability will depend on workforce capability, dementia support, health coordination, infrastructure and stronger evidence about outcomes.

Residential care sits inside two overlapping systems

Understanding Luxembourg’s residential sector requires separating accommodation from long-term care entitlement. A person living in a residential establishment has housing, hospitality and living costs associated with the establishment, while eligible assistance arising from dependency can fall within Luxembourg’s long-term care insurance framework.

This distinction matters because assurance dépendance is not simply a residential-care funding scheme. It is a branch of social security designed to meet eligible dependency-related needs irrespective of whether the person lives at home or in an establishment. Assessment is undertaken through the Administration d’évaluation et de contrôle de l’assurance dépendance (AEC), while the Caisse nationale de santé (CNS) administers long-term care insurance and payments within the statutory framework.

For people living in establishments, eligible assistance with essential activities of daily living is delivered through the professional setting rather than through the home-care combination of a recognised informal carer, cash benefits and a réseau d’aides et de soins. The residential environment therefore changes how the care package is organised, but not the underlying importance of assessed dependency.

Accommodation costs remain a separate concern. Where residents do not have sufficient resources to meet the cost of accommodation in an approved establishment, Luxembourg’s social assistance architecture includes the complément accueil gérontologique, subject to the applicable eligibility and financial rules. This separation between dependency-related care and accommodation support is important for international readers because apparently similar residential systems can distribute these costs very differently.

Operationally, it means that entering an establishment is not equivalent to purchasing one undifferentiated package. Care entitlement, accommodation, personal resources and any applicable social support interact around the individual. Clear information for residents and families is therefore an important part of quality, particularly at a point when people may already be managing deterioration, hospitalisation or the breakdown of a previous home-care arrangement.

Luxembourg regulates the establishment as a living environment as well as a care setting

Residential provision for older people does not operate outside public oversight. Luxembourg has a legal framework governing the quality of services for older people, including requirements affecting establishments and other services within scope. The Ministry of Family Affairs, Solidarity, Living Together and Reception of Refugees has responsibilities within this landscape, alongside the separate social-security arrangements governing long-term care benefits.

This creates an important division of accountability. Long-term care insurance determines and finances eligible dependency-related support through its own mechanisms, while the residential establishment must also meet the requirements associated with operating an accommodation and service environment for older people.

That distinction prevents quality from being reduced to whether reimbursable care tasks have been completed. A resident does not experience an establishment as a sequence of insurance benefits. They experience the room, meals, staff relationships, privacy, activities, communication, safety, responsiveness and degree of control they retain over everyday life.

For that reason, quality, safety and governance in services for older people need to extend beyond technical compliance. The strongest evidence asks whether regulatory requirements and organisational standards are producing a consistently good lived experience.

Organisations exploring similar questions can use the Governance Maturity Assessment to test how operational evidence reaches leadership and how recurring weaknesses are converted into action. It is not a Luxembourg regulatory instrument; its relevance lies in the wider governance principle that assurance should connect formal oversight with what people actually experience.

Capacity is not simply the number of available beds

Residential capacity is often discussed numerically: how many places exist and how many will be needed as the population ages. Those figures matter, but they can create false reassurance if they are detached from capability.

A nominally available place may not be suitable for someone with advanced dementia, significant behavioural distress, complex mobility requirements or a combination of nursing and social support needs. A building may contain physical capacity while workforce shortages constrain safe occupancy. Conversely, a well-designed establishment with a stable multidisciplinary workforce may support residents whose needs would be difficult to meet in less specialised environments.

Future planning therefore needs to distinguish at least four forms of capacity:

• physical capacity: suitable rooms, communal space, accessibility and infrastructure;
• workforce capacity: enough appropriately skilled people to provide safe and relational support;
• clinical and support capability: the ability to respond to the actual complexity of residents;
• system capacity: access to medical, hospital, pharmacy, rehabilitation and other external services when residents need them.

These dimensions interact. Building additional places without creating the workforce to operate them moves the constraint rather than solving it. Recruiting more staff into an unsuitable physical environment may leave residents unnecessarily restricted. Increasing residential supply without strengthening health interfaces can generate avoidable transfers to hospital.

The distinction is increasingly relevant as home-based services enable some people with moderate needs to remain in their own homes. Residential services may consequently carry a progressively higher concentration of dependency. Capacity planning needs to anticipate the residents of the future, not reproduce the service profile of the past.

Operational scenario: a vacancy exists, but is it the right place?

An older woman living alone experiences repeated falls and increasing cognitive impairment. Her daughter has been providing extensive support alongside a professional home-care network, but the arrangement has become difficult to sustain after a hospital admission. A residential move is being considered.

One establishment has a vacancy. On a simple capacity measure, the problem appears solved. The more important question is whether the service can meet her needs. She walks independently but becomes disorientated, particularly in unfamiliar environments. She has a history of leaving home unexpectedly, needs support with personal care and becomes distressed when routines change.

A sound admission decision considers more than whether a room is empty. The establishment needs to understand her dependency assessment, cognitive and communication needs, mobility, medication arrangements, personal history and the circumstances that contributed to the breakdown of home support. Her daughter’s knowledge is particularly valuable because she can explain routines that reduce anxiety and signs that indicate deterioration.

If the establishment can provide the right environment and workforce support, the vacancy may represent appropriate capacity. If it cannot, admission may simply transfer risk from the home into an unsuitable residential setting.

The scenario illustrates why support planning and review are relevant at the point of transition. Capacity becomes meaningful only when the available service can respond to the individual who will use it.

Later admission changes the residential care model

Policies that enable people to remain at home are generally aligned with individual preference and can delay or avoid unnecessary institutional care. Yet there is an important consequence for residential providers: successful home support can change the threshold at which people eventually enter an establishment.

A person may arrive after years of increasing frailty, with multiple conditions and substantial assistance requirements. Another may enter because dementia-related risks can no longer be managed safely within the existing home arrangement. Someone else may move following a hospital episode that reveals the fragility of their previous support network.

Residential care therefore increasingly needs to manage complexity rather than merely provide accommodation with assistance. Staff need to recognise deterioration, support mobility, understand cognitive impairment, work with external health professionals and maintain meaningful daily life despite substantial dependency.

This can create tension between operational efficiency and personal rhythm. Higher dependency may encourage services to organise care around staff rounds and predictable workflows. Yet residents still have preferences about when they wake, what they eat, where they spend time and who supports them.

The challenge is to increase technical capability without making institutional routines more dominant. Person-centred planning for older people becomes more, not less, important as dependency increases because the risk of losing control over everyday decisions becomes greater.

Quality is created in ordinary moments

Residential quality can be measured through staffing, incidents, complaints, assessments and other formal indicators. These provide necessary assurance, but none captures the whole experience of living in an establishment.

A resident may be physically safe yet have little control over their day. Another may receive technically competent care but experience frequent changes of staff and repeated explanations of personal preferences. Someone with dementia may have a detailed plan while spending long periods without meaningful engagement.

Quality therefore emerges through ordinary interactions: whether staff knock before entering, whether residents can make choices, whether assistance is rushed, whether food and activity reflect preference, whether family relationships are supported and whether changes in health are noticed early.

For governance, this creates a measurement challenge. Indicators need to identify significant risks without reducing life in an establishment to a collection of process metrics. Information should combine operational evidence with resident and family experience, outcomes and patterns over time.

The Quality Dashboard Builder can help organisations structure comparable quality information around indicators, trends and assurance. It does not define Luxembourg’s regulatory requirements. Its practical relevance is the discipline of asking whether leadership receives a balanced picture of safety, experience, continuity and outcomes rather than a narrow report of completed activity.

Dementia requires environmental as well as workforce capability

Dementia is central to the future of residential long-term care because cognitive impairment changes how people experience both care and place. A building designed primarily around physical accessibility may still be confusing, noisy or restrictive for someone who struggles with orientation.

Effective support therefore combines staff knowledge with environmental design. Familiar visual cues, understandable routes, access to safe outdoor areas, appropriate lighting and spaces that balance social contact with quiet can reduce avoidable distress. Personal history and communication preferences help staff interpret behaviour that might otherwise be treated simply as disruption.

The environment also affects autonomy. A resident who walks repeatedly may be expressing habit, anxiety, purpose or a need for movement. Preventing walking may reduce one immediate risk while increasing distress and restriction. The better question is how the environment and support model can enable movement as safely as possible.

This is where dementia-friendly environments and adaptations connect directly with governance. Design choices influence incident patterns, staff workload, use of restrictive responses and residents’ ability to navigate daily life.

As dementia prevalence grows, specialist capability also needs to spread beyond explicitly specialist units. A system in which only a small part of residential provision understands dementia will struggle if cognitive impairment becomes common across the wider resident population.

That does not mean every establishment must operate identically. It means workforce planning, refurbishment, new construction and quality assurance should anticipate cognitive as well as physical dependency.

Operational scenario: repeated distress is treated as information

A resident with dementia begins becoming distressed every afternoon. She walks through corridors, repeatedly asks to leave and becomes increasingly resistant when staff attempt to redirect her. Several incidents are recorded because of concerns that she may fall.

A narrow safety response might focus on stopping the walking. A more useful review examines the pattern. Staff compare the timing of incidents, speak with her family and consider her life history. They learn that she spent many years leaving work at approximately the same time each afternoon to collect her children.

The team adjusts the daily routine. Meaningful activity is offered before the period when distress normally begins, staff use familiar conversation rather than repeated correction, and the environment is reviewed to ensure that safe movement is possible. Her mobility needs and falls risk remain actively managed, but the objective is not simply to prevent her from walking.

Over subsequent weeks, the frequency and intensity of distress reduce. The establishment tracks the change rather than relying on anecdotal impressions, while family feedback helps determine whether she appears more settled.

The scenario demonstrates the relationship between distress, behaviour support and meaningful activity. It also shows why incident learning should reach beyond the immediate event. Repeated patterns can reveal something about routines, environment or unmet need that requires a service-level response.

Residential care depends on a workforce that can combine relational and technical skill

Buildings do not create residential capacity on their own. Luxembourg’s future provision will depend heavily on whether establishments can recruit and retain enough appropriately skilled workers.

The challenge is shaped by Luxembourg’s distinctive labour market. Health and care services operate within a multilingual country with extensive reliance on cross-border workers. This expands the potential labour pool but also connects residential care to transport, cross-border mobility, competition for labour and differences in language and professional background.

Residents may themselves use Luxembourgish, French, German, Portuguese or other languages in everyday life. Communication therefore has operational consequences. A worker may be clinically or technically competent but still need support to communicate effectively with a resident whose first language differs from their own. For people with dementia, familiar language can become particularly important as cognition changes.

Skill mix matters alongside numbers. Residential teams may need capabilities spanning personal assistance, nursing, dementia care, rehabilitation, medication, nutrition, palliative support and social engagement. Leadership and supervision need to connect those disciplines rather than allow them to operate as separate layers around the resident.

Workforce planning should consequently look beyond vacancies. Useful intelligence includes turnover, continuity, sickness, reliance on temporary staffing, skills distribution, supervision, language capability and the relationship between workforce instability and resident outcomes.

These questions align with wider workforce and practice competence in older people’s services. For organisations wishing to examine future workforce pressure systematically, the Predictive Workforce Risk Module provides a framework for identifying turnover, vacancy, retention and continuity risks. It is not a Luxembourg workforce model, but its underlying focus on leading indicators is directly relevant to residential capacity.

Family involvement changes after admission but does not end

Residential admission can be accompanied by a mistaken assumption that professional care replaces the family. In practice, relatives and other close relationships often remain important sources of identity, knowledge, advocacy and emotional continuity.

Their role changes. A spouse who previously provided extensive hands-on support may become primarily a partner again. An adult child may no longer coordinate every daily task but may continue to explain preferences, notice subtle changes and participate in important decisions.

That transition can be emotionally complex. Families may experience relief alongside guilt. Some may find it difficult to relinquish responsibilities they have held for years, while others may expect the establishment to resolve every difficulty immediately.

Strong residential practice clarifies the new relationship rather than treating family involvement as either interference or unpaid labour. Staff need to understand what the resident wants shared, how relatives can contribute appropriately and where professional accountability remains with the establishment.

Family feedback can also be valuable quality intelligence, but it should not substitute for the resident’s own voice. Where the resident can express preferences, those preferences remain central even if relatives disagree.

This balance reflects involving family and advocates within person-centred support. Residential care is strongest when admission changes the division of responsibility without severing the relationships that matter to the individual.

Hospital interfaces reveal whether residential care is integrated in practice

Residents of long-term care establishments continue to need acute and specialist health care. The quality of the interface with hospitals therefore affects safety, continuity and the resident’s experience of the wider system.

A hospital transfer can expose weaknesses quickly. Information about medication, cognition, communication, mobility and baseline function needs to travel with the person. Hospital teams need to understand what is normal for the resident so that deterioration is not confused with longstanding dependency. The establishment, in turn, needs sufficient information when the resident returns to understand changes in treatment or function.

For a person with dementia, the disruption can be particularly significant. An unfamiliar hospital environment may increase confusion, while prolonged admission can contribute to deconditioning. Returning to the establishment without adequate communication can then create further risk.

Residential services therefore need effective clinical escalation without using hospital as the default response to every change. Access to primary care, nursing judgement and appropriate specialist advice can help distinguish conditions that can be managed safely in the establishment from those requiring acute assessment.

The wider principle resembles transitions, hospital interfaces and system flow in home-based care: continuity depends on information, responsibility and timing across organisational boundaries.

Operational scenario: returning from hospital with a changed level of need

An 86-year-old resident is admitted to hospital with pneumonia. Before admission, he could walk short distances with assistance and eat independently. After ten days in hospital, the acute illness has improved, but he is weaker, requires more help with transfers and is eating less.

The residential establishment cannot treat discharge as a simple return to the previous care plan. His baseline has changed. Staff need information about medication, mobility, nutrition, any ongoing clinical monitoring and the rehabilitation potential identified during the hospital stay.

On return, the team reassesses how he manages ordinary routines rather than assuming that increased dependency is permanent. Appropriate health and rehabilitation input is coordinated, nutrition is monitored and his family is informed about the change without presenting deterioration as inevitable.

Over the following weeks he regains some mobility, although not all of his previous independence. His support is adjusted as his abilities change.

The important governance evidence is not simply that the discharge was completed safely. It is whether information transferred accurately, whether deterioration was recognised, whether avoidable dependency was challenged and whether the revised support produced measurable recovery.

This illustrates why residential establishments are part of a wider care pathway. Their role after hospitalisation can influence whether a temporary loss of function becomes entrenched long-term dependency.

Residential care can still be restorative

The move into an establishment should not automatically convert every support need into permanent assistance. Even where a person has substantial dependency, opportunities may remain to maintain or regain function.

A resident who can participate in dressing with time and appropriate prompting may lose that ability if staff routinely complete the task for efficiency. Someone who stops walking after illness may become increasingly dependent if opportunities for safe mobilisation are not restored. Conversely, expecting independence beyond the person’s capability can create distress and risk.

A restorative approach therefore requires judgement. The objective is not to force rehabilitation onto every resident, but to identify what the person can still do and what they might reasonably regain.

This changes workforce practice. Staff need time to support participation rather than simply complete tasks. Mobility, nutrition, meaningful activity and access to rehabilitation expertise become part of maintaining independence.

For residents, the benefit is broader than physical function. Retaining small areas of control can protect confidence and identity. Being able to choose clothes, walk to a communal area or participate in an activity may have significance far beyond the task itself.

The relevant outcome is not independence as an absolute state. It is avoiding dependency that is created unnecessarily by the way care is organised.

Medication, frailty and falls require connected governance

Residents with complex dependency frequently experience several interacting risks. Multiple medicines can contribute to dizziness; reduced mobility can increase deconditioning; poor nutrition can worsen frailty; and a fall may then trigger hospitalisation and further functional decline.

Managing each issue in isolation misses the pattern. Residential governance needs to connect clinical and operational information so that repeated falls, medication changes, weight loss and declining activity are considered together where appropriate.

This is particularly important because not every fall indicates poor care and eliminating all risk is neither realistic nor necessarily desirable. Restricting movement excessively may reduce immediate exposure while accelerating loss of strength and autonomy.

The stronger approach combines proportionate risk management with the resident’s goals. Medicines, frailty, falls and safety are therefore connected dimensions of ageing well rather than separate compliance topics.

Good evidence includes trends as well as individual incidents. If falls increase across a unit, leaders should be able to examine timing, location, staffing, medication, environmental factors and resident profiles. If the same patterns persist after interventions, governance should challenge whether the response is actually working.

Operational scenario: repeated falls trigger a wider review

A resident experiences three falls within six weeks. None results in major injury, and each is initially managed appropriately. Viewed separately, the incidents appear relatively minor. Viewed together, they indicate a changing pattern.

The establishment reviews more than the incident forms. Staff consider when the falls occurred, recent medication changes, footwear, hydration, mobility, the physical environment and whether the resident has become less active since a recent illness. The resident is included in the discussion and explains that she has been avoiding asking for help because she does not want to inconvenience staff.

The response therefore changes on several levels. Medication concerns are raised with the appropriate health professional, opportunities for safe mobility are increased, the environment is checked and staff discuss how their communication may unintentionally have discouraged her from seeking assistance.

Subsequent monitoring looks at both falls and mobility. A reduction in incidents would be of limited value if achieved only because the resident stopped walking.

The scenario demonstrates why quality governance needs outcome context. Safety information is strongest when it helps services understand what changed, why it changed and whether the response preserved the person’s independence as well as reducing avoidable harm.

Digital systems should reduce fragmentation, not create more recording

Residential establishments generate substantial information: care plans, dependency information, medication records, observations, incidents, family communication, workforce data and quality indicators. Digital systems can make this information more accessible and reduce duplication, but only if technology is designed around operational use.

A digital record that requires staff to enter the same information repeatedly can consume time without improving care. A sophisticated dashboard built on inconsistent data can produce misleading assurance. Systems that cannot exchange relevant information with external health services may digitise organisational boundaries rather than remove them.

The stronger opportunity lies in using technology to support continuity. Staff should be able to identify important changes, leaders should be able to recognise patterns and information required at transitions should be accessible to the people responsible for acting on it.

Technology also raises privacy and cyber-resilience requirements because residential records contain highly sensitive personal and health information. Access needs to be proportionate to role, and digital continuity needs to be considered alongside ordinary business continuity.

The Digital Transformation Readiness Assessment offers organisations a way to examine strategy, digital capability and resilience before assuming that new technology will improve services. The same principle applies in Luxembourg: digitisation creates value when it improves decisions and coordination, not merely when paper processes become electronic.

Resident voice is an essential source of assurance

Residential services create an unusual governance environment because the organisation is operating where people live. Decisions about staffing, food, activities, visiting, routines and physical space can therefore affect everyday autonomy in ways that conventional service metrics may not capture.

Residents need meaningful opportunities to influence those decisions. Feedback should not be limited to annual satisfaction questions or formal complaints. Everyday preferences, recurring concerns and observations about life in the establishment can reveal quality issues much earlier.

Communication methods need to reflect the resident population. People with cognitive impairment, sensory loss or communication difficulties may require different approaches. Multilingual communication is also important in Luxembourg’s diverse environment.

Family feedback can add another perspective, but organisations should distinguish between the resident’s preferences and those of relatives. A family may value a tightly controlled environment because it appears safer, while the resident values movement and independence. Governance needs to understand that tension rather than automatically privileging one voice.

This makes service-user feedback and co-production an operational quality mechanism rather than a hospitality exercise. Evidence of resident influence is strongest when feedback can be connected to decisions and visible changes in daily life.

Future capacity requires decisions long before the place is needed

Residential infrastructure cannot be expanded instantly. Planning, financing, construction, workforce development and regulatory requirements create long lead times. Luxembourg therefore needs to anticipate future demand before demographic pressure becomes immediate.

The number of older people is only the starting point. Planners need to consider how long people are likely to remain at home, the future prevalence of dementia and complex dependency, household composition, the availability of informal carers, the development of housing alternatives and the capability of professional home-care services.

These variables can pull demand in different directions. Stronger home support may reduce or delay some admissions while concentrating higher dependency within establishments. Better housing and assistive technology may allow more people to remain at home, but they cannot remove the need for environments capable of providing continuous professional support.

Future establishments may therefore need different designs rather than simply more of the same. Smaller living environments within larger organisations, adaptable spaces, dementia-sensitive design, stronger digital infrastructure and better connections with community and health services may become increasingly important.

Workforce planning must happen alongside capital planning. A new establishment that cannot recruit a stable team does not create usable long-term care capacity. Organisations examining this interaction can use scenario modelling to explore how different assumptions affect service stability; the underlying discipline is more important than any single forecast because demographic and workforce conditions will continue to change.

Residential care should remain part of the community

An establishment can provide excellent internal care while still leaving residents disconnected from ordinary community life. This becomes particularly important when mobility, transport or cognitive impairment make spontaneous participation more difficult.

Residential care should therefore be understood as a home located within a community rather than a separate destination at the end of the care pathway. Relationships with families, volunteers, cultural organisations, local services and neighbourhoods can help residents retain roles and connections beyond the establishment.

For some residents, community participation may involve leaving the building regularly. For others with advanced dependency, it may involve bringing community life into the establishment. The objective is not activity for its own sake but connection that reflects the person’s interests and identity.

This perspective also changes how outcomes are understood. Safety and clinical stability remain important, but quality of life includes belonging, relationships, purpose and opportunities to exercise choice. The relevant wider theme is outcomes, independence and community inclusion for older people.

As Luxembourg plans future residential capacity, location therefore matters alongside building design. Services that are physically and socially connected to communities have greater potential to support continuity of ordinary life.

What Luxembourg’s residential model offers for international learning

Luxembourg’s arrangements cannot simply be transplanted into another country. Its social-insurance architecture, population size, labour market, regulatory framework and wider social-security system shape how residential long-term care operates.

Several underlying principles nevertheless have wider relevance. Separating dependency-related entitlement from accommodation costs makes the financing architecture clearer, although it does not eliminate affordability questions. Assessing dependency across home and residential settings can support continuity of entitlement even as the place of care changes. Formal oversight of services for older people recognises that quality extends beyond the reimbursed care task.

The more important lesson concerns capacity. Countries planning for population ageing can easily focus on the number of residential places. Luxembourg’s experience highlights why usable capacity depends equally on workforce, resident complexity, external health interfaces, environmental design and the relationship between residential and home-based support.

Other systems could adapt that principle without replicating Luxembourg’s institutions. Planning needs to ask not merely how many places will be required, but what people entering those places are likely to need and what infrastructure will allow them to live well there.

The same applies to quality. Formal standards provide a necessary foundation, but residential care becomes credible through implementation: stable relationships, responsive support, meaningful choice, effective health coordination and governance that can distinguish between a completed process and a good outcome.

Conclusion

Luxembourg’s residential long-term care sector will remain an essential part of the country’s response to population ageing even as more people are supported to remain at home. Indeed, stronger home-based care may make residential capability more important rather than less important, because people entering establishments are increasingly likely to have substantial dependency, dementia, frailty and complex health needs.

The strategic challenge is therefore broader than adding beds. Luxembourg needs residential capacity that is physically appropriate, professionally staffed, connected to health services and capable of preserving identity and autonomy as needs intensify. Its long-term care insurance provides an important foundation for dependency-related support, while the wider framework governing services for older people shapes the environment in which that support is delivered. The resident experiences those arrangements as one life, so operational quality depends on making the interfaces work.

Future sustainability will be determined by decisions about workforce, infrastructure, dementia capability, digital systems and community connection made well before additional capacity is required. Quality evidence must also move beyond activity to show whether residents are safe without unnecessary restriction, supported without avoidable dependency and able to retain meaningful control over everyday life.

Residential care is therefore not the opposite of ageing well at home. It is another part of the same long-term care continuum. Luxembourg’s strongest opportunity is to ensure that when home is no longer the right setting, moving into an establishment changes where support is provided without diminishing the expectation of dignity, relationships, participation and a life that remains recognisably the person’s own.