Supporting Sustainable Montessori Implementation in Nursing Homes: Key Determinants and Recommendations

Person-centered care is consistently reaffirmed as the gold standard in nursing homes. In addition to serving as an activity framework that demonstrates benefits for residents and professionals, the Montessori method applied to people with dementia represents a concrete model for implementing person-centered care. However, its sustainable application remains a major challenge and few studies have documented its implementation fidelity. This exploratory qualitative study aims to identify factors influencing the long-term implementation of the Montessori method in nursing homes and to provide recommendations to support it. Semi-structured interviews were conducted with twenty-eight professionals across four French facilities exhibiting varying levels of Montessori implementation, assessed using a validated grid. Thematic analysis revealed diverse implementation trajectories, influenced by interdependent determinants at societal, institutional, structural, and organizational levels, as well as factors related to work quality of life, individual actors, and projects. Actions involving professionals, management, training organizations, and external stakeholders are recommended. This study is the first to provide an in-depth analysis of the mechanisms involved in implementing the Montessori method across four different facilities, from which structured recommendations are derived. We hope our findings will enhance understanding of the challenges faced by professionals and guide all relevant stakeholders in overcoming them.