Almost 10 million people worldwide develop dementia every year. As needs in this area increase for the senior living industry, it’s important to remember the role smart design can play in alleviating–and to a certain extent, treating–the symptoms of this difficult disease.
Although programming plays a role, the most crucial design for dementia and Alzheimer’s care revolves around a thoughtful environment. Because of the nature of the disease, residents with memory loss need ways to feel grounded in the present and safe in their surroundings. Perkins-Eastman and the Alzheimer’s Foundation of America published a report last year on excellence in design for Alzheimer’s and related dementias. According to Carol Steinberg, AFA’s president and a key contributor to the report, “In the absence of a cure for Alzheimer’s disease, care is critical.”
From that report, here are 13 smart design strategies for improved care in this growing area of need.
Household structure
Arrange resident living spaces into households of 10-14, either in standalone buildings or within a larger structure. Elements of household-style design include private bedrooms with attached bathrooms, resident-accessible kitchens, and openings to secure outdoor spaces. Common areas arranged for visual and acoustic privacy with designated zones for specific activities can keep residents from becoming anxious and overwhelmed by too much stimulation or variety in one place.
Homelike environment
It’s important that memory-care facilities in particular not feel institutional. Homelike elements create a stronger sense of safety and reduce undesirable behavior. Buildings should follow multiple visual planes, both inside and out, rather than a singular or monolithic structure. Indoors, consider hiding utility boxes, communication devices, or other institutional signals. Surfaces should be soft and furniture should push together or pull apart, according to the number of participants in an activity. Due to increasing levels of incontinence among Alzheimer’s residents, floors should be easy to clean and maintain while still promoting mobility and a homey texture.
Wayfinding and orientation
Spaces should be distinct, with orienting landmarks at each decision-making point. When possible, landmarks should be personalized and should include objects, images, or clear views to outdoor areas. Dutch doors or glass-doored cabinets provide clear views into spaces and destinations that can help residents remember their original purposes and needs, rather than getting caught up in or cut off from activities, simply based on visibility.
Independence, control, and flexible rhythms
As much as possible, residents should be allowed the flexibility to choose their own schedules and activities. They should be able to locate necessities of daily life, such as food, clothing, and toiletry supplies, without having to rely on memory. Accessible kitchens stocked with healthy snacks or warming plates to keep food hot can encourage regular eating, as can community cooking initiatives. Wardrobes should hold limited selections of clothing in wire or plastic containers so that choices are easily visible. Bedrooms should be separated from common activity spaces so that residents can nap in peace.
Safety and security
It’s important that safety in a memory-care facility is both actual and perceived. Design rooms with visually connected spaces to allow for unobtrusive monitoring by staff. Avoid contrasting light and dark flooring colors that could be perceived as steps or holes. Keep hazardous substances or delicate electronics safely locked away, and allow for certain areas to be closed off if necessary for resident safety.
Entry and egress
Many residents with memory loss feel the need to wander or an urgency to be somewhere. While this can be provided for in other ways, exits should be disguised or screened from active resident areas. Put layers of security between residents and the world, so that if one is breached, they will stay safe within another. Implement silent alarms to minimize disruption, and use GPS to alert staff of residents needing redirection.
Spa and bathing
It’s important that bathing spaces, whether private or shared, are as calm and peaceful as possible. Provide a direct visual connection from the toilet to the bed to avoid nighttime accidents. Keep fixtures familiar and homelike to reduce anxiety. Keep lockable storage for razors and other potentially hazardous items. Make sure drain covers are secure and toilets easy to unclog since memory loss may prompt some residents to hoard or hide things in unlikely places.
Secure outdoor spaces
Residents with memory loss can benefit greatly from time spent in the outdoors. Access to outdoor spaces can be vital for reducing agitation and relieving stress. Unrestricted access should be provided whenever possible. Provide clear views for staff monitoring that can also be obstructed by blinds or shutters during inclement weather. Walking paths should be continuous and loop back to entrances. Solid paths to security or service entrances should be avoided. Cultivate non-toxic plants that won’t harm residents with thorns or sharp edges, and light pathways in the dark for nighttime wanderers.
Active engagement
Engagement in activities is necessary and can range from watching from the sidelines to full participation. Make both large and small group activities readily accessible to residents, and provide options for “continuation of life” activities that recall familiar activities performed in past lives. Kitchens, in particular, can be designed for community cooking and gathering spaces where staff can also do charting or other paperwork during down times.
Privacy and quiet
For memory-care residents, peace and privacy are as important as focused activity and engagement. Residents will benefit from private bedrooms for personal belongings. These rooms should be designed both for protection and for connection. Dutch doors allow visual access for monitoring and awareness without physical intrusion. Another Dutch innovation, Snoezelen rooms have been found to reduce symptoms of Alzheimer’s and dementia with their intentional, multisensory stimulation and effectiveness at creating soothing environments.
Engaged wandering
Support typical active walking or wandering behaviors in safe and productive ways. Paths should have several intersecting loops and never terminate in dead ends. Routes leading through activity zones provide opportunities for engagement and redirection. Allow plenty of paths through safe, observable areas (including safe outdoor spaces), and keep unsafe or off-limits spaces out of the general traffic pattern.
Support for family and community involvement
Social engagement can promote both physical and mental health, even in Alzheimer’s patients. Plan spaces with a view to accommodating family visits outside of a resident’s bedroom. In addition to extra seating in bedrooms, create semi-private meeting spaces or communal dining and living areas. Consider how your living center might even serve as a resource to the greater community by offering library resources, workshops, or classes that would promote cross-generational interaction.
Support for professional caregiver involvement
For design elements to be effective, they must be supported by the organizational and cultural empowerment of a well-trained staff. Proximity, communication, and teaming are essential. Households should incorporate staff workspaces into the residential environment. Data ports and adequate space at a residential-style desk or kitchen counter can help staff complete paperwork while monitoring residents and even including them in work when appropriate. Store necessary equipment in strategically located, lockable cabinets and drawers to minimize work time away from residents. Electronic record-keeping systems can help staff stay engaged with residents while performing necessary household tasks. Be sure also to locate staff support areas away from areas of direct care for meetings and retreat space.
Consider implementing design changes, in both physical spaces and organizational ones. In a rapidly changing memory care culture, the two must continue to grow hand-in-hand.
For the full information and background research, please refer to the full 2014 Perkins-Eastman/AFA report.
