As an occupational therapist working in mental health in Dumfries and Galloway I was given the opportunity to work with some of the residential care homes, exploring ways that dementia friendly design principles could be implemented to help create care spaces more suitable for people with dementia.
Dementia friendly design principles focus on ensuring that the environment is comfortable, easy to navigate our way around and that it easily engages us. It requires us to take a step back and ask some simple questions of the spaces and environments around us. The questions which I helped the care homes ask of their environment can be summarised into three themes
- “What do I do here?”
When I walk into any room, the space should clearly tell me what types of things I might do there, for example an ironing board, basket of laundry and an iron, a shed with a brush set out or some potting compost and pots, or toiletries clearly in view at the bathroom sink.
Dementia friendly design aims to reduce the need to guess what to do, where things are or what’s behind closed doors. All too easily in care home environments things are put away in cupboards and activities are limited to groups doing art/craft, the TV goes on and living spaces may do little to engage people. During the course of this project several care homes experimented with creating spaces with more normal, day to day activities available in safe and thought through places, at different times of the day.
The benefit to this was seen where the night staff stopped folding the laundry and left it for a lady who got up early and naturally found a meaningful job to do at the start of her day sorting the laundry!!
- “What can I see?”
There are three golden rules when considering this question.
- The importance of lighting for people with dementia cannot be stressed enough due both to the changes in the eye as we age and also the perceptual changes of how people with dementia may interpret what it is they’re seeing.
The ageing eye requires nearly four times as much light so while providing information on increasing the level of light available through artificial means we also encouraged the care homes to consider ways to increase natural light levels from windows by pulling the curtains back, opening blinds, removing heavy pelmets, ensuring plants and trees near windows are cut back. These are all very cheap and instant ways to increase the lighting levels.
- Positioning of objects and signs is also important. The golden rule for all signage is 4 feet high (1.2 meters) any higher and it is out with the visual field of the person moving around. Unfortunately many signs, stimulating pictures, objects of orientation, interest and way finding markers all being positioned significantly higher than 4 feet. What we did in our project was to move signs and other items lower down which was relatively easy and inexpensive for most of the homes involved.
- Contrast. It was important we thought through with the care home staff about contrast and ask them, does the object the person living with dementia needs to find stand out against the background? Can the person find the door, light switch, chair, plate, cup, toilet seat?
The best tip for this, which we got from the Dementia Design School at Stirling University, is to take a photo and then print it out in black and white. If the item doesn’t contrast well in a black and white photograph, it won’t be easily seen in the printed picture and therefore will be more difficult or impossible to locate for the person with dementia. Some of the care homes used this principle as you can see in the example below.
- “Rome wasn’t built in a day”
Throughout the project the care homes were encouraged to adopt a Traffic Light approach to implementing dementia friendly design principles. They identified changes they’d like to make and coded them according to how easy, quick and affordable it would be to do.
The green items were changes they could make straight away, which wouldn’t cost much at all, for example moving the signs to the correct height or putting a contrasting colour round the light switch in a person’s room.
The amber items were changes which would take some time to organise and may require a moderate degree of funding, for example changing toilet seats to contrasting colours, painting and creating natural way finding activity spaces in long disorientating corridors.
The red items were things which they could identify they would like to change but which were prohibitively expensive at this time for example changing floor coverings. At some point in the future that home will redecorate and replace items and when that time comes a more dementia friendly option would now be ready and waiting and the light could go green!
The project was very rewarding to work on as the impact on the day to day living experience for people with dementia in the care homes which implemented their changes was readily apparent. The care homes which made even the simplest of changes did indeed create living spaces and environments which were more comfortable, easier to find your way around and were more engaging and interesting to be in for residents, visitors and staff alike. Dementia friendly design principles do indeed make life and the world easier for all of us and a create a better, more straightforward place to be.
Wendy Chambers: Team lead occupational therapist, NHS Dumfries and Galloway
As a team lead occupational therapist in organic services in Dumfries and Galloway (dementia and learning disabilities), I am keen to ensure the services we provide are what people need, of a high quality and making a definate impact to help people and their families live well with dementia in Scotland.