3 Themes to Create Dementia Friendly Spaces in Care Home Settings

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

  1. “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!!

a

  1. “What can I see?”

There are three golden rules when considering this question.

  1. 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.

  1. 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.
  1. 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.

Contrasting Handrail

before and after

  1. “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.

wendyWendy Chambers: Team lead occupational therapist, NHS Dumfries and Galloway

@wendyAHPDem

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.

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Three tips to creating an enabling home environment

As an allied health professional consultant and an occupational therapist, part of my role is to help people to keep doing the things they need and want to do in daily life.  This includes working with the person to understand their abilities and difficulties, habits and routines, likes and dislikes.  An important element of this process is considering all of these things in relation to the home environment.   For someone with dementia they might experience problems with their memory, with keeping track of the day and time of day, with finding items around the home and adapting to other age related changes.  By making a few changes at home people can minimise the impact of these problems making everyday life easier and less stressful.  Here are a few things that I have learned along the way.

  1. Let there be light….

Lighting is especially important for people living with dementia because of age related changes to our sight and the fact that dementia can change how we perceive what our eyes are seeing.  Here are a few things to think about in relation to lighting at home:

  • Are you getting as much natural light as possible?  Things like having your windows cleaned regularly, using tie backs for curtains to allow light in and keeping trees and plants near windows cut back can all help.
  • Do you have enough lights and are they bright enough? You might be able to use brighter bulbs in your existing light fittings or have an additional lamp beside your armchair or at the bedside.  Every little helps.

Picture 1

 ….. and dark

Getting a good night’s sleep can be a problem and this can be due to lots of different reasons.  Keeping track of day and night so your body knows when it is time to go to bed and when its time to get up can be difficult.

  • Having a dark bedroom (with thick or black out curtains) can help you get to sleep and stay asleep especially in the summer months.
  • Shutting your curtains when it’s dark outside can also help as some people find the reflections on the window are distracting or even upsetting.

 

  1. Using contrast to help

Contrast can help to make important things more visible.  If you aren’t sure if there is a good contrast then try taking a black and white photograph and see if the object is clear in the picture.

Here are a few items to consider if the contrast is good enough:

  • Does the toilet seat or chair contrast with the floor?
  • Do your plates contrast with the table surface/table cloth?
  • Is the banister a contrasting colour to the wall?

You don’t always need to spend lots of money on increasing the contrast.

  • A replacement toilet seat in a different colour can be purchased at a reasonable cost
  • Rather than replacing all your plates, maybe a coloured table cloth or place mat would be a cheaper option.
  • A new chair or carpet would be expensive but a coloured throw could help without spending so much money.

Picture 2

  1. “A place for everything and everything in its place”

I found the best solutions were usually personal to the individual and used existing habits and routines.  Here are just a few of the strategies that I have learned from people with dementia:

  • Keeping keys on a hook near the door and a sign on the inside of the door as a reminder.
  • Having an extendable key ring “clipped” onto your handbag so it is always attached.
  • Keeping a special bowl/box with “essential items” for tasks in that place e.g. a pair of glasses and the remote control next to where you watch television.
  • Using labels (might have a picture as well as the words) on cupboards or drawers where commonly used items are stored
  • Recognising that sometimes things will be misplaced so having a few spares (e.g. keys, reading glasses) to hand to reduce stress when this happens.

Picture 3

This has just been a small selection of ideas.  It would be great to hear how other people have made changes at home to make living with dementia in daily life easier.

If you have any other hints and tips it would be great if you could share them in a comments section?

Jenny ReidJenny Reid
AHP Dementia Consultant (NHS Lothian)
@JennyAHPDem

My role involves raising awareness of the contribution AHPs make to helping people with dementia, their families and carers live well and supporting AHP service development, education and evaluation.  The national remit of my role includes producing the Dementia AHPproaches newsletter, leading a national pilot of the Tailored Activity Programme and supporting AHPs in the development of early interventions and supported self management for people living with dementia, their families and carers.

 

Useful links….

http://dementia.stir.ac.uk/design/virtual-environments/virtual-care-home

http://www.enablingenvironments.com.au/AdaptaHome.aspx

http://www.scie.org.uk/publications/dementia/dementia-friendly-environments/environment/index.asp

www.cih.org/resources/PDF/Scotland%2520general/Improving%2520the%2520design%2520of%2520housing%2520to%2520assist%2520people%2520with%2520dementia%2520-%2520FINAL.pdf