Saturday, 5 May 2012

Interior Design for Dementia

This page started off as a personal comment on what I was finding in care homes and the treatment regarding people living with dementia in areas of poor interior design.  I did some research, and found some things that had been neglected. Page started. Page incomplete. I am finding out more stories every day and am eternally grateful to those who share what they or their loved ones are going through at this time. This page is constantly being updated.

There are 800,000 people in the UK with some form of alzheimers /dementia- and this number is increasing.
Creating a safe environment for PWD in which they can also feel comfortable is a challenge.

Dementia was described to me as rather like a person is a bookcase, with the most recent memories at the top. Over time the books from the top shelves start falling down. That is not to say people won't learn new things, just that the manner they are learned and retained is as important.
It is not unknown for someone to question whether they have been out for the day or eaten breakfast. Surprisingly they may remember a visiting pet's name more than the owners who is there every day.

Communication is everything anyone ever wants. An article in a tabloid indicated that many hospitals trusts routinely call in security to restrain PWD. Absolutely shocking. Can you imagine a person so trapped in their body with all the confusion dementia does to your head, to be restrained?  All anyone wants is to feel safe. To chat, to talk through issues, to ask you how your day is going today. Same with PWD. the more social communication the better. In early stages where there is some confusion I have always thought, speak to someone how you would speak to yourself. Then when they reply, speak with them. Find a point where you can have communication. If it is not through vocal communication then share a smile listening to music, or stroking a pet, or eating an iced bun. Amazing how many PWD have a sweet tooth.

Time. We all have body clocks, we all have the same hormone cycles. We all react differently different times of the month, be it full moon or hormones. Make sure loved ones aren't in pajamas at 4 in the afternoon if that isn't in their care plan. Who wants to be forced to bed because carers are going off duty and don't want late shift to deal with more than half the residents needing to be undressed, toileted, prepared for bed - often with a third of day staff. Who's fault is that? Certainly not the resident or families who have indicated mum/ dad/ gran likes a toddy before bed and that is normally around 10pm.

Care plan. Yes that written document care homes should adhere to when you are well enough to write, and so unwell they should not legally ignore. Yet they do. They have to diary everything they do activity wise, so read it. They are legally bound to produce some form of activity for residents. This may be a chat, a visit to a tearoom.

Whether the person is still at home in a familiar environment or has moved to a place of care there are still some crucial elements that will assist.

Older people in particular tend to have poorer vision, and often lose glasses making it more difficult for them to see. While visiting opticians will do their best to test a client's vision, the best solution is to ensure that they can see as far as possible clearly. Lighting, in particular daylight, is crucial. Imagine walking into their room and wearing sunglasses, that could very well be how they see things. Too many care homes have net curtains, extensions built on reducing windows, ceiling uplighters. While reducing direct light with glare is important, good lighting is important for colours to be seen appropriately as well as making it safe for people to move about with some freedom.
Access to natural daylight is beneficial for their health as well as their mind. It disturbs me to see residents in beds with no view to the outside world. Many people in care in particular are reluctant to go outside as any chill will invariably make them feel cold, but that is not to say they do not appreciate looking out from a warm room through double glazed units to a beautiful garden.

With lack of vision also comes the need to incorporate contrast into interior schemes. A beige chair against a light wall and neutral carpet will look lost to the occupant. Equally a white toilet against white tiles with a window above near renders the toilet invisible and difficult for an occupant to use independently. Soft pastel tones, but with some intensity of colour, work very well rather than strong colours like deep reds. It is always a good idea to ask the person what colours they like from a chart, or painting a larger section on a board. Again I have seen care home bedrooms with pale shimmery flower wallpaper where their cherished pictures blend into insignificance and the shimmery background renders the pattern into mush as far as the resident is concerned.

One care home decided to replicate a "street" by using red brick wallpaper in a corridor and hanging black and white framed prints too high up wall for anyone stooped or in a wheelchair could see. But this wasn't a street, but a corridor leading to bedrooms, which gave the inevitable complaint from one resident being led to bed "Why are we going outside?".

Grouping furniture is important, not squeezing maximum amount of chairs into a space, or lining them up around the walls. Remember the vision issue, a sense of loneliness is instilled in some care homes who forget people should be in groups so they can identify other people.

At home, make sure areas well light, the person will be familiar with where they are but might forget which side of the wall a light switch is situated. Make sure it stands out against a wall.

Flooring is so important. With people living at home this is not so much an issue as many homes will have carpet in main areas. In some care homes the use of laminate or hard flooring is in much evidence. Given that many residents shuffle along in carpet slippers or socks, there are avoidable trips and falls. Apart from that shiny floors appear wet, making residents doubt whether they should move at all. Of course care home owners could be thinking that hard flooring is more practical in some areas. And in some areas I agree, but not main living areas and bedrooms.With the range of specialist carpets on the market that are impervious, polypropylene and easily cleaned there really is no excuse.

Curtains are as vitally important for the feeling of comfort in care homes as they are for the activity in which some like to engage. A place of residence may have changed, but old habits die hard, and some, women in particular, like to draw the curtains in the evening. While staff in care homes may come in and throw the curtains shut, one should be asking whether anyone in the room would like to help them draw the curtains.

Individually, it is lovely that some places have "memory boxes" attached to a resident's room. If anything this encourages the staff to remember that that frail person who needs their assistance to go to the toilet used to drive trucks in WW2/ was a councillor/ has an OBE. A resident might like their door painted their favourite shade of whatever colour, so they can find their room unassisted. Some older people in care with dementia can wander and staff will find them asleep on available chair later, possibly because they couldn't find their way back to their room.

And while on the subject, remember doors are not locked, people do wander and things will go missing. While this piece of advice is not strictly interior design, it is about ensuring the environment is suitable for the relatives of the people in care who wonder why nan's favourite clock/ vase/ slippers had disappeared. At home it may be worth putting a "chime" over exit doors, a little reminder when a loved one may take it upon themself to to leave the home unnoticed.

Why care homes don't use copper fixtures and fittings is beyond me. Copper inhibits bacterial growth, meaning less likelihood bacteria, and more importantly viruses, can be passed to another person.

Much of the above can be applied to a person's bedroom. It should be important that drawers and wardrobes are easily opened and do not stick, leading to some independence when getting dressed.
Table lamps should not be so fiddly as to be knocked over, or maybe a switch/ or hanging cord above or near the bed that allows the main light to be activated would be more suitable.

Activities that encourage memories are as crucially important and form the "environment" for a person living with dementia. While it can sometimes be difficult to keep a conversation, triggers such as music, familiar smells, tasks they can join in with can help them feel less isolated.


Remember the person 


  1. Ally,

    I'm very touched by this piece and your compassion. You're a star!

    My mum's suffering from dementia and living at home. Doesn't recognise my dad, doesn't recognise the house she has lived in for 30 years, but weirdly does recognise me. Fortunately I live nearby so can pop in regularly.

    I think you've booked your place in heaven.
    "Saint Ally of Wirral" - bit long-winded but sort of works!
    'course when they take your past behaviour into account you'll be going the other way! See you there. *8^)


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