Poor research and verification means newly-built healthcare facilities are often wrongly claimed to be dementia-friendly, argues Professor June Andrews, director of the influential Dementia Development Services Centre (DSDC) at the University of Stirling
Architects make a difference to how people live their lives, and they care about quality of life and how their art and science contributes. The importance of architects for people who have dementia cannot be overstated.
Dementia is the name given to the set of symptoms appearing when people become less able to care for themselves because of gradual cognitive deterioration, usually in old age. It is often described as a memory problem, but research shows that people with dementia and their carers are more concerned about agitation, wandering, aggression, distress and practical problems like nocturnal disturbances and incontinence.
The majority of people with dementia live at home in the UK, about half of them alone. With adaptations and support they can stay home until the end of life. Designed features in the house help. The cost is high; often the family has to give up work, or pay someone to provide home care.
Moving to a care home is even more expensive, though the local authority or the NHS sometimes cover the cost. People say they’d prefer to stay at home as long as possible. Government policy wants that as well, not least because of the expense. There is not enough money and there are too many affected people.
Nevertheless, around 400,000 people live in care homes. Unsustainable old-style adapted care home buildings are closing because of changes in regulation and rising costs. New care homes open every week and should be designed with dementia in mind – up to 90 per cent of care home residents already have the condition.
When journalists call the Dementia Services Development Centre (DSDC) for comment on whether a new care home is ‘dementia friendly’ or built on ‘dementia principles’ it can be embarrassing. Developers frequently make these claims when they’ve only adopted a few superficial, unproven ideas – ‘colour coded corridors’, a mocked up ‘pub’, and an ‘olde sweetie shoppe’ are recent examples. In reality, they are following fashion not science, while trying to give the impression they are making a difference to dementia. Even if they’re challenged, others copy them. Some buildings have won design prizes when they would not reach bronze level in the Stirling dementia design audit process!
Why does it matter?
Real dementia-friendly design reduces the lifetime cost of running a care facility by reducing adverse incidents and staff burden. It improves quality of care and staff morale by ironing out predictable dementia-related problems in the building. That gives staff more time for interactions that matter. If the research-based principles are ignored, cost and quality benefits will not be achieved. Colour coding a facility to help wayfinding requires a resident to learn a new ‘language’ at a time when their capacity to learn is much reduced. Why would you? Instead, research supports well-designed, well-positioned signage.
Incontinence is really expensive in laundry, cleaning and staff time, not to mention the discomfort for the person affected. The right lighting, flooring, signage, and design of toilet spaces can reduce the problem. That’s truly dementia-friendly design.
How can dementia-friendly design be verified?
There is as yet no regulatory standard for dementia design. The DSDC has 25 years of experience in this area, but can’t check every claim that a building is based on Stirling principles. The website offers free advice and low-cost publications and courses at dementia.stir.ac.uk/design, including a virtual dementia-friendly care home dementia.stir.ac.uk/design/ virtual-environments/virtual-care-home. People can self-assess or can use the Stirling design tool, but Stirling has no capacity to check every assertion that is made in their name, so caution is needed about claims.
What should architects do?
Architects and developers need to take greater care when making claims, particularly if the operator has not followed the advice. This is about science, not style. Failure to ensure this is unprofessional.
All designs should work on the assumption that people with dementia will have difficulty in working things out, so making the space easy to read is very important. Which way do I turn when I leave my room? How do I find my way back? How does this shower work? What time of day or night is it? Where do I go for exercise and daylight? How can I get away from noise and stress? Do I belong here? Can I eat something now? Assume their eyesight is poor and they tire easily. Try to make life interesting and rewarding. Use classic design and don’t assume anyone is frozen in a particular time warp.
The Stirling principles are laid out for all to see, but in truth, any architectural solution that would help to answer these needs would be in line with the fundamental idea.
DSDC is supported by a charity to which donations can be made at.www.justgiving.com/