By Tracey Carter, Consultant Nurse for Dementia Care at Exemplar Health Care
For people living with dementia, person-centred care should be at the heart and centre of all care planning and delivery, and this includes designing a space that can be both supportive and enhancing.
Designing a space that is dementia-friendly helps those living with dementia to maintain their independence for as long as possible, reduces stress and anxiety and significantly improves day-to-day mental wellbeing. Here, Tracey Carter, Consultant Nurse for Dementia Care at Exemplar Health Care, advises how environments can be designed and adapted to improve the lives of people with dementia, and why this is important to consider.
Making a house a home
Often, when an individual moves into a care home setting, the new home does not feel like a home, the walls and décor don’t seem familiar, and it’s often a larger place that’s filled with more people.
So, it’s important that at least one small space does feel more familiar to that person – and this is why the team must understand each individual’s own beliefs, values, interests, abilities, likes and dislikes, both past and present.
The care home team should encourage people with dementia and their loved ones to bring items of furniture, mementos and photos that were present in their previous home setting, that can be used to make bedrooms feel more like a place to call home.
Providing a space that encourages independence
Care homes should also provide an environment that facilitates orientation and independence as opposed to confusion and reliance on others. One of the ways that they can do this is by adding signage that appropriately indicates where important rooms are – such as toilets, bathrooms, bedrooms and the dining room.
Additionally, communal areas should be decorated in such a manner that aids orientation and reduces confusion and visual disturbance. For example, avoiding patterned carpets that may trigger the illusion of insects or mice running around which can be unsafe.
Each space should have clear and well-defined pathways (inside and out) that are obstacle free and avoid intersections or decision points.
It might also be useful to provide natural destination points such as an inside seating area, garden bench or kitchen table to encourage people to rest and interact with the environment or others.
Bathrooms should also be made easy to use with easily identified taps and flushing mechanisms. The use of white toilet seats on white porcelain should be avoided, as this may not stand out, therefore increasing the risk of falls, or anxiety around using the toilet.
When considering colour, it is best to stick primarily with neutral colours on walls to avoid visual disturbances. Similar to signage and orientation – handrails and doors should be painted in a standout, contrasting colour to assist with direction and spatial awareness. This also encourages independence while reducing the risk of falls.
To promote familiarity, central hallways and corridors should be painted to a theme or have key markers such as numbers to help aide in location and identification. Aesthetically pleasing murals or busy pieces of art work are not best for dementia-friendly environments, as they can cause visual confusion leading to distress.
Some people living with dementia may also require a degree of brightness that compensates for a loss of visual acuity and a tendency to misperceive what is not clearly seen. Lighting needs to be around three times brighter than average lighting levels to aide those living with dementia to clearly visualise their surroundings. Natural light is useful in keeping track of time especially for those living with dementia, and maximising natural lighting in spaces will aide with this.
A space to maintain and facilitate independence
Care homes should ensure that they have a care model that can encompass all aspects of person-centred dementia care, which will then enable staff to gather all the important information they need to know about each individual before they actually come into the care setting and as they are admitted and on an on-going basis, so that care can be adapted and developed as needs change.
This should be done both with the person with dementia, their loved ones and current care givers, so that everyone can feel part of the process, and engagement and relationships are built from the start, thus building a sense of trust and partnership in the care journey.
It’s important to know all aspects of a person’s life history, from relationships and family, through to work and career, along with cultural needs and spiritual beliefs.
The main aim of the care we provide should always be to maintain and facilitate as much independence as possible, and as dementia progresses this may mean adapting certain activities to be able to better meet people’s needs, whilst maintaining meaning, participation and enjoyment.
For example, if someone is a keen dancer but is no longer able to independently mobilise then we could adapt a music and dance session to wheelchair movement and dance, focusing on arm movements more than feet movements, so that the person can still independently move to the music but with a different emphasis.
Ultimately, any care setting that is delivering a truly person-centred model of dementia care will have residents who feel valued, and whose distress and anxiety is understood from an individual perspective.
For more information on Exemplar Health Care, visit: https://www.exemplarhc.com/