Dementia care: The physical environment

"While principles of good practice are clear - there is no single right way to design and manage a care home for people with dementia.  Decisions about design, the model of service and economic viability needs to be considered in tandem" (Cantly & Wilson)

Dementia care in the recent literature is based on the following nine basic principles:
• Support independence, autonomy and control
• Support functionality through meaningful activity
• Provide an atmosphere that is soothing, pleasant and non- threatening
• Highlight helpful stimuli and provide orientation cues
• Reduce extraneous stimuli
• Provide for wandering
• Be highly negotiable
• Be safe and secure
• Meet the needs of staff

Design guidelines and principles inlcude the following:

  • Domestic design and layout where the physical environment supports continued use of everyday skills as well as instrumental activities of everyday living that are familiar to them.  Cluster bedrooms leading into communal living spaces and to avoid long corridors with dead ends.
  • Adequate use of space by creating meaningful and culturally appropriate activity.  Provide multiple small, accessible lounges.  Dining rooms should be domestic in size and intimate, to encourage participation.
  • Safety should be considered where residents are able to move freely under unobtrusive observation from staff.  Attention should be given to even-surfaced, well-lit walkways with visual cues and proper signage.
  • Garden spaces should be safe and secure and should be a continuation of the inside living space.  Remember to provide areas for residents who are physically challenged, can also partake in gardening.
  • Opportunities for personal control by providing positive stimulation.  Remember to take care by not over-stimulating these residents.
  • Provision of clear cues for orientation by making use of signage that include pictures.
  • Lighting is very important as age has an effect on normal human vision.  Older persons have an impaired ability to adapt to light level changes and are extremely sensitive to glare. 
  • Colour can be used to emphasise information that is important to a person with dementia by using brighter colours with a higher contrast to the background.  You can also de-emphasise unimportant information with toned-down colours.  Remember that floors should not have bold patterns and high contrasts.  Colour changes are appropriate at doorways or transitions between rooms. 
  • Assistive technology can be used for monitoring of residents.Making a decision on what assistive technology to use, should be person-orientated to the specific needs.
  • Allowing residents to care for pets can be very therapeutic.  Doll therapy has also been used very successfully.
  • Staff rest rooms should be away from residents to help alleviate high stress demands.  Rest rooms need to be designed in such a way that staff will feel relaxed and refreshed after time-out periods.