Housing Choices and Home Design for People w it h Dement ia

Professor Kar im Hadjr iHead of School of Architecture

DARG 20188 February 2018

#DARG2018

Content

Content1. Research & policy context2. The design of dementia nursing and residential

care homes using the Design for Dementia Audit Tool of the Dementia Services Development Centre through postal questionnaires addressed to facility managers; and

3. Housing choices available to people with dementia; potential issues with design of nursing homes in the UK context through interviews with facility managers.

4. ODESSA Project.

Research & design gaps1. Ageing-in-place2. Long term housing options3. Dementia-fr iendly environments4. More imaginative and inclusive forms of collective

housing and neighbourhoods5. Design and building standards

Research t imeline

Research t imeline

Research t imeline

SPARC

Care Systems

The Older Worker

Product and Interface Design

Cognition and Communication

Vision

Exercise and Diet

Chemical Biology of Ageing

Oxidative Stress and Ageing Mechanisms

Life in the Home

Streets, Buses and Cars

Strategic Promotion of Ageing Research Capacity

2005-2008

Research t imeline

Research t imeline

Policy t imeline

Policy t imelineBrit ish Standards Institution (2016-17)Helen Hamlyn Design Centre, Royal College of Ar t, London.Design for t he mind.To explored how neur odivergent people experience the built environment, current best design practices, and the key challenges and oppor tunit ies.The study developed eleven design themes, which are intended to form the basis for new BSI guidelines during 2017.

Policy t imelineBrit ish Standards Institution (2016-17)Helen Hamlyn Design Centre, Royal College of Ar t, London.Design for t he mind.1. Literature review.2. 22 face-to-face interviews. 3. One interview included a walkthrough of a transpor t hub,

hotel and restaurant.4. 51 people completed an on-line survey; 5. a co-creation workshop; and 6. a forum of 38 par ticipants explored the future of

neurodiversity and design.

Policy t imelineBrit ish Standards Institution (2016-17)Helen Hamlyn Design Centre, Royal College of Ar t, London.Design for t he mind.Clar ity; sensory; layout; floor ing; decoration; signage; familiar ity; acoustics; safety; preview; lighting.

Pr oject 1Designing dement ia nur sing and r esident ial car e homes (2012).This study seeks to appraise the design of nursing and residential care homes for people with dementia in Nor thern Ireland using the design audit checklist developed by the Dementia Services Development Centre – DSDC… to establish the level of compliance with these cr iter ia. The appraisal used postal questionnaires, based on the DSDC essential design cr iter ia, that were sent to facility managers.

Pr oject 1In 2012, there were 75 nur sing homes and 44 r esident ial car e homesoperational in Nor thern Ireland; a total of 119 homes that are equipped to care for Dementia sufferers at all stages of the disease. 53 questionnaires were

completed and retuned.44.54% response rate.

Pr oject 1Tools for appraisal:1.Multiphasic Environmental Assessment Procedure

(MEAP).2.Therapeutic Environmental Screening Scale (TESS+).3.Professional Environmental Assessment Protocol

(PEAP).4.Therapeutic Environment Screening Survey for

Nursing Homes (TESS-NH).5.Environmental Audit Tool (EAT).6.Design for Dementia Audit Tool (DSDC).

Pr oject 176 questions structured into 13 sections.

Sect ion Quest ions on:1 location, type of building, care capacity, and whether or not the home has a garden2 the entrance hall and wayfinding3 lounge and day room design4 meaningful occupation and activity5 bedroom design6 private/ en-suite toilet area7 communal toilet area8 private/ en-suite bathroom/ shower9 communal bathroom/ shower10 dining room11 treatment/ examination/ consult ing room12 exter ior13 general pr inciples

Pr oject 1

Pr oject 1

Space Essent ial Cr iter ia Quest ions YES Response

s

N/ AResponse

s

Total Valid

Responses

Percentage meet ing cr it er ia

Garden 1. Does the facility have a garden or outdoor spaces?

52 0 53 98.15

Hall / Ent rance / Way-f inding

2. There is par ticular ly clear signage to help way-finding for everybody. E.g. pictor ial representation; large clear letter ing.

47 1 52 88.68

3. There is good access for those with physical or mobility problems including wheelchair users.

52 0 53 98.15

4. Is there contrast between signs and background mounts?

48 1 52 92.45

5. Is the base of the signs around 4 feet or 1.2 metres from the ground?

42 3 50 84.31

Pr oject 1Reponses to questions related to the 69 DSDCessential cr iter ia show that not all cr iter ia are met, and that only five essential design cr iter ia are fully met by all homes.1. provision of easily accessible, safe and enclosed

outside space;2. signage;3. design of en-suite toilets and bathrooms;4. provision of mirrors which can be removed or

covered up; and5. provision of discreet storage space.

Pr oject 1In terms of the differences between nursing homes and residential care homes, it appears that nursing homes align better with DSDC criter ia than residential care homes (68% vs 32%).

Over 80% of cr iter ia are met by 75% or more of nursing homes and residential care homes.

Pr oject 1Percentages of homes meeting cr iter ia by type of home:

Cr iter ia met

Percentages of homes meet ing cr it er ia

Nursing Homes

% Residential care

%

100 2 2.90% 5 7.25%90-99 26 37.68% 17 24.64%80-89 23 33.33% 20 28.99%70-79 11 15.94% 14 20.29%60-69 6 8.70% 13 18.84%50-59 1 1.45% 0 0.00%>50 0 0.00% 0 0.00%Total number of cr it er ia 69 100.00% 69 100.00%

Pr oject 1Percentages of homes meeting cr iter ia by type of home:

Pr oject 2Housing Choices and Car e Home Design for People With Dement ia.1. Review of the current state of housing for people

with dementia by explor ing housing choices available to this group, and identifying potential issues with design of care homes.

2. Interviews with managers of 22 care homes in Lancashire were conducted to explore housing choices and design issues.

Pr oject 2Housing Choices and Car e Home Design for People With Dement ia.1. The challenges of living well at home with dementia:

cognitive decline; wellbeing; independence; access to care & suppor t; physical environment; adaptations; family & community networks.

2. Current housing options and their inadequacies for people with dementia: very sheltered housing / long-stay residential care / end-of-life care / assisted living / continuing care retirement communities. Wayfinding.

3. Design of care settings for people with dementia: Bamford review consultation with service users and their carers raised issues such as ageing-in-place. Assistive technologies and adequate adaptation of the homes. Otherwise in care settings: Small grouping. Wayfinding/ Signage. Community-based model.

Pr oject 2Lancashire County Council has 329 care homes located in 31 urban or rural settlements in Lancashire. These offer 11,202 beds. Of these homes, – 305 are pr ivate.– 15 are under Lancashire

author ity control. – 9 are run by voluntary

organizations. Of the 329 homes, 165 provide care for people with dementia.

22 managers agreed to be interviewed

Pr oject 2The interview schedule contained 9 questions:1. Housing Choices2. New requirements for homes design3. Environmental, social, behavioural and healthcare issues4. Best practice in the design of care environments5. Does the physical environment matter and make a

difference6. Has the Dementia Design Audit been carr ied out7. Design issues8. Staff needs 9. Personalized care in relation to the physical environment.

Pr oject 2Thematic analysis was used to examine the choice of dementia care homes available and the design issues associated with them.

Pr oject 2

Pr oject 2

Pr oject 2

Pr oject 2“I think . . . people move here because . . . they are not able to manage themselves independently or their relatives are sor t of . . . struggling to cope with their needs. I think a lot of the time . . . it ’s . . . the last resor t for many people.” (Par ticipant K)

“They then look for . . . a . . . safe environment, so that the init ial safety will be secured, they cannot just walk out of the door.” (Par ticipant B)

Pr oject 2

Pr oject 2‘‘You can’t train somebody to love and care.’’ (Par ticipant D)

“What is the use of adapted buildings if you have not got the staff to look after dementia residents? You must treat them and have a passion for the dementia.” (Par ticipant F)

A well-designed building is inef fect ive alone w it hout appr opr iate staf f ing.

Pr oject 2“From a comfor t point of view, it has to feel and be like a home where older people feel familiar with.” (Par ticipant A)

“We have assor ted appliances like Afr ican bathrooms, London bathrooms and French bathrooms that br ing home memories to residents.” (Par ticipant K)

Pr oject 2

Pr oject 2“Door signs, photographs, color blinds on the floor and walls to follow, our bathroom doors have door frames painted in red to identify bathrooms, different seat colours, floor ing, etc.” (Par ticipant J)

“Sensory gardens are incredible … and provide the residents with access to walk around for about 5 to 10 minutes with something to look at. It ’s calming and enter taining.” (Par ticipant H)

Pr oject 2Implicat ions for Pract ice:a) a suitable level of care,b) a posit ive atmosphere, andc) design quality within the care home,are elements that lead to a more enabling environment.Design on its own will not lead to successful car ing environment unless appropriate care is provided and a posit ive therapeutic and domestic-looking environment is also available and accessible to people with dementia.

ODESSA Pr ojectODESSA: Optimising care delivery models to suppor t ageing-in-place

An international research venture investigating current long-term care delivery models for older people to allow them to live

independently for longer (3/ 2015-2/ 2018)

ODESSA Pr ojectKey issues:1. Shrinking family size and more dispersed living

arrangements.2. The demand for in-house car ing for older people.3. Challenges of care provision at home.4. Finding innovative care delivery models aimed at

maintaining older people’s safety and improving their quality of life for longer.

5. The physical environment is often a barr ier to accessibility, mobility and independence.

ODESSA Pr oject

Literature Review

Assistive Technology Universal Design & MobilitySocial &

Community

Dementia Care

International Good Practice

Focus Groups

UK

France

China

Case Studies in

China

Case Studies in

UK

Case Studies in

France

Retrofitting Recommendations

Exploratory Focus

Groups in China

Recommendations for Work Package

5 and 6

Literature Review

Findings

ODESSA Pr oject

ODESSA Pr oject“… the technology can’t replace emotion. The creative product is useful, but we need to consider the emotional reasons.”

During discussion with FG2 par ticipants it was discovered that there is a stigma still associated with dementia in China and people are uncomfor table discussing it. FG2 par ticipants also believed that memory loss was an early sign of dementia.“I feel really uncomfor table when I heard the term ‘dementia’.”

ODESSA Pr oject

ODESSA Pr oject

Thank you.