Have you ever opened a door into a space that you expected to be empty, only to find a meeting in progress? Embarrassment and agitation are some of the feelings that can surface. This may match how a resident feels when they don’t understand the purpose of the space and enter in unknowing what to expect.
Space that can be easily understood by those with cognitive impairment requires the design to “be apparent” to all who engage the space. A bedroom should look and feel like a bedroom. A dining room should not sometimes feel like activities, sometimes be a charting space and sometimes be a dining room. A living room should feel like a living room vs. a holding area for residents when not sleeping or eating.
Too often converted space of an assisted living wing or skilled wing gets a locked door at the end of the corridor and becomes a Memory Care Neighborhood. All the available common area space becomes multipurpose for eating, activities and living room space. Purpose of space is lost as cueing for the intended activity is mixed and not easily understood.
When space is easily understood by a resident, they can have a higher level of satisfaction and independence by enjoying moving from area to area for specific activities that engage them and are designed to reinforce their purpose.
2. Natural Light
Although there has been tons of research on the benefit of natural light to interiors in senior living and the effect of melatonin production which helps us sleep, natural light does not always need to come in the form of exterior horizontal windows. Natural Light can come in the form of typical windows but also skylights, light tubes, clearstory windows, French doors and daily outdoor activities (weather permitting). Natural light also helps to cue residents to the time of day which helps early stage Dementia residents to recognize the difference between breakfast and dinner and the appropriate time to go to bed. For a great source for more information on Lighting in senior environments see: Lighting and visual environment for senior living by ANSI/IES RP-28-07
3. Secure Outdoor Spaces
Nature’s healing is well documented in acute care design. Very few can argue the point that most people when offered a choice between spending time in a windowless space and having a space that allows nature to be engaged with, would chose the latter. Nature with its constant rejuvenation, visual interest and o2 it provides, demands that for those that are “locked up” in the interest of protection, be provided an opportunity to engage with nature in a safe environment. This safe environment not only means safe from possible elopement but also safety from over exposure to the elements and toxic plants if they are touched or ingested. Having open spaces, resting benches, safe walking paths and covered seating areas are key. Security must also include having blind spots for the caregivers eliminated so that residents can engage in the space without the caregiver constantly worrying that a resident may be in danger or eloped.
4. Reduced Noise
Acoustic Noise is any unwanted sound by the person hearing it. I might argue that my son's music is noise while he may argue that my music is noise. This means that others speaking, music, clicking of someone's shoes walking on a hard surface flooring, phones ringing, overhead paging, TV shows, dogs barking and alarms going off are just a few of the possible options of what may be considered noise. Noise can also be visual such as in Times Square. Both types can confuse and provide over stimulation especially in residents with cognitive impairment. Designers and Staff need to work together to reduce both Acoustic and Visual noise to a minimum so that only the noises intended to be understood are introduced into the environment. Reducing hard surfaces should be the first item on a designers list. This is not always possible with the increased levels of incontinence in memory care. Moisture Barrier Carpet can be successfully used to reduce and absorb unwanted noise. Limiting visual noise is a balance between keeping the interior looking homelike and avoiding too much stimulation with patterns, artwork and accessories. Staff can assist with both by not having the TV on when it's not an activity, reducing bringing in of personal items to decorate and limiting stereo playing to purposeful activities.
5. Positive Distractions & Engagement
Agitation can be minimized using Positive Distraction and Engagement tools. These can come in various forms from redirection of a resident by a caregiver to another area or topic to Nostalgic Nooks Life Skill Stations and Lap baskets. The key is to have tools for the caregiver to use to engage the resident or redirect them to a more pleasant subject, task or activity. Folding laundry, painting, reviewing a basket of vintage linens, rocking a baby, working in the garden are just a few of the tools that can be used. Caregivers often make the comment that with the exception of the Nursery Nostalgic Nook Life Skill Station the residents don’t seem to use them. When observed to see what the issue may be, we find that the caregivers are not engaging a resident. Not every redirection tool is right for every resident and these tools should also be used not as a mandate but a play activity. They can bridge great conversation gaps between caregivers and even family members with a cognitively impaired resident.
6. Purpose Built Space
Purpose Built Space combines several of the other success strategies together for Memory Care Design. Understanding the needs of the residents you serve, their backgrounds, ensuring that the space is easy to understand, has purpose, engages
natural light and reduces visual and acoustic noise all the while being home like sums up Purpose Built Space in Memory Care. Specialty Areas further this concept and may
include: a quiet room to alleviate being over stimulated, Spa, Sun Room, private family room and art room. All of these spaces combined with the basic daily activity space, bedroom and dining space can allow the caregivers and families to better engage the residents one on one or in small groups.
7. Homelike Design
Reducing Stress for all is always a good thing. The words institutional and clinical should be thrown out the window in Memory Care Design. While the design needs to function and be safe, it also needs to feel like home. This includes using wall and flooring materials that you would have in your home vs. an HGTV designer version of the latest and greatest trends. You want residents who are already confused not to be confused further by the interior design. Furniture needs to be residential scale, look and feel. This can be achieved by working with residential manufacturers to change the foam type and apply moisture barrier fabrics to residential frames allowing the items to be cleaned and met fire code. Resident room furniture should be their own if at all possible to encourage the sense of home and familiarity. Lighting fixtures should be residential in scale and look while meeting the energy codes and ADA. Artwork should be easily understood, not contemporary and have security locks for safety. With thoughtfulness and effort a great residential environment is not hard to achieve in memory care and encourages visit and reduces stress of the residents.
8. Cueing & Way finding
Anytime you have traveled to a city or country you are unfamiliar with you engage in Cueing and way finding. Image the stress of doing this daily. I am on the road 3-4 days a week and have some understanding of waking up and not knowing where I am at, where the restroom is located and what time it really is. Cueing residents with nightlights to more easily find the restroom, shadow boxes at their room when numbers fail to mean something, contrast accent walls to allow seniors to see what needs to be seen and theming of wings with colors, artwork and accessories can all help to orient a senior in memory care. Not every cue will work for everyone but if we can help some of the residents to maintain their independence and dignity longer it is worth the design effort.
9. Family Space
Visiting any senior in Long-term Care is uncomfortable at best let alone a memory care neighborhood. Most family members have difficulty accepting their loved one needs to be in a “locked unit” with folks that are much worse than their loved one. Having a private space that is not in the residents room but is not in the main area with the rest of the residents and caregivers can not only provide a great place to visit with the resident but also be used for care conferences and a respite for the family members that just needs a break to regroup before reengaging with their loved one.
10. Resident Room Layouts that encourage independence and dignity
Laying out the room well and having the proper furniture can ensure that the resident can self-function for as long as possible. The environment should work with the resident, not against them. A couple key strategies are: having the bathroom door opening seen from the bed, the headwall of the bed should be hidden from the hallway from a dignity point of view and a daily open closet that cloths can be placed in just for that day with the rest of the clothes in a locked closet encourages independence in dressing while not overwhelming the resident with too many choices or the wrong choices. A window seat with hidden storage is great for families to have seasonal clothes and supplies stored and creates extra seats for visits. Night light cueing and shadow boxes as mentioned prior also aide to independence and dignity. Furniture should be their own if at all possible to encourage the sense of home and familiarity.
If these 10 Keys Success Strategies to Memory Care Design are employed Residents, Caregivers and Families will all have a higher Quality of Life with reduced stress, more independence, dignity and courage to face then next day.