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Human-Centered Design in Alzheimer’s Care Facilities

Danny Szlauderbach
By Danny SzlauderbachJune 6, 2020
Older adult with dementia getting help at a memory care community.

What does it really mean to make a new place feel like home?

A comfortable environment is a goal for any resident in a senior living community. But when people living with Alzheimer’s disease or other types of dementia move to memory care, familiarity is essential to their care and overall quality of life.

In memory care today, you’ll find unique touches like healing gardens, painted murals on doors, and even a classic car — all intended to create a safe, homelike atmosphere for residents. Learn how researchers and architects work together to design living spaces to meet the specific needs of people with dementia.

The need for specialized memory care

Dementia affects a substantial portion of the elderly population: As many as half of all people age 85 or older may have some type of dementia, according to the National Institute on Aging. Alzheimer’s disease makes up anywhere from 60-80% of dementia cases, making it the most common form of dementia.

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As baby boomers grow into old age, the demand for memory care increases — as does the need to design facilities appropriate for that generation. And because dementia and Alzheimer’s are degenerative conditions with no known cure, medication only goes so far in helping patients. This means therapeutic treatments must be used alongside medication to help improve quality of life.

What is human-centered design?

Senior living options have evolved away from the traditional image of a sterile, hospital-like institution filled with medical equipment. Over the past few decades, researchers and architects have collaborated to create facilities based on a human-centered design approach, which considers how the interior space of a structure affects a person’s thinking, behavior, and emotions.

“We’re looking at the interaction between psychological factors and physical factors in the environment,” says Casey Franklin, assistant professor of interior architecture at the University of Kansas (KU). Franklin, who specializes in environmental psychology and human factors, is a member of the Smart Cities Research Institute at KU, where she helped integrate caregiver apps into a smart home for seniors.

“What we’ve changed to in more of this human-centered design model is trying to design a space that feels like home,” Franklin says. “Research shows that residents have an easier time transitioning and forming bonds in a new facility when they can make it feel like their own space.”

If you have a family member with dementia, you know it’s much more than simply being forgetful. Dementia impairs a person’s memory, communication skills, reasoning ability, concentration, and perception. Everyday effects of dementia may include:

  • Acting inappropriately in social situations
  • Losing the judgment to decide when it’s no longer safe to drive
  • Needing assistance with activities of daily living (ADLs), like bathing, dressing, and eating

Because of these difficulties, people with dementia can lose the ability to regulate emotions. Minor daily obstacles — such as not getting to eat the same meal you’re used to — may lead to anger, aggression, and depression.

To study how the interior environment can address a person’s emotions, the architecture field has moved toward evidence-based design, according to Franklin. This is where architects look at research and data, convert that information into design decisions, and then reevaluate how well those design decisions work.

Evidence-based design means “taking that research and translating it into new design solutions aimed at giving patients a better quality of care,” Franklin says.

Healing gardens: environment as medicine in Alzheimer’s care

As residents walk onto the roof garden in the summer, a screen door slams shut behind them. A path leads to an old Cadillac convertible parked comfortably in a small enclosure of the garden. “It doesn’t run,” says Lee Askew of Askew Nixon Ferguson Architects in Memphis, Tennessee. “But it has nice seats.”

Askew’s firm designed Memphis’s Trezevant Terrace, an assisted living community with a memory care unit. He acquired the Cadillac and installed the screen door on the advice of John Zeisel, president and co-founder of Hearthstone Alzheimer Care.

Healing gardens — sometimes called therapy gardens — are outdoor green spaces, usually in a health care setting, intended to improve people’s overall well-being. A star fixture at each of Hearthstone’s seven Alzheimer’s care facilities in New York and Massachusetts, healing gardens are popular in memory care throughout the country — and for good reason. Studies show these spaces to help reduce agitation, isolation, depression, and aggressive behaviors in people with Alzheimer’s and other types of dementia.

Zeisel, who has a background in sociology and architectural design, was the principal investigator of a three-year National Institute on Aging study that found a balanced combination of medication, behavioral, and environmental approaches is likely to be the most effective treatment for dementia and Alzheimer’s symptoms. The key finding, he says, was that environmental factors are equally as important as behavioral approaches and medication.

Preventing wandering in dementia care through design

Wandering in seniors with dementia is a dangerous behavior that can cause accidents. Often, it results from stress and fear. Wandering may be caused by:

  • Too much noise or stimulation
  • Boredom or inactivity
  • Sundown syndrome, which can lead to rapid mood changes or paranoia
  • Disorientation after looking for a person or place and getting sidetracked along the way
  • An instinct to return to past routines, like a former home or workplace

All of these potential causes have design implications, and designers of memory care facilities can implement different strategies to help prevent scenarios that may lead to wandering.

Wayfinding

An entire field of study on its own, wayfinding includes basic concepts like signage, iconography, carpet design, and lighting. But it’s more strategic than simple arrows and room names. “Think of it like environmental cueing,” Franklin says. “You want to provide physical signals that help people get to identifiable destinations.”

Wayfinding considerations may be something obvious, like a clearly marked restroom with legible text and a recognizable symbol. Sometimes it’s more subtle: A high-traffic room’s doorway with painted woodwork should be clearly outlined, while a doorway for a room residents should avoid should be camouflaged with a mural like a painted bookshelf.

Zeisel suggests wayfinding can involve many human senses. “Design the entire environment so what people see, hear, touch, and smell all give them the same information about the environment,” Zeisel says. “If the kitchen is meant to be the social hub of the setting, make sure it looks, feels, sounds, and smells like a social hub.”

As part of a wayfinding solution, healing gardens can serve as a safe, natural endpoint for residents who wander. In a carefully designed memory care facility, strategically placed hallways may lead a disoriented, wandering resident to a peaceful, centrally located garden surrounded by fences. “If a garden is to be used frequently, make it highly visible through a window and accessible through an easily located and unlocked door,” Zeisel suggests.

Designers often use wayfinding to offset the confusion caused by double-loaded corridors, which are long hallways with doors on both sides, as you see in most hotels. This repetitive design can be disorienting for people with dementia, as every hallway and room appear basically the same.

Ideally, architects would design a memory care facility with residents’ rooms in smaller, more identifiable clusters. But because double-loaded corridors are so common in existing facilities, designers often must use personalization strategies to reduce confusion in long hallways.

Opportunities for personalization

Personalization helps residents recognize their rooms as their own. For example, designers can add permanent frames on or near doors for residents to place photos or important memorabilia into — anything that helps them identify the room as their unique, personal space.

The same goes for the interior of a room: Designers will add bookshelves or other areas for personal objects, minimizing the work new residents must do while moving in. Allowing enough space for a resident’s own furniture — like a favorite chair, love seat, or desk — also goes a long way toward personalization.

Research shows these design considerations, which target residents’ emotional needs, help the overall transition of moving into a new space and creating a bond. “We want to think about this not just as medical, but as experiential,” Franklin says. “What’s going to make you excited to move into a new place and to feel like you belong there? Part of it’s the social connections, but part of it’s also making it your own without actually changing that much about it.”

Other ways to improve Alzheimer’s care home design

These are some additional key aspects of human-centered design that help residents establish a homelike bond when transitioning into memory care.

Maintaining privacy

Some loss of privacy is often unavoidable when an elderly person moves into senior living — particularly if they’re living with a condition like Alzheimer’s and require daily care. They may feel a lost sense of freedom or control as they try to adapt to a new routine or have someone come into their room every day to help with daily tasks. That negative feeling can be amplified when there are too many residents in memory care units.

“The general rule of thumb is that less crowded is better,” Franklin says. But even if a resident doesn’t have a private room, there are other ways to create privacy, such as visual barriers and separate shared spaces for visiting with relatives.

It’s a balance, though, because too much privacy can lead to senior isolation. A design solution could be a window in the resident’s room that looks out into a hallway, or barn doors where top and bottom halves open separately. This allows residents to feel some sense of connection while maintaining distance and control.

Physical safety

Falls are the leading cause of fatal and nonfatal injuries in seniors 65 and older, and the design of an interior space causes up to a third of those falls, according to Franklin. Hard flooring is one way to improve balance and stability. Other design and accessibility considerations for preventing falls include:

  • Door widening
  • Stair lifts
  • Elevators
  • Wheelchair ramps
  • Handrails and grab bars
  • Zero-threshold showers
  • Non-repetitive hallways

Positive distraction

This is any activity or stimulation that takes a person’s mind off any pain or negative emotion they’re experiencing. In a memory care facility, a positive distraction could be reading, TV, music, personal artwork or decor, or a window providing a view of nature. A built-in bookshelf for residents to keep all of their favorite books, movies, and photo albums is a good design solution for promoting positive distraction.

Social support to avoid isolation

An elderly person moving into senior living may have lost a spouse and may not have a strong network of support, so to avoid isolation, it’s important to create opportunities for residents to make new friends and meet regularly. If a resident has friends outside of the facility, there should be a place for the resident to entertain guests. This could be a kitchen and living area in private rooms or a common area for residents to reserve.

Another social consideration is sleeping accommodations for residents’ family members or close friends. Sometimes facilities may provide space for overnight guest stays. In some cases, senior living furniture is designed with guests in mind: Seating in private rooms can convert into beds.

Reducing environmental stressors

Residents with Alzheimer’s or other types of dementia may become easily agitated by seemingly minor issues, like bad lighting or too much background noise. Designers try to create environments that allow residents to focus easily on activities like reading or talking with friends. This might mean making sure residents’ rooms aren’t too close to common areas, installing soundproof walls or curtains to block activity in the hallway, or allowing access to quieter areas like a garden or library.

Another environmental stressor may be medical equipment or supplies. Items like wheelchairs, walkers, and prescriptions are common in memory care facilities, and they undermine the potential for a relaxing, homelike atmosphere. Designers can create built-in storage areas throughout rooms as natural storage for medical items.

Engaging in activities

Whether it’s an art room, outdoor gardening, or a place for spiritual reflection, activities are a crucial part of the healing environment. They allow residents to maintain a sense of self-worth and independence. Additionally, the social aspect of these activities provides an opportunity to embrace the more playful parts of life.

Making memory care a new home

Memory care facility designers should think about the environment as a healing space, according to Franklin. The goal is for the interior space to have a positive effect on dementia symptoms by targeting several basic human needs, including a sense of self-esteem, belonging, and safety. Addressing these needs helps recreate the feeling of connection and comfort a person associates with their home, called place attachment.

“What makes a home a home? That’s a big question,” Franklin says. “When people are moving, it’s an emotional process as well as a physical one, so this is about providing opportunities for that same type of emotional attachment to occur in a new space.”

Senior living options for memory care

There are many different types of memory care options for people with Alzheimer’s or other forms of dementia. Residential care homes may be a good fit for some. Others may find a memory care unit in an assisted living community more desirable, as this arrangement allows couples with different care needs to live near each other. Yet another choice is a stand-alone memory care community.

A Place for Mom’s Senior Living Advisors can share information about all types of senior care options in your area. They can also help assess your family’s specific situation — all at no cost to you.

Danny Szlauderbach
Author
Danny Szlauderbach

Danny Szlauderbach is an editor and content writer at A Place for Mom. Since 2010, his work in strategic communications has spanned across several industries, including education, technology, and financial services. He’s a member of ACES: The Society for Editing and a graduate of the William Allen White School of Journalism and Mass Communications at the University of Kansas.

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