CHP: Where do you begin when designing a dementia friendly home? What parameters do you work within?
DANA O’DONNELL (DO), Interior Design Manager, NHG: Access to the outside is vital so it’s important that dementia rooms are on the ground level.
VERENA WOMERSLEY (VW), Operations Director, Assisted Living, Castleoak: That’s something we are building into all dementia developments now regardless whether it’s extra care. The evidence shows how helpful it is for people to access the outdoors.
APRIL DOBSON (AD), Head of Dementia Innovation, Abbeyfield: In our Winnersh development, for example, everyone has access to the outdoors all the time.
SUE EARREY (SE), Head of Land and Developments, Hallmark: It’s the benefit of getting vitamin D and being somewhere where you don’t feel imprisoned has an immediate impact on how people feel and behave. It’s something we are trying to build into all our new developments.
ROBERT MALLETT (RM), Commercial Business Manager, Karndean Designflooring: We have found from experience that a lot of care homes are bringing the outside in. They are building courtyard areas within the building and using our materials to generate paths and wooden areas and create a nice area where people can go and walk around with families.
NATALIE FIDGETT (NF), London Specification Manager, Karndean Designflooring: We did an award-winning case study for The Fisher Partnership at Whitby Court. We designed a beach setting complete with our pebble effect tile and distinctive tigerwood planks. Being a home where people did not have easy access to the outdoors, The Fisher Partnership looked to our floor to bring a beach effect to life indoors.
CHP: Ed, you have been quite influenced by the De Hogeweyk community village model in Holland?
ED RUSSELL (ER), Director of Innovation & Delivery, WCS Care: I’ve been there three or four times – each time seeing something different. What really inspired me about it was that it was a mature concept which made it very believable. They have an automatic lift designed for people who don’t have the cognitive ability to press the right button. They call it the ‘illusion of freedom’ and we try to design in that spirit.
There’s a whole raft of innovations in terms of safety and creating outdoor space to ensure that people can do the things they normally do. I was particularly impressed with a shop De Hogeweyk had that residents could come and do their shopping for daily produce. On stage it was a shop and back stage it was a dry goods store so it was a very smart use of space which we have adopted. We have now got a launderette so in our next design we are looking to make much more domestic designs where people do their own washing and cooking.
We also changed the way we did food so we didn’t have a central catering kitchen area. We have dining areas in each of our households which again frees up a lot more space to do things like table tennis and other club activities.
CHP: How important are regulations when thinking about dementia design?
VW: They’re not the main focus. Dementia care is subject to an individual or provider. Some of the bigger challenges are getting the efficiencies of the building and ensuring that it doesn’t cost a fortune to build. We have way finding elements so that our homes corridors are not like Travel Lodge hotels. If you ask a building team or a property development team they will want to take everything out of the corridors but that is just not helpful. It’s about having the whole team on board. The development team needs to talk to operations and the building services teams to understand what they are achieving.
AD: We need to design for the current system of conditions of the individual such as loss of vision, hearing impairment and physical immobility. Dementia usually isn’t just a condition by itself.
VW: Making a big building familiar and domestic is a challenge, especially dining spaces. Having that family feel can be quite difficult to achieve unless you have very small dining spaces and it’s a very family environment.
AD: I think you probably need a mix of big and smaller areas. Big dining areas can be very distracting for people with dementia and be quite noisy and there are probably some things with flooring that can help with acoustics.
RM: it’s important that the building does not look like a sterile environment. You want it to look welcoming. You also have the design elements to make sure that dementia patients are looked after as well. The important factors we find are acoustics, slip resistance but also light reflectance value (LRV) values to make sure there’s enough contrast between floor surfaces.
AD: Light is very important. I think Stirling recommend that you put double the amount of light into a building if it’s dementia specialist. I would say that’s really important for everybody because with co-existing conditions it makes life better for everybody. Daylight is incredibly important in terms of helping reset people’s body clock. It helps orientate people if they have natural daylight.
SE: it’s the interior design that really adds the cherry on the icing. It’s important to have people around who can give that specialist advice. We use colour as way finding. We have coloured doors. There are different schools of thought around that. There are different schools of thought about the use of mirrors. We took on board all the industry opinions. What counts is the feedback from our caring team. Is a resident orientated towards a particular colour of door? It’s only the carers that can implement that.
VW: That’s about knowing that person and knowing their journey which is not something you can do until that person is there. There might be one person who reacts badly to something and that’s all about person centred care.
SE: It’s offering a flexible space that can be changed if somebody was particularly disturbed by something in their environment.
NF: There’s a lot more choice now in terms of flooring products, especially with Luxury Vinyl Tiles (LVT). As well as being practical and easy maintenance in terms of spillages and hygiene, LVT offers an array of design options and laying patterns allowing flexibility to create individual spaces to suit the needs of the users. There’s also various types. For example, we have traditional stick down LVT, loose lay and click flooring.
VW: The sound you achieve at night and the sound you achieve in the day can be very different. Some operators are looking at hard flooring but they are probably the same people that are looking at dressing in pyjamas and slippers at night so it doesn’t have that same effect. You have got to introduce something different. You can’t have someone who is walking up and down the corridors in clicking shoes during the night.
CHP: Why should care homes look to Karndean Designflooring?
NF: We specialise in wood and stone effect LVT tiles and planks, all inspired by realistic wood and stone recovered or sourced by our in-house product designers. All of our products have a lot of thought process that go behind them and in turn have a story to tell. We work hard to keep our products as natural looking as possible by paying meticulous attention to detail when replicating intricate knots and grains.
VW: One of the most challenging areas is keeping en suites looking pleasant and homely. It’s quite a long time since I have seen a care home with what I would call a ‘hospital bathroom’. The flooring is a real challenge in those areas.
SE: When you involve health and safety in the design you start to see some conflicts in terms of what looks good.
NF: Many contractors and interior designers look to our wide range of colourways for any space including kitchen areas, WCs and bathrooms. . It’s fantastic to have such a versatile flooring solution, which offers both the specification and design elements required.
VW: Do you think there is potential for flooring that creates the skirting look?
RM: It’s difficult because what we do at Karndean is try to replicate the natural product to ensure a realistic finish. It’s a fine line between creating a floor that’s fine for you and what is natural and aesthetically pleasing. A lot of the time where you have a bathroom or toilet, it’s more to do with what’s beneath the floor. If you are using an epoxy resin in that type of environment you protect the product from any damage from constant water, etc. It’s not just the flooring itself but it’s the prepping underneath the floor we have to look at as well. It’s a crucial part of the specification process and we educate as much as we can on the importance of the sub floor preparation.
CHP: You are doing some research at Winnersh in terms of falls, April?
AD: We want to see whether these new design features that we have put in place actually work for the people who live there. We are looking at how the additional level of light impacts people and whether there are areas they prefer to go to and how the different types of flooring impact how people live. We hope to be sharing our results with the industry in the autumn. We are using family and staff feedback because obviously the building has got to work for staff as well because we want to retain staff and that is becoming more and more important.
NF: This is something we speak about in our own CPD. Even if you have different colour flooring in a lift people may fear it is a hole and they will be scared to step in. They may even fear patterns on the floor or patterns on the curtains. We can help end users and specifiers with flooring choices and we even advise zoning areas to help create divides and a sense of direction.
CHP: How important is technology in dementia design?
ER: Making sure you have a basic Wifi is the first important thing. Using acoustic software at night which is something that will listen into rooms for alerts means we don’t have to do hourly or two hourly room checks. The alerts come into a monitor as an email and they can make a decision on whether to send somebody in. We have had that now installed for over just a year in one of our homes. We started with 16 people among 25 who were awake and we have finished this year with only three. We have been able to reset people’s sleep patterns and as a consequence of getting there quicker for people, that’s reduced falls at night by 34%, which is quite a significant difference. It’s also more efficient use of staffing, which has given us a fast return on investment for the technology.
AD: We are looking at electronic care plan recording. That saves time and makes sure that everybody is aware of each individual’s needs very quickly. We have a monitoring system to make sure we know where people are even though they are outside.
SE: I hadn’t really appreciated how much value you can get from care planning. Cicadian lighting is definitely a way forward. We are looking at iPod technology. We are also looking at voice recognition technology through things like opening and closing curtains for people who are bed bound. The dilemma is how far do you take it and which rooms do you put it in? Do you start moving people around? I have yet to see anybody who has really embraced it as a way of going forward because of the age group. Not everybody is going to have that level of understanding. Sound is an emotive issue for people living with dementia. They like to know where the sound is coming from. So you have to think about how your sound system works.
ER: Our acoustic system can identify whether someone is disturbed by having someone talk back to them. We have a resident who we’ll sing to sleep through the speaker on their bed if she wakes up distressed. We have heard people who have been upset and crying who we would not have heard before. We have heard residents who put on a brave face when staff come in and then when they go out they are not breathing very well. It took a lot for the staff to trust the technology and not keep walking around.
VW: It raises the question of where you go next. Is it video monitoring? How do families feel about that? People will have different reactions but in terms of build specifications, Wifi is a great way to go. It’s a trust issue regarding the use of the technology.
SE: The wiring for our next building has got the potential for use of CCTV should that be needed. We have the ability to introduce it with the permission of the family and the resident should the thoughts and feeling around that change.
VW: it’s cheaper to do while it’s being built rather than try and retrofit it to a building with the disruption you will cause. It makes more sense to slightly overspecify than to underspecify in order to future proof a building.
ER: We focus more on what the technology does rather than what it is. There’s a lack of trust amongst the public in care homes so having a Relatives Gateway for your care planning system will be the norm going forward where relatives with the right permissions can log in and see what’s going on. Acoustic monitoring means any staff that go in at night will set that off so their behaviour has to be exemplary. That’s not lost on residents and their families looking to move in and on their staff. We have not really come up against anyone who has said no. We have worked hard to tell the right stories to show them how the technology works.
We are trialling cameras at the moment with six people. The cameras only come on when there is an alert and when the person clicks into that room to check what that event was. Relatives are generally supportive because they have concerns about why their loved ones are falling. Families don’t have access to the camera, it comes through to our night manager who is monitoring the acoustic notifications.
SE: Access to families opens up a whole legal minefield as you don’t know about conflicts within the family and who should have access to that information. You will be in the position of having to make that decision.
DO: I have also heard about the new app being developed by Stirling University which will be launching in the autumn that assesses a room and whether it is suitable for dementia care. It can notify a family member that a bulb is not on and needs to be changed. There’s also a virtual reality app on You Tube that can show how an environment looks to people living with dementia. It is very important to see this when thinking about design.
AD: Those tools are incredibly useful but we still need to look at people as individuals. What works for some people does not work for others.
VW: You cannot have a sweeping rule for doing things for people with dementia. You may have 64 people who are all suffering in different ways. Personalisation is key. If you went to the extreme you would end up with a very bland hospital environment which is very safe but very boring.
ER: Flexibility and being able to change is key. If mirrors are an issue then have mirrors with screws that can be taken off rather than everybody not having one.
AD: We did a mood board exercise with residents to assess their reactions to different colours and designs and they were able to come up with some very interesting points on the designs that they had put together. We should never forget to look at things from their perspective. They had put design features that related to particular spaces whether it was a lounge or bedroom. We have incorporated the mood boards into some of our guidelines for refurbishment. You can personalise people’s personal space but communal spaces have to be something that works for everybody.