Design for Care Homes
Applying design principles to enabling dignity and independence in care
Forward
In 2011 at the end of my tenure as Senior Research associate for the Helen Hamlyn Centre, Royal College of Art, I coauthored and led the development of a web resource outlining the key learnings from a three year collaboration with Bupa to improve care home design. This work culminated in a web resource, bettercarehomes, that has since been taken down. I often get requests for the contents from this resource, so to make it available, here is the Design Section, without an interactive layer, in long form. The Ability Section is also available in another article. I hope this work is still valuable for design researchers and practitioners working in the field. Happy reading!
1|Designing for different and changing abilities
Care homes must cater for a wide range of disabilities among their predominantly older residents. However care home operators and designers can struggle to reconcile the different and changing needs of residents within the constraints of existing resources and cost stuctures.
In this Design section we show everything from the large-scale site layouts of new homes to the specific details and furnishing of individual rooms. It is built to be accessible and works both as an information source to new designers and as a tool to consolidate wide ranging ideas for experts in the field.
2|Design
In this section we show a series of design concepts to illustrate how the built environment can support the cognitive, sensory and physical abilities of older people living in care. We present a concept home and discuss the principles behind its design.
Care can be provided on different scales. The scale adopted affects both the style of service offered and the design of the building that houses it. Some of the most common models are small-scale household models, cluster models and large-scale institutional models.
Household models are run like a family. As few as eight people can live in a home where all the meals and services are carried out with and around residents. Cluster models comprise many separate households that house 8-15 people; each household shares key services for efficiency. Large-scale institutional models operate in a similar fashion to a hotel and usually house more than 60 residents broken into separate units, which vary in size.
In this guidance we discuss cluster layouts because we believe they offer the best and most viable solution available to answer the diverse abilities of older people living in care. The guidance is flexible. Much of the information given about layouts is applicable to household models and all the guidance given for individual room types can be applied to both large-scale settings and household models.
3|Shared Services
Clusters offer a real alternative in terms of providing a cost-effective service. Each cluster can be run as a household using a familiar scale and style, which supports residents’ abilities. Key services such as food preparation, laundry and staff offices can be run outside of the clusters on a commercial scale, cutting the cost of service provision.
Clusters offer the potential to share facilities, which offer a wide range of activities for clientele such as hair dressing salons, shops, cafés and small-scale cinemas. Services like these, which do not fit into the concept of a residential setting, are appropriate when run as a shared facility and have been shown to be enjoyable activities, adding to the variety of life within the care home community. A well-designed shared space can help soften the boundaries of being ‘in’ or ‘out’ of care.
Activity services like these can also support day care facilities, allowing providers to offer an important amenity for people living outside the care home. This service can attract future clients and ease what can be a turbulent transition for people at the point of needing to enter residential care.
[1] Domestic Cluster
Each cluster unit is run as a protected small-scale domestic environment supporting activities that you would expect to find in a home. To prevent elopement for people with severe way finding problems it is necessary to have a secure cluster parameter. Ensuring each home has open access to a secure exterior garden is essential to prevent the feeling of being locked in and restrained.
[2] Café
A small café is a great location to enjoy a treat with family and friends. Engaging in a normal social activity is an opportunity to build feelings of dignity and respect.
[3] Newsagent
A newsagent is a perfect place to rummage through real products and buy things. Including a pharmacy allows residents to buy cosmetic products that are important for self-care.
[4] Furniture Shop
Allowing residents to personalise their rooms is an essential element of settling into a new home. Providing a second hand furniture shop allows people leaving the home to donate furniture and people living in the home to trade in order to improve their own space.
[5] Play area
Including a fun play area encourages families to bring their children when visiting a loved one. Children bring joy to a home and a playground offers alternative non-verbal opportunities for interaction.
[6] Community hall
Providing a large hall is a useful amenity for the home. It can be a place to hold parties, dances, religious events or memory clinics. If the space is well designed it can also be used to attract outside community groups of all ages such as youth groups, social clubs or charity events. This helps build connection to the community offering opportunities for residents to engage with people outside the home and remain part of wider society. It also makes staff jobs more diverse and rewarding. Halls can be equipped with a projector to run film nights.
[7] Hair and beauty
Hair and beauty areas are one of the most successful features in a care home because they provide an area for pampering and an opportunity for residents to feel dignified and respected.
[8] Visitors work area
Working life is now flexible and people are retiring later. The inclusion of an office with Wifi will allow visitors to work from the care home. This would allow them integrate visits with their working lives.
[9] Offices
Office space for the care home management team
[10] Laundry
Commercial laundry service to ensure the home is efficient and cost effective.
[11] Commercial kitchen
Commercial kitchens reduce the cost of food provision and allow for quality produce to be made for all the eating areas within the home, including the café.
[12] Staff Break Area
Staff break area located outside of residential area.
4|Domestic Clusters
Each cluster unit should be designed as a separate home. Everyone understands the qualities of a home. They include distinctive characteristics that make them instantly recognisable. The bedroom, the kitchen, the living room, the garden and the layout should be a hundred miles from the generic corridors of a hospital ward.
The home is where we spend the majority of our early lives. It appeals to the long-term memory strength of people with dementia. The atmosphere and opportunities we associate with a home give a sense of belonging, control, ownership and security.
The home is the one place we want to be when we feel unwell. It is the environment that is most closely related to the care and protection of those who love us. It is the most logical environment for a person with dementia to feel secure. The design of each cluster home should communicate domestic qualities to those who live and work there.
Size and activity are central to the atmosphere of home. People need to feel they are involved and able to engage in normal activities of their choosing. The home must also be of an understandable size. Very few people are used to living in large-scale communes. A smaller size also assists way finding, supports varied activity spaces and helps create a domestic feeling. The concept shown on this website is a 48 person care home accommodating 12 people in each cluster.
The design of each cluster must carefully balance a secure parameter for those with severe way finding difficulties and the freedom to roam and choose activities to engage in. Outdoor freedom is essential to avoid the feeling of being locked in and restrained.
[1] Personal Bedroom Spaces with En suite
Bedrooms can be personalised to ensure a person can gain ownership and belonging in the home.
[2] Shared Bathroom
For most people a bath is a chance to relax and indulge. The qualities of this room can support this activity. A shared bathroom does not need to be a medical environment caring for people who need help to wash.
[3] Private away space
Providing a small living room creates an alternative space where a person can enjoy privacy from the rest of the group. It also provides a useful amenity for family members who want to spend time alone with their loved one.
[4] Hallway
Operating at this scale eliminates the need for generic corridors and the way finding difficulties associated with them. In-between spaces can represent normal domestic hallways.
[5] Eat-in kitchen
The kitchen is the heart of a home and the social centre. It is the place we expect to find life. In this home the kitchen is where the food is distributed. It is an activity space where cooking can take place with residents. It also includes a staff office in order to create an informal meeting point for residents seeking help and family visiting the home.
[6] Staff office
This is a small office linked to the kitchen to provide a place for staff to carry out activities such as writing, which require them to be away from residents. Its open design means they are still accessible and can also see what’s happening in the home.
[7] Living room
The living room is best described as the recreational space within the home. It houses the piano, TV, games and reading areas. When a royal wedding or tennis match is on, it can be a place of focus and excitement. Otherwise it can be a place to quietly relax or enjoy time together as a group in music or song.
[8] Safe outside space
By making the garden door visually and physically accessible, outdoor freedom is possible. The outside is totally protected with a disguised high fence. It is also visually accessible from the staff office to encourage confidence in staff to allow residents to use the space without supervision.
[9] Lifting hoist and wheelchair storage
Including storage for lifting hoists, weighing chairs and spare wheelchairs ensures these items do not clutter the rest of the home. Storage provision prevents areas such as the bathroom becoming storage dumps and helps eliminate potential trip hazards and impact hazards for people with sensory loss.
[10] Cleaning facilities
Ensuring cleaning facilities are close at hand is really important. When spillages occur they doubly hazardous for those with sensory loss or fragile bones.
[11] Linen storage
Bedrooms need linen. Clothes need to be washed, folded and sorted. If there are residents who would enjoy the opportunity to share this activity, there is no reason why a linen closet can’t be made safe to support this.
5|First floors
Building floors in a care home is problematic as it greatly limits the freedom of those with dementia. Being able to remember and articulate the desire to go outside is prohibitive for a group who live largely in the moment. Lifts require staff supervision, diverting staff from their general duties. In accommodation with upper floors, a person’s control and ability to roam is undermined by architecture.
Homes with upper floors feel more confined. There is less going on because activity and interaction is taking place downstairs. The upper floors become large spaces where no life is going on. They trap staff that must attend to residents who cannot go downstairs, making their job less interactive, less rewarding and less enjoyable.
If there is no other option than to build additional floors there are a number of features that can ease the problems associated with them. These include roof- top gardens, balconies and winter gardens. In this design we show how the second floor might look in our concept cluster if there was no other option than to build it.
[1] Connecting terrace
Include a connecting terrace to provide safe walking routes on upper floors. This route deliberately passes social areas within the home to ensure residents naturally come across opportunities for interaction.
[2] Shared balcony
Including a shared balcony provides opportunities for activities such as meal times to be held outside, giving residents more access to natural light.
[3] Small roof garden
A small roof garden will provide contact with nature and the opportunity to include residents in basic activities such as plant watering.
[4] Private balcony
Providing personal balconies gives residents the freedom to enjoy the outside and a further opportunity for privacy and control of their immediate personal environment.
6|Private spaces
It is critical that a care home provides a sense of belonging and ownership for the residents who live in it. In a home we expect to be able to control our ambient environment, come and go as we please and have private spaces where we can change clothing, sleep or spend time alone. Probably the most important element of a home is that you do not have to adapt to other people’s rules.
In this section we discuss four rooms, which aim to offer residents opportunities for privacy and ownership of their own space. In these rooms they have the right to control the behaviour of others and the freedom to do what they want.
6.1|Personal bedroom
A good bedroom should provide opportunities for adaptation and security for its inhabitant.
Each bedroom should have one occupant with complete ownership of the space. This ensures opportunities for privacy and security. The occupant should be able to come and go as they please. They should not be concerned others will enter the space without their permission.
The room should be designed to offer opportunities for personalisation so that residents can appropriate it to their needs. We all decorate and tailor our homes to suit our own tastes and interests. The home is an extension of our identity. Room shape, size, electric points and care home policies dictate how much a resident or their family members will be able to achieve a good personalised space.
Bedrooms need to be able to adapt to a resident’s changing abilities and health over time. It is essential that a person can develop a sense of security and longevity in their new surroundings. Adaptation is important to allow the person to remain in the same room for the duration of their time in the home.
[1] Walking routes
Safe walking routes through the space with soft secure furnishing and the absence of trip hazards makes the space safer for those with sight loss. Clear space in front of wardrobes and mirrors also helps wheelchair users.
[2] Night light
Automatic wall mounted down lighters can be used to illuminate the floor, improving safety for people with sight loss or memory impairment who wake in the night. It is important that residents who do not want to use these can turn them off.
[3] Electric points
It is important to provide a good number of electric points, as these influence how furniture can be arranged.
[4] Light switch
Provide light switches consistently to the right of doors to aid location for people with sight loss.
[5] Personalisation
Room shape and size should allow furniture to be moved and layout customised. The rail around the room allows pictures to be hung without damaging the walls with hanging hooks.
[6] Natural Light
The room provides a large amount of natural light. Adding louvered panels above the window reduces glare, which can be problematic for the ageing eye.
[7] Visible Storage
Open storage areas address memory problems by allowing residents to see where they have left important belongings.
[8] Visible Toilet
A private toilet is visible from the room to help those with severe memory problems avoid continence issues.
[9] Bed
Beds are the most personal possession a person can own. It is essential that a person can bring their own bed with them to customise their room. Care providers have successfully allowed medical beds, which are often necessary in the later stages of dementia, to be stored off site and brought in if a resident needs one.
[10] Exterior door
Double doors allow safe access to an exterior space. This allows even those with severe mobility constraints in the latter stages of dementia access natural sunlight, which has been shown to be beneficial to wellbeing.
[11] Task light
Additional lighting in task areas can help people with sight loss. Reading or looking through books before bed is also a very normal activity, which may have formed part of a person’s routine before entering care.
[12] Reach and accessibility
All the sockets, light switches and shelves in the room are at an appropriate height to avoid bending and are in reach of wheelchair users. The table and wardrobe should be specified to allow easy wheelchair access.
6.2|En suite
The en suite should cater for people of all abilities and allow for personalisation.
Care home designers often have to balance the need for an en suite against the impact it has on the size of the bedroom. In many care homes showering facilities are shared, which can be appropriate and very normal if the dwelling is sufficiently small and domestic. In larger homes like this one it becomes more problematic as people with high levels of need have to brought through shared areas and this adversely affects their dignity.
In this example we have recommended an en suite with shower as we feel it offers the greatest potential for longevity of use for people of changing abilities. The facility is designed to be adaptable so that it can be used independently or as an area in which assistance can be received in private.
The en suite is seen as an extension of the bedroom. Opportunities for personalisation and storage have been included to promote the idea of ownership.
[1] Shower
This shower has been built at an angle to ensure there is appropriate space for three people and access to help a person wash. It includes a showerhead with hose. Handrails are incorporated to ensure those who are unsteady and need reassurance can use it independently.
[2] Radiators for towels
When helping another person to shower there is a tendency to use tepid water to avoid making the person uncomfortable. In this context a person can get cold. Hot towels add a very pleasant end to what can be an uncomfortable event.
[3] Integrated rails
Rails are essential to help a person to transfer their body independently. They are also extremely institutional. In this design the rails have been integrated to give the appearance of a natural domestic room feature.
[4] Mobile shower seat
A mobile shower seat can be the easiest way to enable a person who needs to sit down to wash independently. A shower chair on wheels can be used to help transfer a person with severe mobility constraints. Shower seats should have arms to help transfer the body.
[5] Mirror
The mirror should be low to allow wheelchair users to see themselves. It should also be disguisable. Some people in the later stages of dementia no longer recognise their own image and can mistake the reflection for someone looking at them. This can be very uncomfortable in a private space. This mirror includes vertical rails to help people steady themselves.
[6] Slip resistant floor
En suites can be very hazardous areas for falls. Floors should be non-slip.
[7] Turning circle
It is essential that there is a good turning circle in the en suite for wheelchair users.
[8] Toilet
It is best to include a normal low toilet. This allows spacers to be added and its height to be customisable for any room occupant. Folding handrails have been incorporated into the toilet to help people to get up and down.
[9] Taps
Use traditional screw taps with space for fingers between the handles. People with limited dexterity have no problem using these and they also appeal to long-term procedural memory of people with dementia.
[10] Personalisation
Provide picture rails and space to include small items of furniture. The en suite is an extension of the bedroom. Many people like to pamper themselves and use cosmetics. It may also be appropriate to include a medicine cabinet. This is a natural place for safe medication and a logical place for people to want to store items for self-care.
7|Shared bathroom
The shared bathroom does not need to be a medical environment that cares for people who need help to wash. For most people a bath is a chance to relax and indulge. The qualities of this room can support this activity.
The design of this room balances the need for assistive technology against the need to make it feel like a normal domestic facility. The room includes soft furnishings, screens for privacy when changing, chairs to help people sit and dress independently and integrated rails.
[1] Hand rails
Rails are essential to help a person to transfer their body independently. They are also extremely institutional. In this design the rails have been integrated to give the appearance of a natural domestic room feature.
[2] Bath lift
The room includes a bath lift to assist those who can no longer get into the bath independently.
[3] Accessible sink
The sink is high on the wall to allow wheelchair users good access.
[4] Mirror
The mirror should be low to allow wheelchair users to see themselves. It should also be disguisable. Some people in the later stages of dementia no longer recognise their own image and can mistake the reflection for someone looking at them. This can be very uncomfortable in a private space.
[5] Slip resistant floor
The bathroom can be very hazardous area for falls. Floors should be non-slip.
[6] Room to manoeuvre
It is essential that there is a good turning circle in the bathroom for wheelchair users. Space has been provided around the bath, shower and toilet to allow care worker to support those requiring assistance.
[7] Toilet
It is best to include a normal low toilet. This allows spacers to be added and its height to be customisable for any room occupant.
[8] Taps
Use traditional screw taps with space for fingers between the handles. People with limited dexterity have no problem using these and they also appeal to the long-term procedural memory of people with dementia.
[9] Contrast
Ensure all the key elements within the space are contrasted to allow those with sight loss to easily locate them. The bath, shower and toilet should contrast with the walls. All rails and bath towels should contrast with the walls. The doorframe should contrast with the wall. The door handle should be visible.
[10] Home like characteristics
The room should include domestic features and furnishing. Include pictures, candles, books, scent dispensers – anything you would expect to find in the home. Consider these elements and strive to make the bathroom unmistakeably domestic.
[11] Privacy
Being assisted with bathing can feel invasive. Include a screen so people can change behind it. Include a chair so those with limited reach or dexterity can change independently. Include bathing robes and towels to cover the body while changing.
8|Private away spaces
Providing a small living room creates an alternative space where a person can enjoy privacy from the rest of the group. It also provides a useful amenity for family members who want to spend time alone with their loved one.
Include opportunities to share activities that do not rely solely on verbal forms of communication. Include opportunities for privacy.
[1] TV and music system
Include a TV and music system so that residents can enjoy a DVD or piece of music with family members.
[2] Soft furnishing
Include soft furnishing so the space can be an alternative area to stretch out and snooze. Include reclining chairs and footstools. Include a soft where family members can sit beside each other and cuddle.
[3] Customisation
The interests of residents will change as occupants change. Ensure the room is customisable to allow the room to include specific interests of new residents. In Lancaster, for example, a loom might be included in the conservatory area for a resident who used to work in the textile industry. In London one corner of the main room might resemble a study for a city worker.
9|In between spaces
The biggest difficulty in planning a successful hallway comes from the amount of bedrooms that have to be accessed from it. Operating at the 12-bedroom scale eliminates the need for a succession of doorways that create a long generic corridor and exacerbate the way finding difficulties associated with sight loss and dementia.
The bedrooms in this design are arranged in small groups and spread out to the corners of the building interior. This creates opportunities for distinctive activity areas and way finding features between them. It avoids long distances between key services ensuring easier access for those with sight loss or physical disabilities.
It also creates more opportunities to let natural light into the central spaces within the home. Bedroom doors are solid so long stretches of doors make it difficult to design hallways that include windows.
A well-designed and logical hallway can help people choose activities and gives them independence by supporting a person’s ability to find their way. It is important to consider the features placed within it. Grab rails, doorways, way-finding features and layout need to be carefully balanced to offer support.
9.1| Hallway
[1] Volume
Changing the width and height of the hallway makes each volume within it more unique and memorable. The acoustics, light and visual aesthetic will differ in each part. This helps reduce the monotony of doorways that create a corridor effect.
[2] Way finding features
When moving through a hallway you are more likely to remember significant three-dimensional features you come across than pictures on the wall. Many older people look downwards, minding their step. They may also have reduced peripheral vision. The best features will include memorable multi-sensory information such as a change in light, air movement, smell or visual distinction.
[3] Natural lighting
Lay out the building to ensure the hallway regularly accesses the building exterior. This creates memorable views to support way finding and opportunities to let natural light in. Where possible, use skylights or light pipes. Avoid glare through careful positioning of windows, using architectural shades or sheer curtains.
[4] Reduce hazards
Ensure features such as seating areas or fire extinguishers are set back from the main line of pedestrian travel to avoid impact hazards for those with sight loss.
[5] Regular seating
Include regular seating opportunities with space for wheelchair users alongside. This will help people with severe mobility problems and create a social space for residents.
[6] Width
Ensure corridors are wide enough for wheelchairs or hoists to pass easily in opposite directions. A wider corridor will reduce the risk of confrontation. People with dementia may misinterpret close proximity as aggressive in a tight space. We can all find invasions to our personal space threatening.
[7] Care station
It is important that people can find help if they need it. In this design we have integrated the care station into the kitchen, as it is the place you would expect to find help in the home. It is open in design so that people can naturally find it. It is centrally located so that passing residents naturally come into contact with carers on duty.
[8] Hand rails
Include rails on all walls. This will help people with mobility problems to steady themselves. It can also help people with sight loss to orientate and way find. Integrate the rails so they look like a dado rail or a natural wall division and not an institutional element.
[9] Destinations
Ensure there are no dead ends. They can become flash point for confusion or conflict in the home. Instead ensure every passageway leads to an opportunity for meaningful interaction. Use unique areas where people can discover different activities and people to engage with. Never place bedrooms at the end of corridors. This will lead to repeated invasions of privacy.
[10] Interaction
Including a coat and shoe rack is a normal element of any hallway. Trying on hats, handbags, coats, boots, raincoats and gloves can be a fun way to communicate with someone who may be losing their ability to communicate through language.
[11] Bedroom doorways
Include tactile room numbers on handrails beside bedroom doors. This will help those with sight loss. Embed a memory box in the wall beside the doorframe. Personal items or old photographs can be beneficial to room identification. Different items will work better for different residents. The door can be Georgian and opaque in style to reinforce the idea of privacy and security.
[12] Exit door
In this design we have been able to make the exit visible as it leads to a safe communal area. In other layouts it may be necessary to hide this door to promote safety. It is important to locate the exit outside of shared activity spaces so through traffic does not create disturbance.
[13] Outside door
Use full-length glass exterior doors so residents can see there is a safe exterior space they have access to. This will also add light to the hallway. Ensure direct sunlight is avoided. If south facing, ensure glare is managed using shading.
[14] Fire safety doors
Fire doors can be integrated into the hallways design so they preserve the domestic aesthetic and do not disrupt the handrail.
[15] Activity room doors
All entrances to safe activity areas such as lounges, kitchens and other shared spaces should promote visual access. Use double doors with glass panels. If the doors are kept open the sound of activity or smell of cooking can also promote access for people with sight loss.
[16] Service area doors
Service area doors or other doors, which lead to unsafe areas, can be disguised to look like the wall. They can also be locked. This reduces the temptation and risk of residents accidently entering these spaces.
10|Shared spaces
Each shared room in the home should present different opportunities to socialise or engage in activity. It should offer a range of activities that are normal to the room type. It is essential to avoid multi-use spaces in which sensory ‘noise’ from competing activities cannot be controlled.
Ensure all rooms are distinctive. Including smaller spaces helps manage noise for people with hearing impairments and manage distracting sensory information for those with attention problems. Including smaller rooms allows people to choose from different sorts of activity within the home. The characteristics of each room should speak of its unique function. This will help people to recognise the room’s purpose and support those with memory impairments.
Including different room types will also help manage difficult behaviours for those with dementia. When there is choice people can express themselves through vocalisation or behaviour in a way that does not impact on others within the space. This has a great benefit for other residents and the staff running the home.
10.1|Eat-in-kitchen
The kitchen is the social centre of the home. It is the place we expect to find life. Growing up, it was the place where mother was. It makes sense that it should act as the meeting point for residents, staff and visitors. In this design the kitchen is the first thing that you come to when you enter the home. It is archetypical and instantly recognisable as a domestic space. A staff office is located to the rear with good visual access to the space.
The design integrates a food distribution point. This allows the home to function efficiently. Unsafe commercial equipment such as dishwashers and chemical cleaners can be located away from residents. Its door is camouflaged and locked to reduce temptation and improve safety.
The kitchen itself is equipped to run safe activities. Cooking activities can be broken into simple parts for those with sequencing problems. People can peel potatoes, mix ingredients, put away dishes, set tables, help clean and feel like they are part of the running of the home. Simple items like dusters and bowls should be accessible and resident involvement should be part of the philosophy of the home.
[1] Tables and chairs
The tables should be designed to allow wheelchair arms to pass underneath, allowing residents to get close to their food. All chairs have arms to assist residents to easily get in and out of them.
[2] Cross-corridor interaction
A seating area across from the kitchen encourages social interaction in this area so that passing residents will naturally come into contact with the social centre of the home.
[3] Flexibility
This central wall is on castors and the opposite wall opens out into the living room. This allows the space to be converted for special events such as Christmas or a 90th birthday when more space is required.
[4] Staff office
The kitchen acts as an informal meeting point between staff, residents and visitors that enter the home. It is the first point of contact when a person enters the home and contains a staff office to encourage staff to naturally gravitate to the kitchen table to do their work. This means they stay accessible to residents. The office has uninterrupted views of the kitchen and outside garden.
[5] Activity notice board
The activity notice board has been included in the kitchen as it is the natural place for it to be located in a normal home.
[6] Soft materials
Curtains, wooded panels, cork floors and acoustic wall panels have been used to deaden noise within the space. This helps people with attention difficulties to concentrate on their meal and those with hearing loss to focus of what is being said.
[7] Smell of cooking
The kitchen is open in design to encourage the smell of cooking to spread through the home when appropriate. This helps orientate residents to meal times and stimulates appetite.
[8] Lighting
Additional lighting should be provided over tables and work surfaces to aid sight loss. Using normal hanging lights is effective and helps reinforce the idea of domesticity. Care should be taken to ensure all bulbs are completely shaded from view. Some people’s view will be upwards if they are being transferred in a reclined position.
[9] Logical layout
The room has been laid out in a logical way to promote consistency for those with sight loss. Although it is flexible and can be rearranged for special events it is important that furniture is consistently located on all other days to allow people with sight loss to build a mental image of the environment.
[10] Sound spaces
The tables used allow small clusters of residents to group together. There are only three tables so there will be a limited amount of people in the space. Food distribution remains outside the space to reduce passing noise. This helps those with hearing loss to more easily communicate.
[11] Visible toilet
The toilet is directly adjacent to the dining area and visually accessible. People commonly need to use these facilities after they eat. Close proximity aids those with sight loss, memory problems and mobility difficulties.
[12] Activity space
The kitchen contains all the facilities necessary to run food events and cooking activities. Any dangerous items can be contained in the adjacent food distribution area. Cooker switches also contained in this area mean that appliances in the shared space can only be used with staff supervision.
[13] Food distribution point
Food cooked outside the cluster can be brought and distributed from here. This area opens into the corridor to ensure the traffic of care workers bringing food to residents throughout the home does not create distracting traffic through the eat-in kitchen. This area can contain commercial washing facilities and anything else deemed inappropriate for general use.
10.2|Living room
The living room is a place we use for recreation within the home. It is where we entertain ourselves and look after guests. A good living room should offer opportunities for entertainment and opportunities to relax.
It is important that the space offers different ways for residents to engage with it and different activities for staff to encourage residents to engage. Everyone will have different interests and abilities. During the day activities can change depending on who is occupying the space. Some people will be able to enjoy music, read, watch TV or entertain friends. Others will be more passive.
When people in the later stages of dementia sit down there is often a natural desire to fiddle. Soft blankets, a soft toy, knitting needles, wool or just the ambience of a fire may be a good way to encourage occupation.
[1] Storage
Including storage allows objects such as cushions, blankets, soft toys or knitting needles to be safely stored away. Objects that are left around can fall on the ground becoming trip hazards, particularly for those with sight loss.
[2] Fire place
A fireplace is one of the most rudimentary symbols of home. Ideally a real fire should be included. In care homes electric versions that are safe to touch can be included for reasons of health and safety.
[3] Lighting
The inclusion of extra task lighting next to seating helps those with sight loss to read.
[4] Sound space
Tables and seating areas can be grouped together to support hearing and lip reading. It is easy to add abundant soft material to a living room by using carpeting and soft furnishing. There is a good selection of soft water resistant fabrics that are cleanable following any incontinence accidents.
[5] Television
The television should not be the centre of attention in the living room. Everyday programmes are less accessible to this group due to short-term memory problems. TV noise will exacerbate hearing problems for those not watching. Keeping a selection of old movies, which appeal to long-term memory strengths, can be good for special events. Residents who enjoy everyday TV can watch it in their bedrooms.
[6] Music
Music has been cited as one of the most enduring pleasures for many people with dementia. Including a piano or other instruments can create opportunities to make music. Including an online music centre with the Spotify software program will allow staff to compile music from every source at low cost. This is an excellent way to encourage interaction and learning between staff and residents.
[7] Reclining chairs
It is important to provide chairs that support different body positions. Many extremely frail people slump forward in a traditional supportive chair because they no longer have the strength to sit upright for long periods. Provide chairs that allow them to sit back and relax.
[8] Sofas
Many people in care will feel isolated. Ensure there are two person sofas. This allows family or staff members to touch or cuddle when sitting side by side. The reassurance of touch is of paramount importance.
[9] No low furniture
Ensure there is no low furniture. A low coffee table can be a trip hazard for a person with sight loss. Provide higher tables.
10.3|Outdoor Space
Outdoor spaces provide excellent opportunities for interaction and activity. They can be designed much like the interior of the home. Pathways can lead through different activity areas providing alternative spaces for residents to engage with depending on their moods and interests.
It is important that outdoor spaces are safe and staff members are confident to let residents use them without supervision. The space should be visible to residents and accessible without any intermediary steps, which might require a lift or assistance to negotiate.
Including sheltered areas from the sun and rain allows the outside to be used all year round. Access to natural light is important for overall health and wellbeing. For people in the later stages of dementia it has also been shown to help consolidate sleep patterns. This is beneficial to the individual and the staff who care for them.
[1] Walking routes
Include clear uninterrupted walking routes. In this design the walking routes go through the interior of the home as well as the exterior space. The route is intentionally interrupted so that residents come into contact with other people and activities within the home. More extensive exterior walking routes are provided in the shared space in the central community area between clusters.
[2] Seating
Include regular seating intervals to provide resting points for those with limited mobility. Ensure there is adequate space beside seating areas for wheelchair users.
[3] Identifiable exit
Ensure the outdoor entrance is visually distinctive from the exterior of the building to promote easy location when outside. Use glass doors so that the garden can be seen from inside.
[4] Floor surface
Ensure paving is flat, slip resistant and contrasts the adjacent surfaces. A hard surface with few inclines will assist people in wheelchairs or those with poor balance or a shuffling gait.
[5] Rails
Include rails on one side of the path to assist those with poor mobility. Rails will also help those with sight loss to navigate.
[6] Multi-sensory stimulation
Promote way finding and orientation by stimulating the senses. Use distinctive visual elements such as arches. Include raised beds with scented plants. Use brightly coloured planting. Include long grasses that can be touched.
[7] Light and shade
Natural light has been shown to help sleep patterns for people in the later stages of dementia. Provide seating in the sun. Provide shade for those who burn easily.
[8] Safety
Ensure the exterior garden promotes confidence among staff to allow residents to have free access to it. Include a high fence with a totally protected perimeter. Obscure the view of the fence with planting to reduce the temptation to climb it. Avoid putting furnishing beside the fence.
[9] Potting shed and gardening area
Many people staying in the home will have enjoyed gardening in their own homes. Design a planting area to run group activities. Include a potting shed full of items that can be tinkered with. Include raised vegetable plots.
[10] Conservatory
A conservatory allows residents to have access to the outdoors and natural light all year round. It can also function as a greenhouse, adding another dimension to gardening activities. It is a natural place to include opportunities for hobbies such as painting, pottery or clay sculpture.
[11] Lawn
A lawn is a simple and flexible amenity. It creates the opportunity to run a host of outdoors activates such as exercise groups, sun bathing, picnics and games.
[12] Gazebo
Including a gazebo provides an alternative private away space where residents can go to be alone, staff can organise small activities or visitors can spend time with residents in private.
[13] Patio and barbecue
Including a covered patio with a barbeque adds another dimension to the dining area. It can greatly improve the quality of meals in summer. It can serve as a useful amenity for staff or family members to run shared events.
Original contributors
Lead researcher
Gregor Timlin
Senior Research Associate
Helen Hamlyn Centre of Design
Project researcher
Jiang Ying
Visiting Resaerch Associate
Helen Hamlyn Centre of Design
Supporting researcher
Lisa Johanson
Research Associate
Helen Hamlyn Centre of Design
Research partners
Helen Hamlyn Centre for Design
Bupa
Acknowledgments
The researchers would like to thank the following people for their support during the project:
Bupa and the Helen Hamlyn Trust for funding the project; Dr Clive Bowman, Medical Director of Bupa Care Services; Dr Graham Stokes, Director of Dementia Care, Bupa Care Services; Sarah Buchanan, Head of research and development, Thomas Pocklington Trust; Barbara Pointon, Ambassador for the Alzheimer’s Society; Dr Robert Cohen, Senior Neuropsychologist in the Memory for the Dementia Services Information and Development Centre; and Samantha Sharp, Policy Officer for the Alzheimers Society.
Editors
Jeremy Myerson
Rama Gheerawo