One of the greatest obstacles to many people embracing residential aged care is the loss of their precious, personalised environment.
This is even harder when symptoms of cognitive impairment can make an institution-style atmosphere seem confusing, destabilising and even frightening.
The Dementia Centre has been working for over 30 years to develop and promote a very different model of residential care that strives for a dwelling that's much more like home.
New guidelines
The new National Aged Care Design Principles and Guidelines take a similar view -domestic-style living arrangements (of 15 or fewer people) lead to the best health and wellbeing outcomes, noting:
"There is substantial research on small household models having wide-ranging benefits, such as reducing agitation, pacing, and exit-seeking, while improving social interaction, eating, and infection control."
The way a residence is designed can have a big impact on the behaviour and symptoms experienced by people living with dementia .
The guidelines are underpinned by four principles. We’ll be looking closely at each of these in turn - read our blog here for the first one, and we'll dive into the second one below.
This second principle aims to support organisations as they move towards small household models. There are 11 guidelines that aim to achieve this goal – we’ve summarised some issues and solutions for each of them to give you an overview.
The functional, clinical and impersonal design of traditional aged care homes can be very off-putting for residents. Personal objects can make a place feel like home, so support residents by decorating bedrooms, common areas and outdoor areas with their own items.
Smaller groups of residents living together record better quality of life than larger care environments in all available measures. Consider ways in which you can split larger residences into smaller ones, training staff in an aligned model of care that allows flexibility in sleep, eating, and showering.
Environments with lots of unwanted interruptions, less privacy and little access to quieter rooms are more stressful, leading to less socialisation and more anxiety and depression in residents. By splitting residents into smaller households with their own entries, there are less comings and goings. You can also consider using vestibules, concealed delivery routes, and other devices to regulate the busyness of entries and staff intrusion.
Domestic-style kitchens provide a powerful landmark to orientation, a place to connect and be active, and better nutrition. Place the kitchen next to the dining room, in view of communal areas, and full of familiar appliances such as stoves, ovens and microwaves. Passive safety features such as a lockable knife drawer are recommended.
In more institutional settings, large scale rooms prompt programming for larger scale group activity. By providing a cluster of smaller rooms for small-group activity, you can cater to residents' cultures and specific interests.
Length, width and shape of a corridor have all been shown to affect a person’s ability to find their way and increase demands on staff. Shorter, straighter, well-lit corridors, with somewhere to rest such as an armchair along the way, help with wayfinding and reduce agitation.
Private bedrooms support privacy, personalisation, comfort, reduced conflict, enhanced wellbeing, increased resident satisfaction, better socialisation, and a sense of a building as ‘home’. Locate bedroom access off a corridor, not a communal room, and stagger entries for improved privacy and wayfinding.
Providing a view of the toilet from the bedroom (ideally from the bedhead) is an important cue supporting independent use of the toilet. Fixtures and fittings should be familiar and intuitive to use. They must be visible through good lighting and use of tonal contrast.
Furniture and fittings can make the difference between a place feeling like home and being easy to use, or feeling foreign and being disabling. Provide furniture, finishes and fittings which are familiar to an older generation and a domestic style, and are robust, not easy to dismantle or tip over, easy to clean, and can be safely moved by staff.
Institutional clutter and noise reduce homeliness, contribute to overstimulating and create barriers between residents and staff. Highlighting resident doors and concealing staff doors can improve independence and clarify the environment. Ensuring staff signage is small, consistently placed, and at high level supports staff without being intrusive.
Dedicated staff areas are important for morale and reducing stress for staff. Equally, for residents, separating staff rooms from resident areas, physically and acoustically, maintains the integrity of a resident area as a home.
Let's work together for better
Shifting to a small household approach is not only about design of the physical environment. It requires a well-defined ‘model of care’ that addresses an approach to governance, operations, staff training, and daily activities within a home.
The Dementia Centre has expertise to share about both physical and social environments. With better spaces and better connections, you'll provide better care, and that leads to better lives for people living with dementia.
We'd love to chat about how we can tailor our services to meet your needs. Just email consulting@dementiacentre.com.au