A study of 32,00 residents from 751 care homes reveals that one in 14 of over 65 year olds in the UK have dementia. Care home residents are typically aged 85, of which 75% are female. When considering our design criteria, it is worth noting that the average weight of residents is 63kg and the average height is only 5’3” and that they sit for an average of 11 hours a day. Obesity, back and neck problems, diabetes, blood circulation, sight loss and heart disease are just some of the issues which must also be considered. We must think about living with dementia rather than suffering from it, and good design helps people live well.
When looking at finishes, install continuous flooring with a small tonal contrast and similar LRV (light reflectance value) between spaces, and acoustic flooring will reduce impact sound transfer between rooms. Do not create barriers unless you want to have them between patient and staff areas. Remember, dark patches and circles can be seen by people with dementia as holes, preventing them from walking over them. Other considerations: no pearlescent flooring, these can be seen as wet floors, therefore people walk differently causing trips and slips. No glossy surfaces or polish either. Avoid ‘flecky’ floors, and if there are any chips such as in safety flooring, keep them the same colour. People with dementia see these flecks as something to pick up. Consider spills and incontinence – choosing the right surface with a practical cleaning regime. The transition to different surfaces should be smooth (i.e. barrier matting to flooring) and reserve pimple or safety flooring for bathrooms and wet areas.
Always recognise that you need to create a homely feel, choosing furniture appropriate for the activities in the room. A reading room should have conveniently positioned shelves, comfy chairs and good lighting. Perspex panels in drawers and doors allow residents to recall what is inside. Memory boxes for each person either in their room or by the entry door will help them with wayfinding. If considering mirrors be aware that while not all people are frightened by mirrors, you may need the ability to hide them away.
There is not one answer to colour palette choice, it is more about the whole scheme. Have contrasts on walls and skirtings, avoiding dark colours, busy designs and patterns, borders, grout lines or welds and floor logos. Hue saturation Tone and LRV (light reflectance value) are key. Indicative LRV’s are: White 95% and Black 2%. The key is 30 points of LRV difference between the floors and walls and walls and ceilings. If they are too close in colour, the resident cannot differentiate between the surfaces. Use strong and warm colours to enliven a space and promote wellbeing. Magnolia and silk paints (which has been the norm for too long) are a big NO. I recommend using the same colour on the door as you use behind the bed. Have different colours for different areas and activities. You would normally differentiate doors but hide doors you don’t want people to go through (i.e. through to staff quarters). Do all toilet doors the same colour and use water-based paints throughout, avoiding gloss surfaces especially on the traditional surfaces such as window cills and skirting. Instead, use satin or matt paint noting that with a trade cleanable matt can be easily cleaned. Antibacterial paints are also being developed. Signs on toilet doors should not only have the word but a picture of the toilet as well. Use a primary colour, either yellow or red. The ability to see green and blue goes first. Make sure you do not use the same colour to show anything else. It would be a huge mistake to have a red toilet seat and a red chair in the same room. Let residents choose their own colour doors if possible.
When considering fabrics, think about the perception of the environment by the individual. Suppliers do seem to understand this concept now. Residents, families and staff should all be considered. The resident should have a home with a five star feel. Fabric must be fit for purpose for longevity and consider whether or not it needs to be waterproof. Contrast the seating from the flooring and walls. Research shows that seniors need three times more light than younger people to see and that they have diminished depth perception. The scheme should be stimulating but not disturbing. Fire retardancy, cleanability and stain resistance all need to be considered when choosing fabrics for this sector. Curtain fabric may need to be washed at up to 71 degrees, but many can still be antimicrobial treated. Colours which the individual can remember is helpful and piping or using a leading edge on the curtains can help with identifying them and clarifying where they are in the room. Try not to use literal designs, instead using stylised or abstract designs.
We need to make care homes and our own homes secure and welcoming for those with dementia. This is a very big subject, but I hope this snapshot will help start the conversation!