Dignity—something that is often taken for granted—is one of the most fundamental elements of the human spirit. Everyone wants to be valued and respected for who they are. Those needs do not disappear if a person is living with Alzheimer’s Disease or other forms of dementia. Translating this innate desire to memory support design solutions demands acknowledgement of each person’s independence and personal choice, regardless of his or her acuity level.
Supporting the needs of people living with dementia requires senior living communities and design professionals to first understand the daily living challenges that a typical congregate environment presents. By identifying these difficulties, memory support settings can be reimagined to nurture independence and meaningful experiences which will, in turn, provide a sense of purpose and personal dignity.
Designing for Dignity Begins by Listening
Creating spaces that honor the user begins with listening. That means listening beyond just words to observe the culture, programming, and overall engagement. This deeper understanding is the foundation of creating a sensitive and responsive care setting that does more than support residents’ needs, allowing them to thrive even with the progression of dementia.
Who better to articulate the needs of a built environment—for both indoor and outdoor spaces–than people living with memory impairments?
Brainstorming with community leadership, health care staff, and resident families is critical, but progressive design also includes residents in this vital process to not only gain their input, but also demonstrate respect for their thoughts.
To define program needs for residential care and community services at LiveWell, we conducted focus groups with people living with dementia. Posters with cup graphics representing the seven domains of wellbeing were placed on the walls. Participant responses to a series of questions were documented on color-coded slips of paper representing physical, operational and personal aspects. Affirming ideas were placed inside the cups and things that should be avoided (draining ideas) were placed below the cups.
For example, the cup representing identity was filled with ideas such as private rooms, art gallery, and “having my own furniture in the bedroom.” Another resident responded simply with “see me.” Below that cup were draining factors such as lack of privacy or shared room (double occupancy). The color-coded responses were then quantified and distilled into themes that guided the design process. This methodology, engaging people living with dementia, informed the final memory support design solutions to a level that would not have been possible without their input.
1. Creating Zones for Privacy and Socialization
Design concepts that clearly define a hierarchy of spaces—for privacy or socialization as desired—convey an inherent respect for resident preferences and self-direction. Through focus groups and post occupancy discussions with communities throughout the country, we’ve learned It’s important to provide a variety of enriched amenity spaces. This allows residents to make choices about what they do, where they go and how they get there.
Finishes used in common areas should look and feel different than private resident spaces. Social areas are typically brighter, more open and larger than private areas. These areas may also have a higher ceiling. Smaller, more private gathering areas are important for family visits, dining for residents who need a quiet alternative to a larger dining venue or just a peaceful retreat when desired. Whenever possible, resident bedrooms should be acoustically and visually separated from dining or other lively activity areas.
2. Fostering Independence and Choice
Autonomy and freedom of choice are common threads in memory support programs. To allow people living with dementia to comfortably navigate throughout the day, we can provide strategically placed signs, artwork, and objects that are easily recognizable along commonly traveled paths. Each of these techniques must be reinforced with the use of material, color, lighting, and accessories.
Post occupancy evaluations have taught us that contrast—for artwork, furniture, finishes, even dishes—empowers residents to enjoy freedom of choice and movement. We have learned that thematic elements, like colors, artwork, even staff uniforms, provide helpful cues to assist residents. In this way, we create clearly defined and differentiated spaces that are easily recognizable to promote resident autonomy.
3. Making it Personal
Another theme that has emerged through post occupancy evaluations with communities and focus groups with older adults and their families is the importance of each resident being known and respected as an individual. Fostering personal relationships and spaces that are individualized can take many shapes and forms. It can be as simple as encouraging residents to furnish their own rooms.
We can also provide ample opportunities for adding personal items to their room, perhaps spilling out into the corridor outside their room. While there are mixed reviews on the value of memory boxes as a cueing device for residents, all agree they help staff members get to know and engage with residents.
New technology continues to emerge that can be directly used by residents, families, and staff to connect in a variety of group and personal activities, from music and art to family photos and letters. One community uses a “storybook,” approach, where family members document the resident’s life, preferences and interests. The books help staff members get to know residents and provides a helpful tool for the residents to share their story with others.
Dignity Must Be the Focus of Memory Support Design Solutions
A strategic, collaborative effort to create person-centered memory support environments can bring clinical and design professionals closer to improving quality of life for those living with dementia. This is particularly important as the number of adults living with dementia and Alzheimer’s disease is projected to rise in the coming years, increasing 40 percent to 7.1 million by 2025. And because the disease affects each person differently—impairing reasoning, memory, judgement, planning, focus, and decision making that support routine activities of daily life—preserving each individual’s personal dignity and sense of purpose should drive memory support design.
Visit our Memory Support Resource Page to access the white paper and other information.
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