Clarifying designs

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Carpet must be carefully chosen for residents with dementia, and artwork should be literal.
Carpet must be carefully chosen for residents with dementia, and artwork should be literal.

The housing and care of Alzheimer's disease and dementia patients has been on a roll. The recent progression of designs and elements has led to improvements for residents and the staff who care for them.

Whether large or small, new or renovated, facilities will continue to employ new waves of strategies, products and care plans to serve the rapidly increasing Alzheimer's/dementia population. In many cases, it's out with the old way of thinking and in with the new and innovative. And no sector is out of play when it comes to accommodating this special-needs population. 

“More and more, communities want an environment where the ultimate goal for seniors with dementia and Alzheimer's is to provide care that encompasses the mind, body and spirit — ultimately raising the quality of life,” says Michael Zusman, CEO of furniture and wallcovering manufacturer Kwalu. “No more are these seniors with special needs being confined to small, institutional spaces. Their environments are well-defined, easily understood, and combine safety and comfort with a nurturing atmosphere.”

In other words, the push is on: Living spaces no longer should merely contain the residents. Instead, providers are challenged to comfort, calm, engage and create a sense of home for residents. 

“I am seeing clients interested in more sophisticated design elements. And they are moving away from ‘traditional' style, creating spaces that feel modern and eclectic,” says Kristy Yang, senior lead interior designer for Direct Supply Aptura.

“Clients are open to using subtle floor patterning, adding interest without creating visual obstacles, and brighter, bolder colors for impact in spaces intended for high energy activity. Architecturally, spaces have become more interesting. A larger focus on details in ceilings, millwork and moldings has become more prevalent both in new construction and renovations.”

Well-studied form

The functionality of these spaces also has improved.

“Much of the current focus is driven from common sense and clinical observations,” says Linda Roehrenbeck, executive director of National Church Residences Mill Run in Hilliard, OH. “A diagnosis of dementia, irrespective of the type, has certain commonalities. Each environment — both personal and social — must have elements of ‘person control.' 

“Beds and toilets should be visible from either location. Windows should be large enough to balance the need for natural light, but not so large as to create an outside space inside.”

Carpet is “the flooring of choice” for comfort, even though it may be difficult to maintain. Shortening long hallways with “destination seating” and clustering helps to reduce the large-scale feeling of some environments, Roehrenbeck adds.

The LaSalle Group, which operates Autumn Leaves facilities for Alzheimer's patients in Illinois, Texas, Oklahoma and Georgia, says it tries to make positive changes for all of its clientele.

“As new residents are introduced to our buildings, the design team has to take account for their generation, as well as the existing generation that's at the property,” says Interior Design Manager Nicole Gray. “It's a delicate balancing act.”

Gender-based common areas are among the elements The LaSalle Group incorporates.

The “Men's Lounge” features browns, neutrals, plaids and tweeds. The women's area uses pastels for an English tea room setting. The furniture has heavily carved appointments for a homelike atmosphere. 

“Artwork plays a major role for our buildings as well,” says Gray. “At every hallway, we off-center a piece of art to help residents understand that the hallway is not a dead end. Artwork must be extremely literal. If it's not, then a resident could get agitated.”

Walkways need special attention, Gray adds. 

“Each hallway has a theme and a color that helps with memory and recognition skills. This is also introduced in the artwork,” she notes.

Common but not simple

In many facilities, larger common areas are designed to engage all residents.

“We are seeing a lot of communities creating a ‘Main Street' concept, which responds to the safety, well-being and way-finding concerns of the residents,” says Kwalu's Zusman. “‘Main Street' is a place that brings the outside in, permitting dementia and Alzheimer's residents a chance to walk safely throughout the community, promoting a change of routine and fostering more social interaction.”

PDC Midwest, in Hartland, WI, employs a five-pronged strategy to further engage residents.

“Experienced architects and interior designers develop building elements that have a positive impact to the unique perceptions of dementia residents,” says company president Bob Gummer. “Positive stimuli are created that spark reminiscence, create visual interest, encourage meaningful ambulation, and inspire socialization.  

“Negative stimuli are eliminated that initiate confusion, create agitation, and remove interaction. The elimination of confusing travel paths, control of lighting, reduction of noise intrusions, and attention to the perceptions of color and texture are just a few of the techniques employed.”

The trend in lighting is “brighter is better.”

“To provide more daylight and brighter artificial light in the building is not a new focus, but I believe it to be one of the most impactful considerations when designing a building for Alzheimer's patients,” says Tim Terry, director of design for The LaSalle Group. “Loss of vision is one of the most common conditions of aging. Research has shown that exposure to bright light synchronizes circadian rhythms, which affect sleep and depression, and stimulate the synthesis of Vitamin D necessary for healthy bones.”

Experts expect more new facilities for Alzheimer's patients to come online. The Alzheimer's Association says that five million people were diagnosed with the disease in 2012, and that will triple by 2050. 

“Since new facility development was restrained during the last few recessionary years, senior care demand for specialized memory care communities outpaced the supply,” observes PDC's Gummer.

 “Add the numbers from the leading edge of the baby boomer demographics experiencing early onset Alzheimer's and the problem becomes compounded. The first baby boomers are now 65-to-66 years of age and that immense demographic has not yet reached the peak care years.  This country is just beginning to experience the tip of the dementia demand.”

Some facilities will be based on decidedly non-traditional concepts.

“We expect more cottage-type communities, each linked by barrier walkways in a campus-like environment,” says National Church Residences' Roehrenbeck.  

“Live walls may serve as barriers while adding the beauty of flowering plants, fresh herbs for meal preparation, and resident participation in the care of the garden. Each cottage may have four to six individual units with a community kitchen that is both functional and homelike.”

New goals, and certainly newer technology, will be key considerations for the future.

“I think we will see a focus on creating spaces that enable residents to function to their highest capability, not just to compensate for abilities that may be diminished,” says Direct Supply Aptura's Yang.

 “We're on the cusp of some very important and exciting trends related to technology applications within long-term care environments,” adds Kian Saneii, CEO of Independa, Inc. 

 “A commodity appliance that everyone uses and is familiar with is being transformed into a strategic delivery portal for social engagement, memory training and retention, reminders and health information. The TV becomes an integral tool in providing effective care and a key competitive differentiator for independent and assisted living communities.”

Independa has partnered with LG Electronics to create a cloud-based system.

“It delivers social interaction through the television via embedded video chat — helping friends and family, as well as professional care managers, enjoy easy remote connectivity with the residents,” explains Saneii.