By Jim Wallis, AIA, EDAC, NCARB, IIDA
Principal and Senior Living Studio Lead
The U.S. senior population is rising, and so is the projected number of Americans living with Alzheimer’s disease and related dementias. America’s 65-and-older population is expected to nearly double by the year 2050 to 83.7 million with an estimated 13.8 million living with Alzheimer’s disease.
A recent boom in senior housing construction means senior living providers are facing more competition, especially among the memory care segment. With more choices available to residents, memory care providers need to provide a therapeutic environment to support a person-centered care model unique to this segment of the senior living market.
Each design strategy should support the implementation of person-centered care, providing residents a dignified, comfortable, functioning environment.
But first, it would be helpful to define what person-centered care is.
Defining person-centered care
Person-centered care is a way of thinking about and providing care that places emphasis on the resident experience. Maintaining selfhood is central to this model of care – enabling residents to continue the rhythms of daily life and live as independently as possible as the disease progresses. Person-centered care shifts the environment for those living with cognitive impairments from that of an institutional care setting to a resident-focused care setting.
1. Unique environmental needs of people with dementia
First and foremost, it is key to understand what dementia means and the unique environmental needs of residents with dementia and Alzheimer’s disease.
Dementia is not a specific disease. It is an umbrella term that describes a group of symptoms associated with the loss of cognitive skills – memory, thinking and reasoning – and behavioral abilities severe enough to interfere with that person’s daily life and activities. There are multiple types of dementias, but the most widely known is Alzheimer’s disease.
Alzheimer’s disease and related dementias do not progress in a linear fashion; therefore, each person experiences Alzheimer’s and related dementias differently.
Therapeutic environments rooted in the person-centered care model of evidence-based design are shown to reduce negative behaviors associated with the disease progression such as wandering, elopement risk, agitation and anxiety.
2. Smaller groups and spaces
Large spaces and groups of people typical of senior living communities can be agitating for residents with cognitive impairment. Reducing spaces to a residential scale and using a household model can alleviate many common agitations.
A household model reflects the familiar elements of a home and includes a living room, residential kitchen, dining room space, private resident rooms with bathrooms, activity areas, and a secured outdoor courtyard. An open plan with clear, familiar room-to-room circulation aids in wayfinding and provides environmental cues as to the intended use for the space.
When Perspectus worked with Brookdale Senior Living at its Atrium Way location in Jacksonville, Florida, we were tasked with renovating an existing assisted living wing into a memory care unit utilizing the household model.
The building was originally designed with a large, two-story central community space that the resident rooms opened up to. The new design reduced the height of the ceilings and defined small spaces within the large existing space to create a more familiar residential scale.
3. Opportunities for social engagement
It’s important to create a community of the right size. The ideal size of a household is 10 to 14 residents. Smaller groups provide more opportunities for residents to interact with each other and caretakers and participate in familiar daily routines.
The design strategy should include spaces of multiple scales to allow for different types of activities. This variety of spaces and scales serves multiple purposes: it allows staff more spaces to program activities that cater to the residents’ interests and needs and gives residents control of desired level of social interaction and privacy.
For instance, the design may include smaller alcoves and seating areas for more intimate social interactions and more public spaces such as a living room or a secured outdoor courtyard to accommodate larger group activities.
Another design feature that promotes social engagement is an open, residential country kitchen located directly adjacent to the dining room. The residential kitchen enhances activities of daily living, creates opportunity for structured programming such as baking or routine household chores, and provides sensory stimulation from cooking aromas which can help stimulate appetite.
Decentralized staff areas maintain a residential environment and encourage more social interaction between staff and residents. Identifiable nurse stations are a necessity in institutional environments, but you wouldn’t want to see a nurse station in your home. Designing the residential kitchen with features that discreetly double as a nurse station facilitates staff interaction without disrupting activities of daily living.
4. Color, lighting and materials
Lighting and material selection are critical design elements in senior living and memory care environments. It is very common for elderly persons, especially those with cognitive impairments, to experience several age-related vision issues including difficulties distinguishing colors, depth perception, and sensitivity to contrast and glare.
The most common lighting problem for memory care residents is that the space is not bright enough, causing agitation. Illumination should be increased to improve visibility and offset contrast sensitivity.
Another common light-related agitator is glare. Materials and surfaces that are not glossy and reflective can help eliminate glare.
The use of color and materials should work both to create a calming environment as well as increase contrast. Flooring color should provide complimentary contrast to the wall color. If a pattern is used, it should be kept simple. Too much contrasting pattern can cause confusion, as memory care residents may see certain areas within the pattern as voids and step around them.
Color contrast also aids in visual cueing. For instance, memory care residents can have difficulty recognizing the need to use the bathroom as the disease progresses. Floor and wall colors that contrast with the toilet help it stand out.
Thoughtful choice in color, lighting and materials are critical to reducing agitated behaviors and increase resident well-being and autonomy.
Person-centered care design strategies for memory care residents are about facilitating as normal a life as possible in an environment that is truly a home. Through a heightened understanding of the disease and utilizing a holistic, person-centered care approach, memory care facilities can provide residents with a dignified experience that nurtures their mind, body and spirit.