Developing supportive design for people with dementia

The EHE Assessment Tool and Developing supportive design for people with dementia: design principles are the first in a series of tools and resources to be developed and produced by The King’s Fund to help individuals and organisations develop more supportive design for people with dementia, particularly in hospital settings.

They have been developed in collaboration with NHS trusts participating in The King's Fund's Enhancing the Healing Environment (EHE) programme and informed by research and evidence of best practice. This phase of the EHE programme was funded by the Department of Health to support the implementation of the National Dementia Strategy.

Why these resources are needed

At least one in four people accessing acute hospital services are likely to have dementia and the number of people with dementia is expected to double over the next 30 years. The health departments of the four UK countries have produced dementia strategies with the aim of ensuring that people with dementia receive high quality care in all health care settings.

Hospital stays in particular are recognised to have detrimental effects on people with dementia. Yet our evidence from the EHE programme is that relatively straightforward and inexpensive changes to the design and fabric of the care environment can have a considerable impact on the well being of people with dementia as well as improving staff morale and reducing overall costs. However the Royal College of Psychiatrists Report of the National Audit of Dementia Care in General Hospitals 2011 suggested that most hospitals had yet to implement such changes. The EHE Assessment Tool and the accompanying overarching design principles are offered as practical resources to help health care organisations develop dementia friendly health care environments.

Is your ward dementia friendly? The EHE Assesment Tool

The EHE Assessment Tool contains seven overarching criteria and a set of questions to prompt discussions. It has been informed by research evidence, reflects best practice and has been robustly and rigorously tested in a range of different hospital settings, including wards and out-patient departments. It is intended to be a guide and prompt for encouraging a review of the physical environment of care and to enable discussions about the way care is being delivered.

Although primarily designed for ward environments, the tool has also been successfully used in outpatient departments, assessment units and other clinical areas. The assessment can be repeated over time to see the degree of improvement that has been made.

It is recommended that the environmental assessment should be carried out jointly by a lay person, ideally a carer of a person with dementia, together with clinical and estates staff.  Involving a range of people in the assessment is recommended, as the actual process will enable discussions that are likely to encourage improvements in the both the physical environment and quality of care delivery.

The time required to undertake the assessment will vary according to the size of the area(s) being assessed but should take no longer than an hour to complete. A section has been provided for comments to identify areas of good practice and issues of concern.

To download the EHE Assessment Tool, please fill in our short form

Developing supportive design for people with dementia: design principles

These overarching design principles have been developed using the experience gained from the 23 trusts participating in the EHE programme to build on the evidence and international best practice in creating more supportive care environments for people with cognitive problems and dementia.

The design principles are presented as a wheel with five sections grouped around the desired outcomes of: easing decision making; reducing agitation and distress; encouraging independence and social interaction; promoting safety; and enabling activities of daily living. Listed under each of the section headings are a series of elements that are known to support, encourage and enable people with dementia in unfamiliar buildings.

It is unlikely that every element will be able to be introduced at a single time unless a new build or comprehensive refurbishment is being planned. However, many of the principles are simple and can be introduced with very little financial outlay and, based on the evidence from the EHE programme, will prove helpful in creating a more supportive physical environment for people with dementia and their carers. 

To download the design principles, please fill in our short form