Developing supportive design for people with dementia

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Part of Enhancing the Healing Environment

To support clinical and care staff, managers and estates colleagues, The King's Fund has produced a range of resources to enable hospitals, care homes, primary care premises and specialist housing providers to become more dementia friendly.

The work that informed the initial development of the resources, the EHE dementia care programme, was funded by the Department of Health to support the implementation of the National Dementia Strategy and the Prime Minister’s ‘Challenge on Dementia’.

Following the completion of the EHE programme, the work on dementia-friendly design is being taken forward by the Association for Dementia Studies (ADS), University of Worcester.

Guide to carrying out the assessment

The EHE assessment tools contain seven overarching criteria and a set of questions to prompt discussions between clinical/care staff, managers, estates and maintenance colleagues, people with dementia, their families and carers.

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/care and estates/maintenance staff. Involving a range of people in the assessment is recommended because the process of undertaking the assessment will enable discussions that are likely to encourage improvements in both the physical environment and the 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.

Design principles

Supporting the assessment tools, the design principles have been developed using the experience gained from 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 can be introduced at once unless a new build or comprehensive refurbishment is planned. However, many of the principles are simple and can be introduced with very little financial outlay.

The design principles have been incorporated into each of the EHE assessment tools above.

How were the tools developed?

The tools have been informed by research evidence, best practice and more than 300 survey responses from the United Kingdom and abroad from people who have used the tools in practice. Each of the sections draws on this evidence to develop a rationale for effecting change in care environments. These rationales also address the visuospatial problems often associated with dementia.

The first assessment tool for ward environments was developed in collaboration with NHS trusts participating in The King’s Fund’s EHE programme. Since then more than 70 care organisations have been involved in field-testing the tools.

Tools were subsequently developed for general hospital environments and care homes. Following requests from the sectors, tools have now been developed for health centres including GP premises and for ‘housing with care’ to include extra care housing, retirement communities and sheltered housing.

How the tools are being used

Evaluations of the tools indicate that they are being used to:

  • Assess progress in developing more dementia-friendly environments
  • Secure finance to improve the physical environment of care
  • Influence managers and estates/maintenance colleagues to support change
  • Educate staff and help change attitudes
  • Improve signage, flooring, lighting and colour schemes as part of maintenance programmes
  • Make small-scale improvements eg, purchasing coloured crockery.