Environments of care for people with dementia

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Part of Enhancing the Healing Environment

In 2003 the Department of Health commissioned The King's Fund to develop specific programmes to enhance the environment of care as part of the department’s work to improve patient experience. The most recent of these was a programme to improve the care environment for people with dementia in hospital 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.

What are the current issues for people with dementia?

Each year the number of people living with dementia is growing and this number is expected to double during the next 30 years. It is estimated that 40 per cent of people aged over 65 in general hospitals will be living with dementia and most of the people living in care homes will likely have dementia or cognitive problems.

In particular, hospital stays are recognised to have detrimental effects on people with dementia who have longer lengths of stay and poorer outcomes. However, there remains a low level of knowledge in the health professions – even among those who have been trained to care for people with dementia – and among estates and facilities staff about what makes a positive therapeutic environment for people with dementia. The volume of applications for the EHE programmes and training events has shown that there is a considerable level of interest in creating dementia friendly environments and there is a desire across the service for practical advice to enhance the quality of the care provided to people with dementia.

What has the EHE programme achieved?

The EHE programme to improve the environment of care for people with dementia was funded by the Department of Health. It involved 23 teams from acute, community and mental health NHS trusts who worked on a range of projects across the dementia care pathway and sought to make hospital environments less alienating for people with cognitive problems. In 2009, ten mental health trusts joined the dementia care programme, and ten acute trusts and two community trusts followed in 2010.

Projects have demonstrated that relatively inexpensive interventions, such as changes to lighting, floor coverings and improved way-finding, can have a significant impact. Evaluation has shown that environmental improvements can have a positive effect on reducing falls, violent and aggressive behaviours, and improving staff recruitment and retention. The EHE schemes have shown that it is possible to improve the quality and outcomes of care for people with dementia as well as improve staff morale and reduce overall costs by making inexpensive changes to the environment of care.

See our EHE and dementia care completed projects

Tools and resources: Developing supportive design for people with dementia

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.

Find out more about our EHE dementia tools and design principles