Dementia Care

2 / 40

Igive quite a lot of presentations on environmental design to organisations that are seeking
tomake their residential aged care facilities more supportive of people with dementia. One
of my favourite parts of these presentations involves a 40-second video clip on the life of
Dot, a person with dementia living in a totally unsatisfactory environment, followed by
another short clip of her life after she moved to a well-designed place. The contrast is stark
and encourages the audience to recognise that a well-designed environment, used by
carefully chosen and trained staff to engage people with dementia in a full life, can have a
very significant impact.
I often follow this up by asking the participants howold they think the video clips are. There
is always a verywide range of answers but the sobering thing is themajority of participants
say the clips are quite recent, perhaps three or four years old. It is sobering because the clips
weremade in 1986 and 1987, yet they seem to reflect the type of accommodation, and the
changes required, that can be seen inmany residential facilities today.
So have we made any progress in the past 30 years? Two of the contributors to this
edition of the AJDC are doubtful that we have. Kirsty Bennett, just returned from a tour of
dementia-specific facilities in Europe, has decided that we have dropped the ball. She
found that European models of care and environments are better able to meet the needs of
people with dementia. This view is backed up by David Hughes, an architect from the UK,
who is concerned that the pioneering work started inAustralia in the mid-1980s appears to
have petered out, to be replaced by a bland, institutional approach. Kate Swaffer, writing
from the consumer’s point of view, can find very few examples of satisfactory dementia-
specific design inAustralia.
I can’t be quite so pessimistic because my work brings me, and my team*, into contact
with many organisations (more than 250 in the past three years) who are thirsty for
knowledge on how to improve their environments and ready to make changes. But there is
something missing, something that would really drive change. It is the same thing that
could drive positive change in all aged care services – the informed consumer.
It is often the case that the person who decides on the residential placement of the person
with dementia is the daughter, or son, of that person. They want to do their best for their
mother or father and, in their experience, the best is going to be somewhere that looks like a
hotel and runs like a hospital. They don’t know the research that tells us that neither of
these models is of much assistance to people with dementia.
If they had a better understanding of what to look for in a residential facility I am sure
they would choose it and market forces would bring about better design. These are the
same market forces that, through increasing competition and giving the consumer the
funds, are being depended on to improve the delivery of home care services.
Unfortunately, in both the selection of well-designed facilities and the selection of
appropriate care packages, the consumer is not well informed. As a result, aged care
providers are able to continue putting unimaginative products into the market knowing
that very few people will be able to differentiate between the good and the mediocre.
It is not all doom and gloom though. The adoption of good design as a requirement for
new facilities can be driven by the funder through the tender process. I was pleased to
spend the Easter weekend reviewing tenders for the next generation of units to be used to
speed up the transfer of confused patients fromNSWhospitals into aged care. The review
was based on howwell the tenderer had demonstrated their ability to apply the principles
of design described in my article in this edition of the AJDC – principles that were first
published in 1987.
The combination of informed consumers and providers willing to use the available
evidence to judge designs would ensure that the next generation of aged and health care
facilities would be better than the last one.
* The NSW/ACT Dementia Training Study Centre Environmental Design Education Services.
Executive Editor Professor Richard Fleming
(02) 4221 3422,
Managing Editor Kerry Schelks
UK Editor Mark Ivory
Production Editor Andrew Chapman,
Website Manager James Baldwin
Publisher Dr Richard Hawkins
The Australian Journal of Dementia Care is
published six times a year by Hawker
Publications Australia Pty Ltd, 7 Conrad
Place, Wishart, QLD 4122.
Printed by Spotpress, Sydney.
© Hawker Publications Australia Pty Ltd 2016
ISSN 2049-6893
Advertising Kerry Schelks
Address NSW/ACT Dementia Training
Study Centre, Building 233 (ITAMS), G13,
Innovation Campus, University of Wollongong,
NSW 2522
Subscriptions $76 per annum (see page
40 for limited special offer) from DCA,
Australian Journal of Dementia Care
Advisory Board
Carol Bennett, Chief Executive Officer,
Alzheimer’s Australia
Professor Henry Brodaty AO, Director,
Academic Department for Old Age Psychiatry,
Prince of Wales Hospital and Dementia
Collaborative Research Centre, UNSW
Marily Cintra, Executive Officer, Health and
Arts Research Centre, Inc, Canberra.
Professor Elizabeth Beattie, Director Qld
Dementia Training Study Centre,
Queensland University of Technology
Dr Penny Flett AO, Chief Executive Officer,
Brightwater Care Group
Emeritus Professor Rhonda Nay, La Trobe
University
Kathryn Quintel, Director SA/NT Dementia
Training Study Centre; CEO Alzheimer’s
Australia SA
Tara Quirke, Member of the Alzheimer’s
Australia Consumer Dementia Research
Network
Margaret Ryan, Head of Dementia Services,
Bupa Aged Care
Dr Andrew Stafford, Director WA Dementia
Training Study Centre, Curtin University of
Technology
Dr Margaret Winbolt, Director Vic/Tas
Dementia Training Study Centre, La Trobe
University
Disclaimer
The opinions expressed in the Australian Journal of Dementia
Care are those of the authors and are not necessarily those of
the publisher. Furthermore the publisher and authors do not
assume and hereby disclaim any liability to any party for any
loss, damage, or disruption caused by errors or omissions,
whether such errors or omissions result from negligence,
accident, or any other cause.
Writing for AJDC: Do you have a project or survey to report, or
a change in practice organisation or structure which has worked
well (or not), and would you like to share this experience with
others? We welcome contributions of this kind, as well as bright
ideas for improving the environment or well-being of people with
dementia, and letters to the editor responding to articles in
AJDC. Contact Richard Fleming at
TheAustralian Journal of Dementia Care is a multidisciplinary journal for all
professional staff working with people with dementia, in hospitals, nursing and
aged care homes, day units and the community. The journal is committed to
improving the quality of care provided for people with dementia, by keeping
readers abreast of news and views, research, developments, practice and
training issues. The Australian Journal of Dementia Care is grounded firmly in
practice and provides a lively forum for ideas and opinions.
What do we need to improve
environmental design?
C O M M E N T
2 Australian Journal of Dementia Care June/July 2016 Vol 5 No 3
By Professor Richard Fleming , Executive
Editor, Australian Journal of Dementia Care