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Vol 5 No 3 June/July 2016
Australian Journal of Dementia Care
31
M
ore often than not the move into a
care home occurs when a person
with dementia experiences a
health crisis. There is probably limited
time to research the variety of competing
care homes. Cost will be a huge
consideration. Confusion will reign. Pure
luck will often be the overriding factor in
finding an aged care development that is
built and managed by an organisation that
will provide the best possible care and
environment for someone with dementia.
There are nowmany care providers
around the world who strive for that
excellence. They have researched
alternative design and methodologies and
incorporated those ideas into their own
product. However, if we were to compare
the current dementia care offer worldwide
to the phone industry, consumers are
more likely to stumble across a 1950s
Bakelite phone than an iPhone.
Slow pace of change
In the UK, for instance, it is only in the
past 12 months that the predicted
predominance of private customers
selecting their care accommodation based
on quality as well as cost has overtaken
the public sector’s demand for residential
care. Since the 1960s local government has
inadvertently contributed to this by
specifying minimum building standards
and low purchase prices. Inevitably, the
domination of one customer in the UK,
effectively the government, has dictated
the product.
Further, until perhaps the turn of the
century aged care accommodation
worldwide was not specifically designed
for a large proportion of residents to have
dementia. We mustn’t forget that we have
only really understood the complexities
and requirements of building for people
with dementia in the past 20 years or so.
Older people often resided for many years
in residential care and it would have
seemed perfectly reasonable to build
motel-like buildings with central facilities
to provide for these clients. Nowadays,
the residents occupying these facilities
have changed. Worldwide the average
occupancy is 18 months and most of the
residents will have some form and degree
of dementia. As a result, many providers
are struggling to provide a satisfactory
service in completely inappropriate
accommodation.
Innovative design
There is research and anecdotal evidence
to prove the benefits for people with
dementia of good dementia design
principles: small group households; open
plan living spaces; access to external space
and creating a domestic, familiar, non-
institutional built environment that
compensates for the impairments of
dementia.
It could be argued that new and
innovative thoughts on designing for
people with dementia started inAustralia
in the 1980s with people such as the
architect Brian Kidd, among others,
developing concepts such as open-plan
living in domestic-style environments.
Such concepts developed further across
the globe over the next decade, including
the group homes which proliferated in
Japan and the Dutch model of family-
sized households of six people sharing
two bathrooms, as any family would do.
In the UK it was 2005 before aged care
providers such as Belong began to
develop these household models based on
international examples. The St Monica
Trust near Bristol successfully
transplanted the design from an existing
WesternAustralia care home to England,
recruiting the manager fromAustralia for
good measure!
Different providers in different
countries have developed variations of
good dementia design, while still taking
into account cultural and
funding/legislative constraints. For
example:
• In the UK, creating community hubs
with facilities accessible to the general
public allows people with dementia to
still be part of the community. Social
cohesion, community and education are
all important benefits, if only on a local
basis.
• Retirement villages with different levels
of care in one campus remain popular in
the US if only due to the gargantuan size
of their development program,
particularly in the 1980s. These villages
enable people with dementia to live in a
community with other older people of
differing physical and cognitive abilities.
• Inter-generational communities and co-
operatives are taking root, particularly in
Scandinavia; families, young people,
older people and people with dementia
living and helping each other. Student
property developers have even shown an
interest in exploring a hybrid product.
• Group houses in Japan and Finland
where people with dementia live in
family-sized houses in residential
neighbourhoods.
• Dementia villages such as De
Hogeweyk in the Netherlands where
people with dementia live together in
households of six people based on their
social or religious background.
• Some Dutch care providers operate
Will good dementia design eventually prevail?
Architect
David Hughes
has been at the forefront of the debate on appropriate design for people with
dementia for several years. Using examples from around the world, including the UK and Australia, he
discusses what’s been achieved and the many challenges still ahead