Dementia Care

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32 Australian Journal of Dementia Care June/July 2016 Vol 5 No 3
individual households as families, with a
weekly budget for each family to spend as
they see fit, again, as any family unit
would.
Replicating excellence
All these products are good examples of
considered innovation. Too often,
however, innovation also means
singularity. Researchers still travel far
and wide to witness excellent new
products. Sometimes they are
disappointed. Innovation of course, does
not guarantee success. Despite the best
intentions based on high ideals some
experiments remain exactly that, often at
great cost. The example at De Hogeweyk
could be cited and argued in this context.
De Hogeweyk is a phenomenal
achievement by almost any measure. It is
literally the realisation of a dream by a
small team so committed to such a large,
different and specific product that on at
least two occasions they abandoned the
project due to the difficulties of
convincing financiers, regulators and
others who were required to understand
and approve the product. Fortunately
they continued and have added a
valuable development which informs the
current dementia design debate.
However is De Hogeweyk replicable?
It is without doubt a finely crafted vision
of its founders, but is it relevant or
simply an experimental cul de sac? For
instance, the building certainly doesn’t
invite any penetration of its hard outer
walls by outsiders – a feature in direct
contrast to other Western current
thinking where aged and dementia care
developments are more often designed to
positively welcome the public in to the
buildings and lose the ‘silo’ connotations
of old.
The future for good design
So what traction is being gained by
currently recognised good design
practice. In the UK the third iteration of
the government-sponsored HAPPI
(Housing our Ageing Population: Panel
for Innovation) report is due in June this
year urging good building design for
older people based on precedent.
However, we mustn’t think that
around the world we are on a trajectory
for universal adoption of all the good
pioneering work in the field of dementia
design that has gone on during the past
couple of decades.
Particularly in the UK, for a variety of
reasons ranging from political, product
choice, land space, planning regulations
and attitudes stemming from social and
cultural backgrounds, there is a massive
reluctance by consumers to move into
any community designed for older
people. According to the UK’s Centre for
Ageing Better, almost 80% of people over
65 do not anticipate moving to a different
property in the future.
In the report An ageing world: 2015 (He et
al 2016) commissioned by the US National
Institute onAgeing, it is predicted that the
number of people aged 65 and over will
rise from 8.5% (617 million) of the total
world population today to 17% (1.6
billion) in 2050. Whether or not we see the
long predicted medical advances in the
delay or prevention of certain forms of
dementia or whether incidences of
dementia decline relatively, it would be
foolhardy not to be accelerating the
dispersal of good practice in the design of
homes for people with dementia. Surely
the word to stress here is home. Hospitals
are too often the environment that people
with dementia experience instead of more
appropriate, less stressful accommodation.
There is a tendency in some countries,
like France for instance, for dementia
design to develop from a medical model
rather than a domestic model. The results
are less than encouraging.
Of many future scenarios, in the
scramble to cope with the increasing
needs of the care sector, there is a
possibility that the wealthier and
politically active health sector steps up to
shoulder the demands on society. The
property expertise of primary health care
providers is comprehensive, due to the
scale of their operations and estates. In
many countries care providers have
refined, complemented and honed their
property skills as their own portfolios are
increased or replaced and are very much
experts in the field.
However, in the UK, property
departments within our public health
services are considerable and securely
embedded within the sector. They are
relatively powerful and therefore
influential. They are listened to within
government circles. They are trusted
with huge budgets, far greater than those
in the private care sector.
As the political debate over dementia
care gains momentum I fear that, in the
UK at least, any building solutions to this
issue could, for convenience sake,
initially be sought on hospital land. The
issue of releasing bed blocking could be
seen as the same issue as providing
dementia beds. Hospitals are more likely
to have land or property for this purpose.
Certainly in the UK, finding appropriate
affordable land is an overriding issue.
Inevitably then in the UK it will be the
property expertise of the hospitals that
will provide the design brief for this
dementia care accommodation. If this
happens we must influence their
decisions using our experiences of good
dementia design principles developed
over the past 20 years.
We must not allow ‘medical models’ to
prevail over all the good work that has
been done to provide appropriate
environments for people with dementia.
We must not lose everything that has
been learnt or be modest or protective
about all that is good. Traction in various
countries is different but it has to
improve everywhere.
Changing the status quo
The role of design is to create the built
environment to allow the best new and
innovative practices of care to flourish. It
could be argued that in many countries
enough examples of this exist to establish
new benchmarks. Of course we shouldn’t
give up striving to be better, but too
many, including governments,
developers and care organisations, are
not keeping pace. Why? Basically it is too
easy to revert to an accepted norm. It
takes an enormous effort to change the
status quo, particularly when improving
standards demands research, proof and
often more capital cost.
Has innovative dementia design
plateaued? Maybe. But perhaps the most
pressing need right now is more
education rather than research –
education of our health providers, GPs,
media, governments, developers,
providers and the public about what
constitutes good design for people with
dementia. Initially, that education has to
come from those of you who are
concerned. Those of you that strive for
excellence in the field of dementia care
design.
David Hughes is an architect and Chief
Executive of Pozzoni Architecture Ltd in
the UK. He has been involved with
various forms of housing for older people
since 1983 and is co-author of the book
Design for Aging – International Case
Studies of Building and Program ,
published in 2012.
David is one of the plenary speakers at
HammondCare’s 2016 International
Dementia Conference, Grand Designs, in
Sydney on 16-17 June, where he will be
discussing the topic Has dementia design
innovation plateaued?
Reference
He W, Goodkind D, Kowal P (2016) An ageing
world: 2015. Washington DC: US Government
Publishing Office. Available at: