Designing for dementia
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Public sector residential aged care 19 September 2022

Designing for dementia

Across Victoria, 100,000 people are living with dementia – and this number is predicted to nearly double in the next 20 years.

Public sector residential aged care services play an important role in supporting access to services for people who:

  • have complex support needs
  • are experiencing socioeconomic disadvantage
  • live where there are no other alternatives.

These services aim to promote residents’ independence, choice and dignity to support their health, wellbeing and quality of life.

People with dementia account for 52 per cent of residents in all residential aged care facilities. This number is even higher in public sector residential aged care services.

As the largest public provider of residential aged care in Australia, the Victorian Government has committed to modernising public sector residential aged care. This includes replacing outdated public aged care homes with purpose-built, modern facilities. It also includes updating, refurbishing and redeveloping existing aged care services.

As part of the modernisation of public sector aged care in Victoria, we have worked closely with the Department of Health’s Aged Care Branch to develop our public sector residential aged care (interim) facility design guidelines.

The guidelines provide an outline on how to deliver residential aged care services that are homelike and familiar, while enabling contemporary and innovative models of aged care. They also include information on how to design dementia-friendly environments.

On screen text: People with dementia account for 52% of residents in all residential aged care facilities. This number is even higher in public sector facilities. New design thinking for these facilities aims to support the independence, privacy and dignity of residents.

IMAGES: Close up shot of Creswick Nursing Home’s new dementia friendly unit, followed by drone shot of facility. Drone footage of St George’s Hospital aged care facility, followed by shot of garden pathway in Edenhope aged care facility.

Richard Blight, architect of Creswick facility: "I think in the dementia space, in the aged care space, there's a lot of really good architects working. We're all out to do the same thing, which is really improve residential aged care facilities.

Our focus is to build solutions which aren’t cookie cutter solutions. They're all custom designed for the particular community we're designing them for. It's a really exciting space to work in.

The people and their family and the carers will spend the last probably weeks, months, days in their life and to design an environment which can make these people feel more comfortable and improve the quality of their life. I think that's just a real privilege."

IMAGES: drone shots of Creswick and view upwards of St George’s apartments. Interior lounge areas and single bedroom at Creswick, drone shot of greater Creswick area.

Golden Oaks aged care facility frontage, bedroom and shared kitchen/dining spaces at St Georges

Sally Delany, Manager Design services, Victorian Health Building Authority: "Our residents are coming in more acute than they used to in the past. The most important thing is that we design flexible spaces that can adapt over time for changing needs of our community. It enhances and encourages their own independence and capacity to live as independently as they can."

IMAGES: rising drone shot of Creswick new unit, art collages on table

Richard Blight: "We were really sort of conscious to make as much effort as we can to engage with the residents. We run art therapy programs which really are a way of workshopping with residents to figure out what they think home is. We run these workshops with a sheet of paper, a drawing of a house on it, and we ask them, through the process of collage, just to stick pictures down of what they think home means to them."

IMAGES: bedroom and brightly coloured hallway at St Georges, bedroom at Creswick

Sally Delany: "One way of creating a homelike environment or also to trigger clues on where your bedroom is, is to have different colours on bedroom doors or a memory box, maybe photos of the family, so it's easier for the resident to find their actual bedroom."

IMAGES: dining table at Creswick

Richard Blight: "Making sure there's not too much contrast on the floor, making sure that the light isn't too bright."

IMAGES: bathroom and toilet with different coloured seat

Sally Delany: "We now have a different colour toilet seat to the floor. If the toilet seat is the same colour as the toilet and maybe the floor then it's very, very difficult for a resident."

IMAGES: drone shot of Creswick, followed by lounge room, and external garden

Richard Blight: "We've increased - we didn't want it to feel like a dementia facility. It's designed to be dementia-centric but it's not designed to look dementia-specific. It's a pod in itself and that forms a community."

IMAGES: drone shot of Creswick featuring integrated external courtyard, dining and kitchen area

Sally Delany: "Creswick now has a wonderful internal courtyard and it also assists with the wayfinding of the resident, as they're walking around the facility from their bedrooms to the shared kitchen and lounge areas."

IMAGES: external garden walkways at Edenhope aged care facility featuring brightly coloured bench seats

Richard Blight: "I think one of the things when designing external space is - is they need just as much consideration as internal spaces. If these spaces aren't directly connected to the interior social spaces of the facility, they just don't get used."

Sally Delany: "There's much more of a natural flow and a natural interaction between the staff and residents without residents feeling like their spaces are being invaded by staff."

IMAGES: Creswick breakout lounge, bedroom and large dining room, view of new unit from bushland

Richard Blight: "Talking to the staff is a real critical step in delivering innovation. When I'm walking around the facility, they probably think, "Oh, there's that pesky architect again. Whether it's the cleaner, I want to know whether we got the vinyl right or whether it's a nurse, I want to know how people are using the social spaces. So, I think the challenge, as a designer, is how you take all those limitations and still come up with something with something which respects the need of these residents. Make things better through understanding where it doesn't work and where it does work from a first person perspective.

A sliding transition screen then displays the Victorian Government logo and Victorian Health Building Authority logo and web address vhba.vic.gov.au

End of transcript

What is dementia-friendly design?

Dementia-friendly environments are created using a flexible approach that maximises people’s freedom and involvement through supportive, familiar, meaningful and safe surroundings.

Dementia-friendly design works to maximise independence and safety using intuitive and ergonomic design. It supports people with a broad range of functional needs such as reduced mobility, sensory losses and a wide variety of complex conditions.

The design approach carefully considers both physical and social environments. It looks at people’s unique needs and abilities, and how they maintain a sense of purpose through familiarity and connection.

‘Dementia-friendly design enhances wellbeing by creating environments that are welcoming and meaningful. It enables the resident to freely navigate their home indoors and outdoors. It promotes independence by creating safe and intuitively engaging spaces – maximising helpful stimulation and minimising unhelpful stimulation that may lead to increased levels of disorientation and anxiety.’

Sally Delany, Manager Design Services, Victorian Health Building Authority
52%

52%

of residents in all residential aged care facilities have dementia

Homelike environments

Homelike environments

give residents choice and independence

Private bedrooms

Private bedrooms

provide dignity and the ability to personalise

Outdoor spaces

Outdoor spaces

provide connection to the natural environment

Slide to Navigate

Creating a homelike environment

A homelike environment is key to dementia friendly design. While home environments can take many forms, they all share certain domestic qualities.

A homelike environment:

  • allows people to continue the tasks of daily living
  • uses their existing skills
  • gives choice and independence with familiarity and comfort.

Richard Blight is a Director at Blight, Blight & Blight – the architecture firm who designed the $3.2 million dementia-friendly unit at Creswick Nursing Home. Richard explains how their team engages with residents to establish what home means to them.

‘We run art therapy programs which are a way of workshopping with residents to figure out what they think home is. We run these workshops with a sheet of paper that has a drawing of a house on it – and we ask them through the process of collage to stick pictures down of what they think home means to them.’

Richard Blight, Director, Blight, Blight & Blight

When building an aged care facility, design strategies to create a homelike environment include:

  • a small household model
  • private bedrooms that can be personalised
  • easy access to outdoor areas
  • a diverse range of common areas.

Small household model

The completed $55.57 million St George’s Hospital aged care facility (Berengarra) was the first stage of the Victorian Government’s Modernisation of Metropolitan Melbourne Public Sector Residential Age Care Strategy.

The 90-bed facility is made up of two separate three-storey houses, with pitched roofs and brickwork to create a homelike feel. Each floor is divided into small households, creating a familiar environment that is easier to navigate. Key facilities such as dining and lounge areas are close by – also assisting those who cannot travel long distances due to frailty.

A communal living room within the Creswick Nursing Home dementia friendly unit

Private bedrooms

Individual bedrooms and bathrooms provide dignity and independence to residents in aged care. The $6.3 million Edenhope and District Memorial Hospital redevelopment included the construction of 18 private rooms and ensuites. This replaced the existing shared rooms, allowing providing privacy to residents.

Easy access to outdoor areas

Easy access to outdoor areas is important when creating a homelike environment. These areas need to be welcoming, engaging and safe.

At the dementia-friendly unit at Creswick Nursing Home, rooms are clustered around a central courtyard that can be sealed off from the rest of the facility. This allows residents to circulate freely and safely. Two outdoor seating areas encourage residents to spend time outdoors, while raised wheelchair-accessible garden beds allow residents to garden.

The outdoor space provides residents with choice. They can enjoy the outdoor space actively, or simply spend time on their own. The courtyard design also means that outdoor areas are visible from indoors, increasing a sense of connection to the natural environment.

‘One of the things when designing external spaces is that they need just as much consideration as internal spaces. If these spaces aren’t directly connected to the interior social spaces of the facility – they just don’t get used.’

Richard Blight, Director, Blight, Blight & Blight

The safe garden space at Mountview Home, Maldon Hospital, has improved the experience of residents living with dementia by creating a walking path and accessible garden within an enclosed courtyard

A diverse range of common areas

A diverse range of common areas facilitate choice and lifestyle options for residents. It also supports them to maintain family and community connections.

For example, once construction of the $81.58 million new Wantirna residential aged care facility is complete in 2022, the facility will include multipurpose common areas, as well as a community room, sacred space and café. This will give residents greater choice, with access to areas for socialising, activities or quiet time alone.

‘The more we get away from the institutionalised approach to aged care, we’re going to have better outcomes. When we make environments more homelike, people feel welcome, they feel safe and they feel included.’

Michael Walker, Principal Advisor, Universal Design, Victorian Health Building Authority

What’s next?

Making public sector aged care facilities dementia-friendly is part of the Victorian Government’s work to modernise public residential aged care facilities.

The interim report released on 31 October 2019 by the Aged Care Quality and Safety Royal Commission signalled the need for fundamental system reform to better support quality and safety. This includes a focus on building design.

We’re working with the Department of Health’s Aged Care Branch to update our Public sector residential aged care (interim) facility design guidelines to respond to some of the recommendations from the Royal Commission. The updated guidelines will also be informed by our recently released Universal design policy and charter.

The Department of Health will also be updating its dementia-friendly environments guidance and resources in consultation with a broad cross-section of stakeholders, including people living with dementia.

‘This collaboration has been important in developing a whole design approach and investment strategy to enhance environments to enable people with dementia to continue living a life of meaning and value and maintain connections with loved ones in a familiar and supportive home. This approach also assists staff to deliver a person-centred model of care.’

Valda Groves, Manager Public Sector Residential Aged Care Services Infrastructure & Planning, Commissioning & System Improvement Division, Department of Health

Continued investment in aged care

As part of the Modernisation of Metropolitan Melbourne Public Sector Residential Aged Care Strategy, the Victorian Government is investing:

  • $81.58 million for a new 120-bed facility in Wantirna
  • $134.6 million for a 150-bed facility at the Kingston Centre in Cheltenham
  • $900,000 to deliver the first phase of designing and planning a new 90-bed public residential aged care facility in Coburg.

For rural and regional Victoria, $65 million was announced as part of the 2021-22 State Budget to modernise and upgrade public residential aged care services:

  • $57.11 million to redevelop the Glenview Community Nursing Home in Rutherglen
  • $4.95 million to design and plan a 36-bed facility within Camperdown Hospital.
  • $2.93 million to design and plan a 16-bed residential aged care facility as well as eight acute beds in Cohuna.

The Victorian Government has also established the $10 million Rural Residential Aged Care Facilities Renewal Program. The program enables rural and regional residential aged care services across Victoria to invest in modern infrastructure and equipment.

By delivering dementia-friendly residential aged care facilities, we’re ensuring access to high quality public aged care close to home. This will support older Victorians to remain independent and keep well for as long as possible.

This article was originally published on 17 March 2022.

Getting support

Dementia is a progressive disease that can affect a person’s memory, thinking, orientation and comprehension, combined with deteriorating senses (sight, touch, taste, smell and hearing). It can cause huge changes in a person’s life and in the lives of those around them.

Information and resources are available:

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Last updated: 19 September 2022