A couple of years ago, my partner Ed and I were invited to a pre-opening tour of a new assisted living and memory care community. It was an enormous three-story edifice that covered most of a city block. A row of tall flag poles in front, the large circular drive, the expansive lobby – complete with a huge flat-screen TV on the wall – made us feel like we had walked into an upscale hotel.
Our particular interest was its memory care community, and when its doors were opened to us, we were awe-struck . . . but not in a positive way! Areas were defined by elaborate and garish carpet patterns. Large mirrors were hung here and there with no apparent purpose but to cover wall space. Common areas featured large windows. Some bathrooms had facing mirrors that created a funhouse effect of multiple reflections.
We concluded that one could not have created an environment more over-stimulating and confusing – and even frightening — for people with dementia. We tried to moderate our reaction and be polite to our host, but we advised her that they should anticipate problems. Of course, if our prediction was correct, the tragedy is that the residents would be blamed and even punished – perhaps not intentionally – for their bad behavior.
Later, we discussed the fact that it was pointless to say anything. There was nothing the hired administrators and staff of this building could do about it. The feng shui insanity had been designed by people who decorate hotels, hired by the investors who built but would never bother to even visit their property, so long as it continued to generate profits. As the flood of Baby Boomers flow into their assisted living years, this appears to be the future of the senior care factory, designed not to facilitate care but to support marketers who must impress the families who control the check book.
But there is an alternative trend emerging throughout the world where evidence-based research is determining that a more dementia-friendly environment can result in more effective and compassionate dementia care. This trend is being developed and proven at “dementia villages” in the Netherlands, France, Denmark, and elsewhere.
For more than five years, Coping with Dementia LLC has researched and advocated for a more dementia-friendly environment through its “Better Baker Act” initiative. Here are some of its recommendations:
• Dementia care facilities should not include obvious exits. Efforts to escape, elope, or wander are often triggered by the visual cue of an exit.
• Wall color can provide an environmental cue of comfort and warmth. Dark or “cold” colors such as blues and greens should be avoided. People with dementia may see dark colors as a void or a hole, which can increase confusion and anxiety.
• Due to changes in a dementia person’s ability to accurately identify 3-D from 2-D, limit the use of murals or wallpapers that can be mis-interpreted as objects, shadows, animals, or people.
• Employ window coverings that can be adjusted so that sunlight can be modulate or totally blacked out at certain times of day.
• Use adjustable lighting to manage the mood of the room by maintaining medium light.
• For better control of space, use movable “half-walls” that can be temporarily secured in place to create physical boundaries for individuals without leaving them feeling trapped or isolated.
• Chairs should have arms, be moveable, but not light enough to be thrown.
• Have plenty of securable storage to promote safety by keeping the care area uncluttered. Too many items to touch and handle can lead to anxiety and confusion.
• Install tall toilets, possibly with colored toilet seats that provide a color contrast with the floor.
• Use a light-color hard flooring throughout.
• Include a flexible sound system that can be modified for volume, bass/tenor, and location.
• If video screens are present, they should be used purposefully and in limited and structured ways.
These recommendations represent only the beginning of the discussion. A better dementia environment is emerging as a science that can benefit individuals with dementia as well as their care partners . . . because they both deserve the best.
Until next time remember: “We all deserve the Best”
Send your comments and stories to deb@coping.today