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Over the last 14 years I’ve spent most of my working time thinking about, designing and manufacturing products aimed at supporting people living with dementia. Prior to that I spent somewhat longer producing visual display material for retail marketing, museums and visitor attractions. This is a great perspective to understand how people react to the things that surround them and what they see.
When I became involved with dementia care I needed to understand what difference dementia might make to how someone perceives the world around them: their environment. I spent a couple of years working on this and seeking the counsel of a number of the most respected people in the sector who were only too pleased to help and were attracted by the novelty of what I was trying to do. And there is great research in this area - Tom Kitwood was writing about the relationship between dementia and the environment in the 1980s. Dawn Brooker and others have continued this since, but for all the academic support for meaningful environments, they’re all too seldom seen.
As a trail-blazer in this area I’ve created something of a legacy, but not one I’m entirely proud of. Although my approach has been widely adopted, it’s frequently interpreted and applied very poorly. This really matters. As my partner (a dementia care specialist of 30 years) pointed out that for care home residents living with dementia ‘It’s the last chance in life they have to enjoy something’.
Of course, I’d love every care home in Britain to employ me to pep-up their environments … sadly somewhat unlikely. But I’d like to share some fundamentals of good design that are crucial to using visual display materials well. Wherever you want to source your products at least you can ensure some basic errors are avoided and you don’t end up wasting your money.
So here’s some basic tips that will help avoid care home carbuncles and ensure your residents will benefit from the investment you make in their living environment.
It’s important that products are safe and durable, otherwise they’ll be there one minute and gone the next. That will only cause confusion. This applies particularly to signage: it’s an important support tool that needs to be reliable.
There are exceptions of course. If you’re going to use something like flowers or trinkets then these should be expected to be very mobile and require replenishing from time to time.
There’s nothing positive in creating false realities, or whatever you like to call them, so make things real. A typically bad example is creating a Mural with shop windows full of desirable-yet-unattainable goods. Creating images with perspective is also a really bad idea, unless you want to encourage residents to fall over. Another common error is to pictorially represent items such as animals, flowers, bottles, food and so on. It is far superior to use real objects for these items - dementia causes cognitive changes but doesn’t suddenly make a person stupid! Why on earth would anyone put in a pub-style bar with only pictures of drinks and shelves and glasses. If you’ve got budget to invest and this is the best you can do, then do something else. Otherwise, build a bar and get some pumps, tables, beer mats, drinks posters, some pub games, paint the walls, buy some unbreakable glassware, and let residents, families and friends enjoy a drink and a chat. Creating the promise of something enjoyable and then not delivering actual experience can cause frustration and confusion.
Further to the points above, Murals should only be there to set a scene. To enhance an experience rather than being the experience in itself. Less is more. The less you put into the mural in favour of enhancing it with ‘real stuff’, the more effective it will be.
When it comes to signage, make sure the product is robust, otherwise it’ll be ‘here today, gone tomorrow’. Use pictures rather than symbols. Text should be clear and contrast is key.
Invest time in filling the environment with things to do and places to go, and make sure the content is relevant to the population. You know your residents so well – make sure that knowledge is evident, and maximise the potential of your valuable wall and floor space.
Everything will work better with the involvement of all interested parties: residents, families and staff. People who are involved will care more. It can be very enlightening watching how people react to choosing images. If they are the right ones, nothing will be said about the images themselves, they’ll be too busy reminiscing about their experiences. The process of consultation itself can have a profound effect. Asking staff to engage in what makes for a content-rich environment for residents can help them learn more about the area and background that has been woven through their residents’ lives, and greatly improve the quality of interactions.
When it comes to use of colour, be it for décor, doors, signs etc, beware primary colours! We used to be told that was the right thing to do but things have moved on. The key to getting this right is to use Light Reflectance Values. The paint companies will provide this information and the simple rule of thumb is as follows; to achieve a suitable contrast between adjacent colours, ensure the LRV is 30% different between them. Taking this route provides for a flexible and very useable colour palate that can be used throughout a home. It’s very supportive of anyone with impaired vision and will positively contribute to a variety of benefits.
The environment is not somewhere that can deliver its potential with a cursory coat of paint. It deserves as much attention as every other aspect of the home. An ‘interior design’ approach can be great at attracting prospective clients, but used alone it won’t deliver a thriving community filled with active, ‘happy’ people.
None of this is ‘rocket science’ and to be blunt, it’s mainly common sense, but getting the environment right and elevating the importance of the home’s surroundings is guaranteed to improve outcomes.