Enabling environments for dementia

A older man and woman are smiling at each other. The man is handing the woman a yellow tulip. Staying home has taken on a new meaning, and for some, a priority, amid the COVID-19 pandemic. But what if the design of the home environment isn’t helping, especially if you have dementia? Alzheimer’s WA has a great website with really practical information on houses and apartments

Of course, staying home also means staying in the community. So the neighbourhood and facilities need to be dementia-friendly too. The website also has this covered. There are sections on, Public buildings, GardensHospitals, and Care environments.

Each section takes you to a floor plan with interactive buttons. Each button takes you to an illustration of a room or space, again with buttons for more information. For example, a click on a floor plan kitchen takes you to an illustration of a kitchen. Within this illustration are buttons checking off each of the design principles, such as lighting and cooking. There are PDF lists for download as well.

This website is a comprehensive virtual information centre for living with dementia. It’s useful for family members and designers alike. Some elements might be something as simple as rearranging things so they can be seen. Others might need more design know-how. A great resource. 

There’s also a Dementia Friendly Home app and a virtual experience by Dementia Australia. 

Image courtesy Alzheimer’s WA.

 

Ageing in the right place

Front cover showing the four steps.Advocates are calling for all new homes to include universal design features, but what about current homes? Even if occupants decide to renovate and include such features, how will they know what might be needed? The My Home My Choices tool can help.

The tool has four steps: individual wants and issues; opportunities for improvement in the home and lifestyle: different options for maximising the use and value of the home; and other choices such as moving, sharing, home modifications and home support. This well researched tool is easily adapted from this New Zealand model. 

Another research group has developed a prototype web application to use at home when needed, over time and at the user’s own pace. It consists of three modules Think, Learn and Act to facilitate awareness, offer information and knowledge and enable the user to decide and act on issues relating to housing. Topics are: preferences, the home, the neighbourhood, health status, social network and support, financial situation, the future, options for help and support and housing options.

A poor fit between the home and what older people need can lead to unnecessary care needs, loneliness, worse quality of life, increased caregiver time and early institutionalisation. 

 

Why wouldn’t you?

Graphic of a purple house shape with green outline for a window and a door.The catch cry “Why wouldn’t you? is the three word tag used in promotional material to promote universal design in housing. A builder, and a building designer are calling their collaboration Project Silver. They are promoting Livable Housing Australia’s Silver Level for improved liveability. The mystery is if it would cost so little in the scheme of things, why aren’t the building designer and builder just doing it automatically? The catch cry should be to the builder – why wouldn’t you just do it? Then no-one would have to label the home as some kind of special design.

The six minute video (below) puts the case very well. It includes contributions from different people, including the mayor of the Sunshine Coast. It’s worth a watch. Another builder in Townsville is telling the same story

Editor’s comment: The builder claims Silver Level costs an additional $3000 to potentially save $60,000. Possibly it is another way to sell an “extra” and therefore the customer pays over and above the actual cost of the features.

Australian Network on Universal Housing Design supports the Gold Level of the guidelines. It considers this level makes homes fit for purpose for the majority of the population across their lifetime. 

 

Home Builder Goes for Silver

A view from the kitchen to the alfresco showing an adjustable bench top acting as a table.A home builder in Queensland, is building Livable Housing Silver level homes and he wants everyone else to follow his lead. He has persuaded Townsville City Council and industry stakeholders to come together to make this possible. In a 9 minute video (below) various people explain the importance of Silver level to them. The best parts of the video are in the second half where Martin Locke shows how Silver level homes are modern and “normal”. One key point is that it shows there are no design or technical impediments for having Silver (or Gold) level in all new housing.

The video begins with several wheelchair users explaining their situation. But wheelchair users are only one part of the story of universal design in housing. The emphasis on wheelchair users is likely to perpetuate the idea that this is “disability housing” and this puts it in the “specialised housing” bracket. The Livable Housing Design Guidelines are about everyone, not just wheelchair users.

Locke believes Silver level can be rolled out without additional regulation. In theory this might be true. However, the evidence is not with him. The industry, particularly the mass market section, relies on regulation to hold the system together so that all the designers, engineers, and trades know what they are doing and can work in tandem.

The Australian Network for Universal Housing Design (ANUHD) supports Gold level of the Guidelines because these thoughtful features are good for everyone, and especially for older people and young children. Locke’s estimations of extra cost need further examination. For example, he doesn’t say why a level shower recess and level access into the home should cost more than current designs. If included as regular practice the cost, if any, would be negligible.

It’s great to see at least one community trying to make a difference in this space. Martin Locke and the Townsville City Mayor are to be congratulated for their efforts in bringing people together to show the way for the house-building industry.

Accessible home design

Front cover of the UD for houses guideline.Lifemark and BRANZ, the building research organisation in New Zealand, have produced a guideline titled Universal Design for Houses. The drawings and design ideas are based on wheelchair users. This is useful for understanding circulation space that’s good for wheelchair users and also good for everyone. However, not everything good for wheelchair users is good for everyone – so not exactly universal design. The guide is concise and has lots of graphs to illustrate design ideas. Topics include what’s legally required, getting in and out of the home, wet areas, kitchens, hardware and lifts in dwellings. 

For more universal application in all homes, see the Livable Housing Design Guidelines

Editor’s comment: Translating the term universal design into designs for wheelchair users is a common error. But if you need to design for a generic wheelchair user, this is a good guide. 

 

Good practice examples of UD in Housing

Australian Network for Universal Housing Design (ANUHD) has a webpage with best case examples in housing design. ANUHD considers the minimum standard should be the Gold Level of the Livable Housing Design Guidelines. ANUHD invites additional examples for the webpage. There are three categories:

      • Universal design in mainstream housing – mass market and architect designed homes that will suit most people across their lifespan.
      • Universal design in housing specifically for older people – residential villages and aged care.
      • Universal design in housing for people with disability – Specialist Disability Accommodation (SDA) for people with higher needs. Most include the Platinum level of the Livable Housing Design Guidelines.  

Dementia friendly home design

Front cover of UD Dementia Friendly homesDementia friendly dwellings are not exclusive – a universal design approach means that anyone can live in them. Creating new and existing dementia-friendly dwellings is the topic of a comprehensive guide from Ireland.

The Centre for Excellence in Universal Design in Ireland have also published the extensive research that underpins the guidelines. Although the resource has a focus on conditions in Ireland, there is good information for everyone. It includes useful examples and design checklists. 

There are five sections to the guidelines that can be downloaded separately: Introduction, Location and Approach, Entering, Exiting and Moving Around, Spaces for Living, and Elements and Systems. Or you can download the sizeable guide in one go.  

Apart from some of the other issues of ageing (although dementia can be experienced at any age), key factors to be considered in the design are:

● Impaired rational thinking, judgement, and problem-solving 
● Difficulty with memory (initially short-term but progressing over time to long-term memory difficulties)
● Problems learning new things
● Increasing dependence on the senses
● Fear anxiety and increased sensitivity to the built and psycho-social environment 

Dementia friendly home ideas

Graphic showing the floor plan of a basic home.The Dementia Enabling Environments website has a page on home design ideas. Some of them are simple and cost nothing, but might not be obvious to the casual observer. The Adapt a House page has a floor plan of five rooms: living room, kitchen/dining, bedroom, bathroom and laundry. It’s interactive, so clicking on a room brings up more detail. For example, in the kitchen they suggest see-through doors on wall cabinets. If replacing an appliance, match it closely to the existing one. In the bedroom colour contrasts are important for finding the bed and other furniture. Block-out blinds on the windows help differentiate between day and night, especially in the summertime. There is lots more information and resources on the website.

The Dementia Enabling Environments web tool was developed by Alzheimer’s WA

Bathroom fittings showing a red toilet seat and other fittings.There’s also help for bathroom fittings from HEWI. Dr. Birgit Dietz explains the background thoughts in the development of the age and dementia-sensitive washbasin, which she designed together with HEWI. She claims that qualitative studies show that the colour red is most easily perceived by people with dementia. Red is also the most easily registered colour for people with age-related vision impairment or inoperable eye diseases, for example, macular degeneration. The dementia washbasin is therefore also suitable for people with low vision. Go to the Hewi webpage for more designs.

Good Design is for a Lifetime

A luxury free-standing two storey home with a large green space in front. There is a for sale sign on display.An article on an American home builder’s website has some good information and dispels many myths. The one about “ugly and costly” is dealt with well. While they are American designs, the principles apply elsewhere. The title of the article is, How Great Aging in Place Design Prepares you for a Llifetime. There are lots of examples on the website of kitchens and bathrooms. There is also a section titled Universal Design.

Editor’s comment: Few older people will use a wheelchair at home, but they might like to sit to do some tasks. So the idea of lower benches could be a mistake unless you know all home occupants are either of short stature or wheelchair users. All family members have to be catered for in a workplace such as the kitchen. Lower bench sections or adjustable height benches help here. A pull-out workboard in the drawer section of the cabinetry is also another way to provide a low workspace for children and others who might need it. Also, in Australia and elsewhere, few homes have the kind of space shown in the pictures to allocate to a kitchen, so designs need to be considerate of all likely kitchen users. Creativity is required. Lowering benches and not having under bench cupboards is the easy solution.

Image by Paul Brennan 

Examples of UD in housing

Five level apartment block with shops at street level.Australian Network for Universal Housing Design put out a call for good examples of universal design in housing. They haven’t vetted them, but they have put them into three categories. This is because people also submitted projects related to retirement living and specialist disability accommodation. You can decide for yourself if they meet universal design principles. ANUHD advocates for mainstream homes to be to Gold level of the Livable Housing Design Guidelines. The three categories are:

You can still submit a project showing how it incorporates universal design features. They are specifically looking for mainstream examples.