Author: Jane Bringolf

Designing hospitals with dementia in mind

A long wide corridor with lots of confusing lines in a hospital. Need to design with dementia in mind.Most of us feel vulnerable in hospital environments. Usually it’s because of their size, lots of people, corridors and signs. For people with dementia and other cognitive conditions, this can be extra scary. A team of researchers in Ireland gathered the research on designing hospitals with dementia in mind and similar cognitive conditions. They’ve come up with key design themes which are expanded upon in their article:

    • Support engagement and participation
    • Provide a people-centred environment
    • Support patient safety, wellbeing, and health
    • Balance sensory stimulation
    • Support legibility, orientation and navigation’
    • Adequate space to support the particular needs of a person with a cognitive conditions. 
    • Space and supports for accompanying persons and staff

The title of the Cochrane Review article is, Hospital design for older people with cognitive impairment including dementia and delirium: supporting inpatients and accompanying persons. It’s by Grey, Fleming, Goodenough, XIdous, Mohler, and O’Neill.

From the abstract

The aim of the study was to assess the effects of planning and design of hospitals, and to find out which approaches and features affect the health and wellbeing of older inpatients with cognitive condition such as dementia and delirium.

The study also assessed the effects of built environment interventions on accompanying persons. The focus was on any design feature that supports any person accompanying the patient in the hospital. The study also assessed the effects of built environment interventions on staff who are providing care to older patients with cognitive conditions. 

Universal design and dementia friendly hospitals

Front cover of the documentAcademic research and consumer input underpins this comprehensive guide to designing dementia-friendly hospitals from a universal design approach. The guide was developed in Ireland where they estimate almost one third of patients have dementia. Of course, dementia friendly design using a universal design approach is good and inclusive for everyone. The guidelines are available to read online using Issuu software. 

The short video below provides an overview of the design factors to consider in creating a dementia friendly hospital.

Dementia friendly hospitals: An in-depth study

A hosptial room with three empty beds. It looks very clinical and not dementia friendly. The design of the hospital environment can have an effect on people with dementia. That’s the finding of some new research carried out in hospitals where they interviewed patients and family members. 

The title of the article is, Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital  You will need institutional access for a free read. Or you can go to ResearchGate and ask for the full text. 

From the abstract

The findings are based on a stakeholder engagement process. The research team spent approximately 150 hours observing within the hospital, administered 95 questionnaires to patients and/or accompanying persons. Two structured interviews were carried out with patients and accompanying persons. 

This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The research points to the value of understanding the lived experience of the person with dementia and accompanying persons. The voices of patients, particularly persons with dementia, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities. 

Placemaking or Making Place?

A blue picture with swirling shapes as if under water.It’s time to move away from the word “placemaking” to “making place” and “making space”. This concept is discussed from an Indigenous Australian context in a book chapter titled, There’s No Place Like (Without) Country. Making place and making space allows for a view of spatial histories, claiming and reclaiming sites, and to uncover stories that are often overlooked in urban design practice. This is an academic text in,  Placemaking Fundamentals for the Built Environment, and you will need institutional access for a free read. It includes an example of the authors’ experience at the Sydney Olympic Park site. Sydney Olympic Park has documented some of the local Indigenous history.

Introduction: “In this chapter, we critique traditional placemaking approaches to site, through the Indigenous Australian concept of Country. We contest that a move away from the word ‘placemaking’ is overdue. We instead propose a practice of ‘making place’, and further ‘making space’ (i) that allows overlooked spatial (hi)stories to reclaim sites that they have always occupied, and (ii) for the very occupants and stories that are ordinarily overlooked in urban and spatial design practice. To do so is to accept that we must look to those marginal occupants, practices and writings that challenge the gendered, heteronormative, white, neuro-typical and colonising discourses that dominate architecture. Placemaking practices employ community consultation, privileging local stories and quotidian ways-of-being in response. It is our position, that even these ‘community-engaged’ processes perpetuate erasure and marginalisation precisely through their conceptualisations of ‘Site’ and what constitutes community. We present a model for an Indigenous/non-Indigenous collaboration that offers methods of spatially encountering site within a colonial context. We share our experiences of a project that we collaboratively produced in the Badu Mangroves at Sydney Olympic Park, to share the overlooked spatial histories and cultures of countless millennia. We have woven together Indigenous epistemologies, ontologies and axiologies, and design-as-research methodology.

See also Introduction: making Indigenous place in the Australian city from Post Colonial Studies journal.

Are you Diverse or Diversish?

A mosaic of many different faces and nationalitiesSometimes wry humour and satire is the way to get the message across. Sheri Byrne-Haber’s article You might be #Diversish if… explains what Diversish means. It’s a satirical term for businesses and organisations that call themselves diverse because they have a diversity policy. However, when you look at what they actually do, the policy is just collecting dust. So their claims lack authenticity. The article includes a British satirical video that really represents many of the business conversations around diversity. Funny but serious.

Designing for dementia using personas

An older woman sits at a table in a room with a tv behind her.Asking users directly is the best way to find out which designs work best.  But when that is not feasible, perhaps personas can help. That’s the claim by a group of researchers who want to help architects and designers to create meaningful public places and spaces inclusive of people with dementia. The process of developing personas proved to be complex and difficult. This is not surprising because dementia affects different people in different ways. The full chapter is via Springer and requires institutional access for a free read. However, it’s possible to get a copy via the ResearchGate route.

The title of the paper is, Developing Dementia Personas for User Centered Architectural Design Considerations in Non-specialized Contexts. 

Abstract: This paper is concerned with dementia persona development as a research and design tool to help architects and designers to uncover important information towards design processes and decisions in practice. Architects design spaces for specific functions, but do they truly consider integrating these objectives with a focus on creating meaningful spaces for people with dementia while designing and if so, on what grounds. The reason for using dementia personas and not directly approaching people with dementia is due to the fact that it can be very hard to understand the needs of dementia care as people with dementia are dependent on caregivers and family members, in addition to this many designers and architects do not have ethical clearance to work with people living with dementia; as a consequence of their designation. A literature analysis and participatory workshops were used to develop the dementia personas discussed in this paper. The process of developing dementia personas posed many challenges; iterative revisions had to be made to make the personas relatable and concrete enough to be used as a successful design tool. The complex context of the case requires more personas to represent the diversity of persons with dementia in the service provision on different levels and this is the start of the persona development process. The findings are reported herein.

Placemaking Toolkit

Children play with bubbles in urban area.Designing public space is not only for trained professionals. Because the Placemaking Toolkit shows how community groups and residents can do their own place make-over. The Toolkit is for community-driven, low-cost public space transformation. With the support of local government anyone can change a neglected space in their neighbourhood into a clean and safe play area or park.

This Guide is especially relevant for developing countries and remote communities in any country. The Guide is from the Public Space Network and includes case studies at the end. The introduction includes criteria for a good public space.

What makes a good public space?

1. Accessibility: Public spaces shall be well-connected to other places frequently used by people. They should be easy to get to, easy to enter, easy to move around, free and/or affordable for the vast majority.

2. Comfort: The place shall be kept clean and contain elements enhancing the comfort for its users. These can be seating facilities and dustbins painted in colours, and greenery (trees, loan, flowers) providing shade.

3. Safety: The space shall be well visible without any obstruction that could provide a hiding space for criminal activities. The space should be free of any illegal activities and the presence of motorized traffic shall be limited to avoid injuries.

4. Active use: Spaces become places when people use them. In an always empty space, people may not feel safe or comfortable. To encourage its social function, the place shall offer a wide variety of activities that can interest various types of users. The activities may include sport and leisure activities, such as space for boardgames and team sports, playground for children as well as a regular organization of community events – such as sports tournaments, concerts, fairs etc.

5. Walkability: Good public spaces provide opportunities for people to walk safely with minimal interruption from vehicles and other motorized transport.

Placemaking Europe

placemaking Europe logo. Yello background with a drawing of a hammer and nail.There’s another toolbox with extended resources from Placemaking Europe. It’s an open source collection of placemaking guides and manuals with lots of pictures. 

“The Placemaking Europe Toolbox is a collection of curated placemaking resources for all to access, learn from, and practice.”

 

Visitable Victoria

Front cover of the kit showing ballooning. Listed as one of the world’s most liveable cities, Melbourne is now aiming to be the most visitable. Visit Victoria and Destination Melbourne have produced resources for both business and visitors. For businesses yet to get on board with being visitable, the individual visitor pages serve as examples of what to look for and what actions to take. 
Accessible Tourism – it’s your business resource kit has six short chapters with case studies:

Discover what you are missing
Explore your local area
Make low cost changes
Assess your building a facilities
Describe your business
Promote your business
Develop a business plan

The PDF version of the kit with graphics has not thought about accessibility of the document in terms of font contrast. However, the Word version addresses this and also reminds us that not all people can access a PDF document.

The Word version cuts out all the graphics and is not only more accessible for screen readers, it is also a better version for printing pages for checklists.

A separate website, Accessible Victoria has specific information and more links. And one specifically for Melbourne also has brief information and more links.  

 

Smart Cities for All Toolkit

cover of Smart Cities for All Toolkit.How smart can a smart city be? ‘Smart’ is everything from the footpath to the website. So not so smart if it doesn’t include everyone and join the dots between all the factors that make a city a city.  With digital transformations happening worldwide, the aim of the Smart Cities for All Toolkit is to eliminate the digital divide and improve urban environments for everyone. 

The main part of the toolkit, the Inclusive Innovation Playbook, is detailed and aimed at a policy and planning level. Stakeholder participation and inclusion is an essential theme. Case studies assist with understanding. There is a helpful checklist at the end of the Playbook.

There’s a lot to digest, but this means it isn’t a cursory overview with simplistic solutions. It goes much deeper than a digital accessibility checklist. This is about joining the dots across city assets and leveraging them for everyone’s benefit. Other sections of the toolkit cover: 

    • Toolkit Overview
    • Guide to adopting an ICT accessibility procurement policy
    • Implementing priority ICT accessibility standards
    • Communicating the case for stronger commitment to digital inclusion in cities
    • Database of solutions for digital inclusion in cities

“The toolkit supports a range of organizations and roles related to Smart Cities, including government managers, policy makers, IT professionals, disability advocates, procurement officials, technology suppliers, and developers who design Smart City apps and solutions.

Each of the tools addresses a priority challenge identified by global experts as a barrier to the digital inclusion of persons with disabilities and older persons in Smart Cities.”  See also Smart Cities for All: A Vision. 

James Thurston of 3Gict came to Sydney in 2019 and discussed the issues and solutions in his keynote presentation in the video below.

5 Pillars of a Smart City

Head and shoulders of James Thurston. He is wearing a light blue shirt and glasses and smiling to the camera.James Thurston is G3ict’s Vice President for Global Strategy and Development. He previously worked for Microsoft, so he knows the territory well. His keynote presentation at UD2021 Conference showed that technology is improving but it’s not inclusive. Cities have to do a lot more if we are to meet the challenges of the digital world.

He lists the five pillars as:

      1. Strategic Intent: inclusion strategy and leadership
      2. Culture: citizen engagement and transparency
      3. Governance & Process: procurement and partnerships
      4. Technology: Global standards and solution development
      5. Data: Data divide and solutions

Six Feelings Framework for Autism

A sense of belonging is an aspect of universal design not often discussed. However, when it comes to including people with autism in plans and designs, it’s a very important element. But what’s the best way to include people with autism/autistic people in the planning process? An article in the American Planning Association magazine provides some answers based on the Six Feelings Framework.    

When Every Day Is Sensory Overload

Six Feelings Framework

1. Feel connected – because they are easily reached, entered, and/or lead to destinations.
2. Feel free – because they offer relative autonomy and the desired spectrum of independence.
3. Feel clear – because they make sense and do not confuse.
4. Feel private – because they offer boundaries and provides retreat.
5. Feel safe – because they diminish the risk of being injured.
6. Feel calm – because they mitigate physical sensory issues associated with autism.

The  Autism Planning Design Guidelines covers urban design, retail, parks, campuses and more. It’s by the American Planning Association and it’s got everything in detail. There’s a webinar on the topic too (see below). The guide is underpinned with the Six Feelings Framework.   

The guide is based on extensive research and it is recommended that:

    • City and regional planners activity accommodates people with autism in their public involvement process.
    • City and regional planners implement autism standards building on this 1.0 attempt into their zoning and design guidelines, and consider policy changes.
    • Professionals in affiliated fields who have concern over the public realm test, retest, and improve the ideas in this toolkit.
    • Civil engineers retrofit infrastructure around the Six Feelings Framework.
    • Real estate developers who are designing master planned communities consider the Six Feelings Framework in their plans. 

  • Planning with people with autism

An American Planning Association magazine has an article about planning with people with autism/autistic people. The first part of the article describes some of the everyday things that can cause anxiety. For example waiting for a bus that doesn’t arrive on time, or two come at once. This can result in confusion followed by poor decision-making for a short time afterwards.

The article tells the story of a group of planners, researchers and community stakeholders working with people with autism/autistic people. People on the autism spectrum aren’t all alike so the group had to find a way to include as many people as possible.

Preparing and facilitating the event

The first step is to think carefully about how to facilitate more inclusive public meetings and workshops and hear the voices of this overlooked group. Many people with autism process information differently to the neurotypical population and have different ways of expressing their thoughts. 

Large public events can be loud, distracting with overlapping conversation and too many ideas to take in at once. Smaller focus groups are a better way to go with. The key points in the American Planning Association article, When Every Day is Sensory Overload are:

Preparation

    • Learn about autism – ask professionals in the field
    • Choose the right venue – no flickering lights or unusual colour
    • Familiarise participants with the space before the event – photos, floor plans, directions, quiet spaces
    • Establish quiet rooms – signage to quiet rooms from the main meeting place

At the meeting

    • Keep visuals ready – photos help focus participants
    • Encourage a range of sharing methods – let participants share they ideas in their own way

After the meeting

It is likely that some participants won’t be able to participate as much as they would like. Or they might come up with ideas after the event. Participants should be encouraged to connect with facilitators by email.

The article concludes with the Six Feelings Framework and a link to the Autism Planning and Design Guidelines from the American Planning Association. Or you can link to a copy from the Ohio State University. There is also a webinar on the guidelines.

There are more articles on designing with autism in mind on this website. Use the search facility on the left hand menu.

Ageing in the right place

Front cover showing the four steps for ageing in the right place
.

The My Home My Choices tool from New Zealand has some good advice about ageing in the right place.

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 tool is easily adapted from the New Zealand model and you can also read the research behind it.  

Ageing better at home

Bathroom in an old house has been stripped and bare walls and old tiles remainThe majority of our homes are designed as if we are never going to grow old, and most of us will need to modify our home as we age. That’s if you want to stay put, which is what most older people say is their preference.

A report from Centre for Ageing Better in the UK gives an excellent overview of how home modification improves quality of life, mental health and overall independence. Dwellings might be a “product” to property developers but for the rest of us a “home” is the pivot point for living our lives.

A great quote from a study participant to reflect upon, “You don’t get taught, at any point in your life, how to become an older person. It just sort of happens, you know…”. So waiting for consumers to ask for universal design isn’t going to work.

Ageing in Place: A timely book

Front cover of the Ageing in Place Book.Across the globe, older people want to stay put as they age. They do not aspire to residential care and are also moving away from the retirement village model. But are our planners, designers and builders listening? COVID-19 pandemic is also challenging established policy about where older people want to live. “Ageing in Place” is a timely book.

The title of the book is, Ageing in Place: Design, Planning and Policy Response in the Western Asia-Pacific. It looks at ageing in place in  Japan, China, Taiwan, Australia and New Zealand. 

From the book review:

Ageing in Place considers diverse cultural, political and environmental contexts and responses to show that regional governments, industries and communities can gain, as well as offer, important insights from their international counterparts. With changes in caring and family dynamics, the chapters demonstrate a clear preference for ageing in place and the need for collaborative efforts.

Australian research

Front cover of the reportThe findings from a 2018 survey gives a good idea of what people think about accessible housing. Four narratives frame the report: the housing industry view; the government view; prospective buyers’ view; and the perspective of people who need mainstream accessible housing.

The Australian Network on Universal Housing Design initiated the research It is a lengthy and detailed report. Essential reading for anyone interested in this topic or the history of this 20 year campaign. 

 

How not to build a library

A long flight of stairs on the left looks out over Manhattan with rows of books tiered up on the right hand side. They are only accessible via the stairs.If ever there was an example of how not to design a public library, this has to be it. All because the architects failed to check with any user groups. The architects still maintain the issues are just “wrinkles” in the design, not flaws. However, bookshelves lay empty, bleacher seating is sealed off for safety reasons, baby strollers block the walkways, and that doesn’t include the issues for people with disability – patrons and staff alike. The building offers wonderful views but it’s not how to build a library. 

The article is from the New York Times, New Library is a $41.5 Million Masterpiece. But About Those Stairs. It explains the issues in more detail and has more pictures. There is also a news video from Spectrum News with the story. A salutary lesson in remembering function as well as form in design. 

An architecture magazine explains more of the back story: Accessibility by the Book: The Case of the Hunters Point Library. It seems the architects heeded the ADA minimum requirements. Treating the tiered section of the library as an “assembly place”  the ADA only requires access to the top and bottom levels. 

2024 Update: New York City sues architects over the design – see more in The New York Times.The City is suing for the $10m it will cost to remedy the current lack of access. 

Any good examples?

Entrance to the LightHouse building showing a man using a cane and a woman with an assistance dog.Do you know of good examples of universal design in buildings? One or two maybe?  Bess Williamson asks in Metropolis magazine, Why Are There So Few Great Accessible Buildings? Of course, accessibility in its fullest sense is much more than compliance to the building code.

Professor Williamson discusses the LightHouse project, and the Berkeley’s Center for Independent Living. Including people with disability in the design process means these buildings are not a regular type of commission. In some respects they are specialised buildings because people with disability were central to design thinking. It’s puzzling to think that architects can’t apply the same thinking to all their projects. After all, everyone benefits from inclusive design. What’s worrying is that the Americans with Disabilities Act (ADA), isn’t being heeded.

Williamson also discusses the recent architectural “triumph” of the new Queens Public Library which revealed major access problems. The architects claimed compliance on the basis that patrons could ask a librarian for help. However, this is not equitable access. It shows scant regard for the ADA and not only people with disability. Families with prams also use libraries, and staff cannot take trolleys to the shelves. Thinking about all users makes a case for universal design. The Queens Library is a case of form over function – the views from the windows, if you can reach them, are fabulous. 

Williamson concludes that access remains an afterthought for designers who look to the minimum. But disability-specific places show that access can be creative beyond the legal minimum. The article is easy to read and has a gallery of illustrations.

 

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