Designing homes with dementia in mind

In most cases, designing homes with dementia in mind does not mean a special type of design.  It’s not news that people prefer to live at home as they age. So, universal design for dementia-friendly dwellings helps people live at home for as long as possible. However, this can sometimes prove challenging for people with dementia and their family members.

Once basic accessibility features are considered, as they should be in all homes, it’s about the details. The research that underpins the guidelines for dementia friendly dwellings found four key design principles:

  1. Integrated into the neighbourhood
  2. Easy to approach, enter and move about in
  3. Easy to understand, use and manage
  4. Flexible, safe, cost effective and adaptable over time

The graphic below shows the elements in the design process that emerged from the research project.

Graphic showing the design process.
The design process from a related article on page 12 of the Housing Ireland Journal

Dementia Friendly Dwellings Guideline

Heading for the Dementia Design GuideThe Dementia Friendly Dwellings Guideline is from Ireland, but the good ideas are not country specific. The online resource produced by the Centre for Excellence in Universal Design is divided into separate downloadable sections: 

  • Home location and approach
  • Entering and moving around
  • Spaces for living
  • Elements and systems

The Dementia Friendly Dwellings Guidelines complement Universal Design Guidelines for Homes in Ireland and are intended as a first step in raising awareness. They provide a flexible framework for designers to apply the guidelines creatively to all new home types through incremental steps.

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. There are plans for houses and apartments.

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.  There are more resources on the Alzheimer’s Australia website on creating a dementia-friendly home

Home adaptations

A group of researchers in the UK wanted to find out the role of home adaptations in supporting people with dementia. They wanted to know what works, what doesn’t, and what more needs to be done. There were four key questions in their literature review:

  • Which housing adaptations are being implemented and used on an everyday basis?
  • How are decisions made to implement and use housing adaptations?
  • What are the barriers and enablers to housing adaptation and use?
  • What is the impact of housing adaptations on everyday life?
A kitchen in the middle of renovations showing stripped walls and a step ladder.

Results of the review

The review found that the most common adaptations were about physical limitations. The emphasis was on preventing falls. Clinical trials found that home adaptations have the potential to minimise falls. Safety relies on predictability of the environment for people with dementia. Nevertheless, this is the one area that is most lacking for people living in the community. 

Professionals and family members were good at coming up with ideas for adaptations. The study also found that carers were often inventive with novel solutions. However, some carers preferred their own trial and error methods when they thought professionals would not be helpful. A key issue here is that most useful information for families is online and not everyone has the ability to access this information.

“I’ll wait until the time comes” was evident in some of the literature. Some families were in favour of adaptations prior to need, whereas others wanted to wait until it was necessary. The type of housing also had an impact on this aspect.

Carers felt the adaptations made their caring tasks easier. They spent less time supervising and resulted in less burden and more sleep. The health and wellbeing of carers was the main gap in the literature. 

There’s a lot more information in this scoping review. The title is, Exploring the contribution of housing adaptations in supporting everyday life for people with dementia: a scoping review.

Universally designed dream home

This is not your average home. This one goes beyond even enhanced features in the Livable Housing Design Standard. However, it shows what is possible with creative design thinking. Depending on where you live, the key features will be embedded in all new homes under the Livable Housing Design Standard. And it’s good for home renovations too.

Contrary to the many myths, introducing universal design features into a home doesn’t compromise aesthetics.

Exterior view of the top part of a two storey home showing a window in the gables of the house. Universally designed dream home.

The video below is from O’Shea and Sons Builders that showcases a high-end of the market home. The additional costs are in the automation, the elevator and some of the fixtures and fittings. However, the key features are possible in mainstream homes at little, if any, additional cost.

As Nick O’Shea says, “… an absolutely amazing home where functionality and style means absolute beauty”. A really great example of universal design in action dispelling the myth that accessibility and functionality are ugly.

Filming by Unveil Media

O’Shea Builders have built other accessible homes so this is not the first. The Independent Builders Network in Queensland has other members doing good work as well. Queensland is also the first state to implement the new Livable Housing Design Standard.

Online learning – Livable Housing Design

CUDA has the licence from the Australian Building Codes Board to run their course on the Livable Housing Design Standard. The course is based on the Handbook and the Standard. This is a technical course for home-building professionals. Find out more about this course.

It covers the various ways to create level entries, doors, circulation spaces, showers and toilets. If you are reading this, take advantage of $30 off with the coupon code NEWS40 at the checkout. Offer ends 10 August.

Front cover of the Livable Housing Design Standard showing a single storey home with garage.

Housing Adaptations Design Toolkit

The Housing Adaptations Design Toolkit comes from Northern Ireland and is focused on government departments collaborating for good social housing outcomes. The aim is to integrate services to promote independent living. As such it has application to government funded home modification services in Australia an elsewhere.

Housing adaptations are a key element in supporting independent living. The other three are assistive technology, social care, and health and wellbeing.

The diagram shows the links between the four elements required for independent living.

Diagram showing the integration of services: health and wellbeing, housing adaptations, assistive technology and social care leading to independent living.

The Department of Communities and the Department of Health collaborated in the development of the toolkit.

The toolkit covers housing adaptions that range from those not needing a referral to occupational therapy services to more complex projects. It has design formats that help service users to visualise the proposed adaptations. Electronic formats facilitate inter-agency communications for the recommended adaptations and specifications.

The toolkit has seven sections. They include design principles for different rooms, space standards for different users, and helpful specification templates. There are three categories of users: ambulant, independent wheelchair user, and dependent wheelchair user.

The development of the toolkit included collaboration with people with disability. It supports a standardised approach to design principles and space standards. The image shows the front cover of the toolkit.

Front cover of the Housing Adaptations Design Toolkit.

The Housing Adaptations Design Toolkit is a guide for government funded adaptations. As such, the toolkit processes could help inform home modifications under Australia’s National Disability Insurance Scheme. This is a very comprehensive approach to bureaucratic processes and technical detail.

Specialist guide for wheelchair housing from UK

Front cover of the guide. Line drawings of housing using light blue, dark blue and lime green

The third edition of the Habinteg Wheelchair Housing Design Guide has input from Centre for Accessible Environments and the Royal College of Occupational Therapists. It is good to see a separate housing design guide for wheelchair users. Not all wheelchair users need the same features. Their abilities vary from part time users of a manual chair to those who are fully dependent on a large powered chair.

When it comes to the concept of “accessible housing” designers tend to think only of wheelchair users when there are many other types of disability that need consideration. Wheelchair housing is not the same as universal design in housing. However, almost all wheelchair users should be able to visit a home designed to the Livable Housing Standard.

Habinteg has instructions on how to purchase in the UK. You can also access a copy via Angus and Robertson

Livable Housing Handbook

The Livable Housing Design Standard applies to all new Class 1a and Class 2 buildings. Class 1a buildings are detached houses, row houses, terraces, townhouses and villa units. Class 2 buildings are apartment buildings and the design requirements apply inside the apartment. Public access requirements cover the public areas. To aid practitioners, the Australian Building Codes Board has produced a Livable Housing Handbook.

The Livable Housing Design Standard sets out minimum requirements for mainstream dwellings.

Front cover of the Livable Housing Design Standard showing a single storey home with garage.

The title, ‘Livable Housing Design’ comes from Livable Housing Australia’s voluntary guidelines. The features in these guidelines form the basis of the mandatory requirements, which are similar to Livable Housing Australia’s ‘silver level’.

The Livable Housing Design Handbook aims to help practitioners understand the relevant sections of the building code. These are Part G7 of NCC Volume One, Part H8 of NCC Volume Two, and the ABCB Standard for Livable Housing Design.

The Handbook covers design issues in generic terms and does not provide specific compliance advice. It aims to assist practitioners develop solutions to comply with the NCC requirements.

The intent of livable housing design is “to ensure that housing is designed to meet the needs of the community, including older people and those with a mobility-related disability.”

Front cover of Livable Housing Design Handbook.

The appendices have examples of bathroom layouts and a guide for meeting compliance with the NCC.

Going beyond the Livable Housing standard

The Australian Building Codes Board has also produced a guide for going beyond the minimum standard. The voluntary standard is generally based on Livable Housing Australia’s “Gold level”. These features provide a greater level of livability across the lifespan for more people, and go beyond the “silver level”. Consequently, exceeding the minimum mandatory requirements will still achieve compliance.

This additional set of non-mandatory technical provisions will better meet the needs of the community. They are similar to the Gold level in the original voluntary Livable Housing Design Guidelines.

Front cover of Livable Housing Design Beyond Minimum Standards guide

Australian homes are some of the largest in the world and the features in the voluntary standard should not be difficult to achieve.

Extensions and major renovations to existing homes will be based on state or territory requirements to comply with the standard. For example, if the works require a council development application.

Online learning – Livable Housing Design

CUDA has acquired the licence from the Australian Building Codes Board to run their course on Livable Housing Design Standard. The course is based on the Handbook and the Standard. This is a technical course for home-building professionals. Find out more about this course. and all the different ways to achieve a level entry.

The long road to Livable Housing

And the journey isn’t over yet. While the Livable Housing Standard is now in the national code, it is up to each state and territory to implement it. Victoria, Queensland, Tasmania, ACT and Northern Territory have agreed to implementation. South Australia has come late to the party but is now working on an implementation strategy.

Australian Network for Universal Housing Design (ANUHD) has been leading the charge for the reforms for twenty years. They believe that Western Australia could also sign up to implement the standard eventually. However, as of September 2023, NSW remains uncommitted. The livable housing story of citizen advocacy is documented in a conference paper.

Universally designed dream home

Not your average home. This one goes beyond even enhanced standards in the Livable Housing Design Standard. The video is from O’Shea and Sons Builders and shows what can be done with creative thinking. While this is a top-end of the market home, all the features are possible in mainstream homes. As Nick O’Shea says, “… an absolutely amazing home where functionality and style means absolute beauty.”

Filming by Unveil Media.

Accessible and adaptable home renovation

Sanctuary magazine has a Design Workshop section where people can apply to have their home design project workshopped by professionals. Architect Mary Ann Jackson comments on the planned renovation of a home for a family of four.

The brief is to renovate without overcapitalising, incorporate accessibility for the long term, improve layout, focus on energy efficiency and to consider acoustics.

Image of the original 1970s home

The existing home discussed in the Sanctuary magazine article. It shows a 1970s two-storey home.

The house is spacious enough but it doesn’t function well. One family member is hard of hearing so large open plan with hard surfaces is challenging. After investigating the option of a knock-down-rebuild, the homeowners, Eric and Caroline, decided to make the most of what they have.

Eric and Caroline engaged a designer who came up with a solution for most of their requirements. The article shows the existing floor plan and the proposed floor plan. Mary Ann critiques the plan from an accessibility perspective. As she says, if it is not accessible, it is not sustainable. So considering accessibility from the outset is worthwhile.

Congested space is the enemy of accessibility and having several small separate wet area rooms eats up valuable space. The walls and fittings take up space in each of these areas. Mary Ann advises at least one larger family bathroom for this family house. She goes on to discuss paths of travel and circulation space and offers improvements by moving some of the rooms around.

The kitchen is next with suggestions for work surfaces at different levels and drawers for under-bench storage. Mary Ann then moves on to the balcony and outdoor areas, explaining her reasoning along the way. The article has much more detail and is worth a read for anyone designing a home renovation.

A universal design approach

“Designing for adaptation in the future is important, and properly executed universal design facilitates multi-generational living”.

A man in a bright yellow T shirt is painting and archway in a wall inside a home. The wall is grey and there are tools on the floor. Articles on home modifications.

The article is in the Sanctuary magazine Design Workshop series, and is titled An accessible, adaptable upgrade. The article concludes with Mary Ann’s alternative design based on her assessment of the property and the family requirements. A really good example of universal design thinking coupled with cost effective energy efficiency.

See also the Livable Housing Design Guidelines for additional ideas. Many of these ideas are in the upcoming changes to the National Construction Code. It will be known as the Livable Housing Standard.

Universal design meets green building

Many home designers have argued for improved environmental sustainability while citizens have advocated for universal design. The 2022 edition of the National Construction Code (NCC) has them both covered. At last, universal design meets green building.

Sanctuary Magazine is a publication for people looking to build and renovate sustainably. Universal design is the focus of their 61st edition. So I was delighted when the editor invited me to contribute on the topic of universal design in housing.

Small things can made a big difference to the ease of use. Things like pedestals to raise washing machines off the laundry floor to minimise bending.

Image by Taylor’d Distinction

Laundry with white fittings. Washer and Dryer raised up.

My article covers the usual benefits of universal design and how it is good for everyone and the elements of updated NCC for housing. And of course, I referenced the Livable Housing Design Guidelines as a good place to start. I was also given the opportunity to offer additional suggestions based on my experience.

Additional suggestions

My suggestions are based on building my own universally designed home, and from working alongside occupational therapists. Here are some of them.

Ensure easy access to storage by installing drawers instead of cupboards under benches in the kitchen, laundry and bathroom. A pull-out workboard in the kitchen is useful too: placed at a sitting height for an adult, it also provides a workspace for children.

Install lever handles on taps and on every door so that you can operate them with your elbows when your hands are full, or if you don’t have good grip. Consider grip strength and dexterity when choosing drawer and cupboard handles and other opening and closing mechanisms. Also consider raising power points from the skirting board and placing light switches and door handles at hip height for ease of use.

In two-storey homes, think about designing a location for the installation of a lift in the future. This space can begin life as cupboards and then be utilised for the lift later.

The Livable Housing Design Guidelines don’t cover level entry to balconies and alfresco areas, but it’s just as important as level entry into the home. For more space in bedrooms, change the space-consuming walk-in robes to cupboards. You might win space in the ensuite too.

“Universal design is about designing inclusively for as many people as possible, without the need for special types of designs. When applied to housing, it’s a design process that considers the real lives of families and households – throughout their lives. In the end, it’s just good sense to have homes that can accommodate the expected and unexpected situations life brings for all family members.”

The editor, Anna Cumming, has allowed me to share my article, A Plus for Everyone. Architect Mary Ann Jackson is also a contributor to this edition with an article on a home renovation. You can access more information about Sanctuary, other articles, and subscribe.

Posted by Jane Bringolf, Editor

What an accessible home looks like

Good examples of universal design are difficult to find. Because universal design is invisible until pointed out, home viewers might not spot it either. Thanks to Taylor’d Distinction Building Design, here are some pictures to show what an accessible home looks like.

Looking forward to the day when there is no need to have a separate section for “accessible housing”. It should be considered mainstream. After all, how many of us can invite a wheelchair basketballer into our home? See more posts on the quest for mainstream universally designed housing

Basic access features are now in the 2022 National Construction Code. However, we are still waiting for states and territories to adopt the Livable Housing Standard. Queensland will lead off in October 2023. 

Kitchen with white benches contrasting with the light brown floor.

Contrast between floor and benches

Kitchen island bench with timber finish giving colour contrast.
Timber finish contrast with kitchen bench

Bathroom design with dark tiles and floor and white bath and vanity bench.
Vanity bench has easy access

A white Labrador dog lays at the opening to the level access alfresco.
Level access alfresco – less trip hazards for all ages

A stainless steel level handle.
Lever handles good for poor dexterity and when hands are full

Shower recess with half screen and hand held shower.
Shower recess with half screen which can be removed later if necessary

View into the bathroom through a wide door.
Spacious bathroom and wide doors througout.

Level access to the outdoors.
Level access to the outdoors for seamless transitions

Light switches with large rockers.
Larger rocker switches easy to use with fingers, wrist or elbow.

Laundry with white fittings. Washer and Dryer raised up.
Raised washer and dryer good for all backs

A view of the kitchen showing the bench height over and access to another room.Circulation space and bench height oven

Timber staircase with handrails both sides.
Handrails on both sides for safety and no see-through risers to cause visual distortion

A person with a four-wheeled walker rolls over the level threshold.
Level threshold gives access for all occupants, visitors, paramedics, and furniture deliverers

 

Adaptable Housing Guide – 6th edition

Front cover of Your Home 6th edition. Your Home is in its 6th edition (2022) published by the Australian Government. It has a section on the livable and adaptable house. This guide is especially helpful for home renovations and modifications as well as new builds.

Accessible, universal design features for all housing are in the 2022 edition of the National Construction Code. These features are similar to the Livable Housing Design Guidelines Silver standard. However, Your Home Guide is yet to catch up with the recent changes to the National Construction Code’s Livable Housing Design Standard.

The old Adaptable Housing Standard (AS4299) continues to be referenced alongside the Livable Housing Design Guidelines. The Adaptable Standard has elements similar to the Gold standard in the Livable Housing guide. However, some elements and design ideas are outdated in this 1995 standard. 

The web version is easy to navigate and covers every aspect of design including adaptation to climate change. It can also be purchased in hard copy. 

There are many detailed diagrams to help explain design features and floor plans. The chapter makes distinctions between liveable and adaptable designs. Drawings and floor plans provide sufficient information for designers, renovators and homeowners alike. 

From the introduction:

Many of the homes we build today will still be in use in 50 or even 100 years. Ensuring our homes are both liveable and adaptable is a key challenge for all communities.

Liveability means ensuring our homes are comfortable, healthy, efficient and connected to the community. But it also means the home is functional, safe, secure and attractive for current and future occupants.

Adaptability means that our homes can cope with changes to our households and to the climate. Making homes that are flexible, adaptable, and resilient helps us to respond to both predicted and unexpected change. It also means that we limit our environmental footprint to ensure that our communities remain sustainable.

CUDA’s Livable Housing Design Course

Front cover of the Livable Housing Design Standard showing a single storey home with garage.Get up to speed with this online course which is provided on licence from the Australian Building Codes Board and endorsed by the Building Designers Association of Australia.  It covers everything from different ways to achieve a level entry, bathrooms and toilets, to doors and corridors. 

Good Design for Social Housing

Front cover of the social housing brochure. A woman sits on the edge of a raised garden bed.Good design for social housing creates neighbourhoods where people feel they belong. The NSW Government has produced a four page brochure outlining their goals for social housing. Wellbeing, Belonging, Value and Collaboration are keywords. There is no explicit mention of universal design principles in this document, but there is in the one that links with it. This is the one on dwelling requirements for good design in social housing.

The more detailed document of dwelling requirements leads with legislation and codes. It follows with Universal Design Principles. They require all new stock to apply a minimum level of Silver as outlined in the Livable Housing Design Guidelines. Each development may require a percentage of Gold level as well.

The document goes on to provide unit and room dimensions. If the NSW Government can design Silver and even Gold into these relatively small areas then everyone else can too. There’s more detail in this 5 page document that covers siting, gardens, utilities and more. 

The documents are titled, Good Design for Social Housing, and Dwelling Requirements

The NSW Government Architect has also introduced a universal design approach into its overarching document, Better Placed. While the term “universal design” is not used explicitly, it is inherent in the way the document is written. 

2023 Update

The 2022 edition of the National Construction Code includes the new Livable Housing Design Standard. The accessible features are based on the Silver Level of the Livable Housing Design Guidelines. There are two handbooks: one for the minimum requirements (silver) and enhanced features (gold). 

As of May 2023 NSW and WA remain uncommitted to adopting the new standard into their building code for mainstream housing.

 

Better Apartment Design Standards

Front cover of standard with internal view of an apartment.The Victorian Government has updated the Better Apartment Design Standards. The aim is to make surrounding neighbourhoods better as well as the dwellings. There is also a section on accessibility at the end. The policy’s main aims are:

      1. More green space
      2. Designing for families
      3. More durable and better quality materials
      4. Attractive and safe street frontages

A buyer and renter guide gives a good overview. The information on accessibility is on the last pages and reflects the following: 

• A clear opening width of at least 850mm at the entrance to the dwelling and main bedroom.
• A clear path with a minimum width of 1.2 metres that connects the dwelling entrance to the main bedroom, an adaptable bathroom and the living area.
• A main bedroom with access to an adaptable bathroom.
• At least one adaptable bathroom.

Some of the floor plans look to be based on the old Adaptable Housing Standard (AS4299) rather than the more flexible Livable Housing Design standard.