Designing for dementia: Long-term memory care, from the ground up

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The Village Langley is a community for people living with various forms of dementia.

The Main Boulevard at the Village, a new development in Langley, B.C., wends through an idyllic scene. Car-free and edged by flower gardens, it starts at something called the Community Building – an airy, skylight space with a spa, salon and fireside café – before passing by clusters of quaint cottages, each painted a unique, rich colour such as terra cotta or teal. The path ends at the Farm – a large vegetable patch with a bright-red barn overlooking a babbling creek surrounded by tall poplar, spruce and birch trees.

Ostensibly, the Village is a suburban fantasy land – the kind of community where many parents would want to raise their kids. It even has a pond, a gazebo and an embarrassment of white picket fences. But the details of the neighbourhood reveal a different, deeper purpose. The cottages are single-storey for wheelchair accessibility, and in fact aren’t cottages at all. Each only looks like a separate home from the outside to create a cozier scale. Within, they are conjoined by communal kitchens, lounges and dining rooms – social spaces for the 72 residents, all of whom have dementia, the most common form of which is Alzheimer’s.

The first of its kind in Canada, following a successful model pioneered in the Netherlands, the Village aims to set a new gold standard in long-term care for people with declining memories. Rather than clinical, hospital-like spaces, it is meant to be reminiscent of the neighbourhoods the residents have left behind, making the transition to a nursing facility less disorienting, alienating or anxiety inducing, common issues for those with dementia. Langley is a suburban locale, but “if we had built this in a more urban setting,” Village architect Eitaro Hirota says, “it might have looked like a block of apartments. For a project like this to be successful, it has to suit its context and be reminiscent of what the residents are used to.”

The need for such provisions is huge and growing. Currently, there are approximately 500,000 Canadians living with dementia, a number that is projected to nearly double, to 937,000, by 2034, according to the Alzheimer Society of Canada. For every person with dementia, one or more of their relatives provides extensive unpaid care, which costs the economy dearly in lost productivity and other expenses – $10.4-billion a year right now, a figure that will be $16.6-billion a year by 2034. Can good design help solve the problem? Or are all the white picket fences simply an idyllic distraction from the broader issue of effective senior care?

According to Toronto-based architect Claudia Salgado, vice-president of design for Amica, a company that builds and manages seniors’ residences, design makes a critical difference. After struggling to find effective care for her mother, who was diagnosed with dementia, she decided to pursue a master’s degree in dementia studies at Scotland’s Stirling University, a world-leading institution when it comes to Alzheimer’s and design. Now, when she’s planning spaces for those with memory challenges, she approaches the work differently. “It’s important to keep in mind that memory lives not only in the brain,” she says. “We experience it through all the senses, through embodied memory in our sense of sight, touch, taste and smell. Highly tactile surfaces, for example, are great, because even if someone has a hard time remembering their suite number, they might recall the unique feeling of [a] handrail near their room.”

The Village follows a model pioneered in the Netherlands.

Elroy Jespersen has spent the past 30 years of his career as vice-president of operations of Verve Senior Living, a company that develops retirement homes for the elderly and which recently completed the Village at Langley. A few years ago, a relative of Jespersen’s was diagnosed with dementia, and in trying to find a place suited to her needs, he realized that few facilities – even among those he had built – “could support her in the way she needed to be supported,” he says.

Facing his own senior years – the Village is Jespersen’s final project before retirement – and inspired by international precedents, such as the De Hogeweyk dementia village in Weesp, the Netherlands, he decided to “work toward building a place that I would want to live if I ever developed dementia,” he says. “I wanted to create a place where people could live their best lives, despite the limitations that come with the condition.”

Among the failings of more traditional seniors’ facilities are long, all-beige hallways where each room looks the same. This can be a wayfinding disaster for people who have lost the ability to remember the subtle differences between highly similar things (one brown door versus the next). Other issues include dead ends or locked entryways that produce agitation because they prohibit a person from walking further, even when that person isn’t sure where they set out to go. Lack of access to green space and poor daylighting are also common concerns. For their own safety, dementia patients can be locked into a facility to prevent them from wandering off and getting lost, the cost of which is the innate need to get fresh air and sunshine.

The Village, on the other hand, hyperattentively addresses such concerns. Built on the five-acre site of a disused school, Bradshaw Elementary, the design balances safety and autonomy. Although the grounds are open to wander across, the perimeter is fenced in so that no one roams too far. Within, the circulation is all free-flowing, with pathways and halls that either meet open doors or loop around, eliminating any chance of dead-end corridors. Skylights and big windows provide lots of natural light, which also helps remind residents of the changing seasons and the time of day, a rhythm that can easily get lost in a hospital, furthering a sense of disorientation from the wider world. Plus, the varied, vivid colours of the buildings help improve wayfinding. It’s easier for someone to remember that they live in the one and only bright green house rather than the third door from the left down the second hallway.

The Village is designed with plenty of natural light and looping corridors that have no dead ends.

As proof of the thoughtful nature of the design, “we didn’t use a ton of yellow,” says Hirota, who works for NSDA Architects, the studio that envisioned the Village. “If a senior has jaundice, their vision might be tinged with yellow, so the colour doesn’t look as distinct.”

One criticism of the Village is that it only provides care for a small group of people at a cost that’s prohibitive for all but the most affluent Canadians – approximately $8,000 a month. “I don’t know who can afford that,” says Marilyn Taylor from Halifax, who was diagnosed with dementia six years ago, when she was in her mid-60s. She currently lives at home, but even looking forward, if her condition changes, she’s not sure that such grand designs will be necessary. “It might be a bit like treating a broken pinky with a full arm cast,” she says. “People with dementia don’t necessarily need more than the typical person to feel happy and fulfilled – fresh air, sunshine, exercise, a sense of dignity. Those things don’t necessarily cost a lot of money.”

Another issue is that such a fancy design might distract from the larger question of what kind of hands-on care actually serves people with dementia the best. “Families choosing a place often get swayed by the brand spanking new, gorgeous home that has a certain look,” says Mary Schulz, director of education at the Alzheimer Society of Canada. “But it’s important not to get seduced. The design is important, but it’s only one element.”

Instead, Schulz advises that family members consider the quality and depth of attention their relative will get in any given place. “Is the culture of the facility built around task-centred care, where everyone gets fed and bathed at the same time, regardless of personal preferences or habits? Or is it person-centred care, where someone gets meals when they normally would at home to provide them the kind of continuity of their day-to-day routine that helps them feel more at ease.” (The Village offers person-specific care, with a one-to-one ratio of staff and residents).

Schulz also points out that existing facilities don’t necessarily need to go through the massive expense of tearing down and rebuilding to take advantage of the latest best practices in design. “Not having dead ends is important,” she says. “But where they exist, there are things people can do, like put a chair next to a table with an activity, or put something tactile to touch on the wall, like a nice fabric, that gets the mind focused on a new idea, before the person turns around to retrace their steps.”

Holy Family Hospital, in Vancouver, has been around since 1953 and has plenty of long, indistinct corridors. Although the hospital is in the process of building a new facility, the project will take a number of years and the hospital administrators wanted to do something more immediate for their care of patients with dementia. Recently, they’ve switched to a person-centric model. If someone is not a morning person, they no longer have to get up for breakfast at the crack of dawn. They also started introducing a number of design updates, most of which are small and inexpensive, to improve the current building.

All the doors are now different colours, with custom door knockers featuring things that each patient holds dear (a man who grew up playing basketball might have a little net and hoop on his). There are also murals in common spaces depicting familiar scenes, such as a vista from Gastown, a popular Vancouver neighbourhood with its famous steam clock.

“New buildings require a very long planning process,” says Rae Johnson, site operations leader for Holy Family. “But it’s possible to take environments that aren't great and make them better. It’s all about moving from a medical way of thinking to a social way of thinking. This might be a hospital, but it can also feel like home.”

Dementia develops in varying degrees of severity, so not every diagnosis requires moving to a care facility. Here are some simple design ideas to help those experiencing mild memory loss live more comfortably in their own home.

  1. After Marilyn Taylor was diagnosed with dementia six years ago, one of the first things she did was declutter. “I thought that it might be confusing if I had lots and lots of utensils,” she says, “whereas all I might need is one.”
  2. Taylor also suggests that people with dementia get an auto-shutoff device for their electric stoves. They work well for people who are still independent enough to cook for themselves, but might occasionally forget to turn off a burner.
  3. According to the Alzheimer Society of Canada’s Mary Schulz, using a dark decal in the bottom of a toilet bowl – one that contrasts with the otherwise light colour of the porcelain – can make the overall, potentially monolithic shape easier to understand and therefore use (“The decal can act as a bullseye,” Schulz says).
  4. Cleverly placed art can help with wayfinding, acting as signposts around a home. The trick, according to architect Claudia Salgado, is to use recognizable, familiar images such as landscapes and still lifes, and avoid potentially confusing abstracts such as Rothkos and Mondrians.
  5. Salgado also suggests avoiding abstraction with practical details such as kitchen and bathroom hardware. “Something sleek and minimal might not be as intuitive as something literal and obvious,” she says, “making it harder for people to comprehend and use.”

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