Design for Dementia: - Australian Association of Gerontology

Design for Dementia:An Analysis of Care Home Layouts

Martin QuirkePhD Candidate, University of Newcastle, Australia

Architect at DSDC, University of Stirling, UK

New Perspective: 67%

Stonefield: 49%

Minna Murra: 77%

J. Douglas (FF): 27%

Dementia Supportive RAC Unit Layout TypesSample Plan-EAT Scores

Childers Place: 74%Southwood SCU: 86%Southwood Home: 80%

Alz’s Ctr Maine: 73% De Hogeweyk: 78%

Namaste 1 (N): 53%Namaste 2 (S): 65%

Alois: 48%

Note: Floorplan drawings copyright of John Hopkins University Press + Pozzoni Architects

Problem

Context:

-200,000 RAC places in 2877 facilities across Australia (ACSL 2017)

-Majority of residents have dementia (AIHW 2012)

-30+ years of research evidence in dementia design

-Lack of building codes for cognitive access (ABCB 2016)

-Limited record of dementia design quality in existing RAC

-Need to build 12,000 new bed-spaces/year (AACFA 2016)

(7k expansion + 5k replacement)

Research Theme and Aims

The relationship between architectural layouts and environments that support people with dementia.1. How does dementia design quality of NSW RAC units

compare to international best practice examples? 2. Has dementia design quality improved over 40 years?3. Do (5) spatial planning factors affect design quality?

-floor area-number of residents-area per resident-storey location-purpose-built, or not

Methodology Floorplan Assessment ToolNo known plan assessment tools.7 post-occupancy audits identified.3 evaluated in detail:

A. Therapeutic Environmental Screening Survey (Sloane et al. 2002)B. Dementia Design Audit Tool (Cunningham et al.,2011)C. Environmental Audit Tool (Fleming 2011)

Conclusions: EAT most suited for floorplan based assessment39 of 72 Queries (54%) applicable to floor plan60% of score relatable to floor plan

Plan-EATEAT (Fleming, Forbes and Bennett 2013)

94 Units36 Layout types+

90 Units72 Layout types

Recruitment

Publication Source: Sites Units TypesAnderzhon et al., (2012) 9 53 13Cohen and Day (1993) 17 38 21Judd et al., (1998) 1 2 1McLaughlin (2010) 1 1 1

Total 28 94 36

NSW Recruited RACFs Sites Units Types[Anonymous] 21 90 72

NSW

Results 1NSW avg. = 55%International avg. = 68%

DDP#1

DDP#2

DDP#3

DDP#4

DDP#5

DDP#6

DDP#8

DDP #9

DDP #10

International average (n=94)

73% 67% 56% 49% 81% 56% 60% 84% 91%

NSW average (n=90)

47% 40% 40% 42% 74% 37% 61% 78% 79%

NSW areas of strengthDDP#5 Helpful stimulusDDP#8 Privacy and Interaction DDP#9 Community linksDDP#10 Ordinary Life

NSW room for improvementDDP#1 SafetyDDP#2 SizeDDP#3 Visual accessDDP#6 Wandering and outdoor space

Results 2: Improvements over time

International improved by 7.2% per decadeNSW improved by 6.5% per decadeNSW doubled score over four decades

International >20% over NSW (Plan-EAT score)

NSW c.20 years behind International

Results 3i: Unit floor area

NSW: No notable difference

Intl.: -2% per added 100m2

Design quality decreases as resident numbers increase.

NSW = -0.35% / bed-spaceIntl. = -0.87% / bed-space

Results 3ii: Number of bed-spaces

Fewer bed-spaces per unit over time International : -5 per decade. NSW : -3 per decade.

Results 3ii: Bed-spaces

Design quality increases as area per resident increases

NSW = +0.4% /m2/residentIntl. = +0.6% /m2/resident

Results 3iii: Floor area per resident

Results 3ivGround vs Upper floorGround floor is superior to upper floor by a margin of about 10%

NSW ground = 59.6%NSW upper =48.78%

Intl. ground = 70.9%Intl. upper = 58.7%

DDPs (Fleming et al, 2011)#1:Safety #2:Scale #3:Visual Access #4:Unhelpful Stimuli # 5:Useful Stimuli

#6:Movement #7:Familiarity #8:Privacy and Interaction #9:Community Links #10:Ordinary Life

Results 3vPurpose Built vsNon-purpose-built

Purpose-built are superior by 10%+

New South Wales Purpose Built = 59.6%Non-Purpose Built= 49.0%International:Purpose built = 68.4%Non-purpose built= 41.9%

DDPs (Fleming et al, 2011)#1:Safety #2:Scale #3:Visual Access #4:Unhelpful Stimuli # 5:Useful Stimuli

#6:Movement #7:Familiarity #8:Privacy and Interaction #9:Community Links #10:Ordinary Life

Five international examples……

Unit Rank #5:Himawari Group, Japan: 77.7%Single Unit – Small GroupStrong on: Scale, Visual Access, Unhelpful Stimuli,

Community Links, and Ordinary Life.Weak on: Movement, Privacy and Interaction

DDPs: #1:Safety#2:Scale #3:Visual Access #4:Unhelpful Stimuli #5:Useful Stimuli #6:Movement #7:Familiarity #8:Privacy and Interaction #9:Community Links #10:Ordinary Life

Fleming et al., (2013)

Unit Rank #6: De Hogeweyk, Netherlands: 77.6%Multiple Units (23) – Small GroupsStrong on: Safety, Scale, Unhelpful Stimuli,

Useful Stimuli, Movement, Community Links, and Ordinary Life

Weak on: Visual Access, Privacy & Interaction



Unit Rank #11 Leonard Florence, USA: 75.3%Multi-storey: 10 units over 5 floorsStrong on: Safety, Scale, Visual Access,

Community Links, Ordinary Life.Weak on: Unhelpful Stimuli



Unit Rank #13: Childers Place, USA: 74.2%Single Unit – Shared DiningStrong on: Unhelpful Stimuli, Movement,

Privacy and Interaction, Community Links.

Weak on: Scale, Useful Stimuli



Unit Rank #17: Alzheimer’s Center, Maine, USA: 72.9%Strong on: Safety, Useful Stimuli, Movement,

Privacy and Interaction, and Community Links.

Weak on: Scale, Visual Access, Ordinary Life



ABCB (2016) Australian Building Codes Board (2016) National Construction Code, National Construction Code. Available at: http://www.abcb.gov.au/ncc-online/NCC/2016

AIHW (2012) Australian Institute of Health and Welfare (2012) Dementia in Australia. Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/reports/dementia/dementia-in-australia/contents/table-of-contents

AIHW (2017) Australian Institute of Health and Welfare (2017) NSW Aged Care Service List 2017. Available at: https://www.gen-agedcaredata.gov.au/Resources/Access-

Cunningham et al. (2011) Cunningham, C., Galbraith, J., Marshall, M., McClenaghan, C., McManus, M., McNair, D. G., Dincarslan, O. (2011) Dementia Design Audit Tool. 2nd Edition, University of Stirling, UK

Fleming, R. (2011) ‘An environmental audit tool suitable for use in homelike facilities for people with dementia’, Australasian Journal on Ageing. Blackwell Publishing Ltd, 30(3), pp. 108–112. doi: 10.1111/j.1741-6612.2010.00444.x.

Fleming, Bennett and Forbes, I. (2013) The Environmental Audit Tool. Wollongong: Dementia Training Australia (formerly Dementia Training Study Centres). Available at: https://www.enablingenvironments.com.au/uploads/5/0/4/5/50459523/eat_handbook_july_13.pdf

Sloane et al. (2002) Sloane, P. D., Mitchell, C. M., Weisman, G., Zimmerman, S., Foley, K. M. L., Lynn, M., … Long, K. M. (2002). ‘The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): An Observational Instrument for Assessing the Physical Environment of Institutional Settings for Persons With Dementia’, The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(2), pp. S69–S78. doi: 10.1093/geronb/57.2.S69.

Smith et al. (2012) Smith R., Fleming, R., Chenoweth, L., Jeon, Y.-H., Stein-Parbury, J. and Brodaty, H. (2012) ‘Validation of the Environmental Audit Tool in both purpose-built and non-purpose-built dementia care settings.’, Australasian journal on ageing. Blackwell Publishing Ltd, 31(3), pp. 159–63. doi: 10.1111/j.1741-6612.2011.00559.x.

Note: FLOORPLAN DRAWINGS COPYRIGHT OF: JOHN HOPKINS UNIVERITY PRESS / POZZONI ARCHITECTS

References

Thank You

Email: [email protected] [email protected]

Twitter: @think_architect

This research was supported by theAustralian Government Research Training Program (RTP)

Supervisors:

Prof. Michael Ostwald, University of Newcastle & UNSW, Australia Prof. Richard Fleming, University of WollongongProf. Mark Taylor, Swinburne University of TechnologyProf. Anthony Williams, Avondale College

Design for Dementia: - Australian Association of Gerontology

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