Designed with care

The population is getting older – survey after survey tells us so. For social housing providers, this means that there will be more elderly people to care for but it also means there will be more people who suffer from dementia, as the condition is linked to the ageing process.

Research from the London School of Economics predicts that within 30 years, 765,000 people in England alone will suffer from some form of dementia – that's nearly two-thirds more than there are at the moment.

Clearly, this is a big issue for the housing organisations who will provide care for these people because the design of the home in which a dementia sufferer lives can have a dramatic effect on his or her symptoms.

"We recognise that people have physical issues as they age, and we should be thinking about mental issues as well," says Anne-Marie Nicholson, an associate at PRP Architects and part of its dedicated special-needs team. "If registered social landlords are thinking about a new building for older people, they should be thinking about dementia. It's their duty."

In the past, people in sheltered housing who develop dementia have often had to be moved to more suitable accommodation. This is very difficult as their symptoms make it hard for them to leave friends and a familiar environment and adapt to new surroundings or a different routine. However, it is possible to design buildings that allow a sufferer to stay in their own home and surroundings, with their partner if they have one, while offering increased care, as several new schemes by PRP demonstrate.

Keeping it together
One, Penfold Court in Westminster, central London, combines 43 self-contained, one-bedroom flats with extra care facilities and two larger flats specifically designed to house dementia sufferers. The two sections share communal dining and leisure facilities so that dementia sufferers are not isolated but can still receive the higher level of support they need.

The scheme, for Notting Hill Housing Trust, has been kept deliberately small: the extra-care flats are spread over a five-storey building while the two larger flats, spread over a connected three-storey wing, will each accommodate four people with a shared bathroom and kitchen.

"Large-scale development inevitably has an institutional feel," says Nicholson. "It needs to be broken down by creating clusters or starting with a model that's already small."

Penfold Court has just received planning permission but a few miles north, another PRP-designed building including dementia care facilities is already being used by Notting Hill Housing Trust tenants. The development, in Islington, north London, opened in December. It combines independent accommodation, a dementia care unit and a day centre, plus private housing for sale that has helped cross-subsidise the cost of the building as well as creating a more "normal" feel for tenants.

Long passages and dead ends should be avoided. Corridors must lead to places of interest or seating areas so that confused people can rest as they get their bearings

Another PRP scheme, this time for Housing 21 and Babergh District Council in Suffolk, has tackled the institutional feeling of a large development by using traditional domestic materials to give a more homely environment. On the edge of the village of Stutton, it comprises 27 flats offering 24-hour very sheltered housing and nine flats for dementia care. The dementia care flats are designed in the same way as the other flats but are grouped in their own unit. There are also large gardens and a day centre.

Nicholson says lighting is vital to creating a domestic ambience. "Nobody likes strip lighting. Lamps and wall lights with nice fittings and ceiling lights that can be controlled and dimmed easily are much better – these provide a nicer living environment for everyone," she says. Technology, while very helpful for care facilities, must be unobtrusive and easy to use.

A real find
People with dementia often lack short-term memory and can get lost easily.

To ease this, they need a familiar environment with a clear, small layout, says Nicholson. Long passages and dead ends should be avoided. Corridors must lead to places of interest or even a seating area so that confused people can rest while they get their bearings. "People with dementia often get frustrated when they set off for somewhere and then forget where they

were going; this can make them aggressive. The design of the building can help with this, making life easier for staff as well as tenants," says Nicholson.

"People must be able to orient themselves well, to see in and out of enclosed spaces so they can tell what time of day it is and where they are in the building," she added. Interior decoration can be used to provide clear landmarks such as large pictures or differently coloured walls outside lifts so that people can tell which floor they've arrived at. Contrasting colours can also help the visually impaired to see where the floor ends and the wall starts.

"The built environment must be sensitive to the needs of its occupants and have been designed in a sympathetic way," says Nicholson. "It's important to employ architects and contractors with specialist knowledge who can prove their past experience in this field. Also, providing a good brief for the architect is very important so that they understand the issues.