Heritage Enterprises (Bloomington, Ill.) was on the forefront in the 1990s when it started dedicating areas of its assisted living facilities to serve dementia patients. While the operator recognized the growing need to deal with this population with special needs, its efforts to change the physical environment didn't go much further than adding a locked door to keep residents from wandering.
In 1997, Heritage built its first purpose-built dementia wing off of an existing facility. The 12-room neighborhood concept design included an open common area, small kitchen, and a few home-like elements.
Todd Wiltse, an architect at Worn Jerabek Wiltse Architects in Chicago, says at the time, the project represented some "great leaps forward" in memory care, such as a kitchen space within the unit to give it a more residential feel and the use of private single rooms. "Dementia care residents do not want to be with strangers," he said, during the session, "Design Evolution: A Collaborative Design Process for a New Model of Memory Care," at the Environments For Aging Conference in Baltimore last week.
But there were still some areas for improvement, such as addressing dead-end corridors to secure egress, which residents would end up going through and triggering an alarm. In addition, the patient rooms lacked private showers, there was a disconnect between the dining area and the kitchen, and residents had limited access to outdoor space.
These lessons provided a starting point for the operator and the firm when they set out to create a new model for memory care in 2010. At that time, the Illinois Department of Healthcare & Family Services had introduced a pilot program to develop five state-of-the-art dementia care units. Among the regulations for the program was the rule that the units could house no more than 20 residents and they must have outdoor space.
Over the last five years, Worn Jerabek Wiltse Architects has been working on three successive projects for Heritage Enterprises, allowing the team to evolve the design principles over the course of the projects.
The first project was The Legacy Memory Care Unit, in Decatur, Ill. Architect Heidi Dahle said the team started out by establishing some priorities for the new environment, including reducing stress, promoting wellness through an emphasis on connecting to nature, increasing opportunity for social engagement, and providing a balance of sensory stimuli.
During their presentation, Dahle and Wiltse detailed the evolution of some of the design elements, including what worked, what didn't, and the tweaks they made along the way, such as:
- Camouflaging exits: The design team tried using different colors and materials and recesseing the doorways to try and keep residents from trying to leave the unit or set off alarms. Landmarks or other focus points were also installed near the area to give residents something else to look at. Still, after follow-up studies on the unit, Dahle said she still saw residents trying to read the exit signage and follow them. "The controlled doors were not hidden enough," she said. In further revisions, the design team located the doorways further off the main path.
- Symmetrical layout: The original design of the unit called for four identical resident neighborhoods connected by a main circular walking path. When staffing services were centralized, the staff complained about the lack of sightlines and ability to keep an eye on residents. To improve the set-up, an asymmetrical layout was introduced that improved the staff's ability to watch residents and also helped residents better understand their location since all the neighborhoods no longer looked the same. Further revisions were made to distinguish some of the shared living spaces, such as placing furniture in different arrangements to differentiate the TV area from the quieter living room area.
The speakers said using an iterative design process helped progress the operator's care model, which they continue to try to advance. And there are signs that they’re on the right track: The staff has noted that residents are staying in the memory care unit longer before they need to transition to a more intensive assisted living community.
