It’s estimated that 6.2 million Americans over the age of 65 are living with Alzheimer’s disease, and that number is only expected to grow.
At this point, we don’t know the cause(s) or have a cure, but care providers and design professionals have continued to seek out and develop better strategies to improve life for people with memory impairments.
Design elements for memory care
Each model and program have unique aspects that require differing approaches to design. However, there are physical design elements that can be applied to all memory care models and programs to allow for authentic interactions and positive life experiences, including:
- Providing a variety of enriched amenity spaces so that residents can make choices about what they do, where they go, and how they get there
- Offering privacy as well as opportunities for social connections and varied experiences, with each environment clearly differentiated
- Creating spatial literacy through embedded wayfinding elements
- Providing abundant visual and physical access to the outdoors.
5 memory care models
A common element to all memory care models and program approaches is a focus on meaningful resident experiences—seeing and engaging with individuals based on what they can do versus their limitations. Resident autonomy and freedom of choice are another common thread, as well as the recognition that isolation, lack of purpose, and feelings of helplessness have a corrosive effect on the human spirit.
As the industry has learned more about the disease and its effects on cognitive aptitude, many design solutions for the built environment have emerged.
Here are some of those models and their attributes:
The home (house).
Familiarity of an environment can be so critical to “comfort” for memory care residents by creating a human-scale setting that’s both familiar and easily navigable. This is why the small house model has gained so much traction.
The house model is traditionally built as a one-story, standalone building within residential settings. It has room for 10-14 residents and often universally trained staff, which fosters a natural family-like setting. Many residents find the smaller scale more manageable than larger-scale environments, but creating opportunities for the social connections and varied experiences of larger or more diverse groups can be challenging.
Small house settings also are well suited for connections to outdoor gardens and natural light from multiple exposures, which can help minimize sundowning.
The neighborhood.
Often attached to an existing building, this model comprises 20-48 rooms arranged into multiple residential wings that converge on a social core that includes living, dining, and activity spaces.
Neighborhoods can be new construction or repurposed existing space. Because of the model’s slightly larger scale compared to a house model, the support space, kitchens, spas, and even staffing can be shared by a larger population, which provides some efficiencies and ultimately lower costs per bed.
These memory care neighborhoods are part of a greater retirement community and can provide more opportunities for larger and more varied social connections. In cases where the model is created within existing space, such as a former assisted living floor, the infrastructure can present design challenges or dictate a linear design, which generally isn’t preferred.
For example, it can be difficult to avoid dead-end corridors in this type of renovation. Placing an easily identifiable activity space, such as an art studio or life station, at the end of a corridor can provide opportunity for engagement and helps with spatial literacy.
Downtown.
A model that gained a lot of momentum a number of years ago was the downtown or Main Street concept, where there was a hub of activity that recreated the quintessential downtown feel. Households and neighborhoods feed into these engaging spaces, which could include beauty/barber shops, stores, theaters, bakeries, and coffee shops, behind the façade of a downtown.
Such settings provide great opportunities for socialization and activities; however, they tend to be more expensive to build because of the cost of the town/street décor.
This approach also begs the question, “Is a simulated reality or a fake façade the right approach to memory care environments?” Do we want to attempt to trick a resident into believing something is real? If they can’t perceive the difference and it creates positive outcomes, does it matter?
The village.
The village takes the house or neighborhood concept to an even larger scale with a connection of houses/neighborhoods that builds a larger sense of community.
One of the most well-known, Dementia Village in Hogeweyk, Netherlands, started in 2009 and is made up of 23 households of seven residents each.
Circulation, like a town, is mostly outdoors with pathways and walks that lead to a more central downtown commons area that includes a grocery store, coffee shop, bakery, and hair salon, to name a few. Residents are free to wander, explore, and socialize without restraints.
This approach has generated a lot of interest and numerous other villages have been built or are in the planning stages, including in the United States.
Dementia-friendly communities.
The above-mentioned models, each with their own attributes, have addressed only a small fraction of those living with Alzheimer’s disease and other forms of dementia. In fact, the majority of care providers are family members.
Recognizing this issue, many communities have adopted a dementia-friendly model, which focuses on training and sensitizing the retirement community, neighborhood, town, or city at large to better understand the disease and how to support those living with it.
Within senior living communities, this model results from an intentional decision to fully integrate residents with dementia into the broader community. Ultimately, these “integrated” communities must strive for spatial literacy throughout their campus to provide authentic autonomy and connectedness for those with cognitive differences.
In addition to intentional planning of the built environment, they must also engage in rigorous staff training, technology use, and, most importantly, a community-wide commitment to understand and support residents living with dementia.
Overall, the dementia-friendly model provides greater autonomy and freedom to people living with dementia by allowing them to remain in the community and engage and thrive in day-to-day living. However, there’s a risk factor associated with this approach because there’s less safety and control.
Design concepts for memory care communities
Within these different memory care models, there are a few fundamental design concepts that favor an effective environment for residents, such as:
- Avoiding dead-end corridors that result in frustration particularly when that corridor ends with a closed (locked) door. Instead, designing looping or more open plans that promote / encourages movement.
- Zoning a plan similar to residential homes with private areas for bedrooms that are separate from the more public spaces, including living, dining, and activity rooms. Loud activities in common spaces can be distracting to an immediately adjacent bedroom.
- Making staff areas efficient but stealth. Providing easy monitoring of common spaces, but in a way to maintain the residential quality. A staff area may take on more of the imagery of a library or fireplace alcove as a foil to the staff working behind it.
- Designing spaces for specific activities versus multi-purpose rooms. The notion of maintaining “life-long learning” does not end with a dementia diagnosis. Rooms with a specific purpose have been shown to be more effective in how residents associate with them. It also allows the aesthetic of that particular room to be more targeted to its feel and use
- Planning for storage. Understanding that there’s a lot of lift equipment and medical/supply carts that need to be accommodated, storage should be a priority during the planning and design phase and not an afterthought. Minimizing travel distances for staff to access supportive equipment is critical, so breaking up utility and storage rooms and providing more of them versus one central is often a good design goal.
Interior design strategies
At even more of a micro level, these are the thousands of small details that make a memory care project sing.
For example, color can be a powerful tool in evoking emotion, with warm tones, including yellows, oranges, and reds evoking a sense of warmth, energy, and happiness. Cooler tones, such as blue, green, and purple, can help create a sense of calm, stability, and peacefulness.
Additionally, color contrast is an effective way to separate objects and draw attention to them, particularly in bathrooms, where darker colored bathroom fixtures or grab bars can be easier to see than a white-finish options.
Wayfinding is getting a lot of discussion these days, too. Décor, color, targeted art, heirloom furniture, memory boxes, curio cabinets, video displays all represent wayfinding techniques.
If residents can see a recognizable object from their past, such as a table located in the foyer to their bedroom or a piece of art, (e.g., an image of golf clubs outside the room of a resident who was a golfer), it can help to identify their personal space.
In an open floorplan with strong connections to the outdoors, orientation to outside objects can also be an effective method for wayfinding. For example, an outside piece of sculpture or unique tree adjacent to a person’s room can help them identify their surroundings.
Furniture selection is also critical to the success of a memory care residence. If a resident perceives a pattern as too busy or a chair isn’t comfortable or easy to get in and out of, they won’t use it. Staff members need to know “the story” or past of each resident to understand how to effectively accessorize a household in a meaningful way.
Next steps in memory care design
In the last decade or so, care providers, memory care consultants, architects, and engineers have made enormous strides in the design of memory care-specific settings, creating warm, welcoming, and supportive settings for residents. As we look ahead, what can we do to take this work to the next level?
Today, memory care settings, although beautiful, tend to be secure and self-contained. However, people are social by nature and the more we can open up social opportunities for residents, connecting them to the greater retirement communities or the community at large, the better their life experience will be.
Ever-changing technology will play a big part in that by supporting and connecting people in ways we can only imagine today.
Eric McRoberts is a partner at RLPS Architects (Lancaster, Pa.) He can be reached at [email protected].
