Memory care was the most popular topic among session proposals for the 2018 Environments for Aging Expo & Conference—so much so, that event organizers decided to dedicate this year’s closing keynote to a panel discussion focused just on that topic.
Editor-in-chief Jennifer Kovacs Silvis led the discussion with a panel of industry experts, including P.K. Beville, founder and CEO of Second Wind Dreams; Richard Kieley, partner and senior manager at C.C. Hodgson Architectural Group; Juliet Holt Klinger, senior director of dementia care at Brookdale Senior Living; and Jane Rohde, principal at JSR Associates Inc.
The hour-long discussion started with an overview of how the industry has evolved over the last decade, moving from a medical-based model to one that recognizes the importance of programming and built environments that support engagement and socialization. Klinger says when she got started in the industry 30-plus years ago, residents with cognitive issues were housed on a locked hallway in skilled nursing where the focus was on creating a very controlled environment with low stimuli. “We even called it the locked unit,” she said.
As the approach to memory care has progressed over the years, there’s been a growing recognition that design matters and can make a difference in residents’ lives. “Realizing there’s still that wellbeing inside and we need to keep them engaged is the order of the day,” Beville said.
Part of what’s driving this evolution is availability of research and data that paints a picture of how widespread the issue is across the country. Beville noted that one in three people is affected by dementia, whether it’s a family member or someone else they know that’s caring for a family member or loved one with cognitive disabilities.
This awareness is leading to more support for new approaches and ideas. Kieley shared his experience 15 years ago working on a memory care unit and getting pushback from regulators on such design features as an open kitchen concept and allotting more space around the toilet for caregivers to assist residents. Today, he said his experience is that regulators are more willing to work with design firms who engage them early in the design process to find more person-centered solutions. “The audience has gotten bigger and the support has gotten bigger,” he said.
As demand grows, and more communities are adding memory care services or looking to update existing units, the panelists said it’s important for organizations and project teams to develop design standards for memory care environments, such as appropriate flooring or lighting choices, and stick to them. So, what are their baseline must-haves? Spas, smaller dining areas, and activity/common areas are tops on the list. Klinger added that access to the outdoors is another must, even in multistory buildings, where designers can add porches with hurricane-strength screening to make them safe while providing residents access to the fresh air.
There was also agreement that there’s still room for improvement in approaches to lighting and acoustics in memory care units. Beville said that residents with cognitive issues have trouble synthesizing sounds, which can be a problem in dining areas, where noise from moving chairs, clinking dinner ware, and food preparation can be overwhelm residents and make it difficult for them to focus on eating.
Rhode stressed the need for further education—for clients and caregivers as well as the public in general—on dementia and how aspects of the built environment can affect residents. She said it’s not uncommon for clients to come to her with a problem they’re seeing among residents that they often don’t know the cause of or how to address it. For example, a client will notice that residents stop at a doorway but don’t understand that the flooring they’ve used, which has a stark transition from light to dark at the doorway, appears like a hole in the ground to residents.
“As much as we know, not enough people know it,” Rhode said. “The more we can do to spread the work about what’s going on and how to achieve it, the better for all.”
Looking to the future, the panelists noted that the memory care populations coming into their communities are more acute, which is driving the need for more equipment, such as mechanical lifts and mobility devices, as well as assistance from caregivers—both of which will impact space needs in memory care units, Klinger said. For example, dining rooms may need to be larger or have larger tables to accommodate caregivers sitting at the table to assist a resident with eating.
Panelists also called for more flexible design solutions, including universal design, that could better serve resident populations with varying degrees of cognitive functioning. For example, adjustable lighting controls that can mimic circadian rhythm can be a positive for all residents and help them get better sleep. “What’s good for memory care is good for everyone,” Kieley said.
Despite all the challenges, panelists were hopeful about the progress they’ve seen and the recognition of the importance of better design solutions for memory care residents. “It’s an exciting time,” Beville said. “For the first time in 10 years, we’re talking about it.”
