A blueprint for dementia care.

How Anna's House became a home to so many

DEMENTIA CARE DESIGN MUST INCORPORATE KNOWN DEMENTIA patient physiological, psychological, and other aging needs into the actual care philosophy of socio-geographic needs and a facility's caregiving philosophy. However, even an excellent design and care model in one facility could fail miserably at another. So how is a team to proceed? And who makes up that team?

Unlike many facilities, it is not appropriate for the end user (the resident) to give direct input. But the resident's needs must be directly represented. Therefore, there must be proper integration among the care team, administration, and the design team.

Williams County Nursing Home (now called Hillside Country Living), in Bryan, Ohio, was originally established in 1873. In 1992 a local elderly woman, Anna, was admitted with dementia because her husband was no longer able to care for her special needs at home. After Anna eloped several times, it was clear that changes had to be made to the facility. The need for Anna's House, the new dementia care center, was born. A team of design professionals met with administrators and staff members to brainstorm ideas for the design.

Most of the traditional concepts (open "family" spaces, memory boxes, wandering paths, and traditional daily home activities) were integrated. These concepts were augmented with special needs of the socio-geographic expectations of the resident, including views, finishes, furniture, and caregiver dress standards. Moreover, the caregivers have put away any semblance of traditional uniforms. Caregivers have also put aside the traditional division of responsibilities. All will assist with whatever the resident's request is, just as one would do for a friend. (A good designer knows, for instance, that an urban setting for a rural heritage would not meet with the same success as a more rural setting.) The challenge was to create a "this-is-home" feeling within the design of the facility, the image, and the activities available to its residents.

Inherent to the best dementia facilities are code and budgeting challenges. Among the most consistent challenges are meeting requirements for fire alarm "pull" stations (if it says pull, a dementia patient will), exit identification, and light levels. These were reviewed and explained to the code officials throughout the design and construction phases. As an example, the 8-foot-corridor requirement was worked into an open space and designated with carpet color and ceiling articulation, the light fixtures and lighting intensities were developed carefully, and the pull stations placed at locations apparent to staff members and visitors but not in places of particular interest to the residents. Thus, code was met in conjunction with appropriate design elements.

While the facility design was taking place, administration was researching the correct care model. It was decided that the optimum would be to permit a two-step process going from the social to medical model. The more acute residents would be moved into the medical model after progressing from a more social environment. Moreover, Hillside administration made the decision to remove all telephones and televisions from resident rooms. This reduces the resident's internalizing emotional situations he may see or hear. It also cuts down on distracting and upsetting noise and images. Additional benefits are the elimination of CTV and telephone costs while allowing for allocation of floor space for another of the resident's memorable end tables, chairs, or dressers.

In Anna's House, its DON says the patients are less confused, more focused, and generally happier than they would otherwise be. A secondary benefit is their care is therefore easier to administer.

Marcia Hauer, NHA, is executive director, Hillside Country Living, Bryan, Ohio. Christopher J. Ewald, AIA, NCARB, is president, SSOE Studios, a unique division of SSOE Inc., Architects/Engineers, Toledo, Ohio.