"The physical environment can be used as a therapeutic resource, just like medicine," states Dr. Kristen Day, associate professor at the University of California, Irvine. Healthcare facility managers and architects are beginning to understand this benefit and are taking steps to design facilities that enhance the well-being of residents with dementia. Designing spaces to allow for private rooms, replacing large nurse stations with residential desk settings, and decentralizing the dining facility into small clusters similar to a family environment all improve residents' familiarity and comfort with the facility. "Designers are drawing on multiple strategies to create assisted-living facilities that compensate for a physical or mental loss," adds Day.

In Chenoa, Illinois, a new assisted-living facility was completed in 1997 that incorporated many of the elements identified by Day. The Meadows Mennonite Alzheimer's/Dementia Care Unit, designed by OWP&P Architects, Inc., includes a special-care unit with 14 resident rooms, a common living room, and an activity kitchen attached to a kiosk that houses nursing functions. "There is definitely a move in the industry toward less institutional design," says Day. "The use of new materials adds to a friendlier, familiar, and more normal feeling." According to Day, the assisted-care industry is undergoing a rapid transformation. Although some of these additions are marketing tools used to attract residents, good design is still good design.

Community kitchens help recreate the normal day that residents are used to. "They have been doing these things—cooking—all of their lives," says Day. At the Meadows Mennonite facility the architects included a central activity kitchen with multilevel countertops to allow both staff and residents to participate. The kitchen is a place for baking cookies as well as a place for residents to help themselves to a cup of tea.

The architects of the building designed streetlike corridors leading to two neighborhoods, or clusters of residents. These neighborhoods surround a central activity center that includes dining areas and a therapeutic kitchen facility. The resident room entrances function as individual houses, each with its own illuminated memory cabinet that displays personal memorabilia that can help residents locate their rooms.

Therapeutic design. One of the main goals in the design of Meadow Mennonite was to create a primary entrance for the Alzheimer's facility that would be visible from the street. Although the entrance is visible to the public, designers felt it was necessary for other features to remain secluded. One of these elements is an outside wandering garden in which residents can relax. "Increasingly we are seeing the therapeutic potential in outside design and not just the interior," says Day, who also notes that, according to some research, walking gardens and outdoor sitting areas seem to reduce the frequency of violent outbreaks.

Many therapeutic goals can be achieved for the residents and their families, staff, administration, and the community by designing these environments. The environments provide a healthy, homelike, and familiar surrounding for them. Second, the memory cabinet and the resident's personal furniture creates and maintains continuity with the past. Third, the proper physical environment can encourage social interaction, promote appropriate behavior, and reduce agitation.

The therapeutic goals for staff and administration are also numerous. Through effective therapeutic provision of care and the enhancement of meaningful activities, caregivers may feel better about the environment in which they work. Families also benefit because the burden of care for relatives with dementia is eased, and they know that their relatives live in an environment that compensates for their physical and cognitive impairment.

The American Institute of Architects and the American Association of Homes and Services for the Aging recognized the Meadows Mennonite facility for its design in Design for Aging Review: Four, published in 1999. The jury also recognized Freedom House, owned by the Air Force Village Alzheimer Care and Research Center, located in San Antonio, Texas.

Creating a homelike environment. Freedom House, along with its care program, is based entirely around the concept of creating a homelike environment. There are 3 households totaling 27 residents. Interaction among the residents is limited to the nine members in each household. Each bedroom in a household opens to the common living and dining rooms. "A kitchen is next to the dining area, allowing the residents to participate in the sights and aromas of meal time," states the Design for Aging Review.

To ensure a noninstitutional look for the building, architect George Vaughn, AIA, of Rehler, Vaughn & Koone, Inc., designed the facility to reflect the scale and architecture of the surrounding area. Large living spaces filled with natural lighting reduce a resident's potential perception of confinement, while a large covered porch provides residents the opportunity to enjoy the outdoors.

"The size of households or clusters of residents has been trending downward over the past 12 to 20 years," relates Day. Creating an atmosphere that is more family-like and smaller in scale helps reduce resident overstimulation. "This reduction in overstimulation is good for both the residents and the staff," adds Day.

Comfortable environments that are conducive to the needs of residents with dementia have increased options for families choosing an assisted-living facility. High-quality architectural design coupled with architects and facility administrators who realize the unique needs of their residents is creating new options in assisted-living facilities. The small-scale nature of many of the clusters or households increases the likelihood that these elements or solutions could be applied to existing facilities.

For additional information, contact: Dr. Kristen Day, University of California, Irvine, (949) 824-5880.

Or see: "The Therapeutic Design of Environments for People With Dementia: A Review of the Empirical Research," The Gerontologist 40 (2000): 397-416, by Kristen Day, Daisy Carreon, and Cheryl Stump.