The science and design behind dementia care housing

April 10, 2016

Published in this month’s edition of LASA Fusion, The Cooinda Aged Care facility is the most recently designed and constructed community orientated project for Paynter Dixon Queensland. Our resident Health and Aged Care specialist Kerrie Storey elaborates on how this magnificent development transformed years of research and careful planning into a reality.

Research conducted over the last 20 years indicates that a person’s sense of self supports their ability to act, even when they have dementia. The creation of an environment that assists a resident with dementia to make choices goes some way to meeting their unmet needs and any resulting agitation.

In planning for a new special care unit to replace its existing facility in Gympie, the team at Cooinda Aged Care determined they wanted a building design and model of care that embraced these research findings. “Our vision was to create an environment that supported residents to do the things they can still do,” said Cooinda CEO, Robyn Kross. “It’s important that we don’t try to fit the resident into the facility and its routine, rather we fit our routines around theirs, supporting their independence and ability to exercise choice.”

To enable this vision the company partnered with Paynter Dixon, utilising their aged care specialist team to explore ways to implement evidence-based design principles while maintaining the relaxed, rural ambiance integral to the rich tapestry of their 40-year history. Participation in Paynter Dixon Study Tours provided an opportunity to gather ideas on design features and business models from facilities in New Zealand and Germany that maintain resident’s dignity and sense of self, while supporting their independence.

The result is Cooinda’s new secure 24-bedroom special care unit, which was completed and opened in April 2015. This unit has won both the Regional and State Queensland Master Builders Association (QMBA) awards for lifestyle accommodation for seniors, and has recently been awarded an Australasian Over 50s Housing Award for the Most Outstanding Rural Aged Care Facility. Early comparative assessment of existing Cooinda residents who moved into the new special care wing show an overall improvement in levels of agitation (utilising the Cohen-Mansfield Agitation Inventory) and a movement towards increased independence (based on Modified Barthels Index Score results). These trends appear to support the positive impact of design and model of care on resident quality of life. Cooinda is working with the University of Tasmania to further investigate and understand these initial results.

Facilitating Orientation

Mobile people with dementia find their way around their environment using information that is familiar and readily accessible, moment by moment, as they move along a path. The design of this special care unit ensures that circulation through the unit takes the form of short continuous loops that are interesting and familiar, easily connecting the bedrooms with social spaces and gardens. Readily accessible spaces offer a variety of choices depending on whether the resident wishes to engage, observe or withdraw.

The central dining, lounge and associated open verandah areas offer a feeling of openness, light and connection to the outdoors while preserving distinct spaces that support more intimate interactions. This is achieved through a combination of a glassed wall that runs along the full length of the room, incorporating two 4m sliding glass doors which open out on to the outdoor living area, and considered placement of furniture both inside the building and on adjacent verandah areas.

Angled corridors leading towards this central area, combined with non-visual cues such as the smell of bread cooking in the servery or the sound of age appropriate music from the jukebox in the lounge area, mean that while there are points in the unit where residents can’t see where they are going, they can nevertheless sense it. Wayfinding is further enhanced through signage that combines words with pictures, a clear line of sight from the resident’s bed to their toilet, memory shelving at the entry to resident’s bedrooms and blending of storage cupboard doors with the unit wall colour to minimise confusing choices.

Careful Lighting

Lighting is important to both the ageing eye and people with dementia. Good lighting can make the most of people’s capabilities and can assist them in making their way around new and familiar surroundings. For example, light uniformity reduces shadows that can be misinterpreted by people with dementia as obstacles. Access to natural daylight provides high levels of diffuse light over a wider area. In addition, the changes in lighting levels over the course of the day help residents’ awareness of the passing of time and thus support normal sleeping patterns. “Cooinda maximises the utilisation of natural light through the north east orientation of the building and the use of large windows and outdoor living areas that increase light penetration into resident areas. This is further enhanced through clerestory windows in the central living area,” Paynter Dixon Design Manager Chris Jacobsen explained. From an operational perspective, an additional energy efficient benefit is the reduced requirement for artificial lighting during daylight hours.

Promoting Independence

Cooinda provides opportunities for residents to move around the unit freely, including unrestricted access to landscaped garden areas offering features such as a men’s shed, a potting/gardener’s shed, a car in a garage, and a windmill and tank. Natural stone walls, picket fences, water features and a small bridge over a water course provide unique ‘stopping places’ that evoke reminiscence of an earlier time and to which residents are naturally drawn. Residents and their families access these areas throughout the day and enjoy al fresco dining on mild evenings.

The design purposefully faces the building and outdoor courtyard into a steep embankment on the eastern face, which acts as a natural security fence. This minimises the feeling of being ‘fenced in’, while the landscaping of the embankment provides a wonderful visual outlook from all areas of the building. A variety of seating spaces with varying degrees of social connectedness provided throughout the unit and gardens allow residents to choose where they ‘want to be’ at particular times throughout their day, conveying a level of control back to the resident.

The design of the unit’s servery, which was inspired by examples seen in Germany, is open and accessible for residents and has a seating bench along the length of the joinery. Residents are able to actively participate in familiar kitchen activities or, if they choose, sit and engage less actively in this domestic setting. Cooinda’s staff team led by an Occupational Therapist, are focussed on supporting residents to make the most of their remaining abilities, and to exercise choice and independence.

A common finding that has become visible through review of many small, non-randomised researched projects over the past twenty years is that the desire for autonomy is of primary importance to residents of aged care facilities. With this in mind, Cooinda has focused on supporting resident autonomy and independence through applying research principles to building design, model of care and culture in their exceptional special care unit.