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Designing a Care Facility
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People with dementia often have trouble in making sense of the world around them. The environment (physical, social and cultural) and design features of a care facility should support the functions of people with Alzheimer’s, accommodate behavioral changes, maximize abilities, promote safety and encourage independence. This page describes key issues to consider in designing a care facility for people with Alzheimer's disease. Additional information on this topic can be obtained through the Alzheimer’s Association Virtual Library.

Maximize awareness and orientation

Dementia often creates confusion with respect to time and place, particularly in unfamiliar settings.

  • Keep signs simple since residents may not be able to comprehend complex language.

  • Place signs at eye level (48 to 52 inches from the floor; lower if there are many wheelchair users).

  • Use bright contrasting colors.

  • Personalize room entry to make it more relevant and understandable to the residents (e.g., hang favorite photos or small mementos on the bedroom door).

  • Create a regular schedule by doing an activity in the same place, at the same time of the day.

  • Create purpose-specific rooms so residents always know what to expect when they enter.

  • Make key destinations, such as the dining room, bathroom and living rooms, easily visible.

Ensuring safety and security

Each care setting must weigh the merits of ensuring safety at all costs versus the risk of allowing and encouraging some resident autonomy.

Control unauthorized exiting

  • Determine the security level of the monitoring system.
  • Exits that lead to unprotected areas should be easily monitored or protected with alarms.
  • Decrease visibility of doors that residents should not use such as utility rooms or staff spaces. If possible, have exit doors not intended for resident use situated parallel to the hallway so they are less visible rather than at the end of the hallway.

Provide appropriate physical support

  • Install handrails (or a ledge to lean on) in the hallways and grab-bars in the bathrooms.

  • Minimize obstacles in hallways.

  • Make sure floors are not slippery.

  • Provide gradual transitions when changing flooring materials (hard surface to carpeting) to minimize falls, and provide handrails or other support in these areas.

  • Minimize sharp color contrasts in flooring, and avoid borders and strong, busy patterns.

  • Choose contrasting colors between the floor and chairs and tables.

  • Install motion detectors in rooms of residents prone to falls.

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Adjust the amount of stimulation

People with dementia have a decreased ability to deal with multiple and competing stimuli, and may be overwhelmed when there is too much activity in a setting. Rather than simply reducing all forms of stimulation, focus on minimizing those sources of stimulation that have a negative impact on residents. Care settings for people with dementia should provide positive, therapeutic stimuli.

Acoustic stimulation

  • Eliminate overhead public address (PA) systems.

  • Avoid playing music throughout the facility.

  • Minimize noise from necessary institutional support systems, such as icemakers, carts, and pill-crushers.

  • Enforce policies regarding caregiving staff talking loudly to each other.

  • Regulate the amount of noise generated by group activities; activity rooms should have doors that can be closed or left open.

  • Utilize sound absorbing materials in public areas.

  • Equip a few bedrooms with extra soundproofing for residents with disruptive vocalizations.

  • Use pleasing sounds as cues (bird songs as residents are rising, or singing show tunes or hymns before meals.)

Visual stimulation

  • Minimize glare from windows and lights by using carpeting, low-gloss floor waxes, and sheer curtains.

  • Provide even lighting as much as possible; avoid pools of light and dark.

  • Emphasize important signs that help orient the resident and minimize or eliminate unnecessary signs, such as signs noting the utility room.

  • Vary design and décor in each room (bedrooms and shared areas) so the experience of one room is different from another.

  • Position nonambulatory residents so that they have interesting views, either a window looking out to a busy street or a view of an active area.

Some of the above design considerations may involve modifying an existing structure, making it difficult to implement them in your facility. However, finishes and fixtures can often be modified for little or no cost. It is important to recognize that the physical world does not exist in isolation, but interacts with the activity program, level of resident capability, staffing, constraints of budget, and organizational policies and procedures.

Margaret P. Calkins, Ph.D., MArch, is president of I.D.E.A.S., Inc., an education, research, and consultation firm in Kirkland, Ohio, dedicated to exploring therapeutic potential of the healthcare environment. Philip D. Sloane, M.D., M.P.H., is a professor at the University of North Carolina at Chapel Hill. Calkins and Sloane contributed to development the Alzheimer’s Association publication Key Elements of Dementia Care.


Alzheimer's Association

Our vision: A world without Alzheimer's disease®.
Formed in 1980, the Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research.