Comparison of Dementia Care Facilities Designs

 

Abstract

Setting is a very important aspect in dementia care; people living with dementia are greatly affected by the designs of the spaces in which they live in. This comparative paper tries to understand the differences between special care homes for dementia patients and dementia care for prisoners living with dementia in the prisons. The paper discusses some of the design similarities that include; group settings, locked down boundaries, shared communal spaces. And also the design differences in the facilities including; interior and exterior environments, way finding assistance, private quarters, safety fixtures and fittings, and lastly modern 1950 themed dementia care villages. Special care homes as compared to prisons are more suited for dementia patients as compared to prions. Their designs have greatly improved over the years with the needs of these patients in mind a good illustration being with dementia care villages. The facilities have trained staffs that understand how to deal and cope with people living with dementia and they hence provide much better care as compared to the untrained prison staffs.

A dementia care village (Sagan, 2015)                                   a prison (Hall, 2016)

                  

 

Dementia Special Care Homes versus Dementia Care in Prison

Dementia is a syndrome that is characterized by physical changes in the brain that cause damage in reasoning most especially thinking, recall, conduct and capacity to perform their everyday tasks (Cooke & Chaudhury, 2013). It is a disorder that is progressive in nature and it mostly affects people as they age, though it is not a normal part of aging. People with dementia require critical care; this is an area of much debate now and in the future. The issues of debates include the best designs for the care homes to ensure that the aged are provided quality care (Cooke & Chaudhury, 2013). Dementia is becoming a growing problem in prisons as the age group of prisoners over 60 years is growing fast (Fazel et al., 2002). A prison is not a place where special care is offered to people with dementia, there are no enough resources to allow people with dementia to get the required special care for their conditions. This paper will analyse and compare care given to dementia patients in specialized care homes and in prisons. The designs of these two facilities will be looked into to understand how design and environment affects dementia care.

Similarities

1. Group settings

Group living is one of the things that special care homes and prisons have in common. People living with dementia in both types of facilities get to live together with other people, they have to share facilities like the dining area, the outdoor spaces and in some cases even the sleeping areas. This is beneficial for dementia patients because it allows for healthy social interactions (Cooke & Chaudhury, 2013). Both prisons and special care homes create an environment where persons living with dementia have an opportunity to socially interact with other people which help improve their conditions. Large social circles have a shielding effect on the intellectual capacity and cognitive aptitude of persons living with dementia. Basic conversation for persons living with dementia is a form of exercise that motivates the brain cells and the development of brain synapses, thus stimulating the conception of new nerve cells (Cooke & Chaudhury, 2013). Group living inspires and supports senior citizen to construct a social system by partaking in social service undertakings and cognitive rehabilitation programs.

2. Locked down boundaries

Prisons and special care homes are environments which are always on a lock down, to ensure that residents stay indoors. Anytime an individual have to conduct activities outside of the facilities, they have to be monitored by the staff members. A prison is a place where, there are very secure measures that have been put in place to ensure that the inmates stay within the premises (Macmadu & Rich, 2015). Special care homes also have very secure measures that ensure that the residents do not roam out of the facility to prevent getting lost issues that are common for persons living with dementia. Persons living with dementia have cognitive impairments which affects their ability to remember things (Cooke & Chaudhury, 2013). This basically means that they are at high risks of wandering of and not being able to find their way back. The lock down in both prisons and the special care facility is very important as it helps to ensure that persons living with dementia within these facilities are safe.

3. Shared communal spaces

Another similarity in both prisons and the special care homes is the concept of sharing communal spaces. Prisons and special care homes have communal dining areas, TV and games rooms, shared outdoor areas and in some facilities shared bathrooms. Communal spaces in both facilities greatly help to ensure that the residents get a time to socially interact with one another whether it is during eating hours or during play time (Fazel et al., 2002).. The shared communal spaces help in easing management of the residents for the staffs because they are all in one roof.

Differences

1. Interior and exterior environment

There are differences in the way that prisons and special care homes are designed. Nursing care homes are specially designed to accommodate seniors living with dementia. This means that a lot of consideration has been put to ensure that these persons are comfortable and also safe within the facility. Special care homes have nurses stationed in every area within the facility during the day and at night to ensure that residents well taken care of in case of any medical emergencies. This is not the same case with prisons which are designed to hold prisoners and not aged dementia prisoners. The few prison staffs that are there are expected to understand various health conditions and forms of disability and respond appropriately under massive pressure that is caused by the budget and staffing cuts (Fazel et al., 2002). This basically means that people with dementia can go undiagnosed and this leaves them without support in a hostile environment.

Special care homes for individuals living with dementia are designed to guarantee that there is security and safety for the patients. Most of these facilities have special staffs that understand the effects that dementia has on cognition and they are hence properly trained to ensure that the residents are properly taken care of (Tester et al., 2004). The staffs within the homes ensure that the residents’ belongings including clothes are well organized and their property well labelled such that they help motivate independence.

This is however, not the same in prisons, an environment designed for wrong doers and not dementia patients. The regimented and routine nature of prison life can be very problematic for people living with dementia (Fazel et al., 2002). This is an environment that can take away the ability of an individual thinking self-sufficiently which can de-skill them to even basic tasks and activities. There are no special facilities or treatments to guarantee that prisoners living with dementia are properly taken care of. In prison, the patients have no experts to label or to organize their belongings in a way that makes it easier for them to find them to avoid confusion (Fazel et al., 2002). Many of the prisoners living with dementia can struggle with the standardised regimes and time tables that they are expected to adhere to which cause them to miss out on important activities can for instance exercise if they are not able to reach the gym in time (Fazel et al., 2002).

2. Way finding assistance

Persons with dementia require special care in regard to safety measures and navigation through their environment which can be accomplished by ensuring that areas within their environments are clearly labelled and there is proper lighting both during the day and at night. Special care homes are secure in that they ensure that are all the residents are well taken care of by experts and this includes ensuring that they are independently able to find their way around the facility (Moyle et al., 2002). Every area within the nursing care homes facilities including various rooms and equipment are all properly labelled help the residents find their way within the compound with any need for support (Tester et al., 2004). Lighting is also greatly considered in the designs of the nursing care homes, because it is understood that persons living with dementia have problems with their eyesight and this can cause them to have accidents if there is no proper lighting. The facilities ensure that they have proper lighting both during the day and at night all around the compound to help the residents find their way around.

This is not the same case with prisons which are designed to hold criminals and so no special attention is paid on matters of safety for prisoners living with dementia. various rooms and areas are not properly labelled to help prisoners living with dementia to independently navigate their way around the prison. Most of these patients have to depend on their fellow prisoners to help navigate their way around the compound which can be really stressful and impactful to their conditions (Macmadu & Rich, 2015). Without proper labelling, the right kind of support and understanding of how dementia can affect an individual’s behaviour, prisoners with dementia can end up spending more time in prison than is necessary because they are not able to follow the rules and the time lines that are set for them in the prions (Macmadu & Rich, 2015).

Elements of domestic kitchen for instance a fridge, microwave and coffee maker among others have become a must have commodity in modern special care homes because they help facilitate independence and social interaction (Cooke & Chaudhury, 2013). The dining spaces in the modern special care homes are designed in such a way that they are of smaller sizes which help ensure that there are reduced incidences of aggression and agitation for the residents. Traditional special care homes which had more than twenty residents had much larger dining rooms which contributed to increased aggression agitation for the residents and this discouraged eating (Cooke & Chaudhury, 2013). This is different from the dining areas in prisons which are designed to hold more than 100 prisoners. This causes aggression on prisoners living with dementia who do much better in dining areas that have a small number of people and it affects their eating.

The furniture and the home decorations which are homely help the residents to adjust to their new environments with any alarms (Calkins, 2018). Homely residential environments are associated with improved emotional and intellectual functioning for persons living with dementia. The prison furniture on the other hand is old and it designed in such a way that it lasts for long not to provide a homely feeling for the prisoners. This leads the prisoners living with dementia to be constantly agitated and depressed which worse their health conditions (Macmadu & Rich, 2015).

3. Private quarters

Privacy is something that is normally disregarded for persons living with dementia because most of them need special care that is offered by their family members or nurses. However, persons living with dementia always require some privacy and they desire is accomplished with them having their personal bedrooms (Cooke & Chaudhury, 2013). Most of the special care home designs today allow residents to have their own bedroom and bathrooms, all furnished and decorated to their liking. This gives the residents a chance to have some privacy most especially those times when they prefer to just spend time on their own either watching a program or reading.

An image showing an enhanced-shared bedroom in a special care home for people living with dementia (Calkins, 2018)

 The toilet areas in the special care homes are designed in such a way that they readily accessible and identifiable to help maintain independence (Calkins, 2018). The image of a toilet or signs such as ‘toilet’ written on the wall greatly helps individuals with dementia to find the restrooms much easier. Amber LED lighting is properly installed all around the facility most especially around the bathroom areas to help reduce falling accidents at night (Calkins, 2018).

Prisons on the other hand are designed in such a way that they can hold as many prisoners as possible. In prisons, most of the activities are constructed communally which means that residents have to share sleeping areas, dining rooms and even the bathrooms. There are no special labels or signs put in place to help people living with dementia to navigate their way around the facility (Macmadu & Rich, 2015). These prisoners have to sleep in a unit with more than twenty other prisoners which lead to increased agitation and very little privacy and this greatly affects their conditions.

An image showing a simple prison plan, where dementia patients have to share various facilities within the prison (Kain, 2011)

4. Safety fittings and fixtures

Safety is important for people living with dementia; these are people who in the course of the disease tend to lose the capacity to identify dangers. A secure living area can be defined is a society where programs set and employees available help individuals living with dementia to be comfortable and safe (Moyle et al., 2002). Special care homes for persons living with dementia have good designs that ensure residents are able to identify and use the fixtures and fittings in the homes that allow them to be more independent. Handrails and grab rails are normally well fixed near stair cases, in the bathrooms and in the toilets to help the residents navigate their way easily (Moyle et al., 2002). Most of the nursing homes understand the importance of colour contrast in and contrasting coloured fittings are normally used to help highlight the switches, the grab railings and the sockets in the special care homes.

This is however, not the same case with prisons. There are no grab railings or any highlighted switches or sockets for the prisoners living with dementia. The prisoners have no control of the lighting within the prisons because this is the work of the prison staffs. Lights in prisons are normally switched on and off at specific times, which means that the prisoners living with dementia have problems finding their way to the bathrooms at night which can accrue to accidents most especially because there are no grab rails.

5. Dementia Villages

Today, there are dementia villages which are designed in the 1950s theme, the facilities look like a normal village with a movie theatre, restaurants, a court yard and beautiful parks among many other features (Powell & Pawlowiski, 2018). These are modern dementia care facilities that have been designed to help patients living with dementia to have a normal active life and to give a sense of purpose. These villages always have trained nurses and caregivers who live among these residents in the restaurants and all other regions of the village, helping take care of them (Powell & Pawlowiski, 2018). These facilities are important and therapeutic for the dementia patients as it helps to elicit memories and to encourage conversation, improves their moods and their sleep quality. Memories for human beings re normally made between the ages of 10 to 30, therefore creating villages themed on 1950s helps the current generation of seniors to go back to their youth ages (Powell & Pawlowiski, 2018). This is a concept that is not available in prisons and so prisoners living with dementia have lower chances of living a purposeful active life.

A well-designed physical environment fosters positive performances such as reduced anxiety, augmented social interaction and less reliance in conducting day-to-day undertakings. In the past, not much was understood about dementia and so most people living with dementia were put in prisons because their conditions were not well understood. Special care homes designs or people living with dementia have greatly changed over time where they greatly consider the wellbeing of the residents. Modern care homes for persons living with dementia are designed in such a way that they hold less than ten persons per unit for easier management. Traditionally, nursing homes for people living with dementia were large facilities holding more than twenty individuals in one unit. Small units help the residents to experience privacy, dignity, meaningful activity and to have better relationships. Residents living in groups of less than ten have better social relationships, greater positive effects, helps them feel more at home and have a higher quality of life scores (Calkins, 2018). Prison designs have not really changed over time to accommodate prisoners living with dementia like the special care homes, prisons are unsuitable for people living with dementia, the staff knowledge is severely lacking to deal with people living with dementia.

 

 

 

 

 

References

Calkins P. M. (2018, January 18). From Research to Application: Supportive and

Therapeutic Environments for People Living With Dementia. Retrieved from https://academic.oup.com/gerontologist/article/58/suppl_1/S114/4816736

Cooke, H. A., & Chaudhury, H. (2013). An examination of the psychometric properties and

efficacy of Dementia Care Mapping. Dementia, 12(6), 790–805. https://doi.org/10.1177/1471301212446111

Fazel S, McMillan J, O'Donnell I (2002). Dementia in prison: ethical and legal implications

Journal of Medical Ethics;28:156-159.

Macmadu, A., & Rich, J. D. (2015). Correctional Health Is Community Health. Issues in

Science & Technology, 32(1), 64–70. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=110096499&site=ehost-live

Moyle, D. Fetherstonhaugh, M. Greben, E. Beattie, AusQoL Group. (2015). Influencers on

quality of life as reported by people living with dementia in long-term care: a descriptive exploratory approach BMC Geriatrics, 15, p. 50

Powell, R., & Pawlowiski, A. (2018, April 10). Dementia day care looks like 1950s town to

stimulate patients' memories. Retrieved from https://www.today.com/health/dementia-day-care-looks-1950s-stimulate-patients-brains-t126727

Tester, G. Hubbard, M. Downs, C. MacDonald, J. Murphy. (2004). What does quality of life

            mean for frail residents? Nursing & Residential Care, 6 , pp. 89-92

Williams, B. A., Stern, M. F., Mellow, J., Safer, M., & Greifinger, R. B. (2012). Aging in

Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care. American Journal of Public Health, 102(8), 1475–1481. https://doi.org/10.2105/AJPH.2012.300704

Additional resources

 

Hall, S. (2016, November 9). What Are the Duties of a Correctional Administrator?

            Retrieved from https://work.chron.com/duties-correctional-administrator-17333.html

Kain, E. D. (2011, August 19). Florida Teenager Dies in Jail After Being Arrested for

Possession of Marijuana. Retrieved from https://www.forbes.com/sites/erikkain/2011/08/03/florida-teenager-dies-in-jail-after-being-arrested-for-possession-of-marijuana/#1ca3d66b705e

Sagan, A. (2015, May 4). Dementia villages: Is getting patients to believe a false reality OK?

| CBC News. Retrieved from https://www.cbc.ca/news/health/canada-s-version-of-hogewey-dementia-village-recreates-normal-life-1.3001258