Through strategic and intentional design, as well as purposeful execution, memory care facilities can reduce resident confusion, frustration, and anxiety while encouraging engagement and independence in a safe environment.
The Association Montessori Internationale created the first Montessori Advisory Group for Dementia and Ageing in 2014, fostering a program whose goal is “to support older adults and people living with dementia by creating a prepared environment filled with cues and memory supports that enable individuals to care for themselves, others, and their community.”
To execute this person-centered philosophy, design teams must understand how people with Alzheimer’s disease and dementia interact with their environments, as well as the wide range of a resident’s abilities and limitations.
While every facility is not equipped to fully adapt to the Montessori method, it is possible to make cost-effective upgrades that enhance a resident’s life by applying best practices.
Case Study: Evergreen House
The Village at Summerville is one of six senior living communities operated by Presbyterian Communities of South Carolina. Evergreen House, a purpose-built memory care facility on that campus, is an example of how incorporating Montessori principles into the built environment can improve resident life.
If a facility is considering adopting Montessori methods, decision-makers are encouraged to visit an existing Montessori facility such as Evergreen House, one of the first intentionally designed buildings of its kind in the United States. Clients may witness firsthand how intentional design influences the environment and its inhabitants. From there, they can begin to think about how to incorporate the different Montessori principles into their vision for a new or revitalized facility.
Wayfinding
Wayfinding should be a primary design consideration in senior living facilities to reduce spatial disorientation. This is accomplished by designing surroundings that are instinctive to navigate and rich with sensory cues. For those with memory impairments, multiple layers of wayfinding methods may be implemented to compensate for cognitive decline that leads to increased spatial disorientation.
Color
Color can serve as a useful tool for making navigation easier. A resident with memory impairment may not be able to tell you their room number, but they may remember that they live in an orange hall. Memory care facilities can select flooring, paint, finishes, art, and signage that coordinates a defined color identity to improve wayfinding.
Each resident pod at Evergreen House leverages the interior environment to create visual cues that better orient residents as they navigate the facility. In resident rooms, bathrooms are color-coordinated to further establish color association, with the wall behind each toilet coordinating with the pod’s designated color.
Contrast
The color behind the toilet enhances a sense of place and provides a distinct contrast between the toilet and the wall. The use of contrasting colors for hardware such as cabinet pulls, grab bars, doorknobs, and plumbing fixtures further aids in creating spaces that promote self-reliance.
Contrast also provides cues for areas residents should and should not access. At Evergreen House, doors leading to staff areas are painted the same color as the wall and feature matching hardware to blend into the surroundings. Meanwhile, resident rooms and community spaces use black hardware and a solid, contrasting color door or wall to make them stand out to residents.
Signage
Signage is the next layer to incorporate into your facility’s wayfinding system. It can work in tandem with color to establish visual cues and landmarks that serve as “memory joggers” for residents. Signage can include resident room signs, back-of-house signs, and invitational cues.
At Evergreen House, bedrooms have signs located adjacent to each resident’s door. Signs include a room number and interchangeable openings where staff members insert the resident’s name and a large format photo of them from the life period they most identify with at a given time. Signage is designed to coordinate with each pod’s color palette and contrast with the wall for easy visibility.
Back-of-house, staff, and general building signage that indicate spaces not intended for resident access—such as the kitchen or utility rooms—are less colorful and more utilitarian. The intent is not to hide these areas, but rather to make them less inviting for residents.
Printed tabletop signs maintained by Evergreen House staff serve as invitation cues. These are brightly colored, high contrast, and meant to grab the attention of residents. Tabletop signs placed directly next to an activity may ask a question like, “Would you like to do a puzzle?” These signs require minimal upfront cost and planning, making them easy to adopt in existing facilities.
Art
Distinctive artwork should be placed throughout the building with clear, single-subject images. Owners and designers should undergo a thoughtful selection process to determine which subjects are most relatable to the residents living in their specific facilities.
Artwork and display surfaces should have a matte finish. Glare creates vision difficulties for elderly residents and may keep them from recognizing the subject of the artwork, thus minimizing its effectiveness as a wayfinding tool.
Floor Plan
Floor plans that encourage movement, are easy to navigate, have built-in spaces for engagement, and are designed to be adaptable to changing resident needs help residents lead fulfilling lives and provide a sense of normalcy.
Scale
Evergreen House is laid out in a similar manner to how a typical residence would be designed. Public spaces, such as the living room and kitchen, are centrally located with short hallways connecting to private spaces, including resident rooms and guest toilets. Support spaces are located in areas between public and private zones, allowing caregivers visual access to monitor residents and exits at all times.
Long corridors and dead ends can cause frustration for residents. The “pod” style arrangement of rooms at Evergreen House minimizes hallway length while allowing the creation of distinctive color identities for each grouping of rooms to help residents independently navigate from public to private space. In renovations, a cost-effective way to break up long corridors is to create visual stopping points using finishes, such as accent carpeting, wallcoverings, and paints.
Resident Engagement Areas
Facilities should have spaces intentionally designed to engage residents and encourage them to participate in stimulating activities.
Dedicated or fixed “lifestyle stations” are programmed into the built environment and provide a place for daily life activities. These may include washing machines for laundry, built-in bookcases for reading, or a piano for music therapy. Flexible stations give staff the ability to adjust areas to offer engaging activities tailored to their facility’s particular population. They may be as simple as a coin-sorting station on a table or a flower-arrangement station with artificial flowers and various vases.
Thoughtful placement of resident engagement areas creates opportunities for both personal entertainment and social interaction. Adding them along a resident’s daily path or incorporating them into common areas encourages people to interact with the space and join in on activities.
Kitchen
Ensuring a centralized and open location for the kitchen helps engage all of a resident’s senses. Residents can see, hear, and smell meals being prepared and can physically interact with the space to grab their own food and drink. Adding a beverage station is another great way to help residents maintain dignity and self-reliance since they can select and prepare their own beverages.
Bedroom
Depending on the level of care, facilities may allow residents to bring their own furniture to help them feel at home. However, there are certain elements that must not be disturbed, such as direct line of sight to the toilet. Residents at Evergreen House have two options for arranging their furniture, guided by the strategic location of power outlets, the nurse call system, and cable and telephone connections. Regardless of which arrangement individuals select, they will always be able to clearly see the door to their bathroom.
Outdoor Space
Providing space for residents to go outside and enjoy nature is an important component of their mental and emotional well-being. The outdoor space at Evergreen House includes multiple zones for socializing, mindful contemplation, and gardening.
Landscaping can be used strategically to establish boundaries while permitting movement and easing frustration. It can be used to disguise fences and gates, as well as inaccessible spaces outside the home.
Design That Puts People First
Applying Montessori for Dementia and Ageing principles into a memory care facility’s built environment can be a substantial undertaking, especially for facilities looking to do a full conversion. However, facilities don’t need to change everything to make a positive impact on their residents.
Embracing even one of these best practices may begin promoting a better sense of independence and enhancing quality of life for residents suffering from memory impairment as they interact with an environment designed with their needs in mind.
Scott Hendrix, AIA, LEED AP, is an Architect at McMillan Pazdan Smith Architecture, a regional, studio-based design firm with offices in Spartanburg, Charleston and Greenville, South Carolina; Asheville and Charlotte, North Carolina; and Atlanta, Georgia. He can be reached at shendrix@mcmillanpazdansmith.com.