Designing Therapeutic Gardens for a Senior Population<p><img src="/Articles/PublishingImages/740%20x%20740/garden.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;250px;height&#58;250px;" />​Therapeutic landscape gardens (TLG) are often designed for elders in nursing homes and senior housing to provide a soothing experience for the resident that brings them outside, closer to nature, and closer to the beauty of a well-designed garden. This senior population may exhibit a series of invisible disabilities (IDs), such as dementia, autism, PTSD, ADHD, sensory processing disorder, blindness, and deafness. These IDs can be found in up to half or more of the typical population and at least 80-90 percent of the elder population.</p><p>There are many articles about the design of these TLGs, but not many deal with the two main challenges in designing these gardens&#58; a lack of instructions and reduced perception.</p><p>The first issue is the lack of an instruction set on how to design an elder therapeutic garden. Most books on TLG show all kinds of images of wonderful gardens, but none of them have an instruction set that will help a designer understand the steps that must be taken in order to design one correctly for elders. By 80, the typical elder has 20 percent of their visual performance range; by 90, it drops to 10 percent. Visual acuity is low, they cannot see clearly with sky brightness, colors are not easily distinguished, adjustment from dark to light takes 10-15 minutes. Vision can be very limited.</p><p>The second issue, which is even more important, relates to aging and sensory deprivation. Elders in nursing and dementia homes are generally coping with very limited ranges of sensory sensitivity. An older resident has perceptual sensitivity dramatically lower than when they were younger. By age 80-90, the sensory sensitivity of an elder is about 10-20 percent of what it was when they were young. Thus, their vision, hearing, tactile sense, thermal and olfactory sensitivity is very low. Their experience of the sensory garden can be limited compared to young designers who design these gardens, because that have a hard time seeing the garden, dealing with sky glare, recognizing color ranges, and smelling the flowers. Audible insensitivity can mean that they cannot hear the sounds of unsteady walking, low level talking of nurse aides, and other sounds over the environmental noise of the site.</p><p>To the elder resident, the gardens look less clear and more out of focus. They see groups of plantings, not individual plants. Colors blend together, as color vision is limited in range, resolution, and sensitivity. The design of the garden must take account of the fact that many elders have visual acuity in the 20&#58;100 or greater (they see at 20 feet what younger folks see at 100 feet).</p><p>If the site is noisy or busy, the sounds of traffic, idling car engines, and people are all of concern. And areas that are light versus dark can cause visual failure due to slow adaptation (visual adjustment from light to dark). These areas can also cause a cognitive load due to complexity that is too great for the elder to process, as too much information is presented in the perceptual and cognitive fields. The experience is often unnerving and overwhelming. Overstimulation of the senses affects our sense of vestibular equilibrium (balance) as well.&#160;</p><p>Well-designed environments can alleviate these problems, via the use of scientific sensory and cognitive design principles. Yet most design schools do not teach about human perception or the science of human-centered building design.</p><p>Design schools believe, as the American Institute of Architects suggests, that expert intuition comes from a design education, and that this alone is adequate training to solve most architectural problems, which is far from correct. Intuition only works when designing for people who are like the designer, and those with disabilities are not often like the designer.</p><h3>Reducing Sensory Noise </h3><p>The experience of disorientation and discomfort are important to avoid when designing for people with invisible disabilities. Unlike physical disabilities, over 70 percent of disabilities cannot be seen or inferred by observers. Cognitive and emotional sensitivities often negatively impact the experience of the garden by masking the experience by causing complexity to take focus away from what we’re looking at.</p><p>Overstimulation in any of the primary senses (hearing, sight, thermal comfort, touch, taste, and smell) creates mental and emotional “noise.” Less sensory stimulation means more clarity in surroundings. Designs should be simpler and more obviously what elders would expect. It is the first priority to understand their sensory and cognitive perceptions.</p><p>Therapeutic gardens should be designed to produce calm, clarity, and the feeling of beauty. The places in the garden must be symbolic and familiar. The framework of a garden needs to be clear, predictable, intuitive, safe, and secure with a perceived sense of balance of freedom and enclosure.</p><p>A quiet perceptual sensory environment is needed for people to experience the environment with less anxiety and more clarity. And the garden must be a stronger and simpler stimulus than would be designed for younger visitors.</p><h3>Integrating Research into Designs</h3><p>Designers who incorporate scientific design information in ways that are perceptually and cognitively much clearer are more successful. Research-based design (RBD) is about applying research methods to determine the definition of what the design should accomplish and to measure and confirm that the final project actually achieves that goal.</p><p>The first step in RBD is to identify the problem and to develop a hypothesis for solving it through the limits of the person with dementia or other disability. People with dementia must be asked to rate their perception based on comfort and pleasure. Landscapes focused on the elderly must take into consideration perceptual performance. Design research has produced lots of data on sensory and cognitive perception of elders.</p><p><img src="/Articles/PublishingImages/2023/SteveOrfield.jpg" alt="Steve Orfield" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;167px;height&#58;189px;" />Consider the model of a monastery garden, as it evokes calm and peaceful emotions. A cloister garden is surrounded by walls that create an enclosure separated from outside distractions and uncomfortable sounds. The layout is simple and allows for walking around the edges of the garden space. Typically, central landmarks and clarified entrances can help with finding the way back to the entry. Visually it can be a simple structure with vegetation and greenery. Areas must be set aside for gardening and harvesting of flowers, herbs, and vegetables.&#160;</p><p>To achieve acoustic comfort, designers may create sound barriers, soft music, white noise, or birdsong. Olfactory comfort may be pleasant fragrances of the plantings, clean air, and limits on odors. Thermal comfort may include places that are sunny in cold weather and shady in hot weather, protected from wind but open to breezes. Visual comfort may be creating large plantings of color, familiar furnishings and plants, clear surroundings, and pathways, with control of bright light.</p><p><img src="/Articles/PublishingImages/2023/MarthaTyson.jpg" alt="Martha Tyson" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;167px;height&#58;190px;" />The end result of this therapeutic garden design process is a very simple, very clear garden that is uncomplicated, has little perceptual noise, and whose simplicity allows the elders to relax and clearly experience this simpler form of garden.</p><p><em>Steven J. Orfield is the founder of Orfield Laboratories, a multi-sensory design research lab in architecture and product development.</em></p><p><em>Martha M. Tyson is the author of the book The Healing Landscape&#58; Therapeutic Outdoor Environments and numerous articles about garden design for seniors and people with compromised cognitive functioning. She is a landscape architect with over 30 years of experience in site design and campus planning.</em><br></p>2023-10-03T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/garden.jpg" style="BORDER&#58;0px solid;" />DesignSteven Orfield and Martha TysonTherapeutic landscape gardens are often designed for elders in nursing homes and senior housing to provide a soothing experience for the resident that brings them outside, closer to nature, and closer to the beauty of a well-designed garden.
Innovation in Senior Living Facilities Design<p>The pandemic shone a light on senior living infrastructure that has leaders and staff of assisted living and skilled nursing facilities looking for progressive and innovative design concepts. As such, senior housing providers from around the world are looking to learn from the successes and challenges that various models faced at the height of the pandemic. </p><h3>Early Adopters of the Green House Model in Rochester, NY</h3><p>Founded in Rochester in 1997 by a group of forward thinkers, the Pioneer Network has since evolved through a partnership with The Green House Project (GHP) into the Center for Innovation. The new alliance focuses on supporting eldercare reform initiatives and educating and advising eldercare organizations that seek to initiate changes to the cultural, organizational, and physical structures of the traditional nursing home. </p><p>Upstate New York is home to early adopters of the Green House model, giving the region two decades of experience with a model that others are now beginning to recognize, due to exceptional outcomes during the pandemic. <br></p><h3>Design Tenets of the Green House Model</h3><p><span><img src="/Articles/PublishingImages/740%20x%20740/innovation.jpg" class="ms-rtePosition-1" alt="RPH Creekstone Memory Care Small Homes in Perinton, New York" style="margin&#58;5px;width&#58;200px;height&#58;200px;" /></span>The primary objective of the Green House model is to provide a culture and environment where seniors can continue to grow and thrive in a period when they may be experiencing physical or cognitive decline. The model strives to create meaningful life and purpose for both residents and staff, leading to enhanced quality of living and improved clinical outcomes for residents, higher levels of satisfaction among residents and their family members<sup>1</sup>, and greater workplace satisfaction and lower levels of stress for frontline caregivers.<sup><a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">2</a></sup> <br></p><p>There are multiple design elements that contribute to these results, including a small-scale environment, private bedrooms with private bathrooms, living rooms and other open public spaces, communal dining areas, access to outdoor spaces, and consistent staffing.</p><h3>Green House Model Benefits</h3><p>The pandemic in particular brought more attention to the benefits of the small-house/Green House model. According to a study published in the Journal of Post-Acute and Long-Term Care Medicine, the small-scale environments of Green House and other nontraditional nursing home models proved advantageous, experiencing significantly lower levels of infections and mortality when compared to traditional nursing homes with larger bed counts.<sup><a href="https&#58;//www.jamda.com/article/S1525-8610%2821%2900120-1/fulltext" target="_blank">3</a><br></sup></p><p>In addition to better clinical outcomes for residents, the Green House model offers many other benefits, including flexibility that allows for modification of occupancies as needs change (e.g., skilled nursing, memory care, rehabilitation, hospice), more private pay residents, daily costs that are lower than the traditional nursing home model<sup><a href="http&#58;//www.greenhouseproject.org/" target="_blank">4</a></sup>, and greater staff retention. Moreover, data collected by GHP reveals that even after the pandemic, Green House homes have reported significantly lower turnover rates for CNAs, LPNs, and RNs.<sup><a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">5</a></sup> This is particularly notable as staffing continues to be a critical concern and maintaining staff with a lower turnover rate may offer a competitive advantage.</p><p><img src="/Articles/PublishingImages/2023/RobertSimonetti.jpg" alt="Robert Simonetti" class="ms-rtePosition-2" style="margin&#58;5px;" />Green House living represents a set of design criteria that reconfigures the operations and environments of a traditional nursing facility into an “intentional community” that offers person-centered care focused on relationships and people. Data is mounting that suggests this design initiative also provides several benefits, including better quality of living for residents, lower levels of infections and mortality, lower staff turnover rates, and lower daily costs. New programs and funding opportunities may encourage, require, and facilitate these innovative models further. </p><p><em>Rob Simonetti is senior living leader at LaBella Associates. He has focused the last 15 years of his career on small house models of care for skilled nursing occupancies. </em><br><br><span class="ms-rteStyle-Normal">References</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">1.&#160;&#160;&#160; &quot;Effects of Green House Nursing Homes on Residents’ Families&quot; by Terry Y. Lum, M.S.W., Ph.D., Rosalie A. Kane, M.S.W., Ph.D., Lois J. Cutler, Ph.D., and Tzy-Chyi Yu, M.H.A., Ph.D.</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">2.&#160;&#160;&#160; &quot;The Green House Difference&#58; By The Numbers,&quot; <a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf </a></span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">3.&#160;&#160; &#160;&quot;Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths,&quot; Journal of Post-Acute and Long-Term Care Medicine, <a href="https&#58;//www.jamda.com/article/S1525-8610%2821%2900120-1/fulltext" target="_blank">https&#58;//www.jamda.com/article/S1525-8610(21)00120-1/fulltext</a></span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">4.&#160;&#160; &#160;&quot;Pilot Study Finds Meaningful Savings in THE GREEN HOUSE<sup>®</sup> Model for Eldercare,&quot; <a href="https&#58;//www.greenhouseproject.org/" target="_blank">www.greenhouseproject.org</a> </span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">5.&#160;&#160; &#160;&quot;The Green House Difference&#58; By The Numbers,&quot; <a href="https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf" target="_blank">https&#58;//thegreenhouseproject.org/wp-content/uploads/The-Green-House-Difference.pdf</a> </span><br><br></p>2023-05-16T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/innovation.jpg" style="BORDER&#58;0px solid;" />DesignRobert SimonettiThe pandemic shone a light on senior living infrastructure that has leaders and staff of assisted living and skilled nursing facilities looking for progressive and innovative design concepts.
Modern Factors in Senior Living Campus and Facility Planning<p>​Increasingly, senior living organizations are seeking to provide a combination of uses for a continuum of ages and care that is specific to each resident’s needs. While these aren’t new concepts, we’re seeing them rise higher on priority lists than ever before.<br></p><p>Modern care communities are being created to blend care efficiency with more nuanced treatment levels. While care options are becoming more specialized, we need to foster meaningful connections between those levels of community.​<br></p><h3>Mixed-Use, Multi-Generational Lifestyle Developments</h3><p>A prime example can be found with the Franciscan Sisters of Perpetual Adoration (FSPA) in La Crosse, Wisconsin. This continuing care retirement community includes 45 skilled/memory care units along with 35 assisted living, 11 independent living/guest spaces, and 32 guest rooms for retreat center participants.<br></p><p><img src="/Articles/PublishingImages/2023/FranciscanSistersPerpetualAdoration.jpg" alt="Franciscan Sisters of Perpetual Adoration" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;535px;height&#58;283px;" />The facility addresses the Franciscan Sisters’ vision of bringing sisters, spread across a wide continuum of care spectrum, together on one campus. Following a comprehensive planning effort, they decided to renovate St. Rose Motherhouse to accommodate all care levels and move those living off-site into the Motherhouse. The existing configuration was not readily suited to incorporate each of the needed levels of care, which presented a great renovation challenge and required a strong commitment from the sisters to bring their vision to life.&#160;<br></p><p>Reflecting on why this renovation project was so important to FSPA, one of the sisters in leadership shared that it was part of how they enacted their assembly mandate to right-size their facilities, and it is vital to their future planning. She explained that they looked at their trends data knowing that they had two large buildings that were less than half full.&#160;<br></p><p>“We knew that as we moved forward, we would have fewer members and would not need both spaces,” she explained. “We realized it was not the best use of the assets we are stewarding to not use the buildings to their capacity. We discerned, as a congregation, that we wanted all of our senior members going forward—as space would permit—to be at our Motherhouse. That is where our adoration chapel is located, which is key to our charism of perpetual adoration.”​<br></p><h3>Res​ponding to Changes in Health Care and Life Safety</h3><p>In recent years, there has been a paradigm shift in care models, including a significant move to assisted living communities. Considering this swing, the solutions are not the same as they have historically been. Innovative design solutions are necessary to best meet the various care community being served. At times, regulations have not kept up with those needs, nor the research, best practices, new products, and special exceptions that will best serve the community.&#160;<br></p><p>Architectural and construction consultants must explore new ways to meet the intent of the code, even when those solutions are not explicitly permitted in the code. Existing codes can sometimes be years behind the continuum of care needs and solutions, so a Petition for Variance is requested in those situations.<br></p><p><img src="/Articles/PublishingImages/2023/177Hoff17.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;365px;height&#58;251px;" />An example is the grab bar variance. Experience and research data is showing that swing-down grab bars can be more effective for residents and staff in assisted care environments. Unlike current code standards, swing-down grab bars are non-handed (correct for left or right-handed people), provide flexibility for residents with unbalanced upper body strength due to injuries or stroke, and permit additional flexibility for assistance.&#160;</p><p>Petitions are sometimes the best way to provide effective design solutions, especially when repurposing existing buildings. Although a useful tool, petitions should not be taken lightly and always pursued in collaboration with all involved parties (owner, operator, care staff, plan reviewers, inspectors, state officials, etc.) to ensure the intended outcome is achieved.&#160;​<br></p><h3>Elevating the Staff Experience&#160;</h3><p>Staff efficiency is at the top of the priority list for our senior living clients. Considering the staffing challenges that most organizations are facing, helping staff be more productive is a critical desired outcome.&#160;<br></p><p>Survey findings demonstrate that staff are one of the most important factors in environmental and care quality. Getting the most out of your staff is accomplished by improving their experience and creating a facility that allows them to work like they want to—smoother and easier.<br></p><p>This is accomplished by involving care givers, culinary staff, and other key stakeholders in early discussions to uncover the intricate details that will ultimately lead them to be fully successful in supporting patient care and independence.​<br></p><h3>We​llness Models for Active Older Adults</h3><p>Never has wellness been as critical in senior living as it is today. Wellness encompasses many themes from physical fitness to social engagement. As providers navigate the wellness landscape in 2023, they are well served to take note of several trends and consider them as they are planning and making improvements to current wellness programs and paradigms.&#160;<br></p><p>We recommend the expansion of wellness programs to create deeper connections, higher levels of engagement, and more fulfilling experiences for residents and associates alike.&#160;<br></p><p>We have found that the expansion of wellness programs across the industry has enabled operators to offer more program customization without overwhelming their operations. One strategy for accomplishing this is to frontload the resident onboarding process with thorough evaluations that focus on lifestyle, preference, and resident history. It empowers operators and associates to create a more personalized experience for each resident. It also drives whole-person wellness by helping residents maintain physical activity, sense of purpose, and a feeling of connection.&#160;<br></p><p>We believe that every operator’s goal should be to create a greater sense of community. True communities are integrated and alive, providing residents with a greater sense of purpose, connection, and togetherness, and built around social engagement models. When the sense of community is the result of empowering residents, they become free to choose how they want to participate and contribute, instead of assuming the associates will do everything for them.&#160;​<br></p><h3>Use of Technology to Maintain Independence and Support Care Operations</h3><p>We have had many conversations with clients about the increased and proper use of technology to make their work easier. You are likely very familiar with such applications as smart vital monitoring, fall detection, and social connectivity tools. These are still very proprietary, and interconnectivity with higher level systems like nurse call and security systems is sometimes limited.<br></p><p>The next shift and latest technology are happening more on the vendor level, versus the industry or system level. With that in mind, operators and administrators wishing to be on the forefront of technology advancement should engage with vendors that are on the cutting edge of specific systems. Then, they should seek to participate in beta tests to be a part of creating the end solutions that will serve residents and staff most effectively.<br></p><p>A crucial decision that we strongly encourage every client to make in a building project is to create a robust wired and wireless infrastructure. This will allow easier “plug and play” for the latest technological advancements, for emerging technologies, and most importantly, for future technologies yet to be developed.&#160;​<br></p><h3>Now and Then</h3><p>Making decisions that allow for flexibility of care, staff efficiency, and wise use of technology will set you up for success. Your staff and residents will be the benefactors and the efficiency and productivity of your facilities will greatly benefit as well.&#160;<br></p><img src="/Articles/PublishingImages/2023/JulieHeiberger.jpg" alt="Julie Heiberger" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;115px;height&#58;145px;" /><p><em>Julie Heiberger is a senior project architect and the Senior Living Market Leader for Hoffman Planning, Design &amp; Construction, Inc. A member of the American Institute of Architects and the National Council of Architectural Review Boards, she received her Master of Architecture from the University of Wisconsin–Milwaukee.&#160;​</em></p><p><em><img src="/Articles/PublishingImages/2023/RandyBremhorst.jpg" alt="Randy Bremhorst" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;115px;height&#58;144px;" />Randy Bremhorst is Vice President of Design at Hoffman Planning, Design &amp; Construction, Inc. A graduate of the University of Notre Dame’s School of Architecture, he has more than 30 years of experience in the design and construction profession.&#160;</em></p>2023-02-14T05:00:00Z<img alt="" src="/Articles/PublishingImages/2023/design.jpg" style="BORDER&#58;0px solid;" />DesignJulie Heiberger and Randy BremhorstModern care communities are being created to blend care efficiency with more nuanced treatment levels.
Best Practices for Designing Memory Care Facilities<p>​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.</p><p>The <a href="https&#58;//montessori-ami.org/about-montessori/montessori-dementia-ageing#&#58;~&#58;text=The%20goal%20of%20the%20Montessori%2c%2c%20others%2c%20and%20their%20community." target="_blank">Association Montessori Internationale</a> 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.”</p><p><img src="/Articles/Guest-Columns/PublishingImages/2022/ScottHendrix.jpg" alt="Scott Hendrix" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />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.</p><p>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.</p><h3>Case Study&#58; Evergreen House</h3><p>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.</p><p>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.</p><h3>Wayfinding</h3><p>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.</p><h3>Color</h3><p>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.</p><p>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. </p><h3>Contrast</h3><p>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.</p><p>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. </p><h3>Signage</h3><p>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. </p><p>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.</p><p>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.</p><p>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. </p><h3>Art</h3><p>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. </p><p>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. </p><h3>Floor Plan</h3><p>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.</p><h3>Scale</h3><p>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.</p><p>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.</p><h3>Resident Engagement Areas</h3><p>Facilities should have spaces intentionally designed to engage residents and encourage them to participate in stimulating activities. </p><p>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.</p><p>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.</p><h3>Kitchen</h3><p>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.</p><h3>Bedroom</h3><p>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. </p><h3>Outdoor Space </h3><p>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.</p><p>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. </p><h3>Design That Puts People First</h3><p>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.</p><p>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.<em><br></em></p><p><em>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 <a href="mailto&#58;shendrix@mcmillanpazdansmith.com" target="_blank">shendrix@mcmillanpazdansmith.com</a>. </em></p>2022-10-11T04:00:00Z<img alt="" src="/Articles/Guest-Columns/PublishingImages/2022/ScottHendrix.jpg" style="BORDER&#58;0px solid;" />Management;DesignScott HendrixMemory care facilities can reduce resident confusion, frustration, and anxiety while encouraging engagement and independence in a safe environment.