Dementia Friendly Environments

1. Dementia Friendly Environments Eve Oldham Commissioner for Older People

2. National position • A national pilot, Dementia Friendly Environments (DFE), takes forward the Prime Minister’s dementia challenge • King’s Fund 2009/11 ‘Enhancing the Healing Environment’ • Both talk about changes in the environment in hospitals and care homes: • Poor signage and lack of way-finding cues • Poor use of colour and contrast • Unhelpful lighting – glare and pooling • Shiny floors • Stark, unwelcoming spaces off long featureless corridors • No personalisation of space • Under-use of gardens and outside spaces

3. ‘You need to see inside my head..’quote from someone with dementia • Someone with dementia may: • Be confused and agitated in unfamiliar environments • Become restless and distracted in environments that are visually over- stimulating or where there is competing visual information, such as highly patterned wallpaper or too many notices or signs • Have difficulty seeing handrails, toilet seats or doors, or the food on their plate, if these are the same colour as the background

4. Affect on quality of life • Someone with dementia may: • Avoid stepping on shadows or coloured strips on flooring because they may look like a change of level • Resist walking on shiny flooring because it looks wet or slippery • Misinterpret reflections in mirrors, windows and shiny surfaces • Have difficulty hearing or understanding conversation if there is competing background noise, for example, from the television • Have a reduced tolerance for sound and feel anxious in situations with unfamiliar or loud noises • Feel curious and want to walk around

5. Advantages of a DFE approach • The Kings Fund programme showed that appropriately designed environments can: • Reduce the incidence of agitation and challenging behaviour • Reduce the need for anti-psychotic medication • Reduce falls • Promote independence • Increase engagement in meaningful activity • Improve staff morale, recruitment and retention

6. Examples from the King’s Fund programme • changed colour scheme in wards in hospitals • improvements to gardens • improved area for therapies • improvements to the entrance of buildings • Improvements to a palliative care suite

7. Why we are interested in Hackney • Dementia one of the four priorities in 2013/2014 of the new Health and Wellbeing Board • Numbers of people with a diagnosis of dementia slowly rising in the locality • Carers expressing their concern at wanting to keep their loved ones at home for as long as possible • Opportunities for influencing new build • Opportunity for influencing move of Dementia Day Centre • Opportunity opened up by getting through Stage 1 of the national DH DFE pilot • New criteria for carer direct payments • 2013/2014 Review of telecare and equipment services

8. DH DFE Stage 1 and 2 bids • Hackney got through to put in a Stage 2 application • Working with two partners, an RSL owned Supported Living Scheme (SLS) and one an Orthodox Jewish nursing and care home • Application for the SLS is to: • Convert a space rarely used into a sensory room • Improve lighting in corridors, vestibules and entrance • Change layout of garden to include coloured circular pathway • Application for the nursing home: • Convert existing conservatory into a sensory conservatory providing a Succoh roof • Change layout of garden paving to include colour circular pathway • Awaiting to hear !

9. Additional benefits • Working with architects on a new build for dementia taking into consideration the principles of DFE • Beginning work with our Private Sector Housing colleagues to ensure that any Disabled Facilities Grant applications will take on board DF • Working with Hackney Homes building and refurb section to raise awareness of DFE and influence estate landscaping, internal refurb etc • Working with our Hackney Parks section to influence their upgrading and design plans • Started working with our planning section to ensure planning applications take account of DFE