Richard Fleming PhD, Honorary Professorial Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
Kirsty Bennett B Arch (Hons), Grad Dip Gerontology, BD (Hons), FRAIA, Architect, Melbourne, Australia.
John Zeisel PhD, Hon D.Sc. Founder of The Hearthstone institute and the I’m Still Here Foundation.
Australia Ireland P. R. of China
Canada Israel Poland
Costa Rica Italy Singapore
Dominican Republic Japan Sri Lanka
Estonia Malaysia Sweden
France Mexico Chinese Taipei
Greece Netherlands Thailand
India Nigeria United Kingdom
Iran Norway USA
Table 1. Respondent countries
They include 20 day care centre, 57 residential care centres, 1 hospital and 5 public buildings. Australia, the UK and the USA are over-represented in the residential care centre category with 31 of the 57 buildings coming from these countries. Volume 2 of this report contains all of the case studies and the contents list provides a clear breakdown of the representation of each country in each building category.
The average age of the buildings varied by category with the residential care buildings being the oldest and the public buildings the youngest (Table 1).
Average age (years)
Day Care 5.3
Residential Care 7.6
Hospital 5
Public Buildings 3
Table 2. Average age of buildings
The majority of day and residential care buildings were purpose designed (Table 2).
Purpose designed Renovated
Day Care 11 9
Residential Care 37 21
Hospital 1
Public Buildings 2 4
Table 3. Purpose designed or renovated The average number of places in residential care centres is not able to be captured in a single number because some of the centres are in fact micro-towns (de Hogeweyk and Newdirections, for example) while other centres are stand-alone units. The four largest residential care centres provide accommodation to more
than 150 people each, the average number of places in the smaller units is 22, with the smallest case study describing a two person house designed for a married couple (Résidence Puijalon et Zaccaria in Canada).
Day care centres are similar but to a lesser extent with only one major outlier providing between 100 and 149 places while the average number of people attending daily in the other centres is 22.
Survey respondents were asked to describe the vision that had informed the design of the building. The flavour of the visions has been captured in the following word clouds, generated by https://www.wordclouds.com.
The frequency of word usage in the day care centre visions suggest a focus on family, community, care, people, professionalism, the environment, activities, caregivers, life, staff and enabling.
When asked how well their environments support their vision two thirds of the respondents reported that it supported their vision ‘extremely well’ and the remainder said that it supported them ‘very well’
Figure 1. Day Care Centre word cloud
The word cloud for residential care centre visions suggests a slightly different emphasis. The primary focus appears to be on the provision of care to the residents, perhaps unsurprisingly, but there is a very satisfying emphasis on life, living, quality, people, design, environment, community, garden, wellbeing and the person.
The great majority of respondents (68%) reported that the building supported their vision ‘extremely well’
with a further 16% saying that it did this ‘very well’ and 7% ‘well’. There were no negative responses but 9% of respondents did not answer this survey question.
Figure 2. Residential Care Centre word cloud
Two of the five public buildings (an area in a shopping mall in Malaysia and a library in Norway) were described as supporting the vision ‘extremely well’. They are both adaptations of existing buildings. One was described as supporting it ‘very well’ and one ‘well’. The remaining building was not rated on this survey item.
The small sample makes interpretation risky but it is tempting to take the most common words at their face value, ‘vision and design improving therapeutic space for the inclusion and well being of people with dementia’.
As there is only one hospital represented in the survey responses no word cloud has been produced for hospitals. The vision for the hospital is reported in the case study, as are all of the visions provided for the individual case studies.
Figure 3. Public Buildings word cloud
Information on the perceived importance of the principles of design that have been described in Volume 1 of this report was gathered during the survey.
Each respondent was asked to identify which of the examples of the implementation of the principles was very important.
The chart in Figure 4 shows the difference in emphasis between the categories of buildings.
0% 20% 40% 60% 80% 100% 120%
Safety Unobtrusive safety Spaces that are of a domestic scale Good lines of sight to help people living with dementia to see
the key places they want to go to
Good lines of sight for supervision of people living with dementia
Reduced levels of stimulation Easily seen way finding cues Easily found and unobstructed access to a garden, courtyard
or outside space
Familiar furnishings Opportunities to bring in personal items.
Provision of places to be alone Provision of places that are shared with the surrounding
community
Being designed with a specific vision of how people living with dementia should be supported
Day Care Residential Care Public building Figure 4.Relative importance of examples of design principles
Safety Unobtrusive safety Spaces that are of a domestic scale Good lines of sight to help people living with dementia to see the key places they want to go to Good lines of sight for supervision of people living with dementia Reduced levels of stimulation Easily seen way finding cues Easily found and unobstructed access to a
garden, courtyard or outside space Familiar furnishings Opportunities to bring in personal items Provision of places to be alone Provision of places that are shared with the surrounding community Being designed with a specific vision of how people living with dementia should be supported
Discussion
While it has already been said, it is worth repeating that the people who provided case studies by responding to the survey, did so at a time when there were many, very urgent, calls on their time and energy. The repre-sentativeness of the sample of buildings that they have described is entirely unknown. There has never been an international attempt to systematically collect data on the nature of buildings used in the service of people with dementia so there is nothing to compare this sample with. What is known is that