Nightingale House in Clapham is setting a benchmark for the future design of dementia care environments
The UK has been hit by a ‘tidal wave’ of dementia that is sparking a national drive to create innovative new environments in which to care for the elderly.
Speaking at the IHEEM Conference in Manchester this week, Stephanie Brada, trustee director of charity, Nightingale Hammerson, said the organisation had responded to the massive increase in people with dementia by creating a landmark development that would set a benchmark for the emerging sector.
It would be dishonest not to say that we provide excellent care and the very best care we offer is in our very best building
“About five years ago the care sector was hit by a tidal wave of dementia,” she said “It has gone from providing residential care to caring for very old people and those with dementia.
“At Nightingale we went really rapidly from a residential home with one dementia unit of about 40 people to having 180 people with some form of dementia. That meant we went from providing essentially hotel services where we offered accommodation for people who lived quite independently to providing much more care and support.”
Currently also head of P21+ development and head of healthcare planning at Willmott Dixon, Brada was instrumental in the creation of the charity’s new dementia unit, Nightingale House in Clapham, south west London. It has created an exemplar for a sector that is expected to grow quickly over the coming months and years.
The garden at Nightingale House has been found to be an important part of the development, with recognisable features an old red phone box
She said: “We set about designing a dementia facility that was to be the very best. We were not profligate with the money given to us, but we were determined to build the highest quality and nothing but the best would be good enough for our residents.
“We regard older people as just people at another stage in their lives with pressures and opportunities and the onus is on us to discover these with people and for people as they cannot always do that themselves.”
As part of the design of the new unit, the charity aligned with Bradford University to consider design-centred care, working with staff, patients and carers to decide on the best approach to the development.
The result is a two-storey, 20-room facility with a number of dining spaces, reminiscence rooms, gardens and terraces that has become an example of best practice for the UK and further afield.
But the process of designing the unit did highlight some surprises in terms of what works and what does not.
The trend towards using art and signage to identify individual bedrooms, and providing reminiscence rooms and objects was found to be less than effective.
Brada said: “We learned a lot. We created a kitchen in which we put items that older people would recognise and use. I don’t think one of the residents has registered them at all. The only thing we did find was that they liked to stir things on the hob, but other than that they didn’t want to use them. We used arts and textiles and hat stands, but we found that the only thing they were obsessed about was their handbags.
“In the bedrooms we have see-through doors on wardrobes and drawers, but even residents with mild dementia do not seem to benefit from them even though they are there.
It’s not necessarily about reminiscence as beauty is the same at any age. It could be about the smell of cooking or being able to walk in the garden. We need to say ‘this is someone’s life’ and design from there
“While we tried really hard to make doors to bedrooms recognisable it did not stop people wandering around and getting into each other’s rooms. We tried everything, but nothing seems to work.”
While the research identified interventions that did not work, it has also highlighted those that do have a positive impact.
“Reminiscence in general does not work, but it is nice to create corners for people based on their own backgrounds. We have a resident who used to work in an office and we have given them a desk with a phone. It is about personal reminiscence spaces and we have found these do work very well,” Brada said.
“Access to the outside is also absolutely critical. People with dementia become agitated and you can easily calm them down if you take them outside.”
Residents like to wash the old-fashioned car in the grounds of the home
In the grounds of Nightingale House are some nods to both the past and present which have proven popular with residents, including an old-style red phone box, a postbox, a bus shelter and an old car, which they can wash. There are also birdsong sound effects and a space for them to grow their own vegetables.
“This is not research, but our impressions of living with a building,” Brada said. “It would be dishonest not to say that we provide excellent care and the very best care we offer is in our very best building.
“Of course there are issues around risk and preventing falls etc; that’s a given, but beyond that I would say the only word I would write on a piece of paper for an architect or a provider is ‘delight’. “We need to create delightful settings. It’s not necessarily about reminiscence as beauty is the same at any age. It could be about the smell of cooking or being able to walk in the garden. We need to say ‘this is someone’s life’ and design from there.” Commenting on the building, Christopher Shaw, an architect at Medical Architecture, said: “What struck me when entering the building was that its success is in its subtleties, not in the dos and the donts. What struck me was the smell, which was not what you would usually associate with a dementia care home, and the acoustics, which were incredible.”
The bus shelter in the garden is another popular feature of the unit