Homey surroundings can comfort Alzheimer’s patients

AT REST: Designers of Darlington Memory Lane aimed to create a warm and nurturing environment to help residents maintain “domestic tranquility.” / COURTESY DARLINGTON MEMORY LANE
AT REST: Designers of Darlington Memory Lane aimed to create a warm and nurturing environment to help residents maintain “domestic tranquility.” / COURTESY DARLINGTON MEMORY LANE

Making sufferers of Alzheimer’s disease and other dementia patients as comfortable as possible is a personal challenge for tens of thousands of caregivers in the state.
According to numbers provided by the Rhode Island chapter of the Alzheimer’s Association, 52,000 Rhode Islanders provide volunteer care for someone with Alzheimer’s or another form of dementia. “Alzheimer’s is often called the caregiver’s disease,” said Camilla Farrell, development director at the Rhode Island chapter. “I know firsthand how difficult this disease can be on the person with the disease as well as the caregiver. My aunt was diagnosed with the disease, and then about 10 years ago my dad was also diagnosed.”
Making people with Alzheimer’s or dementia comfortable is also a business challenge, for those who run assisted-living facilities and nursing homes.
Dr. Louis Marino, chief of geriatric services at Butler Hospital, said there are a variety of ways to create physical and mental comfort for people with dementia. All of them focus on warming up environments.
“Ideally, the setting will appear comfortable to all of your senses,” Marino said in a recent interview. “There should be light. The air ideally does not smell like either a hospital or what you would think a nursing home would smell like. It’s good to see color. Ideally, there’s not a lot of extraneous noise.”
Industry specialists in Rhode Island, some of whom oversaw design and construction for the state’s latest caregiving facilities, say similar things: homier is better.
“In dealing with designing memory-care units, we like to have aspects of the living environment that would remind people of their lives in the past,” said Bill Lassetter, chief architect of the new Tockwotton on the Waterfront facility facing the harbor in East Providence.
Lassetter, who works for Boston architecture firm DiMella Schaffer, said that the residents have what are called “memory boxes” outside their rooms to put items special to them, “pictures of loved ones, whatever small items that are significant to them that can prompt whatever memory that they have left that you can reach.” The latest research shows that the effort to spur memory can be beneficial, even when it is apparently unsuccessful, Lassetter explained.
“A part of dementia is such that the photograph that you have in your memory box, you may look at it and you may not be able to remember who these people are anymore,” he said. “But studies show that even though you can’t remember who the person in the photograph, is you still get a pleasant sensation, even though you don’t know why you’re getting the sensation.”
Other design elements at Tockwotton intended to create a homey atmosphere include having a “residential” kitchen (where residents can observe breakfast being made to order), an abundance of natural light reaching as many points in the facility as possible, and furnishings that bespeak a private living room.
Tockwotton’s executive director, Kevin McKay, said that the kitchen is probably the most important part of creating a sense of home.
“The smells and the aromas are part of it,” McKay said. “When I bring people on tours they always say, ‘That smell, it makes me hungry.’ That’s what we’re trying to do. If you’ve got dementia you may not recognize that you’re hungry, but that smell might remind you that you’d like to eat.”
The space needs, in addition to providing comforts of various kinds, to factor in a tendency of dementia sufferers to roam, according to Lassetter.
“We don’t like to have an exit clearly visible, a door to the outside,” he said. “So, when you go into an Alzheimer’s unit you’ll find that you have entered very discreetly and it’s not like you can see the front door from the inside of the space. You don’t want to remind the residents that there’s a place to wander outside the home.” To compensate for the lack of freedom to exit the facility, gardens are becoming a design feature at some newer facilities, including at Tockwotton.
“It’s excellent to have interior gardens, which are called ‘wander gardens,’ so that the residents can freely walk around without the danger of walking out of the facility,” Lassetter said. “They can go inside and back outside and so forth but not actually leaving the secured, monitored perimeter of the facility.”
Luis Torrado recently designed Darlington Memory Lane in North Providence, a dementia facility. Torrado, president and principal at Torrado Architects in Providence, said that part of doing cutting-edge design for Darlington involved doing research in the medical literature as well as responding to the special considerations that those with dementia require, including fire safety.
“Not only during normal operations do you need to restrict egress from the building but also under a fire condition you have to safely hold in place the residents until the fire department responds. You need to create compartments that are able to accommodate the entire population in a safe environment for one to two hours,” he said.
While cutting-edge design and fairly plush surroundings are a plus in many cases, how the clients are treated is often what matters, according to Butler’s Marino.
“Some of the best care that I have seen is being provided in locally owned nursing facilities that are able to attract staff who treat the residents as if they were members of their own family,” he said.
Still, Marino does not discount the importance of effective design. “If you have a more wonderful environment, it makes the work of the staff much easier,” he said. •

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