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Creating a positive environment
In this chapter we look at the care home environment: what can you do with the physical spaces in your care homes to promote a sense of wellbeing for residents and staff? Could this help avoid the types of situations that can result in the use of restraint?
Increasingly, all care providers - hospitals included - are recognising that the way they set up care environments will make a big difference to the people they are caring for and the staff too.
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Creating a positive environment
Have a good look at the list of items in a lounge room within a care home.
Click on each of the links below to learn more about how some basic design features can positively influence care and care practices. There are many more we could have mentioned - this is just to get you started on thinking.
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Creating a positive environment
Windows
Windows allow residents to look out onto the outside world, follow the seasons, and have access to natural light and fresh air. A well-used outdoor green space that is visible from a lounge can work well to prompt residents to come and go between indoor and outdoor spaces.
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Creating a positive environment
Mirror
Mirrors can be confusing, particularly for people with dementia who may have depth perception problems with their eyesight. The person may also not be sure what it is they are seeing, for example, they may not recognise themselves in the mirror. It could be worse if the mirror is in the bathroom: the person may have visual difficulties with perceiving water on smooth floor surfaces, and they may not recognise the person who is probably appearing half-dressed or naked in the mirror. All these factors together could prompt distressed behaviour, and yet staff may be unclear what is triggering the problems.
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Creating a positive environment
Lighting
Good lighting helps residents to orient themselves and can lead to fewer hallucinatory episodes for people with dementia. Natural lighting is great, but it's important to be able to control it if the light becomes too glary. Watch out for shadows too: people with dementia may not be able to recognise that a shadow is a shadow.
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Creating a positive environment
Signage
Signage should be consistent throughout a facility. It should be hung at the right height (not too high) for older people to see easily. To aid recognition, toilet door signs should be in a consistent contrasting colour.
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Creating a positive environment
Cupboard
When cupboards are closed residents can't know what's inside without looking: some open shelving or glass doors on the cupboards might work better to invite residents to explore the contents on their own.
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Creating a positive environment
Corridor
It helps residents know where they are within a care home if corridors are distinctive: consistent colours for each unit, strong themed artworks, with tactile features could help here.
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Creating a positive environment
Television
The use of televisions needs to be managed quite carefully by staff: residents will have a range of tastes and interests, and also abilities to be able to follow and hear the programme. Televisions should, at best, be a lightly-used addition to a full and varied activities programme.
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Creating a positive environment
Handrails
Strong colour contrasts help with orientation: brightly coloured handrails, door handles and toilets are all easier to see and use if they stand out from their background colours.
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Creating a positive environment
Walls
Light reflects off lightly coloured walls, so pale colours are good. Dark walls make it harder to see.
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Creating a positive environment
Rugs
Patterned carpets can be confusing, particularly for people with dementia who may have depth perception problems with their eyesight: the person may not be sure what it is they are seeing (for example, a dark circle may appear to be a hole), and whether it is real or not (for example, a floral pattern may look like an animal). Patterns can also make it hard for someone with a visual impairment to be able to find something on the carpet. Rugs are also a potential falling hazard.
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Creating a positive environment
Of course there are other areas within a care home where other design issues will arise, such as entrance areas or bedrooms - and the ideas in this chapter are just a start.
Assistive technology is a fast-growing area too, and many new devices are changing the way we provide care. Sensors placed beside a person's bed or on a door, for example, can alert staff that a person is getting out of bed or opening the door.
Ultimately, these devices can aid independence and prevent staff from having to intervene unnecessarily.
For more information on assistive technology, in particular how it relates to people with dementia, go to www.atdementia.org.uk. The Disability Living Foundation also produce valuable resources, including 'AskSARA', an advice tool that includes information on assistive technology.
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Creating a positive environment
There are many ways to improve care home environments, and not all changes need to be expensive.
Have you thought about...
- involving staff, residents and relatives to review and improve the care home environment?
- involving a local community group (such as an art college) or artist to work on a particular project that would enhance the home's environment?
- obtaining resources or expertise that could help guide a renovation process? For some suggestions, see the Resource section.
With the right information to hand, staff can feel more confident to intervene and experiment if necessary with improving the care environment.
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