Dementia Friendly Environments Eve Oldham Commissioner for Older People

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

‘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

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

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

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

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

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 !

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