Damian Utton, RIBA Dementia Design: Examples from Japan POZZONI

Design Principles Older people, particularly older people with dementia, can be more sensitive to the built environment People with dementia may not remember or understand their surroundings. Design can compensate for these impairments and overcome some of the other impairments associated with old age Design can improve the quality of life for people with dementia and facilitate the delivery of care in an efficient, non-institutional way Other impairments can be compensated in a straightforward way with established guidelines, dementia affects people in different ways.

Good design should compensate for impairments should maximise independence should enhance self esteem and confidence should demonstrate care for staff should be orientating and understandable reinforce personal identity welcome relatives and the local community allow the control of stimuli (Marshall et al 1997) There is a consensus of design principles for people with dementia

‘Group Home’ o Domestic household style of accommodation o Typically 8-10 residents to a household o Residents participate in daily living activities 270 Group Homes in Japan in ,000 Group Homes in Japan in 2012 Long Term Care Insurance (LTCI) introduced in 2000 Same regulatory framework to all group homes but not all group homes are the same The Japanese Context

Opened 1996 Influenced group home thought 8 residents plus 1 respite care 3 staff to 9 residents daytime 1 staff to 9 residents at night Service costs met by LTCI Contributions from central government, prefectures, municipalities Residents top-up fee capped at 10% of service cost Owner: Tenjin-kai Social Welfare Foundation Himawari Group Home, Ofunato, Iwate

‘Live an ordinary life’ Familiar environment Private and shared spaces Live as a family: daily tasks Vegetable garden Himawari Group Home, Ofunato, Iwate

Opened residents 25 respite care 6 Young people with disabilities Adult and child daycare Restaurant Established to serve local community with co-operation from local residents 90% of care costs met by LTCI Residents pay 10% of care cost Residents pay for housing and meals Owner: Group Fuji (not for profit) NPO Group Fuji, Fujisawa, Kanagawa

1993: Five housewives started a co-op for locals needing help with care for elderly relatives and childcare Locals are trained as care staff plus volunteers Building costs raised by sale of bonds to local residents Restaurant: community engagement Inter-generational contact 10 resident households Private and public spaces NPO Group Fuji, Fujisawa, Kanagawa

Opened nursing care residents 13 dementia care residents 50 assisted living residents Adult daycare 190 pre-school children 300 college students 3 outreach centres nearby Community centre Restaurant Multi-generational approach 90% of care costs met by LTCI Residents pay 10% of care cost Residents pay for housing and meals Owner: Taiyo no Mori (not for profit) Gojikara Mura Village, Nagakute, Aichi

Philosophy: Create opportunities to establish meaningful relationships Diversity, imperfection, slow-paced lifestyle Walk everywhere No hard paving Non-accessible areas – opportunity for interaction Domestic scale and appearance Simple construction; DIY repairs Built around nature Vegetable garden and farm Gojikara Mura Village, Nagakute, Aichi

School: o Inter-generational o Not obliged to interact but co- exist and share the same spaces Organic restaurant Meals at daycare prepared by mothers of the schoolchildren Staff: emphasis on relationships, not completing tasks. Overworked staff may overlook something important Volunteers within the village Gojikara Mura Village, Nagakute, Aichi

What can we learn from this in the UK?

Dementia design principles are the same – adapted for the different cultural context of Japan Long Term Care Insurance (LTCI) makes small group households (8-10 residents) in Japan affordable to build and operate Currently being reviewed in Japan UK Staffing requirements and funding levels means that UK households have to be residents What can we learn from this in the UK?

Multi-cultural society in UK People who moved to the UK in 1950’s-1970’s may benefit from dementia design now ‘Fine tune’ dementia design principles for specific cultural requirements whilst still maintaining principles What can we learn from this in the UK?

The built environment is just one aspect of a total person-centred care approach It’s the people who make the real difference! Damian Utton, RIBA POZZONI