Design in detail

The following principles are outlined in the HBN 08-02, Dementia- friendly Health and Social Care Environments. Other relevant HBNs for designing care homes include HBN 05, older people and HBN 08, Long-term conditions/long-stay care.

01
Provide a safe environment.
02
Provide optimum levels of stimulation.
03
Provide optimum lighting and contrast
04
Provide a non-institutional scale and environment
05
Support orientation
06
Support way-finding and navigation.
07
Provide access to nature and the outdoors
08
Promote engagement with friends, relatives and staff
09
Provide good visibility and visual access
10
Promote privacy, dignity and independence
11
Promote physical and meaningful activities
12
Support diet, nutrition and hydration

Principle 1: Provide a safe environment. It should be safe, secure and easy to move around

This principle is about promoting independence, allowing residents to make the most of their abilities.

Guidance includes:

  • use of slip-resistant, matt finished flooring with no patterns or shadows.

To those with dementia or visual impairment, highly-polished, shiny flooring can appear wet, causing uncertainty and confusion; instead, the flooring should be matt. We also recommend flooring that is sparkle-free and without a heavy pattern, as these can cause distraction or look like something to pick up, which could result in a fall. We have a wide range of plain, matt flooring options to help avoid this.

  • orientation and way-finding cues to reduce the risk of getting lost and disoriented
  • design features that reduce infection risks

Our safety flooring contains Altro Easyclean technology, making cleaning easier and more effective. Our floors are impervious, preventing water ingress and avoiding trapping bacteria and associated odours. In addition, Altro Whiterock hygienic wall cladding is impervious, stain-resistant and wipe-clean, giving dirt nowhere to hide and making cleaning straight-forward. Together, Altro Whiterock and Altro safety floors offer an integrated system ideal for areas where hygiene matters.

  • slip-resistant surfaces in toilets, bathrooms and wet-rooms
  • safe, level and uncluttered internal and external environments to reduce the risk of inactivity and falls

Using Altro floors to colour-code areas can help with way-finding and reduce the need for clinical-looking signage. However, for residents with visual impairments and with dementia, ensure the colour transition between rooms isn’t profound enough to appear as a step. Altro Whiterock Digiclad also offers an ideal alternative to posters, photo-frames and notice-boards. In removing this type of clutter, hygiene is improved, there are fewer trip hazards and residents are able to move more freely, improving mobility and reducing frustration and boredom.

Principle 2: Provide optimum levels of stimulation

This is all about getting the levels of stimulation right to support residents’ well-being while avoiding over-stimulation which can cause anxiety. Stimulation can range from sensory rooms and quiet zones to a warm, friendly living area that encourages interaction and participation in activities.

It is the case that multiple types and levels of stimulation can be difficult to deal with.

  • Avoid over-patterned walls and general clutter

Using wall cladding such as Altro Whiterock Satins, which is available in a range of colours including Ice and Seafoam, helps create a homely, non-clinical look without the need for a pattern, plus it is durable and easy to clean.

Colour plays an important role here. Colour affects mood and can have a calming or stimulating affect for example, orange and reds should be avoided for children affected by autism, as they can prove overwhelming.

The bathing experience is an important part of a resident’s routine and the right colour stimulation can make all the difference.

Principle 3: Provide optimum lighting and contrast

  • The HBN offers guidance on providing the correct levels of light for people facing dementia and visual challenges

In our experience natural daylight is preferable, after all we all feel better in a light, airy atmosphere. Using lighter shades of our floors or walls such as Altro Wood Safety Bleached Oak or Altro Whiterock Satins Orchard can support this and are a great alternative to plain white, which looks clinical.

Harsh lighting and some LED lights can create false impressions about the environment such as the perception that the flooring is wet when it isn’t, resulting in uncertainty and possibly falls. Choosing sparkle-free safety flooring helps avoid this: we offer a wide range of sparkle-free options across our product portfolio. Please speak to your Altro consultant if you need guidance.

The impact of light reflection

Subtle differences between floors, walls, steps and doorways can cause enough uncertainty to result in a fall for people with various visual impairments. While colour choice is important here, it is the amount of light reflected from surfaces that is the main factor in determining a person's ability to identify different surfaces.

Light Reflectance Values (LRVs) are the best way to measure contrast. Every material has an LRV marked out of 100 points. To meet requirements, there should be at least a 30 point variance in LRVs between adjacent surfaces such as floors and walls.

Find out more about how light reflectance values can support independent movement.

Doors

HBN 08-02 includes the following guidance

  • use colour-coded doors or doorframes to differentiate and improve visibility, in combination with doors that blend in, to hide.

Altro doorsets offer protection, hygiene and a modern, high quality finish. Available in a variety of shades, they offer design flexibility, allowing you to match wall cladding, helping to hide the doorway and discourage entry. They can also be used to create a complete contrast, making the doorway stand out and encourage use.

  • wood and wood-effect finishes should be used where possible to help create a non-institutional feel. Vinyl finishes and/or laminates applied to doors can be an efficient, cost-effective refurbishment solution rather than installing new doors.
  • bold colour-coded door protection can be used either half-height or full height, in a consistent arrangement throughout the entire building if possible

Altro Fortis door protection helps protect doors against scuff and impact damage. It comes in ten colours including several bright shades and can be cut to the required height either on site, or by using our pre-cut ordering service .

Principle 4: Provide a non-institutional scale and environment

This has a huge impact. The places people call home should look like a home. Even in nursing homes where residents need more medical attention, a non-institutional setting can have a positive impact on recuperation, and on the time residents spend with visitors.

In a retirement village setting, ill-health is generally not an issue and the environment should be not only homely, but high-end. Increasingly hotel-standard surroundings are expected.

According to the HBN, areas to consider include:

  • avoiding  long corridors of institutional character
  • support daily activities and interior décor that indicate the function of a room.

An example could be using images of food, crockery and cutlery in Altro Whiterock Digiclad to highlight the dining room

  • support quality of life by introducing non-institutional interior design, decoration and art works.

Have a look at our Altro Whiterock Digiclad page to find out more.

  • dementia-friendly health and social care environments should include small scale, homely and welcoming lounges and day rooms to reduce over-stimulation

For more, see our section on creating a home.

Principle 5: Support orientation

Disorientation is common for residents with certain types of dementia, and may be experienced by other residents depending on their health and familiarity with the setting.

The HBN states that disorientation to location and time might lead patients/residents to:

  • walk about for what appears to be no reason;
  • attempt to leave; and
  • wake in the middle of the night and get dressed, ready for the next day (especially in winter)

Floors and walls can be used to discourage entry to rooms such as the kitchen, or certain exits. Using flooring with very different LRVs creates a visual barrier, for example, Altro Reliance 25 in Arena (LRV: 41) could be installed in a dining room, with Altro Stronghold 30 in Velvet (LRV: 8) could be put in an adjacent kitchen. The difference in LRV is more than 30 points, making it clearer that it's a different room and discourage movement into the kitchen. This colour combinations work in grey-scale too, the true proof that two shades either contrast, or work together, as needed.

  • An example of shades with similar LRVs that can run through, avoiding hesitation or misperception of a step, is Altro Pisces in Sea Urchin (LRV: 34) and Altro Suprema in Bubble (LRV: 52).

Also recommended are internal landmarks including artwork and items that give positive emotions while supporting orientation. These should be placed in a highly visible way, supported by light and colour contrast. See Altro Whiterock Digiclad.

Principle 6: Support way-finding and navigation

Impaired spatial orientation in people living with dementia is frequently reported.  The reduced ability of people with dementia to reach desired destinations (way-finding) on a daily basis affects their personal autonomy and quality of life. Spatial orientation should thus be considered a basic psychological need.

Spatial orientation can be a challenge for those with visual impairment and additional needs. Even for those unaffected by this, way-finding can be difficult, particularly for those new to a setting, or for visitors.

The HBN recommends

  • Avoiding long corridors; monotony and uniform architectural composition create repetitive environments.
  • Introducing noticeable landmarks that might have special meaning to users and can be used as reference points

Clever use of wall cladding or wall protection can ensure that corridors are not repetitive and can provide a contrast between wall and floor.Colour-coding and use of images on the wall can greatly help with way-finding and familiarity.

Way finding 

To promote independence, reduce stress and help those with dementia, or visual impairment, care homes put great emphasis on way finding. Altro floors and walls can both be used to personalise spaces, create points of recognition and even artworks to give residents points of reference and trigger memory. It also makes life easier for visitors and staff!

Colour is one of the ways of helping with way finding. Different colours may be incorporated into way finding and orientation, triggering the memory and helping to create familiarity but it's important to remember that not everyone sees colour the same way, so this should be combined with other visual signs such as art or other landmarks where possible. We have developed shades to suit all tastes and practical considerations, plus, our walls and floors shades combine to look good, and offer the required contrast differences (see ‘the impact of light reflection’ ). Altro Whiterock Satins is available in 27 colours, and Altro Wood Safety in 20.

To see what your choice of solutions and colours could look like, see the Altro space visualiser.

Art can have a therapeutic effect on residents, can act as memory prompts for those with dementia and helps to make an area look less clinical and more homely. Altro Whiterock Digiclad can be used to create art without compromising on hygiene.

  • Altro Whiterock Digiclad enables photographic images to be used. These can act as memory prompts when wayfinding and designers have the flexibility to choose images that will work best with the residents. It can be used instead of traditional clinical signage
  • There should be a focus on images of nature and local reference points. These are proven to help trigger memories and calm, positive feelings

The inclusion of artwork can be beneficial for service users, staff and visitors; it can lend a special identity to spaces and a sense of locality (wayfinding). Users may be consulted when selecting artworks; pieces created by therapists and users could be incorporated in the building designs

Principle 7: Provide access to nature and the outdoors

To encourage movement into outdoor areas,  Altro doorsets are available in a range of colours to create a contrast with the wall so that the door is easy to find. The door could be faced with Altro Whiterock Digiclad, using images to help users recall that the exit leads outside.

Where it is not possible to provide views or access to nature, particular in nursing homes where residents may be very unwell, the use of natural colours and images of natural environments can play a role in aiding recuperation and lifting mood (see The effects of colour and the power of nature) .

Principle 8: Promote engagement with friends, relatives and staff

This is key for the well-being of most care home residents. As well as keeping families and friends together, in nursing homes, carers are seen as extended family.

Dementia-friendly environments should blend with existing buildings and not stand out as ‘special’ units.

  • Spaces should enable residents and visitors to use internal and external environments. These should be attractive, comfortable and encourage visitors to spend time and engage in meaningful activities, such as gardening.

Using complementary, warm colours, particularly wood shades may help reduce the anxiety that a clinical environment can cause and create visual harmony with the rest of the building.

The HBN also recommends a variety of spaces with a variety of character. This is important across all types of care homes as it enables residents to interact with others, spend time with their family, join in with activities or take quiet time alone.  We offer a large number of shades in both floors and walls to create the right mood and can work with you and your residents to help select the appropriate ones.

Principle 9: Provide good visibility and visual access

Help people with dementia make choices and find where they want to go, by making key places, such as a lounge, dining room, bedroom, kitchen and outdoor areas easily identifiable.

See way-finding

Principle 10: Promote privacy, dignity and independence

Although some care home residents may have health or additional needs, there is still an emphasis on living well and being independent. This is particularly important to us when developing floors and walls solutions. By reducing the risk of a slip, safety floors greatly improve the independence of care home residents. Because we offer homely finishes and non-clinical shades, residents may be unaware that they’re walking on safety flooring, further boosting confidence, and that’s just how we like it.

Considerations for dementia-friendly health and social care environments include

  • Wet rooms that make bathing a safer and less intrusive activity

Altro Pisces provides optimum lifetime sustained slip-resistance in wet and dry environments and whether a resident or staff member is wearing shoes or barefoot. Developed without a bobbled surface, it feels smoother to sensitive feet but its profile still feels reassuringly safe, helping to allay fears of slipping, plus it’s easier to clean.

  • Helping people maintain independence by using familiar building design, furniture, fittings and colours

Altro Whiterock Digiclad can be used to personalise spaces and demark areas to create familiarity

  • Activity areas for reminiscence which can improve mood and wellbeing, and promote social inclusion and the person as an individual with a unique life experience

Flooring that supports confident, safe movement

To ensure people are more comfortable with moving from one area to another, it can be preferable to install flooring with similar LRVs and shades throughout key areas. We offer a number of flooring solutions that allow this, encouraging more confident movement but minimising the risk of slips by offering the right solution for the right area. This is particularly important when moving from a bedroom or corridor into a bathroom. Our combination shades can also be matched easily with those offered by leading carpet providers although we would not recommend the use of carpet due to the hygiene challenges they create.

The real test for ensuring a contrast or similarity between surfaces is to look at the chosen images in grey-scale. This gives you a true view and shows that even shades that look totally different can appear exactly the same in certain light.

Residents’ choice

Having a range of appropriate solution to choose from allows personalisation, helping residents maintain a sense of ‘self’ and enabling them to have a wider choice when they are involved in choosing their own décor. The Altro Space Visualiser (LINK) can help residents see what their surroundings could look like.

HBN 08-02 also recommends  matt flooring finishes to promote movement and independence.

We offer a range of flooring with matt finishes, such as Altro Wood Safety, ensuring there is plenty of choice for new-builds or refurbishments, or to fit with existing décor. Additionally, Altro Pisces has a smoother profile than many wet environments’ flooring. Rough finishes can hurt feet, particularly amongst older people. It allows for a shuffling movement while preventing slips in a high risk environment.

Principle 11: Promote physical and meaningful activities

Have an interior design that is non-institutional and stimulates interaction.

Altro floors and walls are designed to be easy to clean and maintain whatever activities are planned. Altro Classic 25 for example is ideal for art rooms, and with a Pendulum Test Value (PTV) of ≥45, helps prevent slips when there’s the occasional spillage.

Our heavy duty safety flooring is ideal for areas where wheelchairs are used, making movement easy and minimising the chance of damage. Altro Fortis wall protection ensures walls look good long term, despite knocks and bumps from passing traffic.

Principle 12: Support diet, nutrition and hydration

Environments should include dining rooms with family-style layout and interior design.