Dementia Village - Dementia Specific Building Design in Residential Aged Care in Australia - Case Study Assignment Help

Case Study Assessment Task

This paper compares and contrasts two dementia specific residential care services from two different countries that manage the BPSD.  

First service is a Dementia Village. This Dementia Village is located in the Netherlands. There are more than 150 people with dementia that live there. The goal of the village is to provide as normal a life as possible and as closely reminiscent of each person’s formative years. In the village, all doors open automatically, except those to the ‘outside’ world. Residents with shared interests and backgrounds live together in “lifestyle groups” and the design and ways in which each is decorated is tailored to each lifestyle. The residents manage washing and cooking with the assistance of staff members. Within each house residents have their own large bedroom, and share a living room, kitchen, and dining room. There is a grocery store where residents of the village buy their groceries, and other basic shops such as hair salon and theatre for entertainment. Residents attend an outpatient clinic for medical needs. The village has a café and parks and fountains through which they can roam freely. All these amenities are designed and labelled in a dementia friendly manner by putting familiar signs and cues to reduce confusion.

Second service is dementia specific building design in residential aged care in Australia. HammondCare residential care facilities in Australia use dementia-specific designed building to care for older adults with dementia with the aim to enhance independence and safety of older people with dementia and control stimuli to better manage BPSD. The building design consists of a closed unit divided into small cottages with small numbers of residents as large buildings are confusing and alienating. The environment in the units are arranged to be familiar, and domestic by decorating a resident’s room with their precious and familiar belonging. To provide time and place orientation for example, kitchens are arranged in such manner that they produce sight, smell and sounds of cooking. As dementia unit residents are not able to remember, environment is built with good visual access and passive cueing such as different timber panels for doors, artwork of furniture; natural lighting or putting picture frames of collectables at bedroom doors as these assists people with dementia to see and sense where they are and where they want to go. The units are designed with no dead ends and any locked doors are unobtrusive. There are number of different daily activities in different rooms that are welcoming and encouraging for visitors and family as well. Unit design controls the stimuli by promoting sounds that assist cueing and by reducing unfamiliar noise such as from equipment. The environment is made safe by using systems like nurse alert, bed and floor sensors. It is unobtrusive so that residents can be in or outdoors as they wish. Design features such as colour coder taps, non-slip floors, remote switches for kitchen appliances is used to promote calmness and reduce confusion.

 Both services seem to be using patient centred care model. According to Brooker (2007) has suggested that meaning of person-centred care for people with dementia and their carers is that they are the most important individuals at the centre of the care to be provided for their individualised needs, the Perspective of the person with dementia must inform our understanding; and the person’s Social environment must be attended to because of the fundamental importance of relationships in sustaining personhood. Person-centred care is firmly based on a psychosocial and spiritual paradigm. It places little emphasis on the medical management of patients. Person-centred care promotes the rights and perspectives of the individual with dementia. However, the patient centred philosophy of care does not specifically consider dementia as an end of life issue or provide guidance to clinicians or families on difficult decisions about medical treatments and withdrawal of medical interventions.

Both services seems to manage BPSD by providing environmental cues and building a familiar environmental surroundings to the residents to there formative years to give client’s sense of belonging, normal vs institutionalised life and to avoid confusion as these can be the reason of agitation and hence BPSD. But there are other reasons for 

Specific therapeutic interventions for different symptoms of BPSD have also been investigated. In relation to agitation and aggressive behavior, and before opting for any intervention, it is important to carefully analyze the causes for the disruptive behavior: such causes may include pain, medical illness, fatigue, depression, loneliness, understimulation, or overstimulation; and social and environmental stressors (Iwata et al., 1993; Salzman et al., 2008). Strategies reported to be useful to reduce agitation include sensory interventions, particularly music therapy (Choi et al., 2009), aromatherapy (Ballard et al., 2009), and environmental modification (Weitzel et al., 2011). Regarding depression, recent studies support the effectiveness of home-based exercise programs for people with dementia and their caregivers to reduce depressive symptoms (Prick et al., 2011). Recently animal-assisted activities were suggested to be associated with a decrease in anxiety and sadness and an increase in positive emotions and motor activity (Mossello et al., 2011).

Mild to moderate BPSD, such as apathy, mild depression, repetitive questioning, shadowing (ie, following other people around very closely), wandering etc may respond to distraction and reassurance and may be prevented by altering interactions and the environment. But other moderate to very severe BPSD such as major depression, verbal aggression, physical aggression, psychosis, sexual disinhibition may require more intensive care within a specialist case-management model, in which tailored programs are implemented by a specialist multidisciplinary team. For example, treatment may involve a psychiatrist (or geriatrician) reviewing the cause of the disturbed behaviour, a specialist doctor prescribing medication, a nurse liaising with staff, a psychologist developing a behavioural plan, and a social worker integrating the family into the care plan. RCTs have demonstrated the effectiveness of such teams in the community and in nursing homes.

While targeted services for people with dementia and very severe BPSD may vary from HammondCare’s dementia specific care model, there are some key components that must be included in these programs. These include, 

A dedicated staff team with specialist training and expertise in dementia:

Access to a specialist support team:

A prosthetic, dementia-friendly physical environment:

A dedicated transition program, aimed at helping residents to move into a mainstream, dementia-specific facility once they have stabilised.

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