Design as a Treatment

A talk with memory care and design expert Dr. John Zeisel “Senior living design should be considered not just as a nice place to be as we do activities. We should see it as a support for what we’re doing to improve quality of life.” —Dr. John Zeisel Dr. John Zeisel, founder and president of Hearthstone

Alzheimer’s Care and president of the I’m Still Here Founda- tion, is an expert on senior living design and has served on the faculty of Harvard University’s Department of Architecture, among many other accomplishments. Zeisel’s research and practice over two decades has resulted in award- winning design and planning guide- books, successful developments, prototype facilities, as well as books and articles used by designers, developers, and service providers internationally.

Senior Living Executive spoke to Dr. Zeisel about senior liv-

ing design trends in memory care. SLExec: What is a major change you’ve seen in senior living memory care design over the last two decades? Zeisel: An old idea is the circular path—the wandering path where people with dementia can wander if they want. It turns out that Alzheimer’s residents need a place to go, a place to walk to. We can shift people’s behavior from aimless wandering to purposeful walking by creating a destination, whether it’s food in the dining room, performances, or the garden as a destination for planting. More and more, what we’re realizing is what gives people with dementia a life worth living is purpose and engagement. The more the physi- cal environment can support that, the more it supports a high quality of life. Aimless wandering happens because people don’t know where they are going. It helps people to have a purpose, a destination. SLExec: How has senior living design adapted to the changing needs of residents? Zeisel: The traditional or straight assisted living buildings

today (not memory care) are housing people who 20 years ago we saw as memory care residents. All assisted living now needs to be designed to support at the minimum people with early-stage memory loss. A whole building, even if it’s not specifically for memory care, needs to be thought of as a memory supportive design—that means security and places

finish selections, providing a space that encourages independence, nurtures the spirit, and involves family and friends in residents' daily lives. Te building is posi- tioned to maximize the mountain views. 14. Paintbrush, Paintbrush Assisted Living and Memory Care, Fresno, CA, Doug Pancake Architects. Te commu- nity is designed to resemble the look and

with engaging activities, privacy, and personalization that reinforces who and where they are. An outdoor garden is safe but it also gives cues as to what to do there—to plant, or sit, or walk. Those criteria that help people with severe memory issues help everybody who is aging. The design is merely the physical shell, and in the physical shell are the programs for engagement. SLExec: Can you give some examples of how building design can serve as a treatment? Zeisel: It’s important to include security through unobtru-

sive surveillance so that staff and others can see residents. If there’s a problem, others are around to help. You don’t want residents to get caught around a corner where no one can see them if they have a problem. It’s important to include supports for people to maintain independence—ways to keep them walking without walkers by including handrails, including restrooms in public areas so they don’t have to walk all the way back to their apartment, and providing support for personalization so residents can express themselves in the environment. For people with dementia, brighter lights are good by

allowing more information to go in, and the more informa- tion they have about their environment the better they can negotiate. Lighting also can be used as a way of creating destinations, reinforcing an activity. A good physical environ- ment can support our cognitive abilities and better support our lives. SLExec: How does building design support engage-

ment? Zeisel: Design and programming are symbiotic. This is a

shift from 20 years ago. Design was seen as chandeliers, nice carpets, and fireplaces—a pretty picture to entice families and residents to move in. Now, we’re realizing that environ- ment must support programming. Years ago we’d see gardens that were nice to look at but residents couldn’t get to them. Don’t look at a pool just as a marketing tool—it should be a support for programming. It’s not enough to say we have a dining room, theater, and garden; it needs to be populated. We should be asking ourselves when we renovate or build new buildings, is this going to make a difference?

feel of the Ahwahnee Lodge in nearby Yosemite National Park. Te memory care community is designed with illu- minated memory boxes at each resident apartment for display of personal items to assist residents' way-finding capabilities. 15. Shelter Group, Brightview

Severna Park, Severna Park, MD, Hord Coplan Macht. Te community was

designed so the center of gravity for the Wellspring Village was located on the east side of the building, providing direct access to a secure outdoor courtyard for memory care residents. Te eastern orientation provides morning sun and afternoon shade for the residents to enjoy and benefit from the calming effect of natural light.


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