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DEMENTIA CARE FACILITIES


returned tender figure – at almost £1 m – was substantially more than the £500,000 budget available, so we had to incorporate a fair amount of value engineering.”


Day-to-day spaces prioritised On being formally appointed as scheme architects, ACA had already identified the areas within Maister Lodge on which to focus – those used daily by the residents; the ward and communal spaces. Alex Caruso said: “The scheme has seen us re-provide the 14 patient bedrooms, but also create two new ‘extra care’ rooms. The latter have a feel of small self-contained studio flats, with a bed, an en suite bathroom, and a lounge space where, for example, a particularly mentally or indeed physically unwell patient can spend a few days with the privacy and the dignity they need, but with close, but unobtrusive observation. As NHS guidelines suggest, the inpatient facilities here are gender- separated, so we created a male ‘extra care’ room at one end and a female one at the other.


“We have also located the two new assisted bathrooms – one formed via the conversion of an existing such facility to make it feel less ‘institutional’, – in the separate male and female inpatient ‘pods’, so that male and female bathroom users are guaranteed separation.” Jo Inglis added: “The refurbished bedrooms have a sink and a toilet, but we previously only had one assisted bathroom.” Alex Caruso said: “One of our aims was to make the new assisted bathrooms feel less institutional and more therapeutic – largely by understanding the finishes we could use from a hygiene/ infection control standpoint, and harnessing a more soothing colour scheme. “We also carefully considered the specification of the baths. Historically, some of the assisted baths the Trust has purchased have been highly functional, but somewhat intimidating, from a resident standpoint. We thus looked at an alternative specification, with similar ‘hi-lo’ and hoist functionality, but with a more domestic look and feel. We had to work with the space that was available, but not compromise on the level of assistance that needed to be provided in terms of staff being able to access a resident from both sides of the bath and the hoist. Both the new assisted bathrooms also have a walk-in shower.”


Enhancing lighting


Returning to the refurbishment as a whole, Alex Caruso said: “One of the key elements was the incorporation of a new lighting throughout the patient and staff areas, because the original fluorescent lighting let in inadequate light. We initially looked at introducing a new circadian rhythm lighting technology, but this proved cost- prohibitive, so we focused on increasing the lux levels, replacing existing fittings with LED lights, and introducing dimmable lighting in the assisted bathrooms and the extra care rooms. The refurbished


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New LED lighting, and the use of brighter colours, have helped to make the interior feel less dark and gloomy, while flooring was chosen both for its noise-absorbing properties, and with careful consideration of light reflectance values.


bedrooms and communal areas are now far better lit – via a combination of natural light brought in via the remodelling works, and new artificial lighting. By opening up some of the rooms we were also keen to maximise natural ventilation, and indeed the various demolitions enabled us to do that. On entering the ward the high degree of natural light is immediately evident. We also integrated mechanical ventilation to levels set out in HTM guidance, and worked to achieve overall design standards set out in HBN 08-02, Dementia-friendly health and social care environments.”


New ‘arrival point’


Other key elements of the reconfiguration included creating both a new ‘arrival point’ and three lounge areas, including a considerably more spacious central lounge, all designed to enable patients to be able to meet, socialise, talk to staff, and undertake a range of activities. Jo Inglis said: “Previously the only central such area available was cramped, and a bit dark and confined, with chairs pretty well lined up in a row in a ‘military’ style.” Alex Caruso said: “What we have thus done is create a much larger, well-ventilated central lounge with access to good light, where patients can spend time comfortably, either alone, or with other residents. Windows in all the bedrooms except one of the ‘extra care’ rooms are openable, with access to fenced external gardens at the rear from the lounges. One thing we had to balance was to what extent we should incorporate anti-


By opening up some of the rooms we were also keen to maximise natural ventilation, and indeed the various demolitions enabled us to do that


ligature components, given that, for example, anti-ligature windows will often not be as intelligible to some patients as the more standard windows they’d find at home. In the end we incorporated anti- ligature design at obvious points, such as handles and door closers, and used a more robust design – for instance with a box bed – in the ‘extra care’ rooms, which may, for example, be used to house patients who are particularly depressed, anxious, or angry.” Bedroom doors feature vision panels, which patients can shut from inside should they wish to. Alex Caruso added: “We didn’t use panels with images incorporated that the company supplies, since as part of the scheme we introduced a new wayfinding system, designed to help patients orientate themselves within.”


Colourful ADL kitchen


Another positive addition following the remodelling is a colourful new ADL kitchen, where, for example, patients and staff can get together and share a meal or a cup of tea or coffee, but where occupational therapists can also assess how well patients that might go home soon are progressing by watching them prepare a simple meal. Alex Caruso added: “Our aim throughout has been to afford a feeling of domesticity. For effective care, however, it is important for nurses and clinicians to have good observation without creating a ‘goldfish bowl’ environment. The new central nurse station we have created is glazed to enable staff to keep a close eye on patients that need this, and is indeed the first thing you see when you walk in.” I asked about colour schemes – an especially important consideration in dementia care environments. Alex Caruso said: “We predominantly used green hues in spaces where we wanted to create a more relaxing environment, as well as natural stone colours, which are easy for


APRIL 2019 | THE NETWORK


ACA/Nazia Hussain


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