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ROUND TABLE REVIEW


later living buildings will potentially be used by people living with dementia.” She added it was key that such aspects “were not added on later in projects.” Fiona Walsh of DDS architects said there was “all this knowledge out there that is just not being used” to benefit supportive design. She warned, “if you put somebody in an environment where they feel anxious, stressed, or it’s unfamiliar, we’re actually accelerating their decline. There’s an awful lot we can do, but we can’t continue the way things are.”


Rob Hayles said there were “entrenched views” in the care sector and a lack of consulting users with dementia on their requirements. There were some arguments for an over-standardised approach, he said: “they wanted to have a universal design to cut costs, not a design that would actually make lives better.” Eef Hogervorst cited research into the effects of design on dementia, however Lesley Palmer admitted there were challenges persuading architects of the merits of some research, when they are “trained to be cynical and ask questions, and want to know the quantitative; they recognise outputs as defined by numeric values.” Lesley Palmer said that in order to design for “person-centred


care” it was essential to have “a common understanding of what it is.” In order to achieve this there needs to be “a common language between the care provision, the operator and the designer, and that has to start at the very beginning of the project.” This could be a cultural issue when designing for overseas projects, she added. Palmer emphasised the need to prioritise needs of care providers, and that a dialogue should be established with design teams, “so that you’re also educating each other.” However, notwithstanding this, more important was the need to “ask the individual,” in order to arrive at a solution which is as suited to them as possible. “We still have a tension in architecture between who is the client, and who is the end user,” and warned that “the conversations you have with the person commissioning the building really don’t relate to the people who are going to be living in that building.” Clare Cameron advocated a flexible approach to the fit-out of facilities, for example allowing residents to bring in their own furniture to increase feelings of familiarity, “or enabling gardening, if that’s what somebody likes to do, or cooking, or allowing them to be with a dog, if they love pets.” She added: “It’s just thinking about how to design to enable all the different kinds of possibilities that somebody might need.” She said that cost was clearly a factor, but enthused that her firm is working on “some really magical projects where all those things are being considered.” Eef Hogervorst interjected that research (by Professor Clive Ballard at Exeter University Medical School) has shown that person- centred care, “when it’s implemented in a care home, actually saves money, because you need less medication; and people aren’t humiliated through medical intervention.” She referred to some exemplary projects which had seen similar results in Rotterdam, including a small unit scheme which “was so homely; people could just wander into the kitchen to get something to eat, and if they wanted to have a pet or wander out, that was fine. People were treated as individuals, the people that they were, and still are.” Cameron mentioned that the client objection is often of increased capital costs of such approaches, but Hogervorst countered these objections saying that person-centred facilities are much more fulfilling places to work, which in turn helps the bottom line. “Often that cost is returned, because you don’t have the enormous staff turnover that most of the specialist dementia facilities have,


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ENGAGING WITH ACADEMICS Sophia Wise, head of regional commercial UK & Ireland at event sponsors Amtico Flooring, chats to Paul Rodgers of Strathclyde University; meanwhile Lesley Palmer engages with Eve Hogervorst (Stirling and Loughborough Universities respectively)


because it’s mind numbingly awful when you’re just running around dispensing tablets and trying to keep people calm.”


Co-design


Our attendees agreed that a diligent and informed approach needed to be taken for co-design to be successful, because cognitive impairments means that traditional user consultation methods may be very inappropriate. Hogervorst is an advocate of co-design, but cautioned that they should not be measured using the normal scientific prism, due to the qualitative nature of the approach. Robert MacDonald, a retired architect with Parkinsonism and dementia, and now design consultant, commented that “people living with dementia don’t like to be asked direct questions.” However, he added that successful alternative methods and approaches have been developed such as ‘Living Labs,’ using design ‘cue cards’ to prompt comments and sand trays – “the questions and answers come out of the play.” Hogervorst advocated “walking and talking” with individual


users, as seen on the Chris and Sally’s House ‘ageing in place’ demonstration project at the BRE Innovation Park. However she acknowledged that subjective opinions had to be viewed as such, saying her team at Loughborough University had developed ‘personae,’ grouping individual characteristics to help designers understand “the common denominators” for the different stages of dementia. She admitted: “There is a tension between ‘person centred’ and what other individuals like; it has to be adaptable to some degree.” She referred to Delft University’s programme for profiling dementia patients on a “person-centred” basis,’ saying: “It’s very simple, you just have a chat with people and get to know a bit of their history, the things they like, the things that irritate them.” Rob Hayles said that one attempt to pursue ‘action research’ to develop tailored design with a client in the NHS led to him being told bluntly that it couldn’t be done, as it “too slow, too big, too governmental.” Hayles concluded that “we need to explain to the NHS that we can do better.” Clare Cameron said better design of dementia care facilities would bring general benefits to society, offsetting the difficulties of setting up improvement programmes.


ADF NOVEMBER/DECEMBER 2024


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