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A look through their eyes

June 5, 2017
by Beth Thomas Hertz
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Good interior design is an important part of creating safe places in which dementia residents can move about confidently, enjoy a sense of independence and stay safe. “Designing and planning helps enable the caregiving team to provide extraordinary care,” says Mitch Elliott, a licensed architect with RDG Planning and Design, a multistate firm that includes specialties in senior living. “The environment can have a very positive impact on enabling caregivers to do what they do best.”

He and colleague Kelley Hoffman, an interior designer at RDG, shared some thoughts on how facilities can use good design principles to help keep residents with dementia safe and engaged.

Listen to the staff

It’s important to employ best practices in dementia-friendly interior design, but design consultants should never underestimate the importance of staff input at a facility, Hoffman stresses.

“We should follow certain rules about the best ways to help people with cognitive disorders, but you need to marry that with the community’s needs,” she says. “We might go into a facility thinking we can’t use certain design elements or, we will think something is perfectly fine, but the staff may say it won’t work for their residents. We need to respect that.”

As an example, Elliott has seen caregiver feedback change the way bathrooms are designed. “We listened to a certified nursing assistant who said, ‘It would be helpful if you would move this toilet to the other wall, giving us better access.’ And we realized that was a great idea,” he says. “We, as designers, really have to drop our pride, drop any arrogance that might be there and know that we can learn a ton from the people that are really doing the work.”

What do your rooms look like to someone with cognitive decline? Everything from flooring patterns to lighting can help or hurt a resident’s ability to navigate safety and enjoy their surroundings. Elliott and Hoffman take a trip through the most commonly designed spaces to show how specific design elements are interpreted by the dementia-affected brain and how design can be used to encourage healthy behaviors in residents with cognitive decline.


When it comes to choosing flooring for a senior living space that serves residents with dementia, Hoffman advises staying away from busy patterns and high-contrast finished materials. However, “You have to balance that with the practical side in terms of maintenance, making sure there is enough pattern that will be forgiving of some soil and staining and will wear well. It’s a fine line,” she says.

Avoid flooring that has a high gloss or a glare under the room’s lighting, since the shine can confuse residents with dementia. “In particular, don’t use anything that will create the illusion of wet floors and discourage a resident from walking across it,” Elliott advises.

This tile mosaic could look like broken glass to a person with dementia.

Carpeting can present visual and navigational issues, Hoffman notes. “We look for a short-pile carpet that is easy to navigate with a walker or wheelchair,” she says. “The texture may make it look like it isn’t [easy], which can be all it takes for a person to feel like they have a hard time getting from point A to point B,” she says.

Transitions between flooring surfaces also are crucial, both as a tripping hazard and a confusing change in surface feel. The age-old technique of using metal or wood transition strips to cover the edges of two different flooring materials creates a cumbersome bump on the floor that can be difficult for people with vision, gait or balance issues. The good news, Hoffman says, is flooring manufacturers have made great strides in creating fusible materials that allow smooth transitions between carpet and hard surfaces. Smooth flooring transitions also benefit staff members because they decrease falls risk and keep wheelchairs and walkers from getting stuck.

Flooring philosophies have changed over the years as the industry has learned more about dementia-related behavior, Elliott adds. For example, it was once thought that putting a solid dark patch of flooring in front of the exit doors would discourage residents with dementia from trying to leave, since it was believed they would perceive it as a “hole” they could not cross. “We thought we were tricking them, but when they see other people walk across that area and leave, they realize it’s the way out and try it for themselves,” he says.


A better way to discourage residents from trying to leave or go into otherwise unsafe areas is the strategic use of increased lighting in places you want them to feel free to go and decreased lighting in other areas, Elliott says. “I think lighting is one of the exciting new frontiers that we as designers are going to be able to incorporate into spaces that will really make a difference in the lives of our residents.”

Spot lights and some track lighting can be harsh on elderly eyes and can confuse the circadian rhythm.

One of the most interesting technologies available today is tunable lighting, which changes the intensity and temperature of lighting to better emulate varying times of day and help residents maintain proper circadian rhythms. Warm yellow lighting may emulate a sunny morning, while cool blue lighting can mimic dusk.