A positive, home-like environment for people with dementia can give personal enjoyment. For comfort and pleasure, a person first has to feel at home in a familiar personalised environment. Many people with dementia, depending on the stage of impairment and personal likes, want a more active connection with their environment, and that benefits their health.
Changes you can make now
- Create an office area for those who want to ‘go to work’, with desks, files, paper and a computer.
- Arrange tables with materials for flower arranging: flowers, leaves, vases and ribbons. Leave them for people to come and go as they please.
- Give staff time to regularly look at each person’s life story and update it in consultation with family members and the person with dementia.
- Set up a film club, choosing appropriate films and shows for regular showcasing.
- Attend local concerts or invite local singers to perform at the facility.
- Hold a bingo night for people with dementia and family members.
- Encourage people to take a stroll around the garden before or after a meal.
- Arrange a visiting pets program such as PALS, Lort Smith Animal Hospital.
- Join the Department of Health and Human Services Healthy Ageing Online Network to share ideas about healthy ageing.
- Build a shed in the facility’s outdoor area for people who want to potter about using tools, listen to the radio or rummage in drawers.
- Buy an old car. Put it in the driveway or backyard to create a sense of familiarity, encouraging activities like tinkering and washing and sitting in the car.
- Put in an activities kitchen so people can wash and prepare vegetables, make biscuits with supervision, put crockery and cutlery away and help themselves to snacks.
- Set up children’s play equipment to encourage families to visit, and giving people pleasure in watching and hearing children play.
- Employ a qualified activities coordinator to work out and run a diverse program of outings and on-site experiences to meet the needs of people at different stages of dementia.
Creating opportunities for personal enjoyment
Regular physical activity can:
- lift a person’s mood
- help deal with negative feelings
- improve sleep
- reduce tension levels
- reduce feelings of stress or fatigue
- increase energy.
Personal enjoyment can be promoted in the smallest social contact, for example, a one-to-one chat producing a smile or effort at communication. People’s capacity for enjoyment can expand by designing activities and the spaces where they occur to extend a person’s connection with the world around them.
Personal enjoyment is improved by an active sense of belonging through joining in daily life tasks and in planned daily life activities. Past practices in residential and respite facilities have often infantilised people with dementia, through inadequate stimulation, unsuitable activities, and poor design of indoor and outdoor spaces for dementia-friendly activities.
To improve people’s involvement, think about how and when to encourage them in different relevant experiences. For example, include:
- physical and social life experiences
- experiences to build on people’s existing strengths and past histories
- experiences reflecting different areas of life everyday life
- experiences around daily routines
- planned activities needing special spaces, equipment or events.
Home-like environment checklist
Daily living and past social roles
Learn about and accept a person’s lifetime of experience. This lifetime is a person’s social and cultural history. Understanding a person’s life-story, likes and interests is vital for their personal enjoyment.
Many everyday activities are linked to social roles helping define who we are, and give confidence and enjoyment. Dementia has a major impact on people’s ability to hold on to roles of meaning and purpose. Well-planned daily life experiences can tap into that past and extend existing skills.
It has been said ‘activities comprise the stuff of everyday life’ (Kuhn et al., 2004). Successful activities support and build on everyday life. It is not having something to do that is important, it is having something meaningful or purposeful for the person involved. It is often thought people with dementia are no longer ‘themselves’, but their past histories continue to shape who they are and what they like.
Creating a life story
Life stories help staff understand a person with dementia as a person with unique needs and interests. Gathering information for a life story can help staff shape enjoyable daily experiences in line with a person’s past roles and interests. Recording a person’s life story and gaining a social understanding is basic to dementia-friendly care. A life story should have information about a person’s:
- previous jobs
- domestic interests
- recreational pastimes
- spiritual views
- family members
- family history
- homes and neighbourhoods
- nationality and countries of residence.
Build a picture of the whole person. Talks with family members, friends and past neighbours, where possible, help give a background to how a person lived before residential or respite care. While this information should be treated as confidential, it is important to share it with staff so it informs everyday interactions and planned daily living.
Maintaining personal identity: respect and dignity
Meaningful and purposeful daily living
Day planning is part of healthcare design. Group and individual planned events have real benefits, but people with dementia often find it hard to keep joining in. Design daily life routines and activities around abilities of people with dementia.
A meaningful experience must have a purpose, be voluntary, feel good and give a person with dementia a fair chance of success (Alzheimer’s Association USA, 2007). Familiar life experiences drawing on the past are deep in long-term memory. This is the secret to designing meaningful and purposeful living.
Purpose: For direction and ongoing interest, daily life needs to have simple aims, with practical, useful tasks rather than simply diversional ones.
Voluntary participation: People must want to join in. For example, some people have never enjoyed group activities and should not be forced to join in if they do not want to. Some may quickly take part, and others want to be formally invited to join in.
Enjoyment: To draw on deep memories and create familiarity, people’s preferences and past roles in life should inform daily life experiences.
Success: Daily living should be failure-free. People should not feel forced to act in ways they find uncomfortable or be reminded of limitations caused by their cognitive impairment.
Example - knitting
The photo shows an older woman knitting. If knitting was a pastime throughout life, it may be remembered and the ability remain when other memories and abilities have long gone. Finding out through talking to others and having a record can provide information about some purposeful activities to try.
Example - playing the piano
The photo shows an older woman playing the piano.
Familiar experiences and activities drawing on the past are deep in long-term memory. Find out what people with dementia used to do and enjoy – they may still be able to do the activity even when they are unable to communicate about it themselves.
Failure-free daily living
Failure-free living encourages ongoing partaking in life and gives a sense of achievement. For interesting failure-free living:
- Keep activities simple.
- Keep decision making within a person’s skill level.
- Break complicated activities down into steps so there is early success.
- Avoid experiences needing new skills.
- Avoid experiences demanding long attention spans or good coordination.
- Design small-group and one-on-one experiences for those with greater cognitive impairment.
- Avoid activities highlighting or exposing impairments.
- Use reminders and orientation cues for those in early to middle stages of dementia.
- Give accurate information about each task and activity.
- Do not force people to join in.
- Be aware some people want to watch and others want to be formally invited to take part.
- Make sure experiences are suitable for adults.
- Provide the right background for experiences.
Activities: living with meaning and purpose
Physical design for successful daily living
The physical environment helps promote activity and encourages people to join in. Design for mobility through wayfinding methods promotes independence and a positive sense of self. Physical design should support different experiences in different spaces.
Activity kitchens let people join in ordinary domestic tasks: washing vegetables, washing dishes, setting tables, sweeping floors, getting drinks and snacks, baking and/or decorating biscuits. If a facility does not have an activity kitchen, work areas for domestic activity can be created with small tables, a small fridge, a microwave or toaster oven with safety features, an old cupboard and a display of familiar kitchen items.
Inside work areas can be created reflecting people’s past interests and jobs. An office area, with a desk, chairs and other features, like writing pads and pens, a typewriter, reading lamp and file folders, may call on past memories and give pleasing experiences for some people. Access to a computer may be appropriate. For others, flower arranging may trigger memories and feelings. Set up a table with vases, dried or fresh flowers, and a few ribbons. This simple arrangement can absorb a person for many hours.
Work areas can be created in public spaces, a specific activity room or in a person's bedroom.
Example - access to a computer
The photo shows an older man using a computer - an everyday activity for many people. Computer skills may remain, and computer work may provide someone with dementia with a purposeful activity that brings calm and focus, even for a short time.
Outdoor spaces give options for people to connect to familiar experiences. A shed with tools for use, shaded rest areas, areas with tables and chairs for eating and having afternoon tea, a clothesline and a play area for visiting children can give much personal enjoyment.
Example - clothesline
The photo is of a rotary clothesline in a fenced backyard. The clothesline can encourage participation in daily tasks, and facilitates wayfinding, while providing an environmentally-friendly way to dry clothes. Everyday tasks like hanging washing can give people with dementia a feeling of purpose. The fence discourages wandering and helps with wayfinding.
Gardens and outdoor spaces
New residential facilities
Some people with dementia rummage through cupboards and drawers and hoard objects. This can be upsetting to other people and can be guided into non-intrusive activity. Set up a box or chest of drawers with objects that feel different near a busy place in a facility or tucked away in a remote corner and watch to see if it is used. Bookcases or shelves with books and small objects can serve a similar purpose for people who rummage.
Home-like environment checklist
Rummaging and hoarding
Case studies - Margriet Manor and St Laurence Costa House
The Eden approach to care helps older people live meaningful lives where they contribute and feel worthwhile by empowering residents and staff, building relationships and team-based work. It seeks to remove loneliness, helplessness and boredom from the lives of people in facilities and uses animals, children and plants to promote quality of life.
DutchCare uses the Eden Alternative™ at Margriet Manor in Kilsyth, re-introducing companionship, sense of purpose, variety and spontaneity by bringing dogs, cats, birds, children, plants and visitors into day-to-day life. Older people teach children chess, read stories, fold washing and give advice to staff members.
Margriet Manor runs school holiday programs, allowing staff to bring their children in before and after work. Staff are given time to take and collect their children from school. Family visitors help look after the facility’s pets, are involved in activities, and sometimes learn Dutch at the facility to communicate with parents who have reverted to speaking Dutch.
St Laurence Costa in Lara includes:
- a care farm with different animals that people with dementia, staff and volunteers care for
- a shed with tools for farm activities
- an aviary
- vegetable and herb gardens and fruit groves.
Issues to consider
- Lack of knowledge of a person: their likes, dislikes and wants
- Lack of a home-like setting to support independence, mobility and joining in
- Restricted options for interesting daily life events
- Daily experiences that do not mesh with a person’s life experiences
Dad’s much happier now
Sitting here watching dad in his rocking chair in the shade of a tree I could for a moment forget he doesn’t know me. He pulls himself out of his chair every so often, strolls onto the bowling green and lays down a few bowls, just like he used to. It’s a small green and the bowls aren’t heavy. The green has some kind of synthetic covering that reduces the risk of injury if people fall. They have chairs around the side of the green and other people all clap no matter who does what. They seem happy. Some people who are not as far along as dad serve drinks from that bar at the side of the green. It’s a great idea. Everyone is involved in some way. They even get dressed up for bowls! I understand the local bowls club sponsors this ‘club’ and this brings the community here on a regular basis; they have barbeques, drinks, even ‘prize nights’.
Research says ...
- Activity programming is important in healthcare design.
- People with dementia are often more capable than they or their care providers realise.
- Breaking down everyday living into small, easy steps and changing the physical and social environment to meet specific needs encourage people to join in.
- Creating a home-like environment gives a chance to join in simple but meaningful and purposeful life experiences.
- An activity kitchen, living room and small laundry make a facility more like home and give choices for purposeful daily living.
- More freedom of movement improves daily experience.
- Having different stimulating group and individual experiences has many short-term benefits.
- How people with dementia are invited to take part is crucial.
- Some people with dementia do not find joining in structured activity programs useful or enjoyable.
- Daily life activities giving options for people to draw on past roles and experiences are likely to be enjoyable.