Reading the signs Wayfinding in care homes for people with dementia

Transcription

1 Reading the signs Wayfinding in care homes for people with dementia Hi, I m Lottie, I m a research associate at the Helen Hamlyn Centre for design at the Royal College of Art. Today I m going to talk to you about a project we undertook last with year with Bupa looking at wayfinding in care homes for people with dementia.

2 We were interested in finding out more about at how people with dementia find their way around in care homes. And what sorts of signage systems are useful in guiding people around these spaces. It s the dementia aspect that makes this such a unique kind of way finding project, as people living with the condition are likely to become disorientated more easily, even in once familiar surroundings. Such problems are magnified when a person moves into these kinds of unfamiliar environments often made up of long winding corridors. Dementia is not a disease in its self, but is a general term used to describe the symptoms of a range of diseases and conditions, the most common of which being Alzheimer's disease and vascular dementia. These diseases can cause damage in different parts of the brain, meaning that it s hard to define typical symptoms, but dementia is generally associated with problems with memory, communication and reasoning. It can affect a person s ability to interpret the world around them, process information and act decisively. Typical signage systems are not always meaningful to a person living with dementia, as they rely on a exactly the kinds of mental processes that people find harder as their condition progresses. For example, remembering which room number you are looking for, decoding information from your surroundings and choosing between options.

3 This project began with visits to a range of Bupa care homes, documenting the signage that is currently used, and talking to care staff. All sorts of different signs are put up in different homes, with no clear idea of what is useful and what is not. One response is to err on the side of caution and put up lots of signs, unfortunately creating confusing environments that feel more like an institution than a home. In order to design a better wayfinding system it was clear that we needed to understand more about the condition, but also more about the day-to-day life of people living in these homes.

4 Literature review The project began with an in depth literature review, to find out what is already known in this area and build a hypothesis for testing.

5 People with dementia may have problems in distinguishing relevant from irrelevant information and screening out visual clutter; a tendency to either not notices signs at all, or to read all of the signs indiscriminately; problems with decoding symbols and abbreviations. Passini, R., (1999), Wayfinding and info processing in dementia, Visual Information for Everyday Use, Taylor and Francis, pp By looking at this existing research, we could uncover a number of particular problems that may affect people ability to navigate their way around. For example, people with dementia may have problems in distinguishing relevant from irrelevant information and screening out visual clutter; a tendency to either not notices signs at all, or to read all of the signs indiscriminately in a way that can lead them to loose sight of the reason for their original search; problems with decoding symbols and abbreviations;

6 Some people with dementia have a tendency to wander without any apparent aim. They tend to explore to find their destination. Instead of planning to do something or go somewhere, people with dementia tend to respond to stimuli within their environment. Passini, R., (1999), Wayfinding and info processing in dementia, Visual Information for Everyday Use, Taylor and Francis, pp Some people with dementia have a tendency to wander without any apparent aim. They tend to explore to find their destination. And instead of planning to do something or go somewhere, people with dementia tend to respond to stimuli within their environment.

7 Many care homes are now designed with this in mind. So that appropriate stimuli will be used to prompt certain behaviour or cue memory. This is done by creating naturally mapped environments that have an obvious use where appropriate furniture, fittings and décor tell us that a particular room is a lounge, a dining room, or a bedroom. This is in contrast to the large amorphous communal spaces of older care home that are given meaning through themes, colour codes and signage. This approach helps these homes to feel less like an institution. But it may also allow us to put up less signage, therefore reducing the visual clutter that causes problems for many residents.

8 Comparative study To test what level of signage is really helpful, a comparative study was set up across three of Bupa s more recently built dementia specialist care homes, to test three different approaches. This would allow us to gain insight into what life is really like in these homes, and find out more about what the wayfinding problems really are.

9 The uncluttered home Firstly we have the uncluttered Home. Here, in this brand new home, I worked with Bupa s property team to avoid visual clutter and focus attention on just the most essential signage.

10 Bright, colourful, clear and familiar signs were installed on the toilet and bathroom doors

11 and subtler shop-type signs were designed for the home s more unusual rooms, such as the hair salon, cinema and cafe.

12 Next we have our co-design home. The co-design home

13 Co-design means I worked with staff in this home to develop their own ideas. This home has already been open for a couple of years, and is full of really enthusiastic staff who love making things for their home, and we created installations for testing.

14 Staff felt that he biggest problem in this home was that it s not possible to see door signs when looking down a corridor, so we made bunting that would display room numbers above bedroom doors

15 and wall mounted, luminous toilet signs designed to be seen from a distance.

16 We also looked at how we could add more environmental cues to give an idea of what happens a different rooms such as large menu boards outside dining rooms.

17 And finally, we have our on-brand home. The on-brand home

18 By on-brand I mean that the signage had been designed by Bupa s marketing team, in line with their corporate identity.

19 It provides a very uniform system of red plaques, next to the door to each room.

20 Findings To judge the effectiveness of these three approaches, three days were spent in each of these homes conducting observations. This time was used to understand how residents interact with staff, each other and the space they are living in. Looking at how residents find the toilets and their own rooms. What happens at meal times, when residents wake up, and at the end of the day.

21 Confident and mobile This uncovered the real range of behaviour common to each home that broadly correlates to the progressive nature of dementia. At one end of the spectrum we have residents who are still fairly confident and mobile. People in the earlier stages of dementia are more able to remember the layout of the home and navigate independently. They are more likely to use the toilets in their own room and tend not to have problems finding them. They will only wander because they are looking for something to do. However, they aren t necessarily completely aware they are living in a care home but may mask their dementia very well.

22 Confident and mobile Confident but infirm Then there are residents who are confident but infirm. These residents are often slightly more frail, but struggle less with memory. They tend to only ask for help with mobility. They are able to find the communal toilets independently, and use them more often than others. This may be because they prefer to walk less far, or have previously suffered with incontinence and have concerns about reaching the toilet in time.

23 Confident and mobile Confident but infirm Confused but communicative Next we have those who are confused but communicative. These residents struggle to remember the location of rooms within the home. They are often quite mobile and will walk the corridors looking for their destination. They seem unable to build up a cognitive map of the home, or retain information about their surroundings. They will ask for help to find their rooms or the toilet. They are able to recognise the toilet signs, but will ask for help from staff before they look for these.

24 Confident and mobile Confident but infirm Confused but communicative Confused and uncommunicative There are those who are confused and uncommunicative These residents are often described as wanderers. They struggle to communicate what they are doing or looking for and their behaviour often seems aimless, or routed in a different time or place they may be looking for a family member who is no longer around, or acting out routines from a job they used to do. Staff look to interpret this behaviour and learn the signs that these residents need the toilet or are likely to get agitated.

25 Confident and mobile Confident but infirm Confused but communicative Confused and uncommunicative Up and about but dependant Next there are people who are up and about, but dependant on help from staff. These residents in the later stages of dementia require prompting to do everyday activities, such as eating and dressing, and are likely to have problems with continence.

26 Confident and mobile Confident but infirm Confused but communicative Confused and uncommunicative Up and about but dependant Bed-bound And finally there are residents in the end stages of dementia who are bed-bound and unable to leave their room unless assisted. They are visited in their rooms by family members, and staff bring their meals to them.

27 We get to know the people living here. Everyone s different. What will work for one person won t necessarily work for another. Bupa Care Assistant This said, it s important to remember, that there are no constants with dementia, people s conditions can change sometimes from day-to-day and certainly over time. As I was often told by staff, solutions are not always universal. I could see the brilliant job the carers did of getting to know residents and developing individual strategies to help them settle in to life in the home. However, certain approaches seemed broadly more successful than others.

28 For example, from the observations in the homes, we saw that the residents who were unsure of where to go were more likely to look for a member of staff to ask than they were to look for a sign. However, some of the signs made it easier for staff to offer directions than others. Brightly coloured, distinct, clearly recognisable, signs mounted at eye-level on doors, gave clear markers for carers to point towards.

29 In fact most of the interventions we tested were more useful as landmarks carers could refer to when interacting with residents, than they were as sign posts that residents might notice independently. For example staff found the menu boards provided a useful talking point, allowing them to point out not only that this is the dining room, but also, what time or day of the week it is, based on what s on the menu, as for example, fish is always served on a Friday.

30 The biggest problem in all the case study homes was that different corridors look to similar

31 One of our ladies will go to the bedroom in the same place as hers, but on a different corridor. She ll then get upset that someone is in what she thinks is her room. Bupa Care Assistant This increases disorientation and and leads to problems locating particular rooms. A carer told me One of our ladies will go to the bedroom in the same place as hers, but on a different corridor. She ll then get upset that someone is in what she thinks is her room.

32 The bunting tested at Warren Lodge offered one solution to this, but there are many other ways of differentiating one corridor from another. Such as more distinctive use of colour in different areas of the home.

33 The observations also gave us insight into what doesn t work. Such as signs mounted high on the wall, which, despite being more noticeable from a distance, seemed to go unnoticed by residents, who tend to look down as they walk.

34 THE FINDINGS! Use solid shapes "##Avoid line drawings Signage should not be thought about in isolation, but within the context of its environment. This includes considering aspects of interior design, as well as what life is like in the homes day to day; how residents interact with staff and with their surroundings. Identifying the key decision points When looking to add greater differentiation between corridors, the rst step is to understand where these points of difference are needed. You can do this by either walking around the home or looking at a oor plan and identifying all the places where a person will have to make a decision about which way to go. We call these places ë decision pointsí ; they are places where people have a choice of direction to take. In the example opposite the key decision points, and choices of destination, are described. These decision points are the places where we need to create real difference in what people can see in their line of vision in each direction. So, when a person exits a room into a corridor, they are not faced with two options that look identical. When exiting the lounge or dining room, the two adjacent corridors should look different. When exiting their bedroom or the communal toilets, they should be able to see different destinations at the end of each corridor. A EXITING BEDROOMS Dining room or the lounge EXITING BEDROOMS 1 13 OR THE TOILET Destination point A or lounge, nurses station and rest of the home EXITING THE DINING ROOM Left for toilet, bedrooms and destination point B or straight ahead for bedrooms 1 22 and the lounge dining room reception wc wc lifts nurse lounge 23 wc EXITING BEDROOMS OR THE TOILET Destination point B or the dining room and the rest of the home EXITING THE LOUNGE Left for toilet, bedrooms 1 13 and destination point A or straight ahead for bedrooms and dining room B Colour pallets allowing for greater contrast between corridors. Zone 1 Zone 2 Zone 3 READING THE SIGNS: WAYFINDING FOR DEMENTIA CARE 25 READING THE SIGNS: WAYFINDING FOR DEMENTIA CARE 27 At the beginning of the project, my brief was to provide Bupa with a manual, outlining guidelines for signage that could be rolled out across all of their homes. But as the project progressed it became clear that what we really needed was a more holistic approach, that also considered aspects of interior design, the kind of care provided, and an understanding of what life is like day to day in the homes; understanding how residents interact with staff, each other, and their surroundings.

35 Implications for designing other assistive systems So, finally. What are the implications for other assistive systems. Well, I think it s important to remember that design solutions are always specific to their context, to it s hard to make direct links between a particular solution for wayfinding in a care home and the design of a telecare service, but I do think there are learnings from our approach can be applied in this context

36 Define and explore the problem before you settle on a technological solution. Firstly, don t start the project assuming you already know the best outcome. As I just mentioned, over the course of this project, I found that on its own signage not necessarily the best way to improve orientation in a care home. Similarly, you may have in mind a particular technology you are keen to use in a project, but until you ve really understood the problem at hand, you won t know that this is the best solution, and by narrowing your brief so early, you may miss other, better solutions.

37 Test your system to see how it will really be used in practice. Get to know your users. Spending real time observing the day to day lives of the people you are designing for will help you define your problem and shape appropriate outcomes. People s lives and behaviours are never simple. Try to look at all the factors that are at play and think about if there are other problems that must be addressed by other means in order for your project to be a success.

38 You aren t just designing for those being cared for, you are also designing systems to aid carers. And finally, make the most of front line staff. If you are delivering any kind of service, these are the people who need to be well trained, well briefed and motivated. I was really lucky to work with really great care staff at Bupa who were able to offer the compassionate, reassuring human aspects of care that technology will always struggle to replace.

39 Thank you for your time.