My Day in a Secure Dementia Unit

As an architect – I have wondered how the care environments we design really feel like and function from the resident and carer perspective. We design places clinically referred to in the briefing documents as ‘dementia specific units’ (DSU), or ‘secure unit’ or just, ‘the dementia wing’.

But really – what does it feel like when it is built and done and becomes a permanent home for 15 or 20 elderly people?

I had the significant opportunity to work as a volunteer in a dementia specific unit in a newly built nursing home that Calder Flower had designed. A valuable experience – and a chance to observe a daily routine and the pattern of a dementia household as well as to check out the success (or not) of a place we had laid out.

This is a home to 22 high behavior residents. Male and female and of varying cultural origins. Some didn’t speak English, but spoke Italian or Russian, and some didn’t speak at all.
There was one man who sang.

First up – it was confronting and incredibly unfamiliar. I felt awkward and unsure and knew nothing about any of the residents. I had little idea about what to expect from them and their ‘behaviour’.

But gradually I got to know some of them a little and they me. Each resident was unique – they all presented with the individual characters and personalities of people anywhere – not just as disturbed characters that I had heard of. But yes, several of them appear to believe they are elsewhere … in a train station; at a beach suburb; in a place only they can see. Some move around untiringly with brief pauses to sit and stop.

The wandering paths through the unit and the free unrestricted access to the really lovely gardens and sunny outside do work and I felt happy to see how successfully they are used. Some residents talked, one man sang as communication, one just smiled almost constantly but did not speak, some chatted to one another – about things the other know nothing about but seemed particularly interested and responded with a totally unrelated answer that was met with the same unrelated but enthusiastic reply!

The group represented a range of nationalities. A Russian man who was quiet and withdrawn and looked sad was dressed in beautifully tailored clothes and  became happy and responsive outside in the garden and clapped his hands over and over shouting ‘Holla!”

Some of what I saw was distressing and difficult. Moods changed from happy to aggressive, kind and sweet to mean and accusatory. But the staff are familiar with the emotional changes and were gentle with their response and actions.

Meals and refreshments were delivered and served. The dining experience is a major part of the day. I could see how staff and residents coped and dealt with the challenges. Challenges of firstly seating everyone – there was a lot of changing seats and companions and general distracted getting up and down before the food arrived. One lady kept packing the utensils away into her handbag, so new ones had to be re-laid and the packed up ones subtly recovered.

When the food arrived, it was simply plated away from view and then served. The residents were patient in waiting to be helped. Some could eat unaided and with hearty appetite but others ate slowly and little needing much encouragement and assistance.

Surprisingly no one complained about the food – although it didn’t inspire me. A mix of brown and green, chicken and meat and salad with thick gravy and then a bright coloured custard desert cake that was surprisingly well liked.

I was aware of enormous waste however, as most of the uneaten food was unceremoniously scraped into a black plastic bag and discarded.

I was unprepared for several things …

The lack of anything to do and the dominance of television. The staff were excellent but there are few and they are very busy with the full routine of showering residents, changing bed linen, getting people up and moving, giving medications etc.

Most residents found themselves unoccupied and either stared into space or searched for something of interest.

Because the TV was on – the curtains were closed on the lovely north-facing lounge that overlooks established gardens and outside spaces. The perfect clear autumn day was closed off from the inside in favour of ‘Wolverine’. No-one even seemed vaguely interested in the content of the movie, but in an unexpected way they seemed to like the movement and action – of which there is plenty.

One lady was very friendly and perky and gently took me around to show me her places. A delight this was because the internal courtyard was her ‘place’. She showed me her collection of coloured watering cans and various plants and described all sorts of things – seen and unseen. The open courtyards are a feature that adds value to the corridor as a functional outdoor room and fills the corridor and adjacent spaces with natural light and fresh air.

Overall, the household was bright and happy. The indoor environment is naturally lit with daylight and extends views through so that residents can move through it with ease and calm.

This does not appear to be a confusing environment to live in. It is simple and legible and destinations are visible from a distance because circulation spaces are generous and open up to merge into living areas and thresholds to resident rooms with doors to the outside. There are no actual doors to living areas, but screen walls and alcoves instead. In this way no one is trapped.

The spaces are not fussy or cluttered but have a positive defining colour palette and a range of complimentary materials and textures.

The unit smelled fresh and clean, the atmosphere was warm and I have often found myself wondering about how those lovely sweet people I met briefly in that one day are doing.