Designing for Compassion

A look at three different approaches to creating effective care facilities and programs

Throughout Alberta and well beyond, health-care professionals, architects, designers and a variety of other experts are exploring new and effective ways of addressing and supporting the needs of individuals living with dementia by creating specific types of environments. Here, we take a closer look at three exciting initiatives.

1 | A Unique Take on Day Programs

In Chula Vista, California, a massive indoor replica townsite for individuals with dementia was designed to provide respite to family caregivers. Operated by George G. Glenner Alzheimer’s Family Centres Inc., Town Square is an indoor, adult day-health care centre where individuals can be dropped off for the day to engage in numerous activities.

What makes Town Square unique is that the model is based on reminiscence therapy. The entire townsite is built to mimic an American town circa 1953– 1961, and it encourages individuals with dementia to reminisce about their past by using specific prompts that stimulate memories. The 1950s/1960s were selected because many individuals with dementia are currently in their early 80s, meaning their strongest memories would have been formed during this period.

The town has numerous vintage storefronts — including a diner, pub, library, pet shop, garage and department store — that offer structured activities designed to facilitate reminiscence. For example, individuals can read period-specific books in the library, try on vintage clothing at the department store or tune up the 1959 T-bird in the garage.

“People will come into this town and go about their day doing different activities within each storefront,” says Lisa Tyburski, director of business development at the George G. Glenner Alzheimer’s Family Centers, Inc. “Because the environment is so large and varied, it gives us dozens and dozens more activities to be able to do.”

Visitors rotate throughout the town in small groups and are grouped based on their cognitive ability and personality (what they like and don’t like). All staff employed at Town Square receive comprehensive training in dementia care, and an on-site nurse can administer medications.

Tyburski says other facilities in the U.S. have offered vintage decor, but not quite to this extent. “We’re able to take that reminiscence therapy to a new and more immersive level,” she says.

2 | Main Street at Schlegel Villages

Creating a sense of community for individuals living with dementia is one of the aims of the “Main Street” design at Schlegel Villages, where various familiar spaces aim to promote planned and informal social interactions between individuals. Based in Ontario, Schlegel Villages operates 12 stand-alone long-term care homes, six continuums (both long-term care and retirement living), and one stand-alone retirement home.

The Main Street design in each Schlegel Village facility is fashioned after a small-town “streetscape” and features several familiar storefronts and destinations — such as a general store, library and café — where residents can interact with each other or loved ones. Windows and skylights flood the area with natural light, and the design is meant to mirror an actual Main Street in a small community. Within each village, the Main Street serves as a connection to nearby “neighbourhoods” where around 30 residents live.

“The beauty of that internal Main Street design is that it still feels like you’re in a familiar space. The use of the brick and the awnings and the wood trim, all those things really do create that sense that you’re possibly in a small town, that you are walking down a small-town street,” explains Heather Luth, dementia program coordinator at Schlegel Villages.

Individuals living with dementia, says Luth, may find trips into the community stressful and may not be able to access public transportation as freely as they once did, and the Main Street design helps give them a purpose.

“It really helps people express freedom,” Luth says. “They’ve got more spaces to explore, more people to connect with and [more meaningful activities] to choose from.”

3 | Embracing the Butterfly Household Method of Care

When Calgary-based Southwood Care Centre adopted the Butterfly Household Model of Care for its 21-bed Willow Park unit, the dull, beige walls had to go.

“We painted — a ton,” says Cheryl Miles, the clinical program leader at Intercare, which operates the facility.

Today, bright and inspiring colours — greens, pinks and yellows — cover the walls of the facility, and the environment has become a representation of the people living there.

The Butterfly Household Model of Care was first introduced in the United Kingdom in 1995 by Dr. David Sheard, founder of Dementia Care Matters, and it has since spread to care facilities around the world. The model is based on the notion that traditional long-term care homes are often devoid of opportunities for meaningful engagement between residents and staff, which can lead to boredom and isolation.

The model aims to improve the lived experience of those with dementia by shifting away from a traditional, task-based approach to care. With this older approach, staff are more focused on completing tasks such as giving medications and feeding instead of forming real connections with residents. The Butterfly Model upholds the belief that “feelings matter most” in dementia care. This is reflected in everything from the environment to interactions between residents and staff.

In February 2017, Southwood Care Centre partnered with Dementia Care Matters for a 12-month pilot project (called a Butterfly Project). The facility received its accreditation in April 2018.

During the transition to the Butterfly Model, Southwood’s two dementia units were renamed Haven Household and Serenity Cottage to reflect a more “home-like” environment.

“Everything you put on the walls, everything you put in the bins, everything you make available to use and to engage with really tells the life story and the life history of the people who live there,” says Miles.

For example, if several residents once counted farming as an occupation, an area with photographs of farmland and objects to engage with might reflect this.

Miles says one of the biggest differences since starting the pilot project is that now the facility feels, sounds and smells more like a home. Today, everyone sits down together family-style and helps themselves at mealtimes. Residents help set the table and clear away dishes.

With the adoption of the model, housekeepers and therapy assistants now cook breakfast on the unit. “Part of their role of engaging is that they’re doing those things with the residents as well. So it becomes much more of that love and connection being shown on a daily basis,” says Miles.

Another Alberta facility, Legacy Lodge, is also experiencing the benefits of having staff sit and be present with residents. Based in Lethbridge, the lodge started its own Butterfly Project pilot in January 2017 and received accreditation exactly one year later. At the start of the pilot, staff completed eight, eight-hour training sessions through Dementia Care Matters that focused on why feelings matter most in dementia care and how to work with residents who have dementia.

“They learned how to nurture [residents], communicate with them, support them and engage them with different things,” says Chelsey Smith, site director at Legacy Lodge. “There are different ways that we can do the tasks [we need to do] and still make it feel more like a home and feel more relaxed.”

Part of creating a more home-like feel at Legacy Lodge meant scrapping uniforms, name badges and nursing stations. Staff now wear their own clothing, and use their “look” to help connect with residents.

Up in Spruce Grove, Alberta, the Copper Sky Lodge has also embraced the Butterfly approach, but has found one of its pillars particularly challenging. The Butterfly Model supports grouping residents based on their stage of dementia, because the needs that are required from caregivers can differ vastly at each stage.

“It’s exhausting for staff because we look at it as having four different stages of dementia that require four different types of interventions,” says Nicole Gaudet, site director at the facility. “It can be difficult to need to use diverse interventions in the course of a 20-minute period.”

Still, according to Gaudet, Copper Sky’s transition to the Butterfly Model has been positive.

“The cottage with the earlier stage became like a pyjama party; vibrant, a great place to be and work and visit,” says Gaudet.

As dementia progresses, individuals need closeness and relate to others in a whole different way. For residents in later stages of dementia, the Butterfly Model encourages greater access to natural light, fresh air and experiences that stimulate the senses, such as visits with children or animals.

“When you go into [our dementia cottages], you see that it’s about love, and you see that it’s about relationships,” says Gaudet.

“I’m a believer that emotionally intelligent and responsive care is what differentiates the good and the bad in terms of all care,” she adds. “If you’re paying attention to what somebody is feeling, then you relate and connect, and then, as a caregiver, you really start to get something because you are being cared about, as well.” [ ]