I have come across this presentation called 'Reading The Signs' by a woman called Lottie Crumblehome, who is a research associate at the Helen Hamlyn Centre for design at the Royal College of Art. They undertook a project last with year with Bupa looking at wayfinding in care homes for people with dementia.
I have been looking at her research to help me with my project. I have gathered some of her findings;
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.
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.
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.
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.
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.
Many care homes are now designed with this in mind. So that appropriate stimuli will be used to prompt certain behavior 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.
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.
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. Bright, colourful, clear and familiar signs were installed on the toilet and bathroom doors…and subtler shop-type signs were designed for the home’s more unusual rooms, such as the hair salon, cinema and cafe.
‘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. 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…and wall mounted, luminous toilet signs designed to be seen from a distance.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.
And finally, we have our on-brand home. By ‘on-brand’ I mean that the signage had been designed by Bupa’s marketing team, in line with their corporate identity. It provides a very uniform system of red plaques, next to the door to each room.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
No comments:
Post a Comment