Help to anticipate Help to live with dementia Implementation of a dementia friendly environmental design model for SCUs congruent with Human Rights. ADI-London / March 9th 2012

Domestic orientation of care and design Existing models Three main orientations of environmental design for people with dementia: (1) therapeutic : relate to a mind-brain approach consisting in compensating “for functional losses” (Zeisel, Hyde & Levkoof, 1994; Calkin, 1988 ; Cohen & Weisman, 1991; Hiatt, 1991; Lawton, 1990) (2) ergonomic/prosthetic : design of facilities should compensate for disability and maximize independence (Marshall, 1998; Fleming, Crookes & Sum, 2008; Fleming & Purundare, 2010) (3) experiential : focus on how the environments can encourage pleasurable and satisfying behaviors amongst the people that live or work in them (Davis, Byers, Nay & Koch, 2009) Domestic orientation of care and design Integrative approach (physical, social and organisational) Transactional approach of human-environment Environment and Human Rights K.Charras 09/03/2012

4 key principles: Respect, Freedom, Dignity and Equality . WISDEM network statements (www.wisdem.org) “the physical environment has little purpose outside of a value system” (Wisdem network, 2011) Human Rights are “a starting point for a discussion of the purpose of designing environments for people with dementia “ appearance and use of the environment should enable people with dementia to exercise their Rights satisfactorily (Charras et al., 2011) The WISDEM network recommends the HR articles: 1, 3, 12, 13, 17, 25 and 27 of the 1948 Universal Declaration of Human Rights to be considered when conceptualizing and designing facilities. 4 key principles: Respect, Freedom, Dignity and Equality Environment and Human Rights K.Charras 09/03/2012

NO READY MADE RECIPIES AVAILABLE! Different environmental approaches Ergonomic/therapeutic Homelike/familiar Environmental changes cannot only be seen as physical changes Design/architecture Social (carers and family) Organisational Role of culture What works somewhere may not work elsewhere Ethics and Environment Look out for the people Designing living environments ( residential and domestic areas) Human Rights Environment and Human Rights K.Charras 09/03/2012

. Method Aim: determine an environmental design model based on HR principles Evaluation grid based on the generative conception method (organisation and use of space) within Respect, Freedom, Dignity and Equality divided in 3 themes: respect of independence, equalities of Rights, respect of norms and values 6 SCUs for people with dementia in France (3 for observation, 3 for validation) All the units were composed of 10 to 12 bedrooms with suites, a dining room, a sitting room, a kitchen, an activity room and corridors. All of them had access to outside areas. 2 independent observers Data processing: Content analysis Environment and Human Rights K.Charras 09/03/2012

Method results : 6 dimensions . Method results : 6 dimensions Dimensions Sub-dimensions Structure of space :Structure of space relates to physical and symbolic division of space enabling it’s users to represent them self and to use the place in which they evolve, according to their norms and values and in with socially adapted means. Quantity and variability of spaces Accessibility of spaces Space induced social cohesion :Social cohesion through space relates to the congruence between structure of spaces and uses that are made of it in order to facilitate social relationships, adapted behaviors and caring of residents. Sharing of spaces Congruence/legibility Atmosphere : domestic or institutional atmosphere can be characterized by the physical and social features of the setting. Usage Appearance Privacy: Privacy relates to the quality of a setting as it is lived, perceived and embraced by its occupants according to their intimate and personal characteristics. Intimacy Appropriation of space Display of care: The way care is displayed within a setting enables to observe the balance of the relationships between caregivers and residents (assistance, authority, collaboration, empathy) in its physical and social dimensions. Professional positioning Vocabulary Control : Control implies supervision and surveillance of residents within their own spaces in order to keep them secure as well as to optimize institutional functioning. Common spaces Private spaces In professional spaces Environment and Human Rights K.Charras 09/03/2012

Human Right Principles . Results : Transposition of HE dimensions to Human Rights Human Right Principles H-E Design dimensions Respect Freedom Dignity Equality Organization of space use the space according to norms values & affects Promote diversity in terms of use with socially adapted means facilitates independent access to different places Social cohesion through space promote adapted behaviors of caregivers toward residents supportive design to promote adapted behaviors facilitate social relationships, and care encourage sharing between caregivers and residents Domestic atmosphere Wished activities according to social status exclusive and extended control feeling at home investment /modeling of settings of residents and caregivers Privacy Enable residents to express their identity enables residents to establish their landmarks regulation of social relationships Express a status towards and within a group and/or a community Display of care Position of professional caregivers toward residents Environmental means used to support orientation of care Vocabulary used by professionals in presence of residence Balanced carer/resident relationships Control Non-intrusive of residents’ intimacy Freedom of movement attitudes toward private spaces secure residents and optimize institutional functioning

. Discussion Dimensions, use of space useful for counseling: Setting arrangements are suggested according to the desired and the factual use of space Setting arrangement can differ from one place to an other according to the culture, organization of care Leaves space for more than one architectural response for people with dementia Tran-cultural (at least for societies that rely on HR) Respectful of HR Needs to be evaluated in term of quality of life, ADL’s, behavioral outcomes (would we feel like staying in an SCU for a whole week?) Comfort and quality of life orientation of design based on the natural and wished use of space Environment and Human Rights K.Charras 09/03/2012

Examples of common spaces designed according to these principles model of intervention Examples of common spaces designed according to these principles Charras, K., Eynard, C., Viatour, G., Frémontier, F. (2011). The Eval’zheimer® model: fitting care practices and environmental design to institutionalized people with dementia. Neurodegenerative Disease Management, 1(1), 29-35. Environment and Human Rights K.Charras 09/03/2012

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Thank you for your attention K.Charras charras@med-alz.org www.fondation-mederic-alzheimer.org