1. Eilidh Young Therapy Lead, Older Adults
Beaconsfield East: Creating an “award winning” dementia friendly rehabilitation unit
Eilidh Young
Therapy Lead, Older Adults

2. Alzheimer’s Society, March 2012
Dementia is a complex condition, which can be difficult to assess, diagnose and incredibly challenging to live with, as it is unlike many physical conditions associated with old age.
Easy to see if someone has arthritis and my colleagues and I are very familiar with the disease process and the ways we can provide support – walking aids, pain relief, joint replacements.
Dementia is less obvious to the untrained eye, and as evident from this slide, is much more common that we may think. 1 in 6 people over 80 have some form of dementia.
Since the publication of the National Dementia Strategy in 2009, there has been a clear message to those of us who work in health & social care about the importance of providing good quality dementia care. We could be more effective in meeting the needs of patients with dementia by investing in the way we look after them, as much as in drugs trials and research. The other key point was that we need to do it now, as you can see from this slide that dementia is already a big issue for many people.
Alzheimer’s Society, March 2012

3. I think it’s important to explain why we’ve chosen to invest in refurbishing a care of the elderly ward.
The last census in 2011 showed the following interesting facts;
There are just over 17,100 people over 75 (6.2%) in Hillingdon, which is higher than the average across London.
In the borough, double the number of the national average describe themselves in the census as not being able to speak English very well at just over 3%.
It’s fair to say we have an local population who are older, with more diversity in ethnicity and languages spoken than other areas.
We are also aware that with an ageing population the prevalence of dementia increases, and so it’s important that healthcare services are able meet this cohort of patient’s multifactorial needs – especially as some of them will experience ageing with degenerative and irreversible decline in cognitive abilities which at present have no cure.
Beaconsfield East provides rehabilitation and complex discharge planning for patients with a wide range of needs and abilities. Patients come from across the acute hospital wards when it has been identified that they need intensive rehabilitation and additional intervention from the MDT before they can be discharged from hospital.
If I were to suddenly age in front of you now, and develop difficulties with my memory which meant I found
unfamiliar places bewildering and unsettling
I had difficulty interpreting what was happening around me
Difficulty remembering what I was told, or who I was
and then became medically unwell and needed to come to hospital, what kind of environment might make my stay better, for me, and those looking after me?
Good dementia design can be achieved with the “less is more” approach. Uncluttered spaces, reduction in noise, clearly defined routes, good use of colour, and effective design create positive spaces which help to reduce anxiety, increase familiarisation, and provide calming and welcoming environments.
These are often in contrast to the typical sterile clinical appearance of traditional hospitals. They help patients feel more settled, and in turn can decrease the often complex behavioural and psychological symptoms of dementia.
Thinking about me who has aged suddenly in front of you, I hope you will see that in what has happened to the environment on Beaconsfield East reflects that less is so much more.

4. Previously….
Through the trust’s Dementia Strategy Steering Group, a successful bid was made to the Dept of Health who had allocated £50million to improve dementia services across inpatient and community services to improve the built environment of Beaconsfield East. Specialist support from architects and designers with experience in dementia friendly design proved to be invaluable as you will see later.
This was our starting point!
The ward environment hadn’t changed much since I started working at the trust, on this ward, in October Some improvement works had taken place to upgrade the toilet facilities, but I think we would all agree that it appeared a very clinical environment, which seemed very “busy” with lots of distractions for the eye.
The ward is on the annexe corridor and all on the ground floor, with views over an uninspiring outdoor space. The discharge lounge was based in the ward’s day room and so there was no social dining area for patients.

5. From a good dementia design point of view, there were several challenges to overcome.
The ward corridor was shiny and gives the appearance of being wet. This can create difficulties for people with dementia as their perceptive skills are often affected, leading them to think they are walking in puddles or on uneven surfaces. The lighting was from older style strip light creating a central area of bright light and then shadows on the floor and darker areas of the ward. There was no clear signage or prompts to help people find their way around the ward.
Looking again at these photos, I noticed there are no clues in the space to explain what you might find where. Looking at them now, would you know you were in a hospital?

6. An estate agent wishing to promote all aspects of these photos might describe views to a paved area with mature shrubs and trees. The rest of us may not have been so flattering in our descriptions. The garden space was not accessible from the ward or the bays, and so was rarely used.

7. Following our successful bid, £845K was allocated to improve the built environment of care on Beaconsfield East. Through consultation with ward staff, therapists, patients, carers, an innovative design emerged with support from some very clever and skilled architects and designers who captured the essence of the priorities for the team: Beaconsfield East is a rehab ward filled with dementia friendly design which enhances the environment for everyone who uses it.
Consideration was given to the use of each space and its purpose in rehabilitation and the day to day working life of the ward.
The changes made have transformed the ward environment, and this is reflected in the rehabilitation we can now offer to patients.

8. The ward clerk and reception desk has been moved to the front of the ward to create a definitive arrival point to meet and greet patients and visitors.
A new multipurpose day space has been one of the stand out features for the ward: therapy activity and exercise groups now take place several times a week, and patients are able to stay in this space for their meals.
The ward also gained a much coveted and needed kitchen assessment space. This means patients can practise making hot drinks and snacks as part of their rehabilitation and assessment. The dementia friendly design aspects are quite subtle – glass fronted cupboard doors provide prompts for the objects held in them, and contrasting plug sockets help them stand out from the background wall colours. The walls are plain to avoid creating any distractions for patients, and allow them to concentrate on the task. A retractable partition wall enables the space to be flexible.
The sensory room is a new and exciting development, and provides the team with a space to engage with patients at a sensory level through music, sound and lighting.
A new PC which is preprogrammed with specialist activities suitable for patients with varying levels of cognitive abilities allows the therapists and patients to work together to tailor therapy sessions to their individual interests. We will also be able to assess patient’s cognition in more detail and understand their abilities better. This is an exciting development, and we think the first time this type of installation has been put into an older peoples rehabilitation hospital ward.

9. New flooring with a matt finish, improved lighting and new ceilings are just some of the many transformations to the ward. You will see the yellow door which is now used as the universal indicator on the ward for all toilet and bathroom facilities, alongside a picture of a toilet to give visual cue as to the room’s purpose. Using pictorial signage in addition to descriptions is really important as we can still interpret a picture even if our language comprehension skills are impaired.
In their old My generation will recognise the stick men and ladies signs for toilets as they have been commonly used since the 1960’s and so will still be part of our childhood memories.
For older generations than mine, some people may not be able to recall these signs as their memory regresses, and so pictures give the same effect. Pictorial representations are also very helpful for people when English is not their first language.

10. The bays now have distinct colour schemes to help with wayfinding
The bays now have distinct colour schemes to help with wayfinding. Commissioned artwork uses the garden for inspiration and each painting has familiar plants and flowers alongwith everyday objects. Close collaboration with the artist meant that we were able to create art which would be enjoyable to look at over a period of time, with defined focal points in the design to help with orientation and created a clear distinct “picture” which was recognisable as this, rather than a photo which could look too real and cause confusion. The artwork was chosen not to incorporate things like bees or ladybirds as insects can feature in hallucinations in older people with dementia or delirium!

11. Finally the garden: the design incorporates a returning path creating a safe space for someone to walk, without getting lost. Plenty of seating and scented planting for patients to enjoy with cottage garden plants chosen to stimulate memories and act as a discussion point.
The patio has been relaid and new seating and planting give patients who are not so able to walk around the garden the same opportunity to enjoy the space.
And the jewel in the crown (in my opinion!) – each bay has access to the garden.
So, to take you back to me in my older state – the refurbishment of this space gives an environment which will make me feel better as I work with the team to get better.
It is too early to say whether the changes to the ward will impact on length of stay; the impact we have seen is on things which are almost as important – more social rehab opportunities through groups, more assessments and treatments outdoors, closer working as an MDT to continue to develop our practice together to put compassionate care, safety and quality at the heart of everything we do.