1. 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

2. 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

3. 4 key principles: Respect, Freedom, Dignity and Equality.
WISDEM network statements (
“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

4. 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

5. .
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

6. 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

7. 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

8. .
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

9. 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),
Environment and Human Rights
K.Charras
09/03/2012

10. Before

11. After

12. Before

13. After

14. Before

15. After

16. Before

17. After

18. Before

19. After

20. Thank you for your attention K.Charras charras@med-alz.org