Dementia-Friendly Design: From Care Homes to Homes That Care

By James Botterill, Director, HSSP Architects (

Supporting people with dementia and its devastating impact is one of the greatest health and social care challenges of modern times. The care home sector has grown significantly to keep pace with the demands of the UK’s ageing society.

It is estimated that 70 percent of care home residents now have dementia or similar challenges and despite evidence showing that the environment in which care is delivered has an enormous influence on its effectiveness and residents’ quality of life, the ‘standard’ building design has evolved little from early institutional architecture. Care homes with long corridors, open communal living and busy internal and external spaces are ill-equipped to support the physical, cognitive and sensory needs of people living with this condition.

Here we explore three aspects of architecture and design highlighted by the Department of Health in its study, Dementia-friendly Health and

Social Care Environments, and see how it can be delivered in practice. Design can improve the health and wellbeing of people living with dementia by reducing symptoms of confusion, isolation and anxiety and help them live more independently in a care setting.


The need for better design in care home provision demands a fresh look at the concept and purpose of the whole living environment. Critically we need to address the hangover of institutional design and incorporate the heart of the home within a safe and functional building.

Changing the layout within care homes can make enormous differ- ences. Best practice design, in line with the 12 principles set out by the Department of Health, highlights the need to avoid busy and crowded areas, unidentifiable spaces, noise and clutter that add to feelings of confusion and anxiety. There is an emphasis on easing the transition through ‘comfort design’ and a ‘home from home’ feel.

By deconstructing the traditional institution into a cluster of six pods that form small self-contained communities within the care facility, we can break down the long corridors and disperse noisy communal living, entertainment and dining areas, in effect reducing the scale of the accommodation, making it quieter, more recognisable and easier to navigate.


A connection to outdoor space, nature and natural light is especially important for residents’ mental and physical wellbeing. Plants, flowers, water and wildlife are all recognised for their contribution to therapy treatment by lowering stress, stimulating the senses and aiding relax- ation, while access to the outdoors encourages exercise and purposeful activities such as gardening or feeding the birds.

While the typical institutional layout hampers access to the outdoors with long corridors, turns and stairways along the way, a modular design

can bring nature closer to each community living space. The area around each pod is easy to navigate and obstacle-free, which provides a sense of familiarity and freedom.

Our memories of our childhood tend to be happy ones and are more easily recalled by dementia patients, who struggle with short-term memory loss. In Leicester, we recently designed a garden space in a care home that echoed an old-fashioned seaside resort with multi- coloured beach huts. The beach huts were used as a device to help res- idents remember care-free times.

Visual comfort also extends indoors. Patterned walls and flooring or chaotic décor can increase confusion and stress, while soothing artwork, block colours and carefully chosen visual cues as to the purpose of each room aid recognition and comprehension.


Dementia affects all five of the senses, also impairing the ability to distinguish and differentiate between different stimuli. This, coupled with the fact that an increasing number of residents with dementia are over 80 and probably suffering hearing impairments, means that thoughtful acoustic design can make a marked contribution to helping people to live well.


The number of people living with dementia is rising by the day, so the challenge sits with the commercial sector to find a cost-effective design solution that meets the needs and expectations of this growing commu- nity and their families. A rethink of everything that care homes used to be, coupled with thoughtful, innovative design holds the key.

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