The August 2014 issue of Signpost included an article by Professor June Andrews, Director of the Dementia Services Development Centre (DSDC) at the University of Stirling. She talked, amongst other things about how environmental issues impact on the symptoms of people living with dementia and how these can be reduced by making “simple relatively low cost changes”. (I’m not sure I would quite agree with the term “low cost” however.) They looked at how light and the design of spaces, including the outdoors, affects people who have Alzheimer’s and other forms of dementia. They found how in some cases, “getting the light right” can make more difference than medication.
This impelled me to make contact and share our story. Writing on Christmas Eve 2014, we’ve just said goodbye to a merry band of engineers, electricians, joiners and plumbers, who have been with us at Heathlands Village since September 2013, helping us to put the theory of environmental design into practice. We have completely transformed the communal areas of our care home.
It’s a full fifteen months since the builders’ portacabin hamlet appeared overnight in our staff and visitor car-park. As they vacate, we look forward to repossessing our lost parking spaces, and more importantly the official handover of our new “communal hub”.
The lives of the 170 residents of our care home, and the hundreds of relatives, staff and volunteers, who spend much of their time here, have gone through more than a year of disruption (mostly with patience and very good humour, might I add) as our main public areas – both inside and out – have been completely reconfigured. Now all we need is for the furniture to arrive alongside the barista style coffee shop to be perked and ready to go and our new-style home will be ready to launch.
The building is largely unrecognisable. Walk into our home today and you’ll immediately be struck by the space and brightness, with public areas flowing into each other and wall to wall, floor to ceiling, patio windows directly accessing our newly laid out secure gardens. It’s magnificent.
The bottle-necked corridor, clogged with walking frames and wheel-chairs, which led to the main restaurant, is gone replaced by wide access from a light-filled glass-roofed atrium. No more undignified queuing for lunch. Off this area is our re-sited village shop and medical suite and just a few yards along the main corridor, a hair and nail bar and recreational therapy area.
Getting to this point hasn’t been easy. We’ve endured power and water cut-offs, collapsed drains, lift closures, room relocations, temporary dining rooms, redirected corridors; a trench dug from the front to the back of the building, right across our main corridor; hanging wires, power-hammers, dust and debris – our own vibrating Jurassic Park at times. But we would go through it all again to create the environment we are now close to completing.
A little bit of history
Heathlands Village opened in 1972, at that time, a modern flag-ship care home for older people – a million miles, (actually just two) from its predecessor – “The Old Home” on Cheetham Hill Road. They left behind the long hospital wards with facing rows of metal beds, replacing these with cosy rooms for four residents and up-to-the-minute care facilities.
Over time the home went through extensions and piecemeal modernisation. Then in 2009 the charity running the home merged with another Manchester charity – Manchester Jewish Federation, known as “The Fed” and from this point began the fundamental transformation of a site originally built to care for older adults, to an intergenerational community facility. Underused or mothballed areas were converted to accommodate community projects, and a children’s centre with outdoor play area and a community centre. The footfall grew and changed as the site began to be used by service-users and visitors of all ages. Residents began to enjoy the sight and sounds of children playing. Service-users from the community pop in for supper and a game of pool; afternoon coffee, an exercise class or a game of Rummikub.
Today’s resident is far older and frailer, both physically and mentally
Two fundamental facts have driven our plans: people are live longer and the public funding pot has shrunk then shrunk then shrunk again and the bar which must be reached to qualify for public funding has been raised proportionately. The 60% of our residents who rely on public funding enter our care, far older and frailer, both physically and mentally, than his or her 1970’s counterpart and with much more complex care needs.
Back in the day when Heathlands was built, many publicly funded residents could today be described as the “walking wounded” – meeting the criteria at that time to qualify for financial provision for their care needs. By today’s standards, they were relatively youthful and capable of managing with little support.
Improvements to staffing levels and training address only half the problem
As the resident profile has changed, we have had to adapt. Resident to staff ratios must reflect increased care needs; training must provide our staff with the skills and understanding to care for people living with dementia – 80% of our residents. Staff need to know how the condition affects a person’s memory, coordination, cognition, communication and mood.
But improvements to staffing levels and training address only half of the problem. As Professor Andrews points out, care has to exist in the right physical environment. We recognised that we urgently needed to make radical changes to the layout of our main internal and external communal areas which were no longer fit for purpose for the post-millennium resident and next generation. We needed to create surroundings which enabled people who are often confused and forgetful, to find their way about and access amenities, particularly outdoor space, and activities, easily and independently (as far as possible). Research told us that this would help them live the fullest life possible with a major positive impact on well-being.
Old improvements had created confusion for today’s residents
Developments to the home since the early 1970’s had created a confusing environment for the people being cared for decades later: By way of example the GP surgery was housed at the opposite end of the floor from the physio room and in a totally different area from where the optician saw his patients. We needed to relocate these services into one central medical suite.
Security needed a total rethink. Having a number of entrance and exit points, removed from the reception area, made it difficult to monitor who was leaving or coming into the building. We needed to reduce these to one point which could be clearly viewed by our reception and security staff.
To reach our old gardens meant crossing a car-park and access road – a potential hazard for people with impaired senses, perception and mobility, and nor were they enclosed. Many residents had to wait for a member of our care staff to help them if they wanted to spend time outside. By rerouting the roadway, moving the car park and re-landscaping the gardens we have created new safe recreational spaces, immediately next to the building. So now many more residents can access and enjoy the fresh air and Manchester sunshine independently and without the risk of meeting a car or going a little “walk too far”.
Our old coffee lounge, tucked away down a corridor and round a corner, was greatly underused – residents literally forgot it existed. By linking it directly to our main lounge we created a much brighter more spacious, L-shaped main sitting area and contemporary coffee shop
Bringing “the outside world in”.
A major aim, when Heathlands Village merged with The Fed, was to create an appealing modern environment which would attract people of all ages from the surrounding community – to volunteer, use our services, pop in to the new central coffee bar for a drink and bite to eat, out of choice and where relatives and friends would want to spend more time with residents.
The more people spend time in our home the less isolated our residents will be. By creating a vibrant communal hub our residents can continue to feel part of things. We want to see an end to the days when our older people are secreted on the periphery of our communities in “God’s waiting room”.
People may live longer but the quality of their life declines we hear. We need to change that – with the right care and environment we hope to maintain our residents sense of wellbeing helping them continue to feel they are a valued part of their community; encouraging as much independence as possible. Old age need not mean a miserable existence.