Damian Utton, RIBA www.pozzoni.co.uk

Dementia Design: Examples from Japan

POZZONI

Design Principles

• Older people, particularly older people with dementia, can be more sensitive to the built environment

• People with dementia may not remember or understand their surroundings. Design can compensate for these impairments and overcome some of the other impairments associated with old age

• Design can improve the quality of life for people with dementia and facilitate the delivery of care in an efficient, non-institutional way

• Other impairments can be compensated in a straightforward way with established guidelines, dementia affects people in different ways.

Good design

•should compensate for impairments

•should maximise independence

•should enhance self esteem and confidence

•should demonstrate care for staff

•should be orientating and understandable

•reinforce personal identity

•welcome relatives and the local community

•allow the control of stimuli

(Marshall et al 1997)

There is a consensus of design principles for people with dementia

• ‘Group Home’ o Domestic household style of

accommodationo Typically 8-10 residents to a

householdo Residents participate in daily

living activities

• 270 Group Homes in Japan in 2000

• 10,000 Group Homes in Japan in 2012

• Long Term Care Insurance (LTCI) introduced in 2000

• Same regulatory framework to all group homes but not all group homes are the same

The Japanese Context

• Opened 1996

• Influenced group home thought

• 8 residents plus 1 respite care

• 3 staff to 9 residents daytime • 1 staff to 9 residents at night

• Service costs met by LTCI • Contributions from central

government, prefectures, municipalities

• Residents top-up fee capped at 10% of service cost

• Owner: Tenjin-kai Social Welfare Foundation

Himawari Group Home, Ofunato, Iwate

• ‘Live an ordinary life’

• Familiar environment

• Private and shared spaces

• Live as a family: daily tasks

• Vegetable garden

Himawari Group Home, Ofunato, Iwate

• Opened 2007

• 21 residents • 25 respite care• 6 Young people with disabilities• Adult and child daycare

• Restaurant

• Established to serve local community with co-operation from local residents

• 90% of care costs met by LTCI • Residents pay 10% of care cost• Residents pay for housing and

meals

• Owner: Group Fuji (not for profit)

NPO Group Fuji, Fujisawa, Kanagawa

• 1993: Five housewives started a co-op for locals needing help with care for elderly relatives and childcare

• Locals are trained as care staff plus volunteers

• Building costs raised by sale of bonds to local residents

• Restaurant: community engagement

• Inter-generational contact

• 10 resident households

• Private and public spaces

NPO Group Fuji, Fujisawa, Kanagawa

• Opened 1987

• 80 nursing care residents • 13 dementia care residents• 50 assisted living residents• Adult daycare• 190 pre-school children• 300 college students• 3 outreach centres nearby

• Community centre• Restaurant

• Multi-generational approach

• 90% of care costs met by LTCI • Residents pay 10% of care cost• Residents pay for housing and

meals

• Owner: Taiyo no Mori (not for profit)

Gojikara Mura Village, Nagakute, Aichi

• Philosophy: Create opportunities to establish meaningful relationships

• Diversity, imperfection, slow-paced lifestyle

• Walk everywhere• No hard paving• Non-accessible areas –

opportunity for interaction

• Domestic scale and appearance

• Simple construction; DIY repairs

• Built around nature

• Vegetable garden and farm

Gojikara Mura Village, Nagakute, Aichi

• School: o Inter-generationalo Not obliged to interact but

co-exist and share the same spaces

• Organic restaurant

• Meals at daycare prepared by mothers of the schoolchildren

• Staff: emphasis on relationships, not completing tasks.

• Overworked staff may overlook something important

• Volunteers within the village

Gojikara Mura Village, Nagakute, Aichi

Gojikara Mura Village, Nagakute, Aichi

What can we learn from this in the UK?

• Dementia design principles are the same – adapted for the different cultural context of Japan

• Long Term Care Insurance (LTCI) makes small group households (8-10 residents) in Japan affordable to build and operate

• Currently being reviewed in Japan

• UK Staffing requirements and funding levels means that UK households have to be 12-15 residents

What can we learn from this in the UK?

• Multi-cultural society in UK

• People who moved to the UK in 1950’s-1970’s may benefit from dementia design now

• ‘Fine tune’ dementia design principles for specific cultural requirements whilst still maintaining principles

What can we learn from this in the UK?

The built environment is just one aspect of a total person-centred care approach

It’s the people who make the real difference!

Damian Utton, RIBA www.pozzoni.co.uk POZZONI