Planning and design guide for community-based day … and design guide for community-based day care centres 2 Quiet room 11 Toilets 11 Bathroom and toilet accessories11 Bathrooms and

Planning anddesign guide forcommunity-based day care centres

This revised edition of the Planning and design guidefor community-based day care centres was originallypublished by the Alzheimer’s Society (UK) in 1992 andis published with permission.

64 Great Suffolk StreetLondon SE1 0BLTel: +44 (0)20 7981 0880Fax: +44 (0)20 7928 2357Email: [email protected]: www.alz.co.uk

Planning and design guide for community-based day care centres 1

ContentsSummary 3

PART 1 Planning Guidelines 3

PART 2 Design Guidelines 3

Introduction 4

Aims and methods 4

Why provide day care for people with dementia? 4

Objectives for a day centre 4

Part 1: Planning guidelines 5

Introduction 5

Community care legislation 5

The planning process 5Initial planning 5Small is beautiful 5

The people 6The clients 6The carers 6Emotional and practical support for carers 6

The staff 6

Main activities 7Reminiscence 7Domestic activities 7Table manners and hygiene 7Entertainment and hobbies 7Physical exercise 7Outings 7

Transport 7

Other considerations influencing design 7General health 7Incontinence 8Meals 8Personal hygiene 8

Part 2: Design guidelines 9Essential qualities 9

Choice of building 9Conversions 9New buildings 9

Design and sizes of rooms 10Entrance 10Main room 10

Access and handrails 10Office 11Dining room 11


Quiet room 11Toilets 11

Bathroom and toilet accessories 11Bathrooms and shower rooms 12Hairdressing and chiropody room 12Staff room 12Staff toilet and changing room 12

Safety and Circulation 12Fire protection and escape routes 12Disabled access 12Protection against wandering 12Corridors 13Handrails 13Dangers of falling 13Lighting with safety 13First aid 13Security 13

Catering and cooking 13Main kitchen 13Therapeutic cooking 14

Typical layouts for toilets, bathrooms and kitchenettes 14

Floors, walls and doors 15Carpets 15Washable floors 15Walls and doors 15

Lighting, colours and pictures 15Natural and artificial light 15Colours and pictures 15

Furniture, fittings and fabrics 16General 16Chairs 16

Garden or courtyard 17Garden layout and design 17Wandering 17

Utilities and services 18Laundry 18Storage 18Cleaners’ room 18Linen store 18Switchgear and services room 18Refuse store 18

How ADI can help you 19

Appendix A 19

Main financial considerations checklist 19Capital costs: 19Revenue costs: 19

Appendix B 20

Essential or desirable building features and spaces 20


SummaryThis design guide sets out the principles for theprovision of day care centres which can give somerespite for people who provide care at home forrelatives with dementia. The main principle is that theday care centre should be as much like home aspossible, but with additional facilities to extend theservices available to both the clients and the carers.

The minimum requirements for a day centre forpeople with dementia are probably the part-time useof the living room, kitchen and toilet in a small house,and for dedicated and skilled staff to look after them.This, after all, is how many families care for a relativewho has dementia.

PART 1: Planning Guidelines

The importance of initial planning for any proposedday centre, including defining objectives, identifyingexisting facilities and resources in the area, andestablishing realistic budgets.

PART 2: Design Guidelines

People: the varied needs of people with dementia (theclients), of the people who look after them at home(the carers), and of the staff at the day centre.Activities and general considerations in the design andfurnishing of accommodation for people withdementia.

Design considerations: a brief description of the mainissues to consider, according to functions, activitiesand rooms, with a cost checklist.

4 Alzheimer’s Disease International

IntroductionAims and methods

This guide aims in a simple way to provide an outlineof the basic requirements for a community-based daycare unit for people with dementia. Its main purpose isto describe the minimum physical provision which isrequired to provide care for a small number of userson a daily basis. Far from seeking to define what isrequired for an ideal day centre, the guide sets out theminimum requirements so that effort and resourcescan be concentrated on those features which areessential.

The guide is based on the results of visits to daycare centres run by voluntary organisations and bysocial services departments. Only two of the centresvisited were purpose built; the others were inconverted buildings in a variety of different settings,with a minimum of adaptation.

The guide does not attempt to deal with thefinancing, staffing and management of day carecentres and is not intended to include sophisticatedschemes for new buildings. The emphasis of theguide is mainly on the use of existing buildings withlimited resources.

Why provide day care forpeople with dementia?

Day care is a key component of a comprehensivesupport service for elderly people, their carers andtheir families. The tradition of providing care on a dailybasis for the frail elderly, the physically disabled andthe mentally ill is well established and people withdementia have many of the same needs as peoplewith other disabilities.

There is no known cure for dementia. Therequirement for care is therefore for the long-termmaintenance and monitoring of the person withdementia, and for relief for the carers. In this designguide the term Alzheimer’s disease is used to includeall types of dementia.

Community day care centres provide, in theory, along term commitment and very often see their mainrole as one of providing respite for the carer. If thisrespite is going to be valuable both for clients andcarers the building should allow for a variety of

activities to take place. These should include thosethat best maintain the individual’s residual skills, andthat stimulate each client to his or her maximumpotential. The necessary medical treatment forsecondary conditions should be made available.

Objectives for a day centre

The objectives for a day care centre could includesome or all of the following:

• to reduce the stress on carers by giving themrespite from the burden of caring

• to contain the problem, primarily by enabling thecarers to continue caring

• to provide therapy for the people with dementia inorder to manage the consequences of the disease

• to enable older people to continue living within thecommunity

• to support carers and their families.


PART 1 PlanningguidelinesIntroduction

The aim of community care is to enable people inneed of care to live as fully as possible, and for aslong as possible, in their own homes. In the case ofpeople with dementia, a key component ofcomprehensive support may be the existence of a daycare centre where they can be looked after for shortperiods of time, giving them the opportunity of outsidestimulus and their families an opportunity for rest orrespite.

This booklet aims to give some guidance tovoluntary organisations who have recognised the needfor a day centre for people with dementia in their areaand wish to set up such a service or have agreed witha local authority to run a centre. The guide focusesexclusively on design considerations and only toucheson the management and financing of such schemes inso far as they are inextricably linked to the buildingrequirements.

This guide does not attempt to be a blueprint forthe ideal day centre. New buildings are beyond itsscope but the more common needs of adapting anexisting building, of choosing appropriate furniture andfittings, of simple adaptations and decorations areaddressed.

Community care legislation

It is essential to check the community care legislationin your country before proceeding with planning yourday care centre.

The planning process

Initial planning

The voluntary organisation will want to ensure that theneed for day care is properly established. It may bethat a more flexible approach to transport, for

example, would mean that an existing centre could beused more fully. It is most important to ensure that anynew facility is really needed and will be used by thecarers. However, it is almost impossible to make anaccurate assessment of the numbers with dementia inany locality and of the potential clients in advance.The necessary steps at the initial stages will include:

• An assessment of local needs, including a review ofthe existing resources and facilities in the area, inconsultation with the social services departmentsand the health authorities. An appraisal of thepotential demand can then be made.

• A statement on the fundamental purpose of theproposed centre. This will include: a definition ofthose who will be eligible as clients; theestablishment of specific targets for the numbers ofclients to be cared for; and the activities andsupport services to be provided.

• The appointment of an executive managementcommittee, with appropriate professional andtechnical advisers, to undertake the planning of theorganisation and its administration, financing,staffing and building requirements.

Small is beautiful

Although the stages of planning for a new day carecentre may seem long and complicated, there aremany practical advantages in planning for this serviceon a local scale:

• Budgets can be relatively modest and may befunded with contributions from a variety of sources.

• Existing buildings of all kinds can be considered foradaptation and may provide opportunities forimaginative and successful projects.

• Collaboration with other organisations and caringservices can enable a day care centre to developas part of a co-ordinated community based serviceto meet the needs of people with dementia.

• The concept of a simple and small scale project iseasy to communicate to all concerned, includingexisting home carers and the community in general.

• The practical realisation of such a project providesstrong motivation for everyone involved.

It should be noted that one of the most successfulcentres visited in the preparation of this guide was anordinary domestic bungalow with a few basic


alterations to improve the access, and the sanitaryand cooking facilities.

The people

The clients

The size of the available building will influence thenumber of clients who can be cared for in any oneday. Even where space is no problem, it is possiblethat about 16 is the maximum number that can beaccommodated comfortably and with themaintenance of a domestic atmosphere. However,financial pressures may result in the day centre havingto be planned for a larger number.

The condition of the clients is likely to varyconsiderably, depending on the stage of dementia andon their physical health and mobility. Most day centreswhich cater for people with dementia cannot copewith those who are also severely physically disabled. Itis possible that elderly people who are mentally ill andsuffering from a non-organic mental illness such asdepression may be accepted. The day care centreorganisation may also find it easier to look after clientswith severe dementia on different days from those inthe early stages of the disease. These are decisionswhich will depend on the numbers requiring theservice, and the numbers of days a week on whichthe day centre will be open.

The design and character of the day centre cancontribute greatly to the amount of independencewhich may be safely allowed during the daily activities.If the group is small, the building is secure, there aresufficient staff and there is more than one room for theclients, it may be possible to allow the clientsconsiderable choice in what they do. Knitting, drawingor cooking may be particularly beneficial becausethese are skills which are often retained for some time.

The carers

Older carersMost people with dementia are elderly and cared forby an elderly spouse. The respite provided by a daycare centre may just be sufficient for the carer to beable to keep their relative at home. They may evenfind that, relieved of the constant pressure of care, thetime spent with their relative becomes more pleasant.For these people, respite care on one or more daysper week from about 10.00 am to 3.00 pm may besufficient. Such care can, if necessary, be provided in

a building which is used for other purposes at othertimes.

Younger carersYounger people with dementia may have a spouse orchildren who have to go out to work and for whompart-time day care is quite inadequate. The situationfor this group of carers is particularly severe. There isa lack of suitable day care provision and there is oftenno alternative to the person having to go to a centrefor the over 65s. For this group, it may be necessaryto provide care for longer hours, so that the ‘breadwinner’ may continue in employment. In thesecircumstances a full time day care centre may be theonly alternative to institutional care and alternativeuses of the building are less likely to be acceptable.Such considerations have a profound influence on thedesign, staffing, management and funding of a daycare centre.

Emotional and practical support for carers

The service provided by the centre can be greatlyextended if there is regular contact with the carers.Every day centre should have a small quiet roomwhere individual carers can be counselled. It is best ifthe quiet room is situated near the entrance so thatcarers can talk things over with a member of staffwhenever they visit the centre.

The staff

Staff at the centre will be greatly assisted if the designof the accommodation and the provision of equipmentand facilities are appropriate. Unfortunately, at manyday care centres, the staff have to manage as bestthey can with limited facilities. Staff may be paid, ormay be volunteers. All will require training and thereshould be sufficient space for this. They will need anunderstanding of dementia and its problems, and ofcaring, communicating, lifting and helping physicallyfrail and disabled people. Staff meetings and trainingsessions will need to take place in the centre.

A day care centre should also, if possible, have aroom where staff can relax from time to time duringthe day and where a member of staff can becounselled when under stress. The demanding natureof the work means that support to staff, whether paidor voluntary, is an important aspect of the managerialtask, and is easier if there is a staff room.


Main activities

The company of other people and the activitiesprovided in the centre may stimulate the person withdementia. Many of the activities at a day care centrewill aim to maintain residual skills.

Reminiscence

Short-term memory loss is the most frequent earlysymptom of Alzheimer’s disease. However, long termmemory may remain largely intact and much pleasuremay be given through reminiscence therapy involvingthe use of newspapers, photographs, objects and soon from the person’s youth. Some centres evenfurnish rooms in styles from the past.

Domestic activities

While people with dementia may not know why theyare carrying out certain tasks, they will derivesatisfaction from doing things that they once did withefficiency. Painting, cooking, gardening and so on canprovide that satisfaction. The appropriate space forthese activities needs to be provided.

Table manners and hygiene

The ability to use a knife and fork and to shave maybe an early loss in the progression of the disease. Ifthe day centre staff can help with these basic skillsand support the person for as long as possible, thefamily will benefit. Toilet facilities with plenty of roomfor assistance are also very important.

Entertainment and hobbies

People with dementia do not lose all their originalinterests at once. Their attention span tends to beshort, but they should be given the opportunity toexpress past talents. Music and singing are oftenamong the last faculties to go, and the words ofsongs are remembered long after normal conversationis a thing of the past. Simple games like dominoes,lotto and bingo are often enjoyed, especially with helpfrom staff or volunteers. A piano and tables wouldthus normally be part of a day care setting.

Physical exercise

People with dementia need as much exercise asanyone else. The temptation to leave the patient infront of a television screen at home is one of thereasons why a good day care programme can be very

valuable. People with dementia may sleep badly andbe more inclined to wander if they have not hadenough exercise.

Space is necessary so that short sessions ofexercise or dancing can be held in the centre.Accompanied walks in the fresh air are even moretherapeutic.

Outings

If the centre has transport, many people enjoy outingsto parks and other places of interest.

Transport

Transport is often a problem when providing day careservices, especially where vehicles are provided byhospitals or other organisations with other demandsfor their services. There are immense advantages if aday care centre has its own vehicle for the transport ofclients.

The most suitable vehicle is usually considered tobe a minibus with forward facing, chair type seats,good visibility through the windows, easycommunication between the driver, the escort and thepassengers, and good heating/air conditioning. Thevehicle should have a tail-lift if possible. Ideally thevehicle should be able to discharge and to pick upclients at the day centre under a canopy or otherprotection from the weather. In any event, the vehicleshould be able to park safely close to the day centrefor the considerable time that may be required totransfer the clients to and from the building.

Other considerations influencing design

General health

People with dementia do not communicate well orregister their complaints reliably so there is a need fora day centre to have good medical records onindividuals and to be able to make contact with theclients’ doctors.

The planning and furnishing of a day centre shouldallow for the necessary records to be kept securelyand for medical consultations to take place if this isarranged with the family doctor or specialist.


Maintaining a day book which records anything ofsignificance happening during the day, which isaccessible to all staff when on duty, may be a greathelp. The location for keeping the day book should beplanned in advance.

Incontinence

The problems of incontinence have considerablebearing on the design and furnishing of a day carecentre for people with dementia. The design of thebuilding should ensure that the toilets are easy to getto and to use, and the selection of furniture andcarpets can help to reduce the problems caused byincontinence and accidents.

It is usually possible to retrain or to controlincontinence by regular toileting. It is thereforeimportant that there should be sufficient space in thetoilet compartments for staff to be able to assistclients. A toilet adapted for wheelchair users is nearlyalways essential. Privacy and dignity for the client arevery important.

Incontinence in people with dementia may not bedue to neurological problems and the reasons for theincontinence should be investigated. For example, theclient may be disoriented and unable to find the toiletor unable to make themselves understood. In othercases the client may be angry and frustrated, usingincontinence as a way to strike back.

People with dementia are often embarrassed andhumiliated by incontinence and appreciate help inovercoming the problem. Sympathetic and matter-of-fact handling are essential. Families or carers may beable to help staff to understand any problems, suchas constipation or diarrhoea, which need to beattended to. The centre needs to be organised so thatcarers can discuss these and other matters of privateconcern either in the quiet room when delivering orcollecting the person, or by telephone, and thataccurate records are maintained to enable thesituation to be monitored.

Meals

Nutritious meals may not be available to the clientsexcept at the centre, and consultation with a dietitianand with the family as to likes and dislikes isadvisable. Dietary restrictions or requirements of theclients, including those of ethnic or religious minorities,should be maintained.

Meals are usually brought in from a separatekitchen and should be similar to a family hot meal.

They should not consist solely of salads orsandwiches. Any wrappings should be removed inadvance. Food temperatures, especially hot soupsand drinks, should be checked by the staff.

If possible, the tables should be set up before theclients enter the dining room or eating area so thatthey can go straight to their places. (Clients could beencouraged to help with the laying of the tables.) Thetables should be set up without salt or sugar as theseare likely to be overused by the clients.

The meals should be an important part of the day. Itmay be helpful if staff eat at the same tables as theclients to minimise problems and to help makemealtimes relaxed and enjoyable.

The concentration of clients is improved by havingas few people standing as possible and tables shouldbe for small groups (say 4-7 people).

Toilets should be near the dining area. Some clientsmay need help and privacy in fitting or removingdentures before and after meals.

Personal hygiene

If possible, at least one bathroom should be providedand should contain a suitable modern type of assistedbath. Baths with a hoist, such as those used inhospitals, may be very alarming for elderly people andare not necessary in a day care centre.

Hairdressing and chiropody services can be verywelcome and, if possible, space needs to be set asidefor them.


PART 2DesignguidelinesEssential qualities

The essential quality for a successful day care centreis that it should be welcoming and domestic incharacter. This is likely to be particularly important forcarers who would not wish to send their relative to aninstitutional environment but who can feel relaxedwhen they know that the person is being well lookedafter in a cosy sitting room.

The quality and design character of a day care centreare therefore important for:

• Clients, providing an environment where they canspend a tranquil and enjoyable day.

• Carers, who need to feel comfortable and relaxed,without feeling guilty, about a loved relativespending time at the centre.

• Staff, who need an environment where they canlook after those entrusted to their care and workefficiently during a very demanding day.

Many different types of building have been used asday care centres for people with dementia. All thesuccessful examples are suitable for a wide range ofactivities to be carried out and, as far as possible, arewelcoming and domestic in character both externallyand internally.

Many activities and rest periods take place withpeople sitting comfortably in a group. Access, floorfinishes, furnishings and lighting all need to bedesigned to meet the special needs of people whomay be frail, elderly and incontinent and, at the sametime, provide a day care centre which has an informaland domestic atmosphere.

For many clients, nutritious meals may only beavailable at the centre and meal times are alsoimportant in the training and observation ofclients.Tables should be laid for a maximum of six orseven people, with an informal and attractive setting.

Choice of building

Conversions

Many different types of converted and new buildingshave been used for day care centres for people withdementia. The majority are converted buildings,probably because of the advantages of cost andavailability. For example:

• A small converted hall used by a local authority toprovide day care on weekdays (12 clients max perday).

• A single storey hospital building, formerly a ward,converted and used by the district health authorityas a day centre on weekdays (13 clients max perday).

• Converted houses used to provide day care on fourweekdays (20-25 clients per day).

• An old social services building on two floors, with alift, used by the local authority as a day care centreon weekdays (up to 25 clients max per day).

• A large converted church hall used by the socialservices department to provide day care five daysper week (15 clients max per day).

• A bungalow used by the local health authority onweekdays.

New buildings

Recent examples of new buildings for day careinclude the following:

• A new single storey building used by a localauthority to provide day care seven days a week(15 clients max per day).

• A community room in a sheltered housing schemeused as a day centre for one day each week (12clients max per day).

• An annexe, sometimes purpose built, which isattached to a private or local authority residentialhome.

• A mobile day care team, providing day care atdifferent locations on different days of the week.(This is the method of staffing some of the part-timeday centres described above and is more commonin rural than in urban areas.)


Design and sizes of rooms

Note: approximate areas for rooms and other spacesare given at Appendix B.

Entrance

The design of the entrance to the centre is extremelyimportant, both in practical terms and because theentrance immediately conveys an impression of theobjectives, character and atmosphere of the centre.

The route between the entrance and the car ormini-bus park should be as short as possible and theentrance should preferably be protected from theweather by a porch or canopy.The entrance should besuitable for wheelchair and assisted access. It shouldbe well lit, but without glare.

A lockable space is required close to the entrancewhere the clients’ outdoor clothes can be put awaysafely and clearly labelled when they arrive.

Main room

The main room for general use in the centre should beattractively designed and domestic in character, withsuitable light fittings, furnishings, carpets and curtainsand planting. Ideally it should offer attractive viewsonto a well landscaped garden or courtyard andwhere possible to a pleasant scene beyond.

If the room is located immediately next to theentrance, anyone entering or leaving the building canbe seen by the staff. This can help in generalsupervision and may help to prevent clients fromwandering out of the building. Ideally, this room should

Space forassistedwheelchairaccess

Handrailcontinuedinto doorway

Ramp with projecting handrails

Access and handrailsAll day care centres should be designed oradapted for wheelchair and disabled accessincluding access ramps and space to enablewheelchair users to move about within the buildingas necessary.

Fire protection and escape routes are primaryconsiderations in the planning and design of a daycare centre. Floor finishes, furnishings, lighting andhandrails should be selected to ensure the safetyof frail and elderly people, many of whom may beincontinent.

Grippable,continous,unobstructivehandrail

Access ramp

Bathroom and toilet accessoriesA number of simple devices can assist clients who are frail,stiff, disabled or confused to use toilets and baths withsafety.


also lead directly to a secure garden or courtyardwhich the clients can use in good weather.

Office

Every day care centre requires an office with atelephone for administration for quiet and confidentialwork and for record keeping. The room may also haveto be used for consultations, especially if a quiet roomis not available. The office should preferably be closeto the entrance.

Dining room

It is preferable, but may not always be practical, toprovide a separate dining room for taking main mealsand snacks.

Quiet room

A small and comfortable room is required forconsultations with carers or relatives, or for clientswho are temporarily upset or disturbed. If necessaryan office may have to be used as a quiet room. Aquiet room may also be used for sessions with smallgroups of clients.

Toilets

At least two toilets should be provided for the clients,preferably next to the main room and readilyaccessible from the entrance. Where possible aseparate toilet and washbasin should be provided forthe staff.

Simple bathtop rail

Fixed rail for bath

Acrylic liner toreduce depth ofbath

Raisedtoilet seatfor peoplewith stiffhips

Toilet railfor generalassistanceBath seat


All toilets for use by clients should have sufficientspace for staff to be able to assist and one of thetoilets must be suitable for a wheelchair. Doors whichopen inwards, or which are hung on the wrong side,are common problems which restrict access forpeople who are disabled or need assistance.

There should be a medium sized washbasin withineach toilet space. Rails and aids are likely to berequired in each of the toilets used by the clients. Thefloors of these toilets should be washable and easy toclean.

Bathrooms and shower rooms

Bathrooms or showers are essential for the effectiveday care of many clients. Although not all clients willwish to be bathed during the day, regular bathing atthe day care centre can make carers’ lives easier. Ifonly one bathroom can be provided it should containeither a modern bath, with suitable rails andaccessories to assist the clients and staff (see page11), or a Medic-bath which enables clients to bebathed in seated position. If a Medic-bath is to beinstalled it is essential to ensure that the bathroomheating is sufficient to keep the clients warm while thebath is being filled. If a second bathroom is available itmay be useful to have an ordinary domestic bathwhich may be more reassuring to clients.

Hairdressing and chiropody room

Hairdressing and chiropody are desirable though notessential services. A new hairdo can achieve much toraise self-esteem for someone who is feeling depressedand untidy. A ‘parlour’ can be set up with few facilitiesbut will be more efficient and useful if provided with agood washbasin, dryer, couch and storage space.

Staff room

Staff will need to relax in privacy for a short period fromtime to time, especially after dealing with distressingsituations. A suitable space needs to be identified forthis even if a separate staff room cannot be provided.

Staff toilet and changing room

Desirable but not essential. The clients’ toilets shouldbe kept in a condition suitable for anyone to use thembut it may be more convenient to have a separatetoilet for staff. In any case, staff will need a safe placeto leave their outdoor clothes and valuables and forchanging.

Safety and Circulation

The main considerations for safety include:

Fire protection and escape routes

It is essential to discuss with the local fire brigade atan early stage any proposals for a conversion or anew building. The fire officer’s requirements are likelyto include the provision of clear main and alternativefire escape routes, protected by half hour fire resistantwalls and doors, and with doors opening outwardstoward the escape route. Smoke and heat detectorsare likely to be required in the main rooms andcirculation areas, together with fire alarms and fireextinguishers. These requirements are likely to be metmost readily in small single storey buildings, with shortdistances to the fire exit. If the use of an upper floor isbeing considered for a day care centre for elderlypeople the requirements for fire escape, andparticularly for elderly people to be assisted down thestairs, are likely to be stringent and could beprohibitively expensive. These issues should,therefore, be examined at an early stage in anyproposal.

Disabled access

Access for wheelchair users and for people withwalking difficulties is fundamental to the planning anddesign for a day care centre. There needs to besufficient parking space for a minibus with awheelchair lift (approximately 3 x 6 metres), and theroute to the front door must be safe and convenientfor all users. This usually involves a ramp up to thefront door (see page 10) but when space is limited itmay be difficult to ensure that the ramp will not be anobstruction or that visitors do not trip over the end ofthe ramp.

Protection against wandering

Although the risk of clients wandering off the premisesoften gives cause for concern, it is important to beaware that doors which may be needed for fireescape should never be locked or bolted when thepremises are occupied. A common precaution againstclients wandering off is for the front door to be fittedwith a buzzer or bell so that staff are aware when thedoor is opened. If necessary, the same arrangementcould be used for some internal doors or they can befitted with two sets of door handles, one above theother, which is usually sufficient to prevent a confused


person from opening the door. An alternativearrangement, which has worked well in some day carecentres, is simply to conceal the door handles behinda curtain or blind as confused clients will not usuallymake any attempt to open a door if they cannot seethe door handle.

Corridors

Ideally there should be little or no corridor space in aday centre. If a corridor has to be provided the widthshould be at least 1.2 metres to enable people to beassisted and to pass each other. The layout shouldminimise the problems of clients losing their way, andthe character should be non-institutional, with sittingplaces or attractive features if possible. Handrails maybe necessary on one or both sides.

Handrails

Most day care centres do not appear to needhandrails on the walls and they are often felt to createa non-domestic atmosphere. However, in existingbuildings with long corridors, it may be helpful forsome clients if a handrail is fitted on one side of thecorridor.

Special handrails to assist disabled people can bevery useful in toilets and bathrooms (see page 11).These need to be designed and located so as not toimpede members of staff when assisting the clients.Handrails may also be useful to provide support forclients during exercise therapy.

Dangers of falling

Steps in awkward or unexpected places should beavoided as far as possible and should, in any case, beprovided with handrails to guide and support theclients. When converting an existing building, stepscan sometimes be converted to a ramp but thisrequires plenty of space as ramps should not besteeper than 1:12.

Loose edges of rugs or carpets can be a hazard insome circumstances but this should not preventrooms in a small day care centre from being furnishedin an ordinary domestic manner. A problem which maynot be anticipated is that coloured floors with broadstripes can be misleading to clients who have pooreyesight or who misunderstand the stripe. They maythink that the change of colour shows a step orobstacle and take unnecessary care when steppingacross it. Conversely, good lighting and a change ofcolour can help to show the edges of steps or ramps.

Lighting with safety

The eyes of elderly people are slow to adapt tochanges in brightness or darkness. Abrupt transitionsand glare, whether caused by artificial lights or bysunlight, should therefore be avoided, particularly inentrance halls and circulation spaces. Avoid windows,mirrors and other bright surfaces which can causeglare at the end of corridors. Shield all light sources tominimise glare and select warm-toned lighting ifpossible. Ordinary fluorescent lighting emphasises theblue-green tones which are the most difficult forelderly people to perceive. Day centres should notcontain light fittings and flexes which could be ahazard

First aid

A member of staff must have either nursing or first aidtraining and a first aid kit should be kept available forminor incidents and emergencies. An accident bookmust be kept in which all accidents must be recorded.

Security

It should be ensured that day care centres are secureagainst intruders and burglaries as they may be usedby a large number of people but be empty andvulnerable at predictable times.

Catering and cooking

Main kitchen

A well equipped main kitchen is required for theproduction of the main meals, whether these arecooked at the centre or supplied from elsewhere to beheated and served at the centre. The kitchen shouldnormally be large enough for three members of staff towork at the same time (possibly less if all cookedmeals are brought in), should include a large sink anda dishwasher, and should be located immediatelyadjacent to the dining space. A refrigerator, freezerand storage space for vegetables are likely to berequired and their sizes will depend on the number ofclients and the method of catering.

Any serving hatch or door between the kitchen anddining room should meet the requirements of the localfire officer. A washbasin is likely to be required in thekitchen and all the catering and sanitary arrangementsshould be approved in advance by the local authorityand the Public Health Inspector.


Therapeutic cooking

In addition to the main kitchen, it is very desirable fora day care centre to have a separate kitchenettewhere the clients can share in cooking activities andenjoy familiar skills, materials and smells. Theminimum kitchenette would probably include aworktop, a sink with a drainer, a kitchen table and anoven.This would enable the clients to carry out simpletasks, either sitting at the table or standing at theworktop, and to enjoy the satisfaction and smells of

baking without any of the risks associated withhotplates or gas burners.

Clients often enjoy participation in the routine ofpreparing the daily meals, although the health andsafety regulations prevent them from helping in thekitchen when meals are being prepared. If, however,there is a separate kitchenette they might bepermitted to assist in such tasks as peeling potatoesor preparing vegetables provided that the standards ofhygiene are maintained and they are supervised.Where a separate kitchenette cannot be provided,

All toilets for theuse of clientsshould havesufficient space forstaff to be able toprovide anyassistance whichmay be needed. Atleast one toiletshould be suitablefor wheelchairusers.

Bathrooms should be at least 2.4 metres (8 feet) wide if there is to bespace for staff to assist clients, or sufficient space for wheelchair users.

A Medic-bath, forbathing in a seatedposition, avoids theneed for liftingequipment andoccupies less spacethan a domesticbath.The room mustbe well heated tokeep elderly peoplewarm while the bathis being filled.

If there is to be a kitchenette for therapeutic cooking,this should contain at least an oven, a sink, worktopsand a table with chairs so that elderly clients can sitdown while preparing ingredients for cooking.

Typical layouts for toilets, bathroomsand kitchenettes


opportunities should be sought to enable the clients touse the main kitchen when it is not in use for meals.

Floors, walls and doors

Carpets

Modern washable carpets are generally preferable toother alternatives for the floors of the main rooms in aday care centre. Also consider carpeting in corridors.Carpets have a more domestic appearance, are softerunderfoot and absorb noise more than sheet or tiledfloors such as vinyl or linoleum.

Traditional carpets with natural fabrics are notsuitable in day care centres because they are difficultto keep clean in rooms used by people who may beincontinent. However there are synthetic carpetswhich are suitable for day care centres. Thesewashable carpets generally have a short synthetic pile(polypropylene), which is totally impervious to liquids,and a waterproof backing which enables them to becleaned by any standard method of carpet cleaningwithout loss of colour. These carpets are available in awide range of mixed colours and are similar inappearance to carpets of natural fibre.

Most synthetic carpets are vulnerable to damagefrom cigarettes and similar burns and extra care isneeded to prevent damage if clients are permitted tosmoke at the centre.

Washable floors

The floors of toilets and kitchens in day care centresshould be easy to wash and, although hard materialssuch as quarry tiles are practical in areas of heavyusage, vinyl flooring is equally practical and morecomfortable. Non-slip vinyl flooring can sometimes beuseful in kitchens and bathrooms but is sightly lesseasy to clean than the more usual smooth finishes.

Walls and doors

The walls in a day care centre can be decorated withpaint or wallpaper as for domestic use. Wall surfacesshould have enough texture to enable clients tosupport themselves but not be so abrasive as tocause injury.

Wallpapers with a vinyl finish are easy to clean anda wide range of attractive patterns are available. Forpainted walls, emulsion paint is practical andconvenient. Gloss paint is very suitable for doors and

woodwork but care should be taken to avoid shinypaints on walls as even the satin finishes, which arevery easy to clean, can catch the light, causing highspots of glare and an institutional appearance inrooms which should be restful and domestic incharacter.

Doors should have lever handles which are easy forelderly people to operate.

Lighting, colours and pictures

Natural and artificial light

Lighting should be generally domestic in character.Tungsten or filament lights are preferable tofluorescent strip lighting. Compact fluorescent lampsprovide a similar quality of light to tungsten filamentlamps and reduce electricity consumption to onequarter. Particular attention should be given toavoiding glare as this can commonly cause problemsfor elderly people so, although sunlit rooms may bewelcoming and warm, curtains or blinds may benecessary to avoid problems of glare or of excessiveheat.

Colours and pictures

Fairly soft colours should generally be used for wallsand ceilings in order to create a light and tranquilenvironment. Most elderly people have failing ordefective eyesight and it may therefore be useful tohave a difference in tone and colour between walls,doors and door handles in the areas where clientscirculate. It is useful for toilets or other rooms to havedoors of a certain colour, but nothing in the colourschemes should detract from the domestic characterof the day care centre. A selection of pictures can addinterest and variety to the rooms in a day care centre,whether or not they are consciously appreciated bythe clients.


Furniture, fittings and fabrics

General

Furniture should generally be arranged in fairly informalgroupings, and should be easy to move so as toenable room layouts to be rearranged. It should alsobe reasonably robust while retaining a domesticcharacter. The main room should be sufficiently largeto contain a piano, which is always popular andgreatly extends the range of enjoyable activities for theclients. A TV set and a radio may or may not beconsidered to be desirable.

Chairs

The selection of chairs requires very carefulconsideration. Most chairs used by clients shouldhave arms and be fairly high (to Department of Health

standards) so as to be easy to get in and out ofwithout help. Select chairs where the arm is above orslightly in front of the front edge of the seat and with aclear space under the front of the seat so that theuser’s heels can be placed underneath. This greatlyreduces the burden on staff and allows them moretime and energy to attend to the clients. Chairs mayhave high or low backs. Avoid seats which are so firmthat they may cause skin ulcers. A variety of chairsand fabrics can help to achieve a more informalatmosphere than in rooms where all the chairs areidentical. For general purposes select chairs with aseat height of 420mm (17 inches) and tables about760 mm high (30 inches).

If incontinence can be contained it may bepreferable to have domestic style chairs but the realityis that at most centres the furniture needs to be proofagainst incontinence and be easily cleaned. Chairs

Examples of chairs with arms available from a typical range (eg. Parker Knoll ‘Milton’)

LOW BACK HIGH BACK

Low seat(height 420 mm, 16.5 ins)

no arms straight arms sloping arms

Uses include: Sitting in groups or at tables Resting for people who are short

Dining seat(height 460 mm, 18 ins)

no arms sloping arms

Uses include: Meals and sitting at tables

High seat(height 470 mm, 18.5 ins)

straight arms sloping arms

Uses include: For people who are stiff or need extra support

High seat and fitted cushion(height 520 mm, 20.5 ins)

straight arms

Uses include: For people who are tall or very stiff

Notes:

1 in a day care centre forpeople with dementia,chairs with arms aregenerally likely to besafer and morepractical than chairswithout arms

2 people need to be ableto sit comfortably withtheir feet in the floor

3 high seats and straightarms provideassistance in getting inor out

4 sloping arms can beused at a table (heightabout 760mm or 30 in)

5 high backs providegood support butrestrict view

6 options include:

- arms with or withoutarmpads

- loose cushions

7 upholstery choices:

- all vinyl (forprotection)

- vinyl seat withmatching fabric(attractive andpractical)


can be protected against incontinence by being fittedwith a fabric with a waterproof lining to protect theseat, or with a vinyl covering or with a mixture of vinyland fabrics. For example, the seat may be coveredwith vinyl and the back covered in matching tweedfabric. The choice of chairs and other furniture shouldtake account of space, durability, weight, comfort andcost. A wide range of furniture, accessories andfabrics suitable for use in day care centres areavailable.

Garden or courtyard

It is highly desirable to have a garden or courtyard at aday care centre. It should receive plenty of sunlight, beplanted with carefully chosen plants and have pavedsurfaces for access over most of the area. Thereshould be plenty of seating, both in the sunshine andin the shade. Provide some seating which gives asense of enclosure and separation from the mainpathway and arrange it so that people can see andtalk to each other easily. There should be access andspace for wheelchair users to use the seating.

Suitable plants and raised planting beds mayenable some of the clients interested in gardening toenjoy familiar and therapeutic activities in the garden.

Garden layout and design

Clients may feel less shut in if the garden or courtyardcan be enclosed by planting or hedges instead of by a

fence or wall. Lighting of the outside space will allowincreased use and provide visual interest after dark.

It may be possible to plan a garden or courtyard soas to provide a pleasant and reassuring route onwhich clients can walk in a circle, or figure of eight,and which enables wandering to become a safe andtherapeutic experience, always returning to the sameplace (see plans below).

Wandering

Day care centres for people with dementia need to bedesigned to prevent clients from wandering off thepremises, but not in ways which emphasise theconstraints. A day care centre should, if at all possible,have an attractive garden with places for people to sitand footpath circuits along which they can wanderwith safety and tranquillity.

Raised flower beds can be helpful forpeople who are stiff or in wheelchairs

A simple garden with a circular path. Seats may be arrangedsingly or in groups and should generally be shielded from thefull heat of the sun.

A garden with a figure 8 path. More elaboratepath layouts can be provided in largergardens, but it is always useful if the outerpath returns people to their starting point.


Utilities and services

Laundry

Clothes and linen may need to be washed on thepremises.

A laundry service to carers could be an invaluablepart of day care service for elderly confused peoplebut this is rarely possible because of the financialimplications.

Storage

Storage spaces are likely to be required for:a) occupational therapy equipmentb) linen and spare clothingc) medical equipment and medicinesd) wheelchairse) office materials

Cleaners’ room

A lockable room, with a sink, and with a lockablecupboard for cleaning appliances and materials.

Linen store

A small lockable cupboard for towels, linen, spareclothing and incontinence pads should be located soas to be readily accessible during the day but securefrom clients.

Switchgear and services room

Depending on the form of the building, and on theheating, air conditioning system and so on, space willbe needed for incoming services, switches, metersand possibly a boiler.

Refuse store

To be located safely and conveniently, and to meet theaccess requirements of the local authority.


Appendix AMain financial considerationschecklist

Note: figures are not included because they are sovariable. The following, however, are some of the mainitems that need to be costed.

Capital costs:

Alterations:plumbingheating/air conditioninglightingwheelchair access safety rails kitchen alterationsdecoration

Equipment:chairs tables cutlery and crockery kitchen equipmenttelephone system (and answerphone?) transport

Revenue costs:

waterrentelectricitygastelephone

Staff:salariesNational Insurance pension schemes (if appropriate) driversvolunteers’ expenses trainingpublic liability insurance property insurance publicity

How ADI can help youAlzheimer’s Disease International (ADI) is a federationof national Alzheimer associations around the worldwhose mission is to improve the quality of life ofpeople with dementia and their carers and to raiseawareness of the disease.

One of ADI’s key roles is to support members intheir activities and encourage the formation of newassociations by disseminating information, supportingan annual international conference, encouragingresearch and stimulating public and politicalawareness at the national and international level.

ADI produces the following publications:

Booklets • Help for caregivers• Starting a self-help group • Influencing public policy • How to develop an Alzheimer’s association and get

results

Factsheets• Prevalence of dementia• Organisation of a prevalence study• Reasons for prevalence studies• Demography of ageing around the world• Alzheimer’s disease and genetics• Caring for people around the world with dementia• Psychiatric and behavioural disturbances in

dementia• Drug treatments in dementia

You can contact ADI for:• Any of the above materials (these are available free

of charge)• Further guidance in developing an Alzheimer

association in your country• Contact details of Alzheimer associations in other

countries

Please call or write to: Alzheimer’s Disease International64 Great Suffolk StreetLondon SE1 0BLTel: +44 (0)20 7981 0880Fax: +44 (0)20 7928 2357Email: [email protected]: www.alz.co.uk


Appendix BEssential or desirable building features and spaces

Note: the following list is intended as a preliminary guide to assist in assessing whether an existingor proposed building is likely to be suitable for use as a day care centre. Where it is not possible toprovide the features listed as essential, it may still be possible to achieve a practical compromise.

FEATURE

Parking

Front entrance

Internalcirculationspaces

Space foroutdoor clothes

Rooms

Toilets

Bathroom

Kitchen

ESSENTIAL MINIMUM

Space for one vehicle with outside lightingArea approx 3 x 6 m

Access ramp for wheelchairsEntrance lobbyArea approx 2.0 x 2.5 m, say 5 sq

Internal circulation spaces, with safetyprecautionsAreas variable

Hanging spaceArea approx 1 x 2 m = say 2 sqm

Main room for general activitiesArea approx 6 x 8m = approx 50 sqm

Office (for occasional use for counselling)Area approx 2.5 x 3 m = approx 8 sqm

2 ToiletsArea each approx 1.5 x 2 m = 3 sqmSay 6 sqm for 2 toilets

Bathroom with special rails, fittings etcArea approx 2 x 3.5m = approx 7 sqm

Main kitchenArea approx 3 x 4 m = approx 12 sqm

DESIRABLE

Parking for five vehicles or more with coveredroute to front doorArea approx 12 x 6 m plus circulation

Entrance hallArea variable

Dining roomArea approx 4 x 6m = approx 2sqm

Quiet roomArea approx 2.5 x 3 m = approx 8 sqm

Group roomArea approx 3 x 5 m = approx15 sqm

Hairdressing/chiropody parlour Area approx 3 x 3.5 m = approx 11 sqm

Staff roomArea approx 3 x 3.5 m = approx 11 sqm

1 Staff toiletArea approx 1.5 x 2 m = approx 3 sqm

Second bathroom (domestic)Area approx 2 x 2.5 m = approx 5 sqm

Kitchenette for clients’ activitiesArea approx 3 x 3 m = say 9 sqm


FEATURE

Washingmachine

Storage

Cleaners’cupboard

Servicescupboard andboiler

Refuse area

Garden

Garage

Total floor areas(examples)

ESSENTIAL MINIMUM

Washing machine (clothes)Located in bathroom if necessary

Storage cupboards or spaces•occupational therapy equipment•linen and spare clothing•medicines and medical equipment•wheelchairs•office materialsTotal area say 8-10 sqm

Cleaners’ cupboardArea approx 1 x 2m = approx 2 sqm

Services cupboard and boiler forhotheating/hot water (eg in kitchen)Location and areas variable

Refuse sacks/binsScreened location close to access road

Small courtyard or gardenArea variable, say 15 sqm (minimum)

Sub-total of internal spaces listed aboveapprox 100 sqm (excluding circulation spaceetc). Eg for 10 clients @ 12 sqm = say 120 sqm15 clients @ 14 sqm = say 210 sqm

DESIRABLE

Laundry room, with facilities for drying andironingArea approx 3 x 3 m = approx 9 sqm

Storage roomsTotal area approx 15-20 sqm

Cleaners’ room with sinkArea approx 2 x 2 m = approx 4 sqm

Services/boiler roomArea approx 1.5 x 3 m = approx 4.5 sqm

Refuse storeEnclosed area approx 2 x 3 m = approx 6 sqm

Garden with space for clients to wander withsafetyArea variable, eg 6 x 15 m = approx 100 sqm

Garage for 1-2 vehicles and for extra storagespaceArea approx 4.2 x 5.5 m = approx 25 sqm

Sub-total of additional internal spaces listedabove, excluding garage etc, approx 125 sqm(plus 110 sqm = approx 225 sqm). Eg for 10 clients @ 16 sqm = say 240 sqm15 clients @ 20 sqm = say 300 sqm

August 1999

Documents

Planning and design guide for community-based day … and design guide for community-based day care centres 2 Quiet room 11 Toilets 11 Bathroom and toilet accessories11 Bathrooms and