New Considerations in Ethical Architecture Design for Memory Care Units

Rockwall, TX (August 16, 2023) – Beloved family members with dementia deserve ethical rights, just as everyone else. Regardless of one’s mental decline, we should never strip away their autonomy, beneficence, and justice. When a loved one is diagnosed with dementia, thoughts that may come to mind are quality of life, safety, and security. Fear and confusion of the unknown can cloud one’s judgment when making future arrangements. However, gone are the days when memory care facilities resembled asylums. Over the past three decades, the coalition of architecture and research has made enormous strides in developing healthcare settings to maximize quality of life and improve patient outcomes.

Although architecture cannot provide a cure, it can be used as a preventative tool and improve the quality of care. The physical environment that one resides in can alleviate fear while strengthening their physical and emotional condition by supplying comfort. Evidence-Based Design (EBD) was launched in 1984 and combines the architect’s imagination, creativity, and judgment with design elements supported by empirical data. This cross-pollination creates a symbiotic relationship between the two fields to enhance ethical design principles by involving clinicians in planning and development.

The first dementia village opened in the Netherlands (southeast of Amsterdam) in 2009. Dementia villages appear to be “real” villages to the patients by combining residential, commercial, and public buildings. There is only one entrance/exit, allowing permissive wandering and significantly reducing the need for sedative medications and restraints. Some villages also include non-functional bus stops or non-working automobiles to let the residents feel they can freely leave.

Design-based approaches can create architecture that works “with” the perceptually challenged brain. For example, dementia characteristics often include sensory impairments such that patients will avoid shiny floors, specific grid patterns near exits, and black areas such as mats for fear of falling. Memory care facilities can use these designs to decrease dangerous behaviors while allowing the patient to feel a sense of autonomy and control.

Numerous evidence-based design studies demonstrate that access to or views of nature reduces stress and lowers blood pressure. Memory care facilities should allow the residents to experience the outdoors, if feasible, or offer views of nature, such as a window that allows natural sunlight. Family members should also pay attention to the proximity of the patient’s room to the nurse’s station, as healthcare outcomes are improved the closer the patient is to the center of the nurse’s station.

The United States has not yet constructed a dementia village facility; however, one is currently being designed in Holmdel, New Jersey, called Avandell. Family members can use the ideas of these villages to inquire about ethical architecture for their loved ones at facilities close to home. It is imperative to ask questions about natural light exposure, the allowance of permissive wandering, and alternatives to sedatives and restraints. When loved ones are affected by dementia, the family must help preserve autonomy, beneficence, and justice regarding the medical care they receive.

Guest column by Jodi Kennedy of Rockwall, a PhD student at Texas Woman’s University in Denton, studying Nursing Science.

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