The approach for residents with dementia has evolved over the last several decades, going from a focus on setting therapeutic goals to help enhance a resident’s quality of life to recognizing that residents should have a voice in their care, from their activities to what they eat and wear.

However, Maggie Calkins, board chair, IDEAS Institute, said it’s time for the industry to go further to what she calls “self-directed relationship-based living.”

“It’s the idea that we are supporting their life,” she says. During her educational session, “Applying Person-Centered Care Values to Environments for Individuals Living with Dementia,” at the Environments for Aging Expo + Conference, being held April 22-24 in Savannah, Ga., Calkins said the person-centered approach, which gives residents autonomy, local decision making, and the opportunity for greater individualism, helps create supportive settings for individuals living with dementia.

But there are also big and small changes to the built environment in shared residential settings that can make an impact. For example, Calkins said changes to the occipital lobe of the brain in persons living with dementia can result in the inability to use memory to understand location, making it important for communities to incorporate cues and landmarks within a facility that support wayfinding.


Changes to the frontal lobe as a part of dementia, which can result in loss of sense of self and executive function, can be addressed in the built environment by allowing residents to incorporate clues to their personal history or environmental supports that can assist a resident in brushing their teeth or getting dressed.

“Design so people can hold onto a sense of who they are,” she said.

These changes that communities can undertake can not only make a difference in the lives of residents living, but also the bottom line. “Research shows that communities adopting person-centered care facilities saw an increase in occupancy and revenue.”

Calkins says it’s important for operators and architects to ask themselves what makes a home and then decide how to incorporate those elements . She cited several examples of communities that renovated existing dementia wings into individual “homes” by adding a front door into the corridor space. Visitors then ring a doorbell to be invited into the home, which can tie into a resident’s memories and create a less institutionalized setting. “It sets up expectations that the person can rely on,” she said.

On the interior design front, Calkins says design teams shouldn’t pick one design standards and apply it to all the public areas. Rather, she says the interior design strategy should focus on providing variety in colors, patterns, and furnishings that make a space feel inviting and like a “place where you want to spend time.” Different design themes or aesthetics, such as color themes, can also be used to distinguish different households, giving residents cues as they navigate the community.

“These things can make a difference in how much you feel at home in a space,” she said.

Furthermore, she says design teams shouldn’t decorate every space but rather give residents an opportunity to add some of their personal items to the common spaces, as well as outside their bedrooms to create some visual distinctiveness.

“It’s not that hard to do some different décor to make a difference,” Calkins said.