Since the start of the pandemic, in order to protect the most vulnerable residents, long term care providers have been forced to make some deep moral and ethical decisions. Some of these decisions have contradicted best practice guidelines, made with best intentions to protect those they care for.
The primary aim of environmental design prior to the coronavirus pandemic was the creation or reconfiguration of long-term care facilities to provide settings which support and enable residents to live their best possible lives. It has long been suggested that environmental design can improve the quality of life for residents with dementia and there is increasing support in the academic literature for a variety of different environmental design interventions which deliver beneficial outcomes for residents, even if significant gaps remain in the evidence base.
As the coronavirus pandemic developed globally, recommended infection control precautions (ICPs) based on the best evidence available were swiftly implemented by long term care providers anxious to protect those that they care for. The ICPs were designed to minimise transmission of COVID-19. In some cases, achieved by restricting residents’ opportunities for physical activity and social interaction (e.g. remaining in and receiving meals/care only in their bedroom, no outside visitor policies). Evidence is starting to emerge that these measures have had ongoing detrimental effects on the overall health and wellbeing of residents.
The new role of environmental design needs to be maximising the benefits to all by supporting providers in maintaining a balance between these competing risks. Architects, designers, academics, long term care providers, residents and their supporters in the wider community need to come together and take up the challenge of developing evidence-based modifications and designing long term care facilities which:
Reduce the risk of COVID-19 disease transmission and/or improve infection control for residents, staff and visitors – where possible without excessive negative impact on other areas of resident wellbeing
Incorporate dementia design principles to support and enable long-term care residents to maintain existing capabilities and enjoy their best possible lived experience of care; and
- Are capable of being adapted to rapidly changing levels of threat from coronavirus and/or other future emerging infectious agents in ways which, in every configuration, maintain the opportunities for stimulation through activity and social interaction that are critical to residents’ wellbeing and quality of life
To succeed we will need to work together, recognising different expertise and valuing every contribution. We must rise to this challenge: until we do every day that passes more lives will be lost and more loved ones will become lost to us. The stakes could not be higher.
Taken from: Dawson et al 2020 ‘Designing for people with dementia and COVID-19’, Alzheimer Disease International, World Alzheimer Report 2020