The report of the national audit of dementia care in general hospitals 2011, published last week, has put a sharp and timely focus on the care of people with dementia in hospitals and the need for improvements in the physical environment of care. A ward at King’s College Hospital, refurbished as part of The King’s Fund’s Enhancing the Healing Environment (EHE) programme, was used as an example of good practice in the extensive media coverage of the report.
Under the EHE programme, funded by the Department of Health, The King’s Fund has been working with acute and mental health trusts across England to develop more dementia friendly hospital environments. The programme has repeatedly shown that local clinically led teams working in partnership with estates colleagues, service users, and carers, can be creative in developing innovative, high-quality, value-for-money schemes that significantly improve the quality of care and the patient experience.
Hospital buildings can appear vast, unwelcoming, and bewildering, adding to the distress that is experienced by patients when they go to hospital. The Alzheimer’s Society highlighted the detrimental effect of hospital stays on the independence of people with dementia in 2009, and the importance of the care environment is recognised in the recent Royal College of Nursing’s commitment to the care of people with dementia in general hospitals. However, there is still a significant knowledge gap about the critical role that relatively straightforward and inexpensive improvements to the built environment can play in improving care and supporting the well-being of people with dementia in hospital.
Faced with bed bays and corridors that all look the same, poor lighting, shiny flooring that looks wet and slippery, no handrails, and basins with new fangled sensor taps, it is no wonder that many patients who have cognitive problems lose their independence in undertaking activities of daily living when in hospital. The result may be that they cannot return home when the acute episode of care is completed which is both devastating for them and their families, and has significant cost consequences for the care system.
Yet relatively simple changes can make a real difference: recognising how dementia can affect perception and vision, working with patients and carers to find out what is important to them and then designing local solutions. One size will not fit all but adjustable lighting systems, matt flooring, and easy-reach handrails all encourage patients to remain mobile. Similarly, colour-coded bed bays, good signage for toilets, and personalisation of bed spaces can help patients to find their way. Social interaction can be encouraged by providing seating space, and better hydration and nutrition supported by providing access to drinks and snacks throughout the day.
Changes to the physical environment can also enable significant practice change. Some of the larger EHE schemes have replaced large nurses’ stations with small, easily identifiable reception desks. Nurses and other staff then write their notes in the bed bays which, as well as making them more visible to patients, seems to be reducing the number of falls and number of times call bells are pressed.
At least one in four people accessing acute services is likely to have dementia. Improving the hospital environment is only one element in developing better care for this group, but it is an important one. Latest figures indicate that there continues to be growth in spending on the physical maintenance of health care buildings. The Royal College of Psychiatrists’ report is a useful wake-up call. Trusts need to ensure that the physical environment of care enables, rather than disables. To assist trusts in this The King’s Fund is developing an assessment tool, based on the principles of dementia friendly design, that can be used by service users and carers in partnership with clinical staff to ensure dementia friendly environments of care.
Sarah Waller is the programme director for Enhancing the Healing Environment. This blog also appears on the King’s Fund website at http://www.kingsfund.org.uk/blog/