CPI recently had a chance to catch up with Amy Schoenemann, Director of Design Development and Project Architect for PDC Midwest, a Wisconsin-based architect-led design-build firm that specializes in senior living.

Throughout the last 18 years, PDC has been commissioned by regional and national senior care owner-operators to provide nearly 490 senior care projects in 27 states, and they are on the forefront of the trend in memory care facilities toward designing environments that engage and support residents.

Firms like PDC Midwest are of special interest to CPI’s Dementia Care Specialists, because we believe strongly that physical environments are critical components of successful memory care programs, where the combination of specialized care and environment create an optimum level of function, safety, and quality of life for those living with Alzheimer’s/dementia.
CPI: We think the science behind PDC’s designs would be especially interesting to both clinicians and caregivers, so can you talk a little about how your environmental strategies for memory care facilities are developed?

Amy: We develop and work with design concepts largely through an evidence-based approach. A majority of our design decisions are based on the immediate results and ongoing feedback we get from communities. We tend to see immediate results from the communities. One specific example would be in the resident bathrooms. We know that contrast is very important for visual recognition in senior populations. For example, all of our resident bathrooms feature vanities designed with a much lighter basin in contrast to a darker-colored countertop. Same thing for the toilets—we put a much darker color behind the toilet so it stands out in starker relief. We’re basically using visual contrast to cue ADLs [activities of daily living].

We’ve found from our operators and our post-occupancy evaluations that there is a reduction in incontinence because residents can see the fixtures. So while the design is based on an intuitive concept about how we use contrast to navigate physically, the results, in this example of reduced instances of incontinence, can be measured scientifically.

One example where biological science has preceded a design decision is in the use of amber-colored bulbs for nighttime illumination of resident bathrooms. We know that blue light inhibits the production of melatonin and that can interfere with the natural sleep cycle, which can already be erratic in senior populations. So by using amber-colored bulbs we limit that exposure to blue light, which we know improves the regularity of the sleep cycle.

CPI: In the past, specialty care units have been designed around moderate to advanced dementia. What design strategies have emerged that engage the abilities of all those living with dementia?

Amy: That’s an important question at PDC, because one of the main goals of our Sensory Design 5® philosophy is to design multisensory spaces that benefit all dementia resident acuity levels. For instance, our kitchen designs look very much like a kitchen would at home, so it is visually familiar to almost all residents. Residents in the early stages of dementia can use the kitchen to cook, while other residents can enjoy the smells, tastes and sounds, as well as the warm social atmosphere they remember as familiar from home. We tend to favor designs that will stimulate memories that have real value to residents, no matter their level of function.

CPI: Could you speak to some ways that dementia-specific architecture might complement a caregiver’s dementia-specific approach?

Amy: I think our spa baths are a great example of how dementia-specific design and dementia-specific training can really come together in a successful way, and taken together they speak to a greater overall paradigm shift. In creating spa baths from more institutional-styled baths known as “central bathing” facilities, we give the caregiver a prime opportunity to turn what was once simply a “caregiver requirement” into a personalized experience for the resident. Design considerations for spa baths go hand-in-hand with the concept of dementia-specific care. The bathing experience can be one of the most caustic occasions for residents, as they must disrobe in front of a caregiver they may be unfamiliar with, in a setting they may not immediately feel comfortable in or recognize as a bath. When residents enter a PDC spa bath, the first thing they encounter is a personal vanity station, so that they can use or simply see all the accoutrements they remember from an earlier time at home. Soothing music, or any music of the residents’ choice, can be played during bathing through an unobtrusive, built-in sound system. We even go so far as to spec spa tubs for their low pressure water jets! Rather than looking at something like basic hygiene as a warehousing kind of function, caregivers can now give deeply personal grooming care with less likelihood of causing anxiety and more of a focus on the preferences and abilities of the resident.

CPI: The Dementia Village in Holland aims to accommodate people from a variety of backgrounds. What design elements does PDC use to spark the interests of people from different backgrounds?

Amy: We strive to incorporate familiar elements of a facility’s locale into the resident environment. When you think about it, dementia can affect all sorts of people, young and old, and there’s been a tendency by facility operators to put all dementia patients in a single environment. Well, non-dementia environments are designed differently for different age groups, so why shouldn’t dementia environments be designed for different age groups? We’re also seeing very positive results for structuring environments for early stage dementia versus later stages of the disease.

I want to stress how important locale is to us in design. Facilities in Colorado should be designed differently than those in, say, Wisconsin. Speaking of regional factors in design decisions, we did a community in Bowling Green, OH, and we strove to incorporate the regional character of the city, a hard-working city, into all aspects of design, from the appearance of the structure to the art on the walls. We have a facility in development in Madison, WI, and our design is created to be reminiscent of university culture, because the resident profile draws very much from the nearby University of Wisconsin. Two of the most prominent design features are the library and pub, and of course Wi-Fi is everywhere!

In an Oklahoma facility, the outdoor resident spaces are fitted with split-rail fences and prairie grasses, outdoor mailboxes, and sheds with safe tools, so the space is very homelike to residents. If someone wants to rake the lawn, they could safely do that. We also bring in the history of the area through paintings and tactile art. We provide a number of programmed gallery spaces, and installations include Indian feathers and soft hides, art the residents can touch and experience along with a caregiver as part of activity therapy. Another programmed space contains photographs of the farms and factories of the region.

CPI: Can you give us some examples of design differences between the older and younger environments?

Amy: I think the environments for early stage dementia are different programmatically for the operator. It would be more program-centric, and activity-centric for early stage residents, versus more care-centric for later stage residents. Certain designs, like our kitchens, are created to offer sensory activity to almost all residents, regardless of the dementia stage they might be in. Other design elements, like gardens the residents can tend and enjoy, or bistros where residents and family gather, would be more likely in a facility for a younger population. It’s important to us to design spaces where families can take an active role in caregiving.

CPI:  Many of the innovations in dementia design are happening in private-pay facilities that not everyone can afford. Does PDC work with state-funded or low-income facilities as well as state-of-the-art facilities like Matterhaus?

Amy: Not all clients can afford to do all things. Currently, only about a third of the nation’s seniors can afford private-pay care, and that number seems bound to decrease, unfortunately, as the baby boomers age. But certainly many of our design concepts can be incorporated into lower cost models. I attended a LeadingAge conference recently in Green Bay, Wisconsin, attended by non-profit operators, and I had the opportunity to share many of our design ideas as an educational session speaker. Although they lacked the financial resources to construct a new facility, they were able to incorporate many of our concepts into their care model. We certainly feel privileged to work with all those providing dementia care.

CPI – Thank you for a fine interview! Would you close by telling us a little bit about why you were attracted personally to your profession?

Amy: It is interesting, you know, because my grandmother had Alzheimer’s. When I was 12 years old, we started to notice a decline in her abilities, and by the time I was 14, we began shuffling her through a number of homes, from small group homes into specialized care homes that then lost funding. She finally wound up in a nursing home, a specialized care wing, and I spent a lot of time visiting with her, noticing the hard surfaces, the eight-foot hallways, only one common area that all the residents would be herded into, and I’ll never forget it. I think we’ve come a long way since then, and I’m proud of embracing and being at the forefront of culture change in memory care environments. The stars aligned when I was able to come to PDC and specialize in senior living!  
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Dementia Care Specialists’ Consulting Resources
Both for new construction and renovation, Dementia Care Specialists has helped facility administrators meet their goals of blending dementia-friendly architecture with person-centered care. Want to learn more? Check out our Consulting Services Checklist and Consulting Services Menu. For more information about trends in senior living, check out Making Memory Care Human: Innovating LTC Design.