FRIIS & MOLTKE Architects / Nusing Homes of The Future

Building homes for people with dementia

Architecture that stimulates and activates

Creating an environment for people who are cognitively and socially fragile presents an opportunity to work with the most fundamental elements of architecture. Architecture has the ability to embrace, support, gather and guide. By working considerately and empathically with all the tools of architecture, our experience has been that we can help significantly improve the lives of the elderly and dementia patients, their professional carers and families.

In relation to this type of building project, our approach focuses heavily on supporting the lives of the local residents through user-driven architecture, making everyday life as enjoyable as possible for each resident within surroundings that guide and support their ability to cope with day-to-day tasks.

Elements such as homeliness, simplicity, familiarity and clear structure are crucial in the development of these projects, where the goal is to build a residential environment without any apparent characteristics of an institution and which offers plenty of opportunities for various activities that can help strengthen the mental and physical health of its residents.

“Hogsnes”, a nursing home for dementia patients in Tønsberg, Norway, was designed with a strong focus on creating appealing outdoor areas that strengthen the residents’ mental and physical health.

Creating optimally designed nursing homes is based on an understanding of what role the architecture will play

Based on the most recent scientific evidence

Dementia means “out of one’s mind” and is a disease that impairs cognitive skills and leads to changes in a person’s conduct. The disease results in a long list of cognitive difficulties that, in addition to gradually becoming more disabled, affects the individual’s memory, sense of orientation, language skills and their ability to think, assess and act in contexts that may result in behavioural disorders. The number of elderly people with dementia is growing rapidly, and there are still only relatively few evidence-based solutions relating to optimal architecture and interiors for affected individuals, as each of the residents of an assisted living facility perceive their surroundings differently. That is the challenge that we must handle in our capacity as architects.

In order to create the most optimal environment and implement the best possible solutions for the patients, we always base our decisions on the most recent scientific knowledge on how dementia patients are affected by their physical surroundings. We attend workshops, conferences, study excursions, etc., on the topic and work with the best operators in the field.

”Hogsnes”, a nursing home for dementia patients in Tønsberg, Norway, was designed according to some fundamental principles aimed at accommodating and supporting the everyday lives of its future residents as well as motivating them. It has no obvious characteristics of an institution and offers plenty of opportunities for various activities that can help strengthen the mental and physical health of its residents.

Danish Alzheimer’s Association (Alzheimerforeningen), 2017: The nursing homes of the future don’t exist...

... what is needed instead is a diversity of care and treatment services

Danish Alzheimer’s Association (Alzheimerforeningen), 2017: There are no elderly people living in nursing homes...

... there are only people living there who require care and treatment 24/7/365...

... and 70-90 per cent of them suffer from dementia or a corresponding cognitive impairment

Creating the atmosphere and feeling of being home

A crucial factor for nursing homes for dementia patients is the feeling of being home. Studies show that feeling at home entails more than merely how the interior of the home has been furnished. Homeliness is to a great extent a matter of what life is like there and how staff, residents, family members and volunteers contribute to the everyday life in and around the individual home and institution in general. The staff must continuously focus on ensuring the residents have the freedom to choose. This results in a constant and ongoing dialogue and conclusions on whether the staff’s routines, workflows and daily activities strengthen or impair the residents’ opportunities to live autonomously.

A good physical environment and empathetic care is only part of what creates a good everyday/working life in dementia housing. Communities also play a major role in ensuring the residents have a relatively good quality of life. They are also a crucial consideration to keep in mind for every new project.

The staff must continuously focus on ensuring the residents have the freedom to choose

SCENES FROM A RESIDENT’S DAILY LIFE

16:00 / SOCIAL GATHERING IN THE DINING ROOM – space for informal meetings and conversations - a time of day where the residents can exchange thoughts, smiles and experiences, play cards, watch TV and have a cup of coffee.

11:00

14:00 / / AFTERNOON IN THE HERB GARDEN - outdoor space with room for social and personal activities. The layout and plant life in the gardens improve the health and well-being of the residents by offering them sensory experiences.

23:00 / EVENING CALM - the interior of dementia housing should feel homely. It is important to create a familiar and homely environment that corresponds to each resident’s personal identity.

/ INTERGENERATIONAL INTERACTION AT THE SQUARE –safe and comfortable surroundings create space for activities and opportunities to interact with the other residents.

09:00 / BREAKFAST IN THE SUN LOUNGE – small manageable spaces where the resident can feel safe and comfortable.

12:30 / LUNCH – shared terraces connecting the individual housing units create opportunities to participate in smaller and less intimidating groups.

Safety, comfort and familiarity is the foundation of a good everyday life

Safety, comfort and familiarity are crucial values for people suffering from dementia. One characteristic of dementia patients is that they get easily confused about where they are and where they are going, i.e. orientating themselves in general. As architects, it is important that we focus on the physical environment and what takes place in it is perceived as understandable, familiar and safe. Safety and comfort also means that each resident has the degree of freedom to move about that they need for their physical and mental well-being. The key is to foster a sense of safety and comfort through homely settings in “Small Scale Living”, focusing on simplicity, familiarity and a clear structure that helps the resident lead an autonomous life.

Dividing the homes into small residential units also emphasise the sense of safety and comfort as well as a feeling of living in a family. Organising the homes around a common area results in simplicity and a sense of safety and comfort, and living in proximity to the common area motivates the residents to participate in social activities. Research shows that dementia patients often seek out social settings rather than withdrawing. In order to create as much simplicity, safety, comfort and calm as possible for the residents, each home is exclusively furnished with the necessary functions.

In “Huset Nyvang”, a nursing home for dementia patients in Randers, the area consists of small individual houses that are not only inspired by the surrounding residential areas but also a type of residence that many people recognize from their family home . In that way, the nursing home becomes a home rather than an institution.

In “Huset Nyvang”, a nursing home for dementia patients in Randers, the area consists of small individual “detached houses” that are not only inspired by the surrounding residential areas but also a type of residence that many people find very familiar. In that way, the nursing home becomes a home rather than an institution.

Happines

INDIVIDUAL FACTORS

Health

QUALITY OF LIFE for people with dementia

Medicine

Self-worth

Relations

Homeliness

A meaningful everyday life

Freedom and autonomy

Aesthetics and physical environment

THE SURROUNDING

ENVIRONMENT

The residents’ perception of quality of life forms the basis for high-quality architecture that promotes and supports the daily lives of those who will be living there.

Accomodating diferent needs

When developing housing for elderly people with dementia, we work actively with different types of residences. We attach importance to being able to offer several different types of homes that can be adapted to the individual needs of the residents. The homes are designed with the residents’ daily lives in mind so as to avoid an institutional atmosphere and ensure their environment feels familiar and homely. The homely touch matters greatly to the residents’ sense of personal identity, safety, comfort and meaningfulness and helps foster relationships and a sense of belonging. For instance, residents will feel stimulated to use a kitchen that looks like the one they had back home, while an institutional kitchen will have a deterring effect. The composition of residents will regularly change, and so will each resident’s needs as their condition deteriorates, e.g. in terms of an increased need of care, isolation, etc. That is why it is important that flexibility is incorporated into the design of each residence from the design stage.

EXAMPLE A: 1-ROOM RESIDENCES

EXAMPLE C: 2-ROOM RESIDENCES

EXAMPLE B: 1-ROOM RESIDENCES

EXAMPLE D: 3-ROOM RESIDENCES

“Tornhøjhaven”, the nursing home for dementia patients in Aalborg, Denmark, has been designed with a major focus on homely surroundings as well as simplicity, familiarity and a clear structure that guides and supports the residents to cope with everyday life.

Environments that encourage activity and mobility

Good, well-defined urban spaces and green surroundings provide a lot of joy and impact a person’s general well-being. The residents must feel motivated to move about as much as possible, both indoors and outside in green spaces. Inviting outdoor areas must be established, providing opportunities for different activities that can strengthen the residents’ mental and physical health and where sensory influences allow the dementia patient to recall old memories and experience the passing of the seasons. Such outdoor areas could take the form of sensory gardens, orchards, vegetable plots, etc. Accessibility in all the outdoor areas must be a priority to ensure they are adapted to elderly residents with dementia, which includes people with bad eyesight or limited mobility as well as wheelchair users. It must be possible to circulate through these varied outdoor spaces without getting lost or ending down a blind alley; the residents should be able to move about safely and without fear of getting lost or disoriented.

The residential clusters in the nursing home for dementia patients, “Huset Nyvang” in Randers, Denmark, is comprised of three different housing types. The residential clusters are spaced and placed differently on the grounds. Some are placed at the edge of the grounds, creating contact with the street life, others are more withdrawn and surrounded by park-like outdoor areas, while another type is more oriented around the nearby garden spaces.

EXAMPLE A: OPEN PLAN

EXAMPLE B: PART OF THE TOWN

EXAMPLE D: CLOSED PLAN

EXAMPLE C: CLOSED PLAN

Holding on to the memories of an everyday life

It is important for architecture to create spaces to “seize the moment” in relation to different everyday activities when such opportunities present themselves. If, for example, a resident suddenly gets the urge to bake something, it is important that they have the opportunity to do so. Similarly, residents also have access to workshops where they can repair their bicycles and other mechanical items.

A successful initiative in “Huset Nyvang” in Randers, Denmark, entails using the local ‘hair salon’ as a pedagogical tool in relation to personal care that presents opportunities to have one-to-one contact with the resident. The key is to create spaces and opportunities that support the residents’ ability to recollect and thus spur them to engage in activities.

With the “Hogsnes” nursing home for dementia patients in Tønsberg, Norway, our starting point was “Small Scale Living” with a focus on simplicity, familiarity and a clear structure to assist the residents.

Exploiting the potential of intergenerational interaction

The project “Huset Nyvang” in Randers, Denmark, which consists of a nursing home for dementia patients as well as a daycare institution, is an excellent example of how incorporating the design of a childcare institution with a nursing home reveals a number of interesting ideas that extend beyond normal everyday life.

Based on an ambitious rationale relating to joint operation of a number of staff and service functions, the thinking behind intergenerational encounters holds an exciting potential where children in daycare and nursing home residents can interact together as a community. Architecture plays a crucial role in the design of the environment for good and unforced social relationships between generations.

The design of the nursing home for dementia patients “Huset Nyvang” in Randers, Denmark, reflects an ambition to create an innovative nursing home that fits in well with its surroundings and provides an ideal environment for the dementia patients as well as the nursing staff. It also provides opportunities for a rewarding interaction between generations - the elderly and children - in the integrated daycare institution. 2017 recipient of the “Healthcare Facility of the Year” award.

Safety in simplicity and familiarity

You create a sense of security by making the residents feel safe and comfortable, which does not necessarily mean that every conceivable risk needs to be eliminated, nor that a nursing home needs to be escape-proof as a matter of principle. On the other hand, it is important to focus on creating easily accessible and meaningful everyday activities that motivate and encourage the residents to participate in them and help relieve behavioural disorders while also shifting the focus away from exit-seeking behaviour.

The key to security is how the residents perceive the overall environment. Consciously using visual measures can also help facilitate that feeling of safety and simplicity.

From care in the room...

From hallways that resemble something out of an institution...

... to paths that naturally link up private spaces to common areas

... to dropping by the hair salon

From a warehouse with a staff entrance...

... to shops where the residents can take part in grocery shopping

RANDERS

LIFE IN “THE DEMENTIA VILLAGE”

SOCIAL GATHERINGS IN THE DINING ROOM

BREAKFAST IN THE SUN LOUNGE

The nursing home for dementia patients “Huset Nyvang” in Randers, Denmark. 2017 recipient of the “Healthcare Facility of the Year” award.

BOENHED BACKSTAGE

DAGINSTITUTION

INTERGENERATIONAL INTERACTION AT THE SQUARE

LUNCH ON THE TERRACE

Familiarity -resemblance to private homes

In the design process for housing suited for dementia patients, it is important to focus on the choice of colours and materials. Familiar colours and materials help people feel more at home. At the same time, it is important to allow room for personal touches, e.g. allowing residents to bring their own furniture and items that all help stimulate recollections and emotions that can form the basis for conversations about previous activities.

Integration of welfare technology

Integration of welfare technology in construction projects for dementia patients helps promote and support everyday activities. Aids are not only used to compensate for disabilities, but also help make a positive difference. In the context of dementia, it is especially aids that can compensate for or relieve the deterioration of cognitive functions - sense of locality, orientation and memory.

A wide range of different technological aids have been developed that can improve the quality of life for people with dementia. Interrupted circadian rhythms and the resulting restless and harmful behaviour for residents with dementia can be countered by incorporating circadian rhythm lighting into the design of the homes. Different types of lighting have been shown to have a positive and beneficial effect on people with dementia in terms of calming, supporting and activating them as well as helping them sleep better.

By integrating the right aids from the start, we can help relieve the workload of the staff and thereby allow more time for interaction with the residents.

The goal is to create a facility that is perceived as being safe and comfortable

The nursing home for dementia patients “Huset Nyvang” in Randers, Denmark, employs circadian rhythm lighting. Clinical studies and evidence from practice across the fields of physical medicine and rehabilitation, psychiatry and nursing have documented the effect of circadian rhythm lighting in relation to factors such as depression, sleep/fatigue, circadian rhythms and cognitive skills.

User involvement ensures the best solutions are found

The development of a good project is based on a thorough dialogue with the project’s stakeholders, which is a key part of the development process. In order to identify all the relevant factors related to the development of the project, the dialogue with the future users is important; each of these users possess important expertise and knowledge that constitute important elements of the creation of a successful project. Such cooperation requires management, as different stakeholders often have widely differing perceptions and hopes.

FRIIS & MOLTKE have extensive experience in process management and use methods that ensure innovative results and usable solutions. Our experience shows that the best results are achieved through user involvement, which is the most powerful valuecreator in terms of creating ownership in the implementation of strategic visions. All new assignments present opportunities for new collaborations, development possibilities and results. As intermediaries and idea developers, we strive to base our work on that knowledge when designing the nursing homes of the future.

Well-planned architecture improves human quality of life and opportunities

RESIDENTS STAFF FAMILY

PROJECT OWNER

Example of meetings in a user involvement process.

JOINT GROUP MEETINGS GROUP MEETINGS

ABOUT FRIIS & MOLTKE ARCHITECTS

Beautiful and useable architecture for everyone

Since its establishment in 1954, the mission of FRIIS & MOLTKE Architects has been to create value for society through development, dialogue and innovation. Drawing on our extensive knowledge and experience, we create beautiful, useful architecture for everyone.

Our aim is to develop and translate our ideas into architecture that leads to positive results far into the future. Our interest lies in the impact of architecture on people as well as the relationship between people and spaces, with a particular focus on social sustainability.

Our professional standards and close relationships with our partners are among our highest priorities, as a close collaboration creates the best possible foundation for a rewarding process and a successful result. Based on the project owner’s wishes and requirements, we design projects with a clear, core concept that unites and utilises the potential of the site. Our architecture is rooted in unique concepts which are further developed and refined throughout the entire process until the building is completed.

We design spaces and buildings that are intended to inspire and benefit the users who frequent them on a daily basis

“Strømme Senter”, a nursing home for dementia patients in Kristiansand, Norway, consists of shared housing with small individual ‘neighbourhoods’ that strongly resemble ordinary housing.

We create environments focused on people

FRIIS & MOLTKE Architects have worked on a broad range of architectural assignments, and we work within the entire professional spectrum of the field of architecture.

Our employees are characterised by their high level of motivation and dedication and include a talented mix of architects and construction designers. We work across professions with a project-oriented focus, and we have a strong competition and development department which produces visionary concepts at a very high standard.

Our firm has a number of specialists within different areas of expertise at our disposal, which allows us to carry out complex assignments at a very high standard. Additionally, the firm has a large project department with experienced and dedicated employees who contribute to ensuring that each and every assignment is executed in accordance with the high professional standard we cultivate in our organisation. The firm is extremely focused on further education and training and regularly takes steps to ensure that its employees’ knowledge and competences are documented and built upon.

The firm is owned and managed by eight partners and has three branches in Denmark.

BOARD OF DIRECTORS

Management

Finance & Accounting, IT & Facilities

Marketing, HR & Resources

SPECIAL DEPARTMENTS

BIM Sustainability

Userinvolment

Aarhus

Aalborg

CPH

STRATEGIC ALLIANCE

Norway

Healthcare

Education

Business

Culture/Leisure

Housing

RESSOURCE CENTRES INTERDISCIPLINARY

Design