Housing design, adaptation and outdoor space
Well-designed housing can help someone live more easily with dementia. It can support their wellbeing and independence, and help them remain at home for longer.
Adapting and making changes to a person’s home can also reduce pressure on carers if the person living with dementia keeps physically active, mentally stimulated, and can find their way around.
Changes and adaptations do not always need to be major. You can:
- consider general design and layout – create the space to move around, prevent falls and make it easier to find your way (e.g. use simple labels and signs for toilets and bathrooms)
- use colour and contrast – make doorways, furniture, bathroom items and other things easier to locate and identify
- improve lighting – see more clearly, make sense of where you are and prevent falls
- reduce excess noise – help concentration and avoid confusion
- consider floor patterns and surfaces – some may cause problems e.g. dark door mats may be mistaken for a hole in the ground
- use heating controls – keep warm and avoid either dehydration or hyperthermia
- use well-designed fixtures and fittings – e.g. glass frontages on cupboards or labels with a picture to remind you where things are.
Other adaptations may also be helpful and can include equipment to keep you safe such as grab rails. Advice is available from a number of professionals and trusted handyperson services. Going outside can have physical and emotional benefits. A well-designed garden or outdoor area can be enjoyed by people with dementia, as well as their friends and family.
Practice guidance Open
Dementia friendly housing charter: guidance on delivering a dementia-friendly approach to housing – Alzheimer’s Society (2018)
Dementia: independence and wellbeing: QS30 – NICE (2013)
NICE Quality Standard, Dementia: independence and wellbeing includes a quality statement on the design and adaptation of housing to help people with dementia manage their surroundings, retain their independence, and reduce feelings of confusion and anxiety.
Making your home dementia friendly - Alzheimer’s Society (2017)
Home environment and dementia - NHS Choices (2015)
Good practice in the design of homes and living spaces for people living with dementia and sight loss – University of Stirling / Thomas Pocklington Trust (2014)
Improving the design of housing to assist people with dementia - Dementia Services Development Centre at University of Stirling (2013)
Outlines broad principles and explains why particular design features are needed, and to give basic guidance on the most important ones.
University of Stirling’s Dementia Services Development Centre (DSDC) website contains information on:
Creating successful outdoor spaces - Dementia Services Development Centre (2016)
Blog emphasising how outdoor spaces need to attract people to actually use them, to maintain quality of life and independence.
The Dementia-friendly environment section of the SCIE website includes issues to consider when making individual rooms dementia-friendly. it includes information on:
Making your home a better place to live with dementia - Care and Repair England and Silverlinks (2017)
The collaborative home improvement agency - Foundations (2016)
This guidance considers the kind of independent living services which older and disabled people will increasingly need. It includes examples of how home improvement agencies can support people living with dementia to remain at home.
Transforming care pathways for people with dementia: linking housing, health and social care – National Housing Federation and HACT (2015). This briefing aims to encourage closer working between health, social care and housing. It includes case studies to show the contribution housing can make to help people live well with dementia.
Dementia: finding housing solutions - National Housing Federation (2013)
This report shows how good adapted housing can play an important role in supporting people with dementia to live independently.
Integrating home adaptations for better health and wellbeing outcomes - Public Health England
Four briefing papers from Care and Repair England to support the local integration of home adaptations into commissioning for better health and wellbeing outcomes. Although not focused on people living with dementia, the briefings highlight how home adaptations can help people live independently at home for longer.
- Disabled Facilities Grant funding via Better Care Funds: an opportunity to improve outcomes (2015)
- Home adaptations, integration and the Care Act (2015)
- Innovation in home adaptations: a fresh chance. The Disabled Facilities Grant funding increase, new Better Care Fund Policy Framework and the public health connection (2016)
- Sustainability and Transformation Plans: analysis of extent to which housing and ageing are mentioned in STPs (2017)
Resources and toolkits Open
Home Improvement Agencies
A searchable directory of Home Improvement Agencies providing information and advice and support people to make modifications to their homes.
Is your housing dementia friendly? EHE environmental assessment tool – Kings Fund (2014).
An assessment tool to help housing and care providers ensure spaces they create support people living with dementia.
More environmental assessment tools (2014) from the King's Fund .
Enhancing Health Environment dementia care programme.
Dementia and housing: an assessment tool for local commissioning – Housing LIN (2016)
A self-assessment tool to help commissioners to enable people with dementia to live well and as independently as possible. The toolkit includes self-assessment questions and links to resources. Sections cover the physical home environment; housing related services and interventions; the housing workforce; and the perspectives of people with dementia and their families.
Living Through Landscapes – Thrive, the Society for Horticultural Therapy
Courses and resources providing information, guidance and learning for all with an interest in supporting people living with dementia.
Handyperson services - Age UK
Handyperson services across the country offering older people extra help with small practical jobs to make their lives easier and safer around the home.
Case studies Open
Are we nearly there yet? Enabling people with dementia to remain at home: a housing perspective - Housing LIN (2017)
This report includes case study examples in the areas of dementia design and home adaptations.
Homewise Memory Matters: Supporting people with memory loss, dementia and their carers at home in East Lancashire, Care and Repair England (2017)
This case study shows how the Homewise Memory Matters service has helped people with memory loss and dementia to be able to continue living at home independently.
The Dementia Dwelling Grant
The grant enables people living with dementia to have a range of adaptations made to their home. The grant is delivered by Care & Repair Worcestershire in partnership with Age UK Herefordshire & Worcestershire and funded by the six Worcestershire district and borough councils.
The Dementia Dwelling Grant
A case study of the Dementia Dwelling Grant is available in: Dementia: post diagnosis support (2018) - Local Government Association. (page 23)
An evaluation of the Dementia Dwelling Grant pilot is also available in Making homes more dementia-friendly through the use of aids and adaptations. Healthcare, 2019 7(1): 43.
Although not focusing on people living with dementia, publications from The Centre for Ageing Better provide evidence to make the case for the importance and effectiveness of home adaptations.
Evidence which suggests that:
- Where adaptations had been installed recipients had fewer declines in Activities of Daily Living, less decline in self-care, fewer behaviour problems and spouses were less depressed (p22)
- Carers of people with dementia “needed much more information about the potential benefits of adaptations as these were poorly understood. (p22)
- Modifications may need to be made in the early stages of the disease to increase acceptance as people with dementia can react with confusion or irritation if changes are made to their normal use of the home (p25)
- Evidence that people can be put off installing adaptations until they reach a point of crisis, in part because they do not wish to change or ‘medicalise’ their home
Other research from the Centre for Ageing Better also found that “people sometimes delay adaptations to their homes due to a perceived “stigma” modifications such as handrails or ramps. See reports:
- Homes that help: a personal and professional perspective on home adaptations - Centre for Ageing Better (2018)
- Primary research with practitioners and people with lived experience: to understand the role of home adaptations in improving later life - Centre for Ageing Better (2018)
Dementia environment at home - SCIE (2013)
This video shows how simple changes to create a more dementia-friendly environment can have a positive impact on a person living with dementia's emotional wellbeing and independence.
Care & Repair England
A national charitable organisation set up improve the homes and living conditions of older people.
The national body for Home Improvement Agencies and handyperson services. Foundations also leads on the transformation of Disabled Facilities Grants
Housing and Development Research Consortium
A membership group of organisations and individuals committed to research and knowledge exchange focusing on ‘what works’ for people living with dementia in housing and care settings.
Housing Learning and Development Network (LIN)
A network bringing together housing, health and social care professionals in England and Wales to highlight innovative housing solutions for an ageing population. The Network maintains an online ‘knowledge hub’, which includes a wealth of information on housing and dementia.
An independent service offering free advice and information to older people, their families and carers about housing and care options for later life.
The Home Adaptations Consortium
A forum to share and promote good policy and practice in home adaptations in England. The forum was initiated in 2008 by Care & Repair England.
Recent and ongoing university research Open
Association for Dementia Studies
The research portfolio of the Association for Dementia Studies at the University of Worcester includes the dementia-friendly design component of The King’s Fund’s Enhancing the Healing Environment (EHE) Programme, work to develop a dementia-friendly environmental assessment tool mobile and tablet app, and research on making homes more dementia-friendly through the use of aids and adaptations.
Research at Bournemouth University includes the ESRC funded project ‘Dementia-friendly architecture: reducing spatial disorientation in dementia care homes’. The project aims to identify the features that make buildings easier for people with Alzheimer’s disease to navigate and will result in guidelines for design.
Catch 22 project
An initiative set up in 2014 to by Care & Repair England to improving the health, housing and ageing evidence base. The initial focus was on home adaptations for disabled people, but the scope now includes other aspects of mainstream housing, ageing, health and care interconnections, including small repairs and handyperson services.
Dementia Services Development Centre (DSDC) at the University of Stirling
A leading organisation in the area of dementia and design.
Salford Institute for Dementia at the University of Salford
The Institute's recent research under the theme of environment has included the development of a ‘dementia hub’, a home like environment showcasing the best in dementia-friendly design.