Dementia-friendly environments: Toilets and bathrooms
The bathroom can present a number of challenges for a person with dementia, given they are likely to have problems with their memory or working out what things are. A number of design features can help. For example, contrasting colours will assist a person with dementia to use bathroom facilities. Toilet seats, handrails and towels should all be easy to identify. This means that they should be easy to see and look like the item they are supposed to be. Even something as simple as providing a bar of soap (which should be a different colour from the sink it sits on) can prompt a person to wash their hands when they might forget otherwise.
There are general design suggestions that are worth implementing to make bathrooms and toilets safer.
While it’s vital to consider an individual's needs, there are general design suggestions that are worth implementing to make bathrooms and toilets safer.
Always provide handrails, bath seats and non-slip bath mats. Make sure that these are in contrasting colours so that people can see them, even if their eyesight is poor. Make sure that the thermostat for hot water is not set too high, in order to help prevent scalding. The person with dementia may forget to check that water is at a safe temperature.
Use a special bath plug that allows the water to drain away if the bath gets too full. Although flood detectors are available, by the time there is a flood, this situation is already dangerous, with a risk of slipping.
Promoting a pleasant experience
Bathrooms should be furnished and decorated to promote a pleasant experience. Avoid a sterile hospital-like appearance that is pale and where it is hard to see things. People with dementia must be able to see what they need to use, because they may not remember easily (see the Lighting feature in this section). Use open shelving to display toothpaste, brushes, shampoo and so on.
A person could find mirrors disturbing in this and other settings as they may not recognise the person in the mirror as themselves. Cover or remove mirrors if necessary (see the Bedrooms feature in this section).
Bathing should be a comfortable experience and design can help facilitate this. The water must not be too hot or too deep. A person may prefer to use bubble bath or to have soap in clear water.
Taps should be of traditional appearance (separate hot and cold taps), simple to operate, with clear indications of hot and cold water. This allows the person with dementia to control the situation themselves.
Assistive technology can help avoid the bath being too hot (see the Assistive technology feature in this section), although you have to be careful not to create a noisy alarm that is hard to understand. People can trip over bath mats and some may be anxious about approaching the bath if they are not sure what it is they are about to step on. Non-slip mats, preferably blending with the bath colour, will reduce the risk of slipping in a wet area. However, if you can replace the whole floor with a non-slip surface, you may reduce the need for mats.
Showers should be level to access and have controls that are easy to use. If the shower door and panels are made of glass, any reflections could cause distress or confusion to a person with dementia. You could overcome this by placing a towel or towels over the shower door. If you have a shower curtain, make it a contrasting colour with everything else in the bathroom. Avoid a jazzy pattern as this could be confusing and distracting.
Soap holders and toothbrush holders could be of contrasting colours to the wash basin. If not, use different-coloured soaps or face flannels to provide the contrast. Some care settings don’t allow the use of sink plugs, in order to prevent flooding. This is unnecessary because you can now buy an inexpensive sink plug which will automatically empty the sink if it gets too full.
Toilets must be easy to find. Hang door signs at the right height for an older person and make them visible from as many viewpoints as possible. Seats should be of a contrasting colour to the pan. Some people think that colouring the toilet water can also aid recognition, which might help if the person is peering into the pan before using it. Of course, bright light in the toilet would help people see what is what, but make sure your lighting does not create glare (see the Lighting feature in this section).
Cisterns should be traditional in appearance: push-button designs are relatively new in the UK and an older person with dementia may search around for a lever flush. You can put simple 'push to flush' signs on concealed cisterns. Toilet roll holders, or toilet paper, should be a different colour from the walls and easy to reach. Some toilet paper dispensers are easier to use than others, so pick a simple one.
These should have low-level lighting overnight to improve visibility without disturbing sleep or a mechanism such as a movement sensor which automatically switches the light on when the person gets out of bed (see the Assistive technology feature in this section). The toilet should be visible from the bedhead position. The reason for this is that you want the person to be able to move between the bed and the toilet as they wish during the night without having to ask for help or being distracted, for as long as they are able to do this. It is more dignified to be able to look after your own needs and this can be made as safe as possible with the right design.
Access and download additional resources
Further reading Open
Brawley, E.C. (1997) Designing for Alzheimer’s disease: Strategies for creating better care environments, Chichester: John Wiley.
Dementia Services Development Centre (2007) Best practice in design for people with dementia, Stirling: Dementia Services Development Centre, Stirling University.
Dementia Services Development Centre (2008) Design for people with dementia: Audit tool, Stirling: Dementia Services Development Centre, Stirling University.
DSDC Virtual care home: The University of Stirling’s Dementia Services Development Centre has produced this ‘Virtual care home’, which allows users to navigate around the various areas within a care home (such as bedrooms, en-suite bathrooms, kitchens, lounges and so on), and read advice about things to consider and ways to improve the care environment for people with dementia.
Pollock, R. (2003) Designing interiors for people with dementia, Stirling: Dementia Services Development Centre, Stirling University.
Useful links Open
Dementia-friendly health and social care environments
This 2015 resource from the Department of Health presents design guidance in relation to new buildings as well as the adaption or extension of existing facilities, and includes case studies drawn from projects funded by the Dementia Capital Programme.
Design Resource Centre
The University of Stirling’s Dementia Services Development Centre (DSDC) has always been a leader in the area of dementia and design. The DSDC website includes the Design Resource Centre. This section includes links to a substantial range of publications and resources in the area of dementia-friendly design including information on the importance of lighting, colour and contrast, getting outside, and orientation and signage. The site also includes the DSDC Virtual Care Home and the DSDC Virtual Hospital. Both these resources allow users to navigate around the various areas within a care home or hospital (such as bedroom, ward, ensuite, kitchens, lounges and so on), and read advice about things to consider and ways to improve the care environment for people with dementia.
Developing supportive design for people with dementia
This is the final report of The King’s Fund’s Enhancing the Healing Environment (EHE) Programme, which ran from 2009 until 2012. The well-illustrated report includes descriptions of the 26 EHE projects completed in NHS Trusts to improvement the environment of care for people with dementia, and also includes the EHE assessment tool and overarching design principles.
Home environment and dementia
This NHS Choices web page sets out good introductory information on how to improve the environment for a person living with dementia. It covers topics such as lighting, flooring, colours, noise and outside spaces.
Making your home dementia-friendly
This 2015 Alzheimer’s Society booklet is aimed at people living at home. It covers a wide range of topics such as lighting, flooring, furniture and furnishings, knowing where things are, and enjoying the outside.
Related pages from this section Open