I feel as if I have just landed in a foreign country where I don’t know the language and the culture is totally different to my own. I have no friends. I don’t know how to get around. I can’t even understand the signs and communication is difficult because I am not understood and I cannot understand those around me…. I feel frightened, frustrated, confused, lost, lonely and I definitely want to go back home!!
This is commonly the experience of persons with dementia who have recently been admitted into a long-term residence. They have been placed in an environment that they do not know, with people they are not familiar with. The daily routine may be different and often they have not chosen to be there. This may result in altered behaviour like aggression, anger, withdrawal, depression, agitation and increased confusion.
Caring for a person with dementia can be very challenging for relatives, especially if the partner or main caregiver is elderly or the daughter or son providing support has to go to work as well as juggle with family and personal commitments. Very often, after a prolonged period of struggling and combatting with feelings of guilt, a decision is taken to find a residence where the person with dementia can be cared for.
Dedicated dementia wards and environments, as the name implies, should be designed to cater for the special needs of persons with dementia. Special care should be put into the planning, design, selection of furniture and furnishing based on expert advice and research. This is what has been done at the Hilltop Retirement Village that has given much attention in the planning and setting up of the dedicated 30-bedded dementia ward and surrounding environment. Measures have been taken to ensure safety, orientation, participation and a sense of well-being. The design includes features like appropriate lighting and specialized signage to assist way finding, colour contrast for identification of objects and furniture e.g. light switches on a contrasting background, specially designed windows for safety, a monitoring system that allows free but safe wandering. Detail in the selection of furniture and equipment that promotes independence, easy access and location of objects have also been emphasized to ensure that the residents continue to participate in daily activities for as long as possible. Knowing how important it is to be in a familiar ambience that the resident can relate to has been a focal point from the start. For this reason, the residents residing at the Hilltop Retirement Village will be encouraged to bring personal items that will help to make the environment more homely and encourage ageing well in place. The outdoor gardens have been designed, keeping in mind the needs of persons with dementia, and have sensory features that promote a sense of tranquillity and encourage interaction. Activities to encourage reminiscence and feelings of continuity between the past and the present will be offered to the residents as part of their daily routine and leisure activities. Different levels of support will also be provided according to the level of independence and activity of the residents since the Hilltop Gardens offers the choice of independent living, assistive living and residential care.
However, the environment alone will not provide all that is necessary to ensure that the older person with dementia is getting the best care possible. The trained staff will be guided by protocols of care and intervention in order to ensure that continuous support, at the level required by each individual resident, is provided in a timely fashion. Hilltop Gardens is committed to delivering a quality service and has recently signed a collaborative agreement with CareMark to provide the necessary ongoing training and monitoring of staff. In fact, all carers, employed at the Hilltop Gardens, will be accredited. The approach and behaviour of the multi-disciplinary team will have a considerable effect on the integration of the older person within the home. Structured programmes of activities will be included, emphasizing the importance of establishing routines and active participation which will prevent the resident from withdrawing into a ‘lost world’ and regress more quickly than expected.
The Hilltop Retirement Village, being the first of its kind in Malta, promotes the concept of integration as opposed to segregation by enabling and giving the residents the opportunity to continue living in an inclusive environment. The Hilltop Gardens aims to provide a life of quality, a sense of security and care for all its residents.
Cynthia Scerri
Occupational Therapist
Dementia Consultant