Building Layout and Circulation

Fleming and Bennett (2017) discuss the importance of a ‘human scale’ in any setting for people with dementia, namely that fewer places/beds are linked to improved quality of life, that larger spaces have been connected to greater levels of disturbance, while more compact spaces have been shown to provide more comfort and aid resident supervision and care, and that lower social density (i.e., more floor area/space provided per resident) is connected to better care and social interaction outcomes.

In terms of infection control, according to Scopetti et al., 2020, predetermined routes for patient/resident transfers within the setting and more spacious circulation areas/corridors are important for infection control (Siegelaar et al., 2020).

”A layout which provides good internal visibility, high levels of natural light and views to/access to outdoor space and nature is beneficial for quality of life.
(Fleming & Bennett, 2017)

Additionally, such design qualities also help to maintain quality of life during pandemic restrictions and allow for natural ventilation.

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During COVID, keeping different areas separate was a challenge.
- Staff

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Smaller, self-contained houses and units help towards reducing spread and outbreak control. Wide open spaces outside aid in the need for social distancing.
- Staff

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Long corridors far away from facilities and nurses’ desk/supervision. If the floor space is too big and too far away from areas such as dining rooms, drug dispending areas, sluice rooms – it means residents have to wait for staff to retrieve items.
- Staff

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Corridors can be cluttered during the daytime.
- Resident

Key Findings

Signage
to orientate

A lack of clear signage was highlighted as an issue, impacting individuals’ capacity to effectively orientate themselves and navigate through the setting.

Door
access

The introduction of automatic doors (infection control measure) has created issues for older individuals who, because of a slower pace of walking or mobility aids, require more time to pass through into the setting.

Spacious
corridors

A lack of space and insufficient storage leads to cluttered corridors, which can create issues with respect to effective social distancing and other infection control measures.

Recommendations

Overall Layout and Scale

The benefit of smaller scale settings, or settings carefully broken down into smaller distinct units has been outlined previously. Therefore, the overall layout of the setting should be considered in this context, and the layout should be designed to provide these smaller units.

For multi-storey settings, residents on all floors should have access to usable and meaningful outdoor space. Furthermore, access to upper floors for visitors should be facilitated through spacious and well-ventilated circulation routes, ideally without having to travel through key parts of the main building.

Provide a coherent, legible, and logical building layout that provides orientation for users and is easy to understand and navigate.

Circulation Routes

Provide calm, spacious, uncluttered circulation routes articulated by visual clues including identifiable spaces, features, connections to external spaces and views, artwork, planting, lighting, fittings, and furniture. This will be supported by clear wayfinding using signage, colour coding, images, or other visual cues to help create a more easily navigated setting.

Where possible, a circular or looped circulation route, that passes through or runs adjacent to the day room, may be appropriate as this provides continuous walking routes that return a person to their starting point. This arrangement also avoids dead-ends and any associated disorientation or anxiety.

Wide, single loaded corridors are beneficial in terms of access and allow for social distancing during periods of restriction.

The ability to easily create one-way circulation systems is helpful in the context of infection control.

Locating key spaces, i.e., storage rooms, nurses’ stations, day rooms, close together cuts down on walking time and enable better staff supervision.

Provide spacious dedicated circulation systems for separation between clean, semi-clean, and contaminated zones where possible.

Carefully consider the location and number of lifts and staircases as part of the overall layout and zoning to provide additional circulation capacity, and possibly separate routes for visitors or service personnel.

Provide spacious dedicated circulation systems for separation between clean, semi-clean, and contaminated zones where possible.

Carefully consider the location and number of lifts and staircases as part of the overall layout and zoning to provide additional circulation capacity, and possibly separate routes for visitors or service personnel.

Signage systems focusing on infection control should be included in the design for the setting (for more information see Orientation and Wayfinding Features in 10.4.5 (b).

Provide increased ventilation for lifts by leaving elevator doors open for a longer period, increasing the lift’s mechanical ventilation capacity, reversing the flow direction of the ventilator, and creating a unidirectional downflow of fresh (e.g., HEPA filtered) air from the ceiling towards the floor of the elevator cabin.

Contact with Nature and Natural Light

The layout of the building should incorporate a centrally located, outdoor space or garden that is easily accessed via the main circulation route, or key common area, such as a living room or dayroom.

Despite being outside, it is still important to consider good ventilation in all outdoor areas, especially in relation to any covered outdoor seating areas or similar outdoor structures.