Why the corridor is no longer relevant in dementia friendly care architecture

Why the corridor is no longer relevant in dementia friendly care architecture?

OPINION PIECE / In all typologies of care architecture the corridor plays a central SMALL DESIGN GUIDE role. Proven by the many meanings given at the corridor, it is impossible to think of its absence in care architecture. Yet, in the following opinion piece I share why the corridor is no longer needed and is in fact obsolete in elderly care for dementia.

Research and existing examples around dementia-friendly architecture have brought me to the conclusion that we should opt for another typology to fulfill this transitioning function that the corridor has. Instead, we need a new type of space that no longer counteracts the daily life of the resident, but actually supports him/her.

STUDIO CARE

KULEUVEN

06.01.2021

ASTRID DE MAZIERE

FIRST, WHAT DOES DEMENTIA FRIENDLY ARCHITECTURE MEAN? And why the corridor isn’t.

Understanding the psyche of a person with dementia is crucial. Society tends to associate certain behaviour with dementia; sometimes seen as problematic and impossible to comprehend. But in fact, the restless, angry or sometimes withdrawn behaviour of a person with dementia only stems from one basic emotion: FEAR. One of the main priorities of dementia caregiving means taking this fear away, so the person with dementia feels comfortable and at ease. Architecture needs to support that. When designing dementia-proof architecture removing fear inducing elements should be a priority. Three main design pillers should be considered.

SENSE OF ORIENTATION As people with dementia experience memory loss, they also start to lose the ability to orientate themselves in space and time. Large rooms and long corridors can feel endless, which can emerge feelings of frustration and anxiety. That doesn’t mean you need one open space, but specific interventions such as sightlines, objects that help the resident to orientate him/herself, clear boundaries of a space etc. can help. Orientation in time is also something to consider in the layout of your plan (see point 2). You want a logical room sequence: bedroom - badroom - kitchen - living room - bedroom, that is parallel to the daily routine.

A small note on the topic of the loop corridor, that was praised for years. Research has now shown the downside of this corridor typology. Imagine you are a person with dementia walking in a never ending loop, where everything looks the same. Better is to have a corridor with a clear beginning and end. And more so, even little sitting areas on the side.

BALANCED SENSORY STIMULI Providing stimuli and keeping them balanced is key. The amount of stimuli one can tolerate depends on different things. Of course, individual preference and one’s mood, but also what time of the day it is. Ideally you create different daytime spaces: one active and one peaceful living room.

If this isn’t possible, then one space where you can adapt the strength of the stimuli and put them on/ off, can be a good alternative. The amount of stimuli can help with orientation in time.

The difference and intensity of stimuli also fits the disease process of dementia: when a resident stays the last years of his life in the same living unit, you want to make sure his/her needs are fulfilled at any time. In the beginning stages you need more activities, social interaction, more emotional stimuli. But later on, this becomes less important. Instead you want a comfortable, peaceful surrounding.

In terms of the corridor, the stimuli are limited, since the corridor is only seen as circulation, not a place to stay for a long period of time. There is no furniture, no indication of the function of the room.

When there aren’t enough stimuli, the resident becomes restless, and can start to wander.

HOMELY ENVIRONMENT When designing an elderly house for people with dementia, you are in the first place creating a house. This means: personalised, human-scaled and a familiar spatial lay-out. Characteristics that also should apply to the corridor. However, 10+ m long corridors with lots of doors do not fit in this idea of a human-scaled corridor. And unfortunately this is more common, than rare.

CONCLUSION: In order to make the corridor dementia-proof, many changes are needed. And even then: relevant problems are still present. In fact, in most cases the corridor actually counteracts the three design priorities mentioned above. When creating this new space, all three design pillars need to be taken into account.

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DEMENTIA FRIENDLY ARCHITECTURE: SMALL DESIGN GUIDE

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Before letting go of the corridor and creating this new transitioning space, it is important to understand what the corridor means, which can differ depending on the project and the vision of caregiving.

Understanding the different meanings of the corridor can help to define this new place.

The first big difference in meaning is correlative to the scale of the corridor. In more traditional elderly care, we see long corridors, inspired by the corridors in hospitals. The main benefit is of course the practicality. Caretakers have an immediate overview and it’s more efficient to have all the patients organized in this line-up layout. The safety aspect and overview is certainly a valid element to use in the new space. (1) Logically the corridor is in most cases a transition space between the common area and the bedrooms. Differently said, a space between the public and private. As is the case in WZC Hollebeek and Sint-Vincentius.

In huis Perrekes this division is even more accentuated: the architects addes a new satelite to the existing house. The new wing works as a night part, the house as the day part. This way the corridor also plays a role in orientation of day and night and so, the daily routine. (2) In Monnikenheide the corridor connects the common areas of different living units. The residents have therefore more freedom of movement, but of course it can be more difficult to orientate. (3) Last to mention is the corridor in Wivina, an assisted living project. Even though the users of the building are more independant, it is still worth mentioning. The corridor is here experienced as an inside street, where neighbours can meet eachother. The architects lowered the windows, so they can be used as benches.

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Conclusion: many meanings are given to the corridor. However these characteristics are not specific for the corridor only. They indicate in most cases a transition.

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TRANSITION SPACE : WHAT’S IN A NAME? To concretize this abstract dementia friendly in-between space, I present you two examples of how this space can be understood. The first example is the only existing elderly home in Belgium for people with dementia, where the corridor is completely eliminated. The second example is an individual interpretation, inspired by an interview with Marian Claeys (director of WZC De Waterdam), where the corridor is replaced by a more intimate, secluded living area. Of course, the list with interpretations is limitless and can be extended, using the guiding above.

I. THE ANTE ROOM In Menos, a WZC in Genk, OSAR architects came up with the idea to eliminate all the corridors and instead add more m² to each bedroom and the common areas. By organizing the 8 bedrooms in immediate distance of the living areas, you bring the daily life, full of stimuli, closer to the residents bedroom door. Another benefit is, when leaving his/her room, the resident knows immediately where the kitchen/living room is, due to the semi-open floor plan and transparant central patio.

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To preserve the privacy of the patient and provide a sort of transition from the active common areas to the more quiet bedroom, the architects added a anteroom. A small room, part of the bedroom, where the resident can add furniture or objects that feel familiar and personal. It can also be an ideal place to invite visiting family over, when more privacy is wanted.

II. THE SECLUDED SITTING AREA The second interpretation starts from the idea of adding a second living room, as surplus to the common area. Some WZC already have this sort of extra sitting corner. After lunch and in the evening, residents tend to seek more calmness.

This room allows this need, because it is smaller, more secluded and private. Therefore, in my opinion, it fits the description of a transition space perfectly.

So why not add the bedrooms directly to this living area? In the morning when leaving his/ her bedroom, the resident can immediately orientate. Without feeling to overwhelmed by too many stimuli, the resident knows that he/she left the night/private part and is now entering the common areas. It works as an unconscious wakeup call to prepare him/her to the hustle

and bustle of the day. The opposite matters for the evening when the resident needs a warm, comfortable, serene space, without feeling totally alone. It will help him/her to orientate in time and induce a sleepy state of mind.

It also works as a transition between private (bedroom) and public (common area). In the first place, because the residents will be given the freedom in how to decorate the room. As an example, if all 3 or 4 residents played music in their younger years, it can feel familiar for them to add an instrument or a record player. They will feel more at home and therefore act more like they are at home. Their overall autonomy increases and so will their confidence, which is especially beneficial in the first phases of dementia.

This sketch plan shows how a floor plan, as described above, could be organized. In this case, it would be a living unit for 7 residents, complementary to the care type of small-normalized living.

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With this opinion piece I hope I have convinced you to rethink the existence of the corridor in dementia care architecture. It is not self-evident to eliminate an architectural element for years so connected to the care system.

And certainly not to act upon this different way of thinking.

Hopefully in the near future architects and care systems will replace the corridor by this new supporting typology.

And if done convincing, it can inspire others to follow.

STUDIO RESEARCH

BOOK

INTERVIEW

Studio Care. (2020) Book of elements: the corridor.

Ghent, Belgium: KU Leuven.

Stroobants, E., & Verhaest, P. (2012). Architectonica.

Een thuis voor mensen met dementie. Berchem, Belgium: EPO.

Studio Care. (2020) Book of elements: through the eyes of. Ghent, Belgium: KU Leuven.