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  • Previous research mainly focused on functional design soluti

    2018-11-14

    Previous research mainly focused on functional design solutions, such as the measures related to accessibility and logistic caregiver support. The design of future nursing homes should ideally incorporate all the available knowledge on dementia and design to provide the best possible housing solutions for residents with dementia and their professional caregivers. The design must highly support the needs of people with dementia. Our findings are in accordance with a recent study, which showed that the physical environment supports a personalized approach and a sense of home in people with dementia (Fleming et al., 2015). Furthermore, the five factors reported in this study should be incorporated in environmental assessment tools (Waller et al., 2016). Several audit tools are available to assess the environment; these tools particularly focus on establishing “dementia-friendly” designs (Marquardt et al., 2014). These tools are helpful in highlighting areas of change. In ap4 Supplier to traditional audit tools, specific instruments should be developed for use in contemporary homelike environments. The Environmental Audit Tool is one example that consists of a set of design principles for nursing homes that provide long-term care for people with dementia; in addition, this tool assists in selecting design modifications that promote the quality of the physical environment and of the life of the residents (Fleming, 2011). By looking at the sense of home as a design challenge, new solutions and lines of thought come to the fore. Sense of home is easily mistaken for homelikeness or homeliness; the two themes are closely related but the former has more architectural and interior design connotations. The sense of home applied in the living laboratory differs from the homelikeness or homeliness through the special needs of older people with dementia. These needs include the special attention to visibility, and recognition of architectural elements and elements that refer to the long-term memory of the occupant. For example, the small tiles in the bathroom refer to the seventies, eighties, and early nineties in the Netherlands. The design also differs from a “normal” home by adapting to the intrusion of caregivers in the private domain of the residents. An example to solve this problem is the use of cupboards for laundry. These cupboards can be accessed from the hall by anyone, and from the bathroom by the occupant and well-known caregivers and/or relatives. In the Netherlands, the main focus is the creation of small-scale homelike environments for people with dementia (Verbeek et al., 2016; van Hoof et al., 2009). Although many architectural solutions or lines of thought are available, the focus on small-scale facilities that are homelike often leads to an architectural template or typology for a dwelling occupied by six to eight people. Physically reducing a large-scale nursing home into a small-scale unit for people with dementia does not necessarily provide homelikeness, nor does a sense of home emerge from both the building and its psychosocial context. Rijnaard et al. determined five environmental factors that support a sense of home; however, they did not find a relationship between the scale of a facility itself and a sense of home in nursing homes. This study and the data sets collected by Rijnaard et al. (2016) and van Hoof et al. (2016a) support the architects, facility managers, and interior designers in creating a sense of home in nursing homes. The retrofitted apartment and the design checklist (Table 1) are an example of evidence-based design, in which the psychological and social aspects of a sense of home are translated into design solutions. In this study, the construction of new nursing homes is considered in terms of design and user needs. In practice, finance plays a major role in the total process of building new properties. The Dutch Healthcare Authority (Nederlandse Zorgautoriteit, NZa) is the supervisory body for all healthcare providers and insurers in the Netherlands. This agency also dictates the financial figures for investment in real estate and the inventory for Dutch healthcare facilities. One of its policy guidelines deals with the costs of housing, which is expressed in terms of normative housing and inventory components for care organizations that offer both care and housing (NZa, 2017). The height of these components is linked to the demand for care of the residents and is applied to (the substitution of new) facilities and maintenance. The yearly sum allows the care organizations to finance the costs of housing (including interests and maintenance costs) at a 97% occupancy rate. A similar set of rules is applied to the inventory of a nursing home. In practice, when a potential resident receives psychogeriatric healthcare assessment, the available investment per person is €127,665 for basic housing and €9500 for support services. Together with the treatment and day care facilities, the total available investment is €163,867. People with more severe healthcare assessments have higher available finances for investment. Even though these figures also include the costs for common living areas and corridors, this amount is sufficient for constructing high quality rooms or apartments for nursing home residents, considering that the price level of total investment costs is approximately €2223 per meter square and includes a 21% value added tax rate (Meijer, 2017).