Designing For Dementia: Beyond the Status Quo

The Human cost of poor design

Many older care homes still mirror hospital layouts: long corridors, dead ends, and large multi-purpose rooms. Such environments confuse residents living with dementia, increasing frustration and behavioural symptoms. Quast’s experience as a former carer reinforces the point: “When residents woke at night disoriented, they believed it was lunchtime. Without the right environment or staffing levels, the only option was often extra medication.” These design shortcomings have a knock-on effect on staff. Agitated residents mean stressed carers. “If you’ve got 10 residents all agitated and only two nurses, it becomes overwhelming. That stress translates into high staff turnover – a major risk for any operator.”

Easy-to-read environments to reduce stress

Health Building Note (HBN) 08-02 outlines dementia-friendly Health and Social Care Environments. Dementia-friendly design, it says, is largely about legibility and predictability: environments should be easy to read, reduce stress and confusion and support independence and dignity throughout the dementia journey. According to Care Homes & Nursing Homes UK , creating environments that support people living with dementia doesn’t require overly complex solutions, just thoughtful, common-sense design. Residents can struggle to recognise their own rooms when every door and corridor looks identical, especially if the lighting is poor or there are few visual cues. This lack of distinction can cause significant confusion, anxiety, and distress.

Dementia-friendly colours can make a real difference. For instance, a dark rug might appear to someone with dementia as a hole in the floor, prompting them to step around it and risk a fall. By using different colours to mark out corridors, doors and skirting boards, designers can help residents navigate more easily and understand where they are within the building. Some care homes even paint bedroom doors in contrasting colours, add flower boxes to windows, or use familiar signage and street names – all small but effective touches to help residents feel oriented and secure.

12 design principles to stick by

1. Provide a safe environment.
2. Ensure optimum levels of stimulation – avoid overload or under-stimulation.
3. Provide good lighting and contrast for ageing vision with minimal glare
4. Create a non-institutional, domestic scale and feel.
5.  Support orientation, providing clear lines of sight to key destinations
6.  Support wayfinding and navigation: landmarks, clear signage, colour cues
7.  Provide access to nature and the outdoors.
8.  Encourage engagement with family, visitors and staff with the right social spaces
9.  Maximise visibility/visual access, for example, sightlines to toilets
10.  Promote privacy, dignity and independence
11.  Enable physical and meaningful activity
12.  Support diet, nutrition and hydration, in other words, create the right dining environment

Scale matters – small groups, not Institutions

One of Quast’s guiding principles is designing for inclusivity and encouraging people to move freely around the home, therefore enabling residents to feel comfortable in their home environment. This also allows residents to truly age in place without any further moves.  Specialist dementia care homes are designed to eliminate potential barriers which can cause frustration and include wayfinding to encourage independence, even for those with advanced dementia.

Designing smaller areas encourage and support natural clustering of friendships and help avoid conflicts between residents who may not get along, a simple design choice that improves quality of life. Such spaces remove isolation and reduces stress for the resident, whilst allowing staff to deliver more personalised care. Health Building Note (HBN) 08-02 suggests that relationship-centred care is enabled by homelike architecture and clustering residents into small, recognisable sub-environments.

Daylight, circadian rhythms and medication

Designing with daylight isn’t just about making buildings look nice – it’s about improving health. In Abbeyfield’s Winnersh dementia care home, designed by Conrad Quast and his team, almost every corridor and living area receives direct natural light. The impact was remarkable: the use of medication was cut in half after the building opened, showing how design can influence wellbeing.

“Direct daylight helps stabilise circadian rhythms,” explains Quast. “It reduces night-time wandering and agitation. Without it, carers often have little choice but to use medication to manage behaviour.”

Scientific studies back this up. Researchers writing in the journal Neuropsychiatric Disease and Treatment found that exposure to bright, circadian-effective light throughout the day helps people with dementia sleep better and feel less agitated or depressed. The studies showed that light acts as a cue for the body’s internal clock, helping people stay awake and alert during the day and rest properly at night. This means that architecture itself can act like medicine. By shaping how light enters a space – bright during the day and dim in the evening – designers can help reduce confusion, improve sleep, and even lower the need for sedative drugs. As Quast puts it, “Good architecture can work as a form of therapy – it’s a treatment without a pill.” Designing with daylight is more than an aesthetic choice; it is a clinical intervention. In Abbeyfield’s Winnersh dementia home, which won a Pinders Award in 2017, Quast’s team achieved direct daylight into nearly every corridor and living space. The result was striking: medication use halved.

Wayfinding beyond signage

Traditional signage alone does little to aid people with dementia. Instead, design should offer intuitive, recognisable cues. According to Guidelines from 2018, Dementia Friendly Hospitals from a Universal Design Approach, wayfinding is architectural: simple route structures, sightlines, recognisable landmarks and differentiated places outperform signage-only approaches.

At Winnersh, four circular “rings” of rooms are connected to a central communal hub. This meant residents walking repeatedly around a loop always arrived back at a recognisable anchor point. Looped circulation like this, with recognisable anchors, supports habitual walking and reduces “dead-end” frustration, say the guidelines. “Corridors without meaningful destinations frustrate people,” Quast notes. “A dead end is simply a closed door you can’t get through. That creates agitation. Instead, give residents something purposeful at the end of a corridor, like a lounge, a window seat, a small breakout area.”

Involving operators early

A recurring challenge is the late involvement of operational teams. “We often only learned which part of a building would be a dementia wing three months before handover,” Quast recalls. “By then, all we could change was colour schemes. It’s far too late.” This disconnect stems partly from short-term financial models. Developers working on five-year investment cycles often cut design “niceties” to meet budgets, despite their long-term operational value. By contrast, charities such as Abbeyfield or the Order of St John take a 30-year view, prioritising sustainability over short-term cost. “When operators and architects sit down together from Stage 1, the outcomes are completely different,” Quast argues.

Financial realities and myths

A common misconception is that premium dementia design inevitably costs more. Quast disagrees: “It doesn’t have to. It’s about choosing the right layout and products at Stage 1. Something as simple as colour-coding toilet doors to aid recognition can be specified upfront at no extra cost but retrofitting later is hugely expensive.” He advocates for financial modelling of operational costs at the design stage. “Capital cost is only a fraction of the overall picture. If we model how the building will run, we make better design decisions. That leads to more sustainable operations and ultimately more profitable business models.

The Overlooked role of acoustics

Noise is one of the most underestimated stressors in dementia care. Large, open dining rooms designed like restaurants often drive residents away. “One gentleman told me he avoided the dining hall not because the food was bad, but because the noise was unbearable with his hearing aid,” Quast recalls. Subdividing spaces reduces noise and allows residents to eat in smaller groups. Yet this must be balanced with clear sightlines, as Alan Davies of Rockfon points out – a challenge where new acoustic products such as wall panels and discreet ceilings can help.