The Home Spirit Environment Audit Tool

How this tool should be used

This tool should be used to highlight ways in which environment changes can be made to make life better for a person with dementia. The aim of the tool is to look at:

Changes to the physical environment have the potential to make big differences in prompting the person to eat more and find their way to the toilet, and to reduce the risk of falls and improve their opportunity to maintain personal hygiene.

one in four people who are admitted to hospital in the UK have dementia, and many physical problems are associated with poor nutrition and infections (resulting from poor hygiene). When a person is admitted to hospital it may highlight concerns around how a person is managing in their home environment, and for some this may mean a transition to residential care. Therefore, by making small changes to the environment you may make the difference as to whether or not a person remains at home.

It is, however, important to be mindful of the scale of changes you make, as familiarity is important. For example, if you need to change a chair because it is the same colour as the walls and the floor and the person cannot see it (because of problems with colour contrast), you should try to replace this with a similar style (but a different colour) to reduce confusion.

Some changes, such as changing the flooring, may cost a lot of money to make, and so may not be possible in the short term, but highlighting these as areas of concern will still inform the support plan, and so enable people to forward plan. Many changes, however, can be made more simply and cost-effectively.

Within this document there have been some recommendations made about possible assistive technologies. However, assistive technologies should be used with extreme care. For example, balanced decisions need to be made as to whether technologies are used to replace human contact/support and if these technologies impact or infringe on the person’s rights, choices and wishes. Perhaps one of the most controversial uses of technologies is the use of surveillance style monitoring or electronic tagging used for ‘safer walking’. For a more comprehensive look at assistive technologies, use the following link: http://www.atdementia.org.uk

There are over one hundred different types of dementia and even within a particular form of dementia such as Alzheimer’s, a person’s symptoms may vary considerably. Therefore, whilst we have attempted to consider the range of difficulties and possible solutions a person might experience functioning in their environment, it is not possible to know every eventuality. Therefore, the tool should be used as a guide, and observation and reporting should be used alongside to determine how best the environment can be manipulated to improve wellbeing. It is also important to work with occupational therapists for independence and mobility aids.

Why do we need this tool?

A person with dementia may face a number of sensory challenges which affect the way in which they are able to find their way round their environment. We use both our sensory skills and our cognitive skills (thinking skills) to navigate our environment. If a person has experienced damage to their thinking skills as a result of dementia then they will rely more on their sensory skills to interpret their environment. Therefore, we need to make sure that we make things more obvious.

As many people with dementia are older they might also have problems with sight or hearing. Sight naturally deteriorates with old age; we lose our ability to focus at close range from mid life, and it slowly worsens over a period of time. We also have difficulty, as we get older, seeing things at a distance, and are more likely to develop age-related eye diseases as we get older, such as cataracts, glaucoma or age-related macular degeneration. The aging eye also has more difficulty discriminating blue colours. If a person has had a cerebral vascular accident (CVA) they might have a visual field loss which would impact on the way they navigate the environment in very specific ways.

Some of the cognitive challenges a person might experience as a result of their dementia are things like using memory to find their way around, recognising certain objects or being able to see the items that are placed against the same or similar objects (colour contrast).

We know that by making the environment the best it can be we

For community-based services this is an excellent way to improve the reach of your interventions, even when you are not physically in the building. This creates a cost-effective intervention that is likely to keep the client within your service for longer.

How the tool works

There is a list of questions that follows. This is divided into the following parts:

The tool will make some recommendations based on your answers.

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