Editor’s Note: This article addresses the best practices in design, decorating and the use of wall art, wall murals and other artwork in dementia and memory care facilities, assisted living, long-term care and other senior care residences. Many of the guidelines here may also be used by caretakers looking after patients suffering from Alzheimer’s or dementia in private homes.
Wall Murals & Wall Art Can Improve Treatment and Outcomes in Dementia & Memory Care Facilities
What will you find in this article?
There’s a lot of conflicting information out there regarding the use of décor that stimulates vs. décor that soothes. Short answer: most patient populations require both environments.
All dementia and Alzheimer’s patients are not the same. Even the same patient may have different needs on different days or different parts of the day. Wall murals offer an excellent and cost efficient way to create different spaces for different needs while still achieving cohesive design across your cognitive care facility.
Reminiscence Therapy employs décor that brings the well-remembered past alive. Wall murals and other wall art depicting bygone days, or just images that are immediately recognizable to all of your clients, can create familiar and comforting care environments.
Wall murals can make the areas where you want your patients to congregate more attractive and those spaces you want to dissuade them from gathering less attractive. Dining room décor can help stimulate the appetite. Bathing rooms can be turned into inviting spas. Exits and elevators can be disguised. Way-finding signage can be clear and attractive.
There’s a lot of information out there. Much of it contradictory.
If you’ve spent any time at all searching for guidance on how to decorate and create an environment that will be therapeutic and beneficial in the care of Alzheimer’s and dementia patients, then you’ve likely found that there is 1) limited science behind the design suggestions for memory care facilities and 2) that different experts have vastly different ideas on how wall art, wall murals and other décor can affect those suffering from dementia.
Magic Murals has conducted an exhaustive survey of all of the research and anecdotal evidence available in creating our collections of door murals, wall murals and other wall art for senior care and memory care facilities – and, while we’re not medical professionals, we’re sharing that knowledge with you. We want to make sure everyone has access to the expertise we’ve developed, whether you’re working with one of our design consultants or not. Of course, we’re here to help: contact us here or call us at (877) 448-7295.
How stimulating should dementia care environments be?
First, let’s address the major disparity among the suggestions you’ll find if you scrub through 100 pages of search results for “wall art and dementia care” yourself.
You’ll find a lot of experts who suggest that senior care facilities, and memory care units in particular, should be decorated in bold and bright colors, using patterns (though avoiding vertical stripes and anything that could resemble prison bars) and other design elements that stimulate the mind. Think multiple birds, animals, balloons or other items that can be counted or that you could ask a patient to find for you (e.g., “how many yellow birds can we find here?”).
You’ll also find a lot of experts who’ll attest that memory care patients are best served in environments that limit excess external stimulation. They’ll advise that colors should be warm, cozy and muted, that patterns should be used minimally, and that artwork with a lot of busy & competing graphic elements might be too distracting, cause anxiety, and generally be disruptive to dementia patients.
So… what’s the right answer?
Well, both answers are correct… it just depends upon the patient or patients you’re taking care of. Just as no two people are alike, no two patients with dementia are alike either.
Decorate with your patient’s specific and changing needs in mind.
In general, patients with minimal dementia or in the initial stages of Alzheimer’s are best served by environments that stimulate their cognitive functions. Give them plenty of things to do and look at while they’re walking along the hallways or staring at the walls (and perhaps they’ll spend less time just staring and more time interacting).
Likewise, patients who are easily made anxious by too many distractions, by bold & loud colors, or by busy patterns and/or too many design elements are best served by warmer, homier, quieter colors. Use patterns to break up the monotony of flatly-colored walls, but keep them simple and familiar (staying away from any pattern that could make them feel closed in, like vertical stripes).
Rita Altman, R.N. and Senior Vice President, Memory Care & Program Services, Sunrise Senior Living, reminds us to avoid busy patterns. “Rugs and furniture should not be highly patterned or have strongly contrasting colors because some with memory loss have trouble with spatial awareness and can perceive darkly contrasting patterns as holes or perceive flecks of color as spots that need to be removed.”
If you’re creating a dementia-friendly home for a senior who is “aging in place,” then you probably have a pretty good idea of what they’ll positively respond to. And if you’re not sure (or even if you are), show different colors, patterns and artwork to them and have them assist in redecorating their home. After all, one of the biggest complaints those in their twilight years have is that every decision is made for them. This is an opportunity to get them involved and working those brain cells in a happy endeavor.
Use bright & bold wall murals in one area, soothing pastels & earth tones in another.
For larger dementia facilities and memory care units that often serve residents in various stages of mental decline, the best guidance may be to have differently decorated residential wings or common areas that cater to different types and levels of dementia.
In fact, differently designed areas may serve the exact same patient depending upon their mental status at a particular moment or time of day (e.g., sun-downing). Bright and bold areas may be more appropriate in the mornings while calm and cozy areas might be perfect for those who are sun-downing at the end of their day.
Pastel colors can be soothing yet stimulating at the same time. If you’ve found a mural image that would be perfect for your care facility, but it is a little too bright or a little too subdued for the planned environment, Magic Murals can usually adjust the color palette to be more suitable. Our custom-sized, custom-printed wall graphics can also be printed in sepia tones and other finishing effects.
Make a strange place seem familiar with wall art that recalls the past.
One piece of design and décor advice for memory care patients (and, really, for all senior housing solutions from independent living to assisted living to nursing homes and rehabilitation facilities) is to make your environment as comfortable, familiar and non-institutional as possible. No one, even those suffering from dementia, wants to live in a sterile, hospital-like setting.
Across the United States and Europe, a lot of senior care facilities are experimenting with what’s being called Reminiscence Therapy care. In a nutshell, Reminiscence Care uses artwork and other décor that mimics the past… a past that those with Alzheimer’s and dementia often recall more clearly and more fondly than they do the past few days or the last 15 minutes.
“Sensory cues are really the secret to providing what we call comfort care,” said Marguerite McLaughlin, who’s in charge of quality improvement at the American Health Care Association, the country’s largest trade group for nursing homes.
Such residences are using rotary phones, vintage looking televisions and radios, lamps and furniture from days gone by, and murals and posters that depict advertisements from the good old days when their residents were in their prime.
Dr. Dilip Acquilla, group managing director for Belle Vue, said:
“We have done things a bit differently and gone very retro with our interior. Dementia sufferers often have short term memory problems – they can forget the names of their children, wives, partners but they remember a lot about the past. It jogs their memory into further activity if they can see things from the past, such as an old picture. It becomes a talking point. It is part of the care we provide.”
The décor is often supplemented with aromatherapy (think cinnamon or vanilla), music from the 1940’s and 50’s, and staff training that has care-takers playing along with their patients’ trips down memory lane rather than correcting them about what year it is, what place they’re at or reminding them that they’re no longer a sailor on shore leave for a bit of fun and recreation.
Jim Macleod, with dementia care facility Scarlet House in Gloucestershire, U.K. remarks, “These sorts of spaces are a great addition to any care home. Anything that evokes memories of times gone by can be really important to someone living with dementia. They can go back in time.”
If you have a rather homogeneous patient population, decorating in the theme of a specific era might be the way to go. You will, of course, have to redecorate as each generation gives way to the next.
These days, however, most memory care units have a wide age-range of patients under their care. A vintage poster that might seem “current” and familiar to a 90 year old might be received quite differently by a 70 year old or a 50 year old.
Likewise, many facilities serve patients who come from multiple and rather different geographical areas, socio-economic backgrounds and/or ethnic and cultural upbringings.
Our best advice: choose décor that will be familiar to all of your residents and their visiting family members. Use wallpaper, wall murals and artwork that all of your patients will recognize and be comforted by.
Facilities that cater to a more local clientele might choose cityscapes from the area, local landmarks and attractions, farms and fields, parks, lakes, beaches, etc. Magic Murals often works with our clients’ local historic societies, chambers of commerce, visitors bureaus and state and local governments to create collections that represent specific towns, states and other geographic areas.
If your patient population is more diverse, then select imagery that is more universally recognizable. Iconic skylines like those of New York or London are known to pretty much everyone, and might provide an opportunity to remember and discuss a vacation or business trip taken long ago.
Natural sights like the Grand Canyon, a beach sunset, a snow-topped mountain or a field covered in wildflowers can be both familiar, comforting and just plain beautiful to look at.
Man-made wonders like the Statue of Liberty, the Golden Gate Bridge, Mount Rushmore, the Eiffel Tower, the Pyramids at Giza, etc. are also universally familiar and might spark memories and conversations among residents and/or staff and provide common topics to discuss.
Even maps, from local cities to states to countries and continents, can be a great way to stimulate the mind. Where did you grow up? Where did you move to? Have you ever visited Montana? Where was your most favorite vacation? Your patients might very well not know where they’re at right now, but many of them will remember where they were in their younger past.
Use wall murals and wall graphics to create desirable (and undesirable) areas.
Wall murals and other wall graphics can be very useful in providing visual cues to places where you want your residents to congregate (dining rooms, bathing rooms, activity rooms, common areas, etc.). Wall murals can also be very useful in discouraging patients from wandering to areas where you don’t want them to go (exits, elevators, supply closets, etc.).
Dining Rooms: Getting memory care patients to the dining area can be a challenge. Getting them to eat enough can be an even greater challenge. Senior care centers across the U.S. and Europe have had great success in using wall art and other décor to assist in both tasks.
Instead of a beige wall and an uninspired doorway, consider decorating the outside of the dining room to look like an outdoor café, a comfortable restaurant, or even a family dining room. Give it a welcoming entryway (check out our door mural collection). And then inside, decorate with murals and artwork that depicts fresh food, wide open wheat fields, tropical fruit trees, etc. – or carry that restaurant theme through with additional scenes depicting restaurants, cooking, baking, eating, etc.
Tub Rooms & Bathing Rooms: Sure… bathing areas need to be sterile and utilitarian, but that doesn’t mean they have to look that way. Imagine how fearful you’d be if getting a bath required a hoist and two strangers!
Wall murals and custom-sized wall art can give your bathing room the look and feel of a resort spa. Tropical sunsets of the beach, a balcony overlooking a spacious pool, even scenes of people swimming can get the idea across that this room is all about the water. A blue sky dotted with fluffy clouds and even bubbles can score the same effect.
Activity Rooms & Common Areas: Remember our discussion above about decorating for your patients and how they respond to various stimuli and how that response might differ during the course of the day. Choose colors, motifs and scenes based upon their need for stimulation, or the lack thereof.
Activity rooms might benefit from bright and bold colors, interesting patterns, and wall murals and other décor that invites interaction. A wall mural or other large art print (Magic Murals custom prints in any size you want) of hot air balloons, colorful coral reefs with tropical fish, multi-colored European homes or various animals can be used to play “pick out the _____,” and encourage conversation.
Common areas and lounges, where patients typically gather when there are no activities or after meals and at the end of the day when they’re winding down, might best be suited for more comforting pastel colors and serene scenes. Think spring or autumn landscapes with a distant horizon (depth of field) that allow you to stare deep into the picture and drift into a peaceful dream. Ocean sunsets with gold and rose-hewed clouds, again offering a space-opening depth of field, are popular as well.
Hallways and Room Entrances: Even those of us without cognitive impairment can get lost and confused when each hallway looks the same and each bedroom door (and all of the other doors) leading off of it looks the same.
When all resident doors look the same, not only is it aggravating to patients to have difficulty finding their room, but the consequences of entering the wrong room can be unsettling to multiple patients. The experts at the Social Care Institute for Excellence write:
“In a care home, these adjustments can help to prevent residents walking into someone else’s bedroom. In their confusion the person might start searching the drawers and cupboards because they think their own things have been replaced with lots of strange things. When the room’s owner comes in they then think the person is prying, or worse, stealing. This can start a major incident, which could have been prevented.”
If you have multiple wings in your memory care unit, then consider giving each wing its own color palette or its own theme (e.g., different seasons, different animals, different geographic areas, etc.).
Within each wing, you can assist your residents in finding their particular rooms by using variations in color (e.g., a medium blue, a medium green, a light blue, a light green, and then repeat again) or in patterns (e.g., thin, medium, thick styles of the same pattern) or in graphic elements (e.g., birds, cats, dogs, fish) on the walls surrounding either side of their specific entrances. “Mrs. Smith… your door is the one surrounded by puppies. I know you love those dogs.”
Using wallpaper and wall mural panels in this way can give you the same effect (at a fraction of the cost) as the architectural build-outs used in the award-winning Lantern of Chagrin Valley facility in Chagrin Falls, Ohio which has been designed to look like a small golf-course community.
Lantern CEO and occupational therapist Jean Makesh remarks that patients with Alzheimer’s often keep the memories they had when they were younger. “I take them back to those memories,” he said. “I create a time capsule. It enables them to embrace everything around them.”
If you can’t get the director to share your vision for different imagery up and down the hallway, a simple yet equally effective solution is to give each resident a unique door. Magic Murals has a broad assortment of door murals that can be custom-sized to fit the doors throughout your facility. Give one an older looking door, one a new. One a red door, one a blue. Everyone gets a different door… without removing a single hinge!
Providing a unique and memorable entryway doesn’t get any easier than that.
The Dementia Services Development Center at Stirling University offers excellent guidance for overall design of dementia care facilities, including the use of custom doors for resident rooms.
Provide patients with custom décor and wall art in their private spaces.
Want to get really creative and provide a custom solution? Work with your patient’s family and see if they can get a high-resolution photo of the door to your resident’s former home and we can custom print a door covering that looks just like the front door of the house they still consider home.
Further personalization can be done by installing custom-printed peel-and-stick decals on their doors featuring their pictures (either recent or vintage), pictures of their families, friends, pets or other pictures which they remember and can trigger positive feelings. These self-adhesive prints are far safer than wreaths or other ornamentation that are hung from the door and subject to falling off or causing consternation when they become lopsided.
In the Bedroom: Depending on mobility and other issues, including uncontrolled physical outbursts, you may not want to have a lot of knick-knacks, breakable memorabilia or picture frames adorning the furniture and walls of your residents’ bedrooms.
That doesn’t mean, however, that their room can’t be decorated with pictures and memorabilia that have long-term memories associated with them. Imagine how welcoming their bed may be when there’s a peel-and-stick print of their family (either current or vintage) and pets serving as a headboard. For those who find television annoying, a self-adhesive, printed collage featuring all of the photos that used to be on their bureau, mantle and throughout their home may be comforting and help to keep those memories alive.
Additional insights can be found in Design for Dementia: improving dining and bedroom environments in care homes published by the Helen Hamlyn Centre for Design at the Royal College of Art. A major point made in the article is:
“The bedroom is the one place in a care home that can be identified as a resident’s personal space. It is a place of refuge where identity is reinforced through familiar objects. It is also a room where a range of tasks such as dressing and sleeping need to be conducted whilst taking account of the range of ability that different residents might have.”
Wall and floor graphics can visually guide residents toward, and away from, select areas.
Way-Finding: Most way-finding signage is crystal clear to those of us who speak the language and continue to have the cognitive skills to read. Signs that state “Exit,” “Nurses Station,” and “Dining Room,” might not work as well for dementia and Alzheimer’s patients.
Instead, consider wall graphics that actually depict someone exiting a room, a nurse providing compassionate care, a delicious meal or residents gathered around a dining table enjoying their meal.
No-Go Areas: Every facility has areas where residents simply are not permitted or where they don’t want residents congregating. It’s time-consuming for the staff and, let’s face it, not the best way for caretakers to bond with their patients and develop strong, trusting relationships if they’re always ushering them away.
Exit-seeking: Exits and elevators are two areas where you don’t want residents congregating. It slows down the movements of the staff and poses a danger to residents who could get hit by quickly-opening doors, food carts and other equipment being moved throughout the halls. It also provides a quick escape for wandering residents and those patients who are always looking for a way out.
Peel-and-stick wall murals depicting bookcases, brick walls, vine-covered trellises and other images provide a “full-stop” visual cue, indicating to residents that there’s nowhere else to go and they should turn back now to continue their walk. Images like these not only hide the exits, but they do so in a beautifying manner. Supply closets and other doors can be disguised in the same manner.
Dark colors on an otherwise bright floor can often be interpreted as a whole in the floor by patients with cognitive impairment. Large, dark floor mats placed in front of exits and elevators can keep residents from approaching these areas. If you’re concerned about trip and fall hazards, Magic Murals offers non-slip floor graphics that can accomplish the same affect.
Wandering-encouragement. Six in 10 people with dementia will wander, according to the Alzheimer’s Association. Dead ends may frustrate or confuse those with dementia, which can lead to agitation among those who are wandering. The right wall graphics can help lead these residents through your hallways (especially if you have a circular or figure-eight corridor system) so they avoid agitation and keep moving. That extra exercise can, in turn, help build their appetites and help them sleep at the end of their day.
We encourage you to contact our design professionals. Not only can we help you with image selection and create custom murals for you, but we can also make sure the materials chosen are easy to clean and maintain, etc. Note: before covering resident doors, exit doors, elevators, etc., we recommend checking fire codes with your local authorities; fire and safety regulations differ from city to city.
We hope this article has been informative and has answered more questions for you than it has raised. For additional advice, the Alzheimer’s Association offers a PDF with a list of more articles on designing for dementia patients. This article from AARP offers advice on how to improve things at home, with a focus on safety, for patients with dementia.
For managers of Alzheimer’s and dementia care facilities, we also direct you to a great article from The Toronto Star on designing for patient care and comfort.
The design consultants at Magic Murals are here to help.
Contact us here or call us at (877) 448-7295.
We look forward to serving you.