‘We go for a homely feel… not the clinical dementia side’: Care home managers’ experiences of supporting residents with dementia to orientate and navigate care environments.

Abstract

Living with dementia can adversely affect people’s spatial (orientation and navigation) and reality (time, date, place) orientation, which can detrimentally impact on their sense of social inclusion and well-being. This is an important challenge to address within United Kingdom (UK) care homes where around 70 per cent of the residents are living with dementia or severe memory problems. Care home managers are key for enacting this agenda, yet a paucity of literature explores their understanding and experiences of this issue. Contributing to this knowledge gap, our exploratory study examined manager’s current practice of supporting residents with dementia to minimise disorientation and their knowledge of dementia-friendly design principles, guidelines and audit tools. Semi-structured telephone interviews with twelve UK care home managers were conducted. Questions started generally targeting resident’s orientation and navigation abilities, followed by specific questions to draw out strategies used to support residents. Thematic analysis identified three higher order themes: (i) aligning strategies with needs; (ii) intuitive learning; (iii) managing within wider business context. The findings demonstrated that managers perceive dementia to impact on a person’s spatial and reality orientation. Consequently the strategies they chose to adopt were tailored towards alleviating both challenges. However, although managers were aware of some design principles they frequently relied on intuitive learning and past experiences to inform their choice of interventions; reporting a lack of knowledge and/or time to seek out orientation specific training and guidance, resulting in a low uptake of guidelines and audit tools in practice. This gap between theory and practice highlights a need for accessible guidelines that integrate strategies with neuropsychological theory, and appropriate training to improve orientation and navigation in care home environments. Managers, staff, business owners, architects and designers all play a key role in implementing orientation guidelines into practice and ensuring dementia-friendly care home environments for residents.