Planning and

design guide for

community-based
day care centres
This revised edition of the Planning and design guide
for community-based day care centres was originally
published by the Alzheimer’s Society (UK) in 1992 and
is published with permission.

64 Great Suffolk Street

London SE1 0BL
Tel: +44 (0)20 7981 0880
Fax: +44 (0)20 7928 2357
Email: [email protected]
Web: www.alz.co.uk
Planning and design guide for community-based day care centres 1

Contents
Summary 3
PART 1 Planning Guidelines 3
PART 2 Design Guidelines 3

Introduction 4
Aims and methods 4
Why provide day care for people with dementia? 4
Objectives for a day centre 4

Part 1: Planning guidelines 5

Introduction 5
Community care legislation 5
The planning process 5
Initial planning 5
Small is beautiful 5
The people 6
The clients 6
The carers 6
Emotional and practical support for carers 6
The staff 6
Main activities 7
Reminiscence 7
Domestic activities 7
Table manners and hygiene 7
Entertainment and hobbies 7
Physical exercise 7
Outings 7
Transport 7
Other considerations
influencing design 7
General health 7
Incontinence 8
Meals 8
Personal hygiene 8

Part 2: Design guidelines 9

Essential qualities 9
Choice of building 9
Conversions 9
New buildings 9
Design and sizes of rooms 10
Entrance 10
Main room 10
Access and handrails 10
Office 11
Dining room 11
Planning and design guide for community-based day care centres 2

Quiet room 11
Toilets 11
Bathroom and toilet accessories 11
Bathrooms and shower rooms 12
Hairdressing and chiropody room 12
Staff room 12
Staff toilet and changing room 12
Safety and Circulation 12
Fire protection and escape routes 12
Disabled access 12
Protection against wandering 12
Corridors 13
Handrails 13
Dangers of falling 13
Lighting with safety 13
First aid 13
Security 13
Catering and cooking 13
Main kitchen 13
Therapeutic cooking 14
Typical layouts for toilets, bathrooms and kitchenettes 14
Floors, walls and doors 15
Carpets 15
Washable floors 15
Walls and doors 15
Lighting, colours and pictures 15
Natural and artificial light 15
Colours and pictures 15
Furniture, fittings and fabrics 16
General 16
Chairs 16
Garden or courtyard 17
Garden layout and design 17
Wandering 17
Utilities and services 18
Laundry 18
Storage 18
Cleaners’ room 18
Linen store 18
Switchgear and services room 18
Refuse store 18

How ADI can help you 19

Appendix A 19
Main financial considerations checklist 19
Capital costs: 19
Revenue costs: 19

Appendix B 20
Essential or desirable building features and spaces 20
Planning and design guide for community-based day care centres 3

Summary
This design guide sets out the principles for the
provision of day care centres which can give some
respite for people who provide care at home for
relatives with dementia. The main principle is that the
day care centre should be as much like home as
possible, but with additional facilities to extend the
services available to both the clients and the carers.
The minimum requirements for a day centre for
people with dementia are probably the part-time use
of the living room, kitchen and toilet in a small house,
and for dedicated and skilled staff to look after them.
This, after all, is how many families care for a relative
who has dementia.

PART 1: Planning Guidelines

The importance of initial planning for any proposed
day centre, including defining objectives, identifying
existing facilities and resources in the area, and
establishing realistic budgets.

PART 2: Design Guidelines

People: the varied needs of people with dementia (the
clients), of the people who look after them at home
(the carers), and of the staff at the day centre.
Activities and general considerations in the design and
furnishing of accommodation for people with
dementia.

Design considerations: a brief description of the main

issues to consider, according to functions, activities
and rooms, with a cost checklist.
4 Alzheimer’s Disease International

Introduction activities to take place. These should include those

that best maintain the individual’s residual skills, and
that stimulate each client to his or her maximum
potential. The necessary medical treatment for
Aims and methods secondary conditions should be made available.

This guide aims in a simple way to provide an outline

of the basic requirements for a community-based day
care unit for people with dementia. Its main purpose is Objectives for a day centre
to describe the minimum physical provision which is
required to provide care for a small number of users The objectives for a day care centre could include
on a daily basis. Far from seeking to define what is some or all of the following:
required for an ideal day centre, the guide sets out the
• to reduce the stress on carers by giving them
minimum requirements so that effort and resources
respite from the burden of caring
can be concentrated on those features which are
essential. • to contain the problem, primarily by enabling the
The guide is based on the results of visits to day carers to continue caring
care centres run by voluntary organisations and by
• to provide therapy for the people with dementia in
social services departments. Only two of the centres
order to manage the consequences of the disease
visited were purpose built; the others were in
converted buildings in a variety of different settings, • to enable older people to continue living within the
with a minimum of adaptation. community
The guide does not attempt to deal with the
• to support carers and their families.
financing, staffing and management of day care
centres and is not intended to include sophisticated
schemes for new buildings. The emphasis of the
guide is mainly on the use of existing buildings with
limited resources.

Why provide day care for

people with dementia?
Day care is a key component of a comprehensive
support service for elderly people, their carers and
their families. The tradition of providing care on a daily
basis for the frail elderly, the physically disabled and
the mentally ill is well established and people with
dementia have many of the same needs as people
with other disabilities.
There is no known cure for dementia. The
requirement for care is therefore for the long-term
maintenance and monitoring of the person with
dementia, and for relief for the carers. In this design
guide the term Alzheimer’s disease is used to include
all types of dementia.
Community day care centres provide, in theory, a
long term commitment and very often see their main
role as one of providing respite for the carer. If this
respite is going to be valuable both for clients and
carers the building should allow for a variety of
Planning and design guide for community-based day care centres 5

PART 1 example, would mean that an existing centre could be

used more fully. It is most important to ensure that any

Planning new facility is really needed and will be used by the

carers. However, it is almost impossible to make an

guidelines accurate assessment of the numbers with dementia in

any locality and of the potential clients in advance.
The necessary steps at the initial stages will include:

• An assessment of local needs, including a review of

Introduction the existing resources and facilities in the area, in
consultation with the social services departments
The aim of community care is to enable people in and the health authorities. An appraisal of the
need of care to live as fully as possible, and for as potential demand can then be made.
long as possible, in their own homes. In the case of
• A statement on the fundamental purpose of the
people with dementia, a key component of
proposed centre. This will include: a definition of
comprehensive support may be the existence of a day
those who will be eligible as clients; the
care centre where they can be looked after for short
establishment of specific targets for the numbers of
periods of time, giving them the opportunity of outside
clients to be cared for; and the activities and
stimulus and their families an opportunity for rest or
support services to be provided.
respite.
This booklet aims to give some guidance to • The appointment of an executive management
voluntary organisations who have recognised the need committee, with appropriate professional and
for a day centre for people with dementia in their area technical advisers, to undertake the planning of the
and wish to set up such a service or have agreed with organisation and its administration, financing,
a local authority to run a centre. The guide focuses staffing and building requirements.
exclusively on design considerations and only touches
on the management and financing of such schemes in Small is beautiful
so far as they are inextricably linked to the building
Although the stages of planning for a new day care
requirements.
centre may seem long and complicated, there are
This guide does not attempt to be a blueprint for
many practical advantages in planning for this service
the ideal day centre. New buildings are beyond its
on a local scale:
scope but the more common needs of adapting an
existing building, of choosing appropriate furniture and • Budgets can be relatively modest and may be
fittings, of simple adaptations and decorations are funded with contributions from a variety of sources.
addressed.
• Existing buildings of all kinds can be considered for
adaptation and may provide opportunities for
imaginative and successful projects.
Community care legislation • Collaboration with other organisations and caring
services can enable a day care centre to develop
It is essential to check the community care legislation
as part of a co-ordinated community based service
in your country before proceeding with planning your
to meet the needs of people with dementia.
day care centre.
• The concept of a simple and small scale project is
easy to communicate to all concerned, including
existing home carers and the community in general.
The planning process
• The practical realisation of such a project provides
Initial planning strong motivation for everyone involved.

The voluntary organisation will want to ensure that the

It should be noted that one of the most successful
need for day care is properly established. It may be
centres visited in the preparation of this guide was an
that a more flexible approach to transport, for
ordinary domestic bungalow with a few basic
6 Alzheimer’s Disease International

alterations to improve the access, and the sanitary a building which is used for other purposes at other
and cooking facilities. times.

Younger carers
Younger people with dementia may have a spouse or
The people children who have to go out to work and for whom
part-time day care is quite inadequate. The situation
The clients
for this group of carers is particularly severe. There is
The size of the available building will influence the a lack of suitable day care provision and there is often
number of clients who can be cared for in any one no alternative to the person having to go to a centre
day. Even where space is no problem, it is possible for the over 65s. For this group, it may be necessary
that about 16 is the maximum number that can be to provide care for longer hours, so that the ‘bread
accommodated comfortably and with the winner’ may continue in employment. In these
maintenance of a domestic atmosphere. However, circumstances a full time day care centre may be the
financial pressures may result in the day centre having only alternative to institutional care and alternative
to be planned for a larger number. uses of the building are less likely to be acceptable.
The condition of the clients is likely to vary Such considerations have a profound influence on the
considerably, depending on the stage of dementia and design, staffing, management and funding of a day
on their physical health and mobility. Most day centres care centre.
which cater for people with dementia cannot cope
with those who are also severely physically disabled. It Emotional and practical support for carers
is possible that elderly people who are mentally ill and
The service provided by the centre can be greatly
suffering from a non-organic mental illness such as
extended if there is regular contact with the carers.
depression may be accepted. The day care centre
Every day centre should have a small quiet room
organisation may also find it easier to look after clients
where individual carers can be counselled. It is best if
with severe dementia on different days from those in
the quiet room is situated near the entrance so that
the early stages of the disease. These are decisions
carers can talk things over with a member of staff
which will depend on the numbers requiring the
whenever they visit the centre.
service, and the numbers of days a week on which
the day centre will be open.
The design and character of the day centre can
contribute greatly to the amount of independence The staff
which may be safely allowed during the daily activities.
If the group is small, the building is secure, there are Staff at the centre will be greatly assisted if the design
sufficient staff and there is more than one room for the of the accommodation and the provision of equipment
clients, it may be possible to allow the clients and facilities are appropriate. Unfortunately, at many
considerable choice in what they do. Knitting, drawing day care centres, the staff have to manage as best
or cooking may be particularly beneficial because they can with limited facilities. Staff may be paid, or
these are skills which are often retained for some time. may be volunteers. All will require training and there
should be sufficient space for this. They will need an
The carers understanding of dementia and its problems, and of
caring, communicating, lifting and helping physically
Older carers
frail and disabled people. Staff meetings and training
Most people with dementia are elderly and cared for
sessions will need to take place in the centre.
by an elderly spouse. The respite provided by a day
A day care centre should also, if possible, have a
care centre may just be sufficient for the carer to be
room where staff can relax from time to time during
able to keep their relative at home. They may even
the day and where a member of staff can be
find that, relieved of the constant pressure of care, the
counselled when under stress. The demanding nature
time spent with their relative becomes more pleasant.
of the work means that support to staff, whether paid
For these people, respite care on one or more days
or voluntary, is an important aspect of the managerial
per week from about 10.00 am to 3.00 pm may be
task, and is easier if there is a staff room.
sufficient. Such care can, if necessary, be provided in
Planning and design guide for community-based day care centres 7

Main activities valuable. People with dementia may sleep badly and
be more inclined to wander if they have not had
The company of other people and the activities enough exercise.
provided in the centre may stimulate the person with Space is necessary so that short sessions of
dementia. Many of the activities at a day care centre exercise or dancing can be held in the centre.
will aim to maintain residual skills. Accompanied walks in the fresh air are even more
therapeutic.
Reminiscence
Outings
Short-term memory loss is the most frequent early
symptom of Alzheimer’s disease. However, long term If the centre has transport, many people enjoy outings
memory may remain largely intact and much pleasure to parks and other places of interest.
may be given through reminiscence therapy involving
the use of newspapers, photographs, objects and so
on from the person’s youth. Some centres even
furnish rooms in styles from the past.
Transport
Transport is often a problem when providing day care
Domestic activities
services, especially where vehicles are provided by
While people with dementia may not know why they hospitals or other organisations with other demands
are carrying out certain tasks, they will derive for their services. There are immense advantages if a
satisfaction from doing things that they once did with day care centre has its own vehicle for the transport of
efficiency. Painting, cooking, gardening and so on can clients.
provide that satisfaction. The appropriate space for The most suitable vehicle is usually considered to
these activities needs to be provided. be a minibus with forward facing, chair type seats,
good visibility through the windows, easy
Table manners and hygiene communication between the driver, the escort and the
passengers, and good heating/air conditioning. The
The ability to use a knife and fork and to shave may
vehicle should have a tail-lift if possible. Ideally the
be an early loss in the progression of the disease. If
vehicle should be able to discharge and to pick up
the day centre staff can help with these basic skills
clients at the day centre under a canopy or other
and support the person for as long as possible, the
protection from the weather. In any event, the vehicle
family will benefit. Toilet facilities with plenty of room
should be able to park safely close to the day centre
for assistance are also very important.
for the considerable time that may be required to
transfer the clients to and from the building.
Entertainment and hobbies

People with dementia do not lose all their original

interests at once. Their attention span tends to be
short, but they should be given the opportunity to
Other considerations
express past talents. Music and singing are often influencing design
among the last faculties to go, and the words of
songs are remembered long after normal conversation General health
is a thing of the past. Simple games like dominoes,
People with dementia do not communicate well or
lotto and bingo are often enjoyed, especially with help
register their complaints reliably so there is a need for
from staff or volunteers. A piano and tables would
a day centre to have good medical records on
thus normally be part of a day care setting.
individuals and to be able to make contact with the
clients’ doctors.
Physical exercise
The planning and furnishing of a day centre should
People with dementia need as much exercise as allow for the necessary records to be kept securely
anyone else. The temptation to leave the patient in and for medical consultations to take place if this is
front of a television screen at home is one of the arranged with the family doctor or specialist.
reasons why a good day care programme can be very
8 Alzheimer’s Disease International

Maintaining a day book which records anything of They should not consist solely of salads or
significance happening during the day, which is sandwiches. Any wrappings should be removed in
accessible to all staff when on duty, may be a great advance. Food temperatures, especially hot soups
help. The location for keeping the day book should be and drinks, should be checked by the staff.
planned in advance. If possible, the tables should be set up before the
clients enter the dining room or eating area so that
Incontinence they can go straight to their places. (Clients could be
encouraged to help with the laying of the tables.) The
The problems of incontinence have considerable
tables should be set up without salt or sugar as these
bearing on the design and furnishing of a day care
are likely to be overused by the clients.
centre for people with dementia. The design of the
The meals should be an important part of the day. It
building should ensure that the toilets are easy to get
may be helpful if staff eat at the same tables as the
to and to use, and the selection of furniture and
clients to minimise problems and to help make
carpets can help to reduce the problems caused by
mealtimes relaxed and enjoyable.
incontinence and accidents.
The concentration of clients is improved by having
It is usually possible to retrain or to control
as few people standing as possible and tables should
incontinence by regular toileting. It is therefore
be for small groups (say 4-7 people).
important that there should be sufficient space in the
Toilets should be near the dining area. Some clients
toilet compartments for staff to be able to assist
may need help and privacy in fitting or removing
clients. A toilet adapted for wheelchair users is nearly
dentures before and after meals.
always essential. Privacy and dignity for the client are
very important.
Personal hygiene
Incontinence in people with dementia may not be
due to neurological problems and the reasons for the If possible, at least one bathroom should be provided
incontinence should be investigated. For example, the and should contain a suitable modern type of assisted
client may be disoriented and unable to find the toilet bath. Baths with a hoist, such as those used in
or unable to make themselves understood. In other hospitals, may be very alarming for elderly people and
cases the client may be angry and frustrated, using are not necessary in a day care centre.
incontinence as a way to strike back. Hairdressing and chiropody services can be very
People with dementia are often embarrassed and welcome and, if possible, space needs to be set aside
humiliated by incontinence and appreciate help in for them.
overcoming the problem. Sympathetic and matter-of-
fact handling are essential. Families or carers may be
able to help staff to understand any problems, such
as constipation or diarrhoea, which need to be
attended to. The centre needs to be organised so that
carers can discuss these and other matters of private
concern either in the quiet room when delivering or
collecting the person, or by telephone, and that
accurate records are maintained to enable the
situation to be monitored.

Meals

Nutritious meals may not be available to the clients

except at the centre, and consultation with a dietitian
and with the family as to likes and dislikes is
advisable. Dietary restrictions or requirements of the
clients, including those of ethnic or religious minorities,
should be maintained.
Meals are usually brought in from a separate
kitchen and should be similar to a family hot meal.
Planning and design guide for community-based day care centres 9

PART 2 Choice of building

Design Conversions

Many different types of converted and new buildings

guidelines have been used for day care centres for people with
dementia. The majority are converted buildings,
probably because of the advantages of cost and
availability. For example:
Essential qualities • A small converted hall used by a local authority to
provide day care on weekdays (12 clients max per
The essential quality for a successful day care centre
day).
is that it should be welcoming and domestic in
character. This is likely to be particularly important for • A single storey hospital building, formerly a ward,
carers who would not wish to send their relative to an converted and used by the district health authority
institutional environment but who can feel relaxed as a day centre on weekdays (13 clients max per
when they know that the person is being well looked day).
after in a cosy sitting room.
• Converted houses used to provide day care on four
weekdays (20-25 clients per day).
The quality and design character of a day care centre
are therefore important for: • An old social services building on two floors, with a
lift, used by the local authority as a day care centre
• Clients, providing an environment where they can
on weekdays (up to 25 clients max per day).
spend a tranquil and enjoyable day.
• A large converted church hall used by the social
• Carers, who need to feel comfortable and relaxed,
services department to provide day care five days
without feeling guilty, about a loved relative
per week (15 clients max per day).
spending time at the centre.
• A bungalow used by the local health authority on
• Staff, who need an environment where they can
weekdays.
look after those entrusted to their care and work
efficiently during a very demanding day.
New buildings

Many different types of building have been used as Recent examples of new buildings for day care
day care centres for people with dementia. All the include the following:
successful examples are suitable for a wide range of
• A new single storey building used by a local
activities to be carried out and, as far as possible, are
authority to provide day care seven days a week
welcoming and domestic in character both externally
(15 clients max per day).
and internally.
• A community room in a sheltered housing scheme
Many activities and rest periods take place with used as a day centre for one day each week (12
people sitting comfortably in a group. Access, floor clients max per day).
finishes, furnishings and lighting all need to be
• An annexe, sometimes purpose built, which is
designed to meet the special needs of people who
attached to a private or local authority residential
may be frail, elderly and incontinent and, at the same
home.
time, provide a day care centre which has an informal
and domestic atmosphere. • A mobile day care team, providing day care at
different locations on different days of the week.
For many clients, nutritious meals may only be (This is the method of staffing some of the part-time
available at the centre and meal times are also day centres described above and is more common
important in the training and observation of in rural than in urban areas.)
clients.Tables should be laid for a maximum of six or
seven people, with an informal and attractive setting.
10 Alzheimer’s Disease International

Design and sizes of rooms A lockable space is required close to the entrance
where the clients’ outdoor clothes can be put away
Note: approximate areas for rooms and other spaces safely and clearly labelled when they arrive.
are given at Appendix B.
Main room
Entrance
The main room for general use in the centre should be
The design of the entrance to the centre is extremely attractively designed and domestic in character, with
important, both in practical terms and because the suitable light fittings, furnishings, carpets and curtains
entrance immediately conveys an impression of the and planting. Ideally it should offer attractive views
objectives, character and atmosphere of the centre. onto a well landscaped garden or courtyard and
The route between the entrance and the car or where possible to a pleasant scene beyond.
mini-bus park should be as short as possible and the If the room is located immediately next to the
entrance should preferably be protected from the entrance, anyone entering or leaving the building can
weather by a porch or canopy.The entrance should be be seen by the staff. This can help in general
suitable for wheelchair and assisted access. It should supervision and may help to prevent clients from
be well lit, but without glare. wandering out of the building. Ideally, this room should

Access and handrails Fire protection and escape routes are primary
All day care centres should be designed or considerations in the planning and design of a day
adapted for wheelchair and disabled access care centre. Floor finishes, furnishings, lighting and
including access ramps and space to enable handrails should be selected to ensure the safety
wheelchair users to move about within the building of frail and elderly people, many of whom may be
as necessary. incontinent.

Access ramp

Grippable,
continous,
Space for unobstructive
assisted handrail
wheelchair
access

Ramp with projecting handrails Handrail

continued
into doorway
Planning and design guide for community-based day care centres 11

also lead directly to a secure garden or courtyard Quiet room

which the clients can use in good weather.
A small and comfortable room is required for
consultations with carers or relatives, or for clients
Office
who are temporarily upset or disturbed. If necessary
Every day care centre requires an office with a an office may have to be used as a quiet room. A
telephone for administration for quiet and confidential quiet room may also be used for sessions with small
work and for record keeping. The room may also have groups of clients.
to be used for consultations, especially if a quiet room
is not available. The office should preferably be close Toilets
to the entrance.
At least two toilets should be provided for the clients,
preferably next to the main room and readily
Dining room
accessible from the entrance. Where possible a
It is preferable, but may not always be practical, to separate toilet and washbasin should be provided for
provide a separate dining room for taking main meals the staff.
and snacks.

Fixed rail for bath

Bathroom and toilet accessories
A number of simple devices can assist clients who are frail,
stiff, disabled or confused to use toilets and baths with
safety.

Simple bathtop rail

Acrylic liner to
reduce depth of
bath

Raised
toilet seat
Toilet rail for people
for general with stiff
Bath seat assistance hips
12 Alzheimer’s Disease International

All toilets for use by clients should have sufficient Safety and Circulation
space for staff to be able to assist and one of the
toilets must be suitable for a wheelchair. Doors which The main considerations for safety include:
open inwards, or which are hung on the wrong side,
are common problems which restrict access for Fire protection and escape routes
people who are disabled or need assistance.
It is essential to discuss with the local fire brigade at
There should be a medium sized washbasin within
an early stage any proposals for a conversion or a
each toilet space. Rails and aids are likely to be
new building. The fire officer’s requirements are likely
required in each of the toilets used by the clients. The
to include the provision of clear main and alternative
floors of these toilets should be washable and easy to
fire escape routes, protected by half hour fire resistant
clean.
walls and doors, and with doors opening outwards
toward the escape route. Smoke and heat detectors
Bathrooms and shower rooms
are likely to be required in the main rooms and
Bathrooms or showers are essential for the effective circulation areas, together with fire alarms and fire
day care of many clients. Although not all clients will extinguishers. These requirements are likely to be met
wish to be bathed during the day, regular bathing at most readily in small single storey buildings, with short
the day care centre can make carers’ lives easier. If distances to the fire exit. If the use of an upper floor is
only one bathroom can be provided it should contain being considered for a day care centre for elderly
either a modern bath, with suitable rails and people the requirements for fire escape, and
accessories to assist the clients and staff (see page particularly for elderly people to be assisted down the
11), or a Medic-bath which enables clients to be stairs, are likely to be stringent and could be
bathed in seated position. If a Medic-bath is to be prohibitively expensive. These issues should,
installed it is essential to ensure that the bathroom therefore, be examined at an early stage in any
heating is sufficient to keep the clients warm while the proposal.
bath is being filled. If a second bathroom is available it
may be useful to have an ordinary domestic bath Disabled access
which may be more reassuring to clients.
Access for wheelchair users and for people with
walking difficulties is fundamental to the planning and
Hairdressing and chiropody room
design for a day care centre. There needs to be
Hairdressing and chiropody are desirable though not sufficient parking space for a minibus with a
essential services. A new hairdo can achieve much to wheelchair lift (approximately 3 x 6 metres), and the
raise self-esteem for someone who is feeling depressed route to the front door must be safe and convenient
and untidy. A ‘parlour’ can be set up with few facilities for all users. This usually involves a ramp up to the
but will be more efficient and useful if provided with a front door (see page 10) but when space is limited it
good washbasin, dryer, couch and storage space. may be difficult to ensure that the ramp will not be an
obstruction or that visitors do not trip over the end of
Staff room the ramp.

Staff will need to relax in privacy for a short period from

Protection against wandering
time to time, especially after dealing with distressing
situations. A suitable space needs to be identified for Although the risk of clients wandering off the premises
this even if a separate staff room cannot be provided. often gives cause for concern, it is important to be
aware that doors which may be needed for fire
Staff toilet and changing room escape should never be locked or bolted when the
premises are occupied. A common precaution against
Desirable but not essential. The clients’ toilets should
clients wandering off is for the front door to be fitted
be kept in a condition suitable for anyone to use them
with a buzzer or bell so that staff are aware when the
but it may be more convenient to have a separate
door is opened. If necessary, the same arrangement
toilet for staff. In any case, staff will need a safe place
could be used for some internal doors or they can be
to leave their outdoor clothes and valuables and for
fitted with two sets of door handles, one above the
changing.
other, which is usually sufficient to prevent a confused
Planning and design guide for community-based day care centres 13

person from opening the door. An alternative Lighting with safety

arrangement, which has worked well in some day care
The eyes of elderly people are slow to adapt to
centres, is simply to conceal the door handles behind
changes in brightness or darkness. Abrupt transitions
a curtain or blind as confused clients will not usually
and glare, whether caused by artificial lights or by
make any attempt to open a door if they cannot see
sunlight, should therefore be avoided, particularly in
the door handle.
entrance halls and circulation spaces. Avoid windows,
mirrors and other bright surfaces which can cause
Corridors
glare at the end of corridors. Shield all light sources to
Ideally there should be little or no corridor space in a minimise glare and select warm-toned lighting if
day centre. If a corridor has to be provided the width possible. Ordinary fluorescent lighting emphasises the
should be at least 1.2 metres to enable people to be blue-green tones which are the most difficult for
assisted and to pass each other. The layout should elderly people to perceive. Day centres should not
minimise the problems of clients losing their way, and contain light fittings and flexes which could be a
the character should be non-institutional, with sitting hazard
places or attractive features if possible. Handrails may
be necessary on one or both sides. First aid

A member of staff must have either nursing or first aid

Handrails
training and a first aid kit should be kept available for
Most day care centres do not appear to need minor incidents and emergencies. An accident book
handrails on the walls and they are often felt to create must be kept in which all accidents must be recorded.
a non-domestic atmosphere. However, in existing
buildings with long corridors, it may be helpful for Security
some clients if a handrail is fitted on one side of the
It should be ensured that day care centres are secure
corridor.
against intruders and burglaries as they may be used
Special handrails to assist disabled people can be
by a large number of people but be empty and
very useful in toilets and bathrooms (see page 11).
vulnerable at predictable times.
These need to be designed and located so as not to
impede members of staff when assisting the clients.
Handrails may also be useful to provide support for
clients during exercise therapy. Catering and cooking
Dangers of falling Main kitchen

Steps in awkward or unexpected places should be A well equipped main kitchen is required for the
avoided as far as possible and should, in any case, be production of the main meals, whether these are
provided with handrails to guide and support the cooked at the centre or supplied from elsewhere to be
clients. When converting an existing building, steps heated and served at the centre. The kitchen should
can sometimes be converted to a ramp but this normally be large enough for three members of staff to
requires plenty of space as ramps should not be work at the same time (possibly less if all cooked
steeper than 1:12. meals are brought in), should include a large sink and
Loose edges of rugs or carpets can be a hazard in a dishwasher, and should be located immediately
some circumstances but this should not prevent adjacent to the dining space. A refrigerator, freezer
rooms in a small day care centre from being furnished and storage space for vegetables are likely to be
in an ordinary domestic manner. A problem which may required and their sizes will depend on the number of
not be anticipated is that coloured floors with broad clients and the method of catering.
stripes can be misleading to clients who have poor Any serving hatch or door between the kitchen and
eyesight or who misunderstand the stripe. They may dining room should meet the requirements of the local
think that the change of colour shows a step or fire officer. A washbasin is likely to be required in the
obstacle and take unnecessary care when stepping kitchen and all the catering and sanitary arrangements
across it. Conversely, good lighting and a change of should be approved in advance by the local authority
colour can help to show the edges of steps or ramps. and the Public Health Inspector.
14 Alzheimer’s Disease International

Therapeutic cooking baking without any of the risks associated with

hotplates or gas burners.
In addition to the main kitchen, it is very desirable for
Clients often enjoy participation in the routine of
a day care centre to have a separate kitchenette
preparing the daily meals, although the health and
where the clients can share in cooking activities and
safety regulations prevent them from helping in the
enjoy familiar skills, materials and smells. The
kitchen when meals are being prepared. If, however,
minimum kitchenette would probably include a
there is a separate kitchenette they might be
worktop, a sink with a drainer, a kitchen table and an
permitted to assist in such tasks as peeling potatoes
oven.This would enable the clients to carry out simple
or preparing vegetables provided that the standards of
tasks, either sitting at the table or standing at the
hygiene are maintained and they are supervised.
worktop, and to enjoy the satisfaction and smells of
Where a separate kitchenette cannot be provided,

Typical layouts for toilets, bathrooms

and kitchenettes
All toilets for the
use of clients
should have
sufficient space for
staff to be able to
provide any
assistance which
may be needed. At
least one toilet
should be suitable
for wheelchair
users.

If there is to be a kitchenette for therapeutic cooking,

this should contain at least an oven, a sink, worktops
and a table with chairs so that elderly clients can sit
down while preparing ingredients for cooking.

Bathrooms should be at least 2.4 metres (8 feet) wide if there is to be

space for staff to assist clients, or sufficient space for wheelchair users.

A Medic-bath, for
bathing in a seated
position, avoids the
need for lifting
equipment and
occupies less space
than a domestic
bath.The room must
be well heated to
keep elderly people
warm while the bath
is being filled.
Planning and design guide for community-based day care centres 15

opportunities should be sought to enable the clients to woodwork but care should be taken to avoid shiny
use the main kitchen when it is not in use for meals. paints on walls as even the satin finishes, which are
very easy to clean, can catch the light, causing high
spots of glare and an institutional appearance in
rooms which should be restful and domestic in
Floors, walls and doors character.
Doors should have lever handles which are easy for
Carpets
elderly people to operate.
Modern washable carpets are generally preferable to
other alternatives for the floors of the main rooms in a
day care centre. Also consider carpeting in corridors.
Carpets have a more domestic appearance, are softer
Lighting, colours and pictures
underfoot and absorb noise more than sheet or tiled
Natural and artificial light
floors such as vinyl or linoleum.
Traditional carpets with natural fabrics are not Lighting should be generally domestic in character.
suitable in day care centres because they are difficult Tungsten or filament lights are preferable to
to keep clean in rooms used by people who may be fluorescent strip lighting. Compact fluorescent lamps
incontinent. However there are synthetic carpets provide a similar quality of light to tungsten filament
which are suitable for day care centres. These lamps and reduce electricity consumption to one
washable carpets generally have a short synthetic pile quarter. Particular attention should be given to
(polypropylene), which is totally impervious to liquids, avoiding glare as this can commonly cause problems
and a waterproof backing which enables them to be for elderly people so, although sunlit rooms may be
cleaned by any standard method of carpet cleaning welcoming and warm, curtains or blinds may be
without loss of colour. These carpets are available in a necessary to avoid problems of glare or of excessive
wide range of mixed colours and are similar in heat.
appearance to carpets of natural fibre.
Most synthetic carpets are vulnerable to damage Colours and pictures
from cigarettes and similar burns and extra care is
Fairly soft colours should generally be used for walls
needed to prevent damage if clients are permitted to
and ceilings in order to create a light and tranquil
smoke at the centre.
environment. Most elderly people have failing or
defective eyesight and it may therefore be useful to
Washable floors
have a difference in tone and colour between walls,
The floors of toilets and kitchens in day care centres doors and door handles in the areas where clients
should be easy to wash and, although hard materials circulate. It is useful for toilets or other rooms to have
such as quarry tiles are practical in areas of heavy doors of a certain colour, but nothing in the colour
usage, vinyl flooring is equally practical and more schemes should detract from the domestic character
comfortable. Non-slip vinyl flooring can sometimes be of the day care centre. A selection of pictures can add
useful in kitchens and bathrooms but is sightly less interest and variety to the rooms in a day care centre,
easy to clean than the more usual smooth finishes. whether or not they are consciously appreciated by
the clients.
Walls and doors

The walls in a day care centre can be decorated with

paint or wallpaper as for domestic use. Wall surfaces
should have enough texture to enable clients to
support themselves but not be so abrasive as to
cause injury.
Wallpapers with a vinyl finish are easy to clean and
a wide range of attractive patterns are available. For
painted walls, emulsion paint is practical and
convenient. Gloss paint is very suitable for doors and
16 Alzheimer’s Disease International

Furniture, fittings and fabrics standards) so as to be easy to get in and out of

without help. Select chairs where the arm is above or
General slightly in front of the front edge of the seat and with a
clear space under the front of the seat so that the
Furniture should generally be arranged in fairly informal
user’s heels can be placed underneath. This greatly
groupings, and should be easy to move so as to
reduces the burden on staff and allows them more
enable room layouts to be rearranged. It should also
time and energy to attend to the clients. Chairs may
be reasonably robust while retaining a domestic
have high or low backs. Avoid seats which are so firm
character. The main room should be sufficiently large
that they may cause skin ulcers. A variety of chairs
to contain a piano, which is always popular and
and fabrics can help to achieve a more informal
greatly extends the range of enjoyable activities for the
atmosphere than in rooms where all the chairs are
clients. A TV set and a radio may or may not be
identical. For general purposes select chairs with a
considered to be desirable.
seat height of 420mm (17 inches) and tables about
760 mm high (30 inches).
Chairs
If incontinence can be contained it may be
The selection of chairs requires very careful preferable to have domestic style chairs but the reality
consideration. Most chairs used by clients should is that at most centres the furniture needs to be proof
have arms and be fairly high (to Department of Health against incontinence and be easily cleaned. Chairs

Examples of chairs with arms available from a typical range Notes:

(eg. Parker Knoll ‘Milton’)
1 in a day care centre for
people with dementia,
chairs with arms are
LOW BACK HIGH BACK
generally likely to be
safer and more
Low seat practical than chairs
(height 420 mm, 16.5 ins) without arms
no arms
2 people need to be able
straight arms
to sit comfortably with
sloping arms
their feet in the floor
Uses include: Sitting in groups or at tables Resting for people who are short
3 high seats and straight
Dining seat arms provide
(height 460 mm, 18 ins) assistance in getting in
or out
no arms
sloping arms 4 sloping arms can be
used at a table (height
Uses include: Meals and sitting at tables about 760mm or 30 in)
5 high backs provide
High seat good support but
(height 470 mm, 18.5 ins) restrict view
straight arms 6 options include:
sloping arms
- arms with or without
armpads
Uses include: For people who are stiff or need extra support
- loose cushions
High seat and fitted cushion 7 upholstery choices:
(height 520 mm, 20.5 ins) - all vinyl (for
straight arms protection)
- vinyl seat with
matching fabric
Uses include: For people who are tall or very stiff (attractive and
practical)
Planning and design guide for community-based day care centres 17

can be protected against incontinence by being fitted Raised flower beds can be helpful for
with a fabric with a waterproof lining to protect the people who are stiff or in wheelchairs

seat, or with a vinyl covering or with a mixture of vinyl

and fabrics. For example, the seat may be covered
with vinyl and the back covered in matching tweed
fabric. The choice of chairs and other furniture should
take account of space, durability, weight, comfort and
cost. A wide range of furniture, accessories and
fabrics suitable for use in day care centres are
available.

fence or wall. Lighting of the outside space will allow

increased use and provide visual interest after dark.
Garden or courtyard It may be possible to plan a garden or courtyard so
as to provide a pleasant and reassuring route on
It is highly desirable to have a garden or courtyard at a
which clients can walk in a circle, or figure of eight,
day care centre. It should receive plenty of sunlight, be
and which enables wandering to become a safe and
planted with carefully chosen plants and have paved
therapeutic experience, always returning to the same
surfaces for access over most of the area. There
place (see plans below).
should be plenty of seating, both in the sunshine and
in the shade. Provide some seating which gives a
Wandering
sense of enclosure and separation from the main
pathway and arrange it so that people can see and Day care centres for people with dementia need to be
talk to each other easily. There should be access and designed to prevent clients from wandering off the
space for wheelchair users to use the seating. premises, but not in ways which emphasise the
Suitable plants and raised planting beds may constraints. A day care centre should, if at all possible,
enable some of the clients interested in gardening to have an attractive garden with places for people to sit
enjoy familiar and therapeutic activities in the garden. and footpath circuits along which they can wander
with safety and tranquillity.
Garden layout and design

Clients may feel less shut in if the garden or courtyard

can be enclosed by planting or hedges instead of by a

A simple garden with a circular path. Seats may be arranged A garden with a figure 8 path. More elaborate
singly or in groups and should generally be shielded from the path layouts can be provided in larger
full heat of the sun. gardens, but it is always useful if the outer
path returns people to their starting point.
18 Alzheimer’s Disease International

Utilities and services

Laundry

Clothes and linen may need to be washed on the

premises.
A laundry service to carers could be an invaluable
part of day care service for elderly confused people
but this is rarely possible because of the financial
implications.

Storage

Storage spaces are likely to be required for:

a) occupational therapy equipment
b) linen and spare clothing
c) medical equipment and medicines
d) wheelchairs
e) office materials

Cleaners’ room

A lockable room, with a sink, and with a lockable

cupboard for cleaning appliances and materials.

Linen store

A small lockable cupboard for towels, linen, spare

clothing and incontinence pads should be located so
as to be readily accessible during the day but secure
from clients.

Switchgear and services room

Depending on the form of the building, and on the

heating, air conditioning system and so on, space will
be needed for incoming services, switches, meters
and possibly a boiler.

Refuse store

To be located safely and conveniently, and to meet the

access requirements of the local authority.
Planning and design guide for community-based day care centres 19

How ADI Appendix A

can help you Main financial considerations
Alzheimer’s Disease International (ADI) is a federation
of national Alzheimer associations around the world
checklist
whose mission is to improve the quality of life of
Note: figures are not included because they are so
people with dementia and their carers and to raise
variable. The following, however, are some of the main
awareness of the disease.
items that need to be costed.
One of ADI’s key roles is to support members in
their activities and encourage the formation of new
associations by disseminating information, supporting
Capital costs:
an annual international conference, encouraging
research and stimulating public and political Alterations:
awareness at the national and international level. plumbing
heating/air conditioning
ADI produces the following publications:
lighting
Booklets wheelchair access safety rails kitchen alterations
• Help for caregivers decoration
• Starting a self-help group
• Influencing public policy Equipment:
• How to develop an Alzheimer’s association and get chairs tables cutlery and crockery kitchen equipment
results telephone system (and answerphone?) transport

Factsheets
• Prevalence of dementia
Revenue costs:
• Organisation of a prevalence study
• Reasons for prevalence studies water
• Demography of ageing around the world rent
• Alzheimer’s disease and genetics electricity
• Caring for people around the world with dementia gas
• Psychiatric and behavioural disturbances in telephone
dementia
• Drug treatments in dementia Staff:
salaries
You can contact ADI for:
National Insurance
• Any of the above materials (these are available free
pension schemes (if appropriate)
of charge)
drivers
• Further guidance in developing an Alzheimer
volunteers’ expenses
association in your country
training
• Contact details of Alzheimer associations in other
public liability insurance
countries
property insurance
Please call or write to: publicity
Alzheimer’s Disease International
64 Great Suffolk Street
London SE1 0BL
Tel: +44 (0)20 7981 0880
Fax: +44 (0)20 7928 2357
Email: [email protected]
Web: www.alz.co.uk
20 Alzheimer’s Disease International

Appendix B
Essential or desirable building features and spaces
Note: the following list is intended as a preliminary guide to assist in assessing whether an existing
or proposed building is likely to be suitable for use as a day care centre. Where it is not possible to
provide the features listed as essential, it may still be possible to achieve a practical compromise.

FEATURE ESSENTIAL MINIMUM DESIRABLE

Parking Space for one vehicle with outside lighting Parking for five vehicles or more with covered
Area approx 3 x 6 m route to front door
Area approx 12 x 6 m plus circulation

Front entrance Access ramp for wheelchairs Entrance hall

Entrance lobby Area variable
Area approx 2.0 x 2.5 m, say 5 sq

Internal Internal circulation spaces, with safety

circulation precautions
spaces Areas variable

Space for Hanging space

outdoor clothes Area approx 1 x 2 m = say 2 sqm

Rooms Main room for general activities Dining room

Area approx 6 x 8m = approx 50 sqm Area approx 4 x 6m = approx 2sqm

Office (for occasional use for counselling) Quiet room

Area approx 2.5 x 3 m = approx 8 sqm Area approx 2.5 x 3 m = approx 8 sqm

Group room
Area approx 3 x 5 m = approx15 sqm

Hairdressing/chiropody parlour
Area approx 3 x 3.5 m = approx 11 sqm

Staff room
Area approx 3 x 3.5 m = approx 11 sqm

Toilets 2 Toilets 1 Staff toilet

Area each approx 1.5 x 2 m = 3 sqm Area approx 1.5 x 2 m = approx 3 sqm
Say 6 sqm for 2 toilets

Bathroom Bathroom with special rails, fittings etc Second bathroom (domestic)
Area approx 2 x 3.5m = approx 7 sqm Area approx 2 x 2.5 m = approx 5 sqm

Kitchen Main kitchen Kitchenette for clients’ activities

Area approx 3 x 4 m = approx 12 sqm Area approx 3 x 3 m = say 9 sqm
Planning and design guide for community-based day care centres 21

FEATURE ESSENTIAL MINIMUM DESIRABLE

Washing Washing machine (clothes) Laundry room, with facilities for drying and
machine Located in bathroom if necessary ironing
Area approx 3 x 3 m = approx 9 sqm

Storage Storage cupboards or spaces Storage rooms

•occupational therapy equipment Total area approx 15-20 sqm
•linen and spare clothing
•medicines and medical equipment
•wheelchairs
•office materials
Total area say 8-10 sqm

Cleaners’ Cleaners’ cupboard Cleaners’ room with sink

cupboard Area approx 1 x 2m = approx 2 sqm Area approx 2 x 2 m = approx 4 sqm

Services Services cupboard and boiler forhot Services/boiler room

cupboard and heating/hot water (eg in kitchen) Area approx 1.5 x 3 m = approx 4.5 sqm
boiler Location and areas variable

Refuse area Refuse sacks/bins Refuse store

Screened location close to access road Enclosed area approx 2 x 3 m = approx 6 sqm

Garden Small courtyard or garden Garden with space for clients to wander with
Area variable, say 15 sqm (minimum) safety
Area variable, eg 6 x 15 m = approx 100 sqm

Garage Garage for 1-2 vehicles and for extra storage

space
Area approx 4.2 x 5.5 m = approx 25 sqm

Total floor areas Sub-total of internal spaces listed above Sub-total of additional internal spaces listed
(examples) approx 100 sqm (excluding circulation space above, excluding garage etc, approx 125 sqm
etc). (plus 110 sqm = approx 225 sqm).
Eg for 10 clients @ 12 sqm = say 120 sqm Eg for 10 clients @ 16 sqm = say 240 sqm
15 clients @ 14 sqm = say 210 sqm 15 clients @ 20 sqm = say 300 sqm
August 1999