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There are many issues to keep in mind when designing the wandering path. Loops of circulation, both interior and exterior, should be created to provide walking circuits. Multiple intersecting loops are preferable to a single one.

Avoid dead ends, such as locked doors at the ends of corridors, that can lead residents to a destination without an obvious choice of what to do next. Instead, provide a seating area at the end of a corridor, preferably with a good view. This makes a destination, a place to sit, and in effect helps to turn the resident around.

People with dementia may shuffle and have gait difficulties, making them prone to falling. Minimize the number of flooring changes, particularly carpet to vinyl. Because residents can become easily disoriented, provide recognizable cues, such as artwork, furnishings, and changes in wall color or texture to lead them back to a familiar area.

Residents tend to watch the floor as they walk, and sharp contrasts in color or light value may cause them to perceive nonexistent steps or changes in depth. High-contrast spots in the flooring may appear to be items that need to be picked up.

The scale of circulation paths should be kept small and residential, but there should be room for seating, especially near intersections and room entrances. Minimize the choices a resident may need to make along the way or mark certain predetermined choices clearly with landmarks.

Alternative Systems

Cognitive impairment, by its very nature, reduces the value of common wayfinding, landmarks, and cueing techniques. Therefore conventional signage, color-coding, and subtle differentiation of finishes, flooring, hardware, and lighting will not provide perceptible cues for most people with dementia.

Designers should reinforce the visual connection between the path (or hallway or corridor) and important destinations. Residents may not be aware what they are searching for, but once they can see an activity or into a room, they may choose to join in. Arrange public and shared spaces as a continuous progression.

Provide flexibility so that visual connections can be controlled. Examples include Dutch doors, which can be open, closed, or half open, and interior windows that can be curtained. These and low partitions may help to increase visibility and enhance the feeling of openness. Use landmarks and objects that will attract a resident's attention.

Create visual cueing for important activities. For example, design the bedroom so there is clear visual connection between the bed and bathroom (specifically the toilet). Be careful to arrange this view so that bathroom activities remain private and are not obvious from public spaces or hallways.

A Room of One's Own

Lighting design and wall finishes should also be integrated parts of the wayfinding concept. A decorative sconce at each room entry not only provides additional light but also serves to mark the location of each unit. In addition to the sconce, the ceiling design and lighting can create a recognizable event at a cluster of resident entries. Like a change in light, a change in wall finish also signals entry into a new area and becomes another layer of the wayfinding system.

Persons with Alzheimer's benefit from multiple layers or cues that can be accommodated within the wayfinding system. They generally have trouble storing newly acquired information but find it much easier to elicit memories from their past.

Thus, residents in special-care units often have difficulty recognizing their rooms. One solution to this problem is the installation of a memory box or package shelf outside the door, where residents can place personal objects, such as photographs or keepsakes, to trigger recognition.

Inside the living quarters, the provision of plate shelves, deep windowsills, and furniture brought from home enable residents to personalize their rooms and provide further opportunities for personalization and recognition.

Researchers are still learning which visual cues are most effective in guiding residents with Alzheimer's back to their house or neighborhood. Subtle single-layered cues such as color changes have not worked well.

What the current research indicates is that staff stations where familiar caregivers are visible, major landmarks (for example, a grandfather clock), and cues that engage other senses (such as sense of smell) are more effective.

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Bradford Perkins, FAIA, RAIC, AICP, is the founder of Perkins Eastman Architects, a New York-based architectural, interior design, and planning firm with branch offices throughout North America. His firm's designs of senior living and care facilities have received many awards for design excellence.

This article is excerpted from Building Type Basics for Senior Living, copyright © 2004, available from John Wiley & Sons and at Amazon.com. It is part of the series, Building Type Basics.

Woodside Place Alzheimer's Residence, Oakmont, Pennsylvania, designed by Perkins Eastman Architects demonstrates circular paths for wanderers. Photo: Robert Ruschak Woodside Place Alzheimer's Residence floor plan. Image: Perkins Eastman Architects Familiar residential furnishings characterize the interior of the Woodside Place Alzheimer's Residence. Photo: Robert Ruschak Copper Ridge, Sykesville, Maryland, designed by Perkins Eastman Architects. Photo: Curtis Martin Inside Copper Ridge. Photo: Curtis Martin Familiar objects, such as this grandfather clock at Copper Ridge, can be effective wayfinding landmarks. Photo: Curtis Martin Asbury Place, Mt. Lebanon, Pennsylvania, designed by Perkins Eastman Architects, illustrates typical planning based on the "house concept" for Alzheimers residences. Image: Perkins Eastman Architects Building Type Basics for Senior Living. Image: John Wiley & Sons (photo by Chuck Choi)   Click on thumbnail images to view full-size pictures.