CHANGES in the way care homes are built will be needed to ensure the elderly are protected from deadly infections such as the coronavirus without “being imprisoned” a report says, as it also warns dementia-friendly design is 30 years behind physical disabilities.

Approximately 152 million people are forecast to be living with dementia by 2050, and it is already the fifth leading cause for death worldwide.

However, experts say most countries are woefully behind in terms of making public spaces, care homes and hospitals accessible for those living with the disease.

The report warns measures put in place in care homes to protect residents from Covid may have indirectly hastened their deaths, with dementia worst affected. 

It concludes: “Better design could have absolutely helped to minimise the spread of the virus in care facilities.”

Figures show in all the deaths involving Covid-19 between March and June 2020, 92 per cent had at least one pre-existing condition and the most common (31%) was dementia.

READ MORE: Government criticised for treating care homes like hospitals during pandemic 

While the transfer of patients from hospitals to care homes and lack of testing has been cited as major factors in the spread of the virus, the report suggests temperature and ventilation may also have played a role.

Dr Alison Dawson, co-lead of the Dementia and Ageing Research Group at Stirling University, who contributed to the report, said: “We need to think about the ways in which the virus has come into care homes.

“One of the things we haven’t really thought about in relation to Covid has been issues around ventilation.

“In the report, the chapter we have written makes the case for a need to think about the particular thermal environment, the relative humidity.

“Care homes tend to have a warmer environment because older people need that, but we haven’t necessarily considered what effect that has in relation to the virus and to the spread of the virus and whether droplets that are produced when people talk, whether those could potentially be evaporated by that particular set of environmental conditions into micro droplets that then behave much as aerosols.


“The question around aerosol transmission is one that the World Health Organisation has suggested does not play a big factor in transmission of Covid more generally but I think we do need to  look specifically at care homes and to consider do we need a higher rate of refreshment of air and how we can do that safely.

“If the air is slower moving in certain areas are the droplets remaining in those areas for longer. Could the air in corridors for example be flushed through?

“I think we need to think about how we can adapt and modify the environment to deal with the challenges we do know about.

“There is evidence that those care homes which have larger numbers of agency workers seem to have had more infections. 

“We can think about whether we’ve had sufficient space for staff to be able to come in get changed and be properly sanitised and to put their PPE on.”

READ MORE: Scottish care home first to trial tracking system that could halt Covid spread 

The First Minister said last week that she had “huge sympathy” for relatives unable to see loved ones in care homes as campaigners gathered outside Holyrood, renewing calls for visiting restrictions to be eased.

Chief Nursing officer Fiona McQueen said the Government is “actively considering” how to increase access for families in the face of a concerning rise in cases of the virus.

“What can we do to allow relatives to visit safely, that’s a key concern.” said Ms Dawson.

“There was a care home in the  Netherlands that put a perspex wall in the middle (of the care home) so that residents could come in one end and family and friends could come in the other.

“These sorts of things are short term solutions but they are not going to work for all care homes in the UK.

“Visiting restrictions happened in many care homes before the general lockdown was announced and that kept residents safe from Covid but it did not keep them safe from the risks of cognitive and physical deterioration.

“The real role of design is how we balance those things and recognise that people who are living in long term care should have the same rights, to be able to see their relatives.”


The report - Design, Dignity, Dementia; dementia-related design and the built environment - compiled by the charity Alzheimer’s Disease International has called for dementia to be recognised as a disability with design principles that govern public buildings to be applied in the same way.

READ MORE: TV presenter fears window closing for mother to recognise her as visiting restrictions continue 

It cites as good practice a plan by furniture giant IKEA  with construction company boklok to launch affordable, flat-pack housing for people suffering with dementia. called ‘silviabo’ homes.

They will include mirror-less rooms, kitchen appliances with old-fashioned knobs to improve accessibility and therapeutic gardens to encourage socialising.

Paola Barbarino, Chief Executive of the charity, said:  “Dementia design needs to be a crucial part of how countries rebuild following Covid-19.

“Better design could have absolutely helped to minimise the spread of the virus in care facilities. 

“When I was in my first job, I remember people saying that accessible lifts and ramps were impossible to install in old buildings but look at it now.

“If we can cater for those with visible disabilities, how can we refuse to cater for those with invisible disabilities? 

“Design is effectively a non-pharmacological intervention, adding to the number of things we can do -in absence of a cure- to make the lives of those living with the condition easier and more fulfilling,”

Dr Martin Quirke who advises designers world-wide about good dementia practice in public buildings and spaces, added: “We’ve heard of cases where care homes are putting social distancing markers on the floor and the degree of distress and confusion that is causing. 

“Covid has made it even more important for designers to consider what is important to maintain people with dementia’s health and wellbeing.”


The Herald is campaigning for improved care standards for people living with dementia.