C A R E OA S I S

Switzerland´s Evidence-based Contribution for a Dementia Care Unit

29th AHCA SeminarMichael Schmieder and Christian FeldkircherOrlando, October 7th 2013

OUTLINE• DEFINITION

• SOFT FACTORS

• OPERATION

• TIME

• CARE GIVER

• RELATIVES

• HARD FACTORS

• CASE STUDIES

• Q & As

STUTTGART

LAKE CONSTANCE

GENEVA

MILAN

MUNICH VIENNA

ZÜRICHSONNWEID

150 MIN

60 MIN

120 MIN

location WETZIKON, Switzerland (near Zürich)owner for profit

year since 1986 dementia careemployees 280 total

SONNWEID CENTER FOR DEMENTIA CARE

residents 155 beds totalunits 9 care groups (110 beds), long-term care 4 family groups (30 beds), more independent 1 oasis (6 beds) 1 oasis under construction (2014)

THEORETICAL BACKGROUND

DEFINITION

“A Care Oasis is a care and housing concept for persons with severe need of care.”

“The basic concept of a care oasis is to allow the resident to participate in the community, hence to antagonize isolation.”

(Michael Schmieder 2013)

CARE OASIS

• 6-8 persons• one room with clear center

• outside garden

PHYSICAL ENVIRONMENT

care oasis 3 - opening 2014

large space (min. 100 m2 / 1100 sft)6-8 residentssecure private area

OPERATIONsoftfactors ELEMENT 1 of 4

center (living area with kitchen)separate room for agitated residentsbathroom / 2 toiletslarge balcony / garden

OASIS 3

2013 (under construction)

OASIS 3

2013 (under construction)

TO FEEL SOCIAL RELATIONSA care oasis is not a cost effective multibed nursing room.

It is not a place to die. But it is a place to live before you die.

TO FEEL SECURE“Not feeeling anxious at the end of one’s life, is probably the highest profit a human can reach.”(Schmieder 1998)

EXPERIENCE COMMUNITY

TIMEsoftfactors ELEMENT 2 of 4

TIMEsoftfactors ELEMENT 2 of 4

Oasis 2 since 2001

create memory and atmosphereTIMEsoftfactors ELEMENT 2 of 4

care oasisconventional care group

CARE GIVERsoftfactors ELEMENT 3 of 4

“Good nursing care involves trying to create a good life for patients where they can experience acceptance, communication, familiarity, a place where they can feel home.” (Zingmark 1993)

CARE GIVERsoftfactors ELEMENT 3 of 4

RELATIVESsoftfactors ELEMENT 4 of 4

RELATIVESsoftfactors ELEMENT 4 of 4

CONTEXTinternational dimension

OUTLINE 2nd part• FUTURE OF CARE

• HARD FACTORS

• CASE STUDIES

• Q & As

CONTEXThistory of nursing homes

CASE STUDY 1city of WIL - INTENSIFY AMBULANT / HOME CARE

CASE STUDY 1STRATEGY - future of nursing homes

HOME

HOME

PUBLICSERVICES

CARE

SENIORAPART-MENTS

HOME

NEIGHBOR-HOOD

CENTER

SENIOR-APARMENTS

PUPLIC &SOCIAL

SERVICES

HOME

PRIVATE HOMES

SENIOR-APARTMENTS

CAREOASIS

CAREOASIS

DAY-CARE

AMBULANT CARE - HOME CARE STATIONARY CARE

REHABTEMPORARY

CARE

DEMENTIACARE

CENTER

A C C E P T A N C E

SENIOR CENTERS

HOME

CASE STUDY 1STRATEGY - future of nursing homes

CASE STUDY 2CARE CENTER APPENZELL - LONG TERM CARE FACILITY WITH FOCUS ON DEMENTIA CARE

APPENZELL CULTURE

t

CARE CENTER APPENZELLLONG-TERM CARE WITH FOCUS ON DEMENTIA CARE

village Appenzell, Schweizowner Bau- und Umweltdepartement Appenzell government of canton, non-profit Architekten Bob Gysin + Partners bpg Zürich

construction 2013-2015beds total: 63 (incl. 6 beds for oasis)Wohngruppen 2 units for people with dementia 4 units for long term care 1 unit as a care oasis

floor space 8’344 m2 / 90’000 sftbuilding volume 28’608 m3

total costs 24.8 Mio Fr. / 27.2 Mio $ - without land - incl. 8% taxes - incl. furniture

N

EXTERIORsoutheast corner / dementia garden / concrete frames - framing a resident room / wooden fillings

2nd floor2 units for dementia care / dementia garden / therapy

4th floor2 units for long term care + care oasis

CATALOG OF CRITERIAS for a CARE OASIS

ONE ROOM turned into SYSTEM OF CARE

INCREASED SIZE

LIGHT

CENTER

ACOUSTICS

ACCESS to NATURE

Redu

ce P

atie

nt F

alls

Redu

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sito

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Redu

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urse

stre

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Redu

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rug

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Impr

ove

resi

dent

Ac

tiviti

es

Impr

ove

Nut

ritio

n

Impr

ove

com

mun

icat

ion

of

resi

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Impr

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patie

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sito

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isfa

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Accessible roof garden

Clear / Symmetrical floor plan

Acoustic Environment

Artwork ( only in private area)

Reduced Design Elements on walls and ceilingCare giver Workstation at Main Table

Main Table in Center of Room

Visible Kitchen element in Center of Roompartition wall with private area / objects

private room / relatives

light from 3 orientations with reduced direct sunlight

large windows along one side

lighting (circadian)

DESI

GN

INN

OVA

TIO

NS

OUTCOMES

MATRIX of FEATURES and OUTCOMES

N

SYSTEM OF CARE TOTAL 1´750 sft

MAIN ROOM 1´250 sftSERVICE 250 sftTERRACE 250 sft

ACCESS to NATURE

ACOUSTICSCENTER

LIGHT

INCREASED SIZE

CURRENT LITERATURE

CURRENT TOPICS COVERED

PUBLICATIONS

2012TITLE: Pflegeoasen in Deutschland: Forschungs- und handlungsrelevante Perspektiven zu einem Wohn- und Pflegekonzept für Menschen mit schwerer Demenz.AUTHORS: Brandenburg H., Adam-Paffrath R., et al.

2008TITLE: Das Demenz-Buch (chapter 5). AUTHORS: Bowlby Stifton C. Verlag Hans Huber, 2008

RESIDENTS - Quality of Life

CARE GIVER - satisfaction and stress level

RELATIVES - satisfaction and engagement

RESULTS and effects of operating a care oasis

CURRENT EVIDENCE

CENTER CARE GIVER• constant view and visual communication causes • increase of communication • more contact • more instructed activities • distinct movement radius

ACOUSTICS

• plane acoustic ceiling for main acoustic ambience

• curtains / partition walls and greenery for interventions

LIGHTHING

• circadian light studies

• team building process at the beginning• higher gratification• less burn-out throuh higher meaning orientation• increase of job variation• higher personal identification

• higher emotional exhaustion• higher physical and pyschological stress

FINDINGS

EVIDENCE

There is substantial evidence for positive outcomes in an oasis for • residents • care givers • relativesIncrease of Qualitiy of Life.Expanded and intensive job requirement for care givers with higher overall gratification.

DESIGN DECISION

Research is in its beginning and spatial design decisions can rarely be based on evidence.

Evidence has mainly influence on furniture, materials and work processes.

ARCHITECTURE

A oasis is a care concept with specific spatial requirements, which expands the conceptual possiblities for planners.

CURRENT LITERATURE

STUDIES

2012TITLE: „Verbesserte Lebensqualität für demente Bewohner: Das Forschungsprojekt St. Katharina in Wien.“AUTHORS: Charlotte A. Sust, Peter Dehoff, Dieter Lang, Dieter Lorenz; 2012

TITLE: “Vom Ruheraum zum bewegt(er)en Lebensraum“AUTHORS: Anja Rutkröger, Renate Berner, Christina Kuhn, 2012

TITLE: Pflegeoase. Eine spezialisierte Betreuung von Menschen mit schwerer Demenz (PosBeD)AUTHORS: Detlef Rüsing, Nicole Ruppert, Christian Mülller-Hergl, Odilia Plietker, 2012

TITLE: Evaluation des Schlafverhaltens in einer Pflegeoase im Vergleich zum Doppel- und EinzelzimmerAUTHORS: Christina Kuhn, Renate Berner, Anja Rutenkröger, Dezember 2011

2011TITLE: “Pflegeoasen: (K)Ein Lebensraum für Menschen im Alter mit schwerer Demenz.AUTHORS: Brandenburg H., Adam-Paffrath R., Brühl A., Burbaum J., 2011. Abschlussbericht einer Evaluationsstudie

TITLE: “Innovative und herkömmliche Versorgungsstrukturen für Menschen mit schwerer Demenz im Vergleich: PflegeOASE. Un-veröffentlichter Abschlussbericht für das Bundesministerium für Gesundheit und das Ministerium für Arbeit, Soziales, Gesundheit, Frauen und Familie in Rheinland-Pfalz.”AUTHORS: Schuhmacher B, Denkingenr H, Heine Y, Hils A, Klie T, 2011

2010TITLE: Lebensqualität und Arbeitsmotivation in der Pflege schwer Demenzkranker. Evaluationsergebnisse einer Pflege.AUTHORS: Becker S, 2010

TITLE: “Milieutherapeutische Effekte in der Pflegeoase”AUTHORS: Jürgen Dettbarn-Reggentin und Reggentin, 2010

2008TITLE: „Im Blick haben“, Evaluationsstudie zur Pflegeoase im Seniorenzentrum Holl.AUTHORS: Rutenkröger A., Kuhn C.; 2008

CURRENT EVIDENCE

STUDIES

Becker 2011DESIGN: descriptive longitudinal compare study, mixed methodRESULTS:Quality of Life: increase of QoL for residents, reduction of negative associated daily life situations,decrease of medicationCare giver: higher personal identification, increase of motivationrelatives: relief through presence

Brandenburg, Adam-Paffrath, et al. 2011DESIGN: longitudinal compare study, mixed methodRESULTS: QoL resident: less agression, agitation, depression and fear, more contacts with care givers for positive eventsjob satisfaction of care givers: higher emotional exhaustion, higher gratificationrelatives: higher satisfaction with care, better communication/information, higher closeness between care giver and residents

Rutenkröger, Kuhn 2008DESIGN: descriptive pilot study / pre-post-test-design / mixed method designRESULTS: QoL resident: better nutrition, increase of communication, less mobility, more attention, less apathycare givers: higher physical and psychological stress

Rutenkröger, Kuhn 2010DESIGN: longitudinal compare study, mixed method designRESULTS: QoL resident: increased QoL, less non-cognitive symptonscare givers: less burn-out through higher meaning orientation, more single contacts, increase of job variation

Schuhmacher, Klie et al. 2011DESIGN: longitudinal compare study, mixed method designRESULTS: QoL resident: less pain, more positive contacts, more instructed activities, same movement radiusjob satisfaction of care givers: team building process at the beginning, education in work according to resident needsrelatives: lack of privacy

SPEAKERS

Michael Schmiedermichael.schmieder@sonnweid.chwww.sonnweid.ch

Christian Feldkircherchristian.feldkircher@firm-zt.comwww.firm-zt.com

CASE STUDY APPENZELL“Alters- und Pflegezentrum Appenzell”Appenzell, Switzerland

ARCHITECTSBob Gysin + Partner BGP Architectsinfo@bgp.chwww.bgp.ch