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52 Medical Construction & Design | M AY/ J U N E 2016 | MCDM AG.COM BY JEFF ELPERS Alzheimer's is the sixth leading cause of death in the U.S. and, as the population ages, housing and caring for those af icted with the disease and related dementias is a growing need. Increasingly, facilities are being designed to support the maintenance of patients' physical and cognitive capa- bilities for as long as possible, including such elements as specialized lighting, fl oorplans that prevent wandering and providing a home-like and mentally engaging environ- ment. Here are tips to keep in mind when designing memory care communities. Preconstruction As building specifi cally for the needs of Alzheimer's patients and their caretakers poses unique challenges, involving contractors in the preconstruc- tion phase can help ensure the design is executed on time and on budget. For example, on the Abe's Garden proj- ect in Nashville, Tennessee, which opened in 2015 as the fi rst memory care community in the U.S. designed to dem- onstrate and disseminate Evidence-Based best practices to improve the lives of indi- viduals impacted by ADRD, the owner, contractor and architect partnered during preconstruction to enable a de- sign that met the overall goals while staying within budget. Built to accommodate 42 full-time residents and 15 adult day/evening care participants, the team of experts in aging design, lighting, gerontol- ogy and construction worked together in preconstruction to develop the campus. Lighting Research has revealed the importance of light in reduc- ing agitation and promoting routine for individuals with Alzheimer's. As many patients struggle with "sundowning" — an elevated confusion later in the day — and deteriorating eyesight, design teams should consider everything from the impact of hallway lighting to the prominence of windows. Research has shown that bright light in the morning and low-level amber night- lights can be used to improve sleep-wake patterns, making it crucial to design facilities to maximize natural light, and incorporate state-of- the-art lighting to support circadian rhythms, reduce glare and minimize shadows. For example, the Villa at Terracina Grand, a memory care community in Naples, Florida, has a Nature Immersion Room equipped with specialized lighting — which even creates starlight at night — to align with circa- dian rhythms, contributing to the room's soothing nature. Additionally, since it is more dif cult for older adults to adjust to changes in lighting, use of screened-in porches and other transitional spaces help eyesight adapt when mov- ing from outside to indoors. Creating home-like environments Another key aspect of design for memory care facilities is creating a home-like environ- ment indoors and out, which can be challenging in a large healthcare facility with many codes to meet, but not impos- sible. For example, at Abe's Garden the commercial grade steel roof design incorporated decorative shingles to retain the appearance of a single- family residence. Shingles are typically nailed through substrate, a second layer below the roof fi nish. However, since the facility is a commercial building featuring a metal structure with metal decking, it was dif cult to nail through. As such, the construction team worked closely with the design team to fi nd a nail-able substrate that could be placed on top of the metal decking. Luckily, the team identifi ed one that met the fi re rating require- ments and could be used for the installation of shingles. In designing and building for memory care, teams must constantly balance the environ- mental needs of the facility's Tips for designing facilities, spaces tailored to Alzheimer's patients Memorable Spaces Top: Taking wander prevention into consideration, the memory care units of Abe's Garden in Nashville, Tennessee are built to surround a courtyard, allowing residents to enter their "homes" by walking through a front door, rather than a traditional healthcare facility entrance. A key aspect of design for memory care facilities is creating a home-like environment indoors and out.