What Are Dementia-friendly Communities?

1. Health Care

A person who has dementia can find visiting a medical provider or other care provider unsettling or distressing. Having a better understanding of who the person really is can help providers deliver care that meets their needs comfortably and effectively. Establishing a system or using a tool that gives the healthcare team insight into the patient’s cultural, spiritual background, interests, routines, sources of anxiety and comfort makes for a respectful, dementia-friendly interaction at medical and allied health appointments. 

“This is me” is an example of such a tool.  It’s a support tool to facilitate dementia-friendly, person-centered care. “This is me” can be used to record details about a person who can't easily share information about themselves. It can record their cultural and family background, important events, people and places from their life, their preferences, and routines. The leaflet can be used in any setting — at home, in hospital, in respite care or in a care home. It helps health and social care professionals better understand who the person really is, which can help foster interactions, reduce stress, and help the team deliver care that is tailored to the person. The use of “This is me” may prevent more serious conditions such as malnutrition and dehydration.

There are also environmental adaptations that healthcare offices can put in place such as clear signage, well-marked restrooms, and quiet waiting areas.  Office staff should be trained to use dementia-friendly communication skills.

Including the caregiver as an integral member of the healthcare team is an often-overlooked element in dementia-friendly healthcare. The family caregiver’s presence and expertise are vital to successful management over the course of dementia. Providers should assess and support care partner needs:  refer care partners to local resources – such as support groups, respite care, care partner education and training programs, and care partner coaching services – and encourage them to use them. Remind care partners to take care of their own health and well-being, including through regular medical checkups. 

2. Transportation

It‘s important to help caregivers and individuals living with dementia to learn how to access information about community transportation services, the range of transportation options that may be available, and considerations for matching transportation options and specific care needs.

If older adults or people with neurocognitive disorders like dementia don’t have access to public transportation or are unable to use it safely, they risk a loss of independence, isolation, and increased dependence on family and friends for everyday errands and essential appointments. Building a dementia-friendly transit workforce is an effective first step. Public transportation entities should train personnel to be calm, friendly and to provide respectful customer service. They should be clear and concise, respond to repetitive inquiries kindly and consistently remind riders of the upcoming stops.

Pre-payment options can prevent anxiety and confusion over payment at the transit station or on the bus or train.

3. Homes and Independent Living

The best way to make your home dementia-friendly is to simplify. Too much furniture can make it hard to move around freely, particularly for an individual living with dementia.  Get rid of clutter, such as piles of newspapers and magazines. Ensure there is a care plan for pets which can provide needed comfort but also be a hazard for tripping.

To ensure safety be sure there are sturdy handrails on stairways.  Put carpet on stairs to improve traction or mark the edges of steps with brightly colored tape so the person can see them more easily.

For individuals with advanced dementia or those experiencing balance problems, for whom staircases pose a danger, place a retractable gate across the stairs if the person has balance problems.  Remove small throw rugs and be sure any rugs that must remain have a non-skid backing.

Add the following items to the person’s home if they are not already in place:

• Smoke and carbon monoxide detectors in or near the kitchen and in all bedrooms
• Large print Emergency phone numbers (ambulance, poison control, doctors, hospital, etc.) and the person’s address near all phones
• Safety knobs and an automatic shut-off switch on the stove
• Childproof plugs for unused electrical outlets and childproof latches on cabinet doors

4. Residential Settings

For people with dementia in assisted living and nursing homes, quality of life depends on the quality of the relationships they have with the direct care staff. Optimal care can occur within a social environment that supports the development of healthy relationships between staff, family, and residents. Good dementia care involves assessment of a resident’s abilities, care planning and provision, strategies for addressing behavioral and communication changes, appropriate staffing patterns, and an assisted living or nursing home environment that fosters community. Each person with dementia is unique, having a different constellation of abilities and need for support. These change over time as the disease progresses. Staff can determine how best to serve each resident by knowing as much as possible about their life stories, preferences, and abilities. Good dementia care involves ongoing staff training to ensure effective, respectful, and dementia-informed care. Using the most current standards of dementia care and information about a resident to develop and implement person-centered strategies, which are designed to ensure that services are tailored to an individual’s circumstances, is the cornerstone of a dementia-friendly residential setting.

5. Town Government

Vermont communities have many people at risk of or living with dementia. Of Vermonters who report Subjective Cognitive Decline, 36% live alone. To date 9% of Vermonters 65 and over have been diagnosed with Alzheimer’s Disease or a related dementia. Many people experiencing cognitive decline or living with dementia, like most of us, wish to remain in their homes and communities.  In 2021, 42% of Vermonters were 50 or over. Vermont’s state and local government, like many states with changing demographics, needs to evolve to support an ever-increasing aging population. For individuals to age in place, communities must be equipped to support people living with dementia and their caregivers. 

To begin the process of building an elder-friendly or age-friendly community, multiple stakeholders, both public and private, need to be involved. These stakeholders include:

• Elected community leadership (mayor, township trustees or city manager)
• Council or selectboard
• City departments and agencies
• Planning and zoning commissions
• Any other entity in a community that affects the physical environment and operation of programs.

In addition, those who have special expertise in matters related to aging, such as the Vermont Department of Health (VDH) and the Vermont Department for Disabilities, Aging, and Independent Living (DAIL), those who serve the older adult population, older adults, as well the public, should be part of the process. These individuals and organizations should be brought together as members of a Dementia-friendly Communities Task Force. The Task Force should reflect the community in terms of age, gender, race, ethnicity, and income.

6. Community Based Services and Supports

Many people living at home may require supportive services to maintain independence, receive adequate nutrition, support well-being, and to remain engaged. Supportive services include:

• Transportation: rides to medical appointments and mobility management training to help older adults navigate public transportation.
• In-Home Services: personal care and other supportive services such as help with bathing, dressing, grooming, light housework, and home-delivered meals.
• Home modifications or repairs that enable older adults to remain safely in their homes.
• Adult Day Care: supervised social or medical care provided in a setting outside the home.
• Professional or “friendly volunteer” visitors to maintain social engagement.
• Legal services, elder abuse prevention programs and Adult Protective Services

See below for a sector guide that can help community-based service providers become more dementia-friendly in their interaction with consumers and in service delivery. Free training is available from the Vermont Chapter of the Alzheimer’s Association to become dementia-informed in providing community-based services.
 

7. Retail Businesses

An age- and dementia-friendly business is one in which people of all ages and abilities can comfortably shop for goods or services. To become dementia-friendly a business must take steps to make their spaces more inclusive including training staff to recognize and serve individuals living with dementia, and their caregivers, with clarity and respect. Dementia-friendly America, Dementia Friendly, is a one-hour educational session for staff of businesses, service organizations and all other community settings.  The training focuses on understanding dementia and taking action to create an environment that is safe, respectful, and welcoming for people living with dementia.

Additional steps businesses may take to become more dementia-friendly include providing resting areas and non-slip flooring, and using signage with universal symbols, like arrows.

For employees with caregiving responsibilities to continue their employment, businesses should offer eldercare options similar to those offered for employees caring for children. The experience of working caregivers with eldercare responsibilities differs from that of workers with childcare or no dependent care responsibilities. Research has found that working caregivers of aging relatives report having less access to flexible work options to carry out their work and caregiving responsibilities and perceive significantly lower job security than workers with childcare needs.

Numerous studies have found that flexible workplace policies enhance overall employee productivity, lower absenteeism, reduce costs, and appear to positively affect profits. Such policies also aid recruitment and retention efforts, allowing employers to retain a talented and knowledgeable workforce and save the money and time that would otherwise have been spent recruiting, interviewing, selecting, and training new employees. Family leave and paid sick days are vital policies for working caregivers also. These workplace benefits can help working adults balance their work, personal lives, family caregiving responsibilities, and make your business workplace more dementia friendly.

8. Finance & Banking

Focus groups conducted with individuals living with dementia found that many folks have difficulty banking. Some issues reported include:

• Remembering PINs, passwords, or information required to access account information either online or on the phone.
• Navigating statements and payment requirements on complicated bills and determining which information is essential.
• Counting or recognizing money.
• Coping with new technology and payment methods or feeling rushed.
• Worrying about other people’s reactions.
• Fears of being vulnerable and risk of becoming a victim of fraud.

The symptoms of dementia can make interactions such as these difficult, particularly if a person experiences forgetfulness or difficulty following processes. This can have significant consequences – for example forgetting to pay a bill could result in debts and lead to financial instability. Making services and products dementia-friendly makes them more accessible for everyone.

A financial institution that strives to create a dementia-friendly environment that is safe and accessible should create quiet places for clients to sit and relax, well-lit uncluttered spaces, and pictures and signs that identify areas such as restrooms. If a person discloses that they have dementia, ask if it can be recorded. Keep records of communications and needs to aid future interactions. It is much easier to assist and support a person who has made this known. If possible, provide alternate security/fraud prevention safeguards that allow individuals experiencing cognitive decline to access their accounts without using PINS or passwords.

9. Airports

A diagnosis of dementia does not mean a person has to stop traveling.  Travel is beneficial for those living with dementia and their partners. As dementia progresses air travel can become more difficult. The extra stimulation in airports can create anxiety for the individual with dementia and their caregiver or traveling companions.

Innovation in Aging 2020 published a study to identify the concerns of persons living with dementia and their travel companions.  The research was conducted by the Dementia-Friendly Airports Working Group at the University of Minnesota School of Public Health. Areas of concern identified by individuals living with dementia and their caregivers included overall anxiety, getting lost or separated from their traveling companions– particularly at security– understanding announcements, and understanding signage. Other frustrations noted: finding a family assist restroom, navigating/walking through the terminal, moving walkways, and finding a quiet place to get away from crowds and noise.

Airports can make changes to address these concerns including: letting the person with dementia and their travel companion stay together at all times (especially in security,) evaluating and updating wayfinding tools, sending announcements via text, using an airport app rather than announcements over a public address system, creating easy to find quiet spaces with seating, having wheelchairs and staffed motorized carts to shorten walking times and helping with navigation issues, ensuring that signage for family restrooms is clear and easy to find. Lastly, to curtail overall anxiety, create a system using lanyards to identify travelers living with dementia to alert airport staff that additional assistance may be necessary.

10. Libraries

Libraries interact with a wide spectrum of the communities they serve. The population interested in dementia-related programs is equally broad, which makes libraries particularly well-suited to offer such programming. Those benefiting from dementia focused programs, events, information, and services might include individuals living with memory loss, those living with a dementia diagnosis, care partners, professionals, and community members interested in the issues of dementia and healthy aging. Anyone impacted by dementia, either personally, as a family member, a professional, or as a community member, may benefit from participating.

One of the first steps in getting started is to convene a group of key community stakeholders or partners. This group should include the library director or designated staff member, any interested community members and, if possible, an individual trained in dementia care – this could be a support group facilitator or health professional. Considerations when getting started:

• Assessment of the library’s capacity to serve as a resource for those impacted by dementia in the community.
• Identify an individual who is best suited to lead the program.
• Types of programs or services that would be most beneficial to the community.
• Is funding needed to support the proposed activities? Potential sources of such funding?
• Contact the Vermont Department of Health Alzheimer’s Disease and Healthy Aging Program as a resource.
• Is the larger community involved in a dementia-friendly initiative?
• Explore accessible dementia training for library staff.

Projects with committed and dedicated people behind them, whether professionals or volunteers, are most likely to succeed.

Libraries can make a concerted effort to obtain current books and materials covering all aspects and types of dementia that allow patrons to access the most timely and up-to-date information available. In addition to traditional books, there are audiobooks, CDs, DVDs, and other materials. These resources should not be limited to books and materials that provide information about dementia, but also include items that may help to enhance cognitive stimulation, reminiscence, or conversation for any patron wishing to protect their brain health and for those experiencing memory issues. Libraries are also a useful place for consumers to obtain information regarding community-based resources in the form of brochures, fliers, posters, and notices. Establishing a consistent place where community-based dementia resources and events can be posted is an easy first step. Many libraries have displays, bulletin boards, and kiosks where such information could be made readily available.
 

11. Faith Communities

Faith communities play a vital role in offering supportive and welcoming environments for people living with dementia and their caregiver(s). Some people with dementia may stop attending regular worship services to avoid social situations that make them apprehensive or that they no longer understand. Others will find peace and comfort in a place of worship.  Family caregivers can become weary, isolated, frustrated, and depressed. Some may not know that their faith community can support them or may be reluctant to ask for help.

To become more dementia-friendly a faith community may invite a person with the lived experience of having dementia, or of being a caregiver, to address the congregation to share their experiences.

Provide congregants with ideas of ways to support families, such as assisting with transportation or spending one-on-one time to help the individual living with dementia feel valued and provide some respite for the caregiver.  Many houses of worship have organized networks of congregants that support members of the faith community experiencing poor health or challenging life circumstances.  These networks can be trained to interact and care for fellow congregants living with dementia and support caregivers by recognizing and helping to address signs of burnout.

Adopt policies such as wearing name tags, designating a quiet area, assuring signage is clear and easily interpreted (using pictures is best), or offering a volunteer companion to help during services.

A home-based or virtual service option can be convenient and opportune when acute illness prevents the individual from attending church in person. If care partners cannot attend services, take services and rituals to them.

12. Legal and Advanced Planning Services

Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimer's disease or a related dementia. Legal and medical experts encourage people recently diagnosed with a serious illness — particularly one that is expected to cause declining mental and physical health — to examine and update their financial and health care arrangements as soon as possible. Dementia friendly legal services can help allay the anxiety around planning for what is to come. Attorneys specializing in Elder Law can help clients express their wishes early and avoid problems such as unpaid expenses, squandered resources, avoidable guardianship, and financial abuse, neglect or exploitation.

An elder care lawyer may encourage a client living with dementia to identify trustworthy family or friends who will make decisions when client cannot and involve care partners in discussions as appropriate as they will take on increased decision making for the client with dementia. The Alzheimer’s Association has created a brochure to help guide individuals with dementia and their legal team.

Stay Connected

Additional Resources

●     For legal and advanced planning help, visit Vermont’s Legal Help website and Vermont Ethics Network

●     Explore Timeslips and Memory Cafe for meaningful and creative ways to engage individuals with dementia

●     Vermont Association of Area Agencies on Aging  responds to the needs and directions of older Vermonters and their families with information and assistance in a number of areas, such as caregiver support, transportation, health insurance counseling, home health services, exercise and wellness and more. Visit the website or call the AAA Helpline: 1-800-642-5119