Bedrooms and privacy

When to get up, how to arrange furniture in your room, when to be alone and when to go to bed are everyday life decisions often out of people’s control in facilities. These are basic decisions most people take for granted.

For all of us, the physical space of a bedroom has special meaning. It is a private space of our own where we keep our most personal possessions. It has privacy and a sense of security.

In residential facilities bedrooms have even more importance. They can be home to people for many years, offering privacy in a sometimes stressful group living situation.

Living in a residential facility does not mean a person has to give up the right to privacy most people take for granted.

Changes you can make now

Low cost

• Start a policy encouraging people to personalise their bedrooms.
• Use personal items at a suitable height outside bedrooms as identifying cues
• Have policies and procedures letting people wake up and go to bed when they choose.
• Have a place for people to sit when dressing and arrange clothing to prompt dressing in order.
• Label drawers and have open wire baskets or an open section of wardrobe to show clothing as prompts.
• Divide cupboards to limit clothing choices and fit a hidden lock to close off a section.

Moderate cost

• Invite people with dementia and their families to choose paint colours and buy the paint for them. Have a choice of three to five colours from apricot, peach, sunny yellow or warm earth colours.
• Put in a mix of overhead lights, task lights and lights at bedroom doors and near wardrobes for best visibility.
• Put in indirect lighting and touch-responsive bedside lamps.
• Have a dressing or grooming area with a seat, mirror and good lighting close to the bedroom or sleeping area.
• Hang high-quality curtains that reflect sunlight, help keep warmth in rooms, and are pleasing to look at.
• Have nightstands and dressers with drawer pulls and handles easy to use for people with limited ability.

High cost

• Design bedrooms with the toilet visible from bed.
• Make bedrooms large enough for future needs such as wheelchair access and family access when a person is ill.
• Fit existing bedrooms with low windows to overlook outside areas.

A personal space

Personalising a bedroom is a way to make life in residential care feel like home. Treasured possessions and familiar pieces of furniture help create a sense of familiarity and make a person feel more comfortable.

People bring a lifetime of experiences to their new home. When they first arrive, involve them and their family in creating a home-like environment. What best suits them will help them feel part of everyday life in the facility. A personalised bedroom gives a sense of ownership of a place to call their own.

Personalising bedrooms helps staff to get to know a person. Family pictures, furniture from home, furniture arrangement, colour scheme and personal items all give information about a person.

Life stories

Example - furniture from home

The photo shows a resident’s room. Furniture from home, such as a wardrobe, dressing table and coffee table can personalise a bedroom without creating a fall hazard for the person with dementia and staff. The dressing table has personal items like photos, a lamp and vase from home, enhancing a home-like environment and providing information about the person. Space between furniture and doors is important to manage falls risks and allow easy mobility.

Example - making room for personal items

The photo shows a wall in a resident’s bedroom with a pinboard attached. The pinboard provides space for photos and pictures or articles to be attached and changed or updated easily. There is a shelf under the pin board where personal items can be left within easy reach. Beside the pin board are small built-in shelves for personal items, photos in frames and small decorative objects.

Maintaining independence

Mobility, for example in private spaces like bedrooms, is important for people with dementia, physically and emotionally. Physical design issues and dementia-friendly care are key. Good design and assistive technologies in the bedroom can improve a person’s independence.

Practical design issues

For enough space and good access, including for people in wheelchairs, rooms should be 14m2 (Building Commission Victoria, 2002) or more. Short-pile carpeting looks home-like and is less likely to cause falls. Falls on carpet with cushioned backing result in fewer injuries. Carpet reduces glare and background noise.

A bedside table or nightstand with a light under the apron of the table can be a nightlight wired with a motion sensor for checking movement at night.

Toilet visibility has a huge impact on use. Placing the bed so there is direct visual access to the toilet can remind those with cognitive impairment to use it. Having a night-light and a clear pathway to the toilet for night-time use aids continence and can lead to fewer falls.

The photo shows a view from a resident’s bed to an open ensuite bathroom door. The following features of the bathroom aid continence, recognition and way finding:

• the toilet is very clearly visible from the bed and only 1.5 meters away
• there is a night light in the bathroom
• the wall and floor are in contrasting colours
• a contrasting toilet seat would aid visibility and recognition.

Assistive technology

Interior design

New residential facilities

Locating the bedroom

As dementia continues, mobility and wayfinding are affected and people are often less able to find their bedrooms.

In early stage dementia, clear, simple signs, in words or pictures, are helpful. In later stages other cues, such as hanging a person’s dressing gown or other known objects on the bedroom door, seem to be more useful.

Other ways to personalise bedroom doors include signs in large lettering with the person’s name, or photographs of the person with family members and friends. Putting a portrait and personal memorabilia in a display case outside people's bedrooms may help room finding. This low-cost, simple approach to a common issue can have other benefits. Just as pictures and memorabilia help personalise living spaces, photographs of people as younger adults remind staff of a person's life history beyond their present situation. These items can start off conversations between staff and the person with dementia. As early life events are often recalled more easily than recent ones, photographs and other items from the past may bring back memories.

Life stories

Wayfinding

Home-like bedrooms

Where size permits, people can personalise their bedrooms with their own furniture, but other personal items can help create a personalised environment in any size space.

Pillows of different shapes, sizes and surfaces can help create a home-like environment. Bedspreads with small classic patterns have a home-like feel. Natural plants bring colour, touch sensation and fragrance into a bedroom; for people with middle to late stage dementia all plants need to be non-toxic.

When there are safety issues about a person’s furniture, look for solutions before removing or rejecting it. Many products are made to cover or pad sharp edges, and handles can be replaced on a dresser or wardrobe for safety or easy use.

The photo shows a modern built-in wardrobe in a resident’s room. The wardrobe has four lockable doors. One door could be left unlocked and contain a day’s worth of clothes, to encourage independent dressing while minimising confusion. Beside the wardrobe there are three small built-in corner shelves for personal items. The floor, wall and wardrobe are in contrasting colours.

Respecting privacy

Privacy is the ability to control who you see, when you see them and what others know about you (Marsden et al., 2001). Cognitive impairment linked to dementia can affect the privacy of people with dementia and others around them. A better understanding of a person’s life experiences gives information for creating physical and social environments to meet their privacy needs.

Organisational procedures and routines can affect privacy. A facility’s policies should reflect the importance of privacy and respect. For example, a person’s privacy around sexual activity should be respected.

When gathering a person’s life story, think about their privacy needs by asking some questions:

• Did the person spend a lot of time alone before moving into the facility?
• Did they live alone?
• Was the person sociable?
• Are there certain things they do not like to talk about?
• Are there activities they like to do when alone?

Knocking before entering a person’s bedroom is basic courtesy and required policy. Staff should always give people a chance to respond. Check this practice continues over time.

Knocking on a door in the middle of the night to check on a person is inappropriate, but it is important to work out if night checks are needed, and how they can best be carried out.

Maintaining personal identity: respect and dignity

Sexuality

Life stories

Rummaging and hoarding are often seen as issues for people with dementia. Rummaging can affect other people’s privacy; items may be hoarded in bedrooms. There are ways to take rummaging and hoarding out of bedrooms.

Personal enjoyment: participation and engagement

Rummaging and hoarding

Issues to consider

• Poor staff understanding of the importance of the bedroom to people
• Morning routines organised for efficiency rather than personal wishes
• Rooms too small for personal possessions
• Decorating bedrooms not permitted
• Lack of respect for a person’s private space

Lived experience ...

Time to go to bed?

They say it’s time for me to go to bed. Haven’t been told that since I was 10 years old. What do they think I am, a baby? When I ask them the time they say ‘bedtime’, but what time is bedtime. Seems to be getting earlier and earlier these days. If they want to go to bed that’s fine with me. I’ll go when I am ready and not before. Anyway it can’t be bedtime - I haven’t had my cup of hot water and they have left all the lights on; no one sleeps with all the lights on.

I love it when Sally is here. She knows what I need to do before going to bed. She takes me round to everyone to say good night and ‘don’t let the bed bugs bite’. I can’t remember why I say it, but it was something said to the children when they were going to bed. Then we go into the bathroom and there are my things, a big mirror over the washbasin and a bright light, the shelf with my hairbrush, and the nice lemon towels neatly folded. Then it’s time to go to the toilet (just the right height), wash my hands and face (I can turn on the taps myself and the towels are not scratchy), brush my teeth (I like these new electric ones — I just put it in my mouth and it does all the work), and then brush my hair, all in that order.

I love my bed. It’s the best place in the world. I can snuggle down and dream my dreams. The smell of fresh sheets reminds me of my childhood, and my favourite bedspread is there waiting for me. Someone has closed the curtains and made sure the window is open. Sally has lowered the bed, so I don’t have to struggle to get in and I can do it myself. She keeps it low just in case I need to get up during the night and she leaves a light on in the bathroom. It’s funny, it’s just like a spotlight on the toilet.