Introduction

An incident some ten years ago alerted me to the fact that the frail aged and people with dementia were being adversely affected by inappropriate (lighting) design and that they had little or no means of doing anything about it. I’ll commence this presentation with a recounting of that story and then canvass various aspects of lighting and provide some recommendations on how the lighting specification process should be undertaken for RACF’s.

Rachael

In 1999, I visited a small dementia-specific facility on a study visit. I was there to acquaint myself with the design and to have a look at how the residents and staff interacted in the environment. During my visit I happened to be sitting down having a chat with a staff member and a lady whom I shall call Rachael (Rachael was not her real name). During the course of that conversation Rachael, who had noted my interest in design, asked if I would like to see her room. The staff member present gave her permission so, Rachael and I proceed to her room which was only a few steps away from where we were sitting.

Rachael entered her room first and proceeded about halfway across and I stepped just inside the door, not wanting to intrude too far into Rachael’s domain. The room was average to small in size and, very clean and tidy and was full of Rachael’s memorabilia. To the left there was a door to a small ensuite (toilet & hand basin only) which ran off the bedroom. Rachael appeared to be quite proud of her room and, I remarked to her what a nice room it was and asked, in passing, if there was anything about it that she did not like.

I have found over the years that in these situations people rarely tell you what they don’t like about anything until you ask the question. People generally don’t like to sound negative or appear to be complaining. When I asked this question I was not looking at Rachael – my eyes were moving around the room taking in all of Rachael’s belongings. Rachael’s answer to my question came back straight away, she said forcefully “The Light!”. When I heard Rachael’s comment, I immediately looked at the ceiling to look at the ‘light’ (at this stage, I was still not looking at Rachael).

The principle light in the room was an ‘Oyster-Type’ ceiling mounted Luminaire. When I was looking at the Oyster fitting I was providing Rachael with my thoughts on it (trying not to be too negative) and then I heard again from Rachael, in an even more forceful voice “No!” she said, and then, “The Light!”. I was quite obviously looking at the wrong thing so, when I heard this second comment I turned my gaze from the ceiling light back across to Rachael who was standing looking at me  but, with one arm outstretched and her index finger pointing straight towards the window! ‘Oh” I said “what is wrong with the window?”. “The Light” said Rachael. It was now quite obvious to me that there was something wrong and that the extent to which Rachael could explain the problem was to point at the window and again repeat, “The Light”. What was wrong with the window?

We were both looking at a standard domestic sized window which was fitted with a face curtain, a sheer curtain and a Holland blind which, was drawn about two-thirds the way down. Below the blind, sunshine was streaming into the room. Up until this point I hadn’t taken much notice of the window or the fact that the Holland blind was drawn down on such a pleasant sunny day. We were in late Autumn and the weather was a little nippy so, I would have expected that some warm sunshine streaming in through the window would normally have been a pleasant experience, even if a little glaring. When I saw the sunshine and the accompanying glare, I said to Rachael “Oh I see, the glare from the sunshine is bothering you”. ‘”No” said Rachael. “The Light”. Now I was puzzled; I looked across at Rachael who was still pointing at the window.

I didn’t understand what Rachael was trying to tell me and it was clear to me that I couldn’t figure it out by staying where I was. So, I asked Rachael if I could move across to the window to take a closer look. Rachael said “Yes” so, I moved a few steps across the room, past Rachael, and stood in front of the window. Rachael stayed standing behind me and had by now lowered her arm nevertheless, she was still looking at the window.

Standing in front of the window, nothing seemed to me to be out of order. Whatever was bothering Rachael must be concealed by the Holland blind drawn two-thirds the way down. I turned to Rachael and asked if I could lift the Holland blind up. Rachael said “Yes”. I turned and drew the Holland blind up and it then became exceedingly clear to me what appeared to be causing such anxiety in Rachael.

The facility in which Rachael lived was located in a standard suburban street and the boundary fence was about 3 metres from Rachael’s bedroom window. The residence next door was much closer: it appeared to be around one metre from the fence-line. Mounted on the side of the building was, what was concerning Rachael. Twin ‘Para-floods’ were mounted just below the eaves to illuminate the narrow concrete pathway between the fence and the adjacent building. Para-floods are indiscriminate light - they cast light in all directions, not just forward. They are blinding in the light that they emit and, are one of the least suitable lights to be used in residential environments particularly, to illuminate long narrow spaces for which they are totally unsuitable.

It was now apparent to me that each night when Rachael was trying to sleep, her world was invaded by highly intrusive flood lighting. The situation was not made any better by the curtains and blinds which were installed on Rachael’s window. Neither the Holland blind nor the curtain installation incorporated ‘blockout’ materials. I assumed that Rachael kept the blind lowered just enough, all of the time, so that she did not have to look at the offending installation, even in daylight hours. Looking at the light through her window would remind her, even in her early stage of dementia, of what was to happen each night. I told Rachael that I could see what was bothering her and said that I would inform the staff. I only stayed in Rachael’s room a few more moments and, as we left I thanked her for allowing me to visit.

I did inform the staff on duty and I suggested that the facility should approach the adjacent property owners and request that they change their light installation to something less intrusive without compromising their apparent security concerns. I did not ever find out if what I suggested was carried through. For Rachael’s sake I hope that the offending lights were changed or modified. Although this story concerned light from an adjacent property it could well have been invasive lighting from within the facility or, from road or public lighting outside the facility boundaries.

There are two significant points about this story:

• People with dementia are at the mercy of the environment in which they live.
• How does a person with a severe cognitive deficit inform other people when they are distressed by negative elements in the environment?

Rachael was fortunate, she had retained enough cognition to inform someone that there was a problem.