Environmental assessment tools – how to use them

There are currently (watch this space) five different environmental assessment tools to help you find out whether your health and care setting is dementia friendly, and they are available to download for free from our website. However, while we hope that they are intuitive and easy to use, we thought it wouldn’t hurt to provide a few pointers on how to use them in practice. Whether you’ve never used any of the tools before or you just want a bit of a refresher, we hope you find this blog helpful.

The Covid-19 pandemic has required a great many changes to be made to the environment in which we care for people. Some changes may be in place for a long time while other spaces may be returning to their pre-covid function, giving you an excellent opportunity to review how dementia friendly they really are.

Step 1 – Choose your tool

Actually, before we get to that, take a moment to congratulate yourself on getting to the point of looking at environmental assessment tools. It might sound a bit corny, but we think it’s worth acknowledging. Think about why you’re doing this. Is it because you know there’s work to do in your care setting? Is it to get some reassurance that your care setting is doing ok? Are you planning some changes and you want to know what difference they will make? It doesn’t really matter. The fact that you’re even considering the importance of having dementia friendly environments is brilliant.

Ok, back to it. So which tool should you use? There are five tools to choose from, and hopefully one will match your care setting:

• Care home assessment tool
• Health centre assessment tool
• Hospital assessment tool
• Housing assessment tool
• Ward assessment tool

If you work in domiciliary care and are more interested in people’s own homes, the Alzheimer’s Society booklet on ‘Making your home dementia friendly’ may be more appropriate. If you’re a community setting such as a Meeting Centre or leisure centre, the guide and checklist originally designed to make village halls dementia friendly could be a better fit. All are available to download for free from our website, so have a look and see what works for you. You may find that whichever one you choose there will be some questions that aren’t relevant to your specific setting, and that’s ok. The underlying principles are still likely to apply, and you can always adapt bits to meet your needs.

Step 2 – Decide who to involve, and how

Once you’ve downloaded your tool, make sure that you have permission from the organisation to undertake the assessment. This is important as it will signal that you are thinking about potential changes which you may need management support to introduce. Then have a think about who will actually carry out the assessment. There’s no right or wrong here and it might depend on what’s going on in your setting, but here are some options to consider.

• Do it by yourself – this could be a quick and easy option, but you’ll need to realise that you’re only getting one perspective. Will you miss things that others might spot?
• Get multiple people to do their own assessment – this could work well as you’ll be able to find out how people see the setting and where their views are similar or very different.
• Do an assessment as a group – this could prompt some good discussions as you’re doing the assessment and give people a chance to say why they feel a particular score is appropriate or even constructively challenge other people’s views.
• Involve a range of people, including people with dementia and their families – as well as giving different perspectives, involving people from the start of a process can help them to feel involved, gain a better understanding of dementia friendly design, and start to gain ownership of the need for change. Presenting a member of your estates/maintenance team with a list of things to do might not be the best approach, but getting them to see the importance of a change by being part of an assessment could get buy-in. Similarly, if you’re potentially going to be making changes to a resident’s home it’s important to make them feel part of the change and have a say in it, as well as giving them time to get used to the idea rather than it being sprung on them as a fait accompli. You don’t necessarily have to include everyone in the process, just think about who the key players are, whose perspectives are important to consider, and who needs to be onboard with it.

Step 3 – Final preparations

While you may be enthusiastic to get going and have other people raring to go too, it’s worth taking a little bit more time before jumping in and doing the assessment. Make sure that you’ve had a chance to look through your chosen tool so you know what you’re doing and what the different sections are looking at. This doesn’t mean you need to know each question off by heart, but just have a general idea of things to pay attention to as you’re going through the assessment. If nothing else, take the time to read the rationale for each section, as this will get you in the right mindset. It can also be a useful learning tool for others who may know less about dementia.

Also plan in time to carry out the assessment. Don’t try and squeeze it in when people are in a rush. If you’re going to do the assessment, do it properly and give it the attention it deserves. Bear in mind too that if you’re doing it as a group, especially one involving residents or patients, you may need to factor in extra time for discussions, moving between locations, or even arrange several shorter sessions to ensure full engagement.

The timing of an assessment should also be considered. While you need to be able to see the different elements you’re assessing and not get in people’s way, you also need to get a true picture of how spaces are used, especially in terms of noise levels generated by people or equipment. If there are particular issues with an area, try to determine if these are normal occurrences and reflect this in the comments section.

Step 4 – Carry out the assessment

The important thing to remember when carrying out the assessment is that it’s not an office-based exercise, you actually need to walk round your setting, spend time looking at the spaces and see the various aspects as you’re assessing them. You might think you know what the flooring in the bathroom looks like, but do you really? Until you’re standing looking at something with the questions in your hands, you won’t know. If you have appropriate permissions, taking some photographs during the assessment can help you remember particular areas.

There’s no specific way to do the assessment, so do what works in your situation. You could work through each question in order and go through the sections as they appear in the tool. Alternatively, you could flick between sections depending on where you are in your setting and what you’re looking at, which is where it helps to be familiar with the tool. The key is to make sure each question is given appropriate consideration.

Try to look at your setting with fresh eyes. Just because you know where a sign is or how to operate a door, it doesn’t mean that someone new to the environment will have the same experience. Also, be honest. There’s no point doing the assessment if you’re not going to give a true reflection of your care setting. Even if you’re reflecting on something within your setting that you personally were involved in (e.g. colour of walls or choice of crockery), be open to admitting that it may no longer be appropriate or the best option.

Be consistent with your scores. You’re answering each question on a scale of 1 (barely met) to 5 (totally met), so try to be clear what you mean for each score. Sometimes you might be able to decide on a score quite easily, but other times it might require a bit of discussion amongst your group. Also, don’t be afraid to change a score if you realise you’ve started too high (or low) after answering a few questions. It’s better to revisit your scores and make them meaningful rather than skewing your results.

As you’re going through the questions, use the comments area. You might spot things you definitely want to change, or have ideas on what you could do differently, so make a note of them while they are fresh in your head. Remember, the assessment is for your benefit, so make it work for you.

Once you’ve scored everything and are happy with the assessment, transfer your scores to the summary page. You may find it useful to colour-code the scores too (e.g. all 5’s are green, all 1’s are red etc.). It might be a bit of extra work, but it really can be useful to have all your scores in one place to get the overall picture.

Step 5 – Using the assessment

It’s all very well carrying out the assessment, but if you don’t do anything with it you might as well not have bothered!

First off, keep a record of the assessment and any relevant photographs as they will give you a benchmark of where you were at a particular point in time. It’s also nice to thank anyone who was involved in the assessment and let them see the summary of the scores, as this helps them realise their input was valued and valuable.

Use the assessment to identify areas where you are doing well (5’s), where you are doing poorly (1’s and 2’s) and where there is still room for improvement (3’s and 4’s). Is there a pattern emerging from your results? For example, do most of your problems relate to flooring, lighting or bathrooms, or is it more general?

Develop a plan of action that you can take forward and discuss with relevant people such as managers. Once you know where your issues are, you can work out how to tackle them. How can you address your low scores? What could be done to improve your mid-range scores? It’s also useful to think about who would be involved with each action, and what timescales you should be looking at. You may also be able to identify some ‘quick wins’ that don’t require time or money but could actually make a big difference, such are getting rid of clutter. These could be good for morale, and again indicate to everyone that the assessment was worthwhile and will actually result in action.

When engaging with people to make changes, refer back to the assessment to show why the change is needed. Your completed assessment is now evidence that can support you and work in your favour, so use it!

Step 6 – Repeat

Although you might carry out an assessment and make changes as a result, you shouldn’t view the tools as a one-off resource. Think about repeating the assessment, maybe even at regular intervals, as comparing the results with previous assessments will enable you to see – and demonstrate to others – where improvements and progress have been made. Again, share this with others to boost morale but also highlight where work is still to be done. It reinforces that it’s not a case of ‘job done, move onto the next thing’ but important to continually be aware of the environment and ensure that you don’t slip back into a situation that is less than ideal.

We hope that’s been a useful overview of how to use the assessment tools, and it maybe even inspires you to give them a go and see how they can help you. Have a look at our website to get a free copy of your chosen tool. If you think your setting could benefit from a bespoke tool, please get in touch and see if we can work with you dementia@worc.ac.uk.

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