Expert: Mary Gordon - 11/8/2008

Question
I am a social worker on a short term geriatric psychiatric unit in a hospital.  We have patients from early stages AD to severe - end stage AD.  One thing that puzzles me is even very confused AD patients still seem to recognize entry/exit doors onto the unit and this is a huge source of anxiety.  The unit is not layed out in a AD - friendly fashion --there are 3 entry/exit doors within 10 feet from the nurses station. The majority of our patients like to congregate near the nurses station (I guess they feel safe there).  How could we camouflage the doors to blend in with the walls? At present the doors stick out like an albatross.  Our unit is locked to keep our wandering AD patients within the unit.  I am convinced if the doors were camouflaged in some manner, it would greatly reduce the patients stress and anxiety as well as their trying to get out the door.

I would appreciate any suggestions on this matter.  Thank you.

Answer
Hi Sandy

Here is a good link discussing the issue
http://dhs.wisconsin.gov/aging/Genage/Pubs/Guide_exitingstrategies.pdf

I've seen various ideas, such as painting the door and frame and knob the same color as the surrounding walls, or even wallpapering the door to make it blend with the surrounding doors. Similarly, you could paint a mural across the wall, that included the door surface in the picture as one continuous scene.

Obviously, a door with a window in it or beside it is going to be attractive to a wanderer. The window should be covered with a blind or curtain the same color as the door, so there is no light or view to tempt anyone.

You could try hanging a picture to the door or a mirror on it, to make it look less like an exit. They actually make mirror effect foil self-adhesive contact wallpaper (see this example - it would really hide the door and wouldn't be breakable in any way)
http://www.allproducts.com/trades/supharve/Product-200812515755.html

People with AD have trouble with high contrasts in coloring in terms of visual interpretation - on a light colored floor, for example they will tend to see dark squares as holes (its a form of visual cliffing). You could try painting or tiling the area right in front of the door black or navy to see if it creates an area they may avoid. Even a dark mat sometimes works.

The entire door could be hidden by a curtain or a screen. Obviously that one would not be practical in most institutional settings - but even a folding medical screen set a few feet in front of the door may form a barrier. For any of these ideas in a hospital, you'd have to check out the local regulations with the fire marshal etc.

Some research has suggested hiding the knob itself is most effective - such as with a cloth strip attached with velcro.

There are wallpapers specifically made for the purpose you describe. Here are two examples - one of bookshelves and one of pantry shelves - I thought these two were kind of cool and not too expensive, either.  
http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=Bt...
http://store.nexternal.com/shared/StoreFront/default.asp?CS=ageless&StoreType=Bt...

I've also seen signs like this one
http://www.posey.com/poseystore/ProductInfo.aspx?productid=8209
I actually liked this version better, but it appears to be discontinued - it was a fabric banner across the whole door and potentially the knob, that attached with velcro
http://marin.networkofcare.org/family/assistive/abledata.cfm?pageid=19327&top=10...

Anyway, this should give you some ideas to try. As I mentioned, because it is an institutional setting, make sure whatever you try is okay in terms of the local safety rules and regulations. Hope this helps.

Mary G.