Business Support Guides

Dementia-friendly tourism A practical guide for businesses Dementia-friendly tourism 2

Contents

3 Introduction

5 Why become dementia-friendly?

7 What is dementia?

9 Living well with dementia

11 Information

15 People

19 Place

29 What can you do next?

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Introduction

There is a powerful business case The guide aims to support for tourism businesses to become tourism businesses of all sizes dementia-friendly. Having an to become more dementia- understanding of dementia and friendly through top tips, case how to support those affected will studies and signposting to help to future-proof your further resources. It highlights business, increase customer the need for increasing satisfaction and generate revenue. awareness and improving Adopting more dementia-friendly physical environments. practices will not only improve accessibility for customers with Small and simple low or no cost dementia and their carers, but changes can make a big staff and the wider public as well. difference. This guide highlights things you can do, organised Visiting attractions and staying around the themes of in accommodation can be Information, People and Place. challenging for people with dementia, their carers, and loved Ensuring your business is ones. Ensuring they have a great dementia-friendly is just one holiday can be extremely aspect of becoming an rewarding for you and your staff accessible and inclusive and can help people with business. It is important to dementia to live well. consider how to support people with the widest range of VisitEngland, VisitScotland and accessibility requirements. Alzheimer’s Society, along with You can find links to further England’s Inclusive Tourism Action guidance on how to support Group, have worked together all customers at the end of to produce this practical guide. this guide.

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Why become dementia-friendly?

Increased revenue – people Improved customer service – with health conditions and increased knowledge and impairments spend around awareness of dementia will £12 billion on trips in England make you and your staff more each year.1 By becoming confident when dealing with dementia-friendly, you will all types of customers. retain customers and win new business as disabled Competitive advantage – people are anecdotally very research shows 3 in 4 disabled loyal to places that meet their customers and their families particular requirements. and friends have moved their business elsewhere as a result  Future-proofing – the older you of a lack of disability are the more likely you are to awareness by businesses.3 develop dementia and tourism businesses are becoming more Enhanced reputation – dependent on older consumers. becoming dementia-friendly The number of domestic will help you to demonstrate holidays taken by the over 55 that you are socially responsible age group continues to increase, and value your customers. with a 43% uplift between 2006 It will also help you to better and 2018.2 By making changes understand the needs of now, you will be reacting to a your customers. growing need from customers References: and staff. 1. Great British Tourism Survey 2015, Great Britain Day Visits Survey 2015, International Passenger Survey 2010, VisitEngland 2. Great British Tourism Survey 2006-2018, VisitEngland 3. Business Disability Forum, 2015

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Reduced seasonality – people Why tourism with dementia may prefer to book ‘out of season’, as places matters to people are likely to be less busy and with dementia staff may be able to give them more time and attention. Staying active helps people with dementia to live well, remain Complying with the law – independent and keep doing the under the Equality Act 2010, things they enjoy. Holidays and businesses have a legal days out can promote physical obligation to ensure consumers and mental well-being for people are adequately protected and with dementia, their friends, that access to services is as families and carers. Tourism has inclusive as possible. This the power to stimulate the includes making ‘reasonable senses, help people to connect adjustments’ for disabled with meaningful places and customers and staff, including provide opportunities for people with dementia. positive experiences and enjoyment. Over 850,000 “I’ve always travelled and people are living with dementia gone places, continuing in the UK, this will increase to over 1 million by 20254 to do this makes me feel included. Why stay in one place, when we have such a beautiful country to explore!” References: 4. Alzheimer’s Society Gill, a person living with dementia

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What is dementia? Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease, or a series of strokes. It is not a normal part of the ageing process.

There are many different types • Have problems with language of dementia, but the most – for example, difficulty common type is Alzheimer’s following a conversation or disease. Dementia is progressive, finding the right word. which means it gets worse over • Be confused about time or place time. Different types of dementia – for example, losing track of tend to affect people in different the day or date, or becoming ways, especially in the early confused about where they are stages. Often it may be hard to (even in familiar places). know if someone has dementia. That’s why it’s really important • Have visual perceptual to provide good support and difficulties – for example, information to everyone. difficulty judging distances or misinterpreting patterns A person with dementia might: or reflections. • Have problems with their day- • Show changes in their mood to-day memory – for example, such as becoming frustrated difficulties recalling events that or irritable, withdrawn, anxious, happened recently. easily upset or unusually sad.

• Have problems concentrating, • Show changes in behaviour planning or organising – for such as repetitive questioning, example, difficulties making pacing, restlessness or agitation. decisions, solving problems Some people with dementia may or carrying out a sequence find that their symptoms can vary of tasks. a lot from one day to another.

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Living well with dementia It is possible to live well with dementia. Many people with dementia continue to be active and carry on with the things they enjoy.

Even as dementia progresses, • Locating and using the toilet. people can lead active, healthy People with dementia may lives, carry on with their hobbies also experience difficulties and enjoy friendships and with continence. relationships. However, as • Difficulties with mobility dementia progresses people and getting around – for will need support from others. example, challenges with a lack of handrails. Common challenges faced by people affected by dementia: • Worries that they or their • Lack of confidence to travel, loved one with dementia will go to new places and stay away get lost or walk off at night if from support systems at home the room or venue is not secure. and their regular routine. • Perceived costs of a holiday, • Unfamiliar and busy coupled with additional costs environments, such as of living with dementia, meaning information desks and service that holidays can be seen as counters, which can make unaffordable by some. communication difficult and increase confusion. This guide suggests ways to support people with • Navigating new places, as these challenges. people living with dementia can sometimes get lost. “If I can go on holiday at my age and with my challenges, anyone can” Dennis, a person with dementia visitengland.org/access 10 11 Dementia-friendly tourism

Information Promote your offer Providing Work with local community information groups and networks including It’s really important for people Alzheimer’s Society and with dementia and carers to Age UK to let people affected have information about where by dementia know about the they’re going beforehand. services you offer. Often people It can help them plan and with dementia will rely on also reassure them of what different communication to expect when they arrive. channels, rather than social You can support people affected media and online. Think about by dementia by giving them taking out adverts in magazines, accessible information about working with key partners your venue and letting them or charities to get the word know what support is in place. out to often isolated people affected who might not know “It was the fear of the support is available. unknown, I suppose. But on that holiday I could feel all my problems falling away...” Jim, a person affected by dementia

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You can assist customers by: • Prompting customers during their booking for any additional • Asking them what support requirements - for example, the they need and stating in ability to reserve a particular your information that you table, a familiar bedroom or fast can support people affected track queues for those unable by dementia. to stand for long periods of time, if possible. • Helping with travel arrangements – for example, • Providing them with letting them know what parking confirmation of the booking, options are available or what clearly stating the amount paid the best public transport or to be paid on arrival, as well options are. as information on the venue. You may also want to think • Informing them about what about providing a written dementia-friendly facilities you confirmation on request and have - for example, accessible reminders for the booking closer toilets and signage. to the date. • Providing information on local • Giving them a named contact dementia-friendly businesses, if they have any questions after activities, events and health the booking. care providers to allow people • Using welcoming terminology to plan in advance. when describing people – for • Offering flexible ticket options example, say “living with - for example, ‘carers go free’, dementia” instead of “suffering reviewing cancellation charges with dementia”. and providing as many different • Ensuring staff wear name ways of booking as you can badges and make it clear manage (phone, fax, text phone, they can support people online, email, third party affected by dementia – for websites). Every customer will example, by wearing the have their own preference. Dementia Friend badge.

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Video or virtual tours and children and more. Many written information with images disabled people look at can be particularly helpful as it Accessibility Guides before can be re-visited. This can help deciding to book or visit. reduce anxiety and prompt someone’s memory. It is also VisitEngland and VisitScotland important to ensure the provide a free to use website for language, style, length and the easy production and format is easily understood by publication of Accessibility people with dementia. Guides. You can produce a guide Customers need to feel confident by answering a series of their booking has been made questions on your venue’s and requests acknowledged. accessibility, uploading useful photos and adding any further information. You will be given a Accessibility Guides unique web link to promote your guide, which you can add The majority of information can prominently to your website and be included in your Accessibility share across social media Guide. This is a guide produced channels. Go to by tourism operators to provide visitengland.org/ potential customers with accessibilityguides. important accessibility information about a venue, Security and safety property or service. The guide Ensure customers are aware of enables individuals with safety or evacuation processes. accessibility requirements, their Offer features which could family and friends to make support customers with informed decisions about where dementia, including portable to stay and visit based on their vibrating alarms or strobe light needs. This includes not just alarms for people who can’t hear wheelchair users but people with audible alarms. Ensure guests hearing loss, visual impairment are made aware of potential or learning disabilities, older hazards such as hot water and people, families with young changes in floor level.

visitengland.org/access Debbie Matthews, Accessible & Dementia Knowing that staff Tourism Consultant, tells are dementia aware us how important advance helps to provide reassurance. information is for people The guide also explains our with dementia #GoRacingGreen initiative, which racecourses are starting “Having pre-visit information to adopt. It is aimed at people is key to whether people with that live with various dementia leave the house or conditions that make coming not. No one wants to risk to the races difficult for them. having a bad experience, as it We explain that a green can be very traumatic if things ribbon can be worn by people go wrong. Good information with invisible conditions, their helps to provide reassurance companions and others to and confidence. show that they support the It is useful to know how the initiative and are empathetic. venue has addressed possible We also promote an afternoon sources of stress. Nottingham tea session to local dementia Racecourse has a specific groups. This is held at Accessibility Guide for people a mid-week race meet for with invisible illnesses. It is a reduced fee. It is great for not only useful for those with the racecourse as it helps dementia but also people with to bring in more people at autism, ADHD, social anxiety a quieter time. and general anxiety disorder. Promoting your business to The guide describes the quiet people with dementia helps room where people can go if to give people the opportunity they get upset or anxious. to live and can have a There is always a Dementia massive positive impact on Friend present and other users their quality of life.” of the room are understanding and sympathetic. Without Find the guide at: such a space, people may thejockeyclub.co.uk/ feel they have to leave and nottingham/visitor-info go home. /go-racing-green/ 15 Dementia-friendly tourism

People Understanding and Dementia Friends awareness Dementia Friends is an Alzheimer’s Gaining a greater understanding Society initiative about learning of dementia will mean you and what it might be like to live with your staff are better able to dementia and then turning that support customers. Training understanding into action by and awareness is particularly helping people with dementia important for customer-facing to feel understood and welcome. staff and those who are most Anyone, at any level of an likely to interact with customers organisation, can become a affected by dementia. Making Dementia Friend. It’s free and sure you and your staff are individuals can complete the aware about how dementia learning using the method and duration that best suits your can impact customers can also alleviate any challenges created business. The simplest route for by your venue’s design – for you and your staff to become example, if a certain route has Dementia Friends is by registering a lot of steps. at dementiafriends.org.uk and watching the online videos. “Staff at the Eden Project It is important Dementia Friends helped my husband to use learning is embedded within staff the zip wire. He had the inductions and a regular refresher time of his life” is undertaken. For more information about rolling out Dementia Friends Maria, a person affected by please contact dementia programmepartnership@alzheimers. org.uk. Further dementia awareness training is available through Alzheimer’s Society.

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10 top communication tips:  Use non-verbal communication – for example, a friendly smile can Talk to the person with go a long way and it may help dementia – don’t just talk to pointing at a picture of someone their friends and relatives when you are talking about or writing they are visiting together. things down. Think about the environment – Consider your body language – try to talk to the person in a sudden movements or a tense quiet area and remove any facial expression may cause unnecessary distractions. upset or distress and can make communication more difficult.  Speak slowly and clearly – use  Do not dismiss a person’s short, simple sentences, check worries – if a person is the person has understood each feeling sad, let them express point and recap if necessary. their feelings. Give the person time – so that Supporting they can process what has been said and respond. staff affected

Listen carefully – be patient and by dementia listen carefully to the words of There are more than 42,000 people, even if they appear people under the age of 65 muddled or unclear initially. with younger onset dementia. Alzheimer’s Society ‘Dementia- Try to communicate in a friendly business guide’ provides conversational way – not just further advice on supporting an question after question. employee affected by dementia, such as flexible working, Rephrase rather than repeat – signposting and reasonable if the person doesn’t adjustments. understand what you’re saying. Go to alzheimers.org.uk/business.

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Providing a warm Be flexible –for example, if a person with dementia wants welcome to go round an attraction in a different order to the usual make sure Inform others – route, or check in earlier or all staff are aware when check out later. you have a customer with dementia visiting so they Be respectful and sensitive – can be extra attentive, helping for example, use discretion the customer if they become as some people may request disorientated and fast tracking additional assistance without any processes if possible. wishing to disclose their condition. Remind and reassure customers Be hospitable – a person with of any arrangements they made dementia may feel tired or at the time of booking. unsettled when they arrive  Don’t make assumptions – somewhere new. Offer a drink for example, if someone on arrival and provide a quiet appears rude it may be place to sit. because they are uncomfortable or anxious. Assist customers – support guests to complete forms Support carers – caring for and take customers to their someone with dementia can destination - for example, hotel be stressful, so be patient and room, cloakroom or garden understanding to improve the space. For accommodation, holiday experience for both the offer a room which is best carer and person with dementia. for them. This could be close Almost half of carers have to the lifts or main facilities, a long term health condition or in a quiet location. or disability themselves.1

References: 1. Source: Personal Social Services Survey of Adult Carers in England, 2016-17: NHS Digital

visitengland.org/access Emily Hope from Beamish of dementia and they Museum tells us why it is can support people affected important for staff to by the condition. Our staff in understand dementia period costume have a lovely crochet version of the badge “Every new member of staff which is in-keeping with or volunteer completes a their costume. Dementia Friends session, regardless of their position. Every year we run a week As a Dementia Friends of activities in Dementia Champion I help to deliver Action Week. This not only these one hour sessions as benefits our visitors but acts part of the induction process. as a useful refresher for staff. Staff tell us that a key takeaway is that dementia Dementia Friends sessions affects everyone differently. definitely help improve As the most recent memories the customer experience often go first, our period at Beamish. For example, settings at the museum can if a visitor is struggling be more familiar for people with change, staff know to with dementia. be patient and reassure them. Our approach to welcoming All staff are given the people with dementia is really Dementia Friends badge rewarding as we can see from to wear. The badge comprises the smiles on people’s faces a small blue forget-me-not that visiting us helps them flower that indicates the to continue to get out and person has an understanding live well.” 19 Dementia-friendly tourism

Place Improving Signage the physical • Provide signage at key decision points to and from facilities, environment including main entrances, toilets, lounges and reception desks. Dementia can cause people difficulties when navigating and • Consider text and pictorial interacting with environments. signs to help people identify Small changes to layout or different rooms. signage, for example, can go a • Use upper and lower case long way to reducing stress and lettering, not block capitals, confusion. Not all improvements and use large, simple fonts along require major refurbishment or with recognisable symbols or expense; consider what low cost images. Avoid abstract or joke adaptations you can make next signage - for example, ‘buoys’ time you renovate or redecorate. and ‘gulls’ on toilet doors. “On arrival, there were no • Make sure there is good colour seats and a lot of noise. contrast between the sign wording and the background. A ‘quiet space’ would have alleviated these issues.” • Ensure signs are at eye level, well-lit and can be seen from Steve, a person living with wheelchair height on the door dementia or place they refer to. Dementia-friendly signage can be purchased or downloaded from Alzheimer’s Society’s website: alzheimers.org.uk/ dementiafriendlysignage

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Visibility and lighting • Make cubicle doors clearly visible - door furniture should • Ensure curtains are open include handles. in the day, remove unnecessary nets and blinds, • Put a ‘Way out’ sign on the and cut back hedges or trees inside of the toilet door(s) if they overshadow windows to help people to easily find and block out sunlight. their way out. • Consider automatic lights, • Label hot and cold taps and especially in toilets show how to use sensor taps, and bathrooms. flushes and hand dryers. • Outline the edges of steps • Provide contrasting toilet seats and stairs to ensure they and hand rails to the walls and are clearly visible. rest of the toilet. • Ensure door handles contrast Seating and flooring in colour to the body of the • Provide high-backed chairs door and the frame and the with armrests in places door contrasts in colour to where people may have to adjacent walls. wait, as well as in quiet areas • Avoid pools of bright light, where people with dementia glare from lighting and can take ‘time out’ if they are deep shadows. finding it difficult with noise and other distractions. • Light switches should be easily accessible and straightforward • Ensure seating contrasts to the to use. floor, wall and surroundings. Avoid abstract designs. Toilets • Avoid dark rugs and mats • Have a unisex accessible toilet, as they can be perceived as and ideally a Changing Places black holes and avoid shiny toilet, where an opposite sex or reflective flooring, bold carer or partner can help if the patterns and stripes, as they person needs assistance. can cause confusion.

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23 Dementia-friendly tourism

Furnishings and facilities • Lay out teabags, coffee sachets, milk and sugar • Avoid surfaces, pictures, separately, with clear walls and window coverings written and pictorial labels that are shiny or reflective or to help people independently have bold patterns and stripes, make drinks. as they can cause confusion - for example, flower patterns • Consider providing accessibility may appear 3D as though products – for example, you can pick the flowers and a wheelchair, large button horizontal lines on blinds may phone, magnifying glass be seen as bars. and coloured towels in white bathrooms. • Position mirrors carefully, as a person with dementia Noise may be distressed if they don’t recognise themselves. Consider • Reduce background noise - providing coverings for mirrors for example, from TVs, radios, and avoid positioning on the alarms, doorbells, back of doors. announcements or telephones, which can impact on an • Consider providing a spare set individual’s ability to of linen in guest bedrooms. concentrate and communicate. • Provide a simple bedside clock and large clocks in • Use carpets, cushions and key areas that display the day, curtains to help absorb date and time. background noise. • Provide a simple system to • Consider promoting a ‘slow’ contact a staff member for or ‘relaxed’ time when music help if required. is switched off and have a quiet room available for people • Avoid rugs and cluttered to take time out. furniture which could create trip hazards and ensure there • Ensure hearing loops are is space to move around tables serviced regularly, turned and chairs. on and advertised.

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Marilyn Buchan discusses I also supply a raised toilet how she has made her seat and shower chair if business accessible for requested and rooms have visitors with dementia signage (at wheelchair level). “Buchanhaven cottage is a There is a notice board on unique self-catering house the wall which can be used situated on the outskirts of to leave notes if required. Kirkwall in the Orkney Islands. The mattresses are all waterproof in case of little Buchanhaven has been accidents. Buchanhaven’s designed to be dementia- sitting room/kitchen is open friendly and attention has plan, which allows the carer been paid to lighting, colours to keep an eye on the person and signage. Bright lighting is with dementia at all times. essential as it allows people The outside area is also to see things clearly and not enclosed so no one can mistake objects for something wander away if outside. else. Contrasting colours is also useful for recognition, A supply of books and such as a brightly coloured DVDs on dementia is toilet seat and a red table available and I am also on cloth which contrasts with hand to offer advice or point white dishes, allowing people in the right direction if anyone to enjoy their food. needs help.”

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visitengland.org/access The Scottish Football Museum and National Galleries provide organised reminiscence activities. Richard McBrearty, Project Director, Scottish Football Museum says:

“We manage a reminiscence programme, Football Meg Faragher, Communities Memories Scotland, which Learning Coordinator, National supports people living with Galleries says: dementia. Groups meet across “We run a variety of Scotland in relaxed and dementia-inclusive creative friendly environments where activities. The focus of these old football images, films and sessions is on playfulness, memorabilia are used as enjoyment and connection, memory triggers to unlock where participants are trapped memories and encouraged to share encourage discussion. memories with others. We have a ‘Memory Lane’ Working with musicians from section in the museum and a Live Music Now Scotland we national ‘Memory Box’ programme quarterly programme. One of the boxes dementia-friendly Music is kept within the museum for Concerts at the Portrait visitors to access, which Gallery. The concerts are short contains things like a football and informal and the rattle and carbolic soap. repertoire includes songs that the audience know and are We also have a weekly invited to sing along with. For dementia friendly care homes or community reminiscence group and a groups, we offer free themed monthly dementia specific reminiscence and creative reminiscence group, supported workshops that can be by Alzheimer Scotland staff.” booked at any time.” 27 Dementia-friendly tourism

visitengland.org/access Zara Luxford from Nymans explains the development of a garden co-created by people with dementia “Our ‘Garden in the Ruins’ is a new garden space. It is part of a three year project to open up the ruins area for the first time and we were delighted to work with the Alzheimer’s Society to bring our plan to life and improve our welcome dementia. We will make the for people with dementia. first hour of opening a quiet hour, to benefit everyone We undertook some audience who would like a place for research and our discoveries reflection away from the encouraged us to think about busy hub-bub of other areas. the potential number of people who could be visiting We have thought more Nymans who already have broadly too about how we can dementia. The Alzheimer’s make the whole experience at Society enabled us to connect Nymans more dementia with small groups from our friendly. The Alzheimer’s local branch, who worked with Society has supported our our Project Manager to select team with training and has plants and helped design the also provided an assessment garden area. of our whole visitor experience with advice about how we can Once the garden is complete, become more dementia we will be keeping contact friendly. The ‘Garden in the with the local branch and their Ruins’ is the start of our members will help our team journey and we are looking tend and care for the garden. forward to getting feedback”. The location of our ruins area For more information about makes the garden perfect as Nymans, please visit: a safe space for people with nationaltrust.org.uk/nymans 29 Dementia-friendly tourism

What can you do next? Further guidance • Talk to your colleagues about Alzheimer’s Society provide dementia and register your information sheets that cover business so you and your staff all aspects of dementia from can become Dementia Friends: communication to managing dementiafriends.org.uk challenging behaviours. These are available for download • Join your local Dementia from the website or via the Friendly Community and work publications order line: with local partners: dementiafriends.org.uk/ alzheimers.org.uk/factsheets communitieslist 0300 303 5933 • C onduct a dementia-friendly audit of your venue: Alzheimer’s Society dementia- alzheimers.org.uk/ friendly guides are available dementiafriendlyenvironment for download from the website: Alzheimers.org.uk/organisations • P roduce and publish an Accessibility Guide: England Business Advice Hub: visitengland.org/ Make your business accessible accessibilityguides visitengland.org/access

Image Credits: Front Cover Image: VisitBritain/Simon Winnall Page 20: VisitScotland / Peter Dibdin Page 4: VisitScotland / Peter Dibdin Page 22: VisitScotland / Peter Dibdin Page 8: ©VisitBritain Page 25 S cottish National Portrait Gallery Page 10: ©VisitBritain ©Andy McGregor Page 14: Debbie Matthews Page 27: VisitScotland / Damian Shields Page 18 Beamish, The Living Museum of the North Page 28: National Trust

visitengland.org/access As the national tourism agency – a non-departmental public body funded by the Department for Digital, Culture, Media & Sport (DCMS), VisitEngland plays a unique role in building England’s tourism product, raising Britain’s profile worldwide, increasing the volume and value of tourism exports and developing England and Britain’s visitor economy. Alzheimer’s Society is the UK’s leading dementia charity. We provide information and support, improve care, fund research, and create lasting change for people affected by dementia. If you have any concerns about Alzheimer’s disease or any other form of dementia, visit alzheimers.org.uk or call the Alzheimer’s Society National Dementia Helpline on 0300 222 1122. With thanks to the following for their contributions to this guide: National Trust (Heather Smith), University of Exeter (Joanne Connell), University of Hertfordshire Business School (Stephen Page), MindforYou (Carol Sargent) and England’s Inclusive Tourism Action Group.

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