Emergency Wayfinding & Safe Egress in Dementia Care Settings
Emergency evacuation presents unique challenges in dementia care settings. This guide covers how to design egress routes, emergency signage, and evacuation procedures that account for the cognitive and physical needs of residents living with dementia.
Emergency wayfinding in dementia care settings is fundamentally different from emergency wayfinding in any other building type. Standard emergency signage, green running-man exit signs and illuminated escape routes, assumes that building occupants can read signs, understand abstract symbols, follow directional arrows independently, and move quickly under pressure. Residents living with dementia may be unable to do any of these things. A fire alarm that helps alert and guide in an office building may cause panic, confusion, and freezing in a care home. Designing emergency wayfinding that accounts for these realities is both a regulatory requirement and a moral imperative.
Progressive Horizontal Evacuation#
The standard evacuation model for dementia care homes in the UK and Ireland is progressive horizontal evacuation. Rather than evacuating the entire building at once, residents are moved horizontally to a protected compartment on the same floor, separated from the fire by fire-resistant walls and doors. This approach minimises the distance residents need to travel, avoids the use of stairs, and allows staff to manage the evacuation in stages. Wayfinding for progressive horizontal evacuation requires clear signage on fire compartment doors, colour-coded evacuation zones, and pre-planned routes that staff can follow under pressure.
Emergency wayfinding design requirements:
- Clearly sign all fire compartment boundaries with high-contrast markers visible in reduced visibility conditions
- Install photoluminescent wayfinding strips along evacuation routes at floor level, as smoke rises and obscures higher signs
- Ensure fire exit signage meets BS 5499 standards while also incorporating dementia-friendly design principles
- Colour-code evacuation zones to match your everyday wayfinding colour system where possible
- Display Personal Emergency Evacuation Plans (PEEPs) at each resident's bedroom door for staff reference
- Ensure emergency lighting activates automatically and illuminates key wayfinding signs and route markers
- Conduct regular evacuation drills that test the wayfinding system under realistic conditions
Designing for Dual Compliance#
A key challenge is reconciling standard fire safety signage requirements with dementia-friendly design principles. BS 5499 specifies the format and placement of emergency exit signs, but these signs are not designed for people with cognitive impairment. The solution is a layered approach: maintain all legally required fire signage in its prescribed format, and supplement it with additional dementia-friendly cues such as colour-coded floor strips, tactile wall markers, and familiar landmark objects positioned along evacuation routes. These supplementary cues do not replace statutory signage but add an additional layer of wayfinding support.
Pro Tip
During evacuation drills, observe which residents are able to follow the emergency wayfinding cues and which require full staff assistance. Use this information to update PEEPs and to identify locations where additional wayfinding support, such as a photoluminescent floor strip or an additional sign, would improve evacuation outcomes.
Staff Training and Muscle Memory#
In a real emergency, staff will not have time to read signs or consult evacuation plans. They must know evacuation routes by muscle memory, and the environmental wayfinding system should confirm and support their knowledge rather than replace it. Regular drills, ideally monthly, build this familiarity. The wayfinding system should be designed so that a staff member moving quickly through smoke-reduced visibility can follow colour-coded strips, tactile wall markers, and photoluminescent cues to the nearest fire compartment without conscious route planning.
Regulatory note
The Fire Safety Order 2005 (England and Wales), the Fire (Scotland) Act 2005, and the Fire Services Acts (Ireland) all require care homes to have adequate emergency wayfinding. CQC and the Care Inspectorate specifically assess evacuation planning as part of the 'Safe' domain. A well-designed emergency wayfinding system contributes directly to a positive inspection outcome.
Emergency wayfinding in dementia care settings requires a fundamentally different approach from standard buildings. By combining statutory signage with dementia-friendly supplementary cues, training staff through regular drills, and maintaining a progressive horizontal evacuation strategy, care homes can ensure that their most vulnerable residents are protected in the event of an emergency.
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