A Report on Dutch
Doors and Alzheimer’s Care
A Dutch door is a type of door with upper and lower halves that can be opened separately. The idea of using Dutch doors in Alzheimer’s or dementia units is a fairly recent concept that serves a dual purpose. The door can be used to both keep someone in their room, or conversely, keep another resident of the facility out of a person’s room. The use of this type of door is apparently rare as there is little research and limited articles about the topic.
After an exhaustive search of the Internet as well as other resources, including the national library of the Alzheimer’s Association, only two references to Dutch doors could be located. The first source is in the Sherertz Franklin Crawford Shaffner’s (SFCS) newsletter Volume 1, Winter 1994. One of the feature articles in the newsletter is a report on SFCS’s innovative design plan for the Westminster-Canterbury of the Blue Ridge’s twelve unit assisted living/memory impaired unit. The new unit utilized the Dutch Doors as a way of maintaining the privacy of the residents by allowing them to open the top of the door and observe the activity of the unit yet keep other residents who wonder out of their rooms. Betty Crenshaw, director of the Westminster-Canterbury of the Blue Ridge’s memory impaired unit, named the Vista, recently commented that the Dutch doors are working well in that facility. The Vista is a small dementia unit (12 residents) based on a household design where the resident rooms open out into the community shared spaces. The doors are not used on a daily basis, but are used frequently as needed for disturbances by people who wonder. The Dutch doors in this facility are, according to Ms. Crenshaw, a "satisfactory option for a dementia unit."
Ms. Crenshaw raised an interesting consideration in the use of Dutch doors in assisted living. There is currently a controversy in Virginia, as well as many other states, as to the definition of a restraint. By regulations, the facility must be able to keep their residents safe; however, they can not use restraints. The Department of Social Services in Virginia is debating whether Dutch Doors are considered a type of restraint since they restrict the movement of a resident. There is no definitive answer on this yet, but it should be monitored.
The other resource found referring to the use of Dutch doors was on a World Wide Web bulletin board offering support and advice to caregivers of Alzheimer’s patients. One posting told of a woman’s experience in using Dutch doors at home to keep her love one safely in her room at night, therefore allowing the caregiver to sleep. She stated that the door was high enough that the Alzheimer’s patient could not climb over it (as one might with a child safety gate), but it still allowed ventilation and easy access to check the status of the loved one. In addition, it allowed the loved one to not be isolated from the activity in the house during the daytime. In response to this posting was another message vehemently warning people of the dangers of Dutch doors. This person’s experience had been in a clinical setting and related the horrors she had witnessed when Dutch doors were used. She stated that she had seen people climb over the doors, climb out the window because they could not get out the door, and completely destroy the interior of the room in frustration. In her opinion, they were a form of restraint.
The information on Dutch doors reflects a varying opinion, but it is opinion. No controlled studies of the use of this type of door were found, so one must infer results from the limited information available. It appears that the use of Dutch doors may be effective and safe if used as a means of restricting movement into a person’s room by another resident who wanders. It is suggested that the door be used only with permission of the resident of the room, when necessary and when supervision is available. Dutch doors do not appear to be effective in restraining a resident inside their own room and can cause frustration and catastrophic reactions by the patient. The implications of using the doors should be carefully considered before installing them with particular attention to the state regulations and definition of a restraint.