Artists Are Painting Trompe L’Oeil Murals to Soothe People with Dementia
In the hallways of a dementia care unit in Ottawa, Canada, artist Andréa Fabricius carefully paints over the exit doors with dynamic and unusual murals. They picture dark wood bureaus and armoires, decorated with books and flower pots and, in some cases, surrounded by patterned wallpaper—essentially, interior scenes that could have been plucked from a mid-century home. Known as diversion murals, they cleverly camouflage doors in order to quell the exit-seeking behavior of some people with dementia.
Exit-seeking behavior is common in dementia units, where residents might consistently stand by the exit door and attempt to escape when staff or family members pass through. Diversion murals have been used to deter this behavior widely in long-term care (LTC) centers for decades. As an article in The New Yorker detailed in early October, today, increasing efforts and resources are being invested into the environments where people with dementia live, particularly through props and scenery that elicit comforting nostalgia. Diversion murals are part of this landscape, as well as strategies for the integrating the visual arts into the residents’ lives to improve their quality of life.
In a recent paper published in the journal Arts & Health, Fabricius and Megan E. Graham, a doctoral candidate in anthropology at Carleton University, documented the creation of new diversion murals in two LTC dementia units. Graham traced the practice back to dementia-care literature of the 1980s and 1990s, which reflected a shift toward more humanistic care for people with dementia, including an emphasis on “the impact of living environments on well-being.”
Prior to using diversion murals, LTC units deterred exit-seeking residents with a variety of “interventions,” including stop signs, mirrors, and tape grids on the floor. Diversion murals emerged as not only a promising solution, but also an aesthetically pleasing one. Their effectiveness has been tied to the use of the art-historical painting technique Pinterest boards, and are even sold as large vinyl stickers that many LTC centers use instead of hand-painted murals.
Fabricius has been painting diversion murals for around a decade, ever since she began working as an art instructor at LTC homes. Her works, which often cover two adjacent walls or a set of doors with a painting of a furniture piece, serve as an illusion, she explained. Residents “see the furniture and keep walking, and they’re not standing at the door.”
On the whole, people with dementia vary widely, Fabricius stressed. Some might be dealing with Alzheimer’s and memory loss; some express themselves in aggressive ways; some spend their days walking laps around the unit or collecting items from various rooms. As such, residents have reacted differently to the diversion murals, though generally, they’ve served as a welcome distraction, she added.
At the care center where Fabricius currently teaches specialized classes in everything from woodworking to mosaics, she’s completed seven diversion murals, and will soon begin an eighth. Each mural begins by measuring the door area and planning out the composition (“It’s a lot of math,” she noted), then sanding and priming the surface area. The murals depict domestic interiors in order to provide the residents with imagery that feels familiar and not too jarring from the setting; murals of natural outdoor scenes, Fabricius has learned, have proven to cause confusion.
Fabricius designs her murals based on the placement of the various elements that need to be disguised—door handles, window panes, security keypads—and often includes nearby fire alarms, as well, as some residents learn that pulling the alarm causes the doors to open. Once the painting is finished, the final step is to apply five or six coats of varnish to seal the paint so that the walls can be disinfected.
Graham and Fabricius found that six months after the murals were painted, staff from the two dementia units reported that exit-seeking behavior had declined among residents. With the transparent window panes in doors obscured, residents were less likely to peer through and try to catch the attention of people on the other side. Additionally, a nurse noted that the mural at her unit was particularly effective with new patients who hadn’t seen the door before it was painted, and may not have realized it was an exit. There were also fewer incidents of residents pulling fire alarms, thus decreasing the stress that follows such an event. And in addition to these positive outcomes, Graham and Fabricius say that the mural-making process is just as beneficial as the final product.
While Fabricius creates the murals, it becomes a participatory art project for residents. “I like them to be part of the process,” she explained, noting that she’ll set up chairs for them to watch, engage them in discussion, or give them sandpaper or other tools to help out.
Whether or not they recognize Fabricius, she continued, the residents are drawn to seeing the artwork in progress, and are prone to watch her work or give her feedback; those residents who do laps around the unit tend to stop by to rest. In some cases, the art awakened deep memories among residents: One woman told Fabricius about her wedding flowers, which were then painted into a mural, and a man recalled an athletic trophy he had won, which was painted onto a shelf.
Fabricius acknowledges that the mural painting process is a compelling way of getting residents involved in art, even if they’re not physically painting. “Some would sit and remark on where I’d missed a spot, or where it wasn’t level,” she explained. “I’m able to engage with them; they’re not just sitting in the dining room, or in their room, or staring at a TV. I’m able to give live entertainment, really—that includes them.”
Casey Lesser is Artsy’s Creativity Editor.