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Let's Stop Tweaking a Flawed Model

June 1, 2004
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Interview with Cynthia Leibrock, MA, ASID, Hon. IIDA
Let's stop tweaking a flawed model

Interview with Cynthia Leibrock, MA, ASID, Hon. IIDA
Although she doesn't see herself as a "contrarian," interior designer Cynthia Leibrock admits to a fondness for controversy. And she is prepared to stir one up with her unorthodox views on that recent ideal of long-term care design, the "homelike" environment. In her view, although designers have swung away-and rightfully so-from the purely institutional model, they have gone too far. It is time to see healthcare design in a new light. Leibrock is qualified to criticize, having been a notable interior designer in the field for 30 years, author of three award-winning books, an instructor at Harvard University for more than a decade, and proprietor of the Easy Access to Health, LLC, consulting firm and the AgingBeautifully.org Web site. She recently explained her views in an interview with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: There seems to be a trend to make healthcare environments more "homelike," but you seem to be going on the premise that homelike isn't enough.

Leibrock: It's not that homelike isn't enough. "Homelike" healthcare environments erode confidence in the professionalism of what is essentially a healthcare facility. I, for one, would question the competency of a provider working out of an office or a facility that looks like a tacky home, with cute wallpaper borders, artificial plants, and wood paneling-not to mention design touches that pose potential infection-control problems, such as flounces that collect dust, wall textures that provide a growth environment for microbes, and other homelike but possibly hazardous materials. A qualified healthcare designer finds the line between a stark, institutional environment and a "homelike" environment clichT. Look at some of the long-term care projects designed by Susan DiMotta with Perkins Eastman. She does a great job of finding this line.

What we really want is not a homelike environment, but a healing environment-an environment with soft colors, warm finishes, music, healing gardens, and the like that support health. We also need a more rehab-centered long-term care model oriented to helping people to become more independent and more interested in doing for themselves.

Peck: What factors should LTC designers take into account to be more rehab-oriented?

Leibrock: The psychological impact of the environment is often overlooked. We have design research available documenting that the built environment can reduce stress and depression. In my latest book, Design Details for Health, I cite research correlating the soothing sounds of moving water with relaxation, linking sunlight exposure to enhanced well-being and reduced length of stay, and documenting the therapeutic benefit of healing gardens. Pleasant aromas have been shown by research to reduce the levels of blood pressure, respiration, and pain perception. Unpleasant odors, such as those of urine and ammonia, can trigger feelings of fear and anxiety, but appealing fragrances, such as spiced apple and strawberry, have been shown to reduce stress. Research has shown that hospital patients assigned to rooms with window views had shorter postoperative stays, had fewer negative evaluations by nurses, and required less medication. Research also proves that window access improves memory, orientation, and sleep, and reduces hallucinations and visual disturbances.

Peck: How might facilities be designed to motivate older people to adopt healthy habits and positive attitudes?

Leibrock: Design can make it fun to stay positive and healthy. For example, I remember one patient who resisted bathing. We thought we could solve the problem by offering a large shower with controls that were easy to use, but the patient still had no motivation to bathe...until he discovered the hot tub. This made getting cleaned up fun-and, because he had to take a shower before he could use the hot tub, the bathing problem went away.

Peck: In viewing the facility as a place providing healthcare, what design concepts would help patients develop confidence in the facility's healthcare orientation?

Leibrock: Some of the ideas supporting professional healthcare provision are obvious-for example, reduce clutter in the common areas and make sure that the waiting areas are not littered with old magazines covered with dried food-in other words, look professional. You would be surprised at how often I see these abuses. Other ideas are more subtle: Avoid environmental stressors such as poor air quality, noise, inadequate lighting, unpleasant odors, and lack of privacy. Provide patients with control over their environment, perhaps in choice of music, lamps for additional task lighting, and accessibility features that keep them caring for themselves to the extent possible. All of these are steps toward promoting good health.