What design features do LTC residents most want?

The psychologist walked into Mrs. Winters’ room and found her in the corner, muttering under her breath. “Is everything okay?” the psychologist asked, concerned. Mrs. Winters was usually a calm lady, but today her face was tight with anger.

“Thank goodness you’re here!” Mrs. Winters cried. “I came over here to get a letter from my nightstand and now I can’t get out of this spot!” She tried to move her chair backward but the wheels jammed into the wall. She pushed the chair forward and ran into the bed. “I’ve been stuck like this for almost an hour and my call bell is on the other side of the bed. It’s a good thing I’m too angry to cry because I can’t reach my tissues either!”

Renovations and redesigns large and small can breathe new life into a facility, especially when they’re focused on the needs of the people who live and work within them. The changes that are most important to the residents tend to be those that center on their psychological need to regain control. Most residents enter long-term care after a fall or other health crisis takes them from their home and thrusts them into an unfamiliar environment with rules not of their own making. Meals are served on schedule, toileting depends on staff availability, and discharge plans rely on a host of factors and players that can’t be managed by the resident. When the big things in life are spiraling out of control, being able to direct the small things can make a world of difference. Here are some design changes that matter most to the residents.

WITHIN RESIDENT ROOMS

To provide increased control within each room, consider that most nursing home residents have limited mobility and are often in wheelchairs that are difficult to maneuver in small spaces. Residents spend significant amounts of time in bed, unable to get out on their own. While most LTC facilities have mechanical beds that allow residents to adjust themselves as needed, there are many additional aspects of the environment that could be under resident control.

• Room temperature. Many times the call bell is ringing because a resident wants a window opened or closed or wants the air conditioning adjusted. Providing remote controls for the air conditioning and heating system allows the residents to take care of this function and frees staff time for other concerns. If the windows can be opened by remote (or easily opened manually) this improves quality of life, especially because getting outside for fresh air can be such a challenge.
• Large remote control for TV. Residents may have remote controls for their televisions, but have difficulty using them due to overly complicated designs with small buttons and tiny labels. The best remote controls are simple, with large well-labeled buttons, yet are not so heavy that frail elders have trouble holding them. Provide recommendations to family members as part of a good customer service program.
• User-friendly telephone. Similarly, the best telephones are the least complicated. They have large buttons, a loud ringer and speaker, are impervious to liquids and can withstand the inevitable falls that occur during use in long-term care.  If families are providing phones, offer them these suggestions because you’re the experts and they’re probably going through this for the first time.
• Easy navigation. In case it doesn’t go without saying, have an elder in a wheelchair test potential redesigns. Is the dresser accessible? Are rooms so tight that it’s difficult to negotiate without getting stuck in a corner? Is flooring smooth so that residents can successfully travel from one location to another? The more residents can do for themselves, the better they feel and the less the staff have to do for them.

OUTSIDE RESIDENT ROOMS

Outside their own rooms, residents are likely to feel less sure of their environment.  Design adjustments can increase their level of comfort with traveling about the facility. Remember that while staff members can easily move from floor to floor, the same trip can become a long journey for a frail elder with a walker or wheelchair.

• Way-faring signs. Labeling important areas and using signs to point residents in the right direction can be a relatively low-cost way of making your facility more resident-friendly. Using relevant wall decorations to create a path, such as paintings of fruit on the way to the dining room, can reassure residents that they’re headed in the right direction.
• User-friendly access to the outdoors. Getting outside can be freeing for the residents—and also frightening for some who worry about getting stuck alone outside. Automatic doors, smooth surfaces, level ground and an emergency call button can make outdoor space more enticing. Options for shade and sun, wheelchair accessible tables, landscaping and other amenities add enjoyment.
• Breathing room. Are common areas large enough to accommodate the number of residents who will be using them? Residents appreciate the ability to enter and leave rooms without necessitating several minutes of rearranging furniture and moving their neighbors out of the way because they’re stuck in the back of a crowded room. If providing additional space isn’t possible, making creative use of recreational programming can offer a way to reduce the number of residents sitting in a dayroom at any given time.
• Accessible nursing stations. Asking for help can be emotionally challenging for people who have been independent throughout their lives. Wheeling up to a desk that obscures the view of the workers behind them emphasizes to residents that they are no longer standing and requires staff members to stand in order to make eye contact. Nursing stations with low desks and without blocking walls allow for easier access and a more egalitarian dynamic of two sitting people conversing.

To find other design enhancements to increase the level of control of the residents, tour your facility in a wheelchair wearing sunglasses to mimic the vision changes of seniors. To read about increasing resident control through adjustments in scheduling and training features, stay tuned.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a speaker and consultant on psychological issues in long-term care.  For more information, visit Dr. El's website, www.mybetternursinghome.com.

To learn more about design in the senior housing and long-term care space, follow Long-Term Living’s coverage of the Environments for Aging Conference, to be held April 6-9 in New Orleans.