Intimate by design

Intimacy and sexuality are important to human identity and wellbeing at all stages of life, including the years long after age 65, and designers are obligated to create spaces that foster health, safety and wellbeing of the people who use them, noted Migette Kaup, PhD, IDEC, IIDA, associate professor, Kansas State University, in an educational session at the 2014 Environments for Aging Conference held this week in Anaheim, Calif.
Kaup and Gayle Doll, PhD, director of the K-State Center on Aging at Kansas State University, researched sexual activity in Kansas nursing homes and found plenty of it. They also found many nursing homes that considered many sexual activities to be "inappropriate," although 59 percent of the nursing homes surveyed said they didn't actually have a policy on sexual activity. The researchers found the lack of assured privacy in nursing homes and the lack of spaces designed for intimacy surprising. "Maybe sexual activity is deemed inappropriate only because there is no appropriate place to have it," Kaup said.
Culture change is beginning to take root, Doll said. Some states, including Kansas, are starting to develop person-centered quality initiatives that include higher reimbursement for communities that respect and support resident intimacy. Nurses are being trained to wait for a response when they knock on a resident's door instead of knocking and walking right in. Some facilities are incorporating conjugal visit rooms onsite for couples to use. 
Others are reconsidering everything from room floor plans to furniture, discovering new ways to provide more privacy, even in semi-private rooms. "Privacy is not only visual, but auditory," Kaup said. "And a curtain separating two semi-private spaces isn't going to cut it."
The "low-hanging fruit" for providing more resident choice may be in the furniture, she said. Administrators need to pry themselves away from assumptions, including the idea that all residents will welcome the same kind of furniture or that everyone will want the chair next to the TV. "Who says every residents will want to sleep in a twin bed?" Kaup noted. 
An attendee raised the issue of "single-serving" furniture—single beds, single chairs—noting that most furniture found in resident rooms and common spaces makes it difficult or impossible to sit side by side.
Giving residents the ability to rearrange the furniture also can enhance their ability to share intimacy, she added. Kaup related a story about a woman who pulled the recliner chair right next to her bed. Nurses said the woman had trouble falling asleep unless she was physically touching her husband. So he sits next to her and holds her hand until she falls asleep. "It was the moment I realized, 'Wow, there's a big piece we're missing about person-centered care design,'" Kaup said.
Designers still face tight limits on square footage and even tighter budgets. Kaup issued a call to action for designers to rethink the "privacy curtain," giving residents in semi-private rooms a greater sense of privacy while adding as little square footage as possible. She also encouraged vendors to develop furniture and products that are versatile and can be rearranged or converted for resident wishes.
"It's not just about living longer," Kaup said. "It's about enjoying it more while we live it."
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