How interior design affects resident behavior

For three years, Mrs. Jones* stayed in her room and rarely ventured into the halls. A cognitively impaired assisted living resident, Mrs. Jones was resolute that she was fine in her room where she felt safe. However, since her facility underwent a new addition and renovation project, Mrs. Jones is always moving about the halls, often bantering with staff and other residents where previously she was considered socially withdrawn. Why? What changed? 

We read about it, plan for it and we make every effort as designers to create functional yet aesthetic interiors, but do our choices as architects and interior designers truly affect the way residents behave? 

At Waverly Heights, Gladwyne, Pa., the impetus for a multimillion-dollar renovation of its healthcare center was to promote a supportive homelike interior for residents. Devonshire, a licensed personal care home at Waverly, was designed to support individuals experiencing memory loss and help them maintain a stimulating, meaningful lifestyle. Devonshire offers a homelike environment, providing a full day of group programs and activities. Assistance with daily tasks such as bathing, dressing or taking medication is provided along with round-the-clock professional nursing care.

EFFECTIVE CORRIDORS

Mrs. Jones represents residents who fear walking the corridors of their health center. Often times under-lit, long and foreboding, these spaces can be a deterrent for a resident’s participation in activities, leading to social withdrawal and depression. 

In a senior living environment we must be aware that we are not designing institutional corridors, but residential hallways. The new hallway design at Waverly offers intermittent places to sit and rest along the way to dining, physical therapy or other daily activities. The racetrack design allows for mobility on the floor. Residents can stroll through activity spaces and dining areas without becoming agitated because of a dead end, as was the case in the former Waverly model.

The carpet’s monochromatic color and simple pattern is subtle and incorporates soft green tones, a color reminiscent of plants and nature, growth and life. Contrasting complementary red tones were softened to a soft salmon color, which enhances the contrast between walls and flooring.

Natural light fills these halls, as windows in activity spaces along the building’s perimeter infuse the spaces with light. And it was essential that all activity and dining areas be equipped with warm lighting on dimmers. As the DON put it, “This much brighter interior adds to their [residents] demeanor—and they can see!”

FLEXIBLE ACTIVITY AREAS

Upon admission, a therapeutic recreation staff member meets with new residents to determine their leisure interests and to orient them to the various programs offered. Residents have responded so well that attendance frequently is more than anticipated and chairs need to be moved from other areas to accommodate. But the design of Devonshire provides this flexibility. All seating and tables are equipped with heavy-duty carpet glides that provide for easy movement on a cut pile carpet. Spaces are reconfigured constantly.

The physical plan supports programming that provides ongoing and diverse activities focusing on the residents’ strengths. Because of the addition of many smaller activity rooms throughout Devonshire, residents can choose from a variety of activities including current events, exercise, trivia, educational programs, musical entertainment, sing-a-longs, card and board games and watching old movies. 

Also centrally located is a covered porch where residents partake in horticulture and relax outdoors. Once phase II of this project is complete, the outdoor experience will be even more enhanced with an elevator to the first-floor secure gardens. 

Activity areas with televisions are always a challenge, especially with the introduction of gaming consoles such as the Wii. As the systems offer the added benefit of exercise opportunities and outlets for lighthearted competition, they also require more space for the participants as well as observers. Waverly opted to move the TV from its originally located living room to a remote activity area which allowed for more spectators. Residents hear the action and are intrigued. Often it is the social banter that encourages residents to join in, even if they had no intention to do so. 

Waverly has observed significant improvement in residents’ mood, behavior and interpersonal skills both during and after group activities. Some short-term residents have even joined in with the residents in memory support because of the encouraging and engaging music and other multisensory stimuli provided throughout the day.

STAFF CONNECTION

Where once a “mother ship” nurses’ station had commanded the halls of the health center, now smaller care bases are centrally located for staff to work discreetly but with views of halls, dining and activities. Behind the chart area is a dedicated med room that is hidden from residents. While there are distinct work areas for staff, they also serve as a retreat for hall activities while still providing visual access to residents through residential windows. The spaces were deliberately intended to be small so that staff is encouraged to participate in activities outside these rooms, spend time charting on tables located in front of the care base and participate in the personalization of care. It is common to see staff playing cards and participating in bingo. 

Residents and staff had formerly congregated at the old “mother ship” nurses’ station located near the entry to the health center. Appearance and noise was always a concern for marketing. The former environment had overhead paging and alarms beeping constantly. With the smaller care bases the staff is broken up into smaller groups. Beepers on vibrate are used to alert staff. The choice to use a dense cut-pile carpet with moisture-barrier backing contributes immensely to a softer and quieter environment. Overall, this has resulted in less agitated residents and the use of hypnotics is measurably down. 

REAL DINING ROOMS

A large dining room can be overwhelming. Multiple small dining rooms serving smaller groups offer a quieter setting and a more pleasant dining experience. The room feels more residential.  There is reduction in noise, which minimizes distraction and promotes concentration on eating. Waverly also keeps the activity areas separate from the dining room to minimize confusion.

The Devonshire dining room is centrally located to resident rooms and furnished so that all tables have at least four chairs. In the former dining room, residents had to order lunchtime selections at breakfast. The new open dining room is complete with menus, allowing residents to dine as if in a restaurant and its proximity along the building’s exterior provides for views of the courtyard below and natural light penetrates the halls. A stone fireplace is the backdrop while an open kitchen of rich cherry cabinets and granite countertops adorn the opposite side of this cozy room, allowing food to be prepped in the dining room. Aromas of the upcoming meal have encouraged more residents to dine outside of their rooms for a social eating experience. Dining now is a pleasant and soothing activity, and families now join their loved ones in meals throughout the day.

A PLACE TO CALL HOME

The Devonshire resident rooms are spacious and encourage a lifestyle that is more reminiscent of their former homes. Encouraging residents to bring their own furniture creates a familiar environment and residents have customized their rooms to be more like their own homes with built-ins and artwork. 

A variety of lighting options are provided:  Indirect cove lighting for ambient illumination, overhead primary lighting,a floor lamp and bedside lamp with a switch on the base for ease of use allows for task lighting, a night light and finally the best of all additions—a  large bay window for natural light. Residents have total control over sunlight and room darkening with the provided draperies and two-inch residential-style Venetian wood blinds. The switch bank is easily seen and labeled for resident use. Residents are now needlepointing and reading comfortablyeven at night – a choice they did not have in the previous medical model.

To enhance privacy, all resident rooms in Devonshire were designed to include European showers for a personal bathing experience. Although some cognitively impaired residents initially find the open shower to be a foreign experience, there are benefits of the personal bath experience in the resident’s room. Toilets were added at standard height and grab bars were provided; the design of the grab bar is reminiscent of a decorative towel bar. The old building had a threshold at the bathroom in the residents’ rooms. This was a problem for wheelchairs. It was also a tripping danger for ambulatory residents. There are no thresholds in the new bathrooms and there is more floor space to place assistive devices so more residents can self toilet. As a result, residents confidently find their way and incontinence has decreased. 

No doubt, cognitively impaired residents have been affected by their new “home.” With all of these features, Devonshire staff members have noticed happier residents and fewer behavioral issues. Truly, the individualized care and inviting environment are geared toward creating a sense of community. When Waverly administrators were asked if they had adopted culture change they replied, “Waverly has embraced the concept of personalized care for over ten years—but in 2012 the environment has finally caught up with the program.”

*A fictitious person.

Carol Reitter Elia, ASID, IIDA, LEED-AP, is principal of CR Design, an interior design firm specializing in senior living environments. Call her at (610) 353-5580 or email carol@crdesign.biz. For more information, visit www.crdesign.com.