Big design changes on small budgets - nursing homes

Nursing Homes, Sept, 1994 by William J. Brown

The importance of residential character in the extended-care facility is recognized by architects, designers and LTC providers alike. But the prospect of transforming institutional decor into a more home-like environment can be overwhelming, and the temptation may be to adopt the attitude, "we can't do it all, so we may as well do nothing."

Fortunately, visual and functional residential character can be achieved with any number of relatively simple and inexpensive modifications, especially when you plan and budget for those modifications as part of the facility's regular maintenance schedule. For example, when resident rooms are due to be painted, do the work as scheduled, but plan ahead to do so in a way that helps to personalize those rooms.

Personalizing Residents' Space

The resident's room is the one place that can be personalized, in the true sense of the word--the door to the resident's room being an excellent place to start. A recent photograph of the resident can be slid into a permanent plexiglass frame (such as those made for medical charts) mounted on the door. Personal items other than photographs can be just as effective. Some residents have chosen to hang a favorite wall hanging or small painting on their doors.

Providing personal space and privacy in the room itself takes a bit of ingenuity. In the typical semi-private room, the beds are placed against the same wall and one resident-the "first-class citizen"-has the luxury of being by the window. This leaves the other resident unable to her immediate space, with views of the outdoors limited to the occasional glimpse.

The most obvious, and least expensive way to overcome this obstacle is to simply rearrange the furniture when space permits, placing beds on opposite walls or directing both beds toward, rather than at right angles to, the window. If the room is of sufficient size, a small table and chairs (probably already in your inventory) can be placed by the window to provide both residents with access to the exterior view. If feasible, lowering the window sill enables residents to see the outdoors from a seated position (though, ideally, this should be a feature of the initial design for a long-term care facility).

When the resident's space cannot be separated by physical means-and even when it can-that space should be personalized with their belongings. A tack board provides a place to display photographs, cards, letters and other mementos, and can be purchased or made inexpensively. For the nursing home with more money to spend, a combination shelf-desk unit is ideal to display items that can't be tacked to the board. This type of unit also provides residents with ready access to personal items, encourages them to get out of bed to do such things as read or write letters, and can be custom-made to meet clearance requirements.

When resident rooms are due to be painted, use a variety of colors and textures, making certain that the colors and finishes on all surfaces are compatible with one another. When making color selections, remember that the aging process may alter residents' perception of color. For this reason, in our design work, we view samples of paint, material and carpeting through a yellow-tinted lens which some say simulates the color perception of many elderly individuals. Among other color-related considerations, researchers have found that light colors against dark areas (or vice versa) are more visible than are all over-bright colors. Pastels fade and dark tones are difficult to distinguish.

Creating an "emphasis wall" is an inexpensive way to add color and heighten visual interest. The wall can be painted with a compatible but contrasting color, papered with a colorful wallpaper or simply decorated with wall hangings, art work, residents' personal items or anything that adds color or texture. The emphasis wall should be directly visible to both residents, i.e., the wall opposite or perpendicular to their beds. Some facilities make the mistake of creating the emphasis wall behind the beds where it is visible only to visitors and staff.

When doors are scheduled for painting, use a compatible, somewhat contrasting color that keeps them from blending into the surrounding walls.

Windows should have blinds or curtains that provide privacy but don't obscure the view. A valance above the window treatment is an inexpensive way to add a homey touch.

Lighting in residents' rooms must be sufficient to compensate for their presumably diminished vision. Cove lighting or fixtures that direct light upward or downward can provide home-like adjuncts to harsh flourescent lighting. Appropriate bedside lamps not only reinforce residential character, but enhance the resident's sense of control over his or her immediate environment, enabling the resident to read or simply remain awake after his or her roommate has turned the light out and gone to sleep.

Carpeting is both visually and accoustically desirable, but can be the most expensive of the modifications discussed. If budgets permit, it's important to know that the carpet industry has responded to the concerns of health care administrators with a variety of easily cleaned and maintained carpets made from antimicrobial materials. We tend to use medium-colored carpeting of a uniform color to contrast with the lighter walls and make the room appear larger (if possible, picking up one of the colors in the emphasis wall).