A fresh look at interiors: experienced designers review the latest interior design trends.

Good housekeeping can only go so far in preserving the ambience of a facility. Foot and cart traffic, spills, direct sunlight, and plain old time contribute to tired-looking interiors. It takes more than a pretty bedspread or crispy chintz drapes to improve the aesthetics of a facility. Although updating your building's look might not appear budget-worthy right now, it can be an investment that pays big dividends as a marketing tool and contributor to resident and employee satisfaction. Recently, Nursing Homes/Long Term Care Management invited three interior design experts to share their perspectives on the latest materials, styles, and elder-focused trends.

Maria Nevelson, Nevelson, LLC: Many healthcare facilities have not addressed their interior finishes and furniture for some time. Because of their inevitable sticker shock, I like to work with the basics and select products that look fabulous while addressing facilities' durability and maintenance concerns.

To avoid the "cutesy-pie" homespun styling often applied to soften the harshness of the institutional setting, I look to hospitality products for a variety of styles. I agree with Cynthia Leibrock ("Let's Stop Tweaking a Flawed Model," Nursing Homes/Long Term Care Management, June 2004, p. 38) that it is imperative to maintain a professional atmosphere within the nursing home or assisted living facility. When you look at the architecture of many long-term care facilities today, the common-area spaces tend to be much larger than anyone's home spaces, making homey decorations look ridiculous. So, in selecting finishes and furniture, I continue to look at the tried-and-true products that have proven themselves over time, and believe their passage through my creative mind produces an updated spin.

Style-wise in general, we have moved from the 1960s to the 1970s, which is progress in the sense that it allows for more variety and motifinfluences from around the globe. Today's updated colors are cantaloupe orange, clear aqua, rich tasty browns, sage green, and turmeric red. Other updated aspects of long-term care design include:

Finishes. In particular, Crypton[R] fabrics (as used by Robert Allen Design) have blessed us with more and more colors and patterns to choose from.

Furnishings. The Arts and Crafts style, exemplified by American of Martinsville's Homestead, works well in long-term care settings. When I designed an assisted living facility in this style in 2000, there was nothing available for the healthcare market. Now there is.

Floorcoverings. Hospitality carpets, such as those produced by Milliken Carpets, are very popular. They come in a variety of beautifully developed patterns and can inspire an entire interior design scheme. They are effectively used in corridors with complementary patterns for adjoining rooms.

Wallcoverings. I still look to vinyl wallcovering (for example, Source One Exclusive from Eykon) and borders for a lot of "design information" (the confirmation of my interior design style and additional "artwork" when the budget doesn't allow for accessorizing). Goat-hair wall carpet (from Eurotex) for the dado--while heavy in the visual aesthetics--is excellent for sound absorption and provides a feeling of intimacy, while withstanding a lot of bumping and scraping. (And, yes, it is fire-rated for vertical applications.)

Lighting Fixtures. For corridors I am specifying Metalux's Aerial for the even, direct light it provides without creating glare. This is a surface-mounted fluorescent light fixture that is low-profile (an attribute that is very hard to find in lighting fixtures).

Special Items. (A) "Little chairs for little people." To encourage the grandchildren to visit, I placed a child's rocking chair in a facility sitting room, hoping that they would look forward to sitting in their own "special chair." (B) Real art. Coming from an artistic heritage, I always try to place real art in a facility. And, yes, it is often refused. A few years back, though, I was lucky with the lobby of an assisted living facility. I commissioned the ceramicist Paul Chaleff to make one of his soothing water fountains as a focal point.

For further information, phone [phone] or e-mail [e-mail].

Elizabeth C. Brawley, IIDA, Design Concepts Unlimited, Inc.: Largely motivated by the growing emphasis on culture change, a greater emphasis on neighborhood or cluster design that is substantially less institutional and more residential is apparent. The long-sacred nurses' station is being replaced with decentralized workstations that are integrated into the environmental setting--a work space in the "family kitchen," for example, or a desk in the living area. These are more residential-looking and fit in the setting more comfortably and with less visual disruption than the large, often noisy "nurses' command center."

With the use of carpet designed for the tough use and special needs of assisted living and nursing homes, designers have begun to visually soften the environment, as well as quiet the noise. However, floorcovering is only part of the solution. Acoustic control is one area in which we need to do a better job.

Manufacturers are now producing carpet that stands up to the wear and abuse of nursing homes. Nursing staff are now beginning to accept that today's floorcoverings offer many positive attributes that contribute to residential ambience, noise control, glare control, and ease of mobility. Many carpets now have a moisture-barrier backing, which is crucial to success in facilities, as is proper floor preparation, installation, and maintenance. Choice of patterns must be carefully controlled because of the prevalence of vision problems in long-term care residents.

It would be nice to see more wallpaper used in facilities, but unfortunately it is typically cut from the design budget. Carefully selected wallcovering used in only one or two places can help a setting feel more like home.

As for finishes, we are seeing increased use of Crypton, which is now offering better textures, colors, and patterns.

Lighting is one area in which we are starting to see significant improvement. With the publication of Lighting and the Visual Environment for Senior Living by the Illuminating Engineering Society of North America, and its subsequent adoption in 2001 by the American National Standards Institute (ANSI) as a national building standard, architects and building engineers are beginning to use these lighting practice standards to address visual requirements of seniors that were largely ignored before. We are seeing much higher light levels, with more use of indirect lighting sources and natural light. This emphasis on daylighting is being driven to some extent by energy conservation concerns, but it is important that attention be paid to controlling glare. Unfiltered light, even from nature, is not a plus.

For further information, phone [phone] or e-mail [e-mail].

Sue Torgrude, Environmental Researcher/Planner, Boelter Design Group, Inc.: The use of interior design elements to enhance wayfinding in nursing homes and assisted living facilities is getting increased attention, but further development is needed. Gerald Weisman, PhD, professor of Architecture at the University of Wisconsin--Milwaukee, has identified four key elements that can have an impact on successful way finding:

1. Architectural Differentiation

* Unique building features that can be used for orientation

* Identifiable groupings of spaces within the facility for residents and visitors to recognize

2. Floor-Plan Configuration

* Physical organization of the spaces

* Definition of paths residents and visitors will follow through the building

* Attention to spatial orientation for the building residents and visitors

3. Sensory Access

* Views to outdoors or other parts of the building

* Aromas and sounds that identify spaces

4. Signs and Graphics

Other design elements that can support wayfinding include landmarks, color contrast, and lighting to distinguish areas.

Unique building features--e.g., atriums, aquatic/exercise center, coffee shops, and other gathering places--can provide reference points for wayfinding. Circulation paths should be easily understood. A current trend is to create neighborhoods or household clusters to achieve smaller, homelike living environments for residents. However, depending on the design, the result may be increased floor-plan complexity, which can have an adverse impact on wayfinding.

Views to the outdoors or into other parts of the building from social activity and other spaces can be helpful to orientation for seasonal changes, as well as to understanding where one is in a building. The aroma of coffee and sound of music can guide people to cafes and activity rooms.

Signage plays a less important role to orientation in nursing homes and assisted living facilities than in healthcare environments such as hospitals and clinics. Some of the reasons include:

Placement: The ADA requires installation of signs at 60" on center (of the sign), which may not provide the optimal visual or tactile access for someone using a wheelchair--thus, there is a conflict between regulation and intent. Also, elderly people often do not look up, so overhead signs may be missed.

Visual Acuity: Some text may be too small for older adults. My recommendation for room identification signs is to use one-inch text. Signs should provide strong background-to-text and wall-to-sign contrast.

Terminology: The use of technical medical terms should be minimized and avoided where possible. All terms should be easy to understand and used consistently throughout the system.

In the case of older adults, experience and field research indicate that landmarks appear to be more effective for wayfinding than signs. Placing a grandfather clock at a major intersection may help a resident find the corridor where his or her room is located. Creating a cluster or center of activity spaces--an aquatic facility, exercise areas with a cafe nearby--offers a prominent reference point and a place to get information.

Color contrast and lighting also are important to distinguishing spaces. Color preferences may be idiosyncratic to residents, but it is important to provide strong color contrast to define spaces and objects. Contrast between seating and flooring is important to prevent falls. Appropriate lighting is important to color perception, and there appears to be more attention to using a variety of lighting options: natural, indirect, and direct.

Successful wayfinding requires that a series of redundancies be built into the environment. Not everyone is color-perceptive; others might have visual acuity or mobility issues that might prevent them from having easy access to information. Incorporating a variety of wayfinding strategies that are unique to a particular facility and its residents is what can make the difference.

For further information, phone [phone], e-mail [e-mail], or visit www.boelterdesign.com.

*Inclusion of specific product and company names is for information only, and does not imply endorsement by Nursing Homes/Long Term Care Management.

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