STRATEGIES for upgrading Senior care environments.

Until only a few years ago, there was little awareness of the potential of the physical environment in long-term care facilities as a therapeutic tool. We now know that the interior design of a skilled nursing facility impacts more than the facility's public image. Interior design can significantly enhance residents' functional independence and autonomy. This means paying particular attention to designing for residents' vision needs, mobility and sensory comfort.

Designing for Vision

Most residents in a skilled nursing environment are in their 80s and beyond. As we age, our vision experiences many changes, e.g.:

* extreme sensitivity to glare

* decreasing ability to react to changes in light levels

* reduced ability to discern details

* a restricted field of vision and depth perception and a reduced sensitivity to contrast and color recognition

To see and function normally, older seniors need at least five to eight times more light in their surroundings than people in their 20s do. Add to this the tremendous number of older adults who have cataracts, macular degeneration, glaucoma and other eye diseases, and the importance of designing for vision enhancement becomes even more apparent.

Scientific research has shown that natural light provides positive photobiological benefits for seniors. Sunlight stimulates the circadian and neuroendocrine systems that regulate sleep and other body functions. Improper lighting affects mobility and such vital sensory functions as hearing, since many seniors with diminished hearing lipread to increase understanding. While we are only beginning to discover the effects of "light starvation," this research comes at a time when we have ignored or all but eliminated natural light from most of our elderly housing environments.

Light in facilities needs to be at consistent levels, avoiding areas of uneven brightness that can create shadows and problems with depth perception. Gradual changes of light levels are also important because older eyes adapt to light changes much more slowly.

Eliminating glare is also very important, because it not only increases resident comfort, but also helps minimize falls and maximize attention span. Light fixtures and windows might produce direct glare, while indirect glare is produced by light reflecting off shiny surfaces such as highly waxed hard floors. With better lighting design and selection of materials that absorb glare, skilled care providers can go a long way toward creating more comfortable living spaces for seniors.

The value of windows as a source of natural light can be enhanced by using light-colored fabrics and paints around them, increasing their reflective value by as much as 80%. Also, when window sills are lowered to 15 to 20 inches above the floor, those residents who must remain seated can experience natural light directly and are more able to enjoy the outside views.

Just as age influences the type and amount of light we need, it also impacts how we see color. As we age, the lens of the eye thickens and begins to yellow. To comprehend this, look at surrounding colors through a piece of yellow cellophane. While appropriately selected colors engender feelings of comfort and well-being, contrast is even more important to older eyes. With aging, the ability to see color differences diminishes. This can have tremendous impact on how residents see visual cues. For example, if carpet is coved up the wall, seniors might perceive the floor to be higher than it really is. To help ensure feelings of security and safety, contrasting colors can be used effectively as a visual cue, to distinguish the difference between floor and wall, between door and doorway, and more.

Since light and color are intricately related, choosing light sources with good color rendition is also critical. The new generation of fluorescent lights, such as T-5 and T-8 lamps, are not only energy efficient, but also mimic natural light.

Designing for Mobility and Sensory Comfort

Mobility--whether with canes, walkers or wheelchairs--is enhanced by designing spaces that support independent movement using these devices. The fear of falling can be reduced by providing well-designed handrails, as well as frequent places for residents to sit and rest in hallways, on walkways between buildings and in rooms they visit frequently. Mobility is also enhanced by sensory comfort that comes from reducing glare from windows and floors and choosing furnishings that absorb rather than amplify sounds. Providing soft-surface floor coverings also adds to resident confidence.

Resilient and hard-surface floors have traditionally been the choices for healthcare settings because of their durability. But, as concerns for resident comfort and safety have emerged, so have worries about the noise and glare generated by hard-surface floors, which can also be perceived by residents as wet and slippery. Hard-surface floors can unintentionally act as "passive restraints," in that residents become less mobile because they are afraid for their safety.

While conventional broadloom carpets provide noise and glare control, they are not without their share of problems. Broadloom carpets traditionally have been difficult to maintain. Because they are constructed with water-soluble latex backings, fluids penetrate the pile and soak into the backing, making mold, mildew and odors difficult to control.

For all of these reasons, soft-surface flooring hybrids, such as vinyl cushion tufted textiles (VCTT), are becoming popular alternatives to conventional carpet. Constructed with a waterproof vinyl backing and a yarn surface, hybrids have the durability of sheet vinyl and the appearance of carpet. Backings with closed cell vinyl cushion construction offer superior long-term performance; these products are warranted for up to 20 years. With an RS micro encapsulated "tackifier" backing, they can be installed with a glue-free "peel and stick" method that virtually eliminates emission of toxic volatile organic compounds (TVOCs). (TVOCs produce the odor during and immediately after installation that is commonly referred to as "off-gassing.") By eliminating TVOCs, flooring can be installed while the building is occupied, minimizing lost work time and disruption to routines.

One of the greatest factors distinguishing institutions from homes and affecting sensory comfort is the quality of the acoustics. Most healthcare settings surround patients/residents with hard, smooth, nonporous surfaces that cause sound to bounce from one surface to another without being absorbed. The resulting excess noise can heighten resident agitation and stress. Selecting quality acoustical ceilings and wall products and taking advantage of the sound absorbing qualities of soft floor coverings will reduce the likelihood of resident agitation and stress.

A designer's touch can humanize institutional healthcare environments. The goal of all healthcare design professionals is, simply, to design living settings that are easier, more comfortable and more pleasant for senior residents to occupy.

Elizabeth C. Brawley, IIDA, is president of Design Concepts Unlimited, an interior design firm specializing in longterm care and Alzheimer's special care. She is the author of Designing far Alzheimer's Disease: Strategies for Creating Better Care Environments (John Wiley & Sons, Inc., 1997). Mark Taylor is chair of the Healthcare Design Council, an industry-sponsored forum that seeks fresh solutions to healthcare design issues, and is also general manager, healthcare markets, for Collins & Aikman Floorcoverings, manufacturer of Powerbond.