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Big design changes on small budgets.

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).

In subacute rooms, where a variety of medical equipment may be visually disturbing to patients, we look to the hospital setting for ideas to help keep equipment out of view. While not an ideal or inexpensive solution, a variety of panels are now available that partially obscure patients' view of medical aparatus.

The typical semi-private room can be completely refurbished for under $5000, depending on material costs and square footage. If budget considerations preclude such an expenditure (as is the case in many facilities), start slowly, making the less expensive modifications, such as adding tack boards or creating emphasis walls, first, and making others as your budget permits. Or one can modify rooms in increments, doing so many each year as funds allow.

Modifying the Facility at Large

Personalizing space takes on a slightly different meaning in common areas such as corridors and lounges which are shared by an increasingly diverse group of people. Therefore, move away from a single style toward a regionalism that conveys a respect for the diverse backgrounds of residents and emphasizes the decor and surroundings most commonly accepted in the homes of your particular region. This principal should be applied in common areas throughout the nursing home, including the following:

Corridors: In larger facilities, giving each corridor its own unique character not only creates a residential feeling, but also helps residents to locate their living area through visual differentiation. This can be accomplished in a number of ways. Painting each corridor a different color will get the job done, but in a more institutional than residential manner. A more residential solution would be to hang groupings of paintings-each with a different theme-on the corridor walls. Residents can then identify their corridor as "the seascape hallway" or the flower hallway." Placing a sculpture or some other aesthetically pleasing object at the corridor entrance is also effective.

Whenever possible, corridors and other coomon areas should be carpeted (again, for both aesthetic and acoustic reasons). A single-color carpeting is preferable to carpeting with large geometric or abstract patterns, which might be visually confusing.

Nurses' stations: The nurses' station should invite interaction between staff and residents. But in most older facilities, high counters create a physical and often a psychological barrier between nurses and residents and can seem quite imposing, especially to the resident looking up from a wheelchair. Anything that opens up the space and lowers the barrier between nurse and resident is desirable. In some nursing homes, this may entail replacing the entire unit. In other cases, however, the station itself can simply be lowered, usually by your maintenance staff.

Sitting rooms: Reception areas, lobbies and lounges provide places for residents to interact with one another, as well as with visiting family members and staff. The design goal for these areas should be to make them as much like the family living room as possible.

Fortunately, most health care facilities have abandoned the practice of lining furniture up along the room's perimeter, a practice that was visually and functionally institutional and isolating. In a large room, such as a lobby or lounge, several small groupings of chairs and sofas encourage interaction and socialization and provide families or groups of residents with a place for private conversation. To ensure that you achieve functional as well as visual residential character, the furniture should be designed with the needs of the elderly in mind, e.g., chairs with arms and firm seat cushions, small sofas that provide each. resident with access to an arm.

Artwork not only provides a visual focal point for the area, but also allows for ready recall of the home environment. Groupings of paintings with similar themes are far preferable to paintings placed randomly-or worse, uniformly-around the room.

Plants also bridge diversity, because they are a source of pleasure in almost everyone's homes. The principles of arrangement that apply to paintings apply to plants as well, i.e., groupings of plants rather than random placement or a plant on every table. Also consider that live plants grow and change and are reminiscent of life and vitality; artifical plants get dusty, can be difficult to maintain, and don't have the same positive visual impact.


The patient admitted to the hospital for a one-week stay can put up with ,less than ideal surroundings. But those surroundings become more meaningful for the nursing home resident who will be calling your facility "home" for the long-term. A commitment toward creating a home-like environment, with design that meets the physical, emotional and psychosocial needs of residents, will go a long way toward enhancing residents' quality of life and making your facility more marketable. And the good news is that this can be done within reasonable budgetary limitations.

William J. Brown, AIA is principal of The Elements Group, a unit of Brown Architects based in Cincinnati, OH. For more than 30 years, he has been involved in the planning of a variety of housing/health care facilities throughout the country, from freestanding care centers to continuing care retirement communities, all with an emphasis on resident-oriented environments. Mr. Brown has given numerous presentations, including his "Dignity by Design Workshop," for national organizations such as AAHSA and ACHCA.
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Title Annotation:nursing homes
Author:Brown, William J.
Publication:Nursing Homes
Date:Sep 1, 1994
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