Designing an active "home life" for Alzheimer's residents: architects and staff worked together to produce this innovative design.
Design for Alzheimer's care facilities has come of age - to the point where architecture is driven by resident' needs to feel secure within familiar, homelike surroundings, where unnecessary stress factors are alleviated and where residents are free to explore with few limitations.
The Lowman Home Bethany Alzheimer's Care Pavilion in White Rock, SC, operated by Lutheran Homes of South Carolina, Inc., is a unique Alzheimer's care facility that incorporates and encourages creative caregiving while affirming the dignity, strengths and abilities of the individual resident. Accommodating 48 residents, it is the first facility in South Carolina to be dedicated specifically for residents with Alzheimer's disease and was designed and built with the following primary goals in mind:
* to provide for a good quality of life for residents in a joyful, homelike setting
* to allow staff the means to better assist residents in coping with the challenges of Alzheimer's disease
* to provide a level of comfort that helps reduce stress for residents and staff
* to help keep residents' minds stimulated and help them function on their own for as long as possible
In planning the Bethany Pavilion, both the owner and the architects allowed the innovative programming style of the facility's director and staff to guide the design. For instance, instead of the long, narrow corridors typical of many assisted living homes or Alzheimer's units, the facility was designed with 18-foot "living" corridors [ILLUSTRATION FOR FIGURE 1 OMITTED]. This enabled activity areas to be located directly outside resident rooms, thus inviting resident participation. The design also reduces the "tunnel vision" effect of a double-loaded corridor. Furthermore, the wide-corridor design, coupled with its curved hallway ends, eliminates the appearance of dead-ends, avoiding the agitation these sometimes produce and allowing residents more sense of freedom in moving about.
Having activities centers located in the corridors was an idea based upon input from the client's nursing staff. Nurses and other staff at the organization's skilled nursing facilities had done a number of informal studies to determine which design factors might have a positive effect on residents with Alzheimer's disease. The nurses observed that when the residents had ample opportunity to be active - whether outside, indoors performing tasks or participating in activities - the "sundowning effect," or agitation at bedtime, was diminished. Don Velsey of Ellerbe Becket, who served as medical consultant/planner for the project, helped to incorporate staff suggestions into the design. The concept of having activities centers within wide corridors was quite revolutionary, certainly in our area, and not everyone involved with the project agreed that this was feasible. Therefore, the design was conceived to be flexible, so that if it was not successful, the space could be used differently. That need hasn't arisen - the building has been occupied for nearly a year and a half, and it remains as originally designed.
The activities areas have proven to be extremely popular with residents. The new 24,000-square-foot facility has an exceptionally high programming space-to-resident ratio. A number of themes were chosen for the living rooms and activity spaces, so that all the residents could have an area or areas with which they could identify and where they could feel comfortable and at home. The "executive work area," for example, might be just the niche for someone who once worked in an office. It has a desk with an adding machine, paper and pens, and other office supplies and equipment that residents can use. Other spaces include a sewing room, grandparents' nook, fashion corner, breakfast nook, gardening room and gentlemen's game room.
Of the total 24,000 square feet of space, not more than 3,000 square feet is dedicated to mechanical rooms and nurses' work areas. Nurses' stations were eliminated, to reduce the institutional feel and to discourage nursing staff from congregating there instead of interacting with the residents. There is a small office in each wing for nurses, but they are encouraged to do paperwork in the activities areas, rather than being isolated in a separate office area.
Further space economies were achieved, in part, by the decision to bring residents' meals into the facility from an adjoining nursing home and to use only small "catering kitchens," which are accessible to residents for cooking, baking or preparing beverages. It was also decided that laundry would be sent out; the small, residential laundry area is only used for the convenience of residents who wish to do some personal clothes washing and drying.
Quality of Life Features
The design for the Bethany Pavilion incorporates elements that can improve the overall quality of life for the residents and stimulate mental and physical activity, such as:
* Two distinct wings for differing levels of care [ILLUSTRATION FOR FIGURE 2 OMITTED], each with eight private, 182-square-foot rooms (one resident per room, private bathroom; Figure 3) and eight L-shaped, 320-square-foot companion rooms (two residents per room), designed to maximize privacy
* Room views that include a wooded area, lake or central courtyard
* Wayfinding that mirrors and accommodates the wandering behavior of a resident with Alzheimer's, such as the curved walls, handrails, knob-free doors and color-coded pathways
* A large figure-eight courtyard garden with sidewalks, sitting areas and outdoor dining patios [ILLUSTRATION FOR FIGURE 4 OMITTED]
* "Familiarity reinforcers," such as color-coordinated rooms and fixtures and photo name plates outside resident quarters
* Separate residential units, based upon individual levels of cognitive functioning
* Beauty parlor/barber shop
* Quiet room
* A shared kitchen, as well as activities and dining room spaces, provided for each 24-bed wing
* On-site laundry rooms
* Staff areas (including private offices and a lounge)
The Bethany Pavilion is a self-sufficient building where resident living quarters, activity areas, outdoor recreation space, dining and staff service areas are all contained in one well-planned complex. Input from hands-on caregivers contributed a great deal to enabling us to design it to be a home where 48 residents live, rather than an institution that they happen to be occupying.
RELATED ARTICLE: Comments from Julie Long, Director of Facility Development, Lutheran Homes of South Carolina
"There isn't another facility like this in the country. The programming space per resident ratio is much higher than at any other facility I've seen or heard about, and it has twice the typical corridor space. Residents can walk right out of their rooms into the themed activity areas in the corridors, where they can pick up and use 'props,' such as hats, dolls, books and other items of interest, and walk around with them or take them to their rooms. Staff members routinely retrieve and replace these items, so that the activity areas are well maintained.
"The configuration of rooms and the total amount of space have made a significant difference in the type of programming we've done. The design has allowed our staff to further develop some unique methods for Alzheimer's care management that are now being taught to other facilities.
"This facility allows our staff the space they need for much better programming and resident care than were possible in our previous Alzheimer's facility, which was smaller and had 8-foot corridors. Features such as the large activity rooms, dining rooms, kitchens, continuous walking tracks, figure-eight garden and outdoor patio areas help keep residents busier and anxiety levels lower. The L-shaped wings of the building are also a positive design feature, because they allow us to break the residents into smaller groups according to their ability levels. All of this translates into residents who are more content and a happier staff.
"The design of the indoor walkways is quite unique. The rounded walls at the end of the hallways, plus the handrails and a continuous border design, help keep residents guided forward. Color-coded wayfinding cues also help; these include photo name plates and memorabilia pegboards in resident rooms. And, because there's no protruding hardware on doors, residents are not as likely to stop along the way and get frustrated by trying to open them. In fact, doors have been eliminated as much as possible, including doors to the bathrooms. Instead, we have curtains. The bathrooms also feature bright red toilet seats, to help residents distinguish among the bathroom fixtures.
"The outdoor walkways are designed so that if residents exit into the garden, they can either stroll on the sidewalk, using a handrail, or they can walk on any of the grassy areas if they wish.
"The dining tables and the themed activity areas are the most popular areas with residents and definitely get the most use during a typical day. Occasionally, though, we can smell home-baked cookies from the kitchens. Baking is an activity residents and staff enjoy doing together.
"All in all, this facility is very efficient and self-maintained, in that areas such as the resident laundry, tub room, beauty shop, kitchen and staff support areas are all in the same building, giving our staff access to everything they need to provide quality resident care. Certain resident-oriented features, such as bringing in meals from our adjacent facility, free up space and staff for other tasks and activities.
"Many people collaborated with the architects in the design process for the Bethany Pavilion, including myself, the vice-president of operations, our CEO and our staff. Staff were especially helpful in conveying the families' and residents' point of view. This collaborative design with Stubbs Muldrow Herin helped us to create a highly successful facility."
Sam Herin, AIA, a partner with Stubbs Muldrow Herin, architects, inc., Mount Pleasant, SC, was project director for The Lowman Home Bethany Alzheimer's Care Pavilion. For more information, phone (803) 881-SMHA.
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|Title Annotation:||includes comments from Julie Long, Director of Facility Development, Lutheran Homes of South Carolina|
|Article Type:||Cover Story|
|Date:||Jun 1, 1998|
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