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Nursing home design bright spot in '93.

With the elderly in this country making up about 13 percent of the population, the need for state-of-the-art nursing homes has increased. And with experts saying the number of elderly will grow three-fold in the next 20 years, there will be even more of a need for services that are provided in long-term-care facilities. Less well known are the architectural implications, which are challenging, but surmountable.

As people stay in nursing homes for more protracted periods, their quality of life becomes increasingly important. To deal with this challenge, architects are concentrating more on deinstitutionalizing nursing homes. And for safety and security, this has major ramifications.

The best way to insure residents' safety and security is to minimize two dangers: Their tendency to wander into the community, and their exposure to the risk of injury. Many nursing-home patients are all too vulnerable on both counts.

The impulse to wander is a strong one. Elderly people like to roam, but they prefer to do so in a familiar environment. And there's nothing wrong with this if it's supervised carefully.

Proper attention to a home's interior design can help. We design and decorate each nursing unit of about 40 patients with both a distinct character and a specific color scheme. These extend to the carpeting, wall, tiles and even the furniture. This not only provides a resident with a feeling of propriety, but re-enforces his or her identity of the unit. This, in turn, helps to reduce the amount of meandering into unfamiliar neighboring areas.

To accommodate residents' innate desire to wander -- while keeping it under strict control -- we have been recommending an extended use of alcoves and seating areas off the corridors, which generally are visible to staff monitoring the facility. Another relatively new phenomenon is wider corridors, which provide enough space for seating areas in plain view of nurses' stations.

Not only do such accommodations permit staff to observe the residents, but the patients themselves tend to prefer to be where things are happening. For architects, it is essential to take into account the residents' desire to be around others.

An even more severe problem in nursing homes is, of course, the growing number of residents with Alzheimer's disease. For them, wandering is a particularly frequent -- and progressively worsening - problem. Accordingly, we like to design a subtly circular layout. So, if they roam, they will tend to return to where they started, within the boundaries of their own nursing unit. Another method to increase resident safety is to provide tactile references on handrails and hardware. A textured door handle or a knob on the end of a hand rail will help patients recognize which areas are off-limits, or orient them to their surroundings.

Wandering is only one aspect of safety, of course. For example, we pay considerable attention to the materials we use. Thus, we usually recommend bumpers on walls and on the corners of beds, and no metal protrusions. If privacy curtains are used around a bed, they are designed with sufficient strength to physically support the patient should he or she pull on them. And, of course, hand rails are vital in showers. Although it is standard to have hand rails inside the nursing home, they should be considered outside as well, for the safety of patients as they traverse the grounds.

Other suggestions for maximizing safety and security include: * Video monitors

* The entire facility fenced in

* A guard post at the entrance

* A gate at the top of stairways to prevent residents from going to the roof

* Alarms at all roof doors

* Numerous call bells in toilet rooms, showers, patients' beds and resident-activity areas

* A stop on all windows to prevent residents from climbing or falling out. Also, resident window sills should be high enough to keep patients from falling into the glass and out the window

* Ground fault interrupters (GFIs) on outlets near sinks or toilets to prevent residents from receiving an electric shock. A GFI will produce a short instead

* Night lights for all patient rooms

* Flame-resistant materials for all curtains and draperies

Having designed nursing homes for 25 years, I've noticed remarkable changes. When I started out, nursing homes were more like hospitals, and residents enjoyed only a very limited amount of space in their rooms. Activity areas were small and scarce. One of the only amenities was the dining room. Residents tended to be tucked away behind closed doors in a formal room. Unless a nurse looked into the room, she did not know how the resident was faring.

Today matters are entirely different. Generally speaking, nursing homes now are much more concerned with the residents' quality of life as people live longer. If their bodies are deteriorating, their minds are active; sometimes, it's the other way around. Areas must be provided for arts and crafts, playing games, learning games. In short, you need much more than merely a dining room. And, of course, the handicapped must be attended to. The patient's quality of life has been enhanced by physical and mental activity.

And with Americans living longer, nursing homes house an older population. This is the major issue and challenge administrators face in the 90% and beyond. The solutions, we feel, already are starting to be designed, today.
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Title Annotation:Mid-Year Review & Forecast, Section III; state-of-the-art nursing homes in demand for 1993 with increasing elderly population
Author:Clarke, Jerrold
Publication:Real Estate Weekly
Article Type:Column
Date:Jun 23, 1993
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