WITH THE PRACTICE OF CLUSTER PLANNING, THE TRADITIONAL floor plans of senior living facilities are evolving into innovative arrangements of Main Streets, neighborhoods, and households. As we hail these new plans as reflecting a certain normalcy of lifestyle--with resident-focused living space surrounded by the "personal harbors" of residents' bedrooms, integrated or invisible staff areas, and nearby destinations of country kitchens, spas, and boutiques--these "corridor-less" senior living environments are not without drawbacks. They may challenge navigational instincts, hinder emergency response, and disrupt the flow of people and materials.
The good news is that design professionals are rising to the challenge of building safe corridors and circulation zones by employing new design strategies for both traditional and more contemporary floor plans. Collaborative planning--beginning with a discussion of architectural and interior-design parameters, residents' psychosocial needs, and the clinical-care implications of increasingly frail and cognitively impaired residents--will give the project team the depth of understanding to develop relevant functional and design criteria. The goal is to create spaces meeting the physical and psychological needs of residents, staff, and visitors.
WHERE HAVE ALL THE CORRIDORS GONE?
Safe travel, generally speaking, requires clear, intuitive, unencumbered circulation routes that support the traveler's physical stamina and cognitive capacity while promoting the use of the senses to navigate the space. Well-designed corridors and circulation routes are those that link destinations safely within a senior living environment, despite challenging program requirements.
The more open floor plans can be compared to the foodservice phenomenon in which cafeteria-style service underwent a dramatic change. The "scatter concept" was introduced to reduce staff while allowing customers to be more engaged in selecting their fare. This decentralization of service created new challenges--a sort of mingling of harried staff, hungry patrons, and spilled milk. While this new environment has visual appeal, it often requires a great deal of strategy, personal energy, and concentration before ever sitting down to eat. Freedom of choice comes at the price of dodging the folks restocking the food lines.
Likewise, the absence of corridors in a senior living unit poses a new set of problems. Conventional wisdom would suggest that the more we configure a living unit to be homelike, the better for residents' orientation, staffing, and visitors. But we must recognize that the difference in the volume of people, activities, and deliveries can be disorienting. Whether your floor plan is open or traditional, the following interior-design components and strategies will enhance resident and staff safety:
THE LIFE YOU SAVE MAY BE YOUR OWN
First, consider building and life-safety codes as minimum standards. As such, they don't always take into consideration operational and maintenance practices, regional weather conditions, the case diversity of your residents, or even the unique culture of your senior living environment. Providers should go beyond such codes. For example, factor in such common-sense issues as selecting flooring materials for greater slip resistance in rainy climates. Where there is a preponderance of dark, cloudy days, increase interior light levels
The flexible, open spaces of household configurations require greater furniture and equipment management to prevent doors from being blocked and to keep circulation areas clear of carts and residents' belongings. Use floor patterns to zone space for staging carts and equipment, or to identify circulation, staff, and resident areas. This promotes consistent placement of furniture and equipment, which is important for residents' physical safety and confidence.
Another hazard of household layouts that is minimally addressed by current life-safety codes is the loss of traditional, hierarchical progressions from room to corridor to exit. Because emergency personnel can become disoriented in a smoke-filled living unit, resident-room doors need to be differentiated from others in the cluster, and additional exit signs may be necessary to cover the diversity of sight lines for residents and staff. Furnishings may be used to address some of these issues. Place wreathes or "welcome" signs on resident-room doors to distinguish them from other rooms in the facility. Large, open spaces may intimidate those less steady on their feet, so stable furniture or additional mobility aides may be needed to compensate for the lack of handrails.
NOT FOR YOUR EYES ONLY
It is critical to remember just who the customer is when selecting decorative treatments. Of all those who circulate about a senior living facility, we must give priority to the occupants with the greatest limitations. Interior-design components are incorporated into architecture to appeal to one's senses and abilities, and they can profoundly affect residents' physical and psychological well-being.
Color differentiation and contrast are key when it comes to resident safety. In developing color schemes, providers may find it useful to consult the Healthcare Design Research Alliance ([less than]www.HDRAlliance.org[greater than]). HDRA provides color-palette guidelines that facilitate balanced proportions of full-spectrum color schemes. These provide a natural harmony that many experts say can promote health and well-being. When used properly and with appropriate contrast--such as with a dark handrail against a lighter wall--these color schemes can give residents additional confidence in negotiating corridors.
With colors and finishes, there must be a delicate balance between too much and too little color, contrast, and pattern. Residents with low visual acuity may rely on highly contrasting borders and floor inlays to provide visual cues. But residents with dementia, or those on various medications that trigger hallucinations, read flooring patterns very differently. A dark border may read as a change in elevation or as a large hole in the floor. Finishes with an appropriate level of visual and actual texture can be used to minimize reflective glare and slipping, but they must be carefully considered in terms of maintenance. Flooring transitions must be designed to minimize trip hazards and the stored energy created as residents leave a carpeted corridor only to shoot across the resilient floor of the dining area.
BALANCING AMBIENCE WITH SAFETY
Building codes simply prescribe average lighting levels for all types of spaces including corridors, stairwells, resident rooms, and bathrooms. Providers should consider going beyond these mandates and use lighting to promote safety. This doesn't mean dialing up levels across the board, but rather incorporating dramatic lighting to create ambience while introducing hierarchy to the space. Higher light levels should be used to call attention to hazardous areas such as the top of ramps and stairs and changes in wall planes. Lighting can also be used to emphasize corridor junctions, special room entrances, and directional signs.
Light-fixture orientation and compatibility with corridor finishes is also a key concern. Again, engineering wisdom suggests running fluorescent fixtures down the center and axis of corridors to efficiently light such spaces. A more appealing design for resident comfort would be running them perpendicular to corridors to visually shorten them. Glare from lighting is particularly hazardous because it creates veiling reflections on shiny floors. Although somewhat more expensive, cove lighting or indirect sources should be used when possible for general illumination; it can then be supplemented by incandescent specialty lighting.
FOLLOW THE SIGNS
An effective "wayfinding" system will address a host of common orientation problems faced by residents, visitors, and staff. Instead of seeing how many signs you can provide, see how few you can use to accomplish your goal.
Starting at the lobby, use broad messages and common terms to lead people sequentially to the proper building, wing, and room. Provide increasingly detailed information on a "need to know basis" as one nears the destination. Consider using artwork or graphic elements to establish landmarks and cues to important spaces. Color, text styles, and contrast also play a critical role in sign-systems design.
Robert P. Volzer, IIDA, is the interiors director for Clark Patterson Associates in Rochester, N.Y., and is a member of the CLTC Advisory Board.
Safe wandering environments
Kirkhaven Nursing Home, Rochester N.Y.
Architecture & Engineering: Clark Patterson Associates, Rochester, N.Y.
Interior Design: Creative Details, Rochester, N.Y.
Type of Construction: 73% new, 27% renovation
Site Location: Urban
Site Area: 1.3 acres
Area of Building: 4,700 gsf
Cost of Construction: $600,233 total building; $649,128 total project
Status of Project: Completed 1998 This design received the 1998 National AIA "Design for Aging" Award from the American Institute of Architects
Design Objective: To provide safe wandering space adjacent to existing nursing units to accommodate the growing population of Alzheimer's residents. The owner also wanted to incorporate some of the cutting-edge amenities for dementia care.
The project consisted of renovating a fifth-floor nurse's station/support area and the expanding the fifth floor out over an existing adjacent roof area. The intent of this design was to eliminate the current linear, institutional feeling of the facility and create an open "household" unit with many different resident amenities. The combined renovation and new construction project created an open wandering path that allows residents to move freely about. Placed along this wandering path are small, sky-lit dining/program areas, a central gazebo with an aviary, a sun room, rummaging areas, memory stations, and small lounge areas. The space was designed with a large, open area in the center to accommodate group activities but still allow for a more intimate, homelike feeling about its perimeter.