Happy elderly lady with flowers

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Caring for the Elderly

How nursing homes need to be re-designed

Eimear Ennis from NODA has a look how nursing homes should be improved to better prevent the rates of infection as seen in this Covid Pandemic that has a detrimental effect on our vulnerable communities.

From our previous look at caring for the elderly in our community “Apartment for All_Increasing Independence of our Aging Population”, we saw how it is the dread of every family the thought of a parent having to go into a nursing home. When this happens, it is normally because the person has become unable to fend for themselves. They may have mobility issues, or even dementia or just that the person may need more medical care such as oxygen and 24-hour assistance.

We know that being part of a community can aid longevity and combat loneliness and so you would think that a nursing home would be something positive. This is seen as a loss of freedom and cannot be a trade-off for not having a choice to what you want to do or even when. Privacy, independence, and dignity must be maintained at all costs. Just because you must rely on more help should not mean you loose sight of what it is to be you. For example, always being glamorous, or shouting for Liverpool, or baking a cake, or tending to your garden.

In terms of spatial planning we need to get away from the ward aesthetic which is more akin to a hospital. We saw that from HIQA reports this was one of the main reasons that COVID spread so rapidly in some clusters of nursing homes. Why can you not remain in your own private room with separate ensuite? It would be more effective if these rooms were clustered in eights for instance with their own lounge kitchen and dining area. This means that if an infection gets into the premises it does not necessarily spread as quickly.

In my research I reviewed the Green House Nursing Homes in the US. What I found interesting was that they had used that idea that people want to feel like they are at “home” and not institutionalised. The key was to make the premises feel like you were living as part of a household, furnishing is domestic in their appearance and in lieu of a large dining area it is one large communal table to gather around. Green House looked at premises which accommodate maximum 10 inhabitants which psychologically must be more appealing.

The shift to look at the hospitality industry is another trend. I think this is a positive thing. There is more progress in wallcoverings and fabrics industry which make them practical for use in homes in that they are wipeable and in terms of fabrics they can be machine washed. This helps to soften the interiors.

Half Century More Homes in Japan with designer team Perkins Eastman http://www.perkinseastman.com/category_2400021_senior_living have responded positively to this with their homes for the elderly. The answer is more like a hotel than a nursing home. In terms of the design you would feel happy with a parent living there. I do realise that there is a lot more to it than just nice interiors and architecture and that like the hospitality sector the service and care must be a high quality also.

Looking into some spatial planning based on groups of 8, we feel at NODA, we are using our Hospitality experience to come up with some good alternatives. The individual unit is designed so that each one has a concealed nurse’s station, taking the medical side of the design and concealing it. Each suite has a disabled level access shower, wardrobe, bed and seating area. We have suggested full height windows looking onto green space. We have allowed glass doors to close off the bedroom area which means that there still is some privacy whilst allowing staff to pop in to check on clientele.

The overall planning allows for these rooms to be grouped around a central social space which could have full height glazing one end to allow light in. This then leads to another lounge with the kitchen/dining facilities. There is no reason why the kitchen could not be more domestic in scale to make the residents feel at home. This then leads to the commercial end of the building, the entrance, the manager’s office, laundry/stores/staff facilities.

Noda Apartment Plan

It is not just spatial planning that needs an overhaul. The same principles of design should be brought into the nursing home sector as per Office Design or Hotels. What we find is the employee to guest mental health is particularly important. By considering the employee goes a long way to getting a better yield in service as they are happier in what they do. Having an environment that reduces stress and anxiety and make employees feel good about their workplace and this can only filter to the inhabitants and in turn make them healthier.

To include more light, and biophilic design will therefore help both staff and inhabitants and bring positive healing to all. Biophilia need not just be bringing plants indoors, but also looking at positive planning and using materials that evoke nature.

Nursing home need to embrace a way to conceal the medical side of the daily routine. This must be practical but at the same time if it can be behind doors that all the better.  From HIQA another of the downfalls of this pandemic was cleanliness in the homes and materials that could be scrubbed. We can achieve this but at the same time specify items that still have a more luxurious feel.

Spatial Planning for nursing homes

Talking to Jenny Pringle from Bolon Studio she said that their product is perfect for the Healthcare services saying “Health and wellness of buildings and their occupants is bound to be at the forefront [now]. Surfaces which are easy to clean and inherently anti-microbial will take on a new meaning - the fact that the product [Bolon]is tactile and aesthetically pleasing is a bonus”. Looking at the product it is as durable as a lino and in terms of biophilia it has low VOC’s and free from phthalates and additives, this in turn leads to a better air quality and environment for the home. It is the texture which sets it apart and one which would be practical in terms of maintenance.

Carpets have come a long way and because of this the clinical lino and beige interiors hopefully will be a thing of the past.

I read recently that there are studies that show that velvet can help people with dementia given its tactilness, one I would gladly see brought into nursing homes.

This extends to wallcoverings. Products like Biomaster from Muraspec have the silver technology ions that can kill off bacteria. It is incorporated within the product, so they are guaranteeing permanence of protection. What is good here is that we can now provide areas with wallcoverings to soften the sterile aesthetic of painted walls.

Biomaster from Muraspec

Biomaster from Muraspec

Thankfully, this issue in providing better fabrics and wallcovering has been at the fore with product designers and a lot of companies are now providing great alternatives with antimicrobial, antibacterial and high maintenance finishes. This means there should be no reason for us not applying this to these nursing homes.

The brain can become forgetful and memory loss can temporarily happen once we are stressed. By designing smaller more personal nursing homes with tactile qualities and a connection to nature we could as designers help its residents by removing anxiety at a time of great change in moving into a “home”.

To say a home means “the place where one lives permanently, especially as a member of a family or household”. These nursing homes are a community living together and we feel it only right that the interiors shift to be more like a home too.

Bolon Studio

noda architects 2020

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