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How interior design affects resident behavior

March 1, 2012
by Carol Reitter Elia, ASID, IIDA, LEED AP
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A case study of a memory support addition
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For three years, Mrs. Jones* stayed in her room and rarely ventured into the halls. A cognitively impaired assisted living resident, Mrs. Jones was resolute that she was fine in her room where she felt safe. However, since her facility underwent a new addition and renovation project, Mrs. Jones is always moving about the halls, often bantering with staff and other residents where previously she was considered socially withdrawn. Why? What changed? 

We read about it, plan for it and we make every effort as designers to create functional yet aesthetic interiors, but do our choices as architects and interior designers truly affect the way residents behave? 

At Waverly Heights, Gladwyne, Pa., the impetus for a multimillion-dollar renovation of its healthcare center was to promote a supportive homelike interior for residents. Devonshire, a licensed personal care home at Waverly, was designed to support individuals experiencing memory loss and help them maintain a stimulating, meaningful lifestyle. Devonshire offers a homelike environment, providing a full day of group programs and activities. Assistance with daily tasks such as bathing, dressing or taking medication is provided along with round-the-clock professional nursing care.

EFFECTIVE CORRIDORS

Mrs. Jones represents residents who fear walking the corridors of their health center. Often times under-lit, long and foreboding, these spaces can be a deterrent for a resident’s participation in activities, leading to social withdrawal and depression. 

In a senior living environment we must be aware that we are not designing institutional corridors, but residential hallways. The new hallway design at Waverly offers intermittent places to sit and rest along the way to dining, physical therapy or other daily activities. The racetrack design allows for mobility on the floor. Residents can stroll through activity spaces and dining areas without becoming agitated because of a dead end, as was the case in the former Waverly model.

The carpet’s monochromatic color and simple pattern is subtle and incorporates soft green tones, a color reminiscent of plants and nature, growth and life. Contrasting complementary red tones were softened to a soft salmon color, which enhances the contrast between walls and flooring.

Natural light fills these halls, as windows in activity spaces along the building’s perimeter infuse the spaces with light. And it was essential that all activity and dining areas be equipped with warm lighting on dimmers. As the DON put it, “This much brighter interior adds to their [residents] demeanor—and they can see!”

FLEXIBLE ACTIVITY AREAS

Upon admission, a therapeutic recreation staff member meets with new residents to determine their leisure interests and to orient them to the various programs offered. Residents have responded so well that attendance frequently is more than anticipated and chairs need to be moved from other areas to accommodate. But the design of Devonshire provides this flexibility. All seating and tables are equipped with heavy-duty carpet glides that provide for easy movement on a cut pile carpet. Spaces are reconfigured constantly.

The physical plan supports programming that provides ongoing and diverse activities focusing on the residents’ strengths. Because of the addition of many smaller activity rooms throughout Devonshire, residents can choose from a variety of activities including current events, exercise, trivia, educational programs, musical entertainment, sing-a-longs, card and board games and watching old movies. 

Also centrally located is a covered porch where residents partake in horticulture and relax outdoors. Once phase II of this project is complete, the outdoor experience will be even more enhanced with an elevator to the first-floor secure gardens. 

Activity areas with televisions are always a challenge, especially with the introduction of gaming consoles such as the Wii. As the systems offer the added benefit of exercise opportunities and outlets for lighthearted competition, they also require more space for the participants as well as observers. Waverly opted to move the TV from its originally located living room to a remote activity area which allowed for more spectators. Residents hear the action and are intrigued. Often it is the social banter that encourages residents to join in, even if they had no intention to do so. 

Waverly has observed significant improvement in residents’ mood, behavior and interpersonal skills both during and after group activities. Some short-term residents have even joined in with the residents in memory support because of the encouraging and engaging music and other multisensory stimuli provided throughout the day.

STAFF CONNECTION

Where once a “mother ship” nurses’ station had commanded the halls of the health center, now smaller care bases are centrally located for staff to work discreetly but with views of halls, dining and activities. Behind the chart area is a dedicated med room that is hidden from residents. While there are distinct work areas for staff, they also serve as a retreat for hall activities while still providing visual access to residents through residential windows. The spaces were deliberately intended to be small so that staff is encouraged to participate in activities outside these rooms, spend time charting on tables located in front of the care base and participate in the personalization of care. It is common to see staff playing cards and participating in bingo. 

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