Bringing Comfort Home
Senior Care Canada, Second Quarter 2016
by Lindesy Patten
It's a matter of great debate as to whether care facilities are truly able to recreate a feeling of house or home.
How far should care facilities go to be home-like and what does that even mean?
Unfortunately, 'home' and 'home-like' carries so many different meanings for people that a care facility is at an immediate disadvantage, one that can be mitigated with careful planning.
According to Irka Dyczok, founder of Designfarm Inc, an interior design firm in Toronto, "home is all about being authentic."
"We could all probably say there's no place like home. When we think of home, it's the absolute best place to be. Your home is your place of belonging. That's where you are cared and loved."
Homes have a sense of history and family, Dyczok notes, "There's a certain joy and pleasure and pride one has in their home."
Home may mean different things to different people but as Dyczok comments, "The main words about home are comfort and well-being."
"It should allow people to be intimate when they want to be intimate," she notes, and "social when they feel like being social and anything in between."
There's a definite feeling of belonging that accompanies one's thoughts of home.
So why is it important for a facility to have a home-like atmosphere?
When asked this question, Rudy Friesen, founder of ft3, an architect and design firm based in Winnipeg, stated bluntly, "You only have to look at the headlines. Is it any wonder that residents of LTC facilities, especially those with dementia, become confused, agitated, and even aggressive in institutional facilities?"
"Consider the physical environment with its long 'horridors', nurses stations, large common areas, rooms furnished the same and sometimes shared," states Friesen.
Also, "consider the rigid schedules, hierarchical staffing structures and use of suppressants. It's an abnormal way of living; human warehousing, really."
Having a homey environment is crucial to the well-being of both the residents and staff.
"In most cases, the LTC facility will be the final home for the residents, so it should be as comfortable and home-like as possible," Friesen remarks.
"It should feel like a home and operate like a home. It should recreate a familiar atmosphere, especially for those with dementia."
Maintaining this environment is also good for the facility.
"Studies show that residents in home-like facilities are much calmer and healthier," Friesen comments.
"The use of suppressants is significantly less, and the staff and families are much happier. At the same time, capital costs and operating costs are lower. In fact, several organizations that operate both household and traditional LTC facilities report lower operating costs at their household facilities."
Even changes like family-style dining in households results in healthier residents, reduced use of drugs and laxatives, and lower food costs, states Friesen.
It ultimately comes down to what is best for the resident.
"When residents come into these facilities, they are very vulnerable," Dyczok points out, "they've had to give up their real home."
"What we try to do is set up an atmosphere that makes people feel safe and secure."
It's that security that can comfort a resident.
"Often when a resident says 'I want to go home' they are not necessarily referring to the house they came from, but rather to a state of being that was comfortable, ordered, and fundamentally orienting," critical components in putting residents at ease, remarks Margaret Calkins and John Marsden in their article "Home is Where the Heart Is: Designing Home-Like Settings."
A great way to do this is by listening to the residents and their family.
"Compatibility is important. That's why it's necessary to understand and integrate the different interests, preferences, routines, former lifestyles and even the culture of the residents," Friesen states.
Dyczok agrees, "Respect the individual and their families. This is imperative."
"For a facility to be truly like home, it must accommodate different patterns, by providing options to residents to personalize their space in different ways." (Calkins, 2000)
"In most homes, different rooms serves different purposes and are designed to look very different. Seldom does a person have the same chair in the dining room as in their bedroom and their living room," notes Calkins, "institutions on the other hand, are marked by a uniformity of both furniture and design. This approach to interior design will not make a place feel like home." (Calkins, 2000)
And as Friesen states, "There's no place in a home-like environment for institutional elements such as nurses stations, med carts, staff offices, etc."
His solution is about changing the way you work.
"The tasks normally carried out at the nurses station can be done in a variety of ways and locations. Workspaces can be decentralized to smaller desks or alcoves or incorporated into kitchen areas," he comments.
"Nurses can fill out their paperwork at the dining room table or in a small staff office outside the household. These offices can also be used for shift change meetings, med preparation, storing files, and private conversations. Meds can be stored in locked cupboards located in an office or even in the resident's room. So you design for discreteness," Friesen says.
Small changes can make all the difference.
"Many facilities find it useful to have a separate, enclosed work area for staff to do paperwork and charting. These spaces are often not visible to the unit, so staff is not expected to be doing paperwork and supervising residents." (Calkins, 2000)
This eliminates the nurses station as the focal point which can lead to residents sitting around the station all day.
Other changes like having enclosed laundry hampers in each room can eliminate the need for large carts sitting in the hallway all morning.
Bringing a sense of the familiar to residents is key to feeling at home, Friesen notes.
Because of this, "every design decision is made within this context. Whether it's the room arrangements, the furniture, the millwork, or the colours and finishes, we ask ourselves 'What are they like in a home?' Fireplaces and screen porches add to a feeling of home. So does space for photos and personal mementos."
However, it's not just the aesthetics that matter, as Dyczok points out. "It's also about the performance of the material."
"We make sensible choices that last a long time both in their appearance and performance."
It can seem daunting to a facility to try to impose design changes, especially when dealing with issues of budget.
Dyczok remarks that professionals don't need to be hired for a big commitment, "The perception in the senior care industry is that they still feel like they can't afford designers."
"They can't {not} afford designers," she says emphatically, "we can work magic even if it's just a small consultation."
Creating and maintaining a home-like atmosphere for your residents may require some out of the box thinking but it ultimately comes down to what works best for you.
"The communities that are true to themselves do the best in terms of making things feel like home." Dyczok says.
"The actual facility should not even feel like it's designed at all," comments Dyczok. "If it's overdesigned, if it's perfect, it looks like nobody lives there."
And now, she notes, "The challenge is for people to really raise the bar as to what it means to {be} home."
After all, isn't that what we all really want? To live comfortably in our home and in a life-giving community?
Works Cited
Calkins, Margaret P. and John P Marsden. "Home is where the heart is: designing home-like settings" Alzheimer's Care Quarterly (ACQ), Volume 1, Issue 1, 2000. Aspen Publishers, Inc., http://www.ideasinstitute.org/article_021103_c.asp Accessed: February 15, 2016.
How far should care facilities go to be home-like and what does that even mean?
Unfortunately, 'home' and 'home-like' carries so many different meanings for people that a care facility is at an immediate disadvantage, one that can be mitigated with careful planning.
According to Irka Dyczok, founder of Designfarm Inc, an interior design firm in Toronto, "home is all about being authentic."
"We could all probably say there's no place like home. When we think of home, it's the absolute best place to be. Your home is your place of belonging. That's where you are cared and loved."
Homes have a sense of history and family, Dyczok notes, "There's a certain joy and pleasure and pride one has in their home."
Home may mean different things to different people but as Dyczok comments, "The main words about home are comfort and well-being."
"It should allow people to be intimate when they want to be intimate," she notes, and "social when they feel like being social and anything in between."
There's a definite feeling of belonging that accompanies one's thoughts of home.
So why is it important for a facility to have a home-like atmosphere?
When asked this question, Rudy Friesen, founder of ft3, an architect and design firm based in Winnipeg, stated bluntly, "You only have to look at the headlines. Is it any wonder that residents of LTC facilities, especially those with dementia, become confused, agitated, and even aggressive in institutional facilities?"
"Consider the physical environment with its long 'horridors', nurses stations, large common areas, rooms furnished the same and sometimes shared," states Friesen.
Also, "consider the rigid schedules, hierarchical staffing structures and use of suppressants. It's an abnormal way of living; human warehousing, really."
Having a homey environment is crucial to the well-being of both the residents and staff.
"In most cases, the LTC facility will be the final home for the residents, so it should be as comfortable and home-like as possible," Friesen remarks.
"It should feel like a home and operate like a home. It should recreate a familiar atmosphere, especially for those with dementia."
Maintaining this environment is also good for the facility.
"Studies show that residents in home-like facilities are much calmer and healthier," Friesen comments.
"The use of suppressants is significantly less, and the staff and families are much happier. At the same time, capital costs and operating costs are lower. In fact, several organizations that operate both household and traditional LTC facilities report lower operating costs at their household facilities."
Even changes like family-style dining in households results in healthier residents, reduced use of drugs and laxatives, and lower food costs, states Friesen.
It ultimately comes down to what is best for the resident.
"When residents come into these facilities, they are very vulnerable," Dyczok points out, "they've had to give up their real home."
"What we try to do is set up an atmosphere that makes people feel safe and secure."
It's that security that can comfort a resident.
"Often when a resident says 'I want to go home' they are not necessarily referring to the house they came from, but rather to a state of being that was comfortable, ordered, and fundamentally orienting," critical components in putting residents at ease, remarks Margaret Calkins and John Marsden in their article "Home is Where the Heart Is: Designing Home-Like Settings."
A great way to do this is by listening to the residents and their family.
"Compatibility is important. That's why it's necessary to understand and integrate the different interests, preferences, routines, former lifestyles and even the culture of the residents," Friesen states.
Dyczok agrees, "Respect the individual and their families. This is imperative."
"For a facility to be truly like home, it must accommodate different patterns, by providing options to residents to personalize their space in different ways." (Calkins, 2000)
"In most homes, different rooms serves different purposes and are designed to look very different. Seldom does a person have the same chair in the dining room as in their bedroom and their living room," notes Calkins, "institutions on the other hand, are marked by a uniformity of both furniture and design. This approach to interior design will not make a place feel like home." (Calkins, 2000)
And as Friesen states, "There's no place in a home-like environment for institutional elements such as nurses stations, med carts, staff offices, etc."
His solution is about changing the way you work.
"The tasks normally carried out at the nurses station can be done in a variety of ways and locations. Workspaces can be decentralized to smaller desks or alcoves or incorporated into kitchen areas," he comments.
"Nurses can fill out their paperwork at the dining room table or in a small staff office outside the household. These offices can also be used for shift change meetings, med preparation, storing files, and private conversations. Meds can be stored in locked cupboards located in an office or even in the resident's room. So you design for discreteness," Friesen says.
Small changes can make all the difference.
"Many facilities find it useful to have a separate, enclosed work area for staff to do paperwork and charting. These spaces are often not visible to the unit, so staff is not expected to be doing paperwork and supervising residents." (Calkins, 2000)
This eliminates the nurses station as the focal point which can lead to residents sitting around the station all day.
Other changes like having enclosed laundry hampers in each room can eliminate the need for large carts sitting in the hallway all morning.
Bringing a sense of the familiar to residents is key to feeling at home, Friesen notes.
Because of this, "every design decision is made within this context. Whether it's the room arrangements, the furniture, the millwork, or the colours and finishes, we ask ourselves 'What are they like in a home?' Fireplaces and screen porches add to a feeling of home. So does space for photos and personal mementos."
However, it's not just the aesthetics that matter, as Dyczok points out. "It's also about the performance of the material."
"We make sensible choices that last a long time both in their appearance and performance."
It can seem daunting to a facility to try to impose design changes, especially when dealing with issues of budget.
Dyczok remarks that professionals don't need to be hired for a big commitment, "The perception in the senior care industry is that they still feel like they can't afford designers."
"They can't {not} afford designers," she says emphatically, "we can work magic even if it's just a small consultation."
Creating and maintaining a home-like atmosphere for your residents may require some out of the box thinking but it ultimately comes down to what works best for you.
"The communities that are true to themselves do the best in terms of making things feel like home." Dyczok says.
"The actual facility should not even feel like it's designed at all," comments Dyczok. "If it's overdesigned, if it's perfect, it looks like nobody lives there."
And now, she notes, "The challenge is for people to really raise the bar as to what it means to {be} home."
After all, isn't that what we all really want? To live comfortably in our home and in a life-giving community?
Works Cited
Calkins, Margaret P. and John P Marsden. "Home is where the heart is: designing home-like settings" Alzheimer's Care Quarterly (ACQ), Volume 1, Issue 1, 2000. Aspen Publishers, Inc., http://www.ideasinstitute.org/article_021103_c.asp Accessed: February 15, 2016.