QUALITY IMPROVEMENT
Design as an Ever Present ‘Care’ Partner By Sara Wildberger
diminishing users’ capabilities. “One’s life space is present 24 hours a
E
day,” noted environmental gerontologist Lorraine Hiatt, Ph.D. “Disregarding its im- pact on elders increases potential for ‘excess disability’.” Dr. Hiatt has culled insights from more
than 45 years of onsite work with more than 800 U.S. providers and their design teams. Data include resident/staffi ng descriptions, participatory planning models, and fi ndings on what users are and could be “doing.” Traditionally, design has spotlighted lobbies, dining, adaptive
appearances:
equipment, and gardens. Why? Hiatt noted that design was intended to satisfy families during marketing. The residential appeal of “small homes” for licensed nursing and memory enhancement has inspired family approval and some increases in Activities of Daily Living (ADLs) capability.
Ideas that make a diff erence Dr. Hiatt noted that we should refocus on optimizing capabilities and redirect staffi ng costs to caregiving outcome priorities. What if we could optimize movement, streamline ADLs, and optimize memory? Might we better attract and retain staff by reallocating time spent accommodating environmental shortcomings to features energizing caregiv- ing and capabilities? Hiatt highlighted the following examples: • Movement: Shorten distances and im- prove clearances. Incorporate realistic upper body and wrist fl exibility in hand- rail design and placement. Select seating created for safely supporting “sit-to- stand,” minimizing assists and lifts.
nvironments designated “for the aged” are fundamental to experi- ences of aging—either boosting or
• Devices: Incorporate actual dimensions and clearances of mobility aids and carts in circulation, dining, bedrooms, bio-care and storage.
• Sensory effi ciency: Reduce stress and sources of confusion by managing back- ground noise, glare, and shadow. Ad- dress realistic grasp and hand strength in selecting hardware and stabilizing furnishings to further improve balance and reduce falls.
• Bathrooms and bio-care: Bathrooms are where most falls and related injuries oc- cur for both older adults and caregivers. Solutions? Incorporate resident and staff assistance variations in bathroom/shower layouts, fi xtures, and hardware; add space for safer staff assists at toilets and showers. Test fl oorplans and full-scale mock-ups with users. Also, improve water manage- ment through shower confi guration, drain location, and a “dry dock” area for staff .
• Social variety in daily life: Variations in group size encourage spontaneity, op- tions for expression, and familiar peer- to-peer interactions.
• Realistic seating area to optimize socializa- tion: Allocate square footage in response to comfortable seating, ease of movement, and participation. Example: typically, 32 NSF per person seated at tables at 50 per- cent wheelchair accommodation.
• Memory enhancement and judgment: Redirect inadvertent exiting; secure perimeters; incorporate high-tech build- ing and wearable devices and low-tech (trained service dogs). Encourage alter- natives to sedentary living, freedom of movement, and “energy outlets” within manageable perimeters.
• Staffi ng convenience: Match layouts to actual numbers of staff present (refl ecting
40 SENIOR LIVING EXECUTIVE NOVEMBER/DECEMBER 2018
Thought Leader Profi le
Lorraine G. Hiatt, Ph.D.
Environmental Gerontologist The Center for Health Design
acuity, shift variations, and convenient supply points). In health and memory care, design for staff to anticipate, see, hear, “get there fast,” both day and night. Plan for multi-tasking (e.g. expediting responses to individuals and groups.) In- corporate discrete “stealth” support ser- vice paths and equipment scaled to living areas. Incorporate supplies and equip- ment in safe, right-sized, convenient cart alcoves or cupboards.
Regulatory implications: From perceived obstacles to successful precedents According to Hiatt, the Americans with Disabilities Act (ADA) guidelines, though adopted in many jurisdictions for housing, community services, and licensed senior care, overlook safety and functionality of older adults and staff . Of greatest concern, she said, are ADA bathroom and shower criteria and illustrations. Authorities having jurisdiction over specifi c projects vary in their experience and response to “exceed- ing” ADA guidelines, referring to ADA’s “Equivalent Facilitation” paragraph. Inno- vation has required formal documentation and successful precedents are multiplying (to date, 26 identifi ed projects in 20 states.) (See
fgiguidelines.org.)
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