May 7, 2001 -- We all have an internalized, TV-movie-of-the-week image of the typical senior center -- long, bleak corridors, dim lighting, drab colors, morose residents. Not a very pretty picture -- but it's one that is rapidly changing as a coalition of architects, designers, healthcare providers, and senior citizens lead a nationwide effort to transform these "facilities" into "homes.
A growing body of research tells us that the physical environment in which a patient receives care can play a vital role in how quickly she recovers and how well she does later. This message is being heard loud and clear at senior centers across the country, where bright colors and progressive architectural design elements are being incorporated to improve residents' quality of life.
Hannah Kalil is 83 years old, and lives by herself in upstate New York. She has aides who help with her caregiving throughout the day. But the responsibility of managing her finances, health care -- both mental and physical -- and long-term living situation falls to one person: her daughter -- and my mother -- Eleanor.
It's almost a full-time job. Making sure my grandmother is happy and not feeling lonely means daily visits. Her never-ending stream of medical issues means weekly -- if not more frequent...
"Twenty years ago, conventional nursing homes looked like hospitals -- based on the medical model," says Uriel Cohen, ArchD, professor of architecture at the University of Wisconsin, in Madison. "They kept residents medicated and warm, but they were essentially designed like a hospital with little special activity except the celebration of holidays. They were not really a place to live in. They were a place for treatment."
Ten years ago in his book Holding on to Home: Designing Environments for People with Dementia, Cohen recommended that caregiving spaces should focus on smaller groups of residents. Architecturally this is achieved by moving away from long corridors, which Cohen describes as "social deserts," toward cluster neighborhoods of 10-14 rooms grouped around a social space or a living room, a kitchen, and access to a small patio or garden.
That way, for instance, instead of residents being awakened at 7 a.m. and herded into a large dining room, they can wake up at different times of the day and get their own breakfast.
"It allows for more control, more flexibility, and more participation in the activities of daily living," he explains.
"Almost universally in this country we see nursing homes as a place where people are strapped to wheelchairs in corridors looking half-comatose, says Roger Landry, MD, MPH, an expert on aging and a consultant on the development of senior facilities. He believes the biggest challenge to incorporating more progressive design elements into senior living environments is overcoming our own biases.
"Since only 30% of successful aging is due to genetics, and 70% is due to lifestyle, which is under our control, the architectural template for building assisted-living centers will radically change," says Landry. "They will have more common areas for social engagement, wellness centers that have resistance training so that people stay independent longer, a cyber café to stay engaged, walking paths, and a pool, which is absolutely necessary for low-impact aerobic exercise."