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.
Fleeing the 'Social Desert'
"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."
Designers See the Light
Keeping elderly people mobile is essential to maintaining a high quality of life -- and mobility and good design go hand in hand, experts say.
"One thing that happens as people age is that mobility is not what it was," says environmental architect Elizabeth Brawley.
"The more immobile people are, the more afraid they are of falling," she says. "Shiny floors, whether or not they are slick, appear to be. And when older people see them, they will sit down and not go on walking any more."
Gerontologists have found that lack of exercise and poor vision are the two biggest contributors to falls among elderly people.
Design experts contend appropriate lighting is essential to help prevent falls. Elderly people need significantly more light, they say -- up to five times as much as younger people in order to see the same thing. High levels of indirect light, Brawley says, are critical to maximizing the vision of seniors.
"Lighting is a huge issue for those of us over 50," laments Brawley, president of Design Concepts Unlimited in Sausalito, Calif.
"It creeps up on you that you're not seeing as well as you used to," she says. "Everybody's on a budget, and if you can only make one or two changes, lighting can give you the biggest bang for your buck. But it really makes sense to work with somebody that understands lighting and understands aging. You can spend an immense amount of money and come out no better. You're just not likely to figure it out on your own."
Graying America Making Its Voice Heard
Architects nationwide have noticed an increasing interest in -- and market for -- senior-specific design and have attributed it in large part to the aging baby boomer population.
"But ADA [Americans with Disabilities Act] made us a lot more aware, too," says Don Able, an architect and senior associate at BSA Design in Indianapolis. "It is something we have to think about with every job."
Able says that subtle ADA mandates may go unnoticed by many. But federally mandated clearances on either side of a door handle make corridors wider, and limits for the rise and run make stairways less steep, although they take up more space, he says.
While certain enhancements are dictated by ADA, they do not always lead to an improved quality of life for seniors, Brawley contends. For example, ADA requires handrails, something Brawley says is rarely helpful for the elderly.
"The No. 1 chronic condition elderly people suffer from is arthritis, which primarily strikes the hands and the knees. But if it strikes the hands, chances are they don't have much grip strength and they can't grasp the little round handrails. They are essentially left with little support," she explains.
And handrails aren't just there for show, she points out.
"They weren't put there because they're pretty. If it doesn't work, it doesn't matter how nice it looks," says Brawley, who switched from high-end residential design to designing for seniors 15 years ago when her mother was diagnosed with Alzheimer's disease.
Cohen admits that there has been "quite a bit of movement" toward incorporating more progressive design elements in assisted-living facilities. However, the "rate of innovation has reached a plateau," he says, largely due to scarce resources.
"The high end will always be a pleasant place to be, with very good food and environment, but the main problem is that people of modest means can't pay $3,000 or 4,000 a month," says Cohen, co-director of the Institute on Aging and the Environment at the University of Wisconsin, in Madison.
The 16,000 nursing homes built 20-30 years ago look and behave the way they were built, Cohen says -- usually with long corridors and fluorescent lights. But they're not unredeemable. Even such old-fashioned environments can benefit from small changes such as better lighting fixtures, new furniture, and use of indirect lighting, all of which can improve appearance and minimize an institutional image.
Just Because You Like It Doesn't Mean Mom or Dad Will
While a pleasant appearance is important, Brawley is concerned that assisted-living facilities and other senior facilities are oftentimes not designed with the elderly person's best interests in mind.
"At assisted-living facilities it is a younger population that is purchasing or contracting for care," says Brawley, and all too often the designers and marketers end up trying to appeal to the younger group, the ones controlling the purse strings.
"You may want hardwood floors in your house, but they may not be the best thing for mom," Brawley points out. "Contemporary furniture may be misplaced in a place for 70- and 80-year-olds who cannot get in and out of it. And while you may like purple and want your whole house purple, older people see colors differently and purple may look like brown to your mom. Try walking around with yellow cellophane [in front of your eyes] and see what colors look like."
Brawley acknowledges this oversight is not intentional, but warns the children of elderly parents not to apply their own standards while residence-shopping, but to think of the needs of the person who will actually live there.
Of course, those adult children will be elderly one day, as well, and in the market for appropriate living quarters of their own. Their current search for -- and dissatisfaction with -- senior housing will "make them experienced consumers and demanding residents, predicts aging expert Landry.
Demanding -- and numerous.
The elderly are the fastest-growing segment of the American population. According to a U.S. Census Bureau study, by the year 2050 one in every five Americans will be retired, and one in 20 people will be 85 or older.
And they are all going to have to live somewhere, says Landry. "There is a national crisis in the making if we don't come up with better ways and communities for people to age," he warns.
