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Convergence Point: Senior Living Design Inspires Acute Care

By Pamela Tabar | April 25, 2018



Set within a burgeoning “senior living city” of more than 110,000 residents over age 55 (projected to grow to 140,000 in the next five years), The Villages Regional Hospital in The Villages, Fla., is one of the nation’s few hospitals built specifically for an older patient population. Its unique demographics—and the design elements employed there—provide deep lessons for the industry on what environment works best to support care delivery to seniors. For example, light sources were selected that reduce glare and hotspots that challenge the aging eye, while acoustical features are integrated throughout to combat noise and better accomodate those experiencing hearing loss.

While The Villages is an unusual market, most hospitals around the country are seeing a rapid uptick in senior patients, especially in their emergency departments (EDs). Thanks to the baby boomer generation, the surge in the over-65 population won’t begin to taper off until at least 2029, according to the U.S. Census. Faced with this reality, healthcare organizations are grappling with how to create acute care spaces that answer the personal and clinical needs of older adults. As such, they’re turning to the senior living industry for lessons and finding that meeting the needs of seniors is no longer just about ADA compliance or safety.

“Hospitals need to pay careful attention to what design firms are doing in the senior living market and bring those lessons into the acute care setting, including addressing issues of patient vision or hearing and seniors’ ultra-sensitivity to noise,” says Sam Burnette, principal at ESa(Earl Swensson Associates; Nashville, Tenn.), which served as the architect on The Villages project. Seniors also communicate and respond differently to the care environment, which requires specialized solutions, adds Jane Rohde, founder and president of JSR Associates(Catonsville, Md.) and an expert in senior care and design.

By considering such characteristics and looking at spaces through the eyes of an older patient, owners and their project teams can better identify appropriate, senior-friendly designs that will ensure hospital settings are primed for baby boomers’ arrival. From the front door to the inpatient unit, experts offer solutions to consider.

The arrival
From the overall layout of a campus to the design of the main entrance, there are many ways to reduce seniors’ stress before they’ve entered the hospital. Wayfinding must begin in the parking lot, Burnette says, with parking areas clearly indicating where ADA-compliant ramps are located. Lot signage should be easy to read at night and include clear navigation that complements hospital-provided patient information.

To ease the way for those who use assistive devices, stairs between parking lots and adjacent buildings should be avoided and benches should be located along sidewalks to provide opportunities for rest.

A human encounter at the building entry is ideal, too, says Tom Bauman, interior designer at ESa who worked on The Villages project. “Good signage is important, but seniors really want a person to greet them and be available to answer questions or help them navigate to the right location.” A greeter station provides an immediate opportunity for patients to ask questions, but it’s important to keep the footprint to a minimum and not to set it behind an imposing glass panel, which can prohibit the up-close-and-personal approach that seniors desire, he adds.

Waiting
Senior acute care is often a uniquely “family affair,” where family members who are part of the older person’s care team will expect to be involved in the process, says Jason Harper, principal at Perkins Eastman (New York). “Senior-friendly settings need social and family support to be built into the environment.” For example, he says, waiting rooms should feel as homelike as possible with special focus on seating, lighting, and acoustics. “Hospitals can feel alien and add to an older patient’s disorientation and agitation.”

Seating is another crucial element to consider. Bauman suggests arranging seats in small clusters and avoiding “bus station seating” in long rows, which can impede communication for those with hearing loss. Chairs should be comfortable yet have sturdy arms to accommodate elderly visitors who may have difficulty with the deep cushions of a couch.

To answer the critical need for access to daylight to reduce stress, aid in healing, and maintain circadian rhythm, designers at The Villages added visitor day rooms at the ends of department corridors that feature abundant windows. If natural light isn’t available, table lamps, wall sconces or cove lighting in warm hues can help brighten spaces. Indirect, evenly distributed lighting is best, says Amy Carpenter, senior designer and vice president at SFCS(Blue Bell, Pa.). “It’s very important to avoid track lighting or anything where you can see the light source, because the glare can be very painful to older eyes that take longer to adjust to different light levels. Severe glare can even cause agitation in those with
dementia.”

Emergency department
The majority of hospital visits for those over the age of 65 originate in the ED, making it one of the most important spaces to adapt to become more senior friendly. Everything from a squeaky gurney wheel to beeping medical devices can agitate an already nervous senior patient, so reducing noise should be a priority. Acoustic ceiling tiles are an obvious choice to help reduce sound levels, and while many hospitals have ditched overhead paging systems in favor of muted or personalized communication devices, moving the staff’s primary traffic pathways away from seating areas can also help reduce noise levels, Bauman says.

Inpatient units
Within patient rooms and bathrooms, ease of movement is crucial for the senior patient, so flooring transitions should be minimal to avoid tripping hazards due to canes, IV poles, walkers, or unsteady feet. Lowering or removing the step-over barrier in showers is also ideal. Contrasting the colors of the toilet and bathroom wall also can help an older patient with orientation, since older eyes have trouble discerning between similar colored surfaces—especially white, which is the least discernable color for aging eyes. “The ADA-compliant grab bars may be in place, but lack of contrast in finishes and materials isn’t a good idea for seniors,” says Peter Bohan, principal at Perspectus Architecture (Cleveland).

Safety isn’t the only concern when it comes to design details, Rohde adds: “Older patients can react in adverse ways to bold patterns, especially if dementia is in the mix.” Dark, solid blocks of flooring can appear as “holes” to a person with cognitive issues, while high-gloss or shiny tiles can look like water. Age-friendly flooring choices include smooth transitions and tonal patterns. Color and themes are also effective solutions to assist with navigation to specific care departments.

Sharing cross-team lessons
As acute care environments grapple with changing patient demographics, the more cross-team learning between senior living design and acute care design, the better, designers say. “It’s about looking back and forth across the acute care and senior living spectrums and comparing the valuable notes,” Bohan says. “With the demographic shift in the aging population, hospitals are being forced to think harder about what it takes to engage geriatric patients from a design standpoint. The needs of the older patient demographic are at the focus of the design process more than ever.”

Pamela Tabar is a senior care writer based in Medina, Ohio. She can be reached at ptabar.writer@gmail.com.

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