Aged Care Design

Advances in healthcare is resulting in a demographic shift in our Australian population as our life expectancy is increasing. Our ageing population are presented with a range of challenge and opportunities where factors in home, design, environment and practicality are necessary to ensure ongoing quality of life. Longer lives aren’t always healthier, of course. Ageing brings its own challenges as our faculties declined, and conditions such as dementia cause further complications. “Nearly 1 in 10 Australians aged 65 and older have dementia. 11,000 deaths per year are due to dementia, it is the second largest cause of death in Australia.”i Understanding the problems posed by ageing, both with and without dementia, is vital to help older people feel content and fulfilled in later life. It is important to focus on the needs of older people in their daily environment as the simplest, most direct way to enhance their quality of life. “47% of people in permanent residential aged area had depression – it was the most commonly diagnosed mental health condition.”ii Although enabling the elderly to stay in their own homes is preferable by far, declining health often makes this impractical. If resident welfare is the prime objective of any aged care facility, there are different aspects of this goal. ‘Ageing well’ usually means retaining physical and intellectual abilities while remaining socially active despite the advancing years. ‘Wellbeing’ refers to state of mind, suggesting positive emotions like happiness or contentment and the absence of depression or anxiety. Good, inclusive design can change the lives of care-home residents, as well as facility staff and the families who visit. After considering the consequences of the ageing process for residents, the additional challenges posed by dementia, and the needs of the caregivers, support staff and resident families, several major factors emerge that influence the design of a care home.

When planning the layout of a care-home, the building will ideally help them compensate for the effects of ageing and the onset of dementia. To achieve these aims, the following factors deserve consideration: 

•Providing a comfortable, reassuring environment without the institutional feel of a hospital or hotel is vital. 

•There should be no sense of stigma about the need for support or treatment. 

•The new surroundings will include a personal space for residents and offer some privacy. 

•Layout, lighting, acoustics and decor will help them deal with the consequences of ageing and conditions like dementia, enabling residents to remain as independent as possible.

Ultimately, the wellbeing of care-home residents is closely linked to that of the people who look after them. Happy, healthy staff working in surroundings designed to help them do their job are able to provide better care. The carer’s role is physically demanding, however, and often involves lifting or moving patients, which puts the carer at risk of muscular strain and injury. Hygiene is another important factor in care-homes, so making cleaning and disinfection as easy as possible contributes to resident care as well as lightening the workload of support staff. It is important for the facility to be well maintained as well as be catered to suit both the residents and the staff. A strong consideration is the aged care bathroom design that must be accustomed to for both residential and staff needs, involving installation of appropriate flooring to access barefoot and with shoes. 

The benefits of considering staff in the design process: 

• Retention 

• Happier staff 

• Creates a friendly environment

Sight becomes impaired with age, so older eyes need two to three times more light than young ones to see properly. Visual contrasts must be heightened, too. This has important consequences for lighting levels in care homes. Variations in light cause sight problems for the elderly, so uniform lighting is recommended along with the avoidance of shadow and darker areas, which can be unsettling to people with dementia. Design can help here by harnessing natural reflected or overhead light. Sunlight holds several benefits for care-home residents, helping to regulate the daily patterns of sleeping and waking often disturbed in old age. Exposure to daylight lifts people’s moods, so architects and designers should think carefully about the size and positioning of windows and skylights.

When natural light is not available, artificial lighting can compensate, but mixing the two should be avoided. The floor’s ability to reflect daylight with all its advantages is another factor to consider. Flooring in agedcare facilities should ideally have a light reflectance value (LRV) between 20 and 40% to avoid glare, something to which older eyes are sensitive.

Interior spaces that are easy and safe to move around are essential to keeping older people mobile. Distances should be carefully planned, while pleasantly tactile handrails and resting points will give residents the confidence to explore. Easily recognisable objects, artworks or figurative symbols contribute to wayfinding more effectively than colour-coded zones and stimulate interest along the way. Smooth, matt, slipresistant floors that are free from obstacles and comfortable to walk or roll on will reduce the risk of falls or accidents while encouraging movement. Flooring products with a low rolling resistance make it easier for residents and staff to navigate with walkers, trolleys or beds, removing any potential frustration of having wheels dig into flooring and making mobility harder. Understanding that an older person with or without dementia will probably perceive their surroundings differently is a good starting point for the design of living environments. Good design can help enormously in making it easier to interpret and navigate a building in safety, and the use of colour and contrast can be used in different ways to assist in this. Contrast is key to vision. Low contrast is a useful way of making flooring safer, by keeping a single colour over different floor finished. It is the sudden contrast which can make floor levels look uneven, like a step, and this can cause hesitation and unsteadiness, which can lead to falls. High, or sudden contrast, is useful for things like stairs.

“70% of Australians aged over 70 have some hearing loss. This increases to around 85% in residential aged care.”vii As hearing is linked to balance this also leads to a great risk of falls either through loss of balance or through an increase in disorientation as a result of an overstimulating an noisy environment. Good acoustic insulation will minimise disturbance from the often-noisy care home environment. Good acoustic management in a facility can also greatly impact the quality of sleep that residents are able to achieve. Those with dementia respond on a sensory level rather than intellectually. Particular sounds have been identified as providing helpful stimulation, including sounds of nature or familiar music or sounds that help facilitate recall. Someone with hearing difficulties needs a quiet environment to communicate with people around them. “People with dementia can lose the ability to interpret what they hear accurately, which can contribute to anxiety.”viii Tiling reflects sound waves but flexible flooring such as carpets or acoustic backed vinyls absorbs them, reducing noise pollution. It’s important to consider the needs of different spaces, acoustic protection between rooms, throughout corridors and in open plan areas all present opportunities to select products to reduce noise.

The interior design strategy needs to promote safety and mobility whilst enabling environments to maintain a resident’s independence and create a warm, non-clinical and residential feel. Providing the ultimate living arrangement provides the opportunity for the elderly to be a greater part of our community.

STIMULATING COGNITIVE FUNCTION 

Whether living with dementia or not, older people benefit from positive mental and sensory stimulation. Memory forms an important part of self-awareness and identity, helping us define ourselves and our worth as people. Senses like sight, smell and touch enable us to interpret our surroundings and interact with them. Walking stimulates our cognitive performance, slowing the age-related decline of our mental faculties. Thoughtfully designed care-home interiors will support residents by using décor and memorabilia to trigger memories and positive associations from the past. Similarly, the view through a window, the smell of cooking from the kitchen or the inclusion of pleasantly tactile fabrics can stimulate the senses and evoke sensations of wellbeing as part of the daily routine.

STIMULATION AND SELF 

Involvement in group activities and interaction with others bring multiple benefits to carehome residents. The more this mental and motor stimulation can be tailored to individual needs, the greater its effect. Physical and intellectual interactions are useful forms of stimulation, such as gentle exercise or having a conversation. Arranging activity spaces for those unwilling or unable to join in so they can oversee what the participants are doing ensures overall positive consequence and collaboration. Activities such as gardening promote exposure to sunlight and an openair environment, allowing opportunity for family members and close friends to be involved. Specialised areas equipped for multisensory stimulation are appearing in care homes with staff monitoring the amount of stimulation for resident’s specific circumstances.

After considering the major challenges caused by ageing, such as sensory impairment and the onset of dementia, Tarkett’s involvement in the care-home sector enables us to develop floor and wall-covering solutions whose aesthetic design and technical performance enhance the quality of life for care-home residents and the staff looking after them. With a wide range of products covering different areas and needs, we work with Architects and designers, one surface at a time to make sure every area of flooring in a facility is fit for purpose. This includes the specific needs highlighted in this document as well as performance characteristics such as longevity, ease of cleaning, VOC levels and the ease of maintaining the visual appeal of each facility for years. Overall, designing a space with the care, cleaning and maintenance teams in mind can only have a positive impact on the quality of their work and, consequently, on the lives of the residents in their charge.