Design Feature: 'Home' stretch
Trying to create the ever-evolving 'homelike' environment has taught long-term care operators a lot over the years."There's no place like home" may have landed Dorothy back in Kansas, but sometimes it's a phrase that lands long-term care providers in hot water.
A "homelike" environment becomes one of the most prized goals when potential residents start shopping for a facility.
Operators have been trying to emphasize the "homelike" feel for 20 or more years. And presentation is a powerful element in any marketing effort.
So what has worked well with regard to the homelike push? What hasn't? How have times changed?
"A designer can definitely create the aesthetic environment the client is looking for, but the key thing is that he or she must observe all the regulations and codes," cautioned Paula Bradley, senior corporate designer for Graham-Field Health Products, Atlanta. "We can't just say, 'Oooh, let's make this look pretty.' The bottom line is function combined with aesthetics."
She said she's seen the homelike push for 25 years. What's still a design problem after all that time? Providers not buying contract furnishings, meaning materials that may look residential but don't hold up well, don't serve frail seniors well or can't be cleaned easily enough.
On the other hand, Bradley is thrilled with the expansion in fabric textures available.
"When they first started with the homelike environment, fabrics were a big issue," she explained. "Crypton has changed furnishings so much over the past few years. There was vinyl on all the chairs and sofas – that's all you had."
Crypton's impervious fabrics have grown from just printed cloth to include wovens, velvet, suede and other finishes, a fact that numerous experts raved about in interviews for this article.
Ironically, Crypton started in healthcare and is now spreading to other, more mainstream markets. Many furnishings and design elements travel the opposite direction.
"Crypton gives us a wide variety of fabrics to coordinate and gives us a real homelike setting. I think that's a major plus for us," said Judy Girod, director of interior design at Lothrop Associates, Valhalla, NY.
A 33-year veteran of the business and a fellow in the American Society of Interior Designers, Girod urges the use of framed mirrors instead of "just a wall-to-wall plate thing" and says safely designed bathrooms, high light levels and clear printed patterns are other "musts."
She feels the hardest place to create a pure "at-home" feel is the resident room itself.
"Oftentimes you're dealing with bedside tables that need to be a certain height, and certainly the bedding is difficult," she said. "The facility wants something that's terribly washable and easily maintainable, and it has to meet code. It's all about finding the right mix. And you don't want to end up with a typical hospital bed light."
Manufacturers have delivered the marketplace an increasing array of newer options lately, notes Jeff Hertz, president of Hertz Supply, Schnecksville, PA.
"Traditionally, the beds in the resident room have been a difficult furnishing to make more homelike. Beds are now offered with assist rails and casters that disappear," he explained, added there are also "concealed motors and telescoping legs that match the wood finish of the bed."
Hertz's company has evolved to make both the nursing staff and the resident important when choosing beds: "This is a change from the past in which the needs of the nursing staff usually prevailed in this decision," he said.
Furniture manufacturers are preparing for future demand but don't know when and how it will hit. Kwalu, for example, has developed a modern line of furnishings, but they haven't "taken off" yet, said Roy Krummeck, the firm's marketing manager.
"Nursing homes are still purchasing older, Queen Anne finishes," he said. "That's the age of their residents."
Some vendors have blended older and newer styles in an attempt to catch an earlier selling wave.
Veteran interior designer Vickee Vollmer advises that more projects need a single point person making decisions.
"I've found it gets out of hand with so many patterns and so many hands in the pot. You might not get a cohesive environment. You need somebody to be the major decision maker," said Vollmer, senior interior designer with Invacare Continuing Care Group, St. Louis. "Usually, it's an administrator or owner."
Other top challenges? Surfaces. "You can introduce wood grain patterns and that helps bring resilience, but you still have glare problems and noise problems," she noted.
Sometimes the building layout is the biggest problem.
"A lot of them are landlocked and you're trying to create something in a model that hasn't worked for 30 years – the floor plan is just horrible," she says. "Now, architects are trying to be creative with that space, with pods and neighborhoods."
Vollmer said design has come "full circle" in some ways over the last 30 years: "We're back to almost where we were when it was a rooming house. A lot of residential furniture, colors and styles – how they were before we got into all that function. What's cool now is function's being addressed, as well as the aesthetics."
Her list of "must" tips includes remembering "detail," such as wood framing around windows, trim and baseboard. They can differentiate.
"And don't take away the artwork. It is very important. People run out of money and say they'll get it later," she said. "It's very crucial to completing your facility and relating to people there.
"Maintenance is probably the No. 1 key thing in a long-term care facility," she added. "If you don't have a good maintenance program, selections don't mean a thing. They'll look tired and dirty just a few months down the road."
Flooring experts Mark Taylor, director of healthcare markets for Shaw Industries, Dalton, GA, and Jennie Selden, vice president of healthcare and education at Bentley Prince Street, City of Industry, CA, agreed wholeheartedly.
"Unfortunately, maintenance in facilities isn't what it needs to be. As a result of that, a lot of facilities have given up on soft surfaces or carpet for hard surfaces," said Selden.
Another problem Taylor said he's encountered is "when people think of carpet in their home, they think of 'plush and thick,'" which would cause unacceptable fall risks.
The model of care has a direct impact on good design elements, says Melissa Young, senior interior designer for Sunrise Medical's LTC Division, Stevens Point, WI.
"One of the most successful design strategies has been the evolution of the household concept for overall facility design. This philosophy embraces the fact that residents are more interactive and less combative (Alzheimer's and dementia residents) when they have a household they are familiar with," Young said. "This means designing households of seven to 12 resident rooms, generally a mix of private and semi-private rooms, placed around a dining-kitchen-lounge-living area."
Adds Alan Nickel, Sunrise product manager for furnishings: "The emergence of assisted living facilities has had a positive impact on the recent changes and acceptance of a more residential look and feel within a skilled nursing facility. Ten years ago, furniture was very institutional looking, lacking style, warmth and sophistication. Today, the market is dictating" them, plus more.
Items that soften the environment and are the right size or scale, such as window treatments, foliage and artwork are "pivotal" to facility design, along with larger "focal" pieces, Young added.
"The trick is, from day 1 to make it a 'residence,' while keeping in mind it's still a commercial facility that has to be durable, withstand commercial usage, and sometimes not-so-fun commercial uses," reminds Beth Kuzbek, business development manager for Eldercare Interiors, a division of Direct Supply, Milwaukee.
But durable doesn't have to mean bulky, she added. For example, the industry has adopted a smaller scale in furniture, she said, dropping down from heavy, unmanageable resident chairs of years ago.
Kuzbek also feels standardization does not work well, having been involved with a hospital group that bought a nursing home chain and then tried to convert the facilities into a "cookie-cutter design."
"There are regional differences: What they like in the Northeast is not necessarily what they like in the Southeast or Midwest," she said.
The essence of "homelike," just as with love, lies largely in the eye of the beholder.
When aiming for a "home-like" feel, one shouldn't think only of interiors. There's a whole other world "out" there.
Expanded uses of patios, gardens and other outdoor areas can bring a new sense of appeal to a facility. But it must be done with the right touch, experts advise, or an excellent opportunity might be wasted.
"Before, someone might have had a patio used by just visitors and staff, but now they're really started to tailor outdoor areas for residents," noted Denise Kallas, the owner of Freedom Outdoor Furniture in Overland Park, KS.
Kallas' company specializes in products – dining tables, chairs, glider seats, planters and more – that are made from recycled plastic.
"Some of the most popular items are the gliders. They get a really good response from residents," Kallas said. "We hear they get used a lot because (residents) remember having one when they were younger, or an aunt who had one on a back porch or something like that."
Another popular item is planters, she said. They allow residents to cultivate personal miniature gardens – flower, vegetable or both. Kallas said providers note that the planters concept works well on several levels, design and therapeutic among them.
Relatively lightweight (except for the planters, which are heavier on purpose), Freedom Outdoor's items typically don't require special finishes, cushions or other features that add to a staff's workload, Kallas said.
"It hits a lot of hot buttons with staff," she noted. "One remark we consistently hear is, 'We finally have a patio area people use.'"
Color their world
Books have been written about the use of color in design. But some planners unfortunately still aren't getting the picture, experts in nursing home design say.
The nicest, homiest, most appropriate furnishings can go for naught if a poor color scheme is used. That's why making sure you get proper advice and consultation before picking colors and patterns can save a lot of headaches and expense.
"I remember 'the mauving of America,'" said Beth Kuzbek, business development manager for ElderCare Interiors, a division of Direct Supply, Milwaukee. "But you have to understand the reasons mauve was so popular. In healthcare, it's a very good color to put around residents. "
Kuzbek has studied color theory and design formally.
"There have been a lot of mistakes in design through the years," she said. "I was always taught yellow is a bad healthcare color. Psychologically, while you may think yellow is nice and cheery, it makes grown-ups cranky and babies cry. It's just a trigger."
Yellow also "makes the skin look jaundiced," Kuzbek added. "They used to call it the 'sickness' color. It can actually create movement in the bowels and gastric juices. Is that really the color you want to put in a facility?"
It's a concept carpet designers are familiar with, too, said Mark Taylor, director of healthcare markets for Shaw Industries, Dalton, GA.
"As the elderly eye ages, it sees things more in the yellow part of the color spectrum. Many times, our colorists and stylists wear yellow-tinted glasses when they're designing to see differently. It can take on a totally different contrast," Taylor explained. "That's why we stay away from bright reds and orange-citrus colors: because of the yellowing of the eye — they see that as extremely dull."
That's not to say those colors – or any color – can't be used in moderation, Kuzbek explained.
"You can still use yellow, but you don't surround people with it," she said. "Use it for accents or borders, but you don't surround them with it."