Resident Safety First in Senior Furnishings
Resident Safety First in Senior Furnishings
Furnishings are some of the many items that will be bought and replaced multiple times during the lifetime of a long-term care facility. In fact, most organizations will make some type of furnishings purchase every year, even if it's not a facility-wide overhaul.
For administrators charged with evaluating and recommending furniture purchases, today's marketplace offers a sometimes dizzying assortment of options: Vinyl or carpet flooring? Rocker or recliner? Dining-room seats with or without arms? Blue, white or amber nightlights?
Interior designers, researchers who study aging and providers who have recently undertaken major furnishings acquisitions weigh in on the most important factors to consider in long-term care: durability, clean-ability, aesthetic appeal, resident comfort and support — and perhaps most important, safety.
“Providing furniture a resident feels safe in is key,” says Lynn Vogeltanz, studio team leader for Direct Supply Aptura. “A chair will not be used if a person feels they cannot get in and out of it safely.”
Talk about an array of options: When it comes to flooring alone, facilities must choose between vinyl composition tile, sheet vinyl, carpet — which has been found to be associated with fewer fall injuries than vinyl floors — or one of several “underlayment” options. These try to combine the durability and water-resistance of vinyl with the warmth and comfort of carpet, says Cheryl Christino, a product line manager with Forbo Flooring.
Further complicating the flooring evaluation and selection process are concerns about the effect of different carpet patterns and flooring transitions on older adults with poor eyesight, depth perception or visual acuity. Research suggests that high-contrast carpet patterns — think large dots or diagonals in contrasting colors — have been associated with more stumbling, handrail reaching, veering and pausing than carpeting with low-color contrast in more natural colors. In addition, eliminating transition strips — from hard flooring surfaces in the hallway or bathroom to carpeting in the resident's room, for example — can help reduce tripping.
“Both the patients and the operational staff need to be comfortable when walking on the floor. But at the same time, the floor must be functional, easily maintained and provide good sound absorption and a smooth, comfortable surface in the event any falls do occur,” Christino says.
Furniture for the frail
Providers looking to make a furniture acquisition should start the selection process with their most frail resident in mind, no matter the level of housing and care for whom the piece is chosen.
“The scale of the furniture is really important — making sure that the seat heights, arm heights and depths are appropriate,” says Rachel Driscoll, interior designer for Direct Supply Aptura.
“The firmness of the cushions also must allow for people to get in and out easily,” she says.
A 2010 monograph examining senior living, published by the National Council of Architectural Registration Boards (NCARB), recommends facilities select chairs with a seat height between 18 and 19 inches, a seat depth of 20 inches maximum and an arm height of 25 to 26 inches. The report also suggests that the arms extend to the front of the seat and be durable enough to support the weight of residents who lean on them in order to stand or sit unassisted, and that cushions be firm enough that the bottom of the seat does not sink much lower than the height of the occupant's knee.
Providers also should consider the clean-ability and maintenance of furniture finishes and upholstery and its ability to sustain wear and tear, repel stains and prevent the passage of moisture through the cushion, says Mark Siciliano, marketing director at Howard Miller Company.
“The current trend in upholstery is Crypton fabrics that look and feel ‘normal,' with barrier protection for resident dignity,” Siciliano says.
In addition to stain and moisture protection, these fabrics also resist mildew, odors and bacteria — great for infection control, another safety consideration. They also can be an attractive alternative to stiff and sticky vinyl upholstery.
As for seating in resident rooms and lounge areas, studies have shown that rocking chairs have a positive effect on the well-being of older adults, yet many safety concerns have arisen with the standard rocking chair. It can be a trip hazard, and there is the possibility of rocking over someone's foot if the piece is not a glider. NCARB recommends a stable rocker or flexible back chair as a way to provide the benefits of the rocking motion, but eliminate the risk of the chair tipping forward when the resident uses the arms for support.
Since space is often limited in long-term care facilities, innovative products that maximize the use of space are also valuable. In addition, selecting pieces that improve a resident's functionality can have a positive effect on quality of life, says Ingrid Fraley of Design Services Inc., which specializes in designing environments for older adults. During a renovation project at Maplewood Park Place, a continuing care retirement community in Bethesda, MD, Fraley installed revolving nightstands in resident rooms and found that it gave residents a greater sense of control by providing bedside access to everything they might need.
“Maybe it's that box of chocolates that no longer has to be stored in a chest of drawers that you can't reach because you can't get out of your bed,” Fraley says. “If you can improve accessibility to things that might be important to a bedridden resident, it can make all the difference in the world.”
Among other benefits, it can increase safety by decreasing transitions in and out of bed, particularly at night.
Research suggests that adults age 65 and older need about three times more light than adults in their 20s. By the time they hit 85, five times more light may be needed, says Eunice Noell-Waggoner, an interior designer and president of the Center of Design for an Aging Society. When increasing the amount of light, however, it's also important to eliminate glare by shielding the brightness of a light source with a diffuser or shade. Noell-Waggoner recommends that providers add table and floor lamps to resident rooms and lounge areas, as well as replace over-the-bed lights with continuous light valances to increase lighting levels and also provide a more contemporary appearance.
“Valances provide more flexibility for bed placement and double or triple the light level, depending upon the length of the fixture,” she says. She also suggests that providers install nightlights that use amber-colored bulbs, which have been shown to disturb sleep less than white, blue or green nightlights.
In lounge areas, she says that a combination of light is best, noting that LED or fluorescent torch lamps may be a good addition if replacing the built-in lighting isn't an option.
In addition to needing more light, adults also lose contrast sensitivity — the ability to distinguish between the color of surfaces and materials — as they age. Those with Alzheimer's disease experience a greater loss of this ability than others. To help visually impaired residents detect level changes, such as a step or the edge of a table, or to locate a handrail or door, Noell-Waggoner recommends contrasting furnishings to flooring and wall colors.
“If the handrail and the wall are of nearly the same light reflectance values, older adults can't see them, and that's an important detail for their independence and safety,” she explains.
The important test run
After navigating your way through the myriad of options when it comes to furnishing your facility, experienced providers also stress the importance of testing the new product or design with a wide sample of residents.
During the resident room redesign at Maplewood, for example, skilled nursing administrator Barbara Harry spent weeks collecting input from residents and their families and working with Fraley's team to select a kidney-shaped overbed table that fit around the body and allowed residents to sit closer to the table. The team installed it in the facility's model room and then had the first resident use it.
They quickly learned that the kidney shape didn't get to the center of the bed, and in order for residents to use the table over the bed, they had to shift to the right. They also found that the table didn't work well with wheelchairs — the base kept getting caught on the wheelchair's gears.
It was a teachable moment: Harry's advice to others in the midst of selecting any piece of furniture: Ask your end-users to try it out before you buy.
“You may feel like you have it perfectly designed, but it's the actual experience of using the item that gives the absolute best feedback you can get,” she says.