My husband and I visit New York City once or twice a year. Love the shows, love the atmosphere, love the restaurants, can’t wait to get home to my relatively bucolic environment.
The last time we went I reserved a boutique hotel within a block of the show we ticketed. We arrived around midnight, the lobby was packed, and it was dark. I don’t mean midnight-dark, I mean the walls were painted high-gloss black, the carpet was gray, there were a couple of LCD lights over the dimly-lit pool table (in front of the reception desk!), and while every color was muted, every sound was amplified.
It’s not just the city that doesn’t sleep. I kept wondering how someone with low-vision could function here. Or find the elevator, also painted black like the walls. Most (normal) hotels are various levels of beige, meant to convey comfort and calm. This one conveyed edgy-hipster-frenzy.
In the last 20 years, new and remodeled Assisted Living (AL) and Skilled Nursing Facility (SNF) designs have looked similar to luxury hotels in order to appeal to the consumer. Wait, not the actual user of their services, but more likely their 55 year old daughter, who may be carrying some guilt and maybe hoping mom won’t be too angry if it looks like a hotel.
But at what risk? Mom is likely to still experience all the mourning stages that come with the sudden loss of 80 years of independence:
Denial: When am I going home?
Anger: I hate you! I don’t belong here!
Bargaining: I’ll eat lunch now, but I’m leaving right after.
Depression: I can’t eat, what’s the point. Nobody comes to see me anyway.
Acceptance: …………….maybe, but it’s still a wait-and-see.
So we design our facilities to look like something she’s seen before to get her to “acceptance” faster. Something that was fun and exciting. But how do our well-meaning design flaws accelerate and accentuate dementia and exacerbate problems associated with low vision?
Recently McKnight’s sponsored a webinar in which an occupational therapist mentioned a client with dementia who kept falling when trying to get into bed. She was independently ambulatory, but the dark afghan placed on her bed looked like a hole that she tried to avoid, resulting in falls. They removed the dark blanket, and no more falls.
People with dementia often have difficulty with 3D vision. Their eyes may be working, but their brains process the information differently. I have had patients who were progressing well, walking with a cane down the hall, and stopping abruptly when the floor covering changed from (beige) carpet to (blue) linoleum. They stopped because it looked like a cliff.
According to Pinnacle Architecture, high contrast design is essential in planning living environments for people with dementia or low vision. A shiny floor can be blinding. A patterned carpet looks like a minefield. A white toilet seat on a white toilet on a white floor is unfindable for someone with low vision.
How many times have we seen clients reach for the (beige) handrail on the (beige) wall and are unable to locate it? How many times has your client with dementia missed the potatoes on their plate because the china is also potato-colored?
Low contrast may be the best bet for areas you want hidden: storage closets, med rooms, key code panels. Utilize high contrast for areas that you want your clients to see. You want them to find the chairs in the dining room? Make sure they’re a different color than the carpet. A beige chair at a beige table on a beige carpet is asking for falls. Get some navy chairs to contrast with the rest.
Changing your design to meet the needs of your clients and keeping them safe may be a hard-sell when the daughter comes for the tour. But explaining the reasoning behind the choices may make her more confident in your ability to keep mom safe. And it will give them both the comfort they need for this major challenge in their lives.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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