Spiritual and end-of-life care go hand-in-hand for many long-term care residents. One aim of many providers is to offer spaces that allow their residents and guests to experience meaningful moments in reverence and style.
The approach to creative worship/meditation areas has undergone a major shift to increase resident and family comfort.
“We have seen a discernible trend toward modernizing the design and furnishings of worship areas,” says Jim McLain, General Manager of the C/S Eldercare Interiors Division of Construction Specialties. “Today’s senior adults have largely grown up in a world where tradition and more conservative values have defined their worship experience, including the design of their places of worship. Many are coming from ‘high church’ religious backgrounds where stone cathedrals, stained glass and candles once defined their worship environments.”
Yet others may be coming from less traditional religious backgrounds where the liturgy and the facility played a lesser role in shaping their worship experience, McLain adds.
“While some might view the absence of a cross in a sanctuary space as being problematic and view it as a step toward secularization, others might view stained glass, candles and icons as unnecessary distractions to their true worship experience,” he says.
“The diversity and proliferation of religious expressions have also multiplied in recent decades, making it even more challenging to identify and design around all the needs and preferences of these various groups, including those of Jewish, Islamic, Buddhist, Hindu and other backgrounds. The challenge is not secularizing the worship facility but making it an equal-opportunity sanctuary.”
McLain has personal experience in the design of long-term care facilities and in the use of long-term care spaces for worship. He graduated from Trinity Evangelical Divinity School with a Master of Arts in Christian Studies degree in 2010. He currently volunteers as a lay pastor in the Senior Adult Ministry of Elmbrook Church in Brookfield, WI.
“The facilities I have ministered at have succeeded in making the worship areas beautiful, comfortable and even reverential for various faiths by using more neutral themes, such as avoiding stained glass or placing religious artifacts in the worship facility.
“This allows each minister to customize their worship space by bringing in temporary articles for their services. By neutralizing the décor, the worship facility can remain inviting and accessible for all residents,” he says.
In his travels, McLain has come across several general issues that affect his services. Noise in the facility can distract and impair congregants. Seemingly innocuous noise from the heating and air conditioning system can disrupt the sound quality.
He suggests buffers like movable walls when needed, and equipment that
provides the necessary sound amplification.
Lighting also is vitally important. It is critical that lights are bright enough for the worshippers to read and safely navigate in the worship space. Adjustable lighting is typically preferred and can enhance the experience.
Some clergy have adopted the use of projectors to enlarge the text of hymns, songs and readings for the worshippers.
McLain also likes movable chairs that can be configured into rows, allowing access for walkers and wheelchairs. That arrangement allows for the addition of seating during the holiday seasons, when worship attendance can peak among residents and include many family and friends.
Proper Exits
Hospice areas at long-term care facilities is needed to accommodate the patient, family and friends in a meaningful environment.
“Those (LTC facilities) that do (have a hospice area) look for segregated areas with separate common areas and access to the outdoors, preferably directly from the rooms,” says Mike Milligan, president at JMM Architects. The Ohio firm has extensive experience with eldercare facilities.
“There is more furniture in the rooms for visitors and overnight guests than in traditional nursing home rooms,” Milligan explains.
The hospice experience in LTC facilities focuses on a home-like setting, says Craig Fukushima, a partner of The Fox Group in Upland, CA. The management consulting firm serves the healthcare organizations and lists providers among its clients.
“The movement is toward the residential feel, and I think this is part of the overall and long-term care movement toward aging in place,” he says.
“This boomer population is very different from their parents. They’re used to having their way and are used to having a menu from which they can choose. They’re used to having an informed choice now with the internet.
“[In] every single survey that you can get your hands on, boomers, pretty much everyone, say the same thing. Where would you want to spend … the last days of your life? Ninety, ninety-five percent say at home.”
One-fourth of hospice deaths occurred in a nursing home or residential facility in 2011, according to a survey conducted by the National Hospice and Palliative Care Organization (NHPCO). Long-term care facilities provide an alternative to the hospital or a standalone hospice.
As hospice use continues to grow, Fukushima looks to a change in the thought process of dying in America.
“We have a healthcare system that basically puts people in boxes,” he says. “It’s not meant to bring the services to a person’s home. When somebody’s really sick, we tend to put them in that box. So when you take a look at hospices, it’s no surprise that they’ve moved away from a hospital setting to a residential feel, to feel like you’re going to be in your own home.
“This client that we’re working with now, what they want to do is retool an institutional setting and make it more hospice home-like. What they want to do is take away the nursing station and put in a living room with couches, with lighting, with carpeting to make it feel more like somebody’s home.”
However, facilities should use a thoughtful approach to flooring, says Cathy Lipton, M.D., the senior medical director at Evercare Georgia, a care coordination provider for those with long-term or advanced illnesses.
“Be careful with rugs, because you want it to be quiet, but it can be much harder to move a wheelchair across,” Lipton says.
Other homelike touches, such as flowers, sound good but “the smell can be overpowering for someone who is sick or nauseated,” she says.
Two things hospice areas can do successfully: have a quiet play area for children, so that adults can say their goodbyes, and to “have enough tissues by the bedside and a comfortable seating area for family and friends.”
Traditionally, Fukishima notes, skilled nursing facilities excel at their interaction with hospice patients.
“It is about the spirituality and holistic approach to a patient,” Fukushima says. “At the end stages of our life, it’s not about sticking you with a needle. It’s not about cutting you open. Whatever you believe, (it’s) about getting you comfortable with that and treating the whole person.”
Fukushima feels LTC workers are able to balance medicine with a homelike environment.
“They understand that it’s a medical model, yes, but it’s in a residential setting — because it’s their home and they’re going to be there 24/7, many months —perhaps many years.
For a long-term care worker, it’s not just about the patient, it’s about everybody that comes to visit. That patient’s world includes more than just the patient. That world includes the family and friends and how you deal with that.”
Judi Lund Person, vice president of Compliance and Regulatory Leadership for NHPCO, agrees.
“A lot of our hospice staff are teaching LTC workers new skills that they can learn in caring for patients at the end of life. So they are very essential,” she says.
“And for the most part, we have patients who depend on LTC workers to serve as their substitute family since they’re in an LTC setting and not their own home.”
From the July 01, 2013 Issue of McKnight's Long-Term Care News
