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A Caregiver's Perspective on Long-Term Care Settings

Illustration of a nurse.
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Skilled nursing, assisted living and advanced care settings are some of the most complex living environments to successfully design. Critical design aspects for these environments are overlooked, under researched, and unfortunately, often disregarded. This results in a facility where older adults spend the last years of their life, rather than a vibrant community for our loved ones. Understanding how older adults live, sleep, eat, socialize and receive care are not only critical aspects to the design of these environments, but they are the foundation to an excellent community for the aging.

Each year, many designers and architects enter the work force with little to no experience in designing long-term care settings. A portion of these young professionals may have loved ones in these communities, and some may even gain employment at design firms that specialize in the design of long-term care settings, but their experience ends there. Most of these designers don’t have first-hand experience as a caregiver. Caregivers in the form of nurses, nurse aides, activity and therapy personnel, visiting doctors, administrators and administrative staff not only work in these environments, but also provide care around the clock. They have intimate knowledge and understanding of how those under their care experience their living spaces. If designers had the opportunity to work as caregivers, imagine how thoughtful and functional their design could be. They would have knowledge of the large and small aspects that have a positive impact not only on the residents, but also their family members and caregivers. This insight would excite design for the aging and would be a forerunner to the thoughtful design and construction of exceptional communities for older adults. It would establish a new benchmark for resident experience and how they live, sleep, socialize and receive care.

Resident sleeping rooms are the most complex spaces within long-term care communities. Depending on the required level of care, the rooms need to be adaptable, maneuverable and livable. These rooms are not only a care space, but also serve as the resident’s home and should be reminiscent of one. They also need to accommodate visiting family members and friends. The same space needs to be an environment where a resident can sleep. Many of us have separate rooms and spaces for dining, working, living, socializing and sleeping. Residents in long-term care environments have many, if not most, of these functions in one room. Successful caregivers are sensitive to these demands and understand how to adapt the spaces to accommodate the resident’s needs and desires.

Caregivers are familiar with the ease or difficulty of moving a resident within their room. Residents who can walk on their own may be able to traverse a room with ease but they are the minority as residents begin to age. Staff assistance requires more space since there are now two people walking in the same direction; walkers or canes pose yet another impediment to the two-person walk to the bathroom. Wheelchairs present another imposing obstacle, due to the need to place them adjacent to a bed for a transfer from bed to wheelchair. A wide path to the bathroom is needed for a wheelchair, and then enough space within the bathroom to accommodate a parked wheelchair and a transfer to the toilet. Standing lift devices are large and occasionally hard to maneuver within small spaces. Whole body lifts are larger devices yet, and require the assistance of two staff members. The resident room can feel cluttered and uncomfortable with the introduction of more bodies, equipment and devices.

Social areas for dining, living and activities are another important part of an excellent senior community. These are the spaces that encourage interaction and foster relationships between residents, family members and staff. Residents who require more assistance with mobility present a challenge to the efficacy of these social spaces. As residents gather, so do their wheelchairs, walkers and transferring devices. Caregivers see the benefits of small pocket storage rooms, but are also aware some residents will want to keep their mobility device close by in case they want to excuse themselves. This presents an interesting challenge to both caregivers and designers. If one resident wants to keep their walker nearby, other residents will want it nearby as well. Residents with dementia find security in the knowledge of having their walkers nearby as the device becomes a symbol of their independence. They may never use it without aid from the staff but having it nearby reduces their anxiety. The designer needs to provide multiple access points to these spaces and provide multiple storage areas for wheelchairs and walkers.

In traditional long-term care communities, most of the staff functions were centralized to keep them organized. Not only has this become an outdated design approach, the caregiver is aware of the efficiency in the decentralization of staff functions. Multiple options for storage and workrooms throughout the resident areas allow the caregiver to spend more time with the resident, respond more quickly to the residents’ needs and to perform care in more private areas of the community.

In designing a long-term care facility, designers need to become not only the resident and family member, but also the caregiver. We must understand how they work and care for their residents. We also need to understand how the caregiver maintains an atmosphere where residents can live comfortably, sleep peacefully, socialize actively and receive thorough and gentle care. These ideals are not the goal; they are the foundation to understanding how to design a successful community for older adults. They are the theoretical cornerstones of a thoughtful and excellent community.

I became a certified nursing assistant in my second year of pursuing my Bachelors of Science in Architectural Studies after volunteering at the local long-term care community. I enjoyed every minute of it. I was happy to provide my residents excellent care and a great place to live, sleep and socialize with other residents. I enjoyed getting to know them and learning how to be sensitive to family members in times of mourning, change and aging. I slowly critiqued the communities I worked in and learned what worked well and what didn’t from a design perspective. I began to understand how even the smallest design decisions had a large impact on the quality of life for residents. After three years of working as a certified nursing assistant on all shifts, I started my pursuit and later, my career as an architect. I am now, enthusiastically participating in the design and realization of excellent communities for aging adults.

With these experiences, I get to collaborate with other designers and planners in our Living Environments Studio at Eppstein Uhen Architects (EUA), working to improve and enhance the experience of residents, families and staff. The personal experiences we bring to the EUA design process vary considerably but they’re all for the benefit of the projects we work on. I like to think that the residents I cared for and the staff I worked with would love the opportunity to experience the projects we design.

Charles Robertson, RA, CDT
Project Manager

Charlie is a Project Manager in the Living Environments Studio and a great mentor at EUA. He brings a perspective and a well-informed knowledge of Senior Living Environments as he is a former Certified Nursing Assistant.

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