When considering the aging process and anticipating our long-term quality of life, how many people look forward to the idea of living in a nursing home?  While the original nursing homes were places where small groups of people resided, the 1960s brought a more institutionalized model into existence.  That increasingly unappealing model dominated the marketplace for decades.

Today, there is a movement to appeal to residents and their families and dissipate the apprehension about nursing homes and other long-term care alternatives.  Healthcare professionals and designers alike are working to continuously improve the model in order to return to a more home-like atmosphere.  This movement is focused on “culture change.”

“When we created long term care in this country, we called them nursing homes,” says Susan Morse, executive director of Three Crowns Park in Evanston, Illinois.  “We focused on nursing and forgot about home. Culture change is about bringing ‘home’ into nursing homes.”

“Culture change” is concentrating on a social model versus a clinical model in creating a supportive living environment for seniors. The goal is to create an environment where residents are empowered and have the freedom to make decisions regarding their daily routine.  Caregivers will work with the residents and understand their needs so they can make decisions that best suit them. Routines are created based on the residents’ wishes and are kept informal like regular home life.  The physical environment is residential in nature and not institutional.

Groups or programs such as the Eden Alternative, Green House, Pioneer Network, Planetree Organization and Wellspring have emerged to address culture change and have developed specific models or plans for success.  While there are many important components to take into consideration, the physical environment plays a key role in establishing the right atmosphere.

According to Morse, “to truly embrace culture change, it is critical for the physical environment to support and complement the essential elements of a household.  The design principles of a household, when put in place both visually and functionally, embrace person-centered care. They send a clear message to all who live, work, and visit the household that this is a home.”

At AG, we identify the key culturally accepted components of a homelike setting as:

  • A place to sleep and keep your belongings – a bedroom to personalize
  • A place for personal hygiene – a bathroom
  • A place to cook and sustain yourself – a kitchen
  • A place to socialize – a living room

Regardless of square footage, these are the components that make up a home.  The challenge is how to maintain a homelike environment when serving 10 or 15 residents as well as how to expand the occupancy or size of the facility while still maintaining the home setting.

We find the critical components in developing the plan to be:

  • The scale of the spaces
  • The interconnectivity of spaces
  • The use of natural light

When working on new construction there is more freedom to define the spaces and create different patterns.  However, when working with an existing building the challenge is carving the needed space out appropriately within the framework of the existing floor plan.  The size of the spaces is important, as is the scale. The size of the rooms should be similar to those we have become familiar with in a typical single family home.

In addition, the interconnectivity of spaces and the ability to lead the residents is important.  The idea is to distinguish between “stop and go” spaces. A “stop” space, like a small parlor or family room, is one where you can focus on an activity, a conversation or just observe the world and people around you.  Access to natural light through an abundance of exterior windows further helps to enhance the cozy feel we have become accustomed to in the favorite rooms in our homes.

At the same time the needs of the operational staff must be addressed.  It is crucial to maintain this warm home appeal for the residents, while providing caregivers quick visual access to keep an eye on all of the people.  This concept can be creatively balanced to be mutually inclusive rather than exclusive.

AG is committed to the long-term exploration of design solutions that support culture change.  The goal is to create “rampant normalcy,” while facilitating a smooth transition in lifestyle and independence from the home to the new environment.  Our staff continues to refer to a typical home and examine how to translate key components of the house into a large facility.  For example, a typical home has an individual entry.  How can the plan be developed to simulate the entry with details such as the door, doorbell, porch, light and mailbox?  These are some of the clear identifiable features of a home.  This is normal life.  The question is how to replicate these distinct characteristics in a nursing home setting.

While the “culture change” movement has made great strides in the evolution of the nursing home, there is still more research to collect and options to explore.  When striving for culture change, Morse believes, “it is important to educate ourselves and engage employees and residents in the growing vision.”  She further advises, “When implementing change, do not underestimate the impact even small changes can have.  Resistance to change is normal, but do not let it become a roadblock.”

With increasingly larger portions of the population reaching the “senior” designation, there is no doubt that the “culture” of senior facilities and communities will be changed!

(Below are Before and After images of how culture change was implemented at Three Crowns Park in Evanston, IL – Visit the Our Work section of the website to learn more about this Repositioned CCRC project.)