A Walk in Their Shoes, a Window into Their Life

One of our firm’s primary concentrations is on Senior Housing.  A growing trend in CCRC’s (Continuing Care Retirement Communities) is to provide dedicated memory support units for personal care or skilled nursing.  In fact, one of the first buildings I worked on at RLPS during my internship was a new building that contained both under one roof, just a few miles from our office.  Coincidentally, my grandmother wound up living there for several years.  You can imagine, through all my visits with her, by me alone or with my family, my eye did not stop looking at her surroundings critically.  Whether a room was too small, a ceiling was a little low or a paint color questioned, I continued to critique our work.

Having a frail relative live in one of the spaces you’ve helped create changes how you look at the building.  It quickly changes from “how does this detail work for the resident” to “how does this detail work for grandma?”  In a surreal course of events, I have now had three family members enter senior housing facilities I was directly involved with the design.  My grandfather spent his last seven days in a Hospice facility we designed, my grandmother spent time in both rehab and memory care in another building that I served as project architect.  Even today as I type, my mother-in-law is receiving treatment at a rehab facility due to a stroke.  I can look on a room size or detail and recall the now invisible signs of compromise.  I can literally see through the walls or ceilings and observe the duct crossings under structural members that produce a less than ideal ceiling height.  Was there anything I could have done differently?  Perhaps.  Perhaps not.

But even as I walk through the building with a family member who is now the "resident", there is another personal experience that can help affect design for those dealing with dementia and memory loss.  About a year ago, our office provided some educational training that some may think unusual for a designer in which to participate.  A non-profit organization called Second Wind Dreams has a Virtual Dementia Tour program that helps people who care those dealing with dementia feel the symptoms of dementia first hand.  Most of the designers in our office participated in the program which was held, coincidentally, in one of the same building one of my grandparents had lived.  So it had even more emotional impact on me I think.

The program is fairly simple.  The course-taker is given some of the symptoms of a dementia resident would have and must navigate a typical resident room and complete several everyday tasks.  Easy, right?  Stay tuned.

The course-taker first places inserts in their shoes that gives the fell of pins and needles on the bottom of the feet.  This affects your mobility and provides a nagging discomfort with which you need to overcome.

Then, you have gloves to wear that both desensitize your sense of touch and impair your dexterity.

Next, you get a set of headphones to wear.  And while you hope for some Pink Floyd, what you hear is cars honking, static like when tuning a radio, voices, and other confusing noises - picture walking through a haunted fun house.

And lastly, some cool goggles.  Instead of a rose colored lens, the world is flushed with a yellow fog and I think they were even more provided with some other vision impairing characterizes, but alas, I had to remove my own glasses in order to fit the goggles on my head, so my eyes were at an even harsher disadvantage.

Once outfitted with our gear, the provider gave us several tasks to perform in the room.  The ability to hear was impacted so I am sure I asked a little too loudly for them to repeat the list for me.  Inside the room, we had to first find the articles we were told to use in the tasks.  It was really hard for me to see, and some level of reading and/or writing was required.  I also had to see colors to find a book and move it, and to find a certain sweater and fold it.  I truly felt that there was not enough light in the room, so I kept carrying things to the open window so I could see the task item.  I didn’t even think to look for light switches to turn them on.

An obstacle course, or rather, a skilled care corridor.  Try this with the goggles.

The tingling in the feet was a bit distracting, but the headphones really were.  Several times very loud noises came from nowhere and startled you.  Plus, I am pretty sure I didn’t hear any of the tasks 100% accurately.  I believe I was looking for a green sweater that didn’t exist where I was supposed to be looking for a pink one.  The gloves on our hands made it difficult to sort through laundry, separate plates and bowls, and to write on paper.

While this program is probably geared toward caregivers and family members of those facing the challenges of dementia, as designers, we really found ourselves learning how difficult it is to navigate through a room we designed.

I don't care who you are, trying to figure out where to go in these bathrooms is a challenge.

Lighting is important.  We had all heard that too much light is not good for dementia units and we need to tone down light levels and glare so residents are not upset, but ordinary tasks in dark rooms are not possible. 

A bad example of glare at the end of a corridor.  Clean floors, but...

Cueing is crucial.  I didn’t think to turn on the lights because the switches were not easily seen.  The same importance can be laid on toilet fixture locations and where clothing to wear the next day is placed.

A standard method of room cueing - memory boxes with personal items of the residents.

Patience is essential.  It takes ten times longer to do any task in this state.  I needed to hear the directions multiple times, and loudly.

But I can do the tasks myself.  I may need assistance, but need to do it myself.

For more information on the Virtual Dementia Tour, see Second Wind Dreams

Not Your Grandmother's Nursing Home (But It Is Mine)

If you’ve read this blog in the past, you may remember that I once wrote about how I refused to design a house for my parents and that it was a very wise decision to let others tell my parents that they are nuts.  I know they are nuts and I didn’t feel the need to become nuttier myself working for them.

However, in 2007 I had the distinct luck to have my grandmother admitted into a project that I designed.  My grandmother had fallen and broken her hip for the third time in about two years and needed structured rehabilitation.  She had been to other nursing facilities for rehab in the past and it was always very depressing to visit her in these very old, medical models.

I decided to try my best to get her into Landis Homes for rehab, with the hopes of securing her a bed in the Memory Support wing permanently.  Grandma had been living in an assisted living facility, but as the series of falls she took would tell you, she was ready for more assistance.  Luckily they had a space open for her in Rehab.    Talk about a post occupancy evaluation.  It so happened that the first day I was able to visit her in her new living arrangements was on her birthday at lunch time.  Since she lived much closer I was able to go over my lunch hour.  I got to see first hand how the food service and dining worked.  The dining room was spacious enough for residents, but did not accommodate visitors too well.  Grandma had three visitors at one time this day.

My aunt was anxious to let everyone know that I was the architect for this building.  While I didn’t think I had anything to be ashamed of, I usually don’t say anything about being the responsible party until I hear what the staff are saying about the place first.  Call me cautious.  On this day though, I truly looked at the building through different eyes.  This was no longer just a building I designed; it was my Grandma’s house now.  Some how everything I looked at was with a critical eye, as in “how does this detail work for my Grandma?”  It was actually quite an experience, almost an out of architect body experience.  I was looking at the building more like an end user.

The real funny thing about this whole experience was the fact that several years earlier, Gregg Scoot and Linford Good (from Landis Homes) did a presentation at a conferences on the design of this building.  As is typical, Gregg was looking for a peppy title for the presentation.  At the time I had a friend who also had a grandmother at Landis Homes in the Dogwood building.  All the residents from Dogwood were moved into the new building once it was competed and Dogwood was adapted to another use.  So my suggestion for the presentation name was “Landis Homes – Not Your Grandmother’s Nursing Home”.  The title stuck.

Once healed up, Grandma then was transfered to the Memory Support House (which was the predecessor to the building I designed, but also by RLPS) and I took my children over to visit on the weekends when I could.  We typically sat in the living room and Grandma enjoyed watching the kids literally run around in circles.   I can not help but remember the marketing photos we have of this space, graciously appointed with loveseats, coffee table, hutches and small dinette set.  The room as it appears now has only gliders and recliners at the perimeter of the room facing inward.  I remember the discussions we had on the design of this building’s successor and because of this situation; each floor of the new building has a much larger activity room to allow more flexibility for seating of the entire neighborhood, as well as several smaller seating arrangements for functions like visiting great-grandchildren. 

At the end of our visits, the children were usually tired of hearing me tell them to stop running and be quiet and Grandma is usually asleep in her rocker.  We would whisper good-bye and see you next time, and as we would leave I hoped that in some way I helped care for Grandma’s needs.  Grandma Helen lived at Landis Homes until Janualry of 2010, just shy of her 92nd birthday, I had gotten to see her just hours before she passed in a place the really had become her home.