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[edit] Considerations in the Design of an Assisted Living Facility

When building an assisted living facility, it becomes apparent that the physical layout of the building, social activities that are used, and safety measures taken are all important considerations that need to be made. The physical layout should be more appealing to the residents, and this would be done by using a smaller, dormitory style layout. It would help make a more relaxing and comfortable experience. A more interactive floor plan for social activities would increase the social activities residents engage in, thus, the cognitive functions, quality of life, and physical well-being of the residents would benefit. Natural disasters and other outside threats need to be taken seriously and be prepared for well in advance in order to increase the safety of residents. Finally, designs in the facility need to include wider hallways, railings and carpeted flooring in order to increase the safety and well-being of residents.

[edit] Physical Layout

[edit] Changing Facilities From Within

A key problem for senior residents is the design of their apartments. Often these homes are too secluded from other residents and promote an independent lifestyle [1]. These assisted living facilities are constructed like regular apartment buildings and do not provide a greater chance of interactions between surrounding neighbours [2].

The floor plans for these facilities are typically the same. Residents are set up in large scale, apartment-style homes to accommodate lots of seniors. Furthermore, cafeterias, social rooms and lobbys are often located in the same areas of each unit and don't vary in terms of design [1]. Additionally, cafeteria cooking does not offer the same quality as cooking from within the home. Social rooms may be at the end of the hall, or on the first floor. There may also be a lack of space devoted toward social activities. The segregation of neighbours into their own units can make it difficult for residents to meet each other.

Assessment Tool on Choosing a Facility When choosing an assisted living facility, these are some of the questions seniors will ask themselves.

There are not many psychological articles that look at the layout of these assisted living facilities and how they can help add to the overall quality of the residents' lives. However, just recently there have been a few articles that suggest changes should be made to the floor plans of these facilities to create a stronger overall quality of life.

[edit] Dormitory Style Design

Social gatherings become easier and less intimidating in assisted living facilities.
Social gatherings become easier and less intimidating in assisted living facilities.
One key change in assisted living facility layouts would be to build them in a dormitory style design. Instead of having each housing unit built with a kitchen, washroom, bedroom and living room all included, the living facility would be built like a University residence dormitory [2]. Each unit would only include a washroom, bedroom and living room, but outside the unit would be a kitchen. Up to four different units would be attached to the kitchen, which would permit up to eight residents to share the kitchen and the extra space it provides.

Having dormitory style rooms will ease individuals into a more comfortable, and therefore, social atmosphere. Those who are new to a retirement home may be less inclined to become social for many different reasons, including the loss of a spouse, or that they are embarrassed to be moving into this home [2]. By structuring these dormitory style units, new residents will be slowly introduced to a limited number of neighbours. This moderate transition will prevent the new residents from feeling overwhelmed because they don't have to meet everyone at once [3]. Nor will this allow for new residents to become isolated and close themselves off from the rest of the facility, which can also be a normal outcome when entering these homes [3]. With the implementation of dormitories and the four-unit system, new residences will be able to make fast, close friendships and to feel more at home.

[edit] Layouts Which Promote Social Engagement

Example of floor plans.
Example of floor plans.
By having a four-unit system, residents will be better able to entertain themselves. Unit-mates can make each other meals, teach each other how to cook, play games or watch tv. These interactions should help provide a key social aspect that, while present in modern assisted living facilities, can only grow stronger with this new four-unit system. Additionally, getting to know others on a stronger personal level can help foster an emotional connection and a better understanding of what each person is going through [4].

[edit] Layouts Which Promote Cognition

Another benefit of this dormitory style is that it will keep its residents functioning at a higher cognitive level. One major issue with assisted living facilities is that there can be a significant drop in cognitive functioning, especially with those who are living by themselves [3]. Furthermore, floor plans can provide a game space for television, chess, cards, etc, in addition to a kitchen space. This allows each resident to have easy access to games, instead of providing them at the end of the halls or on different floors [3]. The physical health of some residents may not be very strong [5], and seniors may feel they are unable to travel down a few flights of stairs or all the way across the hall to play a board game [6]. By providing the space for games within the dormitory, residents will be able to pick up and play at almost no physical costs.

[edit] Smaller Living Facility

These dormitory units would be built within a smaller living facility. It is important to keep the notion of identity for each senior living in these homes. This identity can be lost in a larger space that has up to 4-5 floors of residents [3]. Additionally, more and more seniors are looking towards smaller living facilities as their units of choice [7]. Smaller living facilities should promote more socialization between residents as well as allowing residents the opportunity to know everyone who lives in the home with them.

[edit] Social Activities

Besides the design of the assisted living facility, another important aspect is the incorporation of social engagement for the residents living within these facilities. Social engagement refers to the participation in social activities and sustaining social connections [8]. Participation in activities and sustaining these social relationships are an important part of a resident’s foundation when living within one of these facilities [9]. Social activities can provide them with opportunities that allow them to adjust to their new environment and allow them to connect with others not only in the facility, but outside the facility as well [10]. Research has shown there can be many benefits social engagement can provide older adults when living in an assisted living facility such as quality of life, cognitive functioning, and physical well-being.

[edit] Quality of Life

Visits from family can benefit quality of life.
Visits from family can benefit quality of life.

One of the benefits of having social activities in an assisted living facility is a better quality of life. Research has shown that, when quality of life was defined in terms of overall life satisfaction and general health measures, residents in assisted living facilities showed a substantial increase when they were participating in social events [9]. Social events can include simple visits from friends and family and these visits are predictive of improved quality of life [9]. The quality of these social connections is more important than the quantity [8]. By having meaningful social interactions, residents’ quality of life is greatly increased [11]. These visits from family and friends seem to play a large role in a resident’s life, and these visitations should be incorporated as activities in the facility.

[edit] Congitive Functions

Playing bingo can help with cognitive functions.
Playing bingo can help with cognitive functions.

Another benefit of social activities is better maintenance of cognitive functions. Social activities have been strongly linked to improved cognitive functioning in older adults [12]. Some cognitive functions that are better maintained include memory abilities, perception, and visuospatial abilities [8]. Some of the activities that help with cognitive function include going to restaurants, playing bingo, and going on day or overnight trips [8]. Not only do the activities encourage social interaction, but these benefits are magnified when the activities are organized in a group setting. For example, group activities such as attending arts and crafts and playing cards or bingo provided more social engagement than private activities, such as reading and writing letters [12]. The type of activity had an effect on the social involvement by allowing the residents an opportunity not just to socialize with friends and family outside the facility but allowed them to socialize with others in the facility [12]. It is important for the assisted living facility to schedule activities, specifically group activities, because they help individuals retain cognitive functions and also build new social relationships.

[edit] Physical Well-Being

Walking can help with physical well-being.
Walking can help with physical well-being.

Participation in social activities can also help to maintain physical well-being. Physical well-being can be improved through activities such as going on walks and exercise [10]. Conversely, doing nothing can have a negative effect on the resident’s health, leading to a lower quality of life [10]. Social activities can also affect the number of chronic health conditions in residents. Physical activity can reduce the symptoms associated with cardiovascular disease, diabetes, and hypertension [10]. By participating in social activities, residents can maintain or even improve their physical health, and such activities should be included when designing an assisted living facility.

There is extensive planning involved when designing an assisted living facility in regards to the social engagement of the residents. Without social engagement, residents can possibly show more depressive signs and experience more chronic health problems [9] [11]. Social engagement, through the use of activities such as bingo, family visits, and walks can greatly reduce these effects [9] [11]. Along with social activites, the safety of the residents is of the utmost importance.

[edit] Safety

Not only is the layout of assisted living facilities and the activities that go on inside them important; but the safety of the residents should be top priority. This section will look at safety considerations when building an assisted living facility and build on information that has been discussed in previous sections. Many residents in assisted living facilities demonstrate declining cognitive functions due to natural causes such as age, or diseases such as dementia. This significantly increases the importance of providing safety in these buildings for tenants. The changing and declining cognitive functions of these residents are not always predictable and make it difficult to assess which residents need more assistance for their optimal safety[13]. Safety considerations that should be taken when building the facility need to be directed to areas such as evacuation, fire safety, and general safety within the facility.

[edit] Natural Disasters and Other Threats

Natural disasters, such as hurricanes and earthquakes, may create a need to evacuate residents from their rooms in assisted living facilities. In the past, many people in assisted living facilities have died due to poor evacuation efforts and immobility issues[14]. During Hurricane Katrina, 139 seniors in assisted living facilities did not survive, which shows that future preparation for natural disasters is imperative[14]. The fact that cognitive decline impairs a number of these residents from making informed and prompt decisions on what to do in an emergency situation is enough of a reason alone to increase the planning for natural disasters[15]. There are definitely negative neural changes that occur with the process of age[15]. With various brain pathways having slower connections to each other, a pre-informed resident and staff will have time to process what is going on and what is going to happen subsequently when a disaster strikes since they have more time to reflect on the information. If the state regulates disaster planning, aids in making the arrangements, and ensures the staff and residents are aware of the plan, then assisted living facilities will have a greater chance to efficiently get all of the residents to safety. An example of the benefits of such preparation are evident in this Japanese nursing home[16].

Seniors and older adults living in assisted living facilities have the highest risk of death in the case of a fire[17]. The reasons for this high risk include issues such as lack of fire safety knowledge, hearing problems, building design, and mobility issues[17]. Many of these issues are a result of cognitive decline in the aging patients. Furthermore, the staff-to-patient ratio does not provide enough assistance for all of the residents to evacuate if there were a fire emergency[17]. This statistic should be a major concern for assisted living facilities in which high ratios of seniors live together. As most people know, the population of seniors is growing rapidly, and they are expected to represent at least 20% of the population in the United States by 2050[17]. Measures need to be taken to reduce these safety risks before the amount of seniors in these facilities expands and it is too late to address these concerns. Educating residents about fire safety and planning safe escape routes are ways to reduce this threat. However, as many residents have difficulties with memory, this must be done several times which may become costly and time consuming[17]. In addition to these safety measures, if fire alarms were installed that residents with hearing deficiencies could detect, it would greatly improve their chances of surviving a fire. To protect older adults in assisted living facilities from these threats, it seems as if a combined effort of training the staff evacuation techniques, and planning ahead of time would be the best way to ensure the safety of residents.

[edit] General Safety within the Facility

A wide, visually appealing, and safe hallway.
A wide, visually appealing, and safe hallway.

In addition to these outside factors, there are also many safety issues within the facility that can be addressed. For example, it is beneficial for many senior citizens to engage in physical activity such as walking[18]. For residents of assisted living facilities to acquire optimal freedom, these living facilities must be built safely. Facilities need to install items such as wider hallways, secure handrails, and chairs in their hallways to provide residents with the option of walking by themselves in the safest way possible[18]. Not only do wider hallways promote walking, but they also make it safer for an emergency evacuation, which is a concern that was discussed earlier. Carpeted flooring has also been shown to make residents of assisted living facilities feel safer since it is easier to walk on[18]. Another way to increase the safety in these facilities is to provide enough staff to take care of the residents in a safe and secure manner[13]. Staff should be guided to ensure that residents stay safe since many are not able to make the appropriate choices for themselves. However, residents should be allowed to make decisions on their own when they are able[13].

[edit] Conclusion

There are different issues that surround the design of assisted living facilities. Safety concerns, a lack of socializing opportunities and the physical structure of these homes are just a few problems that exist. All of these problems need to be addressed in order to give residents of these facilities the highest standard of living. Furthermore, it is also important to come up with strong solutions to these problems instead of just being able to identify them. This information is aimed to increase the awareness of the reader to these issues by using scholarly sources.

[edit] Notes and References

  1. 1.0 1.1 Palmer, D. S. (1991). Co-leading a family council in a long-term care facility. Journal of Gerontological Social Work, 16, 121-134.
  2. 2.0 2.1 2.2 Mor, V., Branco, K., Fleishman, J., Hawes, C., Phillips, C., Morris, J., & Fries, B. (1995). The structure of social engagement among nursing home residents. ProQuest Nursing & Allied Health Source, 50, 10-18.
  3. 3.0 3.1 3.2 3.3 3.4 Hawes, C., Phillips, C., & Rose, M. (2000). High service or high privacy assisted living facilities, their residents and staff: Results from a national survey, The Gerontologist, 43, 5-69.
  4. Mara, C. M., & Ziegenfuss, J. T. (2000). Creating the strategic future of long-term-care organizations. Care Management Journals, 2, 116-124.
  5. Manji, S. (2008). Aging with dementia and an intellectual disability: A case study of supported empowerment in a community living home. ProQuest Dissertations and Theses, 7, 21-56.
  6. Hawes, C., Morris, J., Phillips, C., Fries, B., Murphy, K., & Mor, V. (1997). Development of the nursing home resident assessment instrument in the USA. Age and Aging, 26, 19-25.
  7. Ball, M. M., Whittington, F. J., Perkins, M. M., Patterson, V. L., Hollingsworth, C., King, S. V., & Combs, B. L. (2000). Quality of life in assisted living facilities: Viewpoints of residents. Journal of Applied Gerontology, 19, 304-325.
  8. 8.0 8.1 8.2 8.3 Krueger, K. R., Wilson, R. S., Kamenetsky, J. M., Barnes, L.L., Bienias, J. L., & Bennett, D. A. (2009). Social engagement and cognitive function in old age. Experimental Aging Research, 35, 45-60.
  9. 9.0 9.1 9.2 9.3 9.4 Mitchell, J. M. & Kemp, B. J. (2000). Quality of life in assisted living homes: A multidimensional analysis. Journal of Gerontology, 2, 117-127. Quality of life in assisted living homes: A multidimensional analysis. Journal of Gerontology, 2, 117-127.
  10. 10.0 10.1 10.2 10.3 Jenkins, K. R., Pienta, A. M., & Horgas, A. L. (2002). Activity and health-related Quality of life in continuing care retirement communities. Research On Aging, 24, 124-149.
  11. 11.0 11.1 11.2 Park, N.S. (2009). The relationship of social engagement to psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28, 461-481.
  12. 12.0 12.1 12.2 Zimmerman, S., Scoot, A. C., Park, N. S., Hall, S. A., Wetherby, M. M. Gruber-Baldini, A. L., & Morgan, L. A. (2003). Social engagement and its relationship to service provision in residential care and assisted living. Social Work Research, 27, 6-18.
  13. 13.0 13.1 13.2 Kissam, S., Gifford, D. R., Mor, V., & Patry, G. (2003). Admission and continued-stay criteria for assisted living facilities. Journal of the American Geriatrics Society, 51(11), 1651-1654.
  14. 14.0 14.1 Hyer, K., Polivka-West, L., & Brown, L. M. (2007). Nursing homes and assisted living facilities: Planning and decision making for sheltering in place or evacuation. Generations, 31, 29-33.
  15. 15.0 15.1 Bishop, N. A., Lu, T., & Yankner, B. A. (2010). Neural mechanisms of ageing and cognitive decline. Nature, 464, 529-535.
  16. Brown, L. M., Hyer, K., & Polivka-West, L. (2007). A comparative study of laws, rules, codes and other influences on nursing homes’ disaster preparedness in the gulf coast states. Behavioural Sciences and the Law, 25, 655-675.
  17. 17.0 17.1 17.2 17.3 17.4 Jaslow, D., Ufberg, J., Yoon, R., McQueen, C., Zecher, D., & Jakubowski, G. (2005). Fire safety knowledge and practices among residents of an assisted living facility. Prehospital and Disaster Medicine, 20, 134-138.
  18. 18.0 18.1 18.2 Lu, Z., Rodiek, S. D., Shepley, M. M., & Duffy, M. (2011). Influences of physical environment on corridor walking among assisted living residents: Findings from focus group discussions. Journal of Applied Gerontology, 30, 463-484.
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