Human quality of life at the center
Things have improved, but there is still a lot to do. That is the basic sentiment of professor Helle Wijk, Professor in nursing with a focus on care environment and care for the elderly at Gothenburg University, regarding the situation in residential care facilities in the Nordic countries. She is seeing less and less of the institutions that were still common a couple of decades ago and more of person-centred, welcoming, homely environments.
“Today, there is greater awareness that the physical environment is part of the nursing process and that groups need to work across professions to reach the joint goal of creating the best solutions. The level of knowledge is good, but it needs to start having a bigger impact on reality,” she says.
To start with, the function and purpose of the environment should always be formulated. Health is subjectively experienced and means different things to different people. Understanding the target group, listening to the residents and involving and including all those who are impacted, are all a must.
The research needs to become available to all
Helle Wijk wrote in the early 2000s in her dissertation on how we perceive colour as we age. This sentiment is readily referenced when discussing the importance of the care environment for people’s health. She is also a visiting professor at the Centre for Healthcare Architecture at Chalmers University of Technology.
“The collaboration between the Institute of Health and Care Sciences at the University of Gothenburg and Chalmers University of Technology is a welcome one. It is a means of developing the vital dialogue on nursing, architecture and design to reach decision makers,” she says.
She continues: “The best quality care environment cannot be created by a single person or occupational group but instead requires collaboration supported by conscious leadership on all levels
to lay the foundation for development.”
Our basic question to Helle Wijk is how we can best go about creating sustainable, health-promoting environments for the elderly. It is a complex question containing many terms that can be interpreted differently.
A person-centric approach is Helle Wijk’s starting point: anyone can get sick, but you are never only your illness. We are all unique individuals who may fall victim to an illness or injury. This illness or injury is specific for each individual and each person is the expert of their own lives.
From this point of view, many care environment factors that impact the well-being of residents, the staff's opportunities to do their work and the relatives’ perception of the home, become apparent.
“To start with, the function and purpose of the environment should always be formulated. Health is subjectively experienced and means different things to different people. Understanding the target group, listening to the residents and involving and including all those who are impacted, are all a must.”
Sustainable care environments
There are a number of factors to consider when it comes to sustainability.
“Not only do we have aspects such as making climate-smart choices, but sustainability is also about how the physical environment must sustain people, from the elderly residents of the home to the staff. Gains in an individual's health are also gains for society. Designing well-considered interiors is a good investment. It reduces the risk of falling accidents and the amount of heavy lifting and frees up staff time for their actual nursing tasks. With sustainable care environments, everyone comes out a winner.”
She maintains that there are clear connections between sustainable working environments and a sustainable economy in society. Residential care facilities whose staff find the physical environment functionally and aesthetically attractive not only have an easier time recruiting, but also of retaining qualified workers.
“Sick leave and employee turnover can get very expensive, not only monetarily but also in terms of health. Without making any certain predictions, it is a perspective that has become all the more relevant in the throes of the corona pandemic. Having a lot of new, temporary and unaccustomed employees most likely makes it more difficult to prevent the spread of contagion.”
The right colours and contrasts give a sense of security
For a physical environment to be an active part of the nursing process, consideration needs to be taken to hard and soft values. Sensory experiences that give a feeling of security and that stimulate, combined with architecture, design and furniture that is practical and safe.
Environments can, for example, be improved when there is an understanding for how the elderly experience colour, light and contrast. This is an area that is close to Helle Wijk's heart. It's about helping people navigate in their space, feel safe and feel that they are met with respect and dignity.
“Physical environments that are not designed to meet the needs of the elderly generally result in residents ending up in a position of dependency or feeling anxious, totally unnecessarily. It’s a matter of designing an environment that is easy to navigate so it is easy to find and recognise things and to be independent. By painting the toilet door a colour that is in clear contrast to its surroundings, it makes it easier to find the toilet before it's too late. In this case, the colour selection is a vital part of care and of being independent!”
Naturally, the colours chosen in a care environment must meet the facility’s particular needs, but the principle of clearly contrasting colours is important.
“Dark furniture against dark carpeting can cause confusion. A person with visual impairment can have difficulty understanding where the seat is, leading to a greater risk of falling. An attractively coloured easy chair that sticks out from its surroundings is easier to see and will get more use. A dark-coloured mug against a dark tabletop can be difficult to see, leading to a greater risk of spilling. Using different hues of colour on opposite walls can aid a person’s depth perception, whereas sharp contrasts between thresholds and flooring can be interpreted as obstacles or even as height differences and holes,” says Helle Wijk.
Proud to work with the elderly
To a great degree it's about how we view humanity – seeing and approaching people with dignity and respect, regardless of age. As we get older, our needs may change brought on by age, but we are generally the same person as we were throughout our lives.
“Working with the elderly should bring a sense of pride and it should be a positive thing when a relative moves into a retirement home as the new environment will offer better conditions than a home that no longer meets their needs. And more than anything, it should bring joy to the resident!”
5 tips for better care environments
Involve more stakeholders in the planning. The residents, staff and relatives – in other words, the people who will spend time in these environments – must be involved early on in the planning and building process.
Functionality and aesthetics need to go hand in hand. Furniture needs to be adapted to the residents and ergonomically correct while also being attractive and void of an institutional feel.
Invest in quality. Don’t focus on the cost of quality but rather on what contribution it makes. It’s worth it in the long run.
Create clarity with contrast and codes. A sense of security and dignity are achieved by using colour and design that facilitate navigation. It shouldn’t be difficult to do the right thing.
Make person-centric care your point of departure. There needs to be freedom of choice, based on the uniqueness of each person, built into the care environment. Provide space for those who wish to socialise as well as for those who wish to be on their own for a while.