Some Things We are Learning as We Design for Elder Care

My father--91 years old, one of the greatest of the Greatest Generation--had been failing for several years before he died last month.  Firsthand, I experienced his gradual decline and how the healthcare system he was in served him...or failed him.  Here are some observations of the care he received, along with some lessons learned as we visited the numerous facilities that my father was in:

1Experience matters.  Yes, our seniors can teach us--but that's not the type of experience I refer to.  Staff experience, training and , especially, a capacity for compassion were crucial.  During Dad's multiple hospital and nursing home stays, I observed the workers who attended to his needs.  On one end of the spectrum there were those who blustered into the room, waking my father for no apparent reason, not making eye contact, doing things to him but not seeing him.  Dad would glaze over on these occasions and his great humor would evaporate.  On the other end of the spectrum, I think of his last primary caretaker Sheku.  Sheku entered quietly, held my father's hand, asked him what he needed, gave gentle instructions of what he was doing or going to do.  They talked and began a real relationship.  Sheku was like a Zen master.  He saw my father, he had compassion.

Middle English, from Anglo-French or Late Latin; Anglo-French, from Late Latin compassion-, compassio, from compati to sympathize, from Latin com- + pati to bear, suffer with.

Of course most of the workers caring for my father fell somewhere between these two extremes.  Working with Baptist Retirement Community here in San Angelo, I have been impressed that they view training as the first good of great elder care.  They spend a lot of time with workers before they interact with elders.  The training they provide enables workers a much better perspective on the clients they serve...they begin to see them and serve them as a mission, not merely a method (I understand they have one of the lowest employee turnover rates in the country).  I'm not sure that compassion can be taught, at least not in a classroom setting...but it can be modeled, something I am witnessing daily.  Maybe compassion is contagious?

We can have the best facilities imaginable but if there are not compassionate and trained workers employed, what good does it do?

2.  Architecture matters.  As Winston Churchill puts it: "We make our buildings...and forever after, they make us."  The spaces that our elders inhabit make a real difference as life is lived out.  Small but basic things such as privacy (not having to share a bedroom, having a bathroom in your room), views to the natural world outside, natural light, eliminating as many "beeping devices" as possible, entering spaces that felt home-like rather than hospital-like all played a part in making my father comfortable.  I could see him relax or get agitated, depending on his environment.  In one Assisted Living facility where my father stayed, I remember walking out of his room to find a seemingly endless corridor filled with noisy machines of all types and with food carts loaded with different trays.  Workers reviewed charts to see what went where.  A nurse station sat at the end of the corridor, much like a guard station.  We can do better I thought.  We must do better.

Maybe hospitals have to be somewhat institutional to work properly.  Maybe.  Efficiency and cost-control are obviously important.  But when they dictate the architecture and the architecture then overshadows and crushes the spirit of the clients, what good is that?   As I research health care facilities of all types, I notice that things are moving towards a distinctly non-institutional and more home-like environment, even in hospitals.  Even large scale facilities can be broken into smaller, more intimate nodes.  Colors and finishes are more important than ever.  Natural light is crucial.  Assisted Living and Skilled Nursing facilities are really beginning to embrace this new model.  As an architect, I recognize that smaller scale and more intimate spaces cost more--we are continually seeking to balance costs with benefits.  This is a real struggle as we search for more humane and meaningful places.

3.  Options matter.  One of the hospitals where my father stayed had first-rate medical care...but not much else.  He stayed in his bed all day: unable to read, not interested in the reality tv or game shows on the television.  Nurses would come check vital signs and then move on to the adjacent room.  He was bored and I don't blame him.  Were it not for visitations from family and friends, it would have been disastrous.  On the other end of the spectrum, at one of the Skilled Nursing facilities where he stayed, there was an Event Coordinator who visited daily to make sure he knew of the ice cream social downstairs or the bingo event on the second floor, etc.  A physical therapist made scheduled visits and got him up walking several times a day.  These small calendar events were something to look forward to.  Dad got to choose which events he attended and his family got to be in on these decisions.  My father thrived in this setting which allowed him to heal from a fall much more quickly, which then allowed for a shorter stay in the facility--saving lots of money.  It seems pretty basic.

In the better facilities, other small choices could be made:  choice of small or large community room setting (rather than only one room or no community room at all), choice of large or smaller chairs along large windows or smaller windows, choice of various healthy menu options served on real plates.  Yes, these are small choices but they added up to a more humane way of living.  We all want to make choices.

In the not too distant future, we will be the ones who inhabit the health care spaces we (as a community) make--my hope is that the architecture of the spaces serves, ennobles, and inspires those in the final chapters of their lives.  My father trained combat fighter pilots during World War II.  I like to think of him up there in the skies in his AT-6, smiling, as he looks down on some good things happening in an often chaotic world.