Go Outside and Play!

Now that we have celebrated Memorial Day, summer has begun! I wonder how many times we have heard (or said), “Go outside and play!” Turns out that was just one more example of some good advice from Mom.

There is a growing interest in studying the importance of increasing our time outdoors, for young and elder alike. Comealiveoutside.com lists many benefits of being active and spending time outside, from lower risks of obesity, to lower stress and depression levels, to helping you get a better night’s sleep. And the list goes on. But there are benefits even if you are just sitting still and breathing fresh air: the airways of your lungs will dilate more fully and improve the cleansing action of your lungs; you will improve your heart rate, blood pressure, and metabolic rate; and your immune system will fight off disease more effectively. There are also studies that indicate that sunlight helps improve mood and ward off feelings of lethargy.

Susan Rodiek, PhD, NCARB, and Chanam Lee, PhD, MLA, state in their recent study that “well-designed outdoor environments can have a beneficial effect on the health of older adults in residential facilities by encouraging them to spend more time outdoors.” After analyzing what elements prompted elders to spend more time outside, they concluded that key factors of a successfully designed outdoor area include:

• Area viewable from indoors
• An easy-to-cross threshold
• A view of vehicular activity
• Paving without litter or debris
• A variety of plant materials
• Walkways with good views of birds and wildlife

I would add to the list covered areas for shade and comfortable seating groups in a variety of locations. This list seems very realistic and is a great investment for such a big return: healthy, happy elders!

Dementia is coming . . . are we ready?

“Create a definite plan for carrying out your desire and begin at once, whether you’re  ready or not, to put this plan into action.” ~Napolean Hill

 

This rather disturbing question was asked during an informative presentation by Dr. Lena Smith at EFA ’12 last month. Every 69 seconds someone develops Alzheimer’s disease in the U.S. By the year 2050 that will increase to every 33 seconds. And while Alzheimer’s is the most common form of dementia, there are actually 15 different types. The most common characteristics are memory decline; language changes; speech and comprehension difficulties; growing inability in executing motor activities; decreased sensory functions; and difficulties in identifying and regaining objects and images and in planning, judgment, and insight.

A clinical diagnosis of dementia indicates a compromise in three or more of the following areas of mental activity: language, memory, calculations, attention/orientation, praxis judgment, personality orientation, emotional awareness, and conceptual knowledge.

Dementia is a progressive disease and we must design to the behaviors and needs of these elders. A successful environment will be the result of combining good design, good programming, and the care of our valuable staff.

The home must be safe, disease specific, flexible, and provide for some form of daily joy. Our residents who live with dementia truly live in the moment and the spaces we create for them need to look like a place they would want to be and live in. Areas for small group gatherings are important—too many folks in one space can lead to confusion and agitation of one another. Dr. Smith stressed, “It’s all about the relationship.”

The programming must engage the resident and be specific to their needs and their stage of dementia: early, moderate, or advanced. The environment needs to support these concepts and the designer should to work closely with the coordinator to truly understand the daily routine. Key concepts include providing ample space to move, well-planned storage options that are organized and easily accessed for various activities, and above all, flexibility.

Caregivers earn their crown jewels every day. The space needs to function to make their work easier. From finishes that are easy to maintain to a place for them to take a break and breathe, the design must remember them as a vital part of the equation.

The stats are staggering, but with a team effort, we can be ready!

Passion: Words from Dr. William Thomas

“What we need is a radical reinterpretation of longevity that makes elders (and their needs) central to our collective pursuit of happiness and well being.” ~Dr. Bill Thomas

 

As Dr. Thomas has stated, no one has ever accused him being vague. And so it was at the EFA ’12. His passion for elders is inspiring, contagious, and from deep within his being. I had the privilege of attending his lecture, which was titled “Toward a Radical Reinterpretation of Aging and the Built Environment.”

My take-away points:

• Aging is normal. Beyond adulthood is elderhood. We will have to function as elders, which is different from living as an adult. There is life after adulthood.

• Aging describes the biological process, not the stage of life. It is a privilege to live to be an elder.

• We all need elders and they need us. Elders are the glue that holds us all together.

• Design needs to encourage the concept of community. Our current environments for elders are “a mess.”

• We must change the outdated perception that housing for seniors is “a place where broken people live.” The old order is collapsing.

• Design must be evidence-based.

• There is great value in aging. We need to see past our fears and biases, and learn to appreciate and understand our elders’ fullness of life; they offer a boundless reservoir of experience.

Disney-Inspired Design Directives

 

“Disney will never be completed.  It will continue to grow as long as there is imagination left in the world.”  ~ Walt Disney

 

 

Last week a large group of individuals dedicated to enhancing the lives of elders gathered for the Environments for Aging Conference. We assembled at Mickey’s place, in Orlando, Florida: “the leader in creating experiences through environment.” What better destination to spend time with experts, old friends and colleagues, clients, and some of the most creative people on the planet?

The keynote speakers were passionate, informative, and energizing. The sessions were relevant, thought provoking, and a genesis for other ideas. The synergy between participants and presenters inspired new solutions to design concerns currently on our drawing boards. (Yes, I realize drawing boards don’t really exist anymore!)

In future blogs I will be sharing what I gleaned on many different topics, but today I offer parallels between the place where magic begins and key design directives for those we serve.

Family and community

Culture at its best: I watched families and groups of friends, people of all shapes and sizes, the young and the not-so-young from all around the world. Laughing together, crying when they were tired, always saturated in make-believe. Their vocation was playing together while seeking a common destination—moving toward their goal of the day, all the while connected.

Design to encourage a sense of belonging.

Patience

Waiting is a given when so many people gather within boundaries. We waited in check-in lines at the hotel, for dining, and of course for the restroom. As testament to one of the most magical places on earth, the magic spread even to these times. Strangers shared stories of their day, asked questions of the experienced, some started friendships; children of all ages were “stilled” by waiting.

Design time and places to be still—to just BE—spaces for sharing time, our most valuable resource.

Flexibility

Options abound at Disney, from the different theme parks, to the endless attractions within the parks, to the many options for food. Options allow us choices; choices encourage flexibility. Flexibility lowers stress and enhances the quality of life.

Design for options and flexibility.

 The great outdoors

The sun, fresh air, and beautiful blue sky were enjoyed by all—even those of us who only experienced it between conference sessions. The landscaping was lush, well-manicured, and colorful. It allowed for play and relaxation and it was energizing.

Design to encourage spending time outdoors.

 Taking care of details

Disney excels in its attention to details: visual, audible, and kinetic. They must be applauded for their integrated system—it appears flawless. They have thoughtfully planned with the end result in mind: anticipating visitors and their needs. As an example, the signage is simple, strategically located, and integrated with its surroundings; unobtrusive, but there when you needed it, all while being universally communicative.

Design anticipating the needs of others.

 Fun

Most folks on most days at the park appeared to be having fun. Sometimes the best reason for a particular design choice is the simple need to be fun!

Design to encourage fun and make magic an everyday occurrence.

God Bless America

 

“God Bless America”

 

 

Today is our National Day of Prayer. In 1952, President Truman signed a bill instituting a National Day of Prayer. President Reagan amended the law to designate that the day be observed on the first Thursday in May each year. And so, on this first Thursday in May, please take a moment to be grateful for all the blessings we have in America. I know my own list is long!

My husband, Dick, and I, along with an awesome team from our church family, served breakfast to more than 250 folks this morning. The prayer breakfast featured Virginia’s Lt. Governor Bill Bolling, who delivered a wonderful message on our heritage and the role prayer has and will play in the future of our great country. It was very powerful to hear the heartfelt prayers for families, churches, schools, persons in service, our leaders, and our country.

As a very dear friend quite often says, prayer works!

The television…really so many?!?

“The doors we open and close each day decide the lives we live.”  ~Flora Whittemore

 

 

 

 

The beautifully-detailed space I referenced in my last blog (“Life: Look and Learn”) did possess one opportunity for improvement. Scattered through the room were three large, flat-screen televisions. The potential for sensory confusion was minimized, as they were all on the same station, but even so, they interrupted the tranquil, beautiful space and robbed it of its perfection. I reflected on how often this happens in many social spaces designed for elders. We design these areas for sharing time, interacting, playing games and puzzles, and relating to one another . . . yet always, always with a place for the TV and extra cable connections for future TVs.

That morning two things occurred that gave me reason to re-evaluate televisions, their function, and their locations (if you haven’t already noted, I am not a fan of the energy suckers). First, at some point a signal was crossed and on came a very X-rated movie! The staff scrambled to change the station with embarrassment and apologies. The moment was very short-lived and was certainly the fault of the digital programming (not the staff) but such things can happen so easily. Most of the elders did not notice (or in their dignified way, appeared not to have noticed). The second observation I had was that the elders were all talking over the sound level of the televisions and having to repeat themselves due to the background noise. There was certainly no whispering in that room!

I have decided to spend time this summer talking to elders about televisions, asking them who really uses them—and when and why. Once and for all, I need to know what the answer is. Have television-laden living spaces become the norm in response to the mainstream theater rooms in our homes and the modern-day “need” for the latest technology? Are we imposing our high-tech habits and desires on elders, or do our current residents really want to watch television? With the widening practice of culture change, we no longer need TVs as all-day entertainment, and the frontline staff does not have any extra time. Special events like the Olympics and movie nights should not dictate the entire function of a space.

I will let you know the results of my inquiry. And I promise to balance my prejudice with the opinions of my TV-loving business partner and husband.

Some interesting quotes:

“I think it’s brought the world a lot closer together, and will continue to do that.  There are downsides to everything;  there is unintended consequences to everything.  The most corrosive piece of technology that I’ve ever seen is called television – but then, again, television, at its best, is magnificent.” ~Steve Jobs

“If everyone demanded peace instead of another television set, then there’d be peace.” ~John Lennon

“I find television very educating.  Every time somebody turns on the set, I go into the other room and read a book.”  ~Groucho Marx

“They put me on television.  And the whole thing broke loose.  It was wild, I tell ya for sure.” ~Elvis Presley

“It’s a fact that more people watch television and get their information that way than read books.  I find new technology and new ways of communication very exciting and would like to do more in this field.”  ~Stephen Covey

“I hate television.  I hate it as much as peanuts.  But, I can’t stop eating peanuts.”  ~ Orson Welles

Life: Look and Learn

“Every day you have the opportunity to learn and experience some – thing and some – one new.  Seize the opportunity, learn and experience everything you can and use it to change the world.”  ~Rodney Williams

While waiting for Mom during a recent surgical procedure, I took advantage of the opportunity to just sit and take in my surroundings. The waiting room space was a true piece of architectural art. Each detail had obviously been carefully planned and executed. It was a refreshing affirmation of the impact thoughtful design and construction have on individuals in all stages of life.

My attention then turned to one of my favorite subjects: watching elders. We can learn so much by looking! There were many seniors present, as most were there for cataract procedures. Each was accompanied by a companion, most of us “Boomers.” But one gentleman seemed to be alone. I first noticed him when he was trying to get up from his chair. He would rock forward and push up, getting a little higher each time but never quite managed to get on his feet. I walked over and asked if he would like a little help. He smiled and nodded his head yes. Once up, he steadied himself and walked over to the bathroom.

I went back to my seat and began working at my mobile “office,” glancing over from time to time to make sure my new friend was doing okay. A bit later he motioned for me, and through a bit of quiet words and hand signals, he conveyed a wish for a cup of coffee. I fixed his coffee (at a clean and yet again expressively detailed refreshment station) and returned, cautioning him that it was very hot. He took the cup with a grateful smile. He was seated in a group of chairs grouped around a large coffee table which was too far away for him to reach. He obviously needed a place to perch his cup. So, leaping into problem-solving designer mode, I relocated a small end table from my own sitting group, answering the questioning eyes of the staff with the assurance that it would be returned when no longer in use. It was a small thing, but it added comfort to his day. The gentleman evidently found it a struggle to talk, so to respect his space, I smiled and returned to my seat.

Throughout the morning we would glance at one another, and he gave me the universal thumbs-up as he sipped his coffee. A while later, his wife appeared. He sent her over to thank me and to explain his frustrations, which were the results of a stroke. I overheard him trying to tell her about the end table, but she was unable to make sense of what he was saying, so I walked over to briefly explain and then returned the table to its original position. As they left he turned and blew me a kiss! Made my day!!

So what did that experience confirm?

• Details matter.

• It is worth the effort to select a chair that is strong and sturdy with arms at the right seat height, to aid and add comfort for Elders.

• Furniture placement needs to follow practical function.

• And above all, respect and kindness matter most.

Moving Forward Together

 

“If everyone is moving forward together, then success takes care of itself.” ~Henry Ford

 

 

In a recently-released announcement, the Centers for Medicare and Medicaid Services (CMS) state that they will now issue waivers for certain provisions that were adopted in the 2012 edition of the Life Safety Code.

As the S&C memo states: “A National task force developed these changes over three years subsequent to public comments at the CMS/Pioneer Network 2008 National Symposium on Culture Change and the Environment Requirements. These NFPA approved changes give nursing home providers additional ways to enhance resident autonomy and quality of life.”

The changes include allowing for furniture groupings to be arranged in corridors; for alternative kitchen arrangements; for installation of certain types of fireplaces; and for an increased number of decorations on walls, doors, and ceilings.

These items may seem minor, but this is a big step forward in the approach we take in planning and design, in achieving our goal of creating comfortable homes for our Elders—homes that truly feel like home. Each of you is encouraged to request the waivers as needed and take this step!  We will be here to help!

A picture is worth a thousand words…and smiles

“We don’t accomplish anything in this world alone…and whatever happens is the result of the whole tapestry of one’s life and all the weavings of individual threads from one to another that creates something.” ~Sandra Day O’ Conner

 

A client called recently, asking for art for the skilled rooms of their CCRC (Continuing Care Retirement Community). Two issues came to the forefront: (1) the budget was a concern; and (2) we agreed that we wanted the residents to have some choice in the selection. Our solution: we developed a series of photos, all of which corresponded and complemented one another. The subject matter was nature scenes—mostly spring-like, with bright, beautiful colors; clear images; and high contrast.

The concept was that from our offered selection, each resident could pick four pieces for their room, each sized 18 x 24, double matted and framed. The images could be used together in any variety of combinations. From the very beginning on installation day, everyone was excited. Residents, staff, family members, and personal caregivers all participated in the selection of the special pieces for each elder’s room. The photographs sparked reminisces about visits to similar places or a birdbath they once enjoyed in their yard; some just said the cheerful pictures made them feel happy.

The art now hanging in each person’s room serves not only as a source of color and delight, but also as a conversation starter and point of connection with one another. I was thrilled to be part of a solution that brought a bit of joy to all. It was a good day!

Place Matters

 

“The first duty of love is to listen.” ~Paul Tillich

 

 

 

Several weeks ago (March 7^th), I wrote about my mother’s move to a new home in an independent living apartment. What a difference it has made in her attitude toward all things!! She is thrilled with her new home, new friends, and all the options afforded her in this special community. It is such a reassuring, up close and personal reminder that the places we create do matter and impact the health and well-being of all those we serve.

Again, Mom reached this decision on her own and I do not want to undervalue the huge impact that makes in the process, but there were a few other points I think added to the success of her transition:

• All three children were in complete agreement and had one unified voice. Even when it came to dealing with those small details that we weren’t “in sync” on, we remained unified.

• Mom and I talked almost every day about options for the interior, what things to take, etc. By doing this, we built up the sense of anticipation and excitement.

• We let her make all the decisions in her own time. (This was tough, but as my sweet granddaughter says, I was “a zipper” . . . what the family calls keeping our mouths shut!)

• We bought a few new things to compliment her existing pieces.

• We found places for every salt and pepper set she had ever collected.

• We let her take it easy on moving day; we handled the logistics, so she didn’t get overly tired out.

• We installed all the items (shower chair, handheld shower, extra night-lights) that would help keep her safe right from the beginning so they were all part of the “new” and not given particular emphasis as items for the elder.

So to all my colleagues and professional partners: be assured that in this crazy, rushing world, the place called Home matters!