“Touching up” Communal Space of a Residential Home Setting: A Comparative Study of Tools for Assessing Changes in the Interior Architectural Space

Abstract

This study focuses on the interior remodeling of two Swedish residential homes for dependent seniors. A regular maintenance operation was turned into a color intervention project, and the residents stayed during the process. The aim of the study was to assess the changes in terms of supportiveness for elderly individuals with cognitive or functional impairments. The settings were evaluated prior to and after remodeling. Architecture profession method and the Therapeutic Environment Screening Survey of Nursing Homes instrument were used. The conclusion is that a supportive architecture was not achieved, due to a restraining focus on color instead of the relation between aging, color, and homeliness. On the other hand, the architecture profession method and the Therapeutic Environment Screening Survey of Nursing Homes instrument proved to be useful complementary tools for assessing interior changes in architectural space.

KEYWORDS:

• interior remodeling
• maintenance
• residential home
• architecture
• TESS-NH

Acknowledgments

The author is architect SAR/MSA, a member of the Swedish Association of Architects, and a PhD Fellow at the Royal Institute of Technology, Sweden. The author thanks Magnus Rönn, Associate Professor at the School of Architecture, Royal Institute of Technology, Stockholm, for his significant advice and support in structuring this study, and Eva Henriksen, RN, PhD, Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm and head of FOU Äldre NU, the Research and Development Centre for Care of Elderly People, Järfälla, for her challenging comments on the text while maintaining a nursing research perspective, and for her suggestions for improvements. This article is part of a forthcoming doctoral thesis on Swedish architecture for an ageing society. The study was partly supported by the research foundation J. Gust. Richerts Stiftelse, Sweden.

Notes

1. Although the term residential home is complicated due to the different regulatory statuses found in the European countries and the United States (Andrews, 2005), this article uses the term to describe this specific Swedish type of sheltered housing. In this article, the term assisted living is seen as a type of residential home. The Swedish residential homes imply an individual apartment of approximately 20 to 40 square-meters offered by the municipality after an assessment of the individual's need of assistance and eldercare. The dependent senior has a lease on the apartment. In addition to the monthly rent, the tenant pays a fee proportional to the assessed need of eldercare. The apartment is spatially compacted, and this type of housing, together with special housing for university students, holds a special section in the Swedish Building Act. Here, additional space for cooking, dining, and socializing is found in a communally shared space in order to meet the national guideline of an appropriate housing environment (NBHBP, 2008). Besides this space for the residents, additional space is required to provide an appropriate working environment. The actual assistance and eldercare is provided either by the municipal eldercare or by entrepreneurs in this field of service. The Swedish municipalities define these care commissions, and they imply a time-limited contract open for renegotiation in case of badly provided eldercare.

2. The municipal real estate company is one of the Sweden's largest public real estate company and manages buildings for long-term assisted living for elderly, frail people, adults with functional disabilities, and individuals with drug-abuse problems, in addition, other care facilities as activity centers, and day care centers.

3. This project was called “Space for Learning” and comprised an interior modernization of two schools in the City of Gothenburg. The focus of this project was on the interior coloring and enhancement of the exicting setting in two high school buildings. At each school, two working committees were formed with the coordinator of the project and one representative from the following three groups: teachers, pupils, and the municipal real estate company and the coordinator for the project (Göteborgs Stad, Målarmästarna, & landsting, 2005). The project lasted from September 2003 to December 2005.

4. This is an approximate translation of the Swedish name ‘Rum för god omvårdnad’. A year after completion, a book about the project was published in Swedish (SPA, (Svenska_ Målarmästarnas_Riksförening), MRECCF, & (Medichus), 2008).

5. The Swedish Painting Contractors Association (SPCA), in Swedish Målarmästarnas riksförening, is both a trade and an employers’ association. Its annual turnover is approximately 12 billion Swedish Crowns, and the association is divided into seven regional districts. The association has about 1,000 member companies.

6. The word wayfinding is used to describe how the design of the architectural space including artifacts, signage, and other spatial media gives clues for finding one's way. This thinking is inspired by findings in environmental psychology on human interaction with built space (Arthur & Passini, 2002).

7. A plain glass lens was used on a photographic zoom lens of 1:3.5–4.5/28–30 mm, and a 400 ISO color film (Fuji color).

8. The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) instrument has been updated, but an earlier version of the American instrument (with manual) was used. (Sloane, Long, & Mitchell, 2005). The earlier version was chosen because this version had been tested in the pilot study in 2005 (Andersson, 2005b). The TESS-NH instrument and the the Special Care Unit Environmental Quality Scale (SCUEQS) have only been validated in the United States. A translated or validated instrument in Swedish does not yet exist. The validated summary scale, the SCUEQS, in which 18 items of the whole instrument provide a validated numeric value for the physical environment, was not used in this study for this reason. One difference between American and Swedish standards refers to question A1 and questions A2a-A2c, which deal with the nursing station; in Swedish accommodation for the elderly frail people, this function is normally placed outside the unit, which serves several units at the same time. The medicine dispensary and patient records are found in a locked room nearby the nurse's office. A second difference relates to questions that refer to the patients’ rooms (questions 21 to 22, and question 29). In a Swedish context, living in an accommodation for elderly frail people does not imply being medically taken charge of, but rather occupying a rented apartment, that includes a 24-hour assistance and care adjusted to the individual's need. Due to the potential for intrusion into the privacy of the occupier, questions 21, 22, and 29 have been answered by the inventory of one apartment at each unit. The choice of apartment has been suggested by the staff and approved by the occupier. Tenants supply their own furniture and arrange the apartment according to their own taste and liking. Communally shared space for dining socializing and kitchen areas is set by an interior decorator (or in some cases by the nursing staff). To improve working conditions, the bed in each apartment is replaced by an ergonomic hospital bed, which can be adjusted up and down by the occupant or by the nursing staff.

9. This equipment was purchased from the Swedish manufacturer IKEA.

10. This equipment was purchased from the Swedish manufacturer IKEA.

11. 1. Unit nursing station presence/type; 2a. Nursing station for paperwork; 2b. Desk for paperwork; 2c. Combined work area for paperwork; 2d. Enclosed workroom, not a nursing station; 3. Unit use as pathway between other units; 4a. Residents eat on/off unit; 4b. Formal activities on/off unit; 4c. Residents bathe on/off unit; 5a. Doors to rest of facility disguised; 5b. Doors to outside disguised, 6c. Doors are locked; 6d. Locking device triggered by approach; 6e. Lock disengaged by keypads/switch; 6f. Locked at night/during bad weather; 6g. Doors are alarmed; 6h. Alarm triggered by device worn by resident; 6i. Alarm disengaged using keypad, card, or switch; 6j. Alarm sounds with all entries/exits; 7a. Maintenance of social spaces; 7b. Maintenance of halls; 7c. Maintenance of resident rooms; 7d. Maintenance of resident bathrooms; 8a. Cleanliness of social spaces; 8b. Cleanliness of halls; 8c. Cleanliness of resident rooms; 8d. Cleanliness of resident bathrooms; 9a. Bodily excretion odor in public areas; 9b. Bodily excretion odor in resident rooms; 10a. Floor surface in social spaces; 10b. Floor surface in halls; 10c. Floor surface in resident rooms; 10d. Floor surface in resident bathrooms; 11a. Handrails in hallways; 11b. Handrails in bathrooms; 12a. Light intensity in hallways; 12b. Light intensity in activity areas; 12c. Light intensity in resident rooms; 13a. Glare in hallways; 13b. Glare in activity areas; 13c. Glare in resident rooms; 14a. Lighting evenness in hallways; 14b. Lighting evenness in activity areas; 14c. Lighting evenness in resident rooms; 15.% of rooms with a chair per person; 17a. Path leads to dead ends; 17b. Path with places to sit; 18. Configuration of rooms of unit; 19. Public areas homelike; 20. Kitchen on the unit; 21. Pictures/mementos in resident rooms; 22. Non-institutional furniture in resident room; 23. Resident appearance; 24a. Bedrooms with view of courtyard; 24b. Public areas with view of courtyard; 25a. Tactile stimulation opportunities; 25b. Visual stimulation opportunities; 26. Enclosed courtyard; 27a. Attractiveness of courtyard; 27b Courtyard is functional; 28a1. Doors left open; 28b1. Resident's name on/near door; 28c1. Current picture of resident, 28d1. Old picture of resident, 28e1. Objects of personal significance; 28f1. Room numbers; 28g1. Coloor coding; 28a2. Bathroom door left open; toilet visible from bed; 28b2. Bathroom door open; toilet not visible from bed; 28c2. Bathroom door closed; picture or graphic; 28a3. Activity area visible from 50% of resident rooms; 28b3. Visual indicator of activity area visible from 50% of resident rooms; 28c3. Direction, ident. sign visible from 50% of resident rooms; 29a. Privacy curtain pr. separation b. beds in semiprivate rooms; 30. Status of television in main activity area; 31a. Residents screaming/calling out; 31b. Staff screaming/calling out, 31c. TV/radio noise; 31d. Loud speaker/intercom noise, 31e. Alarm/call bell noise, 31f. Other machine noise, 32. Subjective rating of overall environment.