Introduction

The population of people aged 65 years and older is growing. According to Vancouver Coastal Health, this demographic makes up 11.8% of Vancouver’s population with an expected increase to 21.3% by 2036 (Vancouver Coastal Health, 2013).

Currently, Vancouver has 603 publicly funded assisted living beds, 28 publicly funded hospice beds, and 3,886 residential care beds (Vancouver Coastal Health, 2013). It can be projected that the number of residential beds will increase roughly in proportion to the local population. As a result, the demand in residential care coupled with the cultural shift in which we view aging suggests that the designed space for long-term care needs to appropriately facilitate and preserve health and wellness.

Residential Care for Me was a collaboration project between the Quality Improvement Team at Providence Health Care (PHC) and the Health Design Lab (HDL) at Emily Carr University of Art + Design in response to this challenge. Aim to improve the quality of life for residents on a holistic level, this project strives to understand what factors affect the quality of residential care by piecing together the individual experience of people who live, work, and visit their several locations.

Traditionally, many residential care environments within Vancouver reference an acute care model—a clinical environment similar to a hospital and houses multi-bed rooms. As a result, many residents feel these care homes are more institutional than actual homes. This creates a stressor and pain point for the residents as they often feel trapped and unable to rest.

To relieve these pain points and create a better environment, the design team at HDL was hired by PHC to explore and propose possible improvements to the physical environment to help achieve comfort and empowerment within a facility through the implementation of short-term design prototypes and recommendation for future long-term changes.

Design Process

Affinity Mapping

Prior to our involvement from the HDL, the research team at the PHC has conducted over 100 hours of insight gathering. The design team at HDL then sort through all information provided by PHC and generated an affinity diagram: a practice used to organize ideas or insights by sorting them into groups based on their natural relationships for review and analysis. Hundreds of sticky notes were made for the ability to quickly and easily re-organize information into a large affinity map.

Upon reflection, the HDL team considered that one of the major difficulties in providing the best quality of life for residents is in finding the balance between maintaining safety and providing independence. Thus, it was important to the team to design outcomes that considered the following: enabling residents to maintain independence without compromising safety; respecting the dignity of the individual; acknowledging a resident’s right to privacy; addressing the social need to connect to a greater community.

Job Shadowing + Tour

As it was my very first project within the healthcare industry, it was necessary to gain a full understanding and insight into the complexities within a care facility before generating any concepts. To accomplish this, a tour and job shadowing sessions were hosted by the PHC team at the Youville and Brock Fahrni Residence.

The tour and job sessions weren’t just to take photos but to completely put ourselves in the shoes of both the residents and the care staff. Notes, quickly visual sketches, and short on-the-job interviews were also recorded by the design team as a means of gathering baseline information. Some important key insights were gathered from the tour and job shadowing sessions.

Concept Generation & Co-Creation Sessions

Concept Sketches & Affinity Mapping II

Using the data collecting from the first Appinity Map and insights from the tours and job shadowing sessions, the following categories were uncovered as a result of the consolidation process:

• Family Accommodation
• Social Activity
• Independence
• Community Channels
• Personalization
• Safety / Freedom
• INtegration of Home
• Routine
• Privacy
• Social Inclusion and Belonging

With these categories, the design team was able to move forward into the brainstorming stage where quick iterative sketches for each category were created and later translated into more resolved concept sketches. These concept sketches were later transferred onto individual sheets and added back onto the Affinity Map.

The updated affinity map was presented to the PHC research team, project stakeholders, and care staff/administrations for further feedback. As the healthcare workers have a much greater understanding of the design environment, we allowed them to make notes, comments, and selection as to which concept they believe would be worth further investigating.

Co-Creation Workshop #1

Co-creation workshops are an efficient way to gain input through activity-based research. We held our workshop at Brock Fahrni and were able to collect insights from residents, their family members, and Brock Fahrni staff. With the sketches derived from our brainstorming map, we created individual boards for participants to collectively review, offer feedback, and contribute insights for design iteration and refinement.

Each member of the design team, armed with sharpies in hand, encouraged and assisted participants to sketch and write directly on the design boards. The exposure to hands-on design methods and thinking gave the participants ownership in the process that may affect the environment in which they live.

Co-Creation Workshop #2

A second design workshop presented 17 refined concepts to staff, residents, and visitors. The visuals were provided as tighter drawings, allowing participants to more easily visualize them as finished products rather than concepts. At this stage, input was instead sought through the form of sticky notes and conversations. The purpose was to look for general acceptance of the concepts that could be taken to a prototype stage and to be tested in the facility.

Prototype

From the design workshops at Brock Fahrni, and with input from the Brock Fahrni team, four ideas were selected to be prototyped and implemented. These prototypes would be installed and tested for a time frame of one week at Brock Fahrni

Hallway Signs

Update existing hallways signs to enhance the neighborhood and contribute to a home-like environment. The original wall ways signs are parallel to the hallways which would be very hard for the residents to find. Especially in long hallways with many doors, it would be easy for the residents to miss where they are trying to go. The new signages are made to stand out from the hallway and would help guide the residents to where they are trying to reach. This would give them a sense of independence and increase privacy from residents accidentally wander into another resident’s room/home.

Individualized Room (Home) Entrance

To further expand upon the neighborhood theme, an exterior facade for a resident’s door was made to mimic a single-dwelling residence found in a traditional neighborhood. Similar to themed motifs in signage, the residents’ exterior doors could correspond to their unique neighborhoods, differentiating the distinct institutionalized corridors and assisting those with cognitive impairments to navigate to their rooms. For the facade, an image of a red door was printed on high-quality paper and secured to the existing door. Wallpaper of a believable brick image and a series of decorative objects were combined to actualize the exterior facade.

Sensory Lighting

As the majority of rooms (homes) in Broke Fahrni are shared bedrooms, lighting becomes a particularly unique challenge. Prior to the project, to aid residents to and from the washroom at night, Care Aids must leave a light on at all times. While this may provide necessary illumination for some residents, the light can be disturbing to those who are sharing the room, resulting in disturbed sleep. In addition, unless the residents or their family has provided a nightlight, the only accessible lights by the residents would be the headboard lights directly above their head. When turned on, the bright fluorescent tube light would also disturb others sharing the same room as well as dazing the residents going to the washing, increasing hazards for falls. The existing curtains are limited in their ability to block light as they are made from light fabrics and offer no light blocking. To solve this complex problem, the design team developed a new lighting system that would be safe, unobtrusive, and user-friendly for both residents and staff.

The new lighting system proposed by the design team was to move the lighting source under the bed. The emitted light could be directed to illuminate the floor, providing a path and highlight any obstructions. Having the light coming from below the bed, the light emitted would also not disturb those already in bed. To solve the dazing problem from the sudden change of brightness, the system would produce the light starting with a soft and gentle glow and gradually increase to the desired brightness. The lighting temperature was also chosen to be at around 2700k to 3000k. Any lower, the light would be too yellow and would blur out details between edges of objects. Any higher, the light would be too cold and too harsh for the senior eyes; breaking their sleep cycle. For residents suffering from cataract-related eye problems, the cool light would be even harsher on the vision, causing images received to be heavily blurred and washout, further increase changes of fall. Finally, the design team added a motion sensor to the light, which would only trigger when a resident swings their leg down to go to the bathroom, or when a care aid comes close to the bed. The system would be on a timer and would shut off automatically after a set period of time. The same system was also installed along the entrance of a room and in the bathroom. The lighting in the hallway helps the care aids when they are doing their nightly rounds.

Privacy Curtains

Within Broke Fahrni’s shared rooms, curtains are used to help separate one resident from another. Although the curtains do achieve a division of space in between each resident, they do not block sound, light, or odors as they are made out of a lightweight material very similar to the curtains used in hospitals. Furthermore, the aesthetics of the curtains are not conducive to create a warm and home-like environment for a homelike environment. Due to standard care procedures, solid walls are not able to be constructed as they would impede with care. Thus, the HDL team focused on addressing privacy and create a solution that would ensure each resident feel comfortable and secure in their spaces while also accommodating the ability to personalize and establish an esthetic that was familiar to the comforts of home.

Base on the feedback during co-creation sessions, the design team chose to prototype specific aspects of the suggested curtain design. The proposed curtain includes a tab closure in a printed pattern similar to a domestic space. The tab design evokes a more homelike aesthetic and also makes the curtains easier to take down for washing. Using a heavier fabric, the design is able to block the majority of the sound and light coming from hallways and neighbors at night while creating a more dampened acoustic environment that makes the space feels more intimate. As personalization is limited in a shared room with a single built-in nightstand + closet combo, the new curtain design enables the residents to add personal memorabilia such as photographs and magazines with the included elastic straps.

Other Concepts

Although there are several other concepts such as better wayfinding, interactive elevator signs, digital check-in stations, video-call phone booth, and info-by-phone systems, due to time restraints and feedbacks from staff, residents, and stakeholders, the design team has only prototyped the above-mentioned concepts.

Future Directions

Feedback & Analysis

After the prototypes were installed at Brock Fahrni, the design team provided staff and residents with questionnaires specific to individual prototypes for design evaluation. The purpose of the questionnaires was to determine the strength of agreement or disagreement on the prototypes and to gain suggestions for improvements. We wanted to determine if these prototypes were seen as an improvement to Brock Fahrni’s environment. Additionally, staff were interviewed to get a cleaner perspective on any issues with the prototypes.

For additional information please click here to view the official process book designed by the HDL design team.