Comedian Phyllis Diller once said, "Always be nice to your children because they are the ones who will choose your rest home." People aged 65+ represent about one-eighth (12.6 percent) of the total US population of 308 million, and while many older Americans live active and independent lives, some turn to nursing homes for nurturing support. Nursing home residents hope and expect to be in a place where they will feel safe, comfortable and cared for by committed and caring individuals. Nursing home residents will likely live in accommodations that have more in common with a hotel than a hospital with a room of their own, access to gardens and lounges and three meals a day served in the dining room.
However, can a hotel ever be a home? Just as hotels express and reflect the identity and values of the proprietor, the same holds true for nursing homes. Decisions on décor and furnishings are usually the prerogative of the home’s managers and often reflect the assumed tastes of the residents based on a collective whole with the understandable desire not to offend. Chintz, floral patterns and gentle, pastel shades dominate.
Douglas MacArthur once said that "nobody grows old by merely living a number of years. People grow old only by deserting their ideals. Years may wrinkle the skin, but to give up interest wrinkles the soul." Do older adults living in nursing homes have interest in changing the look and feel of their own space? My company partnered with the University of Exeter to see if engaging older adults in the design of their own space would be beneficial to the residents and care home operators.
The study found that nursing home residents felt healthier, happier and more satisfied with their lives after being empowered to influence their own surroundings. The research, carried out at a senior living facility operated by Somerset Care in the United Kingdom, was initiated to investigate whether the trend for residents to retreat to their private space after disruption to their normal lives could be mitigated. The research sought to establish whether residents would make greater use of communal facilities that were re-furnished with the residents’ choice of plants and artwork.
“According to psychological theory, residents in a senior living home who believe that it is within their power to make a difference to the appearance of their living space should feel more empowered, thus leading to more positive feelings towards their fellow residents, the caregivers in the home, and the home itself,” said Dr. Craig Knight, the principal researcher behind the findings and managing director of Prism at the University of Exeter. “A common argument against increasing empowerment in care homes is that devolving power to elderly residents may constitute, or be seen to constitute, an abrogation of care by the home’s managers so given the threat of potential litigation, it would appear that a move away from the hotel model of care to a socially empowered model is not without risk.”
Testing The Idea Of Empowerment
In order to test these hypotheses, Dr. Knight conducted a longitudinal study with two similar groups of residences who, although frail, did not require special care (e.g. for dementia). The residents, previously accommodated on two floors of an existing home, were being moved onto the corresponding floors in a new facility on the same site. This gave the opportunity to conduct a natural experiment. The residents of the upstairs floor were empowered, as a group, to make decisions about aspects of the décor in the new home (the empowered condition) while those on the ground floor (the un-empowered, control group) did not receive this opportunity while still receiving the highest levels of benevolent care that is the standard within the nursing home authority.
The residents in the empowered group were given the opportunity to select from a range of pictures and plants to decorate their home’s shared social spaces, such as the dining room, lounge and corridors. This involved all the residents on the floor taking part in two formal meetings with care home managers, representatives from my interior landscaping company and the researchers. Following these meetings, the residents were asked, as a group, to make collective decisions about the décor of the communal spaces in the new home.
Four weeks before the move, at the time of the move, four weeks after the move and again four months after the move, the residents on both floors were asked a series of questions about their liking for the décor, their comfort, their identification with the staff and fellow residents, environmental satisfaction and physical well-being. Residents were asked to rate their health and well-being on a numerical scale at various times over a four month period. Observations by the staff were also recorded which allowed an assessment of frequency and duration of the use of the social areas together with observations of well-being and general citizenship behavior reflected in the residents helpfulness towards residents and staff.
By the end of the study it was found that, in comparison to their peers, empowered residents:
- Used their lounge more than twice as much—217 percent more
- Were 40 percent more satisfied with their lives
- Were 46 percent more comfortable in their home
- Reported themselves to be 43 percent healthier
“Engaging with groups in this way resulted in residents having a greater sense of psychological comfort and social identification with others in the home,” said Dr. Knight. “Residents tended to display more considerate citizenship behavior towards their fellow residents and they reported and exhibited improved life satisfaction and physical health. The group of residents collectively charged in the design process made much more use of the communal space than those in the control group.”
A Surprising Aside
Although not part of the main experiment, the experimenters were surprised at the choice of plants and art made by the empowered residents at the senior living facility. The residents were given a huge choice of plants, containers and art work in a variety of styles. Contrary to the prejudices of our interior landscape designers who had assumed the residents would choose traditional styles of art and plants, the residents chose bold, abstract art and colorful contemporary plant containers and plants with a distinct architectural form. These empowered residents were seen to steer clear of floral patterns, chintz and pastel colors in favor of more modern art prints, bold colors and more ‘architectural’ plant displays. Although not tested, it has been conjectured that these choices were made because bright, bold colors and shapes are highly visible against the background of the space, standing out for those whose visual senses may no-longer be as sharp as they were when young.
Commenting on the findings, the Care Home Manager, Jackie Howels, remarks, “We could not have predicted the remarkable positive changes in our ‘empowered’ residents.”
A white paper titled “Health, happiness and higher returns’’ provides further detail on the significance of this project. The research is part of a wider body of work from The University of Exeter in collaboration with Ambius to understand how offering individuals the chance to influence their surroundings could impact their health, productivity and well-being and is available for download at: http://www.ambius.com/understand.aspx?id=3232.
Kenneth Freeman, international technical director at Ambius, who managed the research process said, that “findings of this study back up the wider discovery that those ‘empowered’ to control the aesthetics of their surroundings can feel dramatically healthier and happier. The caregivers appreciated the enhanced citizenship of the residents and the nursing home managers experienced easier recruitment of new residents due to the noticeably more engaging atmosphere.” The simple act of empowering a group of individuals resulted in a shift of attitude from being in a home to being at home.