Dignity and Design

Respect is not something to be earned but something we all inherently deserve. This is what dignity is all about.

Post-pandemic design… assisted living… staff retention… government funding… and so on!

These and more related aged care issues have grabbed the limelight in the recent times. And rightly so – since the sector has been due for an overhaul for some time. 

But in this article, we are consciously suggesting a paradigm shift to the softer issues. Ask yourself: Would you live in your own facility? What is new in your next care offering, and what makes it a better place to live, to work, and to visit? How do you improve the mental health of residents? Does the answer always lie in creating new experiences or resolving the existing issues?

We are not going to pretend to have all the answers for you. But what we do have are questions – questions for you to reflect upon – which might give you the answers you are looking for. We are architects in the service of people, so it should come as no surprise that this article focuses on the built environment. Some of these provoking questions can be applied to your managerial overview, care model, staffing, financial streamlining, and other aspects of the aged care offering.

Aren’t we all busy, day in and out? We are performing as industry professionals, family members, and also taking part in wider societal responsibilities. We can be going about our everyday lives, like a well-oiled machine, and then POW! We perceive a slight nudge to our conscious self – be it a standoffish salesperson at the grocery store, or someone jumping the queue ahead of you, or finding a ‘no access’ sign in an art gallery. It makes you wonder… Was that a little belittling? Why did he or she say that? Why can’t I go there? This loss of respect in those situations impacts us at a subconscious level; it’s about the respect that we deserve for being ourselves, without having to earn it.

This respect is what we call Dignity.

A sense of dignity is essential to thrive, both mentally and consequently physically. It’s the basic form of respect and freedom owed any person, regardless of age, cultural background, skin colour, gender, and religious or other beliefs.

While these loaded words are often mistaken as limiting to human interaction, dignity can be perceived due to the built environment together with the freedom and limitations designed within it. The question then is: How do you build an environment that provides a sense of respect and freedom to a resident?

All organisational environments have restrictions, to allow for control of the day-to-day business in a sensible and effective manner. But what happens when these restrictions start impeding an occupant’s mood. This aspect becomes more prominent in an aged care facility where the safety of residents and staff, and the prevention of infection spread, take priority – and for good reason! The question we ask here is: Are you striking the right balance between the restrictions and mental health? Are the residents happy to be there?

Below are a few common statements we have come across, from residents and discussed by care staff, providers, designers, stakeholders, and management. There’s nothing new here, but these statements give an insight into a resident’s mental health.

“It’s nice but I miss my home”- comfort

“I miss my friends and social circle.”- social interaction

“I am not free to do what I want” – freedom

“Can I bring my things along?”- design flexibility

“My grandkids don’t come often” – inclusivity

The response to these statements forms a perception in the resident’s mind about the space, staff, care, and so on. It could lay the foundation stone for the resident’s attitude towards the entire facility.

We analysed these questions to understand how we can be a part of the solution in our role as designers. We urge all readers to give the questions some thought in your capacity too – as a designer, manager, care giver, or whatever role you hold.

Comfort

Cosy home or an awardwinning space?

So, you have got a facility, sparkling new with travertine cladded walls and the latest in upholstery design, with the most fashionable decor. It looks good to you, but how does the ageing resident view this space, their home? Are they relaxed? Or does the glossiness, the wall colour scheme and the lights make them uneasy? If your facility received a design award, Congratulations – but would your resident give you an award for that space if they were on the jury?

Is your space ‘overdesigned’, with a disconnect between the design intention and user expectations?

We all like fashionable spaces to look at – those award-winning homes we see in magazines in every waiting room. But eventually it’s the comfort of the home that we look forward to at the end of a tiring day, of our own couch, our own bed – not a velvet and silk upholstered space set against a carefully pattern-matched Statuario-clad wall.

No, we aren’t suggesting facilities should look ‘used’. But make it liveable instead. How would an 85-year-old lady with macular degeneration perceive the space – can she see the layout clearly, is there adequate lighting? Do the ‘visuospatial’ limitations ensure the furniture placement and wall corners are not a hindrance? How are you improving the spatial awareness in your design?

Now let’s get into the one space which the residents call their own – their room. If a resident moves into your facility after having spent years in their own ‘cosy’ space, has your design made it easier for the resident to adapt, especially considering age and deteriorating health?

There are tools and research providing insight into these specific design needs. If the designer hasn’t integrated this into the built environment, the resident must put up with a daily struggle – resulting in bumps, visual discomfort, and unease in the very space which is now their home. These struggles cause frustration and become a constant reminder of their growing inabilities – thus losing their sense of dignity… All because of the limitations of the space.

And while the resident spaces get all the attention (and funds) in trying to make them attractive, the staff breakout spaces are a stark contrast, both in terms of amenities and finishes. Often, we find them tucked away in basements, with no access to natural light and furnished to the bare minimum. And no, making the staff areas unattractive will not keep the staff on their toes and moving! The support staff spend long hours at the facility – even longer during pandemic-like situations. So, what effect does that space have on their selfworth? Is their performance compromised because their dignity is being compromised?

How can designers support care delivery, beyond providing the basics, including reduced travel distances, clear sight lines, and wider corridors? Choice of materials, clear movement paths, and new technology integration can all work hand in hand in streamlining care delivery.

Eventually, it is the company’s culture and care for its care givers and residents that should be reflected in the built environment. This can have an immensely positive impact on a user’s sense of dignity.

We have recently started working with a provider who is keen to ensure staff retention and is going the extra mile to succeed, by providing a well-designed staff area with comfortable breakout spaces. These rest areas have access to recreation and outdoor, staff-only, gardens.

So, let us ask the question again, and review our design goals. Would you be able to do your best as a care giver, administrative assistant, or maintenance personnel in that space?

Social Interaction

Friends as the new family

With the facility becoming the new home, imagine if residents and staff develop a real kinship. Imagine the wonders it might do for an ageing mind, or a person living with dementia, when they start forming bonds with other residents and staff. Loneliness is by far the number one social problem as we age, and there is a growing expectation that this problem will be addressed when the resident moves into a facility.

What, as designers and providers, are we doing to facilitate this?

The loud TV blaring in the large communal living & dining spaces, if anything, silences any communication. In large spaces, loud noise can appear daunting for a person with limited cognitive abilities.

Now transfer the above scenario into a cosy lounge – with room for two-to-three people. It could be a rest spot along a pathway, in the garden or at the end of the corridor leading up to the bedrooms. Furnished in a homelike manner with some cushions, good quality lighting, views to the outside, even some magazines. Or an outdoor space with some plants, a bench, some shade, and a space to sit down with a cup of coffee. These spaces automatically become busy with residents craving social interaction.

So now the designers have built these wonderful cosy spaces, allowing residents to share a laugh and a cuppa. How does your care model encourage these catchups? Are the staff supportive of such resident get-togethers?

Let’s take it a step beyond the walls of the facility. Is the resident free to build community connections – with the local baker, grocer, or pharmacist? Can technology help in giving the resident an improved sense of freedom?

And what happens when two staff members share a laugh – are they labelled as nonprofessional and wasting salaried time? No – staff need to establish a sense of belonging to the space to perform their duties and provide care in an optimum manner.

Staff areas are rarely a space of choice for the occupants. Is it the layout, the fear of management’s reaction, or the quality of furnishing? The tucked away smoking area, the water cooler, or the tea bench become socially active areas instead.

As designers, do we need to rethink designs for ‘interactive’ spaces and bring them to a human scale, to make them more inviting? A higher frequency of face-to-face interaction results in higher levels of dignity1. Hence building in social interaction possibilities can only do good for residents, staff, and ultimately the overall management of the facility.

Freedom

You cannot go there at this time

Freedom – don’t we all assume we have it? Before coming into the facility, the ageing resident had freedom of movement, though this may not always be supported by their physical ability. But even simply knowing there is no restriction on movement is adequate to positively impact a person’s attitude.

We spoke of this in our Hotseat Supplier conversation, which can be accessed here. Most Aged care facilities have a café, salon, and gym, all located in the front-of-house to create an active atmosphere. But the residents are ‘brought’ or escorted there on set days at a set time. Isn’t this place their home? Why does the occasional visitor movement restrict the movement of the 24-hour, seven-days-a-week resident? A ‘resident first’ review of existing and proposed facilities can easily identify managerial barriers, which when addressed can ease aggravation among the residents.

It is the responsibility of the designer to ensure a space has the necessary level of safety, with improved technology, discreet security points and an integrated model of care.

Now let’s focus a bit more on the staff. We all know of a certain CEO who took away limits on annual leave, which resulted in unwavering staff loyalty and reduced staff turnover. Was it the amount of leave on offer? Or was it simply removing the restriction that led to the positive outcome?

Does RACF design restrict staff from performing at their best? How does the design perform when it comes to staff satisfaction levels? Does the space allow staff to take a mental break? Is there a space to ‘zone out’ without being perceived as slacking off at work?

Often, having freedom of movement and choice imparts a sense of being valued and being respected, provided with dignity.

Flexibility

Can I bring my things with me?

How often has this question been asked by a prospective resident? Being able to carry their personal things with them into their new home, is essentially allowing the resident to carry on living with their lifelong memories. It sure beats locking them up in a box outside the bedroom door. On the other hand, with numerous personality types, how do you stop the place from becoming chaotic with personal collections?

With Aged Care facilities becoming more transient than before, the solution lies in providing more flexibility in the design.

How much ability do residents have to make the space their own? Being able to personalise a room increases a person’s sense of belonging to the space, which is what each provider aims to achieve for their residents. Is it possible to build in flexible storage spaces? Can the display space provide additional storage if need be?

It is noteworthy to mention the ‘Front door project’ implemented by Bethanie Fields Aged Care WA, which helped residents not just identify their room better but also gave them a way to relive their cherished memories. 1

Plus, ageing can present different challenges in a range of varying forms. While one person may develop cognitive issues, another may experience mobility issues. A third person might be active and very alert but also battling anxiety instead. How can the space allow for the changing needs of every resident? Can the room adapt to multiple challenges?

Engaging with the designer early on to build in flexibility can assist immensely with personal adaptations of the space. This can provide a sense of ‘personalisation’, which can go a long way toward making the occupier comfortable.

Inclusivity – (Dignity for all)

Would you be happy in your designed space?

While the ageing resident is the primary occupier of a space, staff, management, and visitors – including the grandkids –  also traverse the built environment.

How does the space cater and allow for such varying occupants? While we have already explored the resident and staff perspectives earlier, how does a four-year-old see the space? Is it boring enough to make her grumpy, resulting in the parents cutting short a visit to grandpa.

While the all-in-one play equipment seen in most RACF cafés proved to be a success with grandkids since it was first installed 10 years ago, attempts to engage visitors hasn’t developed further since.

Is there an activity that can be designed into the resident spaces that encourages intergenerational interaction? Or is the design so overly focussed on the ageing resident’s, safety and sanitary needs that all other age groups find it stifling?

What if kids could share a space with the other residents and grandkids – a space with natural light, interactive tools, and technologically integrated.

When the ABC conducted an experiment for the documentary Old People’s Home for 4 Year Olds, the results were tremendously positive. 1

“After several weeks of activities with four-year-olds, the adults were less frail or depressed. They reported improved mood, confidence, physical strength, and appetite. The social experiment restored their sense of connection and fun.”

Isn’t that what all carers, providers, and other stakeholders want for their care offerings too? A thriving happy community?

The power of dignity in design

The design of a space strongly affects its sense of dignity, especially since it reflects an organisations’ intentions for the occupiers of that space. The design conveys the culture followed by the organisation, including the leadership practices. It can impact the behaviour of the occupants, staff, and management.

What works for one, though, may not work for another, but the basic sense of being respected and valued – of having dignity in that space – is paramount. The desire to move freely, to make your own choices, and to be respected, is universal.

Comfort, Freedom, Social Interaction, Design Flexibility and Inclusivity are goals that can be ‘designed’ into a space from the outset, which in turn can have a positive impact on all occupants. The management, especially care personnel who have a good understanding of the model of care, need to have an active role during the design phase to ensure the built spaces and services offered work together in a streamlined way.

We all want our basic sense of dignity to stay intact. And we can only do this if we are relaxed; not just physically but mentally too, so we can perform our roles – both professionally and personally – to a satisfactory level.

References:

https://www.enablingenvironments.com.au/the-dignity-manifesto-of-design.html

https://www.hassellstudio.com/research/designing-for-dignity

https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf

Whitepaper authored by Mahi Lau – Principal, Stanton Dahl