Designing Environments That Foster Vitality and Capability by Argentum

Designing Environments that Foster Vitality and Capability

About Us.

Designing Environments that Foster Vitality and Capability

5/2/2017

Dr. Maggie Calkins, PhD

Executive Director, The Mayer-Rothschild Foundation

Dr. Calkins is nationally recognized as a creative, dynamic leader, trainer and researcher in the field of environments for elders. She is Executive Director of The Mayer-Rothschild Foundation, the only national philanthropy exclusively committed to person-centered long-term care in the US. She currently serves on the board for the Pioneer Network, and has partnered with The Green House® Replication Project and Planetree. She was a founding member of SAGE- Society for the Advancement of Gerontological Environments, and is on the Editorial Board for The Gerontologist, Journal of Housing and the Elderly, Journal of Clinical Psychology and Health Environments Research & Design Journal.

May 2, 2017

Content Source: Dr. Maggie Calkins, PhD

About Us.

Dr. Lorraine Hiatt, PhD

Lisa Warnock, Principal

Lorraine Hiatt, PhD is an environmental gerontologist who has spent the last 45 years exploring ways that innovations in design can increase the capability of aging individuals to lead richer lives. She has completed over 800 projects throughout the U.S., ranging from community/mission-driven and private projects to government/veteran-focused projects. She has also published on issues of design and planning, and regularly speaks about vitality, memory enhancement, mobility, design, and culture change. Throughout her career, she has sought to evoke greater capability in aging, richer choices in lifestyles, and more inventive but seamless improvements in design.

Lisa Warnock is a Principal with 18 years of professional experience within the field of interior design and space planning, and an additional 5 years of work experience in business management. Lisa holds a Bachelor's degree in Interior Design from Marylhurst University with a special emphasis on LEED design requirements and the specification of sustainable materials. Passionate and knowledgeable about sustainable lighting design practices, Lisa has developed a special emphasis in multi-family housing and senior living communities' design work for Myhre Group Architects.

Environmental Gerontologist

Myhre Group Architects

Source: The Center for Health Design (www.healthdesign.org/)

Content Source: Myhre Group Architects (www.myhregroup.com)

Discussion Topics.

Why are Vitality and Capability Important?

How Can Building Design Foster Vitality and Capability for Residents and Care Providers?

A Healthy Environment for Care Providers and Residents

• Green buildings foster vitality.

• A healthy and happy care provider is one of the most important assets for your Community.

• Safe buildings foster capability. • Good lighting fosters both vitality and capability.

• How can we provide spaces that nurture our care providers so they can nurture residents? • Create environments that foster staff retention. • Healthy environments for both staff and residents (lighting, finishes, etc.) • Staff amenities (daycare, lounges, etc.).

Image Source: The Springs Living (www.thespringsliving.com)

Designing Environments that Foster Vitality and Capability

5/2/2017

Green Buildings. Site and Building Concepts • Maximize site’s development potential. • Building orientation. • Outdoor Areas. • Daylighting. • Solar heat gain/loss. • On-site storm water treatment/detention. • Turning requirements into Design Opportunities and Community Amenities (storm water planters, swales, ponds, etc.)

Green Buildings.

Image Source: Unknown

Green Buildings.

Interior Environment

Light

• Design spaces that are timeless and practical, not just attractive and trendy.

• Natural Light wins over artificial any day. But…. make sure to carefully control natural light.

• Focus on finishes that promote clean air conditions.

• Reduced Energy Costs/Consumption.

• How do we create “clean air”?

• Ranked only behind food service, hospitals and grocery stores, Assisted-living care facilities rank fourth in energyuse intensity nationally.

• Low VOC, eliminate off gassing. • Design HVAC systems that are appropriate. • Be careful not to add unnecessary elements that can add impurities to the air.

• Artificial light should be LED whenever possible. • Embrace available incentives to help offset costs.

Image Source: Myhre Group Architects (www.myhregroup.com)

Image Source: Westminster Village by Perkins Eastman - Photo by Chris Cooper

Safe Buildings. Site Design Considerations • Easy site access for emergency service providers.

• Covered drop-off’s with curbless approach. • Wide sidewalks and intuitive wayfinding. • Good site lighting • Safe passage. • Control light pollution.

Safe Buildings. Image Source: Myhre Group Architects (www.myhregroup.com)

Designing Environments that Foster Vitality and Capability

5/2/2017

Safe Buildings. Interior Environment Design Considerations • Specify floor products and transitions that reduce falls. • Focus on finishes that promote clean air conditions, eliminate/reduce the spread of infection. • Specify furnishings that promote independent resident transfer, eliminate/mitigate falls and ensure the resident is comfortable so they remain engaged in the community’s events and activities. • Embrace innovative technology and new products.

Lighting. Image Source: Kwalu (www.kwalu.com); Grabcessories (www.grabcessories.com)

Lighting.

Why is Well Designed Lighting Important?

Fundamentals of Light Color and Temperature

Increased safety. Increased staff retention. Reduced need for psychotropic medication. Energy efficiency and reduced operating costs.

Temperature

• • • •

• Research studies show an increased risk of cancer, particularly breast cancer, for night shift employees. Some studies suggest up to 50% risk increase.

10000 9500 9000 8500 8000 7500 7000 6500 6000 5500 5000 4500 4000 3500 3000 2500 2000 1500

North Light/ Blue Sky

Daylight fluorescent Clear mercury vapor

High Noon

Warmer

• Benefits of well designed lighting, for both care providers and residents, include:

Cooler

Lighting.

Clear metal halide Cool white fluorescent Halogen lamp Warm white fluorescent 40W incandescent High pressure sodium

Sunrise Candle

Image Source: Unknown

Image Source: Energy Stare (www.energystar.gov)

Lighting.

Eye-to-Brain Pathways

Melatonin

1. 2. 3. 4. 5. 6.

• Highest levels are produced at night.

Retina Optic Nerve Visual Cortex Retinohypothalamic Tract (RHT) Suprachiasmatic Nucleus (SCN) Pineal Gland (Melatonin Secretion 7. Spinal Cord 8. Superior Cervical Ganglion (Sympathetic Nervous System)

• Regulates activity-sleep cycle and body temperature.

3 6

• Is not adversely affected by daytime light exposure.

• Reduced levels can negatively influence circadian rhythm. 7

Visual Pathway

• Healthy melatonin production can suppress cancer and cell growth.

Photobiological Pathway

• Production is reduced by night time exposure to light, particularly blue light.

8 Image Source: Nature Reviews Nephrology (http://www.nature.com/nrneph/journal/)

Image Source: Reiter, R.J. (1995) Experimental Gerontology, 30(3/4), 199-212

Designing Environments that Foster Vitality and Capability

5/2/2017

Lighting.

Effects of Blue Light

Circadian Rhythms – Why are They Important? • Exposure to light increases impulse control, pleasure, and alertness. • Exposure to darkness increases sleep, intelligence and memory. • Circadian rhythm disruptions commonly occur when traveling across time zones and changes in work schedules. These often result in increased daytime sleepiness, insomnia, upset stomach, irritability and mild depression. • Adaptation to night shift work is possible with timed light exposure at night and light avoidance by day. • Intermittent bright light can reset the clock.

Image Source(s): Nature Neuroscience Health Publications; ACS, Sleep Med Rev, American Macular Degeneration Foundation; European Society of Cataract and Refractive Surgeons; JAMA Neurology

Image Source(s): Unknown

Lighting.

Light and Dark

What is Tunable Lighting?

• Both light and dark are essential to good health.

• Tunable LED lighting has the capability to change from cool to warm lighting based on a schedule, user-input or ambient light levels. Additionally, lumen output can be controlled to change from high to low levels based on a schedule.

• Quality darkness is needed. • People often experience too little of both.

• Better matches the color of natural light, and therefore reduces the negative impacts of artificial light.

• Lighting for well-being includes avoidance of discomfort.

• “Light plays a key role in setting and regulating the body’s biological clock. Both the intensity and the spectral content of light can be used to stimulate or suppress the secretion of melatonin and other hormones that in turn affect our mood, alertness and health.”

Office of Energy Efficiency and Renewable Energy (EERE)

Image Source: Shutterstock.com

Image Source: Myhre Group Architects (www.myhregroup.com)

Lighting.

Case Study – Sacramento ACC Care Center

• Study Areas: Corridors, nurse stations, resident room(s).

• Tunable light settings at corridors:

• Objectives: • Better equip the caretakers and nursing staff to provide excellent care by improving the quality of lighting (e.g., reduced glare, better controllability) relative to the incumbent lighting.

• 7 a.m. – 2 p.m.: 6500K @ 66% output • 2 p.m. – 6 p.m.: 4000K @ 66% output • 6 p.m. – 7 a.m.: 2700K @ 20% output

• Learn more about how tunable-white lighting impacts the sleep patterns, nighttime safety and other behaviors of residents, including those with Alzheimer’s or related dementias. • Provide illumination for the residents to safely navigate to and from the bathroom at night, without having to use the overhead lighting. • Provide low-level navigation lighting for nurses who enter the room at night, without the need to turn on additional lighting that could disrupt the residents’ sleep. Image and Content Source: U.S. Department of Energy’s “Gateway Demonstrations: Tuning the Light in Senior Care” (2016) prepared by Pacific Northwest National Laboratory

Image and Content Source: U.S. Department of Energy’s “Gateway Demonstrations: Tuning the Light in Senior Care” (2016) prepared by Pacific Northwest National Laboratory

Designing Environments that Foster Vitality and Capability

5/2/2017

Lighting.

Case Study – Sacramento ACC Care Center

• Tunable light settings • 7 a.m. – 2 p.m.: • 2 p.m. – 6 p.m.: • 6 p.m. – 8 p.m.: • Night-light option:

• For the three months following the trial installation, the following occurred:

at resident rooms: 6000K 4100K 2700K 2400K

• An estimated 68% reduction in energy use relative to the incumbent system (from 3,641 kWh to 1,182 kWh) was measured. This is significant as the healthcare industry accounts for 9% of the energy used in commercial buildings, with lighting systems representing the largest electricity end use in healthcare.

• Controlled by motion sensors, activated when the resident placed his or her feet on the floor near the bed, or when a nurse entered the room.

• Reduction of targeted behaviors such as yelling, agitation and crying, of 41% of residents included in the study. • Reduced psychotropic and sleep medication use by residents. • Longer sleep periods at night by residents included in the study.

• The amber color avoids wavelengths that have the most potential to suppress melatonin.

• Fewer resident falls.

Image and Content Source: U.S. Department of Energy’s “Gateway Demonstrations: Tuning the Light in Senior Care” (2016) prepared by Pacific Northwest National Laboratory

Lighting. Industry Feedback • “In fact, by installing brighter lights on psychiatric ward, depressed patients had a three-day shorter duration of hospitalization.” Anna Wirz-Justice, PhD in Design and Health Scientific Review 2010

• “Patients getting more sunlight experience less stress and lower analgesic medication use.” Jeffrey M. Walch in Psychosomatic Medicine 67: 156-163, 2005

• “Bipolar depression: morning sunlight reduces length of hospitalization.” F. Benedetti et al in Journal of Affective Disorders 2001

• “Neonatal ICs: cycled lighting improves pre-term sleep and weight gain.” C.L. Miller et al in Infant Behavior and Development 1995

Final Thoughts.

Supporting Vitality through Design in your Community .

Why is Vitality and Capability Important. Summary • Healthy environments result in happy care providers and residents. • Happy healthcare providers are one of the most important assets for your Community. • Green building is responsible building. • Don’t underestimate the power of light. • Tunable lighting is becoming more accessible-even in retrofits thanks to companies like Stack.

Image Source(s): Unknown

Designing Environments that Foster Vitality and Capability

5/2/2017

Access to Engaging Nature

The Importance of Privacy & Territoriality Choice

• Options for Engagement

The ideal is for everyone to have their choice of private vs. shared rooms. Not always feasible.

• Direct, largely unrestricted access to active outdoor spaces. • Bird feeders, rain gutters, putt putt golf, butterfly gardens, basket ball court, dining and barbeque options, access to water (gardening and drinking), sun and shade

Brecon Village, Harley Ellis Devereaux

FGI 2018: Shared rooms shall be configured so that each individual has their own alcove with equal access to window, door and bathroom.

Reduces resident-to-resident aggression and is preferred by staff*.

Air Force Village, Nelson-Tremain Partners Cypress Cove, SFCS

* Calkins, M.P., & Cassella, C. (2007) Exploring the cost and value of private versus shared bedrooms in nursing homes. The Gerontologist. 47 (2), 169-183.

Access to Engaging Nature

Supporting Functional Independence • Bathrooms

• On Upper Floors • Views, Access and Green Roofs make outdoor spaces easily accessible.

• Majority of falls in senior living communities are associated with using the bathroom- especially at night. • Amber colored night lighting – at bed, at doorway, within bathroom, light the way without disrupting circadian rhythms. • Recent research concludes that: •

bilateral grab bars mounted 13”-15” from CL of toilet

•

31” – 33” above the floor

•

extending 6”-9” from the front edge of the toilet

•

centerline of the toilet 24” from the wall

Mariana Figueiro

Cypress Cove, SFCS

• Is more supportive of how elders transfer than the traditional ADA configuration.

• 2018 FGI Guidelines. Cypress Cove, SFCS

Supporting Functional Independence – Grab Bar Research

Other Environmental Supports – Memory Care

Cross Keys

Pennybyrn at Marysfield

Designing Environments that Foster Vitality and Capability

Montessori Principles – The Prepared Environment ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢

Orientation Order Exploration Communication Activity Manipulation Work Repetition Exactness Abstraction Perfection

Association Montessori international www.ami-global.org

➢Maintain activities of daily living ➢Sense of accomplishment and self worth ➢Display socially appropriate behaviors ➢Increase focus or concentrated attention ➢Decrease responsive behaviors ➢Engage with one’s social and physical environment

5/2/2017

Supporting Elders in the Community .

www.BrushDevelopment.com

Why Support Elders Who Don’t Live with You? Effective Advance Marketing According to the report Home in Retirement: More Freedom, New Choices*, just 7% of retirees have moved into age-restricted retirement communities. Supporting them in the community means they will think of you if they do decide to relocate.

Where are Elders Living? Myth of Downsizing Roughly 50% of elders who move downsize. 30% actually by a larger home. Reality of Home Renovation People 55+ spent $90 Billion on home renovations last year. Who should they trust – a contractor or an organization that knows and supports elders?

* Merrill Lynch & Age Wave, 2015. https://www.veracast.com/webcasts/merrilllynch/gwim2017pdf/id36100125.cfm?_ga=1.55964013.739287875.1493644379

Besides Housing- What are Elders Looking for?

Questions?

Social Engagement & Support Mather- More than a Café A place that offers great coffee, entertaining activities, care management assistance. No Stigma Health and Wellness Open your health and wellness venues to elders living in the community: pool, exercise equipment, trainers, health nutrition classes, and more

Argentum 1650 King Street, Suite 602 Alexandria, VA 22314 (703) 894-1805