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Two combining forces are making adult day care a hot topic in
the field of elder care. The first is the emerging impact of the
baby boomer cohort, whose initial members are entering retirement
in 2008. “With the first baby boomers turning 60 this year,
exactly how it will play out remains to be seen,” said Lisa
Stark and Megan Carpenter in a recent ABC profile on the subject.
The massive impact that this generation is expected to have on
elder care in the nation is no less than glacial.
Second, the rising cost of health care across the board demands
that alternates be sought that allow the elderly to stay at home
for as long as possible. According to one industry source, in-home
care is one of the fastest growing trends because there’s
little reason to move. “Today’s elderly aren’t
likely to end up living in the homes of their children, the way
previous generations did. They want to grow old at home, the place
they feel most comfortable. They’re hanging on to their homes
as long as possible and they’re finding that much of what they
need can be ordered on the Internet and delivered right to their
doorsteps, and adult day care is a complementary service to the
rising tide of alternative treatment and at-home nursing
programs”.
Even as far back as the mid ‘80s, when congressional
legislation extending Medicare costs to cover hospital related
expenses was widely heralded, John Denning, president of the
American Association of Retired Persons, which at that time had
more than 27 million members, cautioned that “[Medicare] would
not provide comprehensive coverage for extended nursing home stays,
which are the greatest source of catastrophic costs for the
elderly.”
Both of these factors are believed to contribute to the rise of
adult day care as a component of not only senior housing, but
nursing care, community centers and housing for the mentally and
physically disabled, as well as the rising number of Alzheimer
programs emerging across the nation.
Strictly speaking “adult day care” is defined by the
Virginia Dept. of Social Services as “regulated,
non-residential facilities that provide a variety of health, social
and related support services in a protective setting during part of
the day to four or more aged, infirm or disabled adults who reside
elsewhere”.
It is clear that the definition of “adult day care” will
transition over the next decade as baby boomers age. Today it
functions as a respite between full-time home care and full-time
nursing care. The age of its average user ranges between the late
eighties and mid-nineties and is a range that is expected to drop
dramatically. Over time, and as the average participant age drops,
“adult day care” is expected to morph into something akin
to senior center status, with a bevy of additional services
including medical care, counseling and other related social
services, providing relief for full time home care providers.
The range of programs and scale of these facilities can vary
widely; following are some general guidelines for the arrangement
and treatment of facilities intended to address all of these basic
groups:
Layout
Depending on the programs being offered in each center, the
requirement for these centers will be different. On average at
least two program spaces should be provided, one for general use
and one for separated group use. A manager’s office with
direct vision to the program rooms is also important to maintain
staff/elderly supervision. According to the interview with ADC
staff, a square-shaped program space is preferred in the main space
for better supervision and arrangement. On the contrary, in the
program space where small group settings happen, the room shall be
arranged into a more elongated shape so two or more groups can fit
at the same time, each independent to each other, thereby better
enabling staff to offer help and supervision quickly.
Because women are more likely to live longer than men, when
designing bathrooms the fixture counts for each gender should be
designed according to each center’s actual requirement, adding
extra fixtures for each gender. In the VNA’s (Visiting Nurse
Association’s) ADC recently completed in Basking Ridge, NJ, a
single-user handicapped bathroom with a roll-in shower was also
designed to allow staff to assist in clean up if an accident
occurs. A washer and dryer are included in this room for
convenience. All bathrooms must be ADA accessible. Grab bars were
installed in each bathroom stall so minor handicapped people can
still use a bathroom by themselves without help from the staff.
This is not only important for the staff’s efficiency but also
critical for elderly’s self-respect.
While seniors spend their whole day in the center, physical freedom
and a sense of security is the key to a successful center. The
environment should support walking and wandering. Indoor wandering
spaces are very important for offering physical activities in bad
weather. In VNA’s ADC, the extra wide corridor and program
room create a continuous walking route. A wider node outside of
program rooms was provided for wandering. A specially designed
railing was installed to provide support for walking. The height of
the railing was set at 41” above the finished floor instead of
33”-36” in order for the elderly to put their body weight
on their arms and let their elbows rest. The railing also has an
extra wide and flat top surface to make it easier to rest their
elbows.
Daylight is also important for physical and emotional health. If
possible, therefore, a secure outdoor area, preferably a garden
with ample fixed seating, should be created to allow the elderly to
come and go as they please. At the VNA’s ADC, a fenced
wandering garden is immediately accessible from the center, as is
an adjacent County-operated senior center, located on the same
site.
Lighting
Natural sunlight should be incorporated as much as possible into
the built environment. The overall artificial lighting level in the
center, especially in the program rooms, should be even and at
higher levels. Indirect lighting and cove lighting are the best
choices to create even and soft ambient lighting. Full spectrum
florescent lighting is better suited for the seniors than
incandescent and halogen lights, not only from an energy saving
point of view but also because aged eyesight has a more yellowish
tint, which is balanced by the use of these fixtures. Task lighting
such as table lamps should be provided at spots where extra light
is needed.
Interior Finishes
Interior finishes can dramatically affect the mood of human beings,
especially for the elderly who need to spend their whole day in an
unfamiliar environment. Anxiety and stress are common to the
elderly in a cold and institutional environment. A warm, cheerful
and safe “home-like” atmosphere should be provided to
create a positive atmosphere. Clients suffering from
Alzheimer’s suffer from short term memory loss; therefore the
room or space is quite literally new to them every few minutes or
so. Calm finishes and lighting patterns help reduce stress at every
mental reawakening.
There are several rules for creating color schemes, according to
“Designing for Alzheimer’s Disease”. For example,
“avoid using colors of similar lightness adjacent to one
another, even though they differ in saturation or hue,” and
“choose dark colors from hues of blue, violet, purple, and red
against light colors from the blue-green, green, yellow and orange
hues.” Also, “avoid using pastel colors altogether.”
Another important rule is to create a clear contrast and definition
where the wall and the floor meet. Since lights change the interior
color, it’s very important to use full-spectrum florescent
lights. While picking out color schemes, it’s equally
important to choose color and materials under the same lighting
that will be used. At the VNA’s ADC, an earth tone color
scheme was chosen to give the center a sense of warmth, stability
and energy. It also gives the wandering space a cheerful feeling
and provides a more flattering color against the human skin.
When considering a floor covering, carpet adds visual warmth to a
setting and improves the acoustical environment, making it seem
more like home. It also provides a softer surface in case of a
fall. The VNA’s ADC used carpet tiles throughout the facility,
except in the cafeteria. Carpet tiles are not only durable but can
also be easily replaced individually if severe stain or wear
happens on a particular area.
The most important rule when selecting pattern and texture of
materials, especially for flooring, because pattern might trigger
delusions to impaired eyes, is to try to avoid large and
contrasting stripes, as they can be easily misperceived as gaps on
the floor or elevation changes. When choosing a pattern, try to be
more conservative.
Other key points in designing adult day care centers are:
- Large storage to accommodate wheelchairs
- Extra storage and counter spaces in each program space
- Handicapped sinks in each program space to offer the senior
direct access without help from the staff
- Window blinds to balance light and control glare
- Avoid direct lighting, which can cause glare and create scary
shadows
- Low-glare surfaces, such as carpets, wall covering and low
glare wall paint to reduce reflective glare
- Appropriately easy to clean hard surfaces in toilet, utility
and eating areas
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