Jacqui Smith is an experienced healthcare designer, running HomeSmiths with her husband, David. She is an SBID Accredited Designer and Chair of her local Dementia Friendly Community. Having permanently lost the sight in her left eye in 2012, Jacqui has personal experience of visual impairments and the role the built environment plays in supporting people with sensory loss.
Jacqui highlights the key elements of interior design to consider when planning and designing spaces for older people in care:
Interior Design in Care Homes – Where to Start?
The built environment plays a key role in the health and well-being of residents, affecting both their physical and mental health. Good design can make the world of difference to how a resident, carer or relative will feel in a space.
Like all design, function is the most important consideration. A room might look beautiful but unless it serves the needs of the people spending time in it, and the furnishings and finishes have been chosen with practicality in mind, it will not “work”. As we age, our senses deteriorate, and some people will experience cognitive impairment so the design must support these needs and enable residents to live as independently as possible for as long as possible.
I am a firm believer that care homes should be warm and homely, environments which residents can relate to and settle in quickly. Whilst yes, the designs should have impact and an element of aspiration, I do not subscribe to the idea that care homes should emulate the 5-star hotel aesthetic.
My starting point would be to maximise natural light wherever possible. Window treatments should be dressed back from the window and at the same time allow strong daylight to be filtered when necessary, to avoid glare. Well thought through artificial lighting is a worthwhile investment. The wrong type of light can have an enormous impact on a scheme and greatly affect the colour rendering of furnishings and wall colours, and also how people feel in a space. I see many care homes fitted with LED lights on the correct assumption that after the initial outlay, maintenance would be minimal, yet the fitting is a cool blue light LED which renders any furniture or finishes with warm red tones a far from uplifting muddy brown. Light fittings should be diffused to avoid glare and flexible task lighting is a worthwhile addition to a scheme enabling residents to adjust light levels to suit their individual needs.
Lighting can also affect our body clock. Different colours of light have varied wavelengths which the human body responds to in different ways. The cool blue light of the morning kick starts our body clock; the presence of sunlight stimulates the brain to secrete cortisol which promotes a state of alertness, preparing us for the day. As the light changes through the day and then fades to the warm yellow of dusk, we receive the cue to start thinking about winding down and ultimately falling asleep. The science behind this cue is the hormone melatonin which the brain releases towards the end of the day, which causes us to feel drowsy. White and blue based lights will inhibit the secretion of melatonin which will consequently interrupt our body clock, upsetting our usual sleep pattern. So, a cool blue light in a care home dining room at the end of the day is not conducive to a relaxed and restful evening for residents. Difficulties regulating the body clock are common in old age and particularly significant for people with dementia, so getting the lighting right is essential.
If I had to pick one thing which can make a huge difference in supporting independence in living environments for older people, it would be colour contrast. Contrast between objects helps residents make sense of their environment and whilst it’s vital to apply this principle for people living with dementia, it also plays an important role in supporting those with age related sight issues. Ensuring that there is visual contrast between critical surfaces will help a person with poor sight, be it through dementia or old age, navigate their environment as easily as possible. Skirting painted to contrast with the floor will outline very clearly where the floor ends, and the wall begins. Architrave painted to contrast with the wall will define where the door is. For two surfaces to offer enough contrast they must have a 30-point difference in their LRV, Light Reflectance Value which is a measure of the amount of light which a surface reflects back into a room where the lighter the colour, the higher the index. The same logic applies to light switches and fixings like grab rails in bathrooms.
Whilst colour contrast can help define a room, contrast in adjacent flooring surfaces should be minimal. A dark threshold strip or a dark floor mat against a paler toned floor can appear like a step to a person with dementia and might present a trip hazard. Similarly, dark door mats can, to some people, look like a hole. Ideally the flooring throughout the home should be the same colour regardless of the surface.
So, colour contrast comes into consideration in choice of surfaces, but the finish of those surfaces is also important. Hard flooring must be anti-slip especially in wet areas such as bathrooms where an even higher anti-slip level is required. It’s also important to select finishes that do not cause glare so better to avoid polished surfaces, choosing matt and brushed finishes instead.
Poor hearing is something that affects many older people and can in some cases lead to isolation and increase the speed of cognitive decline. Interiors should be designed with acoustics in mind, maximising sound but minimising noise. Think about position of kitchens and lifts in relation to resident areas and consider finishes choices such as acoustic flooring, noise absorbing window treatments and furniture such as room dividers which can help.
Decor and Furnishings
Furniture and décor should be relatable, and the layout of the room should encourage social interaction with clusters of seating, ideally with varying seat heights so that residents can select a chair which most meets their comfort needs. Corridor seating is important, providing residents with resting places as they move from one part of the home to the other, encouraging them to be independent and sociable.
Colour itself plays an important role in designing for health and well-being. The correct choice of colour can make an enormous difference to how a person experiences being in a certain room, affecting how they feel, behave and interact with others.
Art and accessories are often seen as a ‘nice’ to have but I do think they are an important part of a home; not only do they make it more domestic in feel, they can also be used to help residents remember where they are, as many people will navigate by objects rather than words or colour. Which brings me on to wayfinding which should be enough to aid navigation but not ‘overkill’. Wording on signs should be clear with an easy to read choice of font and good contrast; light text on a darker background is preferable because it’s easier for the ageing eye to see than dark on light.