2 Care environments
2.1 Design and organisation of the care environment
The way a care environment is designed and organised can have a profound impact on the residents' lives, and careful consideration of factors such as the physical environment and the care home's values can have positive effects on their quality of life. For example, Philpot (2005) reported on the design of a building that illustrates the kinds of things that make life easier for people with dementia.
Box 1: Design for dementia
The open plan of [Stirling University's Dementia Services Development Centre's] Iris Murdoch Building is a dementia design principle – everything and everybody can be seen. The building is light and non-reflective, there are no shadows and high-quality acoustic tiles on the ceiling combat any echoes. There is a glass-fronted fridge and the cabinets, drawers and doors have glass panels. Carpets are blue, not patterned as these can cause confusion. Different textured carpeting indicates where you are.
As people with dementia can have problems with three-dimensionality, each stair has a different coloured nosing, the skirting is stair-shaped, and the banister is pillar-box red. Different colours distinguish the seat, pan and back of the toilets, the whereabouts of which are indicated by door signs combining symbols, words and pictures. Light switches are in vividly contrasting colours to the plain walls.
Mary Marshall, who influenced the design of the Iris Murdoch Building, argues that appropriate design principles make daily living easier for people with dementia, or other cognitive impairments such as autism, learning difficulties or high levels of stress (Philpot, 2005). Research also shows that careful consideration of living arrangements for children in residential homes is important (Whitaker et al., 1998).
Activity 3 asks you to consider care environments further through reading about some research. This article was first published in 1993 and refers to observations made in the 1970s. Since then much has changed in residential care homes. Standards have been raised by the introduction of Codes of Practice for social care workers and employers. Staff are usually better qualified and provision is more responsive to service users' needs than it was. However, the article usefully offers an illustration of how different philosophies of care and organisational arrangements can produce different qualities of care, irrespective of resources.
Activity 3: Encouraging autonomy in care environments
Read the article, ‘Does group living work?’ by Julia Johnson, where two different environments for residential living for older people are described. As you read:
Consider the features of each care environment. Make two lists:
the factors that promoted residents' autonomy
the factors that restricted residents' autonomy.
Consider any other contexts of care for older people, residential or non-residential, that you know about. What has changed (or has remained unchanged) in recent years?
1 Your lists may have included some of points listed below.
Factors that promoted residents' autonomy
Short distances between communal and personal living areas.
Strategies to promote residents' physical independence.
Promotion of self-reliance by encouraging participation in normal daily tasks and activities, which also increases social interaction among residents.
Mixed-need groups, providing opportunities for more able residents to support those who were less able.
Factors that restricted residents' autonomy
Communal and personal living areas not located near each other.
Staff discouraging residents from using their rooms.
Lack of control over getting-up times, bedtimes and mealtimes.
No attempt to reduce residents' reliance on walking aids.
Residents dependent on staff for moving around the building.
Lack of opportunity to engage in daily care tasks.
2 The author of the article told me in a recent interview that her current research into residential care homes for older people shows that provision intended to enhance residents' lives still varies in quality:
My current research is already demonstrating that some homes are almost paralysed by bureaucracy – health and safety regulations, care standards, and individual risk assessments, which make these kind of enabling environments almost impossible to create. It's depressing that these kinds of developments provide the excuse for why residents are deemed not capable of doing this, that or the other. However, our research is also showing that there is huge diversity in residential care provision which suggests that there may be scope for creativity nonetheless (this I think depends very much on the person in charge of the home).
In terms of providing opportunities for enhancing residents' autonomy, Arden House and Parkview appear to be at opposite ends of a spectrum. Arden House represents a progressive service user-centred approach, while Parkview takes a more traditional service-centred approach, with more features of institutionalised living. Drummond Grange has elements of both care environments. The use of the building's space has more similarities with Parkview, but without a tendency to impair the independent movement of residents. Eric, Bill and Elizabeth, as wheelchair users, welcome the wide corridors and easy access created for them to move about independently. While many of the residents at Drummond Grange are highly dependent on staff to assist them with daily care and living tasks, great emphasis is placed on sustaining interests and enabling residents to engage in activities that interest them. They are also encouraged to personalise individual rooms to create their own space.
Care environments that constrain autonomy can have negative psychological effects that contribute to depression (Boyle, 2005). In Activity 4 you will consider how the dominant values promoted in residential homes can affect residents.
Activity 4: Care home values
In this activity you will consider how the dominant values promoted in a residential home can affect the daily living experiences of the residents.
Listen to the audio clip below as Maria Hutchinson talks about the ‘philosophy’ of Drummond Grange and delivering ‘quality care’. Make notes on what Maria believes to be the guiding principles.
Click to listen to the audio clip (3 min 44 sec)
Transcript: Philosophy and quality care
The principles underpinning National Care Standards mean that care home providers should meet the diverse needs of residents. The Standards describe what people can expect from service providers and focus on the quality of life service users should experience. For care providers, this entails making provision for the range of physical, emotional, spiritual and cultural needs and preferences of the people who come to live there. Homes should take account of service users' cultural preferences when, for example, planning menus or activities and should ensure that residents can practise their religious beliefs. This may mean establishing links with organisations outside the care home, and creating networks to provide relevant services to meet these diverse needs. Careful assessment of needs, competences and abilities enables staff to provide for service users' needs and preferences. Staff working in residential care environments can help to preserve and increase service users' control by recognising and promoting their interests and abilities.