Future nursing home design: an important component in enhancing quality of life.

The first nursing homes were built in Constantinople during the time of the Byzantium empire to provide a home for infirm elderly persons.1 Since these early nursing homes, there have been dramatic changes in the design of nursing homes. In the United States, the original nursing homes were modeled after hospitals, as is still the case for most skilled nursing facilities. These designs focus on nursing efficiency. In the 1970s, M. Powell Lawton, in Philadelphia, moved toward focusing on designs that are more resident friendly and designed the Weiss Pavilion. His concepts stressed the need for privacy and environmental approaches to the care of older persons with dementia.2,3 He stressed the importance of recognizing the importance of the interaction between psychological and environmental influences. Private rooms are associated with better resident, family, and staff satisfaction. With the modern approach to culture change, there has been pressure to develop smaller nursing homes with private rooms for everybody.4e6 In larger nursing homes, there has been a movement to create smaller unitsdspecial care unitsdfor persons with dementia and behavioral problems.7e10 Modern units may incorporate a high-stimulus “Snoezelen” room or “Namaste” room.11e15 Exercise has proven to be highly efficacious, not only for improving cognition but also for decreasing difficult behaviors.16e23 For this reason, having areas such as wander gardens and adequate indoor space represent an important design feature for Special Care Units. There is also need for a quiet conference room where small groups can undergo cognitive stimulus therapy.24e27 Other important areas for dementia care are adequate signage, including personalized pictures or “memory boxes” outside the rooms and using different decorations on each door to make wayfinding easier.28Windows to theoutsideat adequateheight forwheelchairusers also allow persons to better establish different routes to their room or eating space. Floor plan design, aswell as furnishing, also plays a helpful role in wayfinding. Straight pathways from the bedrooms to the living/ diningroomsarean important feature.29Adequate lightingappears tobe important for persons with dementia. High-lux light (2000 lux), especially in themorning, canhelp to readjust alterations in circadian rhythm that occur in persons with Alzheimer disease.30e33 Studies have shown that most natural light in nursing homes is inadequate.34