Lighting: Follow the Research!

By Jane Rohde

Lighting Research

Research regarding natural light and older adults has been championed by the Lighting Research Center at Rensselaer Polytechnic Institute’€™s Mariana G. Figueiro, PhD and Mark S. Rea, PhD.  There is general research and lighting principles for older adults available at http://www.lrc.rpi.edu/programs/lightHealth/LightOlderAdults.asp. Changes occur to the visual systems as residents age and can decrease ability to see, impact balance and stability, and impact the circadian system as it relates to the quality of sleep. Utilization of daylight and artificial sources of light can be used to stimulate the circadian rhythm to improve sleep, increase visibility while completing tasks, and reduce fall risk. There is a resource based upon the research completed called Lighting Patterns for Healthy Buildings that can be utilized by design professionals to improve their lighting design and placement for positive outcomes by residents, patients, and staff.  For example, for a nursing station there is a Base Case provided for reference, and two redesigns with descriptions; one with Circadian Stimulus (CS) that is static and one that is color tunable. The information on the website (http://lightingpatternsforhealthybuildings.org/) is available for various types of senior living, healthcare, and educational spaces.

With the on-set and popularity of a health and wellness focus for workers, as part of the sustainable design of buildings, the General Services Administration (GSA) has completed research on circadian light that found that office workers who received the most circadian stimulation at work during the daytime, slept an average 30 minutes longer at night.[1] This in conjunction with a recent RAND study on sleep estimated that the US loses an equivalent of about 1.23 million working days per year due to sleep loss, translating to an economic cost of $9.9 million per year.[2]  These data could support a business case for investing in circadian effective light in daytime work environments – including healthcare settings. With the high turnover and stress for healthcare workers, the provision of circadian effective light could support staff through various shifts for better performance and healthier individual outcomes.

The two popular rating systems used for the evaluation of Health and Wellness attributes including daylighting and access to views are the WELL Building Standard® and FitwelSM.  WELL is available through the International WELL Building Institute and administered through GBCI, the certification and credentialing organization for USGBC (LEED®).  FitwelSM was developed by the Centers for Disease Control and Prevention (CDC) and GSA.  After the completion of over 80 pilot projects, FitwelSM is now administered by the Center for Active Design. As of the beginning of November 2017, there are 59 current projects certified or in-progress and over 600 committed projects anticipate in 2018.

Standards and Guidelines

There has been an update to the Illuminating Engineering Society’s Standard Lighting and the Visual Environment for Seniors (IES RP-28-16) that includes guidance as well as recommended foot candle levels for designing of various types of spaces within a senior living setting.  The companion standard, Lighting for Hospitals and Health Care Facilities (IES RP-29-16) has also been updated and includes guidance and foot candle levels for spaces found in hospitals and outpatient facilities.  Both standards are referenced in the three 2018 Facility Guidelines Institute (FGI) books; Guidelines for the Design and Construction of Hospitals, Guidelines for the Design and Construction of Outpatient Facilities, and Guidelines for the Design and Construction of Residential Health, Care, and Support Facilities.

Within all types of healthcare settings, most users are over the age of sixty-five.  When designing environments for those with low-vision, the outcomes are good for all users of a setting – including such attributes as reduction of glare by using indirect lighting solutions, providing even lighting on all types of walking surfaces, and providing adequate light levels to easily read and understand information provided by healthcare practitioners. The recommended resource available as a free download is the Design Guidelines for the Visual Environmentcompleted by the National Institute of Building Sciences (NIBS).  This document is also referenced by the FGI’s Guidelines for Design and Construction of Residential Health, Care, and Support Facilities and recommended by the Mayer-Rothschild Foundation.

Design Guidelines for the Visual Environment from the National Institute of Building Sciences (NIBS).

Conclusion

Research is having an important impact on lighting design for healthcare environments. Coupled with the development of tunable LEDs, sensors to control daylighting within healthcare spaces, and designing buildings with easy and safe access to outdoor areas, the opportunity to improve patient, resident, and staff outcomes is clear!  Become a champion of good lighting design€“ as it supports quality of life!

[1] Figueiro MG. (2017). The impact of daytime light exposures on sleep and mood in office workers.

Sleep Health. 2017 Jun;3(3):204-215. https://www.ncbi.nlm.nih.gov/pubmed/28526259

[2] RAND Corporation, 2016.  Why Sleep Matters: The Economic Costs of Insufficient Sleep https://www.rand.org/randeurope/research/projects/the-value-of-the-sleep-economy.html

Blog was written for Sunbrella.

Evidence Based Design: Resources for Senior Living!

By Jane Rohde

Introduction

This month, Sunbrella is bringing to you; Evidence Based Design: Resources for Senior Living!  Sharing resources and building the evidence is an important aspect of working in all segments of healthcare.  Information from post-occupancy evaluations, research that is completed by various educational institutions and health systems, NIH, CDC, GSA, and other governmental agency research studies, and observational site visits are all resources for the design community in evaluating evidence that supports design decisions based upon the specific application, care populations, and overall goals of a project.

Unique Approach to Collaborative Design Guidelines

At the last Environments for Aging Conference, Robert Wrublowsky, Principal Architect at MMP Architects gave a presentation on the newly developed Design Guide for Long Term Care Homes (Guide).  His goal is to share this as an open source resource and have others add to the research base by providing information that can be included in updates of the Guide to allow it to be a living document.  This is a fresh way of looking at information as a shared growth opportunity to reach a greater saturation of person-centered settings within not just North America, but throughout the World.

Embracing a Cultural Shift for Person-Centered Care

The Guide includes Guiding Principles and provides a comparison of institutional models to small house models, including case studies. The organization of the document includes an evidence based design research topic, the use of icons to provide the associated outcomes for the research topic, an explanation of the design issue that the research topic addresses, EBD interventions and the rationale applicable to the intervention based upon a robust systematic literature search, including rating of the rigor of the research.  Robert has generously allowed the Guide to be available on both the Facilities Guidelines Institute website (www.fgiguidelines.org) and on With Seniors In Mind educational website (www.withseniorsinmind.org) as an open source downloadable resource for those working in the senior living and long term care marketplace.

Design Guide for Long Term Homes. Available with permission: ©2017 Robert Wrublowsky all rights reserved at www.withseniorsinmind.org.

The Guide was part of a recent presentation to senior living care providers at the LifeSpan Conference in Maryland. I discussed processes as illustrated within the Guide, the FGI Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, and the Senior Living Sustainability Guide®(www.withseniorsinmind.org).  All of the referenced resources have in common wanting to support the deinstitutionalizing of long term care, which requires embracing culture change, creating small house / household environments, operational restructuring, and following Evidence Based Design principles. As part of the programming and planning process using these various resources, our firm always holds focus groups, gleans information at the onset of a project, understands and helps develop the care models that are being considered, and discusses the goals from a person-centered perspective. Ultimately, we are continually asking for involvement by the operational team throughout the programming and design process. The interesting part of the session was the reaction by the operational and care staff in the audience.  Apparently, what is the norm for asking the operational staff what works, what doesn’t work, and what is important to their residents is not actually the norm – the care managers, front line, and operational staff are being ignored and not used as the most amazing resource available to a design team! One story included a care manager that told the architect that the bed and furniture configuration that they wanted to utilize was not going to work within the layout of the resident rooms. Their comments were dismissed and ‘waved off’ by the design team. I asked, “…so, what did you do?” She replied, “we {nursing staff} just sat back and watched,” and sure enough they were definitely right, and the beds would not fit into the rooms!  This was one of many stories that I have heard in the last few years about design teams “knowing better” instead of embracing the resources that are readily available to assist with making evidence based, thoughtful, and meaningful decisions that improve resident outcomes and quality of life for both staff and residents. When assisting a client with a repositioned project or building a new or replacement project, it is essential to gather information from the operational team, residents, and their families.  If we design something that is decentralized, but the operational team does not provide feedback and education/training for front line staff, they will carry over the centralized, institutional model of care over to the new decentralized setting.  This is setting up a new project environment to fail – the discussions upfront in the planning programming process are the most important prior to completing any design concepts or solutions. Building a framework that assists with decision-making and maintaining the framework throughout the project design process through construction allows all team members to understand the project goals that should support the resident outcomes and ease of staff to implement the desired care model.

Conclusion

Robert and I share the recommendation that all healthcare designers should read Atul Gawande’s Being Mortal – as quoted in the beginning of the Guide: “Making lives meaningful in old age is new.  It therefore requires more imagination and invention than making them merely safe does”.  This is our charge as designers for older adults and other potentially vulnerable populations – collaborate, share, and understand those that you are designing for – including the staff, families, and specifically the residents.

Blog written for Sunbrella.