“It doesn’t have to be complicated.” –Tracy Anderson, Architect, Action Pact Design
If your home is like mine, life revolves around the kitchen and dining area. It’s where we go for a late-night snack or daytime meal; relax with friends and family while sharing news of the day; reflect in solitude over a cup of coffee or day dream while washing dishes.
It is the same in Action Pact’s Household Model: The kitchen and dining space is where residents go anytime to find their favorite treat from the refrigerator or cupboard; develop relationships and interact casually with staff, family members and friends; help prepare a meal or just hang out; feel comfortable eating alone or with others.
Tracy Anderson, Principal Architect at Action Pact Design, is a seasoned architect with extensive expertise in senior care. He and Linda Bump, registered dietitian and dining expert, discuss some fundamentals for kitchen and dining design, the challenges of renovation, and how to involve residents and staff in creating the design:
Bump: It boils down to three words – normal, home and relationships. These are the goals when transforming institutionalized food service to resident-centered, resident-directed dining. What is normal for each resident? How did they do it at home? How can we make the kitchen the heart of the home where dining and food preparation is relationship-based, not task-based?
Institutional dining is task-based. We get the right food to the right residents at the right temperature (whether they want it or not.) But we sometimes just plop it down in front of them without a word.
And unlike home, institutional kitchens and dining areas are usually disconnected and far apart, denying residents the familiar sights, sounds and smells of food preparation.
So Tracy, to achieve normalcy, home and relationships, is designing a household kitchen and dining area for long-term care residents so different from designing them in a family home?
Anderson: Designing for a nursing home household of 20 or for a private family of five is very similar, in my opinion. In the private home, family members guide the design based on their individual preferences. In long-term care, the organization – hopefully including its residents and frontline staff – call the shots. In either instance, the architect offers layout options in which the kitchen and entire household is comfortable and functions as desired by those living there.
Whether in a private home or care setting does it need to be a big, elaborate kitchen? No, absolutely not. Must it look and feel like home rather than an institution? Yes, absolutely.
Openness leads to connectivity
In both private homes and long-term care households we strive to enable whoever is working in the kitchen to remain connected to those in the rest of the house.
Bump: Like the father cooking in the kitchen while the rest of the family visits with guests in another room or the back yard. He can still see and hear them. The connectivity is still there.
Anderson: So, too, must the household kitchen be laid out so staff can do what they have to and still interact with residents. You hear the term “open concept” a lot. That’s part of the design basis. If you can keep the kitchen as open as possible and meet all the safety regulations, you probably will achieve connectivity.
Bump: Positioning kitchen appliances so staff working there can still see the residents … placing dishwashers in the households so staff members don’t have to leave to take dishes to and from the central kitchen — those also affect connectivity with residents. I like your word, “connectivity,” Tracy. I think that’s key.
Anderson: It can mean either verbal or visual connection. The kitchen is a hub in almost every house I’ve designed in the last 10 years. It is relatively open to either a great room, or to the dining or living room. It also connects to either the front or back of the house with visual access to the outside. Those seem like basics to me.
Bump: Connecting with the outside is important…the natural light and sense of nature.
Anderson: We can’t always achieve visual access to the out-of-doors from the kitchen, but it’s an absolute necessity for the dining room. If the dining room and kitchen are relatively open to each other and connected as they typically are in the Household Model, there will be some residual benefit in the kitchen from the outdoor light.
Include private dining options
Bump: What about frail elders with poor hearing and sight? High verbal connectivity in the dining area may not work for those needing a more peaceful environment. Hearing aids often don’t make the same distinctions or do the same filtering as our ears. Children laughing in the connected great room may keep Grandma from enjoying her meal.
Anderson: Our designs usually include a dining alcove for privacy. Sometimes they have doors to shut against the noise. It’s also where children can play if several residents want quiet while eating in the larger dining area.
Better acoustics also can help make dining more quiet and comfortable for Grandma and her friends. Reverberation – the echo of sound off of hard surfaces – plays havoc with hearing aids, so we want to design ways to dampen the sound and lower noise transmission in the dining area and throughout the household.
Design for audio, visual and thermo comfort
Bump: So in addition to connectivity, we’re also designing for comfort?
Anderson: If residents are comfortable, they are happier and feel more secure, so we’re trying to design the most comfortable environment possible, particularly with regard to the audio, visual and thermo aspects.
Lighting is a big part of this and is an especially important consideration in the kitchen and dining area. It affects how the food looks, and that impacts how well residents eat and, ultimately, their health and happiness. Incandescent lighting typically makes the color of food look more natural and appealing than fluorescent lights do. With LED lighting becoming more affordable, there are more options available. However, selecting the correct temperature range of an LED fixture becomes an important factor.
Bump: Good lighting is especially important for those with poor sight.
Anderson: Glare is a big factor for old eyes. As eyes adjust to compensate for a glare spot, they don’t see as much detail in the rest of the visual field. So while you want to generate sufficient light for the task at hand, you also need to eliminate glare. That brings into the equation the reflective value of the carpeting and wall paint. Also, infusing as much natural light into the space as possible will offset the need for artificial light and reduce glare potential.
Clutter also affects visual comfort. Elders’ eyes typically see much less detail than younger eyes do, and can be confused by clutter. So the brighter, airier and less cluttered you can make the room, the more clarity with which residents can understand the space.
Bump: Another huge comfort issue is temperature. Often in long-term care settings, residents are cold while staff members are too hot.
Anderson: That relates to thermo comfort and has to do with temperature control and humidity. Typically in nursing homes staff members are over-dressed and residents are under-dressed, often in nightgowns. At home we adjust our thermostat accordingly. In the nursing home, staff members often control the temperature. We try to design a mechanical heating and cooling system with sufficient adjustment options to give residents as much individual control as possible, but we also want residents and staff clothed appropriately.
If we can think about and resolve these comfort issues early in the design process before they become problems, then obviously that’s the best route to take.
Ceiling height affect intimacy, ambiance
Bump: How does ceiling height affect connectivity and comfort? Vaulted ceilings in the dining area are popular, but do they have a downside?
Anderson: It depends on multiple factors. A high, vaulted ceiling can make it sound like you are in a large space, which may not be desirable. A smaller volume space (achieved by lower ceilings) allows for more natural communication and a sense of intimacy among residents and caregivers. (Editor’s note: volume = space measured in cubic units.)
We often embellish ceilings with moldings or beams simply to break up a large ceiling area. That helps bring down the sense of scale and promote a more intimate setting. When renovating an existing building, ceilings often are kept low at any rate because there may not be much volume to work with.
Renovation challenges: there’s always a solution
Bump: Some of the most successful Household Model kitchens and dining areas were created by renovating conventional nursing home buildings. Besides ceiling and space limitations, what are other design challenges of renovation?
Anderson: The existing plumbing, heating, ducting and mechanical systems all come into play. There may be columns or beams and elevators to work around. Sometimes the building has two or three stories. That was the case at Kansas Masonic Home in Wichita where we designed households for both new construction and renovation.
The renovation included two, three-story assisted-living buildings and a skilled nursing facility. Their old nursing home had two stories and was as institutional as they come … a standard T-shape design, long corridors and huge, centralized nurses’ stations. We designed that building into four households, two on each floor, with kitchens.
Aside from the multiple levels, there were other issues. To satisfy regulations and code requirements, and to allow full production of meals, we used commercial hoods in the kitchens over the range and ovens. It was challenging to design those to look homey and not allow the ductwork to penetrate through the middle of a living space on one of the floors above. This really presents a challenge when the layout of the houses is not identical from floor to floor.
Bump: Were you able to design openness, connectivity and comfort into the renovated Masonic Home kitchen and dining areas?
Anderson: Yes, though I would have designed a couple of them with a little more openness if not for pre-existing obstacles. Still, they’re going to be wonderful (construction begins this summer.)
That’s how it is when working in the confines of an existing envelope. Designers have to be very creative, and everyone has to understand from the start that unless all the cards come together just right there’s probably going to be compromise. You have a rule of thumb that you strive for, and then you deal with the reality of the situation.
Bump: Have you ever faced an insurmountable kitchen renovation project?
Anderson: I can’t remember a single one during the past six years. There is always a solution. We never shy away from creating an open, connected kitchen design in a retrofit.
It definitely is worth exploring the renovation option as opposed to new construction. Most organizations have so much built square footage and infrastructure in place that it may not make financial sense to abandon the building.
Integrated Prefeasibility Analysis gains high resident, staff involvement in design
Bump: Whether designing for renovation or a new building, we want residents and frontline staff to help “call the shots,” as you said earlier. How do you get them involved?
Anderson: Action Pact’s Integrated Prefeasibility Analysis (IPA) is a model for gaining high involvement of residents, staff and other stakeholders.
The entire IPA may take four to six all-day sessions held over the span of two or three months. Two or three of those days include intense planning and design. Usually 15-20 people — sometimes up to 100 — participate. This process helps scope and size the project on every level from financial viability to operations, and on every aspect in between. Once the project moves forward we like to use a charrette process that involves residents, family and staff to help provide feedback to the design team on what they like for different elements within a household. We set up tables with a huge assortment of magazines…Good Housekeeping, Architecture and many others, even publications from Home Depot and Lowes. We ask them to look through the magazines for pictures of items that remind them of “kitchen” (or of whatever room we are designing.)
You might think they would look only for pictures of kitchens, but they pick out things from throughout the house that you wouldn’t expect … knickknacks that remind them of something in their kitchen at home. It’s a heads-up for architects that kitchen design isn’t just about countertops and the cabinets. We’ve got to think beyond the nuts and bolts of the kitchen and consider what truly makes it “home.”
Bump: It’s also about family and the relationship between food and celebration. The kitchen and dining is just so integrated in our lives. When I talk with clients about kitchen design, I always go back to, “How did you do it at home? Describe the most wonderful kitchen you’ve ever seen.”
Residents, staff take ownership when they help design
Anderson: We try to capture all of that during the IPA. It gives residents and staff ownership of the final design. Everybody’s got input. We go around the room and ask, what would you like to see? We generate a list of their ideas, put it up on a board and talk about each one.
Several of us with expertise in the various design and development aspects of the Household Model are on hand. As the architect, I’m designing on the fly at the computer as people align around the various ideas. What’s nice about this process is that they get to see the ideas come to life as they suggest them.
Meanwhile, Martin (Dickmann, CFO, Action Pact Development) is crunching numbers to determine whether a particular design option is financially feasible. A contractor is also there, scrutinizing the construction aspects, while Steve (Shields, CEO, Action Pact Development) facilitates big picture thinking even while offering insights on operations and staffing.
We might follow an idea down a path and hit a dead end when one of us stands up and says, “Hey, that’s not going to work and here’s why.”
As residents and staff see their concepts unfold on the screen they might suggest something like, “how about moving the alcove to there and putting a cabinet here…” They see the design take shape before their eyes, and they begin to understand how the kitchen and entire household might function.
Of course, we keep the regulations and codes in mind as people throw out suggestions. Some ideas are put on hold until regulation manuals are consulted. It might take us five tries, but we eventually find something that everybody can rally behind.
As I said, the process gives residents and staff ownership. Those involved understand the challenges and compromises that have to be made, and why the completed kitchen is as it is.
Bump: The process you describe is opposite of what we usually find in long-term care. In conventional nursing homes, kitchens seem designed first and foremost to enable staff efficiency in performing tasks and to satisfy fire codes and regulations. It’s often difficult for nursing home operators to make the transition to “normal.”
Anderson: Our architects have designed many private family homes. I think that enables us to see design challenges in assisted living and skilled nursing care with person-centered eyes. By nature, we begin a new project as though we’re designing a family home or kitchen. And then we begin thinking through the challenges presented by the regulations.
Making the kitchen the heart of the home and the dining experience as normal for long-term care residents as we do for private families seems so basic to me … it doesn’t have to be complicated.