Sleepovers Open Architects' Eyes on Nursing Home Design 

By Bob Moos, Dallasnews.com

May 27, 2009

David Dillard, president of CSD Architects, is requiring senior living architects at his firm to participate in the Sleepover Project, in which they spend the night at a nursing home as though they were a disabled resident. 

He was 25 years their junior, and he seemed much more curious about his surroundings than anyone else, chatting up the staff and residents and paying careful attention to door widths, hallway lighting and window heights. 

Dillard wasn't at the Pilgrim Haven skilled care center in Los Altos, Calif., because of an illness, injury or long-term disability. The 58-year-old Dallas architect of senior living communities was there to live the life of a nursing home resident for 24 hours. 

"It gives you a new respect for the residents," he said. "Living with them deepens your passion for your work, and it opens your eyes to some practical ways to improve a building's design." 

Dillard believes so fervently in the value of such nursing home stays that he's required all senior living architects at his firm, CSD Architects, to pack their overnight bags and join him on the Sleepover Project this year. 

This may be a first in the architectural profession, said Ingrid Fraley, head of the American Institute of Architects' Design for Aging advisory group. 

"David has raised the bar with his commitment to understanding what nursing home residents face," she said. 

"There's nothing like wheeling through a lobby with only a sheet over you on your way to the shower to understand the importance of design. Sometimes, architects forget how people get from Point A to Point B." 

About three dozen CSD employees will fan out across the country this summer and check in at nursing homes, dementia care facilities and assisted living communities that have agreed to participate in the project. 

Dillard, president of CSD, kicked off the sleepovers last month when he became a roommate of an Alzheimer's patient at the Los Altos continuing care retirement center. 

The Dallas architect has designed dozens of senior living communities over the last 20 years, but Pilgrim Haven's administrators had promised to treat him like any other resident. 

Parkinson's patient 

To help him appreciate his fellow residents' infirmities, the staff placed Dillard in a wheelchair, taped his fingers together to simulate arthritis and gave him a color-coded wristband to alert caregivers that he was prone to falling. 

"We cared for David as though he had Parkinson's disease," said Pilgrim Haven executive director Karen Jenney. "He played the role well. He easily blended into our community and followed the same routine as everyone else." 

That included breakfast, lunch and dinner in the residents' dining room, group stretching exercises in the morning, a blood pressure check followed by a shower (albeit with swimsuit) after lunch and a birthday party for residents in the afternoon. 

"The staff even woke me up in the middle of the night to help me to the bathroom," Dillard said. "Frankly, I'm not sure how I felt about that." 
The Pilgrim Haven skilled care center was built in 1956 and, pending approval from Los Altos city officials, will be demolished next year and replaced by a nursing home designed by CSD Architects. 

Throughout his stay, Dillard asked about the outdated building's deficiencies and took notes of what he saw himself. Spending time in a wheelchair, the architect discovered, for example, the need for bigger rooms, particularly bathrooms. 

"As an architect, you can't cheat on inches when most residents have to maneuver wheelchairs," he said. "You've got to be generous with space." 

Revelations 

Other CSD architects and designers have had their own revelations during their 24-hour stays at skilled care and assisted living facilities in Dallas, Plano and the Baltimore area over the last few weeks. 

Chris Muder, a 31-year-old project designer who was cared for as though he had had a stroke, said the sparsely furnished patient rooms reminded him of the sterile dormitory rooms he knew as a college student. 

"It's one thing to live in such surroundings for a school term but quite another to live with so little for the rest of your life," he said. 

Muder also found that seemingly inconsequential building features can become frustrating to the disabled. He noticed, for example, that high windowsills prevent residents in wheelchairs from enjoying the view. 

Dillard intends to take the lessons he and his colleagues learn from their stays and compile the observations into a journal they can consult as they design other nursing homes, dementia care facilities and assisted living residences. 
CSD's president came up with the idea of the Sleepover Project early this year as a way to keep his staff engaged and stimulated during the construction slowdown. 

"Years ago, a client had asked me to spend a night at his nursing home before starting on a renovation, and the experience taught me a lot," Dillard said. "I figured that what was useful for me then would be helpful to us now." 

Rethinking design 

The Sleepover Project concentrates on facilities that offer a high level of patient care – a niche of the senior living industry that Dillard believes will offer opportunities once the economy revives and construction picks up. 

Industry officials bear out the architect's prediction. Many of the nation's 16,000 nursing homes are now several decades old and will be due for replacement or extensive renovation. 

"It's a good time to rethink nursing homes and create better environments," said Peter Notarstefano, an official with the American Association of Homes and Services for the Aging, an industry trade group. 

"Architects shouldn't design buildings according to what they simply think an 85-year-old patient needs," he said. "They should see for themselves what that person requires." 

Dillard said it's too early to draw any definite conclusions from the Sleepover Project, but he suspects many of the architects' comments will focus on making nursing homes look less like health care institutions and more like homes. 

Aside from the benefits to his business, Dillard said he has a personal stake in the project. 

"What we design today will be what my generation inherits in its old age. That's a big incentive to do better." 

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