In 2011 the Scottish Government published the ‘2020 Vision for Health and Social Care’ establishing a primary aim,
[that] by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.
But what makes a place homely for those that cannot be treated at home?
The scale of most healthcare facilities is so different to most people’s experience of home that past approaches of simply adopting domestic detailing have generally failed to result in an attractive and homely place; being more like a large bungalow and rather institutional.
The factors that affect our perception of home are many and diverse. Age, socio-economic background, culture, personal histories, politics, lifestyle choices and health all influence how we furnish our lives. With so many interrelating factors, it is clear that no one place will replicate ‘home’ for everyone.
However, learning from how this issue has been tackled across a number of sectors, including care homes and the voluntary sector, to achieve a relaxed and homely atmosphere suggests common principles that provide a route through this complexity.
Homely settings offer familiar, comforting experiences at each step on the journey. They allow people, as far as possible, to live the everyday moments and experience the range of activities one can at home.
The arrival experience is the first step. Scale that suggests a domestic or residential nature, even one more like a group of flats or small hotel, can make the building feel immediately more personal and less institutional. Its form and character can also be made familiar and comforting by reflecting the local context; not necessarily through simple replication of domestic styles, but by taking elements of ‘non-institutional buildings’ in the area and using these to inform the proportions or materials.
The ‘front door’ of a healthcare building is likely to be different to a house, as communicating welcome will usually be more important than marking privacy. As a result, creating a ‘front door’ with a sense of welcome increases the amount of glazing, transparency and views into the building. Features such as planting, canopies and the use of soft materials like timber can make the scale of the entrance feel more human and less formal.
The living room or lounge is a key space in every home. It allows the occupant to unwind, entertain, play games, chat, watch television; anything to help them relax and forget about their worries. The waiting areas, sitting rooms etc. in healthcare buildings are their ‘lounges’. They might not necessarily be the same size as a room for a single family, but they can be designed to offer a range of spaces to relax: intimate spaces to sit, read quietly, chat privately, or larger spaces to chat socially, play games, and interact with others. There may be many small spaces or one large space broken up by architectural elements that allow activities and experiences to occur concurrently without distracting one other. It is also important to consider the acoustics of these spaces as large rooms without enough soft furnishings can create a distracting echo, making it difficult to talk, listen and relax for patients who may be anxious or apprehensive.
The ‘front door’ to the patient’s private realm may be much further into the building, such as the entrance to a ward or the entrance to the bedroom. The bedroom at home has its own special sense of ownership, personalisation and privacy that can reflect a person’s character. People tend to retreat to their bedroom for privacy and solitude, or, to a snug or private space that serves a similar purpose. Here, people can relax, collect their thoughts and ruminate during times of stress. The challenge for the designer is to make these entrances feel private and safe yet individual and personal. This can be done through colour choice, natural light, art and letting patients personalise their space with their own objects and photographs. See our guide on Personal Space: Interior design approaches to mental health buildings for further information on bedroom design.
Mealtimes and the event of eating have many sensory, as well as social, associations. For people eating together, it can represent a social event and a chance to chat over their meal; to tell stories, make plans and discuss the day. Similarly, the opportunity to sit somewhere more private to eat or have a conversation over a cup of tea with a friend can be a simple, positive reminder of life at home. In both cases, acoustic distractions should be minimised to allow people to concentrate on enjoying their food and company. Information on dining for patients with dementia can be found in Design for Dementia.
As well as the social and physical benefits of eating, food and drink also have the power to remind people of home through the senses. Taste and smell seem hardwired into our minds with the power to draw out seemingly forgotten memories. This can be a powerful tool for reminding patients of home. Creating the opportunity to let these natural senses be stirred reminds people not only of home but crucially enriches their own personal experiences.
For many people, the garden or courtyard is an extension of the home into the natural world, with huge benefits for health and wellbeing. For those from rural communities, the absence of greenery can in fact be highly stressful. The day-to-day use of a safe, exterior space, like a garden, lets people enjoy the beauty of the natural world. It can be easily replicated for patients to use in the same way that they might at home, to get out of the house for peace, a walk and enjoy the natural elements.
Well-designed, thoughtful landscaping aids orientation and encourages residents to explore a safe and secure environment. This can help prevent stress and provide comforting recognition during spells of confusion and disorientation. This might involve creating routes that return to a central space or that keep a destination in sight to prevent patients from getting too anxious.
Over time, the landscape can move from being something viewed to a healthy activity that gives purpose to recovery through positive interaction and maintenance. Design of gardens and courtyards need to consider the level of maintenance required as well as the appropriate flora for its climate and orientation. If spaces are designed for patients to tend, then the ergonomics and extent to which patients can work will affect the heights and layout of any landscape design. Further information on the importance of contact with nature and the outdoors can be found in Greenspace Design for Healthy Living and in the Green Exercise Projects by the Green Exercise Partnership.
The points above describe the steps on the journey in and around the home. The culture and social nature of homely places are informed by their existing built environment. They reference key built or natural environment features of an area that people will be familiar with, helping them identify with their surroundings more readily when they may be in a vulnerable state. The spaces are designed to support, as far as possible, ‘normal life’ experiences of home, thereby feeling more welcoming and aiding a sense of comfort and belonging. Thus, homely environments can help to alleviate stress; contribute to mental stimulation; provide meaningful distractions and, ultimately, help shape meaningful social relationships in someone’s current situation.
Homely settings make the scale of the facility feel manageable and provide people with appropriate control over their environment.
In an unfamiliar environment, places can be difficult to navigate, especially in older hospitals where corridors can look the same. Simple and intuitive wayfinding for people at a time of stress is therefore critical to maintaining and improving independence. Wayfinding can be made more intuitive through natural light, clear sightlines and views to help orientate the user in the building. These can be framed views out of the building, views of staff, or memorable spaces within the building itself. Memorable spaces can create identity in communal and personal areas through various applications of spatial volume, colour, graphics, art, photographs, furniture, texture, craftsmanship and acoustics.
The proximity and progression between public and private spaces requires particularly careful consideration so that there is a natural progression of privacy from entrances and public space, to social spaces, to private areas and bedrooms. The location of the bedroom is important as few homes are designed so that guests go past bedrooms to reach the living space. Where possible, care environments should place bedrooms at the more private ends of the circulation and bring social areas to the front. This is particularly important for patients that are more sensitive to social interaction and noisy activity. The configuration of these spaces should give patients a range of choices to explore and opportunities to progress into more social spaces at their own speed.
Homely places normalise, as far possible, the daily scale of the place experienced as your home and the relationship of experiences within that. Adjacencies between key rooms should feel manageable and comfortable, encouraging people to move about and experience different parts of the facility should they desire. Without introducing visually oppressive security measures, the scale and layout of the facility should provide people with appropriate levels of privacy so that they feel secure in their own space.
Homely settings help people still feel connected with the life and activity in their community, rather than separated from it.
Most homes are not simply a place in themselves but part of a community where the view from the window and the trip into the park or the town is a key part of domestic life. Feeling a part of a wider community creates meaning for people through a sense of belonging and social worth. Designs that encourage and support this make visitors feel welcome and also provide patients with the opportunities for experiences ‘beyond the home’, helping to retain some sense of normality.
This can be achieved through a number of means. For some it can be as simple as being able to eat and receive visitors somewhere other than in their bed. It could be by providing settings such as a ‘pedestrian street’ that help people retain the familiar control of visiting places, where they might bump into friends or make plans to go to the coffee shop, cinema, hair salon or an exhibition. Group experiences that you might do with family or within the community such as art, music, cookery, dancing, games and hobbies are all creative acts that help stimulate the mind through concentration and imagination, and give people that extra event to look forward to. The organisation MyHomeLife.org.uk has more information on maintaining identity and retaining links with the local community.
By placing facilities where they have views of community life (such as a playground or park) from the more social areas, brings ‘normal life’ into the place. Having the facility near the heart of a community increases both familiarity and the chance for patients to venture out, either under their own steam or accompanied by staff or friends and family. This can reduce the need for purpose-built provision and provides a truly authentic connection with life and place.
Providing homely settings is not simply about mimicking domestic details on a larger scale wherever bedrooms are provided. Community facilities can be made homely by helping people retain their sense of self and self-control through normalising, as far as possible, the arrangements of activities and feeling of control. Creating the opportunities for meaningful experiences of home and maintaining links to life outside the facility through views, places to meet family and friends, and taking trips into the community allows patients to retain connections with their everyday life.