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Residential and nursing care homes remain a major part of uk provision for the elderly. A new Health Facilities Note gives guidance for designers Creating caring environments BY JOHN PENTON

The emphasis placed on 'care in the community' during the last decade has tended to play down the significance of nursing and residential care. Yet the number of people surviving longer into old age continues to increase steadily. Many elderly people who would have died from complications following life-threatening disease are being treated successfully and their lives are being further extended. There are now 2.3 million people over the age of 80 in the uk, and it is anticipated that this will have increased to 3.1 million by 2001. Approximately 5 per cent live in residential or care homes, one in four of those aged over 85.

Such homes are provided by the voluntary sector, by local and health authorities, and increasingly by commercial contractors. Indeed, many local authorities have sold their homes, often to commercial buyers, and now contract into the residential and nursing services provided by the new owners.

All homes are subject to registration and many are 'dual-registered' (public and private). Standards are gradually being pushed up. Many smaller homes in converted former houses are finding it increasingly difficult to reach the standards required to renew their registration. Most often this relates to the lack of individual rooms and en-suite facilities. The demand for good-quality residential and nursing accommodation continues to outstrip supply, and many commercial operators have substantial programmes to build new units throughout the next decade.

With this growth in demand, and in the light of the inevitable increase in infirmity and frailty of many of the occupants of homes, a comprehensive review of their design is timely. hfn 19 (Health Facilities Note 19)* has a strong bias toward new build, which is probably realistic. Even in the case of two of the five profiles of homes illustrated in hfn 19, where existing buildings have been added to, these additions are to all intents and purposes new self-contained units. However, it would have been valuable to include at least one example where genuinely good standards have been achieved through the radical conversion of an existing building. (Hope House in Cambridge is a case in point.)

hfn 19 is straightforwardly arranged in sections covering the design principles, detailed design advice (on communal areas, residents' own accommodation, staff workspace, finishes, fixtures and furniture) and the external environment. This is followed by five profiles of homes, plus a useful selection of references. Throughout the text there is frequent reference to the importance of the onset of Alzheimer's disease and of increasing sensory impairment.

Some of the detailed design advice does not perhaps go far enough in recognising the common problems associated with advanced ageing. The suggested profile of 'window heights for view out' for example (see diagram) has a low sill suited to sitting in a chair or to lying in bed. But, while safety is referred to, the very real and common problem of vertigo is not. The provision of a planting box immediately outside the window could help to overcome this, and would add to the enjoyment of residents.

It is also regrettable that the diagram of the 'wc compartment for wheelchair access' (see illustration) shows the wc 500mm from the adjacent flank wall. While this is proposed both by bs 5810: 1979 and by Part M of the Building Regulations, this dimension is now acknowledged to be too great and should be reduced to 400mm or even 375mm. Certainly for anyone with reduced upper-=body strength the distance to have to reach in order to use the wall-mounted grab bar is impractical.

Nonetheless, this newly published hfn is a useful reference for anyone approaching the design of nursing or residential units, especially for the first time.

John Penton is a consultant architect specialising in disability and ageing

The Design of Residential Care and Nursing Homes for Older People. Health Facilities Note 19. Centre for Accessible Environments (cae)/nhs Estates. cae, tel: 0171 357 8182. £32.50

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