At LLOX we are fascinated by buildings and spaces that are used for long-term accommodation with care.

Over the past 30 years, Europe has experienced an important decrease in the relative number of care institutions. This is a consequence of the development of healthcare at home or in other institutions and of the polyclinical care offered by these care facilities.
The care programmes that were developed between 1980 and 1990 have now reached maturity and are working efficiently. An assessment is possible and the consequences are noticeable.
It has become clear that accommodating residents with a high need for permanent care will yield the best results in small entities that function as micro societies.

The design of care facilities for senior citizens has evolved over the years. In the 1980s, institutions, specifically hospitals, were gradually replaced by residences. The notion of care was extended and the facilities expanded, with an emphasis on core concepts such as assisted living and a home environment.
Although living continued to be a central concept, a new approach was gradually developed around the turn of the century.

The development of home care and improved communication resulted in a new situation in which the people that are hospitalised require more care. The fact that home care is now a fully integrated service and that communication has improved thanks to mobile telephony and telephony, people can now stay at home longer. As a result, the level of care that residents, who are eventually hospitalized, require, is much higher than it used to be in the past. The pressure on caregivers has risen concomitantly, irrespective of the regulations with regard to the required quality while the job market is currently experiencing a shortage of qualified workers.
The concept of “living” has also changedl. The Flanders Structure Plan, which stimulates the concentration of new buildings within the existing residential centres, the cutting down on investments and on available land and the growing importance of sustainable building; all the aforementioned factors have had a considerable impact, which all too often is underestimated, on building plans.
Short connections, efficiency in the use of space and low maintenance reduce the pressure on personnel. A smaller ecological footprint, a reusable structure and a minimal loss of space reduce the pressure on the environment.

Small-scale care programmes can only be efficient if they are based on a clear vision of the management and of personnel. The references below give an idea of our vision; it is up to us to integrate this vision in our architecture, while taking into account the specific location and the available budget.

The images that illustrate this text* are early designs of the care centre campus of the “OCMW Diksmuide”, a project that is representative for the vision stated above. In a compact building, we designed interesting circulation patterns with varying impulses from the outside and the inside world.

A small scaled approach based on the Cantous model** is possible within this space, as well as a possibility to work with larger groups of residents.

As a whole, this environment should improve the general wellbeing of its residents (healing environment) with special attention for
- safety
- privacy
- freedom and autonomy
- interaction between caregivers, employees and residents
- interaction between residents and their visitors, their family
- accessibility
- profitability (maintenance, energy, ecology, sustainable building)
- outside world (the urban and social fabric, ecology, sustainable building,...)

*Open PDF, bottom of this page.
** a shared residential environment for people with a diminished ability to live independently with a special focus on social life, communication and interhuman relationships. Residents are offered a joint sense of independence within a protected environment.

In the last few years, research of the influence of architecture on residents’ and users’ mental and physical health has become more and more important. This sort of research has its roots in environmental psychology, but can be applied to the health care industry.

The emphasis is mostly on buildings with a very literal “healing” function: institutions in the health industry such as hospitals, psychiatric institutions, homes for the elderly, etc. The basic idea is that the architectural environment influences the mental and physical state of people. The frame of mind and thus the physical health of its users would be altered in a positive way by very specific and well-considered changes to the environment.

Psychologists, doctors and sociologists have a specific idea of what such a healing environment should look like, and so they often find themselves venturing into architecture as a result. . Thus, the terminology has found its way into the field of architecture. As architects of buildings for the health care industry, LLOX obviously tries to stay informed about this recent development. The insights gained from this type of research can be very useful for the design of new buildings for the health care industry. Conscious choices in the architectural design might for example enhance the healing process, which would mean a considerable cut in the consumption of care services and of medical costs. Moreover, the care personnel would be more motivated to work within an environment that is geared to their specific needs, which in its turn optimizes the quality of their services.
It is worth noting that the size of the environment is dependent of various factors, though.

The length of the patient’s stay in the care institution could for instance mean that environment will play a bigger role in the healing process.
In practice, a healing environment can result in a quicker recovery, less pain and infections, and more patient satisfaction. For the personnel, it can reduce stress and attract highly qualified people who will be more loyal to the institution.

According to environmental psychology, environmental stimuli cause a certain degree of arousal or stress. At medium arousal level, people are apparently able to function in an optimal way. In order to be beneficial for the patient’s recovery, the number of stress impulses should be reduced to a minimum.
Generally speaking, too much information or too little coherence in the environment, or the lack of control over the environment, would lead to a higher level of stress, which could be detrimental to the patient’s health.

Residents should have a clear overview of their environment and should have a sense of control over it. The sense of privacy is crucial here. When people have lost control over what they consider to be their personal space, this will raise their stress level. Social interaction also plays a major role in their wellbeing. To encourage social behaviour, a common room is necessary, with an adapted layout of the furniture, i.e., chair or sofas arranged around a table.

Different kinds of care institutions also require different types of architecture. A psychiatric institution will have to comply with other standards than a home for elderly people or a hospital. The graphic above illustrates the way we translated this idea at LLOX. It is the outcome of our accumulated experience in all aspects of housing of residents who require care: extra mural (social residences), transmural (assisted living facilities) and intramural (rest homes and hospitals). It is actually our vision on “homeliness”, which we always consider in relation to the capacities of the residents, patients and users.

The residents’ level of arousal is caused by a combination of environmental stimuli as they are perceived through the senses. In order to achieve a medium level of arousal, a sufficient number of positive stimuli needs to be present in the environment. Elements that raise the stress level too much need to be avoided.

Light plays an important role in influencing a resident's physical and mental state in visual impressions. Especially the natural cycle of day and night is essential for normal biological functions. A lack of natural daylight, for example, causes depressions, as the hormone melatonin will shut down one’s body as it were.

Colours can also contribute to a general sense of wellbeing . The UK Health Office attributes a diminished number of epileptic attacks to the colour red. Blue would have the quality of calming down aggressive patients and other shades of red would be beneficial for people suffering from arthritis of rheumatism. Karin Slegers reduces the influence of colours to their brightness or level of saturation. In conclusion, very bright or highly saturated colours (with a larger amount of grey) are generally perceived as more agreeable. A monochromatic colour range for the entire space should always be avoided.

The view on the outside world is also of great importance. In the same way, the presence of plants inside the building will introduce a sense of the outside world, which enhances the atmosphere in the building. Nature views would also have a calming effect and be beneficial for people’s health. Art has the same calming effect and can serve as a point of recognition.
Performance art such as literary readings, concerts and theatre enhance social interaction, even more than pictorial art.
Although the link between architecture and the sense of smell is not very evident, it can be useful when designing an interior to take into account the influence of smell on people’s health. Olfactory messages would have the ability to reach the brain even quicker than auditory or visual impressions. Research has shown that the smell of fruit or flowers has a calming effect on the respiratory functions, the blood pressure, the heart rhythm and the muscles. Smells also have the quality to reduce pain by releasing endorphins and pain killing hormones. A medicinal smell causes anxiety and should be avoided at all times.
Next to this, it is also useful to take into account tactile impressions. These also provide important information about the environment and thus help shape a positive or negative image of one’s environment. Materials with a soothing effect should be chosen.Comfort is a key word here. Fabrics need to be chosen in function of their soft texture, furniture in accordance with the ergonomics of their design, edges should be rounded where possible.

Switches should be easy to use and be within hand’s reach, as should be the controls of windows, curtains, or television. This stimulates a sense of safety and control over the environment.

Sounds, finally, like smells, have the capacity to release endorphins and have a pain killing effect, especially natural sounds like rain, wind, birds, or music. However, the effects can differ from person to person, so there should be a possibility to choose between various sounds. Noise from telephones, alarm systems and monitors should b avoided as much as possible.

NHS Estates, Executive Agency of the UK Health Department, Improving the Patient Experience: The Healing Environment, Slegers, Karin, Literature study of the influence of interiors on the well-being of patients/residents and employees in care institutions