Phase I: Understanding the Current Elder Experience
When we set out to create a real-world laboratory for developing and testing new solutions for improving elder care, we knew it would be challenging. What we didn't know was how deeply personal and inspiring the process of building the Nursing Home of the Future laboratory would be.
The NHoF team used an observational design approach to capture the experiences of residents as they moved through daily life. This allowed the team to construct a more accurate picture of how residents interact with staff, utilize physical spaces, make use of equipment and furnishings, access medical care and engage in recreational activities.
For the team this has meant hundreds of hours at Tockwotton Home, a 30-bed assisted living center and 42-bed skilled nursing facility located in Providence, talking with residents, participating in social events, meeting with families, talking with staff, interviewing experts and documenting everything with audio, video and photography.
The team then synthesized these observations into a series of maps, vignettes and photographic displays that make it easier for non-experts and experts alike to understand the current experience and construct a starter set of opportunities for improving it.
What did we learn?
We know that we can and must do better by our elders. We know there is a better way to deliver care to those elders who can no longer live with full independence. The residents and staff at Tockwotton Home have taught us us that opportunities for intervention and innovation are everywhere—in health and wellness management, in environmental improvements, in developing tools that give residents more comfort or more independence, and in virtually every aspect of the underlying infrastructure of the nursing care model.
Here is summary of what we learned:
1) The journey of aging is non-linear and every individual takes a unique path.
We often think of aging as a simple straightforward arc from birth to the end of life. In fact it is far more complex, with many different and intersecting possible paths. Understanding these paths and how they live a fully independent life to hospitals, senior housing, assisted living, nursing and hospice (and combinations of all), is critical to know how we can better care for our elders both in their own homes and in institutional settings.
2) Families and caregivers travel these paths with the elder.
The elder is only one part of a human triad that includes family and caregivers. The strength of relationships in this triad are crucial to the quality of an elders experience and directly effects health and wellbeing and the path an elder takes on his or her journey from independence to dependence. Strengthening the care triad and developing new ways to support families and caregivers, in both the residential and institutional environment, is vital to creating a new system for elder care suitable for meeting the needs of elders today and tomorrow.
3) Elders are especially vulnerable to inciting incidents.
There are many reasons why individuals may require higher levels of care than can be provided in their own homes. These incidents can be as sudden as a fall leading to broken bones, or as gradual as the onset of dementia or difficulties managing problems with continence. These incidents can happen anywhere but are especially common in areas of transition such as the kitchen, bathroom and moving from sitting to standing, etc. The NHoF team found many opportunities where better design can reduce the occurrence of inciting incidents.
4) The experience of the individual is controlled by variety of systems and sub-systems that are in many cases dysfunctional.
Care for the elderly is shaped and defined by a complex web of stakeholders and influencing organizations such as Medicare and Medicaid, for-profit and non-profit care providers, the medical community, family advocates, insurance companies, and senior advocates. Like the iceberg that lies below the waterline, the extent to which each of these systems affects quality of care and quality of life is unseen at the surface. However, these driving forces create many of the choices and experiences elders encounter as they travel the paths of aging and elder care.
Innovation in the systems and structures that surround Medical Care, Assistive Technology, the elder care Workforce and the physical Environment will reshape the options available to the elder, decrease the cost of care, and help elders to stay independent and active. New options in Business Models & Financing and elder care Policy will expand options for traditional and new players to profitably offer big-win innovations that create completely new experiences for elders.
Many opportunities exist in re-envisioning how all forces and organizations accommodate the individual needs of elders and in finding novel ways for disconnected groups to work together to create elder care services and solutions.
5) The daily routine of elders in care is profoundly different than our own.
Elders, especially those requiring some assistance, tackle the routines of daily life in ways that are hard for younger people to imagine or really understand. Physical disability and cognitive impairment makes some of even the most basic daily experiences extremely challenging and exhausting. The importance and significance of getting around, eating a meal, or taking a shower are measured differently than they would be for a younger or fully able adult. Although routines are different for each elder and each day, in general they include the following elements.
In particular, the NHoF team looked at 10 activities of daily life that have a significant effect on an elder’s quality of life. They are: Transitions, Personal Care, Dressing, Eating, Free Time, Activities, Mobility, Medicating, Paperwork, and Relationships.
A deep examination of each of these elements of the daily routine, across different individuals and care environments, uncovered rich opportunities for innovating new solutions.
6) Opportunities are revealed when you put the elder at the center.
Significant opportunities for innovation lie closest to the elder at the center of the experience, and span from before the elder requires care through death and the grieving process those whom they were close to. New solutions in Aging preparedness and prevention will lead to more independent and capable elders who will require less intensive care. Innovations surrounding the body and mind of the elder will increase mental and physical capacity, and give choice and control back to the individual. Rethinking how we manage the end of life for both elders and the people who care about them will decrease emotional pain and financial burden, and re-introduce human dignity.
7) Even simple design changes could make the experience better.
Elders, whether at home, in assisted living or in a skilled nursing facility, are for the most part poorly served by the products, services, and experiences that are available to them. Four areas in particular are ripe for innovation. Introducing new products and services that enable Relationships & Interactions and Activities, including communications technology, furniture design, and gaming will bring a new level of fulfillment to the most important experience elements in an elder's daily life. Re-envisioning Personal Care and Mobility by focusing on the unique physical and emotional needs of elders will preserve independence and decrease the need for costly (and sometime demoralizing for the elder) human assistance.