Going native in Maine nursing homes

The below was originally scheduled to run in the Sept. 21 edition of The Forecaster. Due to space constraints, it was pushed back and pushed back until it was no longer timely. I thought I’d post it here.

Architect, 28, seeks insight by admitting himself for 9 days

Evan Carroll, co-founder of Bild Architecture in Portland, stayed at Maine Veterans' Home in Scarborough for nine days in an effort to gain insight into how the physical properties of nursing homes affect the daily lives of residents.

SCARBOROUGH — Evan Carroll slowly made his way through the halls of the Maine Veterans’ Home in Scarborough last Monday. He uses a walker, and is making the trek from the dementia unit, where he’s been staying, to the rehabilitation unit. Two nurses help carry all his belongings.

“I’m just going to the other end of the building,” he tells another resident. “I’ll come back and visit.”

Though he’s not going far, it’s still a big shift for Carroll. He said he’s gotten to know the other residents and the staff in the dementia unit. Now he’ll have to get to know new neighbors, new nurses and doctors, new support staff.

Luckily for Carroll, a 28-year-old architect, he didn’t have to adjust permanently. Carroll was participating in “Learning by Living, ” a program created by Dr. Marilyn Gugliucci of the University of New England. At the end of his nine-day stay at the veterans home, he got to go back to his real home in Portland’s East Bayside neighborhood. He doesn’t even need the walker.

The program is designed to give medical students first-hand experience in nursing home living. To date, 28 students have participated by spending two weeks as residents of nursing homes, where they were given a “diagnosis” and receive the standard care that would go with that diagnosis. They eat with residents, participate in activities, and are treated by staff the way any other resident would be treated — including being bathed and helped to the bathroom.

“They’re going to be doing this to their patients, so should know what it’s like,” Gugliucci said in a Sept. 19 interview.

The veterans home has hosted three participants in the program before, but Carroll was the first non-student. He and his wife, Sasha Salzberg, own and operate Bild Architecture in Portland. When they founded the company, they set a goal of designing facilities for Maine’s aging population.

Carroll hoped his stay at Maine Veterans’ Home offered him keen insight into designing functional, healthy elderly living facilities. One thing he’s become acutely aware of, he said, is the importance of creating a “feeling of home.”

That can be as easy as putting the kitchen in a more common space. Most nursing homes, Carroll said, cook their food out of sight — and smell — of residents. He said a better idea might be to place a kitchen in a place where residents can smell food and see people cooking it.

“That’s the kind of thing that contributes to a feeling of home,” Carroll Said. “It’s seeing home-like tasks being done as opposed to hospital-like tasks.”

At the time of the interview, Carroll had been at the home for six days, with still three more ahead of him. And while he admitted himself to gain a keener architectural insight, he said he hadn’t had too many “ah-ha moments” so far. Rather, he said, his conversations with staff at the veterans home will him to ask better questions once he leaves.

For example, Carroll wondered whether the enclosed courtyard included in the design of the residential unit might better serve patients in the dementia unit, who could experience the outdoors without the long vistas that may make a confused resident want to escape. (Many residents with dementia become confused around sundown, Carroll said, when they forget where they live and have an urge to “go home.”)

That inspired Carroll to do research into how to design a building for different personality types. Rooms could be designed to accommodate different levels of socialization or personality.

These kind of considerations are part of a greater push for “culture change” at nursing homes and other kind of elderly care facilities. Both Carroll and Gugliucci said society’s understanding of nursing homes, and of aging in general, could be detrimental to aging citizens.

“It’s very negative what our society has done with the concept of aging,” Gugliucci said. “When people think of a nursing home, they think of it as a warehouse for old, sick people. … But in every case, when the students leave the nursing homes, they sense of community and camaraderie moves them to un understanding I cannot teach in the classroom.”

Carroll said culture change has to do with shifting nursing homes “from a task-centered service model to a people-centered service model.” He said he wants to be a part of that shift.

The work of designing and building nursing homes will be good for business, Carroll said, because there is an increasing demand for that service in Maine, with its aging, elderly population. But it’s also personal, he said.

For Carrol and Salzberg, his wife, nursing homes already are part of their family life. Carroll said his grandparents are “right on the edge,” and could end up having to move into a home. Salzberg’s grandmother recently moved into a home after having lived by herself for years.

“Other family members have had a hard time finding places they liked,” Salzberg said. “They didn’t like the ‘feel’ of the homes.”

For the rest of his stay, Carroll planned to have more conversations with residents and staff as he continued his “treatment.” Those conversations were crucial, he said, because while architecture in a facility can make life more or less difficult for residents, it’s really the staff that make or break a home. He said he learned that first-hand, when a shift change affected him in an unexpected way.

“Just as I was starting to get used to things here, the weekend came and it was all new staff,” he said. “So all over again, I was basically just looking for people who would smile at me.”

“Buildings themselves don’t change society,” he said. “It’s how people use them.”

The program is good for the veterans home, too. They gain valuable insight by having students — and now Carroll — come in and observe the day-to-day operation with fresh eyes.

“It’s a learning experience for us to get different people’s perspectives on the care that we provide and all the work that we do here,” said Bonnie Stewart, admissions director at the veterans home.

Carroll’s insight into how people use the building may be of more value to Maine Veterans’ Home than it would at first seem. The home is working up plans to expand soon, including the construction of a new rehabilitation facility that can handle both in- and out-patient care.

“We’re definitely just in the planning stages, but we hope to begin construction within a year,” Stewart said.

Carroll left the veterans’ home on Sept. 21. Thanks to media coverage, he said he’s already gotten calls from senior care practitioners eager to share their experience and contractors who specialize in nursing homes and are interested in teaming up with Bild Architecture in the future.

That’s all well and good, but for now, Evan is focusing on his current work and happy to be back home.

“I really did enjoy being there,” he said. “But it was nice to be out in the world again, which isn’t too surprising for someone who chooses to live in Portland.”

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  • Evan Carroll

    Thank you Mario.

    • http://www.journalator.net Mario Carmine Moretto

      No problem. Hope you liked it, and sorry it didn’t end up in the paper.

  • Pingback: Portland Maine Architect talks about Senior Living | bild ARCHITECTURE

  • Steve Emmons

    Really solid understanding of residential care, Mario I envy your ability to get such a dead-on feel for things/situations/people through empathy.

    • http://www.journalator.net Mario Carmine Moretto

      Hey, Steve. Had not seen this comment earlier. Thanks for the kind words, though I’m not sure it’s empathy. I’d like to think it is, but I think it’s more just listening and asking the right questions.