Imagine living in a place where someone dictates when you can eat, when you have to wake up, and when -- if ever -- you can go outside. Imagine that the only place you can entertain guests is in your bedroom. Imagine that taking a shower has become a dreaded ordeal. A diverse group of experts recently spent hundreds of hours not just imagining, but observing and documenting just such a place: a nursing home.
Its objective was to understand the experience through the eyes of the residents. And its ultimate goal is to find -- and test -- ways to make it better. This unusual Rhode Island-based project is called the Nursing Home of the Future. The future in question belongs to the baby boomers, who number 78 million nationwide and aren't getting any younger. They are also unlikely to tolerate the restrictions and indignities of today's nursing-home environment.
"There is pitiful little focus on something we know is coming," says Joseph F. Coughlin, director of the AgeLab at the Massachusetts Institute of Technology, speaking of the demographic tidal wave. The first boomers will turn 65 in 2011; already, there are more nursing homes than McDonald's.
The AgeLab is among an array of partners -- including people from the Rhode Island School of Design, Brown University, Quality Partners of Rhode Island and some private companies -- who were pulled together by the Business Innovation Factory, or BIF. BIF is a four-year-old nonprofit organization, launched with support from the state Economic Development Corporation, which envisions and tests new ideas, such as a better design for hospital trauma bays or a new communications system for port security. BIF shelled out $125,000 for the first phase of the Nursing Home of the Future, which ended last month.
Dr. Richard Besdine, director of Brown University's Center for Gerontology and Health Care Research and an adviser to the project, helped the group think through its most important goal: to change nursing homes so they are no longer the last place anyone wants to be. "The thing that's so ghastly," Besdine said, "is that you lose control of your life." You live on a schedule set by the institution. You live in a small room. "If you can walk in the other person's shoes, you're halfway there," he said.
The first part of the project was an effort to enter the lives of elderly people at the Tockwotton Home, a 30- bed assisted-living facility and 42-bed nursing home in Providence's Fox Point. Tockwotton is a not-for- profit nursing home with a good reputation -- Bes- dine called it a "gem" -- which is planning to open a new building in East Providence in 2010. The new Tockwotton will include a "laboratory area" for testing the ideas that emerge from the Nursing Home of the Future project.
"A lot of people are studying in particular silos -- they're studying one particular aspect," says Mickey Ackerman, director of BIF's Experience Lab and the former head of the industrial design department at RISD. Ackerman says that people tend to separately examine medical, social, psychological and business issues. In contrast, he said, the Nursing Home of the Future looks at everything as an interrelated whole. "We are focused on the user -- the person who's living this kind of life," he said.
Back at the office, the researchers created a wall-size map depicting the life experience of the nursing home residents. They identified several areas to work on. A top issue is personal care and hygiene. It's humiliating to need assistance using the toilet or taking a shower, and the process can be cumbersome. Residents avoided showers as long as they possibly could. One of the BIF observers got a sense of why: she sat in the awkward shower seat and imagined being frail and naked, washed by someone else.
"The Nursing Home of the Future is more about reassessing and redesigning the systems we call nursing homes," says MIT's Coughlin, the head of the Web design firm Tellart who worked on the nursing home project. "That includes the relationship with families, how we pay for it, what can [residents] do productively in nursing homes. What we're lacking is innovation. We have more structured programs and connectivity for people who are in prison than for our parents."