HUMAN FACTORS, 1981,23(1),39-58

Residential Design for the Aging (For

Example, the Bedroom)

H. MCILVAINE PARSONSl, Human Resources Research Organization, Alexandria, Virginia

Design requirements for residences for older people can best be examined in a matrix that
relates environmental aspects and people aspects. The former include the entire setting,
resources, spatial arrangement, communication, appearance, consequation, protection, and
ambient conditions. The latter consist of activities, locomotion, social interaction, feelings,
perception, motivation, health and safety, learning, and manipulation. A review of published
design standards, guidelines, and recommendations about bedrooms in housing for the
elderly details what has been specified and demonstrates that much remains to be done.

INTRODUCTION Association. The program included a review

of the human-factors-oriented literature on
This paper is presented in two parts. The
such design (Parsons, 1973). A framework was
first enumerates information sources for
presented at that symposium for examining
practitioners desiring to adopt a human fac-
how such design affects users, and was
tors approach to design for the aging. The
further developed in presentations made on
second deals specificaIly with a particular
several subsequent occasions (Parsons, 1975,
subsetting, the bedroom, to illustrate the
1976, 1977). Arnold Small included residen-
ways in which a constructed environment can
tial design in his Symposium on Ergonomics
affect the people who use it-in this case, the
and Aging at the 1976 International Ergo-
elderly.
nomics Association meeting and further
In May of 1973, Alphonse Chapanis (1974),
demonstrated his long-standing concern with
at a Gerontological-Society-sponsored con-
the topic the following year (Small, 1977).
ference, made what was apparently the first
F. H. Rohles (1976) was also an early signifi-
published appeal in the United States to
cant contributor, as was Fozard (1977). Since
apply human factors knowledge and methods
that time the work of these authors and
to the design of residential environments for
others has matured into an increasingly rich
the aging. In that same year, Ross McFarland
body of design information. Much of that in-
and James Fozard organized a symposium at
formation is available in regularly published
the meeting of the American Psychological
materials.
I Requests for reprints should be sent to Dr. H. McIl-
vaine Parsons. Human Resources Research Organization,
Although some sources are specifically de-
300 No. Washington St.. Alexandria, VA 22314. voted to the topic of human factors for the
, All units are expressed in the form used in the cited
reference.
elderly (e.g., Grandjean's chapter "Flats for
'Due to considerable lag time between submission of Old or Handicapped People" in his Ergo-
this manuscript and its publication, reference to recent
research in the field may have been omitted, e.g., 1980
nomics of the Home, 1973), much has been
revision of ANSI Standard A117.1. published without specific labels. Lawton, a

© 1981, The Human Factors Society, Inc. All rights reserved.

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40- February, 1981
psychologist, has numerous relevant publica-
tions (1970,1972, 1974, 1977) among which is
a chapter on "Designing the Building" in his
book Planning and Managing Housing for the
Elderly. Koncelik (1976), a designer, has
analyzed a great variety of design require-
ments in his volume, Designing the Open
Nursing Home, with chapters on "Design and
Outfitting of Patient-Resident Accessible
Spaces," "Recommendations for Seating,
Furnishings, and Beds:' and "Recommenda-
tions for Architectural Details."
An architectural approach was evident in
Housing for the Elderly: The Development and
Design Process (Green, Fedewa, Jackson,
Johnston, and Deardorff, 1975), in which the
authors set forth guidelines for site, building,
and dwelling unit design based on the ac-
tivities of the users and an extensive set of
technical standards. Their volume drew on a
Canadian publication (Central Mortgage,
1972) which was one of the earliest to attempt
a systematic examination of design require-
ments. In addition, the U.S. Department of
Housing and Urban Development (HUD) has
issued a looseleaf, annually updated set of de-
sign requirements covering subsidized hous-
ing for the aging (USGPO, 1977a). Two other
sets for multifamily housing and one- and
two-family dwellings that include additional
specifications for elderly residents have also
been prepared by HUD. Previously, HUD
(1972) had issued a guide, Management of
Housing for the Elderly, and in 1973 the Mas-
sachusetts Department of Community Af-
fairs published some draft guidelines for the
site plan and design of housing for elderly
and handicapped persons.
Among earlier books that discussed design
requirements were Frush and Eschenbach
(1968), Musson and Heusinkveld (1963),
Beyer and Nierstrasz (1967), and Nierstrasz
(1961). A recent survey volume by the Ameri-
can Psychiatric Association and National As-
sociation for Mental Health (Glasscote, 1976)
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HUMAN FACTORS
includes some of the standards imposed by
the states and HUD on the design of nursing
homes. The American National Standards In-
stitute's Standard ANSI 117.1, .. Making
Buildings Accessible and Usable to the Physi-
cally Handicapped," contains design re-
quirements applicable to wheelchair-bound
elderly. The same can be said of other specifi-
cations of barrier-free design, such as those
issued by the Gerontological Society and
Syracuse University (Steinfeld, 1975), by the
Netherlands Society for Rehabilitation
(1973), and by Goldsmith (1967). Design
suggestions for residential environments for
the elderly have appeared also in articles and
reports by Bendixon (1972), Brody, Kleban,
and Liebowitz (1973), Byerts (1974), Gelwicks
(1973), Gelwicks and Newcomer (1974),
Lindsley (1964), McClannahan (1973), McGuire
(1972), Sherwood (1975), Smith (1959), Snyder
and Willoughby (1977), and the International
Center for Social Gerontology (no date).
Surveys of both physical attributes of resi-
dential environments for the aging and the
reactions of residents have also been con-
ducted. Weiss (1969) collected pictures, floor
plans, and brief descriptions of 76 residences
and nursing homes in the United States and
other countries. Beyer and Nierstrasz (1967)
obtained design data from a large number of
locations in Europe. Important evaluation
studies have been published by Carp (1966,
1975, 1976a, 1976b), Koncelik, Ostrander,
and Snyder (1972), Lawton and Cohen (1974),
Malozemoff, Anderson, and Rosenbaum
(1977), and Rose (1978). Small (1977) re-
ported observations at two Veterans Admin-
istration facilities. Among environment-
directed surveys of residents have been those
by Devlin (1976), Hartman, Horovitz, and
Herman (1976), Rohles (1976), and Rohles
and Rohles (1976).
Two early comprehensive bibliographies
are available: Casto and Day (1976) and
Steidl and Nelson (1972); the latter drew on
H. MCILVAINE PARSONS
bibliographies developed and published in
the Department of Design and Environmental
Analysis of the College of Human Ecology at
Cornell.
USER-DESIGN RELATIONSHIPS
To create a suitable residential environ-
ment for aging persons, it seems advisable to
start out by trying to understand how a con-
structed environment may affect them. From
a human factors viewpoint, it is necessary to
examine four sets of considerations and the
relationships between these sets. The four
are:
(1) Characteristics that distinguish aging resi-
dents from others and from each other.
(2) Aspectsof their behavior and well-being that
the physical environment can affect.
(3) Aspectsof the physical environment that can
affect their behavior and well-being.
(4) Subdivisions of the physical environment, in
this case functionally distinct locations
within residential buildings.
Although no one has succeeded in inter-
relating all of these within a single analysis, it
is refreshing to note some progress in this di-
rection. For example, Fozard (1977) outlined
the aging-associated changes in vision,
learning, and memory to consider in design-
ing suitable environments for older individu-
als. Koncelik (1976) discussed physiological
changes in the aging before describing the
environmental designs these implied. Small
(1977) noted the importance of individual
differences among the aging in health, bodily
functions, physical capabilities, motor skills,
life styles, values and standards, affective re-
sponse, and other factors, and the need to re-
late these to environmental factors. A task
force of the Gerontological Society coordi-
nated by Sylvia Sherwood (Housing and En-
vironment Project, 1975) related elements
within six categories of "user functioning"
(static anthropometric, physical functioning,
cardiorespiratory and metabolic, sensory,
cognitive, and social characteristics) to
"some probable related user dysfunction"
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February, 1981-41
and to "some correlated and relevant ar-
chitectural elements" (along with references
to pertinent research and measurement liter-
ature). This relatively modest but innovative
effort was supplemented by an illustrative set
of relationships between "architectural ele-
ment conditions" (e.g., a drawer in a cabinet)
and "user tasks" (human capacities and other
aspects).
Aging individuals do differ among them-
selves, as do all individuals, and, over time,
within themselves. It cannot be assumed that
one design will make all aging residents of a
particular environment happy or that an-
other design will make them all sad. Some can
walk, others must locomote in wheelchairs,
and, thus, the design requirements differ. The
same individual may have to change at some
time from walking to wheeling. Some can
hear a particular auditory alarm, some can-
not. It would be superfluous to point this out,
if only there were more frequent publications
emphasizing individual differences and the
resulting need for diversity in design. When
users vary greatly in competence, it becomes
difficult to provide design guidelines that
should apply throughout a residential facil-
ity, much less to all facilities.
Behavior-Environment Relationships
Even if the user population were homoge-
neous, it would be necessary to set forth the
various effects their residential environ-
ments might have on them and the various
aspects of the environment that might pro-
duce these. Otherwise one confronts people-
environment relationships as a mass of con-
fusing factors.
Several attempts have been made to estab-
lish frameworks in this regard. Among those
formulated for the elderly, the Architects
Collaborative of Cambridge, Massachusetts,
in developing a design for the New York State
Veterans Home in Oxford, New York, gener-
ated a matrix of 27 "behavioral objectives"
42-February, 1981 HUMAN FACTORS

and 38 environmental design features.
Perhaps less unwieldy is a framework which
has proved useful in describing people-
environment relationships in other contexts
(Parsons, 1976). It reduces environmental as-
pects to eight categories along one dimension
and behavioral aspects to nine along another,
as shown in Table I, along with the principal
interactions between the two dimensions.
Each category consists of a number of sub-
categories.
The categories in each set essentially in-
clude everything that must be considered.
Perhaps inevitably, overlaps will seem to
exist between some categories, depending in
part on the reader's own habits of classifying
environment and behavior. The categories
are simply an aid to human information pro-
cessing in a field (environmental design)
whose published treatment has been notori-
ously incoherent and incomplete; the number
of categories in each set falls within the limits
of George Miller's "m;;tgical number 7, ± 2."
Those for environmental aspects have been
selected for their pertinence to constructed
(in contrast to natural) environments. Some
of those for behavioral aspects parallel the
categories into which psychologists often
subdivide the domain which they study.
Others emphasize salient effects of a con-
structed environment on people.
Some of the terms have specific meaning in
the context of spatial design. For example,
entire setting applies to the whole environ-
ment being examined-building, office area,
apartment, or room.
Resources are the physical components a
person uses in such a setting, such as furni-
ture and equipment. Spatial arrangement is
established by walls, partitions, ceilings,

TABLE I
Matrix of Two Frameworks for Environmental and Behavioral Aspects(MajorInteractions Are Indicated
by X's)

Behavioral Aspects

Social
Environmental Aspects Activities Locomotion Interaction Feelings Perception

Resources X X
Spatial Arrangement X X
Communication X X X
Appearance X X
Consequation X
Protection
Ambient Conditions X X
Entire Setting X X X X X

TABLEl-Continued
Behavioral Aspects

Environmental Aspects Motivation Health and Safety Learning Manipulation

Resources X X X
Spatial Arrangement X
Communication X
Appearance X
Consequation X X X
Protection X
Ambient Conditions X X X
Entire Setting X X X X

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H. MCILVAINE PARSONS
stairs, doors and windows, and locations of
furniture and equipment. Through their de-
sign, components of constructed environ-
ments tell their users what to do, guide or
warn them, or enable them to talk to each
other-all of which falls under communica-
tion. Appearance means what a setting and its
elements look like (or sound like). A built en-
vironment can afford protection from the
weather, from hazards, and from other per-
sons. The design incorporates consequation
features that strengthen or weaken the be-
haviors of persons encountering them. Am-
bient conditions include illumination, sound,
temperature, and humidity.
Along the other dimension, activities are
what we do at work, play, or rest. Locomotion
means getting from here to there, by what-
ever means. When two or more people talk to
each other, look at each other, make love,
play cards, fight, they are engaged in social
interaction. Feelings are the moods and emo-
tions reported experienced and/or inferred in
others from what they say or do and how they
look or through physiological correlates. By
perception (in the present context) is meant
simply talking, writing, or thinking about or
recording or imagining a setting, some part of
it, or its attributes. Aesthetic reactions, then,
are mixes offeelings andperception. Favorable
(reinforcing) or unfavorable (aversive) conse-
quences of what a person does define motiva-
tion, along with the potentiating circum-
stances that make such consequences effec-
tive. Illness and accidents are the reciprocals
of health and safety. We engage in learning
both about environments and within them.
Finally, we buy and sell, visit or stay away,
decorate, redecorate-all matters of manipu-
lation.
These two sets of categories cover a lot of
ground. Why go to such lengths to examine
how constructed environments affect people,
especially since most studies have limited
themselves to one or two categories along
each dimension? One reason is obvious. It
may be important for a designer to consider
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February, 1981-43
other categories than the appearance of a
structure, for example, and its effects on per-
ception and feelings. In an institution for the
aged, should these two be the only user con-
siderations in specifying (and limiting) the
length of a corridor? What about locomotion?
Should a chair be provided that is very dif-
ficult for an elderly person to rise from, so the
effort of doing so reduces the sitter's motiva-
tion to try? Can residents' rooms be arranged
in a nursing home to make social interaction
between them more frequent?
The effects of environmental design on
people have been analyzed within this
framework for residential, institutional
(schools, museums, libraries, prisons), and
commercial (restaurants, stores) settings in a
course in experimental design, as well as for
industrial plants and commercial offices. It
would be possible to do the same in detail for
all of the subsettings of residences for the
aging: bedrooms, bathrooms, kitchens, cor-
ridors, lounges, dining rooms, entrance
foyers, and other locations. For reasons of
space, only one of these will be examined
here-that functional location where indi-
viduals throughout their lives spend so much
of their time, the bedroom. Some design con-
siderations for this subsetting and its princi-
pal component, the bed, have previously been
examined in this journal for people other
than the elderly (Parsons, 1972).
In general, no distinction is made in the
following review between bedrooms in an in-
stitutional setting and thos,e in other kinds of
residential settings, although it is realized
that such a review should in fact try to specify
systematically which design features are ap-
plicable to what kinds of elderly individuals
or types of residence. However, this is not as
simple a task as it might seem, and for the
bedroom it may be less consequential than
for other residential locations. Further,
though design requirements should differ ac-
cording to the competance of the resident,
abilities vary within a particular residential
category, as already noted, and the compe-
44- February, 1981
tence of an older person remaining in a par-
ticular location is likely to change. As for dif-
ferences between settings, it can be argued
that nursing homes, congregate housing, and
other types of dwellings for the aging differ
more in the services they provide than they
should in the physical environments that are
suitable for the aging.
The reader should bear in mind that for the
most part the design recommendations,
guidelines, and standards which follow have
not been based on research, or no research
has been cited in publishing them. That is one
reason for a considerable amount of inconsis-
tency. By describing what has and has not
been provided, this review is intended to
suggest what remains to be done in providing
design guidance, rather than to present such
guidance. This reviewer has foregone the op-
portunity to express his own design recom-
mendations or comment on those of others.
What follows is not supposed to help design-
ers at the drawing board as much as it is to
illustrate how an environmental setting can
be systematically analyzed.
BEDROOMS FOR THE AGING
This section will review those aspects of the
bedroom for an elderly person that merit de-
sign interest because the manner in which
they are designed can significantly affect the
user. It will mention all published design rec-
ommendations, guidelines, or standards
found by the author. Particular features of
bedrooms are considered within each of the
eight major physical aspects.
Entire Setting (Bedroom)
Total number in a facility. How many bed-
room units should there be in a facility for the
aging? The answer depends, of course, partly
on the kind of facility-nursing home (skilled
nursing facility or intermediate care facility),
congregate housing (about which the ques-
tion has usually been raised), or other resi-
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HUMAN FACTORS
dence. The total number varies with the
number of residents and size of the facility
and affects the extent or nature of required
locomotion, of social interaction, of required
learning, of manipulation (a resident's choice
among units), and of feelings (emotional reac-
tion to a large or small establishment, perhaps
related to the individual's previous type of res-
idence). Although the appropriate number of
units or facility size has been much debated
(Beyer, 1965; Beyer and Nierstrasz, 1967), it
has rarely been investigated by gerontologists
as an independent variable, especially as a
nonconfounded one (Lawton, 1970). There
have been no good data on the relationships
of size to residents' satisfaction (Lawton,
1974). The number of bedrooms in a setting
varies widely (Beyer and Nierstrasz, 1967),
with a European maximum of about 100
apartments in a building and a U.S. limit of
250 to 300 (Beyer, 1965). It has been said that
the facility's size should be sufficient to make
it financially feasible, but small enough so res-
idents could fit into the surrounding com-
munity (HUD, 1972). In Massachusetts, pro-
jects were preferred "that provide from 48 to
120 apartments on a site, though where pri-
vate housing density is high or where there is
high commercial activity, a development
larger than this might be considered" (Mas-
sachusetts State, 1973).
Number of beds per room. Should single or
double bedrooms be provided? Other than by
married couples, should bedrooms be shared?
The answer bears on activities, feelings, and
socia( interaction (including sexual inter-
action-although this has been rarely dis-
cussed with regard to either nursing homes
or aggregate housing, as though the elderly
were neither interested in nor capable of
engaging in it or perhaps not justified in
doing so). In one inquiry (Lawton, 1970), it
was found that although residents who re-
garded themselves as partially disabled tended
to want a roommate, there was no evidence
H. MCILVAINE PARSONS
whether same-sex occupants of single or
multiple-bed rooms could do better at such
activities as dressing, grooming, housekeep-
ing, hobbies, and recreation. According to an-
other report (Lawton, 1972), people in homes
for the aged who already had single rooms,
and, to a lesser extent, middle-class residents
with roommates, expressed the same strong
wish for single rooms as those middle-aged
and older individuals outside who were asked
what they might want. Apparently, people in
institutions generally choose what they have
had. "Everyone is very quick to prescribe
multiple-bed accommodations for the other
fellow, but is more likely to think a single bed
is best for himself" (Lawton, 1974). The di-
rector of a home for the aged (Bryan, 1973)
has observed that putting two persons to-
gether in a room leads to many frictions, in-
deed, fights. Roommates quarrel because one
is on the telephone or toilet too long; they
disagree on TV and radio programs; tastes in
decoration differ and so do sleeping habits.
However, funding agencies are not always
sympathetic to single bedrooms, due to their
greater cost per person. A majority of nurs-
ing home bedrooms have two beds (Koncelik,
1976), usually in parallel, one next to the
window, the other next to the door; as a re-
sult, one roommate "controls" light and ven-
tilation, the other visitors and storage. Ac-
cording to Department of Health, Education,
and Welfare (now Department of Health and
Human Services) requirements, patient rooms
in skilled nursing (SNF) and intermediate
care (ICF) facilities may have no more than
four beds (Glasscote, 1976), and some states
require some proportion of single-bed units.
For example, New York has a minimum of
one-tenth for SNFs and one-third for ICFs.
Most residents are single in aggregate housing
for the aging built by the Department of
Housing and Urban Development (HUD,
1972), which emphasizes one-bed apartments
(USGPO, 1977b). For such residential environ-
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February, 1981-45
ments there has been a strong trend to single
rooms in Sweden, the Netherlands, Switzer-
land, Denmark, West Germany, and France
(Beyer and Nierstrasz, 1967). One recom-
mendation has been "a good mix of single
rooms for patients who need or prefer them"
(Stotsky, 1970).
Type of apartment. Whether single or dou-
ble, it has been pointed out (Beyer and
Nierstrasz, 1967) that a bedroom may consist
of an "efficiency" with or without an alcove, a
studio-type apartment, or one with a separate
living room, as has been recommended (Law-
ton, 1975). A bathroom and partitioned-off
kitchen may be associated; an L shape has
been suggested to accommodate a kitchen
(Lawton, 1975). The type of arrangement pre-
sumably has some effect on a resident's ac-
tivities as well as on his or her choice of where
to spend time (manipulation) and on her or
his feelings about it (e.g., level of convenience
or comfort).
Size of bedroom. If only because size influ-
ences the amount of furniture to be accom-
modated and its arrangement, it affects ac-
tivities, locomotion, and social interaction.
Square footage has varied considerably, both
in actuality among countries (Beyer and
Nierstrasz, 1967) and among minimum re-
quirements or standards. In Europe, these
have included 12 (Beyer and Nierstrasz, 1967)
or 14 m2 (Grandjean, 1973) for a bedroom
(though 16 m2 were recommended) and 20 m2
(Grandjean, 1973) (24 m2 recommended) for
living room and bedroom. British standards
have suggested (not required) 320 ft2 for an
efficiency (Lawton, 1975). HUD's minima are
100 ft2 for single bedrooms and 80 ft2 per bed
in multibed rooms in care-type facilities
(USGPO, 1977a); 210 ft2 for combined living
room-bedroom (but without a dining area) in
multifamily housing (USGPO, 1977b); and
180 ft2 for combined living room-bedroom
(but without a dining area) in one- and two-
family dwellings (USGPO, 1977c). The areas
46- February, 1981
are 250 ft2 and 220 ft2 with dining areas; and
120 ft2 for a separate bedroom in each of the
two residential categories. HEW (Glasscote,
1976) has specified the HUD minima for pa-
tient rooms in skilled nursing and interme-
diate care facilities, but state requirements
may differ; for example, New York calls for
at least 125 ft2 of floor space for a one-bed
room and 100 ft2 per bed in a multi bed room
(Glasscote, 1976). Michigan (Green et aI.,
1974) specified minima of 135 ft2 for a separ-
ate bedroom in high- and low-rise apartments
and town houses and 210 ft2, 220 ft2, and
190 ft2 for bedrooms serving also as living and
dining rooms (but excluding food prepara-
tion space) for high-rise .apartments, low-
rise apartments, and congregate facilities,
respectively.
With regard to vertical minima, Michigan
called for 8 ft (Green et aI., 1974), though
perimeter portions could drop to 7 ft 4 in, and
HUD (USGPO, 1977b; 1977c) specified 7 ft 6
in for both multifamily and one- and two-
family units (whether or not for the elderly), 8
ft in nursing areas, and 9 ft in patient rooms
containing ceiling-mounted, patient-lifting
devices in long-term care facilities (USGPO,
1977a). In addition, HUD states that" ceiling
heights shall be such that the movement of
occupants and furnishings is neither physi-
cally restricted nor conducive to unpleasant
sensation." Thus, HUD apparently felt that
vertical dimensions could affect both
locomotion and feelings.
It has been stated (Koncelik, 1976) that
"there is a great need to increase the space
within the patient-resident room for a variety
of reasons" (one of which is wider spacing be-
tween furniture units for easier locomotion)
and that (Lawton, 1975) "there seems to be
general agreement among advocates for the
elderly that new specially built housing for
the elderly provides too little living space,"
partly because the personal possessions (e.g.,
furniture) individuals wish to bring with
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HUMAN FACTORS
them make the smaller areas "difficult and
even unsafe." However, for whatever such
expressions are worth, new tenants of hous-
ing for the elderly express relatively little dis-
satisfaction about apartment size (Lawton,
1975) and they may be taking into account
the added ease of housecleaning, ambulation,
and efficiency of storage that comes from
having a smaller domicile-considerations
of activities and locomotion.
Shape of bedroom. Though bedrooms gen-
erally are rectangular, they might be round,
pentagonal, triangular, etc. Shape affects
perception-it is registered visually. Accord-
ing to one investigator (Snyder and Wil-
loughby, 1977), walls should be "at right an-
gles in that diagonals are not familiar to older
persons."
Location in facility. There has been some
debate as to where bedrooms for the elderly
should be located in a facility, especially with
regard to housing them in high rises. Loca-
tion might affect locomotion, social interac-
tion, feelings, perception, and health and safety.
One investigator (Lawton, 1974) found no
evidence of elderly displeasure with either a
ground floor (garden apartment) or high-rise
location, and the most important factor in
friendship formation was "the proximity of
living units to one another." Another inves-
tigator (Beyer, 1965) said the aging did not
fear using high-rise elevators and liked the
view. Anum ber of sources (e.g., Massachusetts
State, 1973) have noted the need for rapid
and assured exits in fires and other emer-
gencies as a locational factor, as well as se-
curity from intruders and vandals-two
considerations of health and safety.
With regard to relative position of a bed-
room on a floor, it has been proposed that the
elderly (Frush and Eschenbach, 1968) have
corner apartments, or those oriented to give
them a view and cross-ventilation (Beyer and
Nierstrasz, 1967)-considerations of percep-
tion and ambient conditions-and Arizona,
H. MCILVAINE PARSONS
Colorado, New Mexico, and West Virginia re-
quire each room in a skilled nursing facility
to have outside exposure (Glasscote, 1976).
Another question is whether such rooms
should be located so they can be readily
viewed from nursing stations or by a nurse
walking down the hall without having to
enter the room (Glasscote, 1976; Koncelik,
1976; and Snyder and Willoughby, 1977), a
matter of social interaction. A number of loca-
tional schemes have been developed for bed-
rooms in nursing homes to facilitate such in-
teraction with other residents as well as staff,
such as placing bedrooms around a central
court as a lounge-activity center rather than
on long corridors (Lawton, 1977) or placing
small lounge-activity stations between rooms
and the corridor (Koncelik, 1976). By inter-
posing furniture in passageways, such
schemes may encounter difficulties with
fire-related building codes for rapid evacua-
tion, a matter of health and safety.
Resources
The provision of furniture and control de-
vices and their design-good or poor-fall
under this heading; their placement falls
under spatial arrangement.
Chairs are important with respect to ac-
tivities (one must sit to do many things), social
interaction (visitors need to sit down during
conversation, games, etc.), and feelings (chairs
may be comfortable or uncomfortable), and
also to some extent motivation (to sit down or
get up), manipulation (a resident can replace
a chair), and perception (a cluttered room
looks different from a barren one). According
to HUn (USGPO, 1977b), one 1 ft 6 in x 1 ft 6
in chair should be accommodated in a single
occupancy bedroom in multifamily housing
and in one- and two-family dwellings, and the
need for chairs has been speCified elsewhere
(Green et aI., 1974; Central Mortgage, 1972;
and Koncelik, 1976), for reading, sewing,
lounging, and entertaining. The states of Ar-
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February, 1981-47
kansas and California require a "comfortable
chair" in bedrooms of skilled nursing
facilities (Glasscote, 1976). The seat should be
19 in high (Steinfeld, 1975). Lounge chairs
should have arms (Slotsky, 1970). The win-
dow sill may serve as a chair (Green et aI.,
1974). One authority (Koncelik, 1976) pre-
scribed, for a bedroom in nursing homes, two
lounge chairs with arms and foot rests. Along
with an extended discussion of seating for the
elderly, he has specified a 17 in maximum
seat height, 17 in maximum seat depth, 4 deg
seat angle, 32-112 in minimum backrest
height, special lumbar region support, roll-
away leading edge of seat, and a graspable
form on seat arms extending beyond the
leading edge of the seat. Simpler "side
chairs" may on occasion substitute for lounge
chairs. (Wheelchairs and geriatric chairs will
not be discussed here.) A resident may wish to
bring a favorite chair when moving into a fa-
cility (Koncelik, 1976)-a case of manipula-
tion; however, the chair may have suboptimal
design dimensions for activities or feelings.
Tables are obviously associated with activ-
ities and social interaction. They should have
an optimum height for easy reach (McClanna-
han, 1973), e.g., 31 in (Steinfeld, 1975) or 30 in
(Koncelik, 1976) high instead of being coffee
tables, and should have a surface texture that
enables dry hands to grip it in rising and sit-
ting (Koncelik, 1976). Surface dimensions
should be 30 in x 18 in (Green et aI., 1974), 16
in x 20 in for bedside (Central Mortgage,
1972), and 18 in x 18 in for nightstands, and
should accommodate four persons (Koncelik,
1976). Table edges should be rolled (rounded)
to forestall injury during a fall-a considera-
tion of health and safety (Koncelik, 1976).
Residents may want to bring their own table
with them in moving to a facility or to replace
a table at some point (manipulation). Bed ta-
bles should be provided (Koncelik, 1976).
Storage units, which include dressers,
chests, shelves, and hanging bars in closets,
48-February, 1981
are important for activities (storing and re-
moving items). HUD (USGPO, 1977b; 1977c)
requires accommodation for a 18 in x 42 in
dresser in a single occupancy bedroom in
multifamily housing and one- and two-family
dwellings, as well as 2 ft x 3 ft closets for all
residents, not just the elderly, and a 20 in x 22
in closet in patients' rooms in care-type
facilities. Other closet recommendations are
26 in x 82 in (Green et a\., 1974) for closets
and 18 in x 54 in (Central Mortgage, 1972)
and 18 in x 52 in (Green et aI., 1974) for
dressers. Closet shelves, storage cabinets, and
dressers should be reachable from a wheel-
chair (McClannahan, 1973). There should be
storage units accessible from the bed as well
as a dresser and a closet (Koncelik, 1976).
Storage units such as a dresser should be de-
signed so they can function as supports while
the resident is walking (locomotion) or per-
forming some task, and their edges and cor-
ners should be rounded as a precaution
against injury (health and safety) (Koncelik,
1976). Shelving units should be provided for
books, photographs, personal articles, etc.
(Koncelik, 1976). A closet hanging bar should
be 55 in (Green et aI., 1974) above the floor, or
adjustable to 48 in (USGPO, 1977b; 1977c) in
HUD structures (multifamily and one and
two family) for wheelchair users. It has been
proposed (Koncelik, 1976) that storage units
be modular so they can be varied (manipula-
tion) and that full length drawer units have
8-in high, 3-in deep kick spaces so wheelchair
users can have better access (locomotion). It
has also been suggested that there be two 3-m2
"wall cupboards" (Grandjean, 1973), both
closet and dead storage spaces (Koncelik,
1976), and wheelchair storage (Snyder and
Willoughby, 1977), and that storage units and
other furniture be built in to maximize room
size and minimize the chance of injury
(Stotsky, 1970).
A full length mirror (Lawton, 1975), or one
on a cosmetic stand (Koncelik, 1976) that
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HUMAN FACTORS
should be canted 5 deg for the benefit of
wheelchair users, has been recommended.
Mirrors can be significant to activities (e.g.,
applying cosmetics, dressing); perception
(seeing oneself and giving a greater "sense of
space"); and motivation (providing feedback
about oneself and one's actions).
Desks for elderly persons have been called
for by McClannahan (1973), whereas Stotsky
(1970) calls for builtin book shelf-desk com-
binations. HUD (USGPO, 1977b) specified
that single-occupancy bedrooms in mul-
tifamily and one- and two-family homes
should accommodate a 20 in x 42 in desk for
the elderly, though this was not required for
other residents. Desks support activities, such
as writing.
Bed specifications have been provided by
HUD. In multifamily housing and one- and
two-family dwellings, the horizontal dimen-
sions of twin beds should be 3 ft x 6 ft 10 in;
for double beds, 4 ft 6 in x 6 ft 10 in (USGPO,
1977b; 1977c). HUD's omission of bed spec-
ifications for care-type housing (USGPO,
1977a) typifies the indifference found in
housing guidelines and published require-
ments for the aged concerning the place
where they spend so much of their time. Al-
though HEW has likewise omitted dimen-
sional requirements of beds in nursing
homes, at least four states-Arizona, Arkan-
sas, Florida, and West Virginia-have
specified a minimum width of 36 in in skilled
nursing facilities (Glasscote, 1976). Koncelik
(1976) proposed that beds in nursing homes
should be 50% wider than they now are. Their
design "should be conducive to sexual be-
havior" (social interaction) and should ac-
commodate resting, sitting, and sleeping ac-
tivities, and they should not be standard hos-
pital beds. The HUD minimum width for twin
(single) beds was recommended in two other
sets of guidelines (Green et aI., 1974; Central
Mortgage, 1972), but both specified a shorter
length (6 ft 6 in) for either twin or double
H. MCILVAINE PARSONS
beds, and one called for a wider double
bed-4 ft 9 in (Green et aI., 1974). A Mas-
sachusetts guideline (Massachusetts State,
1973), on the other hand, specified 28 in by 6
ft 8 in. Another source proposed 7 ft in length
(Koncelik, 1976). Bed width and length are
significant for sleeping if only because greater
width permits more movement and different
postures while asleep, and sufficient length
not only allows taller people to stretch out
their torsos, legs, and arms, but also accom-
modates the increased length of the prone or
supine body resulting largely from the
greater angle between feet and legs. Length
and width are also significant for other ac-
tivities, such as making the bed and cleaning
under it (Parsons, 1972). So is height. Bed
height is particularly important to the elderly
who are short because beds must be low
enough to get out of easily. The feet should
touch the ground while the aged individual is
sitting on the bed, so he or she does not have
to slide off (Bryan, 1973). It has been said that
nursing home beds should be lower than they
generally are (Koncelik, 1976). However,
guidelines about bed height for the aging
have been few and far between, though sev-
eral writers (Bendixon, 1972; McClannahan,
1973; and Smith, 1959) have advocated beds
adjustable in height; for example, to achieve
15.9 in for sitting and 27 in for nursing (Ben-
dixon, 1972). In some instances, heights
should be matched to wheelchair heights to
facilitate transfer (McClannahan, 1973).
Some research has been conducted on the
height of hospital beds (Parsons, 1972); the
height often specified for the convenience of
nurses frequently makes leaving the bed dif-
ficult or threatening for patients.
Falling while getting out of bed is a major
hazard, and broken hips a serious problem for
elderly people. Thus bed height is a health and
safety factor. (To stand up, there should also
be something for the resident to hold on to.)
Simply falling out of bed can occur if there is
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February, 1981-49
no bed rail. Like excessive height, bedrails
can constitute" a barrier to easy entrance
and egress from the bed" (Koncelik, 1976),
i.e., a motivation disincentive.
Mattress design, discussed by Parsons
(1972), is important to the elderly, but their
needs have remained virtually unmentioned
in the literature either about beds or about
the aged, although the state of Arizona has
required a mattress at least 5 in thick in
skilled nursing facilities (Glasscote, 1976).
Yet aging people have special requirements
in the ways their bodies are supported. Dis-
comfort (feelings) may be more likely due to
reduction in pelvic padding and greater skin
sensitivity. Kyphosis of the skeletal structure
and weaker musculature may inhibit making
major postural changes. For example, the
aged run a particular risk of acquiring de-
cubitus ulcers from resting in the sarpe posi-
tion on a surface with insufficient deflection
when support of the individual's weight is in-
adequately distributed (obviously a matter of
health and safety). It has been suggested that
"research and development studies should be
undertaken to determine the many functional
aspects of the bed used in nursing homes"
(Koncelik, 1976), such as the depth of deflec-
tion, spring rate, suspension members, and
materials.
Though illumination is considered later as
an ambient condition, it should be noted that
there have been recommendations for lamps
at the bed and a chair for reading (McClanna-
han, 1973) (activities). At least nine states re-
quire (Glasscote, 1976), and others recom-
mend (Koncelik, 1976), a "reading light" in
skilled nursing facility bedrooms. With re-
gard to the activities of turning lights on and
off, height of electrical switches above the
floor has been specified as 3 ft to 4 ft 8 in
(Central Mortgage, 1972); for a bedside night
light, 36 in (International Center, no date;
McClannahan, 1973; McGuire 1972; and
Snyder and Willoughby, 1977) and 35 in
50- February, 1981
(Koncelik, 1976); and to the baseplate, 32 in
(Koncelik, 1976). Such switches should be
"simpler switches, easy to operate" (Grand-
jean, 1973); push-button switches rather than
turn switches (Steinfeld, 1976).;.-i.lluminated;
color coded; shape coded; operable with the
palm of the hand; equipped with a dimmer;
and having a positive response or feedback
(Koncelik, 1976). The height of electrical re-
ceptables or outlets above the floor (for the
activities of connecting a lamp or appliance)
should be high enough to eliminate bending
(Stotsky, 1976). Recommendations include:
18 to 24 in (Musson and Heusinkveld, 1963);
24 in (Massachusetts State, 1973; Snyder and
Willoughby, 1977); a minimum of 21 in (Cen-
tral Mortgage, 1972); 24 in (Green, et aL.
1974); or 16 to 20 in to the baseplate (Kon-
celik, 1976). The plug should have a graspable
surface, and the wire should project down-
ward or to the side and should have a differ-
ent color from that of the outlet (Koncelik,
1976). HUD has required, in multifamily
housing for the elderly (USGPO, 1977b), an
outlet for a night light "approximately two
feet above the floor between the bed location
and the bathroom." However, it has been al-
leged (Frush and Eschenbach, 1968) that the
requirement of a greater than normal height
has been a classical cliche of planning for the
elderly, who would be likely to trip over the
cord and who would bend lower and far more
often to put on and take off their shoes.
Opening and closing doors (and windows)
are activities. It has been stated that door
handles should be lever-type (Green et al.,
1974; Massachusetts State, 1973; Interna-
tional Society, no date; Central Mortgage,
1972; Koncelik, 1976; HUD, 1972; and
McGuire, 1972); hexagonal or octagonal
knobs if not the lever type (Musson and
Heusinkveld, 1963); responsive to a light
touch (McGuire, 1972); not round (Steinfeld,
1976); 3 ft (Steinfeld, 1976) or 40 in high, and
round or ovaloid in lever cross-section with
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HUMAN FACTORS
no sharp edges (Koncelik, 1976). Keyed locks
should be 4 ft 6 in high (Green et a!., 1974) or
a t least that high (Central Mortgage, 1971) so
a person does not have to stoop to see and
reach them. They should be trip-locks (Inter-
national Center, no date) and have a light at
the keyhole (Snyder and Willoughby, 1977) or
be otherwise illuminated or at least brightly
colored (Koncelik, 1976). The lock insert
should be curved inward so the key will be
directed toward the opening (Koncelik, 1976).
Keys should have longer shanks than normal
and large gripping surfaces or tabs (Koncelik,
1976).
Windows should be easily operated (Beyer,
1965; Green et aI., 1974; Central Mortgage,
1972; Lawton, 1975; and Smith, 1959), as
with double-hung windows (International
Center, no date). Cranks should be avoided.
Present designs for locking a sliding window
make them difficult to operate (Steinfeld,
1976).
Wash basins warrant specific mention.
HUD has mandated for care-type housing
that "a lavatory suitable for wheelchair user
shall be provided in accordance with ANSI
A1l7.1 in each bedroom, or in an adjacent
toilet room if the toilet room serves only one
room containing not more than two beds"
(USGPO, 1977a). Some state codes have been
requiring lavatories to be moved into patient-
resident living spaces, apparently for the
convenience of staff (for such activities as
cleaning bedpans), with inconvenience for
residents (Koncelik, 1976).
Spatial Arrangement
Furniture affects activities (e.g., bedmak-
ing) and locomotion requirements. A number
of guidelines have appeared to assure suffi-
cient space around each bed, including space
for wheelchair movement: e.g., 36 in on one
side and 12 in on the other for making the
bed, with another foot on each side and 4 ft at
the end for wheelchair passage (Mas-
H. MCILVAINE PARSONS
sachusetts State, 1973); "generous" spaces
around beds, with a minimum of 2 ft on each
side (Central Mortgage, 1972); 18 or 24 in on
each side for bedmaking, and 42 in at the side
or front for dressing (Green et aI., 1974); "ac-
cess to one side of bed, access to two sides of
bed" (Snyder and Willoughby, 1977); at least
3 ft between beds and from foot of bed to wall
or furniture (USGPO, 1977a); at least 2 ft be-
tween bed and wall (New Mexico); at least 3 ft
between beds (Arizona, Arkansas, and New
Mexico) (Glasscote, 1976); free movement
possible around the bed, and space at one side
for a wheelchair (International Center, no
date); 4 ft of clearance between bed and all
other objects and walls, for a wheelchair, 3 ft
being considered insufficient (Koncelik,
1976). According to HUn, "in housing for the
elderly, beds shall be accessible from two
sides and one end" (USGPO, 1977a; 1977b). It
has been proposed that beds be "placed
against the wall and locked into position"
(Stotsky, 1970); be arranged with the length
of the bed parallel to the window wall (USGPO,
1977a); and instead of two beds in paralle'l,
each be aligned against a different wall (Kon-
celik, 1976). "No patient's bed shall be more
than two beds deep from an outside wall"
(USGPO, 1977a). Pleas have been made to
provide sufficient circulation space as a
buffer (Green et aI., 1974); to hold the small-
est room dimension at 9 ft 6 in for ease and
flexibility of furnishing it (manipulation) and
for circulation (locomotion) (Green et aI.,
1974); to provide direct access from bedroom
to bath (International Center, no date) and
movement through an apartment with as few
turns as possible (International Center, no
date); and to assure "placement of appropri-
ate furniture with convenient circulation
space" (USGPO, 1977a).
Privacy screening affects social interaction.
Green et al. (1974) have suggested privacy
screening for the bed. HUn has required
screening for multibed units in skilled nurs-
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February, 1981-51
ing facilities, with tracks or rods installed to
permit enclosing each bed with curtains
(USGPO, 1977a). Privacy screens are similar-
ly required in Arizona, Arkansas, California,
New Mexico, New York, and West Virginia
(Glasscote, 1976). Elsewhere, partitions and
drapes (Koncelik, 1976) and dividers (Stotsky,
1970) have been recommended.
Balconies have been strongly recom-
mended (Frush and Eschenbach, 1968; Cen-
tral Mortgage, 1972; and Lawton, 1975), even
though only a minority of residents may use
them (Lawton, 1975; McGuire, 1972); bal-
conies may be individual or common, and
their height above ground level is a protec-
tion consideration (for health and safety). A
balcony extends a bedroom's space (percep-
tion) and provides a location for sunning, re-
laxing, or growing flowers (activities).
Recommendations about design for win-
dows have involved concerns about opening
and shutting them (resources), external light
(ambient conditions), and making certain they
provide a view (appearance). A window should
not be too high (Green et aI., 1974; Central
Mortgage, 1972; and Lawton, 1975) above the
floor: 2 ft 6 in to 5 ft (Green et aI., 1974; Cen-
tral Mortgage, 1972); 3 ft 10 in to 4 ft 2 in
(Central Mortgage 1972); 4 ft to 4 ft 6 in
(Green et aI., 1974); 17 in high (Snyder and
Willoughby, 1977); no higher than 2 ft 4 in
(Steinfeld, 1976). It should have "compara-
tively low" sills (Grandjean, 1973); wide sills
for safety (McGuire, 1972) or railings (Central
Mortgage, 1972); and a sill height to permit
looking out when sitting on a chair or lying in
bed (Green et a!., 1974; International Center,
no date; Lawton, 1975; and Snyder and Wil-
loughby, 1977).
Widths of bedroom doors are critical to the
locomotion of wheelchair-bound residents,
and many requests have been made for ade-
quate width (for example, Beyer 1965; Beyer
and Nierstrasz, 1967; Green et aI., 1974; Mas-
sachusetts State, 1973; Central Mortgage,
52-February, 1981
1972; and Smith, 1959), such as 34 in (Green
et aI., 1974; Massachusetts State, 1973; and
Central Mortgage, 1972) 44 in in HUD's care-
type housing (USGPO, 1977a); 32 in for the
elderly or wheelchair userS in HUD's mul-
tifamily housing (USGPO, 1977b); or at least
36 in wide (McClannahan, 1973). Doors cur-
rently in nursing homes .. vary from just
under 40 in to over 48 in (Koncelik, 1976).
One recommendation (Snyder and Wil-
loughby, 1977) suggests two sections, one 3 ft
wide and the other 1 ft wide (with dead bolts).
Occasionally such two-part doors are in use; a
standard width door is combined with a flip-
per to provide even greater access (Koncelik,
1976). Door closures should be flush, that is
without a threshold or sill (Beyer and
Nierstrasz, 1967; Green et aI., 1974; Interna-
tional Center, no date; HUD, 1972; Musson
and Heusinkveld, 1963; Snyder and Wil-
loughby, 1977; and Stotsky, 1970). Or, if nec-
essary, a threshold should be no more than
1/2 in high, with beveled edges (Massa-
chusetts State, 1973). Sliding doors recessed
into walls with roller latches to keep them
closed have been advocated (Stotsky, 1970).
Communication
Color coding of hallway doors (or trim) for
better identification and orientation by resi-
dents (locomotion, learning) has been pro-
posed frequently (Beyer and Nierstrasz, 1967;
Brody, Kleban, and Liebowitz, 1973; Green et
aI., 1974; International Center, no date; Cen-
tral Mortgage, 1972; Koncelik, 1976; Lawton,
1974; and McClannahan, 1973). The states of
Arizona and California have insisted that the
doors to patient rooms in skilled nursing
facilities be lettered or numbered (Glasscote,
1976), and it has been suggested (Snyder and
Willoughby, 1977) that identification plaque
receptacles be wall-mounted at the entrance
to each room so the name, room number, and
photographs of the resident can be inserted at
eye level for wheelchair users (Snyder and
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HUMAN FACTORS
Willoughby, 1977). Lettering should be large
(Central Mortgage, 1972; Snyder and Wil-
loughby, 1977). The patient might wear a disc
or name tag with the same color or graphic
design as the color or graphics on his or her
door, so identification of the room from the
hallway would simply require matching to
sample (McClannahan, 1973). Data for
emergencies could be entered on the reverse
side of the card in the card holder (Interna-
tional Center, no date).
Bedroom door bells (social interaction)
should be adjusted in frequency and intensity
to the hard of hearing (HUD, 1972; McGuire,
1972). Nursing home bedrooms might have
chimes so residents could keep their doors
closed more of the time, and lights inside
might go on at the same time as the chimes, if
the resident's hearing is poor (Massachusetts
State, 1973; Koncelik, 1976). Doors should
have peepholes, another matter of social in-
teraction (HUD, 1972; McGuire, 1972).
Emergency communications (social in-
teraction and health and safety) in bedrooms
(as well as in bathrooms) have been widely
specified (Beyer, 1965; Beyer and Nierstrasz,
1967; Green et aI., 1974; Massachusetts State,
1973; Central Mortgage, 1973; Lawton, 1975;
HUD, 1972; and Snyder and Willoughby,
1977). These should be activated by button or
pullstring or both; most guidelines do not
mention the method. The states of California
and Colorado require residents' bedrooms in
skilled nursing facilities to have a nurse call
system that registers a visible signal outside
the room and audible signal at the nurses'
station (Glasscote, 1976). HUD, in its special
requirement for the elderly or handicapped in
multifamily housing (USGPO, 1977b), has
given a choice between (a) an emergency call
system activating an annunciator and alarm
at one or more centrally supervised locations;
(b) a telephonic intercom with a 24-h switch-
board; and (c) an emergency call system ac-
tivating alarms in the immediate corridor
H. MCILVAINE PARSONS
and a visual signal at the entrance. In mul-
tibed units, the calling device must be
situated at one bed location (and the bath-
room); an earlier version of this standard
specified a device at each bed. HUD's re-
quirements for care-type housing (USGPO,
1977a) call for a call button at each patient
bed and bathroom to activate a visual signal
in at least four specified locations; indicator
lights must be installed at call buttons where
there are more than one of these in a room, as
well as at any two-way voice communication
stations (which are not mandated). It has
been urged that the emergency call system be
at the bedside stand "for best flexibility"
(Snyder and Willoughby, 1977); that there be
a combination telephone and alarm system
(Central Mortgage, 1972; Lawton, 1975); that
the system activate a light signal outside the
door of the dwelling unit and perhaps unlock
the door (Green et aI., 1974); that it activate a
light or a buzzer (Lawton, 1975); that there be
an electronic portable signaling device (Law-
ton, 1975); and that there be voice communi-
cations in high rises or in all buildings with
more than one floor (Central Mortgage, 1972).
Location of the telephone jack should be
carefully considered (International Center, no
date). There should be multiple telephone
jacks (Lawton, 1975), but" the desirability of
phones in every patient-resident room is
questionable" in nursing homes, though their
absence for the elderly "is one more indica-
tion of a loss of control and environmental
inaccessibility" (Koncelik, 1976) (manipula-
tion and social interaction).
Large clocks and large calendars should be
installed (Konce1ik, 1976) "in plain view of
patients to aid orientation" (Stotsky, 1970).
This recommendation, related to learning, has
been made also for lounges or corridors.
Appearance
Not a great deal has been written about ap-
pearance factors (for perception or feelings) in
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February, 1981-53
bedrooms of residences built for the aging,
including nursing homes. It has been
suggested that yellow is a better color for
walls than grey because the elderly can see it
more easily (Stotsky, 1970). Drapes have been
mentioned occasionally (Green et aI., 1974).
Choice of wall colors and their combinations
(manipulation) might be a privilege impor-
tant to the resident, though this possibility
has received little attention. Prefurnishing a
bedroom with wal1-to-wal1 carpeting has
been said to limit that choice (Lawton, 1975).
Other discussions of bedroom flooring con-
cern protection rather than appearance, except
for one recommendation to avoid strong pat-
terns to prevent visual confusion (Central
Mortgage, 1972), a perception consideration.
Moldings or panels should be provided for
hanging pictures (Koncelik, 1976; Lawton,
1975; and Stotsky, 1970), and provisions
should be made for displaying objets d'art
and bric-a-brac (International Center, no date;
Koncelik, 1976; and Snyder and Willoughby,
1977) and for placing flower pots (Lawton,
1975; Snyder and Willoughby, 1977) on win-
dow sills. One authority (Koncelik, 1976) has
proposed decorating bedroom ceilings with
"textured surfaces, subtle gradients of paint,
patterns, and other devices" to provide visual
stimulation (perception).
Frequent emphasis (Glasscote, 1976; Green
et aI., 1974; International Center, no date;
Central Mortgage, 1972; Lawton, 1975;
McGuire, 1972; and Snyder and Willoughby,
1977) has been placed on making certain that
residents have a view (perception) through a
window, both distant and close up for variety
(Snyder and Willoughby, 1977). Each room in
skilled nursing facilities in Arizona, Colorado,
New Mexico, and West Virginia must have
"outside exposure, with a draped window
area of at least one-eighth the room's floor
space," and in West Virginia there must be
"an outside view with an unobstructed line-
of-sight of at least twenty feet" (Glasscote,
54- February, 1981
1976). What the view should consist of has not
customarily been mentioned, though win-
dows should be "cleaned frbm the inside" and
may need "hand drawn window coverings"
(International Center, no date).
Consequation
Consequation refers to design-invoked in-
centives or disincentives for elderly bedroom
occupants to do or forego doing anything
that might be influenced by the bedroom en-
vironment or its components. Not surpris-
ingly, consequation has been ignored, at least
as such, in the literature about the aging and
about bedrooms occupied by the aged.
Protection
The prevention of accidents (safety rather
than health) has been the primary concern in
considering protection of aging occupants of
bedrooms. Nonskid flooring has been widely
advocated (Beyer and Nierstrasz, 1967;
Grandjean, 1973; Massachusetts State, 1973;
Central Mortgage, 1972; HUD, 1972; and
Stotsky, 1970) to prevent falls. The area
around the bed should have a surface that
would "provide stability when wet" (Kon-
celik, 1976). Carpets should be nailed to the
floor (Grandjean, 1973). Discussions of bed-
room flooring (Koncelik, 1976; Lawton, 1975)
have not included the other protection consid-
erations often mentioned concerning surfaces
in corridors: the advantages of carpeting to
reduce injury in falls and its disadvantages
because of inflammability and smoke-
production in fires. (The carpet vs. tiles ques-
tion in bedrooms also concerns ease of
cleaning (activities) in case of incontinence
and ease of locomotion in a wheelchair.)
Another protection factor in bedrooms is
the elimination of obtruding obstacles and
sharp points and edges. For example, win-
dows should open out lest residents hurt
themselves by walking into them or striking
their heads against them (Stotsky, 1970). As
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HUMAN FACTORS
mentioned earlier, storage units (e.g.,
dressers) and other furniture should not have
sharp angles (Stotsky, 1970). "There should
be a minimum radius determined for the
edges of all hard surfaces and protrusions
that present possible injury-producing pro-
jections in the tight spaces of the patient-
resident room" (Koncelik, 1976). Beds should
have rounded or "softened" corners (Kon-
celik, 1976). Sufficient clearances between
pieces of furniture are a protection considera-
tion (Koncelik, 1976). Bed rails in a down po-
sition bruise nurses' shins (Koncelik, 1976),
and nursing home residents get entangled in
them or slip on them in leaving their beds
(Koncelik, 1976).
Unmarked glass doors (and tall windows)
can be dangerous to the aging as well as to
other persons who might walk or put their
hands through them (McGuire, 1972). The
need to eliminate door sills or thresholds has
already been noted in connection with spatial
arrangement; they can trip up a walking resi-
dent as well as impede a wheelchair. Doors
should close gently so a person will not be
pulled off balance (Lawton, 1975); automatic
door closure should be avoided or at least
have a 4- to 6-s delay (Green et aI., 1974);
pressure to open a door should not exceed 5 Ib
(Green et aI., 1974). If closets have sliding
doors, they should be designed so they will
not pinch fingers (International Center, no
date). For protection against intruders, doors
should have peepholes (Green et aI., 1974;
McGuire, 1972; and Steinfeld, 1976), as noted
earlier, and dressers should have lockable
drawers to discourage theft (Stotsky, 1976).
Steel door handles should not have sharp
edges, since residents in wheelchairs may run
into them and since staff often open doors
with their hips (Koncelik, 1976).
To prevent burns, heating and hot water
risers should be insulated (International Cen-
ter, no date) and radiators should have enclo-
sures or baseboard covers (Lawton, 1975;
H. MCILVAINE PARSONS
Stotsky, 1970). Fire alarms should be low
pitched (Beyer and Nierstrasz, 1967), pre-
sumably because, with age, auditory thresh-
olds rise less in the lower frequencies, or they
should have both low and high pitch (Musson
and Heusinkueld, 1963).
Temperatures important to health and il-
lumination to prevent accidents are discussed
in the next section.
Ambient Conditions
Odor (which affects feelings) should be con-
trolled "through air conditioning and
deodorizers, with due consideration for the
pleasantness of smell of the disinfecting sub-
stances" (Stotsky, 1970). Interestingly, de-
spite the disagreeable odor from urine as a
result of incontinence among some nursing
home residents, no other references have been
found to odor or its control.
Insulation (Beyer and Nierstrasz, 1967),
seals (Green et aI., 1974; Lawton, 1975), or
sound and weather stripping (Central
Mortgage, 1972) is needed to protect elderly
residents from both exterior noise (e.g., traf-
fic and children) and neighbors (Central
Mortgage, 1972); residents tend to turn up
their TV sound and radios because of their
higher auditory thresholds. Door and window
design (Central Mortgage, 1972) should con-
sider the noise problem; in general, there
should be acoustical treatment or sound
proofing to attenuate sound transmission
(Green et aI., 1974; Central Mortgage, 1972),
especially from corridors (Green et aI., 1974;
Snyder and Willoughby, 1977). Hangings
(Koncelik, 1976; Snyder and Willoughby,
1977), ceilings (Stotsky, 1970), and floor sur-
faces (International Center, no date; Kon-
celik, 1976; and Stotsky, 1970) should have
sound absorbent properties (Snyder and
Willoughby, 1977). HUD has stated (USGPO,
1977a), that care-type facilities should have
..an acoustically controlled environment in
relation to exterior noise and noise from ad-
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February, 1981-55
jacent interior spaces," with sound transmis-
sion limitations at 45 STC for partitions be-
tween a patient's room and another room or
corridor (average noise); 50 STC for parti-
tions between the room and a public space
(high noise); 45 STC for floors-ceilings be-
tween a room and another room or public
space; and 50 STC for floors-ceilings between
a room and public space and service areas
(high noise). Noise annoys (feelings).
Considerable attention has been given to
the need for air conditioning (Green et aI.,
1974; Central Mortgage, 1972; Lawton, 1975;
and Stotsky, 1970) and suitable ventilation in
residents' rooms (Beyer and Nierstrasz, 1967;
Central Mortgage, 1972; and Nierstrasz,
1961), with individual room controls for
heating and cooling (Lawton, 1975; Musson
and Heusinkveld, 1963; and Stotsky, 1970).
There has also been advocacy of automatic
central heating (Beyer, 1965); natural ventila-
tion (Green et aI., 1974) with warnings
against drafts (Green et aI., 1974; Central
Mortgage, 1972; and HUD, 1972); humidity
control (Central Mortgage, 1972); and ade-
quate heating (Central Mortgage, 1972; HUD,
1972). Proper (or customary) temperature has
been specified as 75°F (24°C) (Beyer and
Nierstrasz, 1967; International Center, no
date; Central Mortgage, 1972; and USGPO,
1977b), though 70°F (21°C) is customary in
Great Britain (Beyer and Nierstrasz, 1967).
Although the American Society of Heating,
Refrigeration, and Air-Conditioning Engi-
neers has asserted that all men and women
above 40 years of age prefer a 1°higher effec-
tive temperature than younger people, Rohles
(1969) found that many preferred lower tem-
peratures. HUD (USGPO, 1977a) has stated
that care-type housing must provide "ventila-
tion to achieve a healthful environment" and
••an acceptable degree of comfort" (health and
safety and feelings) .
The need for good illumination (with
higher intensities) in residences for the aging
56- February, 1981
has been noted by many investigators (e.g.,
Beyer and Nierstrasz, 1967; Brody et aI.,
1973; Central Mortgage, 1972; and Lawton,
1975), although attention has been directed
mostly to hallways and stairwells rather than
bedrooms. However, it has been pointed out
that bedrooms should have lights that can be
switched on from two or more positions, so a
resident will not have to walk about in the
dark (Grandjean, 1973). Wall fixtures 5 ft 8 in
high are preferable to overhead lights be-
cause of bulb changing (Central Mortgage,
1972; Lawton, 1975). There should be more
than one bulb and rheostat control (Central
Mortgage, 1972). Artificial lighting should be
indirect except for bed and reading lamps
(Snyder and Willoughby, 1977); there should
be no central ceiling light (McGuire, 1972);
light fixtures should be flush-mounted in the
ceiling to avoid glare and dust collection
(Stotsky, 1970); but light fixtures should be at
accessible heights for replacing bulbs (Inter-
national Center, no date). There should be a
night light (USGPO, 1977a, 1977b; Stotsky,
1970). Peripheral light in a bedroom, from
floor lamps, reading lights, fixtures over mir-
rors, etc., is said to be superior to, or a neces-
sary complement of. a central ceiling source
of illumination (Koncelik, 1976) because,
with the latter by itself, corners, wall areas,
and critical furnishings fall into shadow.
Lighting should be planned to accommodate
both standing and wheelchair eye height
levels (Koncelik, 1976); sources without glare
for a standing person may produce glare for
one sitting. For care-type housing bedrooms,
HUD (USGPO, 1977a) has specified 10fo as a
minimum for artificial light and 30£0 for
reading in bed. In addition, HUD says that at
least two duplex receptacles are required for
each bed, at least one at the head of the bed,
to serve portable lights and for other pur-
poses. Illumination affects activities, locomo-
tion, and perception. Glare can produce dis-
comfort (feelings) and risk of falling from
being temporarily blinded (health and safety).
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HUMAN FACTORS
Various minimum amounts of natural light
or sunshine must be available in a bedroom
(Beyer, 1965; USGPO, 1977a, 1977b; and
Green et a\., 1974). However, glare from natu-
ral light or the sun must be relieved, e.g., by
wider eaves for shade (Stotsky, 1970), by ver-
tical blinds or baffles, by tinting the glass
(KonceIik, 1976), or by window location
(Koncelik, 1976). A resident entering a bed-
room otherwise might be temporarily
blinded by glare from the window.
CONCLUSION
Why the foregoing itemization? There are
several reasons.
(I) To indicate what should be considered in de-
signing bedrooms in residences for the aging.
The literature review has made it possible to
present a more comprehensive checklist than
has been previously provided.
(2) To demonstrate that no published set of stan-
dards, guidelines, or recommendations has
come close to covering all of the items that
should be included. Although undoubtedly
some references have been missed, clearly no
particular publication is listed for more than
a fraction of the items. Nor is there a desirable
consistency in design recommendations.
(3) To show what might be done along ,the same
line for other residential subsettings for the
aging, such as for bathrooms, kitchens, cor-
ridors, lounges, dining rooms, building foyers,
and facility siting. A review of the design lit-
erature has indicated the same extent of
guideline inadequacy as for bedrooms.
(4) To suggest that bedrooms have been sadly ne-
glected in considerations of environmental
design, as pointed out before (Parsons, 1972).
(5) To illustrate, through the detailed application
of the matrix of environmental and human
aspects, how the complexities of built envi-
ronments may be related to the complexities
of human behavior. Appropriate design de-
pends on knowing how design affects people.
(6) To benefit the aging by suggesting how to im-
prove the places where they live.
(7) To imply what might be undertaken in re-
search and analysis to obtain the data to sup-
port published design requirements.
It is to be hoped that the Department of
Housing and Urban Development and the
Administration on Aging of the Department
of Health and Human Services will make
H. MCILVAINE PARSONS
progress toward establishing more com-
prehensive standards and guidelines. Consid-
erable research will be needed. Other groups
should be interested-the Veterans Adminis-
tration (which must house increasingly older
persons), state agencies, gerontologists, ar-
chitects, private organizations (both non-
profit and commercial) which build homes
for the elderly, and many individuals in the
field of human factors.
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