Webster's Dictionary defines a highway as a “main direct road.” So in healthcare for seniors, the corridors that link resident apartments to activity rooms, dining areas, and wellness offices, could then be considered the “highways” of the communities. And not only do residents, guests, and family members use these thoroughfares, but more importantly, staff use these arteries 24/7. Although many of the public spaces in our communities take varying degrees of abuse, hallways have an amazing tendency to wear out quickly and “ugly out” even sooner if the initial design does not address durability, function, and aesthetics from the onset of a project.

Over the past five years, our firm-CR Design-has redesigned more than a million square feet of hallways from independent living to skilled nursing environments and we have encountered many challenges along the way. Some stem from the unchanging architecture of the building, and the client calls us in for strictly a cosmetic fix. Other challenges are budgetary or driven by the fact that a newer addition might have caused the existing structure to require an upgrade. Renovations in corridors are often just that-a requirement-not just a preference. The redesign of these corridors must address innovative design upgrades, durability, product life span, cost, and wayfinding techniques. In addition, lighting, handrails, flooring, and acoustics are just some of the details that play a major role in the overall result of the corridor design.

WHO IS ON THE ‘ROAD’?

First, we must address just who is using these internal highways. The answer quite simply is everyone associated with the 24/7 activities of the community. And having an awareness of the limitations of the resident prior to planning is the key to creating a good design. The senior living population varies, and so do the residents' physical limitations. Some of these physical limitations include loss of ordinary mobility, deteriorating eyesight, loss of grip strength, and hearing impairments. Many residents also suffer from diagnosed or even “undiagnosed” dementia or memory loss. By designing for all of these limitations we can provide a supportive corridor that is safe, durable, and inviting.

MOBILITY IS INDEPENDENCE

Take it from any physician: The best exercise is still considered walking. Foreboding corridors can often discourage a resident from leaving his or her room. Certain medications, obesity, cardiovascular deconditioning, and the limited range of motion associated with an aging body can cause loss of mobility. Changes in vision also contribute to this condition. By creating visual contrast between the upper and lower walls, the floor and the base, the handrail and the wall on which it is fastened, we can provide residents with more visual cues.

First and foremost it should be our goal in the redesign of a senior living corridor to create a residential model, one with the familiarity of home that will encourage independence.

Greg Benson Photography

Sometimes residents require encouragement to leave their rooms and interact within the community. They may avoid it altogether and stay in their rooms longer rather than join in with activities or meals. First and foremost it should be our goal in the redesign of a senior living corridor to create a residential model, one with the familiarity of home that will encourage independence. All finishes and furnishings throughout the design process should be selected with this in mind.

Just as the Department of Transportation ensures that our roads are safe for drivers, designers must pay particular attention to the durability of “roads” within senior environments by creating safe and comfortable passageways for the residents.

EXITING THE HIGHWAY

Long hallways are sometimes unavoidable when it comes to the traditional corridor. Certainly trends in aging design are often focused on households, but what if the client cannot afford a total renovation or if the buildings just cannot handle that much physical renovation? Often, designers are asked to make upgrades to a space without being given license to renovate the architecture of the space. Creativity plays a major role in how we solve the issue of the long, tiring path.

Signage and visual cuing are also part of good corridor design. Location of signage should be in keeping with the ADA regulations as they work for universal design. But signage alone cannot be the answer for visual cuing to our residents.

Greg Benson Photography

Overall, try to think more than just color and signage for creating visual cuing. Locating a particularly interesting piece of artwork can be a reminder of which hall one resides, or where the dining room is located. Making color changes at certain key areas in the hall can provide a natural wayfinding tool as well as add visual interest. “Rest stops” can be incorporated to help with the inevitable length of corridors. If the architecture permits, the addition of window seats can be an attractive and functional way to bring natural light into halls and add a spot for a tired traveler to relax.

PAVING THE ROAD

Tom Crane Photography

Choosing between resilient flooring or carpet can be a real dilemma for you and your client. Because some residents may experience hearing loss, consider the surrounding space when making this flooring choice. If noise is a huge issue because of an abundance of glass or drywall ceilings, try to use sound-absorbing products such as carpet or PVC-free tiles/planks.

Tom Crane Photography

Be careful that the care and upkeep of your resilient flooring choice does not include a high-gloss finish because it can cause glare and even look wet to the aging eye. If choosing carpet, level loop has been found to be the pile style of choice. Also avoid varying levels of loop pile as this too can create tripping hazards. Avoid using any type of padding-it tends to trip those who shuffle their feet and it is difficult for those in wheelchairs or those using walkers to maneuver on. Direct glue is the best choice. And where resilient flooring meets carpet, consider the transition and find one with the lowest possible profile that will be easy to move across.

Select colors with high contrast between floor and walls. Floor coverings in general should be chosen for their minimal contrast and patterning, moisture-resistant backings, and long-lasting fibers. Provide transitions that are not trip hazards.

Backings are almost as important as the actual carpet selection. Ensure that you have moisture-impermeable backings with welded seams versus a carpet backing that simply states that it is moisture-resistant.

Durability and life span and, of course, how the flooring is to be maintained should be a key part of the decision-making process. Involve the facilities manager and housekeeping staff when considering flooring options.

WALLS: OUR ROADS' ‘CRASHRAILS’

Paint versus wallcovering is always a huge issue for most clients. Certainly budget can determine this quickly, but what if budget is not a major factor? My experiences with clients have proven that it is an individual community's preference as to how that question is answered. There are many options but each has its own set of pros and cons.

Rigid wall protection products offer superior durability, but at a cost. The price of a wall-protective material can be anywhere from 4 to 7 times higher than paint. When it comes to comparing that to vinyl or PVC-free wallcovering, the durability was three times greater but cost really depended on the wallcovering itself. It eventually comes down to: Does the facility want to continue to paint the wainscot over and over again, disrupting the hallways and using staff for this task (or hiring outside subcontractors-even more costly), or would the facility like a one-time investment that holds up to abuse and looks good for years?

Although painted wood is less expensive than stained, the use of a white painted handrail means more maintenance over time, whereas a stained rail will be more accepting to hand oils and daily wear and tear.

Handrails in corridors are code driven in skilled nursing but the codes are more lenient in assisted living, personal care, and independent living environments. Often, a “lean rail” or “palm rail” can be best for an arthritic hand, while an ADA-compliant handrail might be less easy to grasp because of its narrow and unfamiliar shape. Face it, how many stairways in our homes have 1-1/4″-diameter round handrails? Like most, we are more familiar with the traditional stair railings that have a wider surface and larger grip area.

When considering handrail design also keep in mind that if two different wall finishes are used and are divided by that handrail, when it ends, there needs to be a continued separation of those two wall finishes. A handrail design that also incorporates a chair rail or can easily be adapted to one is very useful. Also consider the handrail finish. Many times the trim paint color of choice is white. And white would then be the obvious answer for the handrail. Although painted wood is less expensive than stained, the use of a white painted handrail means more maintenance over time, whereas a stained rail will be more accepting to hand oils and daily wear and tear.

LIGHTING THE WAY

Hallway lighting should be indirect if possible, lessening glare for aging eyes. A favorite solution (if the architecture will support it) is to use fluorescent lamping behind decorative cove molding. The resident sees no sign of the actual light source. Try using a highly reflective white paint above the crown molding to reflect light back into the corridor, even if the design calls for a deeper paint or wallcovering on the walls below the molding.

Glare can be a real problem with recessed fluorescent downlights in ceilings especially if the reflector is clear Alzak-and most are! Sometimes the reflectors can be retrofit with a white or matte Alzak reflector, which will help immensely. Also consider LED retrofit kits. For a little more than $100, an LED retrofit kit can be installed in the same locations as the current downlights, providing less glare and over 25,000 hours of lighting before having to replace the lamp.

For visual interest, consider turning ceiling tiles on a 45-degree angle. Break up long halls by adding arches or drywall soffits, crown molding, or paneling to break up the monotony. These options also provide visual cues to help residents find their way.

RENOVATING IN ACTIVE HALLS

It is essential that the project involve a team including staff, administration, the facilities manager, and the designer to develop a plan on how to handle the renovation. Residents and their families should be notified of the dates that contractors will be on site and their work plans. Since the corridor is sometimes the only option for leaving one's apartment or room, it is essential that the contractors leave a clear path of egress during construction. D

Carol Reitter Elia, ASID, LEED-AP, is principal of CR Design, an interior design firm specializing in senior living environments. The firm has a particular focus on bringing eco-friendly benefits of “green” design to communities for the aging. She can be reached by phone at (610) 353-5580 or e-mail

carol@crdesign.biz. For more information, visit

www.crdesign.com. Design Environments for Aging 2011 2011 March;():24-26