Home and care environment

The meaning of home to the elderly is unquestionable. Home is more than just a house or a flat and walls: it is a place for social life and a home for the mind. The meaning of home is based on its familiarity, emotional safety and functional freedom. If the memory starts to degenerate, the elderly copes with the daily living for long because of the routines in the familiar surroundings.

The supporting of living at home is appropriate and sensible both for the elderly and the society. When the functional capacity degenerates living at home should be the elderly’s choice.  When new houses are built, it should be taken into consideration how a person can live through the whole life in own home and environment.

It is important that the elderly feels safe at home. Accessibility in houses must be emphasized. It is important that people start to plan their living in time considering their future needs when the functional capacity degenerates. The community should offer choices for independent and accessible living. In building houses should also be taken into consideration that the living environment of the elderly is a work place for carers when the elderly needs support in coping in the daily activities of life.

In building new houses there are regulations stressing accessibility. Many problems and defects concerning safety and moving in the house can be fixed with reasonable costs. The communities help older people in the renovation work.  The renovation is usually needed in the kitchen and in the bathroom. There may be need for widening the doors, taking off doorsteps and building ramps for the wheelchair. For disabled people the renovation work is compensated.  The aids that are compensated are e.g. elevators, text phones, induction loops and safety alarms.

The care environment of the elderly consists of physical, psychosocial conditions.

To the physical care environment belong the location, the space and shape, the setup of the space, the visage and interiors and the atmosphere caused by these factors. Architectural elements, such as lightning, walls, floors, windows, furniture, decoration and their relation and arrangement have an effect on the atmosphere. Temperature, different caring and handling aids and alarm systems are parts of the care environment. Different noises and silence should be balanced and controlled by the elderly. These physical factors are related to the psychosocial environment. Esthetical factors, like nature, light, colours, harmony, art and different symbols and objects, belong to the physical care environment. Esthetically beautiful environment respects older people.

The psychosocial environment is made of the atmosphere where encouragement, supporting the functional capacity and respecting of the individuals are present. Good psychosocial surroundings enable older people to participate actively in different activities in cooperative environment.

 

Accessible environment

The functional capacity of older people can be improved by developing the accessibility of their living environment. A well planned accessible environment improves the physical, cognitive, psychological and social functional capacity. It decreases the need for help of other people, aid equipments and the risk of injuries.  It increases the independency and equality of older people.

Accessibility means that older people can easily participate in their daily life activities, hobbies, cultural activities and studies. Accessibility enables older people to get different services and to use the tools and aids needed. Older people can go to the situations and places to get the knowledge needed in decision making concerning her- /himself. Accessibility means a safe and convenient building for all users. All floors and rooms are accessible and the functions are easy and logic.

The home and care environment of older people is made accessible and safe by making necessary changes and providing utilities and aid equipments. The gerontechonology supports the independency and participation of older people. Different safety alarm systems and safety phones are part of gerontechnology.

 

Safe environment

Special regard has to be paid to the safety of the living and caring environments of older people.

Fire safety has to be according to the laws and regulations. Preventing the accidents and injuries of older people is an important part of improving the safety. The challenge the carers are confronted with is how to combine the privacy and autonomy with safety.

The safety of the home and care environment can be improved with concrete actions which affect the risk of injuries both inside and outside. After the safety assessment necessary repairs can be started. It is important to guarantee safe passways to older people. If needed, doorsteps can be removed, the steps are marked clearly and on them must be installed non-slip bands. Different railings and grabs prevent injuries well. Sufficient light makes to moving around easier.

The order in home and care environment affects safety. The often used equipments and tools should be situated low and those seldom needed on upper shelves. The elderly must be reminded to use proper and steady ladders. Safety phone is good equipment to an elderly living alone. In case of an accident help can be alarmed.

The elderly must be guided in choosing proper shoes. Non-skid can be installed to shoes used outside in wintertime.

In preventing the fall injuries it is important to pay regard to both external and internal risk factors. Slippery is the most important external factor. In prevention the paths and passways must be sanded, the shoes are equipped with non-slid and regard paid to the shoes’ quality and sturdiness. Falls inside can be prevented with non-slippery floor materials. The floor materials in bathrooms are especially challenging.

The safety inside can be improved in many ways: non-slip bands / mats under the rugs, the rugs can be put partly under the furniture, doorsteps can be removed or made lower, loose objects and electric lines can be removed from the passways, different grabs and railings can be installed, wrist alarms, good lights and if necessary monitoring can be provided. Small, loose rugs should be removed. Loose electric lines are installed to the wall and floor bars off the floors.

It is good to remember that the most dangerous way to the elderly is to go from the bed to the bathroom. It is often dark and the elderly gets up too quickly. In this situation the risk of injury is big if the elderly has dizziness. All the above mentioned means are important in preventing the nightly injuries.

The internal risks of fall injuries are related to the weak functional capacity, e.g. muscle weakness because of little amount of exercise, the orthostatic hypertension, different diseases and medication. In addition sudden fever, anemia, dementia and weak sight are risk factors of injury.

Weak sight can be a reason for falling and it can cause a hip fracture. Hip protectors can prevent these fractures. The prevention of the internal injuries are: checking the medication (sleeping pills, psycho medication, nitroglycerine, blood pressure medication, distillation medication), controlling the blood pressure, Na Ca –balance, liquid balance and also taking care of strong bones. The injuries can be efficiently prevented by sufficient daily exercise, rehabilitation and necessary and versatile equipment helping in moving and daily life.

Fire safety improves by setting a functioning fire alarm. To the fire alarm it is possible to set on a wall a battery box and the batteries can be changed on the correct height without climbing to the ladders. There are vibrating alarms to older people with hearing-challenge. The smokers should be guided to smoke safely and in burning candles guidance is necessary.

The fire safety in kitchens can be improved by installing sensors of overheating or a kettle sensor. These cut out the heating if there is no kettle on. Above the stove can be installed a heat guard which cuts off the heat when it rises too high.

 

Snoezelen environment

Snoezelen environment can be planned and built both to be activating and calming. The elderly perceives the environment by her / his senses. Sight and hearing are important to older people. To cope independently in daily activities of life the elderly needs good sight. Hearing registers different information and stimuli both awake and sleeping. When sight and hearing get weaker, the senses compensate each other.

The most important sense to the elderly is tactile sense and it remains longest also when death is approaching. Without tactile sense the elderly could e.g. burn her-/himself and acting independently would be difficult. Tactile sense gives information continuously of the functioning of the body. Aging and diseases weaken also the senses of smell and taste.

People observe their environment through all senses. The elderly observes the environment many-sided when the information is not conflicting. If even one sense gives conflicting information, it confuses observing. All senses must experience the environment pleasant to get a positive sensation. If with one sense the elderly experiences the care environment negative, the empowering and supporting impact of the environment decreases.  That is why all senses must be considered.

Snoezelen is a method in which there is used a therapeutic and activating environment to support the functional capacity. Its basic idea is to have an impact to many senses at the same time. Snoezelen as a word means snuffing and snoozing. Snuffing refers to the activation of the experience, snoozing refers to the state of relaxation and calmness. The pleasant experiences by different senses it is possible to reach a balance between activation and relaxation. This balanced state is beneficial to learning, imagination, creativity, feelings, building self-esteem, decreasing stress and pressures and communication.  The Snoezelen method is from Holland from the 80’s when Jan Hulsegge and Ad Verheul found out that everyone can get new experiences through the senses.  

In Snoezelen method there are used especially made sensing rooms. The senses are activated by using in different ways light, sound, touch, smells and tastes.  The idea is to offer environments easy and pleasant to access. The senses are activated in the multi-sensory room. Different visual solutions make the space interesting for the sight. The elderly can look e.g. slides, films, candle light or different lamp lights, soap bubbles and mirrors. The hearing is activated e.g. water sounds, birds’ singing and other sounds from the nature and music. The tactile sense is activated by different objects that feel different to touch. The sense of smell is stimulated by pleasant smells and the sense of taste by different food and drinks. There are different multi-sensory rooms such as white room, blacklight room, echo room, music room, activating room, memorizing room, black room, sea room, touching room, vibration room, aroma room, room of silence, garden of experiences and nature room. The white room is different from the others, because there the elderly is more passive than in the other rooms. The philosophical principles of Snoezelen must be considered in realization to be able to get the benefits of the method. The principles in the sense activating environment are right atmosphere, possibility to have freedom of choice correct guidance.

 

The right atmosphere

The atmosphere is pleasant and safe. The carer is emphatetic towards the elderly in the room and uses body language.

 

The freedom of choice

The elderly can choose the stimuli and the rhythm to change them. The elderly chooses the time she / he will spend in the room. Everyone individually needs the time to receive and perceive the stimuli. The carer respects and accepts the rhythm needed by the individual elderly.

 

The correct guidance

The correct guidance is respecting the freedom of choice. The carer creates an environment that  is beneficial to the elderly. The carer acts in the Snoezelen room at terms of the elderly.  The carer uses in guidance both verbal and nonverbal communication and gives up many norms and routines. It is important that the elderly feels safe. The guidance must not cause pressures for performing. Most important is the relaxation and getting positive experiences of togetherness.

Snoezelen rooms can be built in various ways. The room can be a small corner or it can include many rooms.

The white room represents Snoezelen method at its purest. There the elderly relaxes and observes in a peaceful atmosphere. As the name implies the room is white and planned for relaxation. The relaxation can happen in water bed or a bag chair in cosy position and listening to calming music. The room can be equipped with illuminating tubes. To the walls can be projected different pictures for inspiring imagination by colours. Pictures of landscapes can also be used to raise memories from the life span.

The activating of senses is the main idea of Snoezelen. The activating of touch is used because the elderly perceives the physical environment by touch. E.g. a water bed is ideal for the elderly whose ability to move is degenerated. The movements of the body cause waves in the water mass and the elderly can enjoy own movements without help. In ball sea the weight of the elderly is divided evenly and the elderly can get a feeling of swimming. Special Snoezelen rooms are not yet available in all care units for the elderly, but the principles can be adapted in everyday life in the supporting process. It is recommended to build the care and living environment to be versatile in offering sense experiences and relaxation to the elderly.

Instructions for building a Snoezelen room

• Create a pleasant atmosphere
• Take care that colours, lights, voices and music are balanced
• Consider the special needs of older people in furniture and decoration
• Let the elderly choose her-/himself which stimuli she/he wants
• Give pleasant experiences to the elderly by touching, smells, tastes, lights and music
• Let the elderly decide her-/himself for how long she/he wants to stay in the room
• Act at the elderly’s terms
• Use in your guidance both verbal an non-verbal communication
• Be careful not to cause pressures for performing 
• Take care of the feeling of safety and amiability