If You Build It, They Will Care

Designing Empathetic Spaces and Objects 
for the Future of Caregiving

“There is no doubt whatever about the influence of architecture and structure upon human character and action. We make our buildings, and afterwards they make us. They regulate the course of our lives.” —Winston Churchill, addressing the English Architectural Association, 1924

“It doesn’t
 make you feel very good, 
when the stuff around you
 says ‘I’m sick.’” —Michael Graves, architect, designer, and long-term 
rehab patient

In his book, The Architecture of Happiness, Alain
de Botton addresses the skepticism with which people have historically approached the investment of time and money in design. “Beautiful architecture,” he writes, possesses “none of the unambiguous advantages of
 a vaccine or a bowl of rice.” And yet, as de Botton and others have noted more recently, the objects that people use and the spaces in which they use them are central to how human behaviors develop and take 
root – particularly in the area of health and wellness.

After a spinal cord infection left American architect and designer Michael Graves paralyzed from the chest down, he became especially attuned to how the design of rooms, furniture, and even linens could mean the difference between dignity and shame, hygiene and infection, and health and illness. Disturbed by his own slow recovery, Graves began observing the objects and behaviors that surrounded him in rehab facilities. Seeing, for example, that nurses always grabbed food tray tables from under the tray’s surface while cleaning staff only disinfected the tops, Graves understood
 that something as simple as adding a few strategically placed handles to the tray could limit the spread 
of harmful bacteria and have a major impact on patient recovery.

Care in Crisis

While Graves called the patient room the “last frontier of healthcare design,” his work demonstrates that
 it is the conceptual and social underpinnings of that room – a lack of human understanding in designing 
for long-term care – that comprise the broader and more elusive frontier. Indeed, nowhere is thoughtful and empathetic design needed more than in eldercare and care for people with chronic conditions, two segments 
of the healthcare industry that are persistently misunderstood, even as they are experiencing massive growth.

By now, the statistics are familiar. They project a near future in which more people will need care and fewer people will be able to provide it. In the US alone, the ratio of caregivers to care recipients will change from 7:1 in 2010 to 3:1 by 2050, according to the AARP Public Policy Institute. Care recipients will also be younger, have debilitating conditions for longer periods of time, develop more comorbidities as they age, and have more specific needs and wants. Nursing homes, hospitals, and assisted-living facilities are ill prepared for the challenges ahead. Many still resemble a factory floor – with physical and organizational infrastructures that promote Ford-like production and efficiency – and ignore the holistic needs of patients, families, and paid caregivers.

As we look to this near future, we must ask ourselves several questions: What can architecture and design
 do both for the processes of care and for the people involved in those processes? How might care spaces be configured to build relationships, encourage wellness, and promote individual and social health? How can design make people empathize more, communicate more effectively, and ultimately take better care of themselves and one another?

Designing for Interaction: Facilitating Connection and Compassion Beyond the Patient Room

A guiding question for design is that of what the space must do, not just in terms of functionality, but in terms of what behavior, activities, and attitudes the space must facilitate and promote. Experts in biophilic design and neuroscience for the built environment have made the case that design must inspire particular states of mind. Through the interventions of these experts, color and wall art are used in patient rooms to promote relaxation, connection to nature, and other emotional and psychological states.

And yet, care is not just about the individual and their state of mind. It is about social interactions – both planned and spontaneous – as they occur among colleagues, friends, family members, and strangers. Care is a social act that takes place in unexpected ways between various people and in multiple spaces throughout care facilities; as such, designing for care must look beyond the individual to facilitate and encourage interaction, relationships, and engagement.

/  What if hallways, stairwells, and other “transitional spaces” were designed to foster interaction, instead of simply accommodating the flow of people who are moving from one place to another?

/  How might the configuration of common spaces and their furniture encourage patients and their family members to engage as much with the people they came to see as with those who are in the space visiting others?

for Collaboration: 
Balancing the Professional 
and Personal Needs 
for All Care Participants

An additional question of design to consider is who the space or object needs to serve. The non-medical aspect of
 care is increasingly being addressed through patient-centric design that takes into consideration the holistic desires of patients and their visitors. Organized activities
 keep patients occupied and fulfilled beyond just their basic needs.

And yet, care facilities are inhabited
 by numerous stakeholders who are fundamental to the care process, as they are constantly engaged in negotiation, communication, and decision making. As care is a collaborative act that requires the input and commitment of a range of paid and unpaid workers, designing for care must involve caring for everyone in the network of care delivery.

/ What if an increasing number of family caregivers who have grown up as digital natives could use their personal devices and tech solutions to communicate with nurses, physicians, and therapists?

/ What if break rooms were enhanced to allow orderlies, nurses, or staff
 to communicate seamlessly with their colleagues, or to connect remotely to their own families as they spend long hours caring for the family members 
of others?

for Endurance:
 Long-Term Disability 
and the Slow-Care 

A less frequently asked question, both 
in design and in the healthcare industry, is how long care must last. Just as the slow-food movement has directed attention to the various ways in which food is 
made, an emerging slow-care movement encourages us to understand care as
 a set of processes that must be deliberate and sustained over long periods.

And yet the concept of slow care has further to go, specifically in moving beyond the idea of care as a set of skills that are fixed and static. As more people come to need different kinds of care for longer stretches of time, spaces and objects of care will need to be designed for dynamic and flexible activities that adapt to changing needs.

/ What if care spaces were configured in modular ways that could change over time to accommodate different stages of recovery or decline, as well as to suit 
the shifting relationships between patients and their families?

/ How might furniture be built to change, and then change back, in order to suit the requirements of specific times of the day, month, or year?

If buildings where care is provided and the objects within them are able to continuously “make us” – and often in ways that we do not expect – then we have no choice but to ask big questions about the nature of care. What does it mean to design with and for care? How do we balance functionality, empathy, and inspiration in the creation of objects and space? And how can we assure that empathetic design gets under the surface and serves the latent desires, emerging needs, and everyday utility that people seek? As Graves found, it is through observation and real-time engagement that we can truly understand how to design for both utility and inspiration. Going forward, we must make those observations carefully and with a critical eye to bridge the gap between what we know and understand now and what the future demands.

the author

Victoria Scrubb

the author

Maya Shapiro

Dr. Maya Shapiro is a resident anthropologist at Idea Couture.