Nighttime at Tockwotton Home

Posted by Julianne Gauron on August 26, 2008

6:00pm

I’m uneasy about staying overnight at Tockwotton Home’s nursing wing tonight. Going into a place that has locks to keep people in is unsettling.  And even though I go in knowing that when I want to leave I can, just knowing that no one else can causes me to pause.
As a designer I am interested to see what transpires in the home in the evenings and what will surprise me. But as a person who will age just like everyone else, I am not optimistic about what my experience tonight will show me about my own future. We consider ourselves so lucky to live to a ripe old age, but don’t consider the bad luck to have incontinence issues or a fall in our elder years, as is the reality for many. A resident passed away yesterday. I did not know her, she was in hospice care for the majority of our time at Tockwotton and remained semi reclined in a rolling chair almost all the time. Her family spent the week leading up to her death with here and sleeping in the hallway chairs in turn. No matter how “Pollyanna” we want to be about Nursing Homes, they are, in many cases, the place where people eventually die. Our task as designers is to see what we can do to create moments of happiness and fulfillment, to assist, provide ease, and dignity.

9:30pm

After chatting in the dining room this evening I wandered over to first floor nursing home and saw Mary (who lives in Assisted Living) on her way out after a visit with her sister. Ruth was in the TV room watching E!News, Olympic updates and Jeopardy, and as always was a delight, although she admitted to her usual confusion as to who I am and what I do at Tockwotton, which is fair enough.  There were about six women and Bill still up at this point; I assume that everyone else went to bed right from dinner before the staff change. As Ruth pointed out, Culture Change residents choose their schedules, but I have to suspect that ambivalent residents end up in bed early too for ease with staffing scaling back in the evening. But as always the staff was so nice; later in the evening the head nurse shared much of her experiences with us. She talked about her patients with affection and reflected on how foolish it is to have nursing homes modeled after hospitals, saying the new home will be different.  

I wandered down the hall and saw most doors where open (the residents get to choose) and could see only feet at the ends of beds. It was almost eerily quiet. I know we expected more activity in the evening; I’m not sure what exactly but more. We were told some people are night owls and really perk up. One resident tends to sleep during the day at the wrong times and so wakes up at night, so they give her ice cream and keep her company. We all met downstairs in the utterly silent and dark living room when Michael came by to discuss Tockwotton, aging and homes in general along with our observations. We also discussed the death the day before pondering on how we too one day could come to accept this is the way that so many of the residents view death.

11:00pm

All of the assisted living residents are in their rooms with doors shut and in the nursing home, the A/C and respirators hummed and doors were open, requiring silence from anyone still moving about. Everything was hushed and moving in slow motion.

We chatted with the nurses at length who seemed quite peaceful in the evening. Stephanie, David and I then went into the bathrooms on the nursing home side, which I used as an elder might. They fail to be really good geriatric design but succeeds in being institutional enough to make me uncomfortable. The bathrooms are certainly the low hanging fruits for design and are an area in which the new Tockwotton building hopes to make improvements. The toilet is too high with hand rails put on other side though I suspect these get in the way as much as help. The toilet paper is on the wall over the right shoulder and the help pull is over the left one. The staff pulls the strand of toilet paper forwards and wraps it around the hand rails.

For washing one must move and readjust to wash hands, soap and then dry, which must be quite a trick in a walker. This could all happen in one spot; as it is the staff says often people don’t want to bother and so don’t wash their hands. We then went into the shower room. It certainly doesn’t smell hygienic although I am absolutely certain that it is. The space itself is down a bit of a corridor and cluttered with walkers and wheelchairs, turned into a bit of a storage space, with soaps and shampoos in large industrial forms. Bathing should be calming, rejuvenating and a treat but it doesn’t seem likely that it is here. With culture change, residents can choose how often and when they shower, and they often do exercise this freedom of choice, but when we looked at the shower schedule most only shower once a week. In nursing homes without culture change, once a week is standard. Although residents have choice here, because of the failure of the physical space Culture Change can’t take effect in this area. Both people and physical environments must change.

I sat in the shower chair, where the PVC piping of the structure, the medical green synthetic backing fibers and the jammed wheels it rested on, along with the toilet seat for a chair did nothing to make me relax. Nor did the foot rest which I couldn’t quite reach as I slipped down in the seat. I tried to imagine sitting there naked as someone washed me and although it is a necessity to get help bathing at a certain age a loss of dignity came to mind. I felt ill at ease and exposed.

The rarely used bath tub was not better. After sorting out the pin and lifting up the large door to get in, I sat down and the whole roto-molded contraption reminded me of the yellow and red flinstones-esque cars I used to paddle around in as a kid. Because the door opens up the whole tub the bather must sit there for the entirely of the filling up. The controls face the bather like the dashboard of a car, looking far more technical than any bath I’ve ever taken required. Again one must sit and wait for the emptying. Although I am much more of the shower generation I know that baths can be quite the calming luxury and it is certainly a very badly missed opportunity in nursing care. I certainly felt less exposed then I did in the chair but imagining a busy CNA having to hover over me for at least 30 minutes to bathe me made me feel guilty and as if I should rush through it all for their sake.

12:30am

We walked up to the solarium to see the horizon and then down through the darkened library. The silence and lethargy of place seemed to “catchy”. We wondered if it was a bit of the chicken and the egg, people who liked to go to bed early went and everyone else soon after followed because it was too quiet and awkward to be awake. I had intended to stay up in one of the halls for the night but really there was little point. The nurses said that the mornings 6:30-8:30, and afternoons 4:00 to 7:00 are best for activity so we will come back for these times.

In reflection I’m still not quite sure why we were so surprised by the quiet or so uncomfortable for the first time in being there. Certainly staff and all residents who were awake welcomed us and had more time to talk. Maybe night-time is more intimate and personal and we were stepping on its toes. Or maybe as young people we are accustomed to night being an active time. Or perhaps it was that the residents’ lives suddenly seemed more and more like our own. A person propped up dozing in a wheelchair during the daytime bears little resemblance to me, but someone nestling down in bed with a book seems almost to mimic me, projecting my future, both tonight and in 50 years. In that moment, perhaps the gap between us closed.