Taking a stand on seating in long-term care

It is always interesting when a building environment issue drives an operational question, which leads to a passionate, cross-functional discussion.

Recently we walked into a newly completed addition to one of our long-term care facilities. This addition has a rehab focus which includes additional resident rooms in a connected household concept. Because of the rehab component, we tend to provide more seating in the dining room than the resident capacity to accommodate guests. We find that resident family members will join us for a meal more frequently in a rehab-focused household as compared to a LTC household.

Upon entering the household after breakfast, we found nearly half of the dining room chairs lining the walls of an adjacent living room space near the dining room. With one of our vision statements of stewardship in mind, our interior design coordinator asked, "Did we purchase too many dining room chairs?" In the spirit of our team-member focused strategies, we began asking "help me understand questions" of the household staff.

What we found is that many of the residents or patients are eating meals while sitting in their wheelchairs. With so many wheelchairs at the tables, those dining rooms chairs seemed to need a new home. As good designers and leaders we continued to ask questions. Was sitting at the dining room table in a wheelchair a resident/patient preference? Was this a staff preference? Were the resident families involved? What was nursing's opinion? Who placed the "extra chairs" in the living room? Housekeeping? Nursing? Dietary? Why didn't the architect (me) design more storage near the dining room for all these chairs? That was actually a question running around in my head that the staff could not possibly answer! This complex issue resulted in many yes, no, maybe and "I have no idea" responses to our questions.

We took our questions to the next level of expertise. These same questions were brought to our operations team who have incredible insight in the areas of nursing, dietary, life enrichment, environmental. In the past our organization has implemented a "walk to dine" program. We have also promoted the philosophy that a wheelchair should only be used for transportation, not sitting for any length of time. I love that concept.

Time after time, we realize that our processes and philosophies have to be revisited and reiterated constantly. What are the practicalities of transferring a non-ambulatory resident from a wheelchair to a dining room chair, and back again, three times a day? What if the resident, in their mind, doesn't want to "go through the hassle" of that transfer? What if a skin condition drives the need to avoid the wheelchair for a prolonged time, against the desire of the resident? How long does it take to transfer a resident from a wheelchair to a dining room chair? Does this "activity" contribute to the quality of the dining environment for the resident, especially those who are ambulatory? How much do we "institutionalize" our residents by passively convincing them that sitting in the wheelchair in the dining room "is easier for everyone"?

At the end of the day, actually at the beginning of the day with breakfast, the resident wins. The resident's emotional, physical AND health care needs must drive the decision on the seating accommodations in the dining room. Here is where we landed as a team. Provide four chairs for every four-top table, encourage the residents to sit in the dining room chairs rather than in their wheelchair, listen, communicate, document and educate. And last but not least, convince the architect (me again) to design storage near the dining room, for wheelchairs, walkers, some extra dining room chairs or even a space where we can listen.

Mitchell Elliott

As Chief Development Officer, Elliott serves on the Executive Leadership Team for Vetter Health Services (www.vetterhealthservices.com).  He oversees planning, design, construction, and facilities management in 33 senior living campuses in the Midwest. Elliott is currently Vice President of the SAGE Federation and serves on the AHCA Life Safety Committee. He has served as a juror for the Long-Term Living DESIGN competition.