I was delighted to read the article “Home Again: Small Houses for Individuals with Cognitive Impairment” by Rabig (August 2009, Vol. 35, No. 8, pp. 10–15), as it reminded me of a 92-year-old woman who spent most of her life either in an apartment or a small trailer home in a rural community. As her health deteriorated, she was moved to a large long-term care facility in an urban center. She was easily confused by the long halls, the lookalike rooms, and the large dining facility. It never would be home for her. She was unhappy and lost her outgoing social identity by staying in her room to avoid the fear of being lost. The stress of the poor environmental fit affected her in many different ways, including her interest in eating in the dining room. As noted in the article, at least one third of nursing home residents experience malnutrition and dehydration (Burger, Kayser-Jones, & Prince, 2000). I suspect she was also part of this aggregate. Toward the end of her life, all she wanted was ice cream brought to the room.
The small house model would have been a perfect environmental fit for her, and her ability to adapt to this type of setting would have made a difference in her quality of life. The person-centered care plan would have brought out her extroverted personality that remained hidden in an unfamiliar place in fear of loss of control.
In addition, the integration of theory into this article really pulled the information together for me in support of small houses. The use of Havinghurst’s (1972) developmental tasks across the life span, Roy’s adaptation model (Roy & Andrews, 1991), and Watson’s (1988) theory of caring support the need to look at architectural design in geriatric care. As geriatric nurses are experts in providing care, the opportunity to collaborate with experts in environmental health care design brings new opportunities for individualizing and promoting quality of care.
Janice Edelstein, EdD, APRN-BC