“Essentially it’s just a lot of bedrooms”: care homes and the conundrums of designing for care
My mum will be 90 next month, she lives in a care home, on the top floor which is a secured space dedicated for people living with dementia. The layout of each of the three floors of the home is the same, the design is economical with individual bedrooms off a corridor, a shared dining space, a communal living room at one end of the corridor and a ‘film’ lounge. Bedrooms reveal a repeat pattern of en-suite shower and toilet, centrally placed mechanical bed, two chairs either side of a window which has restricted opening, a television on the wall, an overbed table, a bedside table with lamp, draws and a wardrobe. Some personal affects can be found in the room although these invariably appear and disappear between my visits. The uniform bedroom speaks more of hotel than home, although this is no temporary sojourn, and there is no hope a return to her ‘own’ place. Within her care home, the bedroom is – more or less – her space although it was not of her own choosing and throughout the day there is a steady stream of staff. On one occasion not long after she had ‘settled’ in – she recruited me to help her repeatedly make and remake the bed “getting it ready” for family. When carrying out research into the designs of care homes the wider political salience of this moment became apparent.
During a research project Buildings in the Making we followed architects as they developed care home projects in the UK . One architect summed up the designs – ‘essentially they are just lot of bedrooms’ . Of course, care homes are more than this, but his pithy comment was revealing, not least because it foregrounds ideologies of ‘formal care’ as against ideologies of ‘home’. The remark also reminds us that beds are significant to the health and social care sectors and so prompted us to reflect critically on the salience of bedrooms in our study of architects. We delved into our data and identified the varied uses and imaginaries of ‘beds’ (as bedrooms are euphemistically referred) and examined their metaphorical and literal making and re-making.
During our ethnography we followed the commissioning, design and construction of care homes, and observed ‘beds’ figured in a number of ways. First, they are clearly commodities, where the contracting of a care home rests on financial viability of, for instance, staff-resident ratios, projected occupancy levels, and the scope for homes to accommodate 60-80 ‘beds’ on an acre plot. Second, they are markers of social distinction and inequality, where rooms are spatially adjusted so residents can opt to pay for premium, gold or bronze ‘beds.’ Third, beds become synonymous with home where, as one architect they are ‘core because that’s your home.’ Fourth, beds are imagined as a dwelling where, to quote another architect, the ideal is ‘get a sense of life into the bedroom’ and architects should push their clients to consider ‘what the space would feel like, rather than a kind of functional list’ as set out in design guidelines.
We found that, when designing for care, architects are faced with the conundrum of making ‘beds’ that are simultaneously commercially viable and appeal to segmented markets, while creating spaces that are synonymous with a person’s home. Their designs must also comply with the strictures of building regulations, health and safety requirements, and guidelines on dementia and age friendly design. Beds are individualised spaces within the collective home where attempts to allow for the serendipity of homemaking collide with prescriptions for formal care. We call this ‘prescribed personalisation’: the design of personal spaces that are constrained by circumstances that are not of residents’ (or architects’) choosing.
 Nettleton, S. Buse, C. & Martin. D. (2018) “Essentially it’s just a lot of bedrooms”: architectural design, prescribed personalisation and the construction of care homes for later life Sociology of Health & Illness 40 (7) 1156-1171
Sarah Nettleton is Professor of Sociology in the Department of Sociology at the University of York