Care Home Environment Magazine
Since 2001, the Southern family has operated an interiors business from their base in Medstead, Hampshire. To this day, their soft furnishings and upholstery are manufactured in their Hampshire workrooms, and many of their experienced installers and craftsmen have worked with the company from the outset.
Managing Director, Kerry Southern-Reason FCA, chose to specialise in residential care home interior design after many years of working with high-end private clients, show homes and hotel interiors. Her change in path was driven by her genuine desire to make a difference to residents’ lives.
Over the years, Kerry has become a pioneer in dementia interior design. In 2020, she helped one client secure a Pinders Healthcare Design Award in the dementia design category. Using first-hand experience, coupled with best practice dementia advice, she strives to create a comfortable environment for those living with dementia.
The Care Home Interiors Company is a multi-award-winning, family-run business offering exceptional design, in-house manufacturing, and full installation.
What does LRV really mean and why are they so important in dementia design?
By Kerry Southern-Reason, Managing Director, Care Home Interiors Ltd.
Seeing the light when it comes to dementia design in care facilities could be the difference between understanding Light Reflectance Value (LRV) and the positive or negative effects that can have on an interior.
LRV is a bit a buzzword in the care sector. It’s an odd one for many to fathom and apply in a considered adult interior space, especially in dementia design, but the definition is simple: ‘
This is the total quantity of visible light reflected by a surface at all wavelengths and directions when illuminated by a light source. The LRV scale runs from 0, which is a notionally perfectly light-absorbing surface that could be assumed to be totally black, up to 100, a notionally perfectly reflective surface that could be considered to be the purest white. For all practical purposes, black is always greater than 0 and white never equals 100.’1
BS 8493 states ‘LRV is the proportion of visible light reflected by a surface compared to the sensitivity to light of the human eye’2
LRV isn’t about colour; it’s about tone and is measured on a theoretical scale between 0 and 100, with 0 being black and 100 being white with all the tonal variations in between.
Materials with significant different tonal values (over 20 degrees of LRV) will be seen against each other. Materials of similar or less than seven degrees of LRV will not be seen, so we don’t use this to our design.
The Light Reflectance Value is especially important in an interior where an individual’s perception may be altered or limited. Bear in mind as we get older there is a natural thickening of the eye lens, colours are not necessarily experienced how someone with younger eyes might experience them.
The University of Sterling document titled ‘Good practice in the design of homes and living spaces for people with dementia and sight loss’ states ‘older people may experience colours as ‘washed out’ and may increasingly find blues, greens and purples harder to differentiate’ This is why having an understanding of LRV is so important and less so the colour.
The LRV of an interior can either aid or hinder how an individual interacts with that space. With regards to the visually impaired or those with dementia, LRV can be used to make an area more identifiable. The idea is to simplify an environment and limit the ‘triggers’ of frustration and confusion, thus enabling independence and improving mobility within the interior space.
Unfortunately in my experience it seems the vast majority of dementia design understanding seems to suggest primary colours are best! This belief has little if no value in real-terms of improving the mobility and independence of someone with dementia or loss of perception.
I’ll just say it now, painting everything in contrasting primary colours will not help! It is about the contrast not the colour.
We know LRV’s are important but we need to understand why and apply them in a considered way that enhances an individual’s interaction with the space they live in.
There are guiding principles that we should work towards and apply when designing interiors for very specific care spaces, especially those used by the elderly, those with dementia, or individuals who are visually impaired.
Whilst colours such as creams, beiges, whites and greys are popular in modern interior design, they are particularly unhelpful to those living with dementia if used incorrectly. The primary reason is the tone and LRV are far too similar. It would present as a white washed space with little to no definition.
For instance, if an object doesn’t visually represent its use it won’t be seen as the object it is. Understanding this and how the use of LRV in design can make an object more accessible is especially useful in a dementia specific care home to promote the safe and comfortable use of the environment.
Likewise overly colourful and busy with patterns becomes equally inaccessible as it can present the individual with confusion through misperceptions and hallucinations. Patterns can become confusing and present as a moving image. For those suffering from deterioration of sight, such environments hinder movement and can cause high levels of distress and confusion.
We recently applied this thinking to the design of lounge furniture and furnishings in a dementia specific care home.
You can see from the picture we have featured contrasting piping on the seating.
This isn’t a design statement; it is a deliberate designed-in aid, which guides residents where to sit. Whether light piping on darker upholstery, or dark piping on lighter upholstery, the contrast and the LRV of the upholstery against the piping is the key here.
The piping highlights the arms of the seat of the chair. This effectively provides an outline. It’s much easier for someone with dementia to identify the object as a chair, but more importantly the outline piping helps the user know where to sit.
You can start to understand why this creates less opportunity for a resident to misjudge where they are sitting. Without the piping a resident might not know where to sit, or misjudge their reach to the chair arm, which could result in stumbling and falling.
The same principle applies to floor coverings.
How often do you hear of older people shuffling when they walk? There can be many reasons for this, but in my experience if a person is shuffling, or avoiding walking on certain floor areas, it is nearly always down to not being able to see or identify what they are walking on.
Good use of LRV can really assist in limiting shuffling by clearly defining the floor as a safe surface to walk on.
Just think how a bright, shiny white tiled floor looks in a bright sunny interior space. The glare and the sheen on the tiles are accentuated by the daylight flooding in. We have the ability, and capacity, to understand why it looks like it does so it doesn’t affect our use of the space or how we walk on the tiles. However if we had dementia or were experiencing a loss of perception, this bright glaring space could be misconstrued as a wet slippy area. There is no doubt someone with dementia would avoid the space or if feeling brave would attempt to cross the space, but with significant short paced shuffles.
Below I have illustrated a bad and good example of flooring. The first picture is flooring we replaced. We replaced this because it was a feature floor within a dementia care environment. Unfortunately this flooring was hindering how residents transitioned across the space from one room to another.
You can see the flooring features dark boarders. It’s a design statement we see in many places such as hotels, hospitality venues, even in domestic home design. The problem with this feature in a dementia specific care home is the dark boarder. To someone with dementia or those who are visually impaired, it presents as a contrast and could be seen as a step or a rug, for others maybe even a hole.
‘The most critical area of colour choice is where it impacts a person’s physical safety. Therefore preventing falls by specifying a suitable tone of floor covering and matching thresholds’ 3
Given this knowledge you can appreciate how someone with a severe loss of perception may approach this area. They may avoid it all together, or shuffle up to the dark boarder and then attempt to make a step up believing it is a step. This not only leads to confusion, but also could lead to an individual loosing their footing and falling due to the step not being there.
You can see the flooring features dark boarders.
The picture below illustrates how we have used a patterned floor but avoided the associated pitfalls by applying our understanding of LRV. It is patterned, but the tone is so slight someone with a loss of perception is unlikely to identify its existence. You can also see it isn’t a highly reflective surface.
This picture illustrates how we have used a patterned floor but avoided the associated pitfalls by applying our understanding of LRV.
The benefits are that someone with dementia or a visual impairment is highly unlikely to find this floor a challenge to walk across, and the design beauty of the pattern can be seen and appreciated very clearly by those who haven’t a loss of perception. It’s design for everyone!
You can begin to see that empowering environments for those with dementia or visual impairments doesn’t have to be formulaic.
This is an adult environment and as such it should reflect that. Sophisticated, comfortable, beautiful, and yes functional. It’s a home and as such it should represent the familiarity of what a home means to people.
To feel at home is all part of an inclusive interior care environment occupied by varying needs.
One key aspect is the use of artwork. Artwork can make an environment seem familiar, it can support individuals find their way around the home, and it can aid people with their memory loss.
An excerpt from enabling environments states: ‘as people age, many changes occur which affect vision and colour perception. The thickening and yellowing of the lens alters the way colour is perceived. As a result older people may experience:
- A reduction in contrast perception ability, resulting in difficulty differentiating between subtle changes in the environment such as carpets and steps
- A reduction in the perceived saturation or vividness of colours (chroma). For example reds start to look like pinks.
- A reduced ability to discriminate blue colours.’
LRV still applies when choosing artwork. Just because an individual may have an altered perception of a true colour, or doesn’t see it as vividly as we do, doesn’t mean they shouldn’t be able to take enjoyment from a piece of artwork.
This is an image of a piece of artwork we selected. You can see it isn’t muted, it’s graphic, it is bright and it is colourful, and residents with or without visual impairment can appreciate it equally.
You can see from this picture that the artwork is tonally correct, so even if the colours cannot be seen, it still has distinction and can be understood and appreciated for the picture it is by some one with a visual impairment or loss of perception.
The hardest thing is that no one resident is the same, or has the same experience with the home interior, so you have to cover a broad range of needs and wants.
My guiding principles have always been to create a comfortable adult space with the application of certain design principles.
Through the understanding and application of LRV in care home interior design, we can create very inclusive spaces for varying needs and requirements, especially for those who have problems processing the environment they are in.
With an inclusive approach to LRV we can design-in to an environment-enhanced quality of life and independence.
We don’t need gaudy grab rails, or overkill on bright colours, rather a much more sensitive approach to interior design and understanding of the powerful effects LRVs can create through tone.
It’s an opportunity for us to be more creative and create a space that enables everyone whilst still retaining that very essence of what it means to be an adult living in a care home with all those rich and varied experiences. Isn’t that what creating enabling spaces should be about?
If you want to see if an area has contrast put your phone camera on 10 mono and this will give you a very quick appreciation!
- Architects Journal https://www.architectsjournal.co.uk/news/opinion/keeping-an-eye-on-colour-contrast
- British Standards BS 8493
- University of Stirling
The Care Home Interiors Company has extensive experience in interior design for dementia are homes. If you would like to discuss care home interior design for a new build, extension or regeneration project, please contact us.