Dr. Debra Harris, PH.D., CEO RAD Consultants
It’s a must to create restful home-like spaces for residents of senior living facilities. So, absorbing disturbing sounds is very important. What can be done to turn down the volume in senior living environments? Dr. Debra Harris, a leading expert in evidence-based design, has toured the country with Interface, offering CEU sessions that review the research on noise and acoustics, and identify evidence-based strategies for mitigating noise in environments that straddle the line between a healthcare and residential setting, including using carpet tile as a solution.
Senior living facilities can be noisy for two reasons: loud sounds and hard surfaces. Equipment and machinery noise from roller carts, walkers and wheelchairs mix with footsteps, bustling corridor traffic and the voices of staff, visitors, and roommates, spread down corridors and into resident rooms. The noise echoes, overlaps, and reverberates, adding to the stress of workers and residents alike. More than just an annoyance, this stress causes serious repercussions, from resident care errors to lowered resident satisfaction to a reduction in performance standards in the senior living facility. Dr. Debra Harris, CEO, RAD Research + Design (http://rad-consultants.com/), investigates the problem and comes up with some surprising findings.
“The biggest surprise is that while everyone agrees flooring materials play a part in noise control, no one ever studied flooring as an independent variable in patient or healthcare worker stress which is quite parallel to resident care in senior living,” she says. “It’s a missed opportunity.”
To prove her point, Dr. Harris points to several different studies and articles about noise, stress, and satisfaction. In one study cited in the Wall Street Journal, she notes, hospital administrators ranked noise reduction as a top priority for the second time since 2011. Patients also agree that hospitals are too noisy, with only 60% of those surveyed in June 2012 saying that the area outside their room was quiet at night. This is the lowest satisfaction score among 27 questions about the hospital experience.
More than just an annoyance, noise pollution causes serious consequences like high blood pressure, increased heart rate, and increased medical errors. Noise has also been linked to staff attrition, sleep disruption, and stress, all of which impact staff performance, patient outcomes and satisfaction. While everyone wants satisfied customers, hospitals need them as Medicare reimbursement is tied to patient satisfaction.
That’s right. Medicare bases a portion of hospital reimbursement on quality measurements, and one of the quality questions they ask is: How often was the area around a patient’s room quiet at night? But nighttime isn’t the only consideration when it comes to noise control. A 2006 study measuring sources of satisfaction among hospital patients found that environmental satisfaction like interior design, architecture, housekeeping, privacy, and ambient environment proved a significant predictor of overall satisfaction. In fact, it came in second behind perceived quality of nursing and clinical care. Noise, however, constantly receives the worst marks in patient surveys.
Carpeting resident rooms not only provides a great design aesthetic, but also plays a major part in minimizing noise.
Just how loud are senior living and healthcare facilities? That depends on where you look. Dr. Harris found in the FGI Guidelines 2010 that the typical dBA (A-weighted decibels, or the relative loudness of sounds in air as perceived by the human ear) in different rooms almost always exceeded the recommended dBA. Some spaces like the NICU, corridors, and public spaces were exceedingly loud, with typical dBA reaching between 65-80 for NICU and 70-90 for corridors and public spaces. (Recommended dBA for NICU is 30-40 while corridors and public spaces should be between 40-50 dBA.)
Patient rooms fared better, but not by much. The recommended dBA here is 35-45 but the typical room clocked in somewhere between 55-65. These loud sounds can be detrimental to patient’s rest as proven by a sleep study at Harvard Medical School Affiliated Sleep Lab. No wonder patients consistently complain about noise.
Senior living and healthcare workers also suffer from environments that are too loud. Most studies show that healthcare facility noise exceeds OSHA and WHO recommendations, though Dr. Harris notes that current studies of healthcare workers and hospital noise are limited. They generally focus on interference with communication, distraction, effect on cognitive performance, and concentration and contribution to stress and fatigue.
“There is a study that used ceiling tiles as a variable,” she says, “and it found that improving room acoustics can influence positive gains in psychosocial work environments. But further research could explore the possible effects of acoustics on staff turnover, quality of care, and medical errors.”
Ecumen Bethany Community, Alexandria, MN
Nathan Bolster Photography
Several studies also recommend using carpet or carpet tile in high traffic areas to reduce noise. To explore this idea further, RAD is investigating comfort and noise levels using flooring materials as the independent variable. “We compared terrazzo, rubber flooring, and carpet tile,” says Dr. Harris. “The analysis portion of the study is being finished up right now.”
Dr. Harris admits that carpet and carpet tile have perception problem, despite the prevailing research. “People think that it’s dirtier than smooth flooring options or they don’t trust their cleaning staff with it,” she says. “Yet every study since 1982 does not indicate that carpet can transfer illness. Sheet vinyl, however can carry pathogens from shoes or mops.”
“Some senior living and healthcare facilities and architects who work in these areas will not allow carpet anywhere, some will only put it in the corridors,” she continues. “But a few are busting out, reading the research, listening to experts and putting carpet in resident and patient rooms. It will be interesting to watch.”