The Sleepover Project recently led Sleeper #2 - a 32-year-old landscape architect at CSD Architects - to Keswick Multicare in Baltimore, MD.

On June 2, Sleeper #2 took on the role of an 81-year-old woman, who was recovering from gall bladder surgery at Keswick's Baker Rehabilitation Unit. This particular unit is a designated unit for patients recovering from a variety of surgeries and illnesses.

During her stay at Keswick, Sleeper #2 was using a wheel chair and began to slowly transition to walking again.

The Slow Shuffle
Soon after her arrival at Keswick, Sleeper #2 observed and soon joined in on "The Wheelchair Shuffle." It was a slow dance of sorts that residents would do to pull themselves along in their wheelchairs. With limited foot reach, residents would have to lean forward, put their feet out and then shuffle them back to move themselves forward. It was easier to shuffle around than to use their limited upper body strength to turn the wheels. It was slow moving. But it was the only way to get around in the chair.

While shuffling around, and even at a stand still, the simplest daily motions posed the greatest challenges from the seat of the wheelchair. While reaching for items normally at shoulder or head height, Sleeper #2 found herself at a complete loss. Without a stick to knock things off shelves and desks, there was no way to be self-sufficient in grabbing items stored 4' off the ground or higher.

Shuffling up to the dinner table in a fluid motion (and without difficulty) was impossible. Maneuvering through doorways felt like playing a game of Operation; it was impossible to avoid banging the leg rests against the doorframe. The differences in floor surfaces also posed a challenge - carpeting created more friction than smoother floor surfaces.

Adjusting to a New Environment
She was in a new environment, and doing her best to adjust to her new conditions. She could only hope that with several days or weeks of practice, she wouldn't have as much difficulty maneuvering through the facility. But should a patient need that much time to acclimate or could the architecture be adjusted in ways that would help patients move faster and acclimate more easily?

While pondering this thought, she shuffled herself around, attempting turns here and there. She became increasingly aware of how far away things seemed. What she could normally walk to in seconds as an able-body, would take her several minutes to shuffle toward.

And, although the rooms she frequented were designed with extra space for wheelchairs, she had to make several attempts to turn and point the wheelchair in the direction she wanted to head. Turning was the movement she dreaded the most. Turning was frustrating; inevitably, she'd run into something while attempting a turn and she'd exert more energy than she'd imagined. She theorized that perhaps eliminating any extra angles - like the angle created from the wall connecting her bedroom to the bathroom - could save patients some exhaustion.

What the Sky Has to Offer
Being a landscape architect by trade, Sleeper #2 naturally focused much of her attention to outdoor spaces. As she lay in her bed, gazing out the window, she found herself looking at treetops with a bit of sky visible through the trees.

This observation made her realize the importance of being able to see the sky as a small connection to the outside world. The sky allowed her to sense the time of day and weather. And while the trees could be interesting to look at, the sky had much more to offer. She hadn't previously considered this perspective, and the sky's place in relation to landscape and interior design.

She thought, "How else can we tweak healthcare landscape planning/design to become more practical, beautiful, and soothing?"

Some ideas she noted revolved around opening up the view and extending the life of outdoor spaces. A couple of her thoughts included:

• Designing a multi-use landscape to maximize the view from the inside looking out, while also making the landscape appealing to people sitting outside.

  For example: Planting fewer trees or planting trees further away from the building so more of the sky can be seen from inside of the building. Also, adding hardscaping (e.g. heat lamps, outdoor fireplaces) would help extend the usable life of outdoor spaces within the span of a year, which would create a more appealing environment for guests and their visitors.

• Changing the window's orientation in the room and/or its dimensions to allow patients to see what they want to see - a good, wide-open view. The window in Sleeper #2's room was far away from the bed, and required her to turn diagonally to see outside. Not only did this limit the view, but it limited the furniture layout as well.

Institutionalized
Conveniently located on a wall by her bed was a florescent reading light. The light came in handy at nighttime, as Sleeper #2 was getting ready for bed. Another light, positioned in the hallway near floor level - and always on - helped nurses tend to patients throughout the night. It also helped guide patients to the bathroom. However, not so convenient were the light switches, which were placed in hard-to-reach spots from bed. In fact, the reading light was even difficult for nurses to reach.

When bedtime came, Sleeper #2 couldn't turn the reading light off by herself, so she'd have a nurse flip the switch. Disturbingly, the light in the hallway couldn't be shut off. Sleeper #2 decided to sleep with her back to the light instead. The inconvenience made her environment seem less homelike and more obviously institutional.

For her, it underscored the importance of making a patient's environment as comfortable and homey as possible. She theorized that something as simple as a motion-sensored light detector or a light control button on her nurse-calling controller would have created a cozier sleeping environment.

As she thought about creating homier environments, Sleeper #2 recalled the large medical equipment carts in the hallway that didn't have a home. The carts hung around the hallway until they were needed. Because of limited storage, there was nowhere else to put them. Sleeper #2 thought that giving the cart an easy-to-access storage area would only make the environment more appealing and homelike for patients and staff alike.

Sleeper #2 says:

"For me, this was a life changing experience. I didn't grow up with grandparents ... I didn't know or experience people of that age group with physical limitations. I'd never really known anyone who needed that level of care. This experience helped me put a face to the residents and staff, and to completely absorb the reality that we are designing for real people, real communities, and every decision we make will impact their lives on a very personal level."