Quiet, light, cosy - doesn’t sound very modern does it? Doesn’t sound like design-award material. But those three words sum up for me what a great Extra Care Housing development would be like, for those of us with hearing loss (and remember that all Extra Care Housing developments house people with hearing loss; over 70% of over 70s are affected).
Until my hearing began to seriously deteriorate, after my retirement in 2010, I didn’t give much thought to hearing loss and design. Comfort, convenience, attractiveness, space…….all of those things, but not how the design of a building can seriously affect how well someone hears. As my hearing worsened I was shocked by the difference a room could make.
Take my house, for example. In the living room I could cope. In the kitchen I would often be hopelessly, helplessly lost. Floundering around, desperately trying to grasp what the subject was and eventually, often, giving up. The difference was caused by the acoustic properties of the two environments. In our living room there are soft furnishings - cushions, carpets and curtains. In the kitchen it’s all hard surfaces - floor, worktops, table, chairs, and cupboards. It was so much harder to hear in the kitchen because sound literally bounced around, reverberated and echoed, blurring the speech I was hearing until it was unintelligible. (I know this sounds hard to believe. I’d not thought about it until it happened to me. But ask anyone with more than mild hearing loss. It’s real).
After several years of struggling (now rolled back by my miraculous cochlear implant) I have a few design pointers for Extra Care Housing. If design makes a big difference to being able to understand speech in a domestic environment (my house) imagine the difference it can make in a big Extra Care development.
Let’s look at acoustics first and start with a big thumbs down for the atrium. You have no idea how disastrous an atrium is for people with any significant degree of hearing loss. All that space, for voices to disappear into. All those hard surfaces (glass, walls) to bounce the sound around. I used to love an atrium as much as the next woman (light, airy, contemporary) but they are death to the deaf. If you must have one (I see the design awards are still favouring them) make it a space that your residents don’t need to communicate within. An entrance hallway? Possibly OK, so long as you can pass through quickly. A space with armchairs scattered around, as if to encourage residents to sit and chat. No. Please, no.
But, you are saying, not everyone has very poor hearing. Those who can hear can sit and talk in the atrium and those that can’t can go somewhere else. The problem with this argument is that you can make people with a disability feel like a segregated minority. How would you like it if a lovely space was provided for people to enjoy themselves in, but you couldn’t go there? You wouldn’t put a great sitting area up a flight of steps and not worry that the residents using wheelchairs couldn’t use it, would you? Hearing loss is a disability too and many, many Extra Care Housing residents are affected.
Secondly, think very carefully about how you furnish the dining room. What people with hearing loss need are carpeted floors, dining chairs with some soft material incorporated, tablecloths and curtains, NOT bare modern floors, wipe-clean tables and chairs, and bare windows. It may increase your cleaning bill but residents with hearing loss will thank you for it. We don’t want to sit at meals deafened (excuse the pun) by sound, we want to talk to our friends, like anyone else would. If you really can’t contemplate going the whole hog with these recommendations at least have some spaces for eating in where background noise is under control; some quiet corners that people with hearing loss can choose. (Booths can be quite a good concept to think about…..think 1950’s diner but with softer surfaces).
Please, whatever you do, don’t put an eating area in the middle of a public route through the building, with not a soft surface in sight. It might work in a shopping mall but it’s not a comfortable environment for people in Extra Care. Have your dining areas in a separate, reasonably small, room.
Finally, think about ANY part of the development with a lot of hard surfaces. Entrance halls? Circulation areas? People with hearing loss will thank you for carpet, not hard flooring.
We need light to hear because we need light to see your lips. Even people with quite mild hearing loss (who are not consciously reading lips) often know this. It’s what lies behind comments like “it’s funny, but I hear so much better with the light on”. As hearing loss gets more severe the clues that we get from lip shapes and facial expressions make all the difference to how much speech we can decipher (and I use the word “decipher” deliberately, because there comes a point when we don’t “hear” we hear some bits, lip read other bits and guess the rest).
So we need light illuminating faces please, but beware, a strong light coming from behind someone, putting their face in shade, will make matters worse. =What’s best is a good, light environment backed up by additional lighting in the centre of the room or from table lamps positioned so that they light people’s faces.
Cosy is important because spaces that are too big tend to reverberate (see Quiet) and because big spaces attract a lot of people who (heaven forfend) talk a lot and make a lot of noise. Sad to say, even the sound of other people chatting can be enough to stymie our own attempts to hear. As hearing loss gets more significant we more and more prefer (no, can only cope with) talking with just one or two other people at a time.
Therefore, and I’m sure this goes against the grain with many of you, but residents with hearing loss will not thank you for making shared areas open plan. What we like are cosy rooms and small spaces. You can still make them accessible for wheelchairs and mobility buggies, but keeping them on the small side will limit the background noise, which makes a huge difference to how well we can communicate.
Big lounges, for example, are not the greatest for hearing in, even with carpet, curtains, armchairs and cushions. Do you really need an enormous lounge? Realistically, are all your residents ever in such a place at once? Do they need to be? Could you provide a series of smaller spaces instead (still with carpets, curtains, armchairs and cushions)? The aim should be to make it easy and natural to be with a small number of other people in an environment made for chatting. I stress the “easy and natural” because I’ve spent years dragging people who wanted to talk to me out of busy, noisy areas and into some quieter space where I can hear them (think…..out of the coffee break area at a conference and into a quiet corridor). I got quite assertive about this but it’s stress-inducing and highlights your deafness; how much easier it is if you can just naturally “be” in a space where hearing is easier.
I’m sure you are all aware of this one already. People with hearing loss sometimes make a lot of noise. We’re not doing it deliberately. All housing managers know about the distress caused when someone’s neighbour regularly has the TV on too loud but I didn’t take seriously my husband’s attempts to get me to sneeze more quietly until (post cochlear implant) I could hear the din for myself. So yes, be careful about sound insulation between apartments and be careful, too, about other sources of noise. Site the sitting areas in a garden away from a busy road, if you can. Avoid open kitchen areas. If the development includes a busy café aimed at the general population don’t assume that your residents with hearing loss will be able to use it and make sure that any areas your residents WILL be using are out of earshot.
“Won’t it all look a bit old-fashioned?” I hear you say (especially the atrium lovers amongst you). It needn’t. I’ve been to Extra Care Housing developments that ticked all my boxes and still looked bright, modern and welcoming. What’s old fashioned about colour, light, warmth, small cosy places to chat in and peaceful rooms to eat in? Sounds good to me.
With careful thought and planning they are concepts that also fit well with good practice design for people with physical disabilities, sight problems and dementia. Designing for one group doesn’t mean incorporating features that exclude another group. Or rather, it SHOULDN’T mean that. Too often, Extra Care Housing developments should have a notice on the front door saying “warning – people with hearing loss are not welcome here”.
Can you help?
I’m trying to talk to a variety of organisations about promoting the features I’ve talked about here (and indeed others that are important but which I’ll leave for another day, for example, loop systems and other assistive devices). I want to specifically promote good design for residents with hearing loss in Extra Care Housing. Can you help? Do you have any good practice suggestions that you can share with me and the Housing LIN? Contact me via the Housing LIN on firstname.lastname@example.org.
And if you found this of interest, read my first guest Housing LIN blog, Hearing aids and extra care housing; what we can do to make things better.
I worked for Hanover Housing for fifteen years, finishing up as Director of Retirement Housing. My hearing started to deteriorate in my twenties but before my retirement in 2010 it was an inconvenience rather than a massive problem. After 2010 things got a lot worse until I was severely/profoundly deaf in both ears. I was rescued by a cochlear implant in 2017.