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Cognitive considerations must figure into flooring design

June 9, 2015
by Kevin Turner
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I recently had the opportunity to participate as a judge in the  Behavioral Healthcare Design Showcase, which appears in the upcoming Summer 2015 issue.  First of all, let me say: What a great group of projects of all size and all types.  It was a treat to be part of it.  Second, I am always on the lookout for trends, and one really jumped out at us as we looked at the projects: flooring.

Flooring may not seem like a big deal, but in certain types of facilities it can be. In healthcare facilities that treat patients with psychiatric disorders, Alzheimer’s, or other cognitive impairments, flooring is an important environmental element. 

A person who is fully or temporarily experiencing cognitive impairment might have trouble clearly distinguishing unusual elements in their surroundings, such as dramatic changes in floor patterns. For example, a dark area in a light floor might look like a hole to someone who is dealing with neurological damage. If that dark area is a band across the whole floor, it looks like a cliff. This type of flooring pattern can cause extra stress in an already stressful environment. 

High contrast isn’t the only issue to look for. Patterns in flooring as well as patterns cast by light and shadow can have similar effects. 

Fritted glass along a hallway can be very disturbing when the light coming through creates a specular pattern on the floor. To some, it can create an optical illusion that signals danger. Those with visual or balance problems may even fall or feel dizzy when encountering complex or high contrast patterns. 

This is a difficult element for designers to plan for, but with thoughtful design of exterior openings, interior shading and lighting, it can be an important part of designing a therapeutic environment.

Another issue that comes up is the maintenance of floors. In an effort to make a healthcare facility look clean, maintenance staff will often build up a very shiny layer of wax on flooring.  While we know the floor is perfectly safe, the layer of shine can make the floor look slippery to psychiatric or elderly patients.

Improved environments

Realizing these potential issues can also lead to improved safety and facility operations.  For example, a high contrast band around a staff area may help to send the subtle signal that patients should stay back from the door.  Similarly, floor patterns could be used to help direct patients through the spaces and identify seating areas from circulation.  When this is combined with carefully considered wall and ceiling treatments, designers can help to choreograph a therapeutic experience in the space. 

Sally Augustin’s research suggests that while contrast is not desired, darker floors have a grounding effect. Also, while contrast within a floor can be problematic, contrast between floor and walls is highly advantageous to those with a cognitive impairment.  It helps them to clearly identify their boundaries.



Kevin Turner

Principal, Perkins+Will

Kevin Turner

Kevin is a recognized leader in the design and operations of behavioral healthcare facilities. ...

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