When we first began working in this field in the late 80’s, the term “healing environment” was hardly mainstream. It was not being used by most hospitals, nor was it a benchmark, a marketing hook, or a standard. It was simply too new a concept and the design and construction industries were just beginning to work from a new reality that a ‘healing’ environment played a proactive role in improving patient outcomes. Now, 2005, evidence-based design based on research and documentation supports not only the theory that the environment is itself a caregiver, but that it can be a contributing risk factor hidden among other factors that threaten safety and treatment efficacy.

Among the many questions that we are asked has to do with how a hospital committee can be certain that a design professional or architect is qualified to design and implement a healing environment and what outcomes can be expected.

I could say check references and background. However, this may not actually reveal what one would hope. Not every hospital sets facility design and construction on the basis of therapeutic outcomes. Sometimes the bottom-line is limited to functionality, appearance, and budget. In fact, I might suggest that this is most of the time…except for the most cutting-edge organizations.

When I look at the many new hospitals and clinics under construction and what we now know about the impact of color, noise, lighting, way finding, spatial organization, traffic flow…and the demand for less medication, improved rest, privacy, efficiency, and accuracy…it is difficult to understand how a facility could consider one side of this equation without accountability to the other: functionality + clinical effectiveness, or the reverse.

I am interested in your experiences in conceptualizing environmental changes for your hospital or clinic. Is the goal a healing environment? If not, what are the objectives that determine the outcome?

While this topic is so broad, I have felt in recent weeks that the concerns most of us have about our aging parents are filtered through the guilt of being so far away. We are the first generation to move beyond driving distance, set up lives so far away that weekly dinners are impossible. None of my actions in moving away had anything to do with projecting how life would look when my parents would become frail. Nor, how it would look if my siblings or I would become ill or in need of help. Such a dilemma. A life-style outcome that had been so grossly overlooked.

That said, i personally have no regrets about leaving my hometown or leaving my birth family. Nor do they. Nonetheless, learning how to manage the tending of parents and oversee their care from a long way has never been more difficult.

While home health is a booming industry, the costs are often prohibitive, or at the least frightening to look at for long term.

The steps we took, in case this is of value to any of you, is that the two families (we are “blended” since my Dad remarried over 20 years ago following my Mom’s death) have developed strong and clear communication. One of us found a wonderful home-health care manager (www.askhealthcare.com) who has guided us to an eldercare attorney who could review the financial situations and project into the future. Also, we have developed relationships with their caregivers, physicians, and others relevant to their care.

My husband would tell you that the best thing he did was get to know every staff member of the assisted-living facility in which his parents lived until their death. It allowed him to call any time and they would know him and provide both information to him and check on his folks.

Elder care in this country is not great. It is, as Uvi Reinhardt of Princeton said, an embarrassment. However, as in all other aspects, understanding the system is a must and bringing it down to people taking care of people makes it more manageable.

I am interested in how others are managing and any othe resources that might be available.