Configuration and Design in Caring Environments: syntax and quality of life in a sample of residential care homes for older people

Space syntax techniques for the analysis of spatial layouts were the first to demonstrate, in a numerical way, clear and systematic relations between spatial design and observed functioning across a range of building and urban types. In this project, the techniques have been applied for the first time to the problem of layout design in care homes for older people as part of a wider study of care home performance, Design in Caring Environments (DICE), carried out by Sheffield University. We were able to do this because the DICE data included both building plans and quantitative measures of the quality of life of residents and staff. The aim of the work that is reported here was to add the syntactic dimension and to test to see if this related to the DICE quality of life variables. Complex, multi-level regression methods (Gorard, 2003) had been used by the DICE team to plot relationships between the main physical features of each building and quality of life data for residents and staff. An identical approach was used to explore the relationship between a range of syntactic variables and the residents' quality of life scores for each building. In the final event, only two syntactic variables showed significant associations with quality of life outcomes, but these turned out to be the two most important configurational measures - axial global and local integration of the building. These measures are known to work well in predicting space occupancy; use and interaction in buildings that embed a weak organisational programme, where unplanned movement and activity are likely to make a positive contribution to community formation, but prior to this study we were unsure of the extent to which building layout would be able to overcome the effects of a strong organisational programme of the kind that exists in the care home sector and which is usually backed up by rules restricting access to different parts of the building. The results from multi-level modelling revealed clear and positive correlations between spatial design variables and three critical performance variables: the proportion of the residents' active time, frequency of the residents' enjoyable activity and the extent of the residents' choice and control over environment. The research thus shows unambiguously that, as many designers and care home managers suspect, design is indeed a critical variable in care home management and performance.