Q&A with Dr. Eugenia Victoria Ellis, research team lead at Drexel University
What was the inspiration for your research?
My firm, BAU Architecture, has been working for the past five years with the Archdiocese of Philadelphia, a Catholic charity that among other initiatives operates several skilled nursing facilities in the area. A large portion of our work for them has been interior renovations for various areas of their skilled nursing facilities. A few years back, I was invited to St Francis to evaluate their fourth floor dementia unit. Having worked with them for a number of years, I knew there were certain suggestions they would implement and others that they would not.
For example, falls are the leading cause of accidental death for older adults, and 20 percent of seniors with hip fractures die within one year of the accident. The likelihood of falls is exacerbated for older adults because of disability glare (especially reflections from shiny floor surfaces) and the altered states of perception they experience due to changes in vision. A simple way to reduce accidents due to changes in vision and to cushion the fall is by installing carpet on the floor, which additionally gives a more “residential feel” to an institutional setting. Some organizations are conditioned to believe that carpet is unhealthy and is a maintenance issue, and these organizations will not consider carpet as a solution under any circumstances, even if the use of carpet in corridors and public areas is a leading trend for these types of facilities.
The other thing that struck me is that hospitals are a 24/7 operation, which means that the lights are always on in the corridors even if the lights are off in the patient rooms. In order for caregivers to tend to the needs of the residents in case of an emergency, the doors to the sleeping rooms must always be open, which means that the characteristically daylight-corrected fluorescent light fixtures in the corridors also illuminate the resident rooms while the residents are trying to sleep. It would be surprising to me if residents in a skilled nursing facility ever got a good night’s sleep, which is crucial to maintain good health. Additionally, while I don’t have the statistics on this, it seems that the health of older adults rapidly declines after living in a skilled nursing facility. Few live more than a couple of years there. I think a lot of this is due to disrupted sleep patterns.
My research questions were: What if seniors in skilled nursing facilities could actually get better and go home, or relocate somewhere that requires less care, such as assisted living? What if we could figure out a way older adults could actually age in place at home? Can we design interior environments to actually improve health outcomes, perhaps even prevent the older adult’s move to skilled nursing late in life in the first place?
Throughout the research, have you had any unexpected findings?
I had some unexpected questions from the client.
What if we install this light fixture and it doesn’t work? When we were walking the site, the fourth floor dementia unit, the client showed us that when the light intensity was raised at the nurses’ station, the residents got agitated. The LED light system we are developing is designed to get very bright for a short portion of the day. To my horror, I thought, what if this makes things worse? What if instead of reducing the “sundown effect” for residents with Alzheimer’s, this system increases or exacerbates it? As it turns out, the technology is changing so rapidly that the entire system will be computer controlled through a small computer or iPad. The LEDs will be infinitely controllable in color and intensity. The worst case scenario is that the residents will get a good night’s sleep because the lights will go to red at night, which encourages sleep in humans. The red light will be at the intensity required by building codes and the Department of Health for the public areas. But, as it turns out, the human body responds to red light similar to how photosensitive paper in the photographer’s dark room responds — it is not at all affected.
What will we do for lighting in an emergency at night when the lights are red? As it turns out, we will be installing a parallel emergency lighting system that would operate independently of the LED system. If there’s an emergency, then emergency lighting will be provided.
What has been the greatest challenge in your research?
The greatest challenge has been to actually produce the LED luminaire. We have an eager and cooperative client, the administrators at St. Francis Country House, who would like to improve health outcomes for the residents at their facility. Most university research of this type today is carried out in virtual simulations on the computer. Or, through laboratory experiments with mice, rats and even fruit flies. Rarely does a university have the opportunity to invent a new technology and to work with a client eager to test that technology in a real-life situation.
Is there anything you wish you knew now that you did not know when you started the project?
I wish I knew how difficult it would be to develop a new technology for use in the building industry — I have been working on this project for over two-and-a-half years. I knew the LED lighting system would need to meet building codes, would need to go through approvals with Underwriters Laboratories to meet code, would need to go through the permitting process with local authorities, and would need to fit within an existing system so that it could be easily installed. I thought it would be fairly simple to fabricate a 2’ x 2’ LED replacement luminaire that could be used to change out an existing fluorescent fixture. The manufacturer gave me an estimate of the cost to fabricate, gave me a time frame and also seemed to think it would be a fairly simple thing to fabricate. The technology is available, it is not rocket science — LED lighting is actually such a rapidly evolving technology that is hard to keep pace with new iterations of the technology. However, motivating a manufacturer is much more complicated than I anticipated — it is a living reality of the saying “easier said than done!” We are now working with our second manufacturer. Fortunately, St. Francis has a construction manager who is helping me push things forward and the manufacturer is realizing how lucrative this product could be for business.
How do you see the results implemented or used by healthcare facilities?
In June 2012 at their annual meeting in Chicago, the House of Delegates of the American Medical Association (AMA) declared light at night to be a public health issue. The Council on Science and Public Health recommended that the AMA support the need for developing and implementing light technologies that minimize circadian disruption while maintaining visual efficiency. People are presently experiencing a proliferation of light-related disorders and diseases specifically because today’s technologically based society can operate 24 hours per day in illuminated indoor environments. An electric lighting system that can illuminate building interiors by using less energy in this era of climate change together with the ability to mimic daylight to promote positive health outcomes could result in dramatic changes in the health care industry, especially for facilities that care for older adults.
One result of the implementation of this lighting system could be changes in policy for agencies such as Medicare, Medicaid and/or state regulatory agencies. If this lighting system can, indeed, positively affect health outcomes, then it could influence guidelines for health care reimbursements. Another result will be the way hospitals are run and managed. If the lighting system can reduce energy costs for 24/7 institutional operations, then it will dramatically affect building operations and facilities management — operational costs will be reduced due to energy savings and there will be less building maintenance due to the longer life of LED lighting systems. Another result may be to actually influence building codes to recommend the use of red light at night in 24/7 institutional settings where people reside to reduce the negative effects of light at night.
Drexel University Research Team consist of: Dr. Eugenia Victoria Ellis, AIA; Dr. Donald L. McEachron; Dr. Elizabeth W. Gonzalez; and Professor Michael Glaser with Ellen Taylor, AIA, at the Center for Health Design