Contrary to expectations, a modern inpatient stay can be a dangerous experience for a patient over the age of 65, with many seniors leaving the hospital more disabled than when they arrived. Inpatient stays revolve around bedrest, which has long been perceived as contributing to the healing process. However, sustained bedrest and inactivity can result in a daily decline of 5 percent of muscle mass and up to a 10 percent decline in bone density for seniors.

In some cases, older patients may require a stay at an extended care rehabilitation facility before returning home or experience a loss of physical mobility, which can contribute to permanent health decline, since regaining lost strength and mobility can be challenging for this population.

How can the design community create a healing environment that supports seniors and keeps them healthy during hospitalization? The answer is by incorporating spaces that give the patient a reason to get out of bed. Getting patients up, moving, and socializing in a safe way requires a re-examination of patient care—challenging staff to get the patient out of bed and moving, designing a built environment that features elements that support independence and physical activity, etc.

One model that’s been developed specifically to care for elderly patients in an inpatient acute care setting is the Acute Care for the Elderly (ACE) unit. The model, in contrast to traditional standards of care, supports a team of caregivers, family members, and patients and is designed to allow for and encourage patient movement within the patient room, corridors, and other support spaces. For example, areas to sit are included in the layout and can be used by the patient for rest or as a place for staff, families, and the patient to interact.

Using the ACE unit model as inspiration, we suggest improving patient rooms by incorporating design features that create destinations that afford the patient a small amount of activity with ample places to rest. For example, relocating the bathroom entrance adjacent to the headwall of the patient room and including a handrail can help patients move safely between their bed and the bathroom.

Keeping travel paths clear, providing sturdy furniture with arms and no casters, and minimizing tripping hazards through strategic placement of furniture and equipment can also help encourage patient movement.

The corridors can also double as therapeutic spaces with handrails for ambulation, markers to measure walking distances, and seating (near patient rooms and at the end of hallways) to provide places to rest. Incorporating wider hallways (8 feet or greater) and cross-corridor layouts promote communication, aid patient monitoring by staff and family, and encourage patients to move beyond their room. Alcoves carved out from the wider hallways can be used as areas for seating, so the corridor becomes easier to negotiate for a patient.

The more an elderly patient is encouraged to remain active during their stay, the more likely they are to return to their normal life with little lasting detriment. A design that supports this active approach creates a new model where an elderly patient is admitted and discharged at the same level of function.

Deborah Knast is an interior designer at Stantec (Philadelphia). She can be reached at



Kristopher Steele, AIA, is a project architect at Stantec (New York). He can be reached at