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Breaking Out Of The Box
By Nicholas Borrett

Our Saturday tour to Orange County as part of the 2000 Symposium on Healthcare Design proved to be a memorable experience for more than one reason.

Clear blue skies and a fresh faced Breck Austin greeted us at Park Terrace Alzheimer Care Center in Rancho Santa Margarita, designed with great attention to detail to support elderly people who are having difficulty with memory loss or dementia.

The Spanish style architecture is relaxed and friendly. Our group avoided the main entrance in favor of the four 12 bed houses accessed via electronic release doors that led into a comfortable foyer, discreetly monitored by close circuit television. From here, further security doors led into multi-purpose reception room, used for a variety of functions and beautifully balanced with natural and indirect lighting around the sculptured ceiling.

The fireplace created a central focal point and the room enjoyed access and views into the sensitively landscaped central courtyard.

This courtyard, although far from established, allowed a safe area for residents to enjoy. This space was beautifully proportioned with the pastel colored roofs and walls gently enclosing the space. This really did feel like somewhere that could be explored and enjoyed without feeling trapped - a very positive experience compared to what we were to encounter a little later!

Having enjoyed the contrasting foliage of the courtyard, we entered one of the 12 bed units of accommodation and again this was refreshingly open - each house reflects the courtyard with a beautifully lit sitting and dining space, gently enclosed with bedrooms and lounges.

After touring this area, we moved, reluctantly, back into the main assisted living facility to tour the two story supported living accommodation.

The courtyards created by this accommodation were not quite as successful, but there was plenty of interest for residents to enjoy, each apartment having its own patio area with direct access from the sitting room and the small balcony at first floor level.

Our group was invited to tour the first floor via one of the two elevators. Little did we know that we were about to experience what it might feel like to be "locked" in a more oppressive environment where residents may feel they are trapped and unable to break out of their particular "boxes."

We were so busy exchanging ideas and questions that it must have been 30 seconds before we realized that we were certainly going somewhere, but not getting there too quickly!

Our escort realized we were not making progress and pressed the second floor button again and we glided to a stop, most of us still sufficiently engaged in conversations not to notice what was, or wasn't, happening!

A minute passed before looks were exchanged, buttons pressed and the slow realization that we were stuck in our particular box.

Still discussions continued, and the usual elevator jokes exchanged. Our escort decided to use her cell phone.

Conversations continued miraculously with a general feeling that this would soon be fixed. The emergency telephone in the elevator was used, to no avail, buttons pressed at random, and shouts beginning to be heard from somewhere out there questioning as to whether we were alright!

Minutes now passed and the eight of us trapped in our little box began to exchange slightly more earnest expressions, what with our array of cell phones and communication systems, we felt certain that we would be on our way soon.

Our superbly calm escort continued to engage us in conversation about the facility while an assortment of people somewhere outside suggested pressing various buttons in various sequences, all to no avail.

The maintenance man then decided to play with the programming, which involved throwing us into semi-darkness and then a period of five to ten minutes of staccato movement up and down the lift shaft, but unfortunately, not stopping anywhere to let us out.

Fifteen minutes had now passed, and several attempts to land us at a point where the doors might open failed miserably and tension grew, particularly in me if not in anyone else. The sudden panic of lack of air, claustrophobia, and that dreadful thought about "what happens if I really need the bathroom" ebbed and flowed in more than one of us.

Radios crackled, bits and pieces of conversations were heard from well meaning, but ill-equipped colleagues on the outside world. We continued with our upbeat lighthearted conversation peppered with an increasing awareness that we really did want to get out of this box, and quickly.

After 20 minutes, the fire department crew appeared and seemed to be doing something that involved scraping and banging, but with little progress.

A Swiss Army knife suddenly appeared and we decided to take the law into our own hands and began trying to pry the doors open. Convivial conversation had turned into a more determined attempt to break out of our increasingly claustrophobic and frightening environment, but our first attempt failed miserably.

We persevered and with fingers desperately trying to pry our way through the stainless steel. The enterprising nature of the party gained momentum as one or two more fingers decided to participate in the escape plan and our fear turned into a physical battle.

The team support grew, and after a rally call for more finger power, there was utter relief when the doors finally parted, pulse rates calmed, and blood began to pump round our systems. The fire department crew instructed us about releasing the catch on the outer doors and suddenly they came open and we were able to crawl out.

Although we had stayed remarkably calm and collected on the outside, this very short containment experience had taken its toll, and on reflection, we were reminded about how others might feel who are equally contained, trapped and feeling they need to go somewhere, but don't know how to get there.

Our earlier, fresh-faced upbeat Breck, had a slightly more nervous look about him, offering profuse apologies. We had somehow lost interest in the facility and made our way to the big outside world to get fresh air.

What a relief to be out! We reflected on our experience and likened it to that "breaking out of the box" concept that we now recognize is so necessary for us to understand, not only as designers, but out of respect for those people who we are designing for, who also want to be helped to break out of their boxes too.

Nicolas Borrett, a veteran of many Symposia, is the developments director for Trinity Care in Nottingham, England.