Once past the front door of the Orbe, the geriatrics pavilion of the Charles-Foix hospital in Ivry-sur-Seine (Val-de-Marne), it is almost like being in a village square. Circular bench facing large bay windows in front of which green plants grow. Flat marble washbasin, at armchair height, for washing hands or cooling off, like at a fountain. On the walls, paintings made by patients. Here, everything is the opposite of traditional hospital architecture.
This 82-bed care unit was designed and built at the dawn of the 1990s by André Bruyère (1912-1998), following a competition for ideas on the architecture of old age launched by Public Assistance-Paris Hospitals (AP-HP). Before even embarking on the design, the architect immersed himself for several days and a night to understand the lives of patients and caregivers. His notes relate the burden of loneliness, the nauseating odors, the “despicable fluorescent light stuck to the ceiling”. And his dismay at the number of kilometers traveled by staff in the corridors in a straight line. This led him to design a one-storey building with generous volumes, all in curves, where places of care and living are closely intertwined.
At the Orbe, everything is done to make you forget the burden of age. The space is fluid and not very partitioned. The corridors have been abolished and replaced by lively spaces, naturally lit, like so many successive squares. Patients, as soon as they leave their room, can meet people there, talk to someone, sit on an armchair, a sofa. Or freely walk around without feeling constrained by walls, their gaze can be carried far away without being obscured by obstacles. Here, not a place is dark: everything is illuminated by natural light and in the evening by pleasant lighting. Everything is done so that people escape the feeling of confinement.
Soothed, relaxed, often smiling faces
In the individual rooms, the bed is oriented at an angle to allow the view of the garden landscape through the windows and the lively space through the doors – most of them remain open. “Experts from the High Authority for Health, during certification visits, ask that the doors be closed, for reasons of confidentiality. But it is a wish of the patients to leave their door open, and it is in contradiction with the architectural spirit of André Bruyère. It is not by isolating the elderly that we help them to stay alivenotes Amina Lahlou, head of the long-term care department. Well-being, pleasure, being solicited by life are the primary objectives of this service. The articulation of intimate spaces and spaces of social life promotes the movement of patients. By its diversity, the architecture of the place breaks with isolation, solitude. It is thought to stimulate life. » What is striking, moreover, when one passes in front of these patients suffering from Alzheimer’s disease: their faces are soothed, relaxed, often smiling.
“As everything is open, the patients come to the activities on their own, just as they can go out into the garden whenever they wish” Catherine Dewaguet, animator
The four sectors of the service – conceived by André Bruyère as representing nature and life and thus named Fishes, Minerals, Trees and Planet – are arranged around a garden where residents can walk or rest. Benches, chairs, tables are at their disposal. Planters, at wheelchair height, also allow them to garden, with the help of the occupational therapist and the activity leaders. In an entertainment room, residents can also join a painting, writing, gentle gymnastics workshop… “Here everything is open. Patients come to the activities on their own, just as they can go out into the garden whenever they want”explains Catherine Dewaguet, facilitator who has worked in many long-stay hospital departments.
On Thursdays, residents can take part in scenic therapy sessions, during which literary texts on a theme chosen by them are read aloud. “It stimulates memory and language, explains speech therapist Florence Marquis, who leads these sessions. It happens to me, depending on what they evoke, to associate olfactotherapy, so that they find a certain number of memories through smells. »
In this establishment, all the senses are constantly solicited. During the day, a soft sound of classical music inhabits the common areas. Olfactory terminals diffuse fresh (mimosa, lavender, etc.) or relaxing scents that evoke early childhood. Patients have access to an interactive Snoezelen multi-sensory stimulation room, where projections of landscapes, lights and music help them recharge their batteries, and where they can get a massage.
Poetic, musical or dance “orders”
As witnessed A 90 year old girl, the beautiful documentary film made at the Orbe by Valeria Bruni Tedeschi and Yann Coridian, the team also multiplies artistic activities, linked to painting, music and dance. Actors and musicians from the Théâtre de la Ville came, two to three times a week during the year 2021, to deliver their “prescriptions” poetic, musical or danced. Or, as part of an innovative partnership with the Louvre, nursing assistants, nurses, facilitators and speech therapists trained at the museum, to then share their knowledge with patients and organize workshops. for the choice of works – reproductions made available to the department by the Louvre art library to decorate patient rooms and common areas. Life-size statues were also loaned by the museum for the garden. “Our patients often express themselves in a non-verbal way.” As Alzheimer’s disease impoverishes their language, they externalize their emotions differently. However, art stimulates the memory and the awakening of memories in an extraordinary way “, notes Amina Lahlou. As part of an intergenerational project, a soup competition was even organized based on recipes suggested by patients and made by high school students from a nearby vocational school. The elderly are thus solicited by life in all its dimensions.
The configuration and atmosphere of this place reflects on the work of the healthcare team. “It gives meaning to our work, testifies Florence Marquis. We don’t feel like we’re working in a deathbed. The elderly, we see them differently than through the usual meal, the changes… They are beings in their own right. We are not, as the psychiatrist Jean Maisondieu said, in “a parking lot for old people”: we are in a medicalized place of life, a living place. » An illustration: the singular bay window of the dining room and living space, which André Bruyère sculpted in the shape of a standing man to make patients want to sit up, “to show that they are still alive”.