Lighting Res. Technol.

2013; 45: 345–361

Extra-care housing for people with sight loss:

Lighting and design
A Lewis BArch DiplArch MArch PhDa and J Torrington BA BArchb
a
Manchester Architecture Research Centre, University of Manchester, Manchester, UK
b
School of Architecture, University of Sheffield, Sheffield, UK

Received 23 December 2011; Revised 4 May 2012; Accepted 9 May 2012

The study investigated whether United Kingdom-based extra-care housing, which

provides older people with individual dwellings, communal facilities and care
support, complies with current guidance on design for people with visual
impairment and satisfies the needs of residents with sight loss. A total of 41
apartments/bungalows in 11 schemes were surveyed and interviews conducted
with the occupants. Participants’ comments suggest the current specialist
guidance on design for people with sight loss is sound, although there is scope
for additional guidance on aspect and daylight, which were highly valued. Little of
this specialist guidance is included in mainstream design guidance, which might
explain some deficiencies in extra-care housing, including low lounge and
bedroom illuminances, few dimmer switches, and limited use of colour to
enhance the legibility of spaces.

1. Background retain their independence, popular with pol-

One consequence of the United Kingdom’s
ageing population is that more people are
living for longer with chronic health condi-
tions and physical disabilities, including sight
loss. The aged eye is particularly susceptible
to conditions such as macular degeneration,
cataract and glaucoma. It has been estimated
that approximately one in eight people over
75, and one in three people over 90, have a
visual impairment sufficiently serious that
they should be registered as blind or partially
sighted.1
Impaired health and physical disabilities
have a number of consequences, including the
loss of independence. One solution to the
problem of how to enable older people to
Address for correspondence: Alan Lewis, Manchester
Architecture Research Centre, School of Environment and
Development, University of Manchester, 1.11 Humanities
Bridgeford Street Building, Oxford Road, Manchester, M13
9PL, UK
E-mail: alan.lewis@manchester.ac.uk
icymakers in recent years, is the creation of
specialist housing designed specifically for the
typical needs of older people. In particular,
extra-care housing schemes, where each resi-
dent has their own apartment or bungalow
but also has access to onsite communal
facilities such as restaurants and to care if
necessary, have received extensive funding.
Under the previous government, £227 million
was invested in extra-care housing through
the Department of Health’s Extra-Care
Housing Fund Initiative alone.2 This figure
does not include the money invested in extra-
care housing through other government
agencies such as the Homes and Community
Agency, or through local authorities, housing
associations and private developers.
Given the prevalence of sight loss amongst
older people, we would expect extra-care
housing schemes to be well designed for
people with sight loss, but currently there is
little evidence to show that this is the case.
Recent studies of lighting in older people’s

ß The Chartered Institution of Building Services Engineers 2012 10.1177/1477153512450451

346 A Lewis and J Torrington
housing have mostly focused on general needs
housing3 and nursing homes4 with extra-care
housing receiving limited attention.5
Recent studies have also raised questions
about the guidance available to designers of
extra-care housing schemes. Evans et al.
questioned the usefulness of generic recom-
mendations of optimal illuminance levels for
people with sight loss.6 Goodman and
Watson have identified potential conflicts
between guidance for people with sight loss
and for dementia sufferers.7 Littlefair has
observed that current guidance contains little
on daylighting for people with sight loss and
has suggested that further research is required
in this area.8
2. Aims and methodology
This study aimed to investigate whether
existing extra-care housing schemes:
(a) comply with current guidance on design
for people with visual impairment and
(b) satisfy the needs of those extra-care
scheme residents with sight loss
2.1. Scheme survey
To investigate the extent to which extra-
care schemes meet current guidance on design
for people with sight loss, 41 apartments/
bungalows in 11 extra-care schemes were
surveyed using an adapted version of the
EVOLVE survey tool described below.
Schemes were purposively sampled to
ensure a wide variety of building types were
included in the study (Table 1). The aim was
to recruit 10 schemes and survey four living
units in each scheme. A total of 15 housing
providers were approached regarding their
possible participation in the study, but one
declined to participate, one withdrew due to a
lack of interest from residents and two were
non-committal in their response. Two
schemes included in the sample (7 and 10)
catered specifically for people with sight loss,
Lighting Res. Technol. 2013; 45: 345–361
and scheme 7 was designed for this user
group. The other schemes were designed for
older people in general and not specifically for
those with visual impairments.
The EVOLVE tool was developed by the
University of Sheffield in collaboration with
Personal Social Services Research Unit of the
University of Kent.9 The tool consists of a
series of checklists that enable the evaluation
of a housing scheme to assess its suitability as
accommodation for older people. For this
study, a specialised version of the tool was
created, centred on design for people with
sight loss, based on a review of relevant
guidance (Table 2).
In adapting the tool, the key sources were
those specialist design guides focused on the
needs of people with sight loss, particularly
Housing for People with Sight Loss10 that
brought together much of the research on this
topic and guidance issued by the Royal
National Institute of Blind People.11 Where
there were contradictions between more gen-
eral design guides, preference was given to the
recommendations made in these specialist
guides.
The design guidance review also included
generic lighting guidance12,13 and relevant
British Standards.14,15 Also included were
those design codes issued by Government
agencies, such as the Homes and
Communities Agency16–18 and Department
of Health,19 with which architects and hous-
ing providers have to comply if a scheme is
part-funded by public money.
As part of the scheme survey, an illumin-
ance meter was used to measure electric light
illuminance. In order to minimise disruption
to the participants, a simple procedure was
adopted in which one measurement was made
per room, with the illuminance meter placed
at floor level in the centre of the room.
Measurements were taken with all fitted
general lighting at full output, and all task
lighting and portable lighting switched off, to
allow observations to be compared with
 Lighting of extra-care housing 347
Table 1 Scheme characteristics

Scheme Small/large New/ No. of Storeys Age in yearsa Building type

no. remodelled units

1 Small Remodelled 32 2 32 (5b) Small apartment block

2 Village New-build 217 5 2 Large apartment block; bungalows
3 Small New-build 45 4 3 Small apartment block
4 Small New-build 50 3 7 Small apartment block in village
5 Small Remodelled 60 3 24 (4b) Small apartment block
6 Village New-build 152 2 11 Bungalows; central facilities block
7 Small New-build 76 5 2 Large apartment block; cluster block
8 Small New-build 46 4 4 Small apartment block
9 Small New-build 50 2 5 Small apartment block
10 Small New-build 64 3 4 Small apartment block
11 Village New-build 242 4 3 Large apartment block; cluster blocks;
two-storey houses

a
Approximate age at time of visit.
b
Approximate number of years since scheme remodelled.

recommendations issued by Thomas grouping items into categories, or ‘domains,’

Pocklington Trust.10 As most measurements
were made during daytime, one reading was
taken with the light on and another reading
taken with the light off, and the latter figure
subtracted from the former. Measurements
were made with curtains closed if the illumin-
ance meter was found to be in direct sunlight,
or if it became apparent that the illuminance
from natural light was varying rapidly owing
to drifting clouds obscuring the sun.
Uniformity of illuminance was assessed by
eye.
Average daylight factors were calculated
for the lounge, kitchen and main bedroom of
each apartment and bungalow included in the
study. The formula used was that developed
by the Building Research Establishment for
calculating average daylight factor on a hori-
zontal working plane at desktop height,14
with the sky component obtained using a dot
diagram placed over a fish-eye photograph,
following a process described by Tregenza
and Wilson.20 In addition, an extensive
photographic record was made of each dwell-
ing for reference purposes.
EVOLVE tool data were analysed using
descriptive statistics, primarily through
relating to aspects of building design that are
important in design for people with sight loss,
such as ‘daylight’ and ‘colour and contrast’
(see Table 2). Each domain score was
calculated as the sum of the items in the
domain scoring ‘yes,’ divided by the total
number of applicable items in the domain,
and multiplied by 100 to indicate the percent-
age of building features that comply with
current design guidance.
2.2. Qualitative interviews
To investigate whether extra-care schemes
satisfy the needs of older people with sight
loss, qualitative interviews were conducted
with the occupants of the homes surveyed
using the EVOLVE tool. A total of 44 people
were interviewed; three interviews were con-
ducted with married couples who occupied
the same apartment. Individual participants
were recruited through scheme managers.
The sample was purposive with the aim of
recruiting two people with serious visual
impairments and two people with moderate
sight loss in each scheme.
All but three participants had serious
pathologies of the eye (e.g. macular
Lighting Res. Technol. 2013; 45: 345–361
348 A Lewis and J Torrington
Table 2 EVOLVE tool – items that constitute each domain

Domain Rooms – items apply Sources

Entrance Hall Lounge Kitchen Bedroom Bedroom Bathroom General

1 2

Electric Lighting General

The living unit entrance electric light 
illuminance is more than 300 lux
Fitted lights closest to the windows 
can be switched on and off independ-
ently of lights furthest from windows
The artificial light is well distributed      10, 11
throughout the room with no areas
of deep shadow
The electric lighting can be dimmed    10, 11A, 13
The electric light illuminance is more    10B, 13C
than 150 lux
The electric light illuminance is more    10D
than 200 lux

Daylight
The room has natural light       10E, 17F
The lounge has a daylight factor  14, 18
more than 1.5%
The kitchen has a daylight factor  14, 18
more than 2%
The bedroom has a daylight factor  14
more than 1%

Sunlight
The living unit is double aspect  14G
The room receives sunlight in the      
morning or in the afternoon
The room receives sunlight in the       17H
morning and afternoon
S, E, W facing windows are free from     17I
obstruction to direct sunlight

Aspect
The window(s) overlook outdoor     14
spaces where there is human activity
The view from the window(s) consists     14, 17J
of near and distant features of interest
The view from the window consists     14, 17J
of natural features
The view from the window is free     17I
from obstructions, e.g. a blank wall
The sill height is less than 600 mm     14 K, 17 L, 24 M
above floor level

Colour and contrast

The colour of the door contrasts with       10, 11, 13
the colour of the surrounding walls
The colour of the door handle con-       10, 11, 15
trasts with the colour of the door
Hot and cold taps are identifiable by  10
bold visual clues
Oven controls contrast against their  10
background
The colour of the fitted shower seat  10
contrasts against the wall on which it
is fitted
Grab rails contrast in colour and tone  10
with adjacent surfaces
The shower controls contrast in colour  10
and tone with adjacent surfaces
The shower head and any associated  10, 11
rail contrasts in colour and tone with
adjacent surfaces
Shower curtains, where provided,  10
contrast in colour and tone with
adjacent surfaces

Lighting Res. Technol. 2013; 45: 345–361

 Lighting of extra-care housing 349

Shower screens, where provided,  10

contrast in colour and tone with
adjacent surfaces
Any leading edge of a shower screen  10
door contrasts against the door/
screen itself
WC seats and covers contrast against  10
the WC bowl, the cistern/background
and the floor
Pull cords for electric lighting con-  10
trast in tone and colour to the adja-
cent surfaces
The manual thermostat contrasts in  10
colour and tone with adjacent surfaces
Electric light switch plates contrast to      10, 11
the surrounding walls
Electric light switches contrast to the      10
switch plate
Electrical socket plates contrast to      10, 11
the surrounding walls
Switches on electrical sockets con-      10
trast to the socket plate
The room is decorated in a light       10
colour with a matt finish
Worktops and work surfaces are non-  10, 11
reflective and ‘plain’ (i.e. not prom-
inently patterned)
The work surface contrasts against  10
the colour of the wall tiling
Kitchen unit doors and drawer fronts  10
contrast against the work surface
and the floor finish
Kitchen unit door and drawer handles  10, 11
contrast with the cupboard doors and
drawers
The plinth at the foot of the base units  10
matches the door colour of the units
The plinth at the foot of the base  10
units contrasts with the floor finish
The bathroom floor is visually distinct  10, 11
from the bathroom fittings
The bathroom walls are visually dis-  10
tinct from the bathroom floor
The bathroom fittings are visually  10, 11
distinct from the bathroom walls

Notes:
In order to enhance the usability of the EVOLVE tool, some adaptations were made to the source material, leading to
minor discrepancies between source material and individual items, as detailed below.
A Recommends that electric light illuminance in kitchens be adjustable.
B Recommends a minimum electric light illuminance of 150 lux on the floor in lounges and bedrooms, and an average
illuminance of 100–300 lux.
C Recommends an average electric light illuminance of 200 lux on the floor in lounges, dining rooms and bedrooms in
residential homes for the elderly.
D Recommends a minimum average electric light illuminance of 200 lux on the floor in kitchens, and an average
illuminance of 200 lux on the floor in hallways and bathrooms.
E Suggests that natural light ‘should be maximised in task areas’ such as at the kitchen sink and on circulation routes.
F Recommends that corridors are ‘well-lit’ with both natural and artificial light and that kitchens and bathrooms have
windows.
G Suggests providing additional illumination on window wall from other windows can reduce that glare.
H Recommends that the lounge/kitchen window ‘within 308 of South or gets good daylight’.
I Recommends that ‘Principal rooms have windows that do not look out on wall within 3 m’.
J Recommends that ‘At least one main living area has urban views of over 50 m OR distant or rural views’.
K Suggests that, ‘Sills, normally, should be below the eye level of people seated’.
L Recommends that windows in the principal living space ‘should include glazing that starts no higher than 800 mm
above floor level’.
M Recommends that the glazing line in living rooms be ‘no higher than 800 mm from floor level’.

Lighting Res. Technol. 2013; 45: 345–361

350 A Lewis and J Torrington
degeneration, glaucoma or cataracts), but
participants had a wide range of visual
function (see Tables 3 and 4). The National
Eye Institute Visual Function Questionnaire
(VFQ25) was used to assess participants’ level
of visual function.21,22
Participants were asked about their experi-
ences of undertaking everyday activities such
as preparing food, ironing and reading, as a
way of exploring their views on the design of
their home in relation to lighting, aspect,
layout, internal finishes, technology and
safety features. Interviews lasted between 20
minutes and 107 minutes, were recorded using
a digital voice recorder and transcribed ver-
batim. Transcripts were anonymised to ensure
confidentiality. Data were coded and ana-
lysed thematically, with N-Vivo 8 software
used to store and retrieve data. Two research-
ers reviewed the transcripts to ensure agree-
ment on coding frames. Participants’ level of
visual function was taken into consideration
in writing up the findings.
3. Findings and discussion
3.1. Electric lighting – illuminance
It is difficult to prescribe ideal illuminance
levels for people with sight loss not least
because there is no strong correlation between
optimum light levels and specific pathologies
of the eye.6 This study draws on guidance
published by the Thomas Pocklington Trust
on illuminance in domestic settings for people
with sight loss. Specifically, recommendations
for minimum average illuminance at floor
level with all lighting, excluding task lighting
and portable lighting, were used in evaluating
general lighting.10
The recommended minimum illuminance
for domestic lounges is 150 lux,10 although the
Chartered Institution of Building Services
Engineers (CIBSE) recommend 200 lux on
the floor in residential homes for the elderly,13
the closest building type to extra-care housing
covered by their guidance.
Lighting Res. Technol. 2013; 45: 345–361
In the scheme survey, only schemes 1 and 7
were found to have median lounge illumin-
ance levels above those recommended
(Table 5). These were the only schemes to
feature a combination of down-lighters and
up-lighters in apartment lounges, which prob-
ably accounts for the results (Figure 1).
The recommended minimum illuminance
for domestic kitchens is 200 lux,10 exceeded in
all schemes except scheme 4 (Table 5). The
main kitchen fitted ceiling lights in all
schemes were linear fluorescent, except in
scheme 4 where both the kitchen and the
lounge were lit by a single compact fluores-
cent light, and scheme 2, which had the next
lowest illuminance levels, where the main
ceiling lights were halogen spotlights.
The recommended minimum illuminance
for bedrooms is 150 lux,10 although CIBSE
recommend 200 lux on the floor in bedrooms
in residential homes for the elderly.13 Only
scheme 7 had a median illuminance level
above 150 lux and was the only scheme
where bedroom fitted ceiling lights were
supplemented by wall-mounted up-lighters
(Table 5).
Bathroom illuminance was below the
recommended minimum level of 200 lux10 in
two schemes only (2 and 6 – Table 5).
Bathrooms fitted with halogen spotlights or
pendant lights (schemes 2 and 6) had the
lowest illuminance levels. Where illuminance
was higher, bathroom light fittings had 2D
compact fluorescent lamps, with the highest
illuminance levels recorded in schemes where
bathrooms had two fitted ceiling lights (1, 4, 7
and 10).
3.2. Electric lighting – general
For the purposes of evaluating the
schemes, items on illuminance were incorpo-
rated into a domain, ‘Electric lighting –
general,’ along with items on the even distri-
bution of light and degree of control over
lighting afforded to occupants (Table 2).
 Lighting of extra-care housing 351
Table 3 Participant characteristics

Characteristic N (%) Median (Q1, Q3)

Sample 44
Gender
Male 13 (30)
Female 31 (70)
Age (years) 78 (69, 85)
Age (years)  gender
Male 71 (62, 80)
Female 81 (76, 88)
Number of people participant lives with
Live alone 30 (68%)
Live with spouse/other 14 (32%)
Time living in scheme (months) 24 (13, 54)
Tenure
Social renting 30 (68%)
Shared ownership 7 (16%)
Leasehold 7 (16%)
Mobility
Wheelchair user 4 (9%)
Other mobility aid 20 (45.5%)
No mobility aid 20 (45.5%)
Hearing
Hearing aid user 12 (27%)
No hearing aids 32 (73%)

Table 4 Participant characteristics: eye conditions and visual function

Characteristic N (%) Median (Q1, Q3)

Sample 44
Eye conditionsa
No known eye condition 1 (2%)
Long-sightedness, short-sightedness or astigmatism 16 (36%)
Macular degeneration 13 (30%)
Cataract 21 (48%)
Glaucoma 9 (20%)
Retinitis pigmentosa 1 (2%)
Diabetic retinopathy 1 (2%)
Other 21 (48%)
National Eye Institute Visual Function Questionnaire (%)b
General health 50 (25, 75)
General vision 60 (35, 60)
Ocular pain 88 (75, 100)
Near activities 29 (8, 83)
Distance activities 50 (23, 92)
Vision specific
Social functioning 69 (25, 100)
Mental health 75 (42, 100)
Role difficulties 56 (34, 88)
Dependency 83 (25, 100)
Driving – –
Colour vision 75 (25, 100)
Peripheral vision 50 (0, 100)

a
Note that many participants have more than one eye condition.
b
Note that a high score represents better functioning. For details see (VFQ-25).22

Lighting Res. Technol. 2013; 45: 345–361

352 A Lewis and J Torrington
Table 5 Electric light illuminance

Scheme (Sample Electric light illuminance (lux)

no. size)
Lounge Kitchen Master bedroom Bathroom
Median (Range) Median (Range) Median (Range) Median (Range)

1 (4) 258 (89, 351) 408 (361, 836) 106 (50, 206) 327 (245, 472)
2 (3) 69 (40, 186) 283 (198, 294) 112 (58, 126) 98 (94, 153)
3 (4) 101 (49, 166) 340 (333, 423) 57 (53, 262) 281 (89, 400)
4 (4) 102 (65, 171) 114 (73, 146) 75 (69, 118) 475 (235, 490)
5 (4) 56 (50, 146) 348 (296, 834) 74 (68, 173) 272 (165, 296)
6 (5) 90 (56, 256) 448 (245, 503) 64 (11, 148) 104 (63, 163)
7 (5) 273 (107, 320) 655 (240, 730 158 (115, 182) 376 (223, 460)
8 (1) 43 – 359 – 43 – 373 –
9 (4) 61 (32, 97) 656 (570, 730) 75 (61, 78) 202 (113, 209)
10 (4) 64 (43, 156) 491 (409, 565) 143 (69, 159) 469 (360, 539)
11 (3) 67 (63, 142) 308 (189, 413) 79 (75, 100) 276 (274, 288)

be introduced, as this will ‘assist partially

Figure 1 A well-lit lounge; lounge electric light illumin-
ance exceeded recommended levels in two schemes
only, both of which featured a combination of down-
lighters and uplighters in apartment lounges.
Guidance on housing design for people
with sight loss indicates that artificial light
should be well distributed,10,11 although the
CIBSE suggests that in domestic environ-
ments local areas of higher illumination can
sighted residents by enabling them to suit the
lighting to their own clinical conditions.’13
Specialist and CIBSE guidance recom-
mend the use of dimmer switches,10,11,13 and
specialist guides recommend individual
switching for each light fitting, to maximise
the degree of control an occupant has over
lighting.10
In the survey of extra-care schemes it was
found that illuminance levels and the distri-
bution of light was generally good in domestic
kitchens and bathrooms, but less good in
lounges and bedrooms. Lighting schemes
afforded little control over illuminance
levels, with only one of the 11 schemes
surveyed having dimmer switches, although
in five schemes fitted lights closest to the
widows could be switched on or off inde-
pendently of lights furthest from the
windows.
Scheme 7 achieved the highest score for the
‘Electric lighting-general’ domain, achieving a
score approximately 31% higher than the
next highest scoring scheme (Table 6). This
high score reflects the even distribution of
light in all rooms, high illuminance levels and
the high degree of control afforded to occu-
pants, scheme 7 being the only one to feature
dimmer switches for all fitted lights except for
those in bathrooms. Scheme 7 was one of two

Lighting Res. Technol. 2013; 45: 345–361

 Lighting of extra-care housing 353
Table 6 EVOLVE tool – domain scores

Scheme (Sample Domain scores (%)

no. size)
Electric lighting – general Daylight Sunlight Aspect Colour and contrast

Median (Range) Median (Range) Median (Range) Median (Range) Median (Range)

1 (4) 42 (33, 50) 38 (29, 43) 32 (14, 56) 32 (20, 87) 26 (23, 26)
2 (3) 15 (15, 25) 57 (43, 63) 57 (22, 71) 90 (87, 100) 21 (17, 23
3 (4) 27 (15, 53) 33 (29, 44) 59 (14, 69) 38 (20, 75) 30 (28, 46)
4 (4) 22 (17, 42) 33 (33, 43) 43 (0, 70) 95 (53, 100) 35 (32, 41)
5 (4) 42 (31, 54) 38 (38, 38) 60 (30, 70) 80 (47, 80) 42 (29, 44)
6 (5) 19 (19, 47) 78 (67, 78) 47 (31, 65) 58 (40, 60) 22 (21, 25)
7 (5) 75 (63, 87) 67 (56, 67) 57 (7, 77) 35 (30, 55) 80 (78, 80)
8 (1) 31 – 44 – 15 – 10 – 27 –
9 (4) 31 (31, 38) 57 (57, 63) 57 (57, 60) 70 (67, 70) 28 (25, 33)
10 (4) 44 (44, 69) 63 (29, 63) 69 (0, 90) 92 (40, 93) 76 (75, 78)
11 (3) 31 (25, 38) 50 (38, 89) 47 (30, 90) 67 (30, 87) 23 (23, 30)

schemes in the sample that catered specifically
for older people with sight loss and was the
only scheme purpose-built for this use, and
consequently is not typical of extra-care
schemes generally.
In general, those participants who had
control over their lighting, through dimmer
switches or through having fitted lights on
separate switches, appreciated having this
flexibility and took advantage of this high
degree of control, either to prevent glare
(including for watching television) or to
improve the ambience.
Some participants with dimmer switches
liked to keep lights on at a low level
because soft light ‘is more soothing’ (female,
age 78 years), only turning the lights up to
full power when undertaking activities such
as ironing or eating a meal. Others found
their sensitivity to light varied from day
to day.
‘I’ve always loved dimmer switches . . .
Some days . . . I want everything on up
bright, other times when I’ve got a bit of
an eye ache and I want to, want to sit
down and, you know, rest my eyes I will
have the lighting right down dim.’
(Male, age 50 years)
Some participants without dimmer
switches for the fitted electric lights used the
dimmer switches incorporated into standard
lamps. Some participants with glare problems
liked wall-mounted up-lighters.
‘I prefer the side lights . . . the bulb itself
is not showing’ (Female, age 80 years)
Several participants with glare problems,
who did not have dimmer switches or wall-
lights, rarely used ceiling lights, preferring to
use standard lamps or table lamps for most
purposes.
‘I use the side lights . . . I don’t often use
it [the ceiling light] . . . it’s a little bit
bright but if I want to, say if I’m having
my supper or anything like that, if I
want more light I put it on then . . . [But]
it makes my eyes ache.’ (Female, age 100
years)
Some participants with total sight loss,
even though they did not benefit from the
light themselves, reported that they used the
electric lights in their home for social reasons,
such as for the sake of a partner, family
members, visitors or carers, or because ‘it’s
natural’ to do so (male, age 73 years) or to
activate extractor fans. Some of these partici-
pants experienced difficulties with specific
types of dimmer switch, or with pull-cord
switches or where lights had more than one
switch, because it could be difficult to know
Lighting Res. Technol. 2013; 45: 345–361
354 A Lewis and J Torrington
whether a light was on or off. Dimmer
switches could be problematic if the
same action is used for turning lights both
on and off.
3.3. Daylight
Although current specialist guidance on
design for people with sight loss includes
recommendations that natural light be max-
imised in circulation spaces and task areas,10
particularly in kitchens,11 there are no specific
recommendations regarding daylight factors.
Similarly, the Housing Quality Indicators rec-
ommend that all kitchens and bathrooms
have windows, but do not specify daylight
factors.17
CIBSE’s guidance on lighting for commu-
nal residential buildings suggests that lounges
have a daylight factor of 1.5%, kitchens
2% and bedrooms 1%.13 This advice
is echoed by BS-8206 Part 2: Code of
Practice for Daylighting14 and the Code for
Sustainable Homes,18 which make identical
recommendations for lounges and kitchens,
with the further recommendation that in both
cases 80% of the working plane should
receive direct light from the sky.
In the scheme survey, schemes were
assessed using a ‘daylight’ domain (Table 2),
Figure 2 A dual aspect lounge; participants with a dual aspect dwelling appreciated having windows on two sides
because it brought extra light into some rooms or because it increased the amount of direct sunlight.
Lighting Res. Technol. 2013; 45: 345–361
comprised of items on the number of habit-
able rooms with daylight, and whether the
daylight factors in lounges, kitchens and
bedrooms comply with those recommended
by CIBSE.13
In undertaking the survey it became
apparent that many extra-care schemes are
deep-plan buildings with single aspect
apartments that have windows to lounges
and bedrooms only. The schemes that
achieved the highest domain scores were
those where dwellings had the greatest area
of external wall (Table 6), as these are
more likely to have windows to all rooms,
and be dual aspect with windows on two
sides of the building (Figure 2). Scheme 6
was the only scheme included in the study,
which consisted entirely of bungalows,
which consequently achieved the highest
score. Of the homes surveyed in scheme
7, three out of the five were dual aspect
apartments in a cluster block, which
increased the number of rooms with day-
light and increased daylight factors. The
high-scoring home in scheme 11 was an
end-terrace house, while the lower scoring
homes in this scheme were apartments.
Schemes 2, 9 and 10 achieved high scores
because of high daylight factors in lounges
 Lighting of extra-care housing 355

and master bedrooms, attributable to floor-

to-ceiling height windows in these rooms.
In some other schemes, such as scheme 11, the
advantages attained by having large lounge
windows were undermined by the presence of
projections over the windows such as balco-
nies to apartments above or overhanging
eaves.
Many participants felt that having lots of
daylight was important, either because it
improved the feel of a home or because it
enabled people to undertake tasks requiring
close vision.
‘I can see a bit better in the normal
daylight to the artificial lighting.’ (Male,
age 75 years)
Those with a dual aspect dwelling appre-
ciated having windows on two sides because it
brought extra light into some rooms or
because it increased the amount of direct Figure 3 A windowless kitchen; participants valued
sunlight. daylight, partly because it enabled them to undertake
tasks requiring close vision, but also because it improved
the feel of the home.
‘I’m lucky because I’ve got a side
window facing south as well as the west
facing bay window . . . ’ (Female, age 69
years) 3.4. Sunlight
In relation to sunlight, most of the special-
Those with kitchen windows appreciated ist guidance on design for people with sight
having them because they brought in daylight loss focuses on the need to enable occupants
or because ‘it’s nice being able to look to control the amount of sunlight that enters
out’ (female, age 69 years). Some partici- their home through the use of blinds, in order
pants whose apartments lacked kitchen to reduce glare.10,11 In Building Sight it is
or bathroom windows (Figure 3) wished noted that blinds bring problems of adjust-
they had them for daylight or to provide ment and control, and additional methods of
views out. Some participants in apartments reducing glare are suggested including struc-
with low daylight factors wanted more day- tural shielding. Only brief reference is made to
light and some participants in this situ- the benefits of direct sunlight, specifically to
ation found they had inadequate light to the high illuminance provided by sunlight,
undertake everyday activities such as applying although it is also noted that illuminance
make-up, picking out clothing or putting
levels can change rapidly resulting in prob-
on shoes.
lems of adaptation.11
‘The room is dark . . . to get dressed, CIBSE’s Lighting Guide 9 notes that,
choosing colours, I often have to walk ‘Sunshine lifts the spirits,’ and sunlight in
towards the light to get a true, true the home is beneficial for the occupants’ well-
picture.’ (Female, age 66 years) being, and brings additional illumination and
Lighting Res. Technol. 2013; 45: 345–361
356 A Lewis and J Torrington
warmth, although it can also cause unwanted
solar gain. It is suggested that the ideal home
is rectangular in plan with the longitudinal
axis oriented to within 308 of east/west, and
with the principal rooms on the south side.
Ideally bedrooms should be within 458 of due
east to allow early morning sun to enter, while
intermittently used spaces, such as bath-
rooms, can face north.13 Similar advice is
offered in the Housing Quality Indicators,
which recommend that lounge and kitchen
windows be oriented to face within 308 of
south or receive ‘good daylight.’17
The ‘sunlight’ domain comprised of items
relating to whether dwellings were single or
dual aspect, whether individual rooms receive
direct sunlight in the morning or afternoon
and whether there are any obstructions to
direct sunlight (Table 2).
The domain scores arising from the
scheme survey showed much more variation
between individual dwellings within each
scheme than with other domains (Table 6).
This is partly attributable to the high pro-
portion of single aspect dwellings in the
sample (24 out of 41 units, 58.5%). A north-
facing single aspect apartment will receive
no direct sunlight, while an identical apart-
ment facing south will receive direct sun-
light throughout the day, which will be
reflected in its domain score. For example,
the variation in scores for scheme 10 results
from two southeast-facing apartments achiev-
ing high scores and a northwest facing flat
scoring low.
Other factors affected scores. Only one
participant was interviewed in scheme 8 and
the low scores are not representative of the
scheme as a whole. In this case, the partici-
pant struggled to open curtains and blinds, as
described below, and the domain score
reflects the conditions of the building at the
time of the survey, rather than the quality of
the building as designed.
Looking at the domain scores across the
sample, it seems that while architects are often
Lighting Res. Technol. 2013; 45: 345–361
constrained by the site conditions, many find
ways to maximise a site’s potential. In the
sample, 85% of lounges and 83% of master
bedrooms received some direct sunlight,
although only 46% of lounges and 41% of
double bedrooms received direct sunlight in
both the morning and afternoon. Of the 20
dwellings where kitchens had windows, 60%
received some direct sunlight but only 20%
received direct sunlight both morning and
afternoon. Bathrooms and hallways were the
rooms least likely to receive direct sunlight,
with no bathrooms in the sample receiving
sunlight.
Obstructions to windows were common. Of
those rooms oriented to receive some direct
sunlight, only 41% (15 out of 37) of lounges
were free from obstructions to direct sunlight.
Similarly, only 47% (7 out of 15) of kitchens
and 45% (17 out of 38) of master bedrooms
had windows free from obstruction to direct
sunlight. Common obstructions were build-
ings and high hedges.
Many participants appreciated sunlight
because it made them feel better and some
liked having some direct sunlight despite
problems with glare.
‘It’s very nice, it’s absolutely lovely but
sometimes when it’s, sun’s over there
and I’m here I can’t face it because it’s so
brilliant, I have to move, you know,
because it’s so brilliant, but it is lovely, I
wouldn’t have it any other way.’
(Female, age 89 years)
‘I like it because I’m a bit of a sun
worshipper but in practical terms it’s a
bit of a nightmare for me . . . ’ (Male, age
50 years)
Some participants also appreciated sun-
light because it gave them information about
the time of day and the weather, which in turn
gave them a greater sense of connection to the
wider world, particularly important if they
were largely housebound.

‘Well just to know that life is there and
that life’s going on and that it’s a
difference between day time and night
time. Yes you can tell . . . I can tell the
heat or the coldness of the wind. That
combined with the sunlight or lack of it
makes a big difference to sort of general
awareness of things.’ (Male, age 88
years)
A total of 13 participants reported experi-
encing problems with glare from sunlight, and
most reported using blinds to reduce glare.
One participant reported experiencing serious
difficulties in operating their blinds and cur-
tains owing to sight loss and arthritis. In
addition to experiencing difficulties in draw-
ing back the curtains and manipulating con-
trol-cords, the participant struggled to see the
white cords for controlling the blinds against
the magnolia-coloured walls.
‘I pull the string to close the blind in the
kitchen and, and I’ve got it all, all
twisted, you know, in a mess somehow,
and I don’t want to do that . . . so I just
leave it as it is.’ (Female, age 77 years)
Consequently, the participant kept the
blinds closed and had only one curtain
drawn back throughout the day and night,
relying on artificial light in preference to
experiencing problems with sunlight glare.
3.5. Aspect
Little research literature exists on what
people with visual impairments want in a view
from the window, which perhaps explains the
absence of this issue from guidance on design
for people with sight loss. There is extensive
literature on aspect in relation to people with
normal vision,23 and aspect is well covered in
mainstream design guidance.
CIBSE’s Lighting Guide 9 and the British
Standards document BS8206 recommend that
buildings be provided with views of natural
features13,14 or dynamic urban scenes,14 and
emphasise the importance of depth of view,
Lighting of extra-care housing 357
suggesting that the ideal view contains fea-
tures in the foreground, middle-distance and
far-distance. Similarly, the Housing Quality
Indicators recommend that dwellings have
‘urban views of over 50 m or distant or rural
views’ and suggests that the sill height in
lounges should not exceed 800 mm above the
finished floor level,17 a recommendation that
echoes Lifetime Homes standards.24
For the scheme survey, the ‘aspect’ domain
comprised items on the sill height, depth of
view, whether the window affords a view of
natural features or human activity, and
whether there were any obstructions such as
blank walls, for the lounge, kitchen and
bedrooms in each dwelling (Table 2).
As with the sunlight domain, there was
found to be much variation between individ-
ual dwellings within each scheme (Table 6). In
most schemes, views from lounge windows
were good with the lounge sill less than
600 mm above floor level in 76% of cases.
Also, 80% of lounge windows had a view of
natural features, 76% a view of human
activity (only three units had views of neither)
and 78% of lounge windows were free from
obstruction, although only 46% had views of
near and distant features. Schemes that
achieved a high median domain score gener-
ally afforded views with a greater depth of
field, and views were good from most rooms
throughout each dwelling, not just from the
lounge.
Scheme 8, which achieved the lowest
score in this domain, is a special case; the
scores reflect the participant’s difficulty in
opening blinds and curtains, which meant
that in practice the participant’s view was
minimal.
Interviews with occupants suggest that
many people with poor visual function appre-
ciate similar qualities in a view as people with
normal vision. Many participants, particu-
larly those who were largely housebound,
talked about having an increased awareness
of the wider world through proximity to
Lighting Res. Technol. 2013; 45: 345–361
358 A Lewis and J Torrington

human activity and natural features. For

example, one participant who can see objects
only in silhouette talked about how seeing the
trees outside his lounge window moving in the
wind enhanced his awareness of the external
environment (Figure 4).

‘I know everybody gets fed up with the

wind but it’s a friend to me, seeing it
move those trees . . . I get a lot of pleas-
ure just from seeing the winds out there
even though I can’t distinguish the
trees . . . It gives a general feeling of the
weather.’ (Male, age 88 years)

Many participants lived alone, and some

talked about how external views relieved the
sense of isolation.
‘ . . . when my husband died I felt that
this was a little prison and I was a
prisoner within four walls, so in a sense I
think that window was a bit of a lifeline,
that, although there wasn’t an awful lot
to see there was another world out
there.’ (Female, age 66 years)
Even for participants with low visual func-
tion, being able to see signs of human activity
was important.
‘I’m glad I’ve got [a view] but I can’t
make out who’s walking up and who’s
walking down, you know, or what, or
what vehicles are at the, at the
entrance . . . [I like] the feeling that
there’s some activity out there, you
know’ (Female, age 81 years)
For participants with very low visual func-
tion, sounds from the outside world could
also be important. For some, hearing human
activity was ‘very important . . . it’s knowing
that there’s someone around.’ (Female, age 81
years) Others liked hearing nature.
‘I love listening to the birds and I’ve got
my bird table kind of outside, near my
Lighting Res. Technol. 2013; 45: 345–361
Figure 4 The type of view favoured by participants; even
participants with poor visual function appreciated views
of natural features or of human activity as it gave them
greater connection to the outside world.
spare bedroom window and, you know,
I can hear all the birds singing and I love
that, yeah.’ (Female, age 40 years)
3.6. Colour and contrast
Current guidance on design for people with
sight loss includes recommendations on the
use of colour in building design, either to
increase the internal reflectance of room
surfaces or to enhance the legibility of a
room (Figure 5) by highlighting features such
as doors, door furniture, skirting boards, grab
rails, shower curtains and light switches.10,11
CIBSE’s Lighting Guide 9 suggests that
door frames should be in a contrasting colour
to the door and surrounding walls,13 while the
British Standards document BS8300 makes a
number of recommendations about the use of
colour.15 No such recommendations are con-
tained in the more mainstream design

Figure 5 A good use of colour; a band of terracotta tiles
is used to highlight the extent of the room, while the
shower curtain edge and grab rail contrast in tone with
the surrounding surfaces. Participants with limited visual
function appreciated the use of contrasting colours to
highlight room features as it enhanced the legibility of
the space.
guidance, such as that issued by the Homes
and Communities Agency.16–19
For the scheme survey a ‘colour and
contrast’ domain was created comprised of a
wide range of items (Table 2), based on
recommendations made in Housing for People
with Sight Loss.10
The two schemes that cater for older people
with sight loss (7 and 10) achieved signifi-
cantly higher scores than the others in the
sample, with median scores of 80% and 76%,
respectively, compared to the third highest
scoring scheme that achieved 42% and the
lowest that scored 21% (Table 6). While in
many schemes rooms are decorated in a light
colour thus maximising internal reflectance,
including 90% of lounges and 95% of bed-
rooms, the use of colour schemes to enhance
Lighting of extra-care housing 359
the legibility of rooms was rarer. The most
common use of contrasting colours was for
hand-painted building elements such as
doors. Across the whole sample, 97% of
front doors and 38% of lounge doors were in
a contrasting colour to the surrounding walls.
Also, 95% of bathroom floors were in a
contrasting colour to bathroom walls and
fittings. However, much less use was made of
contrasting colour schemes for services, with
electric light switches contrasting with the
switch plate in schemes 7 and 10 only, and
manual thermostats contrasting with sur-
rounding walls in one unit alone.
Participants with limited visual function,
living in schemes where contrasting colours
were used, appreciated these colour schemes
because they enhanced the legibility of inter-
nal spaces.
‘I think [the colour scheme is] fantastic,
yeah, that’s fantastic, because you know
where the wall is don’t you?’ (Female,
age 68 years)
‘I like the bright, I’ve got like a terra,
bright terracotta colouring band around
my, on the tiles around my bathroom,
yeah, I, I like that because I can see the
boundaries of the, of the room.’ (Male,
age 50 years)
While few participants whose homes had
light-coloured walls commented on them,
some of those whose dwellings had dark-
coloured walls were critical of them.
‘I would prefer a lighter patterned
wallpaper . . . I think it would reflect the
light, what light there is, more effect-
ively’ (Female, age 83 years)
4. Conclusion
Using current guidance on design for people
with sight loss as a benchmark, the findings of
the scheme survey suggest that many extra-
Lighting Res. Technol. 2013; 45: 345–361
360 A Lewis and J Torrington
care housing schemes provide adequate elec-
tric light illuminance levels and a good
distribution of light in kitchens and bath-
rooms. However, electric light illuminance
levels in lounges and bedrooms are below that
recommended in the specialist guidance,
lighting systems afford little control, and few
schemes feature colour schemes that enhance
the legibility of spaces.
Many of the issues raised by participants in
the study are covered in the current specialist
guidance on design for people with sight
loss,10,11 suggesting that this guidance is
essentially sound, although there is scope for
additional guidance. Specifically, on the evi-
dence of this study, aspect, daylight and
sunlight are important to people with sight
loss, particularly to those who are house-
bound as it can engender a greater sense of
connection to the world, and design guidance
should reflect this. Few of the recommenda-
tions made in the specialist guidance feature
in more mainstream guidance, such as that
published by the Homes and Communities
Agency,16–19 and this probably explains why
many existing extra-care schemes are deficient
in some areas.
Acknowledgements
The authors would like to thank Anthony
Slater of Thomas Pocklington Trust and
Peter Tregenza, Emeritus Professor of the
University of Sheffield, for their assistance
with this research.
Funding
This work was funded by
Pocklington Trust.
References
1 Thomas Pocklington Trust. Occasional Paper 8:
Prevalence, Causes and Impact of Sight Loss
Lighting Res. Technol. 2013; 45: 345–361
in Older People in Britain. London: Thomas
Pocklington Trust, 2006.
2 Darton R, Callaghan L. The role of extra care
housing in supporting people with dementia:
early findings from the PSSRU evaluation of
ECH. Journal of Care Services Management
2009; 3: 284–294.
3 Bakker R, Iofel Y, Lachs M. Lighting levels in
the dwellings of homebound older adults.
Journal of Housing for the Elderly 2004; 18:
17–27.
4 Sinoo M, van Hoof J, Kort HSM. Light
conditions for older adults in the nursing
home: Assessment of environmental illumin-
ances and colour temperature. Building and
Environment 2011; 46: 1917–1927.
5 Percival J. Occasional Paper 13: Lighting the
Homes of People with Sight Loss: An Overview
of Recent Research. London: Thomas
Pocklington Trust, 2007.
6 Evans BJW, Sawyerr H, Jessa Z, Brodrick S,
Slater AI. A pilot study of lighting and low
vision in older people. Lighting Research and
Technology 2010; 42: 103–119.
7 Goodman C, Watson L. Research Findings
No.35: Design Guidance for People with
Dementia and for People with Sight Loss.
London: Thomas Pocklington Trust, 2010.
8 Littlefair P. Research Findings No.30:
Daylighting and Windows in Homes of People
with Sight Loss. London: Thomas Pocklington
Trust, 2010.
9 Lewis A, Torrington J, Barnes S, Darton R,
Holder J, McKee K, Netter A, Orrell A.
EVOLVE: a tool for evaluating the design of
older people’s housing. Housing Care and
Support 2010; 13: 36–41.
10 Goodman C. Housing for People with Sight Loss:
A Thomas Pocklington Trust Design Guide.
London: Thomas Pocklington Trust, 2008.
11 Barker P, Barrick J, Wilson R. Building Sight:
Handbook of Building and Interior Design
Thomas Solutions to Include the Needs of Visually
Impaired People. London: Royal National
Institute of Blind People, 1995.
12 Society of Light and Lighting. Code for
Lighting. London: Chartered Institution of
Building Services Engineers, 2009.
13 Chartered Institution of Building Services
Engineers. Lighting Guide 9: Lighting for

Communal Residential Buildings. London:
Chartered Institution of Building Services
Engineers, 1997.
14 British Standards Institution. BS-8206-2.
2008 Lighting for Buildings – Part 2:
Code of Practice for Daylighting. London: BSI,
2008.
15 British Standards Institution. BS-8300:
2009þA1:2010. Design of Buildings and
Their Approaches to Meet the Needs of
Disabled People – Code of Practice. London:
BSI, 2010.
16 Housing Corporation. Design and Quality
Standards. London: Housing Corporation,
2007.
17 The National Affordable Homes Agency. 721
Housing Quality Indicators (HQI) Form.
London: Housing Corporation, 2008.
18 Department for Communities and Local
Government. Code for Sustainable Homes:
Technical Guide. London: Communities and
Local Government Publications, 2010.
Lighting of extra-care housing 361
19 Care Services Improvement Partnership
(CSIP). The Extra-Care Housing Toolkit.
London: Department of Health, 2007.
20 Tregenza P, Wilson M. Daylighting –
Architecture and Lighting Design. London and
New York: Routledge, 2011.
21 Mangione CM, Lee PP, Gutierrez PR, Spritzer
K, Berry S, Hays RD. Development of the
25-item National Eye Institute Visual Function
Questionnaire (VFQ-25) – 2001. Archives of
Ophthalmology 2001; 119: 1050–1058.
22 National Eye Institute. National Eye Institute
Visual Functioning Questionnaire – 25 (VFQ-
25): Version 2000. Santa Monica, CA: RAND
Corporation, 2000.
23 Farley K, Veitch J. IRC Report RR136, A Room
with a View: A Review of the Effects of Windows
on Work and Well-Being. Ottawa, ON: Institute
for Research in Construction, 2001.
24 Lifetime Homes. 16 Design Criteria from 5 July
2010. Retrieved April 2011, from http://
www.lifetimehomes.org.uk/index.php.
Lighting Res. Technol. 2013; 45: 345–361
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