Human Comfort: Indoor Environmental Quality: Access to Outdoors, Quality Lighting, Thermal Control, and Improved Acoustics


Rendering completed by Shernise Richardson, Project Designer, JSR Associates, Inc.


This article is dedicated to all elders who deserve quality care without isolation and aims to provide support for human comfort within residential care settings for both elders and their caregivers.  

Human comfort has become the next environmental focus within the sustainability movement. There has been a shift from evaluating only the built environment in relationship to sustainability to evaluating the building occupant outcomes as impacted by the built environment. The inclusion of human comfort is predominant in the certification systems WELL® and Fitwel®, which were originally developed to focus on workplace environments, but have subsequently been influencers in other verticals, such as health care, and for Fitwel®, senior living and multifamily verticals.

Product certifications also focus on contributing to human comfort through meeting criteria related to environmental, health and wellness, and social impacts. Sunbrella Contract fabric has achieved GREENGUARD® Gold Certification, which contributes to healthy indoor air quality for building occupants. More than 100 patterns of Sunbrella fabrics, including those with Defiance technology, have been third-party certified Silver through the Facts™ program, which meets criteria included in the NSF/ANSI 336 Sustainability Assessment for Commercial Furnishings Fabric Standard – 2018. Sunbrella fabrics with the STANDARD 100 label for OEKO-TEX® label have been tested for harmful substances and the upholstery fabric is harmless in human ecological terms.

Additional human comfort aspects of indoor environmental quality (IEQ) include lighting, thermal and acoustical comfort with an additional focus on access to outdoor space by means of gardens and courtyards and including views of nature from within the built environment. In health care and senior living licensing guidelines, the Environment of Care (EOC) sections[1] address the control aspects of lighting, thermal and acoustic impacts on human comfort and also include positive impacts from views of nature and the opportunity to be outdoors as a means of activity, access to daylight, respite, resetting of circadian systems and the synthesis of vitamin D[2].

Illumination is Key – Creating Lighting Comfort

In reviewing the Illuminating Engineers Society (IES) Standard: ANSI/IES RP-12 American National Standard Practice for Office Lighting, the criteria have been updated to not only focus on user control and comfort but also provide lighting levels as required by various users’ ages. This provides designers with additional questions to ask during the planning and programming process that addresses the demographic of those utilizing work spaces, allowing low-vision requirements to become more mainstream versus only referencing ANSI/IES RP-28 Lighting and the Visual Environment for Senior Living for long-term care and ANSI/IES RP-29 Lighting for Hospitals and Healthcare Facilities for all other health care settings. With the focus of inclusive environmental design, the inclusion of all types of spaces focusing on the demographic of users is a great stride for addressing lighting comfort in all types of settings for all occupants, not only within health care and long-term care settings.

Lighting comfort is also addressed through the opportunity to have personal control of task and ambient lighting, as some people need higher levels than others to perform specific tasks and/or for general illumination. The evaluation of location of all lighting controls should be completed for both residents in long-term care and patients in acute care, in addition to controls for staff for clinical evaluation needs. Completing an operational flow diagram of each step at bedside will provide a basis for positioning staff controls versus resident or patient controls.

Newer and more affordable technologies contributing to health and wellness outcomes are available for artificial lighting that supports the reset of circadian rhythm (a natural “clock” within everyone that controls biological systems). The advent of LED lighting and relevant controls provides the right temperature of lighting to assist with circadian light entrainment (synchronization) of light and a person’s physiology. Although daylight is ideal for maintaining a consistent circadian rhythm[3], there are artificial lighting systems that can be tuned to the correct temperature according to the time of day that positively impacts staff, patients and residents. Often a combination of daylight and artificial lighting systems can be used to maximize the benefit to building occupants.

Improving Environments – Creating Acoustic Comfort

The Facility Guidelines Institute’s (FGI) trilogy of guidelines books, Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, Guidelines for Design and Construction of Hospitals, and Guidelines for Design and Construction of Outpatient Facilities, is an evidence-based resource for acoustic comfort information. There is a dedicated group of acoustical experts: academics, researchers and practitioners who have worked diligently for several revision cycles to improve and maximize the opportunities to provide acoustic comfort for building occupants in all types of health care settings. Their work is referenced in Green Building Initiative’s Green Globes® electronic platformed rating system tools and their recently published ANSI/GBI 01-2019 standard, and in LEED® v4.1 rating system.

Acoustic comfort and speech privacy are predominantly achieved through the selection of materials. In some cases, sound-masking systems may be appropriate to improve indoor environmental quality and occupant outcomes. Research is available on the adverse effects of environmental noise on users of space[4], therefore the ongoing task group has been an important initiative of the FGI as it relates to patient, resident and staff outcomes.

Supporting Choice – Creating Thermal Comfort

The American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) is responsible for the ongoing updates and development of Standard 55, Thermal Environmental Conditions for Human Occupancy, which specifies conditions for acceptable thermal environments and is intended for use in design, operation and commissioning of buildings. Standard 55 has a separate method for determining acceptable thermal conditions in occupant-controlled naturally conditioned spaces.

The ability of people to control their immediate environment is one way to address thermal comfort; however, this can also be challenging at the same time, because of the large variety of needs within a built environment. Controls located in multiple zones that can address heat gain from solar or other sources helps thermal consistency within various spaces and can be controlled with monitored sensors. For individual resident or patient rooms, it is recommended to provide a range of temperature that provides individual control based upon the person occupying the room. This may be significantly warmer than staff requirements because of the activity level of staff and the sedentary nature of residents and patients. For bathing areas, there has been some success with using radiant floors and/or radiant wall panels to increase the warmth level for patients or residents but reduce the direct impact to staff members.

Freely Experiencing the Outdoors – Visually and Interactively

A key component in designing gardens for direct outdoor access by residents and patients includes the provision for staff to have clear sight lines to the outdoor garden and activity space. This allows for the freedom of movement that is often desired by those with dementia. Observation allows staff to be comfortable with allowing access to be uninhibited because of safety reasons. Often therapies can be conducted in outdoor spaces that enhances the experience. In colder climates, providing atria or conservancy spaces with plants and exterior views is a good alternative. For care staff, providing access to outdoors or views of nature can provide an opportunity for respite from care activities. This enhances the human comfort of staff, as well as residents, patients, and families[5].


About the Author

Jane Rohde is the Founder and Principal of JSR Associates, Inc. located in Catonsville, Maryland. JSR Associates, Inc. celebrates 24 years of consulting services in 2020. She champions a global cultural shift toward deinstitutionalizing senior living and health care facilities through person-centered principles, research and advocacy, and design of the built environment. In 2015, she received the first Changemaker Award for Environments for Aging from the Center for Health Design and in 2018, she received the ASID Design for Humanity Award, has been recognized as an Honorary Alumni of Clemson University’s Architecture + Health program, and has been honored as one of the top 10 Women in Design demonstrating leadership in health care and senior living design and architecture. For more information or comments, please contact Jane Rohde at


[1] Guidelines for Design and Construction of Hospitals, Guidelines for Design and Construction of Outpatient Facilities, and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. Facility Guidelines Institute:

[2] Wright, K. P., Jr, McHill, A. W., Birks, B. R., Griffin, B. R., Rusterholz, T., & Chinoy, E. D. (2013). Entrainment of the human circadian clock to the natural light-dark cycle. Current biology: CB23(16), 1554–1558.

[3] Wright, K. P., Jr, McHill, A. W., Birks, B. R., Griffin, B. R., Rusterholz, T., & Chinoy, E. D. (2013). Entrainment of the human circadian clock to the natural light-dark cycle. Current biology: CB23(16), 1554–1558.

[4]Münzel, T., Schmidt, F.P., Steven, S., Herzog, J., Daiber, A., Sørensen, M. Environmental Noise and the Cardiovascular System. J Am Coll Cardiol. 2018 Feb, 71 (6) 688-697.

[5] Guidelines for Design and Construction of Residential Health, Care, and Support Facilities: Part 1: General, Chapter 1.2 Planning/Predesign Process, Section 1.2-4.5 Physical Environment Elements and related Appendices: