Elliot J. Stem, M.A.
Associate Executive Director
Miami Jewish Home and Hospital for the Aged and
Stein Gerontological Institute
When the Stein Gerontological Institute (SGI) and the Forecasting and Environmental Scanning Department (FES) of the American Association of Retired Persons (AARP) decided on a joint conference with the title "Universal Design of Living Environments for an Aging Population," the organizations intended to accomplish different goals from those of a conventional professional or association conference. Most simply stated, the concept involved bringing together a select number of architects, designers, inventors, engineers, scientists, and consumers to begin a dialogue on how technological innovation in their respective fields could be integrated and focused on a central problem: how to make the living environment of an aging individual more habitable, functional, and pleasant, even in the face of changes in that individual's sensory and performance capacities. Eighty individuals came together for this conference, held in Miami on 22-23 March 1990, to make significant strides in information sharing and to set goals for future action.
The sponsors have subsequently renamed the conference proceedings, Life-Span Design of Residential Environments for an Aging Population in order to clarify our intention to emphasize design solutions which permit "aging in place." Design for aging in place implies that the living environment will be supportive of changes in function and life patterns which occur as individuals age. In contrast, "universal" design was used in the context of our discussion with the implication that a certain set of design solutions exists which could be adaptable to any individual or all users regardless of age or ability. This notion was quickly dispelled by the presenters and panelists.
The papers that formed the basis of the subsequent discussion in the conference reflect nine individual responses to encourage and stimulate the thoughts of colleagues from their own and different fields. General topics addressed in the papers include: design of community living environments for a mixed population of healthy as well as impaired persons; adaptation of advanced technology to individual living environments, with emphasis on computer communication and signaling devices; specific architectural and design solutions for senior living communities; retrofit of existing home and community environments to make them safer and more accessible; and use of assistive devices, safety devices, and other simple or complex electromechanical technologies to augment or enhance the capabilities of older adults as they perform in their environments.
These papers were organized into the following four major sections:
In the course of the conference, leaders in the fields of gerontology, architecture, health care, manufacturing, finance, and government engaged in spirited discussions with each other and with AARP and SGI staff. Participants represented 15 states, Canada, and Great Britain. Those asked to present papers at the conference were given some guidelines to follow so the subsequent discussions could focus on parallel topics.
The papers responded to the following questions:
The conference debate focused on such issues as what should be done in both private-sector development, and government policy and regulation, to facilitate universal design; and how to assess existing and proposed technology for its suitability to senior living. The goal of each session was to define potential design solutions for living environments. Discussion focused on how this might be achieved; designs created by an architect, engineer, or an inventor are not necessarily solutions. In order to serve as a solution, such things as robotics, furniture, appliances, and household fixtures must be useable to individuals at all levels of functional capacity. This complex interaction of users and products requires the participation in development by de signers, engineers, and users.
Although collaboration among representatives of various disciplines and between producers and consumers is desirable, the rapid pace of innovation and the relatively slower pace of technology transfer make such collaboration difficult. This conference should be seen as a beginning, not a summation, for despite the many interesting questions addressed in the papers and discussions, the subsequent consensus statements produced by each session reflected the uncertainties of how to pursue interdisciplinary activities, and pointed to the need for more frequent contact among professionals and consumers.
There was agreement on the principle if not on the methods, of reaching the kind of integrated effort that is essential for a material improvement in the living environments of an aging population. Suffice it to say, the concerns expressed by individual conference participants regarding the arbitrary segmentation among the consumer and the professional, the scientist and the inventor, the manufacturer and the distributor, the architect and the builder, reflect a deeply felt need to work together and to bridge existing gaps in knowledge and service.
AARP and the Miami Jewish Home and Hospital for the Aged (MJHHA) and the departments of those organizations responsible for the conference place strong value on bridging such gaps by mobilizing those who participated in the conference. The AARP, with an enormous and broad-based constituency of persons over 50, and MJHHA, with its mission of direct service to thousands of clients as well as research and education, both want to see improvements in the living environments of older persons. AARP's Forecasting and Environmental Scanning Department is aimed at promoting the image of older persons as contributors and initiators, while the Technology Center for Independent Living was developed within SGI's central mission to allow individuals, irrespective of their disabilities, to retain independence, exercise control over their own lives, and to continue to contribute as independent actors.
The primary purpose of AARP's Forecasting and Environmental Scanning Department is to promote the continued active involvement of older persons in society. To further this goal, the program analyzes long-range trends and developments in technology, health, the economy, the family, and other social institutions; assesses the effects of the trends and developments on new or expanding roles, opportunities, and responsibilities for older persons during the next several decades; fosters long-range planning and the development of informational, educational, community service research, and policy initiatives to encourage public reexamination of options for older persons; and strengthens the capabilities of the nation's social, educational, research, and political institutions to function effectively and within this changing environment. Through these activities the program promotes greater awareness and use of the considerable pool of talent, experience, wisdom, and energy of the older population for the benefit of society as a whole.
SGI's mission is to promote the safety and functional independence of older people. Within the institute's divisions of research, training, and consultation, a number of research and applied programs in human factors and aging focus on ameliorating the difficulties older persons have in performing activities that are necessary to maintain independent living. For the past nine years, SGI has been evaluating the capabilities of older persons and the demands made by their environments. If the demands of the environment exceed the capabilities of the individual or pose a threat to the individual's safety, solutions are investigated and implemented to bring the environment more in line with capabilities of individuals.
The Technology Center for Independent Living was developed as an extension of this program. The center provides information on assistive devices and technologies, services, products, and the design of living environments that can enhance independent living for older persons living in the community. Its concerns are not only with the built environment and technically sophisticated applications for special populations, but also with simpler, more basic assistive devices that can be used by people who experience normal age-related decline in performance. The Technology Center has designed two exhibit apartments using specially engineered appliances and room designs, and displays of many assistive devices.
SGI staff work with architects and developers to design housing that is accessible to people with varying abilities. Woldenberg Village is an example of a recent project. Sponsored by the Woldenberg Foundation, a New Orleans-based charity, and developed by the Greater New Orleans Jewish Federation, the village for the well elderly is designed to be an application of many of the design principles developed by SGI and others. It was the institute's involvement in this project and others, such as retrofit senior housing and evaluations of furniture, fixtures, and devices, that prompted the following question: how can several professional disciplines, working together, overcome barriers to develop truly age-responsive living spaces and environments and work with housing currently available to seniors?
Both AARP and SGI reject the equation of age with disability and disability with loss of independence. In the case of aging and disability, a change in ability to perform certain activities should be addressed not by stigmatizing the individual but by finding a better solution in the living environment to support the individual's function.
The conference discussion, summarized here, resulted in several strong proposals centering around efficacy of existing regulations, professional constraints on interdisciplinary work, lack of funding, and conflicting perceptions of what constitutes good design or age-sensitive solutions. It provided a forum for people to define these issues as they saw them and to develop a shared commitment to work on solutions to problems. Although the beginnings of a dialogue were established at the conference, we believe they must be nurtured through a consistent attempt at interprofessional and lay professional communication.
After the conference concluded, both FES and SGI received many letters responding to the issues that were presented and discussed. For example, a very thoughtful response by Sylvia Sherwood and Terence G. Louis of the Hebrew Rehabilitation Center for the Aged attempted to deal with the question of overcoming building codes and related regulations that often inhibit homelike community alternatives. Sherwood and Louis proposed that principles developed in federal research guidelines for the protection of human rights could offer a potentially more viable solution. That proposal in itself is worthy of a conference and joint exploration.
Jake Pauls, a life safety specialist with Hughes Associates, Inc., called for architects and senior housing executives who see codes and standards as barriers to innovation to join in changing these codes and standards through participation at public hearings and committee meetings.
Ronald A. Priest of Gracefully Yours, a product design firm, cautioned against polarization of high-tech and low-tech devices and about the use of terms that allow a wide latitude of interpretation. In retrospect, there is clearly a need to focus on use of available technology, as well as on defining the state of the art in technology as it applies to design.
The conference attendees were challenged to explore not only the sophisticated "cost is no object" technologies but also design solutions which can be implemented and operated economically. We paraphrased John Rawls' Theory of Justice in which he defines a "just society" as one in which the most privileged would, if they had to, accept the conditions in which the least privileged actually live. In like manner, the participants were encouraged to help us find solutions which allow those who have difficulty meeting their own needs to live and function better.
Throughout the conference the economic realities of the "marketplace" or the constraints in public funds were mentioned as barriers to low-cost design innovation. Unfortunately, there were few attempts to address this challenge in the participation and discussion. It remains, thus, one of the problems to be addressed more explicitly in a future meeting. It is clear, however, that the consensus statements framed and summarized at the end of each unit reflect an awareness that designs for an aging population must be economically viable for the population and that technology innovation can reduce costs and increase progress for people of modest means.
Many more points and counterpoints were made in the conference discussions. They are captured in the articles and summaries contained in this monograph. We hope that they will live in the thoughts and activities of the conference attendees, and that they will form the basis for new working relationships among professionals of different disciplines whose combined talents can build better structures and tools for us as we age. Through joint endeavors, we can begin to use these ideas to make an impact in our communities.