Life-Span Design of Residential Environments for an Aging Population

PLENARY ROUNDTABLE I: ARCHITECTURE AND DESIGN

OVERVIEW

The conference on Life-Span Design of Residential Environments for an Aging Population began with the heart of the design process-structure and concept. Conference participants asked themselves: What are the critical issues facing architects in designing housing for the elderly, particularly congregate and long-term care housing?

Two papers dealt with the structural and theoretical design considerations that need to be addressed. After the presentations, conference participants discussed and recommended ways to eliminate barriers to good design for elderly housing. These included updating housing codes, encouraging research, educating the public, and improving the design process and the spread of information on design innovations.

Victor Regnier led off with a discussion of "Design Principles and Research Issues in Housing for the Elderly" based on his paper of that title (this volume). Mr. Regnier is with the University of Southern California's School of Architecture and Andrus Gerontology Center in Los Angeles, California.

He was followed by Brad Perkins, who presented a paper by Barbara Geddis, "The Quest for Privacy in the Design of Living Environments for the Aging" (this volume). Mr. Perkins and Ms. Geddis are with Perkins, Geddis, Eastman, an architectural firm in New York City.

PRESENTATIONS

Design Principles and Research Issues in Housing for the Elderly
(V. Regnier)

This paper begins with the background of design guidelines and theory-based research in housing for older persons. Regnier concludes that existing guidelines all suffer from the same weakness: little or no conceptual or theoretical foundation.

In response, Regnier offers 12 principles of design that he believes could be valuable to both theorists and practitioners in creating housing for older people. These principles include housing designs and locations that support:

personal privacy
social interaction
personal control and autonomy
"orientation" and "wayfinding" (assistance in knowing where one is and finding one's way inside the home)
safety and security
accessibility (to needed services) and "functioning" (maintaining or improving personal independence)
stimulation and challenge
sensory assistance (when needed)
familiarity
good aesthetics and appearance
self-expression or personalization, and
adaptable or flexible environments.

The Quest for Privacy in the Design of Living Environments for the Aging
(B. Geddis and B. Peikins)

This presentation centers on an issue of particular importance to older people living in group or institutional settings-privacy. An individual's right to privacy is a fundamental right, Geddis says in her paper, "not to be relinquished at the entrance to the nursing home."

Geddis contends that most specialized housing and care settings for the elderly have been modeled on hospitals, prisons, and hotels and have been designed for the most efficient staff supervision and care. These designs "often defy and intrude upon privacy, inhibit independence, discourage self-reliance, [and] restrict freedom," she says.

Other factors that discourage planning for privacy space, Geddis says, are 1) state and federal codes and regulations that fail to recognize the differing needs of nursing home residents, and 2) concerns about increased costs of planning for privacy without a corresponding increase in reimbursement formulas.

The paper concludes with a challenge to architects to take a more active role and assert their views when facilities are being planned and designed. Her recommendations include:

centering space planning around the individual resident rather than the staff,
raising privacy to the same level of importance as group living and supervisory concerns
opposing and changing codes and standards
and getting away from traditional institutional room layout designs by borrowing designs from hotels, college dormitories, and private residences.

DISCUSSION

The issues raised in the discussion highlighted a major public policy dilemma: How can a facility create a homelike or individual atmosphere at a reasonable cost while still ensuring safety and high quality care?

Discussants explored ideas of:

flexible design features that could be easily reconfigured to accommodate changes in capability that occur when people age in place.
extensive planning up front: bringing owners, funders, and clients into the design and decision process at the beginning and at every step along the way.
consultation with older persons -- not just healthy, active older adults but also frail nursing home residents.

In addition, discussants examined ways to improve safety and building codes. They concluded:

current codes and standards are inflexible and fail to take into consideration the varying levels of ability of long-term care residents.
safety codes are dominated by a concern for fire safety and often overlook other safety, security, and aesthetics concerns
architects should work with code and standards boards to change bad regulations and strengthen good ones, and should become more involved on a local level; and
a clearinghouse could be established to gather information about exceptions to codes that have been successfully implemented in some parts of the country.

Further discussion focused on 1) the need to turn successful innovations in case management and service delivery into models for design, policy, procedures, and codes; and 2) the need to study the effect of different living environments on residents without disturbing their privacy.

RECOMMENDATIONS

Participants formulated a set of recommendations to serve as guidelines for research and design and to stimulate ideas about what is worth pursuing. These recommendations can be divided into two categories:

improving the design process, and
improving and encouraging design research and information dissemination.

Improving the Design Process

Establish a national code committee to share information, challenge inappropriate codes, and influence the development of new codes and standards.
increase the involvement of older persons in the design process.
Move elderly-housing design away from a medical model and move long-term care facilities away from an institutional model.

Improving Research and Information Dissemination

Create a national clearinghouse of design information dealing with materials and devices.
Develop inexpensive products and ideas that work and that produce the greatest cost/benefit result.
Establish an experimental institute that will bring together people from different disciplines who have expertise and interest in elderly housing to share information and to work collaboratively on projects.

CONCLUSION

Housing design for the elderly has recently begun moving away from hospital-like designs that limit individual privacy due to a focus on staff supervision. However, much still needs to be done to provide shelter that is resident-centered, safe, and attractive -- housing that affords privacy and enhances independence.

Designers and residents of housing for the elderly should not be discouraged by what remains to be done. Current designs, codes, public attitudes, and research information can all be improved. The effort will take considerable cooperation and activism from the groups with a stake in the outcome: policymakers, health care providers, social service workers, patients, designers, builders, financiers, and community residents.

Only through this type of cooperative effort it be possible to improve the lives of elderly residents of nursing homes and other long-term care settings that have had to design their facilities around the needs and wants of the clients.

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