Barbara L. Geddis, A.I.A.
Perkins, Geddis, Eastman, Architects and Planners
Universal design principles are being sought, I contribute only an exceedingly short list. I have devoted much of my 17-year career as an architect and planner to creating compassionate and exemplary settings for the aging population. Along the way, I have learned and unlearned many current standards, complied with and critiqued various codes, and accumulated a few biases. The state of the art in design for older people mandates an eclectic approach; an openness to what is happening in other fields of research and design; and a commitment to changing preconceived notions, current standards, and, ultimately, the codes themselves.
One interesting trend in retirement housing is the increasingly popular residential unit with a double master bedroom that is two equally generous separate bedrooms with private baths. The market data seem to suggest that a wide variety of retired persons enjoy this unit: happily married couples who nonetheless want their own domain; other relatives who are roommates (e.g., sisters, sister and brother, mother and daughters); or simply friends who wish to share a unit for economic and/or social reasons and still maintain personal territory. In essence, such an arrangement offers the freedom to choose privacy or community, solitude or friendship. It has been common in college dormitory housing trends for some time. Even hotel design has added the "parlor suite" concept: a private sleeping area and a front entertainment or work space.
Universal means "applying to all"; for my purposes here, this means all settings for the aging and/or all aging persons, whether in a house, home, unit, or institution. The strong, simultaneous trends noted above should alert the design and research professions that such a concept can be widely applied across the continuum of settings for older persons. However, the one fundamental principle privacy-has received little serious attention, particularly in more confined settings.
This paper describes the often thwarted quest for privacy in heavily regulated designed settings for the aging and offers some avenues for future exploration.
The Basic Premises
Specialized housing and caring settings for older persons often defy and intrude upon privacy, inhibit independence, discourage self-reliance, restrict freedom, and offer few opportunities for contemplation, voluntary solitude, or intimacy, for that matter. All these values make direct physical demands on program and architectural design, and all in turn can be directly enhanced by different design.
At the heart of this issue are a few premises about our values:
How then can these values be incorporated into housing for older people? What are the obstacles to be overcome? And what are the precedents for reminding us that, after all, the common unit of privacy is the place where people live, whether it be a house, an apartment, a simple bedroom, or, as poet Robert Browning put it, "privacy, an obscure nook just for me"?.
In evaluating the practice of designing the long-term care setting for the decades ahead, it is useful to review the status of private spaces throughout history, note the ruling criteria today, and suggest enlightened criteria for tomorrow.
To begin with, it is important to review the historical evolution of privacy in house design over the centuries. Even in A.D. 100, Vitruvius, the Roman architect and engineer, made the following distinction:
Private rooms are those into which nobody has the right to enter without an invitation, such as bedrooms, dining rooms, bathrooms. . . . The common are those which any of the people have a perfect right to enter, even with out an invitation, that is entrance courts, etc.
But the concept was lost for centuries as the bustling, all-purpose rooms of the Middle Ages evolved. Only later, as belief in the values of individualism and domesticity began to develop toward the end of the eighteenth century and especially at the beginning of the nineteenth century did the notion of privacy reawaken. In households of the nobility, privacy was recognized in sleeping, eating, religious, and social rituals. The large, all-purpose rooms linked by interconnecting doors gave way to small, single-purpose rooms, especially in Northern Europe. In addition, as the population became better educated and reading became more valued, places in the house to enjoy more introspective activities evolved.
By the end of the late nineteenth century, with the Victorians' penchant for privacy, the separation of spaces became extreme. Family and servants lived on separate floor levels and had separate staircases; children were separated from parents; and an odd assortment of function rooms appeared: foyers, parlors, nannies' rooms, ballrooms, breakfast nooks, libraries, etc. Every aspect of domestic and social existence was compartmentalized. In effect, an implied morality and class separation guided the layout of house design, with clear delineations of public and private domain.
Although the perception of public vs. private space varies significantly from culture to culture, the threshold where private space ends and public space begins must still be acknowledged in design (see Figure 2). One of the inherited burdens in designing living environments for the aging population today is the lack of these clear ground rules of residential design of the past. Instead, the architectural antecedents for both the modem long-term care center and the congregate housing complex derive from three strongly intertwined building types: hospitals, prisons, and hotels, all of which have little to do with residential households. Supervision was their overriding goal, and only in the twentieth century have these buildings evolved to provide for any semblance of privacy.
It is interesting to note that the basic shape of the floor plans of many modem nursing homes-a center point from which one can view all corridors derives directly from the hospital and radial plans of the seventeenth and eighteenth centuries. Today, the nurses' station is at this center. Historically, altars and chapels were at the center, and later, given the high mortality rate, central domes for ventilation and removing used air were constructed. Innovation in design of future settings for older people requires a reconsideration of that center of the universe: at the center should be the person who has to make a home there.
If you live in fear that your own senses may fail, you may not want absolute privacy. But privacy as defined herein does not mean aloneness or isolation or withdrawal. It simply means everyone's right to have whatever level of visual, acoustic, and psychological separation we all occasionally require. And the old saying that good fences can make good neighbors might well apply.
The quest for privacy may mean questioning published space standards enforced by the state's departments of health, social services, or housing. It may mean redefining the physical limits of care and custody. Ultimately, it will also include observing and talking with the residents about their concerns.
We have spent days, months, and years discussing, planning, designing, and building with the idea that an individual's right to privacy is a fundamental one.
As such, it is not to be relinquished at the entrance to a nursing home just because health and/or safety issues have emerged. What follows are some of the most common reservations various sponsors hold about the cost of redesigning to support the quest for privacy, and our answers to these concerns:
In the design of a nursing home, a half-dozen criteria are usually paramount, not one of which is privacy:
Other, more recent requirements imply, if not directly discuss, privacy and self-reliance:
In addition, for cost containment purposes, some jurisdictions have imposed not only minimum space standards but also maximum space standards per bed capacity. These numbers, which may be in the 400- to 500-gross-square-feet/bed range, are supposed to include all support space, infrastructure, recreation, therapy, maintenance, and administration. More than any other working criteria, these maximum standards nearly negate any appropriate private space for the residents. In fact, coupled with accessibility standards, such requirements are contradictory and puzzling. In effect, there is very little to design and plan. The ground rules, enforced by law, are prescriptive.
A few examples will illustrate how such rules can sometimes defy good practice and common sense.
A concerted emphasis on providing privacy and promoting self-reliance as essential ingredients to a resident's quality of life might alter these outcomes as follows:
"The man who goes alone can start today, but he who travels with another must wait until the other is ready."
In our view, to pursue defining what the richest, most varied, and most fining settings are for older persons, changes in many of our current practices are necessary: