The Importance of Architecture in Elder Care

Architecture and assisted living, memory care and nursing homes are woven together to create environments that allow elders to thrive until the very end.

The Top Architecture Design Features for the Future of Senior Care

Assisted living, residential care facilities, nursing homes and memory care facilities should serve to provide humanity to our frail elders. Residents in our facilities are able to thrive in an environment which weaves together their declining abilities and their need to maintain as much autonomy as possible.

When buildings are designed out of the context and abilities of our aging population, they instead serve as warehouses where elders serve their remaining days, waiting for the end. It is important to heed the wealth of research on creating environments that nurture and provide a safe place for elders to thrive using their remaining abilities.  Experts like Christopher Alexander support the notion that architecture and culture are inseparable, and need to be weaved together to obtain optimum livability.

By considering our residents and their abilities in our architecture designs, we are able to provide a much better understanding of the flow of our Oatfield Estates and Fanno Creek buildings. Our elders are in the end of their life, with many disabilities that diminish their ability to adapt to environments and cultures that are more fitting for a younger group. Our elders need buildings in assisted living, memory care and nursing homes which are cognizant of their concerns.

Scale – Small Groups emulate family

A building should scale to a senior’s declining abilities. As we age our ability to develop multiple friendships and relationships diminishes. When we are young we can feel comfortable with up to 150 friends on an ongoing basis. As we age, this number diminishes until we are limited to a small group. The size of this group drives the structure that we want to build. At Elite Care, we have decided to limit the building to 12 units. This architecture allows for an extended family to develop. 12 units require 10 support staff as well,  for a total of 22 people per house. This small size facilitates the development of a family unit that acts together and does not overwhelm any resident’s cognitive abilities.

Intent

In designing a building that encourages all residents regardless of cognitive decline to belong to a family unit the physical layout must be in alignment with that purpose. Long term memory determines the mental comfort of our residents. When trying to figure out a place for mom we need to take into consideration how she lived. Her long term memory will take over as she declines and her new environment needs to remind her of her past.

Kitchen

In any home, the kitchen becomes the heart. It is the room where we gather for meals and conversation. During a party, the kitchen is where people often end up. The primary room in our houses needs to be the kitchen. It needs to invoke the feelings of the past, which are etched deeply into our long-term memory.  Tapping into those long-term memories are an important part of caring for our residents with Alzheimer’s and dementia symptoms.

The kitchen has always been a safe place to be vulnerable.  We find when residents are able to feel safe and vulnerable, they are able to emerge from intense defensive shells. When seniors are unafraid of being embarrassed by their disabilities, they are able to more deeply participate in family activities. The Kitchen should look like the one they grew up with, not hidden away in an institutional setting. White appliances should be open and visible to everyone. An open, inviting cooking area extends the mealtime experience, letting the cues of the kitchen (food preparation, smells, commotion) guide the family meal. When a chef develops a relationship with the residents, they are respectful of the chefs working area and their presence becomes a major part of the family feel that develops. The chef becomes the “mother” of the household, directing meal time traffic but more importantly establishing that the food is cooked with love and care and should be eaten as a sign of respect. As we age our ability to taste and smell greatly diminishes and eating becomes a social and ritual event more than a caloric event. The more the chef becomes the mother of the house the greater the participation and respect the residents show for meals and their nourishment.

Family/Living Room

Our spacious floor plans contain living rooms which are large enough for the whole family to gather while remaining cozy and intimate. Furniture and design choices also let smaller groups form and find space. Groups frequently gather to visit, watch movies, paint nails, and a range of other activities you can find in any living room.

Laundry Area

In our family homes growing up, the laundry areas are generally available and frequently active. Laundry facilities in our homes are much the same. We believe a washer and dryer needs to be available and open to the residents as a signal that this is still a functioning home. Residents are free to use the laundry at will and as always, assistance can be provided when desired or necessary.

Hallways

The hallways in our  need to reflect a residential scale. Short and opening into a common area that is friendly and inviting. This area needs to be a central part of the house where it is likely that other friends/family members will be present to great them.

Dining Room

this needs to be connected and part of the kitchen so that the feeling of an extended family is every present. They have never eaten many meals in the dining room. Only special occasions so to eat separate from the kitchen is unfamiliar to them.

Efficiency

When we speak of efficiency we really are addressing the ability of a building to create a positive environment that meets the needs of the seniors. We talk about noise or distractions that minimizes the elder’s ability to thrive and to a large extent the environment of the building contributes to this ability. There are several areas that we need to look at.

Climate

is the building warm enough and has the right humidity. When we talk about warm enough we are really talking about The mean radiant temperature(MRT) is defined as the uniform temperature of an imaginary enclosure in which the radiant heat transfer from the human body is equal to the radiant heat transfer in the actual non-uniform enclosure. … It is simply the area weighted mean temperature of all the objects surrounding the body. This means that not only does the temperature has to be warm enough but the perceived temperature has to be right. Elders are very sensitive to surfaces that are radiating out temperatures. If the windows are not well insulated then the outside temperature will radiate to the residents and chill them to the bone. We suggest and use triple pane windows so that there is a comfort level even when close to the windows. Triple pane windows allow for the liberal use of windows to bring the outside in and greatly contribute to the natural feeling of the house. The walls need also to be well insulated and tight so that there is not a draft or chill created by building. By attending to details on the insulation and construction of the exterior shell we not only save energy but greatly contribute to the comfort of the residents. When the residents are not comfortable this greatly adds to their anxiety and stress that diminishes their ability to thrive.

Lighting

as we age our need for light increases we do not see as well and need increased light to avoid obstacles. By being able to control the level of lighting we add to the comfort of our elders. At night, we should be able to turn off the white light and allow for there to be a red light that does not wake up the resident. Most people do not realize the importance that light plays in setting the “body clock”, the circadian rhythmis a cycle that tells our bodies when to sleep, rise, eat–regulating many physiological processes. This internal body clock is affected by environmental cues, like sunlight and temperature. When one’s circadian rhythm is disrupted, sleeping and eating patterns can run amok. A growing body of research is examining the adverse health effects a disrupted circadian rhythm can have, like increasing the chances of cardiovascular events, obesity, and a correlation with neurological problems like depression and bipolar disorder. By having good bright lighting that follows the natural rhythm of the day our elders can have a more natural rhythm to their day.

Ventilation

the process or act of supplying a house or room continuously with fresh air. In today’s modern buildings we typically relay on a central HVAC unit that heats and then distributes air to all areas. This is both costly and unreliable. When the filters are not changed enough or there is a sickness in one area it quickly spreads to all areas. We have chosen to use operable windows in most places augmented by local heat pumps. We feel this is the healthiest way for Assisted living, memory care and nursing homes to keep their air fresh and the units smelling good.

Apartment

Regardless if a senior has dementia or Alzheimer their physical space needs to reflect their needs. Seniors or frail elders need the same personal space that we all need. A private bath, bedroom and small living room. These need to be compact so that they always have control of their environment regardless of their decline. If they can move into these spaces before their decline becomes to acute then they can maintain their control to the end of life. When thinking about a place for mom we need to consider all of the items that will make her life comfortable.

Top Ten Design Trends in Senior Living Facility Architecture

10 top design trends in senior living facilities by Bradford Perkins, FAIA, MRAIC, AICP discusses what we should look at when designing assisted living and memory care units.  At Elite Care, we used these trends as guidelines while designing our homes in Milwaukie, OR and Tigard, OR.

  1. Optimizing resident privacy and dignity
  2. Creating homelike settings
  3. Introducing hospitality design concepts
  4. Expanding individual choice
  5. Using technology to enhance senior living
  6. Filling in the continuum
  7. Taking the ‘R’ out of CCRC
  8. Expanding urban options
  9. Seeking more sustainable environments
  10. Capitalizing on globalization