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Housing Design for an Increasingly Older Population: Redefining Assisted Living for the Mentally and Physically Frail



Housing Design for an Increasingly Older Population: Redefining Assisted Living for the Mentally and Physically Frail

Victor Regnier

ISBN: 978-1-119-18003-6 September 2018 336 Pages


“Longer lifespans and the needs of the oldest old are challenging the senior living industry to find bold and compassionate solutions to combine programs and services with housing.  Victor Regnier's latest research provides a thoughtful and insightful roadmap that arrays new ways of thinking from small-scale settings to community based options.  International case studies offer possible solutions with the best thinking from around the globe…all with Vic's unique perspective of extracting themes and concepts that are broadly applicable and essential to addressing the needs of those that live on life's fragile edge.” —David Hoglund, FAIA

“Supporting the independence of the oldest-old is a tough problem Victor Regnier addresses in his latest book on aging and housing. Like previous work, Victor relies on the best practices of northern Europeans to outline a three-prong approach.  First, providing extremely comprehensive home care services in an "apartment for life" setting.  Second, reforming the conventional nursing home by exploring small group style accommodations.  Third, combining new technology with community based services to age in place.  Case studies document the experiences of others in making these programs work here and abroad.  The magnitude of the 90+ and 100+ population increases in the next 50 years make it clear how important it is to address this concern today.” —Edward Steinfeld Darch

“The movement of health care from the institution to the home is a theme that Regnier identifies as one of the most important lessons in rethinking the issue of how to support the ever growing and increasingly aged older population here and abroad.  He examines simple but profound approaches we can take in making long-term care a more humane proposition.  Familiar themes like humanizing technology and optimizing the impact of the natural environment are brought together with clear policy thinking about what we need to do. The timing is good because the impact of this growing segment of society will have major repercussions on health care for the next 50-70 years.” —Stephan Verderber, Ph.D.

A comprehensive guide to designing housing for the world’s aging population

The dilemma of helping older people maintain their independence through better housing with services is growing. This book presents innovative solutions for those who create and provide housing for the world’s increasingly longer-living population. By focusing on three specific housing and service arrangements, it offers alternatives that provide greater freedom of choice than the current living arrangements that exist today. It presents selected examples of housing and service solutions from the US, Sweden, Denmark and the Netherlands to stimulate thinking about the possibilities of community-based service models.

Housing Design for an Increasingly Older Population looks at a trio of options for housing the “oldest-old:” the Dutch Apartment/Condo for Life Model (AFL); decentralized Small/Green Houses; and the provision of enhanced personal and health care for people who want to stay in their own home. It offers unique and eye-opening chapters covering: what older people want; what age changes affect independence; demographics and living arrangements; how long-term care is defined; concepts and objectives for housing the frail; care giving and management practices that avoid an institutional lifestyle; innovative case studies; programs that encourage staying at home with service assistance; therapeutic use of outdoor spaces; how technology will help people stay independent; and more.

  • Based on the author’s numerous conversations with other experts, as well as his examinations of high quality settings from Northern Europe and the US
  • Building case study examples showcase innovative and compassionate solutions
  • In-depth coverage of three major systems that work
  • Examines successful programs such as PACE, Friendly Cities, NORC, and the “Village to Village Network” to demonstrate the progress made in helping older, frail people stay in their own homes for as long as possible

Housing Design for an Increasingly Older Population: Redefining Assisted Living for the Mentally and Physically Frail is an important book for those who create, design, and manage assisted living and skilled nursing facilities, as well as for those who set policies regarding health, and personal care for our world’s aging society.

Related Resources

Acknowledgments xix

Foreword xxiii

About the Companion Website xxxiii

1 What Do Older People Want? 1

What Possibilities Would Frail Older People Prefer in a Housing Solution? 1

How We Age Is Often Unpredictable 1

Strategy One: Stay in the House and See What Happens 2

Strategy Two: Plan the Move and Explore Other Scenarios 5

What Aspects of Housing and Services Best Serve the Older Frail? 9

Endnotes 10

2 What Are the Major Aging Changes that Affect Independence? 13

Changes in Sensory Modalities 13

Chronic Conditions and Disability that Limit Independence 17

Will Chronic Disease Continue to Decrease? 18

Endnotes 22

3 Demographics and Living Arrangements 25

Mortality and Fertility on the World Stage 25

Longevity Is a Primary Driver of Aging Population Growth 26

World Population Growth: 65+, 85+, 100+ 26

China Is the Most Rapidly Aging Country in the World 27

European Aging Experience: Been There, Done That 28

The Triple Whammy of the Aging of Japan: Longevity, Low Fertility, and Low In-migration 29

What About the Growth Rate of the 65+ and 85+ Population in the US? 29

The Centenarians and Near Centenarians: 100- and 90-Year-Olds in the US 31

Impacts of Demographic Growth 31

What Other Demographic Issues Will Affect the Future? 33

Endnotes 34

4 How Is Long-Term Care Defined? What Are the Choices? 37

What Are the Major LTC Alternatives? 37

Nursing Home Facts and Figures 38

What Are the Problems of Traditional Nursing Homes? 38

Will Green House© and Small House Models Replace Traditional Nursing Homes? 41

What Attributes Should We Strive to Include in New Nursing Homes? 42

How Do Assisted Living (AL) and Residential Care Settings Differ? 43

Assisted Living, Problem One: Care for More Dependent Residents 44

Assisted Living, Problem Two: Cost of Care and Lack of Reimbursement 44

How Do Assisted Living Residents Differ from Nursing Home Residents? 45

What Can We Learn from Hospice Models? 45

Home Care Through Family Members and Formal Sources 47

Reformulating Home Care to Work at the Margin of Need 48

Endnotes 50

5 Concepts and Objectives for Housing the Frail 53

First-Order Concepts 53

Second-Order Concepts 53

Environmental Docility Hypothesis 54

Endnotes 55

6 20 Design Ideas and Concepts that Can Make a Difference 57

The Neighborhood, Site Issues, and Outdoor Space 57

ONE: Defining a Good Accessible Site 57

TWO: Orientation to the Outdoors and the Natural World 58

THREE: Courtyards for Density, Views, and Social Exchange 60

FOUR: Interstitial Spaces on the Building’s Edge 60

FIVE: Atriums for Social Interaction and Exercise 62

Refining Design Attributes and Considerations 64

SIX: Making the Building Approachable, Friendly, and Noninstitutional 64

SEVEN: Create a Building that Is Accommodating and Adaptable 65

EIGHT: The Building Design Should Encourage Walking 66

NINE: Invite Natural Light 68

TEN: Embrace the Open Plan 69

ELEVEN: The Impact of Interior Design on the Senses 70

TWELVE: Special Considerations for Designing for Dementia 72

Stimulating Social Interaction 74

THIRTEEN: Places that Welcome Family and Friends 74

FOURTEEN: The 100% Corner or Community Table 76

FIFTEEN: Places for Unobtrusive Observation and Previewing 78

SIXTEEN: The Retreat 80

SEVENTEEN: The Primary Path 81

EIGHTEEN: Triangulation 82

Planning the Dwelling Unit 83

NINETEEN: Personalization that Makes the Unit Your Own 83

TWENTY: Dwelling Unit Design 85

Endnotes 88

7 12 Caregiving and Management Practices that Avoid an Institutional Lifestyle 91

Effective Caregiving Strategies 91

ONE: Accommodating Independence Through a Home Care Model 91

TWO: Primary, Secondary, and Designated Caregivers and the Computer 93

THREE: Activity of Daily Living (ADL) Therapy 94

FOUR: Maintain a Commitment to Serve the Surrounding Neighborhood 97

Full Participation in the Life of the Place 99

FIVE: Use It or Lose It 99

SIX: Commitment to Physical Therapy and Exercise 100

SEVEN: Clubs, Entertainment, and Purposeful Activity 101

EIGHT: The Dining Experience and Nutrition 101

Creating Affect and Joy 104

NINE: Encouraging Cheerfulness and Positive Affect 104

TEN: Avoid an Institutional Lifestyle 106

ELEVEN: Plants, Pets, Kids, and the Creative Arts 107

TWELVE: Treating the Staff with Respect and Dignity 109

Endnotes 110

8 21 Building Case Studies 111

European History of Home-care Serviced Buildings 111

Service House Model Emerges 112

AFLs, Humanitas Style 113

The Continuing Care Retirement Community (CCRC) or Life Plan Community (LPC): A US Invention 118

CS ONE: Humanitas Bergweg, Rotterdam, the Netherlands 120

CS TWO: Rundgraafpark, Veldhoven, the Netherlands 125

CS THREE: La Valance, Maastricht, the Netherlands 129

CS FOUR: Neptuna, Malmö, Sweden 134

CS FIVE: De Plussenburgh, Rotterdam, the Netherlands 138

CS SIX: De Kristal (Crystal), Rotterdam, the Netherlands 144

CS SEVEN: Woodlands Condo for Life Prototype, Woodlands, Texas 146

CS EIGHT: NewBridge on the Charles, Dedham, Massachusetts 151

Small Group Living Cluster Case Studies 157

CS NINE: Mount San Antonio Gardens Green House©, Claremont, California 161

CS TEN: Leonard Florence Center for Living, Chelsea, Massachusetts 165

CS ELEVEN: The New Jewish Lifecare Manhattan Living Center, Manhattan, New York 170

CS TWELVE: Hogeweyk Dementia Village, Weesp, the Netherlands 175

CS THIRTEEN: Ærtebjerghaven, Odense, Denmark 184

CS FOURTEEN: Herluf Trolle, Odense, Denmark 190

Smaller-scale Assisted Living Buildings (25 to 40 Units) and Other Options 195

CS FIFTEEN: Vigs Ängar Assisted Living, Köpingebro, Sweden 195

CS SIXTEEN: Ulrika Eleonora Service House, Louviisa, Finland 201

CS SEVENTEEN: Irismarken Nursing Center, Virum, Denmark 205

CS EIGHTEEN: Sunrise of Beverly Hills Dementia Cluster, Beverly Hills, California 210

CS NINETEEN: Egebakken Co-Housing, Nobedo, Denmark 214

CS TWENTY: Willson Hospice, Albany, Georgia 219

CS TWENTY-ONE: Musholm Bugt Feriecenter, Korsør, Denmark 223

Endnotes 227

9 Programs that Encourage Staying at Home with Service Assistance 229

One: Home Modification Programs 229

Two: Danish Home Care System 232

Three: PACE (Program for All-inclusive Care for the Elderly) 235

Four: Home– and Community–Based Care: The 1915c and 1115 Waiver Programs and Long-term Care Insurance 238

Five: Beacon Hill Village (BHV) 240

Six: Age-Friendly Cities 243

Seven: Accessory Dwelling Units (ADU) 245

Eight: GenSmart House and Next Gen House 247

Nine: Naturally Occurring Retirement Communities (NORC’s) 249

Endnotes 251

10 Therapeutic Use of Outdoor Spaces and Plant Materials 253

How Does the Landscape Make a Difference? 253

Biophilia 253

Physical Health Benefits 254

Mental Health Benefits 255

Design Considerations for Gardens and Outdoor Spaces 256

Dementia Gardens 260

European Atrium Buildings 261

Endnotes 265

11 How Will Technology Help People Stay Independent and Avoid Institutionalization? 267

Transportation Is a Major Barrier Today 267

Internet Service Utilization 268

Home-Delivered Services 269

Driverless Cars 271

Social Robots 271

Functional Electro-mechanical Robots 273

Transfer and Lifting Devices 274

Exoskeletons 275

Protective Clothing 276

Scooters (Personal Operating Vehicles) and Mobility Aides 276

Virtual Reality 277

Replaceable Body Parts 278

DNA-based Medicines and Therapies 278

Endnotes 279

12 Primary Themes, Takeaways, and Conclusions 281

The US and the World Will Experience a Much Older Population 281

Home Care Models and Integrated Health Care Models Are Needed 281

Assisted Living (AL) Is a Viable Alternative but Comes with Restrictions in the US 282

The Apartment for Life (AFL) Model Provides Personal and Medical Care in Independent Housing 282

Small Group Housing Clusters for the Extremely Mentally and Physically Frail Is Likely to Continue, Even with Other Options Available 283

Most Existing US Nursing Homes Are of Poor Quality and Need to Be Phased Out or Upgraded 283

How Can We Help Those with Dementia Live a More Satisfying and Meaningful Life? 284

Baby Boomers Have High Expectations for Quality Long-term Care Services but Lack the Means to Purchase Them 285

Supporting Friendships and Increasing Affect Make Places to Live Happier 285

How Will Advances in Technology Make a Difference? 286

An Emphasis on Exercise and Connections to Outdoor Spaces 286

More Comprehensive Approaches at the City and Neighborhood Scale 287

Conclusions 287

Index 289