Housing Design for an Increasingly Older PopulationRedefining Assisted Living for the Mentally and Physically Frail
“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 examp
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
VICTOR REGNIER, FAIA, is Professor of Architecture and Gerontology and ACSA Distinguished Professor in the School of Architecture at the University of Southern California. As a teacher, researcher, and architect, he has focused his academic and professional life on the design of housing and community settings for older people. He holds a joint professorship between the USC School of Architecture and the Leonard Davis School of Gerontology, and is the only person to have achieved fellowship status in both the American Institute of Architects and the Gerontological Society of America.
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.
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