<p>Acknowledgments xix</p> <p>Foreword xxiii</p> <p>About the Companion Website xxxiii</p> <p><b>1 What Do Older People Want? 1</b></p> <p>What Possibilities Would Frail Older People Prefer in a Housing Solution? 1</p> <p>How We Age Is Often Unpredictable 1</p> <p>Strategy One: Stay in the House and See What Happens 2</p> <p>Strategy Two: Plan the Move and Explore Other Scenarios 5</p> <p>What Aspects of Housing and Services Best Serve the Older Frail? 9</p> <p>Endnotes 10</p> <p><b>2 What Are the Major Aging Changes that Affect Independence? 13</b></p> <p>Changes in Sensory Modalities 13</p> <p>Chronic Conditions and Disability that Limit Independence 17</p> <p>Will Chronic Disease Continue to Decrease? 18</p> <p>Endnotes 22</p> <p><b>3 Demographics and Living Arrangements 25</b></p> <p>Mortality and Fertility on the World Stage 25</p> <p>Longevity Is a Primary Driver of Aging Population Growth 26</p> <p>World Population Growth: 65+, 85+, 100+ 26</p> <p>China Is the Most Rapidly Aging Country in the World 27</p> <p>European Aging Experience: Been There, Done That 28</p> <p>The Triple Whammy of the Aging of Japan: Longevity, Low Fertility, and Low In-migration 29</p> <p>What About the Growth Rate of the 65+ and 85+ Population in the US? 29</p> <p>The Centenarians and Near Centenarians: 100- and 90-Year-Olds in the US 31</p> <p>Impacts of Demographic Growth 31</p> <p>What Other Demographic Issues Will Affect the Future? 33</p> <p>Endnotes 34</p> <p><b>4 How Is Long-Term Care Defined? What Are the Choices? 37</b></p> <p>What Are the Major LTC Alternatives? 37</p> <p>Nursing Home Facts and Figures 38</p> <p>What Are the Problems of Traditional Nursing Homes? 38</p> <p>Will Green House© and Small House Models Replace Traditional Nursing Homes? 41</p> <p>What Attributes Should We Strive to Include in New Nursing Homes? 42</p> <p>How Do Assisted Living (AL) and Residential Care Settings Differ? 43</p> <p>Assisted Living, Problem One: Care for More Dependent Residents 44</p> <p>Assisted Living, Problem Two: Cost of Care and Lack of Reimbursement 44</p> <p>How Do Assisted Living Residents Differ from Nursing Home Residents? 45</p> <p>What Can We Learn from Hospice Models? 45</p> <p>Home Care Through Family Members and Formal Sources 47</p> <p>Reformulating Home Care to Work at the Margin of Need 48</p> <p>Endnotes 50</p> <p><b>5 Concepts and Objectives for Housing the Frail 53</b></p> <p>First-Order Concepts 53</p> <p>Second-Order Concepts 53</p> <p>Environmental Docility Hypothesis 54</p> <p>Endnotes 55</p> <p><b>6 20 Design Ideas and Concepts that Can Make a Difference 57</b></p> <p>The Neighborhood, Site Issues, and Outdoor Space 57</p> <p>ONE: Defining a Good Accessible Site 57</p> <p>TWO: Orientation to the Outdoors and the Natural World 58</p> <p>THREE: Courtyards for Density, Views, and Social Exchange 60</p> <p>FOUR: Interstitial Spaces on the Building’s Edge 60</p> <p>FIVE: Atriums for Social Interaction and Exercise 62</p> <p>Refining Design Attributes and Considerations 64</p> <p>SIX: Making the Building Approachable, Friendly, and Noninstitutional 64</p> <p>SEVEN: Create a Building that Is Accommodating and Adaptable 65</p> <p>EIGHT: The Building Design Should Encourage Walking 66</p> <p>NINE: Invite Natural Light 68</p> <p>TEN: Embrace the Open Plan 69</p> <p>ELEVEN: The Impact of Interior Design on the Senses 70</p> <p>TWELVE: Special Considerations for Designing for Dementia 72</p> <p>Stimulating Social Interaction 74</p> <p>THIRTEEN: Places that Welcome Family and Friends 74</p> <p>FOURTEEN: The 100% Corner or Community Table 76</p> <p>FIFTEEN: Places for Unobtrusive Observation and Previewing 78</p> <p>SIXTEEN: The Retreat 80</p> <p>SEVENTEEN: The Primary Path 81</p> <p>EIGHTEEN: Triangulation 82</p> <p>Planning the Dwelling Unit 83</p> <p>NINETEEN: Personalization that Makes the Unit Your Own 83</p> <p>TWENTY: Dwelling Unit Design 85</p> <p>Endnotes 88</p> <p><b>7 12 Caregiving and Management Practices that Avoid an Institutional Lifestyle 91</b></p> <p>Effective Caregiving Strategies 91</p> <p>ONE: Accommodating Independence Through a Home Care Model 91</p> <p>TWO: Primary, Secondary, and Designated Caregivers and the Computer 93</p> <p>THREE: Activity of Daily Living (ADL) Therapy 94</p> <p>FOUR: Maintain a Commitment to Serve the Surrounding Neighborhood 97</p> <p>Full Participation in the Life of the Place 99</p> <p>FIVE: Use It or Lose It 99</p> <p>SIX: Commitment to Physical Therapy and Exercise 100</p> <p>SEVEN: Clubs, Entertainment, and Purposeful Activity 101</p> <p>EIGHT: The Dining Experience and Nutrition 101</p> <p>Creating Affect and Joy 104</p> <p>NINE: Encouraging Cheerfulness and Positive Affect 104</p> <p>TEN: Avoid an Institutional Lifestyle 106</p> <p>ELEVEN: Plants, Pets, Kids, and the Creative Arts 107</p> <p>TWELVE: Treating the Staff with Respect and Dignity 109</p> <p>Endnotes 110</p> <p><b>8 21 Building Case Studies 111</b></p> <p>European History of Home-care Serviced Buildings 111</p> <p>Service House Model Emerges 112</p> <p>AFLs, Humanitas Style 113</p> <p>The Continuing Care Retirement Community (CCRC) or Life Plan Community (LPC): A US Invention 118</p> <p>CS ONE: Humanitas Bergweg, Rotterdam, the Netherlands 120</p> <p>CS TWO: Rundgraafpark, Veldhoven, the Netherlands 125</p> <p>CS THREE: La Valance, Maastricht, the Netherlands 129</p> <p>CS FOUR: Neptuna, Malmö, Sweden 134</p> <p>CS FIVE: De Plussenburgh, Rotterdam, the Netherlands 138</p> <p>CS SIX: De Kristal (Crystal), Rotterdam, the Netherlands 144</p> <p>CS SEVEN: Woodlands Condo for Life Prototype, Woodlands, Texas 146</p> <p>CS EIGHT: NewBridge on the Charles, Dedham, Massachusetts 151</p> <p>Small Group Living Cluster Case Studies 157</p> <p>CS NINE: Mount San Antonio Gardens Green House©, Claremont, California 161</p> <p>CS TEN: Leonard Florence Center for Living, Chelsea, Massachusetts 165</p> <p>CS ELEVEN: The New Jewish Lifecare Manhattan Living Center, Manhattan, New York 170</p> <p>CS TWELVE: Hogeweyk Dementia Village, Weesp, the Netherlands 175</p> <p>CS THIRTEEN: Ærtebjerghaven, Odense, Denmark 184</p> <p>CS FOURTEEN: Herluf Trolle, Odense, Denmark 190</p> <p>Smaller-scale Assisted Living Buildings (25 to 40 Units) and Other Options 195</p> <p>CS FIFTEEN: Vigs Ängar Assisted Living, Köpingebro, Sweden 195</p> <p>CS SIXTEEN: Ulrika Eleonora Service House, Louviisa, Finland 201</p> <p>CS SEVENTEEN: Irismarken Nursing Center, Virum, Denmark 205</p> <p>CS EIGHTEEN: Sunrise of Beverly Hills Dementia Cluster, Beverly Hills, California 210</p> <p>CS NINETEEN: Egebakken Co-Housing, Nobedo, Denmark 214</p> <p>CS TWENTY: Willson Hospice, Albany, Georgia 219</p> <p>CS TWENTY-ONE: Musholm Bugt Feriecenter, Korsør, Denmark 223</p> <p>Endnotes 227</p> <p><b>9 Programs that Encourage Staying at Home with Service Assistance 229</b></p> <p>One: Home Modification Programs 229</p> <p>Two: Danish Home Care System 232</p> <p>Three: PACE (Program for All-inclusive Care for the Elderly) 235</p> <p>Four: Home– and Community–Based Care: The 1915c and 1115 Waiver Programs and Long-term Care Insurance 238</p> <p>Five: Beacon Hill Village (BHV) 240</p> <p>Six: Age-Friendly Cities 243</p> <p>Seven: Accessory Dwelling Units (ADU) 245</p> <p>Eight: GenSmart House and Next Gen House 247</p> <p>Nine: Naturally Occurring Retirement Communities (NORC’s) 249</p> <p>Endnotes 251</p> <p><b>10 Therapeutic Use of Outdoor Spaces and Plant Materials 253</b></p> <p>How Does the Landscape Make a Difference? 253</p> <p>Biophilia 253</p> <p>Physical Health Benefits 254</p> <p>Mental Health Benefits 255</p> <p>Design Considerations for Gardens and Outdoor Spaces 256</p> <p>Dementia Gardens 260</p> <p>European Atrium Buildings 261</p> <p>Endnotes 265</p> <p><b>11 How Will Technology Help People Stay Independent and Avoid Institutionalization? 267</b></p> <p>Transportation Is a Major Barrier Today 267</p> <p>Internet Service Utilization 268</p> <p>Home-Delivered Services 269</p> <p>Driverless Cars 271</p> <p>Social Robots 271</p> <p>Functional Electro-mechanical Robots 273</p> <p>Transfer and Lifting Devices 274</p> <p>Exoskeletons 275</p> <p>Protective Clothing 276</p> <p>Scooters (Personal Operating Vehicles) and Mobility Aides 276</p> <p>Virtual Reality 277</p> <p>Replaceable Body Parts 278</p> <p>DNA-based Medicines and Therapies 278</p> <p>Endnotes 279</p> <p><b>12 Primary Themes, Takeaways, and Conclusions 281</b></p> <p>The US and the World Will Experience a Much Older Population 281</p> <p>Home Care Models and Integrated Health Care Models Are Needed 281</p> <p>Assisted Living (AL) Is a Viable Alternative but Comes with Restrictions in the US 282</p> <p>The Apartment for Life (AFL) Model Provides Personal and Medical Care in Independent Housing 282</p> <p>Small Group Housing Clusters for the Extremely Mentally and Physically Frail Is Likely to Continue, Even with Other Options Available 283</p> <p>Most Existing US Nursing Homes Are of Poor Quality and Need to Be Phased Out or Upgraded 283</p> <p>How Can We Help Those with Dementia Live a More Satisfying and Meaningful Life? 284</p> <p>Baby Boomers Have High Expectations for Quality Long-term Care Services but Lack the Means to Purchase Them 285</p> <p>Supporting Friendships and Increasing Affect Make Places to Live Happier 285</p> <p>How Will Advances in Technology Make a Difference? 286</p> <p>An Emphasis on Exercise and Connections to Outdoor Spaces 286</p> <p>More Comprehensive Approaches at the City and Neighborhood Scale 287</p> <p>Conclusions 287</p> <p>Index 289</p>