My parents are old—my father will be 93 next month and my mother turns 92 in June—and the time has come for them to sacrifice their independence. My father’s increasing frailty is the tipping point. He has been my mother’s primary caregiver (she has suffered from progressive dementia for several years) but his own infirmities and incipient cognitive decline have convinced him it’s in his and my mother’s best interest for the two of them to transition to life in an assisted living facility.
He has stubbornly resisted this day and its inevitability for as long as possible. It’s not because my parents haven’t already accepted change in their lives. They moved about a decade ago from their large house in Vancouver, B.C. to the small apartment they live in now. My father forfeited his driver’s license shortly after that move, and with it a significant measure of mobility and personal freedom. My siblings have provided them with the considerable assistance they need, including driving them to medical appointments, running errands, grocery shopping, keeping their apartment clean, and more (I owe them so much gratitude for all they do). What my father hasn’t accepted until now is relinquishing the last vestiges of personal control and freedom he still enjoyed.
My family is in the process of identifying where and what living arrangement will be best for my parents. Because I’m an architect, I naturally think about the characteristics and quality of the setting they will move to and most likely spend their remaining years. I want my mother and father to be comfortable, cared for, and able to enjoy life as much as they can.
Assisted living facilities are a choice for seniors like my parents who are no longer capable of living alone. They typically emphasize providing familiar, comfortable, homelike settings for their residents. They help with daily living activities (bathing, dressing eating, toileting, etc.), provide central dining programs, include emergency call systems in private and common areas, assist with or provide local transportation arrangements, and offer organized educational, recreational, and exercise activities. Most assisted living facilities also contract with skilled nursing care and hospice providers. The quality of care and the residential environments vary considerably from facility to facility. A trait common to many of the best assisted living communities is a superior level of design.
The biggest difference between assisted living communities and nursing homes is the extent of medical services provided. Nursing home residents require around-the-clock skilled medical care and monitoring. The trend in nursing home design over the past couple decades has been away from hospital-like facilities toward resident-centered household models. In addition to meeting the needs of the patients rather than those of the institution, the designs of nursing homes increasingly focus upon providing a high quality of living and downplay an overly sterile or institutional appearance. In this respect, the design of assisted living facilities and nursing homes is converging.
While Robertson/Sherwood/Architects cannot claim a large portfolio of residential-care projects for the elderly, I did serve as the project manager and principal designer for a new “protective care unit” serving Alzheimer’s and dementia patients at the Veterans Affairs MedicalCenter in Roseburg, Oregon. In keeping with the shift toward homelike environments, the VA’s charge to my office was to focus our programming and design efforts on the quality of life to be provided to the patients rather than upon achieving machine-like efficiency and maximum staff convenience. Accordingly, our design manifests the transition toward a resident-centered model of care. Despite their afflictions, we employed strategies intended to increase the residents’ autonomy and sense of control. These comprised designing quiet, smaller spaces (even for group settings), including abundant daylight and orienting views to the surroundings, selecting comforting colors and finishes, and providing easy and supportive wayfinding.
The bottom line is design can make a difference in the quality of life residents enjoy. Accordingly, architects have a huge role to play in ensuring the well-being of the most elderly and vulnerable within the communities we serve. As our population increasingly ages, the need for supportive, healthful options for housing seniors who require ongoing help with living is becoming correspondingly acute. Furthermore, the elevated susceptibility of older people to COVID-19 has heightened the need for design adaptations that ensure the comfort and safety of residents. I expect architects will develop strategies for safely connecting residents and maintaining healthful bonds with prospective visitors, family, and friends. Future assisted living facilities and nursing homes will incorporate means to mitigate the loneliness and isolation of the types wrought by the current pandemic.
Despite the best efforts of everyone involved in the design of long-term care facilities, the bottom line is the residents are effectively prisoners of circumstances beyond their entire control. They are, in many respects, disconnected from the greater community. My fear is my father will feel isolated and marginalized, regardless of where he and my mother land. Good architecture can alleviate anxiety and increase comfort, but it can only do so much to overcome the loss of autonomy and dignity that frequently accompanies the ravages of advanced age, and good architecture cannot stand in for the supportive attention and respect only family, friends, and caregivers can provide.
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