Designing in autonomy

If we start to put elderly people’s needs as individuals first and address their physical and cognitive challenges as secondary issues, we can design care homes as places to thrive in our advanced years, rather than accepting inevitable decline.

They should be places that allow not only freedom of movement within the resident’s private space, but also within the whole development, and ideally within a wider, elder-friendly and dementia-friendly community.

Case study - Providence Health Care

This major project in Vancouver accommodates 320 residents with dementia in houses of up 10 people.

Each resident has his or her own studio apartment within the communal house, but the entrance hallway to each property incorporates a kitchenette with cabinets for their personal plates and cups, enabling them to prepare a light meal or host guests.

Down the hall is the communal household with a living/dining area and kitchen, which enables residents to engage with the day-to-day routine of preparing, cooking, eating and clearing up.

This restores one of the central activities of ‘normal life’ and is much more life-affirming than being served up food that has been prepared anonymously and out of sight.

Core design principles

• Connecting to the outdoors & other people.
  The wider development incorporates autonomous routes, with almost all circulation entirely outdoors through courtyards and covered walkways.
  
  This embeds connection with the outdoors into the design, helping residents engage with the world on a sensory level. It also encourages human interaction.
  
  Encouraging active contact with the outdoors should be a core design principle of residential care but not all residents can be involved in outdoor activities.  
  
  
• Visual permeability
  A frontage with views onto the external areas of the care home environment and wider community is paramount, including from individual residents’ rooms, communal areas and circulation areas. 
  
  Conversely, views into the care home from outside the development promote a much more caring and nurturing relationship with the whole community.
  
  Visual permeability provides natural surveillance too – the antithesis of the electronic tracking devices or monitors.

Pioneering multi-generational interaction

Care home residents sadly cease to be part of a diverse community of mixed generations. Opportunities for multi-generational interaction can be rewarding for all parties. And numerous projects have pioneered this idea.

Stantec uses ‘space syntax’ analysis to configure personal, communal and circulation spaces in a way that is naturally interactive. With this approach, interaction and active choice become natural consequences of the building’ layout.

Where there is potential to extend this interaction to the wider community and a more-diverse age demographic, these spatial principles can be extended to embrace the existing veins of movement within the local area.

‘Taking the bubble wrap off residents’

This natural surveillance approach can be complemented with technology.

For example, a Stantec client in Vancouver is currently testing a wristband-based technology that signals the care home if a resident goes beyond a GPS ‘virtual fence’, which can be set around parameters relevant to the individual resident.

A model project

While UK care home operators do not currently build on the scale of this Vancouver project, there is much to learn from such progressive, compassionate, and person-centred care homes.

Our recent designs help providers move away from a medical model. They highlight the quality of life benefits of larger-scale care homes that are designed to enable greater autonomy, mobility and intergenerational integration.