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mental health & dementia
News - November 2018
A new approach to care home design
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.
Stantec’s recent project for care provider Providence Health Care in Vancouver is a major scheme accommodating 320 residents with dementia in houses of up 10 people demonstrates this in practice.
Each resident has his or her own studio apartment within the communal house, but the entrance hallway to each studio apartment 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.
Beyond the sub-community of the resident’s household, the wider community of the whole development enjoys enhanced opportunities for autonomous circulation, 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.
The involvement of residents in activities and movement outdoors should always form a core design principle of residential care, but active contact with the outdoors is not always viable for all residents.
An active 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.
Designing autonomy into the care home not only means 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.
One of the profound shifts that affects all people who live in a care home is that they cease to be part of a diverse community of mixed generations. Opportunities for multi-generational interaction can be rewarding for all parties.
Numerous projects have pioneered this idea.
Multiple design considerations are involved including location, shared outside space and security. However, there are also some commonalities between needs of the very old and the very young such as anti-slip surfaces, low-rise steps and ramp access, and wipe-clean finishes.
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’s layout.
Quality of life
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.
This natural surveillance approach can be complemented with technology, enabling the care home operator to ‘take the bubble wrap’ off residents.
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.
While UK care home operators do not currently build on the scale of this Vancouver project, the model provides insights into elderly care environments that are more progressive, compassionate, and person-centred.
It also highlights the benefits of larger-scale care homes that have the critical social mass to influence public realm improvements designed to enable greater autonomy, mobility and intergenerational integration.
Our recent designs help providers move away from a medical model towards a person-centred model focused on quality of life.