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- Herausgeber: John Wiley & Sons
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
Redefining Assisted Living for the Mentally and Physically Frail
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Seitenzahl: 661
Veröffentlichungsjahr: 2018
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Table of Contents
Cover
Acknowledgments
Foreword
What About Assisted Living?
Shortcomings of the Conventional Nursing Home
How Could Nursing Homes Be Improved?
Housing and Service Alternatives for the Oldest-Old
What Is Driving the Oldest-Old Population Numbers?
More Emphasis on Chronic Disease and Less on Acute Care
Endnotes
About the Companion Website
CHAPTER ONE: What Do Older People Want?
What Possibilities Would Frail Older People Prefer in a Housing Solution?
How We Age Is Often Unpredictable
Strategy One: Stay in the House and See What Happens
Strategy Two: Plan the Move and Explore Other Scenarios
What Aspects of Housing and Services Best Serve the Older Frail?
Endnotes
CHAPTER TWO: What Are the Major Aging Changes that Affect Independence?
Changes in Sensory Modalities
Chronic Conditions and Disability that Limit Independence
Will Chronic Disease Continue to Decrease?
Endnotes
CHAPTER THREE: Demographics and Living Arrangements
Mortality and Fertility on the World Stage
Longevity Is a Primary Driver of Aging Population Growth
World Population Growth: 65+, 85+, 100+
China Is the Most Rapidly Aging Country in the World
European Aging Experience: Been There, Done That
The Triple Whammy of the Aging of Japan: Longevity, Low Fertility, and Low In-migration
What About the Growth Rate of the 65+ and 85+ Population in the US?
The Centenarians and Near Centenarians: 100- and 90-Year-Olds in the US
Impacts of Demographic Growth
What Other Demographic Issues Will Affect the Future?
Endnotes
CHAPTER FOUR: How Is Long-Term Care Defined? What Are the Choices?
What Are the Major LTC Alternatives?
Nursing Home Facts and Figures
What Are the Problems of Traditional Nursing Homes?
Will Green House© and Small House Models Replace Traditional Nursing Homes?
What Attributes Should We Strive to Include in New Nursing Homes?
How Do Assisted Living (AL) and Residential Care Settings Differ?
Assisted Living, Problem One: Care for More Dependent Residents
Assisted Living, Problem Two: Cost of Care and Lack of Reimbursement
How Do Assisted Living Residents Differ from Nursing Home Residents?
What Can We Learn from Hospice Models?
Home Care Through Family Members and Formal Sources
Reformulating Home Care to Work at the Margin of Need
Endnotes
CHAPTER FIVE: Concepts and Objectives for Housing the Frail
First-Order Concepts
Second-Order Concepts
Environmental Docility Hypothesis
Endnotes
CHAPTER SIX: 20 Design Ideas and Concepts that Can Make a Difference
The Neighborhood, Site Issues, and Outdoor Space
Refining Design Attributes and Considerations
Stimulating Social Interaction
Planning the Dwelling Unit
Endnotes
CHAPTER SEVEN: 12 Caregiving and Management Practices that Avoid an Institutional Lifestyle
Effective Caregiving Strategies
Full Participation in the Life of the Place
Creating Affect and Joy
Endnotes
CHAPTER EIGHT: 21 Building Case Studies
European History of Home-care Serviced Buildings
Service House Model Emerges
AFLs, Humanitas Style
The Continuing Care Retirement Community (CCRC) or Life Plan Community (LPC): A US Invention
HOW DO THE LPC AND THE APARTMENT FOR LIFE (AFL) DIFFER?
Small Group Living Cluster Case Studies
Smaller-scale Assisted Living Buildings (25 to 40 Units) and Other Options
Endnotes
CHAPTER NINE: Programs that Encourage Staying at Home with Service Assistance
One: Home Modification Programs
Two: Danish Home Care System
Three: PACE (Program for All-inclusive Care for the Elderly)
Four: Home– and Community–Based Care: The 1915c and 1115 Waiver Programs and Long-term Care Insurance
Five: Beacon Hill Village (BHV)
Six: Age-Friendly Cities
Seven: Accessory Dwelling Units (ADU)
Eight: GenSmart House and Next Gen House
Nine: Naturally Occurring Retirement Communities (NORC’s)
Endnotes
CHAPTER TEN: Therapeutic Use of Outdoor Spaces and Plant Materials
How Does the Landscape Make a Difference?
Biophilia
Physical Health Benefits
Mental Health Benefits
Design Considerations for Gardens and Outdoor Spaces
Dementia Gardens
European Atrium Buildings
Endnotes
CHAPTER ELEVEN: How Will Technology Help People Stay Independent and Avoid Institutionalization?
Transportation Is a Major Barrier Today
Internet Service Utilization
Home-Delivered Services
Driverless Cars
Social Robots
Functional Electro-mechanical Robots
Transfer and Lifting Devices
Exoskeletons
Protective Clothing
Scooters (Personal Operating Vehicles) and Mobility Aides
Virtual Reality
Replaceable Body Parts
DNA-based Medicines and Therapies
Endnotes
CHAPTER TWELVE: Primary Themes, Takeaways, and Conclusions
The US and the World Will Experience a Much Older Population
Home Care Models and Integrated Health Care Models Are Needed
Assisted Living (AL) Is a Viable Alternative but Comes with Restrictions in the US
The Apartment for Life (AFL) Model Provides Personal and Medical Care in Independent Housing
Small Group Housing Clusters for the Extremely Mentally and Physically Frail Is Likely to Continue, Even with Other Options Available
Most Existing US Nursing Homes Are of Poor Quality and Need to Be Phased Out or Upgraded
How Can We Help Those with Dementia Live a More Satisfying and Meaningful Life?
Baby Boomers Have High Expectations for Quality Long-term Care Services but Lack the Means to Purchase Them
Supporting Friendships and Increasing Affect Make Places to Live Happier
How Will Advances in Technology Make a Difference?
An Emphasis on Exercise and Connections to Outdoor Spaces
More Comprehensive Approaches at the City and Neighborhood Scale
Conclusions
Index
End User License Agreement
List of Tables
Chapter 3
Table 3-1 By 2050 China is predicted to have more than a quarter of its total population (348.1 Million) over age 65. This is an amazing 4X increase from the 2000 figure of 86.4 million.
Table 3-2 Even larger growth rates are expected with China's oldest-old. Growth rates are nearly 10X in 50 years. Amazingly, by 2050 China will have a higher percentage of 80+ population than the US.
Table 3-3 Simply put, the US population doubles every 80 years, the 65+ population doubles every 40 years, the 75+ population doubles every 30 years, the 85+ population triples every 40 years, and the 100+ will grow 7–10 times in 40 years.
Table 3-4 Although women outlive men by 4.9 years at birth, that margin decreases to 2.6 years at age 65. Male life expectancy rates are unlikely to catch up with females in the foreseeable future.
Chapter 4
Table 4-1 Forty-five environmental and caregiving attributes that are more effectively addressed in northern European and US Green House© nursing home environments: Old-style nursing homes in the US have many shortcomings that have been overcome by newer designs and caregiving strategies. This is a helpful checklist for any nursing home or LTC setting.
Chapter 8
Table 8-1 80 Apartment/Condo for Life Unit Features: These considerate design features can help older frail people maintain their independence. Among the most critical spaces are bathrooms and kitchens where falls often occur. Many of these ideas and products come from northern European projects designed to support people for as long as possible in independent housing.
List of Illustrations
Foreword
Figure 1 Northern European models of housing and services for the frail have inspired gerontologists and providers for decades: These systems, in addition to being affordable, have also involved careful attention to the physical design of the building and the care giving approach to residents.
Figure 2 The Humanitas Bergweg Apartment for Life contains an open-plan atrium with plenty of space for socializing, taking a meal, and carrying out activities: The AFL philosophy involves helping older people live a full, happy, and satisfying life by aging in place with help from home care workers and nurses.
Figure 3 Home care–based personnel (nurses and helpers) visit older frail residents in their dwelling units at home and/or in purpose-built housing: Home helpers can make as many as five to seven trips per day to provide personal care assistance. This nurse visits on an “as needed” basis to make ongoing assessments and “fine tune” the medical plan for each recipient.
Figure 4 The Iris Marken is a nursing center with two 9-unit clusters of nursing home residents and two 9-unit clusters of dementia residents: The long, thin building is sandwiched between two great views. One side has a pond with ducks and the other side overlooks an active sports playing field.
Figure 5 The Hogeweyk Dementia Village contains 23 small 6–7 unit group clusters of individuals with severe memory loss: The secure plan allows residents to walk freely around the “village.” The boulevard, which links seven courtyards, contains services and activities that residents can visit by themselves or with a care worker.
Figure 6 In a typical PACE program, different professionals diagnose and treat a range of symptoms: These include mental health, physical therapy, neurological concerns, behavioral issues, medication interactions, and dental care. This on-site gym provides a comprehensive array of physical therapy and exercise equipment.
Chapter 1
Figure 1-1 The shopping choices, transportation options, and neighborhood safety within blocks of the Kristal Case Study (CS) make it convenient: Moving is an important choice to consider when faced with a neighborhood or dwelling unit that will cause difficulties as you become older. Staying in the general vicinity may minimize the disruption of losing friends.
Figure 1-2 Age-restricted or age-targeted active adult communities are purpose designed to meet the needs and expectations of an older constituent: Most designs are one story with two bedrooms. Frequently, as in this illustration, the kitchen, living room, and dining are combined into a single “great room.”
Figure 1-3 This Erickson community of approximately 2000 units is a CCRC located on a 120-acre campus: Erickson communities are targeted to middle-income seniors. The scale of the development allows it to support several restaurants, a comprehensive exercise venue, a large auditorium for special events, and many individual clubs.
Figure 1-4 This affordable senior co-housing project in Brabend, Denmark, reduces monthly costs by creating resident committees that take on maintenance tasks: Although residents don't provide direct personal care assistance to one another, they are a tight-knit community who help one another.
Figure 1-5 For some, the ideal is a cottage affiliated with a larger community building that provides meals and activities: This is one of the fifty cottages at the NewBridge CS. People that move to a CCRC/LPC often come from larger single-family homes and even though they downsize they still select relatively large units.
Figure 1-6 The kitchen at the Rundgraafpark CS is a galley configuration with a window overlooking an atrium: One- and two-bedroom units here are larger, ranging from 800 to 1100 SF. The possibility of staying here with additional home care service reduces worry about having to move again.
Figure 1-7 Access to well-designed exercise options is important to many older people: This swimming pool in Denmark is shared with the community and features a recessed edge to facilitate discussion and feedback to individuals seeking aquatic exercise. Water resistance exercises are an effective and benevolent medium for aerobic workouts and strength training.
Figure 1-8 Optimizing Housing and Service Satisfaction: Four important components should be satisfied to create an optimal environment: 1) a physical design and friendly relationships that encourage social inclusion, 2) opportunities for exercise and strength building, 3) nutritious and flavorful food, and 4) careful attention to safety and well-being.
Chapter 2
Figure 2-1 Lawton's Environment-Press Model
1
: This diagram (also known as the Ecological Model) provides a way of matching an individual's competency with the level of difficulty associated with an environmental context. It demonstrates that when the environment slightly challenges the individual, it is usually more satisfying to that person.
Figure 2-2 Trading Ages is a simulation exercise that allows younger people to experience old age: Bandages simulate arthritis and ear plugs reduce hearing capacity. These students are wearing colored glasses that mimic the yellowing of the cornea, while given the task of separating different-colored pastel pills that all look alike.
Figure 2-3 The eyes of an older person need twice as much light to see at the same level of visual acuity as a younger person: The easiest way to solve this problem is to increase the wattage of a light bulb. However, this may not work if the fixture cannot safely accept a higher-wattage bulb.
Figure 2-4 This meeting room in the DePlussenburgh CS uses pendant fixtures for better light coverage and a carpet to absorb unwanted sounds: A pendant fixture is an excellent solution to the problem of glare. Light bounces off the ceiling as well as being spread evenly by the translucent suspended lens.
Figure 2-5 The restaurant in the La Valance CS has employed 48" planters that break up the dining room spatially and absorb noise: There are also soft fabric panels suspended from the ceiling to create additional acoustic absorption. The hard floor and the surrounding glass window wall reflect rather than absorb sound.
Figure 2-6 The bay window in this assisted living dining room is configured to avoid uncontrolled noise: The U-shaped alcove isolates the space from the open plan of the surrounding dining room. Also sound reflected from the lower ceiling makes it easier to understand conversations around the table.
Figure 2-7 The walking club at the Rundgraafpark CS offers regular exercise along with good conversations: One of the great advantages of group housing is the possibility of meeting others and creating new friendships. Making a social experience out of exercise provides an incentive to continue it.
Figure 2-8 This Shaker-style plate shelf and peg design for the Woodside Dementia building near Pittsburgh, Pennsylvania, helps people with memory loss: The narrow shelf allows objects and photos to be displayed while the pegs are convenient for hanging clothing items. This feature is used on two walls of each dwelling unit.
Chapter 3
Figure 3-1 Young children and older people as a percentage of the world population, 1950–2050: It's not just that we are growing older; an even bigger concern is that there will be fewer children to support the aged through transfer payments and family support in the future.
2
Figure 3-2 Total fertility rate and life expectancy at birth in the world, 1950–2050
4
: This diagram is the result of life expectancy and fertility moving in opposite directions. Life expectancy has experienced unprecedented growth for more than 100 years, while urbanization has reduced the need for children.
Figure 3-3 World population 65, 75, and 85+, 1990–2050 (millions)
12
: The population 65+ will grow by a factor of 4.8 from 1990 to 2050, but the 75+ growth rate (6.5X) and the 85+ growth rate (11.6X) are even higher. Most of this growth will occur in less-developed countries.
Figure 3-4 World population 100+, 1990–2050 (thousands)
13
: Centenarians, the fastest-growing age, cohort will be more than 60X greater in 2050 than in 1990. The growth rate is exponential, almost doubling every 10 years. The largest increase in numbers will begin around 2020 and by 2050 (30 years) they will be almost nine times greater.
Figure 3-5 US population growth 65, 75, 85+, 1950–2050 (millions)
33
: The 65+ population will double every 40 years between 1970 and 2050. In 2015 the onset of the baby boomer cohort begins with major increases in the 65+ population. The growth rates in all aged cohorts are high between 2020 and 2040.
Figure 3-6 US population growth 100+ (thousands)
34
: Major increases in the 100+ population are occurring today and are set to continue until 2050 and beyond. With 65+ population numbers doubling every 40 years, the 2010–2050 rate of increase in the 100+ population will be 7.3X.
Figure 3-7 US marital status by gender for three age cohorts
49
: At age 65–74 the majority of men (74%) and women (58%) are married. But by age 85+ the majority of women (73%) have become widows while the majority of men (59%) are still married.
Chapter 4
Figure 4-1 Adult day care in northern European transports residents from their home to a community setting for the day: Because housing and service buildings are community care partners, adult day care often meets in the common space of age-restricted housing. A typical adult day care program serves 10–15 participants who visit 2–4 times/week.
Figure 4-2 Often the assisted living, dementia, or skilled nursing components of a CCRC have a more clinical look than independent living: In the Fox Hill CCRC the same corridor and common space interior treatments used in independent living were carried through to assisted living and dementia care, giving the building a seamless look.
Figure 4-3 Snoezelen therapies often involve colorful projections, soothing music, and affect-laden objects to relax individuals with severe dementia: These methods are used with people who have lost their ability to communicate and they serve as a method for rekindling emotional responsiveness. Snoezelen methods are also used in conjunction with bathing and music.
Figure 4-4 Even though single-occupancy rooms are the standard in northern Europe, many LTC settings in Hong Kong and China continue to use three- and four-bed wards: In the US a shared (two-bed) room has been the standard for decades. Before that multi-bed wards were also common in both hospitals and nursing homes in the US.
Figure 4-5 The Aertebjerghaven CS in Odense, Denmark, houses 45 nursing home residents in 5 small group clusters: A centrally located courtyard daylights the middle of the building and appears in this photo as an extension of a covered patio. Projects at this scale are common in northern Europe.
Figure 4-6 Thought-provoking activities like card playing stimulate memory and recall: In general, activities with genuine purpose have useful benefits. In small Danish towns, residents are often involved in helping to create decorations for special events. Usually everyone participates, even if it involves only watching the activity.
Figure 4-7 Furniture clusters in dementia housing can be focused on activities and themes like grooming, putting on makeup, and playing with life-like baby dolls: These so-called “life stations” not only serve to decorate corners and alcoves but are often a popular source of activity. This vanity table is used for putting on makeup as well as, trying on hats and jewelry.
Figure 4-8 Domestic animals are often an object of affection as well as a source of activity: Having a shared pet or contact with a visiting pet program is the high point in the day for many residents. For the more independent individual, walking or caring for a pet can be a healthy outlet.
Figure 4-9 For older people with limited mobility, a lockbox with an entry key nearby can make it easy for a home care worker to check on a client: These can be unlocked with a code that can be changed to maintain security.
Figure 4-10 This afternoon the dining room table at the Aertebjerghaven CS has been transformed into a workshop so residents can participate in making decorations for a local celebration: Purposeful activities that have a positive impact on others is a priority for how residents choose to spend their spare time.
Figure 4-11 Easy access to gardens with sunny and shaded sitting areas at the La Valence CS is valued by dementia residents: Installations often include raised gardens, a fountain, whimsical sculptures, and looped pathways so individuals can benefit from activities and exercise.
Figure 4-12 Scandinavian designs for wheelchair-dependent individuals are brilliant in their flexibility, beauty, and simplicity: This L-shaped kitchen design is modular and can be height adjusted to match the anthropometric characteristics of the user. The rolling cabinets below the counter are flexible and easily accessible.
Chapter 6
Figure 6-1 The high-density, mixed-use neighborhood around the Neptuna CS is an ideal location: This redevelopment district is a strand along the beach near Malmö, Sweden. It offers convenient stores, safe places to walk, pleasant off-shore breezes, and a view of the sound. The building also contains space for cars, bicycles, and scooters.
Figure 6-2 The outdoor terrace adjacent to the La Valance CS restaurant provides a powerful first impression: The combination of high canopy green trees with bright red umbrellas is striking. Areas from complete shade to complete sun are available and the terrace wraps the restaurant perimeter, providing a lively controlled view from inside.
Figure 6-3 The “bubblan” is an acrylic enclosure for tropical plants at the Neptuna CS: This protected greenhouse-type space allows residents to enjoy the out-of-doors when it is cold or the wind is blowing. The location near the front of the building overlooks the restaurant plaza, a busy pedestrian pathway, and the waterfront.
Figure 6-4a–d These courtyards combine hard and soft surfaces in a confined space that adds security and enhances use: Courtyard designs are popular when high-density development is desired and the space can be used for social purposes and activities. Courtyards are also particularly helpful in providing a secured space for people with dementia.
Figure 6-5 This secured garden in Maryland has several places sandwiched between the inside and outside: Starting on the left is an enclosed sunspace with floor to ceiling windows and a garden view. Next to it is a covered porch and then a screened porch. Each space differs in the amount of protection and the indoor/outdoor experience it provides.
Figure 6-6a–f Atriums are a popular building type for housing older people in northern Europe: They are either conditioned or naturally ventilated and usually have a hard floor (if there is a habitable space below) or combine a soft soil base with pavement. Atriums are popular meeting places for residents and encourage exercise in the winter.
Figure 6-7 The New Bridge CS Villas contains four units on each of three floors with underground parking: The scale is approachable and the material choices include copper, wood shingles, stone, and wood trim, which are authentic and residential in character. These larger, 2000 SF+ units are typical of what residents expect in LPC housing in the US today.
Figure 6-8 Fine art mounted on rough-sawn wood siding gives it a residential feeling in the La Valance CS atrium: The use of landscape materials, daylighting, art, sculpture, and antique objects creates a stimulating environment. Although the building houses very frail residents, the upbeat interiors make it appear very non-institutional.
Figure 6-9 The dwelling unit entry door at the Ulrika CS can accommodate the width of a bed: A normal-appearing 3'0" width door is paired with a 12" hinged side panel with a window. When both are opened, a bed can easily be accommodated.
Figure 6-10 Locating bench seating halfway between the top and bottom of a stair encourages residents to use it: In the Fox Hill LPC in Bethesda, MD a landing with a bench to rest and recharge overlooks the atrium below. Residents use the stairs for exercise instead of taking the elevator.
Figure 6-11 Outdoor exercise equipment for older people is popular in northern Europe: Often located within parks, the equipment is designed to encourage movement, gait, and balance control, which help prevent falls in older people. Exercising outdoors in the summer is clearly preferred over a windowless basement physical therapy space.
Figure 6-12 Full-size window walls are often used to increase natural light: In the Ulrika CS, optimizing natural light is important because the winter sun rises late and sets early in Finland. Low-E glass has been used extensively to reduce heat and maximize the amount of light.
Figure 6-13 In the Neptuna CS large skylights placed above the stair and elevator core allow daylight to filter down through the building: Placing skylights in the middle of the plan, increasing artificial light, and employing aesthetic wall treatments and wood railings can make stairs more attractive and thus encourage use.
Figure 6-14 This cabinet creates a flexible space separator and display wall in a dining/living room at the Holmegårdsparken near Charlottenlund, Denmark: Cabinets on wheels can be moved to reconfigure space that can take on a range of purposes. The space can be intimate for meals or larger for stretching and movement exercises.
Figure 6-15 To establish the NewBridge interior design style, the sponsor described it as Hamish, a Yiddish word connoting the concept of cozy and homey: It encouraged the sponsor to use light wood, comfortable soft seating, residential light fixtures, and a color palette that emphasized earth tones.
Figure 6-16 This small assisted living building greets visitors with a large stone fireplace and Arts and Crafts–style furniture: It is positioned to subdivide the room and create a strong first impression that exudes residential comfort. A large hearth, mantel, and shelves provide locations for accessories and plants.
Figure 6-17 A dilemma with most soft, low couches is how difficult it is to exit from them: Having easy-to-grasp armrests and a higher seat height is often necessary. In the Irismarken CS nursing home, wood blocks were placed under one couch to raise the seat, thus making it easier for residents to stand up.
Figure 6-18 A dementia garden is a necessary component of a residential dementia cluster: In this historic Claremont, California, Arts and Crafts building an outdoor garden pavilion with a walkway was created for activities and exercise. A large live oak tree provides shade and adds character to the garden.
Figure 6-19 In the Akropolis AFL in Rotterdam, the Netherlands, a dementia museum showcases furniture and household objects from the past century: This is a shop installation with hand tools and equipment from a 75-year-old workspace. These displays stimulate intergenerational exchange by having older people recall and describe experiences from the past.
Figure 6-20 This U-shaped kitchen serves a Dutch dementia cluster of 10 residents in the Kristal CS: The space behind the counter is wide enough for several people to prepare food together. Glass-fronted cabinets and open shelving make it easier for residents to identify objects. The kitchen is compact but also spacious and accommodating.
Figure 6-21 This three-season porch in an assisted living building in the UK has a wide-angle view of the street and parking lot: Intimate interior spaces with expansive views are especially attractive to families because they can talk privately in a place that connects them with the landscape.
Figure 6-22 In the Hogeweyk Dementia Village CS families have assembled scrapbooks that represent important events in a resident's life: They are personal accounts that include both happy and sad periods of their life. When viewed with family members they become a vehicle for conversations and a method to stimulate long-term memories.
Figure 6-23 This plan demonstrates the 100% corner idea in an assisted living project near Boston: This table has 10 visual connections to surrounding common spaces, rooms, and circulation routes throughout the building and the grounds. This nexus of visual activity makes the 100% corner a stimulating place to be throughout the day and evening.
Figure 6-24 This table in the La Valance CS overlooks the restaurant, the atrium, and the main circulation pathway that traverses the building: It is centrally located, well lighted, and visible through clear glass partitions. It can be used for a range of activities or it can be ignored, which makes it an effective 100% corner.
Figure 6-25 From the upper floor of the Humanitas Bergweg CS atrium you can overlook the activities below: This unobtrusive overlook allows residents to gain the pleasure of watching an eclectic crowd made up of family members, volunteers, residents, and staff. It is also a great place to watch large group activities which are staged here.
Figure 6-26 The Holmegårdsparken nursing center in Charlottenlund, Denmark, features a cantilevered perch in each typical room that overlooks the site and neighborhood: This space is used by some residents as a living room, while others prefer to make it a bedroom alcove. Armoires on wheels can be moved around the unit to create different spatial configurations.
Figure 6-27 Porches are a great place to survey on- and off site views: Watching deliveries, visiting families, and resident move-in activities gives this location strategic purpose. A porch is also covered and protected from the sun and can be far enough away from the front door to be unobtrusive.
Figure 6-28 A bench 100 feet from the building edge can be an attractive retreat: On this Canadian site, sitting next to a pathway in the shade of a tree with a great view is a wonderful place to read a book. Although many residents prefer the company of others, getting away is also appreciated.
Figure 6-29a–b The “primary path” is the main circulation route between the front door and the elevator: In this example, eight different views into adjacent spaces are available as you proceed along the entry path. The theory posits that the more choices available, the greater the opportunity for observation and social interaction. The four-story L-shaped building in Bellevue, Washington, contains the primary path referenced in the adjacent plan. The building symmetry emphasizes the entry axis (primary path).
Figure 6-30 Triangulation can result from any object that provokes curiosity and can be shared: The theater square in the Hogeweyk Dementia Village has several very intriguing sculptural masks and crowns supported by posts that can be “tried on” by participants. They are fanciful and fun to share with others.
Figure 6-31 Small units require compact thinking about how to use space effectively: In this dementia dwelling unit in the Kristal CS, shelves in conjunction with photos, an armoire, and displayed items optimize the visibility of this resident's collection. This arrangement is a treasure chest of memories.
Figure 6-32a–b The bay window attached to this single-loaded corridor in Sweden has been taken over as an extension of each resident's dwelling unit: Even though every unit has a private balcony, this enclosed corridor can be used to make social contact with neighbors regardless of the weather. Residents have furnished the alcove to meet their interests, which often include a table and chair. Some have furnished the space with plants, while others have brought in a throw rug to make it cozier.
Figure 6-33 The De Plussenburgh CS dwelling unit has 32 continuous feet of window wall: A six-foot-plus sliding door separates the living room and bedroom. When closed, it rests against the exterior window mullion; when open, the wider view is visible. There are no bearing walls and thus all internal partitions can be removed.
Figure 6-34a–b Condominium balconies in the Rundgraafpark CS can be enclosed in the winter, partially open in the fall/spring, or completely open in the summer: In this unit, gaps between glass panels facilitate ventilation in the summer. Differing levels of protection allow freedom in selecting furnishings for the space. These glass enclosures can be quickly opened or closed by sliding vertical glass panels to one side, where they are stored. This level of flexibility allows the space to be used throughout the year.
Figure 6-35 System designs from northern Europe for bathrooms add flexibility and support: Implemented in the nursing care units of the NewBridge CS, this rail system allows lavatories to be adjusted and toilet arm supports to be lowered. The continuous waterproof floor surface accommodates a roll-in shower.
Chapter 7
Figure 7-1 Home care workers visit residents sometimes several times per day to help them with personal and medical care needs: This home care worker has scheduled consecutive visits with different residents in this building. Nurses also make separate planned visits. Grouping visitations in one building creates efficiency.
Figure 7-2 Home care workers visit older people in their own apartments in the neighborhood: In northern Europe, dense urban settings make it easier to get around by bicycle or compact car. Workers typically meet in the morning and late afternoon to discuss resident cases and schedule visits in the middle of the day.
Figure 7-3 The op maat lifestyle is intended to serve resident preferences rather than conform to an institution's schedule: For example, residents at the Irismarken CS can take a late breakfast or snack by themselves if they are hungry. Op maat literally means “cut to fit.”
Figure 7-4a–b The record of resident experiences, care activities, and challenges are transitioning from written notes to computer-based files: This is a better system for recording daily activities but must be used in conjunction with designated caregivers who are assigned to care for a specific older resident and know them well.
Figure 7-5 Helping to prepare a meal is a compelling activity of daily living, even if all you do is watch: In the Kristal CS dementia cluster, potatoes are a frequent menu item. Sharing tasks associated with meal preparation like setting the table or busing dishes is a popular activity.
Figure 7-6 One of the most popular activity of daily living (ADL) tasks at the Hogeweyk Dementia Village CS is the daily visit to the grocery store to buy ingredients for mealtimes: Staff members often take along residents to shop and bring groceries home. This activity allows residents to exercise as well as enjoy the outdoors.
Figure 7-7 Danish nursing homes have a tradition of resident participation that goes back more than 40 years: In this photo, a team leader meets with residents and staff to review events from the last two weeks while introducing them to developments expected to occur in the next two weeks.
Figure 7-8 In the Humanitas Bergweg AFL CS, a call center coordinates home care visits in the neighborhood and the building: These staff members are fielding changes in appointments as well as scheduling new appointments. This type of flexibility is necessary for home care and home health services to operate efficiently.
Figure 7-9 The Humanitas Bergweg AFL CS has several adult day care programs serving people in the surrounding neighborhood: These are separated into smaller cultural and lifestyle groups that meet 3–5 times a week for several hours. Some day care participants are experiencing memory loss, while others are isolated and depressed. Many have become active as volunteers at Bergweg.
Figure 7-10 A common phase used to describe a healthy lifestyle in the Humanitas AFL program is “use it or lose it”: The saying encourages residents to take both physical and psychological control of their life. The tagline is used frequently and is painted on the side of this delivery van.
Figure 7-11 The Danes are committed to keeping older residents as independent as possible: In this dementia facility in Copenhagen, a connecting corridor has been repurposed with equipment for walking therapy. Complete with parallel bars and a lift, it was moved from an isolated room to a public location to encourage and facilitate use.
Figure 7-12 One important muscle group to exercise are upper-body arm muscles: This piece of equipment is designed to give residents in a wheelchair an opportunity to build upper body strength. This is especially important for women, who often lose the muscle strength needed for tasks like transferring to the commode.
Figure 7-13 This music room at the Hogeweyk Dementia Village CS is used by several different music clubs: Residents listen to music, sing, and occasionally play instruments. They have classical music listening sessions that focus on particular composers. Music is one of the last modalities dementia residents lose, which accounts for its popularity.
Figure 7-14a–f Most care settings consider meal times to be important social opportunities: This collection of images demonstrates the diversity of size and style in dining venues. All of these examples encourage visitors. These include friends, relatives, and staff, making the experience a much more inclusive one.
Figure 7-15 A cheerful atmosphere is often hard to create in long-term care: In the Akropolis AFL, this bar is a prominent feature of the dining room. In northern Europe, areas near the entry are often created where musical events, TGIF celebrations, and alcoholic drinks can lift the mood of residents and their guests.
Figure 7-16 The large open atrium in the Akropolis AFL has hosted concerts, political events, and contests: However, one of the most memorable events was a mock circus that featured the administrator, Hans Becker, riding a camel through the crowd. Try not to smile when something that outrageous occurs.
Figure 7-17 Sometimes juxtaposition works exceedingly well at making a situation amusing: This full-size dog toy deserves a double take, but add a hat and it seems totally absurd. Creating situations that provoke humor and whimsy are almost always welcome. Sometimes these can be accomplished more effectively through temporary decorations.
Figure 7-18 Although northern European LTC facilities are used as models in this book, some European countries have worse conditions than the US: In this Lar de idosos (home for elderly) located in a rural community in Portugal, four-bed rooms for indigent older people are common. In Asia, multi-bed wards are also common and are considered acceptable.
Figure 7-19 The six-person clusters in the Hogeweyk Dementia Village CS are like small single-family houses: Although most residents have private rooms, they all share a bathroom. Common spaces include a kitchen, dining room alcove, and living room. The Indonesian lifestyle cluster brings together roommates who share a common cultural bond.
Figure 7-20 The Rundgraafpark CS contains a preschool for a hundred children as well as a publically accessible physical therapy center: The preschool is on the ground floor below the two condominium buildings. Children's day care is considered a compatible land use and is a frequent tenant in 55+ housing projects.
Figure 7-21 Pets are more frequent additions to the households of older residents: In the film-industry-sponsored MPTF retirement community in Woodland Hills, California, a dog park called Doggywood was recently added. Not only are pets considered good companions, but they also encourage residents to walk more for exercise.
Figure 7-22 Inviting staff to use gardens and walking pathways promotes relaxation and exercise: The staff have jobs that are physically and emotionally taxing and they welcome opportunities for stress reduction. Northern European providers frequently invite staff to share on-site exercise and physical therapy equipment.
Chapter 8
Figure 8-1 Dutch Hofje for Widows of the Merchant Marine: Dating from 1731, this one-story courtyard housing arrangement in Haarlem, the Netherlands, was created for 20 widows. They were provided housing and services to help them maintain their independence. Other similar housing projects were supported by religious organizations.
Figure 8-2 The Virranranta service house, located in the small Finnish town of Kiruvesi, contains a mixture of 50 housing and long-term care units for the frail: Service houses vary in size from 20 to 200 units but most provide help to a broader constituency beyond their resident population.
Figure 8-3 The Humanitas Bergweg CS atrium is naturally cooled with roof ventilators: Fans and moveable fabric awnings are also used to reduce the summer heat. Seating for meals and events is moveable and open to everyone including residents, staff, family members, volunteers, neighbors, and workers. Humanitas residents do as much for themselves as possible and also extend a helping hand to others.
Figure 8-4 The five-story atrium at the Rundgraafpark CS is a nexus for social exchange and exercise: A café as well as tables and chairs throughout the ground floor provide places for residents to interact and space for large-scale activities. An adult day care program open to the community is also located on the ground floor.
Figure 8-5 The Neptuna CS has a U-shaped configuration that wraps around a protected garden: The garden provides a controlled view for the first floor common spaces that wrap the perimeter. The Calatrava-designed “Turning Torso” office building, located a few hundred feet away, is a dominant central feature.
Figure 8-6 The central park of the Akropolis AFL in Rotterdam was once a parking lot: Parking was moved to the rear of the building and the space was transformed into a sculpture garden with water features and walking pathways. One area has a small zoo with goats, chickens, and ducks, as well as a playground for children.
Figure 8-7 Humanitas Bergweg was the first Apartment for Life (AFL) building: Located in downtown Rotterdam on the site of an old hospital, the ground floor contains a grocery store. Escalators take you to a first-floor atrium that provides meals, activities, and day care for residents and people in the neighborhood.
Figure 8-8 The first-floor building footprint is a triangular shape: Centrally located bridges (dotted) with access to elevators connect the north and south wings. A 150-foot koi pond near the center of the space is intertwined with a computer center, meeting rooms, mailboxes, tables and chairs, day care, and dwelling units.
Figure 8-9 The triangular atrium creates a focal point at the narrow end: The koi pond has large, attractive fish as well as tropical and indigenous landscape materials. Canvas awnings are shown partially drawn to reduce heat absorption. Tables and chairs support a range of activities as well as games like billiards.
Figure 8-10 The unit is approximately 800 square feet: It contains a fully accessible bathroom and kitchen, as well as a separate bedroom. It also has a small den for overnight stays and an enclosed balcony. Unit access is from a light-filled single-loaded corridor that also provides additional borrowed light for the kitchen.
Figure 8-11 The computer center and reception area has been recently expanded: Resident volunteers work here, which is a place that is open to everyone. Humanitas strongly believes older people must have access to the internet. Murals referencing the koi pond provide an opportunity to make the space more artistically expressive. About 30% of Bergweg residents are active internet users.
Figure 8-12 Twenty-nine units of dementia housing were added to the top of the building in 2009: These units are subdivided into four small group clusters that operate separately. Each resident unit is single occupied with its own private toilet/sink and a shared bathing room. Each cluster contains an outdoor patio.
Figure 8-13 Rundgraafpark contains both subsidized and market-rate rental units as well as forty condominiums: The condominium units in the two seven-story gray buildings are combined with 113 units of rental housing. The site also contains a day care setting for 100 preschool children and a physical therapy clinic.
Figure 8-14 The atrium is cooled through rooftop ventilators that open when thermostats sense overheating: Fresh makeup air is provided by intake grills on lower floors. The top floor has a line of units facing the east, while the west side is a large clerestory window.
Figure 8-15 The 1100 SF Rundgraafpark dwelling unit is open and flexible: A storage room and half bath separates the living room from the kitchen while creating a small dining alcove. The kitchen has a large window that invites borrowed light from the atrium. Eliminating the second bedroom creates a larger living room.
Figure 8-16 Three small group homes for people with dementia (18 people) are located on the ground floor: Each small group cluster operates on its own. Residents who acquire dementia can move here and do not need to leave the building. Dementia residents use the atrium for group exercises.
Figure 8-17 La Valance has four different types of residents: There are 96 dementia residents, 34 skilled nursing residents, 30 units for married couples, and 18 units of “lean-to housing.” Dementia and nursing units are located in three-story triangular clusters on the west side of two glass-covered landscaped atriums.
Figure 8-18 The entry to La Valance is enhanced by a dramatic two-story restaurant and an adjacent outdoor patio: Overlooking the west side of the atrium is housing for dementia residents (first two floors) and skilled nursing residents (top floor). The entry pathway leads directly to the centrally located, landscaped atriums.
Figure 8-19 The landscaped atriums contain trees, plants, and artwork sculptures: The dining rooms for dementia and nursing clusters overlook the atrium. The glass roof opens to ventilate the space in the summer. Wood siding and trim is used on the inside and outside to establish a friendly, approachable residential character.
Figure 8-20 Bathing and physical therapy massage take place in a controlled environment: LED lights allow the room to be darkened and a range of soothing colors to be used as part of the bathing/therapy process. A TV monitor with relaxing visuals as well as aromatherapy are employed.
Figure 8-21 The seven-story “lean-to” housing is located about 150 feet from the front door of La Valance: Residents here take home care services from La Valance and are welcome to take meals in the restaurant or prepare them in their own unit. The average age of residents here is 80–82.
Figure 8-22 “Lean to” housing is for older residents who prefer to be located close to, but not within, the care home: The building has three large two-bedroom (1050 SF) units per floor. The bathroom contains two doors for ease of access but it lacks a stall shower. The average resident age is 85.
Figure 8-23 Neptuna is a mixed-use building that contains a restaurant, a podiatrist, and a hairdresser: The 95 residential units are organized around seven separate stair towers. A centrally located garden is accessible from ground-floor resident common space. The east edge of the site has a park that contains a lagoon.
Figure 8-24 The Neptuna restaurant, bar, and terrace is designed to serve the neighborhood: The five-story building is subdivided into three horizontal zones to foreshorten and reduce its mass. The taller top floor is set back slightly and has a sloped roof form. Views are directed toward the water.
Figure 8-25 The building configuration creates a secluded garden courtyard with the multistory winter garden to the right: Plant materials in the garden are local species while the winter garden has more exotic tropical plants. The unit balconies are cantilevered from the face of the building and overlook the sound.
Figure 8-26 Dwelling units that range in size from 480 to 650 SF are compact but contain large, open balconies: Doors have been removed from the bedroom, living room, and kitchen to make the units more accessible. Without doors, the units also appear larger.
Figure 8-27 Balconies are large enough to contain plants, a large table, and several chairs and are reportedly well used: They compensate for the slightly smaller units and 80% of them have a view of the water. The balcony has a fritted glass translucent design.
Figure 8-28 De Plussenburgh is an award-winning contemporary building intended to bring new life to this older Rotterdam neighborhood: Located next to a retail shopping district and a regional transit hub, it is also adjacent to a nursing home that can provide help for the most frail.
Figure 8-29 The dramatic building consists of two interlocked forms, one horizontal and another vertical: The seven-story horizontal housing configuration floats two stories above a water feature below. A spiral ramp near the front of the building takes residents to a below-ground car park. A lively orange pathway with triangular planters reduces the scale of the entry plaza.
Figure 8-30a-b A light rail transit line wraps around the building and the pond: A community room floats above the pond and below the mass of horizontal units. It has a 270-degree wrap-around view with deep green “landscape-inspired” carpeting. Fountains with swans, and a cantilevered platform reach into the middle of the pond. The twisting balcony rail design is visually lively.
Figure 8-31 Two hundred shaded glass panels add interest to the single-loaded corridors from the inside and outside: The spectacular sunsets have prompted some residents to move furniture into the wide corridors. Each unit has a horizontal glass window that provides borrowed light to the kitchen from the adjacent corridor.
Figure 8-32 Units are adaptable to residents in wheelchairs: The bathroom with two doors can easily accommodate a stretcher bather. The 6-foot+ sliding bedroom door, when opened, reveals a 32-foot-wide panoramic view of the surrounding neighborhood from the kitchen. The one-bedroom plan can be subdivided into two bedrooms to accommodate an additional person.
Figure 8-33 De Kristal, an eight-story courtyard building, contains mixed-use elderly housing, retail, and civic services: Located in the new Nesselrode District of Rotterdam near a light rail station, Humanitas provides fifty residents home care services to maintain their independence. Twenty units of housing are also available for residents with dementia.
Figure 8-34 Single-loaded corridors access 182 low to moderate purpose-built elderly housing units: The open courtyard has recreational facilities, plant materials, and large skylights that daylight the floor below, which contains a library, pharmacy, restaurant, and medical services. A two-story open corner visually connects the courtyard with the adjacent street.
Figure 8-35 The ground floor has a centrally located restaurant with tables that overlook a community information center: This is a heavily used pedestrian pathway, which connects the help desk with the adjacent community library. Residents sit here and watch families and visitors use the library and community activities.
Figure 8-36 This 6- and 10-story L-shaped building contains 133 dwelling units: They range in size from 900 to 1800 SF (average of 1200 SF). The elevator core is centralized to minimize travel distances for home care workers. The units have floor-to-ceiling windows and balconies. Most services, including meals, are discretionary (not required).
Figure 8-37 A swimming pool and exercise room provided options for stretching and movement therapy: Other shared facilities included a community space for socializing, outdoor activity spaces, a dining room, and offices for assessment, monitoring, and care coordination. Residents were expected to be singles and couples in their late seventies.
Figure 8-38 This Condo for Life (CFL) dwelling unit is typical of what might be implemented in the USA: This 1350 SF two-bedroom, two-bath unit has a full kitchen, an office/hobby alcove, four-piece master bathroom, walk-in closet, and balcony. The spaces shown are large enough to easily accommodate a wheelchair, lift devices, and other equipment.
Figure 8-39 The NewBridge Life Plan Community is located on a 162-acre site: The varied topography and the winding path of the Charles River significantly reduced the buildable area. The hilly west side of the site was used for single-family cottages. A K-8 private school was also co-located on the campus.
Figure 8-40 The upper floor of the NewBridge commons is where guests enter: The library is the first space you experience after passing by the reception desk. Located here are three dining rooms and a pre-dining club room. Each dining venue offers different levels of formality and food choices. Business offices are also located here.
Figure 8-41 The NewBridge lower level contains common spaces oriented toward active pursuits: These include exercise, fitness, art, entertainment, and a large multipurpose room. An enclosed swimming pool and a fully equipped exercise area shares space with a casual restaurant adjacent to a two-story informal meeting space.
Figure 8-42 One of the most striking elevations is the two-story glass facade of the commons, which overlooks the site to the north: To the left is the large multipurpose room used for special events. The top floor contains several large “townhouse” units that benefit from a view of the Charles River and the grounds.
Figure 8-43 This typical two-bedroom IL unit (1134 SF) contains two adaptable bathrooms for flexibility: One has a walk-in shower and the other a tub. The bedrooms are on both sides of the living room, making it easier to share the unit. The elongated living room is spacious, with access to a balcony.
Figure 8-44 The 182 Independent Living Units (ILU) in NewBridge are designed to support residents independently for as long as possible: These two buildings flank the sides of a garden courtyard, which covers an underground parking garage. The majority of these units are two-bedroom or one bedroom with den and vary in size from 825 to 2000 SF.
Figure 8-45 The NewBridge CS small house model has nursing clusters, each with 14–16 residents: Single-occupancy rooms surround a kitchen that also operates as a nursing station. Staff were instrumental in designing the space, which is efficient for work activities but also provides places for residents to take a cup of coffee.
Figure 8-46 The 10–12 person Green House© is often designed to appear as a single-family house: In the Mt. San Antonio Gardens CS, the two 10-person buildings fit seamlessly into the context of the single-story, Arts and Crafts–style housing and the garden landscapes that connect them all together on a CCRC campus.
Figure 8-47 All nine residents (and two staff) take meals together at a large table in the Ærtebjerghaven CS in Denmark: Residents come early and stay after the meal for conversations and activities. The atrium in the background provides daylight and a view of the central courtyard. Candles on the table create a homey and intimate atmosphere the Danes call “hyggelig.”
Figure 8-48 Evergreen Villas are the first Green House© nursing homes in California: They utilize a 10-unit cluster plan with generous common areas. Two outdoor patios are created on the north and south sides of this building. Their placement on a CCRC campus allows them access to a range of campus amenities.
Figure 8-49 An Arts and Crafts motif is used with stained horizontal wood siding and gray/black trim: The materials and detailing are residential in character. Surrounding landscape materials are lush but sustainable. Note the spaced siding that secures the patio. The building fits the general character of cottages located on the campus.
Figure 8-50 An open-beam ceiling gives the house a “lodge” appearance: A stone fireplace separates the living and dining areas. Post-and-beam architecture with exposed roof rafters and hardwood floors reinforce its residential character. Clerestory windows invite light from above. The kitchen and patio are visible in the background.
Figure 8-51 The kitchen alcove is adjacent to an outdoor patio, an enclosed scullery, and the dining room table: An accordion fire door partition allows the kitchen to be open but still smoke and fire protected. Counters in the kitchen give it eat-in capability for snacks or small family gatherings.
Figure 8-52 The ground floor contains shared spaces for residents and guests, as well as administrative offices: A chapel, cafe, library, patio, and reception is located here, as well as a spa, hair salon, and exam/treatment room. This space is intended as common space for the 100 residents in the 10 Green Houses© clusters in the building.
Figure 8-53 The brick six-story building is designed to resemble a residential building with large windows and spacious balconies: A sheltering porte cochere welcomes visitors. Outdoors patio spaces are also available here for residents as well as people from the neighborhood.
Figure 8-54 The bakery café on the ground floor is where residents and families can visit and enjoy time in another place away from their small group cluster: This space resembles a neighborhood coffee shop. The stacking of unit clusters above a common meeting space floor in this urban Green House© creates more choices for families and caregivers.
Figure 8-55 A typical floor contains two L-shaped 10-unit resident clusters: The shared spaces in each cluster include a living room, dining table, kitchen, den, and balcony. Each house operates independently. Shared between the two houses are two elevators, a laundry, utility space, and a storage area.
Figure 8-56 The dining table, open kitchen, and den portrayed in this picture represent the scale and residential style of the cluster: Wood floors, residential light fixtures, and residential-scaled furniture establish a noninstitutional character. Large windows and a large balcony provide access to outdoor spaces in each cluster.
Figure 8-57 The 20-story Manhattan Lifecare building is located on the Upper West Side of Manhattan: In addition to Green House© clusters it also contains six floors of post-acute rehabilitation. The building contains two therapy gardens with one located on the roof. The lower two floors have office space, clinical services, and shared common space.
Figure 8-58 Typical Green House© floor for the Jewish Lifecare Manhattan Center: Each floor contains two 12-person Green House© clusters that share a bank of four elevators. There are 22 Green House© clusters (11 floors) in the building (264 units/residents). The 12 units in each cluster are for single-occupancy residents.
Figure 8-59 Each Green House© cluster has an identical stacked plan: The shared spaces include a living room, kitchen, dining room table (which seats 12 residents and 2 staff), a balcony, den, and laundry. The open centralized plan with built-in casework makes it easy for residents to navigate. Finishes and fixtures are residential in character.
Figure 8-60 Dwelling units are relatively small but single occupied: They measure 245 SF and have 10-foot ceiling heights. The windows are large with low sill heights but only 2 out of 12 have corner windows. Ceiling-mounted lifts will allow residents to be moved safely. The bathrooms include three fixtures (lavatory, toilet, and shower).
Figure 8-61 The southeast elevation uses a layer of trees and turf between the façade and the street to soften its appearance: This outer perimeter of the village contains few doors or sidewalks. A variety of brick materials and colors are used with differing fenestration patterns to create a residential look.
Figure 8-62 The central boulevard is the main east-west pathway and contains many offices and common space destinations: “The Passage” is a covered and enclosed space where the restaurant, main activity room, and grocery store are located. “Theater Square” is an outdoor civic courtyard with a fountain, which is also adjacent to the performance space/auditorium.
Figure 8-63 Stores and services along the boulevard resemble the main commercial street of any small Dutch town: They have moved counseling and maintenance offices to these visible locations, as well as shared community spaces, like the restaurant, physiotherapy, and the bistro. These active places add to the liveliness of the boulevard.
Figure 8-64 Hogeweyk Village contains three large plazas and four smaller squares and gardens: These are linked together through a looped pedestrian sidewalk that connects each small residential group cluster with common spaces and services. The landscaping is rich and varied with native plants, water features, and places to sit, relax, and recharge.
Figure 8-65 Residents often accompany caregivers to the on-site grocery store, where they buy groceries for their lifestyle group: The selected food is used to prepare meals, often with recipes familiar to residents. Homes are grouped into seven different lifestyles, which offer activities and food choices based on past experience.
Figure 8-66 Group homes are furnished to match the interior design finishes and treatments of different lifestyles: This living room is from an “urban” lifestyle group. Colors, fabrics, artwork, wall coverings, and furniture styles were identified through interviews with residents and family members, as well as site visits to their homes.
Figure 8-67 The crafts room is one of several common spaces that support the activities program at Hogeweyk: A music room, Snoezelen room, bistro, and theater are also available for a range of weekly clubs. The passage (enclosed arcade) and the theater square (courtyard) are often used to stage larger events.
Figure 8-68 The village is designed to have an inward focus toward courtyards and gardens: This is the “city square,” which contains “urban” lifestyle clusters. The hardscape plaza contains trees, sitting areas, and activities that are familiar to residents from larger cities. Colorful, mature, and indigenous plant materials are located here.
Figure 8-69 The main restaurant at Hogeweyk is elegant: It contains a covered and enclosed dining area in the passage as well as tables outside that overlook Theater Square. Everyone is welcome, including residents and their family members. Hogeweyk also encourages residents to visit restaurants in the surrounding community.
Figure 8-70 Ærtebjerghaven consists of five small group cluster buildings, each with nine residents: Each one-story buildings has a sloped ceiling and a central courtyard for daylighting. A long bar building contains administrative offices and serves to connect three of the five clusters. All connecting corridors are enclosed.
Figure 8-71 This “Osmund” plan is a compact configuration designed to minimize corridor lengths: Each cluster contains six shared common spaces including a dining room, activity area, living room, two patios, and an atrium/courtyard. The ceiling heights in the central portion of the plan vary from 10 to 14 feet.
Figure 8-72 The courtyard provides excellent natural light and an attractive controlled view in the center of the plan: The living room is in the foreground and the activity table is in the background. Note the change in ceiling height and the canvas shades that can be pulled over the atrium on a hot sunny day.
Figure 8-73 The shared living room is located adjacent to a partially covered patio: This space receives natural light from a full height window wall and the adjacent central courtyard. The higher ceiling height makes the room appear spacious but the furniture is residential in scale and type.
Figure 8-74 The kitchen for food preparation and finishing is located adjacent to the dining room table: Breakfast and lunch are prepared in this room, while the dinner meal is delivered and plated here. In this house the dining table is parallel with the courtyard to optimize natural light and view.
Figure 8-75 Each 410 SF dwelling unit is single occupied with a separate bedroom: It is large enough to accommodate a small living room, a patio, a small table, and a tea kitchen alcove. Sliding doors facilitate movement. The compact bathroom has a continuous tile floor and a flexible lavatory that can be moved in four directions.
Figure 8-76 The simple bathroom plan is compact and accessible: Fixtures are located on three walls, opening the center (with a 5-foot diameter turnaround) for shower chair manipulation. Residents are moved by lift from the bed to a chair, which rolls over the commode and can be used for showering.
Figure 8-77 Herluf-Trolle consists of five small group clusters with nine to ten residents each: Each one-story cluster is connected to the building entry via enclosed corridors. The entry area contains office spaces, meeting rooms, and staff support rooms. An external pathway for exercise surrounds the site.
Figure 8-78 The single-story Herluf Trolle entry has a dynamic angled approach: A tall flat roof floats over rooms and corridors allowing clerestory light to enter corridors and common spaces. The combination of brick and wood exterior cladding along with lush landscaping contributes to its residential character.
Figure 8-79 Each residential cluster has a central shared space and two corridors that connect to units: Common spaces include a dining room table, a living room, an open kitchen, a protected courtyard, and an outdoor trellis. The nine units are linked via single- and double-loaded corridors.
Figure 8-80 The L-shaped food preparation space in Herluf Trolle is tucked into one corner of the open plan: The freestanding cooking island can be lowered or raised to encourage resident participation. This large open-plan space with clerestory windows around the perimeter also accommodates the living room and dining room table.
