Aging at ‘home’

Aged care housing is not the most glamorous topic. Images of chintz curtains, floral upholstery and the smell of boiling cabbages readily come to mind. Of course this image is stereotypical. Nonetheless it is enduring. Although there are a handful of examples of innovations in aged care housing (most notably in Europe – see Figures 1 and 2), this is an area that is going to demand a great deal more focused effort, research and architectural ingenuity over the next few years.

Figure 1: Indre Havn Nursing Home, Norway – exterior (Roger Fay)

Figure 2: Indre Havn Nursing Home, Norway – entry lobby (Roger Fay)

Current Government expenditure on aged care in Australia is approximately 0.7% of GDP. It is expected that this will almost triple to 1.9% by mid-century making aged care spending higher than both defence and education.(1) One of the most pressing issues is the imminent retirement of the baby boomer generation over the next two decades. In the UK, it is projected that the number of people over age 65 will increase by over 30% by 2020 and that the people over 50 will account for 40% of the population by 2029.(2) At the same time, longevity of life is increasing. In 1950, the average 65-year-old man could expect to live until age 76. Today, the same man can expect to live until age 85.(3)

As well as the implications that this has for the economy, skills shortages and the increased pressure on the health sector, it also has substantial repercussions for the housing sector. In Australia, it is expected that the number of residents in Residential Aged Care Facilities (RACF) will rise from approximately 170,000 in 2007 to almost 240,000 by 2020.(4)

Perhaps an even greater issue than the demand for RACF places is the provision of alternative forms of housing to meet the diverse demands and expectations of the retiring baby boomer generation. As Professor Stimson from the Australian Housing and Urban Research Institute at the University of Queensland notes, “Their diversity, demanding expectations as consumers, and their lust for lifestyle will create many new market niches as well as large aggregate demand for more specialised living environments”.(5)

One of the key issues surrounding housing for an ageing population is the ability for people to ‘age in place’. This refers to the “capacity for any individual to safely, independently and comfortably live in their own home regardless of age, financial circumstance or physical limitation.”(6) It is pertinent that this definition focuses on the concept of ‘home’ as a site of security, autonomy and comfort. There is no clear definition of what constitutes ‘home’ as distinct from ‘house’, yet this term resonates with all of us. It is an emotional rather than merely physical entity; we feel at home, we reside in a house.

There is an enormous amount of research that attempts to unpack the meaning and significance of home in different contexts. In relation to ageing, the home has particular importance and it is recognised that a continued sense of feeling ‘at home’ is related to health and well-being.

One reason for this is the role that the ‘home’ plays as a repository of memory. Although memories can be ‘captured’ by other means such as photographs, diaries and objects, it is the particular place that is arguably the most significant factor (hence the contention over the dislocation of meaning with the removal of objects from their original context in museums). However, ‘place’ cannot be equated with physical ‘site’. Thus, as Sherman and Dacher (2005) argue, “the very notion of aging in place is called into question when significant alterations are made to the home environment without first establishing a context for assessing how the space is experienced by the older adult.”(7)

This suggests that the ability to modify houses to accommodate physical security and the ability to modify homes to accommodate emotional security are two very different concerns. The latter concern is highly individual and complex and will inevitably require a completely different approach to the provision of generic guidelines on housing adaptation.

In cases where remaining in the family ‘home’ is no longer tenable or desirable, this leads to the question as to whether ‘qualities of home’ can be transferred to physical sites beyond the original house. Research in this area has focused on the issue of significant or ‘cherished’ objects.(8) In the process of downsizing, or more particularly when moving into a RACF, there is inevitably a divestment of personal objects. This potentially leads to an intensification of meaning with those objects that are retained. As well as providing a ‘reassuring sense of continuity’, in the institutional context, objects can be fundamental to maintaining a sense of ‘self’.(9)

Although limits must be applied to the quantity and size of personal objects that can be accommodated within RACFs, the ability to integrate less tangible qualities of home is far more complex. Arguably the most innovative moves that have been made in this area so far are within the design of facilities for people with dementia. This is emerging as a significant area of enquiry due both to the scale of the problem and to the importance of environmental design in the treatment of people with dementia.

In Australia, dementia affects 245,000 people and the number is growing at an incredible rate with almost 70,000 new cases reported in 2009 alone.(10) It is predicted that by 2050 1.13 million Australians will suffer from dementia.(11) While currently there is no known cure for dementia, research has shown that the built environment is a large contributing factor in the health and wellbeing of people with dementia. Issues such as way-finding, familiarity, personalisation of space and the provision of ‘distinctive and varied’ social spaces are key factors in the design of aged care institutions for residents suffering from dementia. Further, it is recognised that the interior should be designed “in a manner reminiscent of home.”(12)

Of course this is easier said than done, particularly when the many and varied meanings of ‘home’ are taken into consideration. Further, while this editorial has focused on the physical entity of the house (or the institution) as the locus of ‘home’, it is important to consider the broader context in which the ‘home’ is situated. Interestingly, research has shown that it is location rather than the family home that is the greatest factor in the desire to ‘age in place’.(13) This requires investment in infrastructure and strategic planning initiatives to address issues such as pedestrian safety and mobility, access to smaller, localised home care facilities and services within neighbourhoods, and the inclusion of ‘accessory apartments’ for co-dwelling of family members or home nurses.(14)

The issue of co-dwelling is embodied in Teddy Cruz’s proposal for the San Ysidro immigrant community in suburban San Diego. The first stage of the development comprises twelve flexible housing modules, a community centre and gardens. The second phase for elderly housing integrates ‘prodigal apartments’ for extended families as well as a full time day care centre as a core part of the development.(15)

This form of multi-generational housing and community facilities provides an interesting counterpoint to the bland mono-dimensional ‘retirement villages’ that are endemic in Australia. Together with similar European innovations in the design of aged care institutions such as the Indre Havn nursing home in Norway (see Figures 1 and 2 above) maybe we can look towards a brighter future that challenges the stereotype of ‘aged care housing’. Maybe it’s not all chintz curtains, floral upholstery and boiled cabbage after all.

Ceridwen Owen
Architects for Peace, March 2010

Acknowledgements
I would like to thank Professor Roger Fay, Head of the School of Architecture, University of Tasmania for his assistance in providing background information and the images for this editorial.

Endnotes
1. Productivity Commission (2008) “Trends in Aged Care Services: Some implications”, Commission Research Paper, Canberra.
2. Latest ONS/ GAD projections
3. DWP (2006) “Security in Retirement: Towards a New Pension System”
4. Australian Institute of Health and Welfare (2008) “Residential aged care in Australia, 2006-2007: A statistical overview”, Canberra; Allen Consulting Group (2002) “The Financial Implications of Caring for the Aged to 2020: A report commissioned in conjunction with The Myer Foundation Project, 2020”
5. http://www.uq.edu.au/news/index.html?article=1597, accessed 26 March 2010
6. http://www.ageinginplace.com.au/, accessed 26 March 2010
7. Sherman, E. and Dacher, J. (2005) “Cherished Objects and the Home: Their meaning and roles in late life” in Rowles, G.D and Chaudhury, H. (Eds) Home and Identity in Late Life, New York: Springer, p. 76.
8. Ibid
9. Ibid, p.66
10. Menzies Research Institute Newsletter (March 2010)
11. Ibid
12. Brawle, E. (2006) Design and Innovations for Aging and Alzheimer’s: Creating caring environments, Hoboken, New Jersey: John Wiley and Sons.
13. Olsberg, D. and Winters, M. (2005) “Ageing in Place: Intergenerational and interfamilial housing transfers and shifts in later life”, Australian Housing and Research Institute, AHURI Final Report No. 88, October 2005, p. vii.
14. Després, C. and Lord, S. (2005) “Growing Older in Postwar Suburbs: The meanings and experiences of home” in Rowles, G.D and Chaudhury, H. (Eds) Home and Identity in Late Life, New York: Springer.
15. Ouroussoff, N. (2006) “ARCHITECTURE; Shantytowns as A New Suburban Ideal”, article in New York Times, published 12 March 2006.