For many of us the thought of choosing a retirement home or care home may seem like a long way off; although some of us may be in the process of finding suitable care provision for our elderly parents or grandparents. For the Government, the prospect of an ageing population is a major issue, and one which will require some creative thinking to create a solution we will want to inherit. There is a saying “be kind to your children – they’ll pick your nursing home”; well we would suggest being kind to ourselves and designing places where we would like to be.
For those of us unable to remain at home, how should we approach the facilities that we will need as we age, to support us to remain at our best? Happily, there are better visions of the future being developed and a confluence of opportunities that, if grasped, can deliver a future we will want to occupy in our old age.
One of the fundamental issues for our future care homes is how they are placed in the community which they serve. It can only be in the best of interests of residents, relatives and friends if care homes are at the heart of our communities. A connection with the wider environment including transport, shops and entertainment, allowing trips out and a glimpse of life is just as important to a care home resident as peace and quiet. This is particularly true in cases of dementia where familiarity decreases confusion and social integration slows down the decline into dementia. One attempt maybe to create a memory or link to a previous place or community – Newbyres village care home in Midlothian does this by naming areas of the building after the streets of nearby Newtongrange to provide a direct link to where some of the residents previously lived.
Understandably care homes seek to look welcoming and friendly – often following a domestic style similar to that of many new housing estates. Whilst the aim is laudable the effect of this ‘stretched domestic’ imagery is that it can look less like a grand mansion and more like an over inflated house or “monster bungalow”. This effect undermines the intention and sets the home apart in the community as something quite different. Given the scale of the building will never allow it to successfully masquerade as a house, we should perhaps consider and learn from other styles or building types more appropriate to the place, lives and memories of the residents.
Does a care home need to continually make reference to the home or house? A more extreme and exciting vision of a care home is the Mornington Nursing home in Australia, developed around the ‘vision’ of a seaside spa hotel it provides an imaginative alternative for how we might spend our latter years, and a positive vision of how caring for some of the most vulnerable people in our society could be.
It is important that care homes be recognisable and memorable to residents as well serving their care needs. This is, after all, their home. However, unusually for a home, the ‘family’ they share it with is likely to be of around 40 to 60 other people; each with their own bedroom but sharing large communal living and dining rooms. Such homes are much larger than in the rest of Europe where groups of 20 are more typical. These large social groups can lead to communal spaces feeling impersonal. Therefore many residents may choose to greet visitors in their own rooms where they can have more privacy, though the space available in their room may not be ideal for this. Increasingly care home designs seek to address this by fragmenting the residential accommodation into smaller blocks or ‘houses’ believing that this combined with smaller lounges create a more homely feel and the opportunity for better interaction within smaller groups.
Marionville Court Care home in Edinburgh has done just this by creating a ‘street’ and a number of ‘houses’. The ‘street’ contains all the staff and service areas with a day care centre at the entrance. From the ‘street’ each ‘house’ is accessed via a small living room with kitchen and dining areas located at the centre.
This breaking down of the large building into smaller ‘family units’ could provide further interesting design opportunities where smaller parts of the care home are dispersed around a more densely populated urban fabric. Perhaps this could be considered along with better connections to secure outdoor spaces – smaller intimate courtyards and the larger landscape.
Internally, these homes require the level of sensitivity we apply to our own homes. Research on designing for dementia http://dementia.stir.ac.uk/ supports this and demonstrates the benefits of careful consideration of many factors including the use of colour, light, controlled stimuli, way-finding, size and relationships of spaces. Additional space, beyond the minimal specified in care home standards, is often required to allow residents more room for their belongings in order to provide familiarity and a space that is recognisably their own. Newbyres village care home provides ‘memory boxes’ outside each resident’s room which they can fill with familiar belongings. Buildings designed specifically for dementia maybe more expensive to build but, as Gareth Hoskins points out in the book ‘Psychiatry in the Elderly’, if codes for good practice design (such as the British Standards on inclusive design) considered dementia as they do other impairments this wouldn’t be an issue as such space standards would simply be “standard”. Further, by making the building work better there would be a reduction in the demands on staff as it has been shown that dementia friendly design contributes to maintaining residents’ levels of independence, reducing confusion and aggression. As the cost of running and staffing a facility is far greater than the build cost, the investment in good design more than pays for itself both financially and, more importantly, in terms of human dignity.