http://ibe.sagepub.com/Indoor and Built Environment

http://ibe.sagepub.com/content/21/1/191The online version of this article can be found at:

 DOI: 10.1177/1420326X11419349

2012 21: 191 originally published online 1 September 2011Indoor and Built EnvironmentYeunsook Lee, Hyegyung Yoon, Soohyun Lim, Somi An and Jihye Hwang

Housing Alternatives to Promote Holistic Health of the Fragile Aged  

Published by:

http://www.sagepublications.com

On behalf of: 

  International Society of the Built Environment

can be found at:Indoor and Built EnvironmentAdditional services and information for    

  http://ibe.sagepub.com/cgi/alertsEmail Alerts:

 

http://ibe.sagepub.com/subscriptionsSubscriptions:  

http://www.sagepub.com/journalsReprints.navReprints:  

http://www.sagepub.com/journalsPermissions.navPermissions:  

http://ibe.sagepub.com/content/21/1/191.refs.htmlCitations:  

What is This? 

- Sep 1, 2011 OnlineFirst Version of Record 

- Feb 9, 2012Version of Record >>

by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from by guest on October 11, 2013ibe.sagepub.comDownloaded from

Original Paper

Indoor and BuiltuiltEnvironment Indoor Built Environ 2012;21;1:191–204 Accepted: July 12, 2011

Housing Alternatives toPromote Holistic Health ofthe Fragile Aged

Yeunsook Lee Hyegyung Yoon Soohyun Lim

Somi An Jihye Hwang

Department of Housing and Interior Design, Yonsei University, Seoul, Korea

Key Words

Dementia elderly housing E Fragile aged E Holistic

health E Small group workshop

AbstractThe purpose of this study was to provide research-

based argument for a better housing for the dementia

elderly within the apartment complex neighbourhood.

Six case study’s designs are included to illustrate the

types of facilities that could be possible that would

provide a better environment for the care of elderly and

older people with dementia. Literature was analyzed to

give the perspectives of ‘‘sustainable and aging

society,’’ ‘‘social integration’’ and ‘‘natural environment

that promotes health.’’ Small group workshop was

carried out with experienced professionals to discuss

the concepts and features of the developed housing

alternatives plans to validate the proposal to integrate

local residents and promote holistic health for the

fragile aged. The findings illustrate the vision for

the shared space community, a community home for

the dementia elderly, with appropriate scale for easy

management and being connected with local com-

munity and with affluent green environment for healing

and natural environment that would ease local resi-

dents’ aversion towards elderly housing. These hous-

ing alternatives would enable the elderly to age in place

and with the most natural social integration available to

local people, with a proper spatial planning to promote

holistic health of the fragile aged.

Introduction

Background and Purpose

Since 1970’s industrialization, mass production of

houses has been possible and as a result, 7.8 million

apartments have been built in Korea [1]. Physical

proximity of apartments has led to active interaction

among residents and this has created a new form of

community culture. However, frequent contact within the

community deepened competition among groups and

generated another social complication.

Alongside with the world’s aging population issue,

Korea has already faced an aged society [2]. With an

increasing aged population and an outbreak rate of

dementia in this population has been rising. According

to Statistics of Korea [3], the outbreak rate of dementia

within the elderly aged over 65 is 8.6%. Approximately

460,000 of the elderly are dementia patients and it is

expected that the number of dementia patients in this

group would ascend to 690,000 in 2020. Contrary to the

general elderly, a physical, psychological and economic

� The Author(s), 2011. Reprints and permissions:http://www.sagepub.co.uk/journalsPermissions.navDOI: 10.1177/1420326X11419349Accessible online at http://ibe.sagepub.comFigures 1–12 appear in colour online

Soohyun Lim,Department of Housing and Interior Design, Yonsei University, Shinchon134,Seoul 120-749, South Korea. Tel. þ82-10-3378-8081, Fax: þ82-2-313-3139,E-Mail gsylim@yonsei.ac.kr

burden on supporting family members or care givers is

great in order to meet the needs of the elderly with

dementia. Therefore, staying in dementia facilities is an

absolute option when the level of dementia is severe.

Despite growing interests on life of the elderly with

dementia and healing environment for them, constructive

base to support their lives is lacking. Furthermore, such

elderly housing is considered an unpleasant facility, thus

local residents avoid it being built within their community.

Yet, our society is aging rapidly and there will be more

needs of elderly housing in a city along with aging speed,

thus evading elderly housing is an inappropriate and

unhealthy aspect as it creates an obstacle in making the

city sustainable and accommodating elderly housing well

in an urban setting is as significant as city’s ecological

issues. Therefore, the purpose of this study is to clarify

usefulness of housing alternatives that would promote

holistic health of the fragile aged within the

neighbourhood.

Methodology

Literature research and small group workshop were

used as a methodology. Literature was analyzed by the

following three perspectives, which are ‘‘sustainable and

aging society, social integration and natural environment

that promotes health’’. These were chosen to build

sustainable society, by solving aging-related social prob-

lems in a socially integrative perspective. The provision of

natural environment can work as a buffer zone for social

integration in an architectural design for the elderly.

Publications, precedence researches, statistics, conference

data etc. were used for literature research. Small group

workshop was carried out on three professionals who have

more than 20 years of experience in providing better

dementia care environment within elderly care facilities.

Concepts and features of housing alternatives for the

fragile aged that could be inserted into the existing

apartment buildings were discussed. Housing alternatives

were explained with visual means i.e. plans, perspective

views, videos. To gather small group workshop partici-

pants’ opinion, IAI-C-CCC method was used which

pursues following process [4].

. Initiate: Speak up and voice your opinion. Do not wait

for others to make statements that you only respond to.

Think about what you want to say and say it clearly. Be

creative. Have ideas.

. Advocate: Stick up for yourself with a good, well

thought-out argument. Refer to facts that can be

verified. Plan your argument so that it is convincing;

but be ready to see other people’s points of view if they

present logical reservations. Be ready to overcome other

team members’ ‘‘reservations.’’

. Inquire: Whenever anyone else in the team makes a

point, before you disagree, ask them to clarify what you

may not understand or to explain what facts they are

basing their argument on. People will listen to you if

you first listen to them.

. Conflict: If everyone in a team agrees totally with each

other, there is no reason to have a team meeting.

Disagreement is the basis of a good team meeting. But

do it right. Do not argue or fight. Do not get personal.

Let the facts speak for themselves. Listen to the other

person’s point of view. Present differences you may

have in terms of well thought-out ‘‘reservations’’ to the

point of view of another. Such a statement is an

invitation to others to overcome the reservation. Until

the other person’s point of view has been discussed, do

not present your own ‘‘counter proposal.’’

. Consensus: The best way to make group decisions is for

everyone in the group to agree without reservation by

consensus. To achieve this quickly, listen to other team

members and if you disagree think carefully about your

concerns, say: ‘‘My reservation is. . .’’ then wait for that

person and other team members to resolve your

concerns. That is their responsibility; not yours. If a

reservation cannot be overcome, the team has to adopt

that change. When everyone’s reservations are resolved

the team has consensus. If you cannot reach consensus,

you have to either vote, which means some people’s

reservations have not been included in the decision, or

you have to appoint one person as the decision-maker.

Both voting and appointing a decision maker are

flawed processes; they leave opinions and people out

of the decision.

. Commitment: When the group in which you are a part

makes a decision together by consensus, every member

of that group is taking that decision as an individual as

well. If you agree to do something either in the group or

as an individual within the group, this represents a

commitment. Commitments are met. There are no

consequences for unmet commitments because that

would give the person the option of choosing to do

what she or he said or to live with the consequences.

When team members repeatedly meet the commitments

they make in the group. When they match their deeds to

their words over time, the group develops trust.

. Critique: In order to improve team results and team-

work skills team members engage in critique before,

192 Indoor Built Environ 2012;21:191–204 Lee et al.

during and after each team meeting. Critique is not

criticism; comparing actions to plans made and prin-

ciples agreed to enable the team to continually improve.

Plan beforehand. Pre-critique. Do not be afraid to say

‘‘time out’’ during the meeting. Time-out critique. Be

sure to review as a team how well you practised

teamwork principles and how you are going to improve

the next time. Post critique.

Literature Review

Sustainable and Aging Society

The concept of is often related to saving natural

resources and environmentally friendly issues that are

related to ecological crisis [5–11], however, supporting

human’s physical decline due to aging should also be

considered to build sustainable society. In other words,

respecting human aspect in an inclusive social environ-

ment would fit the meaning of sustainable society. Thus, in

order to aid physical deterioration of the elderly and to

construct sustainable society, sharing urban space effec-

tively is the key.

Considering characteristics of the elderly who spends

most of the time in their houses, housing issues for the

elderly should be solved with first priority. According to

Lee [12], the ideal elderly housing ought to encourage the

elderly age in place regardless of one’s culture and nation.

‘‘Aging in Place’’ means making the elderly be able to

continuously live in the existing house without moving

[13]. As the elderly prefers small-scaled houses as

managing houses would become problematic due to

physical weakness, desirable housing type would be a

group of homes that would enable them to age in place

within the community and to interact with people [14].

Even though personal resources are limited, utilizing the

space where an elderly group home’s co-residents and local

residents could share would lead to the direction of

building sustainable Korean society and promote the

elderly to age actively.

Social Integration

Social integration is an integrating process that

segregated groups or individuals can adjust to each other

[15], and this means accommodating the minority groups

such as ethnic minorities, refugees and underprivileged

sections of a society into the mainstream of societies.

Members of the minority groups thus gain full access to

the opportunities, rights and services available to the

members of the mainstream.

It is a widespread problem that dementia elderly

housing or social housing is considered as an unpleasant

facility and there has always been objection issue to

develop it in one community due to NIMBYism [16]. Lack

of community spirit and differences among social groups

in an information-oriented society have led to the

exclusion of the socially disadvantaged group like the

elderly with dementia or low-income people from the

mainstream. It has been predicted that making Korean

society socially integrative would be costly and compul-

sory social integration could create side effects, thus

ingenious strategies are necessary to accomplish social

integration naturally.

The national project called ‘‘Development of Socially

Integrative Housing Community Regeneration

Technology’’ carried out by the Ministry of Land,

Transport andMaritimeAffairs approves social integration

issue as a significant factor for urban planning. The project

seeks ways to naturally integrate the social minorities into

the mainstream, to build sustainable society and to bring

liveliness to a local community.With this background, Unit

Insertion Building System (UIBS) has been proposed which

can be applied to apartment buildings in order to promote

active social interaction among apartment residents and

open up to a new way of living. UIBS is the Skeleton Infill

(SI) housing with an open building concept which would

enhance durability of the building and vitalize local com-

munity culture [17,18].

Natural Environment that Promotes Health

Natural environment can provide affluent atmosphere

that would enriches people’s lives. It promotes people’s

physical health through exercises and emotional health via

visual tranquility. Natural environment is also a positive

distraction to the elderly with dementia. Its healing role to

the elderly with dementia has been proven in precedence

researches. Carman [19] indicated that a garden space

within dementia elderly housing facilities would positively

stimulate sensory organs of the elderly with dementia and

helps to cure emotional control and memory disabilities.

Moreover, natural environment would facilitate for the

elderly with dementia to maintain their physical ability

and to heal depression [20] and promotes emotional

stability [21]. According to Oh et al. [22], dementia elderly

housing residents who get access to safe wandering space

and outdoor nature space would have less disruptive

and problematic behaviours and a higher independence

in comparison to those who do not have them.

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 193

Natural environment is beneficial to not only general

public but the elderly with dementia.

Dementia Elderly Housing Plan within

Existing Apartments in Korea

Background of Planning Target

Development of Shared Spaces in Korean Apartments

The word ‘‘community’’ originated from the Latin

word ‘‘communitas’’ that means an unstructured com-

munity in which people are equal with an intense solidarity

and togetherness [23]. This implies people in a community

usually share the common environment and common

concerns. The concept of shared space means that a sense

of community is reflected in a space, and shared space in

apartments in Korea is residents’ common space to satisfy

various functions as daily welfare of residents. Although

more than 7.8 million units of apartments have been built

for last 50 years, apartments in Korea have not formed a

housing culture of community successfully, and shared

space has been made only as a simple common stairway or

an aisle [24]. However, as the restrictions on the maximum

prices of apartments by government were lifted and

residents’ demand to pursue the quality of life has been

on an increase, residents’ shared spaces and community

centres began to be built. In the middle of 2000, more than

100 kinds of shared spaces including community con-

ference room, fitness space and others were built, which

shows apartment buildings are being developed to

stimulate the community activities [25]. In addition,

increasing emphasis in the community-shared space

would form a green infra where residents can experience

and realize the green life [26], though any functional spaces

may be installed in line, and suggested that the com-

munity-shared spaces be converted into ‘‘green þ a’’.Shared space in apartments in Korea is now expected to

promote the symbiotic living environment and function

like a sponge that will relieve many social problems.

Concept of Building Innovation Model

Korean people are resolved to solve the urgent social

problems caused by changing demographic structure and

aging society, and have to challenge diverse issues such as

energy-efficient ways for the existing concrete buildings to

restore the ecosystems. Some representative books for

symbiotic housing culture established by vitalizing shared

space are ‘‘Housing for the Korean Elderly’’ [27], ‘‘Future

Housings and Residents’ Shared Space’’ [28], and

‘‘Millennium Community Center’’ [29]. These researches

suggested a comprehensive model for residents’ shared

space in residential areas. In connection with these studies,

Lee [17] suggested to establish an ‘‘Apartment Community

Space Project’’ as national project or system for apartment

innovation. Key points of this proposal are to utilize the

shared spaces of the apartments for necessary functions

according to social changes. For instance, 5%–10% of the

apartment building is secured as the minimum community

shared space, and the extra spaces are recommended to be

secured with the consensus of the residents. These are new

ideas for the shared spaces that will activate the com-

munity life not only at the level of apartment complex but

also at the level of unit buildings where hundreds or more

residents live together, realizing the vertical community

vitalization.

Benefits of Green Infra and its Relevance of Community

Shared Space

Ecosystem crisis with climate changes, urbanization

and exhaustion of natural resources has become global

issue, and in order to solve this problem, various efforts

and researches for greening by constructing green envir-

onment with plants and developing new eco-friendly

techniques have been made. Introducing community

gardens or farming gardens in buildings for green

environment is one of these efforts, and these green

environments are implemented with green infra concept.

One of the representative ecological problems in the

industrialized cities is the phenomenon of urban heat

island. In order to relieve this heat island effect, formation

of planting and water space, energy efficient construction

technology and installation of pilotis in the residential

complex can be used. If green spaces are installed on

rooftop and walls in the residential building, the air

temperature around the building is adjusted and indoor

heating environment is improved and cooling expense in

summer can be saved [30]. From this viewpoint, if

community-shared space is required to be constructed at

a certain proportion or more in all the buildings, it is

expected that, in most cases, greening space or community

garden will be installed on the roof and the ground floor

[31]. Therefore, community-shared spaces will function as

a space for promoting interaction and cooperation among

the residents through preventing the heat island effect and

by providing the residents with greening experience

information, solving the problems of ecosystem crisis,

achieving the bio diversity and providing a healthy

environment opportunity for the residents including

socially disadvantaged people with easy accessibility.

194 Indoor Built Environ 2012;21:191–204 Lee et al.

Planning Guidelines

Planning guidelines of dementia elderly housing can be

divided into indoor and outdoor space guidelines. Looking

into indoor space first, residents’ privacy in their personal

space should be protected. General indoor space should be

open plan in order to provide urban plaza-like atmos-

phere. Because the elderly with dementia cognizes small

indoor communal space in the facility as neighbourhood

environment within a community, indoor space has to be

planned in a way to enhance cognitive skills of the elderly

with dementia and wandering space should be secured.

Furthermore, natural observation should be reinforced in

the indoor space design [32]. When planning outdoor

environment in dementia elderly housing, outdoor space

should be visible from indoor space. If there is an adjoined

outdoor space to the facility, it should be utilized without

intruding existing space. Placing positive architectural

features near the facility can be an effective way to reduce

local residents’ negative perception on dementia elderly

housing and natural environment should be sufficiently

exploited.

House Planning Cases

Case I

Project Statement

An apartment is the dominant housing type in Korea

and many of them are facing the regeneration phase, so

utilizing space in apartment buildings for all residents is a

key to aim towards socially healthy and sustainable

community. The housing design proposal target was a

rooftop and its design consists of affordable housing with

healing garden for the elderly with dementia and com-

munity garden for the residents. They are linked and

divided naturally and the scheme maximizes benefits for

the users with minimum resources. Five elderly with

dementia and one manager can live in the house.

Site (Figure 1)

. Location: Dongtan New City, Neung-dong, Hwasung-

si, Gyounggi-do

. Name of Apartment Complex: Dongtan Doosan We’ve

. Completion Time: January 2008

Design Outcome

Figure 2 shows a room for the manager is located near

bedrooms for the elderly with dementia for natural

observation on them and a communal bathroom is

available when they require assistance in bathing (A). A

community garden and a garden building is for local

residents to interact and relax with others, have gardening

classes and grow plants, vegetables etc (B). A healing

garden is for the elderly with dementia and a hand bar is

installed alongside with a walkway, thus it is only visually

connected to the community garden (C). There are

personal bedrooms for the elderly with dementia and

open living rooms for them to socialize (D).

Case II

Project Statement

This is a remodelling design case of Banpo Mido

apartment located in the regions that require housing

community regeneration. Two existing housing units were

merged to design a care service supported group home for

four elderly. It is composed with four private units

including a bedroom and a bathroom and a shared space

that enables residents to live both independently and

together with others.

Site (Figure 3)

. Location: Banpo-dong, Seocho-gu, Seoul

. Name of Apartment Complex: Banpo Mido Apartment

. Completion Time: 1987 (refurbishment commenced in

2007)

Design Outcome

A manager or care giver would live in this space to

provide the elderly their care service and needs. The room

can also be used as a storage or a guest room (A). A

kitchen is positioned in the middle of the housing unit for

convenient access from any direction and designed with a

cafe-like concept (B). Universal Design principle is applied

in designing a communal bathroom for securing safety and

convenient usage (C). Personal bedrooms are planned in a

privacy respecting way with an individual toilet (D). A

healing garden is located in a south-facing balcony (E)

(Figure 4). Figure 5 shows the 3-D images of the kitchen

and a living room.

Case III

Project Statement

The original four housing units in newly being built

apartments in Gimpo Han River New City were modified

into two units of dementia care facilities placing a healing

garden in the middle of the plan. Each unit has five

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 195

personal rooms and shared space including a manager’s

room, a kitchen, a dining room, a living room, a bath

room etc. It was designed to be managed effectively with

few care givers and healing aspects were carefully

embedded throughout the space.

Site (Figure 6)

. Location: Gimpo Han River New City

. Name of Apartment Complex: Gimpo Han River

New City AC-11 Block (Undecided yet)

. Completion Time: Planned to be completed in

June 2012

An individual bedroom has furniture that supports the

elderly with dementia to recollect their memories (A). A

living space helps the elderly to exercise and promotes

healing activities (B). Indoor healing garden would

maximize the healing effect through natural factors that

is horticulture (C). A kitchen can work as a nursing station

which would enable care givers to observe both private

space and shared space and designed to be easily accessible

with sufficient storage (D). Water usage space is put

intensively together and it is designed to have enough

space for the elderly with dementia in order to have

professional care providers’ support (E) (Figure 7).

Design Outcome

Case IV

Project Statement

This project focused on offering dignity and comfort to

the elderly with dementia, thus a residential model was

designed in contrary to an existing medical model. Home-

like dementia care facility was planned and designed to

Fig. 1. Site view and original housing unit plan.

B. Community Garden & Garden Building

C. Healing Garden

D. Personal Room & Shared Space

A. Manager Room & Communal Bathroom

Fig. 2. Designed rooftop plan.

196 Indoor Built Environ 2012;21:191–204 Lee et al.

A. Manager or Care Giver Room

B. Kitchen

C. UD Applied Communal Bathroom

D. Personal Room

E. Healing Garden

Fig. 4. Designed care service supported group home plan.

Fig. 5. Three dimensional image of designed space.

Fig. 3. Site view and original housing unit plan.

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 197

consider holistic health of the elderly with dementia and to

contain healing effect throughout the space.

Site (Figure 8)

. Location: Banpo-dong, Seocho-gu, Seoul

. Name of Apartment Complex: Banpo Mido Apartment

. Completion Time: 1987 (remodelling commenced in

2007)

Design Outcome

Figure 9 illustrates a healing garden with a skylight

where the elderly with dementia could get access to natural

environment indoors (A). A double-wall structure would

be energy efficient and provides outdoor-like indoor space

(B). Healing walls would demonstrate familiar images i.e.

street views in the past for the elderly to relax and to be

happy (C). A home-like kitchen provides soothing sensory

stimulation (D). A kitchen is put close to a nursing station

for work efficiency and all spaces are visible from the

nursing station, thus the number of managers could be

minimized (E).

Case V

Project Statement

This housing plan integrates treatments from hospitals

and services from medical hotel in preparation to the

A. Bedroom for Healing

B. Living room for Healing

C. Garden for Healing

D. Kitchen for Healing

E. Bathroom for Healing

Fig. 7. Planned dementia care facility plan.

Fig. 6. Site View and original housing unit plan.

198 Indoor Built Environ 2012;21:191–204 Lee et al.

period when the houses should accommodate the elderly

with a healing environment after severe surgery. This

house would provide the nursing services for the elderly;

thus would sustain residents’ original lifestyle and flexible

in usage according to the space users’ needs.

Site (Figure 10)

. Location: Dongtan New City, Neung-dong, Hwasung-

si, Gyounggi-do

. Name of Apartment Complex: Dongtan Doosan We’ve

. Completion Time: January 2008

Design Outcome

Figure 11 presents a housing unit that secures privacy

of the elderly with easy surveillance on them given by the

care givers (A). By opening up the balcony, indoor

walkway would be created (B). A nursing station is

located close to the housing unit, thus daily care service

can be easily provided for and when it is not in use, it can

be rented (C). Healing garden provides natural environ-

ment that would enhance the quality of care for the elderly

(D). There would be a space for a professional medical

team and equipment for an emergency (E).

Case VI (Figure 12)

Virtual Reality-based images have been developed to

facilitate discussion and interaction among small group

participants easily. These contents are especially intended

to reach a consensus for would-be residents.

Result of Small Group Workshop

Expert workshop was held for 5 h on January

25, 2011, focusing on following two topics: Firstly,

Fig. 8. Site view and original plan.

A. Healing Garden

B. Healing Double Envelope

C. Healing Wall

D. Healing Kitchen

E. Nursing Station

Fig. 9. Designed residential dementia care facility model plan.

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 199

free discussion on basic philosophy on aged people

with dementia, their environment, desirable direction

and current situation; Secondly, explanation on

developed model of dementia environment and free

discussion on major concepts of the proposed project.

Discussions were made about the answers and questions,

and if opposing viewpoints were presented, workshop

proceeded to facilitate to reach the consensus on the topics

ultimately.

Opinions about the Future Direction of People with

Dementia and Their Environment

. Paradigm to enhance the quality of life and under-

standing for the people with dementia

Regarding the desirable paradigm in the future,

following three questions were presented and the experts

opined as follows:

1. Experts generally agreed on the fact that people with

dementiamust be respected properly as peoplewith brain

and emotion without having any viewpoint that they are

people devoid of certain functions, though they suffer

from deficiencies of certain capabilities. This means

efforts must be made to sustain their daily life without

leaving them carelessly by observing their process of

degeneration carefully and protecting them safely.

2. All participants agreed positively on the recent

viewpoint that ascertains a comprehensive approach

combining the medical approach and non-pharmaco-

logical approach must be applied to enhance the

A. Housing Unit

B. Indoor Walkway

C. Nursing Station

D. Healing Garden

E. Medical Core

Fig. 11. Designed medical service provided housing plan.

Fig. 10. Site view and original plan.

200 Indoor Built Environ 2012;21:191–204 Lee et al.

quality of life of the people with dementia.

Particularly, the non-pharmacological method that

used to be overlooked in the past has been recognized

as an important alternative medicine, which implies

the space environment, techniques and technology

can be used as non-pharmacological resources and

their value as important resources is expected to be

improved in the future.

3. Regarding the desirable alternative to make

up for the decreasing service providers while

their care need is increasing, following three

points were proposed: Firstly, it is necessary to

continuously bring up the care providers with

professional skills and qualifications, and as their

numbers fall short absolutely, even multinational

workforces must be accepted. Secondly, though care

providers may fall short of the needs, the caring

environment must be improved for suitable care

services and advanced technologies are required to

be introduced to lessen the burden of the care

providers or replace the care providers. This means

the utilization of space environment as an alternative

to the care providers.

. Opinion on characteristics and scale of residence for the

aged people with dementia

For this purpose, two questions were presented and the

conclusions of discussion are as follows:

1. Among the two terms of ‘‘facility’’ and ‘‘house,’’ all

experts agreed it is more desirable to approach with a

concept of a ‘‘house’’ rather than ‘‘facility’’ and to

name the ‘‘facility’’ as ‘‘house’’ apparently. This

implies that facility means a temporary residence to

serve the people with dementia, while the residence for

the people with dementia must be a house that has

close relationship with settlement and psychological

comfort.

2. Regarding a large-scale and a small-scale facility,

all the experts preferred the small-scaled facility,

and they opined that a facility for 7–10 persons

per unit would be suitable in Korea, but they said

that the accommodation scale per unit can be

expanded up to 30 persons as it is stipulated in

the criteria of AID. This can be explained that, as

for the facility unit, the smaller is the better,

but the scale of the public facilities in Korea

can be expanded up to accommodate 30 persons

per unit considering the various economic

situations, factors and the rising number of

the people with dementia in Korea, if the facility is

well-equipped.

. Status of nursing and caring facilities in Korea

Regarding the level and status of nursing and caring

facilities in Korea, following two questions were

presented:

1. Concerning the current environmental status and

level of the nursing and caring facilities for the aged

people in Korea, all the experts answered the facilities

face difficulties or are not in the desirable situations as

they expect and the facilities cannot take their

environments into consideration presently. The

major reasons for these situations were that the

facilities accept only the dementia people with the 1st

or 2nd degree dementia according to the nursing care

Fig. 12. Examples of Virtual Reality based simulation images of the designed housing.

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 201

insurance and the atmosphere and economic situation

of the facilities have become deteriorating more and

more. That is, though people deeply recognize the

ideal and desirable direction how to care for

the people with dementia, the experts said, currently,

the caring facilities are being operated and managed

in adverse direction in Korea.

2. In order to improve the environmental situation of

the caring facilities for the aged people, first of all, the

hardware of facilities and sufficient skilful care

providers are very important to run the facilities

smoothly and, most of all, what is urgently needed is

the necessary fund and economic support. If the

economic situation is not improved, fund cannot be

invested to improve the environment. Therefore, it is

almost impossible to enhance the environment of the

facilities without the systematic support of the

government. However, though the existing facilities

cannot be innovated due to these reasons, a concrete

guideline for caring facilities must be introduced and

reinforced to prevent these kinds of errors when new

facilities are planned to be built.

Experts’ Response to the Newly Developed Residential

Alternatives for the Aged People

This consulting was processed in the form of workshop.

The backgrounds about the newly developed residential

alternatives for the aged people and their new designs were

explained and comprehensive presentations about their

implications were made for about 20min. Then questions

were asked to the experts about their opinions concerning

the basic concepts of the new models. The conclusions

were as follows:

1. Older people who need nursing and caring facilities

should be integrated into typical apartment units

taking into considerations the rapid increase of older

population. They added that living altogether natu-

rally would be desirable in the end for the society.

However, NIMBY symptom is feared to prevail

during the transitive period. On the other hand,

according to them, the rapid change in the sense of

socio-culture and the breathtaking pace of building

apartment units which is the prevalent type of

residential structure in Korea could hasten integration

of the facilities into apartments.

2. All the experts agreed with the proposal to secure

space amounting to 5%–10% of the space in the main

apartment building as welfare infra so that it can be

used flexibly to meet the demands of the society in

consultation with residents. They only feared the price

of the neighbouring houses could be affected after-

wards. But there was assertion that the house price

would not depreciate due to the establishment of

facilities for older adults in the apartment building as

the secured space can be utilized not only for the

welfare of the aged but also for other needs of the

other residents. The function of the space could be

changed with time. And it was discussed that fear of

price downing is unfounded as the value of houses

neighbouring care facilities might be increased in

parallel with changes in the social attitude towards

such kind of welfare facilities.

3. Those experts agreed in principle that the NIMBY

syndrome that could appear with the availability of

care and service facilities in the residential complex

could be solved with systematic and policy measures.

Then people for whom welfare benefits are not

available will be able to receive care services naturally

and they then need not be moved to care facilities

when they are struck with dementia, the society will

accept the older adults with dementia smoothly.

Discussion

Apartment reform proposal has been presented to

establish a new space infra aimed at vitalizing community

needs and meeting needs in the aging society. The space will

be a community centre space and would comprise spaces of

diverse functions in accordance with changing needs of the

society. A model of care has been presented during a

workshop; this would provide residence for the older people

with serious dementia, which can be housed in the

community space. The opinions of field experts were

surveyed, on what kind of houses that would be needed

for the memory impaired. Experts said wards for the people

with dementia are being built now, as outside the residential

area people are worried that there might be problems with

entering into residential area due to NIMBY syndrome.

But the experts generally agreed that the proposal would be

the ideal direction Korea should go for.

The three experts, who are pioneers in the care services in

Korea, have long engaged in the care service activities for

the people with dementia and have many experiences and

vision for the future-oriented welfare for the older people.

Their responses on the proposed welfare infra in the

apartment buildings would mean that dementia care

environment could be incorporated into the general

residential environment. Such integration would be

202 Indoor Built Environ 2012;21:191–204 Lee et al.

desirable for the holistic health of the older people. People

in the typical care-providing facilities are prone to be

waning as their free movement within the facilities are

controlled due to shortage of care givers, absolutely poor

environment and to meet the safety requirement needed for

these types of accommodation. In contrast, the proposal

will contribute to promoting physical health of the older

people by providing care-giving facilities with environment

that are comparable to that of nearby apartment units.

From the mental point of view, aging in the home-like

environment will help enhance stability of patients. The

most important thing is that the nursing and caring facilities

for people with dementia should have environment like

homes and the smaller size care facilities would be better

than the larger ones to treat the aged with dementia as a

person with dignity. In the proposed space, the older people

with dementia will be better treated in that direction. It is

also anticipated that the planned facilities will help improve

holistic health of residents as the inpatients can interact

with people of diverse backgrounds in the local community.

Furthermore, the planned space is to be established on the

basic plan of green infra enabling the older people to enjoy a

more healthy life surrounded with natural environment.

Conclusion

This study was planned to validate usefulness of

housing alternatives that have been designed to ease

aging crisis, that is lack of appropriate facilities for the

fragile aged, and are an innovative way to utilize urban

space. Apartments have been used in this model as an

innovative mechanism and a focal point is a community

space which could enhance local residents’ welfare by

adapting diverse functions into the space. One of the

housing alternatives proposed has suggested the provision

with visuals for the fragile aged who either has dementia or

requires intensive care on daily basis. This would provide a

socially integrative care environment within the existing

community for the fragile aged and by providing small-

scaled home-like environment and familiarity that would

promote physical, psychological and social health of them,

the validity has been proved.

Apartments are the dominant housing type in Korea,

which should be part of housing the fragile elderly with

dementia effectively. This study has its distinct uniqueness

in promoting holistic health of the fragile aged, natural

social integration and sustainability of our society by

converting negative image of fragile elderly facilities and

making them recognized as one of general housing types.

In addition to this, employing visuals, rendered perspec-

tive views, virtual reality based simulation, which were

developed for an accurate communication among small

group workshop participants, has actualized the housing

alternatives’ concept. Further studies on a wider range

professionals working in elderly facilities and family

members of the fragile aged would be necessary in order

to reconfirm and drawing positive national response out

on these housing alternative models.

Acknowledgements

This work was supported by the National Research Foundationof Korea (NRF) grant funded by the Korea government (MEST)

(No. 2011-0001031) and the Grant of the Seoul DevelopmentInstitute (Research & Development of Silver Industry based onFusion Technology, 10634).

References

1 Ministry of Land, Transport and MaritimeAffairs: Apartment Housing PriceAnnouncement, 2009.

2 Lee YS, Kim HJ, Yoon HG: Spatial representa-tion of community shared spaces preferredby residents: Indoor Built Environ2010;19(1):163–174.

3 Statistics Korea: Statistics on the Elderly:Annual Digital Prints, 2010.

4 Zeisel J: Teamwork Principles: ConsensusTeamwork Process. Hearthstone AlzheimerCare, 2005.

5 Yu CWF, Kim JT: Building environmentalassessment schemes for rating of IAQ insustainable buildings: Indoor Built Environ2011;20(1):5–15.

6 Cho SH, Lee TK, Kim JT: Residents’ satisfac-tion of indoor environmental quality in their old

apartment homes: Indoor Built Environ2011;20(1):16–25.

7 Zeng Q, Lee D, Lee S, Kim JT, Kim S: Ahealth performance evaluation model of apart-ment building indoor air quality: Indoor BuiltEnviron 2011;20(1):26–35.

8 Han MH, Joo MK, Kim JT, Oh YK: Seasonalpreferences and interactions of visual/auditoryelements of streetscape in Namwon City,Korea: Indoor Built Environ 2011;20(1):162–170.

9 Lee YS, Lee YG, Jang MS, Jang MH: Health-enhancing architectural features of modernHanok, experienced in and desired byKorean residents: Indoor Built Environ2011;20(1):171–186.

10 Lo SM, Zhao CM, Cheng WY: Perceptions ofbuilding professionals on sustainable develop-

ment - a comparative study between HongKong and Shenyang: Energ Build2006;38(11):1327–1334.

11 Pfeiffer A, Koschenz M, Wokaun A: Energyand Building Technology for the 2000WSociety - Potential of ResidentialBuildings in Switzerland: Energ Build2005;37(11):1158–1174.

12 Lee YS: Future House for Korean Family.Yonsei University Press, Seoul, 2003.

13 Harris D: Dictionary of Gerontology.Westport, CT, Greenwood Publishing Group,1988.

14 Lee YS, Lee SM: Design for elderly housing.Yonsei University Press, Seoul, 2006.

15 Naver Encyclopedia: Social Integration.Available at: http://100.naver.com/100.nhn?docid¼84871 (accessed July 11, 2011).

Housing Alternative for the Aged Indoor Built Environ 2012;21:191–204 203

16 Lim JH: The Empirical Study of the NIMBYFacility-related Disputes and ItsCharacteristics: J Korean Assoc Political SciCommun 2008;11(1):1–23.

17 Lee YS: Unit Insertion Building System withSocial Integration for the Innovation ofApartment Housing Culture, the ConstructionInnovation Symposium for Urban Spaces,Innovation of Residential Culture of Apartmentsin Future to Meet for Ecological Crisis andDemographical Crisis: Korea Institute ofEcological Architecture and Environment, 2009.

18 Lee YS: Function of unit insertion adaptablebuilding system for housing culture innova-tion; in Urban Space Architecture InnovationSymposium - Practical Strategy for GreenSpace Culture, Seoul, Korea October 13,2009. Vol.1: 51–98.

19 Carman J: Special-Needs Gardens forAlzheimer’s Residents Senses-stimulatingenvironments soothe souls and bring backmemories. Asla, 2002.

20 Gonzalez-Salvador T, Lyketsos C, Baker A,Hovanec L, Roques C, Brandt J, Steele C:

Quality of life in dementia patients in long-term care: Int J Geriatr Psychiatr2000;15(2):181–189.

21 Calkins M, Marsden J, Briller S, Proffitt M,Perez K: Creating successful dementia caresettings. Health Professions Press, Baltimore,2001.

22 Oh EJ, Kim MK, Park YK: A Study on theinfluence of residential environment on thebehaviors of elderly persons with dementia inlong-term care settings: J ArchitecturalInstitute Korea 2000;16(6):41–50.

23 Bonk C, Wisher R, Nigrelli M: Learningcommunities, communities of practice, prin-ciples, technologies, and examples in LittletonK, Faulkner D, Miell D (eds.): Learning toCollaborate, Collaborating to Learn:Understanding and Promoting EducationallyProductive Collaborative Work, New York,NOVA Science, 2004.

24 Apartment House Research: 16 cases ofApartment House in Korea. Tomun, 2000.

25 Shin YS: A study on user’s cognition andbehavior about residential community space in

apartment housing. PhD Thesis, YonseiUniversity, 2006.

26 Lee YS, Lim SH, Kim GH: Improvementcharacteristics shown in holistic regenerationof Ballymun toward sustainable community:Building Environ 2010;45(2):279–286.

27 Lee YS: Housing for the Korean Elderly.Gyoung Chun Co., Seoul, 1993.

28 Lee YS: Future Housings and Residents’ SharedSpace. Yonsei University Press, Seoul, 1995.

29 Millennium Community Center ResearchSociety: Millennium Community Center.Yonsei University Press, Seoul, 2000.

30 Park JY, Jung EH,KimDW,Cha JK, ShimizuA:An analysis of thermal environment changeaccording to green roof system; In: ConferenceProceedings of Korean Housing Association,Seoul, Korea, November 14, 2009. Vol.2: 100-103.

31 Kim DH, Lee YS, Ahn CH: A study oncommunity shared space desired by apartmentresidents for super high rise apartment: JKorean Housing Assoc 2010;21(3):23–31.

32 Lee YS: Elderly Housing Interior DesignGuidelines. Gyoung Chun Co., Seoul, 1993.

204 Indoor Built Environ 2012;21:191–204 Lee et al.