Nursing Home Design for the New Elderly

6766

DESIGN ISSUES DESIGN ISSUESDesign Sourcebook: Re-Imagining the Nursing Home in Singapore

4.14.1

1. INTRODUCTION

New generations of elderly need more than just passive support through apartment/room size or barrier free environment. The elderly are encouraged and expected to build up their physical and mental ability level and competency appropriate to different stages of ageing. The immediate housing environment needs to serve as supportive and therapeutic device in that sense.

Universal design (UD) principles ensure accessibility, equity, flexibility, perceptible information, simplicity and clarity, tolerance for error and low physical effort. UD principles are already a norm.However, there is more to it as spaces need to be challenging too and boost activities that physically and mentally stimulate the elderly. Hapticity becomes paramount in creating pro-active environments for the elderly, the ones that they will love to use, and not just be able to use. Haptic spaces and the overall poetic multi-sensory ambiance are the new agenda for design sensitive to an ageing population.

In public housing, issues of social care and support for elderly affect planning, financing, programming and design solutions too. Programs exceed the standard community club repertoire and incorporate a range of opportunities to activate the elderly and eventually even bring them back to the workforce. The more refined and innovative goals for elderly in public housing are:

a) To create a new imagery and appearance of public housing reflecting the de-stigmatized stand on elderly and ageing.

b) To allow ‘ageing-in-place’ through inclusive and integrative design.

c) To encourage ‘active ageing’, and build up the competency and ability of the elderly to stay independent by providing haptic and sensory stimulating environment.

d) To ensure the continuity of care for the elderly by interlinking independent living units, primary healthcare facilities, assisted living and nursing homes while inserting and integrating them into the public housing fabric and social context.

Public health and independent elderly population is of paramount strategic interest for the country. Preserving good health and independence for as long as possible is not just a private asset but a resource that a country depends upon. Economic strategies already count on extended engaging of the elderly in workforce and taping on their capabilities and experience for as long as possible. Therefore, the nursing home design topic has to be understood as part of a wider environmental context exceeding merely typological discourses.

2. CONTEXT, LEGISLATION AND PLANNING

Integration in urban context/problem of stigma and image, attitudes, trust, and environmental concern/identity and attachment

Successful urban integration of nursing homes is essential in a completely urbanized and densely built Singapore. If a nursing home is eventually built in the housing environment the main objective of integrative attempts is to avoid social rejection, outcast syndrome and ultimately decrease in surrounding property values. To understand the essence of this problem we need to dissect the concept of stigma and understand that in its core lays a deeply rooted generic notion towards life itself. Old age is intrinsically stigmatized and even more so in the competitive Singapore context where being active and working equals considering oneself as being worthy and vice versa.

Example of the famous “umbrella stick”, an apparently practical object, depicts and symbolically represents

Nursing Home Design for the New ElderlyDr Ruzica Bozovic StamenovicAssociate Professor, Faculty of Architecture, University of Belgrade

6968

DESIGN ISSUES DESIGN ISSUESDesign Sourcebook: Re-Imagining the Nursing Home in Singapore Nursing Home Design for the New Elderly

the general view on ageing. Holding an umbrella is appropriate in tropical Singapore and merging it with a stick seems like a practical idea for the elderly. The apparent perfect “two in one” logic of this product disguises stigma as umbrella stick actually cannot serve for rain protection. What is its value then? Walking with an umbrella in one’s hand is fine, but walking with a stick is revealing vulnerability of old age which is not something to showcase. The umbrella stick is of course the ultimate oxymoron, because if the rain starts and umbrella is opened the elderly person loses support and cannot walk on slippery wet surface of the street. Stigma towards old age is however not necessarily a social construct but an intrinsic notion. It could be traced back to our survival instinct responsible for mankind’s biggest fear—the fear of death, which, paradoxically, is the only most certain thing in our lives. Therefore, it is important that nursing home designs simultaneously address both personal, intrinsic fear and social stigma regarding ageing.

The presence of nursing home inevitably influences the neighborhood. It is therefore very important to establish complete physical and social integration and get benefits for both sides.. Proper planning, predicted size and position of the facility, appealing and non-institutional look design features that promote wellness and positive image are necessary tools in building a well-integrated nursing home. Social integration on the other hand depends and relies on opportunities for social encounters. This term exceeds the literal meaning and

Human ecology -Ecosystem: strategic and small scale effects of man-space interactions / sustainability and ecological Impact

Regarding human ecology integration of nursing home in the housing environment implies taking care of environmental impact beyond just energy savings. It requires elaborate planning of integrative environmental strategies. Nursing home built in a typical housing estate could be perceived as intrusive because of its scale and program, but also because it occupies common open areas otherwise used by the neighborhood. Its institutional look is usually in contrast with softer appeal of housing architecture. Even more, the usually hermetic boundary of the nursing home discourages commuters thus disrupting the already established circulation paths, community life and obstructing possibilities for new social encounters.

These are just some of the reasons for unsettling feelings regarding inserting a nursing home in the neighbourhood. It is essential therefore that planning for such a facility addresses sustainability issues and precisely predicts and controls ecological impact on the immediate environment. It is important to note here that in terms of human ecology the ecosystem implies coordination of both living creatures (man, plants and animals) and the inorganic surroundings. For example, if existing green areas are taken by building site then the replacing green surfaces

extends to participation in decision making regarding the neighborhood, established levels of privateness and publicness and other possibilities created through design.

The focus of integrative attempts is the contact zone, usually at ground floor level, established as a democratic inclusive space easily approached and used by all regardless of capabilities, age, race or other distinctions. Planning the well-integrated nursing home implies establishing trust over environmental concerns in the neighborhood. Increasing green ratio and planning gathering spaces for neighbours to meet, letting playing areas for children and adults to be located on the fringes of the nursing home site and overall creating a loose boundary of the nursing home and neighborhood estate should be the basics. Many local shops and small businesses could be also created in this transitional area to allow friendly access for the neighbors but also engage capable residents, visitors and staff of the nursing home alike. Therefore, legislation and procedures connected to building a nursing home should not be in support of a hermetic, self- imposing fenced facility. Regarding integration with community, concerns regarding safety of nursing home residents are valid. However, part of integrative attempts is creating a safety system, relying on new technologies but also on creative design solutions.

have to be planned either on ground-floor or on roofs, terraces and green walls. However, all social values inherent to the original site have also to be restored within the new environment. If elderly from the housing neighbourhood used to sit or walk in this area, the new nursing home has to restore and enhance these functions too. Paved paths, essential for safe circulation of elderly, have to be interconnected, uninterrupted by traffic, sheltered and with provided with resting areas. Public greenery around nursing home should be connected to other, bigger green areas in and around the neighbourhood so that continuity of natural habitat and social patterns are ensured. Operation of nursing home facility implies daily delivery of goods, evacuation of garbage some of which are hazardous requiring special care and handling and increased communication of people (emergency vehicles, employees and visitors). This commotion is threatening for the environmental balance in the housing community and potentially causing chemical, physical and sound pollution. For example, emergency entrances or service entrance, usually also used for evacuation of diseased should not face the community gathering areas to avoid bad psychological impact. Organizational structure of elderly care and impact on design and management – from governmental level to local / Community Level

Organizational structure of elderly care is a hierarchical

4.14.1

Fig. 1 Spatial and social conditions are required for active elderly Fig. 2 Soft edge

7170


system with independent housing at the bottom, then primary care facilities for medical and social support to secondary and tertiary institutions for more specialized geriatric care. The system is established through respective legislation, however, implementation relies on linking these levels at community level. Connectedness of different stages in elderly care system is vital so that elderly can make a smooth transition if and when needed throughout old age.

Common thinking is that moving through stages of elderly care towards the ultimate institution, the hospice, is an irreversible process. However, with careful planning and integration on community level, moving back and forth through different stages of care is possible and easy. For example, if independent living facility shares the healing garden with nursing home, and if in a hypothetical case a spouse has to move there, the other partner can still continue to live independently, but be in close contact with the loved one, to visit and support care and rehabilitation, and eventually to help bring back the person to independent living quarters. Therefore, on one hand we need to have a very clear and complete system with all distinct components of geriatric care set by authorities, and on the other hand have a very democratic and open system at community level to allow for initiative, action and integration of all stakeholders in the community including residents and staff of nursing home.

Compliance with Universal Design principles has to be strictly observed as successful urban and social integration depends on it. We stress again that all walkways and other design details in the vicinity of nursing home have to be safe and easy to use, meaning equipped with slip-proof surfaces, railings, shelters and wayfinding clues and positioned well. However, moving beyond the necessary, we need to observe the design in terms of ergonomics, semantics, cultural values and legibility. If we assume that some of the more capable residents of nursing home could and should venture out to common areas shared by the community, then we have to acknowledge their physical and mental capabilities to do so independently.

Universal design / wayfinding / creative solutions beyond guidelines

Progressive sensorial decline connected to ageing requires response in the form of stimulating environments. Synergy of the ageing body and creative design is essential for successful nursing home design. It can not be achieved by observing the rules only.

We mentioned already that barrier-free concepts reached the status of norm when legislation was agreed upon and made compulsory. Since, criticism on many levels was raised, particularly on design solutions segregating the users and, due to sheer functionality, not contributing to architectural values of the overall environment. Consequently the universal design (UD) concept is adopted as more suitable with its broad definition stretching from products to built environment and relying on creativity. Universal design model values design considerations. For example, a healing garden that all regardless of their age or gender use does not cost much more than common green feature that just beautifies the space or saves energy. As opposed to accessibility requirements easy to fulfil with elaborate guidelines, UD only offers principles while leaving the outcomes to subsequent creative interpretations through design. Thus, a former checklist (accessibility) becomes design manifesto (universal design) and former accessible space transcends into an invigorating holistic realm.

Wayfinding becomes an issue. Distances have to be observed and practical support provided along the way like railings, space for walking frames, sitting spaces and toilets. Case studies in HDB environment confirmed that many nicely designed rooftop gardens stay empty while elderly gather around shops, markets and entrances. Position of common resting alcoves should not be away and disconnected from main walkways and local shops for example. Elderly are very keen to make their own decisions, to be in control of their lives and decide on their actions, even more so when they start actually loosing physical

4.14.1Nursing Home Design for the New Elderly

Fig. 3 Nursing home and independent living for elderly care connected with gardens Fig. 5 Welcoming spots in space

Fig. 4 Nursing home room as home – creative exercise (Doina Ilies)

7372


and mental capabilities. Alternative pathways, one direct and pragmatically designed for commuting, and the other curvilinear, meant for exercising, with pebble surfaces and resting spaces for social encounters could be provided for example. Although leading to the same place, these complementary paths make it interesting for aged commuters to use. Although we are talking about outside pathways on the fringes of nursing home, wayfinding is an issue within the building too. Distinct character of diverse common areas should be created to help orientation and provide choice. Culture and heritage

In times of accelerated changes when the entire urban environment transforms completely every two decades on average, elderly population might have problems anchoring their memories and building the sense of continuity and belonging. In nursing home environment, the homelike paradigm should be built relying on recognizable cultural models. This idea is not new, however, the problem with existing, so called “heritage corners” is that they are staged areas, literal replicas, labeled and separated from all other spaces and thus perceived as artificial and ultimately confusing. Instead, cultural clues should be embedded in a more subtle way. Carefully selected memorabilia regarding everyday life could be strategically placed to support regular activities of nursing home residents. Example of a popcorn machine or ice cream trolley in café like social space in US nursing home is triggering individual memories of similar experiences from real life. Being less literal is better for mental activity of the elderly as cultural clues rather than detailed replicas make the mental process of connecting the seen with memories very vibrant. We should not forget that exercise for elderly implies both physical and

the nursing home and who regularly visit and interact in nursing home public areas are more likely to have a positive attitude towards moving in sometime in the future when their condition might require it. Young people engaged as volunteers will have a positive attitude towards nursing home and disregard stigma.

3. REINVENTING THE EXISTING MODELS

Main criticism on common models of nursing homes is based on their institutional look and isolation. However,

mental activities. Embedding stimuli for both in nursing home environment is essential for well being. Participation, enabling the Residents in Decision Making Processes / Residential engagement and social inclusion

User participation in decision making regarding design and management of activities and processes in nursing home is vital for their self-esteem. It should be established in different stages and with parallel engagement of diverse user groups. In planning and programming phase the engagement of community members through guided workshops is essential for ensuring later acceptance and active participation in nursing home activities instead of stigmatization.

Workshops and seminars should continue even after the nursing home is built as constant changes in space and elderly care ask for continuous renovations. Engagement of elderly, staff and visitors as well as volunteers from the community in workshop environments and around common goals is a good way of establishing bonds, familiar connections and social network so important and so much missing in old age.

Social dynamics amongst different user groups

Social inclusion means that in and around the nursing home participants of all generations have a say. Even children can contribute to maintaining the nursing home healing gardens and elderly could benefit from being experienced instructors.

Programming and design of nursing home and adjacent areas have to provide opportunities for multigenerational encounters. Successful social dynamics in and around nursing home prevents other inherent problems. Thus elderly who live independently in the neighborhood of

the outer appearance is just one of the many causes for rigourous revision of the existing paradigm. Social goal is to form an able and self-sufficient elderly population for as long as possible, however, old age will still imply health issues. The main objective is to address them at the early stage through engaging the environment as motivating rehabilitative device for mental and physical support and exercise. What this exactly means is that everything an elderly encounter in everyday communication with space (comprehend, see, hear, touch, etc.) should be beneficial for their body and mind. Special railings, furniture, views are just some of the possibilities


Fig. 6 Supportive spaces for walking and social encounters; alternative paths Fig. 8 Improving pathway – support for intergenerational encounters (Rosa Markos)

Fig. 7 Living space resembling public plaza and café; memory hints

7574


The issues of scale and urban environments

Geriatric institutions in common experience imply certain scale optimal for functioning and sustaining geriatric care. However, the sheer size of these buildings and their similarity to hospitals cause problems with acceptance for both urban dwellers and nursing home residents. Instead, the issues of size could be flexible and addressed in creative ways, for example:

a) Planning for smaller nursing homes with fewer residents. This option is not widely applicable in densely populated Singapore environment where land is scarce, however could be considered as densification of existing housing environments. Nuclear nursing homes could be then easily positioned in unlikely places, garage or HDB rooftops for example. b) Dispersing the nursing homes even more by breaking into units-wards in a net-like loose yet functionally connected way and imbedding the units in the housing environment through engaging left over spaces, connecting open spaces and so forth. Idea requires new medical planning concept, but units might resemble apartments and be more homely. c) Similar to the previous model the nursing home units–wards might be positioned vertically and parallel to housing blocks or embedded on alternative levels of housing blocks. In this way, nursing home could be seen as an extension of apartments with smooth and natural connection between the two allowing for families to visit and stay in touch with elderly members.

De-Institutionalization and regeneration/bridging the boundary between housing and institutions for elderly care

Therefore, issues of de-institutionalization of nursing home model and regeneration of existing facilities have to be addressed on three levels:

their efficiency is questionable. They are either out of reach when needed or nonfunctional as strings are obstructing movement. More sophisticated alarm systems are installed in beds, to control absence of senile residents for example, or on door locks to notify entrance/exit. However, the current prevailing stand is to connect issues of safety to the elderly person rather than to space. Alarm pendants are very sophisticated devices that help the elderly user call for help if needed or help with locating the elderly person.

b) Space oriented IT - measuring and controlling environmental parameters and measuring health status of users.

New generation control systems and devices are developed to perform diverse measurements. They are interconnected and could be controlled by users or from one central control point.

A number of health parameters could be controlled by the elderly on daily basis if these types of devices are imbedded in nursing home environment. Daily health screening (blood pressure, heart beat, sugar levels and so forth) could be collected just by holding usual grab bars with imbedded sensors and systems that transmit the results to healthcare base (doctor, community care center, or similar) for monitoring and action if

a) Macro urban level and massing as prerequisite for good spatial and social integration. Engagement of environmental resources (water, wind, recycling of natural materials) for efficient functioning and well being of residents

b) Micro level creation of supportive environments; clustering of rooms for example to provide hierarchically diverse spaces for socialization ranging from balconies reachable by room resident only to terraces shared by a few rooms to more public social spaces positioned as extensions along corridors on ward level.

c) Level of design details that complement the care and healing procedures. On all levels, issues cannot be addressed with existing design and geriatric paradigms, but new and creative solutions have to emerge. However, the new should tap on existing urban and social resources and reconsider them in new creative ways.

Technology and design for elderly

Elderly and technology interact through devices and gadgets embedded in design features of nursing home. The average higher level of education of new elderly should justify extensive application of IT devices. However, decline of the sensorial and cognitive abilities require many alterations in IT technology and software to be efficient. Numbers and fonts should be bigger, information layout on screen clear and simple, and design of computer keys and mouse appropriate for the elderly users with stiff joints and poor grip and sensibility levels.

Two major areas where IT could be of great use are:

a) User oriented IT - safetyAlarm systems in nursing homes are usually installed in strategic positions (bathroom, bedroom, etc.) however,

needed. This is also important as mobility; strength and endurance changes on daily bases and elderly could observe their condition and adjust activities accordingly thus preventing falls and injuries.

4. DESIGN AND EVALUATION–PARTICIPATIVE DESIGN AND CONTINUOUS ASSESSMENT IN ELDERLY ENVIRONMENTS

Empowering the patients in nursing home environment is very important for their self-esteem, motivation and active life within the constraints of this institution. One of the modes of engaging the residents in shaping their environment is continuous work on establishing person-environment synchronicity and subsequent post occupancy evaluation.

Person-Environment synchronicity – staging the events and anticipating behaviours through ante occupancy evaluation

Synchronizing the users and their environment in nursing home is a process that starts with designing according to the brief and anticipated user needs. However, usually it also ends here. Critical post occupancy evaluation of nursing homes often detects user dissatisfaction resulting in resident’s apathy, staff fatigue and fiscal problems for


Fig. 9 Elevated planters suitable for gardening and rest, tactile paths –chance for active elderly Fig. 11 Elderly are capable of learning and interested in using even advanced IT technology

Fig. 10 Terrace shared by residents from adjacent room; details:casters + personalized doors

7776


management. Even though adjustments follow it is often too late for radical change. Therefore, we suggest performing the ante-occupancy evaluation of spaces and processes. It means evaluating the spaces in design phase by addressing them as process with duration in time and taking into account both function, respective spaces and resulting effects. For example, in ante occupancy evaluation of living spaces in nursing home, we have to consider the time /length of the occupants’ stay in this space. Only after we can address the related issues like glare and changing light conditions, proximity of toilets, retreat areas, temperature comfort, views, sensorial status (smells, sounds, textures) and ergonomic qualities of furniture for example. All these characteristics contribute to well being in a nursing home living space and therefore have to be anticipated and synchronized in design phase to insure good function. Design can also address anticipated emotions regarding this space like boredom or annoyance; it can predict the occurrence of silence or noise and related design responses, etc. Therefore, design process implies much more than just satisfying the brief in terms of square metres required for he function. Post-occupancy evaluations and well being

After the facility is constructed and inhabited for at least one year, it is important to evaluate the subjective and objective parameters responsible for its overall qualities from the point of view of all stakeholders, staff residents and visitors alike. Objective measurements would encompass water and energy consumption levels, electricity produced by alternative energy resources, indoor air quality measurements and absentees of staff. Subjective responses usually expressed on Likert scale ranging from negative to positive, indicate personal observations regarding function and spaces. However, subjective evaluation is prone to different interpretations. The so-called “forgiveness factor” is observed as the sum of responses for individual spaces did not always coincide with overall judgment on the space as a whole.

5. USERS’ EXPERIENCE, IDENTITY AND ATTITUDES: RESEARCH AND DESIGN IMPLICATIONS

Evidence-based research and design implementation – empowering the elderly

Application of research proven design solutions actually empowers the elderly to act and react as they wish in their environment. Design features that contribute to healing environments are about hapticity and about building the experience of architecture through multisensory

experience is different. They become Banjamin’s flaneur; they move with all senses opened, they notice things; they interact with the environment design features since they have the time. Their experience of the same space is thus entirely different. They are not just mobile but mobilized and relaxed afterwards. As a consequence of this transition from mobility to mobilization, many more design features could emerge organized in distinct scenarios.

Identity and place

Cultural context and representations of known, recognisable and familiar in space are essential for building the identity of place. Typical nursing home paradigm is mainly criticised for generic appearance, absence of specific identity and ultimately lack of integrity.

Experiencing something beyond the physical or sensorial and feeling attached to the aspiring place requires determining the form, the process, the image and the meaning as major facets of the construct that is moulding space into a desired place. Therefore, dichotomy of image and form is necessary for identification with

and affective processes. Elderly not just see, but feel, act and react in relation to spaces they occupy in nursing homes. The establishment of nearness revives the loss of intimacy with the phenomenal world of light, sound, tactility, time. Only through its haptic realm the space in nursing home environment can truly be emotionally appropriated. Engaging user’s emotional and mental state requires conscious alterations and playing with the tectonics of materials to ornament spaces, surface and texture. Therefore, essence of the healing experience in nursing home environment lies in its multisensory nature.

Mobility and mobilization

In nursing home design movements define many areas. If circulation is seen as mono-functional, that is to bring the commuter from one place to another the efficiency and safety are major considerations. However, in more advanced concepts of space, movement exceeds those limits and transcends to poly-functionality by pairing with time as variable. The dynamics of commuters’ movement in space and time creates a constantly changing relation to both. Conversely, this dynamics transforms mobility into mobilization as users act and interact in relation to space they occupy while moving. In multidirectional mobility concept the time is a variable that changes the dynamics of visual perception. If staff for example trespass the spaces in haste major concerns are efficacy and clear wayfinding. With more time, moving through the same space the

place. Although creating identity is a process in time that involves users and their cognitive apparatus, it is the design process that allows for it.

Immediate responses are obvious and not new; programs for public areas reflect local culture like bird-watching areas, local neighbourhood shops and kitchen, tropical plants, place for burning incentives or other local traditions like door decorations, feng shui elements, paving for acupressure, and many more. However, the newest trend looks for different understandings of identity, beyond the visual and obvious. As J. Pallasma puts it, multisensory architecture uses materiality of Euclidian space, perception apparatus and time to build identity of place: “Whereas the architecture of geometry attempts to build dams to halt the flow of time, haptic and multisensory architecture makes the experience of time healing and pleasurable. This architecture does not struggle against time; it concretizes the course of time and makes it acceptable. It seeks to accommodate rather than impress, evoke domesticity and comfort rather than admiration and awe.”


Fig. 12 Spaces for rest in the room and along circulation areas (this page & opp page)

7978


Imagery and branding

Branding is closely related to advertising and trade, so architecture and let alone nursing home was never openly prone to it. However, image of care, affordability, openness and equality was omnipresent in nursing home design as delicate yet clear indications of branding. With commoditisation, the necessity of building a particular image becomes even clearer and bolder. Representation of architecture in the consumer society arguably surpasses the physicality of architecture itself and nursing home design will not be left out of this trend. Despite having real physical qualities in terms of materiality, form and detail we tend to discuss the nursing home design almost entirely based on its representations. Thus, building the sign value, as Baudrillard phrased it, has the potential to become leading design objective for future nursing home design.

References

Berlyne. D. E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts.

Bovill, C. (c1996). Fractal geometry in architecture and design. Boston: Birkhäuser.

Dovey, K. (2010). Becoming Places: Urbanism/Architecture/Identity/Power. London; New York: Routledge.

Freud, S. (1922). Beyond the pleasure principle (C. J. M. Hubback, Trans.). London; Vienna: The International psycho-analytical press.

Gappell, M. (c1995) Psychoneuroimmunology, In Marberry, S. O. (Ed.), Symposium on Healthcare Design - Innovations in healthcare design: selected presentations from the first five Symposia on Healthcare Design. (pp. 115-120) New York: Van Nostrand Reinhold.

Halberstadt, J. (2006) The Generality and Ultimate Origins of the Attractiveness of Prototypes. Personality and Social Psychology Review, 10 (2), 166-183.

Kaplan, R., Kaplan, S., & Ryan, R. (1998). With people in mind: design and management of everyday nature. Washington, D.C.: Island Press.

Kellert, S. R. & Wilson, E. O. (Eds.). (1993). The Biophilia Hypothesis. Washington, D.C.: Island Press.

Koetzsch, R. (2007) Out of Anthroposophy: What the Human Body Tells Us about Healthy Organizations. [Review of the book Organizational Integrity: How to Apply the Wisdom of the Body to Develop Healthy Organizations]. Retrieved May 22, 2009, from http://www.whywaldorfworks.org/03_NewsEvents/documents/renewal_33_outOfAnthroposophy.pdf

Linton, P. E. (c1995) Creating a Total Healing Environment, In Marberry, S. O. (Ed.), Symposium on Healthcare Design - Innovations in healthcare design: selected presentations from the first five Symposia on Healthcare Design. (pp. 121-132) New York: Van Nostrand Reinhold.

Mennan, Z. (2009) From Simple to Complex Configuration: Sustainability of Gestalt Principles of Visual Perception Within the Complexity Paradigm. METU Journal of the Faculty of Architecture. 26(2). 309-323.

Nanda, U., Eisen, S. L., & Baladandayuthapani, V. (2008, March). Undertaking an Art Survey to Compare Patient Versus Student Art Preferences. Environment and Behavior, 40(2), 269-301.

Reber, R., Schwarz, N., and Winkielman, P. (2004).

6 CONCLUDING REMARKS

Issues and topics in design for the elderly constitute an ever changing flow of ideas and experiences. Application of all these ideas is not possible or even necessary. Nursing home design should not be considered successful for its impeccability, but for ability to integrate into the socio-physical environment, to evolve in time and to constantly change and adapt to user needs.

Therefore, beyond new ideas and topic, critical is the relevance of:

Firm political and economic context as decisions from both areas supported by legislation and control are prerequisites for successful ageing strategy. Criticism, as analytical appraisal of design strategies and post occupancy evaluations initiate positive changes Flexibility, as design model has to constantly evolve in time and accommodate demographic, cultural, social and environmental changes. Recognizing on time emerging issues and approaches, new technologies in service of wellbeing and social welfare and acting promptly toward their integration through design.

Processing Fluency and Aesthetic Pleasure: Is Beauty in the Perceiver’s Processing Experience?. Personality and Social Psychology Review, 8(4), 364-382.

Sharr, A. (2007). Heidegger for Architects. London and New York: Routledge.Ötsch, W. (2005). Pictorial Thinking: Symbolic Forms and Internal Pictures, In Shamiyeh, M. & DOM Research Laboratory (Ed.), What People Want: Populism in Architecture and Design. Basel; Boston: Birkhäuser.

Selye H. (1978). The stress of life. New York: McGraw-Hill.

Schweitzer, M., Gilpin, L., & Frampton, S. (2004). Healing Spaces: Elements of Environmental Design That Make an Impact on Health. The Journal of Alternative and Complementary Medicine, 10(1), S-77-S-83.

Smith, P. F. (2003). The Dynamics of Delight – Architecture and Aesthetics. London, New York: Routledge.

Ulrich, R. (1991a). Stress Recovery during Exposure to Natural and Urban Environments. Journal of Environmental Psychology, 11(3), 201-230.

Ulrich, R. (1991b). Effects of interior design on wellness: theory and recent scientific research. Journal of Health Care Interior Design, 3, 97- 109.

Zumthor, P. (c2006a). Thinking architecture. Basel, Switzerland: Birkhäuser.

Zumthor, P. (c2006b). Atmospheres: architectural environments, surrounding objects. Basel, Switzerland: Birkhäuser.

Fig. 13 Well being relays on subjective feelings and personal choices

Nursing Home Design for the New Elderly

Nursing Home Design for the New Elderly

Documents

Transcript of Nursing Home Design for the New Elderly