A Matter Of Fortune- Mature Building For The Aged
Senior homes, sheltered housing, and retirement villages are some of the marketing euphemisms commonly used in promoting housing solutions for the elderly. The advertising jargon often fails to relate to the basic components that are essential in providing an appropriate residential environment for this particular population, whose distinguishing characteristics include impairment of basic functioning ability, lack of self confidence, feelings of isolation and loneliness, and lost identity.
According to the Israel Central Statistics Bureau, the number of elderly people in need of special housing in 1999 was over 600,000, or 10% of the population. Research indicates that the reasons for needing institutional care include physical limitations, social difficulties, housing problems, and family problems. The challenge of an aging population of is not exclusive to Israel; in the U.S. the elderly represent 13% of the population.
The senior population can be divided into four categories: independent, frail, mentally feeble, and in-need-of-nursing. The needs of the elderly are not absolute and are therefore difficult to define. However an increasing dependence on society and fluctuating degrees of independence over time are common to all, and accordingly, new old-age homes are usually equipped to provide for the medical needs of the residents.
Institutional care is expensive and dependent on the long-term provision of funds, which excludes most of the elderly population from available solutions. In reality, reasonable solutions are available to only 8% of the elderly, who enjoy good conditions in a comfortable atmosphere - something between a rest-home and a hospital.
Limited opportunities burden the elderly with the need to make irreversible financial and emotional decisions. The prospect of abandoning a safe and familiar home, to risk savings and assets in order to reside in an unfamiliar institution while being painfully isolated from familiar surroundings and family, is a source of extreme emotional stress for the elderly.
Programme and Planning
In his book, 'Housing The Aging', Victor Reginer, professor of gerontology and architecture at the University of South Carolina, summarizes research on geriatric care. He formulates twelve principles to be considered when planning for the elderly:
Independence and Control
While dependent on an institutional framework, seniors need opportunities that allow for independent decision-making, to strengthen their sense of self. The need to make decisions, control events, and influence outcomes is a basic condition for securing the seniors feeling of independence.
Orientation aids are an essential element in the creation of a functional environment for those with physical limitations that affect spatial orientation.
The elderly experience a higher rate of accidents due to physical infirmity. The environment must be designed to ensure no harm, injury or undue risk, and elements such as slippery surfaces, staircases, flammable materials and obstacles must be avoided.
Loss of self confidence as a result of infirmity means that window bars, doors and locks must be designed to offer security without becoming obstacles or safety traps.
For old people, day to day activities that are usually taken for granted require special effort and can be a source of shame or embarrassment. Privacy is therefore an essential element.
Random and organized Interaction
Social interaction is an essential safeguard against isolation and loneliness. Many homes for the elderly stress the provision of events and organized activities. However, disabilities and limitations are not uniform, and social arenas for random interactions that are not time and place dependent are essential.
A stimulating environment promoting awareness and preventing boredom should be offered, while limiting confusing over stimulation.
Design solutions rich in historical reference and tradition provide a sense of familiarity and continuance to residents who have abandoned their homes and familiar surroundings.
Accessibility and Maneuverability
Provision of a functional environment for the physically limited demands easily accessible doors, and room to maneuver when bending, sitting and standing.
While these observations apply to most of the elderly population, it is the most needy who are left to deal with their problems alone. The Ministry of Housing establishes ‘sheltered housing’ in deprived areas or where there is a large concentration of immigrants. But in the absence of comprehensive government policies on elderly housing, there is no real oversight, and the solution often falls to private entrepreneurs who are in the business to make a profit.
As a result, both programmatic perceptions and architectural solutions are scant and are expressed through the crossing of lines and over-emphasis on 'leisure culture', 'breathtaking view', and 'five-star finishing materials'. These important elements may contribute to personal comfort, but only after the elderly persons essential problems have been addressed with due consideration.
In this gloomy situation, the planner is left with little room for consideration of the users needs, and must give priority to foreign and unrelated aspects of planning, such as landscape integration, or, at best, the creation of an architecturally interesting building. Many institutions, in particular those publicly-owned, appear frightening and repellent. Assuming that the facility should be a substitute for the old persons home, sensitive planners must create a homely atmosphere, while avoiding institutional images. However, the adaptation of living conditions to physical limitations and the need to concentrate a homogeneous population in a protective framework, often results in a building with institutional character, usually resembling a hospital.
A deeply rooted principle in planning for the elderly is the development and maintenance of relations to the community. In practice, this means creating a situation in which the elderly continue living in their own environment, while reducing their direct burden on their community. Placing the home at the heart of a community seems an ideal solution to accessibility problems, while making use of the communitys services and neutralizing the problem of separation from the home. 'Aging within the community' is best-exemplified in a kibbutz setting, where the elderly continue to reside in their natural supportive environment, but also maintain their contribution to society through work and creative endeavors suited to their abilities and limitations.
This utopian aspiration holds almost no relevance in urban reality. Establishment of institutions for the elderly requires allocation of vast areas of valuable real estate. Because housing for the elderly requires twice the investment of regular housing, the financial return must be worthwhile. The Ministry of Housing does establish institutions for sheltered housing, usually limited to those eligible for housing benefits or to recent immigrants. To date, the Ministry of Housing has erected only thirty-two of these institutions, housing a total of approximately 4,000 elderly.
A number of other housing associations and organizations, some partly government-owned, attempt to provide residential facilities for the elderly, but in the absence of land allocations and appropriate budgets, siting of such institutions is a problem. Communities object to 'foreign institutions' being placed in their midst, claiming that a nursing facility will harm property values and detract from the place’s image. Old people are forced to reside in institutions far away from families and familiar surroundings. Often the situation is one of incompatibility between the elderly consumer population in the institution and the community that 'agreed' (or was forced to agree) to its establishment. In such cases, the elderly are again in a no-win situation.
Private and Public
The high costs of land and construction of institutions for the elderly underline the importance of wise utilization of public areas. One solution is the development of mixed-size housing units for couples, singles or groups. Here the advantage of location within a fixed community is expressed; size and nature of the institution depend on the availability of the communitys services for the elderly residents. In an ideal situation, public areas can be reduced in favor of private areas, while suiting them to complementary activities. Research reveals that old people in relatively good physical condition tend to participate less in organized social activities in public areas. In contrast, the frail elderly tend to spend more time in the public spaces. Thus, reduction of public spaces based on research and observed habits increases the area available for housing units or for a wider range of units, while suiting them to the residents’ functionality. Provision of personal host areas for residents’ use is also recommended. Denying the elderlys right to host visitors reduces time spent in rooms, and encourages wandering in the hallways, as well as the need for large public guest areas.
The Old and the View
Limited space in built-up areas means that many institutions for the elderly are located on the outskirts of towns. 'Breathtaking views' may be in abundance, but often as a double-edged sword. Observation of seniors who spend long hours facing the view reveals that in many cases the act of watching the faraway, unattainable view deepens the longing and yearning for home. Creation of a closely available, attainable view is preferable.
In the past few years, the Eshel Association and local authorities have established approximately 130 day-care centers as a solution to the lack of government funding for residential old-age homes. It is worth noting that these institutions serve as a good intermediate solution and as a supportive social framework without hospitalization. This framework provides the elderly community with social activities, guidance and support that allow a period of adjustment, without their having to confront feelings of abandonment of the home and familiar environment. The elderly learn to make productive interactions with others in a similar situation, until they reach the stage in which they are unable to cope with their limitations.
In a small number of residential areas with a high proportion of elderly, Eshel has developed a model that supplies support services for people who wish to remain in their own surroundings. Regular communication with the elderly replicates the framework of sheltered residential units, until the stage in which the resident is in need of constant nursing care. This protects them from being forced to abandon their homes and familiar surroundings.
However, no real provision is made for the needy, for those who require nursing, or the mentally feeble. The government must take serious action towards caring for the nation’s senior population. Perhaps a solution can be found with the help of the coffers of the National Lottery Foundation.