Elderly Care: Active Ageing
National governments are currently raising the disease profile and renewing social commitment to their ageing populations,recognising them as a complex and diverse group.
This is reflected in the high-quality and innovative planning and design of facilities in community settings. The following four case studies are a review of facilities seen by the Medical Architecture Research Unit (MARU) in field visits to France, Finland and Spain between 2005 and 2008.
Finland has a system of homecare that provides nurse-led medical care at the patient’s home, assisting in daily tasks and prescribing for chronic conditions. The home carer can identify potential changes in the health of their patients, thus making early diagnosis and treatment much more likely.
Viola-koti, in the district of Tampere, north of Helsinki, is a facility with a mixture of support services, from day access for those still living in their own homes (respite care) to residential accommodation for those requiring intensive nursing care for advanced forms of dementia. In addition, people can choose to rent or buy a fl at in the building and use the facilities as they wish.
Residential nursing at Viola-koti is free regardless of income, with fees paid by the local municipality. The activities include gym, swimming (hydrotherapy), craft classes, fitness classes and a fully accessible level-access sauna. Additional services such as laundry, a communal restaurant (accessible to the local community) and cleaning are available too at a small cost.
A key design feature here is an external veranda with bi-folding windows. It means that even in the colder months, a view to the outside, with safe access, is possible – when the ability to read and write has disappeared, being able to engage with people and watch the day-to-day comings and goings of town life is essential.
The Kamppi Service Centre in central Helsinki has some 2,400 visitors per day. Its philosophy is “laugh and you will live longer.” A vibrant range of craft, canteen and recreational facilities are run by the users, including shoe-repair workshops, weaving and dressmaking. A small on-site health facility gives people who have continuing daycare the opportunity to access services at a cost of €12 per day; the space includes a quiet corner with day beds for those with advanced dementia who require nursing care, enabling their carer or partner to enjoy the activities alongside them. The centre’s design is all about enhancing people’s dignity and independence. Different spaces allow for different types of engagement and withdrawal – at the user’s own pace.
By contrast, in Spain, the Madrid Alzheimer’s Centre is a 12,000m2 structure with some 156 beds and a 40-place day centre. This centre is integrated with a biomedical research and training unit complete with MRI scanner, full autopsy facilities and laboratories, established to investigate the cause of Alzheimer’s disease with a view to prevention and treatment – the Spanish Ministry of Health’s response to an anticipated 75% increase in Alzheimer’s over the next 25 years.
Teaching is not restricted to academia but is also available for relatives, carers Phil Astley describes four top-quality European facilities for people with dementia that have successfully integrated a real understanding of older people into their design and care groups as part of a holistic approach to embracing the whole spectrum of care.
The centre’s residential units are independent of each other and comprise nine double ensuite rooms and day facilities. Innovative technology – passive infrared detection units and remote monitoring, particularly at night – is brought together with restorative courtyard gardens, plant aromas and themed artwork that creates recognisable zones without the need for signposting. An essential feature is the integration of horticultural therapy (part of a wider occupational therapy programme) in a garden adjacent to the residential areas.
Paris’s Residence de l’Abbaye bucks the patronising approach to ageing by providing a ‘salon’ on a ‘street of activities’ for discussion about the political and societal issues of the day. The aim is to help residents maintain a relationship with the outside world and therefore retain control of their own lives in a safe and secure environment. The average age of the residents is more than 86 years. A 46-bed unit for those with Alzheimer’s disease is part of the larger residential apartment blocks, which each have a consultation surgery space on the ground floor for weekly visits from two site-based GPs and a pharmacist. A travel club coordinates social visits and the dining room allows interaction not only with other residents but also with the crèche for nursery children co-located on the site. Interaction between the children and residents – through storytelling, drama, music and art therapy – is encouraged, helping the residents
to feel useful, needed and more active.
From the UK perspective, these facilities have a humbling effect, providing a high quality of design response that integrates older people and those living with dementia into the urban fabric of their local communities. The residents’ independence is promoted by the architecture, with a complete understanding of the condition of the needs of the older person, from the choice of materials through to environmental control and comfort. These are designs without compromise to privacy, dignity or respect, and they place the comfort and enjoyment of residents and their carers firmly at the centre.
Phil Astley is a senior lecturer in the Medical Architecture Research Unit (MARU) at London’s South Bank
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