Description
In the last 20 years, the fields of activity and with them the role of the architect have shifted considerably. A trend towards greater specialisation, and in this respect professionalisation, through a greater concentration on only specific services is unmistakable. Planning services are increasingly covered by specialised offices: hospital planners, office planners, industrial architects; specialised fields have formed in all sectors creating a barrier for talented young architects entering the field. Selection procedures for competitions, consultancy and job applications follow the same pattern.
Accordingly, what were previously fields of planning are regarded increasingly as sectors in a planning market. Buildings for the elderly fall within a segment of the planning market for social buildings. In order to be able to maintain a high quality of architecture that remains relevant to society’s needs in the context of such changes, we will need to develop new patterns of behaviour founded on a fundamental understanding of the changed conditions. These changes in the planning process, in the contributing participants and their respective legal position with regard to one another lead to a redistribution of rights and obligations.
In principle, the new developments represent a fusion of international, and particularly American, planning procedures and prevailing Central European planning methods. Only 20 years ago in Europe, building for the elderly was characterised by a single client who was both owner and operator of the care facilities. In this constellation, which is still a model for charitable associations today, a single owner of a site approached an architect of their choice with a functional idea for a building and pre-arranged funding. State funding in the form of subsidisation of investment costs became available in return for an ability, on the part of the state, to apply conditions to the planning. State intervention was primarily limited to ensuring equality, both with regard to the applicant as well as the later residents. Legislation was introduced to underpin this form of influence.
This approach has remained largely unchanged in all European countries where state subsidisation for the building of housing for the elderly is anchored in legislation. But here too new, less restrictive, market-financed models are surfacing parallel to the old federal culture of state subsidisation, and even gradually replacing it, depending on the country’s budgetory constraints. To begin with, this applied only to facilities for the richer classes, projects with a high return on investment, but today projects financed with private capital and bank mortgages dominate the market.
What has long been the case in Anglo-American countries will follow suit in Europe too: the ownership and rental or leasing of a property is becoming increasingly independent of the provision of care services by another company. As a consequence, the architecture and the architect will need to address two different sets of interests in the planning of a building: on the one hand the design of an attractive property for rental that is highly flexible and has a long lifetime at minimum cost, and for the operator, a high-quality building with low maintenance and operating costs, a strong image and excellent functionality appropriate to its needs. To achieve these aims, both with regard to quality and costs, a project controller is often employed by both of the contractual partners. The banks, who require additional expertise to assess, plan and monitor the financing of such “special properties”, also draw on the services of specialist consultants and controllers.
The availability of property independent of an operator leads to its classification as commercial property, with the result that an operator needs to contractually guarantee a minimum of ten to 15 years rent. An obvious response is to pool several properties which are then of interest as an open-end or closed-end fund, rather than as individual properties. This has resulted in a strong tendency towards the unification of care properties on the market, which in turn has lead to a standardisation of the accommodation-related costs on the operator’s side and to a greater degree of comparability than has ever been the case in the past.
While the above describes the situation for nursing homes, the range of residential alternatives for the elderly are diversifying ever further. The spectrum ranges from nearly 50 Euros per m² monthly rent to 8 Euros including a fixed price security package. The professional investor market has shown little interest in this market segment due to its lack of clarity and low returns. For architects this situation means that they are often dealing with highly volatile projects which are dependent on highly diverging investor interests: from a single owner to an owner consortium to closed-end and open-end funds. Similarly, the operator can vary from a small family-run business to a public corporation. Project financing varies from classic private capital to company capital of all kinds to closed-end or open-end funds and leasing systems.
In such cases the architect is often the only one with a non-materialistic interest in achieving a good overall result for all interested parties. Very often the diverging interests of the different parties only become apparent as the planning process progresses. The planning process therefore requires a high degree of coordination and transparency from the very beginning. The architect must know the respective applicable parameters for costs, quality and function inside out and have a broad awareness of the legal position of the other participants.
On the side of the operator, the range of service providers in the elderly care sector can be loosely divided into “inpatient” and “outpatient” sectors. If the market for inpatient care is already difficult to describe, the market for outpatient care defies definition entirely. It ranges from a single district nurse to operators with thousands of care assistants in dozens of cities and rural municipalities. Demand for planning services in the outpatient sector is, however, limited as most such services, with the exception of a few small wards, are housed in existing residential and commercial buildings.
The situation is different in the inpatient care sector. The most obvious and most profitable sector is that of nursing homes, which represents the main form of care service offering aimed at an estimated 5% of over 65-year-olds. Closer inspection shows that current societal demand for available places would be fulfilled when places are available for around 2% of 85-year-olds, a percentage that is expected to rise in future, particularly in view of the fact that the average age at which people enter a nursing home is already 83 years. The average residential period falls as the age of entry rises and is at present approximately 1.5 years. In institutions offering special facilities for people with advanced dementia the average residential period can fall below a year.
Architects working in this sector therefore need to acquire a high degree of knowledge regarding current care service offerings. Areas such as night-time care or special services for people who have suffered a stroke, people with progressive dementia or requiring post-operative care feature more heavily than they did a few years ago, when people without a constant need for nursing care also lived in nursing homes. The architect has to reconcile the medical and hygienic requirements of the nursing care regulations with the homeliness and comfort requirements of the residents in such a way that care provision and living in old age are no longer perceived as contradictory. Cooperation with colour psychologists, interior decorators from good furnishing houses and lighting consultants can be of value here. Similarly, grading systems, much like that of hotel star-ratings, are being developed that combine standards of furnishings and materials with carefully selected design requirements to define different standardised levels of quality. However, in all cases the most important aspect of a design is and remains the desire of the resident to be welcomed by a homely atmosphere in their time of need.
Originally published in: Eckhard Feddersen, Insa Lüdtke, Living for the Elderly: A Design Manual, Birkhäuser, 2011.