Description

Focussing on the resident

Until well into the 1970s, the dominant form of institutionalised care for the elderly in Germany was a tripartite facility, the so-called three-stage home. Regarded at the time as modern, it comprised a combination of residences for the elderly, an old people’s home and a nursing home in a single facility and necessitated that residents move as their health deteriorated and care needs increased. The principle of ensuring that whenever possible people could remain in their own homes, a long-standing socio-political fundamental, was therefore compromised not just once but repeatedly.

In history, the building of almshouses for the elderly, usually through the initiatives of local communities or groups of citizens, shows that this did not have to be the case, and their organisational concept and physical structure offer lessons that still have potential today. Instead of rooms with a washbasin, there were apartments with a bathroom, a room for living and sleeping in, a kitchen and a cellar. Help, support and nursing care were provided there where the old people lived. Although, then as now, living and nursing areas were separate from one another, it was up to the resident to decide if and when they needed extra care as they became more infirm.

Since then, progressive housing concepts for old people with and without the need for care and assistance have successively eroded the distinction between outpatient and institutionalised care, offering serviced apartments in combination with reliable nursing care. Over 89% of residents in sheltered housing and applicants awaiting a place cite the ability to receive nursing and health care in one’s own home even when frail as a key factor in their choice of this type of housing for the elderly.[1]

Three significant changes in the demographic structure have had a major effect on the market for “housing for the elderly”, both conceptually as well as in terms of built form:

• more people live to an advanced old age

• there is a greater proportion of elderly women

• a greater proportion of elderly people live on their own

People of an advanced old age are more prone to negative side-effects brought on by ageing, such as isolation, increased susceptibility to illness or the need for constant care. The increasing number of people over 80 accordingly places greater demands on housing and accompanying services for the elderly. The proportion of elderly women to men in residential and nursing homes is currently approximately 80%. Future planning proposals need to take such structural demographic changes into account.

Preferred residential forms

In every survey conducted, people’s first choice of where they would prefer to live in old age is always the same: the familiar surroundings of their own home. Serviced or assisted residential housing occupies second place, followed thereafter by a conversion of their own home. Purpose-built residential alternatives such as retirement homes do not rate as highly. Similarly a flat in or adjoining the children’s home is not the most popular choice. Other alternatives such as communal flats or co-housing are only gradually entering the scene while the traditional old people’s home is now generally regarded as undesirable. Given that most old people would prefer to live in the familiarity of their own home, this should serve as a guiding principle for future residential and special-purpose residential forms for the elderly.

Facilities and fittings

Surveys also show that residents wish their living surroundings to be as normal as possible, whether or not they live in an old people’s residence or nursing home.

This means each apartment should have:

• Its own doorbell

• Its own letterbox

• Its own storage

• Been planned in accordance with relevant DIN norms

• A bath suitable for old people

• An emergency call system

• Its own kitchen

• Special safety measures

Buildings should have:

• Gardens or a park

• A common room

• Washing and drying facilities

• Small common rooms

• A restaurant/dining room

• Gymnastic and fitness facilities

• Where possible a swimming pool

• Where possible a wellness area

The surveys also indicate that demand for single-room flats has all but disappeared and that flats with at least another small room, better two good-sized rooms, are preferred.

Qualitative criteria

The single most important reason why old people move into residential housing is to feel safer, both in terms of receiving adequate care and assistance as well as with regard to personal safety. Furthermore, the average senior citizen today wishes to remain self-sufficient and independent, to live in pleasant surroundings, to avoid daily stress, to maintain social contacts and interaction, partake of health offerings, enjoy good food and to be guaranteed value for money for the services they receive.

Health care and nursing

Outpatient services must be able to provide reliable and dependable help and care in the resident’s home. Residents of all disability levels can be cared for in their own apartment: experience has shown that with careful planning and good organisation this is possible. Transfer to a nursing home or care facility need only be undertaken if the resident so wishes.

For residents requiring psychological support, the complex can provide a form of day-care facility where qualified personnel can provide the necessary care and support.

Residential living and nursing care are no longer mutually exclusive concepts, blurring the boundary between outpatient and inpatient care. Services are becoming increasingly tailored to the needs of the individual, allowing the recipients greater freedom to choose what they need. Greater flexibility can and must be provided at different levels regardless of whether elderly people choose to live in a private household or a nursing home. The strict division between housing and nursing care must give way to more flexible forms of living and health care. The historical example of the almshouses shows that this is possible, and this could once again serve as a model for future developments.

Services

What range of services and provisions are potential residents looking for?

• Help in planning their move

• A reception that is manned day and night

• Qualified personnel on all floors and in management

• A safety concept

• Lunch or evening meal

• Weekly cleaning of the apartment

• Emergency call button linked to the reception

• Valet parking

• Cultural and recreational activities

• Arrangement of supplementary services

• Special care for acute illnesses

• Additional domestic services

• Caretaker services

Future perspectives

The immediate and distant future of housing for the elderly will be dominated by three market segments:

• Private households supported by outpatient health care services,

• Institutionalised nursing care whose services and standards are generally determined by the provider (insurance scheme, social security provider), a sector that will increasingly need to upgrade its concept and quality standards

• A broad spectrum of residential forms of living, that draw on and pay for services as and when required.

The residents and tenants in each of these three segments have one thing in common: they want to be able to live safely, self-sufficiently and independently, retaining control over their own lives, even as their nursing care and support needs increase. This necessitates that all professionals involved – architects, service providers, insurers, the housing industry as well as policy makers – work towards developing networked solutions oriented around the needs and wishes of the elderly themselves. Building projects and operating concepts that do not sufficiently take this into account are destined to fail, as several short-sighted projects have shown in the past. Only when the needs and aspirations of the target group are considered in the planning stage and realised in the operating concept will the various users be suitably satisfied.

The coming generation of senior citizens is used to clearly articulating its needs and will without doubt place greater demands on their living environment and care facilities. The ensuing demand in the marketplace has implications for both existing as well as new projects, and poor-quality concepts will need to respond rapidly in order to survive. And, last but not least, all those involved in the planning and conception process should not forget: everything we build now, we are also building for ourselves.

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Originally published in: Eckhard Feddersen, Insa Lüdtke, Living for the Elderly: A Design Manual, Birkhäuser, 2011.