American-style Senior Living Comes to China

Cypress Gardens / China Senior Care

In China, traditional Confucian values dictate that children take care of their parents in their old age. It’s taboo to put your parents in a home. But from 1979 to 2015, Chinese parents could only have one child, which means there’s a whole generation of Chinese with four grandparents and two parents to take care of. To get around the taboo, China Senior Care, a company based in Shanghai and Hangzhou, launched a Western-style senior residential care facility. The idea seems to be if a facility doesn’t seem typically Chinese, perhaps the stigma associated with placing an elder in a home will be avoided.

At the Environments for Aging conference in Las Vegas, Jane Rohde, principal with Baltimore-based architecture firm JSR Associates and Jerry Smith, FASLA, design principal at SMITH | GreenHealth Consulting, walked us through the brand-new Cypress Gardens, in Fuyang, a suburb of Hangzhou. The project, which took eight years, is a private, 5-star senior care center, with just 64 beds, some for assisted living and some for memory care for patients with neuro-cognitive disorders. Each room rents for about $5,000 per month. There are community spaces, restaurants, a library, a theater for both relaxation and entertainment. In fact, it replicates a traditional American senior care facility model: the car-dependent, self-contained suburban facility.

China, like the West is rapidly aging. According to the Brookings Institution, there will be nearly 250 million people 65 and older in China by 2030. Today, Chinese seniors are essentially cared for during “extended hospital stays,” said Rohde. “It’s OK if it’s called VIP care. But it’s really out of the 1950s,” with rows of beds packed into one room. It will be interesting to see how the culture and current senior care models evolves as the country ages.

Cypress Gardens sits on a steep suburban site in the side of a mountain, which meant major grading challenges for Smith, and his design-build partner, Yumin Li, ASLA, with POD Design, Shanghai. To deal with the slopes, Smith built in layers of stone retaining walls in the form of step terraces.

Retaining walls and terraces / China Senior Care

A winding drive leads visitors up to the upper level entry. Smith said working with multiple Chinese contractors (two for the building and interior and one for the landscape) was a new learning experience — “just getting the drive and entrance to meet each other was a challenge.”

Many of the rooms have their own terraces. And surrounding the base of the 6-story building are a series of “outdoor rooms,” both public and private, where residents can be alone or socialize, or engage in physical activities like Tai Chi.

Cypress Gardens terraces and outdoor spaces / China Senior Care

Smith said the owners “didn’t want the character of the space to be Chinese. They wanted all new, all Western.” A water fountain on the south wall cascades into a pool, in an effort to achieve the “Bellagio Wow!,” the owners said they wanted.

Still, Smith delivered a tasteful landscape that manages to be packed with a mix of Chinese and Western landscape elements, from pagodas, to a bosque of gingko trees, and a labyrinth.

An outdoor room / China Senior Care

The pagodas mark the transition from the larger public spaces to the quiet memory care spaces, and can be “closed off for privacy and security as needed.”

Chinese children paying to have their parents stay at Cypress Gardens will see a “wonderful place with very high-end amenities,” Smith said. The facility opens in next month and it’s already mostly booked.

ASLA 2017 Landscape Architectural Accreditation Board (LAAB) Internship

ASLA Center for Landscape Architecture / Gensler

The American Society of Landscape Architects (ASLA) seeks a full-time, 10-week summer intern for the Landscape Architectural Accreditation Board (LAAB). The intern will work with, analyze, and identify trends in landscape architecture education while reviewing data from undergraduate and graduate programs. The final work product of this internship will be used by the LAAB Board, ASLA Committee on Education, and for ASLA career discovery initiatives.

Responsibilities:

The intern will be expected to work 10 weeks full-time from June through August.

The intern will work with and analyze confidential data collected from LAAB accredited landscape architecture programs.

The intern will review and research LAAB accredited program websites as well as those of allied organizations’ websites with the overall goal of reviewing and updating LAAB’s website with new resources.

The intern will create a graphically enhanced data report/dashboard which can be easily updated with new information in the future.

The intern will create an original written piece for publication in one of ASLA’s outlets summarizing findings about LA programs and their data.

Requirements:

Current enrollment entering final year of Bachelor’s program or in a Master’s program in landscape architecture.

Excellent writing skills. The intern must be able to write clearly for a general audience.

Excellent data analytic, research, and design skills.

Excellent organizational skills, good judgement, and attention to detail.

Excellent professional interpersonal skills and ability to interact with busy staff members and outside experts.

Working knowledge of Photoshop and Microsoft Office suite.

How to Apply:

Please send cover letter, CV, two writing samples (no more than 2 pages each), and names and contact information of two references to kpritchard@asla.org by end of day, Friday, March 31. Up to three examples of graphic communications skills including an infographic is a desirable additional sample. Submit one 8 ½ x 11 PDF file.

Phone interviews will be conducted with finalists the week of April 3 and selection will be made the following week.

The 10-week internship offers a $4,000 stipend. ASLA can also work with the interns to attain academic credit for the internship.

ASLA offers a flexible work schedule but the intern must be at ASLA’s national headquarters, which is conveniently located in downtown Washington, D.C., one block north of the Gallery Place/Chinatown Metro Station on the Red, Yellow, and Green Lines. Learn more about the ASLA Center for Landscape Architecture and our green roof.

Book Review: Seeing The Better City

Seeing the Better City / Island Press

In her book The Eye Is a Door, landscape architecture professor Anne Whiston Spirn, FASLA, contemplates the ubiquity of the digital camera. “Never have so many people owned cameras,” and never have images been disbursed so widely.  “Our world is being recorded,” Spirn writes. “But to what end?”

Author Charles Wolfe proposes an end in his new book Seeing the Better City. And that end, suggests this environmental and land-use lawyer, is the improvement of urban environments. The first job of the book, a how-to guide on maintaining a photographic diary, is to answer the obvious question: what role do photographs play in improving cities?

Every day, Wolfe writes, people living in cities encounter changing skylines and neighborhoods. They often have strong opinions on those changes. Oral arguments are made and editorials are written advising on what changes should be made, and often these arguments lack even the most basic visual aid of a photograph. Perhaps the term “multi-family housing” conjures a specific image in your head. But if assessing whether a multi-family unit belongs in your neighborhood, you’d have an advantage if you could view precedents.

Still, there’s a gulf between taking photos and improving cities. How does one apply what can be gleaned from photographs to the world of decision makers and developers? Wolfe offers several case studies of projects that make use of community photography to inform civic debates.

WALKscope in Denver has users submit photos of sidewalk quality, obstructions, amenities, and maps those observations. California King Tides invites users to submit photos of the sea taken at high tide to spread awareness about sea-level rise. Beyond these novel uses of photos, the simple incorporation of photos into presentations that inform civic decisions would greatly improve the decision-making process, Wolfe argues.

As a guide for becoming a better observer, Seeing the Better City is highly successful. Wolfe provides a structured template for an urban diary, but invites readers to construct their own.

As for actually shooting photos, Wolfe eschews prescribing techniques in favor of offering basic guidelines. He draws upon well-regarded photographers such as Ansel Adams and other visual thinkers. Diarists should know to make a photo, not just take one. Light is critical, as is where one stands. People are more critical still. Visit locations multiple times; light changes, but so do uses, the presence of people and animals, and small details such as litter. Juxtaposing the old and new can be interesting, if a bit derivative. Juxtaposing form, material, and use can yield rich photos.

seeing-the-better-city-2
Google Street View can be very useful for discussing elements of the urban environment, Charles Wolfe suggests. / Google Street View

Wolfe wants us to ask ourselves: what is being evaluated through our lens? Wolfe provides 10 parameters for seeing the city. The relation of building to street, standards for roads and signage, and the role of nature are just a few.

Wolfe also suggests activities for inaugurating a diary, such as visiting your five favorite neighborhoods and recording the sights and sounds you encounter, filming your next bike ride, or writing a couple paragraphs about your morning commute.

Many people effectively keep an urban diary without realizing it. The next step is to organize one’s thoughts and photos, reflect on them, and build off them.

Scattered through Seeing the Better City are Wolfe’s anecdotes on his own diary keeping. His observations often demonstrate a deep knowledge of urban policy and land-use issues. Your observations may not, at least initially. But at the very least, urban diaries expand the diarist’s understanding of their city, and that’s enough to start the process of improvement.

Landscape Architecture in the News Highlights (March 1 – 15)

Biscayne Green /  Modern Cities

Fuji Kindergarten | An Exploration of Space and Learning for Children Landscape Architect’s Network, 3/2/17
“Design is about hosting human life and activity. There are, however, projects that go beyond that, to actually shape human life and activity. Fuji Kindergarten is one of those projects. Given its educational purpose, it would be right to say that it shapes character and personality, as well.”

New Plans Revealed for Detroit’s East Riverfront Architect’s Newspaper, 3/2/17
“The Detroit RiverFront Conservancy (DRFC), the City of Detorit Planning & Development Department, and the Detroit Economic Growth Corporation (DEGC) announced the latest plans to expand Detroit’s riverfront land for public use.”

Five Competing Designs Revealed for Victims of Communism MemorialThe Ottawa Sun, 3/2/17
“The Department of Canadian Heritage Thursday revealed five competing designs for a relocated and drastically downsized Memorial to the Victims of Communism at the Garden of the Provinces and Territories on Wellington Street.”

Landscape Architecture Icons to Know Now: Cornelia Oberlander and Harriet Pattiso Curbed, 3/8/17
“Cornelia Oberlander and Harriet Pattison knew of each other long before they met: In a field with few female practitioners at the time, they were often told of “another” woman working in landscape architecture.”

In Chicago and Philadelphia, The Difference a Park Makes – The New York Times, 3/12/17
“From Philadelphia to Seattle, other American cities are also banking on parks and public spaces to drive social and economic progress.”

Miami’s Giant Pop Up Recreates Downtown Street Modern Cities, 3/13/17
“Temporary installation is the first attempt to showcase possible improvements that could transform Biscayne Boulevard in Downtown Miami into street rivaling the Embarcadero in San Francisco.”

Amur Leopards, Siberian Tigers Get New Sanctuary In China, Bigger Than YellowstoneInternational Business Times, 3/13/17
“”China has reportedly approved plans to create a national park in the northeast areas of Jilin and Heilongjiang that will span 5,600 square miles— about 60 percent bigger than Yellowstone National Park.”

Our Interaction with Nature Doesn’t End When We Age

Senior care facility, Phoenix, AZ / Dr. Lori Reynolds

When an older person loses their cognitive and motor functions, how do they maintain a connection to nature? This is the central question for Dr. Lori Reynolds, a clinical professor of occupational therapy, and landscape architect Brad Smith, ASLA. For a senior care facility in Phoenix, Arizona, with some 80 beds for assisted living and 30 for memory care, which involves helping those with advanced neuro-cognitive disorders, Reynolds and Smith together came up with new approaches to redo their courtyard in order to better maintain that connection. At the Environments for Aging conference in Las Vegas, they presented two options — one geared towards the assisted living residents and one for the memory care residents.

Reynolds made the case for investing in gardens in senior care facilities. “For 100 percent of older adults, nature is important.” As Jack Carman, FASLA, a landscape architect who works on senior care facilities, said: “our interaction with nature doesn’t end when we age.”

Reynolds found studies that show “access to nature increases resident satisfaction. And residents are most satisfied when there is ample seating, a variety of nature elements, walking paths, and adequate shade.”

Furthermore, the presence of a garden in a senior care facility influences those family members making the decision about where to put their parent or grandparent. “Nearly 50 percent report the availability of a garden influenced facility choice.”

Other surveys show that “outdoor activity space is among the top desired features,” and “the second most-important feature after the location.” So, if gardens make residents and families happy, and happy residents recommend a facility to others, than functional garden spaces seem like a no-brainer.

After explaining the many physiological benefits of nature for all people, she focused in on the benefits for those in memory care, explaining how exposure to nature can “reduce agitation and aggression among Alzheimer’s patients.” For these patients, “plants can become like people.” They are a presence that can take on “significant meaning,” Reynolds explained. Plants can also represent a legacy: A plant that has been in someone’s life for many years “is a past-life experience, and adds coherence.” The plant of a loved-one who has passed away can help sustain memory of that person.

Facilities can design ways to maintain this elemental connection — for both those who still have an active relationship with nature and those with a mostly passive relationship. For those able, an active relationship, which involves going out and spending time in the garden, is preferable. For those who cannot, a view out a window of a garden or even indoor potted plants are important. For some, “engagement outdoors may be too difficult — it may be too windy or too far from the bathroom.” But still, this doesn’t mean that accessible, aesthetically-pleasing gardens should be jettisoned from budgets.

The current state of garden design for senior care facilities is more focused on the internal than the external, “despite the acknowledged value of these outdoor spaces,” Reynolds said. If there are outdoor spaces, they are too often ornamental, not functional. More need to be accessible and provide healthy doses of nature.

To that end, Brad Smith worked with Reynolds and a senior care facility in Phoenix, Arizona, which they prefer to leave anonymous, to create garden designs that enable both more active and passive interactions with nature in an interior courtyard (see image at top). There are opportunities for transforming the space, which has a required access lane for a fire truck, into a more dynamic, therapeutic place that enables “inside out and outside in” connections.

The option geared more towards assisted living patients, offers a meandering path, an expanded covered patio and outdoor seating areas with rocking chairs, and a water feature surrounded by trees and plants. There are also bird and butterfly feeders patients can bring nectar and seeds to. For this option, Smith envisions caregivers bringing out wheelchair-bound residents so they can enjoy classes in the morning or early evening when it’s cooler.

For the variation designed for memory care residents, there are “vignettes designed to spark connections to the past.” Smith proposes making the space “as familiar as a backyard,” by designing a space for clothes lines and a gardening shed. “Women of a certain generation spent much of their time drying clothes; just letting memory care patients hang stuff up may make them feel better.” There’s already an old 1940s-era car parked in the courtyard, which he imagines male residents enjoy seeing and exploring. A loop walking path, inspired by the memory garden in Portland, Oregon, would enable chaperoned pacing. And the garden is also designed to provide pleasing views from inside the memory care residences of soothing water features.

With memory care, Reynolds said facility owners should use light furniture that’s easy for caregivers to move around. Also, pergolas should be avoided, as they throw shadows that will “wig out” residents. In Phoenix, the gardens will be really hot much of the day, with lots of glare, so use would be limited to mornings or evenings.

Smith and Reynolds estimated the senior care residence had spent about $57,000 on what they have now, which doesn’t do much. For $155,000 they could have the assisted living landscape, or for $96,000, the one for memory care. For just a little bit more, “they could have a killer garden space that boost marketing, creates positive first impressions and a sense of perceived value” while also providing many of the health benefits of nature, Smith explained. Bringing in volunteers — local Habitat for Humanity or other groups — to help plant could further reduce the costs. But they also noted a need for a maintenance budget up front.

The Case for Humane Prisons

Construction of the amphitheater, Iowa Correctional Institution for Women / Iowa State University News Service

Long before anyone defined the field of environmental psychology, prisons were testing grounds for theories about how the design of the built environment could exert a physical and moral influence on people. In 19th-century England, the “Panopticon” prison design proposed a radial organization of brightly-lit and highly-visible cells around a dark central watch tower, to instill in prisoners the moral pressure and paranoia of constant social surveillance. In 21st-century Norway, prison buildings are separated by rolling hills and forests to promote frequent interaction with nature, and guards’ break rooms are cramped and uncomfortable to encourage them to spend their social time with inmates.

The distance between those approaches speaks to the struggle of societies to define the role of prisons as places for punishment or reform, for repentance or rehabilitation. It’s in this arena — fraught with moral undertones and with concerns about safety, accountability, justice, and injustice — that landscape architect Julie Stevens, ASLA, practices.

Stevens, an assistant professor at Iowa State University, has overseen three design-build projects at the Iowa Correctional Institution for Women, a medium-security prison in the small city of Mitchellville. Her approach to prison design is the same as for any community design: build relationships and recognize the humanity of the whole community, while honoring the voices of the most vulnerable — in this case the inmates, or “the women,” as Stevens referred to them most often during a lecture last week at North Carolina State University’s College of Design.

Stevens became involved at the women’s prison in 2011, when administrators were overseeing a $68 million expansion project that included no funding for design of the landscape. “The department of corrections wanted us to help them figure out where to put a few trees and shrubs,” Stevens said. “The prison was a lot of concrete, a lot of lawn, and essentially what happened is that a crew of about 12 women go out and start on one end of the prison with a cheap lawn mower and start mowing. And they push line after line after line, and when they get done, they start all over again.”

“We looked at this, and we thought, ‘We can do a lot better. We can make spaces more productive, more therapeutic.’”

The first design-build project was a limestone amphitheater flanked by two outdoor classrooms, a lawn mound, an aspen grove, and a constructed native prairie (see image above). Iowa State landscape architecture students designed the one-acre space with help from the women, and a team of students and inmates built the whole thing in one summer, using tons of donated gravel and limestone.

ASLA 2015 Student Community Service Award of Excellence, Landscapes of Justice. Students and inmates plant a tree, Iowa Correctional Institution for Women / Julie Stevens

During that first summer of construction, Stevens and her students noticed that prison staff tended to congregate at their cars after work, decompressing in the hot parking lot before driving home to their families. The next design-build project became a decompression deck for prison staff. When that was done, Stevens and her team created a healing garden to serve prisoners in the mental health unit. Now she’s building support for a design to serve the women and their children.

The projects are driven by the relationships Stevens has cultivated with prison administration, staff, and inmates. The designs accommodate administrators’ requests by promoting calm, creating functional spaces, and addressing security concerns — through open sight lines, for example, and the use of epoxy to keep limestone pieces fixed in place and unusable as weapons. The designs serve the women as daily spaces to gather and, during design and construction, as opportunities to build employable skills. But the effects are also more subtle.

“Some of these women have come from some pretty unthinkable situations, years of abuse. But when we’re in the garden and we’re working together, we have a single vision, we’re working toward a common goal, and we all get to be equal,” Stevens said. “Gardens are inclusive.”

The designs at the prison are informed by research on environmental preference and attention restoration theories, and Stevens has assembled a team of researchers to help capture the impact of the projects. They’re tracking protective factors, which are thought to reduce recidivism and which include demonstrations of teamwork and problem-solving. They’re also using surveys to keep track of the gardens’ effects on prisoners. Results so far suggest that being in the landscape makes the women feel calmer, more optimistic, and in greater control of their lives.

ASLA 2015 Student Community Service Award of Excellence, Landscapes of Justice. Prisoners experience the landscape, Iowa Correctional Institution for Women / Julie Stevens

For Stevens, who is a co-founder of the ASLA’s Environmental Justice professional practice network (PPN), those metrics are important. They start to illustrate the impact of the landscape in people’s lives, and they help make the case for corrections departments everywhere to invest in humane design.

But the root of her work at the prison, and in environmental justice generally, is deeper. It’s a belief — common to the history of thought on prison design — that the measure of a society lies in the treatment of its most vulnerable populations, that good design is important and should not be reserved for those with a voice. Stevens identified the solution at the end of her lecture: design and action driven by love.

“We have a lot of work to do. It’s really good work, and it’s really important work,” Stevens said. “We have to love and care for other people.”

This guest post is by Lindsey Naylor, Student ASLA, master’s of landscape architecture candidate, North Carolina State University.

ASLA 2017 Summer Internship

ASLA 2016 Professional General Design Honor Award. Bishan Ang-Mo Kio Park, Singapore by Ramboll Studio Dreiseitl / Lim Shiang Han

The American Society of Landscape Architects (ASLA) seeks a full-time summer communications intern. The intern will research and update ASLA’s sustainable design resource guides and write weekly posts on landscape architecture and related topics for The Dirt blog.

Responsibilities:

The internship is full-time  Monday through Friday for 10 weeks, from June through August.

The intern will research and update resource guides on climate change, sustainable transportation, residential design, and other topics.

The intern will also create original content for The Dirt, including a weekly series of reviews on new apps and technology useful to landscape architects.

The intern will attend ASLA’s annual diversity summit weekend and write a report on the proceedings.

The intern will also have the opportunity to attend educational and networking events at the National Building Museum, Harvard University’s Dumbarton Oaks, and other museums and think tanks in Washington, D.C. Other communications projects may come up as well.

Requirements:

Current enrollment in a Master’s program in landscape architecture.

Excellent writing skills. The intern must be able to write clearly for a general audience.

Excellent photographic composition and editing skills.

Proven research skills and ability to quickly evaluate the quality and relevance of many different types of Web resources.

Excellent interpersonal skills and ability to interact graciously with busy staff members and outside experts.

Working knowledge of Photoshop, Google Maps, and Microsoft Office suite.

How to Apply:

Please send cover letter, CV, two writing samples (no more than 2 pages each) to aklages@asla.org by end of day, Friday, March 31.

Phone interviews will be conducted with finalists the week of April 3 and selection will be made the following week.

The 10-week internship offers a $4,000 stipend. ASLA can also work with the interns to attain academic credit for the internship.

The internship is in-house located at ASLA’s national headquarters, which is conveniently located in downtown Washington, D.C., one block north of the Gallery Place/Chinatown Metro Station on the Red, Yellow, and Green Lines. Learn more about ASLA’s Center for Landscape Architecture.

New Senior Living Model Needed to Satisfy Aging Boomers

Crotona Senior Residences, Bronx, New York / Rendering by architectural firm of record: Magnusson Architecture and Planning PC, via Welcome to the Bronx

Senior living communities can either be car-dependent and isolated, or an urban or suburban “destination for experiences,” with proximity to transportation, services, arts and culture, restaurants, shopping, and personal development opportunities. Which community would you want to live in? The answer was clear in a session at Environments for Aging in Las Vegas.

According to Michael Hass, managing partner, Drive Development Partners, who is also a member of the Urban Land Institute’s senior housing council, from 1990-2009, senior living communities, mostly geared towards the World War I-era “silent” generation, were all about providing “a sense of security, peace of mind, ‘safety in numbers,’ and belonging.”

But in 2009, occupancy across the senior living industry dropped. This was a key year, the first year baby boomers (those born between 1946 and 1964) became consumers of these places themselves, not just shoppers of these facilities for their parents. Their views on the traditional places could be summed up with: “I’ll never live in a place like that.”

Starting in 2009, senior living developers saw new demand among some of the oldest baby boomers for communities with “flexibility, choice, a unique variety of experiences, and spending opportunities.” They don’t want the self-contained campus, “35 acres in a cornfield.” Hass said: “They want an individualized experience, not the same formal dining room every day.”

Sean Thomson, senior living director, CR Architects, said a new model is needed to reach the 75-million-strong boomers, and walkable urban communities could be it. Walkable urbanism is in demand among all age groups, but is particularly appropriate for seniors.

A report from the George Washington University school of business found that “walkable urbanism is gaining market share.” Furthermore, there is a 90 percent premium for walkable office space, 71 percent premium for retail, and 66 percent premium for multi-family housing.

A 2013 report from Fannie Mae found senior communities with a WalkScore above 80, which means they are walkable, had a “relative risk of default that is 60 percent lower.” Those communities with a WalkScore below 8, which deemed them totally car-dependent, had a “risk 121 percent higher.” As Thomson explained, “walkable communities have a real human impact, but they also have real financial results.” Places with WalkScores in the 60 and 70s have some services in walking distance, but those with scores of 90-plus are ideal.

The ideal walkable senior community is basically found in dense European and Asian cities, or New York City. Imagine an apartment complex in a highly walkable environment, open to the surrounding neighborhood, with ground floor shops, cafes, and restaurants, and close to multi-modal transit opportunities, parks, plazas, self-storage facilities, and co-working spaces. Instead of all these services provided within an isolated campus, they are distributed through the surrounding neighborhood.

Thomson said an urban environment can provide better quality and a higher range of restaurants than any isolated senior community can. Embedding a senior community in a neighborhood also enables that inter-generational contact, social integration, and intellectual engagement so critical to “successful aging.”

Thomson summed up the benefits of walkable urbanism for seniors: “you don’t have to build the amenities; they are already there.”

To make these kinds of communities happen will take some creative housing development strategies. Senior housing developers can partner with medical groups, physicians networks, hospital districts, religious institutions, fitness or wellness companies, or become parts of existing mixed-use developments. “Senior living developers are almost never the top bidders so they need to be part of mixed-use projects, attach themselves to bigger projects.”

In revitalizing second-tier cities, senior housing developers have a real chance, particularly if they piggy-back on mixed-use developments where it’s advantageous to have a set of new fixed-income resident buyers all in one place. “Senior living communities can become an asset to a community.”

Senior housing developers can remake under-performing hotels or extended-stay hotels, or B and C class multi-family housing. “They can partner instead of acquire.”

Also, Thomson can even see universities and colleges building nearby housing for retired alumni who want to return to the area.

They created a vision of a 2.5-acre urban senior development with medical facilities, spa, club, street-facing “fast, fresh” restaurants, shops, a playground, grocery store, and housing for 100-200 residents. “It wouldn’t be adult daycare, but a place where people enjoy themselves.” Perhaps this model could be deemed senior or grey urbanism?

When asked where this comprehensive vision is actually happening in the U.S., both Thomson and Haas said “some elements are happening incrementally, but not all together.”

Empathize and Then Design

Virtual dementia tour / The Davis Enterprise

“Dementia used to be viewed as a psychological problem, a mental illness. There was a stigma associated. Now, we know it’s an organic problem related to cell death in the brain. It’s a medical condition,” said P.K. Beville, founder of Second Wind Dreams, at the Environments for Aging conference in Las Vegas. Dementia, which includes diseases like Alzheimer’s, some forms of Parkinson’s, Lewy body disorders, and others, is now called a neuro-cognitive disorder. It affects more than 5 million Americans and their families.

Throughout the conference, perhaps the major focus was how to orchestrate a shift to more empathetic or patient-centric care for those with neuro-cognitive disorders. Just like with autism, it’s now understood there is a spectrum of neuro-cognitive disorders. One person with the disorder is really one person with the disorder. Designers, physicians, and researchers are partnering to better understand what it’s like to have a neuro-cognitive disorder and then create more sensitive processes and empathetic spaces that can help alleviate the pain these patients experience while institutionalized in memory-care facilities.

With these disorders, there is a loss of cognitive abilities. Our ability to hear, speak, read, and understand come from different parts of our brain. If there is cell death in these areas, then forging understanding connections with others becomes much more challenging. For many of these patients, long-term memory may be intact, but not short-term episodic memory. Also, semantic memory, which deals with abstract concepts, and procedural memory, which helps people remember how to get from point A to B, may be damaged. With the loss of abstract memory, “the goals or intentions of life is lost,” explained Terry Zborowsky, a researcher with HGA architects and engineers in one session, which is why they need “so many cues from the environment.” The loss of procedural memory means those care environments become incredibly confusing, so designers must be really thoughtful to make them more legible.

In her keynote, P.K. Beville said she wants caregivers to better understand why patients with neuro-cognitive disorders behave the way they do. When this is achieved, we can create spaces to better meet their needs. For example, Alzheimers patients in advanced stages “don’t get warning signals when they have to go to the bathroom.” All of the sudden it just comes on and they have to go. If the bathroom is far away, they may miss it and then be labeled incontinent and placed in briefs. “That’s a horrible threat to their dignity. How can we get them to their bathroom faster?” Some ideas: make the bathrooms more easily accessible via hallways, instead of hiding them, and put them in direct line of sight from beds.

Patients with neuro-cognitive disorders often have macular degeneration, which will put a large black spot in the middle of their vision. Their peripheral vision will also be significantly degraded. Their field of view is then limited to just a few feet, which is why they often look down to see where they are going. Beville said, knowing this, “it’s really silly that caregivers are still sitting to the sides of patients when they feed them. Imagine this fork flying out of space into your mouth.” When a patient balks or refuse to eat, they are then labeled difficult and that behavior gets “charted.” It makes much more sense to sit directly in front of the patient and create dining spaces that enable this.

In neuro-cognitive patients, degeneration of the reticular activating system is “what’s causing all the mess. It removes what’s important, causing a loss of focus. When this area of the brain is damaged, the brain picks up all sensory input, relevant or irrelevant.” These patients will hear everything — a door being slammed, a vacuum cleaner, a TV, and even the HVAC system. A dog barking or baby crying will be incredibly painful. When these patients are overwhelmed, they will begin to rock or become agitated. It’s important that memory care facilities then eliminate all sounds that can cause an annoyance. “The dining room can become a cacophony of sound. No wonder the residents don’t want to eat.”

Beville has created an amazing virtual reality tour that demonstrates what it’s like to have a neuro-cognitive disorder like Alzheimer’s. Working with leading medical professionals, researchers at Georgia Tech, and patients, she modeled the effects using goggles, which layers the effects of macular degeneration on whatever you are looking at; gloves that reduce fine motor skills; and headphones that mimic the aural sensory overload these patients can experience. Some two million caregivers in senior facilities have taken the tour.

At the conference, she modeled the newest iteration of the tour using Samsung Gear virtual reality (VR) headsets, instead of goggles, which augment a user’s field of view. The woman who tested it said it was a “terrifying experience.” She said she had “no perception of depth or peripheral vision; it was very hard to hear. I was very, very anxious.”

Studying the responses of the caregivers who have taken the tour, Beville found they exhibit the same behavior as those with Alzheimer’s and other neuro-cognitive disorders. They mumbled or hummed in an attempt to focus and block out the extraneous noises. They were agitated, wandered, rummaged, made negative statements that indicated they felt overwhelmed or depressed. Just 8-10 minutes in the headset caused some to have “strange or bizarre behavior.” Now imagine someone struggling with this condition for years.

Through the tours, Beville found older patients with this condition need “three times the light to see than younger people.” So facilities and their landscapes need to be well lit. The reaction time of the pupil is also delayed, so any changes in lighting causes major issues and should be avoided. Noise needs to be reduced to eliminate distractions. And patients want clear guidance — “something to do” — to help them focus.

After taking the tour, more caregivers agreed with the statement that neuro-cognitive disorder patients “don’t get the care they need.” The tours then help facilities begin to institute performance-based systems to improve quality of care. After taking the VR tour, caregivers say they will be “more patient and understanding with patients, will take more time and provide more attention, and communicate better.” Beville and her group are measuring the changes before and after sensitivity training to demonstrate improvements, which can be measured in adaptive behaviors among patients (engagement, communication, wayfinding, and social integration) and maladaptive behaviors (aggression, confusion, disorientation).

In another session, we heard how to take empathetic design to the next level. Architect Alana Carter, with HGA architects and engineers, explained how she checked herself into a healthcare facility she was redesigning, pretending to be a stroke victim with degraded capabilities on her entire left side. She was fed, washed, and helped in the bathroom. She called the experience “extremely humbling,” but it gave her insights into what needed to be done better from a patient point of view.

Carter and her colleague Zborowsky called for “walking in the footsteps” of patients first, using a comprehensive design methodology to uncover design solutions that will improve environments for aging. Their teams put GPS tracking devices on staff and patients and apply sensors that generate heat maps to understand the flow and popularity of areas in a facility. This kind of analysis can reduce inefficiencies in layout and help discover what features patients feel most comfortable around. Using VR headsets, HGA then prototypes Revit designs of new spaces in real-time, working with caregivers to optimize layouts and features. Finally, they test implemented designs through comprehensive pre- and post-occupancy reviews.

Carter concluded: “We need to move design for seniors out of the care facilities and into museums, galleries, movie theaters, and the home. We need to bring empathetic design to all places. We need to design for the outliers.”

The Goal: “Die Young as Late as Possible”

Live long, die short / Greenleaf Book Group Press

The world is rapidly aging. According to Foreign Policy magazine, the share of the population 60 and older will nearly double to 21.5 percent by 2050, from 12.3 percent today. Aging populations will surge in Japan, South Korea, Germany, China, and the United States. The “‘grey tsunami’ will the defining feature of the 21st century.” By 2050, the median age in the U.S. it will be 42, while the global median will be 36. And the number of dependent people in America will also skyrocket from 49 for every 100 people of working age to 66.

At the Environments for Aging (EFA) conference in Las Vegas, which brought together senior living developers, architects, and landscape architects, along with physicians and caregivers, Debra Levin, president of the Center for Health Design, said 10,000 baby boomers (those born between 1946 and 1964) will turn 65 every day for the next decade. And these boomers have “different expectations about how and where they will age” than their parents, the World War I-era “silent” generation. Furthermore, these boomers are now living longer and want more control over their last years. They want more affordable solutions than increasingly expensive residential home care. The entire senior care industry will need to change to meet their needs and demands.

Dr. Roger Landry, author of Live Long, Die Short: A Guide to Authentic Health and Successful Aging, said “we can’t afford to make mistakes as the baby boomers age.” It’s important to promote “successful aging” strategies that can stave off long, slow declines due to illness, in favor of maintaining high levels of performance before a quick drop off at the end. The goal is to “die young as late as possible.”

He said all our cognitive performance will eventually drop after a long plateau that lasts from our 30s through out 60s. That decline is usually a “painful, degrading, and expensive experience.” But we can dramatically shorten the decline by using some smart approaches. About 70 percent of our ability to avoid the awful extended decline is tied to lifestyle choices, “the choices we make every day.”

First off, it’s important that older people not put themselves out to pasture. They must actively combat the low expectations our societies have for them. In rapid fire, he issued a set of maxims: “Maintain physical and cognitive function. Continue engagement with life. Minimize risk of diseases and disabilities. Don’t be isolated in your home.”

Specifically, he called on older people to move a lot; engage in quick learning — “not coasting or settling” — to stimulate new neural pathways; maintain a strong social network in order to reduce the risk of major diseases like cancer, diabetes, and dementia; find a role and higher purpose — it can be small or big thing, but we “wither without purpose”; take on a slower pace, avoid clocks, and practice mindfulness to reduce chronic stress; eat a Mediterranean diet; create inter-generational connections, particularly with young kids; laugh a lot, which boosts the immune system; engage in creative pursuits in order to “be in the moment”; and be close to nature.

Many of these life-preserving behaviors have been documented in Dan Buettner’s book Blue Zones: 9 Lessons for Living Longer from the People Who Have Lived the Longest about the “living labs,” the unique communities around the world that have high numbers of incredibly vital 90 and 100-year olds. These communities maintain important features of the lifestyles of our prehistoric hunter-gatherer ancestors. Landry said we make mistakes when we veer too far from ancient wisdom.

As the boomers retire, a new approach, rooted in a less-ageist mindset, is needed. “Can we make acting your age a bad thing? As a society, we must change how we see aging. Age should be irrelevant.”

In the past, there has been “too much human capital warehoused in facilities.” We can’t waste the potential contributions of 76 million aging baby boomers and many millions more around the globe.