Designing for high-needs elderly

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Research is under way to develop a design guide to improve the quality of life of the high-needs elderly who live at home. This is increasingly important with the expected future growth in the ageing population.

Figure 1: Apartment floor plan.
Figure 2: Relationships between quality of life and design elements.

CURRENT HOUSING DESIGN is not providing quality of life for the high-needs elderly in New Zealand. Recent research carried out as part of a PhD has established a set of housing design requirements that meet these needs and offer new insights into existing universal design requirements.

Thirty people and their homes studied

The research focused on 30 elderly people who were living in their own homes in senior housing complexes such as retirement villages and rental housing in the Wellington region. They were receiving care from professional caregivers.

Data about the housing environments, resident perceptions and their spatial use were collected through interviews and daytime observation of both the elderly individuals and their caregivers.

Case study of one resident’s experiences

One elderly woman who lived in a 1-bedroom apartment spent most of the day in her armchair in the lounge. Tables and shelves with items such as remote controls, phones, pens, books, CDs and a CD player and her water bottle were adjacent to her chair so she could reach them easily (A in Figure 1).

Figure 1: Apartment floor plan.

The chair was close to the door leading to the bedroom, which had an en suite bathroom. However, the 4 metres between the chair and the bathroom was too far for her using her walker frame by herself (B in Figure 1). ‘Whilst it’s only a step for you, it’s a long step for me now,’ she said.

Her apartment had a kitchenette with a space for a mini-fridge, small cupboards and shelves. She had added a full-height fridge and a separate full-height cupboard to store her food and cooking utensils. By doing this, she could enjoy her private meals even though she was provided with two meals a day.

Personal furniture was put side by side along the walls of her lounge, and cabinets and shelves provided space for displaying her photographs and objects that made the room homely. However, her lounge was too small for the furniture and manoeuvring her wheelchair. The layout of a cupboard made the passage too narrow for her to comfortably pass through with the wheelchair (C in Figure 1) so the wheelchair had to be kept outside the apartment.

When her son visited and stayed over-night, he had nowhere to sleep but ‘on his cushions … on the floor [in the lounge]’. The resident wished she had another bedroom for a guest.

Quality of life needs to be a prime design consideration

This case study illustrates the need to design housing that facilitates satisfactory independent living of the high-needs elderly. To do this, it is essential to clarify and implement design requirements that enhance every aspect of quality of life.

By analysing quality of life, themes relating to physical environments became apparent and were categorised into six main categories:

  1. Independence and control in daily basic activities.
  2. Meaningful leisure activities.
  3. Meaningful relationships.
  4. Maintenance of possessions.
  5. Comfort.
  6. Quality of care.

Design considerations were then distilled, classified into 24 design elements and applied to individual dwellings and communal spaces. Complex relationships were found between the quality of life themes and the design considerations (Figure 2).

Figure 2: Relationships between quality of life and design elements.

Set of design requirements

Synthesising the design considerations and examining existing knowledge enabled a set of design requirements to be established for the 24 design elements. Aspects considered included the following.

Micro-environments in private space

Design considerations of the private space of the high-needs elderly have been clarified. These emphasise the importance of microenvironments that help the elderly maintain control and enable preferred activities even when there is limited mobility.

The design of private space also has an impact on residents’ ability to maintain their important relationships, such as continuing to live as a couple and hosting guests. It is also important to consider the spatial requirements to accommodate a range of personal belongings.

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Spatial needs for caregivers in private dwellings

The study clarified key requirements for accommodating caregivers in private homes. For example, in the bathroom, space is required to accommodate the resident and their caregiver for washing and drying. Shower enclosure design is also important for improving the safety of both the resident and caregiver, as well as maintaining resident privacy and dignity.

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Walker-frame users

The study identified numerous considerations in the design for walker-frame users in contrast to those for wheelchair users. As many of the cohort in New Zealand are walker-frame users, these insights can be an important addition to the existing universal design framework.

Next step – a practical design guide

Following the development of these design requirements into a design guide, testing will be necessary to gauge their practicality and affordability. This will involve four main steps:

  1. Developing prototype units.
  2. Collecting feedback from users and practitioners such as architects and designers regarding the technical and cost aspects.
  3. Examining the effectiveness of the designs in improving quality of life with a wider sampling of the population.
  4. Analysing and incorporating the results into a design guide that is comprehensible to all users.

The development of a design guide will enable a wider implementation of design requirements that facilitates the quality of life of the high-needs elderly in practice, helping more people live independently for longer.

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Figure 1: Apartment floor plan.
Figure 2: Relationships between quality of life and design elements.

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