How architectural design affords experiences of freedom in residential care for older people

Abstract

Human values and social issues shape visions on dwelling and care for older people, a growing number of whom live in residential care facilities. These facilities' architectural design is considered to play an important role in realizing care visions. This role, however, has received little attention in research.This article presents a case study of a residential care facility for which the architects made considerable effort to match the design with the care vision. The study offers insights into residents' and caregivers' experiences of, respectively, living and working in this facility, and the role of architectural features therein.A single qualitative case study design was used to provide in-depth, contextual insights. The methods include semi-structured interviews with residents and caregivers, and participant observation. Data concerning design intentions, assumptions and strategies were obtained from design documents, through a semi-structured interview with the architects, and observations on site.Our analysis underlines the importance of freedom (and especially freedom of movement), and the balance between experiencing freedom and being bound to a social and physical framework. It shows the architecture features that can have a role therein: small-scaleness in terms of number of residents per dwelling unit, size and compactness; spatial generosity in terms of surface area, room to maneuver and variety of places; and physical accessibility. Our study challenges the idea of familylike group living. Since we found limited sense of group belonging amongst residents, our findings suggest to rethink residential care facilities in terms of private or collective living in order to address residents' social freedom of movement. Caregivers associated 'hominess' with freedom of movement, action and choice, with favorable social dynamics and with the building's residential character. Being perceived as homey, the facility's architectural design matches caregivers' care vision and, thus, helped them realizing this vision.

Structuring the Environmental Experience Design Research Framework through Selected Aged Care Facility Data Analyses in Victoria

“…Unnecessary level changes on the floors may reduce or eliminate physical and visual barriers associated with the elderly movements (e.g., with a wheelchair, wheeled walker, scooter and mobile hoist) and other daily life activities including social networking. Van Steenwinkel et al advocate that this open spatial articulation enables more social interactions amongst residents, but also affords "spatial generosity" through combining "surface area, room to maneuver and variety of places" [50].…”

Nurse managers’ perceptions of care environment supporting older people’s ability to function in nursing homes

“…Surprisingly, the viewpoint in the description of the symbolic environment was more about staff perspectives, describing, for example, the norms and the presence and activities of the staff. Previous studies have reported that the care environment provides an important opportunity to restore the residents’ ability to function (Mercante et al, ; Sawamura et al, ; Van Steenwinkel et al, ), but the result of this study shows that it can also easily threaten independence if the nursing care does not seize these opportunities.…”

“…Although the care environment and the care providers’ expertise have been found to have an impact on care outcomes and services (Suhonen, Välimäki, & Leino‐Kilpi, ), the use of the residents’ own resources to enhance the care environment (Van Steenwinkel, Dierckx de Casterlé, & Heylighen, ) and nurse managers’ activities in developing it, have been neglected. The expert use of the care environment can be an important means of care and rehabilitation (Mercante et al, ; Sawamura, Nakashima, & Nakanishi, ).…”

“…The care environment, according to Kim's typology () has been defined in terms of the physical, concerned with the structures within the institution, the social, concerned with people's interactions and the symbolic, concerned with culture, language, religion/spirituality and society norms. Other studies have considered the care environment in terms of people, processes and equipment (Zimmerman et al, ), and the built environment, including information technology (Cook, Crandall, Singla, & Thomas, ) and architecture (Van Steenwinkel et al, ). The elements within these studies (Cook et al, ; Zimmerman et al, ) facilitate an understanding of the care environment but not how this environment acts on and with the residents.…”

“…Functional ability can be maintained and improved in an encouraging physical environment. It has been demonstrated that by modifying the environment, facilitating individuality and increasing the freedom to move, many positive changes in older people's functional ability and well‐being occur (Cioffi, Fleming, Wilkes, Sinfield, & Le Miere, ; Van Steenwinkel et al, ). Wilkes Fleming Wilkes Cioffi and Miere () reported that improving lighting, increasing the size of the windows and providing free access to the garden, decreased patients’ aggression and anxiety, especially among people with memory disorders.…”