Acknowledgments xix
Foreword xxiii
About the Companion Website xxxiii
1 What Do Older People Want? 1
What Possibilities Would Frail Older People Prefer in a Housing Solution? 1
How We Age Is Often Unpredictable 1
Strategy One: Stay in the House and See What Happens 2
Strategy Two: Plan the Move and Explore Other Scenarios 5
What Aspects of Housing and Services Best Serve the Older Frail? 9
Endnotes 10
2 What Are the Major Aging Changes that Affect Independence? 13
Changes in Sensory Modalities 13
Chronic Conditions and Disability that Limit Independence 17
Will Chronic Disease Continue to Decrease? 18
Endnotes 22
3 Demographics and Living Arrangements 25
Mortality and Fertility on the World Stage 25
Longevity Is a Primary Driver of Aging Population Growth 26
World Population Growth: 65+, 85+, 100+ 26
China Is the Most Rapidly Aging Country in the World 27
European Aging Experience: Been There, Done That 28
The Triple Whammy of the Aging of Japan: Longevity, Low Fertility, and Low In-migration 29
What About the Growth Rate of the 65+ and 85+ Population in the US? 29
The Centenarians and Near Centenarians: 100- and 90-Year-Olds in the US 31
Impacts of Demographic Growth 31
What Other Demographic Issues Will Affect the Future? 33
Endnotes 34
4 How Is Long-Term Care Defined? What Are the Choices? 37
What Are the Major LTC Alternatives? 37
Nursing Home Facts and Figures 38
What Are the Problems of Traditional Nursing Homes? 38
Will Green House© and Small House Models Replace Traditional Nursing Homes? 41
What Attributes Should We Strive to Include in New Nursing Homes? 42
How Do Assisted Living (AL) and Residential Care Settings Differ? 43
Assisted Living, Problem One: Care for More Dependent Residents 44
Assisted Living, Problem Two: Cost of Care and Lack of Reimbursement 44
How Do Assisted Living Residents Differ from Nursing Home Residents? 45
What Can We Learn from Hospice Models? 45
Home Care Through Family Members and Formal Sources 47
Reformulating Home Care to Work at the Margin of Need 48
Endnotes 50
5 Concepts and Objectives for Housing the Frail 53
First-Order Concepts 53
Second-Order Concepts 53
Environmental Docility Hypothesis 54
Endnotes 55
6 20 Design Ideas and Concepts that Can Make a Difference 57
The Neighborhood, Site Issues, and Outdoor Space 57
ONE: Defining a Good Accessible Site 57
TWO: Orientation to the Outdoors and the Natural World 58
THREE: Courtyards for Density, Views, and Social Exchange 60
FOUR: Interstitial Spaces on the Buildings Edge 60
FIVE: Atriums for Social Interaction and Exercise 62
Refining Design Attributes and Considerations 64
SIX: Making the Building Approachable, Friendly, and Noninstitutional 64
SEVEN: Create a Building that Is Accommodating and Adaptable 65
EIGHT: The Building Design Should Encourage Walking 66
NINE: Invite Natural Light 68
TEN: Embrace the Open Plan 69
ELEVEN: The Impact of Interior Design on the Senses 70
TWELVE: Special Considerations for Designing for Dementia 72
Stimulating Social Interaction 74
THIRTEEN: Places that Welcome Family and Friends 74
FOURTEEN: The 100% Corner or Community Table 76
FIFTEEN: Places for Unobtrusive Observation and Previewing 78
SIXTEEN: The Retreat 80
SEVENTEEN: The Primary Path 81
EIGHTEEN: Triangulation 82
Planning the Dwelling Unit 83
NINETEEN: Personalization that Makes the Unit Your Own 83
TWENTY: Dwelling Unit Design 85
Endnotes 88
7 12 Caregiving and Management Practices that Avoid an Institutional Lifestyle 91
Effective Caregiving Strategies 91
ONE: Accommodating Independence Through a Home Care Model 91
TWO: Primary, Secondary, and Designated Caregivers and the Computer 93
THREE: Activity of Daily Living (ADL) Therapy 94
FOUR: Maintain a Commitment to Serve the Surrounding Neighborhood 97
Full Participation in the Life of the Place 99
FIVE: Use It or Lose It 99
SIX: Commitment to Physical Therapy and Exercise 100
SEVEN: Clubs, Entertainment, and Purposeful Activity 101
EIGHT: The Dining Experience and Nutrition 101
Creating Affect and Joy 104
NINE: Encouraging Cheerfulness and Positive Affect 104
TEN: Avoid an Institutional Lifestyle 106
ELEVEN: Plants, Pets, Kids, and the Creative Arts 107
TWELVE: Treating the Staff with Respect and Dignity 109
Endnotes 110
8 21 Building Case Studies 111
European History of Home-care Serviced Buildings 111
Service House Model Emerges 112
AFLs, Humanitas Style 113
The Continuing Care Retirement Community (CCRC) or Life Plan Community (LPC): A US Invention 118
CS ONE: Humanitas Bergweg, Rotterdam, the Netherlands 120
CS TWO: Rundgraafpark, Veldhoven, the Netherlands 125
CS THREE: La Valance, Maastricht, the Netherlands 129
CS FOUR: Neptuna, Malmö, Sweden 134
CS FIVE: De Plussenburgh, Rotterdam, the Netherlands 138
CS SIX: De Kristal (Crystal), Rotterdam, the Netherlands 144
CS SEVEN: Woodlands Condo for Life Prototype, Woodlands, Texas 146
CS EIGHT: NewBridge on the Charles, Dedham, Massachusetts 151
Small Group Living Cluster Case Studies 157
CS NINE: Mount San Antonio Gardens Green House©, Claremont, California 161
CS TEN: Leonard Florence Center for Living, Chelsea, Massachusetts 165
CS ELEVEN: The New Jewish Lifecare Manhattan Living Center, Manhattan, New York 170
CS TWELVE: Hogeweyk Dementia Village, Weesp, the Netherlands 175
CS THIRTEEN: Ærtebjerghaven, Odense, Denmark 184
CS FOURTEEN: Herluf Trolle, Odense, Denmark 190
Smaller-scale Assisted Living Buildings (25 to 40 Units) and Other Options 195
CS FIFTEEN: Vigs Ängar Assisted Living, Köpingebro, Sweden 195
CS SIXTEEN: Ulrika Eleonora Service House, Louviisa, Finland 201
CS SEVENTEEN: Irismarken Nursing Center, Virum, Denmark 205
CS EIGHTEEN: Sunrise of Beverly Hills Dementia Cluster, Beverly Hills, California 210
CS NINETEEN: Egebakken Co-Housing, Nobedo, Denmark 214
CS TWENTY: Willson Hospice, Albany, Georgia 219
CS TWENTY-ONE: Musholm Bugt Feriecenter, Korsør, Denmark 223
Endnotes 227
9 Programs that Encourage Staying at Home with Service Assistance 229
One: Home Modification Programs 229
Two: Danish Home Care System 232
Three: PACE (Program for All-inclusive Care for the Elderly) 235
Four: Home and CommunityBased Care: The 1915c and 1115 Waiver Programs and Long-term Care Insurance 238
Five: Beacon Hill Village (BHV) 240
Six: Age-Friendly Cities 243
Seven: Accessory Dwelling Units (ADU) 245
Eight: GenSmart House and Next Gen House 247
Nine: Naturally Occurring Retirement Communities (NORCs) 249
Endnotes 251
10 Therapeutic Use of Outdoor Spaces and Plant Materials 253
How Does the Landscape Make a Difference? 253
Biophilia 253
Physical Health Benefits 254
Mental Health Benefits 255
Design Considerations for Gardens and Outdoor Spaces 256
Dementia Gardens 260
European Atrium Buildings 261
Endnotes 265
11 How Will Technology Help People Stay Independent and Avoid Institutionalization? 267
Transportation Is a Major Barrier Today 267
Internet Service Utilization 268
Home-Delivered Services 269
Driverless Cars 271
Social Robots 271
Functional Electro-mechanical Robots 273
Transfer and Lifting Devices 274
Exoskeletons 275
Protective Clothing 276
Scooters (Personal Operating Vehicles) and Mobility Aides 276
Virtual Reality 277
Replaceable Body Parts 278
DNA-based Medicines and Therapies 278
Endnotes 279
12 Primary Themes, Takeaways, and Conclusions 281
The US and the World Will Experience a Much Older Population 281
Home Care Models and Integrated Health Care Models Are Needed 281
Assisted Living (AL) Is a Viable Alternative but Comes with Restrictions in the US 282
The Apartment for Life (AFL) Model Provides Personal and Medical Care in Independent Housing 282
Small Group Housing Clusters for the Extremely Mentally and Physically Frail Is Likely to Continue, Even with Other Options Available 283
Most Existing US Nursing Homes Are of Poor Quality and Need to Be Phased Out or Upgraded 283
How Can We Help Those with Dementia Live a More Satisfying and Meaningful Life? 284
Baby Boomers Have High Expectations for Quality Long-term Care Services but Lack the Means to Purchase Them 285
Supporting Friendships and Increasing Affect Make Places to Live Happier 285
How Will Advances in Technology Make a Difference? 286
An Emphasis on Exercise and Connections to Outdoor Spaces 286
More Comprehensive Approaches at the City and Neighborhood Scale 287
Conclusions 287
Index 289
