uwm lecture
DESCRIPTION
This PowerPoint briefly reviews current trends in environments for the elderly and some examples of Crepidoma work.TRANSCRIPT
Environments for Aging in the United States
November 6, 2009
University of Wisconsin-Milwaukee
Environments for Environments for Aging in U.S. Aging in U.S.
Environments for Aging in the United States
Outline
I. Introductions
II. Seniors – By the Numbers
III. Historical Perspective
IV. Top 10 Concerns
V. Seniors’ Housing Overview
VI. Regulatory Challenges
VII. Brief Overview of Crepidoma Work
VIII.Trends for the Future
Environments for Aging in the United States
Environments for Aging in the United States
I.Introductions
Environments for Aging in the United States
IntroductionsJeffrey W. Anderzhon, FAIA30 Years Senior Living Experience
Principal / Crepidoma Consulting
•Juror-IAHSA Design for Ageing Symposium-2007 & 2009•Juror-Design for Future Ageing-Yonsei University, Seoul, Korea-2006 & 2007•Juror-Design for Aging Review, AIA/AAHSA-2004•Chair-AIA/Design for Aging Knowledge Community, 2006•Co-author-Design for Aging Post Occupancy Evaluations-Wiley & Sons, 2007
Environments for Aging in the United States
II.Seniors By the
Numbers
Environments for Aging in the United States
Tidal Wave
By 2030 20% of the US Population will be over the
age of 65
Source: Administration on Aging; U.S. Department of Health and Human Services
By the Numbers
Environments for Aging in the United States
Age 55 – 64
92 men per 100 women
Age 85+
46 men per 100 women
Elderly Women Continue to
Outnumber Men
By the Numbers Tidal Wave
Environments for Aging in the United States
Growing Diversity
Members of minority groups projected
to increase:
20005.7 million
(16.5% of elderly pop.)
20108.1 million (20.1%)
202012.9 million (23.6%)
Source: U.S. Census Bureau, 2004b.
By the Numbers
Environments for Aging in the United States
Where Are They Living?
•95% - Independently 95% Non-Congregate
Housing5% in Self Described
Seniors’ Housing
•5% - Professional Caregivers
4.5% Healthcare Settings1.1% 65 – 74 yrs4.7% 75 – 84 yrs18.2% 85+
By the Numbers
Environments for Aging in the United States
Where Are They Living? By the Numbers
Environments for Aging in the United States
Where Are They Living?
Oldest States
FL 17.6%
PA15.6%
WV 15.3%
By the Numbers
Environments for Aging in the United States
Where Are They Living?
3 out of 4 Live in a Metropolitan Area
Source: U.S. Census Bureau, 2001, Table P12.
By the Numbers
Environments for Aging in the United States
Income
Social Security benefits constitute
90% or more of total income for 1/3 of Americans over 65
Social Security Recipients Aged 65 and Over by Relative Importance of Social Security to Total Money Income: 2001
Source: Social Security Administration, 2003a.
(Percent distribution)
By the Numbers
Environments for Aging in the United States
Income
$35,825 median for family
households 65+
$15,193 median for people 65+
reporting income
Percent Distribution by Income:2004
Source: U.S. Census Bureau
By the Numbers
Environments for Aging in the United States
Income
3.6 million elderly were below the
poverty level in 2004
Another 2.3 million were classified as
“near poor”
Source: U.S. Census Bureau
By the Numbers
Environments for Aging in the United States
By the Numbers
1.6 million people are in 18,000 nursing homes nationwide
Nursing Home & Home Care: $111 billion
business
2004 Met Life Market Survey
Cost of Care
Environments for Aging in the United States
Cost of Care By the Numbers
46% of Nursing Home and Home
Care Costs are paid by Medicaid
12.4% are paid by Medicare
Medicaid46%
Medicare12.4%
Out-of-Pocket27.9%
PrivateInsurance
7.7%
Other 6.1%
2004 Met Life Market Survey
Environments for Aging in the United States
Cost of Care By the Numbers
$77,380/year National avg
rate for private nursing room
$68,985/yearNational avg rate for semi-private nursing room
Avg Length of Stay: 2.4 Years2006 Met Life Market Survey
Environments for Aging in the United States
Cost of Care By the Numbers
$36,372/year National avg rates for assisted living
$51,204/yearNational avg rates for assisted living Alzheimer’s Care
Avg Length of Stay: 21 months
2006 Met Life Market Survey
Environments for Aging in the United States
Cost of Care By the Numbers
The Alternative:
1.3 million people received home care from 7200 agencies
nationwide (2000 data)
Average hourly rate for a home health aid: $18.00 per hour
Environments for Aging in the United States
Environments for Aging in the United States
III.A Historical Perspective Seniors’ Housing
and Care in America
Environments for Aging in the United States
Civil WarHistorical Perspective
Environments for Aging in the United States
Nightingale Wards
Civil WarHistorical Perspective
Environments for Aging in the United States
Post Civil WarHistorical Perspective
Post Nightingale
Environments for Aging in the United States
Prior to 1880Historical Perspective
• Extended Families Provide Physical Care / Economic Support
Library of Congress: The Northern Great Plains, 1880 - 1920
Environments for Aging in the United States
1880 - 1930Historical Perspective
• Elderly Unable to Care for Themselves Sent to Almshouses / Poor Farms
Almshouse; London Town, Anne Arundel Cnty, MDLibrary of Congress: Historic American Buildings Survey
Environments for Aging in the United States
Early 1900s
• 1935 - Social Security Act
• Surge in Private Pay Homes
• 1946 - Hill Burton Hospital Survey and Construction Act
Easton Home (1910)Easton, PA
Historical Perspective
Environments for Aging in the United States
1950s
• 1954 - Federal Grants for Construction of Nursing Home in Conjunction with a Hospital
Result: Medical Model
Historical Perspective
Environments for Aging in the United States
1960s
• 1965 - Medicare Social Insurance Program
Health Care Coverage to Americans 65+
Development of Nursing Home Industry Nationwide
• 1968 - Moss Amendments
Life Safety CodeStaff Requirements
Historical Perspective
Environments for Aging in the United States
Next 25 Years
• Institutional DesignServe Many in Economical Manner
• ServiceProvide Room, Board and Nursing Care, but Limited Social Services, Activities or Community
Historical Perspective
Environments for Aging in the United States
Next 25 Years
• Culture of Dependency“We take care of you and make all your decisions for you”
• Management PhilosophyCommand and control all aspects of residents’ lives
Historical Perspective
Environments for Aging in the United States
•Shared Rooms
•Lack of Social Spaces
•Centralized Nurse Station (Hospital)
•Minimal Daylight60 Beds
1970s - 1980sHistorical Perspective
Compromises
Environments for Aging in the United States
Historical Perspective 1970s - 1980s
Environments for Aging in the United States
Historical Perspective19321985
Environments for Aging in the United States
Historical Perspective Attitude Adjustment
• 1980s – Assisted Living
Resident Choice
Individualized Care
Residentially-Inspired Architecture and Interior Environments
Environments for Aging in the United States
Attitude Adjustment
• 1991 - Eden Alternative
Companionship
Opportunity to care for other living things
Variety and spontaneity of an enlivened environment
Historical Perspective
Environments for Aging in the United States
• Early to Mid 90s - Neighborhood Design
Smaller Scale Households
Decentralization
Person-Centered Care
2 Stories20 Beds Each
Entrance
Main Street
Historical Perspective Attitude Adjustment
FoulkewaysGwynedd, PA
Environments for Aging in the United States
The Green Houses at Traceway
Tupelo, MS
• 2002 - Green House®
8 – 10 Resident Homes
Open Plan
Empowerment of Staff & Residents
Historical Perspective Attitude Adjustment
Environments for Aging in the United States
Green House®Historical Perspective
Environments for Aging in the United States
• Unconnected Households – Park Homes @ Parkside
HouseholdsHistorical Perspective
• Unconnected
12-Bed Households
Park Homes at ParksideHillsboro, KS
Crepidoma ConsultingArchitect of record: Invision
Environments for Aging in the United States
• Unconnected Households – Park Homes @ Parkside
HouseholdsHistorical Perspective
• Unconnected
12-Bed Households
Commons
Park Homes at ParksideHillsboro, KS
Environments for Aging in the United States
• Unconnected Households – Park Homes @ Parkside
HouseholdsHistorical Perspective
• Unconnected
12-Bed Households
Commons
Outdoor Connections
Park Homes at ParksideHillsboro, KS
Environments for Aging in the United States
• Unconnected Households – Park Homes @ Parkside
Households - UnconnectedHistorical Perspective
Environments for Aging in the United States
Households - Unconnected
Historical Perspective
Environments for Aging in the United States
Neighborhood A Neighborhood B
Neighborhood C Neighborhood D
Households - ConnectedHistorical Perspective
Gouverneur Healthcare Services
New York Health and Hospital CorporationCrepidoma Consulting
Architect of record: RMJM Hillier
Environments for Aging in the United States
Households - ConnectedHistorical Perspective
Environments for Aging in the United States
Traditional Model Culture Change
Nursing Centered Resident Centered
Physical Care Holistic Care
Task Oriented Program Focused
Rotating Assignments Permanent Assignments
Hierarchical Team Oriented
Centralized Decentralized
Maximizes Efficiency Optimizes Quality of Life
Culture ChangeHistorical Perspective
Environments for Aging in the United States
Environments for Aging in the United States
IV.Top 10
Concerns for Seniors
Environments for Aging in the United States
Top 10 Concerns10.Choice / Flexibility /
Freedoms9. Aging in Place / Aging
with Style8. Health & Wellness7. Community Connection6. Affinity Groups5. Affordability4. Isolation / Loneliness3. Health Insurance
Options2. Improving Medicare1. Financial Security
Environments for Aging in the United States
Environments for Aging in the United States
V.Seniors’ Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
• Independent Living Single Homes Apartments
Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
• Independent Living Single Homes Apartments
• Assisted Living (Personal Care)
Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
• Independent Living Single Homes Apartments
• Assisted Living (Personal Care)
• Memory Support
Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
• Independent Living Single Homes Apartments
• Assisted Living (Personal Care)
• Memory Support
• Skilled Care / Sub Acute
Housing Overview
Environments for Aging in the United States
Types
• Active Adult (55+)
• Independent Living Single Homes Apartments
• Assisted Living (Personal Care)
• Memory Support
• Skilled Care / Sub Acute
• Hospice (End of Life)
Housing Overview
Environments for Aging in the United States
Types - CCRCs
• Active Adult (55+)
• Independent Living Single Homes Apartments
• Assisted Living (Personal Care)
• Memory Support
• Skilled Care / Sub Acute
• Hospice (End of Life)
Housing Overview
Environments for Aging in the United States
Affordable Housing
• Government Sponsored / Funded
Act 222
HUD 232 Assisted Living and Nursing
State Tax Credit
Section 8
Housing Overview
Brethren VillageLancaster, PA
Environments for Aging in the United States
Environments for Aging in the United States
VI.Regulatory Challenges
Environments for Aging in the United States
ADA
Developed for Returning Veterans
Upper Body Strength
Full Cognition
Does Not Accommodate Seniors
Limited Strength Diminished
Mobility
Regulatory Challenges
Environments for Aging in the United States
Bathroom DesignRegulatory Challenges
ADA / ANSI Designed Bathroom
Meets the Code / Not the Need
Does Not Allow for Easy
Assistance
Environments for Aging in the United States
Regulatory Challenges Bathroom Design
ADA / ANSI Designed Bathroom
Meets the Code / Not the Need
Environments for Aging in the United States
Regulatory Challenges Bathroom Design
Mennonite Home
Lancaster, PA
Environments for Aging in the United States
SustainabilityRegulatory Challenges
Energy Codes Senior-Friendly
5 Footcandles in Corridors
20 – 30 Footcandles in Corridors
• Per Illuminating Engineering Society of North America (IES), 75 year old eye lets in 25% of the light of a 25 year old.
Environments for Aging in the United States
SustainabilityRegulatory Challenges
Energy Efficiency Senior Friendly
Typical Working / Living Environment Temperature
72 - 75°
Typical Working / Living Environment Temperature
75 - 78°
• Air Temperature delivered at a Higher Level for Seniors
• More Challenging to Achieve US Green Building Council (USGBC) Leadership in Energy & Environmental Design (LEED) certification points for Energy Efficiency
Environments for Aging in the United States
SustainabilityRegulatory Challenges
Energy Efficiency Senior Friendly
Sophisticated HVAC Systems with Control
System Design for Engineers
Difficult Devices for a Layman to Operate; Not as Easily Adjusted to Senior
Needs
Environments for Aging in the United States
Environments for Aging in the United States
VII.Brief Overview of
Crepidoma
Consulting
Environments for Aging in the United States
Crepidoma Consulting
Consulting Services for Environments for the Aging
Visioning and Enabling Sessions
Built Environment Assessments
Strategic and Master Planning Services
Conceptual and Schematic Design Development
“Culture Change” Consulting
Campus Repositioning Consulting
Development Support
Owner Construction Representation
Post-Occupancy Evaluations
Environments for Aging in the United States
Forest Side ALF for Dementia, Washington, DC
Architect of record: JSA, Inc. Architects
Environments for Aging in the United States
Environments for Aging in the United States
Environments for Aging in the United States
Environments for Aging in the United States
Collington Episcopal Life Care Community, Mitchellville, MD
Environments for Aging in the United States
• Unconnected Households – Park Homes @ Parkside
Park Homes at Parkside, Hillsboro, KS
Architect of record: Invision
Environments for Aging in the United States
Environments for Aging in the United States
Environments for Aging in the United States
House of Hope at Royale Oaks, Omaha, NE
Architect of record: Invision
Environments for Aging in the United States
Environments for Aging in the United States
Environments for Aging in the United States
• Connected Households – Arbor Springs
Arbor Springs, Des Moines, IA
Architect of record: Anderzhon/Carlson Architects
Environments for Aging in the United States
Environments for Aging in the United States
Environments for Aging in the United States
Wesley Palms CCRC, San Diego, CA
SmithGroup Architects
Khoo Teck Puat Healthcare, Singapore
RMJM Hilllier
Coler-Goldwater Healthcare,
New York, NY
RMJM Hilllier
Felician Village, Manitowoc, WI
Eppstein Uhen Architects
Environments for Aging in the United States
Environments for Aging in the United States
VIII.Trends for the Future
Environments for Aging in the United States
Trends for the Future High Rise Urban CCRCs
Creative/Adaptive Re-use
Meaningful Sustainability
Adaptive Regulations
Research & Evidence Based Design
Meaningful Technology
Aging in Place
Environments for Aging in the United States
High Rise Urban CCRCsGoodwin House-Bailey’s Crossroads
Falls Church, VA
DHPY Architects
The Mirabella at South Waterfront
Portland, OR
Ankrom Moisan Associated Architects
Environments for Aging in the United States
Creative Adaptive Re-use
Akasaki-cho Day Centre in Ofunato-shi, Japan
Environments for Aging in the United States
St. Monica Trust-Sanford Station, UK-KWL Architects, Ltd.
Environments for Aging in the United States
Environments for Aging in the United States
Meaningful Sustainability
Nightingale Care Home-Wandsworth, London, UK-Scurr Architects
Environments for Aging in the United States
Adaptive Regulations
Environments for Aging in the United States
Adaptive Regulations
Environments for Aging in the United States
Research & Evidence Based Design
Environments for Aging in the United States
Meaningful Technology
Environments for Aging in the United States
Aging in Place• Adaptable
Environment to Support Aging
• Reduces Anxiety of Moving Frequently
1,500 SF
Peabody Retirement CommunityNorth Manchester, IN
Environments for Aging in the United States
Anticipate Change
Typical Skilled Care Private Room320 SF
FoulkewaysGwynedd, PA
Aging in Place
Environments for Aging in the United States
Typical Skilled Care Private Room320 SF
Conversion to Apartment640 SF
Aging in Place
Environments for Aging in the United States
Environments for Aging in the United States
THANK THANK YOU!YOU!