Six Design Principles for Dignity
The life of the elderly as a building typology is relatively new. At the beginning of the 20e care of the elderly was generally the responsibility of families. ‘Poor’ elderly people have been relegated to a system of ‘poor houses or poor farms’, according to a 2020 myLifeSite interview with Dr Keren Wilson, the gerontologist often credited with starting the first ‘assisted living’ center in 1981. With the launch of Medicare and Medicaid in 1965, many poor homes became the first retirement homes. Gloomy, institutional and deeply sad, these facilities served as a model for the care of the elderly in the second half of the century and cemented a stigma that persists to this day.
As an architect focused on the lives of the elderly, my mission is to undermine this stigma. Together with my colleagues from LEO A DALY, I practice what we now call Dignity Driven Design. With each project, we seek to improve the self-esteem, quality of life and well-being of seniors and their social circles. We do this by creating environments that promote social dynamism, cultural connections, intergenerational gatherings, independence, well-being, cognitive health and longevity, while providing appropriate support at each stage of aging.
While most older people would prefer to age in place, that is, stay in their established way of life for as long as possible, many homes and communities are simply not built to allow people of all skill levels to live. live safely, independently and comfortably. The common disparity between an older person’s environment and their ability level is known as the “environmental press,” and its result, according to gerontologist Esther Greenhouse in Planning magazine, is the phenomenon of “forced fragility”. By navigating or avoiding a capable-built environment, a person will artificially lower their level of functioning, often leading to isolation and premature physical and cognitive decline.
Retiree Continuing Care Communities (CCRCs) meet a need for seniors whose current environment is not suited to aging in place. Providing a continuum of support that includes independent living, assisted living, memory care and skilled nursing, seniors can stay independent longer while enjoying full, meaningful, connected and dignified lives. In this article, I’ll share some of the principles behind Dignity-Driven Design, as well as examples of recent LEO A DALY CCRC projects that are doing it well.
Create a community
A community can be reduced to the sum of the interpersonal relationships between the people who make it up. In Dignity Driven Design, each design element becomes a part of the supportive framework that allows residents to connect with others and create meaningful experiences.
Vi Living at Bentley Village (Naples, FL) draws inspiration from Caribbean country clubs and luxury resorts to create a catalyst for social life. The East Club House is home to a 72-unit tower and serves as the main hub of the community. Connectivity is activated at different scales, with a large entrance and a reception hall; formal, casual and private dining rooms; games and billiards rooms; an arts and crafts room; two bars; library; a golf shop and a multipurpose room that can comfortably accommodate 500 residents.
The West Club House is all about self-care, with a pool, fitness and aerobics center, spa, and salon. A full-service restaurant’s poolside dining connects indoors and outdoors, and a fire pit creates a visual anchor and meeting place. Bold aqua and coral colors, wood slatted ceilings and dramatic lighting create an elegant atmosphere for fun and friendship.
Many people see the elderly as a monolithic group. The Dignity-Driven Design recognizes that residents are people with diverse backgrounds and fascinating life histories.
Vi Living at Aventura (Miami, Florida) celebrates the cultural mix of its residents. Addressing a South Florida population with family and personal connections across the globe, the interior design creates a multicultural destination inspired by international travel. An aquatic palette serves as a backdrop to rich colors, bold patterns, and textiles from many cultures. The travel theme is deepened with installations of vintage suitcases, Japanese vases, lotus flower-reminiscent mirrors, and other artifacts that suggest a citizen of the world’s collection of curiosities.
Create an intergenerational space
Before moving to a CPAB, many residents fear being cut off from their families and social circles. Dignity Driven Design creates amenities designed to attract, welcome and entertain guests of all ages, group sizes and interests.
Sinai Residences (Boca Raton, Florida) was designed as a great place to invite guests. The 4 story independent living building, currently under construction, offers 111 luxury apartments ranging from 900 to 3,200 square feet. While residents typically live alone or in pairs, these units are strategically sized and equipped to accommodate large gatherings of family and friends. The ‘entertainment’ theme runs through the public spaces, which include two restaurants, a movie theater, a meeting room, and a resort-style pool with outdoor bar, taut shade structures, and private cabanas.
Adapt environment to capacity level
The opposite of the environmental press, according to Greenhouse, is environmental adequacy. As some residents age, they will need additional support to overcome cognitive challenges. The Dignity-Driven Design aims to create memory care environments that make activities of daily living easier and more intuitive, making residents feel more comfortable, capable and engaged.
YourLife’s prototype memory care community, which has been replicated in Tallahassee, Stuart, Coconut Creek and Wildwood, Fla., Provides an ideal environment for residents with dementia. Each community is a building, made up of four “quarters”, each positioned around a central courtyard. This arrangement provides the necessary safety and security for residents while providing access to outdoor activities. The easy-to-navigate organization creates comfort and familiarity as residents learn their routine and get to know their neighbors. Each private unit (there are 15 to 25 per ward) has a private bathroom designed to orient residents and promote hygiene. Built-in cabinets use an open-screen “cubby” enclosure to indicate daily dressing. Oversized windows facilitate time orientation, while specialized overhead lighting eliminates contrast and shadows on the floor surface to reduce visual confusion.
For memory care residents, play is occupational therapy. Dignity Driven Design is committed to helping residents maintain their physical fitness, coordination and cognitive skills for as long as possible.
YourLife’s prototype memory care communities are full of play-oriented areas of activity. Infant changing stations, stuffed animals, tool benches and internal mailboxes provide residents with the opportunity to activate muscle memory, develop their dexterity and exercise their creativity. The outdoor amenities, shared between the four neighborhoods, include green spaces, walking paths, decorative benches, putting greens, raised planters for gardening and grilling areas. Using these activity centers with visiting guests adds a fun and meaningful aspect to their time together.
Activate independence through scaffolding
Gradually losing your independence is one of the most difficult stages in aging. Dignity Driven Design seeks to provide an invisible layer of scaffolding to prevent injury and support “one more day” of independence for residents.
YourLife of Palm Beach Gardens (Palm Beach Gardens, Florida) builds mobility for assisted living residents using a very simple design solution. In each assisted living suite, a vertical LED strip shines next to the bathroom door. The warm, yellow light has no impact on sleep, but it will help a disoriented resident sense which way they are on midnight trips to the bathroom. This is just one example of the many design elements that enhance safety and allow residents to remain as independent as possible for as long as possible.
Dignity is the thing
Seniors of all ages share the need for a meaningful, active and dignified life, whether they are aging at home or living in a purpose built community. The dignity-focused design helps residents maintain an appropriate match between environment and ability level at each stage. While it is presented differently in Independent Living, Assisted Living, Memory Care, and Skilled Nursing, the rationale is the same: older people deserve dignity.
Michael Rodebaugh, AIA, NCARB, heads the senior practice of global planning, architecture, engineering and interior design firm LEO A DALY. Its mission is to improve the lives of senior residents through dignity-driven design. He excels at creating inviting spaces that encourage multigenerational interactions between residents, visitors and staff. Rodebaugh extends this passion and knowledge across the continuum of care environments, including independent living, assisted living and memory care.