UWM Lecture

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.


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


I.Introductions


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


II.Seniors By the

Numbers


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


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


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


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


Where Are They Living? By the Numbers



Oldest States

FL 17.6%

PA15.6%

WV 15.3%

By the Numbers



3 out of 4 Live in a Metropolitan Area

Source: U.S. Census Bureau, 2001, Table P12.

By the Numbers


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


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


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


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


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%




$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



$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




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


III.A Historical Perspective Seniors’ Housing

and Care in America


Civil WarHistorical Perspective


Nightingale Wards

Civil WarHistorical Perspective


Post Civil WarHistorical Perspective

Post Nightingale


Prior to 1880Historical Perspective

• Extended Families Provide Physical Care / Economic Support

Library of Congress: The Northern Great Plains, 1880 - 1920


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


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


1950s

• 1954 - Federal Grants for Construction of Nursing Home in Conjunction with a Hospital

Result: Medical Model



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



Next 25 Years

• Institutional DesignServe Many in Economical Manner

• ServiceProvide Room, Board and Nursing Care, but Limited Social Services, Activities or Community



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



•Shared Rooms

•Lack of Social Spaces

•Centralized Nurse Station (Hospital)

•Minimal Daylight60 Beds

1970s - 1980sHistorical Perspective

Compromises


Historical Perspective 1970s - 1980s


Historical Perspective19321985


Historical Perspective Attitude Adjustment

• 1980s – Assisted Living

Resident Choice

Individualized Care

Residentially-Inspired Architecture and Interior Environments


Attitude Adjustment

• 1991 - Eden Alternative

Companionship

Opportunity to care for other living things

Variety and spontaneity of an enlivened environment



• Early to Mid 90s - Neighborhood Design

Smaller Scale Households

Decentralization

Person-Centered Care

2 Stories20 Beds Each

Entrance

Main Street


FoulkewaysGwynedd, PA


The Green Houses at Traceway

Tupelo, MS

• 2002 - Green House®

8 – 10 Resident Homes

Open Plan

Empowerment of Staff & Residents



Green House®Historical Perspective


• Unconnected Households – Park Homes @ Parkside

HouseholdsHistorical Perspective

• Unconnected

12-Bed Households

Park Homes at ParksideHillsboro, KS

Crepidoma ConsultingArchitect of record: Invision




• Unconnected

12-Bed Households

Commons





• Unconnected

12-Bed Households

Commons

Outdoor Connections




Households - UnconnectedHistorical Perspective


Households - Unconnected



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


Households - ConnectedHistorical Perspective


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


IV.Top 10

Concerns for Seniors


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


V.Seniors’ Housing Overview


Types

• Active Adult (55+)

Housing Overview


Types


• Independent Living Single Homes Apartments

Housing Overview


Types



• Assisted Living (Personal Care)

Housing Overview


Types




• Memory Support

Housing Overview


Types




• Memory Support

• Skilled Care / Sub Acute

Housing Overview


Types




• Memory Support


• Hospice (End of Life)

Housing Overview


Types - CCRCs




• Memory Support


• Hospice (End of Life)

Housing Overview


Affordable Housing

• Government Sponsored / Funded

Act 222

HUD 232 Assisted Living and Nursing

State Tax Credit

Section 8

Housing Overview

Brethren VillageLancaster, PA


VI.Regulatory Challenges


ADA

Developed for Returning Veterans

Upper Body Strength

Full Cognition

Does Not Accommodate Seniors

Limited Strength Diminished

Mobility

Regulatory Challenges


Bathroom DesignRegulatory Challenges

ADA / ANSI Designed Bathroom

Meets the Code / Not the Need

Does Not Allow for Easy

Assistance


Regulatory Challenges Bathroom Design

ADA / ANSI Designed Bathroom

Meets the Code / Not the Need


Regulatory Challenges Bathroom Design

Mennonite Home

Lancaster, PA


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.



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



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


VII.Brief Overview of

Crepidoma

Consulting


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


Forest Side ALF for Dementia, Washington, DC

Architect of record: JSA, Inc. Architects


Collington Episcopal Life Care Community, Mitchellville, MD



Park Homes at Parkside, Hillsboro, KS

Architect of record: Invision


House of Hope at Royale Oaks, Omaha, NE

Architect of record: Invision


• Connected Households – Arbor Springs

Arbor Springs, Des Moines, IA

Architect of record: Anderzhon/Carlson Architects


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


VIII.Trends for the Future


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


High Rise Urban CCRCsGoodwin House-Bailey’s Crossroads

Falls Church, VA

DHPY Architects

The Mirabella at South Waterfront

Portland, OR

Ankrom Moisan Associated Architects


Creative Adaptive Re-use

Akasaki-cho Day Centre in Ofunato-shi, Japan


St. Monica Trust-Sanford Station, UK-KWL Architects, Ltd.


Meaningful Sustainability

Nightingale Care Home-Wandsworth, London, UK-Scurr Architects


Adaptive Regulations


Research & Evidence Based Design


Meaningful Technology


Aging in Place• Adaptable

Environment to Support Aging

• Reduces Anxiety of Moving Frequently

1,500 SF

Peabody Retirement CommunityNorth Manchester, IN


Anticipate Change

Typical Skilled Care Private Room320 SF

FoulkewaysGwynedd, PA

Aging in Place


Typical Skilled Care Private Room320 SF

Conversion to Apartment640 SF

Aging in Place


THANK THANK YOU!YOU!

UWM Lecture

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