For older adults, decisions about where to live and what types of support services are needed depend on the level of assistance each individual requires. The standard for assessing independence is the ability to perform a number of activities fundamental to self-care. These activities are known as Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs are basic self-care skills; IADLs are higher-level skills necessary for living independently in the community.
Many types of residential environments are available to older adults. Each option falls on a continuum of care ranging from independent, community-based living to fully supportive residential care settings.
Culture change is a national movement to transform the organizational philosophy of living environments, services, and care for older adults. The goal of culture change is to move away from an institutional model of care toward one that is residential in scale and person-centered—where both older adults and their caregivers can express choice and practice self-determination in all aspects of daily life (Pioneer Network, 2015; Rohde, 2012). The culture change movement promotes programs that deinstitutionalize long-term care at every point on the continuum of care.
Over the past two decades, a number of different conceptualizations of culture change have been implemented, including: Wellspring™, The Eden Alternative, and The Green House Project™. The common thread among these programs/projects is the transformation of organizational practices, physical environments, and workforce relationships to support high-quality, individualized care. The Wellspring™ model of culture change mainly focuses on the clinical aspects of care. The Eden Alternative and The Green House Project™ are considered household approaches to culture change, placing additional emphasis on ways the configuration and design of the physical environment can support individualized care.
A crucial goal of the culture change movement has been to improve quality of life for older adults. Quality of life can be defined as a multidimensional concept comprising physical health, psychological well-being, social relationships, and the physical environment (World Health Organization Quality of Life Assessment Group, 1998). The culture change movement reflects the unwillingness of older adults, their families, and their care providers to accept the status quo of the institutional model of care. It is safe to assume the baby boom generation will continue to demand improvements in the housing and residential care available for their parents and themselves.
A more recent trend in both community and residential healthcare is the focus on wellness programs and facilities. Wellness programs promote healthy living through the integration of mind, body, and spirit. They may be housed in free-standing facilities or reside within residential care facilities. Frequently offered services include fitness equipment and training, mind-body practices (e.g., acupuncture, massage, chiropractic, yoga, meditation), nutrition education, aquatics, and preventative health screenings. The benefits of exercise, preventative care, and good nutrition to overall health are widely known. They are gaining popularity among older adults, especially as government and employer incentive programs spread across the country. Benefits are also derived from art, music, pet, and horticulture therapy programs.
The design and development of future housing and residential care facilities for older adults will be influenced by:
When designing housing and residential care environments for older adults, it is important to consider the level of services and care each facility intends to provide.
Alzheimer’s Association. (2014). 2014 Alzheimer’s disease facts and figures. Retrived from http://www.alz.org/delval/documents/facts2014_full_report.pdf
Joseph, A. (2006). Health promotion by design in long-term care settings. Concord, CA: The Center for Health Design.
Pioneer Network. (2015). Definition of common terms used in long-term care and culture change. Retrieved from http://www.pioneernetwork.net/Consumers/PickerGlossary/
Robert Wood Johnson Foundation. (2014). Long-term care: What are the issues? Retrieved from http://www.rwjf.org/en/library/research/2014/02/long-term-care--what-are-the-issues-.html
Rohde, J. (2012). Residential healthcare facilities. Concord, CA: The Center for Health Design.
World Health Organization Quality of Life Assessment Group. (1998). The World Health Organization quality of life assessment: Development of general psychometric properties. Social Science and Medicine, 46(12), 1569-1585.