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  • St Monica
  • St Monica
  • UWM Lecture

    1. 1. November 6, 2009 University of Wisconsin-Milwaukee Environments for Aging in U.S.
    2. 2. Outline <ul><li>Introductions </li></ul><ul><li>Seniors – By the Numbers </li></ul><ul><li>Historical Perspective </li></ul><ul><li>Top 10 Concerns </li></ul><ul><li>Seniors’ Housing Overview </li></ul><ul><li>Regulatory Challenges </li></ul><ul><li>Brief Overview of Crepidoma Work </li></ul><ul><li>Trends for the Future </li></ul>
    3. 4. I. Introductions
    4. 5. Introductions <ul><li>Jeffrey W. Anderzhon, FAIA </li></ul><ul><li>30 Years Senior Living Experience </li></ul><ul><ul><li>Principal / Crepidoma Consulting </li></ul></ul><ul><ul><li>Juror-IAHSA Design for Ageing Symposium-2007 & 2009 </li></ul></ul><ul><ul><li>Juror-Design for Future Ageing-Yonsei University, Seoul, Korea-2006 & 2007 </li></ul></ul><ul><ul><li>Juror-Design for Aging Review, AIA/AAHSA-2004 </li></ul></ul><ul><ul><li>Chair-AIA/Design for Aging Knowledge Community, 2006 </li></ul></ul><ul><ul><li>Co-author- Design for Aging Post Occupancy Evaluations- Wiley & Sons, 2007 </li></ul></ul>
    5. 6. II. Seniors By the Numbers
    6. 7. 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
    7. 8. 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
    8. 9. Growing Diversity Members of minority groups projected to increase: 2000 5.7 million (16.5% of elderly pop.) 2010 8.1 million (20.1%) 2020 12.9 million (23.6%) Source: U.S. Census Bureau, 2004b. By the Numbers
    9. 10. Where Are They Living? <ul><li>95% - Independently </li></ul><ul><ul><li>95% Non-Congregate Housing </li></ul></ul><ul><ul><li>5% in Self Described Seniors’ Housing </li></ul></ul><ul><li>5% - Professional Caregivers </li></ul><ul><ul><li>4.5% Healthcare Settings </li></ul></ul><ul><ul><ul><li>1.1% 65 – 74 yrs </li></ul></ul></ul><ul><ul><ul><li>4.7% 75 – 84 yrs </li></ul></ul></ul><ul><ul><ul><li>18.2% 85+ </li></ul></ul></ul>By the Numbers
    10. 11. Where Are They Living? By the Numbers
    11. 12. Where Are They Living? Oldest States FL 17.6% PA 15.6% WV 15.3% By the Numbers
    12. 13. Where Are They Living? 3 out of 4 Live in a Metropolitan Area Source: U.S. Census Bureau, 2001, Table P12. By the Numbers
    13. 14. 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
    14. 15. 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
    15. 16. 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
    16. 17. 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
    17. 18. Cost of Care By the Numbers 46% of Nursing Home and Home Care Costs are paid by Medicaid 12.4% are paid by Medicare Medicaid 46% Medicare 12.4% Out-of-Pocket 27.9% Private Insurance 7.7% Other 6.1% 2004 Met Life Market Survey
    18. 19. Cost of Care By the Numbers $77,380/year National avg rate for private nursing room $68,985/year National avg rate for semi-private nursing room Avg Length of Stay: 2.4 Years 2006 Met Life Market Survey
    19. 20. Cost of Care By the Numbers $36,372/year National avg rates for assisted living $51,204/year National avg rates for assisted living Alzheimer’s Care Avg Length of Stay: 21 months 2006 Met Life Market Survey
    20. 21. 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  
    21. 23. III. A Historical Perspective Seniors’ Housing and Care in America
    22. 24. Civil War Historical Perspective
    23. 25. Nightingale Wards Civil War Historical Perspective
    24. 26. Post Civil War Historical Perspective Post Nightingale
    25. 27. Prior to 1880 Historical Perspective <ul><li>Extended Families Provide Physical Care / Economic Support </li></ul>Library of Congress: The Northern Great Plains, 1880 - 1920
    26. 28. 1880 - 1930 Historical Perspective <ul><li>Elderly Unable to Care for Themselves Sent to Almshouses / Poor Farms </li></ul>Almshouse; London Town, Anne Arundel Cnty, MD Library of Congress: Historic American Buildings Survey
    27. 29. Early 1900s <ul><li>1935 - Social Security Act </li></ul><ul><li>Surge in Private Pay Homes </li></ul><ul><li>1946 - Hill Burton Hospital Survey and Construction Act </li></ul>Easton Home (1910) Easton, PA Historical Perspective
    28. 30. 1950s <ul><li>1954 - Federal Grants for Construction of Nursing Home in Conjunction with a Hospital </li></ul><ul><ul><li>Result: Medical Model </li></ul></ul>Historical Perspective
    29. 31. 1960s <ul><li>1965 - Medicare Social Insurance Program </li></ul><ul><ul><li>Health Care Coverage to Americans 65+ </li></ul></ul><ul><ul><li>Development of Nursing Home Industry Nationwide </li></ul></ul><ul><li>1968 - Moss Amendments </li></ul><ul><ul><li>Life Safety Code </li></ul></ul><ul><ul><li>Staff Requirements </li></ul></ul>Historical Perspective
    30. 32. Next 25 Years <ul><li>Institutional Design </li></ul><ul><ul><li>Serve Many in Economical Manner </li></ul></ul><ul><li>Service </li></ul><ul><ul><li>Provide Room, Board and Nursing Care, but Limited Social Services, Activities or Community </li></ul></ul>Historical Perspective
    31. 33. Next 25 Years <ul><li>Culture of Dependency </li></ul><ul><ul><li>“ We take care of you and make all your decisions for you” </li></ul></ul><ul><li>Management Philosophy </li></ul><ul><ul><li>Command and control all aspects of residents’ lives </li></ul></ul>Historical Perspective
    32. 34. <ul><li>Shared Rooms </li></ul><ul><li>Lack of Social Spaces </li></ul><ul><li>Centralized Nurse Station (Hospital) </li></ul><ul><li>Minimal Daylight </li></ul>60 Beds 1970s - 1980s Historical Perspective Compromises
    33. 35. Historical Perspective 1970s - 1980s
    34. 36. Historical Perspective 1985 1932
    35. 37. Historical Perspective Attitude Adjustment <ul><li>1980s – Assisted Living </li></ul><ul><ul><li>Resident Choice </li></ul></ul><ul><ul><li>Individualized Care </li></ul></ul><ul><ul><li>Residentially-Inspired Architecture and Interior Environments </li></ul></ul>
    36. 38. Attitude Adjustment <ul><li>1991 - Eden Alternative </li></ul><ul><ul><li>Companionship </li></ul></ul><ul><ul><li>Opportunity to care for other living things </li></ul></ul><ul><ul><li>Variety and spontaneity of an enlivened environment </li></ul></ul>Historical Perspective
    37. 39. <ul><li>Early to Mid 90s - Neighborhood Design </li></ul><ul><ul><li>Smaller Scale Households </li></ul></ul><ul><ul><li>Decentralization </li></ul></ul><ul><ul><li>Person-Centered Care </li></ul></ul>2 Stories 20 Beds Each Entrance Main Street Historical Perspective Attitude Adjustment Foulkeways Gwynedd, PA
    38. 40. The Green Houses at Traceway Tupelo, MS <ul><li>2002 - Green House® </li></ul><ul><ul><li>8 – 10 Resident Homes </li></ul></ul><ul><ul><li>Open Plan </li></ul></ul><ul><ul><li>Empowerment of Staff & Residents </li></ul></ul>Historical Perspective Attitude Adjustment
    39. 41. Green House ® Historical Perspective
    40. 42. <ul><li>Unconnected Households – Park Homes @ Parkside </li></ul>Households Historical Perspective <ul><li>Unconnected </li></ul><ul><ul><li>12-Bed Households </li></ul></ul>Park Homes at Parkside Hillsboro, KS Crepidoma Consulting Architect of record: Invision
    41. 43. <ul><li>Unconnected Households – Park Homes @ Parkside </li></ul>Households Historical Perspective <ul><li>Unconnected </li></ul><ul><ul><li>12-Bed Households </li></ul></ul><ul><ul><li>Commons </li></ul></ul>Park Homes at Parkside Hillsboro, KS
    42. 44. <ul><li>Unconnected Households – Park Homes @ Parkside </li></ul>Households Historical Perspective <ul><li>Unconnected </li></ul><ul><ul><li>12-Bed Households </li></ul></ul><ul><ul><li>Commons </li></ul></ul><ul><ul><li>Outdoor Connections </li></ul></ul>Park Homes at Parkside Hillsboro, KS
    43. 45. <ul><li>Unconnected Households – Park Homes @ Parkside </li></ul>Households - Unconnected Historical Perspective
    44. 46. Households - Unconnected Historical Perspective
    45. 47. Households - Connected Historical Perspective Gouverneur Healthcare Services New York Health and Hospital Corporation Crepidoma Consulting Architect of record: RMJM Hillier Neighborhood A Neighborhood B Neighborhood C Neighborhood D
    46. 48. Households - Connected Historical Perspective
    47. 49. Culture Change Historical Perspective Optimizes Quality of Life Maximizes Efficiency Decentralized Centralized Team Oriented Hierarchical Permanent Assignments Rotating Assignments Program Focused Task Oriented Holistic Care Physical Care Resident Centered Nursing Centered Culture Change Traditional Model
    48. 51. IV. Top 10 Concerns for Seniors
    49. 52. Top 10 Concerns 10. Choice / Flexibility / Freedoms 9. Aging in Place / Aging with Style 8. Health & Wellness 7. Community Connection 6. Affinity Groups 5. Affordability 4. Isolation / Loneliness 3. Health Insurance Options 2. Improving Medicare 1. Financial Security
    50. 54. V. Seniors’ Housing Overview
    51. 55. Types <ul><li>Active Adult (55+) </li></ul>Housing Overview
    52. 56. Types <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul>Housing Overview
    53. 57. Types <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul><ul><li>Assisted Living (Personal Care) </li></ul>Housing Overview
    54. 58. Types <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul><ul><li>Assisted Living (Personal Care) </li></ul><ul><li>Memory Support </li></ul>Housing Overview
    55. 59. Types <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul><ul><li>Assisted Living (Personal Care) </li></ul><ul><li>Memory Support </li></ul><ul><li>Skilled Care / Sub Acute </li></ul>Housing Overview
    56. 60. Types <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul><ul><li>Assisted Living (Personal Care) </li></ul><ul><li>Memory Support </li></ul><ul><li>Skilled Care / Sub Acute </li></ul><ul><li>Hospice (End of Life) </li></ul>Housing Overview
    57. 61. Types - CCRCs <ul><li>Active Adult (55+) </li></ul><ul><li>Independent Living </li></ul><ul><ul><li>Single Homes </li></ul></ul><ul><ul><li>Apartments </li></ul></ul><ul><li>Assisted Living (Personal Care) </li></ul><ul><li>Memory Support </li></ul><ul><li>Skilled Care / Sub Acute </li></ul><ul><li>Hospice (End of Life) </li></ul>Housing Overview
    58. 62. Affordable Housing <ul><li>Government Sponsored / Funded </li></ul><ul><ul><li>Act 222 </li></ul></ul><ul><ul><li>HUD 232 Assisted Living and Nursing </li></ul></ul><ul><ul><li>State Tax Credit </li></ul></ul><ul><ul><li>Section 8 </li></ul></ul>Housing Overview Brethren Village Lancaster, PA
    59. 64. VI. Regulatory Challenges
    60. 65. ADA <ul><li>Developed for Returning Veterans </li></ul><ul><ul><li>Upper Body Strength </li></ul></ul><ul><ul><li>Full Cognition </li></ul></ul><ul><li>Does Not Accommodate Seniors </li></ul><ul><ul><li>Limited Strength </li></ul></ul><ul><ul><li>Diminished Mobility </li></ul></ul>Regulatory Challenges
    61. 66. Bathroom Design Regulatory Challenges ADA / ANSI Designed Bathroom Meets the Code / Not the Need Does Not Allow for Easy Assistance
    62. 67. Regulatory Challenges Bathroom Design ADA / ANSI Designed Bathroom Meets the Code / Not the Need
    63. 68. Regulatory Challenges Bathroom Design Mennonite Home Lancaster, PA
    64. 69. Sustainability Regulatory Challenges <ul><li>Per Illuminating Engineering Society of North America (IES), 75 year old eye lets in 25% of the light of a 25 year old. </li></ul>20 – 30 Footcandles in Corridors 5 Footcandles in Corridors Senior-Friendly Energy Codes
    65. 70. Sustainability Regulatory Challenges <ul><li>Air Temperature delivered at a Higher Level for Seniors </li></ul><ul><li>More Challenging to Achieve US Green Building Council (USGBC) Leadership in Energy & Environmental Design (LEED) certification points for Energy Efficiency </li></ul>Typical Working / Living Environment Temperature 75 - 78 ° Typical Working / Living Environment Temperature 72 - 75 ° Senior Friendly Energy Efficiency
    66. 71. Sustainability Regulatory Challenges Difficult Devices for a Layman to Operate; Not as Easily Adjusted to Senior Needs Sophisticated HVAC Systems with Control System Design for Engineers Senior Friendly Energy Efficiency
    67. 73. VII. Brief Overview of Crepidoma Consulting
    68. 74. Crepidoma Consulting <ul><li>Consulting Services for Environments for the Aging </li></ul><ul><li>Visioning and Enabling Sessions </li></ul><ul><li>Built Environment Assessments </li></ul><ul><li>Strategic and Master Planning Services </li></ul><ul><li>Conceptual and Schematic Design Development </li></ul><ul><li>“ Culture Change” Consulting </li></ul><ul><li>Campus Repositioning Consulting </li></ul><ul><li>Development Support </li></ul><ul><li>Owner Construction Representation </li></ul><ul><li>Post-Occupancy Evaluations </li></ul>
    69. 75. Forest Side ALF for Dementia, Washington, DC Architect of record: JSA, Inc. Architects
    70. 79. Collington Episcopal Life Care Community, Mitchellville, MD
    71. 80. <ul><li>Unconnected Households – Park Homes @ Parkside </li></ul>Park Homes at Parkside, Hillsboro, KS Architect of record: Invision
    72. 83. House of Hope at Royale Oaks, Omaha, NE Architect of record: Invision
    73. 86. <ul><li>Connected Households – Arbor Springs </li></ul>Arbor Springs, Des Moines, IA Architect of record: Anderzhon/Carlson Architects
    74. 89. 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
    75. 91. VIII. Trends for the Future
    76. 92. Trends for the Future <ul><li>High Rise Urban CCRCs </li></ul><ul><li>Creative/Adaptive Re-use </li></ul><ul><li>Meaningful Sustainability </li></ul><ul><li>Adaptive Regulations </li></ul><ul><li>Research & Evidence Based Design </li></ul><ul><li>Meaningful Technology </li></ul><ul><li>Aging in Place </li></ul>
    77. 93. High Rise Urban CCRCs Goodwin House-Bailey’s Crossroads Falls Church, VA DHPY Architects The Mirabella at South Waterfront Portland, OR Ankrom Moisan Associated Architects
    78. 94. Akasaki-cho Day Centre in Ofunato-shi, Japan Creative Adaptive Re-use
    79. 95. St. Monica Trust-Sanford Station, UK-KWL Architects, Ltd.
    80. 97. Meaningful Sustainability Nightingale Care Home-Wandsworth, London, UK-Scurr Architects
    81. 98. Adaptive Regulations
    82. 99. Adaptive Regulations
    83. 100. Research & Evidence Based Design
    84. 101. Meaningful Technology
    85. 102. Aging in Place <ul><li>Adaptable Environment to Support Aging </li></ul><ul><li>Reduces Anxiety of Moving Frequently </li></ul>1,500 SF Peabody Retirement Community North Manchester, IN
    86. 103. <ul><li>Anticipate Change </li></ul>Typical Skilled Care Private Room 320 SF Foulkeways Gwynedd, PA Aging in Place
    87. 104. Typical Skilled Care Private Room 320 SF Aging in Place Conversion to Apartment 640 SF
    88. 106. THANK YOU!