Elder Care Designed with All the Comforts of Home

Event: Total Design Approaches for Senior Living in Urban Environments: Green House and Small House
Location: Center for Architecture, 10.10.12
Speakers: Rachel Fredman, Community Liaison, Jewish Home Lifecare; David Hoglund, FAIA, Principal, Perkins Eastman; Timothy Barnhill, AIA, LEED AP, Principal, Hord Coplan Macht
Moderator: Lorraine Hiatt, Ph.D., Environmental Gerontologist
Organizer: AIANY Design for Aging Committee

The Green House® and Small House models for the design of living facilities for seniors are rather new. These are person-centered approaches to senior care, with a vision of balancing needed physical care with concerns for social life, privacy, and dignity, reinforced through staffing and design. They offer additional choices for older adults needing skilled and long-term care by providing 24-hour licensed nursing care as in the traditional nursing home, but in an atmosphere that closely resembles a residential environment, with a trained team of caregivers dedicated and assigned to the total needs of the residents. In the process of designing both Small Houses and Green Houses, David Hoglund, FAIA, indicated that he has learned much about how significantly the physical environment can affect people’s lives. This is particularly true for seniors, whose physical capabilities tend to become more limited with age.

The first Small House opened in New Jersey in 2001; the first Green House opened in Mississippi in 2005. “Green House” is a trademarked organization fouonded by Dr. Bill Thomas, with a protocol that outlines both the relationships between seniors and caregivers, and household design elements to be included to maintain a residential atmosphere. The Green House organization offers project development consultation services and staff training, for which sites pay annual fees. As they have received feedback from operating Green Houses, it has modified some of the regulations over time. There are about 200 Green Houses now functioning around the U.S. (of 16,000+ licensed nursing homes). But the idea has also stimulated the development of variations and Small Houses, which are dedicated to the same person-centered care, but innovate to satisfy specific local conditions.

Perkins Eastman is designing an Upper West Side high-rise to extend the values of Small House design to an urban population of 414 residents. The plan is organized into households (essentially, large apartments), two per floor for 12 residents each. The units consist of a private bedroom and bathroom for each resident, a living room, dining room, an open kitchen where residents can help in preparing their meals if they wish, and an all-season screened “porch.” The furniture is movable rather than built in, so it can be arranged as each household chooses, and residents can personalize their bedrooms with some items of their own. Caregiving roles are being redefined to accommodate residents’ total physical and social needs. The lower floors of the building contain shared destinations: community rooms, a library, exercise/therapy rooms, spaces for social services and medical care, and an outdoor garden.

Rachel Fredman explained that Jewish Home Lifecare, the client for the Manhattan Green House, is an organization that has served the needs of seniors on the Upper West Side for well over 150 years. In their new facility they aim to keep the elders as active and independent as possible, including participation in decision-making about the operation of their households, and maintaining meaningful relationships with families and staff. The seniors become an integral part of the power structure, and are expected to thrive in that role.

Tim Barnhill, AIA, LEED AP, spoke about the Levindale Small House that he designed in Baltimore. For economic reasons, it is organized into households of 14 residents each (12 is the maximum permitted in the Green House model). There are three resident floors (“neighborhoods”), each containing two houses, each with its own front door, open kitchen, private bedrooms and baths, with libraries and laundry rooms that function very similarly to the households of the Green House. The facility was designed with much attention devoted to the resident rooms, including full-scale mockups of the bathrooms that were extensively tested to determine many of the details. Each house is designed compactly, with concern for the distances the residents and caregivers are required to travel from bedroom to dining room, and to other parts of the house. A Town Center on the ground floor contains common spaces: a synagogue, café and pub, gift shop, rotating art exhibit, spaces for social services and medical specialists, and an outdoor garden. Levindale’s residential scale relates well to that of the surrounding residential community.

These facilities provide significant new and improved options for senior living. Many Small Houses and Green Houses are being built on existing health-care campuses, where shared common areas offer advantages to new and established residents. And there are likely to be further innovations in the near future: scattered-site Small Houses and Green Houses; co-housing for seniors; elder-friendly cooperatives; elders and intentional intergenerational communities; and urban aging-in-place.

For more information about Green Houses and Small Houses visit the AIANY Design for Aging Committee website.

NORCs Help Make NYC a More Age-Friendly City

Event: NORCs — Naturally Occurring Retirement Communities
Location: Center for Architecture, 06.22.10
Nat Yalowitz, MSW — LCSW President, NORC Program at Penn South Housing Co-op & President, National NORC Center, NYC; Georgeen Theodore, AIA — Principal, Interboro Partners & Assistant Professor, Infrastructure Planning, New Jersey Institute of Technology
Organizer: AIANY Design for Aging Committee


Greenbelt, MD, recently made into a NORC.

Andrew Bossi

The term NORC (Naturally Occurring Retirement Community) is a demographic descriptor, referring to a building or group of buildings in which numerous residents have lived for many years and a significant number of them have become senior citizens. The term was coined in the 1980s, and legislation now exists in many states, including NY, that enables qualifying buildings to apply for official designation, making them eligible for public funding for supportive services programs (SSPs) for seniors. NORCs aim to provide a comprehensive array of these services to meet the specific needs of seniors in close proximity to their residences. This aging-in-place approach is considered to be the most desirable and most affordable solution for seniors living in urban environments.

There are now 43 official NORC programs in NYC, located in four boroughs (none in Staten Island). Their physical characteristics, SSPs, and residents’ activities are described in a book, A Guide to NORCs in NY, researched by Interboro Partners. A surprising number of them are towers-in-the-park complexes. Many of the older building groups (1920s-30s) began as limited equity housing co-ops (LEHCs) sponsored by labor unions, and the original residents were mostly union workers. In the 1960s and 70s many federal, state, and municipal subsidy programs were used to build similar “affordable” housing complexes. These buildings tended to retain their residents for long periods of time, enabling them to become NORCs. With different approaches to the design of affordable housing communities nowadays, the physical characteristics of future NORCs are likely to be more horizontally organized. Interestingly, the entire town of Greenbelt, MD, a garden city with about 2,500 single-family homes built in the 1920s, has recently become a NORC — a significant example of horizontal organization.

NORCs tend to provide generational diversity in urban neighborhoods, since many residents use amenities outside the NORC itself. And there is some evidence that living in a NORC extends residents’ life spans.

Coincidentally, on 06.28.10, Mayor Bloomberg issued a statement indicating that NYC has become the first member of the World Health Organization’s Global Network of Age-Friendly Cities. The Mayor commented, “New Yorkers are living longer than ever before, and it’s important that we engage our senior residents so they, too, can benefit from everything our communities have to offer… We will continue to work with our age-friendly network partners to transform our city into a place that maximizes the health and active participation of New Yorkers of every age.” The development of NORCs contributed to this effort, and the AIANY Design for Aging Committee aims to raise awareness so the city can become ever more age-friendly.

NYC Sets Groundwork for Improved Design for the Aging

Event: Design for the Aging in New York City
Location: Center for Architecture, 04.29.10
Speaker: Lilliam Barrios-Paoli — Commissioner, NYC Department for the Aging
Organizers: AIANY Design for Aging Committee

Commissioner Lilliam Barrios-Paoli of the NYC Department for the Aging (DFTA) spoke at the Center for Architecture on 04.29. The event was organized by the newly formed AIANY Chapter Design for Aging Committee. The committee aims to raise awareness about the needs of the elderly, specifically in an urban context, specifically in NYC. By making NYC’s physical environment reflect greater consideration for the elderly, the city will become a more age-friendly place for people of all ages to enjoy.

Barrios-Paoli emphasized that there is an immense need for age-friendly environments in the city. It’s projected that there will be more than 1.4 million people over age 65 living here by 2030. Currently, there are about 930,000 seniors in NYC, 30,000 of whom pay daily visits to the almost 300 DFTA Senior Centers now in operation. About 300,000 seniors live below the poverty level, so the daily meal served at the centers is often the most nutritious of their day.

DFTA’s environmental concerns focus mainly on public spaces, accessible and affordable transportation, and housing. Some of the details:

Public Spaces: Public spaces should be designed so they are not isolated, thus allowing seniors to view and perhaps participate in activities that involve other age groups. DFTA aims to assure that lighting is adequate, public restrooms are available, surfaces for walking are paved and not uneven, and that there are a sufficient number of benches. Conflicting priorities must be resolved, e.g. preferences by some to remove benches because of their possible use by the homeless.

Transportation: DFTA aims to require larger type on informational signs, so that seniors can easily read bus schedules, to be sure that street-light timing at crosswalks allows the elderly to cross without rushing, to modify left-turn controls for vehicles at intersections, and to increase the number of elevators and escalators for access to subway stations. Street crossings with medians that provide places to rest midway are highly desirable. The design of bicycle lanes can narrow intersections, but speeding bicycles frequently cause accidents, often with the elderly. Improved designs for taxicabs are needed for easy accessibility and to accommodate wheelchairs.

Housing: Housing that allows aging-in-place is especially important in NYC. Continuing Care Retirement Communities (CCRCs) and other assisted-living arrangements tend to be very expensive here. Naturally Occurring Retirement Communities (NORCs) encourage services to be brought to seniors where they live, and focus on preventive health-care needs. Since these activities can prevent fires and other accidents they tend to be positively viewed by landlords. But stairs and other barriers often restrict life-activities of the elderly, so guidelines to encourage aging-in-place need to have a greater influence on the design of multiple dwellings.

DFTA is working with other city agencies toward changing existing regulations that conflict with the needs of seniors, and the department is beginning to involve seniors in the planning process for future improvements. The Design for Aging Committee looks forward to a continuing relationship with DFTA by exploring possibilities and becoming an active advocate for highly functioning, age-friendly physical environments throughout the city.

The Design For Aging Committee meets once a month. At our First meeting since Commissioner Barrios-Paoli’s talk, stimulated by her suggestions, we began to enthusiastically generate many good ideas for future exploration /implementation. If you’d like to join us to further develop and pursue these goals, contact Jerry Maltz.