FMJ, the official magazine of the International Facility Management Association (IFMA), is written by and for workplace professionals and is published six times a year. FMJ is the only magazine that draws on the collective knowledge of IFMA’s global network of thought leaders to provide insights on current and upcoming FM trends. For more information on FMJ, visit www.ifma.org/fmj.

Design for aging and dementia: A new paradigm in research-based design

by Steven J. Orfield — This article originally appeared in the July/August 2018 issue of FMJ

When the Cottages opened on the 100+ year old campus of Western Home Communities in the small town of Cedar Falls, Iowa, a flurry of comments began to be shared by the nursing staff of this aging and dementia campus. Most of the residents had been moved from larger residences on the WHC campus and were under the same social familial care model (the household model), with the same staff and on the same campus over a long period. Yet when these residents moved into the Cottages, they began to eat better, they began to engage more, and in most ways therapeutic, the nursing staff saw a startling change brought on by this new concept in perceptual and cognitive design.

This project demonstrated for the first time that senior housing can be designed using aging science, and especially, aging perception and cognition. Most senior housing and nursing home projects accelerate the declines so often attendant to aging by creating the need to withdraw, because the environment has limited daylighting, is too noisy, too bright, too drafty, too smelly, and the care model too often supports the need for dependence and protection rather than the need for a reasonable quality of life.2,3

It is difficult enough to be a caregiver for elders, and it is an additional burden to begin to lose your family member’s recollection of who you were and that you were part of their family. Finally, it is terribly sad when one finds out that the dementia care center has a focus on resident safety and basic health, but it has little focus on quality of life.

The Design Approach

The design field uses their normal tool, intuition, in design for aging. The American Institute of Architects calls it “expert intuition,” a skill they believe one has upon graduation from architectural school.4 Yet intuition is based on common experiences, and the designer and the dementia resident have few to share.

The typical senior housing design is non-scientific, as the highly decorative nature of these facilities, their bright lights and loud noises and the complexity of their design layouts, is beyond the perception of the resident under care. So, the design of these facilities is forcing the residents to use much of their cognitive reserve just to manage the sensory deprivation and cognitive confusion that is amplified by the very design that their children thought would charm them. There is also a feeling that we need to design for the staff, visitors and residents, who are perceived to need different environments, which is not scientifically valid.

The Americans with Disabilities Act (ADA) mandates the need for inclusive design efforts for all those with the targeted disabilities to access commercial building projects. (2010 ADA Standards for Accessible Design issued by the Department of Justice on September 15, 2010)5 Physical access has long been the standard for accessible design, and it can add additional costs to the budget.

In most buildings, the percentage of occupants with perceptual or cognitive disabilities/losses is at least 40 percent of the population, when we include aging, dementia, autism, mental illness, ADHD, PTSD, Sensory Processing Disorder, blindness and deafness. We are dealing with populations that have limited sensory sensitivity, cognitive processing problems and the physical problems of aging. So, specialized research-based design is a must, and this needs to be driven by science, computer modeling, user measurement and validation of results. A design team member must bridge the gap between researcher and designer, both of whom have clear skills, while neither of them have each other’s skills. This is a role that Orfield Labs played on this project.

The Design Research Concept of Aging

The Cottages at Western Home Communities in Cedar Rapids, Iowa is the first aging and dementia project, worldwide, developed based on quantitative perceptual building performance standards focused on the sensory deprivation and cognitive decline of aging nursing home residents with dementia. Our standards focus on the majority of older residents, who are the most disabled.

Western Home Communities (WHC), headed by CEO Kris Hansen, had just begun their project when Orfield Labs’ participation started, and they were working with their architect, AHTS Architects and with a consultant on “the household care model” before the design of this facility began.

A rendering of the building was done for marketing, showing the gentle statement of local “cottages” for elders. Orfield Labs was brought on board to provide the design-research consulting on aging and dementia. This consulting included acoustics, daylighting, lighting, thermal comfort and indoor air quality.

In discussions with the owner and architect, the focus was on easing out the tension of environments based on the user experience of those with sensory deprivation. OL had spent many hundreds of hours in discussions with experts in aging and dementia research, and the goal was to optimize sensory clarity, with an intended 300 percent increase in visual and aural clarity. The other intent was to reduce cognitive complexity so that the spaces were metaphorically obvious for the residents (in other words, things were easily recognizable and where they would expect them to be).

As work began, the first suggestion was to consider the creation of a building interior that was simpler, gentler and more reflective of the low levels of perceptual clarity of the population. This was quickly accepted by the owner and the architect, and the interior design quickly moved from an old fashioned decorative focus to a much simpler design that would help the older residents to function with more perceptual clarity.

Subsequently, OL put ARC standards in place, a set of quantitative building performance standards for aging and dementia that attempted to reduce all perceptual noise dramatically (noise in the acoustic, visual, thermal and olfactory domains). It also intended to optimize daylighting and views, especially in the resident bedroom, while controlling for visual brightness. It featured a solution to resident confusion by simplifying aspects of the design. Thus, the interior had a simpler, consistent design to calm elders who often wonder where they were.

The specific building performance standards for perception included:

  • Visual – Reflectance, pattern, gloss, color, appearance, lighting level and glare
  • Aural – Noise levels, HVAC noise, privacy, reverberation (liveness), footfall noise and speech interference levels
  • Thermal – Temperature, Drafts, air movement, humidity, thermal symmetry, MET & CLO values6
  • Olfactory – Absence of noticeable smells or odors and recirculation of air

To simplify interiors, no patterns or complex color schemes were allowed on the floors, on wall coverings or on furniture. Wherever elders were in the cottages, the spaces seemed familiar. The selection of furniture finishes included a new and much simpler selection of highly visible and metaphorical colors and finishes.

Thus, the building was gentle, non-institutional and perceptually quiet. The intent was to support all areas of sensory loss and to provide familiarity. It was a Zen-like environment, peaceful and simple. There is no change in building cost, but there is a radical simplicity in the spaces. And this put great emphasis on the importance of the interior design over the façade design. The exterior was to look welcoming and residence-like, but the interior space was about perceptual and cognitive performance.

Cognitive and Perceptual Research

In 2006, Orfield Labs began a self-funded, multi-million-dollar, 10-year journey in researching the perceptual and cognitive disabilities from a user perspective, starting with aging, dementia and autism.1,7 This journey included thousands of hours of discussions with top academic and research experts related to each area of sensation (vision, hearing, etc.) and each of the specialized disabilities (aging, autism, mental illness, etc.). This research has shown clearly how current designs for senior housing are counterproductive to the well-being of the residents.

This effort opened our eyes to what was thought to be a small percentage of disabled occupants who needed “special treatment.” We now understand that approximately half of all people need that treatment, and the results of disability-based design are preferred not only by the disabled but also by those in the non-disabled world.

“We had to change care plans on six residents the first two weeks because they started re-engaging and eating,” Kris Hansen said. “And we had three other residents who had become wheelchair-bound, and all of a sudden they wanted to walk.”

Western Home Communities, which had been operating senior living facilities for more than a century, was, in CEO Hansen’s words, “trying to create an environment where dementia patients could function at their highest capacity.” – PBS Next Avenue, April 5, 20181

We must remember that our connection to the real world is through perception and cognition, and in a move to advance ADA, we must understand that if an individual cannot fully experience a building, then he or she does not have real access. They have arrived at the place, but they cannot function, with full consequence, in that place. Therefore, it is not accessible, and this is a crisis of immense proportions. This is the bad news.

Building Costs – The Good News

We must now begin to change the views in organizations and among designers with regard to elder housing. First, let’s look at some of the assumptions related to disabilities and accessible buildings:

  • Accessible buildings are thought to be more expensive, more suitable for those with disabilities, require different solutions for different disabilities, inhibit many design choices, require specializations on the design team and require far more skilled designers who specialize in this type of building (i.e. senior housing or autism architects) and are thought to be more expensive and less likely to exhibit aesthetic design.

Most of these assumptions are incorrect and their misconceptions underlie the failure to successfully approach these problems of design for disabilities.

Orfield Labs and its design collaboration, The Architectural Research Consortium (ARC), has argued that any building of modest or larger scale can be built for the disabled at the same cost as for non-disabled, including the specialized engineering and research costs. We don’t need more money; we need much more knowledge about design science for elders.

Since buildings should be 100 percent for users, we suggest that the budget be split into two separate budgets: one for occupancy quality issues and one for everything else. And when budget pressures arise, all the cuts must come from the non-occupancy quality budget. This means that a well-designed interior is more important than an expensive façade and grand public entries. And it means that aesthetics must be more about simple appearance than expensive finishes.7,8

Autism Case Study

Another disability-based project was a non-profit autism clinic in Woodbury, Minnesota, called the Fraser Clinic. This is the first autism project in the world based on quantitative building performance sensory standards and cognitive complexity standards. The project was designed to reduce the activation from hypersensitivity of most persons on the Autism spectrum and to provide a simple, consistent design and sensory experience throughout the building. (This was featured in FMJ, March/April 2018)9

Postscript:  What is research-based design?

This article is based on research-based design10 and follows on over 13 years of study in perception/cognition, 20 years administering national RBD collaborations (The Open Plan Working Group and the Architectural Research Consortium), as well as hosting 31 national design-research conferences.11,12 This RBD work is based on 40+ years of user experience research. This includes defining, modeling and measuring environments based on quantitative standards for perceptual comfort and visual design research on perceptual preference in understanding the user’s feelings about the sensory design.

References

  1. PBS Next Avenue, April 5, 2018, “New Cottages Designed for Older Adults With Dementia; Use of daylight, warm colors and a person-centered approach make a difference” Bill Ward
  2. Seniors Housing and Care Journal, Steven J. Orfield, Aging Research, Design Education, and the Perceptual Limits in Seniors Housing Design: Development of a Research-Based Design Model for Better Aging Environments, Volume 21, 2013
  3. Seniors Housing and Care Journal, Steven J. Orfield, Dementia Environment Design in Senior’s Housing, Optimizing Resident Perception and Cognition, Volume 23, 2015
  4. Expert Intuition and Evidence Based Design, Robert Brandt, Gordon Chong, W.Mike Martin, AIA California Council Publication
  5. ADA Reference for Standards Document, https://www.ada.gov/2010ADAstandards_index.htm
  6. ISO Thermal Comfort Standards
  7. Autism Research Institute Newsletter, March 1, 2018, Perceptual and Cognitive Disability Research, Steven J. Orfield
  8. Olmsted County Real Estate Assessment, Steven J. Orfield, Facility Management Journal, September 2014,
  9. UNO Community Engagement Center Project, Steven J. Orfield, Facility Management Journal, November 2014
  10. Facility Management Journal, March-April, 2018, Designing for Disabilities, Steven J. Orfield
  11. Facility Management Journal, October 2000, “The Open Plan Office”, Steven J. Orfield
  12. OPWG/ARC Design Consortium XXIX, Designing for Perceptual Disabilities, The Application of Basic Research and Design Research to ASD Deign, Research from Senior Design and Related Fields, September 16-17, 2013 at Orfield Laboratories, Inc.
  13. OPWG/ARC Design Consortium XXX, Universal Design, Research from Senior Design and Related Fields, September 25-26, 2012 at Orfield Laboratories, Inc.

Biography

Steven J. Orfield, founder of Orfield Laboratories, Inc. in Minneapolis, Minnesota, USA has been involved with architectural and product consulting for over four decades. His career began in the architectural fields of acoustics and lighting, and over its first decade, OL became the first independent multi-sensory building performance consulting lab in the U.S. Orfield Labs takes a human factors approach to architectural technologies, emphasizing user experience. He has authored or been featured in over 350 national and international articles, has written 2 commissioned white papers for ASID, has held over 100 international conferences at OL and is the founder of the Open Plan Working Group, the Sound Quality Working Group and the Architectural Research Consortium. He can be reached at steve@orfieldlabs.com or at Orfield Labs (612-721-2455). 

FMJ, the official magazine of the International Facility Management Association (IFMA), is written by and for workplace professionals and is published six times a year. FMJ is the only magazine that draws on the collective knowledge of IFMA’s global network of thought leaders to provide insights on current and upcoming FM trends. For more information on FMJ, visit www.ifma.org/fmj.

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IFMA is the world’s largest and most widely recognized international association for facility management professionals, supporting 24,000 members in 104 countries. This diverse membership participates in focused component groups equipped to address their unique situations by region (133 chapters), industry (15 councils) and areas of interest (six communities). Together they manage more than 78 billion square feet of property and annually purchase more than US$526 billion in products and services. Formed in 1980, IFMA certifies professionals in facility management, conducts research, provides educational programs, content and resources, and produces World Workplace, the world’s largest series of facility management conferences and expositions. To join and follow IFMA’s social media outlets online, visit the association’s LinkedIn, Facebook, YouTube and Twitter pages. For more information, visit www.ifma.org.